Soundscape and Health – Acoustics Group | Shenyang Jianzhu University

1. Introduction: Defining the Soundscape and its Relevance to Health

1.1. The Emergence of Soundscape as a Concept

The study of our auditory environment has undergone a significant evolution. While early explorations into the sounds around us existed, the term “soundscape” gained traction through the work of Michael Southworth in city planning ¹ and was prominently developed by composer R. Murray Schafer in the 1970s.¹ Initially rooted in acoustic ecology and music, focusing on the relationship between humans and sonic environments ⁴, the concept gradually shifted towards a more human-centric, perceptual approach, particularly within environmental acoustics and psychology.² This shift marked a crucial departure from traditional noise control paradigms, which primarily focused on the quantitative reduction of sound pressure levels (SPL), often measured in decibels (dB).⁵ The soundscape approach, in contrast, emphasizes the quality and perception of the acoustic environment, recognizing that human response is not solely dictated by loudness.⁵ It reframes sound not merely as “waste” (noise) to be eliminated, but as a potential “resource” that can contribute positively to experience and well-being.⁷ This perspective opens avenues for designing acoustic environments that actively promote health and enhance quality of life, moving beyond simple harm reduction.¹⁴

1.2. Defining Soundscape: The ISO 12913 Framework

Recognizing the need for a standardized understanding and methodology, the International Organization for Standardization (ISO) established Working Group 54 in 2008 ²⁸, leading to the publication of the ISO 12913 series on soundscape. The foundational document, ISO 12913-1:2014, provides the internationally accepted definition of soundscape as the “acoustic environment as perceived or experienced and/or understood by a person or people, in context”.² This definition hinges on three key components:

People: The listeners or perceivers, whose individual characteristics, experiences, expectations, and current state influence their perception.
Acoustic Environment: The physical sound field, comprising all sound waves arriving at the listener from various sources, modified by environmental factors like reflection and absorption.
Context: The setting in which the sound is perceived, encompassing the physical place, the activities being undertaken, social and cultural norms, time of day or season, and the listener’s personal background and intentions.² Context is not merely a backdrop but actively shapes perception through the complex interrelationships between the person, their activity, the place, and time.⁵

Subsequent technical specifications, ISO/TS 12913-2:2018 on data collection ² and ISO/TS 12913-3:2019 on data analysis ²², provide guidelines for conducting soundscape studies. These standards aim to foster comparability and replicability in research by outlining methods for assessing the key components (people, acoustic environment, context) and analyzing the collected data.²⁸ However, achieving consensus on a single protocol proved challenging, leading Part 2 to recommend multiple assessment methods.²⁸

1.3. Distinguishing Soundscape from Acoustic Environment

A critical aspect of the ISO framework is the explicit distinction between the acoustic environment and the soundscape. The acoustic environment refers to the objective, physical phenomenon – the totality of sound waves from all sources present in a specific location, as modified by the physical surroundings through processes like propagation, reflection, absorption, and refraction.³ It can be measured using physical instruments and described by acoustic parameters.

The soundscape, conversely, is the perceptual construct that arises from experiencing the acoustic environment.¹ It is inherently subjective and deeply influenced by the listener’s internal state (e.g., mood, expectations, past experiences, cultural background) and the external context (e.g., location, activity, social setting).⁵ Soundscape involves not just hearing, but also interpretation and understanding – a cognitive component.¹ The same physical acoustic environment can thus lead to vastly different soundscape perceptions among different individuals or for the same individual under different circumstances.

This formal distinction established by ISO 12913 between the physical acoustic environment and the perceptual soundscape proved pivotal for the field. By defining soundscape explicitly through perception ‘in context’ ³, the framework moved beyond relying solely on physical metrics like decibels. This step was crucial because human responses relevant to health – such as annoyance, stress, or feelings of restoration – are not determined by sound levels alone; the meaning attributed to sounds and the context of exposure are critically important.¹² This conceptual separation legitimized the systematic study of subjective experience within acoustics and environmental health, providing a necessary foundation for incorporating psychological, social, and contextual factors into the assessment of acoustic environments and their impact on human health and well-being.⁵

1.4. Noise Pollution: A Major Environmental Health Concern

While the soundscape approach embraces the potential positive aspects of sound, a significant portion of research necessarily addresses the negative impacts of noise pollution. Noise pollution is generally defined as unwanted or harmful sound within the environment.⁴⁴ It is a pervasive environmental stressor, particularly in urban areas, with major sources including transportation (road traffic, railways, aircraft), industrial activities, construction, and leisure activities.⁴⁴

The scale of the problem is substantial. The European Environment Agency (EEA) and the World Health Organization (WHO) estimate that at least one in five people in Europe is exposed to long-term noise levels considered harmful to health.⁴⁴ This exposure is linked to thousands of premature deaths and new cases of ischemic heart disease annually in Europe.⁴⁶ Indeed, the WHO ranks traffic noise as the second most significant environmental cause of ill health in Western Europe, surpassed only by fine particulate matter air pollution.⁵⁶ To mitigate these risks, the WHO recommends specific guideline values for long-term average noise exposure, for example, suggesting that road traffic noise should not exceed an Lden (day-evening-night average level) of 53 dB or a night level (Lnight) of 45 dB to avoid adverse health consequences.⁵⁶

1.5. Key Health Outcomes Linked to Acoustic Environments

The influence of the acoustic environment, encompassing both unwanted noise and potentially beneficial soundscapes, extends across a wide range of human health outcomes. Research investigates impacts on both physiological and psychological functioning:

Stress: Noise acts as a non-specific stressor, triggering physiological responses (e.g., activation of the autonomic nervous system and HPA axis, release of cortisol) and psychological stress.¹⁴ Conversely, certain soundscapes, particularly those featuring natural sounds, are associated with stress reduction and faster recovery.¹⁴
Sleep Disturbance: Environmental noise is a primary cause of sleep disruption, leading to difficulties initiating or maintaining sleep, reduced sleep quality, awakenings, and physiological arousal even during sleep.¹¹ Chronic sleep disturbance has knock-on effects on daytime functioning and long-term health.⁶²
Cardiovascular Effects: Chronic noise exposure is epidemiologically linked to an increased risk of cardiovascular diseases, including hypertension (high blood pressure), ischemic heart disease (including myocardial infarction), stroke, and potentially heart failure.¹¹ Mechanisms involve stress pathways, endothelial dysfunction, and inflammation.⁵⁹
Mental Well-being: This broad category includes annoyance (the most common response to environmental noise ⁴⁴), mood changes (positive or negative), anxiety, depression, and overall quality of life.¹¹ Positive soundscapes are linked to improved mood and well-being.¹⁹
Cognitive Performance: Noise exposure can impair cognitive functions such as attention, concentration, memory (especially working memory), and learning, particularly in children and in tasks requiring high cognitive load.⁹ Conversely, some soundscapes, particularly natural ones, may enhance cognitive performance and attention restoration.⁵⁷

1.6. Scope and Structure of the Review

This review aims to provide a comprehensive introduction for new PhD students to the current research landscape connecting soundscapes and acoustic environments with human health. It prioritizes contemporary findings and methodologies, placing less emphasis on detailed historical accounts or speculative future predictions, which are included primarily for contextualization. The review will proceed as follows: Section 2 explores the key theoretical frameworks and mechanisms proposed to explain soundscape-health relationships. Sections 3, 4, and 5 delve into the empirical research within three critical settings: urban open spaces, specific (including vulnerable) populations, and occupational environments, respectively. Section 6 critically evaluates the predominant research methodologies employed across these studies. Section 7 synthesizes the current state of knowledge, highlighting key themes, debates, and gaps. Finally, Section 8 briefly touches upon historical context and potential future directions to frame the current research focus.

Table 1: Core Concept Definitions

Term	Definition	Key Aspects / Relevance to Soundscape Research	Key Sources
Soundscape	The acoustic environment as perceived or experienced and/or understood by a person or people, in context.	The central concept; emphasizes human perception, context-dependency, and subjective experience. Moves beyond physical measures to include meaning and preference. Study involves assessing perceptual attributes (e.g., pleasantness, eventfulness).	ISO 12913-1 ³
Acoustic Environment	The totality of sound from all sound sources as modified by the environment, arriving at a listener/receiver.	The physical basis of the soundscape. Includes all sounds (natural, human, technological) and effects of propagation (reflection, absorption). Measured using physical metrics (SPL, frequency spectrum).	ISO 12913-1 ³
Noise Pollution	Unwanted or harmful sound in the environment, often resulting from human activities (transport, industry).	A major environmental health risk factor. Traditionally the focus of acoustic regulation. Characterized by negative impacts like annoyance and health effects. Soundscape research aims to go beyond just mitigating noise pollution.	EEA, WHO ⁴⁴
Stress	A physiological and psychological response to environmental demands perceived as challenging or threatening.	Noise is a recognized environmental stressor activating physiological pathways (autonomic, endocrine). Soundscapes can modulate stress responses (e.g., natural sounds reducing stress). Measured via cortisol, HRV, self-report.	⁵²
Sleep Disturbance	Disruption of normal sleep patterns, including difficulty falling/staying asleep, reduced sleep quality, and awakenings.	A significant non-auditory health effect of noise, especially at night. Impacts daytime functioning and long-term health. Sound levels and characteristics influence the degree of disturbance.	WHO, EEA ⁴⁴
Cardiovascular Effects	Adverse impacts on the heart and blood vessels, including hypertension, ischemic heart disease, stroke.	Linked to chronic noise exposure, likely mediated by stress responses, sleep disturbance, and endothelial dysfunction. A major focus of environmental noise epidemiology.	WHO, EEA ⁴⁹
Mental Well-being	An individual’s subjective state of psychological health, encompassing mood, affect, life satisfaction, absence of mental distress (e.g., anxiety, depression), annoyance.	Noise is strongly linked to annoyance and can contribute to anxiety/depression. Positive soundscapes (e.g., calm, pleasant) are associated with improved mood, relaxation, and overall well-being/quality of life.	¹⁴
Cognitive Performance	The ability to perform mental tasks involving attention, memory, learning, reasoning, and executive functions.	Noise can impair cognitive functions, especially in demanding tasks or vulnerable populations (e.g., children). Restorative soundscapes (e.g., natural sounds) may enhance cognitive function and attention restoration.	⁶⁰

2. Theoretical Foundations: Understanding Soundscape-Health Mechanisms

Understanding how the sounds around us influence our health requires exploring several theoretical perspectives that bridge acoustics, psychology, and physiology. These frameworks provide potential explanations for both the detrimental effects of noise and the beneficial effects of preferred soundscapes.

