Shade tobacco and green tobacco sickness in Connecticut

[Tobacco cultivation in the south of Brazil: green tobacco sickness and other health problems]

The scope of this study was to identify the presence of health problems and their significance for tobacco harvesters, State representatives, civil society and the tobacco industry, and also understand their coping strategies. An ethnographic study with 35 semi-structured interviews answered by harvesters' families and key informants was carried out in a rural community in the state of Rio Grande do Sul. In addition to that, participant observation of the families was conducted. The harvesters and representatives of civil society acknowledge the presence of green tobacco sickness and other problems. Representatives of healthcare organizations do not identify or recognize the sickness as being a consequence of the productive activity linked to tobacco. Tobacco industry representatives acknowledge that there are health problems, but blame the harvesters. The conclusion reached is that there is a need for a closer approach, monitoring and intervention by Public Authorities in tobacco-producing rural communities, seeking to develop surveillance actions and promote occupational health.

Tobacco, Nicotine, and Headache

BACKGROUND

Migraineurs variably attribute the cause of their headache to tobacco exposure, whereas tobacco is often stated to cause headache-related disability worldwide. Given tobacco's physiological and emotional addictiveness and migraine's substantial economic impact, improved functionality can be difficult for those with migraine exposed to tobacco products. Environmental tobacco exposure in indoor spaces and workplaces is associated with exacerbation of headache. Avoidance of headache triggers is included in most comprehensive migraine treatment programs, yet tobacco awareness, avoidance, or coping is rarely emphasized as part of that regimen.

OBJECTIVE

The aims of this study were to examine the various types of tobacco products to which headache sufferers are exposed and the known basic mechanisms by which tobacco (nicotine) exposure promotes headache pain, and to review the extensive literature on tobacco related to headache with a detailed descriptive narrative providing the basis for conclusions regarding association of noncluster headache-related tobacco exposure. Tobacco-related recommendations are offered.

METHODS

MEDLINE, EMBASE, and Google Scholar databases were searched without yearly restriction through the date of submission (May 2015), using the MeSH terms "tobacco," "tobacco products," "smoking," "tobacco use," "headache," and "headache disorders." The selection of articles was not limited to English studies or to humans. Articles were excluded when "headache" and "tobacco" were not both mentioned with data provided. Case series were included. Bibliographies of all articles were screened for additional relevant articles.

RESULTS

Although migraineurs worldwide report tobacco smoke among triggers, it is rarely among the highest in frequency, and biases abound with predominantly noncontrolled retrospective data. Prospective population-based diary data are extremely limited, and no controlled trials exist to confirm a cause and effect for headache of any type. Although some studies are nonsupportive and even conflicting, headache, pain, and tobacco exposure currently remain associated.

CONCLUSION

Conflicting data support the validity of patient-reported environmental tobacco exposure as a headache trigger. Prospective controlled studies are needed, but unlikely to be performed, to determine the extent that tobacco influences the headache process, in addition to other under-recognized factors. Meanwhile, because of numerous other negative health effects, decreased tobacco exposure should be recommended to headache patients of all ages in hopes of decreasing disability and improving functionality.

First reported outbreak of green tobacco sickness in Brazil

Dermal absorption of nicotine by people harvesting tobacco may cause an acute intoxication called green tobacco sickness. Although Brazil is the second largest producer of tobacco in the world, green tobacco sickness had not been reported in the country to date. We conducted a 1:1 matched case-control study among persons involved in tobacco farming to determine the occurrence of green tobacco sickness in the northeast region of Brazil and to identify the risk factors involved. A case-patient was a person who received a diagnosis by health professional of acute intoxication during the study period and had a cotinine level over 10 ng/mL detected by High Performance Liquid Chromatography. We identified 107 case-patients. The main signs and symptoms observed were dizziness, weakness, vomit, nausea and headache. Independent risk factors identified were being male, a non smoker and having worked in the harvest of tobacco leaves. Case-patients had higher median urinary cotinine levels than controls (p < 0.05). Epidemiological and laboratory data indicate for the first time the occurrence of green tobacco sickness in Brazil.

Green tobacco sickness and skin integrity among migrant Latino farmworkers

BACKGROUND

Green tobacco sickness (GTS) affects approximately one-quarter of tobacco workers. The primary aim of this analysis is to expand existing knowledge of GTS risk factors by delineating the association of measures of skin integrity with the prevalence of GTS among Latino farmworkers.

METHODS

Data are from a longitudinal study of skin disease among 304 North Carolina Latino farmworkers conducted in 2005.

RESULTS

18.4% of the farmworkers met the GTS case definition. Self-reported rash increased the odds of having GTS in the bivariate (OR 2.29, 95% CI 1.21, 4.35), and multivariate analyses (OR 3.30, CI 2.17, 5.02). Self-reported itch (OR 3.54, CI 2.38, 5.24) and superficial wounds (OR 2.49, CI 1.15, 5.39) had a significant relationship to GTS in the bivariate analysis.

CONCLUSIONS

These analyses extend current knowledge of GTS risk factors to include skin integrity. Farmworkers with rash and other skin conditions can protect these affected skin areas from exposure to the tobacco plant to reduce their risk of GTS.

