Beyond the enormous toll on human health caused by smoking, tobacco also harms the health and wellbeing of the people who work in farming and production and the environment where it is grown. The production of tobacco raises a number of ethical issues, including its contribution to deforestation and climate change (see Section 10.15), and as outlined below, the exploitation of farm workers, the use of child labour, occupational health and safety risks, and the methods used for testing products.
10.14.1 The exploitation of tobacco farm workers
The tobacco industry has long argued that tobacco growing is important for the economies of farming countries and is lucrative for farm workers and governments (see Section 17.2.6). Farmers may also perceive tobacco farming as profitable,1, 2 even if they are only left with a small amount of money after paying for loans, debts, and hired labour.3 The majority of tobacco farming is conducted by smallholder farmers located in lower-income countries,4 and several analyses5, 6 have shown that most tobacco farmers make only a tiny profit, which is diminished when the value of their own and other household members’ labour is accounted for. Many are also in debt. 7 The farmers generally live in poverty and have minimal power against tobacco industry decisions regarding prices and exploitative practices.5 Despite some small-scale attempts to ensure farmers receive a living wage, such as the launch of “ethically sourced” cigarettes in the UK in the 2000s,8 investigations into tobacco farming show widespread human rights abuses and sub-poverty wages.9, 10
There are also reports of human trafficking and forced labour among tobacco farm workers. In Malawi, labourers reported being driven hundreds of kilometres from their homes, and then having no money to leave the tobacco farm or return home.11 In the US, where most tobacco farm workers are undocumented migrants, the workers report living in fear of being arrested and deported, of being unable to repay debts, and of retaliation from their employers. The workers commonly report being paid below minimum wage, and working gruelling and long shifts that put their health and safety at risk.9 Because of some workers’ difficulty in settling loans and interest payments, one report noted that they may end up being dependent on the tobacco company, which raises the risk of what could amount to bonded labour.12 A landmark case in Brazil saw a large tobacco exporter charged with using slave labour due to poor working conditions and pay well below minimum wage,13 and an ongoing case has been brought by human rights lawyers in the UK against British American Tobacco and Imperial Tobacco for alleged exploitation of Malawian farming families and child labour.14
A major report by Human Rights Watch concluded that, despite each of the major tobacco companies having implemented human rights due diligence policies and committing to training on and monitoring of such policies, workers on large-scale tobacco farms continue to face human rights abuses that these policies intend to prevent.10 For example, Philip Morris International has established a labour practices program “to achieve safe and fair working conditions on the farms we source our tobacco from”15 and in its 2020 human rights report British American Tobacco states that it is providing “support, technical assistance and capacity building for over 90,000 farmers worldwide, helping to enhance their livelihoods and build their longterm resilience.”16 However, the Human Rights Watch report notes that companies are generally not doing enough to prevent and address human rights abuses throughout the supply chain.10 Another report notes that given the high profits of tobacco companies and very cheap leaf prices, tobacco companies could easily pay farmers a higher wage. This would also go a long way to reducing reliance on child labour.17
A tobacco control advocate with direct experience observing tobacco farmers in Malawi has noted that, ‘tobacco industry activities to promote farmer welfare and sustainable agriculture do have some direct impact on farmers’ livelihoods, such as an increase in the number of children who attend school and improved access to clean water. But at what cost? The industry’s activities are really more about promoting an image of corporate responsibility to deflect public attention from tobacco-related child labour, deforestation, pesticide poisoning and soil depletion—in Malawi and other countries’.18
10.14.2 Tobacco farming and child labour
According to the International Labour Organization [ILO], at the beginning of 2020 there were an estimated 160 million children — 63 million girls and 97 million boys — in child labour globally, accounting for almost one in 10 children worldwide. Seventy per cent of all children in child labour, or 112 million children, were in agriculture. Many are younger children, with more than three quarters of all children aged five to 11 in child labour working in agriculture, with most occurring in families on family farms or in family microenterprises.19
Poverty is a major driver of child labour; with farmers unable to make a living wage, they may have no choice but to use children. Tobacco child labour therefore perpetuates poverty.17 The International Labour Organization also identifies other important influences including social inequality, paucity of educational opportunities and options for decent adult employment, strongly agrarian economies, and traditional and cultural norms. Unscrupulous employers may play a part, and external events such as natural disasters, epidemics (e.g. HIV/AIDS) and armed conflict also push children into the role of breadwinner.20
Child labour is common in many regions in which tobacco is grown, although the overall number of children involved is not known. Research in Malawi found that more than half (57%) of all children in two tobacco producing districts were involved in child labour; among tobacco growing families, this rose to almost two-thirds (63%) of children.21 In the US, while most child labour is highly regulated, there are certain exceptions for farm workers that allow them to hire children.22 Apart from denying children access to education, work in the tobacco fields may also be hazardous, exposing children to dangerous equipment, pesticides and other chemicals, and to toxicity due to nicotine in the leaf (‘green tobacco sickness’—see below).23 They also experience low back pain, wheezing, and coughing.24 Working hours are also long, with some children working 12-hour days, six days per week.23, 25 Children who work in tobacco farms are also significantly more likely to take up smoking.26
Human Rights Watch [HRW], a non-profit, non-governmental human rights organisation, has prepared detailed reports of its extensive field research with child tobacco workers in the US,27 Indonesia,25 and Zimbabwe.10 The reports contain recommendations to governments that could improve working conditions and prevent anyone under age 18 from engaging in work that required direct contact with tobacco in any form. Other recommendations are aimed at the ILO and tobacco manufactures and leaf buyers. HRW recommendations to the ILO include:
- Develop clear, implementable guidance regarding the hazards of tobacco farming for children without delay. Urge states and companies to prohibit all children under 18 from tasks involving direct contact with tobacco in any form.