2.1. The Noise-Stress Hypothesis and Physiological Pathways

A foundational concept, particularly relevant to understanding the negative health impacts of noise, is the noise-stress hypothesis. This model posits that noise, even at levels below those causing direct hearing damage, acts as a non-specific environmental stressor.¹⁴ This stress response can be triggered subconsciously, without requiring cognitive awareness of the noise as annoying or threatening.⁸³

Exposure to noise activates two primary physiological stress systems:

The Autonomic Nervous System (ANS): Specifically, the sympathetic nervous system branch, responsible for the ‘fight-or-flight’ response. This leads to immediate physiological changes such as increased heart rate, blood pressure, and cardiac output.¹⁷
The Endocrine System: Primarily the Hypothalamic-Pituitary-Adrenocortical (HPA) axis. Activation results in the release of stress hormones, notably catecholamines (like adrenaline and noradrenaline) and glucocorticoids (like cortisol).¹⁷

While these responses are adaptive in the short term for dealing with acute threats, chronic activation due to persistent noise exposure becomes maladaptive. Sustained elevation of stress hormones and sympathetic activity contributes to a cascade of downstream effects detrimental to long-term health. These include increased vascular oxidative stress, systemic inflammation, and endothelial dysfunction (impaired function of the lining of blood vessels).⁵¹ Endothelial dysfunction is considered an early step in the development of atherosclerosis and other cardiovascular diseases.⁵⁹ Furthermore, chronic stress can negatively impact metabolic function (e.g., blood glucose levels, lipids) and immune function.⁵⁹

Sleep disturbance acts as a significant mediator in these pathways.⁵⁹ Noise exposure during sleep, even at relatively low levels, can cause physiological arousals (increases in heart rate, blood pressure, hormone release) and disrupt sleep architecture, even if the individual does not fully awaken.⁸³ This chronic sleep fragmentation and deprivation further exacerbates stress responses and contributes directly to cardiovascular risk.⁵⁹ Nighttime noise is therefore considered particularly harmful.⁵⁹ Ultimately, the chronic physiological strain imposed by noise exposure via these stress pathways is believed to increase the long-term risk of developing conditions such as hypertension, ischemic heart disease, and stroke.⁵⁹

2.2. Psychoacoustic Principles: From Sound Waves to Perception

While the noise-stress model explains physiological responses, understanding why certain sounds are perceived as stressful, annoying, or pleasant requires delving into psychoacoustics. Psychoacoustics is the scientific study of sound perception – how the physical properties of sound waves are processed by the auditory system and interpreted by the brain.¹³⁴ It bridges the gap between physical acoustics and psychological response, acknowledging that hearing is an active sensory and perceptual event, not merely passive reception of mechanical vibrations.¹³⁵

Traditional acoustic metrics, such as the A-weighted equivalent continuous sound level (LAeq), provide a measure of overall sound energy but often fail to capture the nuances of perception that drive subjective responses like annoyance or pleasantness.³¹ This is because LAeq averages sound energy over time and uses a weighting (A-weighting) primarily based on sensitivity to pure tones, potentially overlooking important spectral and temporal characteristics that influence how a sound feels.³¹ Psychoacoustics offers a richer set of parameters to describe these perceptual attributes:

Loudness: The subjective perception of sound intensity. While related to SPL, it is influenced by frequency content and duration, and is often measured on scales like sones or phons. ISO 532-1 provides methods for calculating loudness.²⁸
Sharpness: The perception of the balance between high-frequency and low-frequency energy in a sound. Sounds with more high-frequency energy are perceived as sharper, which can contribute to unpleasantness.⁸
Roughness: The perception of rapid (15-300 Hz) amplitude or frequency modulation. It often imparts a harsh or grating quality to sounds.¹²
Fluctuation Strength: The perception of slower (up to ~20 Hz) amplitude or frequency modulation. Relates to the noticeability of variations in sound level over time.²⁸
Tonality: The presence of distinct tonal components (pure tones or narrow-band noise) within a sound. Tonal sounds are often perceived as more noticeable and annoying than broadband sounds at the same overall level.¹²

These psychoacoustic parameters provide a more detailed description of the sound signal, reflecting aspects that are perceptually salient to the human auditory system.¹³⁵ Incorporating these metrics into soundscape analysis allows for a more nuanced characterization of acoustic environments beyond simple SPL. Research suggests that psychoacoustic parameters can sometimes provide better predictions of subjective responses like annoyance or pleasantness compared to traditional noise metrics alone.¹² For instance, a sound with strong tonality or high sharpness might be rated as highly annoying even if its LAeq is moderate.³¹ Understanding these parameters helps explain why certain sounds, regardless of their overall level, might have specific perceptual qualities that influence comfort, stress, and ultimately, health outcomes. Psychoacoustic phenomena like masking, where one sound makes another harder to hear, are also relevant, particularly in complex environments with multiple sources, and are sometimes leveraged in soundscape design (e.g., using pleasant sounds to mask traffic noise).¹³

2.3. Restoration Theories: Attention Restoration (ART) and Stress Reduction (SRT)

Moving beyond the negative impacts of noise, research increasingly explores the potential for certain environments and soundscapes to actively promote recovery and well-being. Two prominent theories from environmental psychology provide frameworks for understanding these restorative effects, particularly in relation to natural environments: Attention Restoration Theory (ART) and Stress Reduction Theory (SRT).

Attention Restoration Theory (ART), developed by Stephen and Rachel Kaplan, focuses on recovery from directed attention fatigue.⁶⁷ Directed attention is the effortful mental focus required for tasks that demand concentration and inhibition of distractions; it is a limited resource that becomes depleted with sustained use, leading to mental fatigue, irritability, and reduced effectiveness.¹²⁶ ART proposes that exposure to environments possessing certain characteristics allows directed attention mechanisms to rest and replenish.¹²⁷ These characteristics are:

Being Away: A sense of escape from routine demands and mental content.
Extent: A sense of scope and connectedness, feeling immersed in a larger world.
Soft Fascination: Elements that gently capture attention effortlessly (involuntarily), without requiring directed focus (e.g., clouds drifting, leaves rustling).
Compatibility: A match between the environment’s characteristics and the individual’s inclinations and goals.¹²⁷ Natural environments are often considered rich in these properties, particularly soft fascination, allowing the mind to wander restoratively while directed attention recovers.¹¹³

Stress Reduction Theory (SRT), proposed by Roger Ulrich, focuses on the rapid affective and physiological recovery from stress.³² SRT posits that exposure to unthreatening natural environments triggers an innate, automatic positive affective response, coupled with physiological changes indicative of reduced stress.⁶⁶ These changes include decreased sympathetic nervous system activity (lower heart rate, blood pressure, skin conductance) and increased parasympathetic activity (‘rest-and-digest’ state), as well as the blocking of negative thoughts and feelings.⁶⁶ This response is thought to be evolutionarily adaptive, as responding with stress in a safe, resource-rich natural setting would be counterproductive.⁶⁶ Conversely, complex, intense urban environments may trigger stress and fatigue.⁶⁶

While ART and SRT are foundational for understanding environmental restoration, they were developed primarily with visual experiences of nature in mind.³² Ulrich acknowledged the likely role of sounds and smells, but the theories’ core constructs often rely on visual properties (e.g., complexity, depth, texture for SRT; visual elements providing fascination for ART).³² However, research is increasingly applying these frameworks to the auditory domain. Studies suggest that natural sounds (e.g., birdsong, water sounds) can indeed contribute to perceived restorativeness, potentially by providing soft fascination (ART) or inducing physiological relaxation (SRT).³² For example, Payne’s development of the Perceived Restorativeness Soundscape Scale (PRSS) demonstrated that ART’s dimensions can be assessed acoustically.³²

These two theories offer complementary views: ART emphasizes cognitive recovery, while SRT emphasizes affective and physiological stress reduction. Evidence suggests that natural soundscapes may engage both pathways. Studies have documented improvements in cognitive performance (e.g., attention, memory) after exposure to natural sounds, aligning with ART’s predictions.⁵⁷ Simultaneously, numerous studies report reductions in physiological stress indicators (e.g., heart rate, blood pressure, cortisol, skin conductance) and improvements in mood following exposure to natural sounds, consistent with SRT.¹⁴ This suggests that soundscapes, especially natural ones, can potentially trigger both cognitive restoration and stress reduction. However, a recognized limitation is the need to better integrate specific acoustic properties (like intensity, frequency, temporal patterns) into these visually-centric theoretical frameworks to provide a more complete explanation of auditory restoration.³²

2.4. Ecological and Enactive Approaches: Perception in Context

Ecological psychology, pioneered by J.J. Gibson and Eleanor Gibson, offers another valuable lens for understanding soundscape perception and its health implications.¹⁴³ This approach fundamentally differs from traditional cognitive perspectives by emphasizing the inseparable link between the perceiver and their environment – the organism-environment system – as the proper unit of analysis.¹⁴³ It posits that perception is direct, meaning that the environment itself contains rich information that specifies possibilities for action, rather than requiring extensive internal cognitive processing or enrichment of impoverished sensory data.¹⁴³ Central to this is the concept of affordances: what the environment offers, provides, or furnishes the organism, whether beneficial or detrimental, relative to the organism’s capabilities and needs.¹⁷ For example, a surface affords walking for a human but not necessarily for an insect; a sound might afford locating a food source or warn of an approaching danger. Soundscapes, from this perspective, can be understood in terms of the affordances they present to the listener – affording safety, orientation, social interaction, threat, or tranquility.¹⁷

Relatedly, the enactive approach to cognition views perception and cognition not as passive representation of an external world, but as embodied, active sense-making that arises through the dynamic interaction between an agent and its environment.¹⁷ Organisms actively explore and shape their environment to satisfy their needs and maintain viability.¹⁷ Perception is thus inherently action-oriented and shaped by the agent’s goals, motivations, and history of interactions. Applying this to soundscape, the appraisal of an acoustic environment (e.g., its perceived pleasantness or eventfulness) might reflect fundamental evolutionary drives related to survival (detecting and avoiding threats, seeking safety) and flourishing (seeking environments that support well-being and opportunities).¹⁷ The meaning attributed to sounds, based on their potential relevance to the listener’s goals and safety, becomes paramount.¹⁷

These ecological and enactive perspectives strongly resonate with the ISO definition of soundscape, particularly its emphasis on perception “in context”.³ They provide a theoretical grounding for why context is so critical. By focusing on the functional relationship between the listener and their sonic environment, these approaches explain how the same physical sound (e.g., engine noise) can be perceived very differently – and thus have different health implications – depending on the listener’s situation, activity, expectations, and interpretation of the sound’s meaning (e.g., Is it a sign of danger? Does it interfere with my task? Is it an expected part of this environment?).¹⁷ They shift the focus from the passive reception of sound waves to the active perception of meaningful environmental information that guides behavior and impacts well-being, thereby highlighting the importance of understanding the listener’s perspective and the functional significance of sounds within their specific life-world.

