Uniforms

Your uniform, your health

In September 2016, AFA members at Envoy, Piedmont, and PSA were provided with new uniforms manufactured by TwinHill. These uniforms are the same as those provided to Flight Attendants at mainline American Airlines (AA). Since then, a growing number of our members are reporting symptoms associated with wearing the new uniforms. The reported symptoms include rash/irritated skin, eye irritation, breathing problems, and headaches. They mirror the types of symptoms reported by our sisters and brothers who are wearing these uniforms at AA.
 
The purpose of this page is to:

  1. Encourage you to report your uniform reactions to AFA;
  2. Make sure that you know your options to get out of the uniform, if needed;
  3. Keep you updated on how AFA is advocating for you;
  4. Provide you with information on the chemical contents of these clothes (where known); and
  5. Provide you with contact information for your AFA representatives.

Quick summary of the advice and information on this page:

  1. If you have a uniform reaction (symptoms that develop when you wear the uniform and improve when you are not wearing the uniform), then document it promptly with your airline and report to AFA;
  2. Make it a priority to follow the directions on this page specific to your airline in order to get out of the uniform into an alternative;
  3. Keep a record of your symptoms and see a doctor, as necessary. If you see a doctor, bring the information on this AFA bulletin. Ultimately, fabrics contain complex mixture of chemical compounds, many of which are undefined. Thus, finding the causal factor(s) will be challenging. The most effective way to protect your health is to wear an alternative uniform if the uniform you are wearing is correlated with symptom onset;
  4. Follow the workers' compensation rules at your carrier, as necessary; and
  5. Contact AFA for help. The bottom line is that no uniform should make you sick.

IF YOU HAVE REACTED TO THE UNIFORM(S), REPORT TO AFA

Calling all members! Please report to AFA using this reporting form so that we can best understand what is happening on the line and advocate on your behalf. Your responses will be kept confidential within AFA and will not be shared with the company. Make sure you also report to your airline, and keep a copy of all reports and correspondence for your records.

OPTIONS TO GET OUT OF THE UNIFORM, AS NEEDED:

Given the uncertainty about the chemical contents of these fabrics and the concerns that have been raised, we recommend as a precaution that pregnant/nursing Flight Attendants wear their blues or their own purchased uniform-like garments for now.

Envoy

  • Members with uniform issues do NOT need a doctor's note to opt out of wearing TwinHill uniform
  • Members with uniform issues are instructed to call the TwinHill/AA Call Center ((1-800-327-0117; select 2,5,6,1, pause, 2) to select an alternative uniform option and get a shipping label to return garments.
  • Members DO have the option to wear their old "blues" (VF Solutions). If they don't have their old "blues", management may be able to source suitable "blues" for them from an inventory of returned garments.
  • Members DO have the option to purchase two grey suiting “bottoms” (i.e., skirt or pants) plus two shirts, and can be reimbursed for some of the cost.
  • Members can request a polyester alternative TwinHill uniform, but it is backordered for approximately four months. However, AFA recommends the other options (i.e., wearing “old blues” or purchasing like-garments) until the chemical contents of the polyester-alternative garments have been defined.
  • Contact your AFA MEC Safety/Health/Security Chair, Baraka Davis for help if the company response does not address your needs. Remember to contact Baraka using your personal email account.

Piedmont

  • Members with uniform issues do NOT need a doctor's note to opt out of wearing TwinHill uniform
  • Members with uniform issues are instructed to call INFLIGHT (and then later call the TwinHill/AA Call Center ((1-800-327-0117; select 2,5,6,1, pause, 2) to get a shipping label to return garments)
  • Members DO have the option to wear their old "blues" (also made by TwinHill, but a different batch). If they don't have their old "blues", management may be able to source suitable "blues" for them from an inventory of returned garments.
  • Members DO have the option to purchase two grey suiting “bottoms” (i.e., skirt or pants) plus two shirts, and can be reimbursed for some of the cost.
  • Members can request a polyester alternative TwinHill uniform, but it is backordered for approximately four months. However, AFA recommends the other options (i.e., wearing “old blues” or purchasing like-garments) until the chemical contents of the polyester-alternative garments have been defined.
  • Contact your AFA MEC Safety/Health/Security Chair, Kimberley Bohr for help if the company response does not address your needs. Remember to contact Kimberley using your personal email (not your company email).