- Consult meaningfully with states, such as Brazil, that prohibit all children under 18 from work in tobacco farming.28 Gather information about the development and implementation of these prohibitions, including government enforcement activities, industry requirements, and educational and training programs.
- Allow a range of different types of experts to contribute meaningfully to the tripartite process on hazardous child labour and occupational safety and health in tobacco growing.
HRW recommendations to tobacco product manufacturers and tobacco leaf merchant companies include:
- Adopt or revise global child labour policies to prohibit hazardous work by children under 18 without exceptions, including any work in which children have direct contact with tobacco in any form.
- Establish regular and rigorous internal and third-party monitoring in the supply chain, including through unannounced inspections at the time of year, time of day, and locations where children are most likely to be working. Engage qualified and experienced monitors who are fluent in the languages that workers speak, and trained in child labour and labour rights. Include private, confidential interviews with workers, as well as growers, as components of inspections. Make the results of internal and third-party monitoring public.
- Enhance collaboration with farmworker families, federal and local governments, the International Labour Organization’s International Programme on the Elimination of Child Labour (IPEC), United Nations Children's Fund (UNICEF), nongovernmental organizations, organized labour, and other stakeholders to provide children with alternatives to working in tobacco farming, including age-appropriate and accessible educational and employment opportunities and alternative sources of income.
- Develop an international industry-wide standard to prohibit hazardous work for children under 18 on tobacco farms, including any work in which children have direct contact with tobacco in any form.
Each of the major tobacco companies claim to be committed to ending child labour. Philip Morris states on its website that it aims to eliminate child labour in its tobacco growing supply chain by 2025, and that is has “maintained a relentless focus on preventing child labor through a robust due diligence system that has allowed the company to identify risks and incidents of child labor, and take immediate action.”29 British American Tobacco has also set itself the “bold ambition” of having no child labour in its supply chain by 2025, and has outlined its monitoring and remediation process in its 2020 human rights report.16 Imperial Brands has also outlined its strategy for addressing child labour, such as through monitoring tobacco farms and enhancing the welfare of farmers.30
The major tobacco company websites also highlight their collaboration with the Eliminating Child Labour in Tobacco Foundation (ECLT) as evidence of their commitment to ending child labour. The ECLT was established in 2000 by the International Tobacco Growers’ Association (see Section 10A.5) and British American Tobacco, with The International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers’ Associations (IUF).31 Its aim was assessing the extent of child labour in tobacco growing, supporting projects to combat child labour, and sharing best practice. All three of the major tobacco companies operating in Australia are ECLT members and provide the foundation with financial support.32
The International Labour Organisation (ILO) is the global United Nations agency responsible for setting labour standards and developing policies and programs promoting decent work. It has worked as an advisor and ally to the ECLT for many years. In 2015, it entered into an agreement to develop global guidance on hazardous child labour and occupational safety and health in tobacco growing, and to “support stronger social dialogue” in three of the countries where ECLT operates projects: Malawi, the United Republic of Tanzania, and Uganda.33 THE ECLT is largely criticised by tobacco control stakeholders34, 35 as being primarily a public relations exercise that delivers few measurable results. In the ASEAN region for example,36 where the ECLT operates projects in Indonesia and The Philippines, the problem of child labour in tobacco farming is still rife. A recent report on child labour in Indonesia described the ECLT as “a form of CSR [corporate social responsibility]-washing”.37
While publicly condemning child labour, ECLT has not committed or taken steps to:
- set a systematic plan to end child labour
- set a deadline to end child labour in its project countries
- reject tobacco leaves produced with child labour
- provide a disincentive for its members who purchase tobacco leaves produced with child labour.
