Leisure noise exposure and hearing outcomes among Canadians aged 6 to 79 years.

OBJECTIVE: To examine the association between individual and cumulative leisure noise exposure in addition to acceptable yearly exposure (AYE) and hearing outcomes among a nationally representative sample of Canadians. DESIGN: Audiometry, distortion-product otoacoustic emissions (DPOAEs) and in-person questionnaires were used to evaluate hearing and leisure noise exposure across age, sex, and household income/education level. High-risk cumulative leisure noise exposure was defined as 85 dBA or greater for 40 h or more per week, with AYE calculations also based on this occupational limit. STUDY SAMPLE: A randomised sample of 10,460 respondents, aged 6-79, completed questionnaires and hearing evaluations between 2012 and 2015. RESULTS: Among 50-79 year olds, high-risk cumulative leisure noise was associated with increased odds of a notch while high exposure to farming/construction equipment noise was associated with hearing loss, notches and absent DPOAEs. No associations with hearing loss were found however, non-significant tendencies observed included higher mean hearing thresholds, notches and hearing loss odds. CONCLUSION: Educational outreach and monitoring of hearing among young and middle-aged populations exposed to hazardous leisure noise would be beneficial.

Personal listening device usage among Canadians and audiometric outcomes among 6-29 year olds.

OBJECTIVE: To describe personal listening device (PLD) usage and sociodemographic variables among a nationally representative sample of Canadians and examine audiometric outcomes among a subsample. DESIGN: Audiometry and in-person questionnaires were used to evaluate hearing and PLD usage across age, sex, household income/education level. PLD exposure was quantified using a common occupational noise limit. STUDY SAMPLE: A randomised sample of 10,460 respondents, aged 6-79, with audiometric analysis of a subsample (n = 4807), aged 6-29, tested between 2012 and 2015. RESULTS: Loud PLD usage was reported by19.5% of Canadians. The highest prevalence was among teenagers (44.2%) and young adults (36.3%). Among children, 13.1% of users listened at loud volumes. High PLD usage (equivalent to or above 85 dBA, LEX 40) among 12-19 year olds was double that of 20-29 year olds: 10.2% versus 5.1%E. Five years or more of loud PLD usage was associated with significantly higher mean hearing thresholds compared to less years. No association between loud or high PLD usage and mean thresholds were found. CONCLUSION: The majority used PLDs safely, however a small proportion reported high risk usage which will impact hearing should this pattern persist over many years.

Prevalence of loud leisure noise activities among a representative sample of Canadians aged 6-79 years.

This population-based study estimates the prevalence of loud leisure noise exposure and hearing protection usage among Canadians, as well as the population potentially at-risk using an occupational limit of 85 dBA, LEX 40 h, which denotes a typical occupational noise limit for a 40 hour work week. A total of 10 460 participants, aged 6-79 years, completed a Canadian Health Measures Survey household questionnaire. Loud leisure noise was defined by vocal effort required while communicating at arm's length except for loud personal listening device (PLD) usage with earbuds/headphones, which included both volume setting and vocal effort. The most prevalent loud leisure noise activities were amplified music, car/home stereo listening, and power tools, with 40% reporting each source, followed by sporting/entertainment (25%), gasoline engines (23%), and loud PLD listening (19.5%). Loud leisure noise was more prevalent among 12-39 year olds and males. Hearing protection usage was uncommon, from 44.2% (firearms) to 20.3% (power tools) and below 3% during amplified music and sporting/entertainment events. Calculations using self-reported duration of loud leisure noise activities estimated that 6.6 × 106 Canadians were in the high cumulative noise exposure category. A large proportion of Canadians would be expected to develop some degree of noise-induced hearing loss should this pattern persist over years.

Survey of reported eye injuries from handheld laser devices in Canada.

