The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70307

Marcia Trapé- Cardoso, MD, FACP¹, Anne Bracker, MPH, CIH¹, Michael Grey, MD, MPH¹, Eddie Sapiain², Cheryl Oncken, MD³, Laura Victoria Barrera, MPH⁴, and Bruce Gould, MD⁴. (1) Division of Occupational and Environmental Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-6210, 860-679-2366, Trape@nso.uchc.edu, (2) ConnectiCOSH, 683 North Mountain Road, Newington, CT 06111, (3) Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3940, (4) Connecticut Area Health Education Center Program, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3960

Shade tobacco farming poses risks to a vulnerable population of migrant and seasonal farmworkers. These workers may develop Green Tobacco Sickness (GTS) due to acute nicotine poisoning following dermal contact with shade tobacco leaves. Shade tobacco leaves are used to wrap cigars.

In Connecticut GTS rarely has been diagnosed among the farmworkers who present at Farmworkers clinics. Although our previous chart review in 2001 demonstrated possible GTS symptoms among this underserved population, GTS appears to be less prevalent among shade tobacco workers than has been reported for tobacco workers that harvest cigarette tobacco. This pattern may be explained by the control strategies used by the workers who handle shade tobacco.

During the summer of 2002, we conducted a study of GTS and salivary cotinine levels among shade tobacco workers in Connecticut. We measured salivary cotinine levels and documented GTS symptoms during the planting and harvesting seasons in an exposed and non-exposed group. Salivary cotinine is a reliable biomarker of nicotine absorption.

We enrolled 136 farmworkers in our study; 77 (57%) were tobacco workers from three shade tobacco farms, and 59 (43%) were non-tobacco workers from a nursery (control group). We will present data that explores whether or not shade tobacco workers and a control group had GTS symptoms and an associated increase in salivary cotinine levels over the growing season. We also will present data that evaluates the contribution of other factors to elevated salivary cotinine levels including age, body-mass-index, country of origin, work tasks and recreational tobacco use.

Learning Objectives:

• At the conclusion of the presentation, the participant in this session will be able to:
• 1.Describe the occupational risk factors associated with acute nicotine poisoning, Green Tobacco Sickness.
• 2.Understand the control strategies that can be implemented to prevent Green Tobacco Sickness.
• 3.Appreciate the multiple factors that can contribute to elevated cotinine levels and the importance of reviewing all of these factors in an assessment of GTS in a working population.

Keywords: Occupational Health, Agricultural Work Safety

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Handout (.ppt format, 7608.0 kb)