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In the United States, the Federal Aviation Administration has officially classified flight crews (FC) consisting of commercial pilots, cabin crew, or flight attendants as "radiation workers" since 1994 due to the potential for cosmic ionizing radiation (CIR) exposure at cruising altitudes originating from solar activity and galactic sources. Several epidemiological studies have documented elevated incidence and mortality for several cancers in FC, but it has not yet been possible to establish whether this is attributable to CIR. CIR and its constituents are known to cause a myriad of DNA lesions, which can lead to carcinogenesis unless DNA repair mechanisms remove them. But critical knowledge gaps exist with regard to the dosimetry of CIR, the role of other genotoxic exposures among FC, and whether possible biological mechanisms underlying higher cancer rates observed in FC exist. This review summarizes our understanding of the role of DNA damage and repair responses relevant to exposure to CIR in FC. We aimed to stimulate new research directions and provide information that will be useful for guiding regulatory, public health, and medical decision-making to protect and mitigate the risks for those who travel by air.

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Addressing the field of health and safety at work, the primary objective of the present systematic review was to analyze the organizational risk factors for aircrew health according to professional category (flight attendants and pilots/co-pilots) and their consequences. The secondary objective was to identify the countries in which studies were carried out, focusing on the quality of content of the publications. The Medline/Pubmed, Cochrane, Web of Science, and Scopus databases were searched for eligible studies according to PRISMA statements. The risk of bias and the methodological quality of the studies were assessed using the Newcastle-Ottawa scale and Loney tools. Of the 3230 abstracts of articles screened, 36 studies met the inclusion criteria. Most of the research conducted on risk factors for the work organization of aircrew was carried out in the United States and the European Union and had moderate or low-quality methodology and evidence. However, the findings are homogeneous and allow the most prevalent organizational risk factors for the health of aircrew to be determined, namely, high work demand, long hours, and night work. Consequently, the most pervasive health problems were sleep disturbances, mental health disorders, musculoskeletal disorders, and fatigue. Thus, the regulation of the aircrew profession must prioritize measures that minimize these risk factors to promote better health and sleep for these professionals and, consequently, to provide excellent safety for workers and passengers.

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In this study, risk factors were identified to assess the impact of burnout on the health and daytime function of 412 female flight attendants from an international airline from 2017 to 2018 with convenience sampling. Data were obtained from self-administered questionnaires. Analysis of variance, Pearson's correlation analysis, and independent t-tests were used to assess the relationships between burnout and demographic and work-related factors. A structural equation model analysis was performed to assess the effect of burnout impact factors on mental health using the Brief Symptom Rating Scale, six common physical symptoms, and daytime dysfunction (a subscale of the Athens Insomnia Scale). The results showed a moderate level of burnout, as reported by 19.2 percent of the participants. Personal and work-related characteristics, including marital status and working hours, were not significantly associated with burnout. Smoking behavior was the only significant risk factor (T = -3.64). The impact model of burnout revealed a moderate direct effect of burnout on mental health symptoms (95 percent CI: 0.27, 0.47) and daytime dysfunction (95 percent CI: 0.04, 0.11) and a small direct effect on physical symptoms (95 percent CI: 0.28, 0.47). Our findings increase our understanding of the risk and impact factors related to burnout in female flight attendants.

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Purpose: This study examined the influencing mechanism and boundary conditions underlying the relation between COVID-19 perceived risk and flight attendants' turnover intention by investigating the mediating role of job insecurity and the moderating effect of job crafting. Methods:  A two-wave survey was conducted with 240 Chinese flight attendants. We used structural equation modeling to test the moderated mediation model. Results: The results indicated that perceived risk of COVID-19 positively affected flight attendants' job insecurity and turnover intention. Moreover, job insecurity plays a fully mediating role in the relationship between perceived risk and turnover intention. Furthermore, the mediating role of job insecurity was moderated by job crafting; for higher levels of job crafting (opposed to low), the effect of job insecurity on turnover intention was significantly weaker. Conclusion:  Our findings indicate that dissipating job insecurity and increasing job crafting behavior are critical to employees' work-related attitudes and behavior during the COVID-19 pandemic.

