Prevalence of Green Tobacco Sickness in Tobacco Production Areas in the Black Sea Region

Ahmet Kinay 1 *, Dursun Kurt 2 , Sıdıka Ekren 3 and H. Vakıf Mercimek 4

To cite this article : Ahmet K, Dursun K, Sıdıka E, H. Vakıf M (2018) Prevalence of Green Tobacco Sickness in Tobacco Production Areas in the Black Sea Region . Int. J. Agr. Life. Sci , 4(1), 217-25, DOI: 10.22573/spg.ijals.018.s12200087

To link to this article : https://doi.org/10.22573/spg.ijals.018.s12200087

Copyright : © 2018 Ahmet K et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) ,

which permits unrestricted use, distribution, and reproduction in any medium, provided the Original work is properly cited.

Data Availability Statement : All relevant data are within the paper and its Supporting Information files.

Funding : The author(s) received no specific funding for this work.

Competing Interests : The authors have declared that no competing interests exist.

© 2018 The Author(s). Published by S k y f o x Published online: 30 Mar 2018.

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RESEARCH ARTICLE

Prevalence of Green Tobacco Sickness in Tobacco Production Areas in the Black Sea Region Ahmet Kinay 1*, Dursun Kurt 2, Sıdıka Ekren 3 and H. Vakıf Mercimek 4

1. Gaziosmanpa>a University, Faculty of Agriculture, Department of Field Crops, Tokat, Turkey; E-Mails: ahmetkinay@gmail.com

2. Ondokuz Mayis University, Bafra Vocational High School, Department of Crop and Animal Production, Samsun, Turkey; Mails: dursun.kurt@omu.edu.tr

3. Ege University, Faculty of Agriculture, Department of Field Crops, Bornova, İzmir, Turkey; E-Mails: sidika.ekren@ege.du.tr

4. Tobacco and Alcoholic Beverages Market Regulation Board, Bornova, İzmir, Turkey; E-Mails: vakifm@hotmail.com * Author to whom correspondence should be addressed/E-Mail: ahmetkinay@gmail.com/ Tel.: +903562521616; Fax: +903562521488. Received: Jan 2018 / Accepted: Jan 2018/ Published: Mar 2018

INTRODUCTION

Being more important than other agricultural products in terms of production, usage, and foreign trade, tobacco has been a matter of debate both in our country and in the world in recent years especially due to its adverse effects on health and its economic return. Tobacco is an annual agricultural product generally useful with its cured leaves. In the world, different types of tobacco are cultivated depending on different ecological conditions and microclimates. In the world’s tobacco production, Virginia, Burley and Maryland, and Oriental are the leading tobacco types with a share of 70%, 15%, and 4%, respectively. They are followed by tobacco types such as Puroluk, Kentucky, Havana, Beneventeno, etc. Approximately 97% of the tobacco grown in Turkey is Oriental, followed by Virginia, Burley, Tömbeki, and Hasankeyf (TAPDK, 2013).

Green tobacco sickness occurs as nicotine dissolves during transplanting, hoeing, harvesting, stacking, and curing and is absorbed by skin (Mcbride et al ., 1998; Arcury TA, 2006). By some researches, it is defined as nicotine poisoning resulting from the absorption of nicotine by skin (Quandt et al ., 2001; Arcury et al ., 2003). The sickness was reported in the medical literature for the first time in 1970 by Weizenecker and Deal (Karafakoglu 2004). During harvest, tobacco producers break off mature leaves and carry them under their armpits. They rarely use protective equipment such as gloves by the reason that it makes harvesting more difficult. As a result, especially tobacco producers’ hands are exposed to nicotine. During harvest, which is performed mostly in the early morning, tobacco producers’ clothes are moistened by the dew that accumulates on leaves. It is thought that, dissolved by dew and absorbed by skin, nicotine causes the symptoms of green tobacco sickness. The symptoms of green tobacco sickness resemble to those of nicotine poisoning observed in new smokers (Karafakoglu 2004). They include weakness, headache, nausea, vomiting, dizziness, abdominal cramps, breathing difficulty, abnormal temperature, pallor, diarrhea, chills, fluctuations in blood pressure or heart rate, and increased perspiration and salivation (Mcbride et al ., 1998; Gehlbach et al ., 1974; Ballard et al ., 1995; Arcury et al ., 2001; Trape-cardoso et al ., 2003).

