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APPLIED ASPECTS OF AUDITORY DISTRACTION |
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| Year : 2010
| Volume
: 12 | Issue : 49 | Page
: 255-262 |
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| Night time aircraft noise exposure and children's cognitive performance |
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Stephen Stansfeld1, Staffan Hygge2, Charlotte Clark1, Tamuno Alfred3
1 Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, United Kingdom
2 Laboratory of Applied Psychology, Centre for Built Environment, University of Gvle, SE-801 76, Gvle, Sweden
3 Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, United Kingdom
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| Date of Web Publication | 21-Sep-2010 |
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Chronic aircraft noise exposure in children is associated with impairment of reading and long-term memory. Most studies have not differentiated between day or nighttime noise exposure. It has been hypothesized that sleep disturbance might mediate the association of aircraft noise exposure and cognitive impairment in children. This study involves secondary analysis of data from the Munich Study and the UK Road Traffic and Aircraft Noise Exposure and Children's Cognition and Health (RANCH) Study sample to test this. In the Munich study, 330 children were assessed on cognitive measures in three measurement waves a year apart, before and after the switchover of airports. Self-reports of sleep quality were analyzed across airports, aircraft noise exposure and measurement wave to test whether changes in nighttime noise exposure had any effect on reported sleep quality, and whether this showed the same pattern as for changes in cognitive performance. For the UK sample of the RANCH study, night noise contour information was linked to the children's home and related to sleep disturbance and cognitive performance. In the Munich study, analysis of sleep quality questions showed no consistent interactions between airport, noise, and measurement wave, suggesting that poor sleep quality does not mediate the association between noise exposure and cognition. Daytime and nighttime aircraft noise exposure was highly correlated in the RANCH study. Although night noise exposure was significantly associated with impaired reading and recognition memory, once home night noise exposure was centered on daytime school noise exposure, night noise had no additional effect to daytime noise exposure. These analyses took advantage of secondary data available from two studies of aircraft noise and cognition. They were not initially designed to examine sleep disturbance and cognition, and thus, there are methodological limitations which make it less than ideal in giving definitive answers to these questions. In conclusion, results from both studies suggest that night aircraft noise exposure does not appear to add any cognitive performance decrement to the cognitive decrement induced by daytime aircraft noise alone. We suggest that the school should be the main focus of attention for protection of children against the effects of aircraft noise on school performance. Keywords: Noise, sleep, cognition, child health, memory
How to cite this article:
Stansfeld S, Hygge S, Clark C, Alfred T. Night time aircraft noise exposure and children's cognitive performance. Noise Health 2010;12:255-62 |
| Introduction | |  |
Children may be a high-risk group vulnerable to the cognitive effects of chronic noise exposure. Recent well-controlled studies have found reliable effects of exposure to aircraft noise on children's reading comprehension and long-term memory as well as annoyance. [1],[2] However, both the Munich and Road Traffic and Aircraft Noise Exposure and Children's Cognition and Health (RANCH) studies employed fairly crude averaged estimates of noise exposure, reported as daytime or 24 hour LAeq levels. To examine whether daytime exposure is better or worse than nighttime exposure, it would have been desirable to have indicators of actual as well as individual noise exposure instead of projected noise contours for large geographical areas. It would also be desirable to have separate time periods for the noise exposure, e.g., a division into daytime, evening and nighttime exposure levels, in the same way that the European Noise Directive subdivides noise exposure into Lday , Lnight , Ldn (day and night) and Lden (day, evening, and night). Having that available, it would be easier to plot dose-effect curves for the different parts of the day and night and to find out whether, for example, the slopes of the dose-effect curves differ between day, evening, and night.
Some years ago, the World Health Organization (WHO) set up a task force to develop guidelines for nighttime noise exposure. One of the sub-tasks was to find out more about how nighttime noise exposure affects children's cognition. In a literature search, no study was found that explicitly investigated the causal link of nighttime noise exposure to impaired cognition.
However, some indirect evidence in the form of the effects of reduced sleep quality on cognitive performance is reported by Jan Born and co-workers at University of Lόbeck. [3],[4],[5],[6],[7] This research group suggests that declarative memory benefits mainly from sleep periods dominated by slow-wave sleep (SWS), while there is no consistent benefit for declarative memory from periods rich in rapid eye movement sleep (REM). This points to the importance of SWS for declarative memory, which is a plausible underlying cause-effect model, although we, in the present study, will have no direct means to test it.
