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Some health effects of aircraft noise with special reference to shift work

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DOI: 10.1177/0748233713518602 · Source: PubMed

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Article
Toxicology and Industrial Health
1–7
Some health effects of aircraft noise © The Author(s) 2014
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with special reference to shift work DOI: 10.1177/0748233713518602
tih.sagepub.com

Sanaa A M Rizk, Nevin E Sharaf,

Heba Mahdy-Abdallah and Khalid S Abd ElGelil

Abstract
Background: Aircraft noise is an environmental stressor. A positive relationship exists between noise and
high blood pressure. Shift work is an additional hazardous working condition with negative effect on the
behavior attitude of workers. Objective: This study aimed at investigating some health hazards for shift work
on workers at Cairo International Airport (CIA), Egypt, as a strategic work place, with more than one stressor.
Subjects and Methods: Assessment of noise effects were carried out in four working sites at the airport
besides control sites. The average noise level in the exposure sites was 106.5 dB compared with 54 dB at the
control sites. The study comprised a group of 200 male workers exposed to aircraft noise and 110 male
workers not exposed to noise as control group. All workers had full general medical examination after filling
specially formulated questionnaire. Hearing impairment, raised blood pressure, headaches, disturbed sleep, and
symptoms of anxiety were more prominent among the exposed workers than the control. Symptoms of upper
respiratory tract were reported among night shifters of both groups with high tendency for smoking. Thus,
night-shift workers at CIA work under more than one stressor. Hypertension and smoking might act as inter-
mediate factors on the causal pathway of complaints, making aircraft noise and night shift acting as two syner-
gistic stressors. Airport workers are in need for aggressive hearing conservation programs. Organization of the
working hours schedule is mandatory to avoid excessive noise exposure.

Keywords
Air craft noise, shift work, health effects, smoking, stress

Introduction to health problems, whereas tinnitus can lead to for-

getfulness, severe depression, and at times panic
Environmental noise, irrespective of its source, re-
attacks (Kryter, 2009). Huss et al. (2010) found that
mains a key issue in most countries. Noise, defined
people exposed to high levels of noise from aircraft
as ‘unwanted sound’ is perceived as an environmental
were at increased risk of dying from myocardial
stressor and nuisance. The predominant health effect
infarction.
of noise is an auditory damage that induces hearing
Shift work generally is defined as work hours that
loss. Besides the auditory noise effect, attention must
are scheduled outside of daylight. Shift work disrupts
also be paid to the nonauditory effects of noise. Non-
the synchronous relationship between the body’s inter-
auditory effects of noise can be defined as ‘‘all those
nal clock and the environment (Berger and Hobbs,
effects on health and well-being which are caused by
2006). The disruption often results in problems such
exposure to noise’’ (Stansfeld and Matheson, 2003).
Nonauditory effects of noise appear to occur at levels
far below those required to damage the hearing organ Department of Environmental and Occupational Medicine,
(Babisch, 2004). National Research Centre, Cairo, Egypt
Noise pollution can cause annoyance and aggres-
Corresponding author:
sion, hypertension, high stress levels, tinnitus, hearing
Heba Mahdy-Abdallah, Department of Environmental and Occu-
loss, sleep disturbances, and other harmful effects pational Medicine, National Research Center, El Behouth Street,
(Passchier-Vermeer and Passchier, 2000). Further- Cairo 12622, Egypt.
more, stress and hypertension are the leading causes Email: hebamahdy2003@yahoo.com

