Green Tobacco Sickness

Person holding green tobacco leaves


Green tobacco sickness (GTS) is a type of nicotine poisoning that occurs while handling tobacco plants. Workers are at especially high risk for developing this illness when their clothing becomes saturated from tobacco that is wet from rain or morning dew, or perspiration. Symptoms of GTS include nausea, vomiting, dizziness, and headaches. Workers have also noted difficulty sleeping or eating. Symptoms of GTS may be similar to those of heat illness and pesticide poisoning, which can make it difficult to diagnose. This topic page provides references to resources intended to help employers, workers, and health professionals identify and reduce risks for job-related green tobacco sickness.

NIOSH Publications

NIOSH and OSHA release Recommended Practice: Green Tobacco Sickness
DHHS (NIOSH) Publication Number 2015-104

Reducing the Impact of Green tobacco Sickness among Latino Farmworkers
DHHS (NIOSH) Publication Number 2011-111

Health Hazard Evaluation Report, HETA-92-403-2329, Kentucky Cabinet for Human Resources, Frankfort, KY. (green tobacco sickness)pdf icon

Green tobacco sickness in tobacco harvesters-Kentucky, 1992
MMWR Morb Mortal Wkly Rep. 1992 Apr 9;42(13):237–240.

Educational Materials

Wake Forest University School of Medicine—winner of the 2006 NORA Innovative Research Award for its GTS projectpdf icon, Reducing the Impact of Green Tobacco Sickness among Latino Farmworkers—produced educational materials for farmworkers that translated research results into media formats culturally and educationally appropriate for workers.

Learning about Green Tobacco Sickness: Juan’s Experienceexternal icon
This black and white fotonovela serves as a teaching tool for farmworkers about exposure, prevention, and treatment of green tobacco sickness.

El Terror Invisibleexternal icon
One segment of this Spanish-language video (with English subtitles), Mean Green and Other Risks, presents information on the symptoms, causes, treatment, and prevention of green tobacco sickness.

Journal Articles

Green tobacco sickness in children and adolescentsexternal icon
Public Health Rep. 2005 Nov-Dec;120(6):602–605

Nicotine exposure and decontamination on tobacco harvesters’ handsexternal icon
Am. Occup. Hyg. 2005 49(5):407–413

Cotinine levels and green tobacco sickness among shade-tobacco workersexternal icon
J Agrmedicine 2005 10(2):27–37

High Levels of transdermal nicotine exposure produce green tobacco sickness in Latino farmworkersexternal icon
Nicotine Tob Res. 2003 Jun;5(3):315–321

Farmer health beliefs about an occupational illness that affects farmworkers: the case of green tobacco sicknessexternal icon
J Agric Saf Health 2003 Feb;9(1):33–45

Detecting patterns of occupational illness clustering with alternating logistic regressions applied to longitudinal datapdf iconexternal icon
Am J Epidemiol. 2003 Sep 1;158(5):495–501

Hispanic farmworker interpretations of green tobacco sicknessexternal icon
J Rural Health, Fall 2002;18(4):503–511

Predictors of incidence and prevalence of green tobacco sickness among Latino farmworkers in North Carolina, USAexternal icon
J Epidemiol Community Health 2001 55:818–824

The incidence of green tobacco sickness among Latino farmworkersexternal icon
J Occup Environ Med, 2001 43(7):601–609

Environmental and behavioral predictors of salivary cotinine in Latino tobacco workersexternal icon
J Occup Environ Med, 2001 43:844–852

Migrant farmworkers and green tobacco sickness: New issues for an understudied diseaseexternal icon
Am J Ind Med. 2000 Mar;37(3):307–315

Spatial and temporal clustering of an occupational poisoning: The example of green tobacco sicknessexternal icon
Stat Med. 1996 Apr 15-May 15;15(7-9):747–757

Familial clusters of green tobacco sicknessexternal icon
J Agromedicine 1996 3(2):51–59

Green tobacco sickness: Occupational nicotine poisoning in tobacco workersexternal icon
Arch Environ Health 1995 Sep-Oct;50(5):384–389

Page last reviewed: September 18, 2014