OBJECTIVE: To study associations between the cockpit environment, psychosocial work environment, home environment, and medical symptoms in a cohort of commercial pilots followed over 3 yr.METHODS: A standardized questionnaire was mailed in February-March 1997 to all Stockholm-based pilots on duty in a Scandinavian flight company (N = 622); 577 (93%) participated. During this time smoking was allowed on long haul flights, but not on shorter flights. Smoking was prohibited on all flights after September 1997. The same questionnaire was sent to the cohort of 577 pilots in February-March 2000; 436 participated (76%). The questionnaire contained questions on symptoms, the psychosocial work environment, and the home environment. Associations were investigated using multiple logistic and ordinal regression.RESULTS: Symptoms were common, especially eye symptoms (38.5%), nose symptoms (39.9%), and tiredness (29.9%). Pilots exposed to environmental tobacco smoke (ETS) on long haul flights had more eye symptoms (odds ratio = 1.91) and tiredness (odds ratio = 2.73). These symptoms were reduced when no longer exposed to ETS. Those who started working on long haul flights developed more nose symptoms. Pilots reporting increased work demands developed more nose and dermal symptoms and tiredness and those with decreased work control developed more eye symptoms. Pilots living in new houses, multifamily houses, and in recently painted homes reported more symptoms.CONCLUSION: Eliminating ETS exposure on board reduced medical symptoms. Further work to reduce ETS exposure globally is needed. Psychosocial aspects of the work environment for commercial pilots should be considered, as well as the home environment.Fu X, Lindgren T, Norbäck D. Medical symptoms among pilots associated with work and home environments: a 3-year cohort study. Aerosp Med Hum Perform. 2015; 86(5):458–465.