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Year : 2002  |  Volume : 5  |  Issue : 17  |  Page : 53-62
Estimated leisure-time noise exposure and hearing symptoms in a finnish urban adult population

1 Tampere Regional Institute of Occupational Health, Tampere, Finland
2 Department of Environmental Sciences, University of Kuopio, Kuopio, Finland

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The aim of this study was to determine a statistical measure for total weekly noise exposure from leisure-time noise activities in a Finnish urban adult population. The subjects´ time consumed in noisy activities, and their self-evaluated loudness of the activities converted into equivalent noise levels of the activities were used in the calculation of weekly noise exposure levels. Self-reported hearing symptoms (i.e., tinnitus, pain in the ear) and hearing loss due to noise exposure were also asked with the questionnaire. No measurements of sound level or hearing loss were made in this study. Forty-one per cent of subjects were estimated to be exposed to noise at levels over 75 dBA, and 9% of the subjects had weekly exposure that was over 85 dBA. The incidence of hearing symptoms seemed to correlate with increased noise dose and age. The noisiest leisure-time activities were going to night-clubs and pubs, using home tools, playing in a band or orchestra, shooting and attending or participating in motor sports.

Keywords: adult population, hearing symptoms, leisure-time, noise exposure

How to cite this article:
Jokitulppo J, Bjork E. Estimated leisure-time noise exposure and hearing symptoms in a finnish urban adult population. Noise Health 2002;5:53-62

How to cite this URL:
Jokitulppo J, Bjork E. Estimated leisure-time noise exposure and hearing symptoms in a finnish urban adult population. Noise Health [serial online] 2002 [cited 2023 Jun 7];5:53-62. Available from: https://www.noiseandhealth.org/text.asp?2002/5/17/53/31834

  Introduction Top

Nowadays leisure-time noise is an ever-present aspect of our environment. Concern about exposure to leisure-time noise has been in the spotlight ever since the 1980s when the first portable stereos were placed on the market (Axelsson et al. 1981a; Catalano and Levin 1985; Medical Research Council Institute Of Hearing Research, 1986). The occupational noise exposure is well known and legislation evaluates daily noise exposure of 85 to 90 dB to be a risk to hearing (EEC, 1986, ACGIH, 2001). The noise levels in particular leisure time environments can be as high or even higher than noise levels at work (Brown and Yearout, 1990). For example, the sound levels of a disco can reach over 100 dB easily, while the mean noise dose could be as high as 95 dB (Bickerdicke and Carter, 1978).

Studies of hearing handicaps among teenagers have indicated an increased incidence of such handicaps due to leisure-time noise exposure (Axelsson et al. 1981a; Rytzner & Rytzner 1981; Lees et al. 1985; Borchegrevink 1990). It is certain that exposure to leisure-time noise involves a risk of hearing loss also in other age groups. However persons tolerance for noise depends on age, noise exposure history and other personal factors (Passchier-Vermeer and Passchier 2000).

Leisure-time noise exposure is more difficult to evaluate than exposure to occupational noise because of the great variety of sound levels of leisure-time activities (Axelsson et al, 1981b; Clark 1991). In 2000 Smith. et al. published their study considering the prevalence and type of social noise exposure in young adults (18-25 year olds). They found that 19 % of subjects were exposed to significant noise from social activities. They also concluded that most of the exposure comes from nightclubs rather than personal stereos.

In spite of knowing the harmful effects of high leisure-time noise levels in teenagers and young adults, there is very little information available on time spent in different leisure -time activities and estimation of leisure-time noise exposure in the adult population. Furthermore, the information is lacking in terms of the total noise exposure of all possible noisy leisure-time activities and hearing disorders related to leisure­time noise exposure. Some studies have been published that have made an overall estimation of leisure-time noise exposure (Meyer-Bisch, 1996; Jokitulppo et al. 1997; Smith et. al 2000), but the studies were focused on young people.

