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


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).

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.


Welcome to the FA Health Blog

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.


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 and is supported by a grant from the Flight Attendant Medical Research Institute (FAMRI).

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


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.
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.

This study found a relationship between health complaints and the introduction of new uniforms in this longitudinal occupational cohort.



A demonstration of the Qigong movement entitled: Drawing Down The Moon

What is Qigong, and what does it have to do with Flight Attendants? –We’re glad you asked!

What is Qigong, and what does it have to do with Flight Attendants? –We’re glad you asked!

Qigong is a traditional Chinese health practice; its roots go back at least 5000 years. Like Yoga? Yes, but Qigong has its own unique methods and is increasingly gaining popular and scientific recognition as a powerful and sophisticated way of dealing with a number of health problems including respiratory problems, bone density and the effects of stress.

Research into Flight Attendant health has confirmed what you all know already: Flight Attendants experience a wide variety of extreme stressors. From the need to remain vigilant to safety issues, to poor cabin air, physically difficult working conditions, crazy schedules, jet lag, demanding passengers and (until smoking was banned in commercial aircraft) second-hand cigarette smoke.  You know how it is!

These different stressors can affect the body at the time of the event. Some continue to influence health for decades after the event.  They impact multiple systems in the body, so one strategy is to find effective interventions that can work on the whole body to reduce imbalances that have adverse effects on health.

Qigong appears to be one of the best candidates! You see, stress operates through its influence on the “autonomic nervous system” (ANS)–that part of the nervous system that regulates blood pressure, heart rate, digestion, and even some parts of the immune system. When we are in a stressful situation, the ANS helps us deal with it by activating, enabling us to be more alert, stronger, quicker, and to ignore the demands of our own body. But if the stress is too great, or goes on for too long, our ANS may be unable to come back into balance and allow us to recuperate. This “accumulated stress” makes us feel tense, or sometimes numb to our own bodies.  In the long run when the ANS is out of balance, it can lead to symptoms: high or low blood pressure, heart disease, breathing restriction, depression or anxiety, and even cancer or immune system disorders!

So where does Qigong come in? Well, it turns out that Qigong is a way of learning to consciously regulate the ANS; in other words, Qigong shows you how to restore balance to your autonomic nervous system, shedding the accumulated stress and enabling your breathing, circulation, digestion, immune system, and even your mood and energy levels, to return to normal.

How does it accomplish this seeming miracle? Qigong draws on a sophisticated “inner know-how”, developed over thousands of years, and recently validated by scientific research. It uses slow gentle movement, accompanied by breathing and focusing the mind in specific ways, to restore the “energy flow” in the body and mind–another way of saying “to balance the nervous system”. You can see a couple of video examples of Qigong exercises here; these are safe and enjoyable, and will reliably help you release excess stress. (insert link to video) Enjoy!

Now, although we know from countless stories about the power of Qigong, and we also know from scientific research that many of its claims are valid, this is not enough for us to be able to say with certainty that it will help Flight Attendants with their accumulated health problems. We were recently funded by the Flight Attendants Medical Research Institute (FAMRI) to find out for sure.  We expect to announce the opening of this study in the Fall of 2014.

In the short term, if you are a flight attendant who flew for at least 5 years prior to the smoking ban and who was not a voluntary smoker, you can participate in a screening study that is being conducted by
Mardi Crane-Godreau and Peter Payne.

Feel free to leave a message  at 1-603-653-9970 or send them an email them at

You can also enter your own work and health history at this link.