Green tobacco sickness and skin integrity among migrant Latino farmworkers

Recent and projected changes in global climate may increase nicotine absorption and the risk of green tobacco sickness

BACKGROUND

Dermal transfer of nicotine during tobacco harvest can cause green tobacco sickness (GTS), characterized by nausea, vomiting, headache and dizziness. Rainfall and high temperatures are etiological factors known to increase the prevalence of GTS. We analyzed recent and projected trends in these factors for major tobacco-growing regions to assess potential exacerbation in GTS occurrence.

METHODS

We analyzed climate parameters, including recent trends (since the 1970s) in temperature and precipitation metrics during the tobacco harvest period for Southern Brazil; Yunnan Province, China; Andhra State, India; and North Carolina, USA. We applied Shared Socio-economic Pathways (SSPs) based scenarios for Tier 1 Scenario Model Intercomparison Project (ScenarioMIP) within the Coupled Model Intercomparison Project phase 6 (CMIP6), (SSPs of 1-2.6, 3-7.0 and 5-8.5 from 2020 to 2100). Established protocol for nicotine dermal patches and temperature were used as a proxy to estimate potential nicotine absorption.

RESULTS

For three locations, cumulative maximum temperatures during harvest and temperature extremes rose significantly since the 1970s as did cumulative rainfall during harvest. Projected maximum temperatures at SSP 3-7.0 and 5-8.5 projections through 2100 did increase for all locations. Estimates of nicotine skin absorption with rising temperature show significant increases for both recent changes in three locations, and for all locations for SSP projections of 3-7.0 and 5-8.5 from 2020 to 2100.

CONCLUSIONS

This study across multiple continents, highlights a potential link between recent and projected anthropogenic change and potential increases in GTS risk. Under SSP 5-8.5, nicotine absorption could increase by ~50% by the end of the century, which may have widespread impacts on the incidence of GTS, especially among younger tobacco workers.

Recent and Projected Changes in Global Climate May Increase Nicotine Absorption and the Risk of Green Tobacco Sickness

Background

Dermal transfer of nicotine during tobacco harvest can increase green tobacco sickness (GTS), characterized by nausea, vomiting, headache and dizziness. Rainfall and temperature are established etiological factors known to increase prevalence of GTS. We aimed to analyze recent and projected trends in these factors for major tobacco growing regions to assess potential exacerbation in GTS occurrence.

Methods

We analyzed climate parameters, including trends in temperature and precipitation metrics during the tobacco harvest period for Southern Brazil; Yunnan Province, China; Andhra State, India; and North Carolina, USA (~50-year period). We applied Shared Socio-economic Pathways (SSPs) based scenarios for CMIP6, (SSPs of 1-2.6, 3-7.0 and 5-8.5 from 2020 to 2100). Established protocol for nicotine dermal patches and temperature was used as a proxy to estimate potential nicotine absorption with rising temperature.

Results

For three locations, cumulative maximum temperatures during harvest season and temperature extremes increased significantly since the 1970s. For all locations, cumulative rainfall during the harvest season also rose. Projected maximum temperatures for the harvest season increased at SSP 3-7.0 and 5-8.5 projections through 2100 for all locations. Estimates of nicotine skin absorption with rising temperature indicate significant increases for both recent changes (since the 1970s) in three of the four locations, and for all locations for the SSP projections of 3-7.0 and 5-8.5 from 2020 to 2100.

Conclusions

This study across multiple continents, highlights a potential link between recent and projected anthropogenic change and potential increases in GTS risk. Under SSP 5-8.5, nicotine absorption could increase by ~50% by the end of the century, which may have widespread impacts on the incidence of GTS, especially among younger tobacco workers.

