Reported cases of green tobacco sickness (GTS) in tobacco field workers in Kentucky were reviewed. There were 27 cases reported to the Occupational Health Nurses in Agricultural Communities project in a 2 week period in September, 1992. Inpatient and emergency department medical records at five hospitals were reviewed for the period 1 May through 2 October; there were 55 persons in whom GTS had been diagnosed. Workers from NIOSH observed the tobacco harvesting process in order to assist in reducing this exposure. The hands, forearms, thighs, and backs of workers received the most dermal exposure to dissolved nicotine (54115) on wet tobacco leaves. Within minutes of beginning field work, dew from the tobacco leaves had saturated the clothing of the workers. Forty nine persons were evaluated for risk factors associated with GTS. The median age of the patients was 29 years. Twelve were hospitalized for 1 to 2 days with two requiring intensive care treatment for hypotension and bradycardia. Of the 40 who were interviewed, the median time from starting work to onset of illness was 10 hours. Most frequent symptoms included weakness (100%), nausea (98%), vomiting (91%), dizziness (91%), abdominal cramps (70%), headache (60%), and difficulty in breathing (60%). Age was associated with a lower risk for illness. Current use of personal tobacco products appeared to be weakly protective. Reported use of protective items of clothing worn at least once during the growing season was 5% for waterproof clothing and 32% for gloves. An editorial note discussed the possible reasons for the reports of GTS in Kentucky in 1992, including increased awareness and surveillance.