There is also very little information about the subjective estimation of the loudness of noise encountered in leisure-time activities. Jokitulppo et. al. (1997) used subjective estimations of loudness (scaling 1 'quiet' to 5 'very loud') of activities in the calculation of the leisure-time noise exposures for teenagers (n=405). They converted the values of 1 to 5 to equivalent noise levels according to literature and calculated the total weekly noise exposures for all the leisure­time activities. It may be possible to use people's estimates to evaluate their exposure levels to noise to some extent. One researcher tried to determine the relationship between loudness and equivalent sound pressure levels of leisure-time activities (Madetoja, 1998). He found statistically significant differences for both the rating of loudness and the equivalent sound level and age. He measured 9 different musical events and sport games (ice-hockey and volley ball games) and asked people (n=100 per each event) to estimate the sound level of the events on scale from 1 'quiet' to 5 'very loud'.

The aim of this study was to describe the noisy leisure-time of working age adults (25 to 58 year old citizens) in the Helsinki metropolitan area and to estimate personal weekly noise exposure levels, and the effects of different leisure-time activities on weekly noise exposure. Self reported hearing symptoms due to noise exposure, were also studied.

  Materials and Methods Top

The study was carried out using a noise exposure questionnaire following the format developed by Jokitulppo et al in 1997. The data of Helsinki followed the general sampling design and the base sample was formed from Finnish-speaking citizens, aged 25-55 years and living in the Helsinki metropolitan area (Helsinki, Espoo, Vantaa, Kauniainen). In the first stage the postal questionnaire was sent to randomly selected subjects of 25 to 55 years olds in Helsinki area. The addresses of subjects (approximately 2500) were ordered from the Central Statistical Office of Finland. The questionnaires (see Appendix A) was mailed to 2523 subjects in the Helsinki area by the EXPOLIS (Exposure Distributions of

Adult Urban Populations) researchers (Jantunen et al. 1998) during May and June of 1996. The subjects sent the completed questionnaires in prepaid envelopes to researchers to be analysed. Of the 1519 questionnaires (response rate of 60%) was returned in this study, 1323 were accepted and 196 were rejected because of missing information.

In order to evaluate how well population sample represented the overall population, the distributions of gender, age, marital status and education of respondents of EXPOLIS base samples (25-55 years old) of the city, were compared to the same age population of the city, respectively. In Helsinki some demographic characteristics of the base sample were available from the census. Therefore it was possible to evaluate the nonresponse bias in Helsinki samples.

The leisure-time questionnaire was divided into two sections. The first section included questions on the time spent (in hours) during the past week in different leisure-time activities and the subjective relative rating of loudness of the leisure-time activity on a scale from 1 'quiet' to 5 'very loud'. The second part included questions about tinnitus, pain in the ear and hearing loss (HL) caused by noise. The alternatives for self-experienced hearing symptoms were: permanently, sometimes during the noise exposure, due to something other than noise and no experience of symptoms (Appendix A).

The leisure-time noise exposure was calculated using the duration of exposure in leisure-time noise activities and the subjective estimated loudness levels (from 1 to 5) of each activity. The regression equation of Madetoja (1998) was used in this study calculations for the age correction. The regression coefficient describes the difference between two consecutive categories or the difference of equivalent noise level (in decibels) when subjective rating of relative loudness is bigger with one unit. The basic regression analysis results in the equation of

y = a + bx, (1)

where a is a constant and b is the regression coefficient.

In the regression analysis Madetoja (1998) concluded with the following equation:

L=48.7+10x[A-0.011x(age-45)] (2)

where , L = the equivalent A-weighted sound pressure level, A = subjective rating of relative loudness on a scale from 1 'quiet' to 5 'very loud'.

For example, the calculated equivalent decibel values for the subjective ratings of a person 30 years by equation 2 is: 1=60, 2=70 , 3=80, 4=90 and 5=100 dBA. For a person 50 years of age the corresponding levels are 58, 68, 78, 88 and 98 dBA. There seemed to be a 2-dBA difference between subjects 30 and 50 years of age according to Madetoja (1998). In this study the rating of 1 to 5 was transformed into A-weighted equivalent sound pressure levels for each activity according to the regression equation given in (2).

Some generalizations of equivalent levels of leisure-time activities were done. All the equivalent levels were assumed as a steady type of noise. The shooting impulses were not asked for separately. The average equivalent levels of shooting firearms and other possible impulsive type of noises were regarded as the same equivalent levels as other leisure-time activities during the week for simplifying the calculation.

