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|Year : 2012
: 14 | Issue : 60 | Page
|Noise sensitivity and multiple chemical sensitivity scales: Properties in a population based epidemiological study
Marja Heinonen-Guzejev1, Markku Koskenvuo1, Helena Mussalo-Rauhamaa1, Heikki S Vuorinen1, Kauko Heikkilä1, Jaakko Kaprio2
1 Department of Public Health, Hjelt Institute, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland
2 Department of Public Health, Hjelt Institute, University of Helsinki, P.O. Box 41, FI-00014; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare; Institute for Molecular Medicine Finland, University of Helsinki, FIMM, Helsinki, Finland
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|Date of Web Publication||29-Oct-2012|
Noise sensitivity is considered to be a self-perceived indicator of vulnerability to stressors in general and not noise alone. Multiple chemical sensitivity (MCS) has to some extent been accompanied by noise sensitivity, indicating a moderate correspondence between them. The aim of this study is to investigate if the Weinstein's Noise Sensitivity Scale and Quick Environmental Exposure and Sensitivity Inventory's (QEESI) Chemical Intolerance Subscale can differentiate noise sensitivity and MCS as different entities, and if there are overlaps in the characteristics of noise sensitivity and MCS. In 2002, 327 individuals (166 men, 161 women; age range 45 - 66 years) from the Finnish Twin Cohort answered a questionnaire on noise-related and MCS items. Somatic, psychological, and lifestyle factors were obtained through earlier questionnaires for the same individuals. Both confirmatory and exploratory factor analyses (CFA and EFA) of the questionnaire items on the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale indicated the presence of three factors - Noise Sensitivity, Chemical Sensitivity, and Ability to Concentrate factors - arising from the forming of two factors from the items of the Weinstein's scale. In the regression analyses, among all subjects, the Noise Sensitivity Factor was associated with neuroticism and smoking, and the Chemical Sensitivity Factor was associated with allergies and alcohol use. The study indicates that the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale differentiate noise sensitivity and MCS as different entities.
Keywords: General sensitivity, multiple chemical sensitivity, noise sensitivity, psychosocial factors, somatic health
|How to cite this article:|
Heinonen-Guzejev M, Koskenvuo M, Mussalo-Rauhamaa H, Vuorinen HS, Heikkilä K, Kaprio J. Noise sensitivity and multiple chemical sensitivity scales: Properties in a population based epidemiological study. Noise Health 2012;14:215-23
|How to cite this URL:|
Heinonen-Guzejev M, Koskenvuo M, Mussalo-Rauhamaa H, Vuorinen HS, Heikkilä K, Kaprio J. Noise sensitivity and multiple chemical sensitivity scales: Properties in a population based epidemiological study. Noise Health [serial online] 2012 [cited 2019 Sep 20];14:215-23. Available from: http://www.noiseandhealth.org/text.asp?2012/14/60/215/102956
| Introduction|| |
Noise sensitivity is defined as a personality trait covering attitudes to noise in general. , It refers to the internal physiological and psychological state of any individual, which increases the degree of reactivity to noise in general  and it is a predictor of noise annoyance.  Noise sensitivity has been either equally present in men and women ,, or in some studies women have scored higher on noise sensitivity. , It is a relatively stable trait , and has not been associated with auditory acuity. ,,, Noise sensitivity aggregates in families and the estimate of heritability is 36%. , The Weinstein's Noise Sensitivity Scale was developed for assessing global noise sensitivity and has been largely used in noise sensitivity studies. It consists of 21 items, which are presented on a six- point scale.  Ekehammer and Dornic studied the reliability and construct validity of the Swedish version of the Weinstein's Noise Sensitivity Scale and stated that the psychometric properties were quite satisfactory with regard to reliability, internal consistency, factor structure, and construct validity.  Kishikawa et al., investigated the validity of each question in the Weinstein's Noise Sensitivity Scale and found that the scale contained some questions, which asked about the respondents' annoyance toward noise, and thus, the answers to these questions could be affected by the type of noise exposure. As the Weinstein's scale adopted the Likert scale of six-response options there was also a possibility that the reported relationship between the Weinstein's Noise Sensitivity Score and the subjective reactions to noise were confounded by a response bias. 
Multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance (IEI), encompasses a wide range of subjective symptoms provoked by exposure to low levels of chemicals. , MCS has been defined as an acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to a demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects.  The most common triggers have been cleaning products, tobacco smoke, perfume, pesticides, and car exhaust. , Most patients complaining of MCS have been women (from 70 to 90 %). , MCS is a highly stable trait.  The Quick Environmental Exposure and Sensitivity Inventory (QEESI) has been designed to facilitate history taking from individuals who report chemical intolerances, as also to understand the role of chemical intolerances in other conditions, and for research on MCS.  The full QEESI contains four subscales: Symptom severity, chemical intolerances, other intolerances, and life impact. In addition, it contains a fifth scale or masking index that offers assessment of the ongoing exposure that may affect an individual's awareness of his / her intolerance and the intensity of his / her response to environmental exposures. The scales have shown good reliability and validity. 
Noise sensitivity has been considered to be a self-perceived indicator of vulnerability to stressors in general, and not just noise, linked to the perception of an environmental threat and lack of environmental control.  Neuroticism appears to be a predictor for noise sensitivity. High correlations have been found with introversion and overall sensitivity to non-acoustical stimuli. It has been suggested that noise sensitivity may not be a single construct, but part of a more generic sensitivity to environmental stimuli.  Sensitivity to sensory modalities, such as, brightness, color, pain, smell, and touch, have correlated significantly with noise sensitivity measures.  Likewise, MCS patients often acknowledge hyperreactivity in various other sensory modalities, including noise, light, and touch.  Chemical sensitivity has been, to some extent, accompanied by noise sensitivity, indicating a moderate correspondence between them. 
Overlaps have been found in the characteristics of persons reporting chemical and noise sensitivities. Noise sensitive individuals have had more prominent symptoms of depression, anxiety, anger, tension, inferiority, and nervousness.  Likewise, psychiatric symptoms are also among the most common manifestations of MCS and the most prevalent psychiatric disorders among them are depressive,  affective, and anxiety disorders.  MCS patients have rated the earlier decades of their lives as more stressful than the controls  and noise sensitivity has also been associated with stress. 
It has been hypothesized that individual differences in limbic system reactivity and central nervous system sensitizability underlie vulnerability to environmental stimuli. , Amygdala, which is also one of several brain regions that modulate startle reactions to unexpected noise, , is also the most sensitive portion of the brain to chemical stimuli.  Connections between the thalamic structures of the auditory system and subcortical areas (amygdala, hippocampus, hypothalamus) may act as a fast reacting 'memory chain' establishing and enhancing adverse excitations during noise exposure. The thalamo-amygdala tract is responsible for full- blown 'fear responses' evoked by auditory stimuli. 
Individuals who are sensitive to both chemicals and noise might be among the most vulnerable to limbic dysfunction and to sensitization of the limbic and central nervous system by multiple environmental factors.  However, environmental limbic system dysfunction has been more associated with chemical rather than with noise sensitivity. 
Mechanism and genetic predisposition for noise sensitivity and MCS may differ from each other. A genetic predisposition for MCS may involve altered biotransformation of environmental chemicals. , Various genes, especially genes of importance to the metabolism of xenobiotic compounds, have been associated with MCS, but findings have been inconsistent. It may be that variants in the genes examined are of less importance to MCS or gene-environment interactions, or significant degrees of genetic heterogeneity in MCS underlie the inconsistent findings in the literature.  As noise-sensitive individuals readily pay more attention to noise, perceive more threat from noise, and may react more to noise than less sensitive individuals,  it can be hypothesized that the startle reflex may be more pronounced among them than in non- noise-sensitive individuals. A functional polymorphism in the transcriptional control region of the serotonin transporter gene (5-HTTLPR) has been found to have an impact on the acoustic startle reflex. 
