Abstracts Submitted for Conference on Air Travel and Health
Aviation has been one of the defining technologies at the heart of
mankind's development from the Wright Brother's first flight to the
delivery of the Atomic bombs that ended WWII to the landing of the first
man on the moon, and finally to that fateful September day. Aviation has
changed the course of history since its inception. The public health
significance of flying is paramount not only due to its historical
significance but also due to the drastic changes that it has brought about
globally. Aviation has greatly strengthened population mixture, social
ties, conflict intensity, economies, communication, etc…..
In previous literature it has been suggested that exposure to higher
levels of cosmic radiation in commercial flight crews may increase their
susceptibility to certain types of cancer. To further investigate the
link between cosmic radiation, cancer and its implications to commercial
aviation it would be prudent to utilize a population that is at an extreme
exposure level of cosmic radiation. The appropriate hypothesis would then
be that those individuals at this exposure level will have a higher risk
of cancer. Thus, I propose an international retrospective-prospective
cohort study of all past, current, and future Astronauts and Cosmonauts.
The exposed group will be defined as having spent any time in space, while
the unexposed group will be those individuals who were trained for space
travel but never actually undertook a mission to outer space.
Thromboembolic events following air travel do occur and have been
reported several times in the literature. A few of the risks factors
often listed are: immobilization, prolonged travel time, alcohol (diuretic
effect), decrease fluid intake, direct pressure on leg veins and
pre-existing medical illness or other predisposing conditions. Special
attention is placed on the fact that (in Europe) thromboembolism following
air travel occurs in young healthy individuals with no previous medical
history. In this regard, airlines have recently inserted a few lower limb
exercises on in-flight safety instruction handouts. Some airlines have
also released education materials on their websites on the health risks of
air travel. Despite these efforts, thromboembolism after air travel
remains a significant medical concern. The purpose of this study is to
evaluate the pilot's role in counteracting the effects of prolonged
immobility in air travel. Does the pilot's announcement of instructions
and recommendations on mobility via the in flight PA system at the
beginning of a flight increase mobility among its passengers in the
The study will be conducted on passengers on randomly selected scheduled
airline flights of more than six hours duration. All participants (in all
randomly selected airline flights), in both the control and prevention
groups will be handed instructions on in- flight exercises and mobility as
well as information on DVT and air travel. The participants in the
intervention group (collectively, per aircraft) will receive a five-minute
announcement via the in flight PA system from the pilot about
counteracting the effects of prolonged sitting and immobility through
carrying out lower limb exercises and encouraging mobility within the
aircraft cabin. Main outcome measure will be increase in mobility and/or
physical activity among passengers in all cabins of the commercial
As in smoking cessation, where physician's instructions and
recommendations are regarded as superior to written patient education
materials in effecting change in behavior, the pilot's role in
counteracting the effects of prolonged immobility during air travel is
deemed necessary to produce similar effects.
The airline industry "pampers" their first class customers. Every day,
thousands of passengers board thousands of airplanes worldwide and opt to
fly first class due to the "perks" that they receive during the flight.
For an increased ticket cost, first class passengers are able to enjoy
spacious seating, a nice meal, and take advantage of the unlimited free
champagne that is offered to them. It is this champagne, coupled with the
extremely dry in-flight air of the cabin that has the potential to
deteriorate the health of first class passengers on a long flight. The
possibility of dehydration among first class passengers becomes quite
real, especially if they consume large amounts of the free, unlimited
champagne that acts as a diuretic, and exacerbates dehydration.
A study that partners a research institution with a local airline is
underway to assess the prevalence and severity of dehydration among first
class passengers based on the amount of champagne or other alcoholic
drinks consumed during flight. First class passengers will be interviewed
near the end of each flight that lasts 5 or more hours in duration. Flight
crew will administer the questionnaire. Questions regarding number of
alcoholic beverages, number of restroom visits, and feelings of
dehydration, will be collected on all first class passengers. The data
will be analyzed to discover if there is an association between number of
alcoholic drinks consumed and severity of dehydration. In-flight
dehydration may decrease markedly if alcohol intake is limited. With the
possibility of improved health among the flying public, first class
travelers may want to reconsider that expensive ticket.
Commercial air travel has increased dramatically in the last 25 years,
which has resulted in increased numbers of passengers traveling. In 1995,
approximately 1.4 billion passengers flew. There are very few
contra-indications to flying in commercial jet aircraft and even
passengers with medical conditions travel regularly without incident.
Air travel is becoming increasingly more accessible to people both through
the availability of cheap flights and because the airlines now cater to
individuals of all ages and disabilities. The wide bodies of many new
aircraft permit the airlines to have very flexible seating options.
Airline operators currently have an important role in determining the
comfort and spaciousness of the seating in their aircraft. Edema is the
presence of excessive fluid in tissue spaces. Sitting still for a long
period of time may cause the lower limb edema and therefore passenger
discomfort. Experiments on 12 healthy volunteers in mock up of an aircraft
were monitored during simulated 12 hours flights at atmospheric pressure,
chosen to represent day and night flying. The results illustrated that
the swelling was greater in night tests and increased proportionally with
duration of sitting. The purpose of this study is to develop a method to
reduce edema of the leg on long distance flights and make flying more
comfortable and enjoyable.
5 commercial airlines that travel overseas will randomly be selected.
