Flight Attendants and respiratory diseases

respiratory

Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: A cross-sectional analysis of the Flight Attendant Medical Research Institute Survey

Alexis L Beatty, Thaddeus J Haight, and Rita F Redberg

9/24/2011

publications
Abstract
Background:
Secondhand tobacco smoke (SHS) is associated with increased risk of respiratory illness, cancer, and cardiovascular disease. Prior to smoking bans on airlines in the late 1980s, flight attendants were exposed to a significant amount of SHS. In the present study, we examine associations between flight attendant SHS exposure and development of respiratory illnesses and cardiovascular disease.Methods:
Between December 2006 and October 2010, three hundred sixty-two flight attendants completed an online questionnaire with information regarding experience as a flight attendant, medical history, smoking history, and SHS exposure. Rates of illnesses in flight attendants were compared with an age and smoking history matched population sample from NHANES 2005-2006. Logistic regression analysis was used to examine the association of reported medical conditions and pre-ban years of exposure.Results:
Compared with the sample from NHANES 2005-2006, flight attendants had increased prevalence of chronic bronchitis (11.7% vs. 7.2%, p < 0.05), emphysema/COPD (3.2% vs. 0.9%, p < 0.03), and sinus problems (31.5% vs. 20.9%, p < 0.002), despite a lower prevalence of medical illnesses including high blood pressure, diabetes, high cholesterol, heart failure, cancer, and thyroid disease. Amongst flight attendants who reported never smoking over their lifetimes, there was not a significant association between years of service as a flight attendant in the pre-smoking ban era and illnesses. However, in this same group, there was a significantly increased risk of daily symptoms (vs. no symptoms) of nasal congestion, throat, or eye irritation per 10-year increase of years of service as a flight attendant prior to the smoking ban (OR 2.14, 95% CI 1.41 – 3.24).

Conclusions:
Flight attendants experience increased rates of respiratory illnesses compared to a population sample. The frequency of symptoms of nasal congestion, throat or eye irritation is associated with occupational SHS exposure in the pre-smoking ban era.

 

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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.

 

Meditative Movement - Peter Payne

Effectiveness of a Novel Qigong Meditative Movement Practice for Impaired Health in Flight Attendants Exposed to Second-Hand Cigarette Smoke

Peter Payne1*, Steven Fiering1, James C. Leiter2, David T. Zava3 and Mardi A. Crane-Godreau 1*

This single-arm non-randomized pilot study explores an intervention to improve the health of flight attendants (FA) exposed to second-hand cigarette smoke prior to the smoking ban on commercial airlines. This group exhibits an unusual pattern of long-term pulmonary dysfunction. We report on Phase I of a two-phase clinical trial; the second Phase will be a randomized controlled trial testing digital delivery of the intervention. Subjects were recruited in the Northeastern US; testing and intervention were administered in 4 major cities. The intervention involved 12 h of training in Meditative Movement practices. Based on recent research on the effects of nicotine on fear learning, and the influence of the autonomic nervous system on immune function, our hypothesis was that this training would improve autonomic function and thus benefit a range of health measures. Primary outcomes were the 6-min walk test and blood levels of C-reactive protein. Pulmonary, cardiovascular, autonomic, and affective measures were also taken. Fourteen participants completed the training and post-testing. There was a 53% decrease in high sensitivity C-Reactive Protein (p ≤ 0.05), a 7% reduction in systolic blood pressure (p ≤ 0.05), a 13% increase in the 6-min walk test (p ≤ 0.005), and significant positive changes in several other outcomes. These results tend to confirm the hypothesized benefits of MM training for this population, and indicate that autonomic function may be important in the etiology and treatment of their symptoms. No adverse effects were reported. This trial is registered at ClinicalTrials.gov and is supported by a grant from the Flight Attendant Medical Research Institute (FAMRI).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318411/pdf/fnhum-11-00067.pdf

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?

 

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.