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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.

 

Miscarriage among flight attendants

Barbara Grajewski, Elizabeth A. Whelan, Christina C. Lawson, Misty J. Hein, Martha A. Waters, Jeri L. Anderson, Leslie A. MacDonald, Christopher J. Mertens, Chih-Yu Tseng, Rick T. Cassinelli II, and Lian Luo

3/26/2015

Background:
Cosmic radiation and circadian disruption are potential reproductive hazards for flight attendants.

Methods:
Flight attendants from 3 US airlines in 3 cities were interviewed for pregnancy histories and lifestyle, medical, and occupational covariates. We assessed cosmic radiation and circadian disruption from company records of 2 million individual flights. Using Cox regression models, we compared respondents (1) by levels of flight exposures and (2) to teachers from the same cities, to evaluate whether these exposures were associated with miscarriage.

Results:
Of 2654 women interviewed (2273 flight attendants and 381 teachers), 958 pregnancies among 764 women met study criteria. A hypothetical pregnant flight attendant with median firsttrimester exposures flew 130 hours in 53 flight segments, crossed 34 time zones, and flew 15 hours during her home-base sleep hours (10 pm–8 am), incurring 0.13 mGy absorbed dose (0.36 mSv effective dose) of cosmic radiation. About 2% of flight attendant pregnancies were likely exposed to a solar particle event, but doses varied widely. Analyses suggested that cosmic radiation exposure of 0.1 mGy or more may be associated with increased risk of miscarriage in weeks 9–13 (odds ratio = 1.7 [95% confidence interval = 0.95–3.2]). Risk of a first-trimester miscarriage with 15 hours or more of flying during home-base sleep hours was increased (1.5 [1.1–2.2]), as was risk with high physical job demands (2.5 [1.5–4.2]). Miscarriage risk was not increased among flight attendants compared with teachers.

Conclusions:
Miscarriage was associated with flight attendant work during sleep hours and high physical job demands and may be associated with cosmic radiation exposure.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849674/pdf/pone.0154432.pdf

 

Clear Skies and Grey Areas: Flight Attendants’ Secondhand Smoke Exposure and Attitudes toward Smoke-Free Policy 25 Years since Smoking was Banned on Airplanes

Frances A. Stillman, Andrea Soong , Laura Y. Zheng, and Ana Navas-Acien

06/04/15

publications
Abstract
Our objective was to provide descriptive data on flight attendant secondhand smoke (SHS) exposure in the work environment, and to examine attitudes toward SHS exposure, personal health, and smoke-free policy in the workplace and public places. Flight attendants completed a web-based survey of self-reported SHS exposure and air quality in the work environment. We assessed the frequency and duration of SHS exposure in distinct areas of the workplace, attitudes toward SHS exposure and its health effects, and attitudes toward smoke-free policy in the workplace as well as general public places. A total of 723 flight attendants participated in the survey, and 591 responded to all survey questions. The mean level of exposure per flight attendant over the past month was 249 min. The majority of participants reported being exposed to SHS always/often in outdoor areas of an airport (57.7%). Participants who worked before the in-flight smoking ban (n=240) were more likely to support further smoking policies in airports compared to participants who were employed after the ban (n=346) (76.7% versus 60.4%, p-value<0.01). Flight attendants are still being exposed to SHS in the workplace, sometimes at concerning levels during the non-flight portions of their travel. Flight attendants favor smoke-free policies and want to see further restrictions in airports and public places.

 

The Relevance of Emotional Intelligence in Personnel Selection for High Emotional Labor Jobs

Sarah Herpertz, Sophia Nizielski, Michael Hock, Astrid Schütz

4/28/2016

publications
Abstract
Although a large number of studies have pointed to the potential of emotional intelligence (EI) in the context of personnel selection, research in real-life selection contexts is still scarce. The aim of the present study was to examine whether EI would predict Assessment Center (AC) ratings of job-relevant competencies in a sample of applicants for the position of a flight attendant. Applicants’ ability to regulate emotions predicted performance in group exercises. However, there were inconsistent effects of applicants’ ability to understand emotions: Whereas the ability to understand emotions had a positive effect on performance in interview and role play, the effect on performance in group exercises was negative. We suppose that the effect depends on task type and conclude that tests of emotional abilities should be used judiciously in personnel selection procedures.

