Health effects and conditions effected by long term air travel

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

Eileen McNeely1*, Sara Gale1,2, Ira Tager2, Laurel Kincl3, Julie Bradley1, Brent Coull1 and Steve Hecker

3/10/2014

publications
Abstract
Background:
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.
Methods:
We surveyed flight attendants from two domestic U.S. airlines in 2007 and compared the prevalence of their health conditions to contemporaneous cohorts in the National Health and Nutrition Survey (NHANES), 2005-2006 and 2007-2008. We weighted the prevalence of flight attendant conditions to match the age distribution in the NHANES and compared the two populations stratified by gender using the Standardized Prevalence Ratio (SPR). For leading health conditions in flight attendants, we analyzed the association between job tenure and health outcomes in logistic regression models.Results:
Compared to the NHANES population (n =5,713), flight attendants (n = 4,011) had about a 3-fold increase in the age-adjusted prevalence of chronic bronchitis despite considerably lower levels of smoking. In addition, the prevalence of cardiac disease in female flight attendants was 3.5 times greater than the general population while their prevalence of hypertension and being overweight was significantly lower. Flight attendants reported 2 to 5.7 times more sleep disorders, depression, and fatigue, than the general population. Female flight attendants reported 34% more reproductive cancers. Health conditions that increased with longer job tenure as a flight attendant were chronic bronchitis, heart disease in females, skin cancer, hearing loss, depression and anxiety, even after adjusting for age, gender, body mass index (BMI), education, and smoking.Conclusions:
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 time.

 

Steward offers food and drinks to economy class passengers on the plane

Symptoms related to new flight attendant uniforms

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

1/3/2018

publications
Abstract
Background:
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.
Methods:
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.Results:
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.

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

 

 

Airliner wing

“Impact factors of ultra long range flights on cabin crew and passengers : “”pushing the plane– pushing the people”” : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Aviation, Massey University”

Haines, Michael John

Abstract: Long distance flight is an entrenched transportation mode that has brought with it a range of issues and impacts on the human cabin occupants. Development of ultra long range aircraft allows a single airline flight to last more than 16 hours in flight time which will have added impact on cabin crew and passengers.

This study was conducted to analyse the varied and diverse issues that ultra long range flights present in relation to the cabin and its occupants. Research included two surveys, one survey to international airlines from around the world and one survey to New Zealand based cabin crew who operate on international flights. Both surveys analysed current long range flight impacts and allowed respondents to identify new ultra long range flight issues.

The survey to organisations was responded to by seven airlines with three of the respondents currently operating ultra long range flights. The seven respondents rated operational issues as areas to be addressed including cabin crew issues related to duties, training and in-flight rest. Passenger related areas were mainly in relation to customer comfort.

The cabin crew survey had 119 respondents with a range of international cabin crew experience up to 36 years and averaging 5.7 long range flights per month. The respondents rated their cabin safety role as extremely important but did not believe their employers rated their safety role as highly. Respondents rated fatigue, sleep and dehydration as the main health impacts from long haul flights and 97.3% believed these health impacts will increase with ultra long range flight. In regard to rest and rest facilities 62% of respondents believed the current rest periods provided were inadequate and 70.7% believed the current rest facilities were inadequate. There was found to be a strong statistical relationship between rest adequacy and rest facilities adequacy. In relation to ultra long range flight respondents rated in-flight rest facilities as the foremost item to address for cabin crew and cabin air quality as the foremost item to address for passengers.

In general the survey of cabin crew identified the cabin environment, fatigue and lack of management emphasis on cabin crew as areas to be addressed for ultra long range flight. For passengers the cabin environment, facilities, and seating issues need addressing for ultra long range flight.

Further analysis based on the survey results found that ultra long range flight research has focussed on aircraft performance, engine reliability and the impacts of extended flight time on flight crew. Study on the impact of ultra long range flight on cabin crew and passengers are limited and lack the depth of research given to flight crew.

This study has identified that aircraft manufacturers and airline operators need to research and address a range of issues related to the cabin, in particular impacts related to cabin crew and passengers. Aviation regulators need to address many areas to improve regulations related to cabin crew and passenger health and safety. These areas need to be researched and addressed to ensure the impacts of ultra long range flight are reduced.

Flight Attendant

Symptoms related to new flight attendant uniforms

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

View the entire article

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.

Methods

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.

Results

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.

Conclusion

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

Keywords

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.

Symptoms related to new flight attendant uniforms

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

1/03/2018

Background:
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.

Methods:
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.

Results:
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.

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

<https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-017-4982-4>

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.

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)

Background
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.

Conclusions
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
time.