Green tobacco sickness among tobacco farmers in southern Brazil

INTRODUCTION:  Studies of tobacco workers in developed countries have found variable prevalence of green tobacco sickness (GTS), between 8.2% and 47%, during the agricultural season. Despite being the second greatest tobacco producer in the world, Brazil does not have population-based studies about GTS. This study aim to evaluate the prevalence and the factors associated with GTS.

METHODS:   A cross-sectional study was carried out in a random sample of 2.469 Brazilian tobacco workers (aged 18 or older). Sample was described according to demographic, socio-economic, behavioral and occupational variables. Multivariable analyses stratified by gender, through Poisson regression examined variables associated with GTS. 

RESULTS:   Prevalence of GTS among men in the previous year, month and week were respectively: 9.6%, 6.6% and 3.3%, while among women were 15.7%, 11.9% and 6.6%. Among men, age was inversely associated with GTS. Being nonsmoker or smoking up to 9 cigarettes a day, hanging tobacco sticks in the barn, harvesting wet leaves and exposure to physical effort were risk factors for GTS, while producing milk in the farms was a protection factor. Among women, tying hands of tobacco, transporting bales, harvesting wet leaves, having had contact with pesticides in the previous year and exposure to physical effort were positively associated with GTS.

CONCLUSIONS:   Research on GTS needs improved methods for the screening of outcomes, as well as, the ability to distinguish GTS from pesticide poisoning. The effectiveness of Personal protective equipment for prevention of GTS should be evaluated. Strategies to prevent GTS should take into account gender specificities. Health professionals taking care of tobacco workers should be educated to diagnose and treat GTS.