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

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.