Survey questions will be distributed among 500 hundreds healthy passengers
from those airlines which will also be selected randomly. Then a physician
will evaluate swelling and any other symptoms that may cause discomfort
before they board their plane. Those individuals will be randomly divided
into two groups. First group will be control so they are going to be
observed after 12 hours flight and the same physician will evaluate them
for any sign and symptom of swelling and discomfort. The other half will
do repeated leg exercise and will be asked to move their leg during the
flight as much as possible. Then the same physician will evaluate them
after 12 hours of the fly and will exam them for any swelling and
discomfort. Survey questions are as follows:
Regression analyses will be used to analyze the data for significant
differences between the groups.
- Did your leg swell during flight?
- Did you take your shoes off during the flight?
- Did you have any problem to wear your shoes the end of the flight?
- Did you have enough space for your legs?
- Did you move your legs during the flight?
- Did you walk in the plan during the flight?
- Did you have any pain on your legs during the flight?
Long flights have been shown to adversely affect passengers' health. This
was established in a number of isolated cases where passengers developed
deep vein thromboses after sitting for prolonged periods of time. The
terrorist events of September 11th, 2001, have consequently prompted
additional discomforts to be enforced during air travel, in order to
ensure safety precautions. One of these safety measures discourages
passengers from forming a line to use the airplane's restroom(s). Thus,
passengers must determine from their seats if the restroom is vacant.
During a long flight, this recurring hassle can simply discourage or
postpone a passenger from using the restroom facility. A delay in
accessing the lavatory may inadvertently cause urinary tract infections
(UTIs) in certain passengers who are already predisposed to UTIs.
Passengers who may be at increased risk for UTIs include: children who
retain urine for longer than usual periods of time, passengers with BPH
(benign prostatic hyperplasia), passengers who are wearing a scopolamine
patch to prevent nausea, and those who take diphenhydramine before or
during the flight (often to promote sleep). In all of the aforementioned
examples, the anatomy (small ureters in children), the disease state
(BPH), or the anticholinergic properties of the medications (scopolamine,
diphenhydramine) can put these passengers at increased risk for UTIs. The
aim of this study is to ascertain if post-September 11th events, have
triggered an increased frequency of UTIs in specific passenger
populations, on flights of greater than eight hours in duration. If there
does, in fact, prove to be a statistically significant difference, then a
subsequent research question that needs to be asked is: Would the
prophylactic use of antibiotics in these particular populations be a
cost-effective and reasonable solution, or would other options need to be
A questionnaire would be randomly administered to passengers who flew
shortly before September 11th and those who flew in the months after
September 11th. Recall bias should not be a substantial confounder, since
patients who are asked to recall a particular event (i.e. UTI) which they
are more likely to remember, given that it is associated with a date of
travel. The questionnaire would be designed in such a way so as to
determine whether or not a causal relationship exists between the date of
travel and the occurrence of the UTI.
Flying is becoming very common activity for many people. In fact,
more than three million people fly every day and 1.3 billion people per
year are flying on commercial flights. Also, diabetes mellitus is one of
the major chronic disease of current era. Approximately 14 million people
in the U.S. are diabetic and quite a few of them depend on insulin
injection for the optimal control of blood sugar. The improper control of
blood suger will result in the acute complications such as hypoglycemia,
non ketoic coma, diabetic ketoacidosis or infections. The protocol for
insulin administration is determined by patients' life style, blood sugar
pattern and meal schedules. However, only very few studies are available
to date about the effect of flying to the different time zones on patients
with diabetes mellitus and optimal way to adjust insulin administration.
Study is done in two phases.
Method: retrospective cohort with questionnaire
- Case: patients with diabetes mellitus using insulin with history of
flight to the area with more than six time zone difference within past
- Control: matched patients with diabetes mellitus using insulin without
flight history during past six month
- Outcome: self report on acute complications such as hypoglycemia, non
ketoic coma, diabetic ketoacidosis or infections during the past six
month, compared as the incidence rate for statistical significance
- Hypothesis: the incidence rates for acute complications are higher
during the flight
Method: randomized control trial
- Patients: volunteers with diabetes mellitus using insulin who are
planning to travel by airplane and going to the area with more than six
time zone difference within next six month, recruited and randomly
assigned to one of four insulin protocols.
- Intervention arms: 1) using the watch from departure site during the
flight to administer patients' own protocol and reset the watch at arrival 2)
using the time of the destination site during the flight by resetting the
watch at departure to administer patients' own protocol 3) using the time
of the departure site for the first half of the flight and reset the watch
to the destination site at the midpoint during the flight to use for the
second half of the flight for insulin administration. 4) stop using the
patients' own protocol and completely switch to sliding scale (this is a
common way to handle blood sugar when frequently fluctuating such as
during hospitalizations) in which patient decides the amount of insulin
based on measured blood glucose level at regular interval (such as every
- Outcome: same as phase I
- Hypothesis: the incidence rates for acute complications are the lowest
with the use of insulin sliding scale.
The number of passengers that fly on international flights and the
duration of these flights increase each year. This means than more and
more people are being exposed to jet jag (circadian rhythm
desynchronosis), when traveling on long flights, especially when passing
through several time zones. Jet lag is not just a nuisance but can give
rise to serious health problems. Symptoms of jet lag significantly impair
the performance of business travelers, sportsmen and pilots, leading to
fatal accidents with loss of many lives. Exposure to chronic jetlag
induces prolonged secretion of the body's stress hormone cortisol.
Prolonged excess exposure to cortisol leads to multi-system structural
changes, which are permanent. Changes in the brain cause cognitive
impairment, increased reaction time, reduction in spatial skills and
impaired short-term memory. Changes in the cardiovascular system give rise
to increased risk of cardiovascular disease. The proposal is to carry out
a cross-sectional study to understand patterns of elevation in cortisol
level in response to jet lag.
