Prevalence and Risk Factors of Green Tobacco Sickness among Korean Tobacco Harvesters

일부 담배 재배농에서 담뱃잎농부병의 유병률 및 위험 요인

  • Lee, Kwan (Department of Preventive Medicine, College of Medicine, Dongguk University) ;
  • Nam, Si-Hyun (Cheongsong-gun Health Center and County Hospital) ;
  • Lim, Hyun-Sul (Department of Preventive Medicine, College of Medicine, Dongguk University)
  • 이관 (동국대학교 의과대학 예방의학교실) ;
  • 남시현 (청송군 보건의료원) ;
  • 임현술 (동국대학교 의과대학 예방의학교실)
  • Published : 2004.03.01

Abstract

Objectives : This study was carried out to understand the prevalence and risk factors of green tobacco sickness (GTS) among Korean tobacco harvesters. Methods : The authors conducted a questionnaire among the tobacco harvesters (1,064 persons from 555 out of 723 tobacco harvesting households) in Cheongsong-gun for 4 days from May 7 to 10, 2002. Results : The study subjects were 550 males and 514 females. The recognition and experience of GTS up until 2001 were 96.4% and 61.9%, respectively. The prevalence of GTS in 2001 was 42.5%, and was significantly higher in females than in males (59.0% vs. 26.6%, p<0.01). The incidence density of GTS according to the number of workdays in 2001 was 12.3 spells/100 person..days. The GTS symptoms reported by the tobacco harvesters in 2001 were dizziness in 441 cases (97.6%), nausea in 414 (91.6%), headache in 349 (77.2%) and vomiting in 343 (75.9%). The use of gloves, hat and wristlets, sweating at work and the number of working hours significantly increased the prevalence of GTS (p<0.05). Multiple logistic re- gression analysis was used to determine the factors significantly associated with GTS. Odds ratios for smoking, working over 10 hours and sweating at work were 0.26 (95% CI:0.19-0.35), 1.64 (95% CI:1.26-2.14) and 1.60 (95% CI:1.14-2.25), respectively. Of those who reported GTS in 2001, 311 cases (68.8%) underwent treatment from their local medical facilities. Conclusions : In Korea, there are many tobacco-harvesting households, and most may be stricken with GTS. More extensive epidemiological studies, including the incidence and associated risk factors, are expected and a surveillance system including measurements of cotinine in urine should be conducted.

