Miscarriage Among Flight Attendants

Grajewski, Barbara; Whelan, Elizabeth A.; Lawson, Christina C.; Hein, Misty J.; Waters, Martha A.; Anderson, Jeri L.; MacDonald, Leslie A.; Mertens, Christopher J.; Tseng, Chih-Yu; Cassinelli, Rick T. II; Luo, Lian

Epidemiology. 9000;Publish Ahead of Print:10.1097/EDE.0000000000000225.


Background: Cosmic radiation and circadian disruption are potential reproductive hazards for flight attendants.

Methods: Flight attendants from 3 US airlines in 3 cities were interviewed for pregnancy histories and lifestyle, medical, and occupational covariates. We assessed cosmic radiation and circadian disruption from company records of 2 million individual flights. Using Cox regression models, we compared respondents (1) by levels of flight exposures and (2) to teachers from the same cities, to evaluate whether these exposures were associated with miscarriage.

Results: Of 2654 women interviewed (2273 flight attendants and 381 teachers), 958 pregnancies among 764 women met study criteria. A hypothetical pregnant flight attendant with median first-trimester exposures flew 130 hours in 53 flight segments, crossed 34 time zones, and flew 15 hours during her home-base sleep hours (10 pm-8 am), incurring 0.13 mGy absorbed dose (0.36 mSv effective dose) of cosmic radiation. About 2% of flight attendant pregnancies were likely exposed to a solar particle event, but doses varied widely. Analyses suggested that cosmic radiation exposure of 0.1 mGy or more may be associated with increased risk of miscarriage in weeks 9-13 (odds ratio = 1.7 [95% confidence interval = 0.95-3.2]). Risk of a first-trimester miscarriage with 15 hours or more of flying during home-base sleep hours was increased (1.5 [1.1-2.2]), as was risk with high physical job demands (2.5 [1.5-4.2]). Miscarriage risk was not increased among flight attendants compared with teachers.

Conclusions: Miscarriage was associated with flight attendant work during sleep hours and high physical job demands and may be associated with cosmic radiation exposure.

(C) 2015 by Lippincott Williams & Wilkins, Inc

Link to article published online ahead of print

Flight Attendant Fatigue, Part IV: Analysis of Incident Reports

Federal Aviation Administration
December 2009

Download the publication: Crew Fatigue IV CAMI 2009

Voluntary safety reporting is one method by which aviation personnel can report safety issues to their airline and the Federal Aviation Administration. The Aviation Safety Reporting System (ASRS) is a program managed by the National Aeronautics & Space Administration (NASA) Ames Research Center. This study reviewed flight attendant reports from the ASRS database to identify the frequency of fatigue reports and the conditions under which fatigue occurred.

During June 2008, 2,628 cabin crew reports were downloaded from the NASA ASRS Web site for reports made between January 1990 and December 2007. CAMI researchers reviewed each fullform report narrative for possible contributors to fatigue, or indicators of fatigue. Although the overall number of flight attendant ASRS reports for which full-form coding was completed has decreased over the last 3 years, both total flight attendant reporting and the number of full-form narratives related to fatigue have increased substantially. This voluntary data allows regulators and operators to discover potential problems in the aviation industry before they result in a mishap. The results of this review indicate that flight attendant fatigue may be occurring more frequently and warrant more attention.

Kali Holcomb
Katrina Avers
Lena Dobbins
Joy Banks
Lauren Blackwell
Thomas Nesthus
Civil Aerospace Medical Institute
Federal Aviation Administration
Oklahoma City, OK 73125
December 2009
Final Report
Office of Aerospace Medicine
Washington, DC 20591

Final Report
Office of Aerospace Medicine
Washington, DC 20591

fa health

Cancer incidence in airline cabin crew

Cancer incidence in airline cabin crew
E A Whelan

Evidence that flight crew are at increased risk for certain types of cancer is growing although epidemiological evidence remains inconclusive.

