Occupational Exposures and Experiences Among Women in Tobacco Production in India

Abstract

BACKGROUND: The tobacco industry is a major contributor to both human and environmental damage. Tobacco farming and manufacturing leads to economic problems, labour exploitation, environmental degradation, and health problems for farmers and workers. Article 17 and 18 of WHO Framework convention on tobacco control addresses concerns regarding the serious risks posed by tobacco growing to human health and abuse by the tobacco industry. Indian tobacco farm laborers are primarily women and children working for very low wages. Beedi is the most common smoking form of tobacco used in India. The rolling of beedis is performed primarily by women in settings that lack occupational safeguards. We explored the use of occupational health of women involved in tobacco farming and beedi industry. SPECIFIC AIMS: The specific aims of this study were to 1. To conduct a systematic review of tobacco control studies conducted using photovoice methodology. 2. To explore occupational and reproductive health challenges faced by women tobacco farm labors in Mysore District, India. 3. To explore the experiences and challenges faced by women beedi workers in Mysore, India using photovoice, a community based participatory method. 4. To determine the occupational exposures among women beedi workers in Mysore, India. METHODS: To address aim 1, we searched six databases using search terms relating to photovoice and tobacco. The selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quality appraisal was conducted using the Critical Appraisal Skills Programme (CASP) tool as a screening tool. For aim 2, we conducted interview and focus group discussions among women tobacco farm laborers. For aim 3, we explored the experiences and challenges faced by women beedi workers using photovoice methodology. Photovoice is an arts-based participatory action research methodology that aims to empower community members to document and share their stories and communicate their lived experiences. For aim 4, occupational exposures to pesticides were assessed through the use of silicone wristbands worn for seven days by workers, and exposure to toxic metals was assessed in dust samples collected in the homes of beedi workers. RESULTS: Findings from aim 1 reports photovoice methodology being used in understanding perceptions of tobacco use and risk, environmental effects of tobacco, and advertisement and marketing of tobacco and e-cigarettes. Aim 2 findings reports green tobacco sickness symptoms including headaches, back pain, gastric problems, weakness, and allergies during menstruation, pre-natal, and post-natal periods among women tobacco farmers. They had poor awareness about the health effects of tobacco farming and there were gender inequalities in wages and use of personal protective equipment. Participants received support from family and community health workers during their pregnancy and post-natal period. Aim 3 finding reported the themes from the photovoice discussion that included occupational health problems and constraints, access to healthcare services, health behaviours, work environment, family responsibility, gender roles lead to interpersonal violence, societal expectations, financial challenges, gender and social inequality, and alternate employment. Findings from Aim 4 report out of the 17 pesticides and pesticide breakdown products tested, 15 were detected in the silicone wristband samples. Pentachlorobenzene, hexachlorobenzene, and 4,4′ dichlorodiphenyldichloroethylene (DDE) were detected above the limit of detection (LOD) in all wristband samples from both beedi and non-beedi workers. High detection rates were also observed for 4,4′ dichloro-diphenyl-trichloroethane (DDT; 92.5%), trans-chlordane (87.5%), and trans-nonachlor (87.5%) among the beedi workers. The levels of trans-chlordane (p = 0.02), trans-nonachlor (p = 0.02), 2,4′ DDE (p = 0.02), and 4,4′ DDT (p = 0.05) were significantly higher in wristbands worn by beedi workers compared to wristbands worn by non-beedi workers. All six tested metals were detected in the household dust samples. Lead, nickel, and chromium were present above the LOD in all samples across both groups. Beedi and non-beedi workers did not differ significantly in household dust concentrations of any of the tested metals. CONCLUSION: Tobacco farmers and beedi workers reported various health problems including the symptoms of green tobacco sickness. Beedi workers appear to be exposed to higher concentrations of several banned legacy pesticides and have a higher detection frequency of some toxic metals in their household dust. These results suggest that beedi workers are exposed to a greater burden of toxic chemicals than are non-beedi workers. We recommend implementing targeted workplace health interventions to address the occupational health problems among women tobacco farm laborers and beedi workers. The future interventions should include regular health screenings, education on occupational hazards, provision and interventions to adopt personal protective equipment like mask to reduce the exposures and improve the access to healthcare services. Additionally, integrating health policies and ensuring occupational health protection measures such as health insurance and paid sick leave can significantly improve the well-being and safety of these workers.