With the use of the Microsoft © Excel computer program, the weekly noise exposure levels of each leisure-time activity were calculated using the sound energy principle referring for working week of 40 hours. Also the total noise exposure levels (noise doses) of all the activities was calculated. The weekly noise exposure levels were compared with 85 dBA risk limit for hearing handicap when working (EEC, 1986, ACGIH, 2001) assuming the exposure at the same during the whole lifetime.

Basic statistical analyses were used to describe the data. The frequency tables were analysed with χ2- test. The difference in the attendance to leisure-time activities, time spent on these activities, loudness level estimations of the activities, weekly noise exposures and hearing symptoms were analysed with gender and age using χ2- test and one-way analysis of variance­test. Also the relation between weekly noise exposure level and hearing symptoms was analysed with one-way analysis of variance. The limit for statistical significance was set at 0.05. All the statistical analyses were performed using the SPSS 10.0 for windows (SPSS Inc.,1999).

  Results Top

A total of 2523 questionnaires were sent and 1519 (response rate of 60%) were returned. 1323 were accepted as 196 had to be rejected due to missing information.. This study's usable response rate of 52% followed the same possible sampling bias as described by Rotko et. al. (2000). In this study the subjects were between the ages of 28 and 58 years (men 561 and 762 women). The men, the youngest (25-35 years old), unmarried, with no children and those living in small apartments (≤60m 2 ), had the lower response rate compared to Helsinki city people in general.

All the subjects (n=1323) attended or participated in at least one or several leisure-time activities during the week. Most time was spent listening to home stereos, moving in traffic and driving a car during the week, whereas the least time was spent exercising to accompaniment of music, using home tools outdoors and listening to concerts [Table - 1].

The statistical differences between men and women with respect to the leisure-time activities were tested with the χ 2 - test. The men were statistically more interested than the women in playing in a band, going to night-clubs and pubs and attending or participating in motor sports , driving a car, attending or participating in indoor sports events, using home tools outdoors (all p- values < 0.001) and practising a musical instrument (p < 0.05). Women on the other hand, travelled by bus/train/underground, exercised to the accompaniment of music, used home tools indoors (all p-values < 0.01) and went to concerts and movies or theatre (p < 0.05) more often than the men.

Playing in a band, going to night-clubs and pubs, going to movies or theatre, exercising to the accompaniment of music and listening to a stereo was statistically more frequent (all p­values < 0.001 among the younger age groups (under 30 years and 30-39 years) than the older age groups (40-49 years and over 50 years) on the basis of the one-way analysis of variance.

The subjects considered shooting firearms, playing in a band, attending or participating in motor sports events and using home tools outdoors to be the 'loudest' leisure-time activities [Figure - 1]. The less noisy activities were estimated to be practising a musical instrument and attending or participating in indoor sports events. There were no statistical differences in the rated loudness between the genders or age groups in the one-way analysis of variance.

The calculated weekly noise exposure medians of the different activities varied from 55 to 80 dBA [Figure - 2]. The highest exposure levels were found for shooting firearms, playing in a band, using home tools outdoors, and attending or participating in motor sports events.

The median of the total weekly noise exposure was 73 dBA for all the subjects and of all the activities [Figure - 3]. Altogether 9.1% of the subjects were exposed to noise levels at or over the 85 dBA risk limit for hearing handicap. 22.8% were exposed to levels over 80 dBA, and for 40.6% the noise levels were above 75 dBA [Figure - 3].

There was no statistically significant difference between the men and women in any of the age groups in the χ 2 -test. However, the age groups under 30 years (median 79.5 dBA) and 30-39 years (median 76.0 dBA) had statistically significantly (p < 0.001) higher weekly noise exposure levels than the 40-49 year (median 72.0 dBA) and over 50 year (median 71.0 dBA) groups [Figure - 3] and [Table - 3].

The incidence of hearing disorders varied with gender and age. The men reported both tinnitus (p < 0.001) and hearing loss (p < 0.05) more often than the women (men: 3.4% permanent tinnitus, and 29.8% with tinnitus in noise exposure; women: 2.0% permanent tinnitus and 18.5% with tinnitus in noise exposure; men: 11.8 permanent hearing loss, and 5.9% with hearing loss in noise exposure; women: 7.1% permanent hearing loss and 5.2% with hearing loss in noise exposure). The women reported pain in the ear more often than the men (p < 0.001, women: 0.2% with continual pain and 7.7% with pain in noise exposure; men: 0% with continuous pain and 7.1% in noise exposure) in χ 2 -test.

