Health and social impacts of tobacco production

Does contract farming arrangement improve smallholder tobacco productivity? Evidence from Zimbabwe

Contract Farming Arrangements (CFA) can be viewed as a pro-active response to lack of reliable markets and steeply rising input prices. CFA proponents argue that CFA can enhance technical efficiency of tobacco farming and productivity. Thus, in this study, the paper interrogates the effect of CFA on tobacco productivity in southern Africa: Hurungwe district of Zimbabwe. The study controls for both observable and unobservable factors, like age, education, and ability to use information-unknown to the researchers, explaining farmers decision to participate in CFA. The study uses the Endogenous Switching Regression (ESR) model, which also acts as a robust check for the Propensity Score Matching techniques as it studies both observable and unobservable factors influencing CFA participation. Based on the ESR model, this study finds that CFA improves tobacco productivity by 39%. Nonetheless, CFA is labour-intensive. Hence, women and the elderly are less likely to participate in CFA, suggesting the need to develop gender-sensitive labour-saving technologies. Even though tobacco products kill their users, we would like to explore whether CFA can make farming more productive or not. We hypothesize that if tobacco farming would be more productive, then perhaps farmers will have enough money to buy food so they can be healthier even if the tobacco leaves, they grow can kill people elsewhere. Thus, these results inform CFA-related policies that improve smallholder tobacco productivity in Southern Africa. With existing tobacco controls, these results are equally valid to other cash crops where most developing economies anticipate the majority resource-constrained smallholder farmers to shift their production systems entirely away from tobacco in the immediate future.

Dry tobacco leaves: an in vivo and in silico approach to the consequences of occupational exposure

Exposure of tobacco workers handling dried tobacco leaves has been linked to an increased risk of toxicity and respiratory illness due to the presence of nicotine and other chemicals. This study aimed to evaluate the DNA damage caused by the exposure of tobacco growers during the dry leaf classification process and the relation to cellular mechanisms. A total of 86 individuals participated in the study, divided into a group exposed to dry tobacco (n = 44) and a control group (n = 42). Genotoxicity was evaluated using the alkaline comet assay and lymphocyte micronucleus (MN) assay (CBMN-Cyt), and measurement of telomere length. The levels of oxidative and nitrosative stress were evaluated through the formation of thiobarbituric acid reactive species, and nitric oxide levels, respectively. The inorganic elements were measured in the samples using particle-induced X-ray emission method. The combination of variables was demonstrated through principal component analysis and the interactions were expanded through systems biology. Comet assay, MN, death cells, thiobarbituric acid reactive species, and nitrosative stress showed a significant increase for all exposed groups in relation to the control. Telomere length showed a significant decrease for exposed women and total exposed group in relation to men and control groups, respectively. Bromine (Br) and rubidium (Rb) in the exposed group presented higher levels than control groups. Correlations between nitrate and apoptosis; Br and MN and necrosis; and Rb and telomeres; besides age and DNA damage and death cells were observed. The systems biology analysis demonstrated that tobacco elements can increase the nuclear translocation of NFKB dimers inducing HDAC2 expression, which, associated with BRCA1 protein, can potentially repress transcription of genes that promote DNA repair. Dry tobacco workers exposed to dry leaves and their different agents showed DNA damage by different mechanisms, including redox imbalance.

An automatic fluorescence phenotyping platform to evaluate dynamic infection process of Tobacco mosaic virus-green fluorescent protein in tobacco leaves

