Household Hazards

How everyday products make us sick.

Not So Good Things from the Valley

Nicotine Getting under Your Skin

Human Rights Watch, whose reports cover topics such as the genocide in Rwanda, police abuses and accountability in Malaysia, and the mistreatment of Tibetans in Nepal, has come a bit closer to home. It issued a new report on child labor in the U.S. tobacco fields and the illness resulting from such work. The key problem is from exposure to a natural pesticide: nicotine.

The 138-page report by Human Rights watch, “Tobacco’s Hidden Children: Hazardous Child Labor in US Tobacco Farming,” is centered on data from interviews with 141 child tobacco workers (http://www.hrw.org/news/2014/05/14/us-child-workers-danger-tobacco-farms). And we are definitely talking child here: the youngest was 7 and the oldest only 17. Two-thirds of them reported symptoms of nausea, vomiting, headache, or other ill-effects all consistent with a nicotine overdose. This happens because nicotine is easily absorbed through the skin; is present on the tobacco plants, especially when the leaves are wet; the plants are above the workers’ heads as they wade through a field’s often dripping plants; and the kids are “protected” from contact only by their own t-shirts and pants.

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This illness has a name and it is well known to Poison Control Centers. It is called Green Tobacco Illness. That does not mean that it is jolly, ho-ho-ho, like the giant of the same color. Green tobacco is not a green sweet pea. The symptoms of green tobacco sickness can be serious, because nicotine is potently toxic. Medical reports of some of the worst cases sometimes appear in regional publications in the big tobacco-producing states such as the Journal of the Tennessee Medical Association (a 1996 report about a young farmer with a slow heart rate as part of the syndrome) or the North Carolina Medical Journal (a 2000 article, “A seizure in the tobacco field. Green tobacco sickness”).

Unfortunately, Poison Control Centers now have yet another childhood nicotine poisoning syndrome to contend with. In late March, the American Association of Poison Control Centers announced that its centers nationwide were experiencing a frighteningly increased number of calls related to e-cigarette devices and the liquid nicotine that fills them – at current rates likely to be close to 2500 reports this year, about half among kids less than age six http://www.aapcc.org/press/29/).

Not long after the Poison Control Centers press announcement, clinicians from the University of Texas posted on the web the report of a case of a poisoned 3 year-old boy (http://www.emdocs.net/electronic-cigarettes-liquid-nicotine-poisoning/). He had been found by his parents after he had drunk from a container of his dad’s e-cigarette liquid nicotine, spilling some on his clothes as well. Then he had a seizure. He was taken to the ED by ambulance (where a strong vanilla smell was noted). Luckily the child recovered without further complications.

Green tobacco sickness and e-cigarette poisoning both put children at risk from nicotine and each is preventable. But there seems to be little connection being made between the two not-so-distinct problems both linked through the same industry.  Maybe it’s a question of insufficient branding. If so, an E-cigarette liquid nicotine company in the U.K. inadvertently may have come up with the solution: Green Giant (Absinthe & Melon flavored) E Liquid, “Yet another refreshing twist that evolved from our ever popular Absinthe E Liquid.”

Paul D. Blanc, M.D., M.S.P.H., is Professor of Medicine and Endowed Chair in Occupational and Environmental Medicine at the University of California San Francisco.

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