Health and social impacts of tobacco production

OBJECTIVES

To summarize current knowledge about the health and social consequences of tobacco production and to outline research needed to better understand these effects.

DATA SOURCES

The literature documenting the effects of tobacco production is scattered, and not always published in peer-reviewed sources. We undertook a systematic search using (1) a literature file based on over a decade of research on the health effects of tobacco work, (2) searches of computerized data bases (Medline, Science Citation Index, Agricola), (3) a review of new sources cited in literature uncovered through data base searches, and (4) professional contacts with others working on the effects of tobacco production.

DATA SYNTHESIS

The health effects of tobacco production include nicotine poisoning (green tobacco sickness), pesticide exposure, respiratory effects, musculoskeletal and other injuries. Most research has focused on nicotine poisoning. Social effects of tobacco production include social disruption for communities in which tobacco production is declining (unemployment, economic loss), and for communities in which tobacco production is being introduced (loss of local food production and local autonomy).

CONCLUSIONS

Research is needed on the effects of tobacco work on the health of women and children through exposure to nicotine and pesticides, the effects of chronic nicotine exposure on all tobacco workers, the neurotoxic effects of pesticide exposure and its relationship with mental health, and the effects of growing tobacco on using tobacco. Greater effort is needed to document the social disruption in communities that are economically dependent on tobacco production, particularly those in developing countries.

Green tobacco sickness in children and adolescents

Tobacco (Nicotiana tabacum) is cultivated in more than 100 countries, and in 2004, some 5.73 million metric tons dry weight of tobacco were grown worldwide. The top five tobacco producers forecast for 2004 are China (2.01 million metric tons; 35.1%), Brazil (757 thousand metric tons; 13.2%), India (598 thousand metric tons; 10.4%), United States (358 thousand metric tons; 6.2%), and Malawi (138 thousand metric tons; 2.4%). Together, these five countries account for two-thirds of worldwide tobacco production. Tobacco farming presents several hazards to those who cultivate and harvest the plant. Although some of these hazards, such as pesticide exposure and musculoskeletal trauma, are faced by workers in other types of agricultural production, tobacco production presents some unique hazards, most notably acute nicotine poisoning, a condition also known as green tobacco sickness (GTS). GTS is an occupational poisoning that can affect workers who cultivate and harvest tobacco. It occurs when workers absorb nicotine through the skin as they come into contact with leaves of the mature tobacco plant. GTS is characterized largely by nausea, vomiting, headache, muscle weakness, and dizziness. Historically, children have played a role in agricultural production in the United States, and they continue to do so today. This includes tobacco farming. The North American Guidelines for Children's Agricultural Tasks, a set of injury prevention guidelines prepared by the National Children's Center for Rural and Agricultural Health and Safety, lists GTS as one of several hazards children face when working on tobacco farms. Children 17 years of age and younger who work on U.S. tobacco farms come from three main groups: members of farm families, migrant youth laborers (primarily Latinos), and other hired local children. All three groups are at risk for GTS. Beyond the U.S., tobacco production using child labor is an emerging topic of concern in developing nations. An international movement, advocated by the Eliminating Child Labor in Tobacco Foundation, is underway to restrict child labor in tobacco production. GTS is a unique occupational poisoning associated with tobacco farming. We suspect that many public health practitioners, clinicians, advocates, and researchers are unaware of GTS among children and adolescents. In this article, we provide an overview of GTS among young people who work in tobacco, summarize reports documenting pediatric GTS cases, explain GTS etiology, and present three case studies of pediatric GTS in Kentucky. In addition, we discuss the need for expanded surveillance and prevention of GTS, both in the United States and globally.

Cotinine levels and green tobacco sickness among shade-tobacco workers

STUDY OBJECTIVE

Symptoms consistent with Green Tobacco Sickness (GTS) were found in 4% (13/331) to 15% (45/303) of the migrant, mostly Latino, shade-tobacco workers who sought medical care at a Connecticut clinic. The objective of this study was to determine whether or not shade-tobacco farm workers absorb nicotine from the tobacco leaves and have a corresponding increase in both salivary cotinine levels (a breakdown product of nicotine) and symptoms consistent with GTS.

METHODS

The study utilized a prospective cohort design to evaluate salivary cotinine and symptoms consistent with GTS in a population of shade tobacco farm workers compared to a control group of nursery workers. The workers were assessed at two points in time, the early tobacco planting season and the harvest season.

RESULTS

There was not a significant increase in salivary cotinine levels among shade-tobacco workers. Salivary cotinine levels over the work season did not significantly increase in shade-tobacco workers when compared with nursery workers. During the harvest season, none of the tobacco workers reported symptoms consistent with GTS.

CONCLUSIONS

Migrant workers in Connecticut who harvest shade-tobacco appear to have a low-risk of occupational nicotine dermal absorption and a low incidence of GTS. The work practices associated with harvesting shade-tobacco, in addition to the fact that shade tobacco may actually have a lower level of nicotine than either burley or flue cured tobacco, may explain these results. Our study appears to reinforce the GTS prevention recommendations made by investigators in other tobacco growing regions, specifically the importance of minimizing close skin contact with tobacco leaves and avoiding dermal contact with the plants when they are wet.