ECLT’s endorsement by international agencies such as the ILO serves to legitimise and promote the program. Meanwhile, the ECLT tobacco industry members continue to profit from tobacco produced by child labour.36 Research by the Center for Tobacco Control Research and Education into the background and modus operandi of the ECLT provided evidence that the primary concern for the tobacco companies involved was to enhance their corporate image, without initiating any real change that might undermine the financial benefits presented by child labour.38 Along with being an integral part of companies’ CSR activities, the ECLT also serves to divert attention from tobacco companies’ violations of human and workers’ rights, and helps them to evade responsibility. Rather than contributing financially to ECLT, companies could instead pay workers a fair wage.39 One study estimated that the costs of banning child labour and introducing decent working conditions and remuneration for adult tobacco workers in Malawi would be about US$10 million a year, a sum easily affordable given the enormous revenues of the tobacco companies.40
The ECLT Foundation is also a member of the Child Labour Platform of the voluntary UN Global Compact (UNGC) Human Rights and Labour Working Group, for which the ILO provides the secretariat, despite the UNGC’s decision to sever ties with the tobacco industry.31 A major report on child labour in Indonesia includes in its recommendations that the United Nations Global Compact must act consistently and deregister the membership of ECLT from its list.37 A 2021 statement from STOP, a global tobacco industry watchdog, along with 176 organisations and individuals, also requests that the ECLT be removed as a participant to the UNGC, in accordance with UN policies.39
Despite commitments to end child labour from the tobacco industry and industry-affiliated groups, several investigations have found that it remains rampant.12, 37, 41, 42 The president of the industry-aligned Tobacco Growers’ Association in Mexico reportedly told the Guardian that child labour was virtually eradicated, yet children were working on the majority of plantation visited by journalists. 41 Findings from a 2021 report showed that the condition of child labour in tobacco plantations in Indonesia had not substantially changed since the Human Rights Watch (HRW) Indonesia study in 2016. Further, a comparison of the types of work, wages, working hours, and health risks of child labour in 2016 and 2021 showed no significant change. 37 One paper notes in response to targets to end child labour by 2025 that the tobacco industry is the problem, not part of the solution, and calls for the ILO to cut ties with the tobacco industry and the ECLT. 42
10.14.3 Occupational health and safety risks for tobacco workers
Green tobacco sickness (GTS) is common among tobacco farm workers, and occurs when nicotine is absorbed through the skin and enters the bloodstream from direct contact with newly cut green tobacco leaves (see Section 3.20.2). It is characterised by dizziness, headache, muscle weakness, nausea and vomiting, and is common among tobacco farmers.43 The global prevalence of GTS has been estimated as between 8% and 47%,44 though one study in Brazil found that among tobacco farmers, 72% of women and 35% of men had GTS, with this difference potentially attributed to differences in tasks performed.43 A study of tobacco harvesters in Korea similarly found a higher prevalence of GTS among women than men.45 Child tobacco workers in Brazil24 and the US23 have also reported symptoms consistent with GTS.
Along with contact with moist tobacco leaves, additional risk factors for GTS include a lack of personal protective equipment during harvest, lack of experience in tobacco farming, and the presence of skin cuts or rashes.43 Despite often feeling sick, some tobacco farmers have reported being unaware of GTS or how to treat and prevent it.10 Workers also report having inadequate protective equipment,46 with children in the US wearing plastic garbage bags to try and keep their clothes dry.23 Migrant workers in Italy have reported not wearing gloves, and being unable to afford to buy their own due to low wages.46
In addition to GTS, a condition called ‘Tobacco worker’s lung’ has been documented among those working in farming and production. It is a type of hypersensitivity pneumonitis – an allergic reaction that causes inflammation in the lungs, caused by tobacco dust and moulds dispersed in the air in cigarette production facilities.47 Exposure to pesticides can also lead to long-term health harms among tobacco workers, including damage to DNA48-50 and hearing.51 In response to pesticides being sprayed nearby, child workers have reported burning eyes, burning noses, itchy skin, nausea, vomiting, dizziness, shortness of breath, redness and swelling of their mouths, and headache. 23 Increased risks of musculoskeletal disorders, heatstroke and skin cancer have also been reported among tobacco farmers,9, 52, 53 and workplace accidents and injuries are common.23, 26, 54 A study in India found an association between occupational exposure to tobacco dust and women’s risk of developing cervical cancer.55 Poor working conditions and adverse health effects may also increase farmers’ risk of mental illness.56-59
10.14.4 Alternatives to tobacco farming
As outlined above, tobacco production generates only minimal profits for farmers, with most living in poverty. Further, due to changes in demand and new technologies, employment in both tobacco manufacturing and cultivation has fallen over time.60 These issues have led to calls for governments to actively seek socially and economically viable alternatives for farmers and production workers,5, 60 and for ongoing and systematic government education, support, and compensation.1, 2, 52, 61 While a transition away from tobacco is likely complex for many farmers, an analysis in Malawi found that it had already largely occurred. The proportion of Malawian crop farmers producing tobacco decreased from 16% in 2004 to 5% in 2019. There had also been an increase in poverty rates among tobacco farmers, reinforcing that tobacco production is not able to serve as a pathway out of poverty.62 Similarly, an analysis of the economic livelihoods of tobacco farming households who had switched to other livelihoods in Indonesia found that they were largely better off; decreasing the share of tobacco crops in a farming household’s farming portfolio likely generates greater income.63
The World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the WHO. At its third session (South Africa, 17–22 November 2008), the Conference of the Parties [COP] to the WHO FCTC decided to establish a working group on economically sustainable alternatives to tobacco growing in relation to Articles 17 and 18.64 At the fourth session of the COP (COP4; Uruguay, 15–20 November 2010), the working group presented a report that included recommendations for policy options. These policy options included64 :
- promotion of opportunities for economically sustainable livelihoods and development of markets
- developing opportunities to counter seasonal trade in alternative crops
- reducing tobacco production and/or promotion
- assistance and cooperation in capacity building for economically sustainable alternative livelihoods
- establishing an international information exchange system.
