Charlotte Clark

Auditory and non-auditory effects of noise on health

Noise is pervasive in everyday life and can cause both auditory and non-auditory health effects. Noise-induced hearing loss remains highly prevalent in occupational settings, and is increasingly caused by social noise exposure (eg, through personal music players). Our understanding of molecular mechanisms involved in noise-induced hair-cell and nerve damage has substantially increased, and preventive and therapeutic drugs will probably become available within 10 years. Evidence of the non-auditory effects of environmental noise exposure on public health is growing. Observational and experimental studies have shown that noise exposure leads to annoyance, disturbs sleep and causes daytime sleepiness, affects patient outcomes and staff performance in hospitals, increases the occurrence of hypertension and cardiovascular disease, and impairs cognitive performance in schoolchildren. In this Review, we stress the importance of adequate noise prevention and mitigation strategies for public health.

Aircraft and road traffic noise and children's cognition and health: a cross-national study

BACKGROUND Exposure to environmental stressors can impair childrens health and their cognitive development. The effects of air pollution, lead, and chemicals have been studied, but there has been less emphasis on the effects of noise. Our aim, therefore, was to assess the effect of exposure to aircraft and road traffic noise on cognitive performance and health in children. METHODS We did a cross-national, cross-sectional study in which we assessed 2844 of 3207 children aged 9-10 years who were attending 89 schools of 77 approached in the Netherlands, 27 in Spain, and 30 in the UK located in local authority areas around three major airports. We selected children by extent of exposure to external aircraft and road traffic noise at school as predicted from noise contour maps, modelling, and on-site measurements, and matched schools within countries for socioeconomic status. We measured cognitive and health outcomes with standardised tests and questionnaires administered in the classroom. We also used a questionnaire to obtain information from parents about socioeconomic status, their education, and ethnic origin. FINDINGS We identified linear exposure-effect associations between exposure to chronic aircraft noise and impairment of reading comprehension (p=0.0097) and recognition memory (p=0.0141), and a non-linear association with annoyance (p<0.0001) maintained after adjustment for mothers education, socioeconomic status, longstanding illness, and extent of classroom insulation against noise. Exposure to road traffic noise was linearly associated with increases in episodic memory (conceptual recall: p=0.0066; information recall: p=0.0489), but also with annoyance (p=0.0047). Neither aircraft noise nor traffic noise affected sustained attention, self-reported health, or overall mental health. INTERPRETATION Our findings indicate that a chronic environmental stressor-aircraft noise-could impair cognitive development in children, specifically reading comprehension. Schools exposed to high levels of aircraft noise are not healthy educational environments.

Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study

PURPOSE Prospective evidence about whether the association of childhood adversity and psychopathology attenuates across the lifecourse and whether effects on mid-life psychopathology are mediated through adolescent and early adulthood psychopathology is limited. METHODS Data were from the 1958 British Birth Cohort, a 45-year study of 98% of births in 1 week in 1958 in England, Scotland, and Wales. Outcomes included International Statistical Classification of Diseases (ICD-10) diagnoses for affective and anxiety disorders at 45 years and psychopathology at 16 years and 23 years. Multiple multi-informant measures of childhood adversity were available at 7, 11, and 16 years, with additional retrospective measures of parental sexual and physical abuse at 45 years. Analyses were determined on the basis of N = 9377; 59% of the surviving sample. RESULTS After adjustment for socioeconomic covariates, childhood adversities were associated with adolescent, early adulthood, and mid-life psychopathology: most associations did not attenuate with age. Mid-life associations were significantly fully or partially mediated by early adulthood psychopathology: cumulative adversity, illness, sexual abuse, and physical abuse remained significantly associated with mid-life psychopathology. CONCLUSIONS The findings confirm the importance of preventing exposure to adversity and suggest that effects of adversity on mid-life psychopathology may operate through psychopathology in early adulthood. Future research is needed to examine other intermediary factors which may explain these associations.

Psychosocial work characteristics and anxiety and depressive disorders in midlife : the effects of prior psychological distress