PSA Airlines

  • PSA management posted detailed instructions for Flight Attendants who wish to opt out of the uniform on Feb. 7, 2017.
  • Members with uniform reactions do NOT need a doctor's note to opt out of wearing TwinHill uniform.
  • Members with uniform reactions are instructed to email INFLIGHT directly and await instructions to either wear their "blues," or purchase "uniform-like" grey garments and be reimbursed for "reasonable costs," all as described in the online posting dated Feb. 7, 2017.
  • Contact your AFA MEC Safety/Health/Security Chair, Megan Hughes for help if the company response does not address your needs. Remember to contact Megan using your personal email (not your company email).

HOW IS AFA ADVOCATING FOR YOU?

  • Your AFA Master Executive Council (MEC) representatives at the three affected carriers (Envoy, Piedmont, and PSA) are working in partnership with staff at the AFA International Safety, Health, & Security Department, Legal Department, and Communications Department.
  • AFA developed an online uniform reaction reporting system and is actively gathering reports and photos of adverse reactions from our members. (If you have reacted to the uniforms, please report to AFA, in confidence, if you have not already done so.)
  • AFA has collected a sample of each garment and has shipped them to a specialist lab for chemical testing.  (More details on chemical testing)
  • AFA has (and will continue to) notify our members who have had adverse reactions to the uniforms of their options to wear something else to work, as described on this website. This includes members who have reacted to the uniforms, or who are concerned about wearing them, either because of pre-existing medical conditions, being pregnant, or planning to become pregnant.
  • AFA has actively worked to clarify uniform options for our members and to push for parity across airlines. It is neither fair nor appropriate for management to treat Flight Attendants at the wholly-owned regional carriers differently than those employed by the mainline American Airlines.
  • AFA is squarely on the record with management at PSA, Piedmont, and Envoy that our affected members need practical, accessible, clear, consistently-applied options for wearing alternative uniform. And for Flight Attendants whose only option is to purchase uniform-like garments, we need the option for them to buy (and be reimbursed for) the cost of a full uniform complement.
  • AFA has carefully researched Flight Attendant uniform options and has identified a safe vendor that uses reliably-sourced fabrics that meet recommended health and environmental standards. We have provided this information to all three carriers and asked that they pursue a new contract with either this or an equivalent uniforms vendor for the good of the Flight Attendant work group.
  • AFA has developed guidance on selecting a new vendor and the suitable garments to protect safety, health and security.
  • For more information about chemicals in clothes in general, visit AFA's uniforms page. Bottom line: your uniform should not make you sick.

CHEMICAL TESTING

Where possible, AFA has monitored available chemical testing reports on these uniform garments. The types of chemicals of concern (listed below in more detail) include:

  • Irritants – chemicals that cause irritation to the skin, eyes, or respiratory tract that is local to the part of the body that is exposed to the chemical in question;
  • Sensitizers – chemicals that cause an immune-mediated response which is generally more serious than the "local" type of irritant reaction and may be systemic, rather than localized;
  • Endocrine disruptors – chemicals that are structurally similar to human hormones, such that they can disrupt hormonal cycles;
  • Carcinogens – chemicals that either can (confirmed ) or may (probable/possible) cause uncontained cell growth/tumor formation; and
  • Other toxins – chemicals that can be toxic to the nervous system, bladder, liver, kidneys, etc.

Testing in a small sample of these uniform garments identified the compounds listed here:

Irritants –

  • 2-Bromo-4,6-dinitro-benzeneamine: women's parka with fur
  • 2-Butoxy ethanol: women's crew scarf
  • 2-(phenylmethylene)-octanol: women's pilot pants and blouse
  • 9,10-Anthracenedione: men's "car coat"
  • 9, 10-Dimethylanthracene: black men's tie
  • 9-0ctadecenoic acid: men's/women's pilot blazers
  • Benzaldehyde: women's pilot blazer
  • Bis-(2-hydroxyethyl)lauramide: men's crew blazer
  • Butylated hydroxytoluene: men's coat, women's parka with fur
  • Caprolactam: women's crew blazer, men's copilot jacket, women's crew jacket
  • Docosane: women's pilot blouse and neckwear, men's car coat, shirt (undefined)
  • Isopropyl palmitate (1-methylethyl ester hexadecanoic acid): women's jacket
  • Methyl palmitate (methyl ester hexadecanoic acid): women's blue-checkered blouse, dress, women's jacket, men's blue tie
  • N-ethyl-4-methyl benzenesulfonamide: women's pilot blouse
  • Octadecane: women's pilot neckwear, men's/women's pilot blazers, men's long-sleeved white shirt, men's long-sleeved pilot shirt, women's short-sleeved blue blouse
  • Oleic acid: pants (undefined)
  • Tridecanol: women's pilot blouse
  • Undecanol: women's pilot blouse

