Question 1 tobacco education expenditures in Massachusetts, USA

BACKGROUND: In 1992, voters in Massachusetts (United States) approved Question 1, a state ballot initiative, which raised the state excise tax to provide funds for tobacco education. OBJECTIVE: To examine Question 1 expenditures for tobacco-specific programmes in the 1994, 1995, 1996, and 1997 fiscal years. DESIGN: This study examined trends in Question 1 expenditures. Data were collected from the Massachusetts Department of Public Health and the Massachusetts Department of Revenue for the 1994, 1995, 1996, and 1997 fiscal years. MAIN OUTCOME MEASURES: The amount of spending on tobacco-specific programmes. RESULTS: Excluding the 1994 fiscal year because the state allocated 18 months of new revenues, from the 1995 fiscal year to the projected 1997 fiscal year, the state will have spent 22% of Question 1 funds for tobacco- specific programmes. Question 1 expenditures for tobacco-specific programmes have declined by 15%, whereas Question 1 expenditures for the other programmes decreased only 0.4%. CONCLUSIONS: The legislature has established a trend that has produced real reductions in Question 1 funding for tobacco education, which appears contrary to the mandate of the voters when they enacted Question 1 in 1992. These reductions undermine the effectiveness of tobacco-specific programmes that are an integral part of the Massachusetts Tobacco Control Programme. These results also highlight the fact that the initial compromises made after initiatives such as Question 1 are adopted have important long-term consequences for funding of tobacco control initiatives.


     

Cigarette taxation in China: lessons from international experiences

This paper draws upon the experiences of foreign countries in implementing tobacco taxation to provide lessons the Chinese government can use when considering the feasibility of raising additional taxes on cigarettes. Based on current international data and Chinese published data, this paper concludes that there is still leeway to raise existing taxes. The Chinese government should consider conducting some pilot experiments in tobacco tax increases, with some of the new revenues allocated for tobacco control programmes as well as for financing healthcare services among the poor.


     

Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States)

OBJECTIVES—To measure the prevalence and patterns of, and risk factors for, smoking and other tobacco use among Vietnamese men in Massachusetts (United States).
METHODS—Data were obtained via a telephone interview of 774 Vietnamese men in 1994.
DESIGN—Cross-sectional survey administered via telephone in 1994.
SETTING—Massachusetts, United States.
SUBJECTS—Randomly selected Vietnamese men (n = 774).
MAIN OUTCOME MEASURES—Present and past use of tobacco products, knowledge and attitudes regarding tobacco, and risk factors for tobacco use. Results were compared with data from the Massachusetts general population.
RESULTS—Vietnamese men smoked at a rate 1.9 times that of the Massachusetts general men's rate (43% vs 24%). The smoking rate did not decrease with increasing length of residence in the United States. In a logistic regression, risk factors for current smoking were: age in the thirties; history of parental smoking; lower educational level; higher depression score; low level of exercise; lack of health insurance; and geographical origin from the south coast of Vietnam. Smoking cessation declined with increasing depression score. Most smokers (76%) had no plans to quit smoking.
CONCLUSIONS—Vietnamese men smoke at much higher rates than the general population, and are much less likely to be planning cessation. High rates of depression and sociocultural barriers to smoking cessation must be addressed in efforts to reduce tobacco use among this high-risk population.


Keywords: smoking cessation; tobacco use; Vietnamese     

Tobacco farmers and diversification: opportunities and barriers

OBJECTIVE: To assess the knowledge, attitudes, and behaviours of tobacco growers and allotment owners in the southeastern United States. DESIGN: Cross-sectional telephone survey. PARTICIPANTS: Tobacco growers (n = 529) and tobacco allotment owners (n = 417) were interviewed by telephone in March 1995. SETTING: Tobacco growing states in the southeastern US. MAIN OUTCOME MEASURES: Attitudes of tobacco growers and tobacco allotment owners towards, and experience with, diversification; and attitudes towards an increase in the federal excise tax on tobacco. RESULTS: Half of the respondents had done something to learn about on-farm alternatives to tobacco, had an interest in trying other on-farm ventures to supplement tobacco income, and found alternatives that were profitable. There was a strong, negative linear trend between age and being interested in or trying alternative enterprises. Structural and economic impediments to diversification were noted by respondents (especially younger respondents), but 73% supported an increase in the federal excise tax on tobacco if the money was used to help farmers overcome these barriers. CONCLUSIONS: These data suggest that farmers and health professionals have reason to establish dialogue around diversification and using excise tax increases to fund diversification and to promote health. Tobacco companies have been successful in mobilising farmers against tax increases, but efforts must be made to show farmers that tax increases can be beneficial both to their diversification efforts and to public health. The outcome of this dialogue may well affect the economic infrastructure of thousands of rural communities, the livelihood of tens of thousands of tobacco farmers and their families, and the health of millions of tobacco users.


