In 2007, researchers mailed a 10-page health survey to 5,444 randomly-selected active-status flight attendants at seven bases in the US working for one of two major US airlines. The survey collected data on demographics, working conditions, health symptoms that necessitated medical attention, and diagnoses, all for the previous year. A total of 2,613 of those flight attendants (48%) completed the survey. In addition, members of the research team participated in “airport sits” for a few days at the seven airports in order to: (1) increase visibility of the study for people who had received a survey by mail (but may have had questions about it); and (2) “enrich” the sample of participants by randomly recruiting flight attendants who were passing through those hubs and willing to participate in the study. In all 1,398 flight attendants at the airports completed a survey, bringing the total number of participants to 4,011. Where possible the flight attendant health data from this survey were compared with comparable US population data from other sources.

• Nearly half of the flight attendants (47%) reported that they experienced one or more work-related injuries/illnesses in the past year and 29% said they had more than one in the last year. This compares to 4.2% for workers all industries and 10.2% of transportation workers in official Bureau of Labor Statistics data. Of the 47% of flight attendants who experienced one or more work-related injuries/illnesses in the past year, 33% were musculoskeletal in nature, 23% were respiratory, 17% were neurological, and 14% were psychological.

Other highlights of the health survey findings include:

Respiratory symptoms: Respiratory symptoms were the most common reason for visits to medical providers in the last year. Sixty-one percent of respondents sought medical care for respiratory symptoms (reactive airways, sinusitis or allergies; shortness of breath or reduced lung capacity; other respiratory symptoms) in the last year (Figure 23). One of the key research findings was that flight attendants (n=4,011) had about a 3-fold increase in the age-adjusted prevalence of chronic bronchitis, compared to a roughly similar US population sample (n =5,713). This finding was surprising considering the considerably lower levels of smoking amongst the flight attendant group. Also, the prevalence of physician-diagnosed chronic bronchitis increased with longer job tenure, even after adjusting for age, gender, body mass index (BMI), education, and smoking. The significantly elevated prevalence of chronic bronchitis reported by this work population (as compared to matched US population data) is worthy of additional study. It is not clear how much of this finding is a function of historical exposure to second-hand smoke on aircraft, and how much is related to current chemical exposures, infectious agents, or other causes.

Fatigue and sleep problems: Fatigue was found to be the third highest cause of medical provider visits in the past year, after respiratory and musculoskeletal ailments. More than a third of the respondents had sought medical attention for fatigue in the past year (1402 of 3809). Fatigue is recognized by the FAA as a highly prevalent condition among flight attendants and is especially important because it may bear directly on the performance of the crew and the safety of passengers. The current study offers further evidence that fatigue and sleeping problems are widely experienced among flight attendants.

Noise exposure and hearing conservation: Due to past lack of jurisdiction of OSHA over cabin crew in flight, noise induced hearing loss has been not been monitored in flight crew. The current study is consistent with previous studies of flight attendants that suggest an unusually high prevalence of hearing loss. Hearing conservation programs need to be universal and mandatory as voluntary screening programs run the risk of stigmatization.

Neurological problems: Flight attendants who sought care for neurological symptoms in the past year were more likely to either be out of work or to have worked in the last three days. The prevalence of neurological symptoms that were described as serious enough to seek medical treatment in the previous year (e.g., severe headache, 23%; dizziness, 19%; numbness/ tingling in face/extremities, 17%; memory loss, 14%; loss of balance/coordination, 9%) is cause for concern. Unfortunately, the prevalence of these symptoms amongst flight attendants could not be directly compared to that in either the general US population or other worker groups. Still, causes of these symptoms need further investigation. Potential occupational factors include exposure to neurotoxic oil-based chemicals in the cabin air supply, hypoxia, noise, and overexposure to pesticide products applied either during or prior to some international flights.