BACKGROUND: Unprotected exposure to handheld lasers can cause temporary or permanent vision loss depending on the laser classification. OBJECTIVE: To evaluate the occurrence of, and details associated with, reported eye injuries resulting from handheld lasers. METHODS: A 14-item questionnaire developed by Health Canada was distributed by the Canadian Ophthalmological Society and the Canadian Association of Optometrists to their respective members. RESULTS: Questionnaire data were available from 909 respondents (263 ophthalmologists; 646 optometrists). Response rates were 23.1% and 12.7%, respectively. Validated data were available from 903 respondents, where 157 (17.4%) reported encountering at least 1 eye injury from a handheld laser. A total of 318 eye injuries were reported with an annual increase of 34.4% (95% CI 21.6%-48.7%, p < 0.0001) between 2013 and 2017. When respondents reported on only their most severe case, 77 (53.5%) reported vision loss that ranged from minor to severe, which persisted for more than 6 months in 42.9% of the cases. Another 59 (41.3%) noted the presence of retinal damage. The prevalence of eye injuries from handheld lasers was higher for males (82.5%) than females (14.0%), more frequent among those under the age of 50 years, and occurred predominately as a result of exposure from another person (67.6%) versus self-induced (26.1%) (p < 0.0001). CONCLUSIONS: Although this pilot study permits insight into the potential prevalence of injuries resulting from exposure to handheld laser devices in Canada, the results are not nationally representative. These findings support additional surveillance activities that may inform risk assessment and potential risk management strategies.

Wind turbine audibility calculations inside dwellings.

The objective of the current paper was to characterize indoor wind turbine sound pressure levels (SPLs) to assess the audibility of wind turbine noise indoors, accounting for window opening, frequency spectra, and presbycusis. Loudspeaker generated noise was used to determine the outdoor to indoor SPL differences at 11 representative dwellings using ISO 140-5:1998. The procedure was extended to 16 Hz. With windows closed, indoor broadband A- and C-weighted SPLs were lower by 25.9 and 15.3 dB, respectively, for wind turbine noise spectra. With windows opened, the corresponding results were 13.8 and 9.9 dB, respectively. Standard deviations for these results were 3 dB so that indoor and outdoor SPL would tend to be highly correlated. For 35 dBA outdoor SPL, the indoor SPL was potentially audible at frequencies as low as 31.5 Hz. Specifically, at 35 dBA, 80% to 100% of adults below the age of 60 years, would potentially be able to hear wind turbine noise indoors with windows partially open. This would drop to 10% to 30% with closed windows. Uncertainties around these estimates are discussed.

Prevalence of laser beam exposure and associated injuries.

BACKGROUND: An increasing number of consumer laser products are available to Canadians, many being purchased from online retailers. Of particular concern are high-powered, handheld laser devices. This study was conducted to assess the impact of this influx of laser products on the number of laser-associated injuries in Canada. DATA AND METHODS: The rapid response component of the 2014 Canadian Community Health Survey collected data from 19,765 Canadians on the prevalence of laser product exposure and usage, the type of laser product used, and the incidence of eye or skin injuries. RESULTS: Approximately half of Canadians (48.1%) reported using or being exposed to a laser product in the previous 12 months. The highest laser product usage or exposure was among those with university education (58.6%) and those with higher income categories (p ⟨ 0.0001). The highest prevalence of exposure or usage involved laser scanners (38.7%), laser pointers (11.1%) and lasers for entertainment (9.7%). Overall, about 1% of Canadians reported discomfort or injury involving a laser product in the past 12 months. Over half the injuries (59.1%) occurred to the eyes. Most of the injuries (74.9%) resulted from someone else's use of the device. The majority of the reported injuries were caused by lasers for cosmetic treatment or laser pointers. DISCUSSION: Despite the prevalence of laser product usage and exposure among Canadians, a low percentage of respondents reported injuries. This is likely because most laser devices are low-powered and typically do not represent a hazard. Nonetheless, efforts to increase awareness of laser product risks may be beneficial given the findings of this study.

Tanning equipment use: 2014 Canadian Community Health Survey.

