We examine the possibility that physiological effects of noise may result not only from noise exposure per se, but also from people's beliefs about the noise. Due to widely publicised changes to the runway configuration at Sydney Airport, aircraft noise levels in nearby areas were expected to either increase, decrease or remain the same. As part of the Sydney Airport Health Study, residents in each of these 3 expected-change areas (N=1015) completed a structured interview which included indices of noise reaction (including annoyance) and physical and mental health, prior to the anticipated changes. Concurrent (pre-change) measures of aircraft noise levels were taken. Self-reported physiological/health effects differed across areas with the same aircraft noise level consistently with differences in psychological reaction across these areas. Expected change in noise level added to the level of self-reported physiological symptoms predicted by noise level in regression analyses. Dose-response functions differed across the expected-change areas. These results are consistent with the hypothesis that noise exposure produces physiological symptoms, but that expectations regarding future noise levels also contribute to the physiological impact of noise, which may be reduced by addressing psychosocial factors related to noise reaction.
Keywords: physiological effects, health effects, community reaction, dose-response, changes in noise exposure
|How to cite this article:|
Hatfield J, Job R, Carter N L, Peploe P, Taylor R, Morrell S. The influence of psychological factors on self-reported physiological effects of noise. Noise Health 2001;3:1-13
Concern regarding human exposure to noise has often been focused on its potential to harm health, and much research has demonstrated adverse physiological consequences of noise exposure (for reviews see Berglund and Lindvall, 1995; Job, 1995). Research has typically been biased towards examination of the direct effects of noise on health, and the influence of various noise parameters on health outcomes have been investigated. However, many of the adverse physiological consequences of noise exposure may not result from noise exposure per se, but might rather be mediated by psychological factors relating to noise exposure. For example the possibility that negative psychological reaction to the noise produces noise-related health problems over and above the immediate consequences of noise exposure has been recognized in several reviews (see Job, 1995, 1996; Levy-Leboyer and Moser, 1987; Staples, 1996), but is yet to be adequately tested (Lercher, 1997).
|How to cite this URL:|
Hatfield J, Job R, Carter N L, Peploe P, Taylor R, Morrell S. The influence of psychological factors on self-reported physiological effects of noise. Noise Health [serial online] 2001 [cited 2020 Aug 3];3:1-13. Available from: http://www.noiseandhealth.org/text.asp?2001/3/10/1/31762
Both theoretical and empirical considerations suggest that the physiological effects of noise exposure might at least in part be mediated by psychological factors. Stress, including psychological stress (Sarafino, 1994), is known to compromise health, probably via its negative impact on immunity (Seyle, 1956; Sieber, Rodin, Larson, Ortega, and Cummings, 1992), or on cholesterol (Brennan, Job, Watkins, and Maier, 1992). Moreover, self-reported psychological stress may be associated with cardiovascular and cerebrovascular morbidity and mortality (Rosengren, Tibblin, and Wilhelmsen, 1991).
There is ample evidence for the claim that excessive noise exposure promotes negative psychological reactions (for reviews see Fields, 1994; Job, 1988; Job and Hatfield, 1998) and psychological stress (Evans, Hygge, and Bullinger, 1995). These psychological effects may have adverse physiological consequences. Indeed, numerous researchers have demonstrated a positive association of psychological reaction to noise with selfreported symptoms (Greaven, 1974; Knipschild, 1977; Lercher, 1992; Rehm, 1983; Tarnopolsky, Hand, Barker, and Jenkins, 1980; van Kamp, 1990; Lercher and Widmann, 1993) and with objective measures of health (e.g. allergies: Lercher, 1992, 1996a; hypertension: Lercher and Kofler, 1993; Neus, von Eiff, Ruddel, and Schulte, 1983; Schmeck and Poustka, 1993; nervous stomach: Ohrstrom, 1989; use of medication: Knipschild and Oudshoorn, 1977; Lercher, 1992, 1996b; Nivison and Andresen, 1993; Watkins, Tarnopolsky, and Jenkins, 1980).
However, correlational evidence cannot identify causality or its direction. The positive association between negative psychological reactions to noise and health outcomes may indicate that physiological problems which are attributed to noise exposure contribute to negative psychological reactions (rather than vice versa), or that both psychological reaction and physiological response are determined by a third factor (e.g. noise sensitivity: see Job, 1996; Stansfeld, 1992). Undermining the claim that psychological reactions contribute to health effects is the possibility that noise exposure alone produces both negative psychological reactions and adverse physiological outcomes. Thus, it is not clear whether psychological reaction to noise, noise, some further noiserelated factor, or some combination of these contributes to noise-related physiological/health effects.