The incidence of tinnitus in noise exposure was more frequent among the subjects in the younger age groups in the one-way analysis of variance­test. The subjects under 30 years of age reported tinnitus statistically significantly more often (p<0.001) in noise exposure than did the subjects of 40-49 years and over 50 years of age. Also the subjects 30-39 years of age also had tinnitus more often (p<0.001) in noise exposure than did those 40-49 years and over 50 years of age [Table - 3]. Permanent hearing loss seemed to increase with age too. The oldest age group, over 50 years, had self-reported permanent hearing loss statistically more (p<0.001) often than any other age group [Table - 3].

The median noise levels were calculated for each hearing symptom group [Table - 2]. The calculated estimated noise exposure was greater in the groups with temporary tinnitus and pain in the ear than in those with no tinnitus and no pain in the ear, respectively (with one-way analysis of variance-test with p-value of p<0.001). However, also noise exposure level in the groups with temporary tinnitus and pain in the ear caused by something other than noise was also statistically significantly higher (p<0.001) compared to the group with no symptoms at any time.

  Discussion Top

This study describes the leisure-time noise exposure of an urban adult population in Finland in May and June of 1996. Rotko et. al (2000) concluded that the random sample in Helsinki represented the Finnish-speaking population (>90% of the total population), between 25 and 55 years of the Helsinki metropolitan area. The women were somewhat over represented, but age distribution represented in line with the overall population. Despite minor differences,it is felt that the exposure results could be generalized for the whole population and used for modelling.

Nine per cent of the adults were estimated to be exposed to leisure-time noise at a level over 85 dB, which is the risk limit for hearing handicap according to the Finnish legislation in lifetime exposure. Our earlier study estimated that 50% of teenagers were exposed to equivalent sound levels of over 85 dBA during the week (Jokitulppo et al.1997). The difference between these two studies can be partly explained by the different calculation method used. If the data considering the teenagers is calculated according to the method used in this study (using equation 2), about 40% of teenagers is estimated to be exposed weekly to equivalent sound levels over 85 dBA .

The difference in the result of these studies may also be due to the total time used for the activities in question. Teenagers were more active spending more time in leisure-time activities and attending several activities than adults. In this study, the weekly noise exposure levels seemed to be related to age also. The younger subjects had higher exposure levels than the older subjects, primarily due to the younger subjects interest in the loudest leisure-time activities, for example, going to night-clubs or pubs, playing in a band, and exercising to the accompaniment of music. Regular attendance at concerts decreased after 30 years of age and it was only occasional after the age of 40 years in study carried out in France (Meyer-Bisch, 1996). In our study, subjects spent about a 9 hours a week (average) listening to home stereos, and this activity raised the basic total noise dose, especially among the young subjects. Attending and participating in motor sport events, shooting firearms, band playing and operating home tools were also very significant noisy leisure-activities in our study. According to our earlier study (Jokitulppo et al.1997), the noisiest activities were also going to discos and pop-concerts, attending and participating in motor sports events, shooting firearms, playing in a band and listening to home stereos and portable stereos.

The incidence of hearing symptoms caused by leisure-time noise seemed to correlate with increased noise dose. Tinnitus was a general symptom among the young adults. Tinnitus can be considered the primary hearing symptom of noise exposure (Davis 1989; Mitchell and Michael, 1991; West and Evans, 1990). Permanent tinnitus was reported by 2.6% of the subjects and tinnitus during noise exposure was experienced by 23.2%. In addition permanent hearing loss was reported by 9.1% of the subjects, and hearing loss sometimes during noise exposure was experienced by 4.4% of the adults in this study. Jokitulppo et al. (1997) reported tinnitus often for 2.5% of their subjects and sometimes for 69.6%, whereas temporary hearing loss was experienced often by 2.7% and sometimes by 42.5 % of the teenagers between the ages of 12 and 17 years. In a study by Davis (1989) prolonged spontaneous tinnitus was found for 10% of the adults aged 17-80 years, hearing loss of at least 25 dB was determined for 16% of the subjects and self-reported hearing

disability was reported by 26%. Axelsson and Ringdahl (1989) reported tinnitus often or always for 14.2% of their subjects between the ages of 20 and 80 years.

