This study suggests that there are modifiable dietary and lifestyle factors that can be addressed within or around flight attendants’ work environment to reduce the risk of COVID-19 and other illnesses. The significant findings between perceived influence of the COVID-19 pandemic on the quality of dietary consumption, perceived diet quality, and COVID-incidence suggests that the flight attendant workspace may be a key area for improvement among airlines to modify potential risks for COVID-19 that are rooted in sleep pattern disturbances, and/or are dietary in etiology.
It is well known that dietary intake is vital for optimal health. Eating a well-balanced diet is crucial to obtain all the daily nutrient recommendations necessary for enhanced immune health and improved overall health status33,34. The WHO has suggested an increased intake of fruit and vegetable consumption beyond pre-pandemic recommendations during this time period to lower the risk of potential infection35. However, studies assessing dietary habits during the pandemic have demonstrated that an increase in processed foods has occurred for many individuals instead36. Furthermore, other studies have shown that nutritional deficiencies can potentially contribute to COVID-19 infection and severity37,38,39. The findings from this study demonstrate similar results with perceived occupational dietary intake to be ‘poor’ or ‘fair’ being associated with positive COVID-19 incidence. Despite the workplace being a major venue for food consumption amongst working adults, there remain many questions surrounding the content of a flight attendant’s diet at work and how it supports the health of the worker40. One study of 5,222 adults found that nearly a quarter of all polled working adults consumed food at work, which was characteristically ripe with foods that are high in sodium and added sugars as well as solid fats40. These are all foods that can contribute to the onset of a variety of chronic illnesses when consumed in excess. In another study, over 30% of adults polled who purchase their meals at work, indicated that workplace cafeterias and vending machines were amongst their most frequented sites of food acquisition41. This suggests the potential for the worksite to be a powerful target location for the promotion of healthy behaviors which can support optimal immune function. Due to the fluid the nature of flight attendants’ work environment and limited access to healthy foods, especially during the pandemic and with their higher incidence of certain chronic diseases, it is imperative that this workgroup is supported in their efforts to consume a healthy diet to reduce risk from environmental exposures to infectious diseases and mitigate the development of chronic diseases. Since the present study is the first of its kind to illuminate occupational lifestyle factors associated with COVID-19 incidence, more research is warranted to add to the scare data on the topic to illuminate how the workplace can best be adjusted to support healthy behaviors.
Respondents reported the largest barrier preventing them from introducing more healthy foods into their diet while working was a lack of infrastructure for food storage. This highlights the need for ensuring access to reserved refrigerated storage. The solution to ensuring flight attendants have adequate storage space on board the airplane to accommodate fresh foods and meals is crucial to improving dietary intake during the pandemic and beyond. This is especially pertinent for flight attendants who have multi-day duty period and/or have extended duty period hours. Access to fresh foods at airports and even local shopping venues during layovers may be compromised due to drastic measures put in place in response to pandemic lockdown strategies, including reduced operational hours, and time for enhanced cleaning strategies42. Additionally, early restaurant and grocery store closures may also not be conducive to the flight schedules of late arriving flights and shorter layover durations, calling for the increased consideration on these occasions during the pandemic and in the future43. Additionally, early training to prepare flight attendants for certain dietary and lifestyle challenges associated with life ‘on the fly’ in the absence of typical daily amenities is needed, however further research is warranted to investigate these health promotion efforts.
Another area of focus indicated by this study is the role of sleep disturbance connected to overall flight attendant health. This point is consistent with the current literature and presents a unique challenge to the flight attendant work group, as longer duty days and changing time zones may interfere with their ability to follow normal sleep schedules44,45. One study found that fatigue rooted in inadequate sleep or sleep disturbance is a common experience amongst flight attendants and affected about 84% of flight attendants polled over the course of their most recent bid period43. Of this group, 71% of flight attendants indicated fatigue impacting their safety-related duties. However, concerns associated with sleep and fatigue span beyond safety-related concerns. Another study which monitored the sleep habits of 202 flight attendants indicated that participants in this study had an average of 6.3 h of sleep at home, 5.7 h of sleep when working, and an even lower average when flying internationally46. Such sleep durations fall below the recommended 7–9 h that are suggested for optimal immune function for adults47. Research has demonstrated diet can impact sleep duration and quality significantly, while poor sleep can negatively influence dietary choices significantly. This is a point which was echoed by Perrin, et al. as their findings demonstrated that disruptions in circadian rhythm amongst flight attendants can subsequently interfere with established eating patterns48,49,50. Our study found similar findings between sleep disturbances interfering with diet quality and risks for positive COVID-19 incidence. Inadequate sleep has also been shown to be connected to reduced immunity function, which may also be a part of the explanation for those who had a higher incidence of confirmed or suspected COVID-19 occurrence also having a higher annual frequency of colds51. Solutions to these issues surrounding inadequate sleep may include a continuing focus during pandemic-times on the period of rest allotted to flight attendants during trips. This may also allow for greater opportunity to access healthy food options as after-hour food venues of convenience are often rich with energy-dense, nutrient-poor food options. Given that diet can play a role in sleep and sleep can impact dietary consumption, these two factors need to be addressed rapidly to combat the COVID-19 pandemic and beyond.
Although this study focuses on a small subset of modifiable factors with regards to COVID-19 risk amongst flight attendants, it is important to note that future studies could better inform the literature by further investigating the many factors which were not within the scope of the present paper. These established risk factors include one’s race, ethnicity and residence, factors which have been established to be risk factors for COVID-19 within the general population are of particular interest3,4,5,6,7,8,9,10,11,12,13,14. Further occupational factors, such as the temperate environment of airplanes, as well the air quality of selected layover destinations may also provide further information on possible risk factors for COVID-19 and subsequent measures of intervention. Temperature variation, humidity, and the presence of air pollution (especially when associated with lower wind speeds) are all factors which have been established to compromise immunity and potentially increase risks for COVID-1913,14,52,53. Strategic approaches to manage crisis should include preventative measures, such as the amelioration of related risk factors54. Therefore, the identification of further risk factors for flight attendants can help inform strategic approaches for future mitigating measures during the COVID-19 pandemic or a potential similar threat arise in the future.
https://www.nature.com/articles/s41598-021-04350-0