Sensitizers

  • Benzyl benzoate: men's pilot tie, long-sleeved men's "rip stop" shirt
  • Disperse orange dye 30: men's pilot tie
  • 2-(phenylmethylene)-octanol: women's pilot pants and blouse
  • Benzaldehyde: women's pilot blazer
  • 9,10-Anthracenedione: men's "car coat"
  • 9, 10-Dimethylanthracene: men's black tie

AFA is aware that the chemical testing lab in question dismissed the relevance of the presence of these compounds in the sample of tested garments, claiming that the levels of each compound are "too low to worry about" (essentially) and may be sourced to personal care products, in some cases. However, there are no allowed/recommended limits for most of these chemicals in clothes. And even if there were health-based limits published for every one of these compounds, the health effects of physical contact with a complex mixture of chemicals is undefined. There are few health-based standards for individual chemicals in fabrics, and there are no standards for contact with complex chemical mixtures in fabrics. The chemical content of clothes sold in the US is practically unregulated.

On Oct. 28, 2016, another report noted the presence of "detectable amounts" of:

  • Pentachlorophenol: an organochlorine compound which can be used as an insecticide, fungicide, and algaecide; it is a highly irritating compound and the EPA classifies it as a probable carcinogen; also, tetrachlorophenols and trichlorophenols; and
  • Free and partially releasable formaldehyde: can be added to fabrics to prevent shrinkage and make fabrics color-fast and wrinkle-resistant, but also an irritant, sensitizer, and carcinogen.

Beyond some of the specific chemicals that have been reported in these uniform garments there is a body of literature on the health effects of contact with certain chemicals in clothes. The chemicals that are cited most often include:

  • AP/APEO: Alkylphenol ethoxylates (APEO) are often called alkyphenols or alkylphenyls (AP); they can be used in textile production as detergents, coating agents, waterproofing agents, adhesives, and in printing/dyeing operations, but they are also endocrine disruptors.
  • Dimethyl fumarate: anti-fungal agent which may be added to packaging material to prevent mold growth during overseas shipment, but also a skin/eye/respiratory irritant and a potent sensitizer; 
  • Dyes, including azo dyes (wool/cotton fabrics) and disperse dyes (synthetic fabrics): add color, but can be allergenic/irritant and/or contain toxic metals;
  • Formaldehyde: can be added to fabrics to prevent shrinkage and make fabrics color-fast and wrinkle-resistant, but also an irritant, sensitizer, and carcinogen;
  • Metals such as chromium, lead, mercury, and (most commonly) nickel: can be added to dyes, and can be sensitizers, neurotoxins, etc.;
  • Perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA): may be used as stain repellants, but are also endocrine disruptors, and PFOA may have a negative impact on thyroid and liver function; and
  • Phthalates: may be found in synthetic fabrics (including those made from recycled plastics) and plastic buttons, both to make them more flexible and to decrease the melting temperature of plastics during production, but are also endocrine disruptors.

Other chemicals in clothes include chlorinated benzene/toluene-based compounds and pesticides. Most of the chemicals listed above, plus the additional chemicals listed below, were identified in Flight Attendant uniform fabrics during an investigation of reported symptoms at another AFA carrier from 2011-14:

  • Tributyl phosphate: can be used as a wetting agent in textile production, but also an irritant and potential endocrine disruptor;
  • Heptadecafluorodecyl acrylate: can be used as a coating agent in polyester dyeing processes but also an irritant to the skin, eyes, and respiratory tract; and
  • Perchloroethylene: a dry-cleaning chemical, but also an irritant, central nervous system depressant, and probable carcinogen.