Download the article: Cancer and Flight Crews – Whelan

Conclusion: The evidence that flight crew are at increased risk for certain types of cancer is growing and current concerns about
potential hazards in this occupation are not without basis. However, thus far, the epidemiological evidence remains inconclusive due to limitations in exposure assessment, sample size, and characterization of confounders. The studies from the European Union and the USA will move us further towards understanding the nature of the risks involved for workers in this unique occupation.

Occup Environ Med 2003;60:805–806

The self-reported health of U.S. flight attendants compared to the general population

Download: McNeely_et_al2014_provisional

Environmental Health 2014, 13:13 doi:10.1186/1476-069X-13-13
Eileen McNeely (emcneely@hsph.harvard.edu)
Sara Gale (gale@hsph.harvard.edu)
Ira Tager (ibt@berkeley.edu)
Laurel Kincl (laurel.kincl@oregonstate.edu)
Julie Bradley (juliembradley@gmail.com)
Brent Coull (bcoull@hsph.harvard.edu)
Steve Hecker (shecker@uw.edu)

Few studies have examined the broad health effects of occupational exposures in flight
attendants apart from disease-specific morbidity and mortality studies. We describe the health
status of flight attendants and compare it to the U.S. population. In addition, we explore
whether the prevalence of major health conditions in flight attendants is associated with
length of exposure to the aircraft environment using job tenure as a proxy.

This study found higher rates of specific diseases in flight attendants than the general
population. Longer tenure appears to explain some of the higher disease prevalence.
Conclusions are limited by the cross-sectional design and recall bias. Further study is needed
to determine the source of risk and to elucidate specific exposure-disease relationships over

A history of second hand smoke exposure: are we asking the right questions?

 A history of second hand smoke exposure:
are we asking the right questions?

CranePaperMardi A. Crane-Godreau* and Peter Payne

The 2006 Surgeon General’s Report, “Health Consequences of Involuntary Exposure to Tobacco Smoke” (Surgeon General, 2006) documents the health implications of exposure to SHS, including firm evidence that SHS contributes to coronary and lung disease, lung can- cer, premature death in adults, slow lung development, SIDS, asthma, and ear infections in children, as well as suggestive evidence that implicate SHS in COPD, asthma, breast cancer, and nasal sinus cancer in adults, and leukemia, lymphoma, and brain tumors in children. The report indicates that there is no risk-free level of SHS. Despite evidence that SHS is a risk factor for disease, most healthcare orga- nizations and many physicians fail to ask patients about their history of SHS exposure. The implications of that failure are considerable because knowledge of a patient’s history of SHS exposure enables providers to make better-informed decisions about what to include in each patient’s examination and lab tests, and how to conduct longterm monitoring, as well as alerting the patient to the need for measures to help them avoid further smoke exposure.

Download: A history of second hand smoke exposure: are we asking the right questions?


Flight Attendant Fatigue

Download: Flight Attendant Fatigue

The Departments of Transportation and Treasury and Independent Agencies Appropriations Bill (House Rpt. 108-671) included a directive to the Federal Aviation Administration to conduct a study of flight attendant fatigue.

The NASA Ames Research Center Fatigue Countermeasures Group (FCG) was contracted by CAMI to conduct the study.

To meet the goals of the study, this report contains a literature review on fatigue as potentially experienced by flight attendants, an evaluation of currently used (actual vs. scheduled) flight attendant duty schedules, and a comparison of these schedules to the current CFRs. The report additionally reviews fatiguerelated incident/accident information from the Aviation Safety Reporting System (ASRS) and the NTSB database.

One report section describes the application of three different performance and fatigue models to assess how flight attendant duty schedules contribute to increased levels of fatigue and predicted changes in performance. The report concludes with 6 recommendations concerning issues that require further evaluation, including:

(1) Survey of Field Operations. To assess the frequency with which fatigue is experienced, the situations in which it appears, and the consequences that follow;

(2) Focused Study of Incident Reports. To better understand details of the incidents;

(3) Field Research on the Effects of Fatigue. To explore physiological and neuropsychological
effects of fatigue, sleepiness, circadian factors, and rest schedules on flight attendants;

(4) Validation of Models for Assessing FA Fatigue. An important step to understanding whether and how models could be used in conjunction with field operations;

(5) International Carrier Policies and Practices Review. To learn how other countries address these
issues and with what results; and

(6) Training. FAs could benefit from information on fatigue, its causes and consequences, its interaction with circadian disruption, and how and when to employ countermeasures (e.g., scheduled naps, physical activity, social interaction, caffeine).