A cross-sectional study will be carried out amongst healthy international
travelers, whose salivary cortisol will be estimated immediately after an
international flight, on two occasions six hours apart. Cortisol will be
estimated in the same person 5 days after the travel, at the same time of
the day, in the same way. The cortisol level at these two different times
will be compared. Degree of differences between the two cortisol levels
will be correlated to factors such as duration of international air
travel, whether the flight was east-ward or west-ward, whether the
passenger slept on flight and whether the passenger was male or female.
This will lead to recommendations to improve adaptation to the new time
zone, improve sleep patterns, reduce fatigue and improve performance.
Deep vein thrombosis (DVT) is a condition in which a blood clot forms in
the vein and impedes the flow of blood. DVT is the third most common
cardiovascular disease ranking behind acute coronary occlusive events and
strokes. DVT affects approximately 2 million Americans per year. DVT
can lead to pulmonary embolism, which is estimated to cause 34,000 deaths
a year. The true frequency of DVTs for air travelers is unknown. I
propose to do this study to determine the frequency of DVTs for air
travelers. This research will define the risk of DVTs to air travelers.
Cases - flights >= 4 hour duration; Controls - flights < 4 hr duration
Hypothesis: passengers flying < 4 hours duration will have less DVTs than
passengers flying > 4 hours duration
Flights would be randomly selected.
Data to be collected on all persons flying on the specified flight:
- Risk factors; demographics; and past medical history [questionnaire
before boarding flight] - immobility, paralysis, recent surgery &/or
trauma, malignancy, cancer chemotherapy, advancing age (i.e., >60 years),
family history of DVT, pregnancy, and estrogen use; age, sex, etc…;
hypertension, lung conditions, etc…
- Symptoms [questionnaire near end of flight] - leg pain, swelling,
pitting edema, warmth of extremity, redness of extremity, tenderness of
- Physical signs [pre-boarding and at the end of the flight] -
measurement of the leg circumference since the most common physical
finding in those with DVT is the development of sudden edema in one
- Videotaping [during flight] - document passengers movements and
- Testing [randomly selected flyers] - noninvasive doppler flow studies
with duplex imaging
Incentive to participate in study: free first-class round-trip airline
ticket would be given to the person selected randomly from the
participants of that flight
Air rage has been estimated to have increased 15% since the events of
"AIR RAGE, like road rage, is the inability to cope with the
challenges of congested traffic. Just like aggressive driving and road
rage, air rage is so common that most travelers are unaware that they
have it. It's just part of the background feeling that goes along with
the stress of travel and transportation."
Some of the causes of increased air rage are most likely frustration
caused by increased delays and a general increase in anxiety regarding air
travel. People whose normal social inhibition against aggressive behavior
has been weakened by the increased stress of long delays, uncertainty over
newer regulations, general increased anxiety and perhaps alcohol can
regress into unacceptable behaviors. In some cases, however, air rage has
been directly attributed to tobacco use. Nicotine is a highly addictive
drug. Nicotine withdrawal can cause an individual to become irritable and
edgy. Many smokers are also accustomed to using cigarettes as a mechanism
to relieve stress.
This abstract presents preliminary results of a study on the use of
nicotine patches on lengthy airline flights to counteract withdrawal
symptoms associated with prolonged smoking bans. Heavy smokers [greater
then 20 cigarettes per day] traveling on flights expected to last greater
then 2 hours were recruited to participate in a double blind study of
flight stress and nicotine. Consenting participants were randomized to
nicotine patches vs identical appearing placebo patches. All participants
filled out pre and post flight questionnaires accessing their stress
levels, alcohol consumption, flight delays, and general travel
complications [lost baggage etc.].
The so called 'economy class syndrome' might result in deep vein
thrombosis, a condition in which clots develop in the deep veins of the
leg. It usually does not happen in business or first class air travelers.
In 1986, Sarvesvaran R et al. reported that of 104 natural deaths
happened during the flights, 12 occurred due to deep vein thrombosis. In
1999, Ferrari E, et al found that of 160 cases of deep vein thrombosis,
39 had recently traveled. However, only 9 were related to flying while 28
followed a trip by car and 2 by train. Thus the controversy regarding the
economy class syndrome has been existed.
A wide variety of factors may influence an individual's likelihood of
developing deep vein thrombosis such as gender, age, family history of
blood clots, certain blood diseases, recent surgery, physical activity
(those who are more physically active during the flight are less likely to
develop deep vein thrombosis). However, it is not easy to determine
whether the passenger was physically active during the flight.
I would like to test whether those passengers who have window seats and
thus felt less comfortable to walk are more likely to develop deep vein
thrombosis. I propose to conduct a case-control study where cases will be
identified among those passengers who developed deep vein thrombosis after
the flight. The rest of the passengers of the same flight will become a
control group. To increase sample size, we might be needed to evaluate
study subjects from more than one flight. Some adjustments during
statistical analysis (gender, age, family history of blood clots etc.)
will be made.