Keywords

References

  1. Ghosh SK, Parikh JR, Gokani VN, Kash-yap SK, Chatterjee SK. Studies on occu-pational health problems during agricul-tural operation of Indian tobacco workers. J Occup Med 1979; 21(1): 45-47
  2. Weizenecker R, Deal WB. Tobacco crop-per's sickness. J Fla Med Assoc 1970; 57(12): 13-14
  3. Gehlbach SH, Williams WA, Perry LD, Woodall JS, Green tobacco sicckness: an illness of tobacco harvesters. JAMA 1974; 229: 1880-1883 https://doi.org/10.1001/jama.229.14.1880
  4. Boylan BB, Brandt V, Muehlbauer J, Auslander M, Spurlock C, Finger R. Green tobacco sickness in tobacco harves-ters-Kentucky, 1992. MMWR 1993; 42 237-240
  5. Ballard T, Ehlers J, Freund E, Auslander M, Brandt V, Halperin W. Green tobacco sickness: occupational nicotine poisoning in tobacco workers. Arch Environ Health 1995; 50(5): 384-389 https://doi.org/10.1080/00039896.1995.9935972
  6. Quandt SA, Arcury TA, Preisser JS, Norton D, Austin C. Migrant farmworkers and green tobacco sickness: new issues for an understudied disease. Am J Ind Med 2000; 37(3): 307-315 https://doi.org/10.1002/(SICI)1097-0274(200003)37:3<307::AID-AJIM10>3.0.CO;2-Z
  7. Arcury TA, Quandt SA, Preisser JS, Norton D. The incidence of green tobacco sickness among Latino farmworkers. J Occup Environ Med 2001; 43(7): 601-609 https://doi.org/10.1097/00043764-200107000-00006
  8. Ghosh SK, Gokani VN, Parikh JR, Doctor PB, Kashyap SK, Chatterjee BB. Protec-tion against 'green symptoms' from tobacco in indian harbesters: a preliminary intervention study. Arch Environ Health 1987; 42(2): 121-124 https://doi.org/10.1080/00039896.1987.9935807
  9. Misumi J, Koyama W, Miura J. 2 cases of green tobacco disease among tobacco harvesters and percutaneous nicotine absorption in rats. Sangyo Igaku 1983; 25(1): 3-9 https://doi.org/10.1539/joh1959.25.3
  10. Lim HS, Lee K. Cases of green tobacco sickness: occupational nicotine poisoning in tobacco harvesters in Korea. Korea J Rural Med 2001; 26(2): 7-14 (Korean)
  11. Lim HS, Lee K. Green tobacco sickness on tobacco harvesters in a Korean village. Korean J Epidemiol 2002; 24(1): 29-36 (Korean)
  12. Chang CH, Lim HS, Lee K, Lee JS. Three cases on green tobacco sickness occurred during drying leaves of tobacco with dryers. Dongguk J Med 2003; 10(1): 129-138 (Korean)
  13. 엽연초생산협동조합중앙회. 2003년 잎담배 계약 현황. 내부자료
  14. Faulkner JM. Nicotine poisoning by absorbtion through the skin. JAMA 1933; 100: 1664-1665 https://doi.org/10.1001/jama.1933.02740210012005
  15. McKnight RH, Levine EJ, Rodgers GC Jr. Detection of green tobacco sickness by a regional poison center. Vet Hum Toxicol 1994; 36(6): 505-510
  16. Hipke ME. Green tobacco sickness. South Med J 1993; 86(9): 989-992 https://doi.org/10.1097/00007611-199309000-00002
  17. Ghosh SK, Saiyed HN, Gokani VN, Thakker MU. Occupational health pro-blems among workers handling Virginia tobacco. Int Arch Occup Environ Health 1986; 58(1): 47-52 https://doi.org/10.1007/BF00378539
  18. McBride JS, Altman DG, Klein M, White W. Green tobacco sickness. Tob Control 1998; 7(3): 294-298 https://doi.org/10.1136/tc.7.3.294
  19. ACGIH. Documentation of the threshold limit values and biological exposure indices; Nicotine. 2001
  20. Ghosh SK, Gokani VN, Doctor PB, Parikh JR. Intervention studies against 'green symptoms' among Indian tobacco harvesters. Arch Environ Health 1991; 46(5): 316-317 https://doi.org/10.1080/00039896.1991.9934396
  21. US Department for Health and Human Services. NIOSH issues warnig to tobacco harvests. Atlanta, Georgia: Cen-ters for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1993
  22. Ives TJ. Use of dimenhydrinate in the treatment of green tobacco sickness. Drug Intell Clin Pharm 1983; 17(7-8): 548-549 https://doi.org/10.1177/106002808301700712
  23. Arcury TA, Quandt SA, Garcia DI, Preisser JS Jr, Norton D, Rao P. A clinic-based, case-control comparison of green tobacco sickness among minority farm-workers: clues for prevention. South Med J 2002; 95(9): 1008-1011 https://doi.org/10.1097/00007611-200295090-00011
  24. Gehlbach SH, Willaims WA, Freeman JI. Protective clothing as a means of redu- cing nicotine absorption in tobacco harvesters. Arch Environ HeaIth 1979; 34(2): 111-114 https://doi.org/10.1080/00039896.1979.10667379
  25. Ulbrich S. Haze still surrounds green tobacco sickness. J Natl Cancer Inst 1994; 86(6): 419-420 https://doi.org/10.1093/jnci/86.6.419
  26. Onoda N, Nehmi A, Weiner D, Mugumdar S, Christen R, Los G. Nicotine affects the signaling of the death pathway, reducing the response of head and neck cancer cell lines to DNA damaging agents. Head Neck 2001; 23(10): 860-870 https://doi.org/10.1002/hed.1125
  27. Mathur RS, Mathur SP, Young RC. Up-regulation of epidermal growth factor- receptors (EGF-R) by nicotine in cervical cancer cell lines: this effect may be mediated by EGF. Am J Reprod Immunol 2000; 44(2): 114-120 https://doi.org/10.1111/j.8755-8920.2000.440207.x