ARTICLE IN PRESS

Journal of Air Transport Management 13 (2007) 264276

www.elsevier.com/locate/jairtraman

Aircraft noise exposure and residents stress and hypertension: A public

health perspective for airport environmental management
Deborah A. Blacka, John A. Blackb,, Tharit Issarayangyunc, Stephen E. Samuelsd
a

School of Public Health and Community Medicine, UNSW, Sydney, NSW 2052, Australia
b
Botany Bay Studies Unit, UNSW, Sydney, NSW 2052, Australia
c
Institute of Transport & Logistics Studies, School of Business, Faculty of Economics and Business, The University of Sydney, NSW 2006, Australia
d
School of Civil and Environmental Engineering, UNSW, Sydney, NSW 2052, Australia

Abstract
Noise management regulations and policies at commercial airports are reviewed. A cross-sectional study of environmental noise and
community health based, on the SF-36, was conducted in residential neighborhoods near Sydney Airport with high exposure to aircraft
noise and in a matched control suburb unaffected by aircraft noise. Noise measurements were analysed and a novel noise metric
formulated based on background environmental noise levels. After controlling for confounders, subjects who have been chronically
exposed to high aircraft noise level are more likely to report stress and hypertension compared with those not exposed to aircraft noise.
Policy implications and further research are described.
r 2007 Elsevier Ltd. All rights reserved.
Keywords: Aircraft noise; Social and health survey; Stress and hypertension; Health impact assessment; Policy

1. Introduction
Governments, air trafc controllers and airport managers aim to minimize community exposure to aircraft
noise as far is practical. Mitigation schemes are based on
the dose-response relationship between an aircraft noise
metric and community annoyance to noise. Such policies
underestimate the social impact of aircraft noise because
health effects have been ignored when formulating
environmental management plans at airports. The World
Health Organization (WHO) denition that health includes
physical, psychological and social well-being (Berglund and
Lindvall, 1995) is taken as a starting point for this research.
The effects of aircraft noise on the health and well being of
the community must be understood before devising
strategies and counter-measures.
The research presented in this paper aims to develop a
better understanding of the impacts of aircraft noise on
community health and well-being by seeking to answer two
core questions: Is health related quality of life worse in a
Corresponding author.

E-mail address: j.black@unsw.edu.au (J.A. Black).

0969-6997/$ - see front matter r 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jairtraman.2007.04.003

community chronically exposed to aircraft noise than in a

community not exposed? and Is long-term aircraft noise
exposure associated with elevated blood pressure in adults
via noise stress as a mediating factor? The research also
develops a new noise metric to describe and assess the
impact of aircraft noise on the health and well-being of
residents. The noise parameter is termed the noise
gap index that distinguishes between aircraft noise and
background environmental noise in a novel manner
(Issarayangyun et al., 2004). It has been developed on the
assumption that people living in areas of different background noise may have different reactions to the same
aircraft noise level.
This paper provides an overview of research undertaken
by our multi-disciplinary team. The literature review
spanned a wide range of disciplinary elds. From this
review, the hypotheses were formulated and appropriate
survey instruments were identied. A pilot study of a small
suburb south of Sydney Airport, Australia, is described.
From there a wider-ranging study is reported that involved
the selection of a highly exposed, noise-affected area and a
control study area with similar demographic and socioeconomic characteristics. The sample size and response

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

rate, and the environmental noise measurements conducted

in both study areas are explained. The results obtained
from univariate and multi-variate statistics are summarized
and interpreted. They revealed that there is a statistically
signicant association between aircraft noise and wellbeing.
The literature on physiological effects of exposure to
aircraft noise suggests there are several kinds of reex
responses (Spreng, 2000, 2004) that cause a stress reaction
(emotional stress). Stress is dened as a non-specic,
activation response to adversities or challenges in a
persons life. Chronic (or long-term) suffering from stress
may lead to health problems. The study concludes that: (a)
long-term aircraft noise exposure was signicantly associated with chronic noise stress; and (b) chronic noise stress
was signicantly associated with hypertension. After
controlling for potential confounding factors, subjects
(aged 1587) who have been chronically exposed to high
aircraft noise level have the odds of 2.61 (95% CI
1.424.80) of having chronic noise stress, and these chronic
noise stress person have the odds of 2.74 (95% CI
1.554.84) of having hypertension compared with those
without chronic noise stress. Finally, the paper discusses
the public policy implications of our ndings both from an
airport environmental management perspective and from a
public health perspective. It also outlines directions for
further research.

28 commercial airports where Airservices Australia provides a terminal service (www.airservicesaustralia.com.au).

The relevant legislation for airport operators and those
authorities responsible for air navigation can be summarized as follows.

2. Research problem
Policies and regulations for aircraft noise at international airports aim to minimize, as far as is practical, the
total number of people in the community exposed to high
levels of aircraft noise from take-offs, landings, over-ights
and ground operations such as taxiing and engine ground
running. When quantifying community impact, many of
these mitigation strategies are based on an empirical
relationship between annoyance and noise exposure
(Schultz, 1978; Fidell, et al., 1991; Miedema and Vos,
1999; Fields, et al., 2001). Issarayangyun (2005, Chapter 3)
has shown a degree of commonality in noise abatement/
mitigation programs (community programs, attitudinal
surveys, sound insulation programs, noise monitoring,
noise and ight track system, preferred runways and ight
path usage, aircraft certication, land-use compatibility,
curfew, ground running and complaints unit) at major
USA, UK, Canadian and Australian airports, although
institutional arrangements differ (in the USA airports are
managed mainly by local government; Australian airports
have been privatized).
Australia is one country where a community survey on
aircraft noise and annoyance (Hede and Bullen, 1982;
Airservices Australia, 1999, Figure A1, p.5) underpins
current environmental policies for airports. The doseresponse relationship uses the Australian Noise Exposure
Forecast (ANEF) as the relevant metric to dene land-use
compatibility surrounding airports. In Australia, there are

265

Air Services Act 1995, Part 2 s. 8(1) and 9(2).