BACKGROUND: Tanning equipment use is related to the early onset of cancer, with the risk increasing as the duration and repetition of exposure increase. In 2009, the International Agency for Research on Cancer classified tanning equipment use as carcinogenic to humans, and according to the World Health Organization, the risk of skin melanoma increases significantly when use begins before age 35. DATA AND METHODS: The rapid response component of the 2014 Canadian Community Health Survey collected data on the use of tanning equipment in the previous 12 months, including reasons for use, frequency/duration of use, precautions taken, and adverse reactions or injuries. This analysis examines the prevalence of self-reported indoor tanning in a nationally representative sample of Canadians aged 12 or older in the 10 provinces. RESULTS: In 2014, 4.5% of Canadians (an estimated 1.35 million) reported that they had used tanning equipment in the past year; 70.3% of them were female, and just over half of female users were aged 18 to 34. The prevalence of indoor tanning was highest among people with some postsecondary education and among those in higher income households (trend p-value ⟨ 0.0001). Most users reported fewer than 10 sessions in the past year. The most common reason (62.0%) was to develop a "protective" base tan. INTERPRETATION: Females made up the majority of tanning equipment users, particularly at ages 18 to 34. Efforts to increase awareness of the risks may be beneficial, given the high percentage of users who believed that indoor tanning offers some level of skin protection from future sun exposure.

Prevalence of Hazardous Occupational Noise Exposure, Hearing Loss, and Hearing Protection Usage Among a Representative Sample of Working Canadians.

OBJECTIVE: The aim of this study was to estimate the prevalence of hearing loss (HL), self-reported occupational noise exposure, and hearing protection usage among Canadians. METHODS: In-person household interviews were conducted with 3666 participants, aged 16 to 79 years (1811 males) with 94% completing audiometry and distortion-product otoacoustic emission (DPOAE) evaluations. Occupational noise exposure was defined as hazardous when communicating with coworkers at an arm's length distance required speaking in a raised voice. RESULTS: An estimated 42% of respondents reported hazardous occupational noise exposure; 10 years or more was associated with HL regardless of age, sex or education. Absent DPOAEs, tinnitus, and the Wilson audiometric notch were significantly more prevalent in hazardous workplace noise-exposed workers than in nonexposed. When mandatory, 80% reported wearing hearing protection. CONCLUSIONS: These findings are consistent with other industrialized countries, underscoring the need for ongoing awareness of noise-induced occupational HL.

Prevalence of Hearing Loss Among a Representative Sample of Canadian Children and Adolescents, 3 to 19 Years of Age.