Fibromyalgia is a chronic pain syndrome, mostly affecting women, with the
presenting symptoms of diffuse myalgia/arthralgia, fatigue, and
non-restorative sleep. Estimated prevalence of fibromyalgia syndrome in
the general population in the United States is 2%, which increases with
age. 80% to 90% of patients have been female, and the mean age has varied
from 30 - 60 years. Flight attendants are likely to be at higher risk of
having fibromyalgia syndrome due to the nature of the occupation. The
potential risk factors are jet-lag, little room for movement or lack of
physical activity, increased stress from change of environments, increase
anxiety from recent terrorism, and being away from family members
frequently. Pain is the most important determinant of "severity", but
psychologic status and functional disability contribute independently to
severity. Previous studies on general populations reported varying
disability rates from 9-44% with regard to function in fibromyalgia.
My hypothesis is that there is a higher prevalence of fibromyalgia
syndrome in flight attendants than the prevalence in the general
population as well as an even higher prevalence of fibromyalgia for those
flight attendants who frequently cross the international date line.
Surveys will be sent out to all the flight attendants employed with
Northwest Airlines. Questionnaires will include the following: 1) the
average mileage/week for the individual flight attendants; 2) any symptoms
of generalized myalgia/arthralgia; 3) chronic fatigue; 4) poor sleep or
nonrestorative sleep; 5) ever been diagnosed with fibromyalgia or
myofascial pain syndrome in the past. The Stanford Health Assessment
(HAQ) will also be included, which is the best predictor of work ability.
This study will identify flight attendants at risk of fibromyalgia
syndrome and increase awareness for early interventions to prevent
Background and Significance:
A quote on the Highway to Health web page reads "And remember: the most
dangerous leg of your journey is the ride home from the airport" and
further reports that the most common way travelers, particularly
international travelers, are injured is in motor vehicle accidents (MVA).
This most often is attributed to the perils of driving under unfamiliar
road conditions. The web abounds with advice to travelers about the risks
of MVAs and methods to reduce this risk. Numerous web sites are also
devoted to jet lag, the effects it has on the body, and methods of
reducing its impact (e.g. melatonin and bright light therapies). Jet lag
occurs when an individual's circadian rhythms are not synchronized (become
"desynchronized") with daylight cues at the point of destination and
become out of phase with other rhythms. Symptoms include fatigue,
insomnia, gastrointestinal disorders, headache, irritability, and
decreased performance on attention-related tasks. The period of
"restabilization" is dependent upon the number of time zones crossed and
can take up to two weeks for full recovery . According to the U.S.
National Highway Traffic Safety Administration, MVAs caused by driver
fatigue is identified as the primary cause of at least 100,000 accidents
and 1,500 fatalities annually. Other studies have reported that drowsy
drivers cause about 50% of fatal accidents on highways . In 1996, 16.5
deaths per 100,000 involving MVAs were recorded . The occurrence of
flying has risen on an average of 2.0% per year since 1971. The health
hazard of MVAs resulting from jet lag caused by air travel is a little
studied, yet serious public health threat . Overall there is no
definitive evidence of the enormity of the accident risk due to jet lag,
either for air accidents, accidents on board, or accidents occurring after
the flight . Numerous studies have established that circadian rhythm
disruptions caused by shift work and high demand jobs (e.g. medical
residents) result in increased accident rates. Little evidence exists
that has directly measured the magnitude of the effects jet lag following
air travel on the incidence of motor vehicle accidents and consequent
morbidity and mortality.
Hypothesis: Sales representatives in positions that require
frequent air flight to destinations in different time zones will have a
greater incidence of MVAs than Sales Representatives with travel
restricted to regional destinations.
Study design: This will be a longitudinal study with the aim to
prospectively follow participants for five years to record the incidence
of MVA's. Data will be collected on age, number of years employed in
current position, alcohol consumption habits, sleep patterns, and number
of miles driven each month. For regional travelers, data will be collected
on the driving conditions associated with each trip (e.g. highway vs.
local roads, etc.). For long distance travelers, data will be collected on
the frequency of trips, the number of time zones crossed each trip and
duration of each trip, as well as a survey of jet lag symptoms following
each business trip. This data will be collected each month.
Sample population: Five large companies employing sales
representatives in positions that require frequent travel to both long
distance and regional locations will be asked to participate. A random
selection of sales representatives will be enrolled in equal size from
two categories of employment:
Sales representatives who are not responsible for their own ground
transportation (e.g. driving) will not be included in the study.
- Sales representatives who routinely travel long
distances by way of commercial aircraft involving passage through at least
one time zone and
- Sales representatives with routine travel involving
distances within 300 miles of home.
For some, flying has always been a fear-inducing event. In the post-9/11
world, flying has seemed more fraught with danger. The increased security
measures may reassure some that flying is not to be feared, but the sight
of armed guards and body searches only heighten the sense of danger for
others. The whole process of getting to the airport, checking in and
boarding the flight, plus the actual flight itself, continually draw
attention to the need for such security measures and the tragedy from
which they resulted. While it is now impossible to study people's
reactions to flying pre-9/11, we can study current reactions and attempt
to determine ways in which the process may be made less anxiety-producing
for those individuals.
This study will attempt to determine the effects of flying on the physical
and psychological well-being of passengers through interview and
monitoring devices. An attempt will also be made to determine coping
strategies that may be useful for anxious passengers and to make
recommendations which will enable more passengers to travel with less
anxiety. Subjects will be randomly selected passengers entering the
airport who agree to participate by answering the interview questions pre-
and post-flight and wearing the heart and pulse monitor throughout. Data
will also be collected regarding any unusual events which occur on the
flight and which could affect participants' responses. Data will be
analyzed to determine how events and thoughts related to flying influence
heart rate and pulse. Results will also be presented on how travel could
be made less anxiety-producing.