Tobacco is one of the important economic crops all over the world. Tobacco mosaic virus (TMV) seriously affects the yield and quality of tobacco leaves. The expression of TMV in tobacco leaves can be analyzed by detecting green fluorescence-related traits after inoculation with the infectious clone of TMV-GFP (Tobacco mosaic virus - green fluorescent protein). However, traditional methods for detecting TMV-GFP are time-consuming and laborious, and mostly require a lot of manual procedures. In this study, we develop a low-cost machine-vision-based phenotyping platform for the automatic evaluation of fluorescence-related traits in tobacco leaf based on digital camera and image processing. A dynamic monitoring experiment lasting 7 days was conducted to evaluate the efficiency of this platform using Nicotiana tabacum L. with a total of 14 samples, including the wild-type strain SR1 and 4 mutant lines generated by RNA interference technology. As a result, we found that green fluorescence area and brightness generally showed an increasing trend over time, and the trends were different among these SR1 and 4 mutant lines samples, where the maximum and minimum of green fluorescence area and brightness were mutant-4 and mutant-1 respectively. In conclusion, the platform can full-automatically extract fluorescence-related traits with the advantage of low-cost and high accuracy, which could be used in detecting dynamic changes of TMV-GFP in tobacco leaves.

Tobacco farming: overcoming an understated impediment to comprehensive tobacco control

Tobacco farming has emerged as an important concern for tobacco control advocates. Tobacco-growing countries face unique and important challenges to comprehensive, intersectoral tobacco control. These challenges stem from narratives that position tobacco as an important driver of economic growth and development, perpetuated by tobacco interests with close ties to government decision-making. While the global tobacco control movement has enshrined a commitment to alternatives to tobacco growing, there remain numerous obstacles. Tobacco growing is often situated in contexts with limited markets for other agricultural products, limited knowledge and economic resources to pursue alternatives, and/or a structure that favours industry control over the supply chain, all constraining the decision space of farmers. An evidence-informed approach is necessary to address tobacco supply, including growing, processing, manufacturing and trade, in this complex context. This paper reviews the economic, environmental and policy context of tobacco growing with an emphasis on the past decade of empirical work on the political economy of tobacco supply and introduces strategies to pursue alternatives. This analysis debunks many of the arguments used to perpetuate the narrative of tobacco's prosperity and provides critical insights into the institutional constraints faced by government sectors in pursuing a policy of alternatives.

A Comparative Study on the Health Problems and Substance Abuse among the Tobacco Farmers and Non-Tobacco Farmers in Hassan District, Karnataka

Background and Aims

India ranks third in the worldwide tobacco production (2017), and it is increasing every year. Hassan is an important tobacco growing district in Karnataka with over 12,000 growers. These growers are exposed to health risks during cultivation of tobacco, pesticide exposure, long duration of work, mental stress, and nicotine toxicity - Green Tobacco Sickness (GTS) due to direct handling of green tobacco leaves.

Objectives

To determine the prevalence of health problems associated with tobacco farming. To determine the extent of substance abuse in tobacco farmers as compared to non-tobacco farmers.

Methodology Study design

Cross-sectional study.

Duration

3 months.

Sampling technique

30 × 7 Cluster sampling technique. House-to-house survey was conducted in 30 tobacco growing villages of Hassan. Seven tobacco growers and seven non-growers were interviewed in each village. Alcohol use disorder identification test (AUDIT) & Fagerstrom nicotine dependence (FND) scale was used to assess the extent of substance abuse.

Results

Symptoms of GTS like nausea, dizziness, poor appetite, insomnia were reported more in tobacco growers (p < 0.01). On FND assessment, 63% had moderate to high dependence. On AUDIT assessment, 55.07% growers who had drinking habit had hazardous drinking behavior. Logit function model was used to assess parameter estimate (OR) on substance abuse.

Conclusion

Lack of knowledge regarding health effects of tobacco farming, lack of use of PPE, dust and smoke exposure during curing, intense physical and mental stress maybe some reasons for health problems in tobacco growers.

