GREEN TOBACCO SICKNESS (GTS) IN THAI TRADITIONAL TOBACCO FARMERS RELATED TO THEIR OCCUPATIONAL EXPOSURE IN NAN PROVINCE, THAILAND

The aim of this study was to investigate prevalence of Green Tobacco Sickness (GTS) and occupational exposure on Thai traditional tobacco farmers in Nan Province, Thailand. To measure salivary cotinine levels and to measure pesticide exposure levels by Test Mate OP Kit and personal protective behaviors on tobacco farmers. To determine the relationship between GTS and salivary cotinine levels, pesticide exposure levels, personal protective behaviors. This study was a cross-sectional study and prospective study that conducted on 473 tobacco farmers; 319 Thai traditional tobacco farmers from Praputtabath Sub-District, Chiangklang District and 154 from Phatow Sub-district in Thawangpha District were randomly selected and interviewed in person by means of questionnaires and environmental surveying. Descriptive statistics including Chi-squared Test, spearman’s correlation (Spearman’s rho) and multiple logistic regression analysis were used to potentially identify risk factors pertaining to GTS. The prevalence of GTS was found to be 22.62%. risk factors which are associated with GTS were dependent of certain farmer characteristics; gender, smoking, skin rash, wearing wet suit, process of curing tobacco leaves and watering tobacco plants. Almost of them were using rubber latex gloves that it is possibility to increase nicotine absorption due to climate weather may promote sweat on their hand and were not statistically significantly associated with GTS (Chi-square test, p>0.05). The prevalence of risky level of AChE was 61.90% and safe level was 38.10%, risk level of PChE was 42.86% and safe level was 57.14%. However, pesticide was not applied in all period and a symptoms of GTS in which some of them do not use pesticide before, thus possible to indicate a safe level of AChE and PChE contribute to associate with nicotine poisoning in the other name of GTS(Chi-square test, p<0.05) .From this study demonstrated the usefulness to use salivary cotinine level measured by NicAlert™ cotinine test strips (NCTS), were well correlated with farmers who working with dry tobacco producing. Salivary cotinine levels were also significantly correlated with the prevalence of GTS among tobacco farmers group in any time to testing across crop season.The six test (T6) was strongly correlate between salivary cotinine levels and GTS (Spearman's correlation coefficient=0.735, P<0.01) Dealing with strong positive correlated between wore mask, good practices through changing wet suit during work and GTS is most remarkable from this study(Spearman's correlation coefficient=0.894, 0.496, P<0.01) respectively. Finally, the long-term effects of such exposure should be investigated and health education program with health risk exposure for increase awareness of farmers is recommended.