     

Smoke and mirrors: how Massachusetts diverted millions in tobacco tax revenues

OBJECTIVE: This study examines the politics of appropriating Question 1 tobacco tax revenues in the first budget year after Massachusetts voters passed the ballot initiative in 1992. The initiative increased the tobacco tax on cigarettes by 25 cents per pack and on smokeless tobacco by 25% of the wholesale price. METHODS: Data were collected from newspapers, letters, memoranda, budgets, press releases, legislative floor debates, government documents, legislative journals, personal interviews, and tobacco industry documents that were downloaded from the Tobacco Archives internet site. RESULTS: During the first budget year, programmes mentioned by the initiative that were not exclusively tobacco related accounted for 27% of total Question 1 expenditures, while 50% of the revenues were allocated for programmes that were neither mentioned by the initiative nor provided any tobacco education, prevention, and cessation services. Only 23% of Question 1 funds were appropriated for programmes that provided exclusively tobacco education, prevention, and cessation services. Question 1 revenues were also used to supplant funding for pre-existing programmes, which was explicitly prohibited by the initiative. The first budget year became the template for Question 1 appropriations in subsequent fiscal years. CONCLUSION: Politics did not end after voters passed Question 1. Public health advocates lacked a strategy and budget plan to influence the appropriation of Question 1 funds after the passage of this ballot initiative.     

Cigarette advertising on taxicabs in Boston, Massachusetts (USA)

OBJECTIVE: To examine the frequency of tobacco advertisements on taxicabs within Boston, Massachusetts (USA). DESIGN: At seven locations throughout Boston, an observer counted all taxicabs over 30-minute periods in December 1995. MAIN OUTCOME MEASURES: Confirmed sightings of taxicabs with cigarette advertisements were recorded with information collected on the cigarette brand and taxicab company. RESULTS: A total of 314 taxicabs were observed over 210 minutes of observation time, including 127 (40.4%) with cigarette advertisements. Taxicabs with cigarette advertisements were seen once every 1.65 minutes on average, with Marlboro as the most frequently advertised brand (69 of 127 advertisements, 54.3%). Less affluent locations were serviced by greater proportions of taxicabs carrying cigarette advertisements compared with more affluent locations (odds ratio = 2.08, 95% confidence interval = 1.18-3.68). CONCLUSIONS: Taxicabs represent a major form of exposure to cigarette advertising in Boston.




     

Why did Swiss citizens refuse to ban tobacco advertising?

A ban on tobacco advertising is one of the major tools to promote tobacco control. Swiss citizens recently refused to modify the Swiss Constitution to ban tobacco advertising. This case study shows how a strong alliance among the tobacco industry, the state, the media, and sports and cultural activities planners made it difficult for people to make an informed decision. The promoters of the ban were unable to provide counter-arguments to the mostly fallacious claims made by the opponents regarding the likely health and economic impact of this ban. A comparison to successful campaigns in Canada and New Zealand provides insight regarding factors missing in the Swiss campaign which might have been useful in obtaining support from Swiss citizens.


