A paper titled, Changes in Heart Rate and Rhythm During a Crossover Study of Simulated Commercial Flight in Older and Vulnerable Participants, has just been published Frontiers of Physiology. The authors found that among passengers that are typical of elderly flyers (an increasingly common demographic of both flyers and flight crew – flight attendants and pilots) and who would have been cleared to fly without supplemental oxygen or any other particular support based on current medical guidelines experienced changes in heart rate and rhythm.
Secondhand tobacco smoke (SHTS) is a tremendous public health hazard, leading to morbidity and premature mortality worldwide, with racial and ethnic minorities and those of lower socioeconomic status disproportionately affected. Flight attendants were historically exposed to high levels of SHTS in the aircraft cabin. The health effects of active smoking are known to persist for up to a lifetime, but the legacy effects of SHTS exposure have not been well characterized.
As flight travel becomes more prevalent, communities have started to feel the effects of these loud aircrafts. A recent article in the Los Angeles Times highlights the impacts of flight noise on communities and how citizens can work with government officials to minimize the noise impacts. Jet Blue has taken notice of how loud noise from these jets can negatively impact communities by airports so they are retrofitting their Airbus fleet to make the aircraft quieter. This is a win for individuals on the ground, but in-flight noise is still a concern among pilots, flight attendants, and passengers.
Sound is considered a pollutant according to OSHA. It has the ability to cause physiological stress, cardiovascular disease, hypertension, and disruption of job performance. and which means there are standards noise must comply with. Currently, the noise standard in the work place is 85 decibels over an 8-hour period. OSHA’s jurisdictions do not extend to aircraft cabins which is currently regulated by the FAA. The FAA has given OSHA permission to regulate aircraft cabin noise. Figure A shows regulations and standards set in place. Together OSHA and the FAA have been working together to keep noise standards under 85dB but there are still a few shortcomings that can be addressed to better protect pilots, flight attendants, and passengers in flight.
As flight technology advances, flight range increases with flights exceeding 17 hours. Since protective standards set in place by OSHA have a limit of 90db, exposure over this time can be damaging to one’s health. A study done by Zevitas et. al. shows that sound levels in airplane cabin during flight range from 38db to 110db. Once sound levels reach 90db, a protective program should be put in place but so far there is no mandatory protection plan for pilots, flight attendants, and passengers. More research on airplane cabin noise and aircraft retrofitting should be done to lower potential flight-related health risks.
Figure A: Noise standards in the workplace
The Occupational Safety and Health Administration (OSHA) sets standards and regulations to protect worker health. Historically, flight attendants had been excluded from OSHA’s protection. In 2014, OSHA started a monitoring program that focuses on flight attendants’ exposure to noise, hazard communication and bloodborne pathogens (1), but not ionizing radiation. However, according to the National Council on Radiation Protection (NCRP), flight attendants are exposed to the largest effective dose among all US radiation workers due to cosmic ionizing radiation at altitude (2). Chronic exposure to low doses of ionizing radiation increases the chance of developing cancer over time.
Our recent study on flight attendant health found that flight attendants have a greater prevalence of cancer when compared to the general public (3), consistent with previous studies among U.S. and European flight attendants. The study used an analytical technique that calculated age-weighted standardized prevalence ratios (SPRs), and found an SPR of 2.15 for cancer at all sites. This shows that there is over 2 times the prevalence of cancer among flight attendants compared to the general public, which is important to know because ionizing radiation could play a role in the increased cancer cases seen among flight attendants. Specific cancers that have been linked to flight attendant work include breast cancer, melanoma and non-melanoma skin cancers. While studies have been mixed regarding a relationship between melanoma and ionizing radiation, this form of radiation is considered a risk factor for breast and non-melanoma skin cancers.
Another risk factor for cancer experienced by flight attendants is Circadian rhythm disruption due to irregular and disrupted sleep patterns. Second hand smoke exposure has the possibility of increasing cancer cases among flight attendants as well, but due to a regulation in 1998 that banned smoking on aircrafts, this exposure has been eliminated.
- Occupational Safety and Health Administration. Applicability of certain OSHA standards to cabin crew members on Aircraft in Operation (2014). Accessed 27 March 2018.