Airservices Australia has the function of carrying out
activities to protect the environment from the effects of,
and the effects associated with, the operation of
Commonwealth jurisdiction aircrafty and in a manner to perform any functions to ensure that, as far as is
practicable, the environment is protectedy. In practice, this is the determination of the use of runways and
ight paths so as to minimize the noise impact in
surrounding residential areas to an airport.
Sydney Airport Curfew Act, 1995. The objective of this
policy is to eliminate noise exposure to the community
during sleeping hours. Curfew operations at Sydney
Kingsford Smith Airport, where the surrounding
residential population is the largest of any commercial
airport in Australia, is dened as being from 11pm
through to 6am the next day when aircraft, except for
those specied under Part 3 of the Act, are not
permitted to take off or land. Those aircraft operations
during the curfew period are restricted to take-off and
landings only over Botany Bay, and there are procedures for controlling the use of reverse engine thrust and
missed approaches (Part 2, s. 8 and 9). Breaches attract
nes of up to Aus$550 000.
Air Navigation (Aircraft Noise) Regulations 1984 made
under the Air Navigation Act 1920. This act controls the
engagement of jet and propeller aircraft in Australia in
accordance with ICAO aircraft noise certication. In
practice, a subsonic jet is not allowed to engage in air
navigation unless it complies with Chapter 3 of the noise
certicate.
Airport Act 1996, Part 6, s. 116. A draft, or nal, airport
environment strategy must specify inter alia: (a) the
sources of environmental impact, (b) the methods of
study, review, and monitoring of the environmental
impacts, and (c) the methods to prevent, control or
reduce environmental impacts.
Airport (Environment Protection) Regulations 1997.
This regulation, in conjunction with the previous act,
is a Commonwealth Government system of regulation
of those activities at airports that generate pollution or
excessive noise, and the promotion of sound environmental management practices. The noises included in
these regulations are construction noise, ground transport noise (road and rail trafc providing access) and all
ground-based aircraft operations (aircraft auxiliary
power units, aircraft re-fuelling, operation of plant and
machinery, and ground-based aircraft running after
engine repair and maintenance). Schedule 4 Parts 2 and 3
of the Regulations describe the acceptable levels of the
above noise at sensitive residential and commercial

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

receptors in the airports vicinity. It is important to note

that these regulations do not apply to aircraft in-ight,
taking-off, landing nor taxiing.
Aircraft Noise Levy Act, 1995. The policy objective is to
disadvantage airlines that operate noisy aircraft at
Australian airports by imposing a levy on every landing
(exceptions include emergency and charity disaster relief
ights) that generates noise above a specied level. The
formula to calculate the levy is provided in subsection
6(1) and in Aircraft Noise Levy Regulations, s. 5 and 6,
(see, also, Nero and Black, 2000).

In addition, for Sydney Airport (www.sydneyairport.com)

operated by Sydney Airport Corporation Limited, a
Macquarie Bank owned corporationtwo additional
strategies must be mentioned. These two aircraft noise
mitigation strategies, aimed to reduce environmental and
social impact, stemmed from the Draft Noise Management
Plan, produced as part of the development consent by the
then Federal Airports Corporation (prior to airport
privatization in Australia) to construct and operate a third
runway (Mitchell McCotter, 1994), and later work. The
rst is the Long-Term Operating Plan which incorporates a
noise-sharing principle with the use of 10 modes of runway
operations (Airservices Australia, 1996). The objectives
are: to use all three runways; to maximize ights over water
and non-residential areas; to share fairly noise impacts; to
cap aircraft movements at 80 per hour; to maximize the
hours per day over residential areas that are either free
from over-ight, or have a minimum of unavoidable overights; to ensure all arriving aircraft operate at low power
and low noise; and to ensure that residential areas overown by aircraft arriving should not also be over-own by
aircraft departing from the same runway.
The second strategy is the Commonwealth Government
administration and implementation of the Sydney Airport
Noise Amelioration Program. From 1995 to the end of
1997, 93 public buildings (schools, religious buildings, such
as churches, and health care facilities) and 4600 residences
were provided acoustical treatment; at a capital cost of
nearly Aus $400 millionapproximately the cost of the
construction of the third runway at Sydney Airport. The
agreed noise metric by the Federal Government was the
ANEF (Australian Noise Exposure Forecast) system that
is based on survey evidence of the reaction of Australian
communities to aircraft noise. As with the US NEF system
(Nelson, 1987), the ANEF unit incorporates into a single
predictive formula, the noise levels of individual aircraft (in
units of Effective Perceived Noise Level, EPNdB, as
measured and derived by noise monitoring equipment or
using ICAO certication) using the airport, plus a
logarithmic function of the daily average number of
aircraft noise events, with a weighting penalty (of four
per aircraft ight) to capture community sensitivity to
aircraft noise during evening/night-time hours (dened as
7pm7am). The forecast number of daily ights by aircraft
type by time of day on each of the designated ight paths

provides the input data to the ANEF contour calculationsin the case of the Sydney Airport Noise Management Plan (Mitchell McCotter, 1994) the forecast year was
2010. The eligibility criterion was location within the 30
ANEF contour. It should be noted that community
reaction to aircraft noise within the 25 ANEF contour is
substantial (Commonwealth of Australia, Senate Select
Committee, 1995).
Having pointed out the commonality in the way that
aircraft noise is being managed at Australian (and
international) airports, and provided the specic regulatory
and legislative framework to enable this environmental
management in Australia, a number of research issues
arise. The current practice in quantifying aircraft noise may
be a cause that retards the resolution of aircraft noise
problems as far as the community is concerned because of
the misunderstandings surrounding the use of aircraft noise
metrics, and an underestimation by the government of
public health impacts from long-term exposure to chronic
aircraft noise. The sound equivalent energy technique with
time-of-day weighting (such as Australian Noise Exposure
Forecast and Day-Night Average Sound Level (DNL)) was
designed for land-use compatibility advice and regulation
around commercial and military airports (Horonjeff and
McKelvey, 1999, pp. 729731), but it has been widely
interpreted as a metric correlated with community annoyance. Numerous reports (Commonwealth of Australia,
Senate Standing Committee, 1995) have criticized its
application to the study of community reaction to the
effects of aircraft take-offs, landings, and over-ights. A
stakeholder forum, Botany BayMoving Forward, held in
February 2004to determine research priorities as part of
the New South Wales Governments Botany Bay Strategy
(the international airport has two parallel runways that
project into Botany Bay)nominated community impacts
of aircraft noise as a priority topic (www.bbsu.unsw.edu.au/pages/program.asp).
3. Aircraft noise and stress and hypertension
Given the social importance of this noise issue, especially
in Sydney, we explored, rst, in the medical literature,
whether aircraft noise had any public health impacts. A
comprehensive literature review was undertaken by Issarayangyun (2005, Chapter 2) within a trans-disciplinary
framework (Issarayangyun et al., 2005a; Black and
Hayashi, 2005; Higginbotham et al., 2001) that retrieved
information irrespective of its disciplinary base. Stress
means that the person is experiencing a physical reaction to
something that is perceived as threatening or dangerous to
the survival of the individual. Hypertension is the medical
term for elevated blood pressure.
There is clear evidence that sound can impact on blood
pressure. Blood pressure is the result of a pumping action
of the heart to create enough force to push blood through
the arteries, into the arterioles, and nally into tiny
capillaries (German and Staneld, 2000, pp. 417429).

