Wet Tobacco Research Articles

Working Hours and Personal Protective Equipment Effect on Blood Cholinesterase Levels of Tobacco Plantation Workers

Introduction: Tobacco production is increasing in certain regions of Indonesia due to its high economic value. Tobacco and its products can have harmful effects on the health of consumers, producers and processing workers. Analysis of blood samples has shown that tobacco farmers are at risk of developing occupational diseases related to pesticide exposure and nicotine absorption through the epidermis of wet tobacco leaves. The aim of this study was to compare blood cholinesterase levels in tobacco plantation workers in relation to their working hours and use of personal protective equipment (PPE). Methods: This cross-sectional observational study was conducted in ten subdistricts in Jember district, Indonesia, and included 50 participants selected using proportional sampling. Spearman’s test was used to analyse the relationship between variables. Results: The significance value of the relationship based on Spearman’s test between working hours and blood cholinesterase levels of tobacco farmers in Jember was 0.058 > α (0.05). Meanwhile, the significance value of the relationship between working hours and complete blood count, specifically mean corpuscular haemoglobin concentration (MCHC), was 0.00 < α (0.05), and between PPE use and blood cholinesterase levels was 0.035 < α (0.05). Conclusion: Working hours were not associated with blood cholinesterase levels, but were associated with blood MCHC levels. Meanwhile, the use of PPE was found to be associated with cholinesterase levels in tobacco farmers.

From Leaf to Lip: Tracing Contaminants in Aceh's Traditional Chewing Tobacco (Bakông Asóê)

Bakông Asóe is a typical Acehnese snack loved by older people in Aceh since ancient times. This snack is made from wet tobacco which is used as chewing tobacco. The process of drying Bakông Asóê in the open triggers heavy metal contamination by air pollution from motor vehicles. The process of storing Bakông Asóê in a wet state also triggers the growth of microbes such as bacteria and fungi due to a growth medium in the form of water. The purpose of this study was to determine the content of heavy metal contamination (Pb, Cd, Se, Cu and Hg) and microbiological contamination in the form of bacteria (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa) and fungi (Candida albicans and Aspergillus niger) in Bakông Asóê which sold on the side of the road without adequate hygiene. The research refers to a qualitative research approach with the type of research that is descriptive research. This study showed that heavy metal exposure in the form of Pb, Cu and Se in the three samples was still in the safe range for consumption. However, exposure to heavy metals in the form of Cd and Hg in the three samples exceeded the consumption standard. The results of the analysis of microbiological contamination in the three Bakông Asóê samples were proven to contain bacterial and fungal contamination, where cocci-shaped bacteria were more commonly found and fungi with the genus Aspergillus sp were also more dominant in the three Bakông Asóê samples. The conclusion of this study is positive for chemical and microbiological contamination in Bakông Asóê, which is sold in Aceh, Ule Kareng and Lambaro Markets.

Accelerated methane storage in clathrate hydrates using the natural tobacco

The rapid formation rate and high storage capacity of clathrate hydrates are crucial for natural gas storage and transportation. In this study, a series of wet tobacco samples prepared by soaking different masses of tobacco shred/granules in water were used to store methane in the hydrate. Gas consumption experiments were conducted in an unstirred reactor to investigate the hydrate formation kinetics in the tobacco/water mixtures and their filtrates at 274.15 K and 8.0 MPa. The results demonstrated that the tobacco solutions with surfactivity played a promoting role in the hydrate formation. The wet loose biomass materials provided abundant nucleation sites for gas to solid hydrates. Compared to pure water, the tobacco–water mixtures significantly shorten the induction time of nucleation and accelerate hydrate growth. The amount of methane stored in tobacco granule systems ranged from 112.3 to 160.3 cm3 cm−3, and the storage rates reached 2.06–5.58 cm3 cm−3·min−1. The wet tobacco shreds exhibited higher gas uptakes (132.6–171.6 cm3 cm−3) than the tobacco granule systems and tobacco shreds filtrates at the same liquid–solid ratio. The use of green wet tobacco samples to enhance of hydration should be helpful for the extension of hydrate-based technology.

