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Original article
peer-reviewed

Systematic Review 2013: Association Between Wind Turbines and Human Distress



Abstract

Background and Objectives: The proximity of wind turbines to residential areas has been associated with a higher level of complaints compared to the general population. The study objective was to search the literature investigating whether an association between wind turbines and human distress exists.

Methods: A systematic search of the following databases (EMBASE, PubMed, OvidMedline, PsycINFO, The Cochrane Library, SIGLE, and Scirus) and screening for duplication led to the identification of 154 studies. Abstract and full article reviews of these studies led to the identification of 18 studies that were eligible for inclusion as they examined the association of wind turbines and human distress published in peer-review journals in English between 2003-2013. Outcome measures, including First Author, Year of Publication, Journal Name, Country of Study, Study Design, Sample Size, Response Rate, Level of Evidence, Level of Potential Bias, and Outcome Measures of Study, were captured for all studies. After data extraction, each study was analyzed to identify the two primary outcomes: Quality of Study and Conclusion of Study Effect.

Results: All peer-reviewed studies captured in our review found an association between wind turbines and human distress. These studies had levels of evidence of four and five. Two studies showed a dose-response relationship between distance from wind turbines and distress, and none of them concluded no association.

Conclusions: In this review, we have demonstrated the presence of reasonable evidence (Level Four and Five) that an association exists between wind turbines and distress in humans. The existence of a dose-response relationship (between distance from wind turbines and distress) and the consistency of association across studies found in the scientific literature argues for the credibility of this association. Future research in this area is warranted as to whether or not a causal relationship exists.

Introduction

Unlike most industries, the global wind industry grows annually by 21% despite the recent economic challenges. Canada is the ninth largest producer of wind energy in the world with a 45-fold growth in the industry in the year 2012 relative to 2000 [1-2].

The invention of the wind turbine as an electricity generating machine dates back to 1887 by James Blyth, a Scottish academic, and it used to light his holiday home in Marykirk, Scotland [3]. Wind turbines were at first welcomed by the public as being a source of energy that is both renewable and carbon emission-free. The need to generate electrical power on a large scale was the main driver in establishing the industrial wind turbines (IWTs) [4].

Wind turbines can be located as solo wind or in groups called "Wind Farms". In either form and for various reasons (e.g., minimizing transmission costs), wind turbines are usually positioned in close proximity to residential areas (farms, villages, towns, and cities). This proximity to residential areas has been associated with a higher level of complaints compared to the general population [5]. These complaints are coined in research conducted and articles written on the subject under different terms, such as "Extreme Annoyance", "Wind Turbine Syndrome (WTS)", and "Distress", among others. In this article, the term "distress" will be used unless we are quoting other articles.

Complaints resulting from the proximity to wind turbines vary in their nature, and distress is often attributed to different mechanisms, such as noise, visual impact, sleep disturbance, infrasound, and others [5-7]. Noise is the complaint that has been studied most often, especially given that environmental noise has become one of the major public health concerns of the 21st century [8].

These complaints triggered the debate about possible mechanisms of effect. Several hypothetical mechanisms have been suggested to explain the possible link(s) between wind turbines and the reported distress; some of these hypotheses attribute distress to one or more of the following: chronic noise exposure, infrasound effect, visual impact, perceived lack of control over noise, attitudes, personality, and age [5-6].

To assess the possible effects of wind turbines on human health, different outcome measures have been suggested, including annoyance, sleep disturbance, and cortisol levels. An alternative approach to health assessment involves the subjective appraisal of health-related quality of life, a concept that measures general well-being in all domains, including physical, psychological, and social domains [8].

Although the focus on researching mechanisms of effect may very well be a good first step to identifying the cause, finding an association is a cornerstone of establishing any causality, according to Hill's Criteria of Causality [9]. A key missing piece of the scientific literature is that of an up-to-date and thorough review that examines the possible existence of an association between wind turbine and human distress. Therefore, the objective of our study was to search the literature investigating whether or not an association between wind turbines and human distress exists.

Materials & Methods

Study design 

A systematic review of the existing literature of published peer-reviewed studies investigating the association between wind turbines and human distress between January 2003 - January 2013 was undertaken. This study was conducted as a collaboration between the Northern Ontario School of Medicine (NOSM), Sudbury, and Grey Bruce Health Unit, Owen Sound, Ontario, Canada.

Eligibility criteria

Inclusion Criteria:

- Peer-reviewed studies

- Studies examining association between wind turbines and distress

- Studies published in peer-review journals

- English language

- Studies involving humans

- Studies published between January 2003 - January 2013

Exclusion Criteria:

- Non-English language reports

- Investigations reporting interim analysis that did not result in stopping the study

- Secondary and long-term update reports

- Duplicate reports

- Cost effectiveness and economic studies

- Engineering studies

- Studies involving animals

Information sources

The following bibliographic databases were searched: EMBASE, PubMed, Ovid Medline, PsycINFO and The Cochrane Library, SIGLE, and Scirus, the last two of which deal with grey literature (materials that cannot be found easily through conventional channels, such as publishers; for example, thesis, dissertations, and unpublished peer-reviewed studies). Authors who published multiple studies included in our review were also contacted to identify any additional studies.

Search

Two search approaches were taken: subject heading and keyword searching. Electronic keyword searches were conducted in EMBASE, PubMed, PsycINFO, The Cochrane Library, SIGLE, and Scirus for published peer-reviewed studies according to the study inclusion criteria. All search strategies included the same search terms and combinations ([Wind power OR wind farm OR air turbine OR wind turbine] AND [Distress OR annoyance, sleep disturbance, noise OR sound OR infrasound OR sonic OR low-frequency OR acoustic OR hear OR ear OR wind turbine syndrome]).

Appropriate subject headings and limiters were identified in consultation with the corresponding author and were used to conduct electronic searches in the following bibliographic databases: EMBASE, PsycINFO, Ovid Medline, and PubMed. In order to retrieve all relevant published studies, subject headings were exploded; select subject headings were also chosen as the major focus of the search. Searches were refined by setting a publication restriction of 2003 to current and limiting results to humans.

Study selection

Study selection was performed in three stages (Figure 1):

Stage 1: Database Search

The studies that were identified through the database subject heading search (194 studies), the keyword search (142), and other sources (13 studies) were screened for duplication, yielding 154 studies.

Stage 2: Titles and Abstract Review

Screening of the titles and abstracts of the 154 retrieved studies was conducted by one qualified reviewer (the first author) in order to exclude any obvious non-eligible studies. Of these, 40 studies were deemed eligible for inclusion in a full article review.

Stage 3: Full Article Review

Two qualified reviewers conducted a full article review of the 40 studies. This review had two goals: first, to exclude any studies of non-eligible trials; second, to extract data on specific variables for further analyses. Of the 40 studies, 18 studies were deemed eligible for inclusion in our analysis.

Data collection process

Data extraction was conducted by a qualified reviewer (the first author) during the full article review of the 18 included studies. The source of data in the individual studies was confirmed by contacting investigators who authored multiple studies included in the review, due to the aggregated weight of these studies potentially affecting our conclusion. The confirmation aimed to verify whether the data examined in the individual studies were collected from a single population and used in more than one study, or from different independent populations.

Data items

Primary Outcomes:

- Quality of Study: The quality of the study was categorized into three groups (Low, Moderate, High) (categorical variable)

- Conclusion of Study Effect: (whether the study concluded association of wind turbines with the effect on human health that was under investigation) (binary variable)

Variables (Outcome Measures of Individual Studies):

- First Author: The name of the first author (nominal variable)

- Year of Publication: The year in which the study was published (ordinal variable)

- Journal Name: The name of the publishing journal (nominal variable)

- Country of Study: The name of the country where the trial was originated (nominal variable)

- Study Design: The design of the study (nominal variable)

- Sample Size: The study sample size (continuous variable)

- Response Rate: The response rate of subjects in the study (continuous variable)

- Level of Evidence: The Level of evidence of the study (nominal variable)

- Level of Potential Bias: The level of risk of bias. Categorized into three groups according to Cochrane's recommendations [10]. (Low risk of bias: Plausible bias unlikely to seriously alter the results; Unclear risk of bias: Plausible bias that raises some doubt about the results; High risk of bias: Plausible bias that seriously weakens confidence in the results) (categorical variable)

- Outcome Measures of Study: The outcome measure under investigation in the study (nominal variable); these outcome measures are:

      - Annoyance (Sensitivity to Noise)

      - Sleep disturbance

      - Visual impact

      - Well-being (Quality of Life/Mental Effect)

      - Dose-response (description of the change in distress caused by differing distances from a wind turbine)

      - Infrasound effect

      - Existing background noise (comparison of stress associated with wind turbines to stress associated with road traffic noise/quiet rural environment)

      - Attitude to wind turbines (whether people who complain have negative personal opinions toward wind turbines)

      - Economical benefit (whether people who benefit economically from wind turbines have a decreased risk of distress)

Risk of bias in individual studies

Assessing the risk of bias of individual studies was performed at both the study level (study design, sample size, response rate, direction and magnitude of any potential bias and how it was handled, limitations, and reporting quality) and the outcome level (a cautious overall interpretation was drawn of the study's conclusions, whether effect of human distress exists, considering the specific study's objectives).

Summary measures and synthesis of results

After data extraction, each study was analyzed to identify the two primary outcomes: First, quality of study, taking into account the study's principle outcome measures; all outcomes, exposures, predictors, potential confounders, and effect modifiers; how the study size was arrived at; how quantitative variables were handled in the analyses; description of all statistical methods; and how loss to follow-up and missing data were addressed. Second, conclusion of study effect as a cautious overall interpretation of the study's conclusions, taking into account the specific study's objectives and how well these conclusions were supported by the study results.

Risk of bias across studies

To reduce potential sampling bias (for example, the quality of study could be confounded by journal name and name of first author), the reviewers blinded themselves to the name of the journal and authors until all data on the other variables of interest were collected. To reduce potential measurement bias, the following three measures were undertaken: The data were directly entered into the database instead of using collection forms, quality assurance on all steps of data collection and management was performed, and in any case of uncertainty in deciding the quality of study, the reviewer consulted one of our senior authors to confirm the decision. Furthermore, the source of data was confirmed by contacting investigators who authored multiple studies included in the review, due to the weight their aggregated studies would have in affecting our conclusions.

Ethics approval

This study used previously published data making it exempt from institutional ethics board approval.

Results

Study selection

Figure 1 presents a flowchart depicting the study screening process. The database searches produced 154 publications. From this group, 40 publications were eligible following screening the titles and abstracts. From this group, 18 publications were eligible for inclusion after full article review. These 18 studies, shown in Table 1, consist of six original studies and 12 non-original studies (secondary analyses and literature reviews based on some of these original studies). Only the six original studies were included in the final analysis shown in Table 2. The 12 non-original studies were excluded from the analysis to minimize potential bias associated with repeated results.                                                                                                                   

This review used previously published data; therefore, there was no missing data for any of the variables of interest.

