Fatigue issues faced by Flight Attendants.


Measuring and identifying large-study metrics for circadian rhythm disruption in female flight attendants


Grajewski, Nguyen, Whelan, Cole, Hein

Flight attendants can experience circadian rhythm disruption due to travel through multiple time zones. The objectives of this study were to determine whether flight attendants are more likely than teachers (comparison group) to experience circadian disruption, as measured by melatonin production, and to identify metrics of circadian disruption for epidemiologic studies of reproductive health in which biomonitoring is infeasible.

Each day, for one menstrual cycle, 45 flight attendants and 26 teachers kept a daily diary, collected and measured their overnight urine, and wore an activity monitor to assess sleep displacement. The relation between melatonin production and flightattendant and teacher status was analyzed with linear and multiple logistic regression. The relation between sleep displacement, melatonin, and flight-history-derived variables (including time zones crossed) were examined with exploratory factor analyses.

Flight attendants experience increased circadian disruption, as measured by a higher adjusted melatonin rate variance, than teachers [2.8 x 10(5) versus 1.0 x 10(5) (ng/hour)2, respectively: P=0.04] and are more likely to be in the highest quartile of melatonin variance (odds ratio 2.3; 95% confidence interval 0.6-9.1). In the factor analysis, the number of time zones crossed was related to both melatonin desynchronization and sleep displacement.

Flight attendants experience increased circadian disruption, as measured by more variable melatonin rates, than a minimally flying comparison group. For epidemiologic studies of flight crews in which melatonin measurement is infeasible, the number of time zones crossed is a useful indicator of both sleep displacement and melatonin desynchronization.


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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


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.
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.


Alarm clock on bed in morning with sun light

Flight Attendant Rest Times Increased!

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.

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

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

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

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).