The Impact of Commercial Aircraft Noise on Human Health: A Neighborhood Study in Metropolitan Minnesota.

Abstract

The study reported in this paper assessed the impact of commercial-aircraft noise on human health and well being. Four neighborhoods exposed to commercial-aircraft noise were ranked according to the severity of the exposure by frequency of loud exposures and decibels. Two nonexposed communities in the Minneapolis/Saint Paul metropolitan area were included in the study for purposes of comparison. Over 2,000 subjects responded to a randomly administered survey that measured general health; mental health; sense of vitality; and noise annoyance, noise sensitivity, and perceived stress levels. All health measures were significantly worse in the neighborhoods exposed to commercial-aircraft noise. Respondents with the worst health status tended to be among those experiencing commercial-aircraft noise of the greatest severity. Stress and noise annoyance levels were significantly higher in the exposed neighborhoods, and these measures were also significantly worse for those neighborhoods exposed to the highest levels of commercial-aircraft noise.

Introduction

Exposure to aircraft noise has become an increasing public health concern and arena of research within the international environmental health community (1,2). Exposure to commercial-aircraft noise has been associated with direct damage to the hearing system and indirect effects such as psychophysiological stress, chronic cardiovascular reactivity, sleep disturbance, and impacts on morbidity and mortality (3-8). It has been more difficult to establish a causal link between exposure to commercial-aircraft noise and health impacts because of 1) the individual variability in risk factor accumulation, 2) the multi-factorial etiology of chronic diseases, 3) variability in exposure to commercial-aircraft noise, and 4) the difficulty of actually measuring health status at the population level.

Past Studies

Early studies of exposure to aircraft noise found increased risk of hypertension and related cardiovascular disease conditions, and a dose-response relationship between the health effects and increasing sound level exposure (9-12). Subsequent studies attempted to segment communities on the basis of average decibel (dBA) levels to more fully assess the dose-response causality. (A decibel (dB) is a unit of sound given by the logarithm of the ratio of the sound pressure of the signal to a reference pressure [0.0002 dynes per centimeter squared]. For environmental noise assessment, researchers use the A-weighted scale exclusively.) The Okecie Airport (Poland), the Paris-Orly Airport (France), and the Okinawa Prefecture (Japan) studies all employed a self-administered health questionnaire to measure physical and mental health status (13-15). The Okecie Airport study found that among women (but not men), health measures in a community with commercial-aircraft noise levels exceeding 100 dBA differed significantly fr om those in communities with exposures of less than 100 dBA. The Paris-Orly study found a dose-response relationship for physical health and feelings of malaise with increasing levels of aircraft noise. The Okinawa Prefecture study found essentially the opposite. A dose-response relationship was evident for subjective complaints about mental instability, depression, aggressiveness, nervousness, and neurosis, but not for physical health measures. Such apparently conflicting results typify much of the commercial-aircraft noise exposure research.

In Germany, the impact of the new Munich International Airport on stress, quality of life, and cardiovascular reactivity was assessed among children nine to 11 years of age. Over a two-year period, systolic and diastolic blood pressures were significantly higher, as were stress hormone levels (epinephrine, norepinephrine, and cortisol). Quality-of-life measures dropped in the lives of the children exposed to commercial-aircraft noise, although this decrease did not occur until 18 months after the opening of the airport (16). A recent study in New York found that exposure to chronic aircraft noise actually reduced the ability of school children to acquire language skills needed for reading (17). Finally, the Staten Island community study surveyed residents residing within aircraft flight patterns (n = 130) and those not exposed (n = 136). Respondents residing within the flight patterns reported poorer health status than did nonexposed residents (18).

The present study used a general health questionnaire to assess physical health, personal well being, and mental health. The authors selected four neighborhoods that are exposed to high levels of commercial-aircraft noise near the Minneapolis/Saint Paul Airport (neighborhoods in Minneapolis, Bloomington, Saint Paul, and Eagan), along with Shoreview and Mounds View, two comparable north-area metropolitan cities that are not exposed to commercial-aircraft noise. These last two cities served as comparison communities. In addition to noise annoyance and perceived stress levels, a variety of potentially confounding variables were measured (e.g., marital status, age, gender, smoking status, work exposure to loud sounds endogenous noise sensitivity). As illustrated in Figure 1, the etiological framework used for this study holds that commercial-aircraft noise exposure produces a chronic stress response that is adverse to human health over extended periods of time. Decibel and frequency data were obtained from the M etropolitan Airport Commission of Minneapolis.

