A paper titled, Changes in Heart Rate and Rhythm During a Crossover Study of Simulated Commercial Flight in Older and Vulnerable Participants, has just been published Frontiers of Physiology. The authors found that among passengers that are typical of elderly flyers (an increasingly common demographic of both flyers and flight crew – flight attendants and pilots) and who would have been cleared to fly without supplemental oxygen or any other particular support based on current medical guidelines experienced changes in heart rate and rhythm.
Secondhand tobacco smoke (SHTS) is a tremendous public health hazard, leading to morbidity and premature mortality worldwide, with racial and ethnic minorities and those of lower socioeconomic status disproportionately affected. Flight attendants were historically exposed to high levels of SHTS in the aircraft cabin. The health effects of active smoking are known to persist for up to a lifetime, but the legacy effects of SHTS exposure have not been well characterized.
As flight travel becomes more prevalent, communities have started to feel the effects of these loud aircrafts. A recent article in the Los Angeles Times highlights the impacts of flight noise on communities and how citizens can work with government officials to minimize the noise impacts. Jet Blue has taken notice of how loud noise from these jets can negatively impact communities by airports so they are retrofitting their Airbus fleet to make the aircraft quieter. This is a win for individuals on the ground, but in-flight noise is still a concern among pilots, flight attendants, and passengers.
Sound is considered a pollutant according to OSHA. It has the ability to cause physiological stress, cardiovascular disease, hypertension, and disruption of job performance. and which means there are standards noise must comply with. Currently, the noise standard in the work place is 85 decibels over an 8-hour period. OSHA’s jurisdictions do not extend to aircraft cabins which is currently regulated by the FAA. The FAA has given OSHA permission to regulate aircraft cabin noise. Figure A shows regulations and standards set in place. Together OSHA and the FAA have been working together to keep noise standards under 85dB but there are still a few shortcomings that can be addressed to better protect pilots, flight attendants, and passengers in flight.
As flight technology advances, flight range increases with flights exceeding 17 hours. Since protective standards set in place by OSHA have a limit of 90db, exposure over this time can be damaging to one’s health. A study done by Zevitas et. al. shows that sound levels in airplane cabin during flight range from 38db to 110db. Once sound levels reach 90db, a protective program should be put in place but so far there is no mandatory protection plan for pilots, flight attendants, and passengers. More research on airplane cabin noise and aircraft retrofitting should be done to lower potential flight-related health risks.
Figure A: Noise standards in the workplace
The Occupational Safety and Health Administration (OSHA) sets standards and regulations to protect worker health. Historically, flight attendants had been excluded from OSHA’s protection. In 2014, OSHA started a monitoring program that focuses on flight attendants’ exposure to noise, hazard communication and bloodborne pathogens (1), but not ionizing radiation. However, according to the National Council on Radiation Protection (NCRP), flight attendants are exposed to the largest effective dose among all US radiation workers due to cosmic ionizing radiation at altitude (2). Chronic exposure to low doses of ionizing radiation increases the chance of developing cancer over time.
Our recent study on flight attendant health found that flight attendants have a greater prevalence of cancer when compared to the general public (3), consistent with previous studies among U.S. and European flight attendants. The study used an analytical technique that calculated age-weighted standardized prevalence ratios (SPRs), and found an SPR of 2.15 for cancer at all sites. This shows that there is over 2 times the prevalence of cancer among flight attendants compared to the general public, which is important to know because ionizing radiation could play a role in the increased cancer cases seen among flight attendants. Specific cancers that have been linked to flight attendant work include breast cancer, melanoma and non-melanoma skin cancers. While studies have been mixed regarding a relationship between melanoma and ionizing radiation, this form of radiation is considered a risk factor for breast and non-melanoma skin cancers.
Another risk factor for cancer experienced by flight attendants is Circadian rhythm disruption due to irregular and disrupted sleep patterns. Second hand smoke exposure has the possibility of increasing cancer cases among flight attendants as well, but due to a regulation in 1998 that banned smoking on aircrafts, this exposure has been eliminated.
- Occupational Safety and Health Administration. Applicability of certain OSHA standards to cabin crew members on Aircraft in Operation (2014). Accessed 27 March 2018.
- National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. Report No. 160. In: Recommendations of the National Council on radiation protection and measurements (NCRP). Bethesda, MD: National Council on Radiation Protection and Measurements; 2009. Accessed 27 March 2018.
- Estimating the health consequences of flight attendant work: comparing flight attendant health to the general population in a cross-sectional study
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. Our research experiments show that Cialis for potency based on Tadalafil has many advantages, namely, guaranteed effectiveness and restoration of potency within 20-40 minutes after taking the pill. The drug helps men with serious erectile function disorders with the possibility of regular use without developing an addiction. At any time, you can cancel the drug without harm to health, as well as a safe composition, rarely accompanied by side effects.
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.