Bearing this in mind, the WHO Kφln office in 2005 took the initiative to sponsor supplementary analyses of the RANCH and Munich studies of aircraft noise and children, to see whether any discernible effect of night noise exposure could be detected for the cognitive measures that showed reliable changes with differing aircraft noise exposure in the initial reports. [1],[2]
In the Munich study of aircraft noise and children, the same 330 children were studied in three measurement waves a year apart, before and after the switchover of airports in May 1992. [1],[8],[9] The children were assessed on psycho-physiological, perceptual, cognitive, motivational and quality-of-life measures. At both airports, noise-exposed, or to-be noise exposed, children were socio-demographically matched with groups with low levels of aircraft noise.
For three of the cognitive tasks, [1] there was improved performance after the closure of the old airport and impaired performance after the opening of the new airport. Mean errors on a difficult word task decreased when the old airport closed and increased when the new airport opened. Basically, the same pattern was also shown for a long-term recall task and a reading task. That is, the chronically aircraft noise exposed children at the old airport showed lower performance than their controls before the old airport closed down, but there was no difference after the closure. At the new airport, there was worse performance in the noise group than in the control group after the closure of the airport, but not before.
In the Munich study, noise exposure levels were recorded as 24 hour LAeq [inserted into [Figure 1]]. These noise measures were mainly intended as a check of the experimental manipulations, that is, securing that the closure and opening of the airports resulted in the expected noise levels changes, and the control groups did not change in noise exposure. However, these noise measures did not separate daytime from nighttime noise levels. | Figure 1: Mean errors on a difficult word list as a function of airport, noise group, and measurement wave. Error bars are SE of the means. Also, 24 hour outdoor LAeq values are given for waves 1 and 3 (adapted from Hygge, Evans and Bullinger)[1]
Click here to view |
To find out whether daytime and nighttime noise exposure contributed differently to the noise effects on cognitive performance, an attempt was first made to get approximate retrospective separate estimates of nighttime and daytime noise exposure levels in the geographic areas that were included in the original Munich study of aircraft noise and children. However, this turned out to be impossible. As an alternative, self-reports of sleep quality were retrieved from the original database and analyzed across airports, aircraft noise exposure and measurement wave. The basic analytical idea was that if increased or decreased nighttime noise exposure had any effect on reported sleep quality, this would show up in the aircraft noise exposed areas at the two airports, but not in the control areas. If a consequential change in self-reported sleep quality also showed the same pattern as for changes in cognitive performance, it could then be analyzed and statistically tested as a mediator of noise effects on cognitive performance.
The RANCH project examined exposure-effect relationships between chronic aircraft noise exposure, chronic road traffic noise exposure and combinations of aircraft noise and road traffic noise exposure, and cognitive and health outcomes. It is the largest cross-sectional study of noise and children's health examining 9-10 year old children living around three major airports, Schiphol (Amsterdam, the Netherlands), Barajas (Madrid, Spain), and London Heathrow (United Kingdom).
The basic findings of the RANCH study with respect to aircraft noise were impairment of reading comprehension and recognition memory.
For the London sample of the RANCH study, it was possible to retrieve night noise contour information from the Civil Aviation Authority and link the levels to the children's home postal codes. These were secondary data analyses which took advantage of the existing data but necessarily had limitations: an ideal study might include physiological recording of sleep disturbance, measurement of personal exposure to nighttime noise and more detailed assessment of sleep quality.
| Method | | |
The Munich study
In the Munich study, 326 children took part in three measurement waves one year apart, starting around 6 months before the switchover of airports in May 1992. Two experimental groups comprised children who were (old airport) or would be (new airport) exposed to aircraft noise. Two control groups, one for the old and one for the new airport, were selected from areas that had little aircraft noise exposure, and matched with their respective experimental groups on socio-demographic characteristics. The number of children in the four groups was: Old-No aircraft noise 43, Old-Aircraft noise 65, New-No aircraft noise 107, New-Aircraft noise 111. Most children were 9-11 years old at the outset of the study (M = 10.4, SD = 0.85). Criteria for taking part in the study were a minimum of 2 years of residence and German fluency.