2.5. Perceptual Models: Mapping the Soundscape Experience

To systematically study and quantify the subjective experience of soundscapes, researchers often employ perceptual models that aim to capture the key dimensions along which acoustic environments are judged. The most widely adopted model in current soundscape research is the Pleasantness-Eventfulness Circumplex Model.⁸

This model, influenced by general models of affect, proposes that the perceived affective quality of a soundscape can be largely described by two primary, orthogonal dimensions:

Pleasantness: A valence dimension, ranging from pleasant/comfortable to annoying/unpleasant.¹⁴
Eventfulness: An arousal or activation dimension, ranging from eventful/vibrant/chaotic to uneventful/monotonous/calm.¹⁴

These two dimensions form a two-dimensional space, often visualized as a circle or ‘circumplex’, within which specific soundscape descriptors can be located.²² The interaction of these dimensions yields four general soundscape categories:

Vibrant: Pleasant and Eventful
Calm: Pleasant and Uneventful
Chaotic: Annoying and Eventful
Monotonous: Annoying and Uneventful.¹⁴

Assessment of these dimensions typically relies on semantic differential scales included in questionnaires, as recommended in ISO/TS 12913-2 and -3.²¹ Participants rate the soundscape using pairs of bipolar adjectives corresponding to these dimensions, such as pleasant-annoying, eventful-uneventful, calm-chaotic, and vibrant-monotonous.²¹

This circumplex model has proven useful for several reasons. It provides a standardized framework for describing and comparing subjective soundscape perceptions across different studies and locations. Furthermore, these perceptual dimensions, particularly pleasantness, have been shown to correlate with health-related outcomes. For instance, soundscapes rated as more pleasant or calm are often associated with positive effects such as faster stress recovery, better self-reported health, and improved mood.¹⁴ This linkage makes the model a valuable tool for investigating the mechanisms through which soundscapes influence well-being and for guiding soundscape design aimed at promoting health.

While Pleasantness and Eventfulness are the core dimensions, other related perceptual attributes are sometimes assessed alongside or instead of them, such as Appropriateness (how suitable the soundscape is perceived to be for the place or activity) ¹⁴⁹, Tranquillity ¹⁹, or overall Acoustic Comfort.¹⁹ These attributes often show correlations with the primary dimensions but may capture additional facets of the soundscape experience relevant to specific contexts or research questions.

Table 2: Overview of Key Theoretical Frameworks in Soundscape-Health Research

Framework Name	Core Concepts/Principles	Key Mechanisms Linking Soundscape to Health	Relevance/Application in Soundscape Research	Strengths/Limitations	Key Sources
Noise-Stress Hypothesis	Noise as a non-specific environmental stressor.	Activation of ANS (sympathetic) & HPA axis -> stress hormones (cortisol, catecholamines) -> increased BP, HR, oxidative stress, inflammation -> chronic disease risk (CVD). Mediated by sleep disturbance.	Explains physiological pathways for negative health effects of chronic noise exposure (hypertension, heart disease).	Strong physiological basis for noise impacts. Less emphasis on perceptual factors (meaning, context) or positive effects.	⁵²
Psychoacoustics	Study of sound perception; links physical sound properties to subjective experience.	Quantifies perceptual attributes (loudness, sharpness, roughness, tonality) that influence annoyance, comfort, pleasantness, which in turn affect stress, mood, etc. Masking effects.	Provides metrics beyond SPL to characterize sound stimuli; helps explain why sounds are perceived differently. Useful for predicting subjective response and informing design.	Can be complex to measure/calculate. Focus is often on stimulus properties, may need integration with context.	²⁸
Attention Restoration Theory (ART)	Recovery from directed attention fatigue through exposure to restorative environments.	Natural/preferred soundscapes provide ‘soft fascination’, allowing directed attention to rest and replenish -> improved cognitive performance (attention, memory).	Explains potential cognitive benefits of certain soundscapes (esp. natural). Applicable to learning environments, workplaces, urban parks.	Primarily developed for visual stimuli; needs better integration of acoustic features. Less focus on immediate stress reduction.	³²
Stress Reduction Theory (SRT)	Rapid affective and physiological recovery from stress in natural/unthreatening environments.	Natural/preferred soundscapes trigger innate positive affect & reduce physiological arousal (lower HR, BP, cortisol; increased parasympathetic activity) -> stress recovery, improved mood.	Explains rapid stress relief and mood enhancement from certain soundscapes (esp. natural). Strong link to physiological measures. Applicable to healthcare, therapeutic settings, stress management.	Primarily developed for visual stimuli; needs better integration of acoustic features. Less focus on cognitive restoration.	³²
Ecological / Enactive Approaches	Perception is direct, action-oriented, arises from organism-environment interaction. Focus on affordances (what environment offers) and sense-making.	Soundscapes provide meaningful information about the environment (safety, threat, opportunities) relevant to the listener’s goals and actions. Perception (and health impact) depends on this interpreted meaning within context.	Provides theoretical basis for the importance of context, sound source meaning, and individual factors in soundscape perception and health outcomes. Aligns with ISO definition.	Can be conceptually abstract; less focused on specific physiological mechanisms or quantitative prediction compared to other models.	¹⁷
Perceptual Models (e.g., Circumplex)	Mapping subjective soundscape experience onto core dimensions (Pleasantness, Eventfulness).	Links overall perceptual assessment (pleasant, calm, vibrant, chaotic, etc.) to health-related outcomes (stress recovery, well-being).	Provides a standardized way to measure and describe subjective soundscape quality. Dimensions correlate with health indicators. Widely used in current research.	Model dimensions may not capture all nuances of experience. Relationship between dimensions and specific acoustic features is complex and context-dependent.	¹⁴

3. Soundscape and Health in Urban Open Spaces (Parks, Squares, Streets)

Urban open spaces, such as parks, squares, and streets, represent critical arenas where large populations interact with diverse and often complex acoustic environments. Understanding the soundscapes of these spaces and their impact on public health and well-being is a major focus of current research.

3.1. Characterizing Urban Open Space Soundscapes

The acoustic character of urban open spaces is highly variable, shaped by the interplay of different sound sources and the physical environment. Common sound sources include:

Traffic Noise: Often a dominant source, particularly in streets and squares adjacent to roads, contributing significantly to overall sound levels.²¹ Motorcycles and cars are frequently cited as unpleasant sources.¹⁰⁷
Human Sounds: Voices (conversations, shouting), footsteps, sounds related to activities (e.g., playing, markets) are prevalent, especially in squares and busy parks.²¹
Natural Sounds: Sounds from birds, water (fountains, rivers), wind rustling through vegetation are characteristic of parks and green spaces, though sometimes present in other areas.²⁸
Mechanical/Technological Sounds: Construction noise, building ventilation systems, alarms, music playback can also contribute to the urban soundscape.²⁸

Identifying the dominant sound sources is crucial, as perception is heavily influenced by the type of sound, not just its level.¹² Acoustically, these spaces exhibit significant variability. Streets and squares often have high average sound levels (LAeq), frequently exceeding recommended guidelines for comfort and health due to traffic.¹⁰⁷ Parks generally offer lower sound levels, especially further from boundaries.¹⁵⁰ Beyond overall levels, psychoacoustic parameters like loudness, sharpness, roughness, and fluctuation strength help differentiate the perceptual quality of soundscapes in different types of open spaces.²⁸

Perceptually, urban open spaces are evaluated along dimensions like Pleasantness and Eventfulness.¹⁰⁸ Parks are typically perceived as more pleasant, calm, tranquil, and restorative compared to streets or noisy squares, largely due to the prevalence of natural sounds and lower levels of traffic noise.⁷⁰ Natural sounds, particularly water sounds, are consistently rated as pleasant.⁸⁰ Human sounds can increase the perceived eventfulness of a space, which may be desirable in some contexts (e.g., vibrant squares), but they often decrease pleasantness, especially if perceived as intrusive.¹⁰⁸ Traffic noise consistently has a strong negative impact on pleasantness ratings.³⁴

3.2. Health and Well-being Impacts

The soundscape quality of urban open spaces has demonstrable effects on visitors’ health and well-being.

Restoration and Stress Recovery: Urban green spaces, particularly parks, are recognized as important restorative environments.⁷⁰ Their ability to facilitate recovery from stress and mental fatigue is significantly linked to their soundscapes.⁷⁰ Environments dominated by natural sounds promote psychological restoration, including attention restoration and stress reduction, more effectively than environments dominated by traffic or mechanical noise.²⁴ Access to pleasant urban soundscapes, even outside of parks, has been associated with faster physiological stress recovery (e.g., measured by skin conductance) and better self-reported health conditions in surveys.¹⁴ Natural sound elements like water and birdsong appear particularly potent in facilitating these restorative effects.⁵⁷ The perceived restorativeness of a soundscape is linked to characteristics like pleasantness, calmness, and naturalness.¹⁰⁸
Mood and Affect: Soundscapes influence emotional states. Pleasant soundscapes, often found in parks or well-designed squares, are associated with positive moods, described using terms like cheerful, relaxed, and energetic.⁸⁶ Conversely, exposure to high levels of noise, especially traffic noise prevalent in streets and some squares, is linked to negative affective responses, primarily annoyance, but also feelings of stress and irritation.¹⁹
Behavior: The characteristics of the soundscape can also shape how people use urban open spaces. Studies in parks suggest that soundscape dimensions influence visitor activities. For example, soundscapes perceived as high in both pleasantness and eventfulness may encourage static behaviors (e.g., sitting, relaxing), while eventfulness alone might promote more dynamic behaviors (e.g., walking, playing).¹⁰⁸ The presence of pleasant human sounds might enhance the perceived suitability of a space for social interaction.¹⁵¹

The evidence strongly suggests that the restorative potential often attributed to urban green spaces is not solely a function of visual greenness. The acoustic environment plays a critical mediating role. A park visually rich in vegetation might offer limited restorative benefits if its soundscape is dominated by intrusive traffic noise from adjacent roads.⁷⁰ Studies explicitly comparing natural and artificial environments find that the acoustic dimension is a significant predictor of the higher perceived restoration reported in parks compared to streets.⁷⁰ Furthermore, the interaction between auditory and visual elements is crucial; congruent audio-visual environments (e.g., natural sounds paired with natural scenery) tend to yield higher restorative potential and more positive perceptions.⁸⁵ Therefore, realizing the full public health potential of urban open spaces necessitates careful consideration and management of their soundscapes, ensuring that auditory experiences align with and enhance the intended functions and restorative qualities of these spaces.