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High blood pressure (or hypertension) is the elevation of

the blood pressure in the arteries. Exposure to sudden, or
uncontrollably intense, noise sources activates the autonomic and hormonal systems, increasing blood pressure,
heart rate and vasoconstriction. Secondary hypertension is
caused by various factorsa medical condition, medication, alcohol consumption, cigarettes, and emotion state,
such as mental stress, anxiety and depression.
A study of the blood pressure in women in Fukuoka,
Japan, collected from general health examinations concluded there was no evidence that aircraft noise is a risk
factor in hypertension (Goto and Kaneko, 2002). They
compared the blood pressure data of women (N 469)
living around Fukuoka Airport (a few kilometers from the
Hakata CBD) with women living in non-aircraft noise
exposed areas (N 1177), controlling for variables such as
anti-hypertension treatment, diet, alcohol consumption
and smoking. The authors also observed the changes of
blood pressure levels of a group of 183 women living near
the airport from 1980 to 1988. However, Rosenlund et al.
(2001), in a mail back survey asking questions about
individuals history of hypertension in two randomly
selected groupsexposed near Stockholm Arlanda Airport, and non-aircraft noise exposed (N 485; response
rate, 73%)concluded that the association between aircraft noise and hypertension was marginally signicant.
Previous studies have paid attention to the effects of
aircraft noise on the blood pressure levels of children, but
the conclusions are also mixed. The resting blood pressure
of school children, selected from elementary schools
located around Los Angeles International Airport, and in
non-aircraft noise exposed areas of comparable socioeconomic status and grade, were recorded on an automated
blood pressure recorder in a longitudinal study design of
one year (Cohen et al., 1980, 1981). Statistical methods
show the difference of 3 mm Hg higher in both systolic and
diastolic blood pressure of children in the noise exposed
schools was signicant, but no such difference could be
detected in the follow-up survey. Using the same methodology but in a cross-sectional study, Evan et al. (1998)
found the resting blood pressures of children before and
after the opening of the new Munich International Airport
had signicantly increased, although no evidence of
controlling for confounders can be found in this paper. A
sample of children in primary schools within 20 km of
Sydney (Kingsford Smith) Airport in a longitudinal design
(N 1230 in 1994 and 1995; N 628 in 1997), again using
automated blood pressure measuring equipment and
controlling for the necessary confounding factors, found
no statistically signicant cross-sectional correlations
between mean resting blood pressure and aircraft noise
exposure (Morrell et al., 1997).
Studies have focused on one airport with relatively small
study populations. Therefore, large, multi-centered studies
are needed to test the hypothesis that airport-generated
noise may give rise to elevated blood pressure. The aim of
the Hypertension and Exposure to Noise near Airports

267

(HYENA) project is to assess the impacts on cardiovascular health (high blood pressure) of both aircraft and road
trafc noise near six airports: Athens, Milan Malpensa,
Amsterdam Schipol, Stockholm Arlanda, Berlin Tegel and
London Heathrow (Jarup et al., 2005).
If aircraft noise can cause stress in people we would
expect to nd higher usages of medicines and drugs to
alleviate stress and help sleep in aircraft noise exposed
neighborhoods. This was found to be the case both for
physician visits for hypertension, psychological and psychosomatic problems and cardiovascular disease, and for
the prescriptions for medicinal drugs around Schipol
Airport, Amsterdam, in areas with Ldn greater than 64,
when compared with residents in low noise areas with Ldn
less than 51 (Knipschild, 1977; Knipschild and Oudhoorn,
1977, cited in Kryter, 1994, pp. 542543). The issues of
confounders were addressed, but Morrell (et al., 1997, p.
228) criticized these studies on their small sample size. A
study of Munich Airport took urine samples from children
and analyzed stress levels, showing that epinephrine and
norepinephrine increased rapidly in noise exposed areas
(Evan et al., 1998). On the contrary, a study of the effects
of long-term exposure to aircraft noise and stress
(catecholamine, cortisol and perceived stress) in primary
school children around Heathrow Airport, London, found
no correlation once confounding factors had been controlled (Haines et al., 2001a b).
Noise sensitivity is a factor related to personal vulnerability and intervenes between noise exposure and annoyance (Stansfeld, 1992; Job et al., 2001; Hateld et al., 2002;
Van Kamp et. al., 2004) and is a possible confounder.
Theoretically, noise sensitivity has a two-way relation with
stress. Noise sensitive people have a low capability to cope
with a noise stimulus leading them to get more stressed
than normal. Stress itself makes people less tolerant to an
unwanted sound, or more sensitive to noise than people
who are more mentally calm. Some health problem (s) are
assumed to have either a positive or negative effect to noise
sensitivity factor. For example, people who have psychiatric illness are most likely to be more noise sensitive than
normal and people who have an auditory deciency are less
sensitive to noise because of the lack of their hearing
ability. The noise sensitivity scale developed by Weinstein
(1978) (called the Weinstein scale) is one that has been
referred to by the most international publications, including being used in the instrument designed by Meister and
Donatelle (2000). The Weinstein scale consists of a
comprehensive set of 21 items asking about how people
feel about noise at home, in a library, in movie theatres, or
in the work place.
4. Conducting the study
4.1. Related studies
Subjective, self-assessed health-related quality of life (for
a denition, see Patrick and Erickson, 1993, p. 22) survey