Faktor Risiko Kejadian Green Tobacco Sickness (GTS) pada Buruh Tani Tembakau: Literature Review

Abstract
 Background: Background: Green Tobacco Sickness (GTS) is a form of nicotine poisoning caused by direct contact between the skin of tobacco farm workers and wet tobacco plants during the planting and harvesting process. This study aims to analyze the risk factors for the incidence of GTS in tobacco farmers. Method: The method used was a literature review. Articles were obtained from the online database Scopus, PubMed, ProQuest, Google Scholar, and Garuda Portal published during 2010-2020. The selected article used an observational study design and discussed the risk factors for the incidence of GTS in tobacco farmers. The assessment of the quality of the articles used guidelines from the Joanna Briggs Institute. Based on the article search, twelve articles were consisting of three articles from national journals and nine articles from international journals. Article analysis was carried out by comparing the percentage of significant variables in the entire article. This study resulted in the most dominant risk factor for GTS is the use of personal protective equipment with a percentage of 50% of the total articles.

Risk Factors of Green Tobacco Sickness on Tobacco Farmers in Jember Indonesia

Introduction. Green Tobacco Sickness (GTS) is a disease in the working population that is still not widely disclosed. GTS characterized by the main symptoms of nausea, vomiting, dizziness, excessive sweating, and occurs when in contact with wet tobacco. This research purpose is to assess the factors associated with the incidence of GTS in tobacco farmers in Jember, Indonesia. Methods. The research design is case control. Research variables are occupational factors and individual factors. Data analysis using binner logistic regression. Result and Discussion. The results stated that the variable influencing the case of GTS in tobacco farmers was the work period OR = 2,944, (CI 1,127-7,693) smoking status OR = 18,083 (CI 6.815-47,984) dermatosis complaints OR = 3,876 (CI = 1,238-12,138) and nutritional status was assessed with a BMI, OR = 2.643 (CI = 1.038-6.733). Farmers with a working period of working 18 years have a risk of 2,944 times GTS compared to farmers with a work period of <18 years. Farmers with smoking status have a risk of 18,083 times GTS compared to non-smoking farmers. Farmers who have dermatoses have a risk of 1,355 times GTS compared to farmers who do not have complaints of dermatosis. Farmers with an abnormal (overweight) BMI have a risk of 2,643 times GTS compared to farmers with a normal BMI. Conclusion. Factors that influence the GTS are age, sex, smoking status, complaints of dermatosis, nutritional status, and years of service. The findings of this study suggest that integrated promotive and preventive measures from both agricultural owners and first-rate health care providers need in the form of providing self-help to reduce direct contact with wet tobacco, healthy living behavior without smoking and maintaining nutritional status.

THE OVERVIEW OF GREEN TOBACCO SICKNESS AMONG TOBACCO FARMERS IN JEMBER DISTRICT, INDONESIA

Background: Green tobacco sickness (GTS) is a type of disease that is still not widely understood, but is often experienced by tobacco farmers. The duration and frequency of contact, the work procedures associated with wet tobacco, and individual vulnerability are risk factors for GTS. Purpose: This study aimed to measure the factors associated with incidences of GTS in tobacco farmers in Jember, Indonesia, to contribute to the prevention of GTS. Method: The research design used case-control. This research was conducted in Jember District, within a group of tobacco farmers. The case group included farmers who experienced GTS and the control group included farmers who did not experience GTS. The study measured age, sex, nutritional status, passive smoking status, alcohol consumption status, subjective complaints, individual hygiene, Occupational Health and Safety (OHS) attitudes, OHS actions, use of personal protective equipment, principal occupation, extra work, type of tobacco leaf, length of service, length of work-rest period, and workload. The study population were tobacco farmers. The sample size was determined using the Lemeshow sampling formula for case-control. The sampling technique was simple random sampling. Data analysis was conducted using chi-squared tests. Results: Variables related to GTS cases in tobacco farmers were sex (p = 0.01) and nutritional status (p = 0.03). There were no significant occupational factors. Conclusion: Factors that influence GTS are sex and nutritional status.

