Journal of Public Health

, Volume 15, Issue 4, pp 255–264 | Cite as

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

  • Natalie M. Schmitt
  • Jochen Schmitt
  • Dimitris J. Kouimintzis
  • Wilhelm Kirch
Review Article

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.

Keywords

Farm worker Green tobacco sickness Health risk Occupational disease Tobacco 

References

  1. Arcury TA, Quandt SA, Preisser JS (2001a) Predictors of incidence and prevalence of green tobacco sickness among Latino farmworkers in North Carolina, USA. J Epidemiol Community Health 55:818–824CrossRefGoogle Scholar
  2. Arcury TA, Quandt SA, Preisser JS, Norton D (2001b) The incidence of green tobacco sickness among Latino farmworkers. J Occup Environ Med 43(7):601–609CrossRefGoogle Scholar
  3. Arcury TA, Quandt SA, Garcia DI, Preisser JS, Norton D, Rao P (2002) A clinic-based, case-control comparison of green tobacco sickness among minority farmworkers: clues for prevention. South Med J 95(9):1008–1011PubMedGoogle Scholar
  4. Arcury TA, Quandt SA, Preisser JS, Bernert JT, Norton D, Wang J (2003a) High levels of transdermal nicotine exposure produce green tobacco sickness in Latino farmworkers. Nicotine Tob Res 5:315–321CrossRefGoogle Scholar
  5. Arcury TA, Quandt SA, Simmons S (2003b) Farmer health beliefs about an occupational illness that affects farmworkers: the case of green tobacco sickness. J Agric Saf Health 9(1):33–45Google Scholar
  6. Ballard T, Ehlers J, Freund E, Auslander M, Brandt V, Halperin W (1995) Green tobacco sickness: occupational nicotine poisoning in tobacco workers. Arch Environ Health 50(5):384–389PubMedCrossRefGoogle Scholar
  7. Behera D, Uppal R, Majumdar S (2003) Urinary levels of nicotine and cotinine in tobacco users. Indian J Med Res 118:129–133PubMedGoogle Scholar
  8. Browning SR, Truszczynska H, Reed D, McKnight RH (1998) Agricultural injuries among older Kentucky farmers: the farm family health and hazard surveillance study. Am J Ind Med 33(4):341–353PubMedCrossRefGoogle Scholar
  9. Centers for Disease Control and Prevention (CDC) (1993) Green tobacco sickness in tobacco harvesters—Kentucky, 1992. MMWR Morb Mortal Wkly Rep 42(13):237–240Google Scholar
  10. Chloros D, Sichletidis L, Kyriazis G, Vlachogianni E, Kottakis I, Kakoura M (2004) Respiratory effects in workers processing dried tobacco leaves. Allergol Immunopathol (Madr) 32(6):344–351Google Scholar
  11. Commission of the European Communities (Commission) (2003) Tobacco regime—extended impact assessment. Commission staff working document. Commission of the European Communities, BrusselsGoogle Scholar
  12. Curwin BD, Hein MJ, Sanderson WT, Nishioka M, Buhler W (2003) Acephate exposure and decontamination on tobacco harvesters’ hands. J Expo Anal Environ Epidemiol 13(3):203–210PubMedCrossRefGoogle Scholar
  13. Curwin BD, Hein MJ, Sanderson WT, Nishioka MG, Buhler W (2005) Nicotine exposure and decontamination on tobacco harvesters’ hands. Ann Occup Hyg 49(5):407–413PubMedCrossRefGoogle Scholar
  14. D’Alessandro A, Benowitz NL, Muzi G, Eisner MD, Filiberto S, Fantozzi P, Montanari L, Abbritti G (2001) Systemic nicotine exposure in tobacco harvesters. Arch Environ Health 56(3):257–263PubMedCrossRefGoogle Scholar
  15. Eckholm E (1978) Cutting tobacco’s toll. British-American Tobacco Company 20Google Scholar
  16. Etter JF, Vu Duc T, Perneger TV (2000) Saliva cotinine levels in smokers and nonsmokers. Am J Epidemiol 151(3):251–258PubMedGoogle Scholar