CONFORTO TÉRMICO DE TRABALHADORES RURAIS DURANTE A COLHEITA DO TABACO

A cultura do tabaco é desenvolvida principalmente em propriedade familiar por necessitar de mão-de-obra intensiva e pouco mecanizada. O presente trabalho tem como objetivo investigar o conforto térmico de trabalhadores rurais durante a colheita do tabaco, utilizando os índices de conforto térmico: Índice de temperatura e umidade (ITU) e Temperatura Equivalente de Windchill (Twc), na região do Vale do Rio Pardo – RS. Para isso, primeiramente realizou-se a coleta de informações por meio de um questionário respondido por 80 produtores rurais e, posteriormente, foi realizada uma análise bioclimática por meio do cálculo e interpretação dos índices. A análise dos índices e os tipos de desconfortos sentidos durante a colheita do tabaco relatados pelos produtores rurais, são indicativos de estresse calórico no turno de trabalho da tarde (14:00 às 19:00 h) para os meses de dezembro e janeiro. Já, para o turno de trabalho da manhã, a sensação térmica é de frio (< 15ºC), em função da velocidade do vento existente na região (>2,0 m/s). Pausas na atividade de colheita devem ser realizadas no período da tarde, em que o estresse calórico existe em função das condições meteorológicas e pode ser potencializado com estresse físico acumulado ao longo do dia de trabalho.

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.

Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

Youth working in tobacco farming: effects on smoking behavior and association with health status

BACKGROUND

Cultivation of tobacco raises concerns about detrimental health and social consequences for youth, but tobacco producing countries only highlight economic benefits. We compared sociodemographic and health-related characteristics of school-age youth who worked and did not work in tobacco farming and assessed the effects on smoking behavior and health at 1 year.

METHODS

We used existing data collected in the province of Jujuy, Argentina where 3188 youth 13 to 17 years of age from a random middle school sample responded to longitudinal questionnaires in 2005 and 2006. Multivariate logistic regression models predicted association of tobacco farming work with health status and smoking behavior at 1 year.

RESULTS

22.8% of youth in the tobacco growing areas of the province were involved in tobacco farming. The mean age of initiation to tobacco farming was 12.6 years. Youth working in farming had higher rates of fair or poor versus good or excellent self-perceived health (30.3% vs. 19.0%), having a serious injury (48.5% vs. 38.5%), being injured accidentally by someone else (7.5% vs. 4.6%), being assaulted (5.5% vs. 2.6%), and being poisoned by exposure to chemicals (2.5% vs. 0.7%). Youth working in tobacco farming also had higher prevalence of ever (67.9% vs. 55.2%), current (48.0% vs. 32.6%) and established smoking (17.8% vs. 9.9%). In multivariate logistic regression models tobacco farming in 2005 was associated with significant increased reporting of serious injury (OR = 1.4; 95%CI 1.1-2.0), accidental injury by someone else (OR = 1.5; 95% 1.0-2.1), assault (OR = 2.2; 95% CI 1.3-3.8), and poisoning by exposure to chemicals (OR = 2.5; 95% CI 1.2-5.4). Tobacco farming in 2005 predicted established smoking 1 year later (OR = 1.5; 95% CI 1.1-2.0).

CONCLUSION

Youth who work in tobacco faming face a challenging burden of adversities that increase their vulnerability. Risk assessments should guide public policies to protect underage youth working in tobacco farming. (298 words).

The Economic Geography of Kenyan Tobacco Farmers' Livelihood Decisions

INTRODUCTION

The narrative of prosperous economic livelihood of tobacco farmers in Kenya as alleged by the tobacco industry deserves challenge as evidence increasingly suggests that smallholder tobacco farmers are making little or no profits. Article 17 of the World Health Organization Framework Convention on Tobacco Control encourages viable alternative livelihoods for tobacco farmers. There is little evidence, however, on how tobacco farmers make livelihood choice decisions.

METHODS

A total of 527 purposefully selected smallholder tobacco farmers in Kenya from three main tobacco-growing regions participated in a 2017 economic livelihood survey. Geo-economic data were matched to surveyed farmers' Global Positioning System coordinates to estimate each farmer's access to nearby economic centers. Ownership of cell phones or radios was also used to estimate farmers' virtual access to nearby economic activities to understand better the role of information. Multivariate logistic regressions were used to control socioeconomic status and self-reported activity in nearby economic centers.