The prevalence of hearing loss has been found to be greatly dependent on age (Mitchell and Michael 1991; Axelsson and Ringdahl, 1989). In our study the subjects over 50 years of age had permanent hearing loss more than any other age group, which could be partly explained for the accumulation effect of noise exposure. Furthermore, part of the hearing disorders may not be the result of the exposure to noise. For example, the percentage of hearing handicap sometimes caused by other reasons than noise were at same as it was with category of permanent hearing handicap from noise exposure. Same situation exists with the tinnitus, as most people who experienced it did not relate their tinnitus with the noise exposure.

The noise exposure levels were statistically significantly higher in the group with tinnitus and pain in the ear caused by something other than noise. This result leaves the question of the reasons open. It is possible that spontaneous tinnitus and temporary hearing loss during noise exposure are more-specific hearing symptoms of exposure to leisure-time noise than permanent tinnitus or permanent hearing loss. Pain in the ear could be related to exposure to acute noise, but it may also have had other causes (e.g. otitis media). In addition it could have resulted in higher subjective rating levels being recorded for the leisure noise activities, and have contributed to the higher total weekly noise exposure levels. Nevertheless the results provide information on the total weekly noise exposure of the subjects during one week in the spring and summer of 1996. There may however, be seasonal differences in the participation in certain leisure­time activities. The total noise history of the subjects was not covered by the questionnaire, and therefore seasonal differences could have an effect on the results in relation to the hearing symptoms. In addition no information was gathered on exposure to single noise events such as fireworks, or the daily use of equipment such as mobile phones. Also the generalization of equivalent noise levels as the steady noise leaves the question of estimation of loudness level of each leisure-time activity somewhat open. There are activities such as motor sports and movies, where noise levels vary during the time and estimation of loudness may be based on relatively short periods of time of action.

However the results of this study gives one type of method to evaluate the total leisure-time noise exposure, in the adult population.

  Conclusion Top

According to the calculations of this study 9%of the adult population is under the risk of hearing handicap as a result of exposure to noise in leisure time activities, if the noise exposure continues at the same level during a lifetime. Participation in the noisiest leisure activities seemed to be higher among subjects under 30 years of age. The results seem to confirm the assumption that people attend the noisiest activities, such as going to night-clubs or pubs during a certain period their lifetime. Exposure to leisure-time noise may be a very significant factor for all age-groups when cumulative noise exposure from both occupational and non­occupational activities are taken into account. It could increase the chances of hearing loss but the question remains open as our study does not include questions on occupational noise exposure and the total noise history.

In order to obtain overall information on leisure­time noise exposure, data should be gathered from a representative sample of the entire population, including all age groups, and the total personal noise history and hearing levels of the subjects should be taken into account. More information of equivalent sound levels of some leisure-time activities (such as equivalent level of listening to home stereos and movies) and estimation of loudness levels of leisure-time activities is also needed.[23]