Objectives: The association between work stressors and adult psychiatric diagnoses may be biased by prior psychological distress influencing perception of work or selection into unfavourable work. This study examines the extent to which the association between work stressors and adult psychiatric diagnoses is explained by associations with earlier psychological distress and whether childhood and early adulthood psychological distress influences reported midlife work characteristics. Methods: Follow-up at 45 years of age of 8243 participants in paid employment from the 1958 British Birth Cohort. Karasek’s work characteristics and psychiatric diagnoses (Revised Clinical Interview Schedule) were measured at 45 years. Childhood internalising and externalising problems were measured at 7, 11 and 16 and malaise at 23 and 33 years. Results: Internalising behaviours in childhood and early adult psychological distress predicted adverse work characteristics in mid-adulthood. High job demands (women: relative risk (RR) = 1.75, 95% CI 1.2 to 2.5; men: RR = 4.99, 95% CI 2.5 to 10.1), low decision latitude (RR = 1.46, 95% CI 1.1 to 1.9), high job strain (OR = 1.88, 95% CI 1.5 to 2.4), low work social support (RR = 1.97, 95% CI 1.5 to 2.6) and high job insecurity (OR = 1.86, 95% CI 1.4 to 2.4) were associated with mid-adulthood diagnoses. The association between work stressors and mid-adulthood diagnoses remained after adjustment for internalising behaviours and malaise at 23 and 33 years although diminished slightly in magnitude (eg, adjusted RR for support = 1.82, 95% CI 1.4 to 2.4; job strain OR = 1.78, 95% CI 1.4 to 2.3). Conclusions: Childhood and early adulthood psychological distress predict work characteristics in mid-adulthood but do not explain the associations of work characteristics with depressive episode and generalised anxiety disorder in midlife. Work stressors are an important source of preventable psychiatric diagnoses in midlife. Psychological distress may influence selection into less advantaged occupations with poorer working conditions that may increase the risk of future depressive and anxiety disorders.

Noise exposure and children’s blood pressure and heart rate: the RANCH project

Background: Conclusions that can be drawn from earlier studies on noise and children’s blood pressure are limited due to inconsistent results, methodological problems, and the focus on school noise exposure. Objectives: To investigate the effects of aircraft and road traffic noise exposure on children’s blood pressure and heart rate. Methods: Participants were 1283 children (age 9–11 years) attending 62 primary schools around two European airports. Data were pooled and analysed using multilevel modelling. Adjustments were made for a range of socioeconomic and lifestyle factors. Results: After pooling the data, aircraft noise exposure at school was related to a statistically non-significant increase in blood pressure and heart rate. Aircraft noise exposure at home was related to a statistically significant increase in blood pressure. Aircraft noise exposure during the night at home was positively and significantly associated with blood pressure. The findings differed between the Dutch and British samples. Negative associations were found between road traffic noise exposure and blood pressure, which cannot be explained. Conclusion: On the basis of this study and previous scientific literature, no unequivocal conclusions can be drawn about the relationship between community noise and children’s blood pressure.

Does Traffic-related Air Pollution Explain Associations of Aircraft and Road Traffic Noise Exposure on Children's Health and Cognition? A Secondary Analysis of the United Kingdom Sample From the RANCH Project

The authors examined whether air pollution at school (nitrogen dioxide) is associated with poorer child cognition and health and whether adjustment for air pollution explains or moderates previously observed associations between aircraft and road traffic noise at school and childrens cognition in the 2001–2003 Road Traffic and Aircraft Noise Exposure and Childrens Cognition and Health (RANCH) project. This secondary analysis of a subsample of the United Kingdom RANCH sample examined 719 children who were 9–10 years of age from 22 schools around Londons Heathrow airport for whom air pollution data were available. Data were analyzed using multilevel modeling. Air pollution exposure levels at school were moderate, were not associated with a range of cognitive and health outcomes, and did not account for or moderate associations between noise exposure and cognition. Aircraft noise exposure at school was significantly associated with poorer recognition memory and conceptual recall memory after adjustment for nitrogen dioxide levels. Aircraft noise exposure was also associated with poorer reading comprehension and information recall memory after adjustment for nitrogen dioxide levels. Road traffic noise was not associated with cognition or health before or after adjustment for air pollution. Moderate levels of air pollution do not appear to confound associations of noise on cognition and health, but further studies of higher air pollution levels are needed.

A systematic review of the evidence on the effect of the built and physical environment on mental health

This paper assesses the strength of the evidence on the impact of the physical environment on mental health and well‐being. Using a systematic review methodology, quantitative and qualitative evaluative studies of the effect of the physical environment on child and adult mental health published in English between January 1990 and September 2005 were sought from citation databases. The physical environment was defined in terms of built or natural elements of residential or neighbourhood environments; mental health was defined in terms of psychological symptoms and diagnoses. A total of 99 papers were identified. The strength of the evidence varied and was strongest for the effects of urban birth (on risk of schizophrenia), rural residence (on risk of suicide for males), neighbourhood violence, housing and neighbourhood regeneration, and neighbourhood disorder. The strength of the evidence for an effect of poor housing on mental health was weaker. There was a lack of robust research, and of longitudinal research in many areas, and some aspects of the environment have been very little studied to date. The lack of evidence of environmental effects in some domains does not necessarily mean that there are no effects: rather, that they have not yet been studied or studied meaningfully.