The onset of the sickness is 3-17 hours after nicotine absorption. The duration of the sickness is 1-3 days (Mcbride et al ., 1998). For some researchers, it progresses within 1-6 hours after symptoms occur and ends within 6-24 hours (Karafakoglu 2004). Change of clothing, taking a shower, fluid intake, and rest are recommended as initial treatment. In extreme cases, it is necessary to seek medical help (intravenous rehydration, anti-emetics and dimenhydrinate). Water-resistant protective clothing such as gloves, boots, and socks may reduce the risks (Mcbride et al ., 1998). Skin lesions such as rash, incision, and abrasion may increase the likelihood of skin absorption and green tobacco sickness. The level of nicotine absorption by skin may be higher in sick skin than healthy skin (Wester RC, 1983; Benowitz 1987).

According to the results of the research conducted on 685 Flue Cured Virginia (FCV) tobacco producers in India, the prevalence of green tobacco sickness in tobacco workers is 47% (55,7% in women, 42,66% in men) (Parikh et al ., 2005). In a research of the nicotine residue on the hands of the workers working at different parts of the FCV tobacco harvesting machine and the removal of such residue by washing hands at different times and in different manners, it was reported that the mean pre-wash and post-wash nicotine levels were 10 and 0.38 mg cm 2, respectively. It was found that working on the bottom, rather than the top, of the tobacco harvesting machine was directly associated with the amount of nicotine residue and that washing hands with soap and water right after the completion of work reduced nicotine residue levels on hands by approximately 96% (Curwin et al ., 2005). It is indicated that the risk of getting green tobacco sickness is higher for younger tobacco workers [Ballard et al ., 1995; Gehlbach et al ., 1979). In their studies, some researchers defined green tobacco sickness in farmers and agricultural laborers in different regions of the US (Florida, North Carolina, Kentucky, Tennessee, and Connecticut), Japan, India, and Italy (Ballard et al ., 1995; Arcury et al ., 2001; Trape-cardoso et al ., 2003; Weizenecker, 1970; Gehlbbach et al ., 1975; Ghosh et al ., 1979; Misumi et al ., 1989; D’Alessandro et al ., 2001; Arcury et al ., 2001). (Arcury et al ., 2001; Arcury et al ., 2001) report the incidence density of green tobacco sickness in Latino farmworkers in North Carolina as 1.88 days in 100 days and the prevalence in agricultural season as 24%. In the study conducted in North Carolina, 18.4% of the tobacco harvesters were diagnosed with green tobacco sickness, and rash and abrasions were found to be directly associated with green tobacco sickness (Arcury et al ., 2008).

As tobacco production continues, the frequency of green tobacco sickness shall increase among tobacco workers and producers (Arcury TA, 2006; Chacha BK, 2002). For this reason, it is necessary to know the risks posed by the sickness and to determine its prevalence. This study aims to summarize the socio-economic status of tobacco producers living in the Black Sea Region and to ascertain the awareness and prevalence of green tobacco sickness among them.

EXPERIMENTAL SECTION

The data which is obtained from face-to-face interviews with tobacco producers forms the material of this study. The results of the surveys prepared accordingly and made face-to-face with tobacco producers were gathered and analyzed.

The area of study was determined to be the districts of the Black Sea Region which had the highest number of tobacco producers and the highest amount of tobacco production according to the 2012 production year contracts (Table 1). In the study, the number of tobacco producers to take part in the survey was determined to be 296, using simple random sampling method (Cicek, 1996).

Data was collected by visiting 4 districts and conducting face-to-face interviews with tobacco producers. Survey results were analyzed on SPSS 17.0; data was presented as crosstabs and a correlation table.

RESULTS AND DISCUSSION

Tobacco is a social plant because all family members contribute to the process of cultivation (seedbed period, transplanting, hoeing, harvesting, stacking, curing, boxing, and storage). In the study, it was found that all family members contributed to tobacco production. In 61.8% of the establishments analyzed, the number of family members varied between 4 and 6. 58.9% of the household heads were below the age of 50. 96.3% of them were married. 16.2% of them were female. The share of illiterate tobacco producers was 6.4%. 0.6% of all tobacco producers were undergraduates. 74.7% of the household heads were primary school graduates. The data proves that the level of education of tobacco producers is low. It was understood that 75% of the tobacco producers in the region had engaged in tobacco production for more than 20 years and more, and 80.1% did not have any source of income other than tobacco. In spite of the search for an alternative to tobacco production in the rural area, tobacco remains to be the most significant source of income for the local community (Table 2).

