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

Child labor is regarded as the employment of children less than 18 years of age [1]. It is associated with poverty, inadequate educational opportunities, gender inequality, and a variety of health risks as many are involved in hazardous occupations [2‐5]. Children who work have higher rates of mortality, malnutrition and disability compared with those who do not work [6]. An estimated 6 million work-related injuries occur among children that result in 2.5 million becoming disabled and 32,000 fatalities each year [7]. Working children are more susceptible to harm from exposures than adults [8, 9] and more susceptible to emotional and physical abuse and drug addictions [10, 11].

Widespread cultivation of tobacco leaf has raised diverse public health issues including concern for child labor and for occupational health hazards. Children contribute significantly to the tobacco farming workforce in low and middle income countries [12]. In this occupation they are exposed to unsuitable working conditions and toxic chemicals [13]. Pesticides can cause skin and eye irritation, nerve damage, and respiratory symptoms. Dermal absorption of nicotine from contact with wet tobacco leaves can cause green tobacco sickness [14, 15]. Other health effects associated with tobacco farming include, respiratory disorders, musculoskeletal injuries and psychiatric disorders [16‐20].

Van Minh et al. (2009) [21] conducted a survey among tobacco and non-tobacco farmers in Vietnam. The occurrence of 9 out of the 16 health problems was higher among tobacco farmers. Tobacco farming was the second predictor of self-reported health problems after the effect of age, placing these workers at increased risk of injury and illness. Similarly, Le Cai (2012) [22] conducted a cross-sectional survey among 8681 adults aged ≥18 years in rural areas of the Yunnan Province, China from 2010 to 2011. Tobacco farmers had higher rates of current smoking, nicotine dependence, and second-hand smoke exposure compared with farmers not engaged in tobacco farming. Most tobacco users (84.5%) reported initiating smoking during adolescence.

In the past 20 years, the tobacco production in Argentina has grown and the country is among the top six worldwide. In 2009/2010 the production reached 132,869 tons, with 37.2% produced in the province of Jujuy. However, the tobacco farming labor force represents highly vulnerable sectors of the population facing poor living and working conditions [23]. More than 50% of the total production is exported in the form of tobacco leaf. In May 2003, Argentina signed the Framework Convention on Tobacco Control, but the agreement has still not been ratified by the National Congress. Nevertheless, in 2007 the National Program for Tobacco Control was established within the Ministry of Health. Several national and local tobacco control laws have been enacted, including the ban on selling tobacco to minors, the regulation of tobacco product advertising and promotion, and indoor tobacco consumption in public places. Regarding child labor, the country has ratified ILO Convention 138 Concerning Minimum Age for Admission to Employment. The Law 26,390 raised from 14 to 16 years the legal age for employment and set special protection for employees between 16 and 18 years of age [24, 25].

There is currently a gap in the state of the knowledge regarding the relationship between tobacco farming and smoking among underage youth in Latin America. This study evaluates the role of working in tobacco farming on tobacco use behavior among underage youth attending schools in the province of Jujuy. The research questions addressed in this analysis were the following: 1. Are the sociodemographic characteristics of youth who work in tobacco farming different from peers not working in tobacco farming? 2. Are indicators of self-reported health status worse among youth working in tobacco farming? 3. Is there an effect of working in tobacco on smoking behaviors at 1 year of follow-up?

The mean age for girls was 14.5 years (95% CI 14.4–14.6) and for boys, 15.1 years (95% CI 14.9–15.3) (data not shown). Low SES was more prevalent among girls than boys (25.8% vs. 20%, p = 0.006) and 71.7% of the girls self-identified as being Indigenous, compared with 65% of the boys (p < 0.001). A greater percentage of girls reported living with an adult who smoked at home (76.8% vs. 73.2%, p = 0.018).

A greater percentage of girls perceived that their health status was fair or poor, compared with boys (25.3% vs. 14.3%, p < 0.001). However, boys were more likely to report serious injures (46.9% vs. 33.5%, p < 0.001), being accidentally injured by someone else (6.2% vs. 4.0%, p = 0.002) and being assaulted (4.5% vs. 1.6%, p < 0.001) (Table 1). At T1 (2005), the prevalence of ever (56.6%) and current smoking (34.4%) was similar for boys and girls but established smoking was more prevalent among boys (13% vs. 8.9%, p = 0.004). The prevalence of working in tobacco farming was unevenly distributed across geographical regions, involving 22.8% of youth in the lowlands where tobacco is cultivated, and between 4.5 to 4.9% in the other areas (data not shown). Ever working in tobacco farming was reported by 11.5% of the total sample (Table 1). Involvement in tobacco farming was more prevalent among boys (12.9% vs. 10.3%, p = 0.044) but the mean age of initiation did not differ significantly between girls (12.0; 95% CI 11.4–13.0) and boys (12.7; 95% CI 12.1–13.2).