  17. Food and Agriculture Organization of the United Nations (FAO) (2006) FAOSTAT. Food and Agriculture Organization of the United Nations, Rome, Italy. Available from http://faostat.fao.org. Cited 13 Feb 2007
  18. Gehlbach SH, Williams WA, Perry LD, Woodall JS (1974) Green-tobacco sickness. An illness of tobacco harvesters. JAMA 229(14):1880–1883PubMedCrossRefGoogle Scholar
  19. Gehlbach SH, Williams WA, Perry LD, Freeman JI, Langone JJ, Peta LV, Van Vunakis H (1975) Nicotine absorption by workers harvesting green tobacco. Lancet 1(7905):478–480CrossRefGoogle Scholar
  20. Gehlbach SH, Williams WA, Freeman JI (1979) Protective clothing as a means of reducing nicotine absorption in tobacco harvesters. Arch Environ Health 34(2):111–114PubMedGoogle Scholar
  21. Gosh SK, Parikh JR, Gokani VN, Kashyap SK, Chatterjee SK (1979) Studies on occupational health problems during agricultural operation of Indian tobacco workers. A preliminary survey report. J Occup Med 21(1):45–47Google Scholar
  22. Gosh SK, Saiyed HN, Gokani VN, Thakker MU (1986) Occupational health problems among workers handling Virginia tobacco. Int Arch Occup Environ Health 58:47–52CrossRefGoogle Scholar
  23. Gosh SK, Gokani VN, Parikh JR, Doctor PB, Kashyap SK, Chatterjee BB (1987) Protection against “green symptoms” from tobacco in Indian harvesters: a preliminary intervention study. Arch Environ Health 42(2):121–124CrossRefGoogle Scholar
  24. Ives T (1983) Use of dimenhydrinate in the treatment of green tobacco sickness. Drug Intel Clin Pharm 17:548–549Google Scholar
  25. Kimura K, Yokoyama K, Sato H, Nordin RB, Naing L, Kimura S, Okabe S, Maeno T, Kobayashi Y, Kitamura F, Araki S (2005) Effects of pesticides on the peripheral and central nervous system in tobacco farmers in Malaysia: studies on peripheral nerve conduction, brain-evoked potentials and computerized posturography. Ind Health 43:285–294PubMedCrossRefGoogle Scholar
  26. Mannetje A, Kogevinas M, Chang-Claude J, Cordier S, Gonzalez CA et al (1999) Occupation and bladder cancer in European women. Cancer Causes Control 10:209–217PubMedCrossRefGoogle Scholar
  27. McBride JS, Altman DG, Klein M, White W (1998) Green tobacco sickness. Tob Control 7:294–298PubMedCrossRefGoogle Scholar
  28. McKnight RH, Spiller HA (2005) Green tobacco sickness in children and adolescents. Public Health Rep 120:602–605PubMedGoogle Scholar
  29. Nakamura T (1984) Tobacco dermatitis in Japanese harvesters. Contact Dermatitis 10:310–318PubMedCrossRefGoogle Scholar
  30. Nefedov VB, Popova LA, Zhalolov ZZ (1991) Lung function in tobacco growers suffering from exogenous allergic alveolitis (in Russian). Ter Arkh 63(3):124–126PubMedGoogle Scholar
  31. Noland MP, Kryscio RJ, Riggs RS, Linville LH, Perritt LJ, Tucker TC (1990) Use of snuff, chewing tobacco, and cigarettes among adolescents in a tobacco-producing area. Addict Behav 15:517–530PubMedCrossRefGoogle Scholar
  32. Olade R, Lessnau KD (2006) Tobacco worker’s lung. WebMD, e-medicine, March 2006. http://www.emedicine.com/med/topic2282.htm. Cited 12 Feb 2007
  33. Onuki M, Yokoyama K, Kimura K, Sato H, Nordin RB, Naing L, Morita Y, Sakai T, Kobayashi Y, Araki S (2003) Assessment of urinary cotinine as a marker of nicotine absorption from tobacco leaves: a study on tobacco farmers in Malaysia. J Occup Health 45:140–145PubMedCrossRefGoogle Scholar