Pesticides used in tobacco often pose hazard to the health of tobacco producers and workers. Tobacco workers come into contact with such chemicals during work. It is as dangerous as exposure to nicotine [Karafakoglu YS, 2004; Ballard T et al ., 1995). For this reason, in our study, establishments were asked about pesticide application, frequency of application, method of application, compliance with directions for use, and factor in deciding the time from harvesting to application. In the study, it was found that a great majority of the tobacco producers (91.6%) applied pesticides. 70.9% of them applied pesticides 1 to 2 times during production season. 80.8% of the tobacco producers applied pesticides using pipes or backpack sprayers. 72.8% of them decided to apply pesticides taking the recommendations of their contracted tobacco company official into consideration. In tobacco production, both the right dose of application and the right time of application are the keys to minimize environmental damage as well as damages to tobacco producers and workers. Only 3.7% of the tobacco producers took that decision by themselves; 87.9% of them made dose decisions by reading the directions for use or consulting to the Provincial Directorate of Agriculture, pesticide vendors, or tobacco company officials. 8.4% of them did not applied pesticides at all. One of the most frequent problems in tobacco production areas was non-compliance with time of waiting after pesticide application. In this study, although 50.5% of the tobacco producers stated they complied with such time with applicable methods, it was understood that 40.8% of them still decided on the time of entering the land after pesticide application based on their experience, without need for any guidance (Table 3). Tobacco having residue over tolerance limits does not have any commercial value, not to mention its adverse effects on health. So, it is absolutely necessary to observe the dose of application and the time of waiting written on labels.

Green tobacco sickness occurs as nicotine on tobacco leaves is absorbed as a result of contact with skin. The key factors that help nicotine absorption are failure to use protective equipment, breaking off tobacco leaves when they have dew on them, and collecting tobacco leaves under armpits. In the study conducted in the region, it was ascertained that, of the tobacco producers, 99% did not harvest in rainy weather, 91% did not harvest in case of dew, 35% harvested when the height of tobacco was at waist level, 41% harvested when the height of tobacco was at chest level, 89.5% used protective equipment, and 61% carried harvested tobacco leaves mostly in a basket. It was found that, in general, tobacco producers did not have breakfast before harvest (82%) or snacked during harvest (84%) (Table 4).

It was seen that almost all (96.4%) of the tobacco farmers in the region had not ever heard of green tobacco sickness and that, after harvest, a great majority (96.6%) of them had not ever encountered such a sickness. The ones who thought tobacco production had adverse effects on their health were in minority (16.2%). The majority (83.8%) of them thought the opposite (Table 5).

In the study, an inverse and statistically significant (p<0.01) relationship was observed between the method of application and the application of pesticides. The relationship between snacking during harvest and the height of tobacco leaves during harvest and harvesting after rainfall or dew was found to be a direct relationship. On the contrary, there was an inverse and statistically significant (p<0.01) relationship between snacking during harvest and protective equipment usage during harvest. In other words, it was seen that the tobacco producers who used protective equipment did not snack during harvest. However, as the height of tobacco leaves during harvest increased and harvesting after rainfall or dew became more frequent, tobacco producers snacked more during harvest. An inverse relationship was observed between the height of tobacco leaves during harvest and having heard of green tobacco sickness, the adverse effects of tobacco cultivation on health, and protective equipment usage during harvest. On the other hand, the relationship between the height of tobacco leaves during harvest and tobacco leaf stringing was directly proportional. In addition, an inverse and statistically significant (p<0.01) relationship was observed between having heard of green tobacco sickness and tobacco leaf stringing. As can be seen in the results obtained, the less tobacco producers come into contact with green tobacco, the less they have/hear of green tobacco sickness (Table 6).

CONCLUSIONS

The researches performed all around the world report that green tobacco sickness exists and leads to some negative effects on tobacco producers. The Black Sea Region is one of those having the highest amount of tobacco production in Turkey. The purpose of this study was to examine the presence of green tobacco sickness in the region and tobacco producers’ level of knowledge of green tobacco sickness.

