Aug 1, 2006 speech to the St Louis County Council
I just became aware that some studies have been conducted to determine if flight attendants are at increased risk of health due to increased exposure to cosmic radiation. However, since these workers were exposed to lots of smoke during most of their careers, these data also can be used to access if ETS is really a hazard.
The largest, of approximately 58,000 USA flight attendants, found they had 37 to 42% as much lung cancer as would be normally be expected. These flight attendants were either retired, or actively working in the airline industry between 1988 and 1995. Their work history goes back well into the 1970s:
"In summary, this study provides strong evidence that while the overall cancer experience of flight attendants does not differ from that of the general population, they do experience higher rates of certain cancers, particularly female breast cancer and malignant melanoma of the skin. This observation is consistent with similar suggestions from the limited literature on this topic to date."
Ref: http://ashsd.afacwa.org/docs/CDPH_AFA%20Final%20Report%20to%20BCRP.pdf
A study of Greek airline workers found only 1/10 the incidence of lung cancer expected. It should be noted, approximately ½ of all Greeks were active smokers during the study period 1960-1997, so the prevalence of smoking in the airline cabins was high.
". METHODS: We performed a retrospective cohort study including 843 Olympic Airways cockpit crew and 1835 cabin attendants. RESULTS: For cockpit crew, the overall SMR ( Standard Mortality Ratio) was 0.7 The SMR for all cancers was also significantly decreased (n = 17; SMR = 0.6; Most of this reduction was due to a large deficit in lung cancer deaths (SMR = 0.1; The SMR for cardiovascular death was close to unity. Among female cabin attendants the SMR for all causes was 0.8 The SMR for all cancers was 0.8 Mortality from breast cancer was not increased. Among male cabin crew, SMR for all causes was 0.5 Analyses according to duration of employment showed no pattern. Ref: http://ije.oxfordjournals.org/cgi/content/full/32/2/244 .
And a study of 44,000 European cabin attendants over 15 years, when smoking was allowed on European airlines, found "The cardiovascular mortality of female cabin crew, regardless of time since first employment, was consistently 60-70 percent (male cabin crew: 30-40 percent) lower than that in the general population." And lung cancer was only 88% of expected.
"Among airline cabin crew in Europe, there was no increase in mortality that could be attributed to cosmic radiation or other occupational exposures to any substantial extent.." Ref http://aje.oxfordjournals.org/cgi/content/full/158/1/35
The following is a clarification concerning ventilation cannot protect nonsmokers: Amer Soc. of heating, refrigeration and air-conditioning engineers has actually stated ventilation cannot protect nonsmokers in the smoking area, but it can protect nonsmokers in the nonsmoking area. June 2005. See: http://www.ashrae.org/content/ASHRAE/ASHRAE/ArticleAltFormat/20058211239_347.pdf
Recently, a 45-year-old man died of a heart attack while riding a rollercoaster . In fact such events as heart attack and stroke are not uncommon among older amusement park patrons on thrill rides. If your worried that you might have a heart attack or stroke in an amusement park, don't go on these thrill rides, but we don't ban others from doing so.
Within this past week a skydiving plane crashed right here in Missouri, killing 6.
If your worried you might die skydiving, don't go, but we don't ban others from doing so.
We have drownings in our public waterways all the time. Yet, no one's talking about banning swimming in our public waterways. Every year or two, someone drowns in a motel swimming pool right here in our county. Yet I hear no discussion about banning swimming pools.
Banning outdoor swimming pools and water parks would also help cut future incidences of malignant melanoma of the skin; the deadly skin cancer whose incidence is increasing. This kind of ban would protect future incidences of skin cancer among lifeguards and maintenance personal in these outdoor facilities too. Yet if your worried about skin cancer, you just don't go to these facilities, but we don't ban others from doing so.
Several years ago Sonny Bono died colliding with a tree while snow skiing. Yet we don't hear any call for banning snow skiing. If your worried about having an accident snow skiing, don't go, but we don't ban others from doing so.
Every year, one or two NASCAR drivers die. We could protect these workers if we banned NASCAR, but I don't hear of any proposals to do so.
There are lots of entertainment and recreational activities which carry risk of injury and death, for which the cause-effect link is indisputable. EG: there are no studies finding NASCAR drivers are no more likely to die in a crash than the rest of us. There are no studies finding outdoor life guards are no more likely to get malignant melanoma than the rest of us.
There are no studies finding swimmers are no more likely to drown than those who do not go swimming. But there are lots of studies which find those exposed to smoke get no more disease than those not so exposed.
The point is, patronizing bars, bowling alleys, casinos, and restaurants are entertainment and recreational activities too. Even if you believe the presence of smoke carries a risk, these venues are patronized by those who are well aware of the supposed risks, and are willing to accept them in order to enjoy the recreational activity, analogous to the other entertainment and recreational activities I just spoke of.
Those who are worried about skin cancer can patronize indoor pools. Lifeguards worried about skin cancer can work at indoor pools. Workers and patrons worried about smoke can work in and patronize smoke-free bars and restaurants.
In fact, I believe singling out one risk associated with entertainment and recreational activities, while ignoring other kinds of risk connected with other kinds of entertainment and recreation is discriminatory. If the concern is public health, then banning all the activities I just spoke of is justified, otherwise, none are justified.
David W. Kuneman
Flight Attendants exposed to smoke in confines of aircraft had less lung cancer and in one study, the same heart disease rates as other workers not exposed.
Zeeb, 2003 no excess mortality of airline crews in europe from occupational exposures
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Blettner, 2003,flight crews had lung cancer SMR=.53 1960-1997
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Paridau 2003 very low lung cancer deaths among Greek cabin crews
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Blettner, 2002, occupational exposure of German flight crews not associated with risk of cancer.
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Reynolds, 58,000 domestic flight attendants, RR= .37 to .42 for lung cancer 1988 to 1995 but remember most of these attendants worked back in the 1960's 70s and 80s
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I have compiled a list of secondhand smoke studies with outcomes less than 1.05 the risk of not being exposed to secondhand smoke.
Wang 1997 OR= 0.91
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Wang 1996 not sig
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Kabat 1996 little risk
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Kabat 1995 little association
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LeVois 1995 ETS and CHD not related (publication bias study)
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Layard, 1995 little association ETS and isochemic heart disease
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LaVois 1994 workplace ETS exposure does not cause Lung cancer
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Crawford, 1991 Flight attendants exposed to less than one cig equivalent/year.
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