Assessment of whether psychological reaction to noise has adverse physiological/health effects over and above those of noise exposure, requires a situation in which psychological reaction varies where noise exposure remains constant. For example, in areas with equivalent noise exposure psychological reaction might be manipulated (for example by attempting to modify attitudes to the noise source, see Job, 1988, 1993; Job, Hatfield, Peploe, Carter, Taylor, and Morrell 1998), and health outcomes measured. Unfortunately, the required methodology is likely to be difficult and expensive, and has not yet been undertaken. However, psychological reactions to noise have been shown to be influenced by anticipating changes in noise exposure, even before such changes occur (Job, Topple, Carter, Peploe, Taylor, and Morrell, 1996a), affording the opportunity to examine the influence of negative psychological reactions on health, in the absence of differences in noise exposure.
The present paper reports data collected during the natural experiment created by the reconfiguration of Sydney (Kingsford Smith) airport. Plans to open a third runway parallel to one of two existing runways and virtually close the perpendicular runway, were well publicized. Consequently, some residents in the vicinity of the airport with low noise exposure before the changes could be expected to anticipate their noise exposure to increase, whereas others could be expected to anticipate no change. Conversely, some residents with high noise exposure before the changes could be expected to anticipate their noise exposure to decrease, whereas others could be expected to anticipate no change.
Psychological reaction has been shown to be influenced by anticipating changes to noise exposure (Job et al, 1996a). Specifically, in areas with similar high aircraft noise exposure, less negative psychological reactions were observed in areas anticipating decreased noise exposure, than in areas anticipating no improvement. In areas with similar low aircraft noise exposure, more negative psychological reactions were observed in areas anticipating increased noise, than in areas expecting no worsening.
Thus, residents with the same aircraft noise exposure at the time of testing may have different psychological reactions to noise (because of different expectations regarding noise change). If physiological reaction is determined entirely by noise exposure, it should not depend on expected change in noise exposure. However, if psychological reaction to noise contributes to noise-related health problems, we would predict higher levels of physiological responses in areas with low aircraft noise exposure anticipating increases in exposure compared to those anticipating no change, and in areas with high aircraft noise exposure anticipating no change in exposure compared to those anticipating decreases. Further, if psychological reaction to noise contributes to the adverse physiological consequences, anticipated noise change should add to the prediction of physiological effects afforded by noise level alone.
| 1. Methods|| |
Noise exposure measures
During the time interviews were being conducted (before the airport reconfiguration) aircraft noise was measured at numerous residential sites near flight paths in the vicinity of Sydney Airport. Mathematical noise models for aircraft arrivals and departures were developed from these measurements. These models allowed verification of the Integrated Noise Model (INM) program developed by the US Federal Aviation Administration when applied to Sydney Airport operations. The INM was then employed to produce aircraft noise exposure data (ANEI) for the sample areas and sample periods (see Peploe, 1996 for further details). ANEI parallels NEF with a modified evening penalty (based on Australian reaction data, Bullen and Hede, 1983) of 6dB between 7pm and 7am. Further, it is a measure of what has occurred rather than being a forecast. These noise data were geocoded to each participating residential address using Geographic Information System software.
Because of the distribution of respondents, the impact of non-aircraft noise sources is likely to have been equivalent across the four noise change areas.
Subjects and Sample Selection
523 female and 482 male residents of areas were selected on the basis of noise exposure and location relative to Sydney (Kingsford Smith) Airport to produce a 2x2 design; current noise exposure was "high" or "low" and noise exposure was projected to either decrease, increase or remain unchanged due to flight-path changes. The four noise change areas thus produced- "high to high" (H-H), "high to low" (H-L), "low to low" (L-L), "low to high" (L-H)were approximately equally represented in the sample. Each noise change area sampled encompassed several census collection districts. [Table - 1] provides numbers, demographic details and noise exposure levels for participants in each of the noise change areas.
A structured interview (based on previous socioacoustic survey questionnaires- see: Bullen, Hede, and Kyriacos, 1986; Job, Bullen, and Burgess, 1991)- and revised on the basis of the results of a pilot study) assessed aspects of physical and mental health, psychological reactions to noise, attitudes to the noise source, sensitivity to noise, demographic variables and noise-induced disturbance.
