Epidemiology

It is believed that incidence rates for green tobacco sickness are low because it may be misdiagnosed, previous estimates do not reflect the changing nature of the workforce (more Latino migrant workers), and because of a lack of education among the public (farmers specifically) and medical community. In addition, croppers are not likely to be seen by a medical professional as a result of the recurrent nature of the illness and the fact that symptoms appear and resolve without notice over a short time period. Despite these challenges, estimates of incidence rates in Kentucky and North Carolina during a particular growing season are roughly 10 cases per 1,000 tobacco farmers. As a result of the relationship between the type of tobacco, weather conditions, and green tobacco sickness, cases are nearly always found in clusters. Studies examining green tobacco sickness cases on particular farms have found between 24% and 89% of harvesters becoming ill. While the incidence rates vary greatly, young age has consistently been found to increase the risk for green tobacco sickness. In one study, workers under the ago 30 were 3 times more likely to have green tobacco sickness. Additionally, as the length of time employed in the tobacco industry increases, disease risk decreases, especially after 5 years of employment. In terms of race, early studies have all shown significantly higher incidences among white workers, despite the higher prevalence of African Americans working in tobacco fields. These studies relied on emergency room cases, and it is believed that fewer African Americans sought treatment (50,52,56,59,60).

The point of greatest contention in the literature is whether smoking provides a protective effect for tobacco farmers. In some studies it appeared to do so, however the results are highly disputed and not always reproduced. Smoking is certainly not recommended as a form of disease prevention. If any protective effect is obtained from smoking, it appears that green tobacco sickness would still occur once the nicotine level in the body rose above the person's "normal" nicotine threshold (51,52).

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