Jellyfish Gallery

Jellyfish Gallery Leigh Anne Couch (bio) A bloom, a swarm, a smack, a giant glassof slick undulations through the water—they look like brains! No, aliens, brother revises.Neither boy has ever come screamingfrom the surf, thrust his heel into cooler-slush,or watched wide-eyed as daddy ate his cigaretteand plastered the hurt in wet tobacco to pullout the sting. Before emerging into a slapof light we turn left into the last chamberof the aquarium: five hundred million yearsand four walls of jellyfish—a slipperyillusion, a mise en abyme of mirrors in whichour eyes get tired trying to pry reflectionfrom depth and vice versa—a working definitionof ennui. In the midst of infinity I find it's hard to breathe; my boys have years to gobefore the age of recursion when every new day,every new heart sting is swimming in déjà vu.Of course we've been here before, deardour Ecclesiastes: the first few timesredoubling our efforts at change, at beingunprecedented, but our failure was resounding:reductio ad absurdum. For we are offspringof the old cosmogonies but never spring far enoughto explode the chandelier, upend the trayof Droste cocoa in the Dutch nurse's hands.Syria was Rwanda when I was a child, then it wasBosnia then Somalia. It's hard to breathe. [End Page 404] Past stars and satellites, ontologies and spacestations waltzing in orbit, past the earth,planet and dirt, past humanity pockedwith infinity, past culture, past politics,past my life, my body, I find the lastcircle circulating, the tiniest jellyfishin Tennessee: a coiled engine mixingwater and electricity like it's nothing, a heartand only a heart, its neon blood flashingin and out like an open sign.It is a sign. As a drop of green dyefeathers the clear water. [End Page 405] Leigh Anne Couch LEIGH ANNE COUCH's second book, Every Lash, will be published by the University of North Texas Press in early 2021. Her poems have appeared in many magazines, including PANK, Pleiades, Subtropic, Cincinnati Review, Salmagundi, and Gulf Coast. Now a freelance editor, she edited for years at Duke University Press and The Sewanee Review. She lives in Tennessee with writer Kevin Wilson and their sons, Griff and Patch. Copyright © 2020 Leigh Anne Couch

Hoping for the Best, Preparing for the Worst: Everyday Life in Upper Canada, 1812–1814 by Dorothy Duncan (review)

