Health risks in tobacco farm workers—a review of the literature
Latino migrant and seasonal farmworkers, like all agricultural workers, experience high rates of occupational illness and injury. Interventions to reduce occupational injury among farmworkers must attend to the health beliefs of agricultural employers as well as employees, as employers control many aspects of the work environment. Occupational safety programs for Latino migrant and seasonal farmworkers must also be conceptually based in health behavior change and health disparities theories. We examine health beliefs of tobacco farmers about green tobacco sickness (GTS) to show the importance of delineating employer beliefs in agricultural safety. GTS is a highly prevalent occupational illness among tobacco workers that results from nicotine poisoning through dermal absorption of nicotine during cultivation and harvesting. We use qualitative methods structured by the Explanatory Models of Illness approach to identify farmer beliefs about the etiology, onset, pathophysiology, course, and treatment of GTS. Data were collected through semi-structured in-depth interviews with 15 North Carolina tobacco farmers. A computer-assisted, systematic qualitative analysis framework was applied to the interview transcripts. While tobacco farmers were generally knowledgeable about GTS, their explanatory models for this occupational illness often mis-identified its causes (heat and bending rather than nicotine) and minimized its seriousness. These models included methods of prevention that are not proven (e.g., use of anti-nausea drugs) or are more harmful than GTS (smoking cigarettes). The need for medical treatment was also discounted. Addressing each of these beliefs is important in any program to prevent GTS among farmworkers. Documenting and understanding the beliefs and knowledge of agricultural employers is an important undertaking in our efforts to reduce occupational injury and illness among farmworkers.