Child Labor in Family Tobacco Farms in Southern Brazil: Occupational Exposure and Related Health Problems

Tobacco farming is considered Hazardous Child Labor in Brazil. This study examined the work of children and adolescents in tobacco farming, characterizing the level of urinary cotinine and the occurrence of Green Tobacco Sickness (GTS), pesticide poisoning, respiratory symptoms, and musculoskeletal disorders. A cross-sectional descriptive study was conducted with a random sample of tobacco growers under 18 years old in Southern Brazil. Ninety-nine young people were interviewed at 79 family farms. The majority began working in agriculture before they were 14 and worked harvesting and tying hands of tobacco; 60% were 16 or 17 years old, and 51.5% were male. During their lifetime, 24.5% reported GTS, and 3% reported pesticide poisoning. In the previous year, 29.3% reported low back pain, 6.1% wheezing, and 16.2% coughing without having a cold. Half of the 12 young people evaluated had over 100 ng/mL of urinary cotinine. The study indicates that child laborers do various activities and present a high prevalence of health problems. Health workers should be trained to identify child laborers and their impacts on health. Full-time farm schools could provide knowledge about sustainable agricultural production, reducing the rates of age-grade mismatch, without taking young people away from rural areas.

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

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.

[Neck pain among tobacco farm workers in Southern Brazil]

This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.

Dor na coluna torácica e fatores associados em fumicultores

Resumo Introdução: dor na coluna torácica diz respeito a traumas cumulativos envolvendo má postura, movimentos repetitivos e longos períodos na mesma posição. Objetivo: avaliar a prevalência de dor na coluna torácica e fatores associados em fumicultores no sul do Brasil. Métodos: estudo transversal cuja associação entre o desfecho e os fatores sociodemográficos e comportamentais, atividades laborais, cargas de trabalho e comorbidades foram examinadas pelo teste de Wald para heterogeneidade e tendência linear. A análise multivariável foi realizada utilizando modelo hierárquico e regressão de Poisson com variância robusta. Resultados: o estudo envolveu 2.469 indivíduos de ambos os sexos. A prevalência de dor na coluna torácica foi de 21,2%. Limpar equipamento para aplicação de agrotóxico, número de episódios de Doença da Folha Verde, sintomas respiratórios e transtornos psiquiátricos menores foram positivamente associados ao desfecho em ambos os sexos. Tabagismo e intoxicação por agrotóxicos foram associados ao desfecho entre as mulheres, enquanto escolaridade e passar varas com folhas de tabaco foram associados aos homens. Conclusões: reestruturação ergonômica, redução das cargas de trabalho, trocas de posição durante o turno de trabalho e mecanização do processo de trabalho são estratégias importantes para reduzir a exposição à nicotina, agrotóxicos e carga de trabalho ergonômica.

Green Tobacco Sickness among Brazilian farm workers and genetic polymorphisms

OBJECTIVE

Green Tobacco Sickness (GTS) is an occupational illness caused by dermal absorption of nicotine from tobacco leaves. It affects thousands of farm workers worldwide. Brazil is the second tobacco producer in the world; despite this, there are few studies on GTS among Brazilian harvesters. This study aimed to determine the prevalence of GTS among a population of tobacco workers from a producing area in northeastern Brazil and investigate whether the occurrence of the disease was influenced by factors such age, gender and smoking status. In addition, it was investigated if there was association between the onset of GTS and genetic polymorphisms in genes that encode some detoxification enzymes. A semi-structured questionnaire was used to collect demographic, behavioral and occupational data from the referred workers. Polymorphisms were tested through the Polymerase Chain Reaction technique.

RESULTS

The total prevalence of GTS found was 56.9%, with a significant difference between genders (71.7% for women and 35.3% for men, p < 0.0001). No association was identified between the investigated polymorphisms and GTS. This study confirms the occurrence of GTS among tobacco harvesters in Brazil with high prevalence. The investigation suggests the need to take preventive measures to protect tobacco workers against this disease.

Knowledge, attitudes, and practices of women farmers concerning tobacco agriculture in a municipality in Southern Brazil

The study aimed to explore the knowledge, attitudes, and practices of women farmers working in tobacco production concerning the social, environmental, and health impacts of this economic activity. Focus groups were used in this qualitative study, and themes were explored until reaching saturation. The study was conducted in a municipality (county) in southern Brazil in 2013 and included 64 women farmers. The discussions revealed participants' familiarity with health problems associated with workloads in tobacco production: green tobacco sickness, pesticide poisoning, musculoskeletal disorders, and others. The discussions also revealed a concern with the negative impacts of tobacco agriculture on the environment. They also revealed apprehension concerning decisions on switching to alternatives for sustainable agricultural production, emphasizing that on-going and systematic government support would be necessary for such a transition. Women farmers identified various factors that contribute to the persistence of tobacco farming: small holdings for cultivation, lack of guarantees for marketing crops, and indebtedness to tobacco companies. The study showed that an integrated approach is needed to deal with tobacco farmers' problems, considering a balance between farmers' beliefs and government decisions. This approach, in keeping with the recommendations of the WHO Framework Convention on Tobacco Control, may help strengthen policies and measures to promote health and sustainable local development.

