Occupational exposure to unburnt tobacco and potential risk of toxic optic neuropathy: A cross-sectional study among beedi rollers in selected rural areas of coastal Karnataka, India

Abstract

BackgroundBeedi also known as poor man’s cigarette is manufactured in almost all major states of India. Beedi workers are exposed to various health risks. There is an increased risk of systemic absorption of tobacco through skin and mucous membrane. The optic nerve is susceptible to damage from several toxic substances including tobacco. This group of disorders is known as toxic optic neuropathy (TON). The association of TON with occupational exposure to unburnt tobacco in beedi rollers has not been explored.ObjectivesAmong the beedi rollers in Mangaluru and Bantwal talukas of Dakshina Kannada District, Karnataka, India: to assess the magnitude of potential TON utilizing colour vision and contrast sensitivity as screening tools and to identify the demographic, biological and occupational factors associated with potential TON.MethodsA community-based cross-sectional study was conducted from April-Sept 2016 in Mangaluru and Bantwal talukas, of Dakshina Kannada district, Karnataka. Beedi rollers from twelve villages (six from each taluka) were included. In each of the selected villages, the investigators identified beedi collection centres and all the eligible beedi rollers were included in the study till the required number of beedi rollers for that village was achieved. Participants were screened at the study site for visual acuity, colour vision and contrast sensitivity and those with abnormal colour and contrast sensitivity in the presence of good visual acuity were considered to have potential TON.ResultsA total of 377 beedi rollers were approached; of which 365 consented to take part in the study (response rate: 96.81%). Women constituted the majority of the participants (n = 338, 92.6%). Based on the screening criteria, the prevalence of potential TON was 17.5% (n = 64, 95% CI: 13.5–21.9). On multiple logistic regression analysis, duration of beedi rolling (Adj OR: 1.061; 95% CI 1.015–1.109, p = 0.009), advancing age (Adj OR: 1.096; 95% CI 1.058–1.136, p<0.001) and presence of diabetes (Adj OR: 6.315; 95% CI 1.4572–27.376, p = 0.014) were independent correlates of potential TON.ConclusionIn the present study, almost one out of six beedi rollers displayed clinical signs of potential TON. Increased duration of beedi rolling, advancing age and presence of diabetes were the independent correlates of potential TON. However, with this cross-sectional study it is not possible to conclude if these factors play a role individually or collectively or are a serendipitous association, for which large scale analytical studies are required.

Comparative Evaluation of Salivary Sialic Acid Levels Among Beedi Rollers and Tobacco Users in Mangalore, South India

“…The estimated sample size was 35 in each group with a level of significance 5% and power 80% based on a previous study [ 8 ].…”

“…The nicotine which is released from the tobacco leaves can be absorbed through the skin, respiratory epithelium, and mucous membrane of the mouth. Increased levels of tobacco constituents were found in the urine of beedi workers, which suggests increased systemic exposure to tobacco [ 8 ]. A study conducted by Bhisey et al in 1991 at Bombay's Cancer Research Institute revealed that workers engaged in the manufacturing of beedis were exposed to dangerously high levels of carcinogens that are either absorbed through the skin or inhaled as dust [ 9 ].…”

The Political Economy of Public Health Inequalities and Inequities in India: Complexities, Challenges, and Strategies for Inclusive Public Health Care Policy

“…It was largely reported that occupational health hazards for people working in every sector (from manufacturing and waste management to migrant labor and agriculture) in India include hypertension, liver disease, tuberculosis, stress, diabetes, cancer, skin disease, impaired vision, hearing disability, urinary tract problems, and problems related to the circulatory, digestive, musculoskeletal, behavioral, and nervous systems. The reasons for such health problems among workers include a lack of proper protective gear, basic amenities, and adequate training and awareness; employers' callous attitudes and reluctance to organize treatment for work-related accidents exacerbate the problem [54][55][56][57][58] .…”

Gender, women, and the future of tobacco control

“…Women who roll bidis, or hand-rolled cigarettes containing unprocessed tobacco, are mostly impoverished, have low literacy and are members of Scheduled Castes and Scheduled Tribes (Committee on the Welfare of Scheduled Castes and Scheduled Tribes, 2019; Mazumdar, 2011). They experience health issues such as muscle and joint pain (Joshi et al , 2013), respiratory problems from inhaling tobacco dust (Shukla et al , 2011), and sickness from nicotine absorbed through the skin (Kaup et al , 2017). The home-based contract system of the bidi industry enables companies to evade labor laws and exploit workers, the majority of whom are women (Mazumdar, 2011; John, 2016).…”