As a result of the study, no green tobacco sickness was encountered among tobacco producers living in the Black Sea Region. Black Sea Region tobacco producers do not harvest on rainy days. They have protective equipment during harvest and generally use baskets for carrying tobacco leaves. In addition, oriental tobacco contains low amount of nicotine. These are the main reasons why green tobacco sickness was not encountered in the region. Additionally, it was understood that tobacco producers living in the region did not have knowledge of green tobacco sickness. Thus, it is required to inform them about the symptoms and risks of green tobacco sickness and give occupational health and safety training to them. For protecting the health of individuals working in tobacco production, it is of high importance to conduct national and international campaigns intended to raise public awareness of green tobacco sickness. Besides, we believe that attempts to perform tobacco harvest by mechanical methods and technical equipment would be helpful in solving the problems caused by using hands. It is necessary to repeat this study conducted in the Black Sea Region in other tobacco producing parts of Turkey as well. We think that, in future studies, relevant medical academics should be included in the team to determine the amount of nicotine absorbed, performing pre- and post-harvest measurements, and results should be incorporated into considerations.

ACKNOWLEDGEMENTS

We would like to extend our thanks to the Tobacco, Tobacco Products, and Alcoholic Beverages Market Regulation Board and to Levent Dumantepe, an expert of the Board, as well as to Prof. Dr. Necdet Çama> and Prof. Dr. Ali Kemal Ayan, academics at Ondokuz Mayıs University, and Tolga Zorba, an academic in the Tobacco Expertise Vocational School of Celal Bayar University, for their contributions to this study.

REFERENCES

1. Arcury TA, Quandt SA, 2006. Health and social impacts of tobacco production. J Agromedicine. 11: 71-82.

2. Arcury TA, Quandt SA, Preisser J., Bernert JT, Norton D, Wang J, 2003. High levels of transdermal nicotine exposure produce green tobacco sickness in Latino farmworkers. Nicotine Tob Res. 5: 315-322.

3. Arcury TA, Quandt SA, Preisser JS, 2001. Predictors of incidence and prevalence of green tobacco sickness among Latino farmworkers in North Carolina, U.S.A. J Epidemiol Community Health. 55: 818-825.

4. Arcury TA, Quandt SA, Preisser JS, Norton D, 2001. The incidence of green tobacco sickness among Latino farmworkers. J Occup Environ Med. 43: 601-610.

5. Arcury TA, Vallejos QM, Schulz MR, Feldman SR, Fleischer AB, Verma A, Quandt SA, 2008. Green tobacco sickness and skin integrity among migrant Latino farmworkers. Am J Ind Med. 51(3): 195-203.

6. Ballard T, Ehlers J, Freund E, Auslander M, Brandt V, Halperin W, 1995. Green tobacco sickness: Occupational nicotine poisoning in tobacco workers. Arch Environ Health. 50: 384-390.

7. Benowitz NL, Lake T, Keller KH, Lee BL, 1987. Prolonged absorption with development of tolerance to toxic effects after cutaneous exposureto nicotine. Clin Pharmacol Ther. 42: 119-121.

8. Chacha BK, 2002. From pastoralists to tobacco peasants: The British American Tobacco and socio-ecological change in Kuria District, Kenya, 1969–

1999. In Killing Trees to Cure Forests: Ethnicity, Economy, and Environment. Conference Proceedings. Nairobi, Kenya:Great Lakes Colleges Association, University of Nairobi.

9. Cicek A, Erkan O, 1996. Agricultural Economics Research and Sampling Methods. Gaziosmanpasa University, Agricultural Faculty Publications, Pub. No: 12, p. 58-73, Tokat, Turkey.

10. Curwin BD, Hein MJ, Sanderson WT, Nishioka MG, Buhler W, 2005. Nicotine exposure and decontamination on tobacco harvesters' hands. Ann Occup Hyg. 49(5): 407-414.

11. D’alessandro A, Ben Owitz NL, Muzi G, Eisner MD, Filiberto S, Fantozz P, Montanari L, Abbritti G, 2001. Systemic nicotine exposure in tobacco harvesters. Arch Environ Health. 56: 257-264.

