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Predictors of Incidence and Prevalence of Green Tobacco Sickness Among Latino Farmworkers in North Carolina, USA

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Predictors of Incidence and Prevalence of Green Tobacco Sickness Among Latino Farmworkers in North Carolina, USA 818 J Epidemiol Community Health 2001;55:818–824 J Epidemiol Community Health: first published as 10.1136/jech.55.11.818 on 1 November 2001. Downloaded from Predictors of incidence and prevalence of green tobacco sickness among Latino farmworkers in North Carolina, USA T A Arcury, S A Quandt, J S Preisser Abstract of fitting multivariate models of green tobacco Study objective—The characteristics of sickness risk factors. some populations make epidemiological Green tobacco sickness is acute nicotine measurement extremely diYcult. The ob- poisoning caused by the dermal absorption of jective of this study is to identify risk fac- nicotine from mature tobacco plants, Nicotiana tors that explain variation among tabacum.1 There are no established diagnostic incidence densities and proportions of one criteria for green tobacco sickness. Symptoms occupational illness, green tobacco sick- include dizziness or headache and nausea or ness, within one such special population, vomiting, but may also include abdominal Latino migrant and seasonal farmworkers cramps, headache, prostration, diYculty in the United States. breathing, abdominal pain, diarrhoea, and Design—Prospective cohort study. occasionally fluctuations in blood pressure or Setting—37 farmworker residential sites heart rate.1–12 Green tobacco sickness is nor- located in Granville and Wake Counties, mally a self limiting condition from which North Carolina, USA. workers recover in two or three days. However, Participants—182 migrant and seasonal symptoms are often severe enough to result in farmworkers that included 178 Latino dehydration and the need for emergency medi- men, three Latino women, and one non- cal care. Hispanic white man. The first medical report of green tobacco Main results—Green tobacco sickness had sickness was published in 1970 based on cases a prevalence of 0.082, and an incidence in Florida.13 Reports of green tobacco sickness copyright. density of events per 100 days of 1.88 have since been published describing its occur- among the farmworkers. Prevalence and rence in North Carolina among white farm- incidence density increased from early to ers214 and Latino farmworkers,15 as well as in late agricultural season. Major risk fac- Kentucky,11 12 16 India,7–10 and Japan.17 Data on tors included lack of work experience, green tobacco sickness incidence or prevalence work activities, and working in wet are limited. Gehlbach et al14 reported the earli- clothes. Tobacco use was protective. est estimate of green tobacco sickness preva- Conclusion—Green tobacco sickness has a lence, stating that, “during the 1973 harvesting high incidence among migrant and sea- season, an estimated 9% of North Carolina’s sonal farmworkers. Because workers have 60 000 tobacco growers reported illness 3 little control over most risk factors, fur- among their workers”(page 478). CDC re- http://jech.bmj.com/ ther research is needed to identify ways to Department of Family ported that the crude two month incidence rate and Community prevent this occupational illness. for hospital treated green tobacco sickness in (J Epidemiol Community Health 2001;55:818–824) Medicine, Wake Forest Kentucky during 1992 was 10 per 1000 work- University School of 15 Medicine, ers. Quandt et al found 41% of 144 Latino Winston-Salem NC Epidemiological research is often concerned migrant and seasonal farmworkers interviewed 27157–1084, USA with measures of incidence and prevalence of at the end of the 1998 season in North T A Arcury illness in a population, yet the characteristics Carolina reported having green tobacco sick- ness at least once during that season. There are on September 25, 2021 by guest. Protected Section on of some populations make such measurement Epidemiology, diYcult. These characteristics include high no data on green tobacco sickness among Afri- Department of Public mobility, rapidly changing membership, and can American farmers or farmworkers. Health Sciences, Wake speaking a foreign language. Populations with Quandt and colleagues15 present a biobehav- Forest University these characteristics include the homeless, ioural model of green tobacco sickness (fig 1) School of Medicine based on the existing green tobacco sickness S A Quandt drug users, undocumented immigrants, and migrant and seasonal farmworkers. The goal research and on the physiology of percutaneous 18–21 Department of of this study is to identify the biobehavioural absorption of nicotine and other chemicals. Biostatistics, risk factors for one occupational illness, green They argue that green tobacco sickness results University of North tobacco sickness, among Latino migrant and from the rate of transdermal absorption of Carolina at Chapel seasonal farmworkers in North Carolina. Our nicotine, determined by the amount of dermal Hill J S Preisser analysis estimates the incidence density and exposure to tobacco plants as well as several prevalence of green tobacco sickness in this other factors. Dermal exposure to nicotine is