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.

Smokeless tobacco use and reproductive outcomes among women: a systematic review

Background: Both smoked and smokeless tobacco use have deleterious effects on most major organ systems including the reproductive system. We conducted a systematic review on smokeless tobacco (SLT) use and reproductive outcomes among women. Methods: We searched Pubmed, ProQuest, Cochrane, Wiley and Emerald databases for studies involving smokeless tobacco use in women with any or a combination of three conditions: infertility, menstrual disorders and pelvic inflammatory disease (PID). Eligibility criteria included English language publications from 1st January 1990 - 31st October 2020. CADIMA software used for filtering the studies and modified SIGN checklist for the quality assessment. The findings are reported as per the PRISMA guidelines. The AXIS and ROBIN E tool were used for assessment of risk of bias. Results: In total, three studies addressed our research question. Two studies addressed infertility (prospective cohort: n=501, cross sectional: n=192) of which, the cross-sectional study compared the mean cotinine levels between those with infertility, menstrual disorders and PID. This study also explored the association between SLT and PID. PID was the most common gynecological complaint. Women with PID had significantly higher urinary cotinine levels = 24.95±12.259) ng/ ml (p=0.0144). Mean urinary cotinine in women with menstrual complaints was 19.32±10.29 ng/ml. The other study used population-based sampling of 501 couples who attempted pregnancy (enrolled in the LIFE Study). Results showed that only 2% (n=28) of men and none of the women used smokeless tobacco. Compared with never users of tobacco, smoking by females was individually associated with longer time-to-pregnancy; smoking among males remained significant when modeling partners together. Conclusions: Available studies exploring associations between SLT and reproductive outcomes are inconclusive due to limitations in the study methodologies. More studies with robust study designs are required from low- and middle-income countries with high prevalence of SLT use.

Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala

ObjectivesThere is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu).DesignWe evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points.SettingGuatemala.Participants283 sugarcane workers.Primary outcome measuresCompared self-reported smoking status and urinary cotinine levels in two agricultural worker studies.ResultsSelf-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population.ConclusionsAccording to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.

Evaluation of Effectiveness of Chronic Care Model on Smokeless Tobacco Cessation by Measuring Urinary Cotinine Level among the Patient Attended in the Selected Dental College & Hospital, India -An Experimental Study

Background: Smokeless tobacco is one of the most common causes of preventable death. It is a big social and health issue. Smokeless tobacco utilization is a significant cause of morbidity and mortality in India, with more than 20% of the world's tobacco-related mortality occurring in India. The Chronic Care Model is a guide for the principal care management of higher-quality chronic diseases. The Chronic Care Model gives a structure that redirects health care resources to better meet the demands and issues of individual with chronic illness. Objectives: To explore the effectiveness of chronic care model for smokeless tobacco cessation in patients reporting to Sharad Pawar Dental College and Hospital. Methodology: The study will be conducted among patients reporting to Out Patient Department of Sharad Pawar Dental College and Hospital who are chronic smokeless tobacco users. This study will be conducted between two groups, in one of the groups chronic Care Model will be used and behavioural counselling will be given and in other group only behavioural counselling will be given. Urinary cotinine level test will be performed on both groups of patients consuming smokeless tobacco. Results: The chronic care model would be advantageous for the smokeless tobacco cessation. In India, there appears to be an immediate need for the promotion of awareness and informing people about the health problems associated with the use of smokeless tobacco through the model of chronic care. Conclusion: The utilization of Chronic Care Model (CCM) helps patient realize that not only it is a habit to use smokeless tobacco, but a chronic condition that requires long-term treatment to cure it.

Association between Self-Reported Survey Measures and Biomarkers of Second-Hand Tobacco Smoke Exposure in Non-Smoking Pregnant Women

Second-hand tobacco smoke (SHS) causes adverse health outcomes in adults. Further studies are needed to evaluate psychosocial SHS exposure measures in comparison to SHS exposure biomarkers, particularly in pregnant women. This study aimed to compare self-reported SHS exposure to urinary cotinine levels in pregnant women. A cross-sectional correlation design was conducted using a convenience sample of 70 non-smoking pregnant women. Measures included self-reported questionnaires and laboratory confirmation of cotinine levels in the urinary samples. Multiple regression analysis was used to assess the correlation after controlling for potential confounding variables. The average level of urinary cotinine among non-smoking pregnant women was 6.77 ng/mL. Medium-strength correlations were found among psychosocial SHS exposure measures and urine cotinine levels. Questions regarding ‘instances of smoking in front of the individual’ and ‘subjective perceived frequency of SHS exposure in past 7 days’ are feasible items for pregnant women in clinics (particularly the first question). Hence, we suggest that these simple questions should be used to assist pregnant women in reducing the harm associated with SHS exposure.