College students travel, take risks and are the future airline consumers
of tomorrow. Their perceptions of the risks associated with commercial
airplane travel as well as their ideas for safety improvements can provide
important insight to make airline travel safer. We propose to complete an
internet-based survey of college students' attitudes and perceptions about
commercial airplane safety. This topic is significant because in a global
and mobile society, attitudes and perceptions about airplane safety can
cause more Americans to drive automobiles rather than fly which may lead
to increase mortality related to automobile accidents. Perceptions of
risk are powerful drivers of health behaviors, and college
students'attitudes and perceptions can shape an entire generation of
We propose to administer an internet-based survey of college students'
attitudes and perceptions regarding commercial airplane travel and safety.
This survey will measure exposure in the previous twelve months, as well
as attitudes and behaviors. A random sample of college sophomores and
seniors will be selected from 100 universities and colleges from across
the county, selected to be representative of American post-secondary
institutes. The survey will be introduced initially as an email message
with an internet hyperlink directly to the survey. Up to three follow-up
email messages will be sent to improve response rate.
The survey will include video game-like graphics and music. It will
include simulated scenarios of airplane travel, with prompts for responses
at key locations. Music and images will evoke a variety of moods and
emotions, from relaxed to excited to adventurous to fearful.
The main hypothesis to be tested is to determine if college students are
particularly fearful of flying, what aspects of airplane travel are
particularly of concern, and what are their ideas for improved safety.
Introduction and Significance:
Prolonged non-stop flights imply the hazard of thromboses in the deep
veins of the leg. Recent reports have linked air travel with deep-vein
thrombosis (DVT). Although the magnitude of risk stills a controversial
matter, the risk itself is not. Since more than a billion passengers each
year travel by air, DVT, once called the economy class syndrome, has
become a rather frequent complication among travelers. The true frequency
of deep-vein thrombosis during long-haul air travel still is not well
known. However, in a recent study published in Lancet, it was concluded
based on a relatively small sample size that symptomless DVT might occur
in up to 10% of long-haul airline travelers.
As it was concluded in a recent study that the majority of
venous thrombo-embolism (VTE) associated with air travel occur in those
with identifiable risk factors prior to their flight, certain people are
more vulnerable to develop DVT on a flight, including pregnant women,
people who are overweight, those whose feet don't reach the floor (because
the seat puts more pressure on the backs of their legs), the elderly,
smokers and those with coronary artery diseases and certain blood
Based on the previous data reported increased risk of DVT among
certain vulnerable groups, it is necessary as a second step to investigate
a possible prevention strategy in these groups, the aim of this study is
to test effectiveness of a feasible new seat design (by covering the seat
with thin air filled vibrating cushion) in prevention of DVT on a flight
- Hypothesis: the new seat design decrease the incidence of DVT on a
flight in the study group more than the other group.
- Design: randomized prevention trial.
- Population: economy class long international flight travelers
traveling more than 10 continuous hours who are classified as high risk
group based on questionnaire and examination prior flight.
- Intervention: the travelers population is randomized to either the new
or the regular seats. Both groups are asked not to take aspirin prior
flight, alcohol in flight, or to move more frequent than usual, plenty of
fluids are permitted in both groups.
- Outcome: DVT diagnosis made by ultrasound scans after the flights
(within 24 hours)
Commercial air-liners are by far the safest mode of transportation.
However, is air travel healthy? There have been many reports that suggest
long distance air travel may increase the risk for deep vein thrombosis
(DVT), respiratory diseases, and may aggravate other medical conditions.
We are interested in the psychological impact of air travel on health.
Since the terrorist attacks of September 11, 2001, security measures at
airports, specifically passenger gates have increased dramatically. The
presence of armed military personnel, scanners with increased sensitivity,
and manual searches of personal carry-on items, and ones own person is the
norm. We hypothesize that these increased measures may result in
increased psychological stress, leading to increased levels of
frustration, anxiety, and irritability of air commuters. These effects
may in turn result in negative health consequences for individuals who are
required to travel by air on a regular basis. Furthermore, this increased
stress may influence travelers to select other means of getting to their
destinations, which would result in a decrease in air travel and revenue
for airlines, and may put travelers at increased risk for accidents due to
motor vehicle collisions (the principal alternative to air travel).
To investigate this hypothesis we have formed a collaborative
relationship with USAirways and the federal air safety board. We will
randomly select 500 travelers from the USAirways ticketing records.
Subjects will be asked to complete a simple survey on their experiences
before, during, and following their trip. Subjects will be queried about
the overall experience of the trip and to rate experiences, and to
describe their feelings towards things that may have happened to them from
the time the arrived at the airport until they left the airport of their
destination. Participants will also be given a wrist monitoring device
that will record heart rate, blood pressure, and temperature. Subjects
will wear the wrist watch device for 4 hours before the flight to 4 hours
following their arrival. Data will be downloaded and analyzed by
specially designed software. Subjects will have the opportunity to
follow-up with the investigator to review their biochemical and "diary"
type data. Data will be analyzed with considerations for frequency of air
travel, size and geographic location of airports, age, gender, and SES.