Subjects were asked to indicate whether they expected that changes at Sydney Airport would result in increased, decreased or unchanged noise exposure. "Don't know" was the fourth response option.
Two questions assessed general psychological reaction to the noise: (i) "Would you please ... estimate how much you personally, are affected overall by aircraft noise?"; (ii) "How dissatisfied are you with aircraft noise in this neighbourhood? Please ... estimate how much dissatisfaction you feel overall." Subjects indicated their subjective using an "opinion thermometer"- a card depicting a thermometer marked with numbers from 1 to 10 and an associated 5-point verbal scale ("none", "a little", "moderate", "a lot", very much"). A General Negative Psychological Reaction index was computed by combining the scores for these two questions on the basis of factor analysis. This measure of psychological reaction has demonstrably superior psychometric properties (validity, internal consistency and stability) compared with measures of specific psychological reactions such as "annoyance" (Job, Topple, Hatfield, Carter, Peploe, and Taylor, 1996b).
Three scales measuring noise-related physiological effects appeared during the interview. First, subjects were asked to report whether "aircraft noise in [their] neighbourhood affects" them in any of nine ways (e.g. startle, irritability, headaches, tenseness/nervousness, edginess, tiredness/listlessness, difficulty sleeping, upset stomach, health effects generally). A General Symptoms index was computed by totaling the number of symptoms experienced (Chronbach's alpha=.97). Second, subjects were asked to indicate whether their use of five substances (cigarettes, alcohol, tranquilizers, sleeping pills or headache pills) is affected by aircraft noise (reduced, not affected, increased, never used). Reduced use of each substance was scored 1, no change and no previous use were scored 2, and increase in substance use was scored 3. Then scores for the five substances were added to produce a Substance Use index. Third, subjects were asked whether they had a "spell or attack when all of a sudden [they] felt frightened, nervous or very uneasy for no apparent reason". Subjects who reported having a panic attack (14.7% of the sample) were then asked to indicate whether they had experienced any of seven panic symptoms (pounding heart, dizziness, chest pain, weakness, trembling, cold flushes, fear of dying of craziness). A Panic Symptoms index was then computed by totaling the number of symptoms experienced. Subjects who did not report having a panic attack automatically scored zero on this index.
After the interview, subjects completed 19 items comprising the Profile of Mood States (POMS) Depression-dejection, Tension-anxiety and Anger-hostility scales, as well as the GrossarthMatticeck health risk personality questionnaire (70 items).
Before the changes to the configuration of Sydney (Kingsford Smith) Airport, interviews were conducted by trained interviewers at subjects' homes. From a random starting point within each census district, every 7th residence along a predetermined path was approached. Further selections, for example of every 11th residence, were made if the number of successful approaches within any census district did not reach the quota.
First, a letter was sent to every selected residence announcing the investigation. Second, interviewers door-knocked at the selected residences and asked to speak to the person over 18 living at the residence who had last had a birthday. If this person had an inadequate command of English, was infirm, or was not a usual resident at the home, the residence was classified as "out of range" and no other person there interviewed. If the relevant person refused to participate, no other resident was interviewed but one follow up call was made to the home. If the relevant person was not present, the residence was classified as "non-contact" and up to 5 calls were made. When a suitable individual agreed to participate, the structured interview was conducted and questionnaires given to the subject to complete while the interviewer waited.
| 2. Analysis|| |
Within areas with currently low noise exposure, areas anticipating a worsening in noise exposure (L-H) were compared to areas anticipating no change (L-L) with respect to scores on each selfreported health index (General Symptoms, Substance Use, Panic Symptoms, POMSAnxiety, -Anger, and -Depression. Within areas with currently high noise exposure, areas anticipating an improvement in noise exposure (H-L) were compared to areas anticipating no change (H-H) for each self-reported physiological index. Independent samples t-tests were employed to test the one-tailed hypotheses that there would be fewer self-reported physiological problems in L-L than in L-H, and in H-L than in H-H areas.
Correlations between psychological reaction and each self-reported physiological outcome were then assessed within each noise change area.