3.3. Methodological Approaches in Urban Open Spaces

Research investigating soundscape perception and its effects in urban open spaces employs a variety of methodologies, often in combination:

Soundwalks: This is a cornerstone method for in situ assessment. Participants traverse predefined routes within an urban space (park, square, street), focusing on their auditory experience and providing evaluations at specific points or overall, typically using questionnaires or semantic scales.² Soundwalks excel at capturing perception within its real-world context, providing high ecological validity.²³ ISO 12913-2 offers guidance on conducting soundwalks.¹³
Questionnaires and Surveys: These are versatile tools used both during soundwalks and in standalone in situ or laboratory/online studies. They gather data on perceptual attributes (using scales like semantic differentials for pleasantness, eventfulness, annoyance, comfort), identification and perceived dominance of sound sources, sound preferences, overall soundscape quality, and relevant contextual or demographic information.¹⁸
Acoustic Measurements: Objective physical measurements are typically conducted concurrently with perceptual assessments. Standard metrics include various SPL indicators (LAeq, Lden, Lnight, L10, L90, Lmax) and spectral analysis (octave/third-octave bands).¹² Increasingly, psychoacoustic parameters are also calculated.²⁸ Binaural recordings using dummy heads or specialized microphones are frequently employed to capture realistic spatial sound information for later laboratory analysis or reproduction.¹²
Laboratory Experiments: To achieve greater control over variables, researchers often use recorded audio-visual stimuli from urban open spaces presented in controlled laboratory settings.⁷⁹ This allows for systematic manipulation of soundscape components and the use of more sensitive physiological measures. Virtual reality (VR) is increasingly used to enhance immersion and realism in lab settings.³⁶
Triangulation: Relying on a single method can be limiting. Soundscape research strongly advocates for triangulation – combining multiple methods (e.g., objective acoustic data, subjective questionnaires during soundwalks, perhaps supplemented by physiological measures or lab experiments) to provide a more comprehensive and robust understanding of the phenomenon.¹³

3.4. Soundscape Design and Interventions

The growing understanding of soundscape’s impact on health and well-being has spurred interest in soundscape design – proactively shaping acoustic environments to achieve desired perceptual outcomes.⁴ This represents a shift from reactive noise control to a proactive approach that considers sound as a positive design element. Key strategies include:

Noise Reduction and Mitigation: Traditional approaches remain relevant, especially for dominant unwanted sources like traffic. Techniques include physical barriers (walls, gabions ¹³), dense vegetation belts, quieter pavement materials ⁴⁶, traffic management schemes, and strategic placement of buildings or sensitive areas away from noise sources.²⁵
Introduction of Positive/Desired Sounds: Actively incorporating sounds perceived as pleasant can significantly improve soundscape quality. Water features (fountains, streams, waterfalls) are highly effective and consistently rated positively.¹³ Designing habitats that attract birds can enhance natural sounds.²⁴ Depending on the context, appropriate human sounds (e.g., children playing in a designated area, market sounds) or even music might be considered positive additions.²⁴
Sound Masking and Camouflaging: In situations where reducing unwanted noise is difficult, introducing more pleasant or preferred sounds can mask the noise or divert listeners’ attention.¹³ This can involve natural sounds like water or specifically designed sound installations, sometimes referred to as ‘audio islands’.¹³
Spatial Zoning: Designating specific areas within larger spaces for different acoustic experiences, such as designated ‘quiet areas’ in parks or cities, allows users to choose environments that suit their needs.⁷

Successful soundscape design requires careful consideration of the specific context – the place, its intended use, and the expectations of its users.²⁴ A soundscape appropriate for a bustling market square will differ greatly from that desired in a quiet contemplative garden. Participatory approaches, involving potential users and local residents (‘local experts’) in the design and evaluation process, are increasingly recognized as valuable for ensuring interventions are effective and well-received.¹³

Effective interventions often require a dual strategy. Simply reducing noise levels, while often necessary, may not automatically create a high-quality soundscape; excessive quiet can even be perceived negatively in some urban contexts.⁷ Conversely, adding pleasant sounds may have limited impact if dominant noise sources remain overwhelming. Therefore, a balanced approach that simultaneously mitigates major negative sources (like traffic noise) while actively introducing or enhancing desired positive sounds (like water or natural elements) is often the most effective path towards creating genuinely health-promoting urban soundscapes.⁴ The example of Sheffield’s intervention, combining a gabion wall for noise reduction with ‘audio islands’ playing preferred sounds, illustrates this integrated approach.¹³

4. Differential Impacts: Soundscape and Specific Populations

While general principles govern soundscape perception and its health effects, it is crucial to recognize that responses can vary significantly across different population groups. Certain groups may be more vulnerable to the negative impacts of noise or may have unique needs and preferences regarding their acoustic environment.⁸⁹ Understanding these differential impacts is essential for equitable environmental health policies and targeted interventions.

4.1. Vulnerable Groups: An Overview

Vulnerability in the context of soundscape refers to an increased susceptibility to the adverse effects of environmental noise or a greater need for specific acoustic conditions due to physiological (e.g., age-related changes, illness), psychological (e.g., sensitivity, cognitive state), or socio-economic factors.⁸⁹ Research focusing solely on average population responses may overlook the heightened risks or specific requirements of these groups. Furthermore, noise exposure itself is often unevenly distributed, with disadvantaged communities sometimes facing higher levels of environmental noise, potentially exacerbating existing health inequalities.¹¹ Therefore, investigating soundscape effects within specific populations is critical for promoting health equity.

4.2. Elderly Populations

Older adults represent a significant group with distinct considerations regarding soundscape and health:

Hearing Changes: Presbycusis (age-related hearing loss) is common and interacts significantly with environmental sound.⁸⁹ Difficulty hearing in noisy backgrounds can impede communication and social participation. Hearing loss may also alter the perception of the broader soundscape, potentially reducing the ability to discriminate or appreciate certain sounds, including natural ones.¹⁰⁹ While hearing aids (HAs) can restore audibility for some sounds, their effectiveness in diverse soundscapes and impact on overall listening experience and quality of life (QoL) require further investigation.¹⁰⁹ The importance of natural sounds and satisfaction with HAs in perceiving them appears significant for this group.¹⁰⁹ The living environment (urban vs. rural) may also influence auditory perception and needs in older age.¹⁰⁹
Dementia Care: For individuals living with dementia, the sensory environment, including sound, plays a critical role in influencing behavior and psychological well-being.¹¹⁰ Excessive or inappropriate noise can exacerbate behavioral and psychological symptoms of dementia (BPSD), such as agitation and confusion. Conversely, research suggests that tailored soundscape interventions hold promise as non-pharmacological approaches. Pilot studies indicate that augmented soundscapes, incorporating elements like music or natural sounds (e.g., streams, birdsong), delivered at specific times, can be feasible and may effectively reduce specific symptoms like resistance to care, even if broader neuropsychiatric inventory scores are not significantly different from usual care in short-term trials.⁸⁹ This highlights the potential for designing therapeutic sonic environments in dementia care settings.
Nursing Homes and Residential Care: The acoustic quality of nursing homes significantly impacts residents’ subjective evaluations and overall comfort.¹¹¹ Standard building acoustics may not adequately meet the needs of older adults, particularly those with hearing loss or other sensory impairments.⁵⁴ For blind older adults residing in care homes, hearing becomes a primary sense for orientation, information gathering, and social connection. Their sound perception is shaped by their living needs (e.g., identifying activities, navigating space) and the specific acoustic environment of the facility (sounds from equipment, staff, other residents, environmental sounds).¹¹¹ A poor acoustic environment can negatively impact health and hinder daily life.¹¹¹

4.3. Children

Children constitute another population group where soundscape impacts warrant specific attention, particularly concerning development and learning:

Cognitive Performance and Learning: Schools are often noisy environments, and this noise has well-documented detrimental effects on children’s learning and cognitive function.⁵⁶ Speech noise (e.g., background chatter) significantly impairs verbal working memory, a crucial skill for learning.¹³¹ Non-speech environmental noise (e.g., traffic, construction) can negatively affect academic performance, with reading comprehension being particularly vulnerable.¹³¹ Noise acts as a distractor, interferes with speech intelligibility (making it harder to understand the teacher), and taxes cognitive resources.¹¹² Noise annoyance in school settings is common and linked to negative emotions (irritation, stress), physical symptoms (headaches, tension), and reduced well-being.¹¹² Acoustic conditions in the home environment also play a role, with higher home noise levels potentially hindering home learning and impacting executive function.¹³¹ Children are also physiologically more vulnerable to permanent hearing changes from chronic noise exposure.⁶³
Restorative Potential of Soundscapes: While noise is clearly harmful, research suggests that positive soundscapes can offer restorative benefits for children, even within educational contexts. Laboratory studies simulating classroom environments have found that exposure to pleasant sounds like music or natural sounds (birdsong, water sounds like fountains or streams) can facilitate recovery in sustained attention and short-term memory performance after cognitive fatigue.¹¹³ The effectiveness of specific sounds might be context-dependent; one study found birdsong more restorative in a simulated classroom, while fountain sounds were more effective in a simulated park context.¹⁰⁶ Achieving a positive signal-to-noise ratio (SNR), potentially around 5 dB or higher, seems important for realizing these restorative effects in the presence of background noise.¹⁰⁶
Developmental Considerations: The impact of noise and the potential for restoration may change with age.¹³¹ However, there is a noted lack of longitudinal studies tracking these effects across different developmental stages.¹³¹ More research is needed to understand age-related differences and potential long-term consequences of early life acoustic environments.