Through this study we hope to develop and understanding of the
degree and types of stress experienced psychologically and physiologically
by air travelers. The data collected in this investigation will impact our
understanding of airport security measures on health and may lead to
improvements in these necessary processes such that traveler stress is
In the last twenty years, as air travel has became less expensive, more
and more people have incorporated long distance flights into their
lifestyle, whether it be for work or pleasure. While this has led people
from around the world to be able to collaborate in business and research
venues, and allowed people to see parts of the world they never imagined,
the long distance flights have not been without their consequences. One
such consequence that is often experienced from rapid time zone shifts,
which disturbs our circadian rhythms, is "jet lag," a term used to
encompass symptoms such as sleepiness, sleeplessness and disturbance in
performance. Jet lag can interfere with a person's ability to be their
best whether they are traveling for work or to sightsee, making it a
concern of the general population. In addition, it may have more critical
consequences for professional athletes, who travel the world to compete
against their most fierce competitors.
Past research that has studied both the determinants of jet lag and the
remedies for decreasing it, has found no major differences in jet lag
between business travelers, tourists and high-performance athletes. They
have also found no significant relief from benzodiazepine drugs such as
triazolam and temazepam, or melatonin, which are all marketed to relieve
jet lag symptoms. A few studies have found that age, time of flight
arrival, and direction of flight affect jet lag, such that younger adults,
those arriving in the evening and those traveling west experience less jet
lag, probably because their inner circadian rhythm re-synchronize more
Since a person can not control their age or the direction they are
traveling, this study aims to confirm the sparse evidence that evening
arrival time improves jet lag. This study will also examine the sleep
patterns of subjects for a full week before travel since this has not been
assessed in other studies and may very well influence jet lag recovery.
If differences in arrival time or pre-trip sleep patterns affect jet lag,
recommendations can be made to travelers who are concerned about their
performance after travel.
300 lay persons and 60 professional soccer players who are scheduled for
an easterly flight across five time zones will be recruited to
participate, such that 120 arrive in the early morning, 120 mid-day and
120 in the evening. A test battery will be administered 7 days before
flight time, and at 4 time periods throughout the first full day of
arrival and then once a day for the next 7 days. Measures in the test
battery will include time of sleep, sleep quality, sleep length,
subjective jet lag (one-to-ten simple analogue scale), tympanic
temperature, one-, two-, four- and eight-choice reaction time, and
strength tests. In addition, as part of the test battery the professional
soccer players will rate their level of performance in their specific
sport, as well as undergo a 2 day pre and 2 and 4 day post treadmill test.
We hypothesize that those who arrive in the evening report less jet lag
and report more quickly that those who arrive in the morning or mid day.
We also hypothesize that those who sleep more hours and report better
sleep quality before their trip will sleep more hours and report better
sleep quality after their arrival and report less jet lag.
There is some truth in the saying that if man was supposed to fly, he
would have been given wings. Recently there has been much talk about
flying and its risks for health. One disturbing fact is that newer jets,
as compared to older models, have been designed with less fresh air
capacity for passengers in economy class. This controversial step-back in
plane technology may present a danger for health of the passengers.
Potential problems include a risk of deep vein thrombosis (DVT) and, more
often, acute respiratory infections that increases a risk of bioterorism.
In-flight air is not humid and fresh enough (humidity falls to 5-10% in
long distance flights), air pressure is low, which together causes
dehydration and hypoxia and slows the blood flow. The oxygen saturation in
our blood falls and our body produces more red blood cells to carry as
much oxygen as possible. Moreover, the concentrations of the body
chemicals associated with blood clotting are increased in such conditions.
Finally, passengers in economy class have less room than normal to move
around and boost circulation in their lower extremities. All these factors
are responsible for increased risk of DVT. Another dangerous aspect of
recycling the air is spreading microorganisms through ventilation system.
Already, there has been evidence that the tuberculosis is spreading easily
through cabin air, so there is an actual danger of spreading many
respiratory germs through ventilation system, especially in economy class
where the air is recycled. Thus, having more fresh air in planes would
improve health status of the passengers and prevent spreading acute
respiratory infections or potential harm of bioterorism act.
Taking into consideration above information and studies that showed that
DVT and acute respiratory infections are potential health hazards in
flying, we are planning to carry out a pilot clinical trial and compare
passengers from planes that followed intervention program and passengers
from planes with regular procedures. We will look at the prevalence of
deep venous thrombosis, acute respiratory infections, allergies and visual
problems to see if our intervention program made a significant difference.
It is estimated that on Boeing 747 aircraft the average cost of running an
air package is 80$/hour. If the aircraft is full (about 400 people), it
should cost us 20¢ per passenger per hour to have completely fresh air.
Intervention program will increase air packs usage on randomly selected
flights. Also, passengers on these flights will be given a brochure
explaining health risks. The brochure will recommend exercising the day
before the flight, in flight exercises with detailed description, and a
preventive low dose of aspirin before the flight (with previous
consultation with the doctor that we will provide). Passengers will be
advised to avoid alcoholic and coffee beverages (diuretically effects), to
wear comfortable cloths, and wash hands with soap and water before
touching mouth, eyes and nose. Servings of beverages will be doubled.
Intervention program will be inexpensive and easy to implement. Before
flying we will collect baseline data and after landing the passengers will
be examined. Examination will be repeated after 7 days. We will also
establish offices at the Pittsburgh International Airport and at the
airports in London and Frankfurt in collaboration with our colleagues
abroad. Prior to the flight, passengers who are willing to participate
will sign informed consent.