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

instruments have become an important component of

contemporary public health research (Jenkinson, 1994).
Our study of self-assessed health and aircraft noise is the
rst of its kind in Australia, but there have been other
studies reported in the literature along the lines of quality
of life, health and aircraft noise. Bronzaft et al. (1998)
determined health perception and quality of life of people
living in two areas of New York of similar socio-economic
composition but one exposed to aircraft noise (DNL465).
From a postal questionnaire (N 3000; valid responses 9%) chi-squared analysis showed that respondents who were bothered by aircraft noise were more likely
to complain of sleep difculties and more likely to perceive
themselves to have poorer health.
A well-designed, cross-sectional, survey to measure
health-related quality of life and aircraft noise was
conduced in metropolitan Minnesota, USA (Meister and
Donatelle, 2000). A postal questionnaire sample (N 4000
aged 1899 years; response rate 52%) measured general
health outcomes, perceived stress, noise sensitivity, and
noise annoyance. After controlling for potential confounding factors, multiple analysis of co-variance revealed that
all health measures (general health, sense of vitality, mental
health) were signicantly worse in areas exposed to high
aircraft noise. Stress and noise annoyance were also found
to be signicantly worse.
Using a different instrumentthe Todai Health Index
(developed by the University of Tokyo) that contains 130
questions on a 12-point scale to measure physical and
mental health outcomesMiyakita et al. (2002) studied the
effects of military aircraft noise around Kadena and
Futenma Airelds in Japan on a sample of residents aged
1575 (N 8084; response rate 83%). The cross-sectional study, with a control group and adjustments for
confounding factors, found that the components of
physical and mental health deteriorated with increasing
noise exposure levels. Similarly, a cross-sectional study
using a postal self-administrative technique (N 30 216
addresses; response rate 39%) with 13 questions on
health complaints and an overview question, how is your
health in general? concluded that the associations between
aircraft noise and health indicators (general health status,
use of medication for cardiovascular diseases and use of
sleeping medication) were statistically signicant (Franssen
et al., 2004). Also vitality-related health complaints (tiredness, headaches) were associated with aircraft noise,
whereas most other physical complaints were not.
4.2. Questionnaire
In our research, subjective health outcomes were measured by a questionnaire that was designed from validated,
internationally recognized instruments, SF-36 (Ware and
Sherbourne, 1992). This research employs a cross-sectional
study with a matched control group. When contacting
potential respondents the cover letter explained that the
study was one of environmental noisenot mentioning

aircraft noise in an attempt to neutralize the likelihood of an

increased response rate of those residents who are especially
annoyed by aircraft noise. Field measurements of environmental noise were undertaken according to Australian
standards (Australian Standard, 1997) to determine noise
at the points of receptors in the control and noise exposed
study areas. Univariate and multi-variate statistics were used
to analyze the data collected.
To determine individual predisposition to noise a noise
sensitivity scale (Weinstein scale) was modied. Ten items
were carefully selected as they are considered more functional
to the study than the remaining items. The higher the noise
sensitivity score then the more noise sensitive people are. The
reliability of those selected items was also tested by the pilot
study. The questionnaire has been developed from an
international, well-established questionnaire instrument
(Ware and Sherbourne, 1992; Ware et al., 1993; Ware,
2000; Jenkinson et al., 1994) that measures seven major
characteristics of each subject: (1) health related quality of life
(HRQoL); (2) hypertension condition; (3) noise stress; (4)
noise sensitivity; (5) noise annoyance; (6) demographic
characteristics; and (7) confounding factors. Some scales of
the medical outcome study (MOS) 36-item short form (SF-36,
v.2) (which are physical functioning, general health, vitality,
and mental health) have also been added to our research
instrument to measure HRQoL.
For each health measure, a summary score in the range
of 0100 was obtained with the SF-36 algorithm, with a
higher score implying a more positive health status. Table 1
provides the interpretation of the lowest and the highest
scores of those selected SF-36 scales.
A set of closed-end question for assessing hypertension
has been developed for this research. Have you ever been
told by a doctor or nurse that you have high blood pressure
sometimes called hypertension (1) Yes (2) Yes, but only
temporarily (3) No, and then If YES, do you currently
have high blood pressure? (1) Yes (2) No. It is evident that
the history of hypertension of parent(s) and cholesterol

Table 1
Interpretation of lowest and highest scores of selected SF-36 scales
Denition
Lowest possible score

Highest possible score

Physical
Very limited in performing all Performs all types of physical
functioning physical activities, including activities including the most
(PF)
bathing or dressing
vigorous without limitations
due to health
General
Evaluates personal health as Evaluates personal health as
health
poor and believes it is likely to excellent
(GH)
get worse
Vitality
Feels tired and worn out all of Feels full of pep and energy
(VT)
the time
all of the time
Mental
Feelings of nervousness and Feels peaceful, happy, and
health
depression all of the time
calm all of the time
(MH)
Source: Ware and Sherbourne (1992, Table 1, p.475).

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level are related to hypertension. Therefore, to prevent the

distortion effects from those variables, closed-end questions for assessing this history of hypertension of parent(s)
and high cholesterol status were asked: At any time in the
past, have either of your parents ever been told by a doctor
or nurse that they have high blood pressure sometimes
called hypertension? (1) Yes (2) No (3) Dont know. Have
you ever been told by a doctor or nurse that you have high
cholesterol? (1) Yes, and, currently, have (2) Yes, but
already healed (3) No. The modied annoyance measurement consists of two sections. Each section consists of two
questions assessing annoyance from trafc noise and
aircraft noise. The rst section measures annoyance of
subjects from daily activity disturbances (during the past 12
months) when they are at home. The second section asks
people to consider all items from the rst section and rate
their overall annoyance from each noise source by using
opinion scale (010) where zero means not at all annoyed
and 10 means extremely annoyed.
The questionnaire was designed to capture all potential
confounders. The confounder questions such as employment status, exercise activities, smoking status, alcohol
consumption, nutrition and demographic characteristics
have been adapted from the Australian Bureau of Statistics
(ABS, 2002). Some questions have been designed specically for this research. For instance, a question measuring
smoking status of other members of the household has
been included to eliminate the impact of passive smoking.
A question asking how long has the respondent lived in his/
her house was developed to satisfy the research assumption
that long-term aircraft noise exposure has negative impacts
to human health. A noise-confounding question (which is
Have you recently insulated your house from noise?) was
included into the questionnaire to eliminate the effect from
acoustic insulation (which has been a feature of the noise
management plan at Sydney Airport following the opening
of the Third Runway in 1996).
4.3. Pilot study
A small residential suburb at Kurnell, located to the
south of Sydney Airport, acted as a case study for the pilot
test with sample size of 100 (Issarayangyun et al., 2005b).
The reliability of the noise stress scale and the noise
sensitivity scale were checked using Cronbach Alpha. The
alpha values of the noise stress scale and the noise
sensitivity scale were found to be 0.931 and 0.903,
respectively, which are considered too high and result in
high level of item redundancy of both scales (higher than
0.9). Therefore, the pilot study recommended the exclusion
of some noise stress items and noise sensitivity items from
the nal survey.
4.4. Study population and sample
Sydney (Kingsford Smith) Airport has been selected as a
case study. Only the highly exposed areas (where on an