4.4. Hospital Patients

The hospital soundscape is a critical factor influencing patient experience, recovery, and overall well-being:

Negative Impacts of Hospital Noise: Hospitals are notoriously noisy environments due to alarms, medical equipment, staff activities, conversations, and other sources.⁹⁰ High noise levels are consistently linked to negative patient experiences, reflected in low scores on surveys like HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), particularly regarding quietness at night.⁹⁰ This noise contributes significantly to patient stress, anxiety, depression, and sleep disturbance, all of which can impede the healing process.⁷² Objective acoustic measures, such as minimum background sound levels (LAMIN) and the frequency of noise peaks, have been found to correlate with patient satisfaction scores.⁹⁰
Positive and Restorative Soundscapes: Conversely, creating an appropriate and positive acoustic environment can support patient recovery.⁷² The soundscape approach encourages viewing sound not just as a nuisance to be minimized but as a potential therapeutic tool.¹⁰⁰ Studies have shown that introducing pleasant sounds, particularly music and natural sounds (like birdsong, water, wind), can have measurable benefits. These include reductions in patient-reported pain, anxiety, and stress, as well as improvements in physiological indicators of relaxation (e.g., faster skin conductance recovery, trends towards lower heart rate) and psychological well-being (e.g., improved mood, higher perceived restorativeness).⁶⁹ Sound can also be informative and reassuring in a clinical setting.¹⁰⁰
Soundscape Design in Healthcare: There is a growing recognition of the need to move beyond basic noise control towards the intentional design of therapeutic soundscapes in healthcare facilities.⁷² This involves not only reducing disturbing noises but also considering the introduction of sounds that promote healing and comfort. Patient preferences and perceived control over their sonic environment are also important factors to consider.¹¹⁴

4.5. Individuals with Auditory Sensitivities (Autism, Hyperacusis, Noise Sensitivity)

Certain individuals exhibit heightened sensitivity to sound, making the acoustic environment a particularly critical factor for their health and functioning:

Autism Spectrum Disorder (ASD): A high percentage of individuals with ASD experience significant differences in sensory processing, with auditory hypersensitivity (often termed Decreased Sound Tolerance, DST) being one of the most common challenges.¹¹⁵ For these individuals, ordinary everyday sounds (e.g., vacuum cleaners, traffic, background conversations, even refrigerators humming) can be perceived as intensely loud, overwhelming, or physically painful.¹¹⁵ This can trigger strong negative reactions, including fear, anxiety, agitation, physiological stress responses, and avoidance behaviors (e.g., covering ears, fleeing the environment).¹¹⁵ Such hypersensitivity significantly impacts daily life, interfering with social interactions, communication, participation in school or community activities, concentration, sleep, and overall emotional well-being.¹¹⁶ Difficulties filtering background noise are also common.¹¹⁵
Hyperacusis: This condition is characterized by a reduced tolerance to sounds at levels that most people find acceptable.¹¹⁷ It often involves experiencing sounds as uncomfortably loud or painful at much lower intensities than typical.¹¹⁵ Hyperacusis frequently co-occurs with other conditions, including ASD, tinnitus, PTSD, anxiety disorders, and migraines.¹¹⁷ Physiologically, it may involve lower loudness discomfort levels (LDLs) or uncomfortable loudness levels (ULLs).¹¹⁷ While the exact causes are still debated, theories suggest involvement of increased central auditory gain (amplification within the auditory pathway), altered neural synchrony, or issues within the limbic system.¹¹⁷ Psychoacoustic tests are used in assessment, but standardization remains an issue.¹¹⁷
Noise Sensitivity: This refers to an individual personality trait reflecting a higher degree of reactivity or annoyance towards noise in general.⁵³ Individuals high in noise sensitivity tend to report greater disturbance, annoyance, and stress from noise exposure compared to less sensitive individuals, even at similar objective noise levels. Studies have shown that noise sensitivity can moderate physiological responses (e.g., HRV) to noise stimuli.⁸⁹

The experiences of these groups starkly illustrate that the negative health impacts of sound are not solely dependent on high decibel levels. Auditory hypersensitivity, rooted in differences in sensory processing and neurological function, means that the perceptual experience of sound – its perceived loudness, intrusiveness, or aversiveness – is a critical determinant of adverse outcomes like stress, anxiety, and functional impairment.¹¹⁶ This reinforces a core principle of the soundscape approach: perception, shaped by individual factors and context, is key to understanding the sound-health relationship. Management strategies for these individuals often involve environmental modifications (creating quiet spaces), protective measures (noise-canceling headphones), and therapeutic approaches like sound desensitization or habituation training.¹¹⁵

4.6. Other Defined Groups

While the groups above have received considerable attention, soundscape research is also relevant to other defined populations. For instance, studies have begun to explore the impact of acoustic environments on drivers’ physiological states and behaviors in highway tunnels ⁸⁹, the influence of music environments on college students’ emotions during communication ⁸⁹, and the soundscape preferences of specific cultural groups (e.g., urban residents post-pandemic, visitors to Buddhist temples).⁸⁹ Occupational groups are discussed in the next section. The principles of differential impact suggest that future research could fruitfully explore soundscape effects in numerous other specific populations defined by age, health status, cultural background, or activity.

4.7. Methodological Considerations

Studying soundscape effects in specific populations requires tailored methodological approaches. Standard questionnaires may need simplification or adaptation for children or individuals with cognitive impairments. Gathering consent and ensuring participant comfort require careful ethical consideration, especially with vulnerable groups. Measuring baseline characteristics, such as hearing ability in the elderly or pre-existing noise sensitivity, is crucial for interpreting results. Given the potential challenges with self-report in some groups, combining subjective measures with objective physiological or behavioral indicators (e.g., HRV, EDA, facial expression analysis, activity monitoring) can provide particularly valuable insights into their responses to different soundscapes.⁸⁹

5. Soundscape in Occupational Settings: Implications for Health and Productivity

The acoustic environment of the workplace significantly influences employee health, well-being, and productivity. Research across various occupational settings highlights both the detrimental effects of noise and the potential for soundscape design to improve working conditions.

5.1. Open-Plan Offices (OPOs): A Common but Contentious Environment

Open-plan offices became a dominant workplace design prior to the COVID-19 pandemic, housing a large majority of office workers.⁷⁵ While intended to foster collaboration and reduce costs, OPOs are frequently associated with significant acoustic challenges. The most common complaints revolve around excessive noise, particularly irrelevant speech from colleagues, lack of speech privacy, and constant distractions.⁷³

These acoustic issues have measurable impacts on employees:

Productivity and Performance: Noise in OPOs is consistently linked to impaired concentration, increased perceived cognitive workload, and reduced motivation and energy.⁷³ While some short-term experimental studies show mixed results on objective task performance ⁷⁵, the overall evidence points towards a negative impact on cognitive performance and productivity, especially for tasks requiring focus.⁷³
Stress and Well-being: Exposure to typical OPO noise, even for short durations in simulated settings, has been shown to increase physiological stress indicators (e.g., increased heart rate, skin conductivity) and heighten negative mood states (e.g., annoyance, irritation, fatigue).⁵⁸ Chronic exposure to such stressors is detrimental to long-term mental and physical health.⁷⁶
Communication: The lack of acoustic separation hinders confidential conversations and can make employees uncomfortable discussing sensitive matters.⁹¹

Applying soundscape assessment methods to OPOs reveals that perception is multidimensional. Key dimensions identified include Pleasantness, Eventfulness, and sometimes a dimension related to ‘Emptiness’ or lack of stimulation.⁷⁴ Crucially, the perceived presence of human sounds (colleagues’ conversations) tends to correlate negatively with Pleasantness but positively with Eventfulness.⁷⁴ This highlights the complex nature of OPO soundscapes – they can be lively but unpleasant. Importantly, overall soundscape Pleasantness has been found to correlate positively with employees’ psychological well-being and their perception of work-related quality.⁷⁴ However, standard acoustic metrics like LAeq often show little or no correlation with these perceptual ratings, underscoring the need for a soundscape approach that considers sound sources and subjective responses.⁷⁴

5.2. Sound Masking in OPOs: Effectiveness and Considerations

Sound masking systems are a common technological intervention aimed at improving the acoustics of OPOs.⁹¹ These systems introduce a continuous, low-level, broadband background sound (often resembling airflow) engineered to reduce the intelligibility of distant speech.⁵⁸ The primary goals are to enhance speech privacy (making it harder to overhear conversations) and reduce the distraction caused by intermittent conversations.⁹¹

Reported benefits include improved privacy, reduced distractions, and subsequent gains in productivity and acoustic comfort.⁹¹ By raising the background sound level in a controlled manner, masking can decrease the “radius of distraction” – the distance over which speech remains intelligible and potentially disruptive.¹²²

However, the effectiveness and acceptance of sound masking are subject to several considerations:

Implementation is Key: The success of sound masking heavily depends on proper design, installation, and tuning. Systems set at inappropriate levels (too loud or too quiet), with incorrect spectral characteristics, or with poor loudspeaker placement can fail to provide benefits and may even become an additional source of annoyance or discomfort.⁹¹ Gradual introduction (“ramping up”) is often recommended to allow occupants to acclimatize.⁹¹
Focus on Speech Intelligibility: Traditional sound masking primarily targets the masking of human speech. While this addresses a major complaint in OPOs, it may not mitigate annoyance from other types of noise (e.g., mechanical sounds, sudden impacts) and doesn’t necessarily contribute to creating a positively perceived soundscape (e.g., pleasant or calm). The neutral, broadband noise used, while designed to be unobtrusive, has been linked in some studies to physiological stress responses.⁵⁸
Emerging Alternatives: Recognizing these limitations, alternative approaches like biophilic sound masking are emerging. These systems use natural sounds (e.g., water, subtle nature recordings) instead of broadband noise, aiming not only to mask unwanted sounds but also to leverage the potential restorative and well-being benefits associated with nature exposure.⁵⁸
Safety: When correctly installed and operated at typical levels (e.g., 40-48 dBA), sound masking systems are considered safe and operate well below occupational noise exposure limits set by bodies like OSHA.⁹¹