                                                                                  Study Characteristics
1st Author, Year Country Design Sample Size Response Rate % Level of Evidence Risk Of Bias Within Studies Quality of Study
Bakker [11] 2012 ^ Netherlands Cross-sectional 725 37 4 Unclear risk of bias Moderate
Hanning [12] 2012 ^ UK Expert Opinion/Review N/A N/A 5 Unclear risk of bias Moderate
Nissenbaum [13] 2012 ¥ USA Cross-sectional 106 75 4 Low risk of bias Moderate
Knopper [6] 2011 ^ Canada Review 15 N/A 4 Unclear risk of bias High
Shepherd [14] 2011 ¥ New Zealand Cross-sectional 39, 158 34, 32 3,4 Low risk of bias High
Janssen [15] 2011 ^ Netherlands Secondary analysis 1820 68, 58,  <30 4 Low risk of bias High
Pedersen [16] 2011 ^ Sweden Secondary analysis 1755 * 4 Low risk of bias High
Bolin [17] 2011 ^ Sweden Review N/A N/A 4 Unclear risk of bias Low
Pedersen [18] 2010 ^ Sweden Secondary analysis 725 37 4 Low risk of bias High
Salt [7] 2010 ¥ USA Expert Opinion Report N/A N/A 5 Unclear risk of bias High
Pedersen [19] 2009 ¥ Netherlands Cross-sectional 1948 37 4 Low risk of bias High
Keith [20] 2008 ^ Canada Expert Review N/A N/A 5 Unclear risk of bias High
Pedersen [21] 2008 ^ Sweden Secondary analysis 1095 N/A 4 Low risk of bias High
Pedersen [22] 2008 ^ Sweden Secondary analysis 1822 60 4 Low risk of bias High
Pedersen [23] 2007 ^ Sweden Qualitative Study 15 N/A 5 Low risk of bias High
Pedersen [5] 2007 ¥ Sweden Cross-sectional 754 58 4 Low risk of bias High
Leventhall [24] 2006 ^ UK Report N/A N/A 5 Unclear risk of bias High
Pedersen [25] 2004 ¥ Sweden Cross-sectional 351 68 4 Low risk of bias High

1st Author, Year Does-response Road Traffic Noise / quiet rural environment Sleep Disturbance Annoyance/ sensitivity to noise Visual impact Attitude to wind turbines Infrasound effect Well-being (Quality of Life / mental effect) Economical Benefit
Nissenbaum [13] 2012 p < 0.05   p = 0.03         p = 0.002  
Shepherd [14] 2011     U-R = 0.43 p < 0.001 U-R = 0.44 p < 0.001       U-R = 0.20 p < 0.01  
Salt [7] 2010       Exp     Exp    
Pedersen [19] 2009 LRC = 0.50 p < 0.001 LRC = 1.07- p < 0.01   LRC = 0.35 p < 0.001 LRC = 1.04 p <0.001 LRC = 0.54 p < 0.001     LRC = -2.77 p < 0.001
Pedersen [5] 2007   OR = 1.1 (95% CI 0.91 to 1.21)   OR = 1.1 (95% CI 1.01 to 1.25) OR = 1.1 (95%  CI 0.97 to 1.21) OR = 1.1 (95%  CI 1.00 to 1.25)      
Pedersen [25] 2004     Rs = 0.35  p < 0.001 Rs = 0.42  p < 0.001 Rs = 0.52  p < 0.001 Rs = 0.33  p < 0.001      

Study characteristics and risk of bias within studies

Table 1 shows data on the 18 peer-reviewed studies captured in our review, including individual study characteristics, level of potential bias, and quality of study.

Results of individual studies

Table 2 shows summary data on the six original studies' objectives, p-values, and outcome measures.

Risk of bias across studies

One main source of potential bias across these studies was that 10 of them, listed below, were mainly based on three data sets. The first data set (SWE00) was collected in Sweden in the year 2000 in agricultural areas, the second (SWE05) was collected in different environments in Sweden 2005, and the third (NL07) was collected all over the Netherlands in 2007. This potential bias was eliminated by using only the three original studies that collected the data sets [5, 19, 25].  The rest of the 10 studies (non-original studies) were excluded from the analysis to avoid repeated results.

      - Bakker [11] 2012 Science of the Total Environment (NL07)

      - Pedersen [16] 2011 Noise Control Eng J (SWE00) + (SWE05) + (NL07)

      - Janssen [15] 2011 Acoustical Society of America (SWE00) + (SWE05) + (NL07)

      - Pedersen [18] 2010 Energy Policy (NL07)

      - Pedersen [19] 2009 Acoustical Society of America (NL07)

      - Pedersen [21] 2008 Journal of Environmental Psychology (SWE00) + (SWE05)

      - Pedersen [22] 2008 Environ Res Lett (SWE00) + (SWE05)

      - Pedersen [23] 2007 Qualitative Research in Psychology (SWE00)

      - Pedersen [5] 2007 Occup Environ Med (SWE05)

      - Pedersen [25] 2004 Acoustical Society of America (SWE00) 

Another source of bias was that three of the studies were reviews of previous literature [6, 12, 17].

Key results

- All 18 peer-reviewed studies captured in our review found an association between wind turbines and one or more types of human distress. These studies had a level of evidence of four and five.

- None of the studies captured in our review found any association (potential publication bias). 

- These studies were published in a variety of journals (representative sample).

- Two of these studies showed a dose-response relationship between distance from wind turbines and distress (Table 2).

- There is still no evidence of whether or not a causal relationship between distance from wind turbines and distress exists.

Discussion

Summary of evidence

The peer-reviewed studies we reviewed provide reasonable evidence (Levels Four and Five) that an association exists between wind turbines and distress in humans.

Two of these studies showed a dose-response relationship between distance from wind turbines and distress, and none of the 18 studies concluded no association (consistency of association). The existence of a dose-response relationship and consistency, two of the Hill's Criteria of Causality, argues for the credibility of the association.

All the evidence comes from expert opinion, case studies, and cross-sectional studies. No higher level of evidence observational studies, namely case-control and cohort studies, were utilized to investigate the subject. For example, although Shepherd, et al's study [14] had a sound design and was well conducted and reported, it is considered at a lower level of evidence as a cross-sectional study has an increased potential for bias of its results.

Although three of the studies [6-7, 24] suggested that low-frequency sound energy wind turbines (i.e., infrasound below 20 Hz) may directly and negatively affect health, the level of evidence for these studies is also weak (expert opinions [7, 24] and a review [6] citing these two studies).

Economic benefit found in two of the studies [15, 19] could be intuitively and prematurely viewed as a factor lowering the credibility of the complaint. However, in our opinion, compensation would have lowered the credibility of the complaint only if these people had no distress following compensation. People in the studies who benefited economically from wind turbines had a decreased risk of distress but not a complete elimination of distress. Furthermore, the fact that the level of distress could be altered with financial compensation only speaks to the existence of distress.

It is worth pointing out that no causality has been established. The distress could be due to factors other than actual noise exposure. For example, the distress experienced by the participants in the original studies may have been generated or exaggerated by exposure to negative opinions on wind turbine.

Limitations

This study has a number of limitations and sources of bias. One source of bias is the exclusion of non-English studies. For example, China is the world’s leading country in the number of wind turbines [1]. The exclusion of non-English studies might have affected the overall conclusions of our review.

Another source of bias is the fact that the reviewer could not be completely blinded to the journals' or authors' names. There might be a theoretical incline to give studies in high impact journals higher quality because of their reputation (potential sampling bias). Nevertheless, if this bias took place, it would have an effect on the magnitude of evidence and not on the existence of the association due to the dichotomous nature of this variable (the number of studies that speaks for an association will not change). 

Publication bias could be the reason for the finding that none of the 18 peer-reviewed studies captured in our review found no association. However, potential publication bias was decreased by conducting a search in two major grey literature databases (SIGLE, and Scirus).

Generalizability

The 18 studies were published in a variety of journals, making the captured studies a representative sample, which in turn increases our results' generalizability (external validity).

The fact that the data in two of the three mentioned data sets were collected in Sweden may decrease the external validity, but simultaneously may increase the internal validity following the above logic. Furthermore, although these data were collected from one country, it still would be a safe assumption that the people and their experience with wind turbines, on which these data were collected, are not fundamentally different from people and experiences in other countries.

Future research

Further research in the area of exposure assessment and measurement is needed. The mechanism and physiology of harm needs to be confirmed. There is a need to identify the actual risk of harm and the health outcomes in people exposed. Until research can separate out specific sets of significant factors for the exposure with higher-level evidence than is available now, our ability to mitigate the harm is limited. Possible future research could be conducting longitudinal studies, performing measurements before wind turbines and after, and observing what happens to people over time.

Conclusions

We have demonstrated in our review the presence of reasonable evidence (Levels Four and Five) supporting the existence of an association between wind turbines and distress in humans. The existence of a dose-response relationship between distance from wind turbines and distress as well as the consistency of association across studies found in the scientific literature argues for the credibility of this association. Future research in this area is warranted.


References

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  7. Salt AN, Hullar TE: Responses of the ear to low frequency sounds, infrasound and wind turbines. Hear Res. 2010, 268:12-21. 10.1016/j.heares.2010.06.007
  8. World Health Organisation: Night noise guidelines for Europe. (2009). Accessed: October 30, 2013: http://www.euro.who.int/__data/assets/pdf_file/0017/43316/E92845.pdf.
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  10. Higgins JPT, Altman DG, Sterne JAC on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group: Chapter 8: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions. 2011, Version 5.1.0:Accessed: October 30, 2013: http://handbook.cochrane.org/chapter_8/8_assessing_risk_of_bias_in_included_studies.htm.
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Original article
peer-reviewed

Systematic Review 2013: Association Between Wind Turbines and Human Distress


Author Information

Ian Arra Corresponding Author

Public Health and Preventive Medicine, Northern Ontario Medical School- East Campus - Laurentian University, Health Sciences Education Resource Centre

Public Health and Preventive Medicinece Centre , Health Sciences Education Resource Centre

Hazel Lynn

Public Health and Preventive Medicine, Grey Bruce Health Unit, Ontario, Canada

Kimberley Barker

Public Health and Preventive Medicine Program, Northern Ontario School of Medicine, East Campus - Laurentian University, Medical Officer of Health, Algoma Public Health

Chiebere Ogbuneke

Public Health and Preventive Medicine Post Graduate Program, Northern Ontario School of Medicine, East Campus - Laurentian University, Health Sciences Education Resource Centre

Sophie Regalado

Health Sciences Librarian, Northern Ontario School of Medicine, Lakehead University Campus


Ethics Statement and Conflict of Interest Disclosures

Animal subjects: This study did not involve animal subjects or tissue. Human subjects: This study used previously published data making it exempt from institutional ethics board approval. issued approval This study used previously published data making it exempt from institutional ethics board approval.

Acknowledgements

Thank you, Andrea M. Davison, for assisting with the preparation of this manuscript.


Original article
peer-reviewed

Systematic Review 2013: Association Between Wind Turbines and Human Distress


Figures etc.

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Henk Daalder
May 25, 2014 at 10:33 AM
Henk Daalder

My conclusion about this article, is that its purpose is NOT science, but anti windpower propaganda.
The authors do not explain how they evaluated the 40 articles, an d used only 18. Why were the other 22 excuded?

They also show that people are annoyed in the precense of wind turbines, but give no cause effect explanation.
So, the annoyance may very well be induced by anti wind propaganda, or exclusion of people from any involvement in the wind farm project. Then the exclusion is a more likely cause than the turbines themselves. This is one of the findings of a team of the university of Amsterdam, where they investigated the citizens evaluation of a small windfarm near a village, for 2 different villages. In one village the windfarm was setup ottom up, by and for citizens, with high acceptance afterwards. And the othger village, a utility planned, built and operated the windfarm, excluding the citizens of the village. these dit not appreciate the wind farm very much.

Furthermore the authors show no evicence or even an indication that the noise of turbines is the cause of the distress.
This is also falsified by many dutch turbine owners, mostly farmers that live with their family, within 100 m of their own turbine, on their farm yard.
There is not any signal that these peopel are more annoyed than othgers, and also not less healthy.
An other falsification that wind turbine noise would have any relation with annoyance or less sleep, is with the millions of people that live on the coast, in the in surf noise, or with the other millions that live in windy areas near trees. Some trees make a lot of noise, eg poplar, which is very common in the Netherlands, where 3 of the 18 studies originate, these trees produce mote than 60 to 70 dB at the base of the trees above bft 5, hundreds of thousands dutchmen live in homes near these trees, but there is no "dutch poplar noise disease" In fact, Van den Berg reports in one of his many attempts that turbines where only the noise of turbines can be measured are very rare.

Alexander Muacevic
May 27, 2014 at 03:48 AM
Alexander Muacevic

Mr. Daalder, we appreciate your critical comment on the paper of Arra et al.. We do think your comment is over critical and partly unfounded. This paper is from different academic institutions from Canada and without any obvious links to anti windpower propaganda. The authors did describe why they did not include the 22 articles you mention. It is obvious that this subject is of political interest and has an emotional component. We advise you to raise your concerns in an scientific manner and not use a propaganda like style yourself. It seems you belong to an institution which is pro windpower and therefore you need to be particularly cautious.