Marino, Holt, Chen, Davis
Endometriosis is the presence of functioning endometrial glands and stroma outside the uterine cavity, most often in the pelvic peritoneal cavity. Women with endometriosis commonly have dysmenorrhea, dyspareunia, pain, menorrhagia and/or metrorrhagia; disease complications can include adhesions, chronic pain, and infertility. This exploratory case-control study investigated the relationship between lifetime occupational history and surgically confirmed endometriosis in a population-based sample.Methods:
Interviews were conducted with cases, all reproductive-aged female enrollees of a large health-maintenance organization first diagnosed with surgically confirmed endometriosis between April 1, 1996 and March 31, 2001 and randomly selected controls from the reproductive-aged female enrollee list from the same time period. Each reported job was coded using US Census Occupations and Industries codes, and jobs were classed into categories. Having ever worked an occupation in a given job class was compared to never having done so using unconditional logistic regression.Results:
Having ever worked as a flight attendant, service station attendant, or health worker, particularly as a nurse or health aide, was associated with increased risk of endometriosis (flight attendant: OR 9.80, 95% CI 1.08 – 89.02; service station attendant: OR 5.77, 95% CI 1.03 -32.43; health worker: OR 1.49, 95% CI 1.03 – 2.15). Income and education did not make a difference in the odds ratio estimates for the occupations examined.
Elisabete Weiderpass, Margrethe Meo, and Harri Vainio
The knowledge on the etiology of breast cancer has advanced substantially in recent years, and several etiological factors are now firmly established. However, very few new discoveries have been made in relation to occupational risk factors. The International Agency for Research on Cancer has evaluated over 900 different exposures or agents to-date to determine whether they are carcinogenic to humans. These evaluations are published as a series of Monographs (www.iarc.fr). For breast cancer the following substances have been classified as “carcinogenic to humans” (Group 1): alcoholic beverages, exposure to diethylstilbestrol, estrogen-progestogen contraceptives, estrogen-progestogen hormone replacement therapy and exposure to X-radiation and gamma-radiation (in special populations such as atomic bomb survivors, medical patients, and in-utero exposure). Ethylene oxide is also classified as a Group 1 carcinogen, although the evidence for carcinogenicity in epidemiologic studies, and specifically for the human breast, is limited. The classification “probably carcinogenic to humans” (Group 2A) includes estrogen hormone replacement therapy, tobacco smoking, and shift work involving circadian disruption, including work as a flight attendant. If the association between shift work and breast cancer, the most common female cancer, is confirmed, shift work could become the leading cause of occupational cancer in women.
Alexis L Beatty, Thaddeus J Haight, and Rita F Redberg
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).
David F. Yankelevitz, Claudia I. Henschke, Rowena Yip, Paolo Boffetta, Joseph Shemesh, Matthew D. Cham, Jagat Narula, Harvey S. Hecht
An association between SHTS and CAC was recently reported in a single study, but the quantitative aspects of the relationship are not known.Methods:
A cohort of 3,098 never smokers 40 to 80 years of age, enrolled in the FAMRI-IELCAP (Flight Attendant Medical Research Institute International Early Lung Cancer Action Program) screening program, completed a SHTS questionnaire, and had a low-dose nongated computed tomography scan. The questionnaire provided a quantitative score for total SHTS exposure, as well as separately as a child and as an adult at home and at work; 4 categories of exposure to SHTS were identified (minimal, low, moderate, and high exposure). CAC was graded using a previously validated ordinal scale score that ranged from 0 to 12. Logistic regression analysis of the prevalence and ordered logistic regression analysis of the extent of CAC were performed to assess the independent contribution of SHTS adjusted for age, sex, diabetes, hypercholesterolemia, hypertension, and renal disease. Linear and quadratic regression analyses of CAC and SHTS were performed.Results:
The prevalence of CAC was 24.3% (n �� 754) and was significantly higher in those with more than minimal SHTS exposure compared with those with minimal SHTS exposure (26.4% vs. 18.5%, p �� 0.0001). The adjusted odds ratios for CAC prevalence were 1.54 (95% confidence interval: 1.17 to 2.20) for low SHTS exposure, 1.60 (95% confidence interval: 1.21 to 2.10) for moderate exposure, and 1.93 (95% confidence interval: 1.49 to 2.51) for high exposure. The association of the extent of SHTS with the extent of CAC was confirmed by the adjusted odds ratio (p �� 0.0001).
- Work, Gender, and Sexual Harassment on the Frontlines of Commercial Travel: A Cross-Sectional Study of Flight Crew Well-BeingSeptember 8, 2020 - 1:39 pm
- Changes in Heart Rate and Rhythm During a Crossover Study of Simulated Commercial Flight in Older and Vulnerable ParticipantsOctober 31, 2019 - 2:07 pm
- Legacy health effects among never smokers exposed to occupational secondhand smokeApril 18, 2019 - 2:25 pm