  References Top

1.ACGIH: Threshold limit values for Physical Agents in the Work Environment: Adapted by ACGIH 2001. ACGIH, Cincinnati, OH 2001.  Back to cited text no. 1    
2.Axelsson A., Jerson T., Lindberg U., Lindgren F. (1981a) Early noise induced hearing loss in teenage boys. Scand. Audiol. 10: 91-96  Back to cited text no. 2    
3.Axelsson A., Jerson T., Lindgren F. (1981b) Noisy leisure time activities in teenage boys. Am Ind Hyg. Assoc. J. 42: 229-233  Back to cited text no. 3    
4.Axelsson A., Ringdahl A. (1989) Tinnitus - a study of its prevalence and characteristics. Br. J. Audiol. 23: 53-62  Back to cited text no. 4    
5.Bickerdicke J. Carter A. (1978) A survey of sound levels in discotheques -A preliminarey report. Environmental Health 1978: 136-137.  Back to cited text no. 5    
6.Borchegrevink H. M. (1990) Horsel Stoy of larmskade [Hearing, noise and hearing handicap]. Nord. Med. 105: 184-186 (in Norwegian)  Back to cited text no. 6    
7.Brown P. J., Yearout R D. (1990) Impacts of leisure noise levels on safety procedures and policy in the industrial environment. Int. J. Industrial Ergonomics 7: 4: 341-346  Back to cited text no. 7    
8.Catalano P. J., Levin S. M. (1985) Noise induced hearing loss and portable radios with headphones. Int. J. Ped. Otorhinolaryngol. 9: 59-67  Back to cited text no. 8    
9.Clark W.W. (1991) Noise exposure from leisure activities: a review. J. Acoust. Soc. Am. 90: 175-181  Back to cited text no. 9    
10.Davis A. C. (1989) The prevalence of hearing impairment and reported hearing disability among adults in Great Britain. Int. J. Epidemiol.18: 4:911-917  Back to cited text no. 10    
11.EEC: Counsil Directive of 12 May 1986 on the Protection of Workers from the Risks related to Exposure to Noise at Work. EEC Counsil Directive 86/88(EEC. EEC, Brussels 1986.  Back to cited text no. 11    
12.International Organization for Standardization (ISO) (1990) 1999 Acoustics - Determination of Occupational Noise Exposure and Estimation of Noise-Induced Hearing Impairment. ISO, Geneva,1990  Back to cited text no. 12    
13.Jantunen M. J., Hanninen O., Katsouyanni K., Knpeel H., Kuezli N., Lebret E., Maroni M., Saarela K., Sram R., Zmirou D. (1998) Air pollution Exposure in European Cities: the EXPOLIS -study. J. Exposure Analysis and Environmental Epidemiology 8: 4  Back to cited text no. 13    
14.Jokitulppo J., Bjork E., Akaan-Penttila E. (1997) Estimated leisure noise exposure and hearing symptoms in Finnish teenagers. Scand. Audiol. 26: 257-262  Back to cited text no. 14    
15.Lees R. E. M., Hatcher Roberts J., Wald Z. (1985) Noise induced hearing loss and leisure activities of young people: a pilot study. Can. J. Public Health 76: 171-173  Back to cited text no. 15    
16.Madetoja S. (1998) Vapaa-ajan melulle altistuminen ja aanekkyyden arviointi. [Exposure and subjective rating of loudness in noisy leisure time activities] Department of Environmental Sciences, University of Kuopio, Kuopio, 52 p. (In Finnish)  Back to cited text no. 16    
17.Medical Research Council Institute of Hearing Research. (1986) Damage to hearing arising from leisure noise. Br. J. Audiol 20: 157-164  Back to cited text no. 17    
18.Meyer-Bisch C. (1996) Epidemiological evalutation of hearing damage related to strongly amplified music (personal cassette players, discotheques, rock-conserts) - high-definition audiometric survey on1364 subjects. Audiology 35: 121-142  Back to cited text no. 18    
19.Mitchell S. M., Michael J. C. (1991) Subspecialty clinics: otorhinoloryngology, tinnitus. Mayo Clinic Proceedings 66: 6: 614-620  Back to cited text no. 19    
20.Passchier-Vermeer W., Passchier W. (2000) Noise and public health. Environ. Health Perspec. 108: 1: 123-131  Back to cited text no. 20    
21.Rytzner B., Rytzner C. (1981) Schoolchildren and noise. Scand Audiol 10: 213-216  Back to cited text no. 21    
22.Smith P. A, Davis A, Ferguson M, Lutman M. (2000) The prevalence and type of social noise exposure in young adults in England. Noise and health. 6: 41-56.  Back to cited text no. 22    
23.West P. D. B., Evans E. F. (1990) Early detection of hearing damage in young listeners resulting from exposure to amplified music. Br. J. Audiol. 24: 2: 89-103  Back to cited text no. 23    

Correspondence Address:
Jaana Jokitulppo
Finnish Institute of Occupational Health, P.O Box 486, FIN-33101 Tampere
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Source of Support: None, Conflict of Interest: None

PMID: 12537835

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  [Figure - 1], [Figure - 2], [Figure - 3]

  [Table - 1], [Table - 2], [Table - 3]

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