The aim of the present study is to investigate if the Weinstein's Noise Sensitivity Scale  and QEESI's Chemical Intolerance Subscale  differentiate noise sensitivity and MCS as different entities, and to study the associations of noise sensitivity and MCS with somatic, psychological, and lifestyle factors.
| Methods|| |
The study is based on the Finnish Twin Cohort, which was compiled in 1974, from the Central Population Registry of Finland and consists of all Finnish adult same-sex twin pairs (n=17 357) born before 1958, and with both members alive in 1967.  Questionnaires have been sent in 1975, 1981, and 1990 to the twins of the cohort, as described in detail elsewhere. ,
In 1988, a questionnaire was sent to 1005 twin pairs discordant for hypertension. One thousand four hundred and ninety-five individuals (688 men, 807 women) replied. The age range was 31 - 88 years. In 2002, a new questionnaire was sent to a sample (n = 405) of the subjects who had replied to the 1988 questionnaire. Of these, 327 individuals (166 men, 161 women) replied, yielding a response rate of 81%. The age range was 45 - 66 years. They are the participants of the present study. In the 2002 questionnaire Weinstein's Noise Sensitivity Scale  and QEESI's Chemical Intolerance Subscale  were used. Other somatic, psychological, and lifestyle factors were obtained from the questionnaire studies for the same individuals in 1988 and 1990 (or in 1981, if 1990 information was missing).
Noise sensitivity was studied using the Weinstein's Noise Sensitivity Scale.  It consists of 21 items, which were presented on a six-point scale rating from 'agree strongly' (1) to 'disagree strongly. (6). Several items were scored in the opposite direction before responses were summed  and those items were scored in the opposite direction before the factor analyses.
Multiple chemical sensitivity was studied using following questions based on QEESI's Chemical Intolerance Subscale  modified into Finnish language and environment: 'People experience odors in different ways. How often do the following odors make you feel sick (i.e., you would get a headache, feel weak, feel dizzy, have trouble breathing, get an upset stomach have difficulty concentrating, or something like that) when you are exposed to them? How often do you feel sick: (1) almost never; (2) seldom; (3) sometimes; (4) often; (5) almost always; (6) I cannot say, because I have not been exposed to that odor'. The odors were: 'Diesel or gas engine exhaust; Insecticide (sprays and repellents); Paint or paint thinner; Certain perfumes, air fresheners or other fragrances; New furnishing such as new carpeting, a new soft plastic shower curtain or the interior of a new car; or the smell of mold (like in the ground cellar) in mold damage; Dustiness; Tobacco smoke.' The scale was transformed before the factor analyses in the following manner: Answers '1'(almost never) were recoded as '0', answers'2' (seldom) were recoded as '1', and answers'6' (cannot say) were recoded as '2' and replaced between the answers 'seldom' and 'sometimes,' while others remained the same.
The 21-item scale of the Beck Depression Inventory (BDI)  was used to assess depressiveness. Missing data were randomly distributed by items. Details of this procedure have been published in Varjonen et al.  In the present study, we classified the subjects with BDI score 0 - 9 as having none or minimal depression, more than 9 and under 17 as mild depression, and 17 or more as at least moderate depression, which is nearly identical to the guidelines for BDI cut-points of scores. ,
Life satisfaction was measured on Allardt's four-item scale  according to whether respondents found their lives to be interesting, happy, easy, or lonely. , The subjects were rating each descriptor on a four or five point scale and a sum scale was formed (range 4 - 20). High scores indicated dissatisfaction.
