title: Unintentional child poisonings through ingestion of conventional and novel tobacco products.
abstract: OBJECTIVE
  This study examines child poisonings resulting from ingestion of tobacco products throughout the nation and assesses the potential toxicity of novel smokeless tobacco products, which are of concern with their discreet form, candy-like appearance, and added flavorings that may be attractive to young children.
  
  
  METHODS
  Data representing all single-substance, accidental poisonings resulting from ingestion of tobacco products by children <6 years of age, reported to poison control centers, were examined. Age association with ingestion of smokeless tobacco versus other tobacco products was tested through logistic regression. Total nicotine content, pH, and un-ionized nicotine level were determined, and the latter was compared with values for moist snuff and cigarettes.
  
  
  RESULTS
  A total of 13,705 tobacco product ingestion cases were reported, >70% of which involved infants <1 year of age. Smokeless tobacco products were the second most common tobacco products ingested by children, after cigarettes, and represented an increasing proportion of tobacco ingestions with each year of age from 0 to 5 years (odds ratio: 1.94 [95% confidence interval: 1.86-2.03]). A novel, dissolvable, smokeless tobacco product with discreet form, candy-like appearance, and added flavorings was found to contain an average of 0.83 mg of nicotine per pellet, with an average pH of 7.9, which resulted in an average of 42% of the nicotine in the un-ionized form.
  
  
  CONCLUSIONS
  In light of the novelty and potential harm of dissolvable nicotine products, public health authorities are advised to study these products to determine the appropriate regulatory approach.
authors.affiliation: Division of Public Health Practice, School of Public Health, Harvard University, Boston, MA 02215, USA.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Connolly
authors.forename: Patricia
authors.initials: P
authors.lastname: Richter
authors.forename: Alfred
authors.initials: A
authors.lastname: Aleguas
authors.forename: Terry F
authors.initials: TF
authors.lastname: Pechacek
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Stanfill
authors.forename: Hillel R
authors.initials: HR
authors.lastname: Alpert
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D009538:Nicotine / Q000506:poisoning; D011039:Poison Control Centers / Q000706:statistics & numerical data; D011041:Poisoning / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D019064:Product Packaging; D014030:Tobacco, Smokeless / Q000506:poisoning; D014481:United States
chemical_list: D009538:Nicotine