The International Labour Organisation addressed the fourth session of the Conference of the Parties as an observer and highlighted that viable economic alternatives needed to be developed for many tobacco-dependent communities where members’ livelihoods would be seriously affected as a consequence of the implementation of the WHO FCTC. The International Labour Organization called on the Conference of the Parties to adopt a holistic approach when considering alternative employment options for affected parties, and reiterated its willingness to continue collaborating with the WHO FCTC by sharing its experience and expertise in labour market-related issues.65
At the sixth session of the parties (Russia, 13–18 October 2014), the COP then adopted a set of policy options and recommendations on economically sustainable alternatives to tobacco growing. These policy options build on the recommendations from COP 4 and include an emphasis on research, training and education for workers and growers, establishing mechanisms to support alternative livelihoods, and developing international partnerships.66
At COP7 (New Delhi, India, 7–12 November 2016), the Convention Secretariat was asked to continue documenting experiences and outcomes concerning alternative livelihoods for tobacco workers, growers, and sellers; to organise and periodically update an international database of resources of best practices and instruments; and to put in place measures to support the implementation of the policy options and recommendations adopted in 2014.67 A global meeting on Articles 17 and 18 then took place in 2017 in Tanzania organised by the Convention Secretariat in cooperation with the Food and Agriculture Organization of the UN, the UN Development Programme and the WHO. Outcomes of the meeting included the creation of working group on Articles 17 and 18 and the development of an economic model for implementing alternative livelihoods for tobacco growers.68
A 2019 report commissioned by the Convention Secretariat documented progress, practices and lessons learned from Parties in the implementation of Article 17. It concludes that there are strategies that could increase the success of helping tobacco farmers make the shift to alternative crops, including:
- integration of tobacco diversification programs in more comprehensive rural development programmes;
- providing support to farmers from government grants, farmers’ associations and non-governmental organisations in launching of diversification and crop substitution initiatives and in identifying profitable market channels and opportunities;
- provision of training, technical and financial support to ease transition to alternative crops; and
- consideration given to the local or regional context in which diversification programs are promoted, including the existing infrastructure that could enable the development of a suitable diversification or substitution strategy.69
10.14.5 Testing of tobacco products
Along with the health risks from exposure to tobacco during farming and production, outlined above, an analysis of tobacco industry documents showed examples of employees being used to ‘taste test’ products. It showed that since the 1940s, tobacco companies in the US conducted employee panels that included both smokers and non-smokers to evaluate pesticides’ impact on cigarette flavour. Despite attempts to self-regulate this practice, the authors highlight a number of ethical issues, including conflict of interest and informed consent, and argue that privately-funded research involving humans should be subject to stringent regulations and oversight.70
In addition to the exploitation of humans in the production of tobacco, ethical concerns have been raised regarding the use of animals for testing tobacco products. Thousands of studies have been conducted examining the effects of nicotine or tobacco exposure in animals,71 including in dogs,72 monkeys,73 and rodents,71, 74 both by the tobacco industry and by research institutions. One of the most well-known early examples is a 1975 investigation when a journalist went undercover at an animal testing laboratory in England and published photos of ‘smoking beagles’. 75
While these studies ostensibly aim to identify the risk of disease in humans, some have argued that such experimentation is largely pointless, given the health risks of smoking have been demonstrated beyond doubt.76 Further, animals may respond differently than humans to toxins,77 and there is decades of research on the risks of tobacco and nicotine exposure from human epidemiological and clinical studies.78 One source of such knowledge is the publicly available Adverse Outcome Pathway (AOP) Wiki created by the European Commission’s DG Joint Research Centre (JRC), the US Environmental Protection Agency (EPA), and the Organization for Economic Co-operation and Development (OECD), which is a theoretical framework that describes a sequence of events and mechanisms by which chemicals can cause adverse human health effects. 79 This existing knowledge, combined with non-animal forms of testing such as computational modelling and cell-based (in vitro) tests, may be used by companies to predict health risks of particular products or constituents, including from alternative nicotine delivery devices such as e-cigarettes.80
