Officials often tackle cigarette-related health issues from the consumer’s perspective — pushing for public smoking bans and increasing age restrictions. But a Human Rights Watch (HRW) report released today indicates that a major health concern is looming in the tobacco fields of the US, where children as young as seven can be found working each summer.

According to the report, nearly three quarters of the child workers on the tobacco farms who were surveyed experienced health effects and symptoms consistent with acute nicotine poisoning, otherwise known as Green Tobacco Sickness (GTS).

“I didn’t feel well, but I still kept working. I started throwing up. I was throwing up for like 10 minutes, just what I ate. I took a break for a few hours, and then I went back to work,” one of the interviewees, 16-year-old Carla P., told HRW.

'The vast majority of these teens don’t have a tolerance to nicotine, so they are highly vulnerable to suffering Green Tobacco Sickness.'

Between May and October 2013, HRW interviewed 141 child laborers between seven and 17, who work as many as 50-60 hours a week in the tobacco fields of Kentucky, Virginia, North Carolina, and Tennessee. Those interviewed were largely children of Hispanic immigrants, some worked in fields near their homes during the summer months, and others traveled seasonally with their families.

The children surveyed planted seedlings, harvested tobacco leaves by hand, and applied pesticides. They reported the sudden onset of symptoms including nausea, vomiting, and headaches.

“To any urban person or someone not involved directly in agriculture and farming, this is an unseen thing,” Clifford Douglas, director at the University of Michigan's Tobacco Research Network, told VICE News. “Most people regard the tobacco problem as being solved, but it clearly hasn’t been solved in an agricultural sense.”

GTS is an illness specifically associated with tobacco farming due to nicotine absorbing into workers’ skin following prolonged contact with the plants. The long-term effects of the condition are unclear. Nicotine exposure via smoking, however, can have negative implications for brain development in adolescents.

“The vast majority of these teens don’t have a tolerance to nicotine, so they are highly vulnerable to suffering GTS,” Douglas said.

And it’s not just one cigarette’s worth of nicotine that the workers are being exposed to in the fields. A 2005 study from the College of Public Health at the University of Kentucky, Lexington, found that the equivalent of 50 cigarettes’ worth of dissolved nicotine can be absorbed by workers each day.

Interestingly enough, this is all legal. Labor laws in the US set the legal age of hazardous agricultural work at 16 years, but tobacco farming does not fall into this category. Children as young as 12 can be employed on any farm as long as they have parental permission and are not working during the school day. Once a child turns 14 they can work without their parent’s consent.

Highlighting the Department of Labor’s failure to push through new youth labor regulations in 2012, HRW has recommended that the list of hazardous occupations is updated while also making it illegal for children under 18 to perform these tasks.

But talk of increased legislation brings about skepticism, especially from those looking at the larger picture of child labor in the agriculture industry. Deborah Reed, an associate professor of public health professor at University of Kentucky, told VICE News that education and farm training should be a priority.

'Migrant children workers, those children need an extra layer of protection because they aren’t part of a farm family, they’re part of a farm force.'

“You can pass all the regulations you want, but there’s two million farms in this country and there’s no one to enforce it until after the fact and that’s not what you want,” Reed said, explaining that preventative training was important.

Reed sees the fact of children either working or being on the farm as inevitable, noting that many of the youth deaths in agriculture are bystanders, not workers. She says making sure the kids are physically ready is also important, especially in manual tobacco harvesting in the heat of the day. With the case of migrant workers, Reed says education is particularly important.

“Migrant children workers, those children need an extra layer of protection because they aren’t part of a farm family, they’re part of a farm force,” she said.

While there might always be the case of kids working on their family farm, the labor force in the tobacco industry speaks to a larger issue.

“It’s a serious social justice issue involving migrant workers, poverty and children,” said Douglas. “The victims here are mostly poor and largely invisible to the rest of us, but that doesn’t mean they don’t need to be protected.”

Douglas sees tobacco companies as a crucial player in changing labor conditions. He says these companies have the power to force policy changes and make the farming industry more accountable, but they have done little to address the issues.

According to HRW, tobacco giant Philip Morris has outlined the most detailed corporate policies and guidelines on child labor. The company has developed a specific set of hazardous tasks not allowed for workers under the age of 18. Philip Morris’ holding company, Altria Group, reportedly said it would work to meet labor regulation compliances.

Yet Marty Otañez, an anthropology professor and a board member of the Human Rights and Tobacco Control Network, told VICE News that the companies have been more concerned with their bottom line than eliminating child labor. He says with the major corporations buying tobacco from farms at a very low cost, cheap or unpaid labor is unavoidable. This results in families who can't afford to not have their child working in the fields. “You have a situation where you have this whole industry founded on slave labor and that persists into 2014,” said Otañez.

Otañez said he would like to see the companies employ a third party to assess conditions in the farms. He added there is also a need for collective bargaining and union representation in order to improve conditions, which he describes currently as deplorable.

“It’s not about just looking at the public health issues of smoking anymore, but taking a holistic approach to holding a company accountable,” he said. “The cost of tobacco is low, but the impact is huge.”

Follow Kayla Ruble on Twitter: @RubleKB