The sociodemographic profile of these Jujuy youth working in tobacco farming highlights the roots of the child labor problem at a global level, involving youth belonging to poor families and of non-dominant social groups, particularly Indigenous populations. Our results highlight that socioeconomically vulnerable youths may be further impaired in their development by occupational health problems and the increased risk of cigarette smoking associated with a large set of health risks throughout the life course [13]. Furthermore, youth who worked in tobacco farming reported having a fair or poor self-reported health status in a greater proportion than other youth, as well as increased rates of exposure to toxic chemicals. Although we cannot ascertain the precise nature of sustained injuries, or a direct relation to the occupational context, we identified an increased risk of exposure to violence through assaults among youth working in tobacco farming. The increased exposure to interpersonal violence finding has not been reported in other studies, largely of adult populations. As a primary finding we ascertained a one-year effect of work in tobacco farming among youth, on being an established smoker defined as current smoker of at least 100 cigarettes lifetime. To our knowledge, this finding has not been previously reported and is unique in focusing on underage youth.

Prior research postulates that there may be an association between exposure to pesticides and mental health problems [31‐35], and smoking has been associated to psychological distress among adolescents [36]. On this basis, future research could investigate the mediating role of mental health status on smoking among youth who work in tobacco farming. In addition, violence, and its associated stress, may trigger increased desire to smoke linked to coping mechanisms [37]. Not only does working in tobacco farming increase the risk of established smoking, but tobacco related illnesses caused by smoking may be compounded by the occupational hazards of tobacco farming. For example, respiratory illnesses caused by particles and microorganisms growing on tobacco leaves may exacerbate damage to lung cells [19, 18]. Future studies should evaluate synergistic adverse health effects between smoking and occupational hazards in tobacco farming.

This study’s strengths include the population-based sampling strategy which enhances the generalization of results. The repeated sampling of participants between 2005 and 2006 was useful for examining longitudinal effects of tobacco farming. However, with this dataset we were not able to determine a precise date of initiation in tobacco farming to calculate a time of exposure variable, as this information is based on recall and it is not unusual for children to become involved in this activity at very early ages. Likewise, we were not able to determine the type of tasks performed and the amount of time in months and years of previous exposure or if respondents were still working in tobacco farming at the time of the study. The inclusion of youth with less exposure time to tobacco farming work would potentially reduce the effect of the exposure and bias results towards the null. Therefore, we are presenting conservative results. Although the one-year time frame used for this analysis is a limitation and was based on the fact that tobacco farming work questions were not consistently included in all waves of the study. In addition, we cannot ascertain that injuries and poisoning with chemicals occurred while conducting tobacco farming activities. Another limitation is that we are not able to draw causal inference about health-related factors since the health data used for this analysis was collected at only one time point. Although the data were collected more than 10 years ago, the practice of hiring underage youth in tobacco farming is a current practice [38].

More than 250,000 hectares of tobacco are planted throughout the globe in more than a 100 countries [39]. However, the governments of tobacco producing countries largely view tobacco cultivation as an important contributor to the national economy by generating tax revenues, employment and income in otherwise deprived areas, while overlooking labor rights and health issues, including the economic costs of illness and social problems related to tobacco farming [38].

This report contributes to breaching the knowledge gap of the longitudinal effect of tobacco farming on smoking behavior among youth. In addition, poor self-perceived health, more accidents and exposure to violent settings in this population, highlights the need to develop structural mechanisms to protect youth from the often overlooked social and health risks involved in tobacco farming. In the process of setting national economic priorities and policies, state agencies other than those pertaining to the economic sector, namely health, social work, education, environmental and other related agencies, practitioners and scholars should be called upon to contribute to diagnostic assessments and policy formulations that take into account the complex nature of tobacco farming.

Tobacco farming work by underage youth in the Province of Jujuy, Argentina is associated with adverse health events, worse perceived health status and greater odds of becoming established smokers. Risk assessments should guide public policies to protect underage youth working in tobacco farming through structural change and enforcement of existing regulations.