At each wave, the children were tested individually in silence for 1.5 hours on 2 consecutive days in a specially designed, temperature-controlled, and sound-attenuated mobile laboratory. The children worked individually on an array of different tasks. In this article, only the reading and memory tasks are reported. [1],[8],[9] Both in the trailer and at home, the children filled out questionnaires about life quality and also about sleep quality. On the first day, the children were accompanied by a parent, as a rule the mother, who filled out a questionnaire about, among other things, sleep quality.
Reading and memory
A standardized German reading test was employed. [10] Children read paragraphs and word lists of increasing difficulty. Some of the words in the list were pseudowords, but phonologically appropriate in German. On the first day, the children read a text in intermittent 80 LAeq broad-band noise and were tested for long-term memory (recall) in silence on the second day. Noise exposure during encoding was introduced to make the task more difficult.
Self-reports of sleep quality
For the children, four questions about sleep and sleep quality were included in the questionnaires: (1) During the last week I slept well (never-always, 0-4), (2) During the last week I was tired and out of energy (never-always, 0-4), (3) How often do you sleep poorly? (never-always, 1-5), and (4) Do you sleep well? (yes-no, 1-2).
In the questionnaires for the parents there were five questions related to sleep quality: (1) I usually get enough sleep, (2) I have a problem with falling asleep, (3) I have an uneasy sleep, (4) I wake up several times at night, and (5) I wake up too early in the morning. The replies were made by choosing one of four boxes labeled never, sometimes, often, and always (scored as 1-4).
The RANCH study
In the London sample of the RANCH study, 857children took part. They all lived around the London Heathrow Airport and were aged 9-10 years. Children were selected by external aircraft and road traffic noise exposure at school predicted from noise contour map modeling and on-site measurements. Schools were selected from a grid of increasing aircraft and road traffic noise exposure. Selected schools were matched for socioeconomic position within countries. In the UK, two classes were selected from each cell in the grid. No children were excluded from any of the selected classes. [2]
Cognitive tests
Standardized pen and paper cognitive tests were developed to measure episodic memory, working memory, prospective memory, and sustained attention. For reading comprehension nationally, standardized tests of reading were employed in each country. [11] A children's questionnaire assessed perceptions of noise and annoyance, self-rated health and opportunities for psychological restoration. Parents completed a questionnaire about confounding factors such as socioeconomic position, parental education, and ethnicity. The parental questionnaire also included the Strength and Difficulties Questionnaire to measure children's mental health. [12] The cognitive tests and questionnaires were group administered in a fixed order in the classroom. Written consent was obtained from the children and their parents. Indoor and outdoor noise measurements were made at the schools during testing.
Measurement of night noise
Night noise contour information around Heathrow Airport was obtained from the Civil Aviation Authority. Noise levels were linked to children's homes through postcodes. This enabled a nighttime measure of aircraft noise, between 11 p.m. and 7 a.m., for each child involved in the study.
| Results | | |
The Munich study
Children
As a baseline for comparisons, the effects of 24 hour aircraft noise on one of the children's cognitive tasks in the Munich study is shown in [Figure 1].
An analysis of variance of the four questionnaire replies from the children, with Airport (A) and Noise condition (E) as independent between subject factors, and measurement wave (W) as a within subject factor, yielded no significant interaction A*E*W (all P values >0.41), with the exception of a significant interaction [F(2, 548) = 3.50, P = 0.039] for the item "Do you sleep well?" (yes-no, 1-2), [Figure 2]. This interaction across the airports did not come out as a significant E*W interaction when each airport was analyzed separately, indicating that although trends for the two airports moved in different directions, they were not strong enough to stand out as statistically significant at both the airports. Judging from [Figure 2], it seems that sleep deteriorated most at the old airport in the No aircraft noise control group between waves 1 and 2, and did not improve in the Aircraft noise exposure group after the airport closed down. At the new airport, sleep deteriorated in the groups that became exposed to aircraft noise from wave 2 and onward, but it also worsened in the control group, but not as much. | Figure 2: Means of children's self-reported good and bad sleep and awakenings during night as a function of airport, noise group, and measurement wave. A higher value indicates lower sleep quality. Error bars are SE of the means
Click here to view |
Compared to the clear-cut pattern of results for the cognitive measures in the Munich study, as the example shown in [Figure 1], it is evident also from a visual inspection that changes in self-reported sleep do not mediate the noise effect on cognition. This is corroborated by an analysis of covariance, identical to the analysis of variance behind [Figure 1], with the replies to the question "Do you sleep well?" were added as a covariate. This analysis did not lower the significance level of the A*E*W interaction; it increased the level (from P = 0.007 to P = 0.003) although there was a significant effect of the covariance on the dependent measures (P = 0.022). Thus, these results are not consistent with the hypothesis that aircraft night noise impairs cognition by mediation of self-reported sleep quality.