Reviewed by: Hoping for the Best, Preparing for the Worst: Everyday Life in Upper Canada, 1812–1814 by Dorothy Duncan Catharine Anne Wilson Hoping for the Best, Preparing for the Worst: Everyday Life in Upper Canada, 1812–1814. Dorothy Duncan. Toronto: Dundurn, 2012. Pp. 247. $21.99 On the two hundredth anniversary of the War of 1812, this book leaves political and military matters in the background and makes the everyday its focus. This is a refreshing departure from the scholarly and popular literature on the war, which has proliferated over the last few years. It is a mix of popular history and first-hand accounts, most of which were, it must be admitted, written by the elite at the time. Accounts of daily life written by ordinary folk have rarely survived. To make up for this and breathe life into the past, the author has created letters between two fictional sisters. Nearly two-thirds of the book explores life from the American Revolution up to the eve of the War of 1812. Duncan takes 131 pages to set the scene, implicitly arguing that Upper Canadians were ingenious, persevering, practical people who learned to make the most of their environment and who were concerned primarily about providing for [End Page 147] their families. They put these qualities to good use when war entered their lives. Though they were reluctant to leave their farms to fight, when their families and property were threatened they displayed their loyalty and bravery in helping to push back the invaders. It is a comforting story full of familiar characters such as Mrs Simcoe, the Rev John Strachan, Molly Brant, “Tiger” Dunlop, and Laura Secord. Short chapters read like a series of vignettes each highlighting a few individuals from different walks of life and parts of the province, and including lengthy excerpts from letters, diaries, travel journals, and business records. Many of these primary accounts have been published before, but they are now brought together in this book. They cover a wide range of experiences, from provisioning soldiers at Fort Niagara to clearing land in Glengarry County to falling in love with Captain Bird. Dorothy Duncan, one of Canada’s foremost culinary historians, author of the award-winning Canadians at Table: Food, Fellowship, and Folklore; A Culinary History of Canada and other works, not surprisingly spends a great deal of attention on food. This is one of the strengths of the book, as the author sits down at one dinner table after another, letting the reader feast on boiled black squirrel with Elizabeth Simcoe in Niagara or select marzipan figures over peppermint pastilles in a confectionery on King Street in York. Stories amuse, such as the one about a friendly dinner between British and American soldiers eight days after war had been declared. One chapter is devoted to recipes such as spruce beer, dandelion wine, and Michilimackinac stew. Another chapter delves into folk cures found in recipe books, such as cedar bark to cure scurvy and wet tobacco applied to bee stings. The author intermittently comments on the impact that war had on everyday life: teachers had to leave school to enlist, the transport of furs and provisions was disrupted, and families had to constantly balance their duty to defend Upper Canada with the necessity to plant and harvest crops, and to protect and ensure the survival of their families. Their everyday lives were interrupted with worrying about their loved ones who were away fighting, and watching apprehensively for approaching American troops and raiding parties, or even the British regulars and Native allies who sometimes transformed citizens’ homes and barns into headquarters and hospitals. The most cleverly conceived chapter is one that begins in a parlour where young women are creating a banner and traces that banner through the events of war, its hiding place underground during the invasion of York, and its glorious retrieval and carriage through every engagement of the 3rd York Regiment thereafter. The four fictional letters created by the [End Page 148] author also help show the progressive impact of the war on Martha, who was hired help at an Inn on Yonge Street. Martha writes to her sister of her duties...

Epidemiologic investigation of an occupational illness of tobacco harvesters in southern Brazil, a worldwide leader in tobacco production

ObjectivesAs part of smoking surveillance, the authors conducted an epidemiologic investigation in southern Brazil to identify the occurrence of Green Tobacco Sickness and risk factors for illness and to recommend...

The Green Hazards: A Meta-Analysis of Green Tobacco Sickness

Green Tobacco Sickness (GTS) has been one of the unexplored areas of occupational health safety. The condition mainly affects the tobacco harvesters. The condition is prevalent in Asian and South American tobacco harvesters. Although transient, the condition can affect multiple organ systems. The objective of this review is to extensively discuss the background, epidemiology, clinical features and measures to counter the problem.A literature search of Medline with terms such as “green”, “tobacco” and “sickness” was done covering years 1970-2007. All studies, reviews and commentaries on health effects of farming green tobacco and preventing the disease were included.Green Tobacco Sickness is caused by the absorption of nicotine through the skin from wet tobacco plants who have direct contact with tobacco plants during cultivation and harvesting. The early symptoms often include headache and nausea followed by vomiting, weakness, pallor, dizziness, headaches, increased perspiration, chills, abdominal pain, diarrhoea, and increased salivation which may also progress to extreme conditions like prostration, shortness of breath, and occasional fluctuations in blood pressure or heart rate. The duration of the illness is usually between one and three days. The use of protective, water-resistant clothing, chemical-resistant gloves, plastic aprons and rainsuits with boots and socks has reduced the chances of contracting GTS.It is important to educate the tobacco workers and the employers about GTS in order to reduce its incidence. An international level awareness campaign has to be taken up and more stringent workers safety regulations have to be formulated.DOI: http://dx.doi.org/10.3126/ijosh.v2i1.4963 International Journal of Occupational Safety and Health, Vol. 2 No. 1 (2012) 11-14