269

average annual day N70 is higher than 50 events per day)

were selected as the study population for the aircraft noise
exposure area. The N70 is the number of aircraft noise
events that are louder than 70 dB(A). The threshold level of
70 dB(A) was chosen because, approximately, it will then
be attenuated 10 dB(A) by the structure of house (with
open windows) and that 60 dB(A), or above, is the indoor
sound pressure level of a noise event that is likely to
interfere with conversation, or with listening to the radio,
or watching the television (DOTARS, 2002). The 2003
daily average N70 contour map around Sydney Airport
was obtained from AirServices Australia, Canberra.
The control areas, in locations not exposed to aircraft
noise, were matched on the socio-economic status of the
exposure areas. Suburbs located outside of the ight paths
were selected by visual inspection from Sydney Airports
Track Plots provided by Airservices Australia. Socioeconomic indices of these selected suburbs (Trewin, 2001)
were then compared with the study population of the
aircraft noise exposure area by using non-parametric test
(Mann-Whitney U). Finally, the suburb of South Penrith,
located in the western suburbs of Sydney (approximately
55 km from Sydney Airport), was chosen as a matched
control group for this research.
To estimate the sample size required for the main
survey, two factors were considered: the expected response
rate and the power to detect a statistically signicant difference in health status measures (Ware and
Sherbourne, 1992, Table 7.6, p 7.11). From the pilot study,
the expected valid-response-rate of the health survey
procedure from a mail-back survey (Dillman, 2000) was
50%. Consequently, the required sample sizes per group
for the main survey would be 274 (estimated sample size
needed to detect 5-point difference in health status
instrument score) divided by 50% (expected response rate),
which yield 548 subjects. The total sample size required for
the main survey is 1 096 subjects. Nevertheless, this
research improved the power by increasing the sample size
for each group to 750 subjects. The total sample size
becomes 1 500 subjects. Every home address (excluding
apartments, commercial buildings, addresses for sale or
lease, and abandoned addresses) located in the aircraft
noise affected area and in the control area were observed to
minimize the address error.
4.5. Noise measurement
Noise stations were set up outside randomly selected
households that were mostly located in what could be
termed local trafc areas. Households located close to
railway lines, industrial areas and major highways were
excluded. Noise data were collected at 26 stations located
around Sydney Airport and 3 stations in the control area
from 7am to 6pm on various days from October 2003 to
November 2004. There is a night-time curfew in operation
at Sydney Airport from 11pm to 6am. Fieldwork
conducted by researchers at UNSW is subject to clearance

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

by an ethics committee and by occupation, health and

safety considerations. Therefore, noise measurements
during night-time hours had to be avoided due to possible
safety concerns for the recorder.
Twenty-minute samples per hour were measured using a
Bruel and Kjaer sound level meter Type 2236. It was
mounted in front of each residence 1 m from the nearside
lane of trafc and at least 1 m from the fac- ade (AS 1055.11997). Several environmental noise indices were recorded
throughout each measurement period. Note that, the
denitions of environmental noise indices stated in this
paper can be found in Australian Standard AS 1055.1-1997
(Australian Standard, 1997). In addition, the noise sources
and events heard by the recorder were manually noted. The
primary index of interest, particularly in quantifying the
background environmental noise, was the LAeq because it
would be used subsequently to develop a new parameter
termed the noise gap index (NGI).
This parameter distinguishes between aircraft noise and
background environmental noise in a novel manner that is
necessary to assist the exploration of our core research
questions. The NGI is based on the assumption that
people living in areas of different background environmental noise level may have different reactions to the same
aircraft noise level. To quantify the aircraft noise levels for
input into the NGI, a suitable aircraft noise index was
required. A Number-Above (NA) metric was selected for
this purpose according to recommendations provided by
the Australian Department of Transport and Regional
Services. Comparisons between the NA of aircraft noise
and the LAeq,T of background noise could not be made
directly because of the inherent differences between these
two indices. The NA of aircraft noise would need to be
transferred into an index measured in dB(A). Consequently, the concept of the day-night average sound level
(DNL) was adapted to overcome this problem. The DNL
also employs the concept of energy sound equivalent but
uses the sound exposure level (LAE) as the single-event
sound level descriptor with time-of-day weighting factors.
Nevertheless, the time-of-day weighting was ignored
because the measurement periods did not cover night-time
periods. Therefore, the adjustment factor of the time
interval was varied depending on the background environmental noise time interval.
To analyze the background environmental noise level,
the approach taken was to exclude all the aircraft noise and
unusual noises (such as ambulance sirens, garbage trucks,
lawn mowing, and dogs barking) from the noise time
curves which results in a background environmental noise
time curve. A high noise group included those noise
stations located on roads that are connected with highways
or major roads with high trafc volume. The background
environmental noise level in this group was highly
inuenced by trafc noise from nearby roads. The
medium noise group is dened as those noise stations
located on roads that are linked to alternative roads (or
roads with medium trafc volume). The background

environmental noise level in this group was moderately

inuenced by trafc noise from nearby roads. Finally, the
low noise station group represented those locations located
on roads that are not connected with any highways, major
roads, or alternative through routes. The impacts of trafc
noise from other roads were either very low or negligible.
The long-term time average A-weighted sound pressure
level of the background noise level (LBAeq,7 am6 pm) was
determined for the high, medium, low, and control noise
station groups to be 59.5, 56.5, 52.0 and 48.8 dB(A),
respectively.
5. Survey results
5.1. Response rate
796 responses returned to the researchers were in the
stamped addressed, postage-paid, envelope (704 respondents completely lled in the questionnaire). The number
of responses from subjects in the control group was a little
bit lower than from the noise exposure area. This might
reect the lack of relevance of a questionnaire about
environmental noise in daily life of subjects in the control
area. Overall, the total response rate was slightly lower
than the expected response rate of 50%.
5.2. Demographic and socio-economic status of samples
The demographic characteristics and socioeconomic
status of both study groups were compared. In the
total sample, age ranges from 15 to 87. The distributions of age were considered Normal. The mean age of
the control group was approximately four years higher
than the noise exposure group. Using a t-test, it was
found that this difference was statistically signicant
(p-value 0.001). This might reect the higher percent
of not in labor force of subjects in the control group.
In the control group, 66.1% of the sample was female,
which is 10.1% higher than in the noise exposure group.
And a chi-square test revealed that this difference was
signicant (p-value 0.009).
In terms of socioeconomic status, subjects in the
noise exposure group seem to have a higher education
(p-valueo0.001) and better employment status (p-value
0.003) than the control group. However, both groups were
similar in term of household income (p-value 0.451). The
consumption of alcohol (p-value 0.623) and salty food
(p-value 0.135) of subjects from both groups were not
signicantly different. Subjects in the noise exposure group
were more likely to be smokers (p-value 0.014) than the
control group. In the control area, subjects took proportionally less exercise (p-value 0.034) than in the noise
exposure area. Therefore, the percentage of obesity in the
control area was considerably higher (p-value 0.006).
The marital status between both groups was signicantly
different, with a higher proportion being married in the
control group (p-valueo0.001). Not surprisingly, there was