Methods

Study Population

Researchers mailed 4,000 surveys to potential subjects in the Minneapolis/Saint Paul area, using stratified random sampling. Four neighborhoods exposed to commercial-aircraft noise (total neighborhood population = 12,438) were identified within the cities of Minneapolis, Bloomington, Eagan, and St. Paul. The Cities of Shoreview and Mounds View (total neighborhood population = 10,084), in the north metropolitan region, constituted the two nonexposed comparison communities. Since a supposition of the study was that duration of exposure to commercial-aircraft noise is a critical aspect in the manifestation of chronic stress and health effects, renters were excluded from the study and only adult homeowners were surveyed. Finally, the researchers selected neighborhoods that excluded major highways, to minimize the potential impact of nonaviation traffic noise on study subjects (19,20).

Health and Related Measures

Three measures of health were obtained with the MOS-36 Health Survey Scale, as follows: general health, sense of vitality, and mental health (21). For each health measure, a summary score in the range of 0 to 100 was obtained with the MOS-36 algorithm, with a higher score implying a more positive health status. Stress was measured with the stress scale developed by the Centers for Disease Control (22). Noise sensitivity is a measure of an individual's particular sensory system based on reactivity to environmental sound stimuli and was assessed with the Weinstein Instrument (23,24). Noise annoyance is a form of psychological morbidity, and was measured with a scale derived from previous research (25).

Noise Data

Data on commercial-aircraft noise were obtained from the Metropolitan Airport Sound Abatement Commission's Airport Noise Operations Monitoring System (26). The commission operates 24 remote sound-recording towers in the neighborhoods surrounding the Minneapolis/St. Paul Airport (Figure 2).

These towers make a continuous recording of sound levels and tally "noise events," which are defined as occurring when A-weighted decibel levels exceed 65, 80, 90, and 100. (It should be noted that humans experience a 6- to 10-point increase in decibels as a doubling of loudness). For each neighborhood studied, two sources of noise event data were selected as follows: remote-monitoring towers 5 and 6 for Minneapolis, remote-monitoring towers 17 and 19 for Bloomington, remote-monitoring towers 14 and 24 for Eagan, and remote-monitoring towers 9 and 11 for St. Paul.

Neighborhood Ranking

Two aspects of noise impact were considered in ordering the neighborhoods from worst to least by the severity of commercial-aircraft noise: (a) the mean of the annual maximum decibel levels (i.e., commercial-aircraft noise loudness), and (b) the conditional proportion of high-decibel occurrences (i.e., the frequency of commercial-aircraft noise loudness). Table 1 displays the ranking of neighborhoods according to the mean decibel levels over a 12-month period.

Table 2 displays the ranking of neighborhoods according to the frequency of noise events exceeding 65 decibels. In the Minneapolis neighborhood, for example, which had a total of 145,469 noise events, 52 percent of the Noise Events exceeded 80 dBA, 18 percent exceeded 90 dBA, and one percent exceeded 100 dBA.

Potentially Confounding Variables

A great many factors contribute to a person's health status and must be controlled for in any analysis of the extent to which noise exposure affects health. Potential confounding variables considered in this study included marital status, income, education, smoking status, body mass index, gender, and age. In addition, several other key environmental factors were considered: occupational exposure to noise, length of residency, type of shift work, and hours at home per week. The potential confounding effects of individual sensitivity to noise also were taken into consideration in the analysis.

The analysis presented below addresses the two basic research questions:

1. Were health measures worse in neighborhoods exposed to commercial-aircraft noise than in neighborhoods not exposed?

2. Among the neighborhoods exposed to commercial-aircraft noise, did health and related measures differ significantly by severity ranking (i.e., the loudness and frequency of noise events)?

Results

Response Rate

A total of 2,088 surveys were returned, with 2,001 deemed usable for data analysis. Neighborhood-specific response rates were as follows: Minneapolis, 57.2 percent; Bloomington, 54.4 percent; St. Paul, 64.0 percent; Eagan, 50.2 percent.

In the comparison communities of Shoreview and Mounds View, the response rates were 46.3 percent and 35.6 percent, respectively The lower response rate in the comparison communities may reflect the lack of relevance a questionnaire about commercial-aircraft noise had in day-to-day life.

Sample Demographics

In the total sample, 53.2 percent of respondents were women and 46.8 percent were men, with mean ages of 46.6 for women and 48.5 for men. Subjects ranged in age from 18 to 99. The mean for years of education was 14.9, and most households had an annual income in excess of $50,000 per year. Time at current residence averaged 13.3 years. The mean number of hours spent at home per day per week was 13.6.

Overall Mean Scores

Table 3 displays the mean scores for all health and related measures, by neighborhood. Minneapolis and Bloomington had the lowest mean scores for general health, sense of vitality and mental health. Minneapolis and Eagan had the highest mean scores for stress and noise annoyance. Mean scores for noise sensitivity did not differ by neighborhood or exposure status.