RESULTS

Tobacco farmers rarely live within 10 km of an economic center. Results suggest that the further away farmers live from economic centers, the less likely they are to grow tobacco, but more likely to grow tobacco under contract. Also, farmers owning a cell phone or radio are not only less likely to grow tobacco, but also to not engage in farming under contract if they do grow tobacco.

CONCLUSIONS

Physical and virtual access to nearby economic activities is significantly associated with tobacco farmers' livelihood choice decision and should be taken into consideration by decision makers while developing interventions for FCTC Article 17.

IMPLICATIONS

Smallholder tobacco farmers in lower-income countries are making little or no profits, but few studies have been conducted to illuminate what perpetuates tobacco production, with such studies urgently needed to support governments to develop viable alternative livelihoods for tobacco farmers. This study suggests that geographic and technological factors that shape farmers' economic decisions can help policy makers tailor alternative livelihood policies to different regional contexts and should be a focus of future research in this area.

From Plant to Waste: The Long and Diverse Impact Chain Caused by Tobacco Smoking

Smoking is a social phenomenon of global scope. The impacts start from the cultivation of the plant to the disposal of cigarette butts in the most diverse places. These aspects go beyond economic and public health issues, also affecting natural environments and their biota in a serious and indistinct way. Of the six trillion cigarettes consumed globally each year, four and a half trillion are disposed somewhere in the environment. Cigarette butts are predominantly plastic, non-biodegradable waste, prevalent in coastal environments in various parts of the world, and with high potential for generating impacts on a wide range of socioeconomic and environmental aspects. Among the 5000 compounds found in a cigarette, those with higher toxic potential are mainly concentrated in the filter and in tobacco remnants, which are items found in discarded cigarette butts. After surveying published studies on this topic, the present study addressed the interaction between the impacts related to tobacco smoking, highlighting the problem as an important and emerging issue that demands joint efforts, and actions especially focused on the reduction of environmental impacts, an aspect that has not yet been assessed.

Latinx child farmworkers in North Carolina: Study design and participant baseline characteristics

BACKGROUND

Although children as young as 10 years can work in agriculture, little research has addressed their occupational health. This paper describes a large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study.

METHODS

Survey interviews were conducted in 2017 with 202 Latinx children aged 10-17 years employed in agriculture across North Carolina (NC).

RESULTS

Most (81.2%) participants were born in the United States, 37.6% were female, and 21.3% were aged 10-13 years. Most (95.1%) were currently enrolled in school. Thirty-six (17.8%) were migrant workers. 34.7% had worked in agriculture for 1 year; 18.3% had worked 4+ years. 33.7% worked piece rate. 57.4% worked in tobacco. Participants in western NC differed in personal and occupational characteristics from those in eastern NC.

CONCLUSIONS

This study has enrolled a large and diverse child farmworker sample. This overview indicates several important issues for further analysis.

Engaging outreach workers in the development of a farmworker health research agenda

Farmworker health outreach workers have not traditionally been involved in the prioritization and design of research studies. This report from the field shares the results of a survey administered to outreach workers providing health services to farmworkers in North Carolina. Priority areas of research and best practices for engaged research are presented from the perspective of the outreach worker community. The purposeful involvement of outreach workers can make farmworker health research more meaningful and solution-oriented.

[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.

Brain Anatomy in Latino Farmworkers Exposed to Pesticides and Nicotine

OBJECTIVE

Migrant tobacco farmworkers experience regular occupational exposure to pesticides and nicotine. The present study was designed to determine whether there are differences in brain anatomy between Latino farmworkers and non-farmworkers.

METHODS

Magnetic resonance brain images were compared between farmworkers and non-farmworkers. In addition, blood cholinesterase activity and urinary cotinine levels were also used to identify associations with pesticide and nicotine exposure.

RESULTS

Farmworkers had greater gray matter signal in putamen and cerebellum, and lower gray matter signal in frontal and temporal lobes. Urinary cotinine was associated with the observed differences in brain anatomy, but blood cholinesterase activity was not.

