Letter to the Editor Industrial Health 2009, 47, 200–201 Use of Personal Protective Equipment in Agricultural Workers under Hot and Humid Conditions Eun-Kee PARK1, 3, Kirsty HANNAFORD-TURNER1 and Hu Jang LEE2* 1Research and Education Unit, Dust Diseases Board, Sydney, NSW, Australia Institute of Life Sciences, College of Veterinary Medicine, Gyeongsang National University, 900 Gajwa-dong, Chinju 660-701, Korea 3NICNAS, Department of Health and Ageing, Australian Government, NSW, Australia 2Research Received September 4, 2008 and accepted November 27, 2008 We read with interest the full report on the adverse health effects of a hot environment on outdoor workers at a construction site1) and thermal limits of men in moderate to heavy work in tropical farming2). Both studies highlighted the importance of heat stress for outdoor workers and the implementation of administrative and engineering controls to reduce heat stress exposure. Our interest in this topic is in relation to agricultural workers in tropical environments who have multiple occupational exposures and who must rely on personal protective equipment (PPE), in the absence of higher level control strategies. Among different economic activities, agriculture is placed as one of the most hazardous industries3). Working in hot climates may lead to dehydration and heat exhaustion which can cause acute- or chronic-illnesses, and in some cases death. Severe dehydration was observed in many Nicaraguan banana plantation workers and their children4). Importantly, chronic dehydration seems to increase the risk of urolithiasis5), and dehydration combined with heat, heatstroke and hyperthermia is directly related to increased mortality6). The annual death rate caused by heat in agricultural industry is 20-fold higher than that for all civilian workers in the USA7). Furthermore, dehydration and exhaustion caused by heat can adversely affect worker productivity, safety and behavior. Another hazard is pesticide exposure which can result in acute and chronic adverse health effects8, 9). Despite the obvious importance of PPE and the knowledge that correct usage and good personal hygiene reduce occupational pesticide exposures, PPE use is still not extensive. In developed countries, guidelines and regulations for pes*To whom correspondence should be addressed. ticide use including the appropriate application of PPE are well documented and established, but similar support may not be expected in developing countries. A combination of climate and economic issues limits PPE use in less developed nations. Climate factors such as high humidity and temperature make the use of PPE very uncomfortable, especially respirators, face masks and overalls. It is obvious that high humidity and temperatures are not favorable working conditions but in combination these factors affect the attitude and behavior among agricultural workers resulting in reduced PPE use. A recent study on Californian farmers10) showed the complexity of the PPE issue when they observed a significant reduction in the use of dust masks or respirators over a prolonged period of time. Although low education and income are recognized as contributing factors to limiting PPE use, this study showed the workers’ perception of health risks was also important and highlights the importance of continued education. Whilst we recognize the conflict between PPE use and these adverse climate factors, and we acknowledge the substantial costs in supplying PPE and providing training on its use, there must be more concrete efforts in reducing adverse health problems in agricultural workers. 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Int Arch Occup Environ Health 80, 16–24. 7) Centers for Disease Control and Prevention (CDC) (2008) Heat-related deaths among crop workers-United States, 1992–2006. MMWR 57, 649–53. 8) Bassil KL, Vakil C, Sanborn M, Cole DC, Kaur JS, Kerr KJ (2007) Cancer health effects of pesticides: systematic review. Can Fam Physician 53, 1704–11. 9) Mitchell DC, Schenker MB (2008) Protection against breathing dust: behavior over time in Californian farmers. J Agric Saf Health 14, 189–203. 10) Schenker MB, Orenstein MR, Samuels SJ (2002) Use of protective equipment among California farmers. Am J Ind Med 42, 455–64.