Thank you,

Alex Muacevic, MD
Professor at the University of Munich
Co-Editor-in-Chief
www.cureus.com

Simon Chapman
June 18, 2014 at 09:23 PM
Simon Chapman

Commentary: Major problems with recent systematic review on wind farms and distress.

Simon Chapman AO PhD FASSA
Professor of Public Health
University of Sydney

At least 20 reviews of the evidence on whether wind turbines cause health problems including stress have been published since 2003 (1). Cureus recently published another (2) where the authors referenced none of these.

Highlights of the findings of these reviews may be found here (1). The most recent (2014) review by Australia’s peak health and medical agency, The National Health and Medical Research Council (3) concluded:

“There is no consistent evidence that noise from wind turbines… is associated with self reported human health effects. Isolated associations may be due to confounding, bias or chance. There is consistent evidence that noise from wind turbines―whether estimated in models or using distance as a proxy―is associated with annoyance, and reasonable consistency that it is associated with sleep disturbance and poorer sleep quality and quality of life. However, it is unclear whether the observed associations are due to wind turbine noise or plausible confounders.”
and
“The association between estimated noise level and annoyance was significantly affected by the visual attitude of the individual (i.e. whether they found wind farms beautiful, or ugly and unnatural) in the three studies that assessed this as a potential confounding factor. Residents in [one] study with a negative attitude to the visual impact of wind farms on the landscape had over 14 times the odds of being annoyed compared with those people without a negative visual attitude. …This means that factors other than the noise produced by wind turbines contribute to the annoyance experienced by survey respondents.”

Against this background, I was curious to see what a new systematic review would conclude. According to the Cureus website, the new paper was peer reviewed. This is difficult to understand because of the sheer volume of major and minor problems it contains. Together, these make its contribution valueless to scholarly understanding of the phenomenon of noise and health complaints about wind farms. The paper shows many signs of poor understanding of the subject matter of their review, of critical appraisal methods, of some basic conventions in systematic reviewing, of structuring in scientific writing, and much more besides.

The problems commence in the first line of the abstract where the confusing statement is made that “the proximity of wind turbines to residential areas has been associated with a higher level of complaints compared to the general population.” I assume here that they are trying to say that those living near turbines have a higher prevalence of health complaints like sleep disturbance and general “human distress” than in the wider population. The prevalence of sleeping problems in general populations is as high as 33% (4) and reference material exists that quantifies the prevalence of many health problems in general populations (5, 6). Instead, the authors support their statement with a reference to a small qualitative study of 15 people both affected and unaffected by turbines (7). No conclusions about the prevalence of health problems in communities near turbines or in matched comparison populations can be drawn from that paper. I know of no published evidence that would allow such a statement to be made.

The authors state that their search strategy located 18 eligible papers but that these were based on six original studies. They explain that the 12 non-original “studies” (several of which were reviews or commentaries) were then excluded. Yet in their “key results” they proceed to describe the characteristics of all 18 papers and thus act as if these were not excluded (“All 18 peer-reviewed studies captured in our review found an association…”).

The authors do not appear to understand what an “outcome” is. The abstract lists “outcome” variables that are not outcomes at all (such as study quality and journal name). These are independent variables, not dependent ones.

Their eligibility criteria for study selection are perplexing. What for example, is the difference between “peer-reviewed studies” and “studies published in peer-reviewed journals”? So too, is their noting that they searched the Cochrane Library for relevant studies. The Cochrane Library is a repository of reviews of evidence for health interventions, not for data on the prevalence of health complaints.

The authors seem not to understand the difference between studies and trials. For obvious reasons, there have been no trials conducted in this area.

Their main conclusions are that:

• An association exists between wind turbines and distress in humans.
• The existence of a dose-response relationship (between distance from wind turbines and distress) and the consistency of the association across studies .. argues for the credibility of this association.

The first conclusion is very imprecise and sweeping and ripe for being megaphoned by anti-wind farm interest groups as if it actually meant something. One of the six original studies reviewed (Salt & Hullar) (8) should have never been included in this review – see below. The Nissenbaum et a study (9) is listed as of moderate quality with a low risk of bias. Yet all three authors and two out of three reviewers of that paper are members of Society for Wind Vigilance, an anti-wind organization. Nissenbaum has been raising health concerns in study areas for several years, potentially biasing collected data. Neither of these problems is mentioned in this review. Two critiques of this study were published in Noise and Health pointing out the very poor quality of the results, analysis and the overstatements of conclusions (10, 11).

The Shepherd et al study (12) which the authors rate as of “high” quality, failed to make any mention that the small wind farm community involved had for years been subjected to a local wind farm opposition group fomenting anxiety about health issues (13). Indeed, with one exception (14), the five studies referenced were performed in areas where complaints of annoyance were being raised. But such farms are unlikely to be representative of all wind farms. As our work shows, over nearly 65% of wind farms in Australia have never received a single complaint (15), and 73% of complainants in Australia are concentrated around just 6/51 farms. The failure of the authors to note this fundamental problem of study sample selection bias is another major problem.

Among the five “original” studies they considered satisfied their selection criteria was a paper by Salt & Hullar (8). This paper is not in any way a “study” of “the association between wind turbines and human distress.” It reports no original empirical data and is essentially a backgrounder on infrasound and the “possibility” that wind turbine might create auditory distress. It is unfathomable why this paper was included in the data set.

Table 2 purports to be a meaningful summary of the findings of these six studies on the association between turbine exposure and “distress”. I would defy anyone to make any sense of the Table, particularly the column headed “does [sic] response”.

By way of comparison to the lack of detail provided by the authors of this review, it is instructive to look at the results from the Dutch study which formed the basis of the Pedersen 2009 paper(14) which were further analysed by Bakker et al (16) who noted that sleep disturbance was assessed by a question dealing with the frequency of sleep disturbance by environmental sound (“how often are you disturbed by sound?”). Two thirds of all respondents reported not being disturbed by any sound at all. Disturbance by traffic noise or other mechanical sound was reported by 15.2% of the respondents. Disturbance by the sound of people and of animals was reported by 13.4% of the respondents. Relevantly, disturbance by the sound of wind turbines was reported by only 4.7% of the respondents (6% in areas deemed to be quiet and 4% in areas deemed to be noisy). Bakker and colleagues (16) note that it was not clear from the study if there was a primary source causing sleep disturbance and how respondents attributed being awakened by different environmental sound sources. What was clear was that wind turbines were less frequently reported as a sleep disturbing sound source, than other environmental sounds irrespective of the area type (quiet versus noisy). Analysis showed that among respondents who could hear wind turbine sound, annoyance was the only factor that predicted sleep disturbance. The authors speculated that being annoyed might contribute to a person’s sensitivity for any environmental sound, and the reaction might be caused by the combination of all sounds present. It might also be the case that people annoyed by wind turbine noise attribute their experience of sleep disturbance to wind turbine noise, even if that was not the source of their awakening.

Swathes of the paper are given over to descriptions of their efforts to rate the levels of evidence in the four reviewed studies. But they never ever describe their approach in any way that might permit replication of how they went about such rating. How was level of evidence actually determined? It should have been explicitly defined in the text. Their discussion of the risk of bias across studies is bizarre. "The quality of the study could be confounded by journal name and author". Surely the authors mean here that the evaluation of the quality of the study could be biased by this knowledge. The term “confounded” has another meaning.

Their “key results” consist of no more than five bullet points. These read like draft notes-to-self (eg: None of these studies captured in our review found any association (potential publication bias)”.

The authors chose to use the term “distress” instead of “annoyance". The American Medical Dictionary defines distress as 1. Mental or physical suffering or anguish or 2. Severe strain resulting from exhaustion or trauma. Annoyance on the other hand is defined as 1. The act of annoying or the state of being annoyed or 2. A cause of irritation or vexation; a nuisance. (The American Heritage Dictionary of the English Language, Fourth Edition copyright 2000) and is generally identified as a highly subjective state in medical literature. It is clear that the authors chose a stronger term than was used by the majority of studies. Most literature refers to annoyance, while the referenced alternative of “Wind Turbine Syndrome” was coined in a vanity press published case study with extraordinary weaknesses of selection bias, methodology and analysis (17). Similarly, “extreme annoyance” is rarely used in the literature. Annoyance is by far the most commonly used term in the material referenced, so it is unclear why “distress” was chosen.

The paper is riddled with imprecise, mangled and contradictory language. For example: key finding 1: “All 18 peer-reviewed studies captured in our review found an association…” and key finding 2: “None of these studies captured in our review found any association (potential publication bias)”; infelicitous prose: “these complaints are coined in research”; “There might be a theoretical incline to give studies in high impact journals higher quality…”; basic grammatical errors: “the study’s principle outcome”; “there was no missing data.” It is unconventionally structured with extremely scant results and methods sections providing no adequate explanations of how key decisions on quality or bias were made.

The publication of this very poor paper is regrettable.

Acknowledgements: Fiona Crichton, Cornelia Baines and Mike Bernard each contributed comments to me for this response.

Competing interests: Simon Chapman receives no financial or in-kind support from any company, individual or agency associated with wind energy.

References

1. Chapman S, Simonetti T. Summary of main conclusions reached in 20 reviews of the research literature on wind farms and health. Sydney University eScholarship respository: University of Sydney; 2014; Available from: http://hdl.handle.net/2123/10559.
2. Arra I, Lynn H, Barker K, Ogbuneke C, Regalado S. Systematic review 2013: Association between wind turbines and human distress. 2014; Available from: http://www.cureus.com/articles/2457-systematic-review-2013-association-between-wind-turbines-and-human-distress?utm_medium=email&utm_source=transaction - .U6DaMi90xT5.
3. Merlin T, Newton S, Ellery B, Milverton J, Farah C. Systematic review of the human health effects of wind farms. Canberra: National Health and Medical Reserach Council; 2014; Available from: https://http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/eh54_systematic_review_of_the_human_health_effects_of_wind_farms_december_2013.pdf.
4. Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Predictors of primary medical care consultation for sleep disorders. Sleep medicine. 2008;9(8):857-64. Epub 2007/11/06.
5. Rief W, Barsky AJ, Glombiewski JA, Nestoriuc Y, Glaesmer H, Braehler E. Assessing general side effects in clinical trials: reference data from the general population. Pharmacoepidemiol Drug Saf. 2011;20(4):405-15. Epub 2011/03/29.
6. Petrie KJ, Faasse K, Crichton F, Grey A. How common are symptoms? Evidence from a New Zealand national telephone survey. BMJ open. 2014;4(6):e005374. Epub 2014/06/15.
7. Pedersen E, Hallberg LR-M, Waye KP. Living in the vicinity of wind turines - a grounded theory study. Qualitative Research in Psychology. 2007;4:49-63.
8. Salt AN, Hullar TE. Responses of the ear to low frequency sounds, infrasound and wind turbines. Hearing research. 2010;268(1-2):12-21. Epub 2010/06/22.
9. Nissenbaum MA, Aramini JJ, Hanning CD. Effects of industrial wind turbine noise on sleep and health. Noise Health. 2012;14(60):237-43. Epub 2012/11/03.
10. Ollson CA, Knopper LD, McCallum LC, Whitfield-Aslund ML. Are the findings of "Effects of industrial wind turbine noise on sleep and health" supported? Noise Health. 2013;15(63):148-50. Epub 2013/04/11.
11. Barnard M. Issues of wind turbine noise. Noise Health. 2013;15(63):150-2. Epub 2013/04/11.
12. Shepherd D, McBride D, Welch D, Dirks KN, Hill EM. Evaluating the impact of wind turbine noise on health-related quality of life. Noise Health. 2011;13(54):333-9. Epub 2011/10/01.
13. Anon. Makara Guardians. Wikipedia; Available from: http://en.wikipedia.org/wiki/Makara_Guardians.
14. Pedersen E, van den Berg F, Bakker R, Bouma J. Response to noise from modern wind farms in The Netherlands. Journal of the Acoustical Society of America. 2009;126(2):634-43. Epub 2009/07/31.
15. Chapman S, St George A, Waller K, Cakic V. The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: support for the psychogenic, 'communicated disease' hypothesis. PloS one. 2013;8(10):e76584. Epub 2013/10/23.
16. Bakker RH, Pedersen E, van den Berg GP, Stewart RE, Lok W, Bouma J. Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress. Science of the Total Environment. 2012;425:42-51.
17. Pierpont N. Wind Turbine Syndrome. A report on a natural experiment. Santa Fe: K-Selected Books; 2009.

