Health risks in tobacco farm workers—a review of the literature

Abstract

Aim To systematically describe and summarize the specific occupational health impact of tobacco farm working. Subjects and methods Qualitative systematic review applying a standardized electronic literature search strategy (MEDLINE, TOXNET, EMBASE, AGRICOLA, Science Citation Index; until January 2007) and hand search within eligible articles. Double assessment of eligibility and study results. Inclusion of all studies on specific work-related health risks of tobacco farm workers, e.g. risk factors for and frequency of green tobacco sickness (GTS) and other specific health risks, as well as intervention studies.Results We identified 31 relevant publications. Concerning GTS substantial heterogeneity was observed in terms of the case definition and frequency of disease occurrence. Seasonal prevalence ranged between 8 and 89%. Incidence was reported to be 1.9 cases per 100 person days. In the two studies included on primary prevention of GTS hand washing and the use of protective clothes were effective. Studies conducted on cancer as well as on urticaria and contact eczema in tobacco harvesters are scarce. Conclusion Health problems due to transdermal nicotine absorption are frequent among tobacco harvesters. GTS as well as chronic health effects in this population need to be further investigated. The toxicity to the cardiovascular system and carcinogenicity of chronic dermal nicotine exposure are likely to exist as non-smoking tobacco harvesters show similar cotinine and nicotine levels compared to active smokers in the general population. Effective intervention strategies addressing the specific needs of the tobacco harvesters in different regions around the world must be developed, evaluated and further improved. It is important to educate tobacco farm workers, farmers and health care providers on GTS and other health risks.

First reported outbreak of green tobacco sickness in Brazil

“…The signs and symptoms observed among the workers of the region (vomit, nausea, headache and dizziness) were also described by Arcury et al 2,3,4 during tobacco production in Hispanic farmworkers in the USA. In our study, case-patients were identified during the period of tobacco harvesting in the region, when greatest exposure of the farmers to the nicotine in the tobacco leaves occurs 5,6,10 .…”

“…The condition has not been reported in any country of the Latin American region or in Brazil, which is the second largest tobacco producer in the world 6 with more than 190,000 family farmer families involved in the farming of tobacco.…”

“…Diagnosis is based on the triad of a history of exposure to tobacco farming, clinical presentation, and elevated nicotine or cotinine levels 1,2,3,4,5,6 . Cotinine, the main metabolite of nicotine measurable in saliva, blood and urine, is widely used as a measure of nicotine exposure 7 .…”

“…The incidence and prevalence of green tobacco sickness have been described in the United States, India, Japan, Malaysia and Italy 6,7,10 . The condition has not been reported in any country of the Latin American region or in Brazil, which is the second largest tobacco producer in the world 6 with more than 190,000 family farmer families involved in the farming of tobacco.…”

“…Cases were reported as acute pesticide intoxication among tobacco workers during the months of August and September, when tobacco harvesting occurs 12 . However, pesticide use is minimal during the harvest season, leading to a suspicion that the cases might be due to green tobacco sickness 6,7,10 .…”