Correspondence: Dr Arcury population, considers bivariate relations be- increased by greater skin exposure and work ([email protected]) tween incidence density and prevalence and activities that increase contact with the plants. Accepted for publication the diVerent risk factors specified in the Wearing protective clothing (for example, a 22 May 2001 biobehavioural model, and reports the results plastic rain suit) decreases exposure, as does www.jech.com Green tobacco sickness among Latino farmworkers 819 J Epidemiol Community Health: first published as 10.1136/jech.55.11.818 on 1 November 2001. Downloaded from and were randomly replaced. All selected sites +Rashes, cuts, abrasions were visited, a census taken, and preliminary (skin integrity) consent obtained from residents. All residents +Alcohol consumption at inhabited sites agreed to participate. The +Contact with tobacco (four or more drinks) initial goal was to recruit five workers at each (type of work) +Wet conditions (season) (work in wet clothes) site. At 13 sites with fewer than five residents, +Skin area exposed +Humidity all farmworkers were recruited. At 21 sites with (work with no shirt) (average high humidity) at least five residents, between five and seven +Low surface area to +Heat were recruited; at two of these sites four volume ratio (average mean (BMI) temperature) participants were recruited. As there were so many sites with fewer than five resident farmworkers, attempts were made to recruit Dermal exposure to nicotine Transdermal absorption Green tobacco sickness more than five participants at some sites. At the end of the initial recruitment period the sample included 169 farmworkers from 36 sites. –Protective clothing –Tobacco use (wear rainsuit) (tobacco use) Between the initial period and the first follow –Dry conditions (live with a smoker) up one entire site was abandoned by its (change out of wet residents, and a 37th site was selected for par- clothes) ticipation. There was suYcient turnover of –Work experience (years worked in workers at some sites that some replacement of tobacco) workers who had left the area was needed. For the third to final follow up interview periods, Figure 1 Biobehavioural model of green tobacco sickness causation (based on Quandt et new residents were randomly selected and 15 al ). recruited if more than three sampled residents learned avoidance gained through work experi- from that site were reported by other residents ence with tobacco.10 The relation of dermal to have permanently left the site. All replace- exposure to transdermal absorption is medi- ment resulted in the addition of 18 farmwork- ated by several factors. Compromised skin ers to the sample. If a sampled resident who integrity (for example, cuts, rashes)10 may had not permanently left the site could not be increase absorption, as may factors that located for an interview within two days before increase vasodilatation, particularly consump- and three days after the scheduled two week tion of alcoholic beverages and work in hot and follow up, this interview was not completed. The total sample included 187 farmworkers. humid weather. Working in wet tobacco also copyright. increases dermal absorption because nicotine However, after examination of the data we is water soluble.18 22 Use of tobacco products found that five of the farmworkers who worked (smoking or smokeless) seems to decrease on farms that produced tobacco had never absorption.21114 actually worked in tobacco during the entire data collection period, and were therefore not at risk for green tobacco sickness. These work- Methods ers were excluded from the final sample. The This study used a prospective cohort design to final sample included 701 data points from 182 collect data from Latino migrant and seasonal farmworkers with one to five data points per farmworkers in North Carolina. Migrant and farmworker. This sample included 178 His- seasonal farmworkers in North Carolina are panic men, three Hispanic women, and one 23 24 largely Latino. The study followed up and non-Hispanic white man. http://jech.bmj.com/ interviewed a total of 182 workers from one to five times over the summer of 1999, giving a DATA COLLECTION total of 701 interviews. Data were collected by three interviewers bilingual in English and Spanish. The inter- SAMPLE SELECTION view questionnaire was developed in English to Sample selection began with the random selec- ensure all of the topics important to the data tion of 36 farmworker residence sites evenly collection were included. The questionnaire divided between those served by migrant clin- and the consent form were translated into on September 25, 2021 by guest. Protected ics in Wake and Granville Counties, North Spanish by a professional translator. These Carolina. These counties were selected be- were then reviewed by native Spanish speakers cause they diVer in the size of farms. Granville from Mexico who had been farmworkers. The is the more northern of the two counties and is questionnaire and consent form were then pre- characterised by hilly terrain with small farms. tested with eight farmworkers. At baseline Wake is closer to the coastal plain and has flat- (defined as a worker’s first interview) questions ter terrain and relatively large farms.
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