Regression analyses were conducted to ascertain the variance in each self-reported physiological response accounted for by current noise exposure (ANEI) and by anticipated change in aircraft noise exposure (increase, decrease, or no change). For self-reported physiological response indices which were significantly predicted by the regression equation, linear, quadratic and cubic dose/response functions were tested within each noise change area.
| 3. Results|| |
Expectation of noise change in each area
71.6% of respondents living in low noise areas in which noise was to increase reported expecting noise to increase, compared to 28.3% in areas in which noise exposure was expected to remain low. 22.5% of respondents living in high noise areas in which noise was to decrease reported expecting noise to decrease, compared to 2.4% in areas in which noise exposure was expected to remain high. Thus, respondents' expectations were generally consistent with the manner in which the runway reconfiguration would affect their area.
Area differences in psychological reaction and self-reported physiological responses
[Table - 2] presents mean values for each selfreported physiological index in each noise change area and the results of the statistical comparisons. Also presented in the table are the means and comparisons for General Negative Psychological Reaction (dissatisfaction /affectedness) as reported by Job et al. (1996a).
As predicted, self-reported health appeared to be significantly better in low noise exposure areas expecting continued low noise compared to low noise areas expecting a worsening in noise exposure, in terms of each self-reported health index. Whilst high noise areas expecting an improvement in noise exposure reportedly had fewer health problems than high noise areas expecting no change for every index, the difference was not significant for any index.
As reported by Job et al. (1996a), general negative psychological reaction to aircraft noise was significantly less prominent in low aircraft noise areas anticipating no increase in exposure compared to low noise areas expecting noise exposure to increase. Similarly, general psychological reaction was significantly lower in high aircraft noise areas expecting a decrease in noise exposure compared to those expecting no change.
Correlation of psychological reaction with self-reported physiological responses within each noise change area
Relationships of psychological reaction with each self-reported physiological response index are presented in [Table - 3] for each noise change area separately.
Significant correlations of psychological reaction with self-reported general symptoms, and with self-reported noise-related changes to substance use, were observed in each noise change area. Low but significant correlations were observed between psychological reaction and anger only in the low noise areas expecting no change in aircraft noise exposure. No significant relationships with anxiety or depression were observed.
Regression of self-reported physiological symptoms on current noise exposure level and anticipated change in noise exposure.
In order to better control for the direct effect of current noise exposure on self-reported physiological response, current exposure (ANEI) and anticipated change (decrease=1, unchanged=2, increased=3) were entered stepwise in a multiple regression equation for each self-reported physiological outcome index (entry criterion: p= 0.05).
For self-reported general symptoms, current noise exposure entered at the first step (multiple r=0.225, F1,981= 52.186, p<0.001), followed by anticipated change (multiple r=0.250, F2,980= 52.186, p<0.001). For anxiety, anticipated change entered at the first step (multiple r=0.074, F1,1000= 5.498, p=0.019), followed by current noise exposure (multiple r=0.102, F2,999= 5.244, p=0.005). Neither current noise level nor expected change in noise exposure entered the regression equations for self-reported substance use, panic, anger or depression.
In order to compare the impact on anxiety of expected change versus noise level, the linear relationships between each of these variables and anxiety were plotted see [Figure - 1].
The worsening in anxiety associated with living in an area anticipating increases in aircraft exposure, compared to areas anticipating decreases, could be expected to result from an increase of 176.25 ANEI.
Self-reported general symptoms and anxiety were plotted against current noise level under each of the anticipated change conditions. In each case, linear, quadratic and cubic functions were tested. None of these functions was significant within the two areas in which changes to aircraft noise exposure were anticipated. In areas expecting aircraft noise exposure to remain the same, all three functions were significant for both general symptoms (for all tests, F>31.64, p<0.001) see [Figure - 2] and anxiety (for all tests, F>3.31, p=0.037) see [Figure - 3].
| 4. Discussion|| |
Self-reported noise-related physiological/health problems were found to be more prevalent in areas with worse psychological reaction to noise, despite similar noise levels.
Residents of areas with currently low noise exposure reported statistically significantly higher scores for general symptoms, substance use, panic, anxiety, anger and depression if their noise exposure was expected to worsen, than if their noise exposure was expected to remain the same. In currently high noise areas, there appeared to be fewer of these adverse physiological effects amongst residents who could anticipate an improvement in noise than those anticipating no change, but none of the observed differences were statistically significant. The observed dissociation of currently low noise areas from currently high noise areas is consistent with Neus et al.'s (1983) finding of an association between hypertension and psychological reaction to noise in moderate but not high noise areas.