OBJECTIVES: There are no nationally representative hearing loss (HL) prevalence data available for Canadian youth using direct measurements. The present study objectives were to estimate national prevalence of HL using audiometric pure-tone thresholds (0.5 to 8 kHz) and or distortion product otoacoustic emissions (DPOAEs) for children and adolescents, aged 3 to 19 years. DESIGN: This cross-sectional population-based study presents findings from the 2012/2013 Canadian Health Measures Survey, entailing an in-person household interview and hearing measurements conducted in a mobile examination clinic. The initial study sample included 2591 participants, aged 3 to 19 years, representing 6.5 million Canadians (3.3 million males). After exclusions, subsamples consisted of 2434 participants, aged 3 to 19 years and 1879 participants, aged 6 to 19 years, with valid audiometric results. Eligible participants underwent otoscopic examination, tympanometry, DPOAE, and audiometry. HL was defined as a pure-tone average >20 dB for 6- to 18-year olds and ≥26 dB for 19-year olds, for one or more of the following: four-frequency (0.5, 1, 2, and 4 kHz) pure-tone average, high-frequency (3, 4, 6, and 8 kHz) pure-tone average, and low-frequency (0.5, 1, and 2 kHz) pure-tone average. Mild HL was defined as >20 to 40 dB (6- to 18-year olds) and ≥26 to 40 dB (19-year olds). Moderate or worse HL was defined as >40 dB (6- to 19-year olds). HL in 3- to 5-year olds (n = 555) was defined as absent DPOAEs as audiometry was not conducted. Self-reported HL was evaluated using the Health Utilities Index Mark 3 hearing questions. RESULTS: The primary study outcome indicates that 7.7% of Canadian youth, aged 6 to 19, had any HL, for one or more pure-tone average. Four-frequency pure-tone average and high-frequency pure-tone average HL prevalence was 4.7 and 6.0%, respectively, whereas 5.8% had a low-frequency pure-tone average HL. Significantly more children/adolescents had unilateral HL. Mild HL was significantly more common than moderate or worse HL for each pure-tone average. Among Canadians, aged 6 to 19, less than 2.2% had sensorineural HL. Among Canadians, aged 3 to 19, less than 3.5% had conductive HL. Absent DPOAEs were found in 7.1% of 3- to 5-year olds, and in 3.4% of 6- to 19-year olds. Among participants eligible for the hearing evaluation and excluding missing data cases (n = 2575), 17.0% had excessive or impacted pus/wax in one or both ears. Self-reported HL in Canadians, aged 6 to 19, was 0.6 E% and 65.3% (aged 3 to 19) reported never having had their hearing tested. E indicates that a high sampling variability is associated with the estimate (coefficient of variation between 16.6% and 33.3%) and should be interpreted with caution. CONCLUSIONS: This study provides the first estimates of audiometrically measured HL prevalence among Canadian children and adolescents. A larger proportion of youth have measured HL than was previously reported using self-report surveys, indicating that screening using self-report or proxy may not be effective in identifying individuals with mild HL. Results may underestimate the true prevalence of HL due to the large number excluded and the presentation of impacted or excessive earwax or pus, precluding an accurate or complete hearing evaluation. The majority of 3- to 5-year olds with absent DPOAEs likely had conductive HL. Nonetheless, this type of HL which can be asymptomatic, may become permanent if left untreated. Future research will benefit from analyses, which includes the slight HL category, for which there is growing support, and from studies that identify factors contributing to HL in this population.

Wind turbine sound power measurements.

This paper provides experimental validation of the sound power level data obtained from manufacturers for the ten wind turbine models examined in Health Canada's Community Noise and Health Study (CNHS). Within measurement uncertainty, the wind turbine sound power levels measured using IEC 61400-11 [(2002). (International Electrotechnical Commission, Geneva)] were consistent with the sound power level data provided by manufacturers. Based on measurements, the sound power level data were also extended to 16 Hz for calculation of C-weighted levels. The C-weighted levels were 11.5 dB higher than the A-weighted levels (standard deviation 1.7 dB). The simple relationship between A- and C- weighted levels suggests that there is unlikely to be any statistically significant difference between analysis based on either C- or A-weighted data.

Wind turbine sound pressure level calculations at dwellings.

This paper provides calculations of outdoor sound pressure levels (SPLs) at dwellings for 10 wind turbine models, to support Health Canada's Community Noise and Health Study. Manufacturer supplied and measured wind turbine sound power levels were used to calculate outdoor SPL at 1238 dwellings using ISO [(1996). ISO 9613-2-Acoustics] and a Swedish noise propagation method. Both methods yielded statistically equivalent results. The A- and C-weighted results were highly correlated over the 1238 dwellings (Pearson's linear correlation coefficient r > 0.8). Calculated wind turbine SPLs were compared to ambient SPLs from other sources, estimated using guidance documents from the United States and Alberta, Canada.

Exposure to wind turbine noise: Perceptual responses and reported health effects.

Health Canada, in collaboration with Statistics Canada, and other external experts, conducted the Community Noise and Health Study to better understand the impacts of wind turbine noise (WTN) on health and well-being. A cross-sectional epidemiological study was carried out between May and September 2013 in southwestern Ontario and Prince Edward Island on 1238 randomly selected participants (606 males, 632 females) aged 18-79 years, living between 0.25 and 11.22 km from operational wind turbines. Calculated outdoor WTN levels at the dwelling reached 46 dBA. Response rate was 78.9% and did not significantly differ across sample strata. Self-reported health effects (e.g., migraines, tinnitus, dizziness, etc.), sleep disturbance, sleep disorders, quality of life, and perceived stress were not related to WTN levels. Visual and auditory perception of wind turbines as reported by respondents increased significantly with increasing WTN levels as did high annoyance toward several wind turbine features, including the following: noise, blinking lights, shadow flicker, visual impacts, and vibrations. Concern for physical safety and closing bedroom windows to reduce WTN during sleep also increased with increasing WTN levels. Other sample characteristics are discussed in relation to WTN levels. Beyond annoyance, results do not support an association between exposure to WTN up to 46 dBA and the evaluated health-related endpoints.