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

only 3% of the sample in the control group that has

insulated their house from noise. Around 37% of houses
in the noise exposure group have been insulated from
noise.
5.3. Health and related measures
Table 2 summarizes the descriptive statistics of health
and related measures of both study groups. It appears that
most of the health measures of the noise exposure group
were lower than the control group, implying that the
HRQoL of subjects from noise exposure group was worse
than the control group. However, without any control for
covariates, analysis of variance (ANOVA) revealed almost
all of these differences (except mental health score) were
not statistically signicant. The proportion of people with
hypertension in the control group was slightly higher
than in the noise exposure group. However, this difference
is not statistically signicant (p-value 0.450). The proportion of hypertension in parent(s) and high cholesterol
level in the noise exposure group was higher than the
control group. However, these differences were also not
statistically signicant. The differences of hypertension
in parent(s) (p-value 0.298) and high cholesterol level
(p-value 0.215) between groups were not statistically
signicant.
Undoubtedly, subjects in the noise exposure group were
more sharply annoyed by aircraft noise (p-valueo0.001)
than the control group. The level of trafc noise annoyance
between both groups was slightly different, it was also
statistically signicant (p-value 0.001). This might reect
the fact that the LBAeq,(7 am6 pm) of the matched control
group was lower than the noise exposure group. The level
of noise sensitivity between both groups was not signicantly different (p-value 0.193). Obviously, subjects
from the noise exposure area have a high level of noise
stress (p-valueo0.001) than the matched control area.
Thus, there are many different aspects between these two
study groups, which need to be carefully controlled when
drawing inferences about health and well being. To control
for covariates binary logistic regression was used.

271

5.4. Relationships between health quality of life (QOL)

factors and aircraft noise
The study rejected the null hypotheses and concluded
that when removing the linear effects of covariates, and
controlling for potential confounding effects, the mean
score of physical functioning, general health, vitality, and
mental health of aircraft noise exposure group were
signicantly lower than the matched control group. This
implies that HRQoL (in terms of physical functioning,
general health, vitality, and mental health) of subjects from
aircraft noise exposure group was worse than the matched
control group.
5.5. Prevalence of hypertension and aircraft noise
The analyses of association between prevalence of
hypertension and aircraft noise exposure were divided into
two sub-sections: (a) aircraft noise exposurechronic noise
stress; and; (b) chronic noise stressprevalence of hypertension, based on an assumption that Aircraft noise has
indirect impacts to hypertension. It disturbs daily activities
and creates chronic noise stress which becomes a mediating
factor for hypertension in the future. The null hypotheses
of each sub-section assumed no association between
exposure and risk factors. Binary logistic regression
analysis was performed on each sub-section.
For the rst sub-section, the analysis was performed to
assess prediction of presence/absence of chronic noise
stress based on: (a) an exposure variable of aircraft noise
exposure (GROUP); and (b) four potential confounding
factors of noise sensitivity (SEN), trafc noise annoyance
(ANNOTRAF), aircraft noise annoyance (ANNOAIR_7),
and an interaction between trafc noise annoyance and
aircraft noise annoyance (ANNOTRAF by ANNOAIR_7).
Table 3 shows regression coefcients, Wald statistics, odd
ratios and 95% condence intervals for odds ratios for
each of the exposure variable and the four potential
confounding factors. According to the Wald criterion,
GROUP (z 9.46, p-value 0.002), SEN (z 11.35,
p-value 0.001), ANNOTRAF (z 26.54, p-valueo0.001),

Table 2
Descriptive statistics of health and related measures by study groups
Variable

Noise exposure group

Control group

p-value

Mean physical functioning score

Mean general health score
Mean vitality score
Mean mental health score
Hypertension
Hypertension in parent(s)
High cholesterol level
Mean noise stress score
Mean noise sensitivity score
Mean aircraft noise annoyance
Mean trafc noise annoyance

79.09
64.49
54.58
68.02
51 (15.0%)
154 (45.4%)
62 (18.3%)
6.44 (SD 2.31)
27.76 (SD 7.92)
6.27 (SD 3.04)
2.61 (SD 2.57)

79.23
66.08
57.02
73.53
55 (17.4%)
132 (41.8%)
47 (14.9%)
4.25 (SD 1.93)
26.97 (SD 7.38)
1.03 (SD 2.01)
1.96 (SD 2.31)

0.941
0.370
0.128
o0.001
0.450
0.297
0.215
o0.001
0.193
o0.001
0.001

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

272

Table 3
Logistic model to predict presence/absence of chronic noise stress
Variable

Coeff.

GROUP
SEN
ANNOTRAF
ANNOAIR_7
ANNOAIR_7 by ANNOTRAF
Constant

0.958
0.057
0.376
2.699
0.257
5.062

Std. Err.

Wald

0.312
0.017
0.073
0.408
0.092
0.583

9.455
11.347
26.537
43.799
7.757
75.423

Table 4
Logistic model to predict presence/absence of prevalence of hypertension
Variable

Coeff.

Std. Err. Wald

STR_7
1.008 0.290
GROUP 0.484 0.276
CHOL
1.350 0.262
AGE
0.067 0.009
PARHY
0.530 0.258
Constant 5.906 0.623

12.124
3.082
26.562
51.618
4.228
89.921

df Sig

Odds 95% CI
ratio
Lower Upper

1
1
1
1
1
1

2.741
0.616
3.858
1.070
1.700
0.003

0.000
0.079
0.000
0.000
0.040
0.000

1.554
0.359
2.309
1.050
1.025

df

4.835
1.058
6.446
1.089
2.818

ANNOAIR_7 (z 43.80, p-valueo0.001), and ANNOTRAF by ANNOAIR_7 (z 7.76, p-value 0.005) reliably
predicted chronic noise stress. The Hosmer-Lemeshow
goodness-of-t statistic revealed that this model is a good
t (w2 3.92, df 8, p-value 0.865).
For the second sub-section, the analysis was performed
to assess prediction of presence/absence of prevalence of
hypertension based on: (a) an exposure variable of chronic
noise stress (STR_7); and (b) four potential confounding
factors of high cholesterol status (CHOL), age (AGE),
history of hypertension in parent(s) (PARHY), and aircraft
noise exposure (GROUP). Table 4 shows regression
coefcients, Wald statistics, odd ratios and 95% condence
intervals for odds ratios for each of the exposure variable
and the four potential confounding factors. According to
the Wald criterion, STR_7 (z 12.12, p-valueo0.001),
CHOL (z 26.56, p-valueo0.001), AGE (z 51.62, pvalueo0.001), and PARHY (z 4.23, p-valueo0.04)
reliably predicted prevalence of hypertension. Even though
GROUP (z 3.08, p-value 0.079) was not statistically
signicant to predict prevalence of hypertension implying
that aircraft noise has no direct association with hypertension, it has been maintained to allow the model to control
for the effect of aircraft noise exposure. The HosmerLemeshow goodness-of-t statistic revealed that this model
is a good t (w2 5.082, df 8, p-value 0.749).
The study rejected the null hypotheses and concluded
that: (i) long-term aircraft noise exposure was signicantly
associated with chronic noise stress; and (ii) chronic noise
stress was signicantly associated with prevalence of
hypertension. After controlling for potential confounding