  34. Osim EE, Musabayane CT, Mufunda J (1998) Lung function of Zimbabwean farm workers exposed to flue curing and stacking of tobacco leaves. S Afr Med J 88(9):1127–1131PubMedGoogle Scholar
  35. Parikh JR, Gokani VN, Doctor PB, Kulkarni PK, Shah AR, Saiyed HN (2005) Acute and chronic health effects due to green tobacco exposure in agricultural workers. Am J Ind Med 47:494–499PubMedCrossRefGoogle Scholar
  36. Preisser JS, Arcury TA, Quandt SA (2003) Detecting patterns of occupational illness clustering with alternating logistic regressions applied to longitudinal data. Am J Epidemiol 158(5):495–501PubMedCrossRefGoogle Scholar
  37. Priester WA, Mulvihill JJ (1975) Letter: green-tobacco sickness. Lancet 1(7910):803PubMedCrossRefGoogle Scholar
  38. Quandt SA, Arcury TA, Preisser JS, Norton D, Austin C (2000) Migrant farmworkers and green tobacco sickness: new issues for an understudied disease. Am J Ind Med 37:307–315PubMedCrossRefGoogle Scholar
  39. Rao P, Quandt SA, Arcury TA (2002) Hispanic farmworker interpretations of green tobacco sickness. J Rural Health 18(4):503–511PubMedCrossRefGoogle Scholar
  40. Salvi RM, Lara DR, Ghisolfi ES, Portela LV, Dias RD, Souza DO (2003) Neuropsychiatric evaluation in subjects chronically exposed to organophosphate pesticides. Toxicol Sci 72:267–271PubMedCrossRefGoogle Scholar
  41. Swinker M, Meredith JT (2000) A seizure in the tobacco field. Green tobacco sickness. N C Med J 61(1):390–392PubMedGoogle Scholar
  42. Szarmachz H, Poniecka H (1973) Contact allergy in agriculture (in Polish). Przegl Dermatol 60(4):479–484Google Scholar
  43. Trapé-Cardoso M, Bracker A, Grey M, Kaliszewski M, Oncken C, Ohannessian C, Barrera LV, Gould B (2003) Shade tobacco and green tobacco sickness in Connecticut. J Occup Environ Med 45(6):656–661PubMedCrossRefGoogle Scholar
  44. Trapé-Cardoso M, Bracker A, Dauser D, Oncken C, Barrera LV, Gould B, Grey MR (2005) Cotinine levels and green tobacco sickness among shade-tobacco workers. J Agromedicine 10(2):27–37PubMedCrossRefGoogle Scholar
  45. Ueda A, Ueda T, Matsushita T, Ueno T, Nomura S (1987) Prevalence rates and risk factors for allergic symptoms among inhabitants in rural districts. Jpn J Ind Health 29:3–16Google Scholar
  46. Ulbrich S (1994) Haze still surrounds green tobacco sickness (news). J Natl Cancer Inst 86(6):419–420PubMedCrossRefGoogle Scholar
  47. United States Department of Agriculture, Foreign Agricultural Service (USDA) (2004) World’s leading unmanufactured tobacco producing, trading, and consuming countries. United States Department of Agriculture, Washington, D.C. Available from http://www.fas.usda.gov/tobacco/circular/2004/082004/TBL1.PDF
  48. Weizenecker R, Deal WB (1970) Tobacco cropper’s sickness. J Fla Med Assoc 57:13–14PubMedGoogle Scholar
  49. World Health Organization (WHO) (2004) Tobacco and poverty. A vicious circle. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Natalie M. Schmitt
    • 1
  • Jochen Schmitt
    • 2
  • Dimitris J. Kouimintzis
    • 3
  • Wilhelm Kirch
    • 1
  1. 1.Research Association Public Health Saxony, Medizinische Fakultät Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  2. 2.Department of Dermatology, Unit of Dermato-Epidemiology and Health Services Research, University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  3. 3.Department of Hygiene and Epidemiology, School of MedicineNational and Kapodistrian University of AthensAthensGreece

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