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Original research
Occurrence of respiratory symptoms and lung function deficits among fruit and vegetable market workers
  1. Behzad Heibati1,2,
  2. Maritta S Jaakkola1,2,
  3. Taina K Lajunen1,2,
  4. Alan Ducatman3,
  5. Zinat Zafari4,
  6. Marzieh Yekkalam4,
  7. Ali Karimi5,
  8. Jouni J K Jaakkola1,2,6
  1. 1 Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
  2. 2 Biocenter Oulu, University of Oulu, Oulu, Finland
  3. 3 Occupational and Environmental Health, West Virginia University, Morgantown, West Virginia, USA
  4. 4 Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
  5. 5 Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
  6. 6 Atmospheric Composition Research Unit, Finnish Meteorological Institute, Helsinki, Finland
  1. Correspondence to Prof Jouni J K Jaakkola, Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland; jouni.jaakkola{at}


Objective The objective of this study was to investigate the potential effects of occupational exposures among fruit and vegetable market workers on the occurrence of respiratory symptoms and on the level of lung function parameters.

Methods We conducted a cross-sectional study of 140 men working as fruit and vegetable market workers (response rate 100%) and a reference group of 77 male office workers as the reference group (response rate 55%) from Shiraz, Iran. The outcomes of interest included occurrence of respiratory symptoms assessed by a standard respiratory questionnaire and lung function assessed by spirometry.

Results In Poisson regression analyses, the exposed group showed increased prevalence ratio (PR) of wheezing (adjusted PR 5.32, 95% CI 1.40 to 20.26), after controlling for confounding. Cough (PR 3.30, 95% CI 1.16 to 9.40) and wheezing (PR 9.40, 95% CI 2.28 to 38.64) showed increased PRs among vegetable distributors. Forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity were significantly decreased among exposed workers after controlling for confounders. The absolute value of FEV1 level was reduced significantly among fruit and vegetable carters (−0.99, 95% CI −1.68 to −0.32) and vegetable (−0.51, 95% CI −0.93 to −0.10) and fruit (−0.51, 95% CI −0.86 to −0.15) distributors in comparison with the reference group in the adjusted full model.

Conclusions This study provides evidence that fruit and vegetable market workers are at an increased risk of respiratory symptoms and reduced lung function. Workplace conditions and safety training clearly need improvement, and there is a likely role for proper use of personal protective equipment.

  • epidemiology
  • occupational health practice
  • respiratory
  • agriculture
  • organic dusts

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  • AK and JJKJ contributed equally.

  • Contributors Data were collected by ZZ and MY, and analysis was performed by TKL and BH. The manuscript was drafted by BH and reviewed by AD and MJ, and supervised by AK and JJKJ. All authors were involved in editing of the manuscript for intellectual content.

  • Funding The authors would like to express their appreciation to the vice-president of Shiraz University of Medical Sciences for the endless financial support regarding this research project (grant no. 93-7225). BH was funded by Biocenter Oulu. TKL was financially supported by the Ella and Georg Ehrnrooth Foundation and by Jenny and Antti Wihuri Foundation. JJKJ was supported by the Academy of Finland (grant no. 310372).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the ethics committee of the Shiraz University of Medical Sciences.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data comprised deidentified participant data based on questionnaire information and spirometry. Please contact the corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.