This study was designed to evaluate the association between sugar cane plantation burning and hospital visits in Araraquara in the state of São Paulo, Brazil. From June 1 to August 31, 1995, the daily number of visits of patients who needed inhalation therapy in one of the main hospitals of the city was recorded and used as health impairment estimation. Sedimentation of particle mass (the amount of particles deposited on four containers filled with water) was measured daily. The association between the weight of the sediment and the number of visits was evaluated by means of Poisson regression models controlled for seasonality, temperature, day of the week, and rain. We found a significant and dose-dependent relationship between the number of visits and the amount of sediment. The relative risk of visit associated with an increase of 10 mg in the sediment weight was 1.09 (1-1.19), and the relative risk of an inhalation IMPLICATIONS Biomass fuels are considered to be a cleaner alternative than petroleum-derived sources of energy. Because of its renewability, zero balance in terms of CO 2 production, and less toxic emission, ethanol received a great focus in the development of the energy matrix in São Paulo. This paper deals with the possible but not always considered side effects of producing ethanol with low technological resources--the harvesting process after burning the plantations. The results of this paper indicate that the environmental benefits of using ethanol as automotive fuel have to be balanced with the adverse effects promoted by harvesting, pointing out that better agricultural technology has to be adopted to avoid adverse health effects due to smoke in the producing regions.therapy was 1.20 (1.03-1.39) on the most polluted days (fourth quartile of sediment mass). These results indicate that sugar cane burning may cause deleterious health effects in the exposed population.