Anger expression was measured with the Finnish adaptation  of the Spielberger's trait anger scale. , State anger was left out from the Finnish version.  Anger expression dimensions were anger suppression ('Anger In'), anger control ('Anger Control'), and anger expression ('Anger Out'). All 18 anger expression styles and trait anger items were rated from 1 (almost never) to 4 (almost always) so they could have values from 18 to 72.
Hostility was measured using a three-item scale as described by Koskenvuo et al.  A hostility scale was formed by summing the Likert scale responses to the following three items: Ease of anger arousal, irritability, and argumentativeness. The score ranged from 3 to 15.
Neuroticism was measured using 10 items of the abbreviated Eysenck Personality Inventory (EPI). 
Hypertension was elicited by asking: 'Has a doctor ever told you that you have elevated blood pressure?' The response alternatives were: 'no' or 'yes'.
Allergy included asthma, allergic rhinitis, and / or allergic eczema. Information on allergy was obtained by three questions which asked, 'Have you ever been told by a doctor that you have had: Asthma; allergic rhinitis, such as hay fever; or allergic eczema?' The response alternatives for each condition were: 'No' or 'yes'.
Information on the use of pain relievers and on use of sleeping pills and tranquillizers was elicited by asking: 'During the last year, on how many days together did you use the following types of medicines: pain relievers sleeping pills, tranquillizers?' The response alternatives for each class of medicines were: 'have not used', 'less than 10 days', '10 - 59 days', '60 - 180 days (2 - 6 months)', 'over 180 days (over 6 months)'. The first response alternative was classified as being of no use, the other alternatives were classified as any use.
The experienced stress of daily activities was measured on a scale developed by Reeder et al.  on the basis of the four self-reported statements of stress in daily activities. 
A cigarette smoker was defined as a person who had smoked at least 5 - 10 packs of cigarettes in his or her whole life. Current smokers were those who were smoking daily or almost daily at the time of the questionnaire study. The subjects were divided into categories of current, former, and never-smokers.  Occasional smokers were classified as current smokers.
Alcohol use was measured by asking the subjects how much beer, wine, and spirits they consumed on an average per week or month, as well as, the frequency of their use.  This was used to calculate the use, in units of 100 g of alcohol per month. Abstainers were classified as using zero grams.
Both confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to explore the relationship between the questionnaire items in the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale. Correlations and stepwise regression analyses were used to study the associations of factor scores with somatic and psychological factors. Variance inflation factors (VIF) for the independent variables were used in regression, post estimation, to check for collinearity.
| Results|| |
[Table 1] presents the distribution of subjects by age group; 48.9% of all subjects, 53.0% of the men and 44.7% of the women, were in the oldest age group of 61 - 66 years.
Factor analysis of the noise sensitivity and chemical sensitivity questionnaire items was performed. Scale reliability coefficient (Cronbach alpha) for the Weinstein's Noise Sensitivity Scale was 0.855 and for the QEESI's Chemical Intolerance Subscale, 0.904. Confirmatory and exploratory factor analyses (CFA and EFA) were first conducted for both scales (Weinstein and QEESI) separately, and then for all items from both scales in the same analysis, and the sex differences were tested. Factor loadings of > 0.4 were considered to be of major impact.
Among all subjects in the factor analysis of the items on the Weinstein's Noise Sensitivity Scale, after orthogonal varimax Kaiser off rotation, two factors were formed. In the factor analysis of QEESI's Chemical Intolerance Subscale one factor was formed. Separate factor analyses among men and women showed no significant differences (data not shown).