Subarachnoid hemorrhage in Kashmir: Causes, risk factors, and outcome

Context:Kashmir, a snow bound and mountain locked valley, is populated by about 7 million ethnic and non-migratory Kashmiris who have specific dietary and social habits than rest of the world. The neurological disorders are common in Kashmiri population.Aims:To study the prevalence and outcome of spontaneous intracranial subarachnoid hemorrhage (SAH) in Kashmir compared withother parts of the world.Settings and Design:A retrospective and hospital based study from 1982 to 2010 in the single and only Neurosurgical Centre of the State of Jammu and Kashmir.Materials and Methods:A hospital based study, in which, information concerning all Kashmiri patients was collected from the case sheets, patient files, discharge certificates, death certificates, and telephonic conversations with the help of Medical Records Department and Central Admission Register of Sher–i-Kashmir Institute of Medical Sciences, Kashmir India.Statistical Analysis:Analysis of variance and students T-test were used at occasions.Results:Incidence of SAH in Kashmiris is about 13/100,000 persons per year. SAH comprises 31.02% of total strokes and aneurysmal ruptures are cause of 54.35% SAHs. The female suffers 1.78 times more than the male. Total mortality of 36.60% was recorded against a good recovery of 14.99%. The familial SAHs and multiple aneurysms were also common. Intra-operative finding of larger aneurysmal size than recorded on pre-operative computed tomography (CT) angiogram of same patients was noteworthy. In 493 patients of SAH, the angiography revealed 705 aneurysms.Conclusion:Spontaneous intracranial subarachnoid hemorrhage, due to aneurysmal rupture, is common in Kashmir, with worst outcome. Food habits like “salt-tea twice a day”, group-smoking of wet tobacco like “Jejeer”, winter season, female gender, hypertension, and inhalation of “Kangri” smoke are special risk factorsof SAH, in Kashmiris. The plain CT brain and CT angiography are best diagnostic tools. The preventive measures for aneurysmal formation and rupture seems most promising management of future. The detachable endovascular aneurysmal occupying video assisted micro-camera capsules or plugs may be future treatment.

RANCANG BANGUN UNIT PENGERING HIBRIDA HEMAT ENERGI UNTUK PENGERINGAN TEMBAKAU RAJANGAN

The general objective of this research is to design and making hybrid dryer unit is used drying the chopped tobacco, in particular is to examine the performance of the hybrid dryer, the temperatures found in each rack, and compare the results of drying tobacco with naturally dried tobacco or dried above the traditional rack. This research method by creating a hybrid construction of the dryer unit, as follows: (1) determining the size of the design of space heating, (2) determining the size of the rack and the many levels of shelving, (3) purchasing of necessary materials and equipment, (4) implementation of manufacturing components or major parts of the dryer according to its function, (5) assembling the components into the dryer construction. This study focus are the performance of the hybrid dryer unit that has been created, namely: (1) homogeneity of dried tobacco content of each rack, (2) production capacity of each generation, (3) a long drying process, (4) operational costs and financial analysis. The results of this study is a prototype unit of a viable hybrid dryer used to dry tobacco with a capacity of 50 kg of chopped wet tobacco to produce 10 kg of dried tobacco drying time is 18 hours. Hybrid dryer unit is fit for use based on the analysis of the structure of production and financial feasibility analysis based on investation of hybrid dryer Rp 15.000.000 and working capital Rp 10.000.000. The method of Net Present Value (NPV) = Rp 48.747412, Internal Rate of Return (IRR) = 60%, Net Benefit Cost Ratio (Net B / C) = 2, 95, and Pay Back Period (PBP) = 1.16 years.

