Recent and Projected Changes in Global Climate May Increase Nicotine Absorption and the Risk of Green Tobacco Sickness.

Background: Dermal transfer of nicotine during tobacco harvest can increase green tobacco sickness (GTS), characterized by nausea, vomiting, headache and dizziness. Rainfall and temperature are established etiological factors known to increase prevalence of GTS. We aimed to analyze recent and projected trends in these factors for major tobacco growing regions to assess potential exacerbation in GTS occurrence. Methods: We analyzed climate parameters, including trends in temperature and precipitation metrics during the tobacco harvest period for Southern Brazil; Yunnan Province, China; Andhra State, India; and North Carolina, USA (~50-year period). We applied Shared Socio-economic Pathways (SSPs) based scenarios for CMIP6, (SSPs of 1-2.6, 3-7.0 and 5-8.5 from 2020 to 2100). Established protocol for nicotine dermal patches and temperature was used as a proxy to estimate potential nicotine absorption with rising temperature. Results: For three locations, cumulative maximum temperatures during harvest season and temperature extremes increased significantly since the 1970s. For all locations, cumulative rainfall during the harvest season also rose. Projected maximum temperatures for the harvest season increased at SSP 3-7.0 and 5-8.5 projections through 2100 for all locations. Estimates of nicotine skin absorption with rising temperature indicate significant increases for both recent changes (since the 1970s) in three of the four locations, and for all locations for the SSP projections of 3-7.0 and 5-8.5 from 2020 to 2100. Conclusions: This study across multiple continents, highlights a potential link between recent and projected anthropogenic change and potential increases in GTS risk. Under SSP 5-8.5, nicotine absorption could increase by ~50% by the end of the century, which may have widespread impacts on the incidence of GTS, especially among younger tobacco workers.