In the exploratory factor analysis of the questionnaire items, of both Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale, among all subjects, three factors were formed [Table 2]. Factor 1 included twelve noise sensitivity questionnaire items (Items 2, 5, 6, 7, 10, 11, 13, 16, 17, 18, 19, and 21). Item 21 'I am sensitive to noise' got the highest factor loading (0.758). Factor 1 was considered to describe noise sensitivity and was named the Noise Sensitivity Factor. The factor loadings of Item 4 (0.327) and Item 9 (0.356) were somewhat below 0.4, and hence, were not included in the Noise Sensitivity Factor. Factor 2 included all eight chemical sensitivity questionnaire items (items 1 - 8) and it was considered to be chemical sensitivity-specific and was named the Chemical Sensitivity Factor. Factor 3 included five noise sensitivity items (Items 1, 3, 8, 14, and 20). As it included Item 14 'I'm good at concentrating no matter what is going on around me' and other items describing the ability to concentrate, it was named the Ability to Concentrate Factor. The factor loadings of Item 12 (0.245) and Item 15 (0.393) were below 0.4, and were not included in Factor 3.
|Table 2: Factor loadings of the items of the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale|
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In factor analyses among men and women, separately, there were no meaningful significant differences (data not shown).
Correlations of the factor scores with somatic and psychological factors
We examined the correlations of the factor scores of Noise Sensitivity and Chemical Sensitivity Factors with age, sex, smoking, alcohol use, stress of daily activities, neuroticism, hostility, anger expression, life satisfaction, BDI score (Beck Depression Inventory), use of sleeping pills and tranquillizers, use of pain relievers, hypertension, and allergy. These items were chosen for the analyses, because in previous studies they had been associated with noise sensitivity and MCS.
Among all subjects, the Noise Sensitivity Factor was correlated significantly with hostility, anger control, neuroticism, use of pain relievers, anger out, depression, and stress. The Chemical Sensitivity Factor was correlated significantly with allergies and use of pain relievers. The factor analytic scales, Noise Sensitivity Factor, and Chemical Sensitivity Factor, were not correlated (corr = 0.005), in contrast to the 0.39 correlation of Weinstein's Noise Sensitivity Scale with QEESI's Chemical Intolerance Subscale.
Regression models of the association of factor scores with somatic and psychological factors
[Table 3] presents non-standardized regression coefficients for Noise Sensitivity and Chemical Sensitivity Factors in relation to psychological, lifestyle, and medical factors, among all subjects. In the regression analyses, the Noise Sensitivity Factor was associated with neuroticism (Coef. 0.069, 95% CI 0.007, 0.132) and smoking (current) (Coef. - 0.339, 95% CI - 0.657, - 0.021). The Chemical Sensitivity Factor was associated with allergies (Coef. 0.439, 95% CI 0.201, 0.677) and alcohol use (Coef. 0.043, 95% CI 0.011, 0.075).
|Table 3: Non-standardized regression coefficients for the Noise Sensitivity Factor and Chemical Sensitivity Factor in relation to psychological, lifestyle, and medical factors|
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Because of substantial differences between men and women among other variables, there is a possibility that there are both biological and social reasons for them. Thus the analyses were also conducted separately in men and women. In men the Noise Sensitivity Factor was associated with neuroticism, allergies, and depression (mild) and the Chemical Sensitivity Factor with allergies, depression (at least moderate), alcohol use, and smoking (current). In women, the Noise Sensitivity Factor was associated with anger control and the Chemical Sensitivity Factor with allergies and alcohol use.
| Discussion|| |
In the present study, the factor analyses (CFA and EFA) of the questionnaire items of the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale indicated the presence of three factors - Noise Sensitivity, Chemical Sensitivity, and Ability to Concentrate factors - arising from the forming of two factors from the items on the Weinstein's scale. Items loading onto the Noise Sensitivity scale did not load onto the Chemical Sensitivity scale and vice versa. Overall the Noise Sensitivity Factor was not correlated with the Chemical Sensitivity Factor, in contrast to the modest correlation of the Weinstein's Noise Sensitivity Scale with the QEESI's Chemical Intolerance Subscale. The association profiles of the Noise Sensitivity Factor and Chemical Sensitivity Factor with the medical, psychological, and lifestyle factors were mainly different.
Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale
According to this study, the Weinstein's Noise Sensitivity Scale was heterogeneous as two factors, the Noise Sensitivity and Ability to Concentrate factors, which were both formed in the factor analyses. Kishikawa et al. studied the Weinstein's Noise Sensitivity Scale by applying the multiple logistic regression analysis to assess the correlation between L dn and the answer to each question of the Weinstein's Scale. They found that the Weinstein's Noise Sensitivity Scale contained some irrelevant questions like Items 7 and 10, which asked about the respondents' annoyance toward noise, and that could be affected by the type of noise exposure.  However, in the present study Items 7 and 10 loaded on the Noise Sensitivity Factor.
In the study of Ekehammar and Dornic, on students (77% women), the psychometric properties, including the factor structure of the Swedish version of the Noise Sensitivity Scale, based on the Weinstein's Scale, were analyzed. The principal component factor analysis yielded one major factor, which explained 26.9% of the total variance. The other factors explained less than 7.7% each. The factor loadings of the main factor were substantial for all items except for Item 12.  In the present study Item 12 did not load on any of the factors and was not included in the Noise Sensitivity Factor.
The results of this study show that QEESI's Chemical Intolerance Subscale is homogeneous and uni-dimensional. The Chemical Sensitivity Factor includes all the Chemical Intolerance Subscale items (Items 1 - 8). The QEESI scales have shown good reliability and validity in previous studies. Used together, they have provided a sensitivity of 92% and a specificity of 95% in differentiating the chemically sensitive persons from the controls. 
As in this study, the original measures, the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale are correlated, the measures of noise sensitivity and MCS should be and already have been developed further. Kishikawa et al., have developed a noise sensitivity measurement scale named WNS-6B, by excluding, according to them, biased questions from the original Weinstein's Noise Sensitivity Scale (WNS) and applying binary coding to six response options, in order to reduce the response bias.  Due to the limited applicability of the Weinstein's Noise Sensitivity Scale, Zimmer and Ellermeier have developed another noise sensitivity questionnaire to measure global noise sensitivity and they have reported a four-factorial structure explaining 37.5% of the variance, suggesting that noise sensitivity depends on different daily situations. , Later NoiSeQ (the Noise Sensitivity Questionnaire) was developed to measure not only global noise sensitivity, but also the sensitivity of the five domains of daily life: leisure, work, habitation, communication, and sleep. 
Nordin et al. evaluated an instrument analogous to the Weinstein's Noise Sensitivity Scale, for quantifying individuals' self-reported sensitivity to chemicals, which evokes odor irritation to such an extent that it has affective behavioral consequences. They have developed a Chemical Sensitivity Scale (CSS) of 21 statement/questions about the chemical environment, as analogous as possible to the Weinstein's Noise Sensitivity Scale. They conclude that the analogy of the CSS to the Weinstein's Noise Sensitivity Scale implies that the use of both scales in combination may enhance the understanding of the issue of general environmental sensitivity versus specific sensitivity to chemicals. 
Associations of Noise Sensitivity Factor and Chemical Sensitivity Factor with somatic, psychological, and lifestyle factors
In this study, the association profiles of the Noise Sensitivity Factor and Chemical Sensitivity Factor with medical, psychological and lifestyle factors were mainly different. However, in the further analyses in men and women, separately, in men the association profiles of the Noise Sensitivity Factor and Chemical Sensitivity Factor with depression and allergies were similar.
The association analyses were conducted using the stepwise regression analysis, which together with limited sample size did not allow us to accurately evaluate the magnitude of associations of individual variables. There was some collinearity between the medical, psychological, and lifestyle items, which could have affected the results. In addition, the somatic, psychological, and lifestyle factors were studied about 10 years earlier (mainly 1990 and 1988) than noise sensitivity and MCS (in 2002), which could have caused some underestimation of the correlations and associations. However, in previous studies, psychological factors like neuroticism and hostility were stable traits. ,,
In the present study, the Noise Sensitivity Factor was associated with neuroticism and smoking among all subjects. In men, the Noise Sensitivity Factor was associated with neuroticism, allergies, and depression, and in women with anger control. These results are in concordance with the previous studies. Noise sensitivity has been associated with neuroticism  and smoking.  Noise-sensitive individuals have also been found to have more prominent symptoms of depression and anger  and individuals with high noise sensitivity have had more allergic complaints than persons with low sensitivity. 
