title: Nicotine deprivation and pilot performance during simulated flight.
abstract: OBJECTIVE
  Most airlines enforce no-smoking policies, potentially causing flight performance decrements in pilots who are smokers. We tested the hypotheses that nicotine withdrawal affects aircraft pilot performance within 12 h of smoking cessation and that chewing nicotine gum leads to significant relief of these withdrawal effects.
  
  
  METHODS
  There were 29 pilots, regular smokers, who were tested in a Frasca 141 flight simulator on two 13-h test days, each including three 75-min flights (0 hr, 6 hr, 12 hr) in a randomized, controlled trial. On the first day (baseline), all pilots smoked one cigarette per hour. On the second day, pilots were randomly assigned to one of four groups: (1) nicotine cigarettes; (2) nicotine gum; (3) placebo gum; (4) no cigarettes/no gum. Flight Summary Scores (FSS) were compared between groups with repeated measures ANOVAs.
  
  
  RESULTS
  No statistically significant differences in overall simulator flight performance were revealed between pilots who smoked cigarettes and pilots who were not allowed to smoke cigarettes or chew nicotine gum, but there was a trend for pilots who were not allowed to smoke to perform worse. However, pilots who chewed placebo gum performed significantly worse during the 6-h (FSS = -0.03) as well as during the 12-h flight (FSS = -0.08) than pilots who chewed nicotine gum (FSS = 0.15 / 0.30, respectively).
  
  
  CONCLUSIONS
  Results suggest that nicotine withdrawal effects can impair aircraft pilot performance within 12 h of smoking cessation and that during smoking abstinence chewing one stick of 4-mg nicotine gum per hour may lead to significantly better overall flight performance compared to chewing placebo gum.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. msm@stanford.edu
authors.forename: Martin S
authors.initials: MS
authors.lastname: Mumenthaler
authors.forename: Neal L
authors.initials: NL
authors.lastname: Benowitz
authors.forename: Joy L
authors.initials: JL
authors.lastname: Taylor
authors.forename: Leah
authors.initials: L
authors.lastname: Friedman
authors.forename: Art
authors.initials: A
authors.lastname: Noda
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Yesavage
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D000368:Aged; D002638:Chewing Gum; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects*; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D002638:Chewing Gum; D018722:Nicotinic Agonists; D009538:Nicotine