# Women’s Occupational Tobacco Dust Exposure in Indonesia (T-CHARM): Protocol for a Prospective Cohort Study

## TL;DR

This study aims to investigate the health effects of tobacco dust exposure on women in Indonesia by tracking their health over 20 years.

## Contribution

The T-CHARM study introduces a detailed, long-term cohort design to assess the chronic health impacts of occupational tobacco dust exposure.

## Key findings

- The study recruits 400 nonsmoking women, including tobacco workers and unexposed controls.
- Health metrics like blood count and lung function will be analyzed in relation to urine cotinine levels.
- Baseline data collection is ongoing with plans for 20 years of follow-up.

## Abstract

The consumption of tobacco is regarded as a contributing factor to several diseases. However, the impact of tobacco dust exposure (TDE) on tobacco workers has not been extensively investigated.

This protocol introduces the design and implementation of the Tobacco Dust Cohort for Health Assessment and Risk Monitoring (T-CHARM) study, a prospective cohort study aimed at evaluating the health impacts of TDE.

This prospective cohort study will recruit women working in tobacco processing who are nonsmokers and women who do not work for the tobacco industry and are nonsmokers living in a nearby area (unexposed group), with a total of 400 expected participants. The impact of TDE on health, including metabolic syndrome parameters; complete blood count; and cardiovascular, liver, renal, and lung function, will be evaluated in relation to urine cotinine levels. Air quality and chemical substances in the air and leaves will also be analyzed. The data will be subsequently analyzed using appropriate statistical tools.

A total of 120 respondents have participated as of August 2025. Another 80 respondents will be recruited, laboratory analysis is ongoing, and baseline results are expected by the end of 2025.

The strength of the T-CHARM study’s approach is its detailed occupational and environmental factors and longitudinal health data from the corporate clinic or the district health center, as well as links to cancer and mortality registries and self-reported health. The current phase of the study focuses on baseline data collection for long-term follow-up. The cohort will be monitored for up to 20 years, depending on sustained funding. T-CHARM offers a robust framework for understanding the chronic health effects of occupational TDE.

DERR1-10.2196/84231