Parents
An analysis of variance of the five questionnaire replies from the parents, with Airport (A) and Noise condition (E) as independent between subject factors, and measurement wave (W) as between subject factor, yielded no significant interactions A*E or A*E*W (all Ps > 0.21).
The typical response pattern across for the two airports and the three measurement waves for 258 parents are shown in [Figure 3] in response to the question "I wake up several times at night". | Figure 3: Means of parents' self-reported awakenings during night as a function of airport, noise group, and measurement wave. A higher value represents more frequent awakenings. Error bars are SE of the means
Click here to view |
Thus, for the Munich study, the results are not consistent with the hypothesis that aircraft night noise impairs cognition by mediation of self-reported sleep quality.
The RANCH study
[Table 1] describes the distribution of nighttime and daytime aircraft noise for the sample around Heathrow Airport. Mean daytime aircraft noise was 53 dBA, whereas mean nighttime aircraft noise was 43 dBA. There was a fairly wide range of exposure for both daytime and nighttime aircraft noise exposure. The socio-demographic details of the sample are presented elsewhere. [2]  | Table 1: Descriptive statistics of night and day aircraft noise in dB(A) for overall sample (N = 857)
Click here to view |
[Table 2] shows the frequencies of pupils exposed to high or low levels of aircraft noise during the day and during the night. Most of the sample was exposed to less than 50 dBA during the night and less than 57 dBA during the day. However, a sizeable proportion was exposed to greater than 57 dBA during the day and greater than 50 dBA at night. Relatively fewer subjects had a higher daytime aircraft noise level and a low night aircraft noise level. Very few subjects indeed had a higher aircraft noise level exposure level at night than during the day.
[Figure 4] depicts the relationship between daytime aircraft noise exposure and nighttime aircraft noise exposure for the UK sample. What this shows is that although there is a fairly strong relationship between night aircraft noise and day aircraft noise exposure, there is also quite a large amount of scatter in terms of varying night aircraft noise levels within the higher levels of daytime aircraft noise. | Figure 4: Relationship between daytime aircraft noise exposure at school and nighttime aircraft noise exposure
Click here to view |
[Table 3] and [Table 4] analyze the association between nighttime noise exposure and various measures of cognitive performance incorporating daytime exposure as well as nighttime exposure. Multilevel modeling was used to take into account the hierarchical nature of the dataset, with pupils being clustered within schools. Multilevel modeling makes most statistically efficient use of hierarchical data of pupils (level 1) clustered within schools (level 2), allowing both levels to be examined in the same model. [13] The multilevel method produces correct standard errors and significance tests as the analysis takes account of the clustered nature of the data. Three models are described in the tables: | Table 3: Multilevel models for night and day aircraft noise exposure at school on reading comprehension (N = 842)
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 | Table 4: Multilevel models for night and day aircraft noise at school on recognition memory (N = 830)
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Model 1: nighttime aircraft noise unadjusted for the daytime aircraft noise at school;
Model 2: adds daytime noise at school;
Model 3: is formally equivalent to model 2 but centers the nighttime aircraft noise for each pupil at their school daytime aircraft noise exposure, so its coefficient is the effect of the difference between a pupil's nighttime noise exposure and their daytime exposure at school. Therefore, increases in "night aircraft noise centered on school daytime aircraft noise" relates to the difference attributable to night noise-related effects on top of that contributed by daytime noise.
