Estimating the health consequences of flight attendant work: comparing flight attendant health to the general population in a cross-sectional study

Link to the publication


Flight attendants are an understudied occupational group, despite undergoing a wide and unique range of adverse job-related exposures. In our study, we aimed to characterize the health profile of cabin crew relative to the U.S. general population.


In 2014–2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their health conditions to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013–2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and selected health outcomes, using logistic regression and adjusting for potential confounders.


Compared to the NHANES population (n = 2729), flight attendants (n = 5366) had a higher prevalence of female reproductive cancers (SPR = 1.66, 95% CI: 1.18–2.33), cancers at all sites (SPR = 2.15, 95% CI: 1.73–2.67 among females), as well as sleep disorders, fatigue, and depression, with SPRs ranging between 1.98 and 5.57 depending on gender and the specific condition examined. In contrast, we observed a decreased prevalence of cardiac and respiratory outcomes among flight crew relative to NHANES. Health conditions that increased with longer job tenure were sleep disorders, anxiety/depression, alcohol abuse, any cancer, peripheral artery disease, sinusitis, foot surgery, infertility, and several perinatal outcomes.


We observed higher rates of specific adverse health outcomes in U.S. flight attendants compared to the general population, as well as associations between longer tenure and health conditions, which should be interpreted in light of recall bias and a cross-sectional design. Future longitudinal studies should evaluate specific exposure-disease associations among flight crew.

Symptoms related to new flight attendant uniforms

Eileen McNeely, Steven J. Staffa, Irina Mordukhovich and Brent Coull

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Flight attendants at Alaska Airlines reported health symptoms after the introduction of new uniforms in 2011. The airline replaced the uniforms in 2014 without acknowledging harm. To understand possible uniform-related health effects, we analyzed self-reported health symptoms in crew who participated in the Harvard Flight Attendant Health Study between 2007 and 2015, the period before, during, and after the introduction of new uniforms.


We calculated a standardized prevalence of respiratory, dermatological and allergic symptoms at baseline, as well as during and after uniform changes in 684 flight attendants with a varying number of surveys completed across each time point. We used Generalized Estimating Equations (GEE) to model the association between symptoms at baseline versus the exposure period after adjusting for age, gender and smoking status and weighting respondents for the likelihood of attrition over the course of the study period.


We found the following symptom prevalence (per 100) increased after the introduction of new uniforms: multiple chemical sensitivity (10 vs 5), itchy/irritated skin (25 vs 13), rash/hives (23 vs 13), itchy eyes (24 vs 14), blurred vision (14 vs 6), sinus congestion (28 vs 24), ear pain (15 vs 12), sore throat (9 vs 5), cough (17 vs 7), hoarseness/loss of voice (12 vs 3), and shortness of breath (8 vs 3). The odds of several symptoms significantly increased compared to baseline after adjusting for potential confounders.


This study found a relationship between health complaints and the introduction of new uniforms in this longitudinal occupational cohort.


Environmental health, Textiles, Uniforms, Flight attendants, Occupational epidemiology, Allergic, Respiratory, Dermatological, Multiple chemical sensitivity

What this paper adds

  • We know little about the health effects of chemicals in our clothing as compared to substances we ingest, even though skin absorption can be quite efficient and researchers have found metals, dyes, formaldehyde and formaldehyde releasers, dioxin, perfluorinated compounds, flame retardants, phthalates and other plasticizers such as diisodecyclmaleate, pesticides and fungicides in clothing.

  • This study offers a unique window into the potential health effects of textile chemicals after the introduction of new work uniforms in an occupational cohort– a rare opportunity to appreciate a common exposure in a defined population with a specific release date.

  • We found significantly increased prevalence of symptoms after the introduction of new uniforms including eye pain/dry eyes/itchy eyes, blurred vision, combined EENT, cough, hoarseness/loss of voice combined lower respiratory, itchy/irritated skin, and rash/hives.

  • These findings together with reports of similar health reactions in yet another U.S. flight attendant population after the introduction of new uniforms this year warrants further investigation of the specific chemical toxicants, clothing concentrations, body burdens and health effects.

Airplane pilot mental health

Environ Health. 2016 Dec 15;15(1):121.

Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey.