Pulmonary Function Abnormalities in Never Smoking Flight Attendants Exposed to Secondhand Tobacco Smoke in the Aircraft Cabin

Mehrdad Arjomandi, MD 1,3,4, Thaddeus Haight, MA 5, Rita Redberg, MD 1,3, and Warren M Gold, MD 1,2,3
1 UCSF FAMRI Center of Excellence, University of California, San Francisco
2 Cardiovascular Research Institute, University of California, San Francisco
3 Department of Medicine, University of California, San Francisco
4 San Francisco Veterans Affairs Medical Center, University of California Berkeley, California
5 School of Public Health, University of California Berkeley, California

Download the publication: Pulmonary Function Abnormalities In Never Smoking Flight Attendants

Objective: To determine whether the flight attendants who were exposed to secondhand tobacco smoke (SHS) in the aircraft cabin have abnormal pulmonary function.
Methods: We administered questionnaires and performed pulmonary function testing in 61 neversmoking female flight attendants who worked in active air crews before the smoking ban on commercial aircraft (pre-ban).
Results: While the pre-ban flight attendants had normal FVC, FEV1, and FEV1/FVC ratio, they had significantly decreased flow at mid- and low-lung volumes, curvilinear flow-volume curves, and evidence of air trapping. Furthermore, the flight attendants had significantly decreased diffusing capacity (77.5±11.2 %predicted normal) with 51% having a diffusing capacity below their 95% normal prediction limit.
Conclusions: This cohort of healthy never-smoking flight attendants who were exposed to SHS in the aircraft cabin showed pulmonary function abnormalities suggestive of airway obstruction and impaired diffusion.

Self-assessed occupational health and working environment of female nurses, cabin crew and teachers

Herdis Sveinsdo´ ttir1 RN, PhD (Professor), Ho´ lmfrı´ður Gunnarsdo´ ttir2 Msc, PhD (Senior Researcher) and
Hildur Friðriksdo´ ttir3 MS (Research Assistant)
1Faculty of Nursing, University of Iceland, 2Research Center for Occupational Health & Well-being, Administration of Occupational Safety &
Health and 3Faculty of Social Sciences, University of Iceland, Reykjavı´k, Iceland

Download the article: Flight Attendant vs Registered Nurse health

Aim: The aim of this study was to describe and compare the self-assessed occupational health among female nurses, cabin crew and teachers, in relation to their working environment.

Background: Similarities between the three occupations, i.e. predominantly female and service-oriented, render them interesting in comparison with respect to health and working environment.

Methods: The participants were female Icelandic cabin crew, nurses and elementary school teachers. A questionnaire including items on socio-demographics, working environment (addressing work pace, job security, monotonous work, assistance, physically strenuous work and physical environmental factors) and a symptom list was used for data collection. Factor analyses on the symptom list resulted in five symptom scales: Musculoskeletal, Stress and exhaustion, Common cold, Gastrointestinal and Sound perception scale. A total of 1571 questionnaires were distributed. The response rate was 65.7–69%, depending on occupation. Data were collected in 2002.

Results: Cabin crew reported worse gastrointestinal, sound perception and common cold symptoms than nurses and teachers. Cabin crew and teachers reported worse symptoms of stress and exhaustion than nurses (p < 0.05). When compared with teachers and nurses cabin crew reported less job security and more physically strenuous and monotonous work. Nurses were likelier to seek assistance from co-workers or patients as well as to take care of an older relative than teachers and cabin crew. Regression analysis found that within each occupation distress from environmental factors resulted in higher score on all the
symptom scales.

Conclusions: Nurses experience less stress and exhaustion than teachers and cabin crew. In comparison with one or both of the other occupations nurses are more likely to assist each other with their work, experience job security, reporting physically complex work and take care of older relatives. This should be highlighted as positive aspects of nurses’ work praised as displaying responsibility and interconnectedness of nurses’.