Cotinine levels and green tobacco sickness among shade-tobacco workers

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.

Suicide mortality among agricultural workers in a region with intensive tobacco farming and use of pesticides in Brazil

OBJECTIVE

To investigate whether suicide risk among agricultural workers is higher in regions with heavier pesticide use and/or presence of tobacco farming.

METHODS

Suicide mortality data were gathered from residents of the Brazilian state of Alagoas. Agricultural census data were used to arrange and classify Alagoas cities into distribution groups on the basis of variables concerning pesticide use and/or tobacco farming. Mortality odds ratio calculations were then used to compare suicide risk among agricultural and nonagricultural workers in different groups.

RESULTS

Suicide risk was higher among agricultural workers than among nonagricultural workers, elevated in regions that used more pesticides, and greatest in regions that produced more tobacco.

CONCLUSIONS

This is one of the first studies of its kind to suggest that combined effects of pesticide and tobacco exposure may be linked to higher suicide risk among agricultural workers.

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.

A case of eosinophilic pneumonia in a tobacco harvester

BACKGROUND

Eosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs. The distinct etiology of eosinophilic pneumonia is unknown, although the previous case series have indicated a relationship between acute eosinophilic pneumonia and the exposure to exogenous substances including the constituents of cigarettes.

CASE SUMMARY

A 60-year-old nonsmoking female, who had started to harvest and sort tobacco leaves two months before presentation, was admitted because of persistent coughing, breathlessness, and general malaise. Her laboratory findings revealed eosinophilia. Chest computed tomography showed nonsegmental airspace consolidations bilaterally. A bronchoalveolar lavage fluid analysis also revealed that the numbers of total cells and eosinophils had increased. Although the urine level of cotinine was within the normal range, positive findings were found in the skin scratch-patch tests using tobacco leaf and its extracts, and a biopsy specimen obtained from the positive site demonstrated infiltration of eosinophils in the dermis. The patient was successfully treated with corticosteroids.

DISCUSSION

Green tobacco sickness, a type of nicotine poisoning caused by the dermal absorption of nicotine, is a well known occupational illness of tobacco harvesters. Although it is unclear whether the present case could be identified as a subtype of green tobacco sickness, this is the first report of eosinophilic pneumonia occurred in a tobacco harvester which was possibly induced by tobacco leaf exposure.

Health and social impacts of tobacco production

OBJECTIVES

To summarize current knowledge about the health and social consequences of tobacco production and to outline research needed to better understand these effects.

DATA SOURCES

The literature documenting the effects of tobacco production is scattered, and not always published in peer-reviewed sources. We undertook a systematic search using (1) a literature file based on over a decade of research on the health effects of tobacco work, (2) searches of computerized data bases (Medline, Science Citation Index, Agricola), (3) a review of new sources cited in literature uncovered through data base searches, and (4) professional contacts with others working on the effects of tobacco production.

DATA SYNTHESIS

The health effects of tobacco production include nicotine poisoning (green tobacco sickness), pesticide exposure, respiratory effects, musculoskeletal and other injuries. Most research has focused on nicotine poisoning. Social effects of tobacco production include social disruption for communities in which tobacco production is declining (unemployment, economic loss), and for communities in which tobacco production is being introduced (loss of local food production and local autonomy).

CONCLUSIONS

Research is needed on the effects of tobacco work on the health of women and children through exposure to nicotine and pesticides, the effects of chronic nicotine exposure on all tobacco workers, the neurotoxic effects of pesticide exposure and its relationship with mental health, and the effects of growing tobacco on using tobacco. Greater effort is needed to document the social disruption in communities that are economically dependent on tobacco production, particularly those in developing countries.