The focus of traditional sound masking on reducing intelligibility, while addressing a key OPO issue, may not fully align with the broader soundscape goal of fostering positively perceived, health-promoting environments. Its effectiveness is highly dependent on careful implementation, and the neutral nature of the masking sound itself might not contribute to positive well-being outcomes. This suggests a potential advantage for alternative approaches, like biophilic sound masking, that attempt to integrate masking functionality with potentially restorative sound content, thereby bridging the gap between noise control and salutogenic soundscape design.⁵⁸

5.3. Industrial Environments

In contrast to offices, the primary acoustic concern in many industrial settings (e.g., manufacturing, construction, mining, agriculture, military) is the high level of noise exposure, which poses a direct risk to auditory health.⁹⁵

Noise-Induced Hearing Loss (NIHL): Prolonged exposure to high noise levels generated by machinery and industrial processes is a major cause of occupational hearing loss.⁵¹ Estimates suggest occupational noise accounts for a significant percentage (7-21%) of hearing loss among workers globally, with higher rates in developing countries.⁹⁵ Impulse noise (sudden, loud bursts) may be particularly damaging.⁹⁵ While NIHL prevalence appears to be declining in some industrialized nations due to better prevention and regulation, it remains a critical occupational hazard.⁹⁵ It’s important to note that hearing loss is often multifactorial, with age being the primary factor, but genetics, lifestyle (smoking), co-existing health conditions (diabetes, hypertension), and exposure to vibration or ototoxic chemicals also playing roles.⁹⁵
Cardiovascular Health: Beyond hearing damage, high levels of occupational noise exposure (typically exceeding 85 dBA) are increasingly linked to adverse cardiovascular outcomes.⁵¹ Epidemiological studies show associations between chronic industrial noise exposure and increased prevalence or risk of hypertension (high blood pressure).⁹⁶ The risk appears to increase with the duration of exposure.⁹⁸ Population attributable fraction (PAF) estimates suggest that occupational noise exposure may account for a substantial portion of hypertension and elevated cholesterol cases among workers.⁹⁶ The mechanisms likely involve the chronic stress pathways discussed earlier (Section 2.1).
Prevention: Given the clear health risks, noise control at the source, engineering controls, administrative controls (limiting exposure time), and consistent use of personal hearing protection devices (HPDs) are essential in industrial environments.⁹⁵

5.4. Healthcare Environments: Staff Impacts

The acoustic environment in healthcare settings impacts not only patients (Section 4.4) but also the staff working within them. Hospitals, clinics, and particularly critical areas like operating rooms (ORs) or intensive care units (ICUs) often feature complex and demanding soundscapes characterized by frequent alarms, equipment noise, high levels of activity, and constant communication.⁹⁰

Staff Well-being and Performance: This noisy and often unpredictable environment can act as a significant stressor for healthcare professionals. Noise exposure has been linked to increased staff fatigue, distraction, heightened cognitive workload, and stress.⁶⁴ Studies measuring physiological responses have found associations between excessive noise peaks (e.g., during surgery) and increased staff heart rates, suggesting elevated workload or stress.¹¹⁸ Such conditions can interfere with optimal performance, concentration, and decision-making, particularly during critical procedures.¹¹⁸
Communication: Clear and effective communication is paramount for teamwork and patient safety in healthcare.¹¹⁸ High background noise levels can significantly impair speech intelligibility, leading to misunderstandings, repeated requests, and potential errors.⁶⁴ Interventions aimed at improving communication in noisy environments, such as the use of wireless headset communication systems in ORs, have shown promise in improving perceived communication quality among team members and reducing exposure to peak noise levels.¹¹⁸
Patient Safety Implications: There is a well-established link between healthcare staff well-being, effective teamwork, and positive patient safety outcomes.¹¹⁹ Factors that compromise staff well-being (like chronic stress from noise) or hinder teamwork (like poor communication due to noise) can indirectly increase the risk of medical errors and adverse patient events.¹¹⁸

Therefore, the soundscape of healthcare environments creates an important feedback loop. Poor acoustic conditions can simultaneously degrade the patient experience and recovery while also negatively impacting staff well-being and performance. This dual impact underscores the importance of addressing hospital soundscapes not only for patient comfort but also as a critical component of workforce safety and overall quality of care. Interventions that improve the acoustic environment are likely to benefit both patients and the professionals caring for them.

5.5. Research Methods in Occupational Settings

Investigating soundscape effects in workplaces utilizes a range of methods, often combining objective and subjective approaches:

Acoustic Measurements: Characterizing the physical sound environment using SPL meters (measuring LAeq, Lpeak, Lmin, percentiles) and spectral analysis is fundamental, especially in industrial settings for assessing NIHL risk and in offices/healthcare for characterizing background noise and specific sources.⁴⁸
Subjective Assessments: Questionnaires are widely used to gauge employee perceptions of noise annoyance, disturbance, acoustic comfort, privacy, overall satisfaction, as well as self-reported well-being, stress levels, and perceived workload.⁴⁸
Performance Measures: Objective assessment of task performance (e.g., accuracy, speed on cognitive tasks, simulated work tasks) is used to quantify the impact of noise on productivity.⁴⁸
Physiological Measures: Increasingly employed to provide objective indicators of stress, arousal, or cognitive load. Common measures include heart rate (HR), heart rate variability (HRV), skin conductance (EDA), and sometimes more advanced techniques like EEG or facial emotion recognition AI.⁴⁸
Experimental Settings: Both field studies conducted in real workplaces ⁷³ and controlled laboratory or simulated environment studies (including VR) ⁴⁸ are utilized. Lab studies allow for greater control and manipulation of acoustic conditions, while field studies offer higher ecological validity.

6. Methodological Landscape: Evaluating Current Research Techniques

The study of soundscape and its relationship with health relies on a diverse toolkit of methodologies drawn from acoustics, psychology, physiology, and environmental science. Each approach offers unique strengths but also faces limitations. A critical understanding of these methods is essential for interpreting existing research and designing future studies.

6.1. Acoustic Measurement Techniques

Quantifying the physical acoustic environment is a foundational step in most soundscape research.

Sound Pressure Level (SPL) Metrics: Standard metrics like the A-weighted equivalent continuous sound level (LAeq), day-evening-night level (Lden), night level (Lnight), maximum level (Lmax), and percentile-exceeded levels (e.g., LA10, LA90) are widely used.⁸ These are mandated by noise regulations and provide basic information about sound energy. However, their correlation with subjective perception (annoyance, pleasantness) and health outcomes is often weak, as they average out temporal variations and don’t fully capture spectral characteristics relevant to perception.⁸ The difference between LA10 and LA90 is sometimes used as a simple indicator of level variability.⁷⁴
Spectral Analysis: Analyzing the frequency content of sound, typically using octave or third-octave bands, provides more detailed information than broadband SPL measures.⁹⁰ The difference between C-weighted and A-weighted levels (LCeq – LAeq) is often used as an indicator of low-frequency sound energy dominance.⁸
Sound Source Identification: Recognizing the types of sounds present (e.g., traffic, human voices, nature, mechanical) is crucial because human perception is highly dependent on the meaning and connotation of the source.¹² This can be achieved through direct listening by researchers or participants (e.g., during soundwalks) or increasingly through automated classification techniques using machine learning algorithms applied to audio recordings.¹²⁰
Psychoacoustic Parameters: These metrics aim to quantify specific perceptual attributes of sound, going beyond simple energy measures. Commonly calculated parameters include Loudness, Sharpness, Roughness, Fluctuation Strength, and Tonality.⁸ Metrics like Relative Approach (RelApproach), related to the saliency of sound events, are also used.²⁸ These parameters often show stronger correlations with subjective assessments like pleasantness or annoyance compared to SPL alone, offering a more perceptually relevant description of the acoustic environment.⁸ However, their calculation requires specialized software and understanding.
Recording Techniques: The choice of recording equipment influences the type of analysis possible. Calibrated sound level meters (SLMs) are used for standardized SPL measurements. Binaural recording techniques, using microphones placed in a dummy head (Head and Torso Simulator, HATS) or worn by individuals, capture sound as it arrives at the ears, preserving spatial cues (interaural time and level differences, spectral cues from the pinnae) necessary for realistic reproduction over headphones and spatial audio analysis.¹³ Microphone arrays can be used for sound source localization.¹⁷⁰ For long-term monitoring, particularly in ecological studies or urban noise mapping, Autonomous Recording Units (ARUs) are increasingly deployed.³⁵

6.2. Perceptual Assessment Methods

Capturing the subjective experience of the soundscape is paramount, as defined by ISO 12913.

Questionnaires: The most common method for gathering subjective data. They can assess a wide range of constructs, including perceived affective quality (pleasantness, eventfulness, etc.), annoyance, acoustic comfort, identification and perception of sound sources, sound preferences, overall environmental quality, and relevant health and well-being indicators.² Questionnaires can be administered in situ during field studies or used in laboratory or online settings with reproduced stimuli.
Semantic Differential Scales: A specific format frequently used within questionnaires, particularly for assessing affective quality. Participants rate the soundscape on scales anchored by bipolar adjectives (e.g., calm–chaotic, pleasant–annoying).² ISO/TS 12913-2 and -3 recommend a set of eight attributes forming the Pleasantness-Eventfulness circumplex: Pleasant, Vibrant, Eventful, Chaotic, Annoying, Monotonous, Uneventful, and Calm.²¹ Efforts are ongoing to develop and validate standardized soundscape assessment scales in different languages and contexts.²²
Soundwalks: A standardized field method where participants actively experience the acoustic environment by walking along a predetermined route, focusing on listening and providing evaluations, often using questionnaires at designated stops or afterwards.² This method offers high ecological validity by capturing perception in its natural context.²³ ISO 12913-2 provides specific guidance.¹³ Drawbacks include resource intensity and lack of environmental control.
Interviews and Focus Groups: Qualitative methods used to gather richer, more nuanced data on individual experiences, interpretations, meanings, and contextual factors influencing soundscape perception.⁵ Particularly useful for exploring complex issues, understanding user needs, and involving ‘local experts’ in participatory research or design processes.¹³

6.3. Physiological and Behavioral Monitoring

To complement subjective self-reports and provide objective measures of response, researchers increasingly incorporate physiological and behavioral monitoring. These methods can capture responses that may occur below conscious awareness or that individuals may have difficulty articulating.³⁸