We propose to collect a descriptive report of deaths consequent to fly
that have occurred in the past year, named "possible post-fly deaths"
(PPFD). The purpose of the PPFD report is to clarify whether flying truly
exposes at higher risk of death when deaths rates are compared with the
The PPFD report will include all the causes of death that have occurred
within 48 hrs from the arrival and have not been caused by any other major
accident or injury. The specified cause of death (e.g.: pulmonary
embolism, stroke etc.), race, age, gender, number of previous
comorbidities and number of known risk factors for cardiovascular diseases
(being all the deaths conducible to cardiovascular factors) will be
reported, together with origin, duration (hrs) and final destination of
the flight. These variables will be used to construct a regression
analysis model to answer the question: is flying significantly predicting
the death of these subjects? What is the proportion of deaths attributable
to flying alone? We will then compare this value to the known predictive
value of each single known risk factor (including age, gender, race,
number of comorbidities) for each of the causes of deaths observed in the
PPFD report. A comparison of the mortality after a flight with the
mortality in the general population will also be evaluated.
The issue of the relationship between air travel and health is a major and
important topic in contemporary times given recent reports in the news
media and suspicion by physicians and the public of increased risk of
diseases such as deep venous thrombosis and pulmonary embolism, luekemia
and skin cancers and the transmission of infectious diseases such as
tuberculosis. Of particular importance also is the issue of safety in air
travel given the recent tragic terrorist attacks in New York and
Washington DC on September 11, 2001. In addition, the volume of air
traffic has been increasing in the past two decades and this is likely to
continue as a result of cheaper airfares. Another important issue is the
threat of lawsuits against airline companies by victims of air travel
There has been limited research in the area of health risks associated
with air travel due primarily to difficulties in the design and conduct of
such studies. Most of of the initial studies have been case reports mostly
of cases of deep vein thrombosis and pulmonary embolism in individuals
after long-haul flights. Recently three case-control studies have examined
the risk of thromboembolism associated with long distance travel but the
results have been conflicting. Some other studies have tried to evaluate
the cancer risk associated with increased exposure to cosmic radiation in
air travel but again the results are not conclusive due to difficulties in
evaluation of exposure and other confounding variables related to the
etiology of these disorders. The argument for an increased risk of
infections such as tuberculosis from air travel is more tenuous. Except
for few case reports, there appear to be no solid evidence in support of
such a hypothesis. Safety issues have become a major issue of concern
globally in the recent past and this has been hieghtened by information
mismanagement. Available data, however, indicate that the incidence of
airplane crash has been falling consistently since the 1970s. In
conclusion, although it is biologically plausible to speculate that air
travel may be associated with increased risk of certain health-related
risks, the extent of the problem appears to be overestimated due to the
lack of adequate data on the subject. There is need for properly designed
randomized trials to address this important issue in the 21st century to
ensure more healthy and safer flights for the global community.
To maximize profits, airlines have taken steps that affect the comfort of
their customers, the passengers. Namely they have decreased seat size,
overbooked flights, and possibly decreased the amount of oxygen in the
cabin. The increased discomfort caused by these changes may be leading to
an increase in what has become known as "air rage". The potential assault
of flight personnel and fellow passengers is a health risk of flying.
I propose a study to measure the incidence of "air rage". All U.S.
airlines will be invited to participate. An internet-based coordinating
center will be established. Each time an incident occurs, a member of the
flight crew will complete an online questionnaire regarding the incident.
Data collected will include a description of the nature of the attack and
any injury to crew or passengers. If possible, airline records will serve
as a source for the amount of oxygen used in the cabin during the flight.
Outcome measurements will be incidence of air rage attacks and the number
and types of injuries sustained.
Traveling by airplane has become more and more common. However, there are
only a few researches investigating the relationship between health and
flying. The less people know about something, the more dangerous people
will think it is. The main idea of this study is to link and compare the
health condition during flying to that during other transportations.
A belt like instrument will be designed to monitor both external
and internal index for a person while he or she is traveling by airplane,
by bus, by car, by train, by bike, by walk and while this person is stay
at home and at the office. External indexes include temperature, moisture,
pressure, light, cosmic radiation and infectious origins. Internal indexes
include blood pressure, heart rate, breath, blood dynamic index, tension
of muscles and contraction of digestive organs. 50 men and women between
18 to 75 years old will be recruited for the study. They will be followed
up for three to six months until they finish all the above traveling and
staying methods. The instrument will collect data continuously for one
hour and three times under each of the above conditions. The mean and
changing pattern of both internal and external indexes will be compared
for each condition.
The hypothesis is: all the health related indexes are the same
during flying compared with those during traveling by other
After the recent terrorist attacks in Washington D.C. and New York, a
great deal of attention has been given to both flight security and
bioterrorism. The first one, obviously because the destructive potential
demonstrated and the possibility of killing innocent people aboard
airplanes and the second because of the potential mass hazard that could
be perpetrated on large populations. Nonetheless, little (or no) attention
has been given to a possible combination of these two issues.
Air-borne viruses are the easiest organisms to be spread among a large
number of people. At least two viruses deserve special concern due to
their potential disastrous consequences. The first one, the smallpox
virus, "eradicated" form our environment, but still preserved, somewhere
by someone. The other one is the influenza virus, our old acquaintance not
really lethal at this point, but I'm sure that the 1918 pandemic showed us
its potential, and nobody knows if a genetic-modified '1918-like' strain
could be developed for bioterrorist purposes.
A very efficient way to widely spread smallpox or influenza viruses in the
US (or anywhere else in the world) would be the use of airplanes. In a
coordinated fashion it would be easy for terrorists to get inside
airplanes going to different US cities, infected with the either virus, in
a early phase of the disease, when it is highly contagious and the
symptoms have not yet been fully developed.