Benefits, Facilitators, Barriers, and Strategies to Improve Pesticide Protective Behaviors: Insights from Farmworkers in North Carolina Tobacco Fields

Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino farmworkers perceive little control over their occupational health. Using the Health Belief Model as a theoretical guide, we explored the perceptions of Latino farmworkers working in tobacco in North Carolina (n = 72) about benefits and facilitators of pesticide protective behaviors as well as barriers, and strategies to overcome barriers to their use. Interviews were conducted with participants at farmworker housing during non-work time. Qualitative data were analyzed using ATLAS.ti. Farmworkers recognized pesticide protective behaviors as helping them to not get sick and stay healthy. Farmworkers perceived work experience as facilitating protective behaviors. Wetness in the field was the most commonly cited barrier to protective behavior use. To overcome this barrier, farmworkers suggested use of water-resistant outerwear, as well as packing a change of clothes for mid-day, with space and time to change provided by employers. Examination of the efficacy and feasibility of farmworkers' suggestions for addressing barriers is warranted. Training and behavior modeling by experienced peers may improve behavior adoption and perceived control.

[Tobacco cultivation in the south of Brazil: green tobacco sickness and other health problems]

The scope of this study was to identify the presence of health problems and their significance for tobacco harvesters, State representatives, civil society and the tobacco industry, and also understand their coping strategies. An ethnographic study with 35 semi-structured interviews answered by harvesters' families and key informants was carried out in a rural community in the state of Rio Grande do Sul. In addition to that, participant observation of the families was conducted. The harvesters and representatives of civil society acknowledge the presence of green tobacco sickness and other problems. Representatives of healthcare organizations do not identify or recognize the sickness as being a consequence of the productive activity linked to tobacco. Tobacco industry representatives acknowledge that there are health problems, but blame the harvesters. The conclusion reached is that there is a need for a closer approach, monitoring and intervention by Public Authorities in tobacco-producing rural communities, seeking to develop surveillance actions and promote occupational health.

Urinary Cotinine Levels Among Latino Tobacco Farmworkers in North Carolina Compared to Latinos Not Employed in Agriculture

INTRODUCTION

This analysis describes urinary cotinine levels of North Carolina Latino farmworkers, compares cotinine levels of farmworkers to those of Latinos non-farmworkers, determines factors associated with farmworker cotinine levels, and determines if differences in farmworker and non-farmworker cotinine levels are associated with smoking.

METHODS

Data are from 63 farmworkers and 44 non-farmworkers who participated in a larger study of occupational exposures. Questionnaire data and urine samples collected in 2012 and 2013 are analyzed.

RESULTS

Farmworkers had urinary cotinine levels that were far greater than the non-farmworker group. Geometric mean (GM) urinary cotinine levels for farmworkers were 1808.22ng/ml in 2012, and 396.03ng/ml in 2013; corresponding GM levels for non-farmworkers were 4.68ng/ml and 9.03ng/ml. Farmworker GM cotinine levels were associated with harvesting tobacco (1242.77ng/ml vs. 471.26ng/ml; P = .0048), and working in wet shoes (1356.41ng/ml vs. 596.93ng/ml; P = .0148). Smoking did not account for cotinine level differences; the GM cotinine level for farmworkers who did not smoke was 541.31ng/ml; it was 199.40ng/ml for non-farmworkers who did smoke.

CONCLUSION

North Carolina farmworkers experience large nicotine doses. The long-term health effects of these doses are not known. Although procedures to reduce occupational nicotine exposure are known, no changes in work practices or in policies to protect workers have been implemented. Research on the health effects of occupational nicotine exposure must become a priority. Current knowledge of occupational transdermal nicotine exposure must be used to improve occupational safety practice and policy for tobacco workers.