Personal and situational variables associated with wind turbine noise annoyance.

The possibility that wind turbine noise (WTN) affects human health remains controversial. The current analysis presents results related to WTN annoyance reported by randomly selected participants (606 males, 632 females), aged 18-79, living between 0.25 and 11.22 km from wind turbines. WTN levels reached 46 dB, and for each 5 dB increase in WTN levels, the odds of reporting to be either very or extremely (i.e., highly) annoyed increased by 2.60 [95% confidence interval: (1.92, 3.58), p < 0.0001]. Multiple regression models had R(2)'s up to 58%, with approximately 9% attributed to WTN level. Variables associated with WTN annoyance included, but were not limited to, other wind turbine-related annoyances, personal benefit, noise sensitivity, physical safety concerns, property ownership, and province. Annoyance was related to several reported measures of health and well-being, although these associations were statistically weak (R(2 )< 9%), independent of WTN levels, and not retained in multiple regression models. The role of community tolerance level as a complement and/or an alternative to multiple regression in predicting the prevalence of WTN annoyance is also provided. The analysis suggests that communities are between 11 and 26 dB less tolerant of WTN than of other transportation noise sources.

Self-reported and measured stress related responses associated with exposure to wind turbine noise.

The current study was the first to assess stress reactions associated with wind turbine noise (WTN) exposure using self-reported and objective measures. Randomly selected participants, aged 18-79 yr (606 males; 632 females), living between 0.25 and 11.22 km from wind turbines, were exposed to outdoor calculated WTN levels up to 46 dBA (response rate 78.9%). Multiple regression modeling left the great majority (77%-89%) of the variance in perceived stress scale (PSS) scores, hair cortisol concentrations, resting blood pressure, and heart rate unaccounted for, and WTN exposure had no apparent influence on any of these endpoints. PSS scores were positively, but weakly, related to cortisol concentrations and resting heart rate (Pearson r = 0.13 and r = 0.08, respectively). Across WTN categories, modeled mean PSS scores ranged from 13.15 to 13.84 (p = 0.8614). Modeled geometric means for hair cortisol concentrations, resting mean systolic, diastolic blood pressure, and heart rate were 150.54-191.12 ng/g (p = 0.5416), 113.38-116.82 mmHg (p = 0.4990), 67.98-70.34 mmHg (p = 0.5006), and 68.24-70.71 bpm (p = 0.5223), respectively. Irrespective of WTN levels, diastolic blood pressure appeared to be slightly (2.90 mmHg 95% CI: 0.75,5.05) higher among participants highly annoyed by blinking lights on turbines (p = 0.0081). Collectively, the findings do not support an association between exposure to WTN up to 46 dBA and elevated self-reported and objectively defined measures of stress.

Estimating annoyance to calculated wind turbine shadow flicker is improved when variables associated with wind turbine noise exposure are considered.

The Community Noise and Health Study conducted by Health Canada included randomly selected participants aged 18-79 yrs (606 males, 632 females, response rate 78.9%), living between 0.25 and 11.22 km from operational wind turbines. Annoyance to wind turbine noise (WTN) and other features, including shadow flicker (SF) was assessed. The current analysis reports on the degree to which estimating high annoyance to wind turbine shadow flicker (HAWTSF) was improved when variables known to be related to WTN exposure were also considered. As SF exposure increased [calculated as maximum minutes per day (SFm)], HAWTSF increased from 3.8% at 0 ≤ SFm < 10 to 21.1% at SFm ≥ 30, p < 0.0001. For each unit increase in SFm the odds ratio was 2.02 [95% confidence interval: (1.68,2.43)]. Stepwise regression models for HAWTSF had a predictive strength of up to 53% with 10% attributed to SFm. Variables associated with HAWTSF included, but were not limited to, annoyance to other wind turbine-related features, concern for physical safety, and noise sensitivity. Reported dizziness was also retained in the final model at p = 0.0581. Study findings add to the growing science base in this area and may be helpful in identifying factors associated with community reactions to SF exposure from wind turbines.