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2 Toxicology and Industrial Health
Table 1. Comparison between noise levels at exposure
and control sites.a
Exposure sites Control sites
Noise level (dB) Mean + SD Mean + SD
106.5 + 2.5 54.0 + 1.5
a
p < 0.001.
as disruption of biological rhythms, with a negative
influence on performance efficiency, health, and
social well-being. Deterioration of health can mani-
fest in the short-term as sleep disorders (Admi et al.,
2008), jet-lag syndrome, and increased risk for errors
and accidents at work as compared to those workers
on a straight daytime shift schedule (Fido and Ghali,
2008). In the long-term, there is an increased risk of
high blood pressure, colorectal cancer (Schernham-
mer et al., 2003), psychoneurotic, and cardiovascular
diseases (Costa, 2003). Harada et al. (2005) reveal
that the three-shift system of employment increases
work-related stress and job control is low among
shift workers.
International Labour Organization and European
Council directive have recently stressed the need for
the careful organization of shift and night work, and the
protection of shift workers (European Council Direc-
tive, 2003; ILO, 1995). This study was aimed at inves-
tigating some health hazards for shift work on workers
at Cairo International Airport (CIA), Egypt, as a strate-
gic work place, with more than one stressor.
Methodology
The four sites of noise exposure were the runways, the
luggage section, the workshop for maintenance, and
ground assistants of other vehicles in the CIA. The
control sites consisted of four closed offices for ser-
vices related to the CIA and classified as quite areas.
A precision sound level meter (type 2232; Bruel
and Kjaer, Denmark) was used to measure noise lev-
els at the sites included in the study. It is equipped
with a high-sensitivity ½ inch diameter condenser
microphone. The sound level meter was calibrated
using calibrator type 4230. This was achieved by
adjustment of sensitivity potentiometer on the sound
level meter. However, the detailed environmental
noise survey is a separate subject for the engineering
team (under publication).
The study population consisted of all workers at the
selected sites (200 male workers) employed at CIA.
Downloaded from tih.sagepub.com at Egyptian National Science & on December 21, 2015
They were all exposed to aircraft noise for 8 h daily
for 6 days/week. A control group of unexposed work-
ers (110 male workers), matched for age and socioe-
conomic status underwent the same investigations.
Consents were obtained from all the participants prior
to the study.
The two groups of the study were subdivided into
two groups namely day and night shift. Detailed per-
sonal and occupational histories were taken with spe-
cial reference to smoking habits, current complaints
such as ear pain, tinnitus, vertigo, discharge, feeling
of diminished hearing acuity, receiving ototoxic
drugs, difficulty of concentration during work and
subjective feeling toward noise, headaches, sleep dis-
turbance, irritability, and symptoms of upper respira-
tory disease and symptoms of anxiety. A special stress
sheet Shaheen and Rakhawy (1971) was filled for
every worker by the same investigator in order to
avoid personal errors. The stress scale was used to
detect the state of anxiety expressed by the subject
under investigation. The questionnaire used is an Ara-
bic version of the middle six questionnaire, consisting
of 30 questions and were self-answered by the workers.
The score was divided into (0–15) for low and (16–30)
for severe stress. After filling up the specially formu-
lated questionnaire, a general medical examination
was carried out with special stress on blood pressure
measurement using an ordinary mercury sphygmo-
manometer. Blood pressure was estimated in sitting
position after 15 min at rest, 140 mm Hg systolic
or 90 mm Hg diastolic or both were considered hyper-
tensive (Black and Yi, 1996). Hearing impairment was
considered by subject complaints.
Results were tabulated and differences between
means and proportions were tested for significance
using standard statistical methods. Frequencies for
each response were determined and subsequently
computed into percentages. Student’s t tests were
used to compare the means of two continuous vari-
ables. 2 test was used for comparison of qualitative
data. Statistical significance was set at p  0.05.
Results
Results of this study showed a statistically significant
difference between the average noise level at the work-
ing sites and the control ones (Table 1). There was no
statistically significant difference between studied
groups concerning their ages p > 0.05. When the dura-
tion of employment was assessed between groups, it
was observed that the duration of employment is not
Rizk et al. 3

Table 2. Smoking habits among the studied population.

Exposed group (n ¼ 200) Control group (n ¼ 110)
Day shift group Night shift group Day shift group Night shift group
Groups (n ¼ 120) (n ¼ 80) (n ¼ 70) (n ¼ 40)
Smoking habits
Smokers no (%) 50 (41.6%) 40 (50%) 10 (14.2%) 10 (25%)
Nonsmokers no (%) 70 (58.4%) 40 (50%) 60 (85.7%) 30 (75%)

Table 3. Smoking habits among day shifters.

Exposed group (n ¼ 200) Control group (n ¼ 110)
Groups Day shift group (n ¼ 120) Day shift group (n ¼ 70) p Value
Smoking habits
Smokers no (%) 50 (41.6%) 10 (14.2%) <0.000a
a
Significant value.

Table 4. Smoking habits among night shifters.

Exposed group (n ¼ 200) Control group (n ¼ 110)
Groups Night shift group (n ¼ 80) Night shift group (n ¼ 40) p Value
Smoking habits
Smokers no (%) 40 (50%) 10 (25%) <0.05a
a
Significant value.