IMPLICATIONS

This study documents the heavy burden of nicotine exposure and dose experienced by tobacco workers in North Carolina. Hundreds of thousands of farmworkers and farmers in the United States and Canada, as well as agricultural workers around the world, share this burden of nicotine exposure and dose. These results support the need to change work practices and regulations to protect workers. They also document the need to delineate the health effects of long-term exposure to high transdermal nicotine doses.

Sleep Quality Among Latino Farmworkers in North Carolina: Examination of the Job Control-Demand-Support Model

Sleep problems are associated with physical and mental health disorders and place individuals at an increased risk of workplace injuries. The demand-control-support model posits that job demands and the capacity to control work processes influence workers' level of distress, thereby affecting their physical and mental health; supervisor support can buffer the negative effect of high demands and low control. Data on the sleep quality and the organization of work of Latino men were collected in agricultural areas in North Carolina in 2012. 147 Mexican-born farmworkers ages 30 and older, most of whom had H-2A visas, provided information about sleep quality and organization of work. Most (83 %) farmworkers reported good sleep quality. The association between working more than 40 h per week and reporting poor sleep quality approached statistical significance. Additional research is needed to understand whether job demands, job control, and social support affect farmworkers' sleep quality.

Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana

BACKGROUND

The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana.

OBJECTIVES

To determine the prevalence of ocular injuries and health seeking behaviour following injury among cocoa farmers in Ghana.

METHODS

Five hundred and fifty six participants were recruited through simple random sampling using a multistage approach from four cocoa growing districts in Ghana. A structured questionnaire was used to collect relevant information such as demography, ocular hazards and injuries experienced. An ocular examination was also conducted to assess the eye health of the participants. Descriptive and regression statistics were used to analyze the data. The rate of ocular injuries was calculated by using the number of injuries reported that resulted in lost work time/days divided by the number of worker years at risk of injury (sum of years worked in cocoa farms for all the participants).

RESULTS

The rate of ocular injuries was 11.3/1000 worker years (95% CI: 9.4 - 31) which led to lost work time of 37.3/1000 worker years (95% CI: 34.1 - 40.8). The major causes of ocular injury were plants/branches (n=73, 51.1%), chemicals (n=27, 18.9%), cocoa pod/husk (n=14, 9.8%) and occurred mostly during weeding, harvesting and chemical spraying. Few (n=34, 6.1%) participants reported the use of ocular protection. Fifty-five (38.5%) participants visited the local chemical shops, while 37 (25.9%) visited hospitals/clinics for ocular treatment of their injuries.

CONCLUSION

There is a high rate of ocular injuries among cocoa farmers who make insufficient use of appropriate eye care services. There is the need for eye health education among cocoa farmers in Ghana.

Chronic low back pain among tobacco farmers in southern Brazil

BACKGROUND

Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group.

METHODS

This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression.

RESULTS

Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP.

CONCLUSIONS

This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP.

Occupational exposure to pesticides, nicotine and minor psychiatric disorders among tobacco farmers in southern Brazil

INTRODUCTION

Exposure to pesticides has been associated with psychiatric problems among farm workers, although there is still controversy as to chemical types, intensity and forms of exposure that represent risk factors for neuropsychological problems. Furthermore, tobacco workers are exposed to dermal absorption of nicotine, although its effect on mental health has not yet been studied.

OBJECTIVES

To identify the prevalence of minor psychiatric disorders (MPD) among tobacco farmers and associated factors, paying special attention to pesticide and nicotine exposure.

METHODS

This is a cross-sectional study with a representative sample of tobacco growers, characterizing economic indicators of the farms, socio-demographic factors, lifestyle habits and occupational exposures. Multivariate analysis was performed using a hierarchical Poisson regression model.

RESULTS

A total of 2400 tobacco farmers were assessed and MPD prevalence was 12%. MPD was higher among women (PR 1.4), workers aged 40 or over, tenants/employees (PR 1.8) and those who reported having difficulty in paying debts (PR 2.0). Low socioeconomic status was inversely associated with MPD prevalence. Tasks involving dermal exposure to pesticides showed risk varying between 35% and 71%, whereas tobacco growers on farms using organophosphates had 50% more risk of MPD than those not exposed to this kind of pesticide. The number of pesticide poisoning and green tobacco sickness episodes showed linear association with MPD.

