The overall goal of this study was to understand the nature of Green Tobacco Sickness (GTS) and the social and biologic factors that influence minority farmworkers' risk for this occupational disease. GTS is acute nicotine poisoning following dermal contact with mature tobacco plants, Nicotiana tabacum. It results in weakness, nausea, vomiting, and dizziness. In most cases, workers lose 1 or 2 days of work as a result of GTS; in severe cases, dehydration resulting from GTS can be life threatening. Clinicians are increasingly concerned about GTS among minority farmworkers. However, information on the incidence of this occupational disease or the level of exposure to tobacco needed to produce GTS symptoms is very limited. GTS risk factors and the means to prevent GTS are only partially known. Much of the tobacco in North Carolina and an increasing amount in other states (Kentucky, Ohio, South Carolina, Virginia) is harvested by migrant and seasonal farmworkers, who must endure the disability and loss of work that results from GTS. Migrant and seasonal farmworkers in the U.S. are almost exclusively minority -Hispanic (78%), African American (2%), and other groups (Asian, Native American) (2%). During the growing season, the North Carolina Employment Security Commission estimates that there are over 140,000 migrant farmworkers and dependents in the state, with approximately twice this number of seasonal farmworkers. Almost all of the migrant farmworkers, and 90% of the seasonal farmworkers in North Carolina are Hispanic, with the remainder being almost exclusively African American. To achieve the proposed study goal, this study addressed 5 specific aims. These were to:1. Estimate the incidence of GTS in seasonal and migrant farmworkers employed in tobacco production in North Carolina. 2. Determine the risk factors for GTS, including (1) physical environmental (temperature, humidity, precipitation, plant harvest stage) and (2) social environmental (ethnicity, work experience, the organization of work) risk factors, as mediated by (3) biological (body size, sex, health status) and (4) behavioral (tobacco use, fluid consumption, use of protective clothing) variability. 3. Measure the association of tobacco exposure biomarkers (e.g., cotinine and other nicotine metabolites) with GTS symptoms and with work related exposure to tobacco plants, as modified by such GTS risk factors. 4. Understand farmworker and health care providers interpretations of GTS symptomatology, self-care behaviors, and barriers to prevention and treatment seeking. 5. Disseminate findings concerning GTS risk factors to farmworkers and to those providing services to farmworkers (e.g., health care providers, outreach workers, labor organizations).