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Editor,—The development of the US Federal Aviation Administration policy to prohibit smoking in both the passenger cabin and flight deck of scheduled passenger flights1 2 offers lessons that may be considered in other countries and workplace settings. This policy was driven by the findings that environmental tobacco smoke (ETS) is a serious health risk to those exposed, that aircraft air quality was adversely affected by cigarette smoke, and by frequent complaints of respiratory irritation by crew and passengers.3-5 Similar concerns have been raised in other occupational settings such as prisons.6 The development and implementation of the policy, however, was slowed and complicated by fears that prohibiting smoking might adversely affect pilot performance. This summary of the policy development and the cited references may be useful in other efforts to develop smoke-free workplace settings in which there are similar challenges of impaired performance and attendant safety concerns.
In 1978, a National Institutes of Health report on cigarette smoking and airline pilots concluded that while smoking itself did not have significant effects on flight safety, the adverse effects of smoke withdrawal might adversely affect pilot performance.7 This finding supported the exemption of the flight deck from the commercial aircraft smoking ban that was passed by the US Congress in 1989.8 9 Nonetheless, many airlines voluntarily developed their own policies restricting smoking on the flight decks, and the successful implementation of these policies supported the April 2000 government action to ban smoking throughout commercial aircraft. To conform to the new legislation, the office of the Secretary of the US Department of Transportation and the FAA amended their smoking policies and have published updated rulings.1 2
Scientific knowledge of the effects of smoking and nicotine withdrawal, as well as treatment options, expanded considerably after 1978,10 and in 1994 the FAA requested that the Centers for Disease Control assemble an expert panel to follow up on the 1978 report, re-examining the effects of smoking and smoke deprivation relevant to pilot performance.11 The science documented in that report supports the banning of smoking that was ordered by regulators in 2000. In brief, the panel concluded that nicotine withdrawal in dependent cigarette smokers does not generally lead to cognitive and behavioural deficits until at least four hours after the last cigarette. Because more than 94% of US commercial flights are less than four hours in duration it was assumed that there would be sufficient opportunity for pilots not able to completely cease smoking to smoke before flights. Furthermore, the panel observed that nicotine withdrawal related performance deficits could be prevented using nicotine replacement medications. This knowledge and such medications were not available in 1978. The facts that less than 15% of pilots smoke and that most pilots actually reported discomfort and decreased performance as a result of ETS11 provided additional support for the policy. The ideal course recommended for tobacco using pilots of longer flights was treatment for tobacco dependence to alleviate withdrawal symptoms and sustain abstinence.11
Our discussions with several airlines and government regulatory agencies suggest that the policies are not yet well understood nor have they been adequately disseminated. Nonetheless, it appears that smoking restrictions on flight decks and passenger cabins are being implemented without major problems or concerns regarding safety. In practice, implementation of such policies may be increasingly manageable as the prevalence of cigarette smoking continues to decline in many sectors of the workforce. Finally, the greater range and accessibility to effective treatments for tobacco dependence and withdrawal available both with and without prescriptions should make this goal more practical.
Correspondence to: Jack E Henningfield, PhD, Pinney Associates, Inc, 4800 Montgomery Lane, Suite 1000, Bethesda MD 20814, USA;&
The research and writing of this letter was supported by a Robert Wood Johnson Foundation's Innovators Combating Substance Abuse grant awarded to JEH.
Competing interests: Pinney Associates Inc undertakes commissioned research from GlaxoSmithKline on smoking cessation and related matters. JEH has a financial interest in a nicotine gum product that is under development.
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