CONCLUSIONS

The study reinforces the evidence of the association between pesticide poisoning and mental health disorders. It also points to increased risk of MPD from low socioeconomic status, dermal pesticide exposure as well as from exposure to organophosphates. Furthermore, the study reveals intense nicotine exposure as a risk for tobacco farmers' mental health.

Genotoxic assessment in tobacco farmers at different crop times

Agricultural workers engaged in tobacco cultivation are constantly exposed to large amounts of pesticides as well as to the nicotine present in raw tobacco leaves. Pesticides have been considered potential chemical mutagens: experimental data revealed that various agrochemicals possess mutagenic properties. Studies have affirmed that nicotine absorbed through the skin results in the characteristic green tobacco sickness (GTS), an occupational illness reported by tobacco workers. This study sought to determine genotoxic effects in farmers occupationally exposed to agrochemicals and nicotine. Peripheral blood samples were collected from 30 agricultural workers, at different crop times (off-season, during pesticides application and leaf harvest), and 30 were non-exposed. We obtained data on DNA damage detected by the Comet assay and Micronucleus test as biomarker of occupational exposure and effect. The serum cholinesterase level, which in general present relation with exposition to organophosphates and carbamates, as well as serum cotinine level, which is a metabolite of nicotine, were also evaluated. The results showed a significant increase in Damage index and frequency in tobacco farmers compared to the non-exposed group, for all different crop times; and a significant increase in micronucleated cells in the off-season group. No correlation was found between age and exposure time in relation to biomarker tests. The DNA damage was greater in males than in females, but with a significant difference only in off-season group. No difference, in cholinesterase activity, was seen among the group of farmers and non-exposed group. Elevated level of cotinine was observed in leaf harvest group. This investigation suggests increased DNA damage in all tobacco crop stages, calling attention to the significant increase during the off-season and tobacco leaf harvest.

Green tobacco sickness among tobacco farmers in southern Brazil

BACKGROUND

Despite being the second largest tobacco producer in the world, Brazil does not have prevalence studies about green tobacco sickness (GTS).

METHODS

A cross-sectional study was carried out on a sample of Brazilian tobacco workers. The sample was described according to socio-demographic, behavioral, and occupational variables. Gender-stratified multivariate analyses examined variables associated with GTS.

RESULTS

GTS prevalence among men in the previous month was 6.6%, while among women it was 11.9%. Among men, age, being a non-smoker, hanging tobacco sticks in the barn, harvesting wet leaves, and exposure to physical exertion were risk factors for GTS. Among women, tying hands of tobacco, transporting bales, harvesting wet leaves, having had contact with pesticides, and exposure to physical exertion were positively associated with GTS.

CONCLUSION

Research is required to improve methods for GTS screening, as well as the ability to distinguish GTS from pesticide poisoning. Health professionals should be trained to diagnose and treat GTS.

Overview of immigrant worker occupational health and safety for the agriculture, forestry, and fishing (AgFF) sector in the southeastern United States

BACKGROUND

Manual labor in the Agriculture, Forestry, and Fishing (AgFF) Sector is provided primarily by immigrant workers. Limited information is available that documents the demographic characteristics of these manual workers, the occupational illnesses, injuries and fatalities they experience; or the risk factors to which they are exposed.

METHODS

A working conference of experts on occupational health in the AgFF Sector was held to address information limitations. This paper provides an overview of the conference. Other reports address organization of work, health outcomes, healthcare access, and safety policy.

CONTENTS

This report addresses how best to define the population and the AgFF Sector, occupational exposures for the sector, data limitations, characteristics of immigrant workers, reasons for concern for immigrant workers in the AgFF Sector, regulations, a conceptual model for occupational health, and directions for research and intervention.

