Scientist Grajewski 830

8/13/2019 Scientist Grajewski 830

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NIOSH Studies of Flight Crew

CAPT B Grajewski, CC Lawson, LCDR LA MacDonald,

LCDR LT McKernan, CAPT LE Pinkerton, MA Waters,

CAPT EA Whelan, LC Yong

Partners

Federal Aviation Administration

Department of Defense

HHS Office of Womens Health

National Cancer Institute

NASA

NOAAAirline Companies

Unions

Website: http://www.cdc.gov/niosh/topics/flightcrew/The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and

should not be construed to represent any agency determination or policy.


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Flight Crew Research at NIOSH

160,000 US workers in commercial aircraft cabins

and 500,000 workers worldwide

NIOSHs mission is to generate new knowledge inthe field of worker safety and health and to transfer

that knowledge into practice

Study of the health effects arising from aircraft cabin

work is a significant area of research for NIOSH

www.cdc.gov/niosh/topics/flightcrew


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NIOSH Flight Crew Studies

Reproductive Menstrual Function Pregnancy Outcomes

Other Respiratory Symptoms Downsizing and mortality

ExposureHealth Effects

Cancer Incidence/mortality in FAs

and pilots Breast cancer among FAs Cytogenetic effects in pilots

Radiation Measure Model

Circadian Disruption Desynchronization Sleep disturbance

Other Physical work demands Psychosocial factors

Cabin air quality

Bioaerosol levels


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Cabin air quality

Bioaerosol levels


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Cancer Studies

Personnel/medical records of former Pan Am

employees, 1940-91

Approximately 10,000 female flight

attendants and 7,000 pilots

Mortality studies of FAs and pilots

Breast cancer incidence study of FAs

Cytogenetic effects in pilots


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Cancer Incidence/mortality in FAsand pilots Breast cancer among FAs Cytogenetic effects in pilots




Cabin air quality

Bioaerosol levels


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Reproductive Studies: Background

Flight attendants may experienceincreased risk of:

Miscarriage

Menstrual disorders

Other adverse reproductive outcomes

Is work as a female flight attendant

associated with adverse reproductiveeffects?


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Reproductive Outcomes Questionnaire

Study: Design 2,273 FAs and 381 teachers, age 18-40

Selected U.S. airlines and domiciles

One hour telephone interview

Employment and flight histories

Outcomes: adverse reproductive effects

Miscarriage

All major birth defects Menstrual function

Time to pregnancy

Low birthweight, preterm birth


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Characterize menstrual function in flightattendants and teachers (comparison group)

~50 indices of menstrual/hormonal function

Markers of infertility/subfertility

Links with adverse reproductive outcomes andadverse exposure

Biomonitoring Feasibility Study

of Menstrual Function


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Study Design

45 flight attendants, 26 teachers Two major U.S. cities

Baseline interview

Urine/saliva collection for one cycle

Daily diary for three cycles

Sleep/activity monitor


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Travel through multiple time zones:

External desynchronization

Internal desynchronization

Physiologic/behavioral

disturbances including sleep-wakedisturbance

Assessing Circadian Rhythm Disruption

NIOSH Approach

Monitor sleep and a circadian marker

Identify useful metrics for larger studies


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Flight attendants experience increased

circadian rhythm disruption, as measured by

more variable melatonin rates.

For studies without biomonitoring, time

zones crossed is a useful indicator of both

sleep displacement and melatonindesynchronization.

Conclusions: Circadian Disruption


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Fixed night shift

work increases risk of

late fetal loss

Shift work sleepdisorders affect~10%

of the night/rotating

shift work population

Arendt J 2005; Zhu J 2004; DrakeCL et al, 2004

The swing shift is the killerJosephine Arendt


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Cabin air quality

Bioaerosol levels


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Cosmic radiation measurement

study: objectives

Measure cosmic radiation doses

function of altitude, latitude, flight distance

Compare measured doses with FAA model CARI

can model be used to estimate historical radiationdoses for epidemiologic studies?

Compare dose data with other models?


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Dose/Cumulative Dose Equivalent vs Time

Seattle to Tokyo

0.0E+00

2.0E-08

4.0E-08

6.0E-08

8.0E-08

1.0E-07

3:27

3:57

4:27

4:57

5:27

5:57

6:27

6:57

7:27

7:57

8:27

8:57

9:27

9:57

10:27

10:57

11:27

11:57

12:27

Time (GMT)

AbsorbedDoe

(Gy/min)

0.0E+00

2.0E-05

4.0E-05

6.0E-05

8.0E-05

CumulativeDoseE

quivalent(Sv)

1306-AD 1307-AD 1306-DEQ 1307-DEQ

35K ft 36K ft

38K ft


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Dose/Cumulative Dose Equivalent vs Time

Miami to Buenos Aires

0.00E+00

2.00E-08

4.00E-08

6.00E-08

8.00E-08

1.00E-07

0:28

0:58

1:28

1:57

2:27

2:57

3:27

3:57

4:27

4:57

5:27

5:57

6:27

6:57

7:27

7:56

8:268:56

9:26

Time (GMT)

AbsorbedDo

se(Gy/min)

0.0E+00

2.0E-05

4.0E-05

6.0E-05

8.0E-05

CumulativeDose

Equivalent(Sv)

1306-AD 1306-DEQ

33K ft 37K ft


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Implications for flight crew

dose equivalent rates

0.9 - 6 Sv/block hour

FAs work 600 - 900+ block hrs / yr

annual doses at 900 block hrs/yr for our study

0.8 - 5.4 mSv

compare: ICRP occupational limit 20mSv / year

ICRP limit 1 mSv / term of pregnancy


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Conclusions

CARI model sufficient for computing historicaldose estimates for our health effects studies

measurement bias data may be used to adjustCARI estimates


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A

LTI T

U DE

(ft)

(TAK

E-OFF

TIME)

CRUISE

DESC

ENT

(LANDIN

GTIM

E)TAXI-IN

TIME (min)

FLIGHT TIME

BLOCK TIME

BLOCK OUT

TAXI-OUT

ASCENT

Phases of a Flight Segment

BLOCK IN


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Current Issues

Cosmic Radiation Exposure Assessment

Reproductive outcomes are often time-sensitive Create windows of exposure from individual flight

dose estimates

The biologic role of specific particles, especially

neutrons 40-80% of effective dose

expected to have high biological effectiveness

IARC carcinogen

Estimate particle and total doses for 2.5M+ flights

How to account for Solar Particle Events?

Evaluate every flight for SPE status/NOAA

collaboration


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Analyses Completed/In Progress

Radiation dose estimation methods (2002)

Feasibility assessment and menstrual cycle characteristics (2002)

Comparison of self-reported flight hours and company records

(2004)

Sleep quality (in preparation)

Psychosocial stress (2003)

Melatonin and Circadian Rhythms Disruption (2003)

Flight Attendant mortality (in preparation)

Menstrual Function (in preparation)

Cosmic radiation exposures (4 papers, 3 submitted)

Indoor air quality in aircraft cabins (1 paper, 2 submitted)

Air cabin endotoxin levels (2003)

Ergonomic factors (2004)

Salivary cortisol biomonitoring (in preparation)


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Significant strengths:

Detailed flight history records

Exposure assessment developed for flight

exposures Multiple health outcomes

Improving the dose in dose response

Unique contribution to understanding health effects Major study findings published 2009+

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Scientist Grajewski 830