The Chemical Sensitivity Factor was associated with allergies and alcohol use among all subjects in this study. In men, the Chemical Sensitivity Factor was associated with allergies, depression, alcohol use, and smoking, and in women with allergies and alcohol use. In the previous studies, chemically sensitive subjects have reported significantly higher rates of all types of allergies  and they have been significantly more likely to have alcoholism and major depression than persons without chemical sensitivity.  Previously MCS has not been associated with smoking. ,
Some previous studies, using other MCS scales than those used in the present study, have found moderate correspondence between noise sensitivity and MCS. In the study of Nordin et al., chemical sensitivity was to some extent accompanied by noise sensitivity. However, they stated that the sample of students and university staff members they used could not be considered representative of the general population. In that study, the Weinstein's Noise Sensitivity Scale and Chemical Sensitivity Scale (CSS) analogous to the Weinstein's Scale were used. 
In the study of Andersson et al., on teenagers (aged 13 - 19 years), noise sensitivity, probable anxiety, and female sex, were found to be a risk factor for general chemical sensitivity. Also in that study, the Swedish version of the Weinstein's Noise Sensitivity Scale was used. The general chemical sensitivity and respiratory symptoms were assessed, using a short question and a version of the chemical sensitivity scale developed by Nordin et al., and were used for sensory hyperreactivity. A subgroup also conducted a capsaicin inhalation test. The sensitivity variables were positively intercorrelated and risk factors for general chemical sensitivity were noise sensitivity, probable anxiety, and female sex. 
However, because of the differences in the chemical sensitivity scales used, the results of the studies of Nordin et al. and Andersson et al. are not fully comparable with the results of the present study. In this study, the age profile is also different from the study of Andersson et al., as the subjects were 45 - 66 years old.
It has been suggested that sensitization is a major mechanism for MCS  and that it is a psychobiological mechanism underlying a cluster of illnesses, referred to as 'subjective health complaints', including annoyance to noise. Sustained stress responses or sustained arousal may be important factors for the development of these conditions.  In the study of Bell et al., on college undergraduates, the group rating high both for illness from chemicals and for noise sensitivity, had characteristics predictive of heightened sensitizability on time-dependent sensitization. However, they stated that the differences among three groups with sensitivity to chemical odors and / or to noise, indicated that self-reported sensitivity to one class of environmental stimuli did not necessarily involve a universally descriptive picture for all types of sensitivities or sensitive persons. Environmental limbic system dysfunction was associated more with chemical sensitivity than with noise sensitivity. 
The present study indicates that the Weinstein's Noise Sensitivity Scale and QEESI's Chemical Intolerance Subscale differentiate noise sensitivity and MCS as different entities. Further large sample studies are needed to investigate whether sensitivity and MCS are a part of the general environmental sensitivity. The underlying mechanisms of noise sensitivity and MCS should also be studied.
| Acknowledgments|| |
This study was carried out as part of the Finnish Twin Cohort Study at the Department of Public Health of the Hjelt Institute, at the University of Helsinki, Finland. The Finnish Twin Cohort study is supported by the Academy of Finland Center of Excellence in Complex Disease Genetics. The study was financially supported by The Finnish Work Environment Fund (Grant 109008 and 111005), which is gratefully acknowledged.
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Department of Public Health, Hjelt Institute, University of Helsinki P.O. Box 41, FI-00014, Helsinki
Source of Support: The Finnish Twin Cohort study is supported by the Academy of Finland Center of Excellence in Complex Disease Genetics. The study was financially supported by The Finnish Work Environment Fund, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]
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