     

Impact of the Tobacco Price Support Program on tobacco control in the United States

OBJECTIVES—To evaluate the impact of the United States Tobacco Price Support Program (TPSP) on domestic cigarette consumption and the potential political impact of the TPSP on efforts to reduce smoking.
DATA SOURCES—Published studies known to the authors and a search of AGRICOLA from 1980 to 1996.
STUDY SELECTION—Studies published in a refereed journal or research reports published by an accredited university or institution.
DATA SYNTHESIS—The TPSP decreases cigarette use by increasing the price of cigarettes. The price increase resulting from the TPSP, however, is small—about one cent per pack. The resulting decrease in cigarette consumption is also very modest—an estimated 0.23%. However, the TPSP creates tobacco quota owners, who have a strong financial interest in opposing measures to reduce smoking. The TPSP also changes the political influence of tobacco farmers by keeping a large number of small farmers in tobacco production.
CONCLUSIONS—The negative impact of the TPSP (opposition to tobacco control measures) is probably greater than the positive impact of the programme (reducing smoking). Therefore, the net impact of the TPSP on tobacco control efforts is likely to be negative.


Keywords: cigarette consumption; Tobacco Price Support Program; United States     

Measuring support for tobacco control policy in selected areas of six countries

OBJECTIVE—To explore the validity, reliability, and applicability of using a short, psychometrically sound survey instrument to measure population attitudes toward tobacco control policies.
DESIGN—Surveys.
SUBJECTS AND SETTING—Student respondents attending university in Australia (n = 403), Hong Kong (n = 336), the Netherlands (n = 351), South Africa (n = 291), the United Kingdom (n = 164) and the United States (n = 241); total n = 1786.
MAIN OUTCOME MEASURE—The Smoking Policy Inventory (SPI), a 35-item scale. SPI scores were adjusted for age, income, gender, and smoking status. Estimates of internal consistency and tests of factorial invariance were conducted in each sample.
RESULTS—Across all six countries, the SPI was found to be highly reliable and to have a consistent factor structure, indicating that the SPI scale represents a higher order construct that assesses general attitudes about tobacco control policy with five dimensions. In general, the degree of endorsement of anti-tobacco policies as measured by the SPI reflected the extent and strength of tobacco control legislation in those countries. Dutch students were the least likely, and Australian and Hong Kong students the most likely, to support tobacco control policies.
CONCLUSIONS—It is possible to develop appropriate and meaningful measurement tools for assessing support of tobacco control policies. Strong evidence was found for internal reliability and structural invariance of the SPI. The SPI may be a useful mechanism for monitoring ongoing policy initiatives, making cross-cultural comparisons, and evaluating population receptiveness to proposed policy approaches.


Keywords: policies; tobacco control; Smoking Policy Inventory     

Comparing tobacco use among incoming recruits and military personnel on active duty in the United States

OBJECTIVE—To compare the tobacco use profile of recruits with that of military personnel on active duty to determine whether the military environment in some way induces service members to initiate tobacco use.
DESIGN AND SETTING—Cross-sectional survey of United States armed forces active duty and recruit personnel in 1994-95.
SUBJECTS—2711 military recruits and 4603 military personnel on active duty.
MAIN OUTCOME MEASURES—Comparative cigarette smoking and smokeless tobacco use prevalence between recruits and personnel on active duty controlling for age, sex, and race. Impact of demographic factors on the odds of smoking or using smokeless tobacco.
RESULTS—Increases in tobacco use in American military personnel occurred exclusively in men. The highest tobacco use resided with white men on active duty (43% cigarette smoking; 24% smokeless tobacco use) and represents a doubling of tobacco use seen among white male recruits. Among non-white men, tobacco use increased 2-4 times between recruits and personnel on active duty.
CONCLUSIONS—Efforts to reduce tobacco use by American military personnel on active duty should focus more on discouraging the initiation of tobacco use.


Keywords: tobacco use; military personnel; United States     

Banning tobacco sponsorship: replacing tobacco with health messages and creating health-promoting environments