Wu ACDonnelly-McLay DWeisskopf MGMcNeely EBetancourt TSAllen JG.



The Germanwings Flight 9525 crash has brought the sensitive subject of airline pilot mental health to the forefront in aviation. Globally, 350 million people suffer from depression-a common mental disorder. This study provides further information on this important topic regarding mental health especially among female airline pilots. This is the first study to describe airline pilot mental health-with a focus on depression and suicidal thoughts-outside of the information derived from aircraft accident investigations, regulated healthexaminations, or identifiable self-reports, which are records protected by civil aviation authorities and airline companies.


This is a descriptive cross-sectional study via an anonymous web-based survey administered between April and December 2015. Pilots were recruited from unions, airline companies, and airports via convenience sampling. Data analysis included calculating absolute number and prevalence of health characteristics and depression scores.


One thousand eight hundred thirty seven (52.7%) of the 3485 surveyed pilots completed the survey, with 1866 (53.5%) completing at least half of the survey. 233 (12.6%) of 1848 airline pilots responding to the Patient Health Questionnaire 9 (PHQ-9), and 193 (13.5%) of 1430 pilots who reported working as an airline pilot in the last seven days at time of survey, met depression threshold-PHQ-9 total score ≥ 10. Seventy-five participants (4.1%) reported having suicidal thoughts within the past two weeks. We found a significant trend in proportions of depression at higher levels of use of sleep-aid medication (trend test z = 6.74, p < 0.001) and among those experiencing sexual harassment (z = 3.18, p = 0.001) or verbal harassment (z = 6.13, p < 0.001).


Hundreds of pilots currently flying are managing depressive symptoms perhaps without the possibility of treatment due to the fear of negative career impacts. This study found 233 (12.6%) airline pilots meeting depression threshold and 75 (4.1%) pilots reporting having suicidal thoughts. Although results have limited generalizability, there are a significant number of active pilots suffering from depressive symptoms. We recommend airline organizations increase support for preventative mental health treatment. Future research will evaluate additional risk factors of depression such as sleep and circadian rhythm disturbances.

Flight Attendants in a Qigong Meditative Movement Study Experienced Improved Endurance and Reduced Blood Pressure

Qigong can help alleviate a cluster of symptoms related to chronic obstructive pulmonary disease (COPD) and chronic or traumatic stress in first responders.

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

Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study

Andrew W Correia quantitative analyst 1, Junenette L Peters assistant professor 2, Jonathan I Levy
professor2, Steven Melly geographic information systems specialist3, Francesca Dominici professor,
associate dean of information technology

Download the article: Aircraft Noise and CVD admissions

Objective: To investigate whether exposure to aircraft noise increases the risk of hospitalization for cardiovascular diseases in older people (≥65 years) residing near airports.

Design: Multi-airport retrospective study of approximately 6 million older people residing near airports in the United States. We superimposed contours of aircraft noise levels (in decibels, dB) for 89 airports for 2009 provided by the US Federal Aviation Administration on census block resolution population data to construct two exposure metrics applicable to zip code resolution health insurance data: population weighted noise within each zip code, and 90th centile of noise among populated census blocks within each zip code. Setting 2218 zip codes surrounding 89 airports in the contiguous states. Participants 6 027 363 people eligible to participate in the national medical insurance (Medicare) program (aged ≥65 years) residing near airports in 2009.

Main outcome measures: Percentage increase in the hospitalization admission rate for cardiovascular disease associated with a 10 dB increase in aircraft noise, for each airport and on average across airports adjusted by individual level characteristics (age, sex, race), zip code level socioeconomic status and demographics, zip code level air pollution (fine particulate matter and ozone), and roadway density. Results Averaged across all airports and using the 90th centile noise exposure metric, a zip code with 10 dB higher noise exposure had a 3.5% higher (95% confidence interval 0.2% to 7.0%) cardiovascular hospital admission rate, after controlling for covariates.

Conclusions: Despite limitations related to potential misclassification of exposure, we found a statistically significant association between exposure to aircraft noise and risk of hospitalization for cardiovascular diseases among older people living near airports.

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

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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 (
Sara Gale (
Ira Tager (
Laurel Kincl (
Julie Bradley (
Brent Coull (
Steve Hecker (

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