 

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

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.

 

 

Cancer prevalence among flight attendants compared to the general population

Eileen McNeely, Irina Mordukhovich, Steven Staffa, Samuel Tideman, Sara Gale and Brent Coull

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

 

Cancer incidence in California flight attendants (United States)

Peggy Reynolds, James Cone, Michael Layefsky, Debbie E. Goldberg, Susan Hurley

publications
Abstract
Objective:
To examine unusual exposure opportunities to flight crews from chemicals, cosmic radiation, and electric and magnetic fields.

Methods:
This project evaluated the incidence of cancers of the breast and other sites among Association of Flight Attendants (AFA) members residing in California. AFA membership files were matched to California’s statewide cancer registry to identify a total of 129 newly diagnosed invasive cancers among AFA members with California residential histories between 1988 and 1995.

Results:
Compared to the general population, female breast cancer incidence was over 30% higher than expected, and malignant melanoma incidence was roughly twice that expected. Both of these are cancers that are associated with higher socioeconomic status and have been suggestively associated with various sources of radiation.

Conclusions:
Consistent with the results from Nordic studies of cabin crews and a recent meta-analysis of prior studies, these data suggest that follow-up investigations should focus on the potential relative contribution of workplace exposures and lifestyle characteristics to the higher rates of disease for these two cancers.

 

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. Tramadol is a medicine that is given only on prescription. It helps, even if other painkillers do not cope. Relief after taking comes almost immediately. This remedy is considered narcotic, so it is impossible to prick a part of it, otherwise the person develops dependence on the medicine. It turns out that only this medicine relieves pain, if not stab, develops a breakdown. We use it very rarely, only in extreme situations.

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.

Dr. Mardi Crane-Godreau

Digital Delivery of Meditative Movement Training Improved Health of Cigarette-Smoke-Exposed Subjects

https://www.frontiersin.org/articles/10.3389/fpubh.2018.00282/full

Download the Article – PDF

Many FA who flew prior to the ban on smoking in commercial aircraft exhibit an unusual pattern of long-term pulmonary dysfunction. This randomized controlled study tested the hypothesis that digitally delivered meditative movement (MM) training improves chronic obstructive pulmonary disease (COPD)-related symptoms in flight attendants (FA) who were exposed to second-hand cigarette smoke (SHCS) while flying. Phase I of this two-phase clinical trial was a single-arm non-randomized pilot study that developed and tested methods for MM intervention; we now report on Phase II, a randomized controlled trial comparing MM to a control group of similar FA receiving health education (HE) videos. Primary outcomes were the 6-min walk test and blood levels of high sensitivity C-reactive protein (hs-CRP). Pulmonary, cardiovascular, autonomic and affective measures were also taken. There were significant improvements in the 6-min walk test, the Multidimensional Assessment of Interoceptive Awareness (MAIA) score, and the COPD Assessment Test. Non-significant trends were observed for increased dehydroepiandrosterone sulfate (DHEAS) levels, decreased anxiety scores and reduced blood hs-CRP levels, and increased peak expiratory flow (PEF). In a Survey Monkey questionnaire, 81% of participants who completed pre and post-testing expressed mild to strong positive opinions of the study contents, delivery, or impact, while 16% expressed mild negative opinions. Over the course of the year including the study, participant adoption of the MM practices showed a significant and moderately large correlation with overall health improvement; Pearson’s R = 0.62, p < 0.005. These results support the hypothesized benefits of video-based MM training for this population. No adverse effects were reported.