Effects of Wind Turbine Noise on Self-Reported and Objective Measures of Sleep.

STUDY OBJECTIVES: To investigate the association between self-reported and objective measures of sleep and wind turbine noise (WTN) exposure. METHODS: The Community Noise and Health Study, a cross-sectional epidemiological study, included an in-house computer-assisted interview and sleep pattern monitoring over a 7 d period. Outdoor WTN levels were calculated following international standards for conditions that typically approximate the highest long-term average levels at each dwelling. Study data were collected between May and September 2013 from adults, aged 18-79 y (606 males, 632 females) randomly selected from each household and living between 0.25 and 11.22 kilometers from operational wind turbines in two Canadian provinces. Self-reported sleep quality over the past 30 d was assessed using the Pittsburgh Sleep Quality Index. Additional questions assessed the prevalence of diagnosed sleep disorders and the magnitude of sleep disturbance over the previous year. Objective measures for sleep latency, sleep efficiency, total sleep time, rate of awakening bouts, and wake duration after sleep onset were recorded using the wrist worn Actiwatch2® from a subsample of 654 participants (289 males, 365 females) for a total of 3,772 sleep nights. RESULTS: Participant response rate for the interview was 78.9%. Outdoor WTN levels reached 46 dB(A) with an arithmetic mean of 35.6 and a standard deviation of 7.4. Self-reported and objectively measured sleep outcomes consistently revealed no apparent pattern or statistically significant relationship to WTN levels. However, sleep was significantly influenced by other factors, including, but not limited to, the use of sleep medication, other health conditions (including sleep disorders), caffeine consumption, and annoyance with blinking lights on wind turbines. CONCLUSIONS: Study results do not support an association between exposure to outdoor WTN up to 46 dB(A) and an increase in the prevalence of disturbed sleep. Conclusions are based on WTN levels averaged over 1 y and, in some cases, may be strengthened with an analysis that examines sleep quality in relation to WTN levels calculated during the precise sleep period time.

An assessment of quality of life using the WHOQOL-BREF among participants living in the vicinity of wind turbines.

Living within the vicinity of wind turbines may have adverse impacts on health measures associated with quality of life (QOL). There are few studies in this area and inconsistent findings preclude definitive conclusions regarding the impact that exposure to wind turbine noise (WTN) may have on QOL. In the current study (officially titled the Community Noise and Health Study or CNHS), the World Health Organization QOL-BREF (WHOQOL-BREF) questionnaire provided an evaluation of QOL in relation to WTN levels among randomly selected participants aged 18-79 (606 males, 632 females) living between 0.25 and 11.22 km from wind turbines (response rate 78.9%). In the multiple regression analyses, WTN levels were not found to be related to scores on the Physical, Psychological, Social or Environment domains, or to rated QOL and Satisfaction with Health questions. However, some wind turbine-related variables were associated with scores on the WHOQOL-BREF, irrespective of WTN levels. Hearing wind turbines for less than one year (compared to not at all and greater than one year) was associated with improved (i.e. higher) scores on the Psychological domain (p=0.0108). Lower scores on both the Physical and Environment domains (p=0.0218 and p=0.0372, respectively), were observed among participants reporting high visual annoyance toward wind turbines. Personal benefit from having wind turbines in the area was related to higher scores on the Physical domain (p=0.0417). Other variables significantly related to one or more domains, included sex, age, marital status, employment, education, income, alcohol consumption, smoking status, chronic diseases and sleep disorders. Collectively, results do not support an association between exposure to WTN up to 46 dBA and QOL assessed using the WHOQOL-BREF questionnaire.