Occurrence of green tobacco sickness and associated factors in farmers residing in Dom Feliciano Municipality, Rio Grande do Sul State, Southern Region of Brazil

Abstract

This study aimed to evaluate the occurrence of the green tobacco sickness (GTS) and its associated factors in tobacco familiar farmers residing in Dom Feliciano, Rio Grande do Sul State, Brazil. A cross-sectional study was conducted evaluating the sickness in 354 small tobacco farmers, between October 2011 and March 2012. The urinary concentration of cotinine, a biomarker of exposure to nicotine, was determined during the tobacco harvest period. Subjects presenting cotinine urinary levels ≥ 50ng/mL, that had contact with tobacco leaves up to 48 hours before the sample collection and reported at least one disease symptom were deemed as cases. A non-conditional logistic analysis was performed to evaluate the association between GTS and the population characteristics. A total of 122 (34.5%) cases were identified, with 39% of them being smokers and 61% being males. The median cotinine urinary concentrations were 75.6ng/mL (74.1ng/mg of creatinine) for non-cases and 755.8ng/mL (632.1ng/mg of creatinine) for the cases (p-value ≤ 0.01). The multivariate analysis showed a positive association between GTS and sunlight exposure time, exposure to pesticides, worse health status, and inverse association with wood cultivation. This study presented a high GTS prevalence and suggest that the use of urinary cotinine is a significant biomarker to determine GTS cases, influencing in the distribution by sex. Once the tobacco production involves health hazards, is important to implement measures to prevent the harm caused to tobacco farmers, as set in articles 17 and 18 of the World Health Organization Framework Convention on Tobacco Control.

Deteriorating Quality of Life and a Desire to Stop Growing Tobacco Among Virginia and Burley Tobacco Farmers in Thailand

“…One of the considerable health issues among tobacco farmers is green tobacco sickness, which involves skin-to-skin contact with nicotine poisoning from tobacco leaves that is absorbed and inhaled, causing symptoms such as dizziness, nausea, and vomiting. 6 - 10 In addition, through the harvesting of tobacco leaves, they are likely to be at risk of exposure to toxins and accumulated pesticides, 11 which were associated with an increased risk of cancer in farmers, 12 development of mental health problems because of depression, and increases in suicide because of poverty, debt, and family stress. 13 …”

“…One of the considerable health issues among tobacco farmers is green tobacco sickness, which involves skin-to-skin contact with nicotine poisoning from tobacco leaves that is absorbed and inhaled, causing symptoms such as dizziness, nausea, and vomiting. [6][7][8][9][10] In addition, through the harvesting of tobacco leaves, they are likely to be at risk of exposure to toxins and accumulated pesticides, 11 which were associated with an increased risk of cancer in farmers, 12 development of mental health problems because of depression, and increases in suicide because of poverty, debt, and family stress. 13 For these reasons, the WHO has mandated in Article of the WHO Framework Convention on Tobacco Control to support activities that are economically beneficial to tobacco cultivation as one of the combined measures to reduce tobacco demand sustainably and to ensure that the member states meet the requirements of the Convention.…”

Biomonitoring of Nicotine Exposure in Tobacco Farmers with Green Tobacco Sickness Symptoms

“…Article 3 by Campos et al (2020) is a cross sectional study in Dom Feliciano, Rio Grande do Sul, Brazil investigating the factors associated with the occurrence of GTS. Samples were taken from as many as 354 tobacco farmers who were considered to meet the criteria.…”

“…Cotinine can be measured in a variety of biological matrices (e.g., blood, saliva, and urine) (Campos et al, 2020). Urine samples are preferred and considered suitable for measuring cotinine because urine is easier to collect and has a higher concentration than serum or saliva.…”

“…Different studies have suggested different cutoffs for cotinine levels in the urine (Balhara and Sarkar, 2016). According to Article 3, GTS appeared when urinary cotinine levels were 756 ng/mL (632 ng/mg Cr), not too different from Article 2 with 700-1000 ng/mg Cr (Park et al, 2018;Campos et al, 2020). Article 4 shows a lower level (144 ng/mL), whereas the study was conducted on tobacco farmers specifically the Burley tobacco (Cezar-Vaz and Cargnin, 2019).…”