David Banach, BS¹, Marcia Trapé, MD, FACP², Anne Bracker, MPH, CIH³, Deborah Dauser, MS⁴, Cheryl Oncken, MD⁵, Laura Victoria Barrera, MPH⁶, and Bruce Gould, MD⁶. (1) School of Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, (860) 803-1847, banach@mph.uchc.edu, (2) Division of Occupational and Environmental Medicine, University of Connecticut, 263 Farmington Ave., Farmington, CT 06030-6105, (3) Division of Occupational and Environmental Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030-6210, (4) Division of Community Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, (5) Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3940, (6) Connecticut Area Health Education Center Program, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030-3960

Background: Green Tobacco Sickness (GTS), headache or dizziness and nausea or vomiting, is an occupational illness that may be caused by dermal absorption of nicotine while harvesting mature tobacco. The illness is most commonly found in farmworkers who harvest cigarette tobacco in the Southeastern United States. Connecticut farms employ workers to harvest shade tobacco used for cigar wrappers. Harvesting shade tobacco requires techniques that differ from those used to harvest cigarette tobacco. A retrospective chart review among tobacco workers seeking medical care in Connecticut showed a 4 to 15% prevalence of GTS compatible symptoms.

Methods: A prospective cohort study of 31 tobacco farmworkers was conducted to examine the incidence of GTS and its relation to multiple variables, risk factors for GTS. All subjects were non-tobacco users (confirmed with exhaled breath carbon monoxide levels). The variables included work task, utilization of protective clothing, experience working with tobacco, wetness of leaves, and elevation of salivary cotinine levels (a biomarker of transdermal nicotine absorption). The cohort was sampled 5 times throughout the 2003 summer. Salivary cotinine analysis was done using gas chromatography.

Results: All 31 subjects were Mexican males (mean age = 29.9) who lived in barracks at the farm. Preliminary data analysis identified 18 episodes of symptoms compatible with possible GTS. There was a significant increase in cotinine levels from planting (2.7, sd=2.2) to harvest season (16.9, sd=11.2) (F(1,24) = 27.76, p < .001). GTS symptoms were not associated with salivary cotinine levels.

Conclusions and limitations of the study will be presented.

Learning Objectives:

• Learn about the methods used to protect workers from dermal nicotine absorption when they harvest shade tobacco in Connecticut
• Recognize the constellation of symptoms associated with Green Tobacco Sickness
• Identify three potential Green Tobacco Sickness risk factors

Keywords: Migrant Workers, Occupational Exposure

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.