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Eustachian tube (ET) function is of utmost importance in people who are under constant barometric pressure changes in their daily lives. Proper functioning is essential in avoiding pressure related injuries. We aimed to investigate how well the ET functions in flying personnel and how it compares to the non-flying population.Prospective study. Acibadem University Atakent Hospital. 115 participants were included in the study. Each underwent a thorough otorhinolarynglogic examination then undertook a tympanogram followed by eustachian tube function (EtFT) test. A statistically significant difference in ear volume was observed in flight personnel. EtFT results showed the ability to equalize pressure after Valsalva manouvre was also significantly higher in flight personnel. Flight attendants that are subject to pressure changes throughout their careers do seem to be more capable of equalizing pressure through manoeuvres such as the Valsalva. This may be due to the fact that continuous pressure changes creates a more pliable tympanic membrane.

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This study investigated the factors that cause job stress among male flight attendants in a female-dominated airline organization, as well as the impact of job stress on their mental health and turnover intention. It also attempted to determine whether perceived family support, perceived organizational support, and job positions had moderating effects on male flight attendants' job stress. Six job stress factors were identified through focus group interviews and a literature review. A survey was conducted from 1 January to 2 February 2022 to validate the research model, and 188 valid samples were used for statistical analysis. This study discovered that gender differences in communication, relationship conflict with colleagues, hierarchical organizational culture, and role overload had a direct impact on male flight attendants' job stress. Job stress was found to have a negative impact on mental health and a positive impact on turnover intention. Perceived organizational support was also found to reduce job stress. This study is notably the first to address stress encountered by male flight attendants at work. It offers new directions for future airline personnel management and research. It also presents practical implications, such as the development of training and personnel management programs for male flight attendants.

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Background: Both genetic and environmental factors strongly affect serum uric acid (SUA) concentrations. The incidence of hyperuricemia tends to be younger in the Chinese population. In particular, we have found a high prevalence of hyperuricemia among Chinese flight attendants, aged from 20 to 40, in our survey. This study aims to evaluate whether there is an association between gene polymorphisms and hyperuricemia among Chinese flight attendants. Methods: A total of 532 flight attendants with high and normal serum uric acid levels were recruited. Allele-specific polymerase chain reaction (AS-PCR) was performed using blood samples of enrolled subjects. Results: Previous studies have reported single nucleotide polymorphisms (SNPs) that are tightly associated with uric acid levels. Among them, six SNPs that are strongly associated with SUA or gout in Asians, for instance ABCG2 (rs2231142, rs72552713 and rs2231137), GCKR (rs780094), SLC2A9 (rs1014290) and SLC17A1 (rs1183201), were selected for AS-PCR analyses. We found that SNPs such as ABCG2 rs2231142, GCKR rs780094 and SLC2A9 rs1014290 are strongly associated with hyperuricemia in male flight attendants, and SLC2A9 rs1014290 among female flight attendants. Conclusion: Our study provides evidences of an association between SNPs and hyperuricemia in the Chinese flight attendants, and highlights the significance of improving diagnostics and prevention of disease development in uric acid metabolism disorders and gout using these SNPs.