OBJECTIVE: To evaluate the replacement of Western Australian tobacco sponsorship with health promotion sponsorship by the Western Australian Health Promotion Foundation (known as "Healthway"), following the Tobacco Control Act 1990. DESIGN: Process measures of performance were collected from 25 tobacco replacement projects (sponsorship by Healthway of sport, racing, and arts groups previously supported by tobacco companies) and 727 other health sponsorship projects, that is, new sponsorship provided by Healthway to these groups. Cross-sectional survey data were obtained from 917 respondents at tobacco replacement and 2352 at other sponsorship venues. SETTING: Sport, racing, and arts venues sponsored by the Western Australian Health Promotion Foundation (Healthway) in 1991-95. MAIN OUTCOME MEASURES: Population reach, occasions of media publicity, healthy structural changes, cognitive/attitudinal impact of health messages, and the prevalence of five health-risk behaviours. RESULTS: Tobacco replacement and other sponsorship projects achieved comparable performance in publicity for health messages and in healthy structural change, but replacement projects achieved a fourfold higher level of direct population reach for a given amount of funding. Structural change towards a smoke-free environment occurred more often in tobacco replacement projects and a permanent smoke-free policy was achieved in 47% of projects, compared with 15% in other sponsorship projects. The prevalence ratio of current smoking at tobacco replacement venues was 1.86 (95% confidence interval 1.62 to 2.04) relative to other sponsorship venues. There was evidence of higher cognitive resistance to health messages at venues previously sponsored by tobacco companies. CONCLUSIONS: A comprehensive ban on tobacco sponsorship linked to health promotion activities funded by tobacco tax delivers potential public health benefits that exceed those achieved by prohibition of tobacco sponsorship alone. Tobacco replacement venues offer opportunities for environmental modification, promotion of anti-smoking messages, and targeting groups that are hard to reach.


     

Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies

It is now well established that children's exposure to environmental tobacco smoke (ETS) results in substantial public health and economic impacts. Children are more likely than adults to suffer health effects from ETS exposure, and the home is the most important site of such exposure.
  Although the responsibility and authority of the community and health professionals to protect children from harm are entrenched in North American society, social, economic, legal, and political factors contribute to a lower level of support for ETS control measures in homes compared with workplaces and public places. It is now clear that ETS control in home environments must be a priority on the public health agenda. Programme and policy options and strategies for ETS control in home environments are outlined. We conclude that the current research base is inadequate to fully support programme and policy development in this area and priorities for research are identified.


Keywords: environmental tobacco smoke; homes; children     

Worldwide survey of education on tobacco in medical schools

OBJECTIVES—To determine the extent of teaching about tobacco, tobacco-related diseases, and smoking cessation techniques in medical schools around the world; and to ascertain the problems of getting the teaching about tobacco onto the medical curriculum.
DESIGN—Cross-sectional survey. Questionnaires were sent to the 1353 medical schools in 143 countries around the world using the World Health Organization's Directory of Medical Schools. The questionnaire was translated from English into French, Russian, Mandarin, and Japanese.
SUBJECTS—Deans of medical schools worldwide, or their nominees.
MAIN OUTCOME MEASURES—Extent and format of teaching about tobacco in the medical curriculum, objectives and content of the courses on tobacco, and problems encountered in introducing the topic of tobacco.
RESULTS—493 medical schools responded, representing 64% of countries and 36% of schools. Only 12% of medical schools did not cover the topic of tobacco in the medical curriculum. 58% of medical schools taught about tobacco during the teaching of other subjects. 40% taught tobacco by systematically integrating teaching with other modules. 11% had a specific module on tobacco. The medical schools reported on the objectives and content of their courses on tobacco, which commonly included knowledge about tobacco-related diseases and pharmacological issues. Only a third taught about smoking cessation techniques. 22% had encountered problems in introducing the topic of tobacco, and respondents offered solutions to overcome these problems.
CONCLUSIONS—Medical schools need continued encouragement to include tobacco issues in their curricula, with particular emphasis on teaching about smoking cessation techniques.


Keywords: smoking cessation; medical schools; tobacco education     

Predictors of tobacco use initiation in adolescents: a two-year prospective study and theoretical discussion