Informal occupational safety information exchange among Latino migrant and seasonal farmworkers

Latino farmworkers in North Carolina are a hard-to-reach population that faces diverse occupational health risks, including pesticide exposure. Health and safety education efforts often employ lay health advisor or promotor(a) de salud models in which farmworker community members are trained to provide health education. As a frequently tight-knit and isolated group, farmworkers may be well suited to serve as resident lay health advisors. This paper presents data collected from a nonrandom sample of Latino farmworkers living in North Carolina regarding the natural level of occupational safety information exchange among Latino farmworkers, specifically pesticide safety information. The data affirm that farmworkers informally exchange occupational safety information with one another, with the level of exchange increasing during the agricultural season. Consequently, if trained, the data suggest that farmworkers might be situated to provide in situ occupational health and safety education to their peers. This remains to be systematically tested and evaluated.

Application of the buccal micronucleus cytome assay and analysis of PON1Gln192Arg and CYP2A6*9(-48T>G) polymorphisms in tobacco farmers

Tobacco is a major Brazilian cash crop. Tobacco farmers apply large amounts of pesticides to control insect growth. Workers come into contact with green tobacco leaves during the tobacco harvest and absorb nicotine through the skin. In the present study, micronucleus frequency, cell death, and the frequency of basal cells were measured in tobacco farmers using the buccal micronucleus cytome assay (BMCyt), in parallel with measurement of blood butyrylcholinesterase (BChE) and nicotine levels. Polymorphisms in PONIGln192Arg and CYP2A6*9(-48T>G) were evaluated to verify the relationship between genetic susceptibility and the measured biomarkers. Peripheral blood and buccal cell samples were collected from 106 agricultural workers, at two different crop times (during pesticide application and leaf harvest), as well as 53 unexposed controls. BMCyt showed statistically significant increases in micronuclei, nuclear buds, and binucleated cells among exposed subjects in differentiated cells, and in micronuclei in basal cells. In addition, the exposed group showed higher values for condensed chromatin, karyorrhectic, pyknotic, and karyolitic cells, indicative of cell death, and an increase in the frequency of basal cells compared to the unexposed control group. A slight difference in mutagenicity using the BMCyt assay was found between the two different sampling times (pesticide application and leaf harvest), with higher micronucleus frequencies during pesticide application. Elevated cotinine levels were observed during the leaf harvest compared to the unexposed controls, while BChE level was similar among the farmers and controls. PONIGln192Arg and CYP2A6*9(-48T>G) polymorphisms were associated with DNA damage induced by pesticides and cell death.

Health, environment and working conditions in tobacco cultivation: a review of the literature

This study presents a review of the literature published between 1979 and 2010 on health and working conditions in tobacco cultivation, with particular emphasis on the Brazilian context. A review of computerized databases (PubMed, Scopus, WilsonWeb and Bireme/PAHO Virtual Health Library - Public Health) was carried out using the following search terms: tobacco, agricultural worker health, agricultural worker disease, working conditions, unsafe working conditions, occupational risk, occupational disease, and labor force. Articles published in English, Spanish and Portuguese were analyzed. Thirty-seven articles were selected from 214 references that were initially identified. Thirty-four additional publications (reports, etc.) were also analyzed. Among the many effects described in the literature, especially noteworthy are "green tobacco sickness," respiratory disorders, musculoskeletal injuries, mental disorders, and a negative environmental impact. Very few studies have been carried out in Brazil.

Absorption of chemicals through compromised skin

Skin is an important route of entry for many chemicals in the work place. To assess systemic uptake of a chemical in contact with the skin, quantitative information on dermal absorption rates of chemicals is needed. Absorption rates are mainly obtained from studies performed with intact, healthy skin. At the work place, however, a compromised skin barrier, although not necessarily visible is common, e.g. due to physical and chemical damage. As reviewed in this article, there are several lines of evidence that reduced integrity of the skin barrier may increase dermal absorption of chemicals in the occupational setting. An impaired skin barrier might lead not only to enhanced absorption of a specific chemical, but also to entrance of larger molecules such as proteins and nanoparticles which normally are not able to penetrate intact skin. In addition to environmental influences, there is increasing evidence that some individuals have an intrinsically affected skin barrier which will facilitate entrance of chemicals into and through the skin making these persons more susceptible for local as well for systemic toxicity. This review addresses mechanisms of barrier alteration caused by the most common skin-damaging factors in the occupational settings and the consequences for dermal absorption of chemicals. Furthermore, this review emphasizes the importance of maintained barrier properties of the skin.