Tobacco testing in animals was banned in the UK in 1997, and in Europe is banned in Belgium, Estonia, Germany and Slovakia. Animal testing is no longer required by law for tobacco products in the US, though is not banned.80 In its guidance on the use of investigational tobacco products, the FDA states that it “supports reducing the reliance on animal testing where adequate and scientifically valid non-animal alternatives can be substituted.“81 In Australia, there is a ban on cosmetic testing on animals, but not on the testing of chemicals used for other purposes. When discussing the Bill in 2017, the then Health Minister stated that Australia is “moving away from the use of animal test data for other purposes, so that animal test data, like in the EU, would be used as a last resort where science has not yet developed valid alternatives that can assure continued protections for human health, worker safety and the environment.”82 In the meantime, the Australian Code for the Care and Use of Animals for Scientific Purposes83 has incorporated the “3Rs”:
- Replacement: using alternative means to animal testing
- Reduction: using fewer animals in testing
- Refinement: using methods that reduce potential pain and suffering of animals subject to testing
Relevant news and research
For recent news items and research on this topic, click here. ( Last updated June 2022)
References
1. Wan X, Jin J, and Ran S. Willingness of tobacco farmers to accept compensation for tobacco crop substitution in Lichuan City, China. Tobacco Control, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34535508
2. Talukder A, Haq I, Ali M, and Drope J. Factors associated with cultivation of tobacco in Bangladesh: A multilevel modelling approach. International Journal of Environmental Research and Public Health, 2020; 17(12). Available from: https://www.ncbi.nlm.nih.gov/pubmed/32549295
3. Caze AMB, Lacerda ABM, Luders D, Conto J, Marques J, et al. Perception of the quality of life of tobacco growers exposed to pesticides: Emphasis on health, hearing, and working conditions. Int Arch Otorhinolaryngol, 2019; 23(1):50–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30647784
4. Li Q, Magati P, Lencucha R, Labonte R, Makoka D, et al. The economic geography of Kenyan tobacco farmers' livelihood decisions. Nicotine & Tobacco Research, 2019; 21(12):1711–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30690496
5. Magati P, Lencucha R, Li Q, Drope J, Labonte R, et al. Costs, contracts and the narrative of prosperity: An economic analysis of smallholder tobacco farming livelihoods in Kenya. Tobacco Control, 2019; 28(3):268–73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29967193
6. Makoka D, Drope J, Appau A, Labonte R, Li Q, et al. Costs, revenues and profits: An economic analysis of smallholder tobacco farmer livelihoods in Malawi. Tobacco Control, 2017; 26(6):634–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29066593
7. Chingosho R, Dare C, and van Walbeek C. Tobacco farming and current debt status among smallholder farmers in manicaland province in Zimbabwe. Tobacco Control, 2021; 30(6):610–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32848076
8. Benjamin A. Ethical smoke screen. The Guardian, 2007. Available from: https://www.theguardian.com/environment/ethicallivingblog/2007/nov/07/abrandofcigarettesthat
9. Oxfam America. A state of fear: Human rights abuses in North Carolina's tobacco industry. 2011. Available from: https://www.oxfamamerica.org/explore/research-publications/a-state-of-fear-human-rights-abuses-in-north-carolinas-tobacco-industry/.
10. Wurth M. A bitter harvest. Child labor and human rights abuses on tobacco farms in Zimbabwe. Human Rights Watch, 2018. Available from: https://www.hrw.org/report/2018/04/05/bitter-harvest/child-labor-and-human-rights-abuses-tobacco-farms-zimbabwe.
11. Otañez M, Sandramu R, and McGill A. Human trafficking and forced labour in Malawi's tobacco growing sector. Tobacco Induced Diseases, 2018; 16(1). Available from: https://doi.org/10.18332/tid/84669
12. SwedWatch. Smokescreens in the supply chain. 2016. Available from: https://swedwatch.org/publication/the-hidden-side-effects-of-tobacco/.
13. Teixeira F. Tobacco exporter faces slavery charges in landmark Brazil case. Thomson Reuters Foundation News, 2021. Available from: https://news.trust.org/item/20210301205054-hrdk4/
14. Boseley S. UK tobacco firms fail in bid to have Malawi child labour case struck out. The Guardian, 2021. Available from: https://www.theguardian.com/business/2021/jun/25/uk-tobacco-firms-fail-in-bid-to-have-malawi-child-labour-case-struck-out
15. Philip Morris International. Fair working practices on tobacco farms. Available from: https://www.pmi.com/sustainability/upholding-labor-rights-on-the-farms
16. British American Tobacco. Journey to a better tomorrow: Human rights report. 2020. Available from: https://www.bat.com/group/sites/UK__9D9KCY.nsf/vwPagesWebLive/DO964UGU/$file/BAT_Human_Rights_Report_2020.pdf
17. Rowe M. Smoke signals. Framework Convention Alliance 2019. Available from: https://www.fctc.org/wp-content/uploads/2019/05/Dossier-Tobacco-Geographical-UK-Article.pdf
18. Otanez M. Views on trying to change the tobacco industry: Health justice and marginalization of tobacco companies. Tobacco Control, 2009; 18(5):339–40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19779059
19. International Labour Office and United Nations Children’s Fund. Child labour: Global estimates 2020, trends and the road forward. New York: ILO and UNICEF, 2021. Available from: https://www.ilo.org/wcmsp5/groups/public/---ed_norm/---ipec/documents/publication/wcms_797515.pdf.