OBJECTIVE: To test whether baseline data from a randomised clinical trial are predictive of initiation of tobacco use over a two-year follow-up interval, and to discuss results in the context of a theoretical model. DESIGN: Secondary, non-experimental analyses of data collected from a prospective cluster-randomised clinical trial comparing an intervention with a control condition for reduction of tobacco incidence rates. Orthodontic offices in southern California were recruited and randomised to an experimental or control group. Patient participants were sampled within each office, and completed a short survey, repeated two years later. SUBJECTS: 13,923 patients, 11- 18 years of age, randomly sampled from each office. MAIN OUTCOME MEASURES: The ability of baseline data to predict initiation of tobacco use over the two-year follow-up interval was tested through a series of logistic regression models. Significant predictors and their interactions were identified in fixed-effects models, and verified in a mixed-effects logistic regression model to account for cluster randomisation. RESULTS: Clinician advice against tobacco use was associated with a lower rate of tobacco use initiation among young people whose peer group considered smoking socially desirable. Rates of initiation increased with age, but this association differed by gender and by whether the adolescent had been offered tobacco within 30 days prior to the baseline assessment. People from minority groups were less likely to initiate tobacco use than whites, and young people engaging in other risk practices were more likely to initiate tobacco use. CONCLUSIONS: Findings support predictions based on learning theory that social processes are critical in the development of health-risk behaviours. Future preventive efforts should target changing the density with which young people encounter pro- and anti-tobacco prompts and consequences in the community.


     

Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13

OBJECTIVE: To prepare a history of the enactment of California Assembly Bill 13 (AB 13), a state law prohibiting smoking in most workplaces passed in 1994, and to discuss its initial impacts. METHODS: Data were gathered from open ended interviews with representatives of voluntary health organisations, local government organisations, and principal legislators involved in the process, as well as observers around the state who could provide insight into the legislative process. Information was also obtained from legislative hearings and debates, public documents, letters and personal communications, internal memoranda, and news reports. RESULTS: The success of local tobacco control legislation in California led to a situation in which some health groups were willing to accept state preemption in order to attract the support of the state restaurant association for a bill. The decision to accept this preemption compromise was made by the state level offices of the voluntary health agencies without consulting the broader tobacco control community within California. In contrast, local tobacco control advocates did not accept this compromise, in part because of their belief that local legislation was a better device to educate the public, generate media coverage, and build community support for enforcement and implementation of clean indoor air and other tobacco control laws. Enactment of AB 13 was associated with a slowing of all local tobacco control legislation, including youth oriented laws. CONCLUSIONS: Because its supporters initially doubted that AB 13 would pass, there was never an effort to reconcile the policy differences between state oriented and locally oriented tobacco control policies. This lack of consensus, combined with the political realities inherent in passing any state legislation, led to a bill with ambiguous preemption language which replaced the "patchwork of local laws" with a "patchwork of local enforcement."


     

State legislators' perceptions of lobbyists and lobbying on tobacco control issues

OBJECTIVE: To determine state legislators' perceptions about health and tobacco lobbyists, their frequency of contact with these lobbyists, and the amount of campaign contributions from health professional organisations and the tobacco industry. DESIGN: Cross-sectional study. SUBJECTS: State legislators from North Carolina, Texas, and Vermont (USA), serving in 1994. MAIN OUTCOME MEASURES: Perceptions about lobbyists representing the tobacco industry, non-profit health organisations, and state medical societies with respect to their credibility, importance as sources of information, and persuasiveness; extent of lobbying activities; campaign contributions from health professional organisations and the tobacco industry. RESULTS: Almost all legislators reported that medical society and non-profit health organisation lobbyists are credible on tobacco issues and just over half believed that these lobbyists are important sources of information. More legislators said they could be persuaded by medical and health lobbyists than by tobacco lobbyists. Although health professional Political Action Committees (PACs) gave campaign contributions to more state legislators, and gave higher amounts on average, than tobacco PACs, legislators reported less contact with medical society lobbyists than tobacco lobbyists about tobacco issues. CONCLUSIONS: State legislators have positive attitudes toward lobbyists for non-profit health organisations and state medical societies regarding tobacco issues. These groups may be an underused resource for educating legislators about tobacco control measures.


     

Non-ceremonial tobacco use among southwestern rural American Indians: the New Mexico American Indian Behavioural Risk Factor Survey

OBJECTIVES—To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States).
DESIGN—A geographically targeted telephone survey.
SETTING—Rural New Mexico.
PARTICIPANTS—American Indian residents aged 18 years and older.
MAIN OUTCOME MEASURES—Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour.
RESULTS—Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and 16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI = 6.0 to 9.3) cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use.
CONCLUSIONS—The prevalence of current smokers among rural American Indians in New Mexico was lower than among American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same patterns as reported among American Indians of other regions.