Nighttime exposure to aircraft noise was significantly associated with impairment of reading comprehension, adjusting for road traffic noise, difficulty getting to sleep, number of times awake, age, sex, parental employment status, crowding, homeownership, mother's education, long-standing illness, main language spoken at home, parental support for school work, and classroom glazing [Model 1, [Table 3]]. Difficulty getting to sleep, number of times awake in the night, female sex, low mother's education, not being a homeowner, having a long-standing illness and low parental support were also significantly related to impairment of reading comprehension in this model. After adjustment for daytime aircraft noise exposure, both the effects of nighttime aircraft noise and daytime aircraft noise became nonsignificant [Model 2, [Table 3]]. This is not altogether surprising as daytime aircraft noise exposure is highly correlated with nighttime aircraft noise exposure and this could be considered over adjustment. In Model 3 [Table 3] in which pupil values of home night noise exposure are centered on school noise exposure, it is demonstrated that night noise exposure does not have an additional effect to that of daytime noise exposure on reading comprehension.
Nighttime exposure to aircraft noise was also significantly associated with impairment of recognition memory, adjusting for road traffic noise, difficulty getting to sleep, times awake, age, sex, parental employment status, crowding, homeownership, mother's education, long-standing illness, main language spoken at home, parental support for school work and classroom glazing [Model 1, [Table 4]]. After adjustment for daytime aircraft noise exposure, both the effects of nighttime aircraft noise and daytime aircraft noise became nonsignificant [Model 2, [Table 4]]. Again, this is not altogether surprising as daytime aircraft noise exposure is highly correlated with nighttime aircraft noise exposure and this could be considered over adjustment. In Model 3 [Table 4] in which pupil values of home night noise exposure are centered on school noise exposure, it is demonstrated that night noise exposure does not have an additional effect to that of daytime noise exposure on recognition memory.
Neither daytime nor nighttime aircraft noise exposure was associated with impairments of recall memory, information recall, attention, working memory, self-rated health, and overall mental health measured by the Strengths and Difficulties Questionnaire. [12] Nighttime noise was also not associated with the subscales of the Strengths and Difficulties Questionnaire: emotional symptoms, conduct disorder, hyperactivity, peer problems, and prosocial behavior.
| Discussion | | |
The most consistent effects of aircraft noise found in children are cognitive impairments, though these effects are not uniform across all cognitive tasks. [14],[15] Tasks which involve central processing and language comprehension, such as reading, attention, problem solving and memory, appear to be most affected by exposure to noise. [1],[9],[14],[15] In the Munich study, a difficult word test, long-term recall of a text, and a reading test were impaired by aircraft noise (24 hour values). The supplementary analyses reported here do not support the idea that aircraft night noise, with ensuing loss in sleep quality, further adds to this deterioration.
In the RANCH study, we found the effects of chronic daytime aircraft noise exposure on reading comprehension and recognition memory, but not on recall memory or attention. [2] The findings from these further analyses of RANCH data from the UK show that nighttime aircraft noise exposure shows no additional impact on reading or recognition memory beyond the effects of daytime noise exposure. It also shows no effects of nighttime noise exposure on self-rated health or overall mental health.
The assumption behind the studies in which schools are selected as the primary focus of noise exposure is that noise exposure during the school day has the most important effects on cognitive performance. However, primary age children attending noise-exposed schools usually live in noise-exposed homes. [16] In addition, the Munich study selected children on home, not school, noise exposure. [1] It seemed possible, therefore, that aircraft noise exposure outside school hours, perhaps especially in the early morning or late at night, might also have an impact on children's learning and school performance. This was plausible for several reasons. First, effects on performance have been demonstrated in adults, which persist after the noise exposure is over; secondly, noise exposure levels in the playground or on the journey to school may be louder than those experienced in school; and thirdly, learning, especially language development, may occur as much at home as at school; fourthly, aircraft noise exposure at night, largely in the shoulder hours, might disturb sleep and cause aftereffects on children's school performance, the next day. This further set of analyses suggests that nighttime noise exposure does not affect children's school performance during the day over and above the effects of daytime noise exposure. However, it does not address whether aircraft noise exposure at home outside the night hours (11 p.m.-7 a.m.) influences school performance.
Our analyses of the effects on children's cognition of aircraft night noise have two important limitations. First, we did not have an orthogonal and independent variation of nighttime and daytime aircraft noise exposure in the way a good experiment should have to test independent effects of nighttime and daytime noise. The nighttime and daytime noise exposure in the RANCH study were so highly correlated that there was insufficient variability to test whether daytime and nighttime noise exposure had independent effects. This restricts our ability to draw a definite conclusion on the effects of night aircraft noise exposure other than that such an exposure does not appear to add any cognitive performance decrement to the cognitive decrement that was induced by daytime aircraft noise alone.