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Background: Prolonged past exposure to secondhand tobacco smoke (SHS) in never-smokers is associated with abnormal lung function and reduced diffusing capacity suggestive of an associated lung tissue injury and damage. The mechanisms by which past SHS exposure may contribute to lung tissue damage are unknown. Elastin is a major constituent of extracellular matrix in lung parenchyma. Objective: To determine whether past exposure to SHS is associated with ongoing lung tissue damage as indicated by elevated elastin degradation products that are linked to lung function. Methods: We measured the plasma levels of elastin degradation markers (EDM) from 193 never-smoking flight attendants with a history of remote SHS exposure in aircraft cabins and 103 nonsmoking flight attendants or sea-level control participants without such history of cabin SHS exposure and examined those levels versus their lung function with adjustment for covariates. The cabin SHS exposure was estimated based on airline employment history and years of the smoking ban enactment. Results: The median [interquartile range] plasma EDM level for all participants was 0.30 [0.24-0.36] ng/mL with a total range of 0.16-0.65 ng/mL. Plasma EDM levels were elevated in those with a history of exposure to cabin SHS compared to those not exposed (0.33±0.08 versus 0.26±0.06 ng/mL; age- and sex-adjusted P<0.001). In those with a history of cabin SHS exposure, higher EDM levels were associated with a lower diffusing capacity (parameter estimate [PE] 95% [confidence interval(CI)]=4.2 [0.4-8.0] %predicted decrease per 0.1 ng/mL increase in EDM; P=0.030). Furthermore, EDM levels were inversely associated with forced expiratory volume in 1 second (FEV1), FEV1 to forced vital capacity (FVC) ratio , and forced expiratory flow rate between 25% and 75% ( FEF25%-75%) (PE [95%CI]=5.8 [2.1-9.4], 4.0 [2.2-5.7], and 12.5 [5.8-19.2] %predicted decrease per 0.1 ng/mL increase in EDM, respectively; P<0.001). Plasma EDM mediated a substantial fraction of the association of SHS with FEV1, FVC, and FEF25%-75% (P<0.05). Conclusions: Long after past exposure to SHS, there is ongoing elastin degradation beyond what is expected from the aging process, which likely contributes to lower lung function and a reduced pulmonary capillary bed as seen in chronic obstructive pulmonary disease (COPD).

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This study was conducted to empirically investigate the effects of intrinsic and extrinsic motivation on job satisfaction perceived by married female flight attendants after reinstatement, the effect of job satisfaction on service performance after reinstatement, and the moderating effect of the marriage period on the relationship between intrinsic and extrinsic motivation. A questionnaire survey was conducted to collate data from 248 married female flight attendants who had been reinstated after parental leave. The data was analyzed quantitatively, and the main results and implications of this study were as follows. First, intrinsic motivation related to job, aptitude significantly affected job satisfaction, whereas self-realization did not. Second, extrinsic motivation, lay over, salary, and external recognition had significant positive effects on job satisfaction, while welfare did not affect job satisfaction. Third, job satisfaction perceived by married female flight attendants had a significant effect on their service performance after reinstatement. This demonstrates that there is a need to support married women to induce high job satisfaction and for them to reach a level of service performance similar to or better than before they took leave. Fourth, an analysis of the moderating effect of the marriage period on the relationship between intrinsic and extrinsic motivation demonstrated that the marriage period only significantly moderated the relationship between salary and job satisfaction. The study is related to the quality of life and subjective well-being including mental health of service workers in tourism and hospitality. The results of this study can be widely used as reference materials for successful reinstatement, job re-adjustment, job satisfaction, and commitment of all married female employees, especially flight attendants.

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Without vaccines or pharmaceutical treatments for a viral pandemic, non-pharmaceutical interventions (NPIs) such as washing hands and wearing masks are likely the most effective ways to control infections at airports and on airplanes. Although the aviation market is a major entry point for viruses, little is known about how flight attendants view the risk of COVID-19 and whether they follow individual-organizational-governmental NPI protocols. Guided by protection motivation theory (Rogers, 1975), this study proposed an NPI model tailored specifically to the airline industry and examined how an extended NPI would affect job satisfaction and customer orientation of Korean flight attendants (n = 371). Results revealed that perceptions of COVID-19 are positively related to three types of NPIs, which in turn positively influenced job satisfaction and customer orientation. Given that the examined three types of NPIs had not been paid attention in previous research, the study's proposed conceptual model should better guide the airline industry in protecting its flight attendants with NPI strategies inside and outside aircraft.