1
1
1
1
1
1

Sig

0.002
0.001
0.000
0.000
0.005
0.000

Odds ratio

2.608
1.059
1.456
14.872
0.773
0.006

95% CI
Lower

Upper

1.416
1.024
1.262
6.686
0.645

4.804
1.094
1.680
33.079
0.927

factors, subjects (aged 1587) who have been chronically

exposed to high aircraft noise level have the odds of 2.61
(95% CI 1.424.80) of having chronic noise stress, and
these chronic noise stress person have the odds of 2.74
(95% CI 1.554.84) of having hypertension compared with
those without chronic noise stress.
6. Implications for public policy
Aircraft noise has a health impact in terms of hypertension and stress: can the noise levels be entirely eliminated
from the inner city by closing down the airport at Mascot
and relocating it elsewhere, as in fact was achieved in Hong
Kong and in Jakarta. Finding a site for a second Sydney
Airport has proved a futile exercise from the 1970s
onwards. Current governments appear to have abandoned
a site once selected at Badgerys Creek, in the outer western
suburbs of Sydney, so even the medium term prospects of a
new airport seem remote. In any case, the owners of the
Sydney Airport, as a purchase condition of the airport in
2002 on a 99-year lease from the Commonwealth Government, have the rst option to bid on the construction and
operation of any second Sydney commercial airport. Given
the commercial interests at Sydney Airportretailing, car
parking revenue, and the development of airport land for
business purposes on its 905 ha of prime real estateits
closure is unlikely in the long term. By 2020, 62 million
annual passengers are projected to use the airport and the
number of aircraft movements will increase considerably.
As we have demonstrated, aircraft noise has a health
impact in terms of hypertension and stress: can the levels of
noise be reduced by the nomination of different runway
usage and ight paths? Under the Air Services Act 1995,
Part 2 s. 8(1) and 9(2), Airservices Australia has the
function of carrying out activities to protect the environment from the effects ofyaircrafty and to ensure that,
as far as is practicable, the environment is protectedy.
The use of runways and ight paths so as to minimize the
total number of people exposed to aircraft noise in
surrounding residential areas at Sydney Airport could be
achieved (as demonstrated in the draft noise management
plan by Mitchell McCotter, 1994) by operating parallel
runway operations and simultaneous approaches and takeoffs, unless wind directions and velocities dictate the use of

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

the east-west runway. Other things being equal, this will

reduce the number of people experiencing high blood
pressure and stress from aircraft noise, and lead to health
benets. However, the present Liberal-Coalition Commonwealth Government has adopted a policy of sharing the
noise, which increases the total number of people affected
by aircraft noise. Any elected Labor Government would be
reluctant to change the long-term operating plan in fear of
stirring up again community anger as they were responsible
for the development approval of the third runway at
Sydney (Kingsford Smith) Airport (see, Commonwealth of
Australia, Senate Standing Committee, 1995).
Could the curfew hours be extended by an hour at either
end to give extra relief from aircraft operations to the
community? This would require amendment of the Sydney
Airport Curfew Act, 1995. Such an amendment would work
against the long-term commercial interests of the owners of
the airport (see above) who derive some of their business
revenue from aeronautical charges. The airport sale price
to the Government, and the conditions of sale would have
been predicated on the legislation remaining unchanged.
The government has imposed an hourly cap on aircraft
movements of 80 at Sydney Airport. An extension of
curfew hours by two hours would, in the long-run result
in lost revenue in landing fees and aeronautical charges
from the airlines equivalent to a maximum of 160 aircraft
per day.
The prognosis, then, it has the source of the health
impact (that is, aircraft) will not go away, and, if anything,
the noise exposure levels will increase slightly with the
growth of passenger, freight and aircraft trafc. Engine
technology may help arrest the rate of growth in aircraft
noise. With all of the magic bullets played from the noise
management plan, the only option within the current
policy would be to consider the extension of the building
insulation scheme from the 30 ANEF boundary to eligible
buildings within the 25 ANEF contour. The benets of an
improvement to the quality of life of residents, community
facilities and educational establishments would have to be
calculated to argue for the enormous costs of this extra
building insulation scheme. New Commonwealth Legislation would be required, and the costs of implementing the
scheme would be passed on to the airlines to collect (from
higher ticket prices), as was the case with the original
scheme (Nero and Black, 2000).
One somewhat related proposal that we have been trying
to attract research funding involves a scientically based
investigation of a novel technique for the assessment and
treatment of aircraft noise impacts. The primary application of the outcome of aircraft noise impact assessment is
the allocation of noise insulation treatments to adversely
affected residences. In Sydney, these processes have been
ongoing for some years now. However, there are inequities
that arise in the insulation treatment allocation processes.
A classic example of this is the situation where a critical
ANEF noise contour falls along the center-line of a
residential street such that residences on one side of the