The second limitation is more pronounced for the Munich study than for the RANCH study, as the former has no direct measurement of night exposure levels, but is relying solely on self-report sleep quality as an indicator of night noise exposure. However, as the RANCH study could not report any effects of sleep quality measures on the direct effect from aircraft night noise to the cognitive measures in Model 3 in [Table 3] and [Table 4], it seems to follow that there is no such effect and it is not mediated by sleep quality. In this respect, Munich and the RANCH studies corroborate each other. One further potential limitation is that because cognitive effects were tested under quiet conditions in the Munich study, any noise effects could be interpreted as being due to change in state effects.
Taken together, our analyses suggest that the school should be the main focus of attention for protection of children against the effects of aircraft noise on school performance. This conclusion may partly be evident because the study was designed to examine school level effects. Definite evidence for the mechanisms of cognitive impairments induced by night noise is still awaited, although narrowing of the attentional focus, impairments of auditory discrimination and speech perception, and communication difficulties in the classroom and learned helplessness seem to be plausible candidates. Studies specifically designed to address the effects of nighttime noise exposure are needed to provide definitive information on this topic.
| Acknowledgments | | |
We acknowledge with gratitude the support provided by the late Xavier Bonnefoy of the European Centre for Environment and Health, WHO Office in Bonn. Xavier was an example of the best type of enlightened civil servant passionately committed to using science to investigate the influence of the environment on health and applying that enthusiastically to policy development and public health.
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Correspondence Address:
Stephen Stansfeld
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1463-1741.70504
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4] |
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Association between Ambient Noise Exposure and School Performance of Children Living in An Urban Area: A Cross-Sectional Population-Based Study |
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| Sophie Pujol,Jean-Pierre Levain,Hlne Houot,Rmy Petit,Marc Berthillier,Jrme Defrance,Joseph Lardies,Cyril Masselot,Frdric Mauny | | Journal of Urban Health. 2013; | | [Pubmed] | [DOI] | | | 16 |
Exposure to road traffic noise and childrens behavioural problems and sleep disturbance: Results from the GINIplus and LISAplus studies |
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| Carla M.T. Tiesler,Matthias Birk,Elisabeth Thiering,Gabriele Kohlbck,Sibylle Koletzko,Carl-Peter Bauer,Dietrich Berdel,Andrea von Berg,Wolfgang Babisch,Joachim Heinrich | | Environmental Research. 2013; 123: 1 | | [Pubmed] | [DOI] | | | 17 |
Does the Limit of Noise for School Rooms Correspond to Contemporary Knowledge of Traffic Noise Impact on Children's Cognitive Development? |
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| Bohumil Havel | | Hygiena. 2013; 58(1): 43 | | [Pubmed] | [DOI] | | | 18 |
Nigh-time aircraft noise exposure: flying towards arterial disease |
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| M. Charakida,J. E. Deanfield | | European Heart Journal. 2013; | | [Pubmed] | [DOI] | | | 19 |
Long term exposure to nocturnal railway noise produces chronic signs of cognitive deficits and diurnal sleepiness |
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| Patricia Tassi,Odile Rohmer,Anne Bonnefond,Florence Margiocchi,Franck Poisson,Sarah Schimchowitsch | | Journal of Environmental Psychology. 2013; 33: 45 | | [Pubmed] | [DOI] | | | 20 |
Effects of low intensity noise from aircraft or from neighbourhood on cognitive learning and electrophysiological stress responses |
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| Michael Trimmel,Jrgen Atzlsdorfer,Nina Tupy,Karin Trimmel | | International Journal of Hygiene and Environmental Health. 2012; 215(6): 547 | | [Pubmed] | [DOI] | | | 21 |
Indoor environment and childrens health: Recent developments in chemical, biological, physical and social aspects |
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| Pierre Le Cann,Nathalie Bonvallot,Philippe Glorennec,Sverine Deguen,Christophe Goeury,Barbara Le Bot | | International Journal of Hygiene and Environmental Health. 2011; 215(1): 1 | | [Pubmed] | [DOI] | |
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