CONCLUSIONS

Nicotine exposure was associated with neuroanatomical differences between Latino farmworkers and non-farmworkers. Future studies are needed to differentiate iron deposition from brain atrophy and to further assess the potential role of nicotine and pesticide exposure.

Curating Employee Ethics: Self-Glory Amidst Slow Violence at The China Tobacco Museum

Seen through the prism of public health, the cigarette industry is an apparatus of death. To those who run it, however, it is something more prosaic: a workplace comprised of people whose morale is to be shepherded. Provisioning employees of the cigarette industry with psychic scaffolding to carry out effective daily work is a prime purpose of the China Tobacco Museum. This multistoried exhibition space in Shanghai is a technology of self, offering a carefully curated history of cigarette production thematized around tropes such as employee exaltation. Designed to anchor and vitalize the ethical outlook of those working for the world's most prolific cigarette conglomerate, the museum is a striking illustration that industrial strongholds of 'slow violence' produce their own forms of self-care.

[Adhering to or resisting tobacco cultivation? Stories of rural workers from a producing region in southern Brazil]

This study sought to understand the standpoints of farming families who have resisted or abandoned tobacco cultivation and also the perceptions of State representatives, civil society organizations and the tobacco industry regarding the implementation and the continuity of this cultivation in a producing region in southern Brazil. In this ethnographic study, 27 semi-structured interviews were conducted with farming families and key informants. Besides that, participant observation was conducted. For those who abandoned tobacco cultivation, the main reason mentioned was indebtedness, and for those who have never planted, the main reasons alleged were fear of indebtedness, a limited workforce or religious issues. State representatives and civil society organizations highlighted illusory financial returns as the main reason for tobacco cultivation. Tobacco industry representatives insisted on the difficulty of commercializing the production and the low price of foodstuffs as a stimulus to adhere to the integrated system. It is therefore concluded that the formation of associations and the development of crop rotation plans are important strategies to be adopted to facilitate the change of cultivation in order to promote better working and living conditions for the rural population.

Work organization and occupational health: perspectives from Latinos employed on crop and horse breeding farms

BACKGROUND

Agriculture is hazardous and increasingly dependent on Latino workers, a vulnerable population. However, little research has studied how work organization influences Latino farmworker health.

METHODS

Using a work organization framework, this cross-sectional study describes and compares the work organization and occupational health characteristics of a sample of Latino crop (n = 49) and horse production (n = 54) workers in Kentucky.

RESULTS

Crop workers experienced more physical demands, work-related and environmental stressors, and musculoskeletal and ill-health symptoms. Significantly more crop workers indicated work-related illness or missed work due to work-related illness/injury, though one-fourth of both groups reported work-related injury in the past year. A majority of both groups cited exposure to toxic chemicals, a minority of whom received training on their use.

CONCLUSION

Further surveillance is needed to understand the rate and precursors of illness/injury in these populations, as is research on the relationship between supervisory practices, psychosocial stressors, and occupational health.

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.

Green tobacco sickness and skin integrity among migrant Latino farmworkers

BACKGROUND

Green tobacco sickness (GTS) affects approximately one-quarter of tobacco workers. The primary aim of this analysis is to expand existing knowledge of GTS risk factors by delineating the association of measures of skin integrity with the prevalence of GTS among Latino farmworkers.

METHODS

Data are from a longitudinal study of skin disease among 304 North Carolina Latino farmworkers conducted in 2005.

RESULTS

18.4% of the farmworkers met the GTS case definition. Self-reported rash increased the odds of having GTS in the bivariate (OR 2.29, 95% CI 1.21, 4.35), and multivariate analyses (OR 3.30, CI 2.17, 5.02). Self-reported itch (OR 3.54, CI 2.38, 5.24) and superficial wounds (OR 2.49, CI 1.15, 5.39) had a significant relationship to GTS in the bivariate analysis.

CONCLUSIONS

These analyses extend current knowledge of GTS risk factors to include skin integrity. Farmworkers with rash and other skin conditions can protect these affected skin areas from exposure to the tobacco plant to reduce their risk of GTS.