Even the published literature will not capture all of the possible chemicals that are added to clothes because the market is so diverse and fluid. A single garment may be comprised of multiple fabrics sourced to different factories all over the world, each with its own standards and production practices.  The origin of each of the fabrics that comprise these garments is unknown but, collectively, a sample of 14 of these TwinHill garments were assembled in five countries (Bangladesh, China, Indonesia, Sri Lanka, and Vietnam). See Table 1.

Table 1: Sample of uniform garments, description of component fabrics, and country of origin

Garment Fabric composition Country where fabrics were assembled
white shirt FABRIC (white): 100% cotton Bangladesh
blue checkered shirt FABRIC (blue/white checkered): 100% cotton Bangladesh
scarf FABRIC (navy/red/medium blue): 100% polyester China
suiting pants OUTER FABRIC (dark grey):  53% wool/45% polyester/2% spandex suiting fabric; LINING FABRIC (light grey): 94% polyester/6% elastane lining fabric on front of legs; POCKET FABRIC (black striped): composition not defined Indonesia
apron FABRIC (dark grey): 67% cotton, 33% polyester Bangladesh
suiting vest OUTER FABRIC (dark grey): 53% wool/45% polyester/2% spandex suiting fabric; LINING FABRIC (dark grey): 94% polyester, 6% elastane Indonesia
suiting skirt ("wrap skirt") OUTER FABRIC (dark grey): 53% wool/45% polyester/2% spandex suiting fabric; LINING FABRIC (light grey): 94% polyester/6% elastane; POCKET FABRIC (black): composition not defined Indonesia
suiting dress OUTER FABRIC (dark grey): 53% wool, 45% poly, 2% elastane suiting fabric; LINING FABRIC (light grey): 94% polyester/6% elastane lining fabric Sri Lanka
polyester alternative skirt OUTER FABRIC (dark grey): 63% polyester, 33% viscose, 4% elastane; LINING FABRIC (light grey): 94% polyester/6% elastane; POCKET FABRIC (black): composition not specified Indonesia
suiting blazer OUTER FABRIC (dark grey): poly/wool blend suiting fabric, specifics not  listed on label; LINING FABRIC inside body of blazer (light grey): synthetic fabric, composition not specified; LINING FABRIC in arms of blazer (cream with grey stripes): composition not specified Vietnam
all-weather coat OUTER FABRIC (black): water-repellant exterior fabric with strip of charcoal-colored fabric down the interior front alongside the strip of buttons (fabric content not specified); LINER: detachable liner with "3M Thinsulate label" and grey padding (65% olefin/35% polyester) on the side facing out, with slippery light grey lining (95% polyester/6% elastane) on the interior Vietnam
cardigan sweater (buttoned) KNIT FABRIC (medium-blue): 61% acrylic, 23% wool, 16% nylon China
cardigan sweater (zipper) KNIT FABRIC (dark grey): 60% acrylic, 25% wool, 15% nylon China
cardigan sweater (zipper) KNIT FABRIC (dark grey): 80% acrylic, 20% nylon China

Comprehensive chemical testing has not been conducted on a representative sample of garments and it is not clear if the test results listed above represent the garments in circulation now. AFA has sent these 14 garments to a specialist lab for testing.

If you have symptoms associated with wearing these garments, keep a record of symptom onset/improvement and see a doctor, as necessary. If you see a doctor, bring the information on this AFA bulletin. Talk to them about what testing may be helpful; for example, skin patch/prick testing may help to identify the causal factor(s) for skin reactions. Ultimately, fabrics contain complex mixture of chemical compounds, many of which are undefined. Thus, finding the causal factor(s) will be challenging. The most effective way to protect your health is to wear an alternative uniform if the uniform you are wearing is correlated with symptom onset.

CONTACT INFORMATION FOR AFA SAFETY AND HEALTH REPRESENTATIVES

More questions? Contact your AFA - MEC Safety Health & Security Chair – details below.

AFA favors progressive uniform policies that prioritize Flight Attendants' health and well-being.

And for more information about chemicals in clothes in general, visit AFA's Air Safety, Health, & Security Department uniforms page. Bottom line: your uniform should not make you sick.

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