Table 5. Distribution of work (noise)-related symptoms among the exposed and the control groups.
Exposed group (n ¼ 200) Control group (n ¼ 110)
Groups Night shift group (n ¼ 80) Night shift group (n ¼ 40) p Value
Complaints
Hearing impairment 26 (32.5%) 16 (17.6%) <0.000a
Headaches 28 (35%) 22 (20%) <0.001a
Symptoms of anxiety 27 (34%) 20 (18.0%) <0.001a
Raised blood pressure 24 (30%) 15 (13.6%) <0.01a
Sleep disturbance 25 (31%) 18 (16.3%) <0.05a
a
Significant value.

a contributing factor on the two-studied stressors (p >
0.05). Regarding the smoking habits, Tables 2 to 4
showed that the exposed groups smoke more than the
control groups. The night-shift workers tend to smoke
more than day-shift workers in both groups (i.e.
exposed and control group).
The work-related symptoms tabulated in Table 5
showed that both the physiological and the psycholo-
gical effects of aircraft noise in the exposed group
were statistically significant when compared with the
controls. Headaches (35%) and symptoms of anxiety
(34%) followed by complaints of hearing impairment
(32.5%) showed the highest complaint records among
the noise-exposed group.
There was no significant difference between the
night shifters of both the exposed and the control
groups, concerning some symptoms (cough and
expectoration); nevertheless, there was a difference
in proportion of workers suffering from chest pain and
dyspnea of the same groups.