Given this situation it is imperative that some kind of early detection of
this threat be developed before a disaster of unprecedented magnitude take
place among our population. The purpose of this project id to develop a
sputum-based rapid diagnosis test for smallpox and influenza viruses to be
used in airports around the country - or perhaps the world.
The structures of these viruses are very different. The smallpox virus
(Poxviridae family) is a double-stranded DNA virus, while the influenza
virus (Orthomixoviridae family) is a single-stranded RNA virus. Because of
that there should be developed two different media to diagnose each of the
viruses, even though the idea for both is the same: to develop a
color-sensitive medium to detect DNA or RNA-specific fragments of the
virus genome from a simple sputum sample. The first phase of the project
is to develop the media in vitro and subsequently test it with animal
models and then with the public itself. For this last phase, we cannot use
real cases of smallpox, only if there's a real epidemic, but we can use
cases of regular strains of influenza virus.
It is a well-known fact that airplane passengers spend most of the entire
flight in a sitting position. Except for first class passengers, there is
a limited amount of leg room space. Since airplane passengers are now
expected to arrive at the airport at least 2-3 hours prior to their
scheduled departure, travelers are more likely to develop circulation
problems such as deep vein thrombosis (DVT) as a result of the additional
In the past, there has been much debate about the risk of developing DVT,
especially during lengthy flights. Although data have inconsistent
regarding the risk of DVT and flying, the additional time passengers spend
in the airports and during flights may increase the occurrence of this
serious health problem.
To test the hypothesis that airplane travel increases the risk of
developing DVT, airline passengers scheduled on flights longer than 2.5
hours in duration will be asked to complete a 10-item questionnaire at the
conclusion of the flight. Passengers will be randomly selected as they
exit the plane. The 10-item questionnaire will include demographic
information, general health, frequency of airline travel, feelings of
discomfort, and predisposing conditions that may increase the risk of DVT
such as previous injury to the leg, recent surgery, poor circulation,
pregnancy, infections liver disease and some cancers.
The questionnaire will be administered by airline staff. Participants
will be asked for contact information to facilitate a brief follow-up
self-administered interview (postcard format) 4 weeks after to the
baseline interview. Follow-up questions will inquire about the onset of
any health conditions after airline travel. Participants who do not return
the completed follow-up postcard will be contacted again by mail and then
by telephone, if possible, and interviewed via telephone. The
interviewing phase will be conducted for approximately six months.
Air quality in the passenger cabins of commercial airplanes has been an
ongoing concern for many years. In 1986, The National Research Council of
the National Academies published "The Airliner Cabin Environment: Air
Quality and Safety". As a result the Federal Aviation Administration (FAA)
tightened its air quality standards that included elimination of smoking
in all domestic flights, requiring more fresh air in the cabin, lowering
the maximum level of carbon dioxide, and developing better record keeping
systems. As a result of these changes, research shows that air quality
has improved significantly in today's airplanes. However, the FAA
airworthiness standards in Part 25, Subpart D, Design and Construction
Specifics, includes current standards for certifying larger passenger
airplanes that are purchased by the airlines. The section only specifies
standards for new transport category airplanes and these may not be the
standards that were applied when older airplanes were certified. The
standards were not developed to retrospectively apply to older airplanes
and therefore the air quality may not be as good in older airplanes that
are still in use today. A comparison of air quality between airplanes
constructed prior to and after 1986 may lead to further air quality
The following null hypothesis will be tested: there is no difference in
the quality of commercial airplane cabin air between airplanes built prior
to and after 1986. Quality of air is defined as per the FAA's airplane
cabin air quality standards. Air sample analysis will be done for
airplanes built before and after 1986. The data will then be analyzed and
recommendations will be made if appropriate.
Hypothesis: There is no association between the disruption of Circadian
rhythms and the incidence of depression in flight attendants on long haul
international flights when compared to those on short domestic
Within the medical literature it is an accepted fact that consistent
disruptions in the Circadian rhythm can lead to depression and
psychological stress. Flight attendants on long-haul flights
(transatlantic or equatorial or polar (North-South/East-West)) may be at
increased risks for depression when compared to flight attendants on
domestic (30' to 6 hr) flights. Severe depression has a profound impact
on an individual's ability to function, i.e. day-to-day activities and can
be detrimental to job performance.
Methods: Flight attendants (FAs) currently employed by American Airlines
and living in the Dallas-Forth Worth region were eligible for this study.
Dallas-Forth Worth is the hub for American Airlines and the majority of
its FAs reside in this region. FAs with long-haul/domestic assignments
will be recruited using contact information from the airline's Human
Resources Departments and the American Airline Flight Attendants' Union.
After sending an introductory letter, flight attendants will be recruited
(contacted and consented) and interviewed at their homes by Registered
Nurses with specialties in mental health. Demographic data, depression
and stress inventories will be administered. Depression will be measured
using the Beck's Depression Inventory and the Hamilton Rating Scale for
Depression. A sub-sample of interviews will be taped (with the consent of
the study participant) and evaluated by the team psychologist in order to
monitor the reliability of interviewer rating. Employment histories will
be obtained from the airline's Human Resources Department, i.e, number of
flights completed by week, month and year, number of international vs
domestic flights, types of airplanes that crew members have flown on,
applications for sick leave and reasons for requesting sick leave etc.
The airline's health insurance carriers will be queried for data on claims
for doctor's visits, both for primary and specialist care. The outcome
variable will be the number of individuals with receiving scores that
indicate some form of depression. Studentized t- tests will be used to
compare the scores obtained for FAs on long-haul and domestic flights.
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