Rao Pamela, Quandt Sara A, Arcury Thomas A
Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Rural Health. 2002 Fall;18(4):503-11. doi: 10.1111/j.1748-0361.2002.tb00917.x.
This paper describes the explanatory model of green tobacco sickness (GTS) held by migrant and seasonal farmworkers in North Carolina and compares it with a research-based biobehavioral model. GTS is a form of acute nicotine poisoning that affects individuals who work in wet tobacco fields. It is characterized by nausea, vomiting, headache, and dizziness. There are no standard diagnostic criteria for GTS; clinicians must diagnose it based on a combination of symptoms and exposure risk. GTS resembles pesticide poisoning, but treatment is quite different. Many farmworkers in tobacco today are Spanish-speaking immigrants from Mexico with limited experience in tobacco work. In-depth interviews about GTS were conducted with 23 Hispanic farmworkers in central North Carolina to explore their understanding of the problem. Workers generally attributed the symptoms to other aspects of working in tobacco, such as pesticides or heat, rather than nicotine. They cited many of the same risk factors identified in the biobehavioral model, such as wet work conditions and inexperience with tobacco work. Prevention and treatment include a combination of exposure avoidance and common medications. The symptoms of most importance to farmworkers were insomnia and anorexia, both of which impaired the ability to work. This jeopardized their income, as well as their work security. If health care providers understand the explanatory model held by farmworkers, they will be more effective at diagnosing and treating GTS and be better prepared to teach patients how to prevent future episodes.
本文描述了北卡罗来纳州流动及季节性农场工人所持有的绿烟草病（GTS）解释模型，并将其与基于研究的生物行为模型进行比较。GTS是一种急性尼古丁中毒形式，影响在潮湿烟草田工作的个体。其特征为恶心、呕吐、头痛和头晕。GTS没有标准诊断标准；临床医生必须根据症状和接触风险的综合情况进行诊断。GTS类似于农药中毒，但治疗方法截然不同。如今烟草行业的许多农场工人是来自墨西哥的讲西班牙语的移民，他们在烟草工作方面经验有限。对北卡罗来纳州中部的23名西班牙裔农场工人进行了关于GTS的深入访谈，以探讨他们对该问题的理解。工人们通常将症状归因于烟草工作的其他方面，如农药或高温，而非尼古丁。他们列举了生物行为模型中确定的许多相同风险因素，如潮湿的工作条件和烟草工作经验不足。预防和治疗包括避免接触和使用常用药物。对农场工人最重要的症状是失眠和厌食，这两者都损害了工作能力。这危及了他们的收入以及工作保障。如果医疗保健提供者了解农场工人所持有的解释模型，他们在诊断和治疗GTS方面将更有效，并能更好地准备教导患者如何预防未来发作。