Longitudinal Risk Factors for Persistent Fatigue in Adolescents

OBJECTIVE To examine whether sedentary behavior, obesity, smoking, and depression are risk factors for persistent fatigue in adolescents. DESIGN Longitudinal population-based survey. SETTING Twenty-eight randomly selected schools in east London, England, in 2001 and 2003. PARTICIPANTS A total of 1880 adolescents (49% male; 81% nonwhite British) aged 11 to 12 years and 13 to 14 years in 2000. INTERVENTION Confidential questionnaires completed in class. MAIN OUTCOME MEASURES Persistent fatigue (extreme tiredness twice weekly or more often in the previous month at both surveys), sedentary behavior, physical activity, depressive symptoms, body mass index, and smoking. RESULTS Severe fatigue was reported in 11% of participants aged 11 to 14 years and 17% of participants aged 13 to 16 years. Eighty-four participants (4%) reported persistent fatigue. Across both surveys, only 3 pupils reported chronic fatigue syndrome. In multivariate logistic regression, risk of persistent fatigue was independently associated with being sedentary for more than 4 hours per day (odds ratio = 1.6; 95% confidence interval, 1.1-2.3; P = .01), being physically active (odds ratio = 1.5; 95% confidence interval, 1.1-2.3; P = .004), and depressive symptoms (odds ratio = 2.0; 95% confidence interval, 1.5-2.7; P < .001) in the first survey, after adjustment for age, sex, and socioeconomic status. Obesity and smoking were not associated with fatigue. CONCLUSIONS Persistent fatigue is common. Being highly sedentary or highly active independently increased the risk of persistent fatigue, suggesting that divergence in either direction from healthy levels of activity increases the risk for persistent fatigue. Mental health is important in the etiology of persistent fatigue. To help define effective preventive strategies, further work is needed on the mechanisms by which these factors contribute to fatigue.

Does the local food environment around schools affect diet? Longitudinal associations in adolescents attending secondary schools in East London

BackgroundThe local retail food environment around schools may act as a potential risk factor for adolescent diet. However, international research utilising cross-sectional designs to investigate associations between retail food outlet proximity to schools and diet provides equivocal support for an effect. In this study we employ longitudinal perspectives in order to answer the following two questions. First, how has the local retail food environment around secondary schools changed over time and second, is this change associated with change in diet of students at these schools?MethodsThe locations of retail food outlets and schools in 2001 and 2005 were geo-coded in three London boroughs. Network analysis in a Geographic Information System (GIS) ascertained the number, minimum and median distances to food outlets within 400 m and 800 m of the school location. Outcome measures were ‘healthy’ and ‘unhealthy’ diet scores derived from adolescent self-reported data in the Research with East London Adolescents: Community Health Survey (RELACHS). Adjusted associations between distance from school to food retail outlets, counts of outlets near schools and diet scores were assessed using longitudinal (2001–2005 n=757) approaches.ResultsBetween 2001 and 2005 the number of takeaways and grocers/convenience stores within 400 m of schools increased, with many more grocers reported within 800 m of schools in 2005 (p< 0.001). Longitudinal analyses showed a decrease of the mean healthy (−1.12, se 0.12) and unhealthy (−0.48, se 0.16) diet scores. There were significant positive relationships between the distances travelled to grocers and healthy diet scores though effects were very small (0.003, 95%CI 0.001 – 0.006). Significant negative relationships between proximity to takeaways and unhealthy diet scores also resulted in small parameter estimates.ConclusionsThe results provide some evidence that the local food environment around secondary schools may influence adolescent diet, though effects were small. Further research on adolescents’ food purchasing habits with larger samples in varied geographic regions is required to identify robust relationships between proximity and diet, as small numbers, because of confounding, may dilute effect food environment effects. Data on individual foods purchased in all shop formats may clarify the frequent, overly simple classification of grocers as ‘healthy’.

Common mental disorders, unemployment and welfare benefits in England

OBJECTIVES Individuals who are out of work have a higher rate of common mental disorders (CMD) than individuals who are employed. People who are unemployed in the UK are entitled to welfare benefits to alleviate financial strain. This study examined rates of CMD in individuals who were employed, unemployed and receiving various UK benefits. It also investigated associations between duration of unemployment, gender and CMD. STUDY DESIGN An analysis of 5090 working-age participants from the Adult Psychiatric Morbidity Survey 2007, a stratified probability sample survey conducted among adults aged 16 years and over living in private households in England. METHODS CMD was assessed using the Clinical Interview Schedule (Revised). Information was gathered on sociodemographics, employment, income, benefits and debt. Data were analysed using logistic regression. RESULTS Risk of CMD was significantly greater in individuals classified as: unemployed; economically inactive; not working due to physical health reasons; unable to find a suitable job; receiving housing, care or sickness benefit; and receiving income support. However, risk of CMD was not significantly greater in individuals receiving jobseekers allowance. Individuals unemployed for less than 1 year or more than 3 years had a higher risk of CMD. Some interactions with gender were significant, with associations being greater in men than women. CONCLUSIONS Job loss events are not the only reason for unemployed people to develop CMD. The state of unemployment itself may be detrimental to mental health. Risk of CMD is increased in those who have been out of work for 3 years or more. Associations between benefits and mental health are likely to be due to social, health or economic circumstances associated with benefit eligibility.