Tobacco is a global paediatric concern

Tobacco has major adverse consequences for children. Despite its devastating consequences, in countries facing immediate issues of poverty, lack of access to potable water and infectious diseases, tobacco is often viewed as a lower priority health threat. In this editorial, we consider specific areas of harm and suggest some strategies for combating tobacco harm to children. Tobacco use is a global problem; worldwide there are almost 1 billion male and 250 million female smokers. Every day an estimated 82 000 to 99 000 young people start smoking; many are children under the age of 10 and most reside in low- or middle-income countries.1 Globally, tobacco is marketed to children; the tobacco industry recognizes that new smokers must be recruited to replace those who quit or die from tobacco-related diseases.2,3 Current projections indicate that the number of smokers globally will increase to 1.6 billion over the next 25 years.1 While the dangers of tobacco consumption and second-hand smoke have been widely recognized, children are also harmed in less apparent ways; through hunger and malnutrition when scarce resources are diverted to tobacco purchases rather than food, exploitation of children as workers in tobacco farming, and by death and injury resulting from fires caused by cigarettes. Short-term adverse health consequences of active smoking have been demonstrated in children, in addition to the known consequences of continued use into adulthood. Children are also harmed by involuntary exposure to other people smoking; rates of such exposure are high. The Global Youth Tobacco Survey is a school-based survey conducted in 137 countries using a standard method for constructing the sample, selecting schools and classes, and processing data. Results indicate that almost half of the children who had never smoked were exposed to second-hand smoke both at home (46.8%) and outside the home (47.8%).4 Children are exposed to tobacco promotion and marketing at early ages; cigarette marketing and promotion are endemic throughout the world.2 There is strong evidence that tobacco industry imagery and advertising cause tobacco use and dependence in children.3 Depiction of smoking in movies has been a particularly pernicious influence.5 Although most of the research on media influences has been conducted in a few high-income countries, distribution of free cigarettes and widespread awareness of tobacco advertisements has been demonstrated among children in Africa.6,7 Tobacco consumption is a major cause of illness and death. When primary breadwinners die or are too ill to work due to smoking-related diseases, entire families can be thrown into poverty. In addition, smoking prevalence tends to be highest among those with the lowest levels of education and income. If family income that is already inadequate is diverted from meeting basic needs, including food, to purchasing tobacco, this can have a devastating impact upon children.8 Furthermore, poor children in developing countries are frequently employed in tobacco farming to provide essential family income. These children commonly suffer exploitation through long hours and very low wages, denial of educational opportunities and exposure to toxic pesticides.8 Although tobacco growing is not the only form of agricultural production with harmful exposures, pesticides used in tobacco farming, including aldicarb, chlorpyrifos, and 1,3-dichloropropene, are especially toxic and can lead to chronic health problems especially when used without protective equipment.9,10 Children are also vulnerable to green tobacco sickness from nicotine absorbed through the skin from handling wet tobacco leaves.11 Tobacco exposure is a serious and increasing global paediatric issue. Child health-care delivery organizations have new opportunities for improving tobacco control interventions.12 In March 2009, at the 14th World Conference on Tobacco or Health held in Mumbai, India, the American Academy of Paediatrics and the International Paediatric Association launched an international initiative to promote involvement of child health clinicians worldwide as actors and opinion leaders in tobacco control. It aims to call attention to the harm that tobacco causes to children, disseminate best practices to reduce exposure of children to tobacco and second-hand smoke, and train clinicians in advocacy for policy change and effective methods of counselling parents regarding these issues. The American Academy of Paediatrics and the International Paediatric Association are strongly committed to working with other partners to combat the global paediatric tobacco epidemic. We are dedicated to advocating for increased resources and priority for tobacco control, especially relating to children, and we call upon others to join us in this effort. Global tobacco use, exposure and production are major public health crises for children and threaten progress towards the United Nations Millennium Development Goals of eradicating extreme poverty and hunger and achieving universal primary education. It’s also a moral crisis when governments and other stakeholders idly stand by. Recognizing tobacco as a paediatric problem is one key step towards focusing efforts to extinguish this global public health disaster. ■

Our recent experiences with sarin poisoning cases in Japan and pesticide users with references to some selected chemicals