Several explanations may be offered for the failure of the differences between H-H and H-L groups to reach statistical significance. For example, there may be an overdetermination effect, whereby the direct effects of high noise exposure on health may be so great that the impact of psychological variables cannot be detected. Alternatively, a ceiling effect may operate, whereby high noise exposure may cause harm to such an extent that it cannot be further worsened by other (e.g. psychological) factors. Thus, psychological factors (e.g. reaction) would not contribute to physiological effects in the stable high noise areas, so their reduction (as a result of anticipating a reduction in noise) would have no significant effect. Finally, there may be a "ratchet up" effect, whereby physiological response to noise is fairly readily worsened by psychological reaction, but not easily or rapidly improved when psychological reaction is lower.
The observed differences in self-reported physiological response cannot be explained in terms of noise exposure only, but may be due to differential psychological reaction. The pattern of area differences in general psychological reaction are consistent with this claim. More negative reaction was observed in low noise areas anticipating a worsening in noise exposure (rather than no change) and in high noise areas expecting no change (rather than an improvement). That is, more negative psychological reaction was observed in areas where more adverse physiological effects were reported.
Significant positive correlations were observed between negative reaction to noise and self reported general symptoms and changes in substance use in each noise change area, supporting the contention that negative reaction to noise contributes to self-reported noise-related health effects. The failure to observe significant correlations between reaction (e.g. dissatisfaction, affectedness) and psychological disturbance (i.e. anxiety, anger and depression) is inconsistent with earlier findings (e.g. Stansfeld, 1992; Tarnopolsky, Watkins, and Hand, 1980). The correlation of psychological reaction with anger in the low noise area may indicate that only individuals who are prone to dissatisfaction demonstrate negative psychological reactions to low noise exposures. The regression analyses support the contention that negative psychological reaction to noise contributes to self-reported noise-related health effects, over and above the effects of noise exposure itself. Statistically significant regression estimates of noise exposure only emerged for the self-reported General Symptoms index and POMS-Anxiety, perhaps due to insufficient variance in the other indices. Whilst actual noise exposure entered the regression equation for self-reported General Symptoms at the first step, anticipated change to noise exposure further contributed to the prediction of self-reported physiological effects. For POMSAnxiety, anticipated change entered the regression equations before current noise exposure. The noise exposure equivalent of living in an area anticipating increases in aircraft exposure, compared to areas anticipating decreases, in terms of worsening anxiety (176.25 ANEI) suggests a potentially profound public health impact of expected noise changes.
Further, dose-response curves appear to vary depending on anticipated noise change. For example, linear, quadratic and cubic functions relating current noise level to self-reported General Symptoms and POMS-Anxiety were significant only in areas where noise was expected to remain the same. This may indicate that the relationship between current noise level and health is weaker when psychological factors (e.g. reaction due to anticipated changes) contributes to the variance in health effects. However, this finding may be a statistical artifact. Because "areas where noise was expected to remain the same" includes both L-L and H-H, analyses involving this grouping employ approximately twice the number of subjects as are employed in analyses of either LH or H-L, making them more statistically powerful.
Because all of the physiological/health indices employed were self-report, it might be objected that the results could reflect demand characteristics. For example, participants may report more symptoms due to the Hawthorn effect. Further, one might plausibly expect relationships between beliefs regarding the health outcomes of noise and other noise-related attitudes, even in the absence of relationships between "real" health effects and noise-related attitudes. However, given the complexity of the relationships observed between noise exposure and self-reported physiological effects across the expected noise change areas, these seem unlikely accounts of the present findings. Further, perceived effects, as well as real effects, may have important policy implications (although self-reports may not be an accurate reflection event of perceived effects). Nonetheless, it would be beneficial to incorporate direct, objective, physiological measures in future studies of this nature.
In conclusion, although other factors may influence both psychological reaction and physiological response to noise, it seems clear that psychological variables contribute to the adverse physiological effects of noise. This offers the possibility of ameliorating the negative impacts of noise exposure when reductions in aircraft noise exposure are not possible, by addressing psychological factors. Development of techniques for reducing negative psychological reactions (for example by modifying attitudes and coping via cognitive behavioural treatment) might also be of substantial practical importance.
| Acknowledgements|| |
This research was supported by funds from the Federal Airports Corporation (of Australia) to the authors.
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Department of Psychology, University of Sydney, NSW 2006
Source of Support: None, Conflict of Interest: None
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2], [Table - 3]