Mike Barnard
June 18, 2014 at 11:49 PM
Mike Barnard

This paper does not add anything of value to the literature on wind turbines. All of the 20 reviews [11] performed world wide as well as the papers cited by this review agree that some people near some wind farms experience annoyance. Attempting to bootstrap this into a more serious claim of 100% correlation of distress by people near wind farms is inappropriate and indicative of at minimum academic weakness on the part of the authors.

Comments on conclusions

1. The studies referenced (with one exception) were performed in areas where complaints of annoyance were being raised.

As the Chapman 2013 study shows, over 50% of wind farms in Australia receive no complaints at all.[1] This gap in the data and selection bias of studies to areas of complaints is not identified by the authors as a concern and significantly weakens their hypothesis.

2. The authors chose to use the term “distress” instead of “annoyance".

The American Medical Dictionary defines distress as 1. Mental or physical suffering or anguish or 2. Severe strain resulting from exhaustion or trauma. (The American Heritage® Medical Dictionary Copyright © 2007, 2004). Annoyance on the other hand is defined as 1. The act of annoying or the state of being annoyed or 2. A cause of irritation or vexation; a nuisance.
(The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000) and is generally identified as a highly subjective state in medical literature.

The authors chose a significantly stronger term than is used by the studies they reference. The peer-reviewed literature related to wind energy and health refers to annoyance, while the referenced alternative of “Wind Turbine Syndrome” was coined in a vanity-published case study with extraordinary weaknesses of selection bias, methodology and analysis.[2] Similarly, “extreme annoyance” is rarely used in the referenced literature. Annoyance is by far the most commonly used term in the material referenced, so it is unclear why “distress” was chosen.

3. At most, the study conclusions should have stated that some people near some wind farms are annoyed by them. The paper’s much stronger conclusion of a strong correlation between wind farms and the much stronger term distress is unwarranted. This constitutes hyperbole, not a useful assessment of the literature.

Comments on included papers

1. In general, there are many good inclusions. There is evidence that the study authors cast a wide net and found relevant material. There are challenges with specific papers that they have included however.

2. The Nissenbaum Aramini Noise and Health study is listed as of moderate quality with low risk of bias.

This is an improvement on original presentations of this material in February 2013 when it was listed as of High quality and identified as “Excellent research”.[3] All three authors of the Nissenbaum paper and two of three reviewers are members of the Society for Wind Vigilance, an anti-wind organization[4]. Nissenbaum has been raising health concerns in the study areas for several years with initial publication of concerns in 2007, potentially biasing collected data. Neither of these sources of bias are mentioned in the published Nissenbaum paper, or reflected in the literature review.

Two critiques of this study were published in Noise and Health pointing out the very poor quality of the results, analysis and the overstatements of conclusions. [5], [6] (Full disclosure: one of the two critiques was authored by the author of this comment on Cureus.) Neither of the two critiques were referenced or apparently read by the authors of this paper although their publication long predates the publication of this review in Cureus.

The much more robust and reliable Australian National Health and Medical Research Council study whose draft results were published in late 2013 included the Nissenbaum study but found it to be very low quality.[7] To quote its conclusions on the quality of the paper:

“Poor

High risk of:
• exposure misclassification
• recall bias
• selection bias
• confounding
• significant associations due to chance

Potential for:
• outcome misclassification”

This must be compared with Arra and Lynn’s assessment of this paper of “Low risk of bias”.

3. The referenced Salt paper is listed as of high quality.

This paper is an opinion piece based on no studies on any wind turbine neighbours. It accepted a set of unpeer-reviewed, internet-sourced case studies of very low quality as factual, e.g. Pierpont, Harry. These studies did not merit inclusion or mention in even this literature review. Salt’s extension of minor guinea pig physiological changes to human distress without any evidence of human distress has been strongly criticized by Leventhall among others.[9] The Salt paper’s inclusion in the results is not aligned with the review’s stated inclusion criteria, purported thesis or intent. Reference to it all never mind as being of High quality is a quality problem with this paper.

4. The much more robust NHMRC study just released found a small number of studies showing any degree of credible linkage and that those studies were of uniformly poor quality with significant weaknesses - a finding not found by this review.[7]

Comments on exclusions

1. The review excludes the Lawrence et al paper from Feb 2013 [8], a single month difference than the stated inclusion period, as well as Chapman [1] and Chricton [10] papers from mid-2013. Given May 2014 publication on Cureus, updates would have been expected. The cutoff is unfortunate as is the lack of substantive updating of the material for 12 months between the initial internet dissemination and publication in Cureus. Other updates were performed in the interim, such as the downgrading of the Nissenbaum Aramini paper from High quality to Moderate, so it’s unclear why other updates could not have been performed as well.

General comments

1. The introductions’ list of causes excludes the nocebo effect hypothesis (CanWEA study[11], Crichton[10]) and psychogenic hypothesis (Chapman [1]) - the two related hypotheses pre-dated Jan 2013 although formal papers were published after the cutoff.

2. The introduction also excludes the relationship of annoyance to lack of economic benefit and negative attitudes to aesthetics of wind turbines. Economic benefit is assessed in the Discussion but is dismissed on unreferenced statement that it only relates to diminishment of distress.

3. Krogh, Aramini WindVoice material published in the unindexed BSTS is referenced as is Hanning guest editorial in BMJ although they are not included in table of assessed papers. These are unbalanced discussions of concern by Society for Wind Vigilance members, and inclusion in the references is likely indicative. Opinion pieces of higher quality and provenance finding no cause for concern are not included in the general references.

Summary

It is unfortunate that this paper passed peer review in this form. It appears as if no neutral peer reviewer familiar with the literature of wind energy was asked to assess this paper, and that little substantive assessment was performed before publication.

The SIQ score of 3.5 as of June 19, 2014 suggests that this weak paper is being voted up by those opposed to wind energy, as the merits of the paper certainly do not suggest a rating above the lowest.

[1] The Pattern of Complaints about Australian Wind Farms Does Not Match the Establishment and Distribution of Turbines: Support for the Psychogenic, ‘Communicated Disease’ Hypothesis , Simon Chapman, Alexis St. George, Karen Waller, Vince Cakic, PLOS One, Oct 2013, http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0076584
[2] Wind Turbine Syndrome is More Wind Than Syndrome, Mike Barnard, barnardonwind.com, Feb 2013, http://barnardonwind.com/2013/02/28/wind-turbine-syndrome-is-more-wind-than-syndrome/
[3] Literature Review 2013: Association between Wind Turbine Noise and Human Distress, Ian Arra, Hazel Lynn, 2013, Grey Bruce Public Health, http://www.publichealthgreybruce.on.ca/HOME/Publications/Board/BOH_Reports/2013/Literature%20Review%202013%20Association%20Between%20Wind%20Turbine%20Noise%20and%20Human%20Distress.pdf
[4] Society for Wind Vigilance, http://web.archive.org/web/20140407160806/http://www.windvigilance.com/, Note: this formerly public site has been made private by the administrators, necessitating the use of a web archive
[5] Letter to Editor: Are the findings of "Effects of industrial wind turbine noise on sleep and health" supported?, Ollson CA, Knopper LD, McCallum LC, Whitfield-Aslund ML. , Noise Health [serial online] 2013 [cited 2014 Jun 19];15:148-50. Available from: http://www.noiseandhealth.org/text.asp?2013/15/63/148/110302
[6] Letter to Editor: Issues of wind turbine noise, Barnard M, Noise Health [serial online] 2013 [cited 2014 Jun 19];15:150-2. Available from: http://www.noiseandhealth.org/text.asp?2013/15/63/150/110305
[7] Systematic review of the human health effects of wind farms, Merlin, T, Newton, S, Ellery, B, Milverton, J & Farah, C 2013, National Health and Medical Research Council, Canberra, http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/eh54_systematic_review_of_the_human_health_effects_of_wind_farms_december_2013.pdf
[8] The influence of negative oriented personality traits on the effects of wind turbine noise, Jennifer Taylor, Carol Eastwick, Robin Wilson, Claire Lawrence, Personality and Individual Differences, Volume 54, Issue 3, February 2013, Pages 338–343, http://www.sciencedirect.com/science/article/pii/S0191886912004783
[9] Concerns About Infrasound From Wind Turbines, Geoff Leventhall, July 2013, Vol 9, Issue 3, Acoustics Today, https://acousticstoday.org/issues/2013AT/Jul2013/#?page=30
[10] Can expectations produce symptoms from infrasound associated with wind turbines?, Crichton, F., Dodd, G., Schmid, G., Gamble, G., & Petrie, K. J. (2013), Health Psychology, http://www.ncbi.nlm.nih.gov/pubmed/23477573
[11] Full list of all Wind Health Reviews maintained by Professor Simon Chapman, School of Public Health, University of Sydney, http://ses.library.usyd.edu.au/handle/2123/10559

Niki Heany
March 20, 2016 at 01:44 AM
Niki Heany

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Elizbeth Truss
March 20, 2016 at 06:28 PM
Elizbeth Truss

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Original article
peer-reviewed

Systematic Review 2013: Association Between Wind Turbines and Human Distress

  • Author Information
    Ian Arra Corresponding Author

    Public Health and Preventive Medicine, Northern Ontario Medical School- East Campus - Laurentian University, Health Sciences Education Resource Centre

    Public Health and Preventive Medicinece Centre , Health Sciences Education Resource Centre

    Hazel Lynn

    Public Health and Preventive Medicine, Grey Bruce Health Unit, Ontario, Canada

    Kimberley Barker

    Public Health and Preventive Medicine Program, Northern Ontario School of Medicine, East Campus - Laurentian University, Medical Officer of Health, Algoma Public Health

    Chiebere Ogbuneke

    Public Health and Preventive Medicine Post Graduate Program, Northern Ontario School of Medicine, East Campus - Laurentian University, Health Sciences Education Resource Centre

    Sophie Regalado

    Health Sciences Librarian, Northern Ontario School of Medicine, Lakehead University Campus


    Ethics Statement and Conflict of Interest Disclosures

    Animal subjects: This study did not involve animal subjects or tissue. Human subjects: This study used previously published data making it exempt from institutional ethics board approval. issued approval This study used previously published data making it exempt from institutional ethics board approval.

    Acknowledgements

    Thank you, Andrea M. Davison, for assisting with the preparation of this manuscript.


    Article Information

    Published: May 23, 2014

    DOI

    10.7759/cureus.183

    Cite this article as:

    Arra I, Lynn H, Barker K, et al. (May 23, 2014) Systematic Review 2013: Association Between Wind Turbines and Human Distress. Cureus 6(5): e183. doi:10.7759/cureus.183

    Publication history

    Received by Cureus: April 03, 2014
    Peer review began: April 06, 2014
    Peer review concluded: May 22, 2014
    Published: May 23, 2014

    Copyright

    © Copyright 2014
    Arra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background and Objectives: The proximity of wind turbines to residential areas has been associated with a higher level of complaints compared to the general population. The study objective was to search the literature investigating whether an association between wind turbines and human distress exists.

Methods: A systematic search of the following databases (EMBASE, PubMed, OvidMedline, PsycINFO, The Cochrane Library, SIGLE, and Scirus) and screening for duplication led to the identification of 154 studies. Abstract and full article reviews of these studies led to the identification of 18 studies that were eligible for inclusion as they examined the association of wind turbines and human distress published in peer-review journals in English between 2003-2013. Outcome measures, including First Author, Year of Publication, Journal Name, Country of Study, Study Design, Sample Size, Response Rate, Level of Evidence, Level of Potential Bias, and Outcome Measures of Study, were captured for all studies. After data extraction, each study was analyzed to identify the two primary outcomes: Quality of Study and Conclusion of Study Effect.

