title: Comparison of Multiple Measures of Noise Exposure in Paper Mills.
abstract: BACKGROUND
  Noise exposures are associated with a host of adverse health effects, yet these exposures remain inadequately characterized in many industrial operations, including paper mills. We assessed noise at four paper mills using three measures: (i) personal noise dosimetry, (ii) area noise measurements, and (iii) questionnaire items addressing several different aspects of perceived noise exposure.
  
  
  METHODS
  We assessed exposures to noise characterized using the three measures and compared the relationships between them. We also estimated the validity of each of the three measures using a novel application of the Method of Triads, which does not appear to have been used previously in the occupational health literature.
  
  
  RESULTS
  We collected 209 valid dosimetry measurements and collected perceived noise exposure survey items from 170 workers, along with 100 area measurements. We identified exposures in excess of 85 dBA at all mills. The dosimetry and area noise measurements assigned to individual subjects generally showed good agreement, but for some operations within mill, large differences between the two measures were observed, and a substantial fraction of paired measures differed by >5 dB. Perceived noise exposures varied greatly between the mills, particularly for an item related to difficulty speaking in noise. One perceived noise exposure item related to difficulty hearing due to noise showed strong and significant correlations with both dosimetry and area measurements. The Method of Triads analysis showed that dosimetry measures had the highest estimated validity coefficient (0.70), and that the best performing perceived exposure measure had validity that exceeded that of area measurements (0.48 versus 0.40, respectively).
  
  
  CONCLUSIONS
  Workers in Swedish pulp mills have the potential for exposures to high levels of noise. Our results suggest that, while dosimetry remains the preferred approach to exposure assessment, perceived noise exposures can be used to evaluate potential exposures to noise in epidemiological studies.
authors.affiliation: 1.Department of Environmental Health Sciences and University of Michigan Risk Science Center, University of Michigan, 1415 Washington Heights, 6611 SPH I, Ann Arbor, MI 48109, USA; rneitzel@umich.edu.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Neitzel
authors.affiliation: 2.Sahlgrenska Academy, Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: Marianne
authors.initials: M
authors.lastname: Andersson
authors.affiliation: 2.Sahlgrenska Academy, Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Andersson
mesh_terms: D004784:Environmental Monitoring / Q000379:methods; D006801:Humans; D066192:Manufacturing Industry; D009623:Noise, Occupational; D016273:Occupational Exposure / Q000032:analysis*; D010209:Paper; D013548:Sweden
keywords: area measurements; dosimetry; job exposure matrix; method of triads; noise; perceived exposure