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The work of flight attendants is associated with exposure to long-term stress, which may cause increased secretion of cortisol. The aim of the study is to determine the circadian rhythm of cortisol and to seek factors of potential influence on the secretion of cortisol in female flight attendants working within one time zone as well as on long-distance flights. The prospective study covers 103 women aged 23-46. The study group (I) was divided into two subgroups: group Ia, comprising female flight attendants flying within one flight zone, and group Ib, comprising female flight attendants working on long-distance flights. The control group (II) are women of reproductive age who sought medical assistance due to marital infertility in whom the male factor was found to be responsible for problems with conception in the course of the diagnostic process. The assessment included: age, BMI, menstrual cycle regularity, the length of service, the frequency of flying, diurnal profile of the secretion of cortisol, testosterone, estradiol, 17-OH progesterone, SHBG, androstenedione, and progesterone concentration. Descriptive methods and inferential statistics methods were used to compile the data. Comparing the profile of flight attendants from groups Ia and Ib shows that the curve flattened among women flying within one time zone. The secretion curve is also more flattened in women with less years worked and in flight attendants working less than 60 h per month. Due to the character of work, the female flights attendants do not have hypersecretion of cortisol. Frequency of flying and length of work affect the dysregulation of HPA axis.

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INTRODUCTION: Epidemiological observations indicate that stewardesses are exposed to reproductive and endocrine system disturbances. The aim of the study was to assess of thyroid function disturbances as well as to identify factors affecting the thyroid function among stewardesses working both within one time zone and on long-distance flights. MATERIAL AND METHODS: The cross-sectional study covered 103 women aged 23-46. The study group (I) was divided into two subgroups: group Ia comprising stewardesses flying within one flight zone and group Ib stewardesses working on long-distance flights. The control group (II) were women of reproductive age who sought medical assistance due to marital infertility in whom the male factor was found to be responsible for problems with conception in the course of the diagnostic process. The assessment included: age, BMI, menstrual cycle regularity, length of work, frequency of flying, thyroid stimulating hormone (TSH) concentration, level of free thyroxine (fT4), antibodies to thyroglobulin (aTG) and to thyroperoxidase (aTPO), prolactin concentration, sex hormone binding globulin (SHGB) concentration, total cholesterol, and low density lipoprotein (LDL) fraction. Descriptive methods and inferential statistics methods were used to compile the data. RESULTS: The difference between the concentrations of TSH in the study group (2.59 mcIU/mL) and the control group (1.52 mcIU/mL) was statistically significant (p < 0.01). An elevated titer of thyroid antibodies (aTPO and/or aTG) was revealed in 46.3% of stewardesses and in 15.1% of patients from the control group (p < 0.001). Groups Ia and Ib in individual concentrations were not statistically significant. The frequency of occurrence of an elevated titer of thyroid antibodies depended on the length of work in the study group (p > 0.05). No statistically significant difference was found in patients spending up to 60 h a month flying and in patients spending more than 60 h flying, the percentage of the occurrence of thyroid antibodies was 50% and 43.5, respectively. CONCLUSIONS: The occurrence in stewardesses of a higher TSH concentration than in the control group can signify that stewardesses are burdened with a higher risk of the development of hypothyroidism in the future. The character of the work of stewardesses (frequency of flying as well as length of work) does not affect the immunological profile of the thyroid.

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BACKGROUND: A high prevalence of work-related musculoskeletal disorders (WMSDs) has been reported among flight attendants. Identifying the root causes of these disorders may improve the health conditions of flight attendants and further improve flight safety and service quality. OBJECTIVE: In this study, we aimed to identify WMSD risk factors for a specific population, namely Chinese female flight attendants. METHODS: A two-stage survey including an online questionnaire (46 flight attendants) and a semi-structured interview (16 flight attendants) was used to assess the WMSDs of Chinese female flight attendants. Text analysis tools in NVivo 11 were used to identify the main concerns and risk factors for WMSDs of Chinese flight attendants. RESULTS: In the online questionnaire, more than 86% of the participants reported discomfort in at least one body part. Biomechanical factors, work organizational factors, and psychosocial factors were reported by participants in this study. Chinese passengers were found to have an effect on WMSD development in Chinese flight attendants. CONCLUSIONS: The results of this study suggested that WMSDs are severe problems among Chinese flight attendants. General factors as well as the passenger-relevant factor were identified as the most influential causes of WMSDs.

