On the basis of this study it cannot be ruled out that the appraisal of the noise affects the association between air and road traffic noise exposure and children's health and cognition. However, the conclusion is limited due to the relatively small group of annoyed children, which may have influenced our group comparisons. Furthermore, the observed relation between annoyance and perceived health is possibly biased due to the fact that both were measured within the same questionnaire. These are the main conclusions of a cross-sectional multi-center study carried out among 2,844 schoolchildren (age 9-11 years) attending 89 primary schools around three European airports. The aim was to investigate how annoyance affects the relation between air and road traffic noise exposure and children's health and cognition. Different, sometimes competing, working mechanisms of how noise affects children's health are suggested. Some effects are supposed to be precipitated through (chronic) stress, while others may arise directly. There is still no theory that can adequately account for the circumstances in which noise will affect cognitive performance.