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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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 55:818–824
Arcury TA, Quandt SA, Preisser JS, Norton D (2001b) The incidence of green tobacco sickness among Latino farmworkers. J Occup Environ Med 43(7):601–609
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):1008–1011
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 5:315–321
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):33–45
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):384–389
Behera D, Uppal R, Majumdar S (2003) Urinary levels of nicotine and cotinine in tobacco users. Indian J Med Res 118:129–133
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):341–353
Centers for Disease Control and Prevention (CDC) (1993) Green tobacco sickness in tobacco harvesters—Kentucky, 1992. MMWR Morb Mortal Wkly Rep 42(13):237–240
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):344–351
Commission of the European Communities (Commission) (2003) Tobacco regime—extended impact assessment. Commission staff working document. Commission of the European Communities, Brussels
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):203–210
Curwin BD, Hein MJ, Sanderson WT, Nishioka MG, Buhler W (2005) Nicotine exposure and decontamination on tobacco harvesters’ hands. Ann Occup Hyg 49(5):407–413
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):257–263
Eckholm E (1978) Cutting tobacco’s toll. British-American Tobacco Company 20
Etter JF, Vu Duc T, Perneger TV (2000) Saliva cotinine levels in smokers and nonsmokers. Am J Epidemiol 151(3):251–258
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
Gehlbach SH, Williams WA, Perry LD, Woodall JS (1974) Green-tobacco sickness. An illness of tobacco harvesters. JAMA 229(14):1880–1883
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):478–480
Gehlbach SH, Williams WA, Freeman JI (1979) Protective clothing as a means of reducing nicotine absorption in tobacco harvesters. Arch Environ Health 34(2):111–114
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):45–47
Gosh SK, Saiyed HN, Gokani VN, Thakker MU (1986) Occupational health problems among workers handling Virginia tobacco. Int Arch Occup Environ Health 58:47–52
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):121–124
Ives T (1983) Use of dimenhydrinate in the treatment of green tobacco sickness. Drug Intel Clin Pharm 17:548–549
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 43:285–294
Mannetje A, Kogevinas M, Chang-Claude J, Cordier S, Gonzalez CA et al (1999) Occupation and bladder cancer in European women. Cancer Causes Control 10:209–217
McBride JS, Altman DG, Klein M, White W (1998) Green tobacco sickness. Tob Control 7:294–298
McKnight RH, Spiller HA (2005) Green tobacco sickness in children and adolescents. Public Health Rep 120:602–605
Nakamura T (1984) Tobacco dermatitis in Japanese harvesters. Contact Dermatitis 10:310–318
Nefedov VB, Popova LA, Zhalolov ZZ (1991) Lung function in tobacco growers suffering from exogenous allergic alveolitis (in Russian). Ter Arkh 63(3):124–126
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 15:517–530
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
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 45:140–145
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):1127–1131
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 47:494–499
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):495–501
Priester WA, Mulvihill JJ (1975) Letter: green-tobacco sickness. Lancet 1(7910):803
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 37:307–315
Rao P, Quandt SA, Arcury TA (2002) Hispanic farmworker interpretations of green tobacco sickness. J Rural Health 18(4):503–511
Salvi RM, Lara DR, Ghisolfi ES, Portela LV, Dias RD, Souza DO (2003) Neuropsychiatric evaluation in subjects chronically exposed to organophosphate pesticides. Toxicol Sci 72:267–271
Swinker M, Meredith JT (2000) A seizure in the tobacco field. Green tobacco sickness. N C Med J 61(1):390–392
Szarmachz H, Poniecka H (1973) Contact allergy in agriculture (in Polish). Przegl Dermatol 60(4):479–484
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):656–661
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):27–37
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 29:3–16
Ulbrich S (1994) Haze still surrounds green tobacco sickness (news). J Natl Cancer Inst 86(6):419–420
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
Weizenecker R, Deal WB (1970) Tobacco cropper’s sickness. J Fla Med Assoc 57:13–14
World Health Organization (WHO) (2004) Tobacco and poverty. A vicious circle. World Health Organization, Geneva
The DIRERAF study was supported by partial financing from the EU Health and Consumer Protection Directorate and the Stavros Niarchos Foundation.
Conflict of interest statement
We declare that we have no conflict of interest.
*On behalf of the DIRERAF partners:
1. Department of Hygiene and Epidemiology, Medical School University of Athens
2. Institute of Preventive Medicine, Environmental and Occupational Health
3. Nofer Institute of Occupational Health
4. International Centre for Pesticides and Health Risk Prevention
5. Institut Municipal d’Investigacio Medical
6. Erasmus University, Rotterdam
7. Technische Universität Dresden
8. Charles University of Prague
9. Finish Institute of Occupational Health
10. Medical University of Sofia Institute of Rural Health, Bratislava
About this article
Cite this article
Schmitt, N.M., Schmitt, J., Kouimintzis, D.J. et al. Health risks in tobacco farm workers—a review of the literature. J Public Health 15, 255–264 (2007). https://doi.org/10.1007/s10389-007-0122-4
- Farm worker
- Green tobacco sickness
- Health risk
- Occupational disease