- National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. Report No. 160. In: Recommendations of the National Council on radiation protection and measurements (NCRP). Bethesda, MD: National Council on Radiation Protection and Measurements; 2009. Accessed 27 March 2018.
- Estimating the health consequences of flight attendant work: comparing flight attendant health to the general population in a cross-sectional study
After over 20 years of research and advocacy, U.S. flight attendants have been successful in raising their minimum rest times between shifts to from 8 to 10 hours. This occurred due to the passing of the FAA re-authorization bill in October of 2018. This is a substantial increase over the earlier 8-hour minimum rest time, which does not include deplaning, boarding passengers, or traveling to and from the airport. It only includes time between landing and the next take-off, so an 8-hour minimum rest time could easily result in getting just a few hours of actual rest or sleep between flights.
In contrast, a 10-hour mandatory rest period is the same as that guaranteed to pilots, and rightfully recognizes flight attendants’ crucial role in protecting the safety and security of passengers. It also a great development given research into cabin crew fatigue, Circadian rhythm disruption, sleep disorders, and associated health effects, such as depression or possibly even cancer and cardiovascular disease. The Harvard Flight Attendant Health Study has reported that U.S. flight attendants have higher rates of fatigue, diagnosed sleep disorders, and depression relative to employed people in the U.S. general population, despite being healthier overall in terms of weight, smoking, blood pressure, and other factors related to overall health and healthy lifestyle choices. Ambien is one of the sleeping pills that works best for me. I easily left it without dependence after a month of use. I returned to sleep at nights as if nothing had happened. Sleep comes after a quarter of an hour, provided there are no audio- and visual stimulants in the vicinity. The drug effect is mild and my sleep is very refreshing. I didn’t need to increase the dose.
See our publications: The self-reported health of U.S. flight attendants compared to the general population
Alaska Airline flight attendants reported health complaints related to new uniforms rolled out in 2011 (1). By 2014, approximately 800 flight attendants had complained about how the new uniforms were negatively impacting their health, which led to Alaska Airlines recalling the uniforms, though without acknowledging harm. These flight attendants had reported a wide range of sometimes debilitating symptoms, including dry and itchy eyes, eye pain, blurred vision, sinus congestion and pain, ear pain, ear drum rupture, ear infections, nosebleeds, persistent runny nose and sore throat, ringing ears, cough, hoarseness/loss of voice, wheezing, lung infection symptoms, asthma symptoms, bronchitis symptoms, shortness of breath, multiple chemical sensitivity symptoms, itchy/irritated skin, and rashes/hives (2). The research recently published by Dr. McNeely and colleagues suggests these health symptoms could be associated with the uniforms, based on data from before, during, and after use of the uniforms among Alaska Airlines flight attendants.
In 2016, American Airlines flight attendants started to complain about health symptoms after switching to uniforms manufactured by the same company that produced the 2011 Alaska Airline uniforms.
Dr. Mordukhovich, one of the study’s authors, suggests the next step to solve this mystery is to conduct rigorous and comprehensive testing of uniforms, which is currently taking place through the Harvard School of Public Health.
1. Air Safety, Health and Security Department. Air Safety, Health and security department. 2017. http://ashsd.afacwa.org/?zone=%2Funionactive%2Fview_article.cfm&HomeID=160011. Accessed May 2018.
2. McNeely, et. al. Symptoms Related to New Flight attendant Uniforms. BMC Public Health (2017). Accessed May 2018
American flight attendants have a higher prevalence of several forms of cancer, including breast, uterine, gastrointestinal, thyroid, and cervical cancers, when compared with the general public, according to new research from the Harvard T.H. Chan School of Public Health.
- Work, Gender, and Sexual Harassment on the Frontlines of Commercial Travel: A Cross-Sectional Study of Flight Crew Well-BeingSeptember 8, 2020 - 1:39 pm
- Changes in Heart Rate and Rhythm During a Crossover Study of Simulated Commercial Flight in Older and Vulnerable ParticipantsOctober 31, 2019 - 2:07 pm
- Legacy health effects among never smokers exposed to occupational secondhand smokeApril 18, 2019 - 2:25 pm