273

street are eligible for noise insulation treatments while

those on the other side are not eligible. One idea is
essentially that an interest-free loan could be provided for
insulation treatments to residences, including various
provisions for repayment of the loan. For example, such
a scheme could propose arrangements for not having to
repay the loan should the aircraft noise impacts on the
residence increase by an (as yet) undetermined amount
over an (as yet) unknown period of time. There are at
present many unknowns associated with this idea and
further research could be directed at a scientically based
exploration of these ideas.
In Australia, the ndings of our research into aircraft
noise and stress and hypertension are most relevant to the
Airport Act 1996, Part 6, s. 116, where an airport owner
must draft an airport environment strategy that must
specify: the methods of study, review, and monitoring of
the environmental impacts, and the methods to prevent,
control or reduce environmental impacts. We have already
conrmed the hypothesis that aircraft noise in Sydney has a
statistically signicant impact on health and well-being
including stress and hypertension. Under this Airport Act,
strategies would need to be designed to mitigate the adverse
impacts of noise on public health. Other international
studies that link aircraft noise and stress, most notably the
HYENA study (http://www.hyena.eu.com) would add
support that it is the responsibility of airport management
to include a health impact assessment as part of airport
environmental management.
To our knowledge, no study has attempted to determine
how stress from airport noise can be alleviated from other
than pharmaceutical drugs. For example, a recent extensive
analysis of more than 800 000 health insurance data sets
of the Cologne/Bonn airport region, which revealed a
statistically signicant increased probability of the prescription of anti-hypertensive drugs for residents of areas
considerably affected by night aircraft noise. Aircraft noise
potentially disturbs (or annoys) daily activities of residents
living in the vicinity of the airports, but there have been no
studies reported in the literature that apply cognitive
behavioral therapy (CBT) as an intervention to alleviate
stress experienced by residents from long-term exposure to
aircraft noise living around commercial or military airports. Behavior modication techniques to alleviate stress
associated with environmental noise have been conducted
but this was in an ICU setting in Rhode Island, USA
(Kahn et al., 1998).
There are stress management techniques that we have
identied for trial in the proposed research from the
cognitive behavioral therapy literature, especially on
chronic pain management (Morley, 2004; White, 2001)
and on severe asthma (Manocha et al., 2002). There
is a recent surge in interest in mindfulness practice
and principles which have their origins in many contemplative and philosophical traditions: this can be attributed to the publication of some well-designed empirical
evaluations of mindfulness-based cognitive therapy

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

(Melbourne Academic Mindfulness Interest Group, 2006).

Although there are now more than 200 mindfulness-based
stress reduction (MBSR) programs as therapeutic invention in mainstream health care settings, including physicians and psychotherapists, in the USA (Kabut-Zinn,
1999), most published studies lack randomized control
trials (Roth and Robbins, 2004).
A study of inner-city patients in the Community Health
Centre of Meriden (Connecticut) is of particular pertinence
for further research into the evaluation of alternative
techniques (Roth and Robbins, 2004). An intervention
group of 68 patients (most with chronic pain) completed
the SF-Health survey (plus questions on sleep quality and
family harmony) before and after completing the 8-week
MBSR program developed at the University of Massachusetts Medical Center. The course met 2 h each week, and
patients were given supporting tapes and asked to devote
3045 min each day for 6 days a week on breathing
meditation, walking meditation, eating meditation, and
Hatha yoga. The completion rate was 66%, slightly above
the 60% from two other inner-city studies, but less than the
8595% completion rate of hospital-based studies.
Therefore, one hypothesis that we hope to test in future
research is that the stress and other health problems caused
by aircraft noise can be ameliorated by non-chemical
complementary medicine stress management interventions.
This hypothesis is based on understanding the neuroscience
of the brain and its response to noise as an environmental
stressor. We are planning to implement an intervention
with aircraft noise affected residents of Sydney (a parallel
research proposal will examine stress in the workplace and
evaluate SMI). In the proposed study to examine the
effective SMI and aircraft noise, there will be a control
group, also affected by aircraft noise, not receiving the
intervention. The intervention planned includes a modied
8-week course from the University of Massachusetts that
includes relaxation techniques, yoga (Roth and Robbins,
2004) or Mental Silence-based Sahaja Yoga Meditation
(Manocha, et al, 2002). The respondents could be
measured at baseline, 6 months and 12 months with the
SF-36 survey and questionnaires on hypertension and
stress, and a comparison of the effectiveness of the methods
established.
There are public policy implications arising from these
research proposals. The signicance of this research, if the
hypothesis proves correct, is that it will provide a patientcentered and cost-effective method to improve the quality
of life of residents located near busy commercial or military
airports. The intervention has the potential for to provide a
complementary health program applicable to any airport
where residences are located close to the airport. National
governments and their research funding agencies should
support scientic research into the effectiveness of alternative stress management interventions. Airport managers,
in the preparation of environmental management plans,
should fund, as part of health impact assessment and
mitigation, such stress management programs to comple-

ment current initiatives in airport compatible land use

planning and acoustical treatment of buildings.
7. Conclusions
An overview of a major, multi-disciplinary research
study into aircraft noise and the quality of life of residents
surrounding a busy international airport have been
provided. The best way to establish any causality between
exposure and disease is to conduct analytic epidemiological
studies (such as the case-control study, the cohort study,
or the clinical trial study). Our study is limited to the
descriptive epidemiological study according to time and
budget constraints. This research applied a cross-sectional
study with a matched control group as a tool to explore the
core research questions: the relationship between healthrelated quality of life and aircraft noise, and long-term
exposure to aircraft noise and adult high blood pressure
levels. A social survey with self-assessed health status
(SF-36) has been undertaken in aircraft noise exposed
residential suburbs and in a control suburb not affected by
aircraft noise.
Noise measurements were undertaken in this area that
lead to the development of a novel metricthe noise gap
index that includes considerations of background environmental noise levels. The noise gap index, NGI, has been
developed as an index that is easy to understand by the
layperson, and that also quanties relevant aspects of the
potential impacts of aircraft noise. This paper presents a
preliminary analysis of the relationship between aircraft
noise annoyance and the NGI. It was found that subjects
residing in high and medium background environmental
noise areas were more likely to be annoyed by the same
aircraft noise exposure level than subjects living in low
background environmental noise areas. This might reect
the characteristics of people suffered from high level of
background environmental noise to be more vulnerable to
aircraft noise than people from low background environmental noise areas.
Our research concluded that: (a) long-term aircraft noise
exposure was signicantly associated with chronic noise
stress; and (b) chronic noise stress was signicantly
associated with prevalence of hypertension. After controlling for potential confounding factors, subjects (aged
1587) who have been chronically exposed to high aircraft
noise level have the odds of 2.61 (95% CI 1.424.80) of
having chronic noise stress, and these chronic noise stress
person have the odds of 2.74 (95% CI 1.554 .84) of having
hypertension compared with those without chronic noise
stress. Further research is needed that will validate, and,
where appropriate, translate the survey instrument and
apply it to other Australian and international airports.
Given the ethnic composition of neighborhoods surrounding Sydney Airport our questionnaire was translated into
Arabic and Greek.
Both the assessment and the treatment of aircraft noise
impacts around airports represent important issues for all

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D.A. Black et al. / Journal of Air Transport Management 13 (2007) 264276

levels of government, for the general community, for

organizations involved with airport operations and for
many other parties. Specically for the general community,
this research will inform public policy initiatives that might
lead to an alternative aircraft noise assessment procedure
(self-assessed health-based criterion to replace annoyance) and more appropriate mitigation strategies, such as
the cognitive behavioral therapies outlined in Section 6, to
ultimately improve the quality of life for those exposed to
aircraft noise.
Acknowledgments
The authors thank the residents of Sydney who
participated in this survey. An earlier draft of this paper
beneted from comments by anonymous referees.
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