Thousands of young children are accidentally poisoned by tobacco products each year in the US, and new dissolvable tobacco products that resemble candy might pose an additional risk, according to researchers.
In a study of reports to US poison control centres between 2006 and 2008, investigators found that 13,705 children younger than 6 were accidentally poisoned by tobacco products. Cigarettes were the most common culprit, followed by smokeless tobacco products, and more than 70% of the victims were infants younger than one year.
The findings are published in the journal Paediatrics.
Small amounts can poison
In a baby or small child, even a small amount of nicotine, as little as 1mg, can cause nausea and vomiting. Larger doses could lead to weakness, convulsions or potentially fatal respiratory arrest.
The new study appears to be the first to bring together the numbers on accidental child tobacco poisonings nationally, according to lead researcher Dr Gregory N. Connolly, of the Harvard School of Public Health in Boston.
"These numbers are alarming," Connolly told Reuters Health. "Parents need to get the message: Don't leave these products around where children can reach them."
That, he said, includes making sure to clear cigarette butts from ashtrays or anywhere else a baby or child could get a hold of them. In this study, cigarettes or filter tips were responsible for nearly 10,600 of the poisonings the researchers documented. Smokeless tobacco products were behind another 1,768.
Melt-in-the-mouth tobacco products
But there is now a new concern, according to Connolly's team - namely, the melt-in-the-mouth tobacco products recently put on the market.
Tobacco companies say the products - which come in the form of flavoured, candy-like pellets, sticks and strips - are meant to give adults a smoke-free way to get their nicotine fix. But they could also end up as a new route for accidental child poisonings, Connolly and his colleagues say.
Attractive to kids
"Now we've got something in the marketplace that could be more attractive to kids," Connolly said.
The products are too new to have been behind any of the poisonings in the current study. However, Connolly and his colleagues did do a chemical analysis of one - Camel Orbs, tobacco pellets with a Tic-Tac-like appearance introduced last year by R.J. Reynolds.
The researchers found that the pellets contained a greater proportion of "free" nicotine than the norm for cigarettes or dipping tobacco.
Free nicotine is more quickly absorbed into the bloodstream, raising the possibility that it could be more toxic to a child than other tobacco products are.
The Camel Orb packaging is said to be child-resistant; however, Connolly noted that the packaging is tricky enough that many users might prefer to dispense a number of pellets at a time, leaving some lying around.
He cautioned against doing that in any area where a young child might see them. One pellet contains about 1mg of nicotine, so might cause nausea, Connolly said. "But if a child gets a few of them," he added, "that could be very serious."
Keeps smokers addicted to nicotine
Connolly and other public-health experts had already been critical of the new dissolvable tobacco products - saying they may only serve to keep smokers addicted to nicotine, and could be especially attractive to teenagers.
David Howard, a Reynolds spokesman, told The New York Times that Camel Orbs were marketed only for adults and come in child-resistant containers. He denied that they look like Tic Tac mints.
"Those packages don't at all look alike to me," Howard told the Times.
In an editorial accompanying the study, officials with the US Food and Drug Administration (FDA) note that while teenagers' smoking rates have slowly declined in recent years, their use of smokeless tobacco products is rising.
Tobacco industry shifts focus
Meanwhile, the tobacco industry - faced with a growing number of indoor smoking bans in the US - seems to have shifted focus to developing new smokeless products, write Drs Marisa L. Cruz and Lawrence R. Deyton.
They say that the fact that the nicotine from dissolvable products may be more quickly absorbed raises concerns not only about poisonings in young children, but also about the addiction potential should older kids use them.
The FDA is currently collecting study data from tobacco companies and independent researchers on dissolvable tobacco products and their "potential misuse", according to Cruz and Deyton. They say the agency will use that information to make any future regulatory decisions on the products.
The FDA has already banned cigarettes with added fruit, candy or clove flavourings, but the prohibition does not apply to other tobacco products, including dissolvable ones.
Issues with flavouring
According to the Times, Reynolds' Howard said it was unfair to criticise the flavouring of Camel Orbs because many other products, including the quit-smoking aid Nicogum, come in flavours. Howard also told the Times that many other common products posed risks to infants or children from accidental ingestion.
"Virtually every household has products that could be hazardous to children, like cleaning supplies, medicines, health and beauty products, and you compare that to 20% to 25% of households that use tobacco products," he said. - (Amy Norton/Reuters Health)
SOURCE: http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-2835v1 Pediatrics, May 2010.