Keywords: American Indians; tobacco use; smokeless tobacco     

Evolution of a comprehensive tobacco control programme: building system capacity and strategic partnerships--lessons from Massachusetts

BACKGROUND: Since the passage of a voter approved state referendum in 1992 to establish a 25 cent increase on the excise tax on cigarettes and smokeless tobacco, Massachusetts has received an average of $40 million annually for its tobacco control programme. This funding allowed Massachusetts to expand and develop its tobacco control programme to become one of the most comprehensive in the world. OBJECTIVES: The development of the Massachusetts Tobacco Control Program is outlined, focusing on three stages of development: formation, strategic partnership building, and shared leadership. METHODS: The development of management structures, programmatic infrastructure, communication and partnership networks, and advisory structures are tracked throughout the three phases. RESULTS: The use of pre-existing public health resources, implementation of a strong training component, a geographical management structure, the creation of public and private partnerships, and the development of a shared leadership model contributed to building consensus and provided the foundation for coordinated approaches to tobacco control. CONCLUSION: Other states and countries can use lessons learned from Massachusetts about the organisational development of a comprehensive tobacco control programme as they embark upon similar efforts.     

What should be the elements of any settlement with the tobacco industry?

Litigation and regulatory assaults on the tobacco companies may create a willingness among tobacco manufacturers to bargain resources and acceptance of public policy changes for limitations of liability, as has been seen by the recent settlement with the Liggett Group. Two elements absolutely critical to any plan are the elimination of tobacco advertising and promotion and the removal of addiction as a reason for tobacco use. Minimal components of any settlement should include: (a) acceptance by the tobacco manufacturers of the causal relationship between tobacco use and disease, and the addictive nature of nicotine; (b) a total ban on tobacco advertising and promotion; (c) FDA jurisdiction over tobacco products and their nicotine content, with the intent of removing nicotine as soon as acceptable nicotine substitution products are available; (d) reimbursement to the states for Medicaid and other state expenditures attributable to smoking, to the maximum extent feasible; (e) funding for local, state, and federal programmes and research in tobacco control; (f) acceptance of legislation and regulations protecting the right of non-smokers to breathe air free of tobacco smoke; (g) funding for a large, national, media-led, anti- tobacco campaign; and (h) cessation assistance for addicted smokers. If negotiations toward a settlement proceed, it is essential that the public health community participate in defining the elements of any agreement to ensure that whatever agreement develops is focused on reducing tobacco-related disease rather than continuing the profitability of American tobacco companies. That participation requires articulation of the core elements essential to an acceptable agreement. If resolution of the public health issues surrounding continued sale of tobacco products can be reached in the United States, it may provide a model for similar resolution in other countries.


     

Green tobacco sickness

OBJECTIVE—To describe the health impact of harvesting tobacco and to suggest prevention and risk reduction strategies to avoid contracting green tobacco sickness (GTS).
DATA SOURCES—A literature search of Medline, Toxline, and Toxline65 with the terms "green", "tobacco", and "sickness" covering the years 1966-1998.
STUDY SELECTION—All studies, reviews, and commentaries that provided information on the health effects of harvesting green tobacco and disease prevention strategies.
DATA SYNTHESIS—GTS occurs when tobacco workers hand-harvest, cut, or load tobacco plants, usually in the early morning or after a rainfall when tobacco plants are covered with moisture. GTS occurs through skin exposure to dissolved nicotine from tobacco leaves. Symptoms of GTS include weakness, headache, nausea, vomiting, dizziness, abdominal cramps, breathing difficulty, abnormal temperature, pallor, diarrhoea, chills, fluctuations in blood pressure or heart rate, and increased perspiration and salivation. The onset of the illness is three to 17 hours after exposure and the duration of illness is one to three days. Initial treatment includes cessation of work, change of clothing, showering, fluid intake, and rest. In more extreme cases, intravenous rehydration, anti-emetics, and dimenhydrinate are administered. Protective, water-resistant clothing; chemical-resistant gloves, boots, and socks; working in dry conditions; and dimenhydrinate can reduce the likelihood of contracting GTS.
CONCLUSIONS—It is important to provide education to tobacco workers and employers about GTS. An international public awareness campaign about GTS timed to coincide with the tobacco harvest, along with enforced worker safety regulations, should be undertaken to protect the health of individuals working in tobacco production.