Documenting health risks at 35,000 feet

Flight attendant serving

April 3, 2018—Alaska Airlines flight attendants began reporting symptoms such as itchy eyes, rashes, and shortness of breath soon after the company introduced new uniforms in 2011. Although the uniforms were replaced three years later, the company didn’t acknowledge a possible connection between the introduction of the uniforms and the spike in health complaints. The National Institute for Occupational Safety and Health (NIOSH) agreed, ruling that there wasn’t enough evidence to establish a link.

The case piqued the interest of researchers from Harvard T.H. Chan School of Public Health who had been studying the health effects of working in the airplane cabin environment as part of the Flight Attendant Health Study. The study is an ongoing effort to understand the risks faced by a group of workers who, because they work in the air, fall outside of standard health and safety protections.

The researchers analyzed survey data taken from 684 Alaska Airlines flight attendants before and after the uniforms were introduced in 2011 and published the results earlier this year in BMC Public Health. Their findings showed that respiratory, dermatological, and allergic symptoms increased following the introduction of the new uniforms, most significantly itchy skin and rash, itchy eyes and blurred vision, and sinus congestion.

Flight risk

Eileen McNeely, the study’s lead author, said that while just a few complaints about a consumer clothing item can prompt a fix, airlines have been slow to respond to flight attendants’ concerns. “That’s emblematic of the limited health and safety protection that flight attendants receive even from bodies such as the Occupation Safety and Health Administration,” she said. McNeely is co-director of SHINE, the School’s corporate health and sustainability program based in the Exposure, Epidemiology and Risk program.

American Airlines flight attendants filed a class action lawsuit last year over their uniforms, which were made by the same company as the Alaska Airlines uniforms, following more than 3,500 complaints.

While flight attendants are healthier overall than the general population—they have lower rates of smoking and maintain healthier weights—they have higher rates of certain diseases and conditions, including female reproductive cancers, sleep disorders, and depression, according to research by McNeely and colleagues. The findings were published March 23, 2018 in BMC Public Health.

McNeely began studying flight attendant health in 2007, when the School was chosen as one of the Centers of Excellence tasked with studying cabin air quality prior to the Federal Aviation Administration’s reauthorization by Congress. Once that was completed, funding to continue the Flight Attendant Health Study was provided by the Flight Attendant Medical Research Institute, a non-profit research funding body created as part of the settlement of a class action lawsuit brought against the tobacco industry on behalf of non-smoking flight attendants. Now on its third wave of recruitment, the study has already attracted more than 12,000 participants—the largest cohort for an epidemiologic study of flight attendant health.

While flight attendants no longer have to work in smoke-filled cabins, they face other exposures, such as flame retardants on seat cushions, abusive passengers, extended periods in low-oxygen environments, grueling schedules, and vulnerability to flu and other infectious respiratory diseases.

Chemically treated clothing

The same types of chemicals used by the manufacturer of the flight attendants’ uniforms are found in consumer clothing, McNeely said. This includes wrinkle-resistant and stain-resistant chemicals, dyes, and fungicides to keep clothes fresh in transit from factories. These chemicals are not included on labels, and even if they were, no one knows what level of exposure is safe.

With the help of testing by researchers in the School’s Hoffman Program on Chemicals and Health, McNeely is working to get answers. And flight attendants are filling in a crucial piece of the puzzle—by wearing the same articles of clothing under the same, limited conditions, they make the airplane cabin an ideal laboratory environment for researchers, McNeely said.

To obtain additional data, McNeely and her colleagues recently launched an app that was distributed along with wearable sensors to some study participants. It will track flight-related changes in measures that may affect health, such as blood oxygenation, sleep, and mood, and is available free in the Apple app store for use by anyone who flies.

Upcoming studies from the research team include an analysis of sexual harassment faced by flight attendants and its effects on their health, and the prevalence of cancer among flight attendants compared to the general U.S. population.

“The field has been glamorized, but it’s a hard job,” McNeely said. “Flight attendants have to put up with a lot and they have little protection.”

Amy Roeder

Photo: iStock/Ruben Ramos