12. Gehlbach SH, Williams WA, Freedman JI, 1979. Protective clothing as a means of reducing nicotine absorbtion in tobacco harvesters. Arch Environ. Health. 34(2): 111-115.

13. Gehlbach SH, Williams WA, Perry LD, Freedman JI, Langone JJ, Petal V, Woodall JS, 1975. Nicotine absorption by workers harvesting green tobacco. Lancet. 305 (7905): 478-481.

14. Gehlbach SH, Williams WA, Perry LD, Woodall JS, 1974. Green tobacco sickness: An illness of tobacco harvesters. JAMA. 229: 1880-1884.

15. Ghosh SK, Parikh JR, Gokani VN, Kashyap SK, Chatterjee SK, 1979. Studies on occupational health problems during agricultural operation of Indian tobacco workers. J Occup Med. 21: 45-48.

16. Karafakoglu YS, 2004. Oxidative status in tobacco harvesters. Kocatepe Medical Journal. 5(2): 7-11.

17. Mcbride J, Altman D, Klein M, White W, 1998. Green tobacco sickness. Tob Control. 7(3): 294-299.

18. Misumi J, Koyama W, Miura H, 1989. Two cases of ‘‘green tobacco sickness’’ in the tobacco harvesters and the absorption of nicotine through the skin in the rat. Sangyo Igaku, 25 (1): 3-9.

19. Parikh J.R., Gokani VN, Doctor PB, Kulkarni PK, Shah AR, Saiyed HN, 2005. Acute and chronic health effects due to green tobacco exposure in agricultural workers. Am J Ind Med. 47: 494-499.

20. Quandt SA, Arcury TA, Preisser JS, Bernert JT, Norton D, 2001. Behavioral and environmental predictors of salivary cotinine in Latino tobacco workers. J Occup Environ Med. 40: 844-853.

21. TAPDK 2013. Tobacco and Alcoholic Beverages Market Regulation Board. Available online: www.tapdk.gov.tr (accessed on 04.07.2013).

22. Trape-cardoso M, Bracker A, Grey M, Kaliszewski M, Oncken C, Ohannessian C, Barrera LV, Gould B, 2003. Shade tobacco and green tobacco sickness in Connecticut. J Occup Environ Med. 45: 656-662.

23. Weizenecker R, Deal WB, 1970. Tobacco cropper’s sickness. J Fla Med Assoc. 57 (12): 13-15.

24. Wester RC, Maibach HI, 1983. Cutaneous pharmacokinetics: 10 steps to percutaneious absorption. Drug Metab Rev. 14: 169-206.

List of Tables:

Table 1. Tobacco production in the Black Sea Region and in the area of study

Number of Contract Amount Area of Production Number of

Turkey 63.156 83.464.900 1.020.354

*Source: [1]

Total 59 19.9% 149 50.3% 71 24.0% 17 5.8% 296 100.0%

Freq.: Frequence, Perc.: Percent

Recommendation of the 0 0.0% 5 1.7% 1 0.3% 1 0.3% 7 2.3%

Provincial Directorate of

Recommendation of Tobacco 57 19.3% 98 33.1% 47 15.9% 13 4.5% 215 72.8%

Recommendation of the 0 0.0% 3 1.0% 0 0.0% 1 0.3% 4 1.3%

Provincial Directorate of

Recommendation of Tobacco 39 13.1% 73 24.7% 25 8.4% 13 4.5% 150 50.7%

Freq.: Frequence, Perc.: Percent

Total 59 19.9% 149 50.3% 71 24.0% 17 5.8% 296 100.0%

Freq.: Frequence, Perc.: Percent

Freq.: Frequence, Perc.: Percent

Table 6. Correlations between green tobacco sickness and tobacco producers

Non-agricultural income (%) -.086

Method of application .045 -.011 -.702 **

Harvest after rainfall or dew -.068 -.048 .046 -.099 .185 **

Protective equipment usage .021 -.025 -.075 .104 -.211 ** -.010 -.190 **

Adverse effects of tobacco -.147 * -.013 .076 -.115 * .018 .042 -.126 * .098 -.058 .070 .059

*0.05 >p, **0.01>p

CONFLICTS OF INTEREST

“The authors declare no conflict of interest”.

© 2018 by the authors; Published by SKY FOX Publishing Group, Tamilnadu, India. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/ ).