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4 Toxicology and Industrial Health
Discussion
In our studied population, age and duration of
employment were matched in both exposed and con-
trol groups. Regarding the smoking habits of the stud-
ied population, the night-shift workers used to smoke
more than the day-shift workers in both groups. The
explanation for this could be attributed to the fact that
work schedules may influence rates of unhealthy
behaviors. Bushnell et al. (2010) concluded that night
and rotating shifts were observed generally to be asso-
ciated with less sleep and more smoking, and this is
consistent with that reported by our study. Also, the
study of Fido and Ghali (2008) reported higher rates
of cigarette smoking, coffee/tea consumption, consti-
pation, job stress, and poor sexual performance
among variable shift workers. On average, variable-
shift workers were significantly more likely to
complain from loss of concentration, poor work per-
formance, and fatigue than fixed-shift workers. The
variable-shift workers were also significantly more
prone to errors and accidents at work and had a ten-
dency to register more absence from work than did the
controls (Fido and Ghali, 2008).This could initiate a
future research on this aspect of ill-health among
workers at stress.
Complaints of hearing impairment were signifi-
cantly higher in the exposed group (32.5%) than in the
control group (17.6%), and this impairment due to
noisy workplace was in agreement with that of Kur-
mis and Apps (2007), in which their data suggested
that excessive noise attributes to approximately 37%
of all adult causes of hearing loss and remains a sig-
nificant contributor to employment-related morbidity
internationally. Also, Thakur et al. (2004) found that
the continuous exposure to the relatively high level
of noise in the surroundings of an airport is likely to
affect the central pathway of the auditory system. This
was also confirmed by others (Chen et al., 1992;
Guest et al., 2011) where a damage of both peripheral
cochlear organs and the central auditory pathway by
high-frequency aircraft noise exposure was reported.
According to the Egyptian Environmental Law
(1994), working hours should be reduced to half for
every 5 dB above the permissible limit which is 90
dB. However, this law needs to be reinforced.
Many studies showed that exposure to acute noise
affect the sympathetic and endocrine systems, resulting
in nonspecific physiological responses, for example,
heart rate, blood pressure, vasoconstriction, stress hor-
mones, electroencephalographic changes (Lusk et al.,
Downloaded from tih.sagepub.com at Egyptian National Science & on December 21, 2015
2004; Raggam et al., 2007). This was manifested in our
study as headaches and raised blood pressure. Those
workers exposed to noise reported complaints of head-
ache and blood pressure representing 35 and 30%,
respectively, and the differences were significant com-
pared with those of the control group.
Also, our data are in accordance with that of Aydin
and Kaltenbach(2007), who concluded that a popula-
tion exposed to a nocturnal equivalent continuous air
traffic noise level of 50 dB for three quarters of a
given time has a higher average blood pressure com-
pared to a population exposed to the same equal
energy noise level for only one quarter of the time.
Finally, Babisch and Kamp (2009) concluded that
there was sufficient evidence for a positive relation-
ship between aircraft noise and high blood pressure.
Noise is a stressor that directly or indirectly
affects the autonomic nervous system and the endo-
crine system. Epidemiological noise studies when
focused on mean blood pressure found that there is
sufficient evidence that noise, especially aircraft
noise, increases the risk of hypertension in adults
(Babisch and Kamp, 2009). Other effects of high
noise levels were increased frequency of headaches
(Martin et al., 2005), vertigo (Tzaneva et al., 2000),
and stomach ulcers (Castle et al., 2007).
Epidemiological studies carried out in the occu-
pational field have shown that employees working
in high-noise environments are at a higher risk
for high blood pressure and myocardial infarction
(Concha-Barrientos et al., 2004). This fact was
confirmed in our study.
In our study, there was a significant high preva-
lence of headaches (35%) and symptoms of anxiety
(34%) among workers exposed to aircraft noise com-
pared with the controls. This could be explained by
the relationship between aircraft noise and annoy-
ance, where many studies stressed on this relation.
Chronic aircraft noise exposure was associated with
higher levels of noise annoyance and cognitive
impairment (Haines et al., 2001; Kroesen and Apps,
2007; Martin et al., 2005).
Social surveys have established dose–response rela-
tionships between aircraft noise and annoyance with a
number of psychological symptoms including higher
psychiatric hospital admission rates and increased use
of psychotropic medications. People with a preexisting
psychological or psychiatric condition may be more
susceptible to the effects of exposure to aircraft noise
(Schreckenberg et al., 2010).
Rizk et al.
Noise-disturbed sleep is a cause of considerable
annoyance with potential health and well-being
effects (Hume, 2010). This was found in our study,
as the workers exposed to aircraft noise showed a sig-
nificant sleep disturbance, compared with that of con-
trols. There are an ample number of laboratory and
field studies which provide sufficient evidence that
aircraft noise disturbs sleep. Many recent studies
(Basner et al., 2010; Hume, 2010; Perron et al., 2012)
provide an overview for sleep disturbance particularly
due to exposure to aircraft noise.
Also, there are many studies that provide suffi-
cient evidence that aircraft noise disturbs sleep and
may impair behavior. Moreover, clinical sleep dis-
orders have been shown to be associated with
increased risk of cardiovascular diseases. Noise-
disturbed sleep is a cause of considerable annoy-
ance with potential health and well-being affection
(Hume, 2010). Annoyance studies showed that air-
craft noise was more annoying than road traffic
noise of the same average noise level and the
risk may increase at even lower night noise levels
(European commission, 2002).
In addition, shift work disrupts the synchronous
relationship between the body’s internal clock and the
environment. The disruption often results in problems
such as sleep disturbances, increased accidents and
injuries, and social isolation. Physiologic effects
include changes in rhythms of core temperature, var-
ious hormonal levels, immune functioning, and activ-
ity–rest cycles (Costa, 2003; Fido and Ghali, 2008;
Thakur et al., 2004).
The upper respiratory symptoms showed that there
were no differences in some symptoms (cough and
expectoration) between noise-exposed and control
night shifters. Nevertheless, there was an increase in
the frequencies of workers suffering from chest pain
and dyspnea among exposed workers and control
ones; however, it did not reach statistical significance
(p > 0.05). This might be explained by the fact
that night work and rotating shift work disrupt the cir-
cadian timing system. This disruption may produce
significant deleterious symptoms in some workers
(Scott, 2000). In addition, those working during
nonstandard working hours, including shift and
night work, recognized to be under risk factors for
health, safety, and social well-being (Costa, 2003).
Finally, the study of Castanon-Cervantes et al.
(2010) showed that experimentally induced circadian
disruption altered innate immune responses. In
addition, sleep deprivation (Fido and Ghali, 2008)
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5
and stress (Castanon-Cervantes et al., 2010; Harada
et al., 2005) are known to alter immune function and
are potential mediators for the occurrence of cough
and expectoration among night shifters, who tend to
smoke more (Fido and Ghali, 2008). Chest pain and
dyspnea occurred more among the night shifters
exposed to noise, who suffered from hypertension,
which has been proven to be statistically significant
among this group (Babisch and Kamp, 2009).
Conclusion
In general, aircraft noise is perceived as environmental
stressor and nuisance, and there is sufficient evidence
for a positive relationship between aircraft noise and
high blood pressure and other health problems. Shift
work is an additional hazardous working condition that
disrupts the biological rhythm with negative effect on
the behavior attitude of workers. This is considered
as a convincing explanation for the high tendency of
smoking among night shifters of both groups; the
noise-exposed group and the nonexposed (control) one.
Any difference in exposure to noise and smoking may
contribute to more complaints of chest pain and dys-
pnea working. In conclusion, night-shift workers at
CIA work under more than one stress. Hypertension
and/or smoking might act as intermediate factors on the
causal pathway that make aircraft noise and night shift
act as two synergistic stressors.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
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