Cardiovascular Measures: Heart Rate (HR) and Heart Rate Variability (HRV) are commonly used indicators of autonomic nervous system activity.¹⁴ HRV indices (e.g., SDNN, RMSSD, LF/HF ratio, HF power) can provide insights into the balance between sympathetic (stress) and parasympathetic (relaxation) activity.⁷⁷ Blood Pressure (BP) is another key indicator, particularly relevant for assessing cardiovascular risk associated with noise.⁹
Electrodermal Activity (EDA): Measures changes in skin conductance (SCL, SCR) due to sweat gland activity, reflecting sympathetic nervous system arousal.¹⁴ Often used to assess stress responses and recovery.
Neurophysiological Measures: Electroencephalography (EEG) records electrical activity in the brain, allowing analysis of brainwave patterns (e.g., alpha and beta band power) associated with relaxation, alertness, attention, or cognitive workload.⁴⁸ Event-Related Potentials (ERPs) can track brain responses to specific sound events.⁴⁸ Functional Magnetic Resonance Imaging (fMRI) provides higher spatial resolution to identify brain regions activated or deactivated during soundscape exposure, potentially revealing networks involved in processing or restoration (e.g., Default Mode Network – DMN).⁷⁷ These methods typically require laboratory settings.
Hormonal Measures: Salivary cortisol is a commonly measured biomarker of HPA axis activity and physiological stress.⁵⁸ Collection is non-invasive but levels fluctuate diurnally and require careful sampling protocols.
Respiratory Measures: Changes in Respiration Rate (RR) and depth (RD) can also reflect physiological arousal or relaxation states.²⁷
Behavioral Monitoring: Observing or tracking behavior provides another layer of objective data. This includes activity tracking (e.g., movement patterns in a park using GPS or sensors) ¹⁰⁸, eye-tracking technology to measure visual attention allocation in response to audio-visual stimuli ⁹, automated facial expression analysis to infer emotional states ⁷⁵, and objective measures of task performance (reaction time, accuracy) in cognitive studies.⁴⁸

While powerful, physiological and behavioral measures present challenges. Responses can be non-specific (e.g., increased heart rate can indicate excitement or stress), exhibit high inter-individual variability, and be influenced by numerous factors beyond the acoustic environment. Interpretation often requires careful experimental control and sophisticated analysis techniques.³⁸ Furthermore, the link between specific physiological patterns and subjective perceptual attributes like pleasantness is not always straightforward or consistent across studies.⁴²

6.4. Experimental Designs

The choice of experimental design significantly influences the type of questions that can be answered and the generalizability of the findings.

Laboratory Studies: These offer the highest degree of environmental control, allowing researchers to precisely manipulate auditory and visual stimuli and isolate their effects.⁸ This control facilitates causal inference and is often necessary for employing sensitive physiological measures like EEG or fMRI. The main limitation is potentially lower ecological validity, as the laboratory context differs significantly from real-world listening experiences.⁷⁹
Field Studies: Conducted in real-world environments (e.g., parks, streets, offices, homes), these studies prioritize ecological validity, capturing soundscape perception and responses within their natural context.⁸ However, controlling extraneous variables is much more difficult, making it harder to establish clear causal relationships. Field studies can also be logistically complex and resource-intensive.
Virtual Reality (VR) and Augmented Reality (AR): These immersive technologies represent an attempt to combine the control of the laboratory with the contextual richness of the field.³² VR allows researchers to create and manipulate complex, multi-sensory virtual environments (often based on real locations) within a controlled lab setting. AR overlays virtual elements onto the real world. The key advantage is the potential for high levels of immersion and presence, potentially enhancing ecological validity compared to traditional lab setups.³⁶ The validity, however, depends heavily on the fidelity of the audio-visual reproduction.³⁶ Comparative studies suggest that VR can yield subjective responses similar to real-world experiences if implemented carefully, making it a promising tool for soundscape assessment and design testing.⁷⁹ Online VR or web-based experiments offer greater accessibility but sacrifice control over the participant’s environment and playback equipment.⁷⁹
Cross-over Designs: In this design, each participant experiences multiple experimental conditions (e.g., exposure to different soundscapes, walking in both a park and a street).⁶⁸ This allows participants to serve as their own controls, reducing the influence of inter-individual variability and increasing statistical power.
Longitudinal Studies: These designs involve repeated measurements on the same individuals over extended periods. They are crucial for understanding the chronic health effects of long-term soundscape exposure, adaptation processes, and developmental trajectories.⁹³ Despite their importance, longitudinal studies remain relatively rare in soundscape-health research, representing a significant gap.¹⁸

6.5. Data Analysis Approaches

Analyzing the complex datasets generated by soundscape research requires appropriate statistical and computational methods.

Basic Inferential Statistics: Standard methods like t-tests and Analysis of Variance (ANOVA) are used to compare mean responses (perceptual ratings, physiological measures) between different groups or experimental conditions.³⁷ Correlation analysis explores linear associations between variables (e.g., acoustic metrics and annoyance ratings).¹²
Dimensionality Reduction and Clustering: Techniques like Principal Component Analysis (PCA) or Factor Analysis are used to identify underlying latent dimensions within sets of perceptual ratings (e.g., deriving Pleasantness and Eventfulness from multiple semantic scales).¹² Cluster analysis can group participants based on their response patterns or classify soundscapes based on their characteristics.³⁷
Regression Models: Widely used to model the relationship between a set of predictor variables (e.g., acoustic parameters, sound source types, contextual factors, demographics) and an outcome variable (e.g., perceived pleasantness, annoyance, a health indicator).⁸

Linear Regression (LR) is common, often with variable selection techniques like stepwise or Lasso.⁸ However, soundscape relationships are often non-linear.
Non-Linear Regression (NLR) methods, often drawn from machine learning (e.g., Random Forests, Gradient Boosting Machines like XGBoost, Support Vector Regression, Artificial Neural Networks), generally provide better predictive performance, especially when dealing with complex interactions between predictors.⁸
Mixed-Effects Models (Multilevel Models) are essential when data has a hierarchical or clustered structure (e.g., multiple ratings per person, multiple participants per location). They account for non-independence of observations within groups, providing more accurate estimates and allowing examination of variance at different levels (e.g., individual vs. location).⁸
Machine Learning (ML) / Deep Learning (DL): Beyond regression, ML/DL techniques are increasingly applied, particularly for:

Automated Sound Event Detection and Classification: Identifying and labeling sound sources in large acoustic datasets, crucial for ecoacoustics and detailed soundscape characterization.³⁵
Acoustic Scene Classification: Categorizing overall acoustic environments.¹⁷⁰
Modeling Complex Relationships: Potentially capturing intricate patterns in perception-health data that traditional statistical models might miss.⁸ There is a growing trend towards unsupervised or semi-supervised methods to handle the vast amounts of unlabeled acoustic data generated by long-term monitoring.¹⁶⁶
Systems Thinking Approaches: Methods like developing Causal Loop Diagrams (CLDs) through participatory workshops help visualize and understand the complex, dynamic, and often non-linear interrelationships between soundscape quality, public health variables, socio-economic factors, environmental justice issues, and biodiversity.²⁰ This approach focuses on feedback loops and system-level behavior, identifying potential leverage points for intervention and anticipating unintended consequences.²⁰

6.6. Critical Evaluation and Triangulation

No single methodology is perfect; each comes with inherent trade-offs. Laboratory studies offer control but may lack real-world applicability, while field studies provide context but suffer from confounding variables.⁷⁹ Subjective reports capture essential perceptual experience but are prone to biases, while physiological measures offer objectivity but can be difficult to interpret and may not directly map onto conscious perception.⁷⁸ Standard acoustic metrics are easily measured but often fail to predict human response accurately.⁷⁴

Recognizing these limitations, the soundscape field emphasizes the importance of triangulation: combining data from multiple methodological approaches (e.g., in situ perceptual ratings, objective acoustic measurements, perhaps laboratory validation or physiological monitoring) to build a more convergent and robust understanding.¹³

Methodological rigor is paramount. This includes clear reporting of procedures and participant characteristics, the use of validated assessment tools (e.g., standardized questionnaires, calibrated equipment), appropriate statistical analysis that accounts for data structure (e.g., using mixed-effects models for clustered data), careful consideration and control of potential confounding factors, and robust validation of predictive models using techniques like cross-validation to ensure generalizability.⁸ The choice of methodology inevitably shapes the findings and conclusions of a study; therefore, a critical awareness of the strengths and weaknesses associated with different methods is essential for both conducting and interpreting soundscape research.

7. Synthesis: Current Knowledge, Debates, and Gaps

Synthesizing the research across urban open spaces, specific populations, and occupational settings reveals several common themes, ongoing debates, and significant knowledge gaps regarding the relationship between soundscape and health.

Common Themes and Converging Findings:

Negative Impact of Unwanted Noise: Across all settings, exposure to high levels of unwanted noise, particularly from transportation and mechanical sources, is consistently linked to negative outcomes. These include increased annoyance, stress, sleep disturbance, impaired cognitive performance (especially attention and memory), and increased risk factors for cardiovascular disease.⁴⁷ This reinforces the public health importance of traditional noise mitigation strategies.
Beneficial Effects of Natural Sounds: The presence of natural sounds (water, birdsong, wind) is frequently associated with positive perceptual and health outcomes, including increased pleasantness, perceived restorativeness (stress reduction, attention restoration), improved mood, and potentially enhanced cognitive function.⁵⁷ This theme is prominent in studies of urban parks and therapeutic settings (hospitals, dementia care) and forms the basis for biophilic sound design approaches.
Importance of Perception and Context: A core tenet emerging across diverse studies is that subjective perception, heavily influenced by context (place, activity, individual factors), is a stronger determinant of response than objective sound levels alone.³ The meaning attributed to a sound source (e.g., traffic vs. nature vs. human activity) significantly shapes whether it is perceived as pleasant, annoying, informative, or restorative.¹⁷ This supports the fundamental rationale of the soundscape approach over purely level-based noise control.
Multidimensionality of Soundscape Perception: The Pleasantness-Eventfulness circumplex model appears broadly applicable for describing affective responses in various settings, including urban open spaces and potentially offices.¹⁴ This provides a common language for characterizing perceptual quality.
Audio-Visual Interaction: Perception is multisensory. The visual context significantly influences auditory perception and overall environmental assessment, and vice versa.²⁶ Congruence between visual and auditory elements often leads to more positive experiences (e.g., natural sounds in a park setting).¹⁵³ This highlights the need for integrated design approaches.