Stress and Noise Annoyance

Stress scores among those exposed to commercial-aircraft noise were significantly higher than those among controls (F = 6.449, p = .000); however, post hoc analysis (Tukey HSD) indicated that this difference was attributable only to Minneapolis (p = .000) and Bloomington (p = .003) (Figure 3). The difference in stress scores was evident even after all covariates (i.e., potential confounding factors) were controlled for. No significant difference in personal noise sensitivity levels was found among the neighborhoods and controls (F = 1.1974, p = .3099).

Noise annoyance levels were also significantly worse among those exposed to commercial-aircraft noise than among controls (F = 96.572, p = .0000). Post hoc analysis indicated that all communities exposed to commercial-aircraft noise had significantly higher noise annoyance levels than did controls, in the following highest-to-lowest order: Minneapolis, Eagan, Bloomington, St. Paul (Figure 4). Noise annoyance and stress levels were also modestly and positively correlated (r = .2874, p = .0000).

Health Measures

All health measures were significantly worse for the neighborhoods exposed to commercial-aircraft noise than for the controls. (Multivariate analysis of covariance [MANCOVA] results: F = 5.821 Phillai's Trace, Hotelling's Trace, Wilks's Lambda, Roy's Largest Root, p = .001). Post hoc contract analysis revealed that the Minneapolis and Bloomington neighborhoods scored significantly worse on general health and sense of vitality, while Minneapolis, Bloomington, and St. Paul scored significantly worse for general health, sense of vitality, and mental health (Table 4).

Discussion

Attributing adverse health measures to commercial-aircraft noise is a complex task. The first crucial assessment for this study was assessing individual noise sensitivity, since stress and health measure differences that could be attributable to personal noise sensitivity (i.e., those people with hypervigilance for noise would be more stressed by uncontrollable commercial-aircraft noise). This study found no significant differences in noise sensitivity among the neighborhoods. That result means that respondents were essentially the same in their degree of noise sensitivity and that personal noise sensitivity thus could be ruled out as a confounding factor in the overall results.

Second, perceived stress levels were significantly higher in neighborhoods exposed to commercial-aircraft noise, and these stress levels were positively associated with the severity rankings of the neighborhood. The pivotal question is whether these exacerbated stress levels are attributable to the commercial-aircraft noise exposure. This study did find that the stress levels were higher among those exposed to commercial-aircraft noise. Furthermore, the magnitude of reported stress exactly matched the severity ranking. Hence, the issue is whether the proportional increase in measured stress levels resulted from exposure to commercial-aircraft noise. Given the severe loudness levels and frequency of loud exposures that were recorded by the remote monitoring towers in these neighborhoods, it seems plausible that such exposure would contribute to stress load. This contention is also bolstered by the fact that Minneapolis had the highest levels of noise annoyance, followed by Eagan and Bloomington, and by the fi nding that noise annoyance and stress were positively and significantly correlated. Noise annoyance has been previously found to contribute to stress level (27). Furthermore, this study did not need to establish a causal link between stress and poorer health status, since there is voluminous research confirming the worsening of health as a result of increasing stress loads (28-32).

Extensive research has established a causal link between lower social economic status and poorer health outcomes (33-37). Since poorer people tend to reside in lower-valued houses that are located in higher-noise neighborhoods containing freeways, train stations, bus terminals, and airports, one might argue that the results of the present study simply reflect reduced health status among residents with lower socioeconomic status. A unique feature of the present study, however, was the socioeconomic makeup of the surveyed neighborhoods. The Minneapolis/St. Paul airport happens to be located near residential neighborhoods of high socioeconomic status with higher-than-average education and professional status. Approximately one-third of respondents had at least a four-year university degree, and about 10 percent had advanced degrees. Over 50 percent of the households had incomes exceeding $50,000 per year. These demographic characteristics tend to neutralize the potential effect that social economic status might be thought to have on health status.

Health per se is difficult to define and equally difficult to measure. This study employed the standardized and validated MOS-36 health questionnaire that in recent years has emerged worldwide as a strong and useful health measurement tool. Australia has adopted the MOS-36 form for use in its nationwide health survey. This tool gives a very sensitive measure of medical and psychiatric conditions; thus, the observed neighborhood differences in health measures can be interpreted with a good deal of confidence (38,39).

This study found mental health scores in neighborhoods exposed to commercial-aircraft noise to be significantly lower than scores in the control neighborhoods. Mental health, however, remains a controversial measure in association with aircraft noise exposure (40-42). It is usually measured indirectly by comparisons of rates at which people residing near airports are admitted to psychiatric hospitals (43). Clearly, aircraft noise can be a highly intrusive source of sound that can increase irritability, reduce tranquillity, foster negative emotions, and impose a sense of vulnerability. It also may be an exacerbating factor in the psychiatrically vulnerable population (44).