Attention has been paid to neurobehavioral effects of occupational and environmental exposures to chemicals such as pesticides, heavy metals and organic solvents. The area of research that includes neurobehavioral methods and effects in occupational and environmental health has been called “Occupational and Environmental Neurology and Behavioral Medicine.” The methods, by which early changes in neurological, cognitive and behavioral function can be assessed, include neurobehavioral test battery, neurophysiological methods, questionnaires and structured interview, biochemical markers and imaging techniques. The author presents his observations of neurobehavioral and neurophysiological effects in Tokyo subway sarin poisoning cases as well as in pesticide users (tobacco farmers) in Malaysia in relation to Green Tobacco Sickness (GTS). In sarin cases, a variety effects were observed 6–8 months after exposure, suggesting delayed neurological effects. Studies on pesticide users revealed that organophosphorus and dithiocarbamate affected peripheral nerve conduction and postural balance; subjective symptoms related to GTS were also observed, indicating the effects of nicotine absorbed from wet tobacco leaves. In addition, non-neurological effects of pesticides and other chemicals are presented, in relation to genetic polymorphism and oxidative stress.

Assessment of urinary cotinine as a marker of nicotine absorption from tobacco leaves: a study on tobacco farmers in Malaysia.

To assess dermal absorption of nicotine from tobacco leaves in relation to Green Tobacco Sickness (GTS), urinary cotinine concentrations were measured in 80 male tobacco-growing farmers and in 40 healthy males (controls) who did not handle wet tobacco leaves in Kelantan, Malaysia. Among non-smokers, urinary cotinine levels in farmers were significantly higher than those of controls; farmers with urinary cotinine of 50 ng/ml/m2 or above showed eye symptoms more frequently than those below this level (p<0.05). Farmers who did not wear protective equipment had subjective symptoms more frequently than those who used the equipment (p<0.05); some of these symptoms were seen more frequently in organophosphate (Tamaron) users than in non-users. As tobacco farmers evidence a risk of nicotine poisoning from tobacco leaves, assessment including GTS together with effects of pesticides will be necessary.

Hispanic farmworker interpretations of green tobacco sickness.

This paper describes the explanatory model of green tobacco sickness (GTS) held by migrant and seasonal farmworkers in North Carolina and compares it with a research-based biobehavioral model. GTS is a form of acute nicotine poisoning that affects individuals who work in wet tobacco fields. It is characterized by nausea, vomiting, headache, and dizziness. There are no standard diagnostic criteria for GTS; clinicians must diagnose it based on a combination of symptoms and exposure risk. GTS resembles pesticide poisoning, but treatment is quite different. Many farmworkers in tobacco today are Spanish-speaking immigrants from Mexico with limited experience in tobacco work. In-depth interviews about GTS were conducted with 23 Hispanic farmworkers in central North Carolina to explore their understanding of the problem. Workers generally attributed the symptoms to other aspects of working in tobacco, such as pesticides or heat, rather than nicotine. They cited many of the same risk factors identified in the biobehavioral model, such as wet work conditions and inexperience with tobacco work. Prevention and treatment include a combination of exposure avoidance and common medications. The symptoms of most importance to farmworkers were insomnia and anorexia, both of which impaired the ability to work. This jeopardized their income, as well as their work security. If health care providers understand the explanatory model held by farmworkers, they will be more effective at diagnosing and treating GTS and be better prepared to teach patients how to prevent future episodes.

