title: Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: a cross-sectional survey.
abstract: BACKGROUND
  Little is known about long-term adverse health consequences experienced by flight attendants exposed to secondhand smoke (SHS) during the time smoking was allowed on airplanes. We undertook this study to evaluate the association between accumulated flight time in smoky airplane cabins and respiratory tract diseases in a cohort of never smoking flight attendants.
  
  
  METHODS
  We conducted a mailed survey in a cohort of flight attendants. Of 15,000 mailed questionnaires, 2053 (14%) were completed and returned. We excluded respondents with a personal history of smoking (n = 748) and non smokers with a history of respiratory tract diseases before the age of 18 years (n = 298). The remaining 1007 respondents form the study sample.
  
  
  RESULTS
  The overall study sample was predominantly white (86%) and female (89%), with a mean age of 54 years. Overall, 69.7% of the respondents were diagnosed with at least one respiratory tract disease. Among these respondents, 43.4% reported a diagnosis of sinusitis, 40.3% allergies, 30.8% bronchitis, 23.2% middle ear infections, 13.6% asthma, 13.4% hay fever, 12.5% pneumonia, and 2.0% chronic obstructive pulmonary disease. More hours in a smoky cabin were observed to be significantly associated with sinusitis (OR = 1.21; p = 0.024), middle ear infections (OR = 1.30; p = 0.006), and asthma (OR = 1.26; p = 0.042).
  
  
  CONCLUSIONS
  We observed a significant association between hours of smoky cabin exposure and self-reported reported sinusitis, middle ear infections, and asthma. Our findings suggest a dose-response between duration of SHS exposure and diseases of the respiratory tract. Our findings add additional evidence to the growing body of knowledge supporting the need for widespread implementation of clean indoor air policies to decrease the risk of adverse health consequences experienced by never smokers exposed to SHS.
authors: Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. ebbert.jon@mayo.edu
authors: Jon O
authors: JO
authors: Ebbert
authors: Ivana T
authors: IT
authors: Croghan
authors: Darrell R
authors: DR
authors: Schroeder
authors: Judith
authors: J
authors: Murawski
authors: Richard D
authors: RD
authors: Hurt
mesh_terms: D000337:Aerospace Medicine; D000401:Aircraft; D001359:Aviation; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D000078329:Workforce
chemical_list: D014028:Tobacco Smoke Pollution