20. Muwanga-Bayego H. Tobacco growing in Uganda: The environment and women pay the price. Tobacco Control, 1994; 3(3):255–6. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/3/3/255
21. International Labour Organization. ILO cooperation with the tobacco industry in the pursuit of the organization’s social mandate 2017. Available from: https://www.ilo.org/wcmsp5/groups/public/---ed_norm/---relconf/documents/meetingdocument/wcms_545944.pdf
22. Ramchandani A. The overlooked children working America’s tobacco fields. The Atlantic, 2018. Available from: https://www.theatlantic.com/family/archive/2018/06/child-labor-tobacco/562964/
23. Human Rights Watch. Tobacco’s hidden children: Hazardous child labour in United States tobacco farming. 2015. Available from: https://humantraffickinghotline.org/sites/default/files/Tobaccos%20Hidden%20Children%20-%20HRW.pdf.
24. Fassa AG, Faria NMX, Szortyka A, Meucci RD, Fiori NS, et al. Child labor in family tobacco farms in southern Brazil: Occupational exposure and related health problems. International Journal of Environmental Research and Public Health, 2021; 18(22). Available from: https://www.ncbi.nlm.nih.gov/pubmed/34832014
25. Human Rights Watch. “The harvest is in my blood” hazardous child labor in tobacco farming in Indonesia United States: Human Rights Watch, 2016. Available from: https://www.hrw.org/sites/default/files/report_pdf/indonesia0516web_0.pdf.
26. Alderete E, Livaudais-Toman J, Kaplan C, Gregorich SE, Mejia R, et al. Youth working in tobacco farming: Effects on smoking behavior and association with health status. BMC Public Health, 2020; 20(1):84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31959140
27. Human Rights Watch. Teens of the tobacco fields: Child labor in United States tobacco farming. 2015. Available from: https://www.hrw.org/report/2015/12/09/teens-tobacco-fields/child-labor-united-states-tobacco-farming.
28. Wurth M. Tobacco’s children. Brazil sets an example for the US. The Progressive, 2015. Available from: http://progressive.org/magazine/tobacco-s-children.-brazil-sets-example-u.s./.
29. Philip Morris International. How PMI’s targeted approach is helping eliminate child labor. 2021. Available from: https://www.pmi.com/sustainability/how-pmi-s-targeted-approach-is-helping-eliminate-child-labor.
30. Imperial Brands. Addressing child labour. Available from: https://www.imperialbrandsplc.com/content/dam/imperial-brands/corporate/sustainability/sustainability-documents/addressing-child-labour.pdf
31. Tobacco Tactics. Eliminating child labour in tobacco-growing foundation,. University of Bath, 2021. Available from: https://tobaccotactics.org/wiki/eclt/.
32. Eliminating Child Labour in Tobacco Foundation. Governance. About us. 2013. Available from: http://www.eclt.org/about-us/governance/.
33. International Labour Organization. ECLT foundation and ILO sign agreement to combat child labour in tobacco. 2015. Available from: https://www.ilo.org/pardev/public-private-partnerships/WCMS_371395/lang--en/index.htm.
34. Hefler M. Big tobacco, child labour and the international labour organization. Tobacco Control Journal blogs 2016. Available from: http://blogs.bmj.com/tc/2016/02/08/big-tobacco-child-labour-and-the-international-labour-organization/
35. Graen L. Tobacco industry confronted with child labour. Tobacco Control blog, 2015. Available from: http://blogs.bmj.com/tc/2015/01/27/tobacco-industry-confronted-with-child-labour/
36. Southeast Asia Tobacco Control Alliance. Child labour in tobacco cultivation in child labour in tobacco cultivation in the ASEAN region. Indonesia: Southeast Asia Tobacco Control Alliance, 2013. Available from: http://seatca.org/dmdocuments/ChildLabor%20Final%202013.pdf.
37. Emancipate Indonesia | Yayasan Lentera Anak. The tobacco industry reaps double benefits from children: Executive summary. 2021. Available from: https://seatca.org/dmdocuments/EXECUTIVE%20SUMMARY_Child%20Labour_SaveSmallHands_Indonesia_24%20Aug%202021.pdf.
38. International Labour Organization. About child labour. Geneva: ILO, 2011. Available from: http://www.ilo.org/ipec/facts/lang--en/index.htm.
39. STOP. Letter to CEO & executive director United Nations Global Compact. 2021. Available from: https://exposetobacco.org/wp-content/uploads/UNGC-Reject-TI-Partnerships-ECLT-2021.04.30.pdf
40. International Tobacco Growers' Association. Trees and tobacco. Castelo Branco, Portugal: International Tobacco Growers' Association, 2008.
41. Lakhani N. Mexico: Children toil in tobacco fields as reforms fail to fix poverty The Guardian, 2018. Available from: https://www.theguardian.com/world/2018/jun/27/mexico-child-labour-tobacco-fields-nayarit
42. Assunta M. Ending child labour in tobacco production by 20: The tobacco industry is the problem, not part of the solution, in Tobacco Control Blog, Hefler M, Editor 2018. Available from: https://blogs.bmj.com/tc/2018/06/12/ending-child-labour-in-tobacco-production-by-2025-the-tobacco-industry-is-the-problem-not-part-of-the-solution/.