Diagnosis and Management of Green Tobacco Sickness

Nicotine is a liquid alkaloid present in tobacco leaves at a 1~6% concentration. Green tobacco sickness is an occupational illness caused by absorption of nicotine through skin exposed to wet tobacco leaves. It occurs throughout the world in tobacco-growing areas. The almost universal symptoms of weakness, nausea, vomiting, diarrhea, and dizziness may be confused with pesticide poisoning or heat stress illness. Since its recognition in the 1970s, green tobacco sickness is self-limited, usually lasting 1 to 2 days. There is no antidote, so treatment is supportive (for example, intravenous fluids for hypotension, antiemetics). The diagnosis can beconfirmed by measuring the nicotine concentration in the serum or urine, but its half-life is only 3~4 hours. Cotinine, the major nicotine metabolite, has a half-life of 36 hours, and thus is more useful. Young workers may be at higher risk for green tobacco sickness. Tobacco use is thought to offer weak protection by inducing tolerance. Handling tobacco that is wet from rain or dew increase the risk of green tobacco sickness. Repeated daily exposure over more than a week may also increase the risk. Green tobacco sickness is preventable by use of protective clothing and by avoiding skin contact with wet tobacco. When clothing becomes wet from environmental dampness or sweating, it should be changed to maintain an effective barrier. The best treatment is avoidance of poisoning : in addition to wearing gloves, long pants and a full shirt, workers picking or handling tobacco leaves should clean their hands frequently.

Determination of tobacco alkaloids using solid phase microextraction and GC-NPD

The sampling approaches using solid phase microextraction (SPME) were evaluated for the analysis of tobacco alkaloids. Because of their low volatility and ionic nature, sampling alkaloids from the headspace of dry or wet tobacco samples often required more effort to improve extraction efficiency. Directly dipping the SPME fiber coated with polydimethylsiloxane film into the tobacco extract was proved to be a simple, effective tool for sampling alkaloids from tobacco. When combined with the practice of fast GC and nitrogen-phosphorus detection, nicotine and a group of selected minor alkaloids (i.e., nornicotines, myosmine, anabasine and anatabine) were separated with baseline resolution within 3 min. The detection limits for these alkaloids are below 0.1 μg mL−1. In addition, the carry-over problem frequently occurred in alkaloids analysis was eliminated. The influence of tobacco matrix and fiber aging on the partition of alkaloids, as well as the use of an internal standard to compensate these deviations, were also studied.

Green tobacco sickness: occupational nicotine poisoning in tobacco workers.

In this study the authors describe the investigation of a 1992 outbreak of green tobacco sickness, a form of nicotine poisoning from dermal exposure, among 47 tobacco workers in a five-county region of central and south-central Kentucky. Cases were identified through medical record searches at participating hospitals, as well as from reports submitted to the Occupational Health Nurses in Agricultural Communities program. A case-control study was undertaken to assess risk factors for green tobacco sickness. In a 20-min telephone interview, 40 cases and 83 controls responded to questions contained in a questionnaire. In 1992, 47 persons (3 were under age 16 y) in the study region sought medical treatment for green tobacco sickness. Twelve persons were hospitalized and 2 required intensive-care treatment. The crude incidence in 1992 was 10.0/1,000 tobacco workers. In 1993, 66 cases (7 were under age 16 y) of green tobacco sickness were identified in the study region (i.e., annual incidence of 14.0/1,000). A case-control study demonstrated that ill workers were younger, and were more likely to have worked in wet conditions, compared with workers who were not ill. Green tobacco sickness is a common problem among tobacco workers that may be prevented by avoiding work in wet tobacco or by use of protective clothing. Children younger than 16 y of age represented 9% of the green tobacco sickness cases in 1992 and 1993. Current occupational safety and health laws do not address protection of tobacco workers with respect to green tobacco sickness.

Green Tobacco Sickness in Tobacco Harvesters—Kentucky, 1992

Green tobacco sickness (GTS) is an illness resulting from dermal exposure to dissolved nicotine from wet tobacco leaves; it is characterized by nausea, vomiting, weakness, and dizziness and sometimes fluctuations in blood pressure or heart rate (1-3). On September 14, 1992, the Occupational Health Nurses in Agricultural Communities (OHNAC) project of Kentucky* received reports of 27 cases of GTS. The cases occurred among tobacco harvesters who had sought treatment in several hospital emergency departments in south-central Kentucky during the preceding 2 weeks. This report summarizes the findings of the investigation of these cases.