Contrasting Findings and Ongoing Debates:

Role of Human Sounds: The impact of human sounds (speech, activity) is context-dependent and debated. In some settings (e.g., OPOs, quiet parks), they are often perceived as major distractors or annoyances, decreasing pleasantness.³⁴ In others (e.g., vibrant public squares, social settings), they contribute positively to eventfulness and perceived liveliness, and may even enhance sociability if appropriate.¹²⁰ Finding the right balance is a key design challenge.
Effectiveness of Interventions (e.g., Sound Masking): While interventions like sound masking in OPOs aim to address specific acoustic problems (speech distraction), their overall effectiveness in improving well-being and productivity is debated, often depending heavily on implementation quality and the specific metrics used.⁹¹ The debate extends to whether masking simply replaces one noise with another or genuinely improves the perceptual quality of the environment.⁵⁸
Physiological vs. Perceptual Concordance: While physiological measures offer objective insights, their correlation with subjective perceptual ratings (e.g., pleasantness) is not always consistent.⁴² Sometimes, significant physiological changes occur without corresponding changes in self-reported feelings, or vice versa.⁷⁷ Understanding the dissociation and interplay between these response levels remains an active area of research.
Generalizability of Lab Findings: Studies using VR or controlled lab settings offer valuable insights into mechanisms but face questions about ecological validity.⁷⁹ The extent to which findings from simulated environments translate directly to real-world experiences is an ongoing methodological debate, though comparative studies are showing increasing convergence with careful design.⁷⁹
Standardization vs. Flexibility: While ISO 12913 provides a framework, the recommendation of multiple assessment methods ²⁸ reflects the difficulty in achieving a single standardized protocol suitable for all contexts and research questions. Balancing the need for comparability with the flexibility required to capture context-specific nuances remains a challenge.²⁹

Significant Knowledge Gaps:

Longitudinal Studies: The vast majority of soundscape-health research is cross-sectional or involves short-term experiments. There is a critical need for longitudinal studies to understand the long-term health consequences of chronic soundscape exposure (both positive and negative), adaptation effects, and developmental impacts across the lifespan.¹⁸
Mechanistic Understanding: While associations between soundscapes and health outcomes are being established, the precise underlying physiological and neurological mechanisms are often still being elucidated. More research is needed to clarify the pathways linking specific soundscape features (beyond noise levels) to stress responses, cognitive function, and emotional regulation.⁵⁹
Vulnerable Populations: While research is growing, studies specifically focusing on vulnerable groups (elderly, children, patients, those with sensory sensitivities, low SES groups) are still relatively limited compared to studies on the general adult population.⁸⁹ More research is needed to understand their specific needs, sensitivities, and responses to interventions.
Indoor Soundscapes: Much soundscape research has focused on urban outdoor public spaces. While work exists on specific indoor settings (offices, hospitals, schools), a more systematic understanding of everyday indoor soundscapes (e.g., homes, public transport) and their cumulative health impact is needed, especially given the amount of time people spend indoors.²⁷
Intervention Effectiveness: While various soundscape design strategies are proposed (water features, vegetation, masking, zoning), rigorous evaluations of their long-term effectiveness in real-world settings, including cost-benefit analyses and assessment of unintended consequences (e.g., gentrification ²⁰), are relatively scarce.¹¹ Tools are needed to quantify the societal and economic impact of interventions.²⁹
Integration of Other Senses: While audio-visual interactions are increasingly studied, the role of other sensory modalities (e.g., olfaction, thermal comfort) in modulating soundscape perception and health effects requires further exploration for a truly holistic understanding of environmental experience.⁹
Translation to Practice and Policy: Despite growing academic interest and the development of ISO standards, the translation of soundscape principles into routine urban planning, architectural design, and public health policy remains limited.¹¹ Barriers include lack of awareness, resource constraints, disciplinary silos, and insufficient practical guidance.²⁹

Addressing these gaps requires continued interdisciplinary collaboration, methodological innovation (particularly in longitudinal designs and ecologically valid measurement), and focused efforts to translate research findings into practical applications and policy recommendations.

8. Context and Future Directions

8.1. Brief Historical Context

The formal study of soundscape as a perceptual concept, distinct from simple noise measurement, has a history spanning roughly half a century.² Emerging from initial explorations in urban planning ¹ and significantly shaped by the work of R. Murray Schafer and the World Soundscape Project in the 1970s ², the field initially had strong ties to acoustic ecology and music composition.¹¹ Over the past few decades, particularly since its introduction to the broader noise research community around the late 1990s ², the focus has increasingly shifted towards understanding the human perception of everyday acoustic environments and its implications for health, well-being, and quality of life.⁵ This evolution culminated in the development of the ISO 12913 standard series starting in 2008, which provided a crucial formal definition and conceptual framework centered on human perception in context.² This standardization marked a paradigm shift away from purely noise-centric approaches towards a more holistic, multidisciplinary understanding of our sonic world.⁵

8.2. Future Directions and Emerging Trends

The field of soundscape research concerning health is dynamic and poised for significant advancements, driven by methodological innovation, technological developments, and a growing recognition of its societal importance. Key future directions include:

Enhanced Standardization and Implementation: While the ISO 12913 series provides a foundation, ongoing work is needed to refine methodologies, potentially develop reference methods for better comparability ³³, and address barriers to wider adoption and implementation in practice and policy.²⁹ This involves increasing awareness, providing practical guidance and case studies, fostering interdisciplinary collaboration, and demonstrating the socio-economic benefits of soundscape interventions.²⁹
Technological Integration: Advances in technology offer new possibilities:

Virtual Reality (VR) and Augmented Reality (AR): These technologies will likely play an increasing role in soundscape research and design, offering immersive platforms for controlled experiments, pre-construction evaluation of designs, and potentially therapeutic applications.³⁶ Refining audio rendering techniques (e.g., binaural audio, Ambisonics) to ensure ecological validity remains crucial.³⁶
Machine Learning (ML) and AI: ML algorithms are becoming indispensable for analyzing large acoustic datasets (e.g., from ARUs), automating sound source identification and classification, and potentially building more sophisticated predictive models of soundscape perception and health outcomes.⁸
Wearable Sensors: Continued development of wearable sensors for physiological monitoring (HRV, EDA, EEG) will facilitate more objective data collection in real-world settings, complementing subjective reports.⁴⁸

Focus on Positive Health and Well-being: Moving beyond noise mitigation, future research will likely place greater emphasis on identifying and designing soundscapes that actively promote positive health outcomes, such as restoration, relaxation, positive affect, and cognitive enhancement.¹⁴ This involves understanding the characteristics of salutogenic sound environments.
Longitudinal and Intervention Studies: Addressing the gap in longitudinal research is critical for understanding long-term effects and causality.¹⁸ More rigorous, well-designed intervention studies are needed to evaluate the real-world effectiveness of soundscape design strategies in improving health and well-being across different settings and populations.²⁰
Personalized Soundscapes: Recognizing the significant role of individual differences (e.g., personality, noise sensitivity, cultural background, personal history) in perception, future research may explore possibilities for tailoring acoustic environments to individual needs and preferences, potentially leveraging smart technologies.¹²
Multisensory Integration: A deeper understanding of how auditory perception interacts with other senses (vision, smell, touch, thermal sensation) to shape overall environmental experience and health outcomes will be crucial for holistic environmental design.⁹
Addressing Health Inequalities: Future research should explicitly consider how soundscape quality and noise exposure relate to social determinants of health and strive to develop interventions that promote acoustic equity in diverse communities.¹¹

9. Conclusions

This review has charted the current landscape of research connecting soundscapes and acoustic environments to human health, focusing on urban open spaces, specific populations, and occupational settings. The field has firmly established that the sounds surrounding us are not mere background noise but potent environmental factors with significant consequences for physiological health, psychological well-being, and cognitive function.

The transition from a purely noise-centric view to the holistic soundscape approach, formalized by the ISO 12913 standards, represents a critical advancement. It acknowledges that human perception – shaped by context, meaning, and individual factors – is paramount in determining the impact of an acoustic environment. While the detrimental effects of noise pollution (stress, sleep disturbance, cardiovascular risk, cognitive impairment) remain a major public health concern demanding mitigation, the soundscape perspective concurrently highlights the potential for positive, health-promoting acoustic environments. Natural sounds, in particular, consistently emerge as beneficial, fostering restoration, reducing stress, and improving mood across various settings.

Research across the three focal areas – urban open spaces, specific populations, and occupational settings – reveals both commonalities and context-specific nuances. Parks and green spaces offer restorative potential significantly mediated by their sound quality, contrasting sharply with the often stressful acoustic environments of busy streets or open-plan offices. Vulnerable populations, including the elderly, children, hospital patients, and individuals with auditory sensitivities, exhibit unique responses and require tailored consideration in research and design. Occupational soundscapes pose distinct challenges, ranging from NIHL and cardiovascular risks in industrial settings to stress, distraction, and communication breakdowns in offices and healthcare environments, impacting both employee well-being and potentially patient safety.

The methodological toolkit for soundscape research is diverse, encompassing objective acoustic measurements, subjective perceptual assessments (soundwalks, questionnaires), physiological monitoring, and various experimental designs, including the increasing use of virtual reality. While each method offers specific advantages, the complexity of soundscape perception necessitates triangulation – combining multiple approaches for a robust understanding. Critical evaluation of methodological rigor and the limitations of each technique is essential for advancing the field.

Despite significant progress, key knowledge gaps persist. There is a pressing need for more longitudinal studies to understand chronic effects, further research into the underlying mechanisms linking perception to health, greater focus on vulnerable populations and indoor environments, and rigorous evaluation of soundscape interventions. Furthermore, bridging the gap between research findings and practical implementation in urban planning, architecture, and public health policy remains a crucial challenge, requiring enhanced communication, collaboration, and development of practical tools and guidelines.

For emerging PhD researchers entering this vibrant field, the opportunities are substantial. Future work should strive for methodological rigor, embrace interdisciplinary perspectives, leverage technological advancements responsibly, and maintain a focus on translating knowledge into tangible improvements for human health and environmental quality. By continuing to explore the intricate relationship between people, sound, and context, soundscape research can make significant contributions to creating healthier, more supportive, and more enjoyable environments for all.

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