43. da Mota ESMS, da Gloria da Costa Carvalho M, Moreira JC, de Oliveira Barreto E, de Farias KF, et al. Green tobacco sickness among Brazilian farm workers and genetic polymorphisms. BMC Res Notes, 2018; 11(1):20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29329603
44. Fotedar S and Fotedar V. Green tobacco sickness: A brief review. Indian J Occup Environ Med, 2017; 21(3):101–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29618907
45. Park SJ, Lim HS, Lee K, and Yoo SJ. Green tobacco sickness among tobacco harvesters in a Korean village. Saf Health Work, 2018; 9(1):71–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30363073
46. Muzi L and Tondo L. 'I had pain all over my body': Italy’s tainted tobacco industry The Guardian 2019. Available from: https://www.theguardian.com/global-development/2019/may/31/i-had-pain-all-over-my-body-italys-tainted-tobacco-industry
47. Zaga V, Dell'Omo M, Murgia N, and Mura M. Tobacco worker's lung: A neglected subtype of hypersensitivity pneumonitis. Lung, 2021; 199(1):13–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33427972
48. Kahl VFS, Dhillon V, Fenech M, de Souza MR, da Silva FN, et al. Occupational exposure to pesticides in tobacco fields: The integrated evaluation of nutritional intake and susceptibility on genomic and epigenetic instability. Oxid Med Cell Longev, 2018; 2018:7017423. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29967663
49. Kahl VFS, Dhillon VS, Simon D, da Silva FR, Salvador M, et al. Chronic occupational exposure endured by tobacco farmers from Brazil and association with DNA damage. Mutagenesis, 2018; 33(2):119–28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29669110
50. Kahl VFS, da Silva J, and da Silva FR. Influence of exposure to pesticides on telomere length in tobacco farmers: A biology system approach. Mutat Res, 2016; 791-792:19–26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27566293
51. Franca DM, Bender Moreira Lacerda A, Lobato D, Ribas A, Ziliotto Dias K, et al. Adverse effects of pesticides on central auditory functions in tobacco growers. Int J Audiol, 2017; 56(4):233–41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27869513
52. Reis MMD, Oliveira APN, Turci SRB, Dantas RM, Silva V, et al. Knowledge, attitudes, and practices of women farmers concerning tobacco agriculture in a municipality in southern Brazil. Cad Saude Publica, 2017; 33Suppl 3(Suppl 3):e00080516. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28954049
53. Meucci RD, Fassa AG, Faria NM, and Fiori NS. Chronic low back pain among tobacco farmers in southern Brazil. Int J Occup Environ Health, 2015; 21(1):66–73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25633930
54. Zago AM, Meucci RD, Fiori N, Carret MLV, Faria NMX, et al. Workplace accident prevalence and associated factors among tobacco farm in Sao Lourenco Do Sul-rs, Brazil. Cien Saude Colet, 2018; 23(5):1353–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29768592
55. Joseph N, Nelliyanil M, Supriya K, Babu Y, Naik R, et al. Association between occupational history of exposure to tobacco dust and risk of carcinoma cervix: A case-control study. Indian J Cancer, 2016; 53(1):44–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27146738
56. Cruzeiro Szortyka ALS, Faria NMX, Carvalho MP, Feijo FR, Meucci RD, et al. Suicidality among south Brazilian tobacco growers. Neurotoxicology, 2021; 86:52–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34214458
57. Muniswamy S and Maliakel SF. A comparative study on the health problems and substance abuse among the tobacco farmers and non-tobacco farmers in Hassan District, Karnataka. Indian J Occup Environ Med, 2021; 25(1):33–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34295060
58. Faria NM, Fassa AG, Meucci RD, Fiori NS, and Miranda VI. Occupational exposure to pesticides, nicotine and minor psychiatric disorders among tobacco farmers in southern Brazil. Neurotoxicology, 2014; 45:347–54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24875484
59. Krawczyk N, Meyer A, Fonseca M, and Lima J. Suicide mortality among agricultural workers in a region with intensive tobacco farming and use of pesticides in Brazil. J Occup Environ Med, 2014; 56(9):993–1000. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25046321
60. International Labour Organization. Food, drink and tobacco sector. 2017. Available from: http://www.ilo.org/global/industries-and-sectors/food-drink-tobacco/lang--en/index.htm.
61. Clark M, Magati P, Drope J, Labonte R, and Lencucha R. Understanding alternatives to tobacco production in Kenya: A qualitative analysis at the sub-national level. International Journal of Environmental Research and Public Health, 2020; 17(6). Available from: https://www.ncbi.nlm.nih.gov/pubmed/32204418
62. Wineman A, Chilora L, and Jayne TS. Trends in tobacco production and prices in Malawi. Nicotine & Tobacco Research, 2022; 24(2):227–32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34605884
63. Sahadewo GA, Drope J, Li Q, Nargis N, and Witoelar F. Tobacco or not tobacco: Predicting farming households' income in Indonesia. Tobacco Control, 2021; 30(3):320–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32404519
64. WHO Framework Convention on Tobacco Control Conference of the Parties. Economically sustainable alternatives to tobacco growing (in relation to articles 17 and 18 of the WHO Framework Convention on Tobacco Control) progress report of the working group. Provisional agenda item 5.5 (FCTC/COP/4/9 for Uruguay 15-22 November 2010)15 August Geneva: World Health Organization, 2010. Available from: http://apps.who.int/gb/fctc/PDF/cop4/FCTC_COP4_9-en.pdf.