Sense of vitality is a construct that measures subjective well-being--that is, how good a person feels about living his or her life. The present study found sense of vitality significantly reduced among those exposed to commercial-aircraft noise as compared with those not exposed. This reduction was most pronounced in the Minneapolis and Bloomington neighborhoods, in which the mean severity of commercial-aircraft noise was greatest. These findings are similar to those of recent research among children residing near the new Munich Airport who experienced a reduction in their subjective assessment of quality of life (16). Stress load seems to be a key ingredient in mental health and vitality, since in this study stress was significantly and negatively correlated with both of these measures (r = -.7239, p = .0001, r = -.5588, p = .0001)--that is, as stress increased, mental health and sense of vitality decreased.

Finally this study ranked the severity of exposure to commercial-aircraft noise according to the decibel levels of aircraft noise events and the frequency with which those noise events occurred in each neighborhood. That strategy could be seen as failing to provide a precise measurement of actual noise exposures for each individual in the study (i.e., what daily dose of decibels does the individual actually receive?). This study however, was not conducted in a laboratory setting where the researcher would be able to incrementally adjust the decibel dosage. It was designed as a population-based community study and employed a cross-sectional epidemiological design to compare health measures in neighborhood populations exposed to commercial-aircraft noise and those not exposed to commercial-aircraft noise (45). In addition, post hoc analysis assessed the differences among neighborhoods exposed to commercial-aircraft noise and ranked them on the basis of noise severity. The findings of this latter analysis const itute a quasi-dose-response comparison that followed exposure to actual decibel loudness and the frequency of aircraft noise events.

Conclusions

This study found evidence to support positive answers to the two research questions outlined in the Methods section above: General health measures were significantly worse in neighborhoods exposed to commercial-aircraft noise than in communities not exposed to that noise, and the greater the severity of the noise (ranked by loudness and frequency of noise events), the worse the health measures were. People residing in neighborhoods exposed to commercial-aircraft noise have significantly higher stress and noise annoyance levels. Finally, commercial-aircraft noise also adversely affected sense of well-being measured as sense of vitality.

These results need to be interpreted with caution because of the inherent limitations in cross-sectional study design. There is some level of uncertainty about causality since exposure and health indices are measured at the same time (i.e., the ordering of events is not known). Also, this study lacked a biomarker measure of the stress response (e.g., cortisol stress hormones) and relied on personal assessment by each respondent.

The study design and data analysis were intended to overcome these limitations. This study had over 2,000 respondents, and the large sample size greatly facilitated assessment of aggregate health measures at the population level. The mean Cronbach's Alpha for reliability of the health measurement scales was .8329. In addition, the resultant health differences were evident even after a great many potentially confounding variables were controlled for with a multivariate analysis of variance that previously had not been included in study designs. Finally this study employed a rigorous stratified random-sample design with replacement to ensure that each individual had a constant probability of being selected from the population. Probability sampling enhances internal (causal) and external (generalizable) forms of validity. Future research on commercial-aircraft noise and health needs to be undertaken using a long-term cohort design, with time-series measurement of stress biomarkers.

Aircraft noise is physically and psychologically distinct from all other forms of uninvited sound that affect the urban dweller. The perceived lack of control over a stressor such as aircraft noise may contribute to diminished coping ability, as well as to a sense of risk or vulnerability (46,47). Modern aircraft travel has certainly become an essential and permanent fixture in contemporary life. The results of this study however, suggest that in the planning of airport locations and expansions, careful consideration needs to be given to the potential adverse human health effects caused by aircraft noise.

Acknowledgements: This study was in part supported by the College of Health and Human Performance at Oregon State University.

Corresponding Author: Dr. Edward A. Meister, Ph.D., Assistant Professor, Department of Kinesiology and Health Science, California State University--Sacramento, SLN: Solano Hall 3002, 6000 J St., Sacramento, CA 05819-6073.

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* This study assessed the impact of commercial-aircraft noise on human health and well-being.

* Four neighborhoods exposed to commercial-aircraft noise were ranked according to the severity of the exposure by frequency of loud exposures and decibels.

* Two nonexposed communities were included for comparison.

* Over 2,000 subjects responded to a survey that measured

-- general health;

-- mental health;

-- sense of vitality; and

-- noise annoyance, noise sensitivity, and perceived stress levels.

* All health measures were significantly worse in the neighborhoods exposed to commercial-aircraft noise.

* Respondents with the worst health status tended to be among those experiencing the most severe commercial-aircraft noise.

* Aircraft noise is physically and psychologically distinct from all other forms of uninvited sound.

* Lack of control over this stressor may contribute to diminished coping ability, as well as to a sense of vulnerability.

* The authors suggest that in the planning of airport locations and expansions, careful consideration be given to the potential adverse human health effects caused by aircraft noise.