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Flight attendants experience circadian misalignment and disrupted sleep and eating patterns. This survey study examined working time, sleep, and eating frequency in a sample (n=21, 4 males, 17 females) of Australian flight attendants (mean age=41.8 yr, SD=12.0 yr, mean BMI=23.8 kg/m2, SD=4.1 kg/m2). Respondents indicated frequencies of snack, meal, and caffeine consumption during their last shift. Reported sleep duration on workdays (mean=4.6 h, SD=1.9 h) was significantly lower than on days off (M=7.2 h, SD=1.2 h, p<0.001), and significantly lower than perceived sleep need (M=8.1 h, SD=0.8 h, p<0.001). Food intake was distributed throughout shifts and across the 24 h period, with eating patterns incongruent with biological eating periods. Time available, food available, and work breaks were the most endorsed reasons for food consumption. Caffeine use and reports of gastrointestinal disturbance were common. Working time disrupts sleep and temporal eating patterns in flight attendants and further research into nutritional and dietary-related countermeasures may be beneficial to improving worker health and reducing circadian disruption.

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OBJECTIVE: To study the influencing factors of menstrual disorder in flight attendants,and to do a good job in prevention and education.METHODS: Totally 845 qualified flight attendants of an airline company in 2018 were selected and questionnaires were conducted to list the possible influencing factors of menstrual disorder: mental factors,poor sleep,excessive fatigue,polar airlines,irregular diet,and menstrual flight.RESULTS: Among 845 respondents,312 crew members had menstrual disorders in the past year,accounting for 36.92%.Among them,dysfunctional uterine bleeding occurred most,accounting for 51.28%,followed by dysmenorrhea,premenstrual syndrome and amenorrhea.Univariate analysis showed that the incidence of sleep disorder,mental factors,excessive fatigue,irregular diet,menstrual flight and polar flight in the menstrual disorder group was significantly higher than that in the normal menstrual group(P<0.05).Logistic stepwise regression analysis showed that poor sleep,excessive fatigue,mental factors,irregular diet,menstrual flight(OR = 20.747,11.982,5.590,4.284,3.120,P<0.01),and polar airlines were removed from the equation(OR=0.741,P=0.389).CONCLUSION: The special working nature of flight attendants is more likely to lead to menstrual disorders.Sleep quality and excessive fatigue are the main factors of menstrual disorders.

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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. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02612389.

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BACKGROUND: Flight attendants are an understudied occupational group, despite undergoing a wide range of adverse job-related exposures, including to known carcinogens. In our study, we aimed to characterize the prevalence of cancer diagnoses among U.S. cabin crew relative to the general population. METHODS: In 2014-2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their self-reported cancer diagnoses to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013-2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and the prevalence of selected cancers, using logistic regression and adjusting for potential confounders. RESULTS: Compared to NHANES participants with a similar socioeconomic status (n = 2729), flight attendants (n = 5366) had a higher prevalence of every cancer we examined, especially breast cancer, melanoma, and non-melanoma skin cancer among females. SPR for these conditions were 1.51 (95% CI: 1.02, 2.24), 2.27 (95% CI: 1.27, 4.06), and 4.09 (95% CI: 2.70, 6.20), respectively. Job tenure was positively related to non-melanoma skin cancer among females, with borderline associations for melanoma and non-melanoma skin cancers among males. Consistent with previous studies, we observed associations between job tenure and breast cancer among women who had three or more children. CONCLUSIONS: We observed higher rates of specific cancers in flight attendants compared the general population, some of which were related to job tenure. Our results should be interpreted in light of self-reported health information and a cross-sectional study design. Future longitudinal studies should evaluate associations between specific exposures and cancers among cabin crew.

