Review Article

Journal of Public Health

, Volume 15, Issue 4, pp 255-264

First online:

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

  • Natalie M. SchmittAffiliated withResearch Association Public Health Saxony, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden Email author 
  • , Jochen SchmittAffiliated withDepartment of Dermatology, Unit of Dermato-Epidemiology and Health Services Research, University Hospital Carl Gustav Carus, Technische Universität Dresden
  • , Dimitris J. KouimintzisAffiliated withDepartment of Hygiene and Epidemiology, School of Medicine, National and Kapodistrian University of Athens
  • , Wilhelm KirchAffiliated withResearch Association Public Health Saxony, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden

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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.


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.


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.


Farm worker Green tobacco sickness Health risk Occupational disease Tobacco