Results: All peer-reviewed studies captured in our review found an association between wind turbines and human distress. These studies had levels of evidence of four and five. Two studies showed a dose-response relationship between distance from wind turbines and distress, and none of them concluded no association.

Conclusions: In this review, we have demonstrated the presence of reasonable evidence (Level Four and Five) that an association exists between wind turbines and distress in humans. The existence of a dose-response relationship (between distance from wind turbines and distress) and the consistency of association across studies found in the scientific literature argues for the credibility of this association. Future research in this area is warranted as to whether or not a causal relationship exists.

Introduction

Unlike most industries, the global wind industry grows annually by 21% despite the recent economic challenges. Canada is the ninth largest producer of wind energy in the world with a 45-fold growth in the industry in the year 2012 relative to 2000 [1-2].

The invention of the wind turbine as an electricity generating machine dates back to 1887 by James Blyth, a Scottish academic, and it used to light his holiday home in Marykirk, Scotland [3]. Wind turbines were at first welcomed by the public as being a source of energy that is both renewable and carbon emission-free. The need to generate electrical power on a large scale was the main driver in establishing the industrial wind turbines (IWTs) [4].

Wind turbines can be located as solo wind or in groups called "Wind Farms". In either form and for various reasons (e.g., minimizing transmission costs), wind turbines are usually positioned in close proximity to residential areas (farms, villages, towns, and cities). This proximity to residential areas has been associated with a higher level of complaints compared to the general population [5]. These complaints are coined in research conducted and articles written on the subject under different terms, such as "Extreme Annoyance", "Wind Turbine Syndrome (WTS)", and "Distress", among others. In this article, the term "distress" will be used unless we are quoting other articles.

Complaints resulting from the proximity to wind turbines vary in their nature, and distress is often attributed to different mechanisms, such as noise, visual impact, sleep disturbance, infrasound, and others [5-7]. Noise is the complaint that has been studied most often, especially given that environmental noise has become one of the major public health concerns of the 21st century [8].

These complaints triggered the debate about possible mechanisms of effect. Several hypothetical mechanisms have been suggested to explain the possible link(s) between wind turbines and the reported distress; some of these hypotheses attribute distress to one or more of the following: chronic noise exposure, infrasound effect, visual impact, perceived lack of control over noise, attitudes, personality, and age [5-6].

To assess the possible effects of wind turbines on human health, different outcome measures have been suggested, including annoyance, sleep disturbance, and cortisol levels. An alternative approach to health assessment involves the subjective appraisal of health-related quality of life, a concept that measures general well-being in all domains, including physical, psychological, and social domains [8].

Although the focus on researching mechanisms of effect may very well be a good first step to identifying the cause, finding an association is a cornerstone of establishing any causality, according to Hill's Criteria of Causality [9]. A key missing piece of the scientific literature is that of an up-to-date and thorough review that examines the possible existence of an association between wind turbine and human distress. Therefore, the objective of our study was to search the literature investigating whether or not an association between wind turbines and human distress exists.

Materials & Methods

Study design 

A systematic review of the existing literature of published peer-reviewed studies investigating the association between wind turbines and human distress between January 2003 - January 2013 was undertaken. This study was conducted as a collaboration between the Northern Ontario School of Medicine (NOSM), Sudbury, and Grey Bruce Health Unit, Owen Sound, Ontario, Canada.

Eligibility criteria

Inclusion Criteria:

- Peer-reviewed studies

- Studies examining association between wind turbines and distress

- Studies published in peer-review journals

- English language

- Studies involving humans

- Studies published between January 2003 - January 2013

Exclusion Criteria:

- Non-English language reports

- Investigations reporting interim analysis that did not result in stopping the study

- Secondary and long-term update reports

- Duplicate reports

- Cost effectiveness and economic studies

- Engineering studies

- Studies involving animals

Information sources

The following bibliographic databases were searched: EMBASE, PubMed, Ovid Medline, PsycINFO and The Cochrane Library, SIGLE, and Scirus, the last two of which deal with grey literature (materials that cannot be found easily through conventional channels, such as publishers; for example, thesis, dissertations, and unpublished peer-reviewed studies). Authors who published multiple studies included in our review were also contacted to identify any additional studies.

Search

Two search approaches were taken: subject heading and keyword searching. Electronic keyword searches were conducted in EMBASE, PubMed, PsycINFO, The Cochrane Library, SIGLE, and Scirus for published peer-reviewed studies according to the study inclusion criteria. All search strategies included the same search terms and combinations ([Wind power OR wind farm OR air turbine OR wind turbine] AND [Distress OR annoyance, sleep disturbance, noise OR sound OR infrasound OR sonic OR low-frequency OR acoustic OR hear OR ear OR wind turbine syndrome]).

Appropriate subject headings and limiters were identified in consultation with the corresponding author and were used to conduct electronic searches in the following bibliographic databases: EMBASE, PsycINFO, Ovid Medline, and PubMed. In order to retrieve all relevant published studies, subject headings were exploded; select subject headings were also chosen as the major focus of the search. Searches were refined by setting a publication restriction of 2003 to current and limiting results to humans.

Study selection

Study selection was performed in three stages (Figure 1):

Stage 1: Database Search

The studies that were identified through the database subject heading search (194 studies), the keyword search (142), and other sources (13 studies) were screened for duplication, yielding 154 studies.

Stage 2: Titles and Abstract Review

Screening of the titles and abstracts of the 154 retrieved studies was conducted by one qualified reviewer (the first author) in order to exclude any obvious non-eligible studies. Of these, 40 studies were deemed eligible for inclusion in a full article review.

Stage 3: Full Article Review

Two qualified reviewers conducted a full article review of the 40 studies. This review had two goals: first, to exclude any studies of non-eligible trials; second, to extract data on specific variables for further analyses. Of the 40 studies, 18 studies were deemed eligible for inclusion in our analysis.

Data collection process

Data extraction was conducted by a qualified reviewer (the first author) during the full article review of the 18 included studies. The source of data in the individual studies was confirmed by contacting investigators who authored multiple studies included in the review, due to the aggregated weight of these studies potentially affecting our conclusion. The confirmation aimed to verify whether the data examined in the individual studies were collected from a single population and used in more than one study, or from different independent populations.

Data items

Primary Outcomes:

- Quality of Study: The quality of the study was categorized into three groups (Low, Moderate, High) (categorical variable)

- Conclusion of Study Effect: (whether the study concluded association of wind turbines with the effect on human health that was under investigation) (binary variable)

Variables (Outcome Measures of Individual Studies):

- First Author: The name of the first author (nominal variable)

- Year of Publication: The year in which the study was published (ordinal variable)

- Journal Name: The name of the publishing journal (nominal variable)

- Country of Study: The name of the country where the trial was originated (nominal variable)

- Study Design: The design of the study (nominal variable)

- Sample Size: The study sample size (continuous variable)

- Response Rate: The response rate of subjects in the study (continuous variable)

- Level of Evidence: The Level of evidence of the study (nominal variable)

- Level of Potential Bias: The level of risk of bias. Categorized into three groups according to Cochrane's recommendations [10]. (Low risk of bias: Plausible bias unlikely to seriously alter the results; Unclear risk of bias: Plausible bias that raises some doubt about the results; High risk of bias: Plausible bias that seriously weakens confidence in the results) (categorical variable)

- Outcome Measures of Study: The outcome measure under investigation in the study (nominal variable); these outcome measures are:

      - Annoyance (Sensitivity to Noise)

      - Sleep disturbance

      - Visual impact

      - Well-being (Quality of Life/Mental Effect)

      - Dose-response (description of the change in distress caused by differing distances from a wind turbine)

      - Infrasound effect

      - Existing background noise (comparison of stress associated with wind turbines to stress associated with road traffic noise/quiet rural environment)

      - Attitude to wind turbines (whether people who complain have negative personal opinions toward wind turbines)

      - Economical benefit (whether people who benefit economically from wind turbines have a decreased risk of distress)

Risk of bias in individual studies

Assessing the risk of bias of individual studies was performed at both the study level (study design, sample size, response rate, direction and magnitude of any potential bias and how it was handled, limitations, and reporting quality) and the outcome level (a cautious overall interpretation was drawn of the study's conclusions, whether effect of human distress exists, considering the specific study's objectives).

Summary measures and synthesis of results

After data extraction, each study was analyzed to identify the two primary outcomes: First, quality of study, taking into account the study's principle outcome measures; all outcomes, exposures, predictors, potential confounders, and effect modifiers; how the study size was arrived at; how quantitative variables were handled in the analyses; description of all statistical methods; and how loss to follow-up and missing data were addressed. Second, conclusion of study effect as a cautious overall interpretation of the study's conclusions, taking into account the specific study's objectives and how well these conclusions were supported by the study results.

Risk of bias across studies

To reduce potential sampling bias (for example, the quality of study could be confounded by journal name and name of first author), the reviewers blinded themselves to the name of the journal and authors until all data on the other variables of interest were collected. To reduce potential measurement bias, the following three measures were undertaken: The data were directly entered into the database instead of using collection forms, quality assurance on all steps of data collection and management was performed, and in any case of uncertainty in deciding the quality of study, the reviewer consulted one of our senior authors to confirm the decision. Furthermore, the source of data was confirmed by contacting investigators who authored multiple studies included in the review, due to the weight their aggregated studies would have in affecting our conclusions.

Ethics approval

This study used previously published data making it exempt from institutional ethics board approval.

Results

Study selection

Figure 1 presents a flowchart depicting the study screening process. The database searches produced 154 publications. From this group, 40 publications were eligible following screening the titles and abstracts. From this group, 18 publications were eligible for inclusion after full article review. These 18 studies, shown in Table 1, consist of six original studies and 12 non-original studies (secondary analyses and literature reviews based on some of these original studies). Only the six original studies were included in the final analysis shown in Table 2. The 12 non-original studies were excluded from the analysis to minimize potential bias associated with repeated results.                                                                                                                   

This review used previously published data; therefore, there was no missing data for any of the variables of interest.

                                                                                  Study Characteristics
1st Author, Year Country Design Sample Size Response Rate % Level of Evidence Risk Of Bias Within Studies Quality of Study
Bakker [11] 2012 ^ Netherlands Cross-sectional 725 37 4 Unclear risk of bias Moderate
Hanning [12] 2012 ^ UK Expert Opinion/Review N/A N/A 5 Unclear risk of bias Moderate
Nissenbaum [13] 2012 ¥ USA Cross-sectional 106 75 4 Low risk of bias Moderate
Knopper [6] 2011 ^ Canada Review 15 N/A 4 Unclear risk of bias High
Shepherd [14] 2011 ¥ New Zealand Cross-sectional 39, 158 34, 32 3,4 Low risk of bias High
Janssen [15] 2011 ^ Netherlands Secondary analysis 1820 68, 58,  <30 4 Low risk of bias High
Pedersen [16] 2011 ^ Sweden Secondary analysis 1755 * 4 Low risk of bias High
Bolin [17] 2011 ^ Sweden Review N/A N/A 4 Unclear risk of bias Low
Pedersen [18] 2010 ^ Sweden Secondary analysis 725 37 4 Low risk of bias High
Salt [7] 2010 ¥ USA Expert Opinion Report N/A N/A 5 Unclear risk of bias High
Pedersen [19] 2009 ¥ Netherlands Cross-sectional 1948 37 4 Low risk of bias High
Keith [20] 2008 ^ Canada Expert Review N/A N/A 5 Unclear risk of bias High
Pedersen [21] 2008 ^ Sweden Secondary analysis 1095 N/A 4 Low risk of bias High
Pedersen [22] 2008 ^ Sweden Secondary analysis 1822 60 4 Low risk of bias High
Pedersen [23] 2007 ^ Sweden Qualitative Study 15 N/A 5 Low risk of bias High
Pedersen [5] 2007 ¥ Sweden Cross-sectional 754 58 4 Low risk of bias High
Leventhall [24] 2006 ^ UK Report N/A N/A 5 Unclear risk of bias High
Pedersen [25] 2004 ¥ Sweden Cross-sectional 351 68 4 Low risk of bias High

1st Author, Year Does-response Road Traffic Noise / quiet rural environment Sleep Disturbance Annoyance/ sensitivity to noise Visual impact Attitude to wind turbines Infrasound effect Well-being (Quality of Life / mental effect) Economical Benefit
Nissenbaum [13] 2012 p < 0.05   p = 0.03         p = 0.002  
Shepherd [14] 2011     U-R = 0.43 p < 0.001 U-R = 0.44 p < 0.001       U-R = 0.20 p < 0.01  
Salt [7] 2010       Exp     Exp    
Pedersen [19] 2009 LRC = 0.50 p < 0.001 LRC = 1.07- p < 0.01   LRC = 0.35 p < 0.001 LRC = 1.04 p <0.001 LRC = 0.54 p < 0.001     LRC = -2.77 p < 0.001
Pedersen [5] 2007   OR = 1.1 (95% CI 0.91 to 1.21)   OR = 1.1 (95% CI 1.01 to 1.25) OR = 1.1 (95%  CI 0.97 to 1.21) OR = 1.1 (95%  CI 1.00 to 1.25)      
Pedersen [25] 2004     Rs = 0.35  p < 0.001 Rs = 0.42  p < 0.001 Rs = 0.52  p < 0.001 Rs = 0.33  p < 0.001      

Study characteristics and risk of bias within studies

Table 1 shows data on the 18 peer-reviewed studies captured in our review, including individual study characteristics, level of potential bias, and quality of study.