65. International Labour Organization. Statement to the WHO Framework Convention on Tobacco Control Conference of the Parties Punta del Este - Uruguay, 15-20 November 2010. Geneva: ILO, 2010. Available from: http://www.ilo.org/public/english/dialogue/sector/papers/food/statement.pdf.
66. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Policy options and recommendations on economically sustainable alternatives to tobacco growing (in relation to articles 17 and 18 of the who FCTC). Geneva: WHO, 2014. Available from: http://www.who.int/fctc/guidelines/adopted/Policy_options_reccommendations_Articles17_18_COP6.pdf?ua=1.
67. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Economically sustainable alternatives to tobacco growing (in relation to articles 17 and 18 of the who FCTC): Report by the Convention Secretariat. Delhi, India 2016. Available from: https://www.who.int/fctc/cop/cop7/FCTC_COP_7_12_EN.pdf.
68. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Progress report on technical matters related to articles 4.2.D (gender issues), 5.3 (tobacco industry interference), 17 and 18 (alternative livelihoods and protection of the environment) and 19 (liability). Geneva, Switzerland 2018. Available from: https://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_9-EN.pdf.
69. WHO Framework Convention on Tobacco Control Secretariat. Country practices in the implementation of article 17 (economically sustainable alternatives to tobacco growing) of the WHO Framework Convention on Tobacco Control. 2019. Available from: https://www.who.int/fctc/implementation/publications/country-practices-implementation-article-17-WHO-FCTC.PDF.
70. McDaniel PA, Solomon G, and Malone RE. The ethics of industry experimentation using employees: The case of taste-testing pesticide-treated tobacco. American Journal of Public Health, 2006; 96(1):37–46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16317198
71. Dos Reis Izolan L, Bandiera S, Pulcinelli RR, Nin MS, Almeida FB, et al. Low-cost apparatus for cigarette smoke exposure in rats. J Neurosci Methods, 2022; 366:109412. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34798213
72. Park SS, Kikkawa Y, Goldring IP, Daly MM, Zelefsky M, et al. A72animal model of cigarette smoking in beagle dogs: Correlative evaluation of effects on pulmonary function, defense, and morphology. Am Rev Respir Dis, 1977; 115(6):971–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/262108
73. Zhu L, Di PY, Wu R, Pinkerton KE, and Chen Y. Repression of cc16 by cigarette smoke (CS) exposure. PLoS One, 2015; 10(1):e0116159. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25635997
74. Beckett EL, Stevens RL, Jarnicki AG, Kim RY, Hanish I, et al. A new short-term mouse model of chronic obstructive pulmonary disease identifies a role for mast cell tryptase in pathogenesis. J Allergy Clin Immunol, 2013; 131(3):752–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23380220
75. Greenslade R. Mary beith, the journalist who broke the 'smoking beagles' story. The Guardian, 2012. Available from: https://www.theguardian.com/media/greenslade/2012/may/20/thepeople-investigative-journalism#:~:text=She%20was%20the%20undercover%20reporter,allegedly)%20%22safe%22%20cigarette.
76. European Parliament. Parliamentary questions: Testing of tobacco products on animals. 2013. Available from: https://www.europarl.europa.eu/doceo/document/E-7-2013-007135_EN.html.
77. Van Norman GA. Limitations of animal studies for predicting toxicity in clinical trials: Is it time to rethink our current approach? JACC. Basic to translational science, 2019; 4(7):845–54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31998852
78. U.S. Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf.
79. Organisation for Economic Co-operation and Development. Adverse outcome pathway wiki Available from: https://aopwiki.org/.
80. Manuppello JR. Avoiding animal testing under the US Family Smoking Prevention and Tobacco Control Act. Applied In Vitro Toxicology, 2017; 3(1):10–1. Available from: https://www.liebertpub.com/doi/abs/10.1089/aivt.2016.0033
81. Food and Drug Administration. Use of investigational tobacco products. 2019. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/use-investigational-tobacco-products.
82. Parliament of Australia. Industrial Chemicals Bill 2017: Second reading. 2017. Available from: https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22chamber%2Fhansardr%2F3664ab2c-ce16-46fe-9470-d2cd459dfdc9%2F0044%22
83. National Health and Medical Research Council. Australian code for the care and use of animals for scientific purposes, 8th edition. Canberra: NHMRC, 2013. Available from: https://www.nhmrc.gov.au/about-us/publications/australian-code-care-and-use-animals-scientific-purposes.