title: Epidemiologic investigation of an occupational illness of tobacco harvesters in southern Brazil, a worldwide leader in tobacco production.
abstract: OBJECTIVE
  As part of smoking surveillance, the authors conducted an epidemiologic investigation in southern Brazil to identify the occurrence of Green Tobacco Sickness and risk factors for illness and to recommend control and prevention measures.
  
  
  METHODS
  A 1:2 case-control study matched by subjects' smoking habits. The study population was residents of Candelária, Rio Grande do Sul state, who farm tobacco and provided a urine sample for cotinine measurement by high-performance liquid chromatography. Confirmed cases were persons with compatible clinical presentation (headache, nausea, vomit, dizziness or weakness) and cotinine level >10 ng/ml. Controls were persons without compatible signs or symptoms. The association measure was the matched OR with 95% CIs and p<0.05.
  
  
  RESULTS
  Of 33 confirmed cases, 64% were men, average age was 33 years (SD ± 11.8 years) and 57% were landowners. Cases have had similar illness in the past and were likelier to be workers hired by farmers-landowners than controls. Multivariate analysis yielded independent association between these variables and illness, controlled for age and sex. Contact with pesticides and working with wet tobacco leaves were not associated with illness.
  
  
  CONCLUSIONS
  The authors confirmed Green Tobacco Sickness in southern Brazil; the authors recommend investigation of its prevalence in tobacco-growing regions and monitoring of and education about the disease and its prevention by occupational health authorities.
authors.affiliation: Field Epidemiology Training Program EPISUS, Health Surveillance Secretariat, Ministry of Health - Brazil, Brasilia, Distrito Federal, Brazil. patricia.bartholomay@saude.gov.br
authors.forename: Patrícia
authors.initials: P
authors.lastname: Bartholomay
authors.forename: Betine Pinto Moehlecke
authors.initials: BP
authors.lastname: Iser
authors.forename: Patrícia Pereira Vasconcelos
authors.initials: PP
authors.lastname: de Oliveira
authors.forename: Tania Esther Herc Holmer
authors.initials: TE
authors.lastname: dos Santos
authors.forename: Deborah Carvalho
authors.initials: DC
authors.lastname: Malta
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sobel
authors.forename: Lenildo
authors.initials: L
authors.lastname: de Moura
mesh_terms: D000328:Adult; D000382:Agricultural Workers' Diseases / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003367:Cotinine / Q000652:urine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009538:Nicotine / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects*; D010067:Ownership; D018515:Plant Leaves / Q000737:chemistry; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000652:urine; D055815:Young Adult; D014026:Nicotiana
chemical_list: D009538:Nicotine; D003367:Cotinine