Results of individual studies

Table 2 shows summary data on the six original studies' objectives, p-values, and outcome measures.

Risk of bias across studies

One main source of potential bias across these studies was that 10 of them, listed below, were mainly based on three data sets. The first data set (SWE00) was collected in Sweden in the year 2000 in agricultural areas, the second (SWE05) was collected in different environments in Sweden 2005, and the third (NL07) was collected all over the Netherlands in 2007. This potential bias was eliminated by using only the three original studies that collected the data sets [5, 19, 25].  The rest of the 10 studies (non-original studies) were excluded from the analysis to avoid repeated results.

      - Bakker [11] 2012 Science of the Total Environment (NL07)

      - Pedersen [16] 2011 Noise Control Eng J (SWE00) + (SWE05) + (NL07)

      - Janssen [15] 2011 Acoustical Society of America (SWE00) + (SWE05) + (NL07)

      - Pedersen [18] 2010 Energy Policy (NL07)

      - Pedersen [19] 2009 Acoustical Society of America (NL07)

      - Pedersen [21] 2008 Journal of Environmental Psychology (SWE00) + (SWE05)

      - Pedersen [22] 2008 Environ Res Lett (SWE00) + (SWE05)

      - Pedersen [23] 2007 Qualitative Research in Psychology (SWE00)

      - Pedersen [5] 2007 Occup Environ Med (SWE05)

      - Pedersen [25] 2004 Acoustical Society of America (SWE00) 

Another source of bias was that three of the studies were reviews of previous literature [6, 12, 17].

Key results

- All 18 peer-reviewed studies captured in our review found an association between wind turbines and one or more types of human distress. These studies had a level of evidence of four and five.

- None of the studies captured in our review found any association (potential publication bias). 

- These studies were published in a variety of journals (representative sample).

- Two of these studies showed a dose-response relationship between distance from wind turbines and distress (Table 2).

- There is still no evidence of whether or not a causal relationship between distance from wind turbines and distress exists.

Discussion

Summary of evidence

The peer-reviewed studies we reviewed provide reasonable evidence (Levels Four and Five) that an association exists between wind turbines and distress in humans.

Two of these studies showed a dose-response relationship between distance from wind turbines and distress, and none of the 18 studies concluded no association (consistency of association). The existence of a dose-response relationship and consistency, two of the Hill's Criteria of Causality, argues for the credibility of the association.

All the evidence comes from expert opinion, case studies, and cross-sectional studies. No higher level of evidence observational studies, namely case-control and cohort studies, were utilized to investigate the subject. For example, although Shepherd, et al's study [14] had a sound design and was well conducted and reported, it is considered at a lower level of evidence as a cross-sectional study has an increased potential for bias of its results.

Although three of the studies [6-7, 24] suggested that low-frequency sound energy wind turbines (i.e., infrasound below 20 Hz) may directly and negatively affect health, the level of evidence for these studies is also weak (expert opinions [7, 24] and a review [6] citing these two studies).

Economic benefit found in two of the studies [15, 19] could be intuitively and prematurely viewed as a factor lowering the credibility of the complaint. However, in our opinion, compensation would have lowered the credibility of the complaint only if these people had no distress following compensation. People in the studies who benefited economically from wind turbines had a decreased risk of distress but not a complete elimination of distress. Furthermore, the fact that the level of distress could be altered with financial compensation only speaks to the existence of distress.

It is worth pointing out that no causality has been established. The distress could be due to factors other than actual noise exposure. For example, the distress experienced by the participants in the original studies may have been generated or exaggerated by exposure to negative opinions on wind turbine.

Limitations

This study has a number of limitations and sources of bias. One source of bias is the exclusion of non-English studies. For example, China is the world’s leading country in the number of wind turbines [1]. The exclusion of non-English studies might have affected the overall conclusions of our review.

Another source of bias is the fact that the reviewer could not be completely blinded to the journals' or authors' names. There might be a theoretical incline to give studies in high impact journals higher quality because of their reputation (potential sampling bias). Nevertheless, if this bias took place, it would have an effect on the magnitude of evidence and not on the existence of the association due to the dichotomous nature of this variable (the number of studies that speaks for an association will not change). 

Publication bias could be the reason for the finding that none of the 18 peer-reviewed studies captured in our review found no association. However, potential publication bias was decreased by conducting a search in two major grey literature databases (SIGLE, and Scirus).

Generalizability

The 18 studies were published in a variety of journals, making the captured studies a representative sample, which in turn increases our results' generalizability (external validity).

The fact that the data in two of the three mentioned data sets were collected in Sweden may decrease the external validity, but simultaneously may increase the internal validity following the above logic. Furthermore, although these data were collected from one country, it still would be a safe assumption that the people and their experience with wind turbines, on which these data were collected, are not fundamentally different from people and experiences in other countries.

Future research

Further research in the area of exposure assessment and measurement is needed. The mechanism and physiology of harm needs to be confirmed. There is a need to identify the actual risk of harm and the health outcomes in people exposed. Until research can separate out specific sets of significant factors for the exposure with higher-level evidence than is available now, our ability to mitigate the harm is limited. Possible future research could be conducting longitudinal studies, performing measurements before wind turbines and after, and observing what happens to people over time.

Conclusions

We have demonstrated in our review the presence of reasonable evidence (Levels Four and Five) supporting the existence of an association between wind turbines and distress in humans. The existence of a dose-response relationship between distance from wind turbines and distress as well as the consistency of association across studies found in the scientific literature argues for the credibility of this association. Future research in this area is warranted.

References

  1. The Global Wind Energy Council. Accessed: October 30, 2013: http://www.gwec.net/?s=canada.
  2. The Global Wind Energy Council.. (2012). Accessed: October 30, 2013: http://www.gwec.net/wp-content/uploads/2012/06/Top-10-Cumulative-Capacity-December-2012.jpg.
  3. University of Strathclyde Archives. Accessed: January 20, 2014: http://stratharchives.tumblr.com/post/85511105886/week-18-windmill-designed-and-built-by-james.
  4. Krogh C, Gillis L, Kouwen N, Aramini J: WindVOiCe, a self-reporting survey: adverse health effects, industrial wind turbines, and the need for vigilance monitoring. Bull Sci Technol Soc. 2011, 31:334-45.
  5. Pedersen E, Hallberg L, Waye KP: Living in the vicinity of wind turbines--a grounded theory study. Qualitative Research in Psychology. 2007, 4:49–63.
  6. Knopper LD, Ollson CA: Health effects and wind turbines: A review of the literature. Environ Health. 2011, 10:78. 10.1186/1476-069X-10-78
  7. Salt AN, Hullar TE: Responses of the ear to low frequency sounds, infrasound and wind turbines. Hear Res. 2010, 268:12-21. 10.1016/j.heares.2010.06.007
  8. World Health Organisation: Night noise guidelines for Europe. (2009). Accessed: October 30, 2013: http://www.euro.who.int/__data/assets/pdf_file/0017/43316/E92845.pdf.
  9. Hill AB: The Environment and Disease: Association or Causation?. Proc R Soc Med. 1965, 58:295-300.
  10. Higgins JPT, Altman DG, Sterne JAC on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group: Chapter 8: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions. 2011, Version 5.1.0:Accessed: October 30, 2013: http://handbook.cochrane.org/chapter_8/8_assessing_risk_of_bias_in_included_studies.htm.
  11. Bakker RH, Pedersen E, van den Berg GP, Stewart RE, Lok W, Bouma J: Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress. Sci Total Environ. 2012, 425:42-51. 10.1016/j.scitotenv.2012.03.005
  12. Hanning CD, Evans A: Wind turbine noise. BMJ. 2012, 344:e1527. 10.1136/bmj.e1527
  13. Nissenbaum MA, Aramini JJ, Hanning CD: Effects of industrial wind turbine noise on sleep and health. Noise Health. 2012, 14:237-43. 10.4103/1463-1741.102961
  14. Shepherd D, McBride D, Welch D, Dirks KN, Hill EM: Evaluating the impact of wind turbine noise on health-related quality of life. Noise Health. 2011, 13:333-9. 10.4103/1463-1741.85502
  15. Janssen SA, Vos H, Eisses AR, Pedersen E: A comparison between exposure-response relationships for wind turbine annoyance and annoyance due to other noise sources. J Acoust Soc Am. 2011, 130:3746-53. 10.1121/1.3653984
  16. Pedersen E: Health aspects associated with wind turbine noise—Results from three field studies. Noise Control Eng J. 2011, 59:47-53.
  17. Bolin K, Bluhm G, Eriksson G, Nilsson ME: Infrasound and low frequency noise from wind turbines: Exposure and health effects. Environ Res Lett. 2011, 6:1-6. 10.1088/1748-9326/6/3/035103
  18. Pedersen E, van den Berg F, Bakker R, Bouma J: Can road traffic mask the sound from wind turbines? Response to wind turbine sound at different levels of road traffic. Energy Policy. 2010, 38:2520–2527. 10.1016/j.enpol.2010.01.001
  19. Pedersen E, van den Berg F, Bakker R, Bouma J: Response to noise from modern wind farms in The Netherlands. J Acoust Soc Am. 2009, 126:634-43. 10.1121/1.3160293
  20. Keith SE, Michaud DS, Bly SHP: A proposal for evaluating the potential health effects of wind turbine noise for projects under the Canadian Environmental Assessment Act. Low Freq Noise Vib Active Control. 2008, 27:253-65.
  21. Pedersen E, Larsman P: The impact of visual factors on noise annoyance among people living in the vicinity of wind turbines. J Environ Psychol. 2008, 28:379–89. 10.1016/j.jenvp.2008.02.009
  22. Pedersen E, Waye KP: Wind turbines - low level noise sources interfering with restoration?. Environ Res Lett. 2008, 3:1–5.
  23. Pedersen E, Waye KP: Wind turbine noise, annoyance and self-reported health and well-being in different living environments. Occup Environ Med. 2007, 64:480-6.
  24. Leventhall HG: Low frequency noise and annoyance. Noise Health. 2004, 6:59-72.
  25. Pedersen E, Waye KP: Perception and annoyance due to wind turbine noise--a dose-response relationship. J Acoust Soc Am. 2004, 116:3460-70.

Community Discussion

Henk Daalder
May 25, 2014 at 10:33 AM
Henk Daalder

My conclusion about this article, is that its purpose is NOT science, but anti windpower propaganda.
The authors do not explain how they evaluated the 40 articles, an d used only 18. Why were the other 22 excuded?

