Review of studies on flight attendant health and comfort in airliner cabins.

BACKGROUND: A number of studies have examined the effect of the airliner cabin environment and other factors on the health and comfort of flight attendants (FAs), but no comprehensive review of such studies is available.
METHODS: This paper reviews studies conducted after 1980 that addressed FA short-term health and comfort effects. Relevant literature was identified using the National Institute of Health's PUBMED database.
RESULTS: Twenty-one studies were identified and classified into two types: in-flight surveys and surveys of general flight experiences. Most studies used questionnaires to obtain perceptions of the cabin environment, comfort, and health-related symptoms, but some included objective measurements. Only a few studies used a random sample or control groups. Effects of confounding variables generally have not been analyzed. DISCUSSION: Most studies shared some weaknesses such as poor response rate, significant response bias, exclusive reliance on questionnaires, or limited analysis. Taken together, the studies indicate that various complaints and symptoms reported by FAs appear to be associated with their job duties and with the cabin environment. Most notable are "dryness" symptoms attributable to low humidity and "fatigue" symptoms associated with factors such as disruption of circadian rhythm. Practically all symptoms are exacerbated by longer flight durations. Studies citing problems of "poor aircraft cabin air quality" tend to be weak in design and have addressed only general flight experiences of FAs. Although certain FA complaints are consistent with possible exposure to air pollutants, the relationship has not been proven and such complaints also are consistent with causes other than poor air quality.