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BACKGROUND: Flight attendants may have an increased risk of some cancers from occupational exposure to cosmic radiation and circadian disruption. METHODS: The incidence of thyroid, ovarian, and uterine cancer among ∼6000 female flight attendants compared to the US population was evaluated via life table analyses. Associations of these cancers, melanoma, and cervical cancer with cumulative cosmic radiation dose and metrics of circadian disruption were evaluated using Cox regression. RESULTS: Incidence of thyroid, ovarian, and uterine cancer was not elevated. No significant, positive exposure-response relations were observed. Weak, non-significant, positive relations were observed for thyroid cancer with cosmic radiation and time zones crossed and for melanoma with another metric of circadian disruption. CONCLUSIONS: We found little evidence of increased risk of these cancers from occupational cosmic radiation or circadian disruption in female flight attendants. Limitations include few observed cases of some cancers, limited data on risk factors, and misclassification of exposures.

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OBJECTIVE: To measure sound levels in the aircraft cabin during different phases of flight. METHODS: Sound level was measured on 200 flights, representing six aircraft groups using continuous monitors. A linear mixed-effects model with random intercept was used to test for significant differences in mean sound level by aircraft model and across each flight phase as well as by flight phase, airplane type, measurement location and proximity to engine noise. RESULTS: Mean sound levels across all flight phases and aircraft groups ranged from 37.6 to >110 dB(A) with a median of 83.5 dB(A). Significant differences in noise levels were also observed based on proximity to the engines and between aircraft with fuselage- and wing mounted engines. Nine flights (4.5%) exceeded the recommended 8-h TWA exposure limit of 85 dB(A) by the NIOSH and ACGIH approach, three flights (1.5%) exceeded the 8-h TWA action level of 85 dB(A) by the OSHA approach, and none of the flights exceeded the 8-h TWA action level of 90 dB(A) by the OSHA PEL approach. CONCLUSIONS: Additional characterization studies, including personal noise dosimetry, are necessary to document accurate occupational exposures in the aircraft cabin environment and identify appropriate response actions. FAA should consider applying the more health-protective NIOSH/ACGIH occupational noise recommendations to the aircraft cabin environment.

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BACKGROUND: Flight attendants are an understudied occupational group, despite undergoing a wide and unique range of adverse job-related exposures. In our study, we aimed to characterize the health profile of cabin crew relative to the U.S. general population. METHODS: In 2014-2015, we surveyed participants of the Harvard Flight Attendant Health Study. We compared the prevalence of their health conditions to a contemporaneous cohort in the National Health and Nutrition Examination Survey (NHANES 2013-2014) using age-weighted standardized prevalence ratios (SPRs). We also analyzed associations between job tenure and selected health outcomes, using logistic regression and adjusting for potential confounders. RESULTS: Compared to the NHANES population (n = 2729), flight attendants (n = 5366) had a higher prevalence of female reproductive cancers (SPR = 1.66, 95% CI: 1.18-2.33), cancers at all sites (SPR = 2.15, 95% CI: 1.73-2.67 among females), as well as sleep disorders, fatigue, and depression, with SPRs ranging between 1.98 and 5.57 depending on gender and the specific condition examined. In contrast, we observed a decreased prevalence of cardiac and respiratory outcomes among flight crew relative to NHANES. Health conditions that increased with longer job tenure were sleep disorders, anxiety/depression, alcohol abuse, any cancer, peripheral artery disease, sinusitis, foot surgery, infertility, and several perinatal outcomes. CONCLUSIONS: We observed higher rates of specific adverse health outcomes in U.S. flight attendants compared to the general population, as well as associations between longer tenure and health conditions, which should be interpreted in light of recall bias and a cross-sectional design. Future longitudinal studies should evaluate specific exposure-disease associations among flight crew.

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