They also show that people are annoyed in the precense of wind turbines, but give no cause effect explanation.
So, the annoyance may very well be induced by anti wind propaganda, or exclusion of people from any involvement in the wind farm project. Then the exclusion is a more likely cause than the turbines themselves. This is one of the findings of a team of the university of Amsterdam, where they investigated the citizens evaluation of a small windfarm near a village, for 2 different villages. In one village the windfarm was setup ottom up, by and for citizens, with high acceptance afterwards. And the othger village, a utility planned, built and operated the windfarm, excluding the citizens of the village. these dit not appreciate the wind farm very much.

Furthermore the authors show no evicence or even an indication that the noise of turbines is the cause of the distress.
This is also falsified by many dutch turbine owners, mostly farmers that live with their family, within 100 m of their own turbine, on their farm yard.
There is not any signal that these peopel are more annoyed than othgers, and also not less healthy.
An other falsification that wind turbine noise would have any relation with annoyance or less sleep, is with the millions of people that live on the coast, in the in surf noise, or with the other millions that live in windy areas near trees. Some trees make a lot of noise, eg poplar, which is very common in the Netherlands, where 3 of the 18 studies originate, these trees produce mote than 60 to 70 dB at the base of the trees above bft 5, hundreds of thousands dutchmen live in homes near these trees, but there is no "dutch poplar noise disease" In fact, Van den Berg reports in one of his many attempts that turbines where only the noise of turbines can be measured are very rare.

Alexander Muacevic
May 27, 2014 at 03:48 AM
Alexander Muacevic

Mr. Daalder, we appreciate your critical comment on the paper of Arra et al.. We do think your comment is over critical and partly unfounded. This paper is from different academic institutions from Canada and without any obvious links to anti windpower propaganda. The authors did describe why they did not include the 22 articles you mention. It is obvious that this subject is of political interest and has an emotional component. We advise you to raise your concerns in an scientific manner and not use a propaganda like style yourself. It seems you belong to an institution which is pro windpower and therefore you need to be particularly cautious.

Thank you,

Alex Muacevic, MD
Professor at the University of Munich
Co-Editor-in-Chief
www.cureus.com

Simon Chapman
June 18, 2014 at 09:23 PM
Simon Chapman

Commentary: Major problems with recent systematic review on wind farms and distress.

Simon Chapman AO PhD FASSA
Professor of Public Health
University of Sydney

At least 20 reviews of the evidence on whether wind turbines cause health problems including stress have been published since 2003 (1). Cureus recently published another (2) where the authors referenced none of these.

Highlights of the findings of these reviews may be found here (1). The most recent (2014) review by Australia’s peak health and medical agency, The National Health and Medical Research Council (3) concluded:

“There is no consistent evidence that noise from wind turbines… is associated with self reported human health effects. Isolated associations may be due to confounding, bias or chance. There is consistent evidence that noise from wind turbines―whether estimated in models or using distance as a proxy―is associated with annoyance, and reasonable consistency that it is associated with sleep disturbance and poorer sleep quality and quality of life. However, it is unclear whether the observed associations are due to wind turbine noise or plausible confounders.”
and
“The association between estimated noise level and annoyance was significantly affected by the visual attitude of the individual (i.e. whether they found wind farms beautiful, or ugly and unnatural) in the three studies that assessed this as a potential confounding factor. Residents in [one] study with a negative attitude to the visual impact of wind farms on the landscape had over 14 times the odds of being annoyed compared with those people without a negative visual attitude. …This means that factors other than the noise produced by wind turbines contribute to the annoyance experienced by survey respondents.”

Against this background, I was curious to see what a new systematic review would conclude. According to the Cureus website, the new paper was peer reviewed. This is difficult to understand because of the sheer volume of major and minor problems it contains. Together, these make its contribution valueless to scholarly understanding of the phenomenon of noise and health complaints about wind farms. The paper shows many signs of poor understanding of the subject matter of their review, of critical appraisal methods, of some basic conventions in systematic reviewing, of structuring in scientific writing, and much more besides.

The problems commence in the first line of the abstract where the confusing statement is made that “the proximity of wind turbines to residential areas has been associated with a higher level of complaints compared to the general population.” I assume here that they are trying to say that those living near turbines have a higher prevalence of health complaints like sleep disturbance and general “human distress” than in the wider population. The prevalence of sleeping problems in general populations is as high as 33% (4) and reference material exists that quantifies the prevalence of many health problems in general populations (5, 6). Instead, the authors support their statement with a reference to a small qualitative study of 15 people both affected and unaffected by turbines (7). No conclusions about the prevalence of health problems in communities near turbines or in matched comparison populations can be drawn from that paper. I know of no published evidence that would allow such a statement to be made.

The authors state that their search strategy located 18 eligible papers but that these were based on six original studies. They explain that the 12 non-original “studies” (several of which were reviews or commentaries) were then excluded. Yet in their “key results” they proceed to describe the characteristics of all 18 papers and thus act as if these were not excluded (“All 18 peer-reviewed studies captured in our review found an association…”).

The authors do not appear to understand what an “outcome” is. The abstract lists “outcome” variables that are not outcomes at all (such as study quality and journal name). These are independent variables, not dependent ones.

Their eligibility criteria for study selection are perplexing. What for example, is the difference between “peer-reviewed studies” and “studies published in peer-reviewed journals”? So too, is their noting that they searched the Cochrane Library for relevant studies. The Cochrane Library is a repository of reviews of evidence for health interventions, not for data on the prevalence of health complaints.

The authors seem not to understand the difference between studies and trials. For obvious reasons, there have been no trials conducted in this area.

Their main conclusions are that:

• An association exists between wind turbines and distress in humans.
• The existence of a dose-response relationship (between distance from wind turbines and distress) and the consistency of the association across studies .. argues for the credibility of this association.

The first conclusion is very imprecise and sweeping and ripe for being megaphoned by anti-wind farm interest groups as if it actually meant something. One of the six original studies reviewed (Salt & Hullar) (8) should have never been included in this review – see below. The Nissenbaum et a study (9) is listed as of moderate quality with a low risk of bias. Yet all three authors and two out of three reviewers of that paper are members of Society for Wind Vigilance, an anti-wind organization. Nissenbaum has been raising health concerns in study areas for several years, potentially biasing collected data. Neither of these problems is mentioned in this review. Two critiques of this study were published in Noise and Health pointing out the very poor quality of the results, analysis and the overstatements of conclusions (10, 11).

The Shepherd et al study (12) which the authors rate as of “high” quality, failed to make any mention that the small wind farm community involved had for years been subjected to a local wind farm opposition group fomenting anxiety about health issues (13). Indeed, with one exception (14), the five studies referenced were performed in areas where complaints of annoyance were being raised. But such farms are unlikely to be representative of all wind farms. As our work shows, over nearly 65% of wind farms in Australia have never received a single complaint (15), and 73% of complainants in Australia are concentrated around just 6/51 farms. The failure of the authors to note this fundamental problem of study sample selection bias is another major problem.

Among the five “original” studies they considered satisfied their selection criteria was a paper by Salt & Hullar (8). This paper is not in any way a “study” of “the association between wind turbines and human distress.” It reports no original empirical data and is essentially a backgrounder on infrasound and the “possibility” that wind turbine might create auditory distress. It is unfathomable why this paper was included in the data set.

Table 2 purports to be a meaningful summary of the findings of these six studies on the association between turbine exposure and “distress”. I would defy anyone to make any sense of the Table, particularly the column headed “does [sic] response”.

By way of comparison to the lack of detail provided by the authors of this review, it is instructive to look at the results from the Dutch study which formed the basis of the Pedersen 2009 paper(14) which were further analysed by Bakker et al (16) who noted that sleep disturbance was assessed by a question dealing with the frequency of sleep disturbance by environmental sound (“how often are you disturbed by sound?”). Two thirds of all respondents reported not being disturbed by any sound at all. Disturbance by traffic noise or other mechanical sound was reported by 15.2% of the respondents. Disturbance by the sound of people and of animals was reported by 13.4% of the respondents. Relevantly, disturbance by the sound of wind turbines was reported by only 4.7% of the respondents (6% in areas deemed to be quiet and 4% in areas deemed to be noisy). Bakker and colleagues (16) note that it was not clear from the study if there was a primary source causing sleep disturbance and how respondents attributed being awakened by different environmental sound sources. What was clear was that wind turbines were less frequently reported as a sleep disturbing sound source, than other environmental sounds irrespective of the area type (quiet versus noisy). Analysis showed that among respondents who could hear wind turbine sound, annoyance was the only factor that predicted sleep disturbance. The authors speculated that being annoyed might contribute to a person’s sensitivity for any environmental sound, and the reaction might be caused by the combination of all sounds present. It might also be the case that people annoyed by wind turbine noise attribute their experience of sleep disturbance to wind turbine noise, even if that was not the source of their awakening.

Swathes of the paper are given over to descriptions of their efforts to rate the levels of evidence in the four reviewed studies. But they never ever describe their approach in any way that might permit replication of how they went about such rating. How was level of evidence actually determined? It should have been explicitly defined in the text. Their discussion of the risk of bias across studies is bizarre. "The quality of the study could be confounded by journal name and author". Surely the authors mean here that the evaluation of the quality of the study could be biased by this knowledge. The term “confounded” has another meaning.

Their “key results” consist of no more than five bullet points. These read like draft notes-to-self (eg: None of these studies captured in our review found any association (potential publication bias)”.

The authors chose to use the term “distress” instead of “annoyance". The American Medical Dictionary defines distress as 1. Mental or physical suffering or anguish or 2. Severe strain resulting from exhaustion or trauma. Annoyance on the other hand is defined as 1. The act of annoying or the state of being annoyed or 2. A cause of irritation or vexation; a nuisance. (The American Heritage Dictionary of the English Language, Fourth Edition copyright 2000) and is generally identified as a highly subjective state in medical literature. It is clear that the authors chose a stronger term than was used by the majority of studies. Most literature refers to annoyance, while the referenced alternative of “Wind Turbine Syndrome” was coined in a vanity press published case study with extraordinary weaknesses of selection bias, methodology and analysis (17). Similarly, “extreme annoyance” is rarely used in the literature. Annoyance is by far the most commonly used term in the material referenced, so it is unclear why “distress” was chosen.

The paper is riddled with imprecise, mangled and contradictory language. For example: key finding 1: “All 18 peer-reviewed studies captured in our review found an association…” and key finding 2: “None of these studies captured in our review found any association (potential publication bias)”; infelicitous prose: “these complaints are coined in research”; “There might be a theoretical incline to give studies in high impact journals higher quality…”; basic grammatical errors: “the study’s principle outcome”; “there was no missing data.” It is unconventionally structured with extremely scant results and methods sections providing no adequate explanations of how key decisions on quality or bias were made.

The publication of this very poor paper is regrettable.

Acknowledgements: Fiona Crichton, Cornelia Baines and Mike Bernard each contributed comments to me for this response.

Competing interests: Simon Chapman receives no financial or in-kind support from any company, individual or agency associated with wind energy.

References

1. Chapman S, Simonetti T. Summary of main conclusions reached in 20 reviews of the research literature on wind farms and health. Sydney University eScholarship respository: University of Sydney; 2014; Available from: http://hdl.handle.net/2123/10559.
2. Arra I, Lynn H, Barker K, Ogbuneke C, Regalado S. Systematic review 2013: Association between wind turbines and human distress. 2014; Available from: http://www.cureus.com/articles/2457-systematic-review-2013-association-between-wind-turbines-and-human-distress?utm_medium=email&utm_source=transaction - .U6DaMi90xT5.
3. Merlin T, Newton S, Ellery B, Milverton J, Farah C. Systematic review of the human health effects of wind farms. Canberra: National Health and Medical Reserach Council; 2014; Available from: https://http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/eh54_systematic_review_of_the_human_health_effects_of_wind_farms_december_2013.pdf.
4. Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Predictors of primary medical care consultation for sleep disorders. Sleep medicine. 2008;9(8):857-64. Epub 2007/11/06.
5. Rief W, Barsky AJ, Glombiewski JA, Nestoriuc Y, Glaesmer H, Braehler E. Assessing general side effects in clinical trials: reference data from the general population. Pharmacoepidemiol Drug Saf. 2011;20(4):405-15. Epub 2011/03/29.
6. Petrie KJ, Faasse K, Crichton F, Grey A. How common are symptoms? Evidence from a New Zealand national telephone survey. BMJ open. 2014;4(6):e005374. Epub 2014/06/15.
7. Pedersen E, Hallberg LR-M, Waye KP. Living in the vicinity of wind turines - a grounded theory study. Qualitative Research in Psychology. 2007;4:49-63.
8. Salt AN, Hullar TE. Responses of the ear to low frequency sounds, infrasound and wind turbines. Hearing research. 2010;268(1-2):12-21. Epub 2010/06/22.
9. Nissenbaum MA, Aramini JJ, Hanning CD. Effects of industrial wind turbine noise on sleep and health. Noise Health. 2012;14(60):237-43. Epub 2012/11/03.
10. Ollson CA, Knopper LD, McCallum LC, Whitfield-Aslund ML. Are the findings of "Effects of industrial wind turbine noise on sleep and health" supported? Noise Health. 2013;15(63):148-50. Epub 2013/04/11.
11. Barnard M. Issues of wind turbine noise. Noise Health. 2013;15(63):150-2. Epub 2013/04/11.
12. Shepherd D, McBride D, Welch D, Dirks KN, Hill EM. Evaluating the impact of wind turbine noise on health-related quality of life. Noise Health. 2011;13(54):333-9. Epub 2011/10/01.
13. Anon. Makara Guardians. Wikipedia; Available from: http://en.wikipedia.org/wiki/Makara_Guardians.
14. Pedersen E, van den Berg F, Bakker R, Bouma J. Response to noise from modern wind farms in The Netherlands. Journal of the Acoustical Society of America. 2009;126(2):634-43. Epub 2009/07/31.
15. Chapman S, St George A, Waller K, Cakic V. The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: support for the psychogenic, 'communicated disease' hypothesis. PloS one. 2013;8(10):e76584. Epub 2013/10/23.
16. Bakker RH, Pedersen E, van den Berg GP, Stewart RE, Lok W, Bouma J. Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress. Science of the Total Environment. 2012;425:42-51.
17. Pierpont N. Wind Turbine Syndrome. A report on a natural experiment. Santa Fe: K-Selected Books; 2009.

Mike Barnard
June 18, 2014 at 11:49 PM
Mike Barnard

This paper does not add anything of value to the literature on wind turbines. All of the 20 reviews [11] performed world wide as well as the papers cited by this review agree that some people near some wind farms experience annoyance. Attempting to bootstrap this into a more serious claim of 100% correlation of distress by people near wind farms is inappropriate and indicative of at minimum academic weakness on the part of the authors.

Comments on conclusions

1. The studies referenced (with one exception) were performed in areas where complaints of annoyance were being raised.

As the Chapman 2013 study shows, over 50% of wind farms in Australia receive no complaints at all.[1] This gap in the data and selection bias of studies to areas of complaints is not identified by the authors as a concern and significantly weakens their hypothesis.

2. The authors chose to use the term “distress” instead of “annoyance".

The American Medical Dictionary defines distress as 1. Mental or physical suffering or anguish or 2. Severe strain resulting from exhaustion or trauma. (The American Heritage® Medical Dictionary Copyright © 2007, 2004). Annoyance on the other hand is defined as 1. The act of annoying or the state of being annoyed or 2. A cause of irritation or vexation; a nuisance.
(The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000) and is generally identified as a highly subjective state in medical literature.

The authors chose a significantly stronger term than is used by the studies they reference. The peer-reviewed literature related to wind energy and health refers to annoyance, while the referenced alternative of “Wind Turbine Syndrome” was coined in a vanity-published case study with extraordinary weaknesses of selection bias, methodology and analysis.[2] Similarly, “extreme annoyance” is rarely used in the referenced literature. Annoyance is by far the most commonly used term in the material referenced, so it is unclear why “distress” was chosen.

3. At most, the study conclusions should have stated that some people near some wind farms are annoyed by them. The paper’s much stronger conclusion of a strong correlation between wind farms and the much stronger term distress is unwarranted. This constitutes hyperbole, not a useful assessment of the literature.

Comments on included papers

1. In general, there are many good inclusions. There is evidence that the study authors cast a wide net and found relevant material. There are challenges with specific papers that they have included however.

2. The Nissenbaum Aramini Noise and Health study is listed as of moderate quality with low risk of bias.

This is an improvement on original presentations of this material in February 2013 when it was listed as of High quality and identified as “Excellent research”.[3] All three authors of the Nissenbaum paper and two of three reviewers are members of the Society for Wind Vigilance, an anti-wind organization[4]. Nissenbaum has been raising health concerns in the study areas for several years with initial publication of concerns in 2007, potentially biasing collected data. Neither of these sources of bias are mentioned in the published Nissenbaum paper, or reflected in the literature review.

Two critiques of this study were published in Noise and Health pointing out the very poor quality of the results, analysis and the overstatements of conclusions. [5], [6] (Full disclosure: one of the two critiques was authored by the author of this comment on Cureus.) Neither of the two critiques were referenced or apparently read by the authors of this paper although their publication long predates the publication of this review in Cureus.

The much more robust and reliable Australian National Health and Medical Research Council study whose draft results were published in late 2013 included the Nissenbaum study but found it to be very low quality.[7] To quote its conclusions on the quality of the paper:

“Poor

High risk of:
• exposure misclassification
• recall bias
• selection bias
• confounding
• significant associations due to chance

Potential for:
• outcome misclassification”

This must be compared with Arra and Lynn’s assessment of this paper of “Low risk of bias”.

3. The referenced Salt paper is listed as of high quality.

This paper is an opinion piece based on no studies on any wind turbine neighbours. It accepted a set of unpeer-reviewed, internet-sourced case studies of very low quality as factual, e.g. Pierpont, Harry. These studies did not merit inclusion or mention in even this literature review. Salt’s extension of minor guinea pig physiological changes to human distress without any evidence of human distress has been strongly criticized by Leventhall among others.[9] The Salt paper’s inclusion in the results is not aligned with the review’s stated inclusion criteria, purported thesis or intent. Reference to it all never mind as being of High quality is a quality problem with this paper.

4. The much more robust NHMRC study just released found a small number of studies showing any degree of credible linkage and that those studies were of uniformly poor quality with significant weaknesses - a finding not found by this review.[7]

Comments on exclusions

1. The review excludes the Lawrence et al paper from Feb 2013 [8], a single month difference than the stated inclusion period, as well as Chapman [1] and Chricton [10] papers from mid-2013. Given May 2014 publication on Cureus, updates would have been expected. The cutoff is unfortunate as is the lack of substantive updating of the material for 12 months between the initial internet dissemination and publication in Cureus. Other updates were performed in the interim, such as the downgrading of the Nissenbaum Aramini paper from High quality to Moderate, so it’s unclear why other updates could not have been performed as well.

General comments

1. The introductions’ list of causes excludes the nocebo effect hypothesis (CanWEA study[11], Crichton[10]) and psychogenic hypothesis (Chapman [1]) - the two related hypotheses pre-dated Jan 2013 although formal papers were published after the cutoff.

2. The introduction also excludes the relationship of annoyance to lack of economic benefit and negative attitudes to aesthetics of wind turbines. Economic benefit is assessed in the Discussion but is dismissed on unreferenced statement that it only relates to diminishment of distress.

3. Krogh, Aramini WindVoice material published in the unindexed BSTS is referenced as is Hanning guest editorial in BMJ although they are not included in table of assessed papers. These are unbalanced discussions of concern by Society for Wind Vigilance members, and inclusion in the references is likely indicative. Opinion pieces of higher quality and provenance finding no cause for concern are not included in the general references.

Summary

It is unfortunate that this paper passed peer review in this form. It appears as if no neutral peer reviewer familiar with the literature of wind energy was asked to assess this paper, and that little substantive assessment was performed before publication.

The SIQ score of 3.5 as of June 19, 2014 suggests that this weak paper is being voted up by those opposed to wind energy, as the merits of the paper certainly do not suggest a rating above the lowest.

[1] The Pattern of Complaints about Australian Wind Farms Does Not Match the Establishment and Distribution of Turbines: Support for the Psychogenic, ‘Communicated Disease’ Hypothesis , Simon Chapman, Alexis St. George, Karen Waller, Vince Cakic, PLOS One, Oct 2013, http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0076584
[2] Wind Turbine Syndrome is More Wind Than Syndrome, Mike Barnard, barnardonwind.com, Feb 2013, http://barnardonwind.com/2013/02/28/wind-turbine-syndrome-is-more-wind-than-syndrome/
[3] Literature Review 2013: Association between Wind Turbine Noise and Human Distress, Ian Arra, Hazel Lynn, 2013, Grey Bruce Public Health, http://www.publichealthgreybruce.on.ca/HOME/Publications/Board/BOH_Reports/2013/Literature%20Review%202013%20Association%20Between%20Wind%20Turbine%20Noise%20and%20Human%20Distress.pdf
[4] Society for Wind Vigilance, http://web.archive.org/web/20140407160806/http://www.windvigilance.com/, Note: this formerly public site has been made private by the administrators, necessitating the use of a web archive
[5] Letter to Editor: Are the findings of "Effects of industrial wind turbine noise on sleep and health" supported?, Ollson CA, Knopper LD, McCallum LC, Whitfield-Aslund ML. , Noise Health [serial online] 2013 [cited 2014 Jun 19];15:148-50. Available from: http://www.noiseandhealth.org/text.asp?2013/15/63/148/110302
[6] Letter to Editor: Issues of wind turbine noise, Barnard M, Noise Health [serial online] 2013 [cited 2014 Jun 19];15:150-2. Available from: http://www.noiseandhealth.org/text.asp?2013/15/63/150/110305
[7] Systematic review of the human health effects of wind farms, Merlin, T, Newton, S, Ellery, B, Milverton, J & Farah, C 2013, National Health and Medical Research Council, Canberra, http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/eh54_systematic_review_of_the_human_health_effects_of_wind_farms_december_2013.pdf
[8] The influence of negative oriented personality traits on the effects of wind turbine noise, Jennifer Taylor, Carol Eastwick, Robin Wilson, Claire Lawrence, Personality and Individual Differences, Volume 54, Issue 3, February 2013, Pages 338–343, http://www.sciencedirect.com/science/article/pii/S0191886912004783
[9] Concerns About Infrasound From Wind Turbines, Geoff Leventhall, July 2013, Vol 9, Issue 3, Acoustics Today, https://acousticstoday.org/issues/2013AT/Jul2013/#?page=30
[10] Can expectations produce symptoms from infrasound associated with wind turbines?, Crichton, F., Dodd, G., Schmid, G., Gamble, G., & Petrie, K. J. (2013), Health Psychology, http://www.ncbi.nlm.nih.gov/pubmed/23477573
[11] Full list of all Wind Health Reviews maintained by Professor Simon Chapman, School of Public Health, University of Sydney, http://ses.library.usyd.edu.au/handle/2123/10559

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March 20, 2016 at 01:44 AM
Niki Heany

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Ian Arra, M.D., M.Sc.

Public Health and Preventive Medicine, Northern Ontario Medical School- East Campus - Laurentian University, Health Sciences Education Resource Centre

For correspondence:
ian.arra@nosm.ca

Hazel Lynn

Public Health and Preventive Medicine, Grey Bruce Health Unit, Ontario, Canada

Kimberley Barker

Public Health and Preventive Medicine Program, Northern Ontario School of Medicine, East Campus - Laurentian University, Medical Officer of Health, Algoma Public Health

Chiebere Ogbuneke

Public Health and Preventive Medicine Post Graduate Program, Northern Ontario School of Medicine, East Campus - Laurentian University, Health Sciences Education Resource Centre

Sophie Regalado

Health Sciences Librarian, Northern Ontario School of Medicine, Lakehead University Campus