Frequency and outcomes of accidental ingestion of tobacco products in young children

https://doi.org/10.1016/j.yrtph.2011.07.010Get rights and content

Abstract

This review assesses published literature related to frequency and outcomes associated with accidental ingestion of tobacco and pharmaceutical nicotine products among young children. Twenty-seven years of annual reports by American Association of Poison Control Centers (AAPCC) were analyzed for occurrence and outcomes associated with accidental ingestion events involving tobacco and pharmaceutical nicotine products among young children. Over a 27-year period, and of >50 million contacts for all categories combined, 217,340 contacts involving ingestion of tobacco products were reported. Approximately 89% involved children <6 years old. One fatality was reported, however the co-ingestion of both cigarettes and diazepam complicates an assessment of a contributory role of tobacco. The rate of major, non-fatal, outcomes was <0.1%. Data from AAPCC reports and other sources indicate the frequency of accidental poisoning events is relatively low for tobacco products compared with other products such as drugs, dietary supplements, cleaning products, and personal care products. These findings, along with those for pharmaceutical nicotine products, are consistent with published case reports and reviews, indicating that the frequency and severity of outcomes associated with accidental ingestion of tobacco products by young children appear to be relatively low. However, adults should keep tobacco products out of the reach of children.

Highlights

► Accidental ingestion of tobacco products by young children is an ongoing concern. ► Twenty-seven years of surveillance data were analyzed. ► The frequency and severity of outcomes appears to be relatively low. ► Adults should keep tobacco products out of the reach of children.

Introduction

Cigarettes, cigars, smokeless, and other tobacco products have been widely used in the United States for well over 100 years (US Department of Health Education and Welfare, 1964). Accidental ingestion of these products by young children could lead to acute toxicity due to their nicotine content. Consequently, cases involving children ingesting tobacco products, and other nicotine containing products, have been monitored for decades, and studies have been published assessing the frequency and severity of such accidental ingestion events (Malizia et al., 1983, Smolinske et al., 1988, Wain and Martin, 2004, Woolf et al., 1997).

Concerns have recently been raised about the potential toxicity of both conventional and “novel” smokeless tobacco products which may be accidentally ingested by young children (Connolly et al., 2010). Because some of the newer smokeless tobacco products have only recently been introduced into the market, there is limited information concerning the potential consequences resulting from accidental ingestion of these products by children. However, all tobacco products share the common characteristic of containing nicotine, which is the primary focus of concern associated with possible acute toxicity resulting from accidental ingestion by young children (Goepferd, 1986, Smolinske et al., 1988). The levels of nicotine contained in newer smokeless tobacco products are within the range of levels occurring in conventional smokeless products (Stepanov et al., 2008).

This assessment reviews available published literature related to the frequency and outcomes associated with accidental ingestion of tobacco products among young children.

Section snippets

Data assessment

The American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) is a non-profit, national organization founded in 1958 that represents the poison control centers of the United States and the interests of poison prevention and treatment of poisoning. Among its activities, the AAPCC maintains a National Poison Data System. Data in this system are compiled from exposure case data from 61 regional poison centers serving the entire population of the 50 United States, America Samoa,

Exposure events and outcomes associated with all tobacco products

Data on numbers of contacts and outcomes for the years 1983–2009 are summarized in Table 1. Over a period of 27 years, the AAPCC has reported 217,340 contacts involving tobacco products. The majority of these, approximately 89%, have occurred in children <6 years old. Medical outcome categories were assigned to approximately 63% of the total reported contacts.

Over a period of 27 years and out of 217,340 contacts, six fatalities have been ascribed to exposure to “tobacco products”. Of these, four

Discussion

Accidental poisonings in young children from ingestion of household products is an ongoing concern. Over 27 years of annual reporting, the AAPCC population consisted of 50,935,385 exposure-related contacts for all agent categories combined. Because of the widespread use of tobacco products by adults, potential ingestion by children is also a concern. Indeed, case reports involving both tobacco and pharmaceutical nicotine products have been published (Malizia et al., 1983, Smolinske et al., 1988,

Conflict of interest

The author is an employee of Altria Client Services.

Funding sources

None.

Acknowledgment

The author acknowledges the editorial assistance of Eileen Y. Ivasauskas of Accuwrit Inc.

References (44)

  • T.L. Litovitz et al.

    1992 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1993)
  • T.L. Litovitz et al.

    1993 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1994)
  • T.L. Litovitz et al.

    1994 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1995)
  • T.L. Litovitz et al.

    1995 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1996)
  • T.L. Litovitz et al.

    1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1997)
  • T.L. Litovitz et al.

    1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1998)
  • T.L. Litovitz et al.

    1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (1999)
  • T.L. Litovitz et al.

    1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (2000)
  • T.L. Litovitz et al.

    2000 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (2001)
  • T.L. Litovitz et al.

    2001 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (2002)
  • J.C. Veltri et al.

    1983 annual report of the American Association of Poison Control Centers National Data Collection System

    Am. J. Emerg. Med.

    (1984)
  • W.A. Watson et al.

    2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

    Am. J. Emerg. Med.

    (2003)
  • Cited by (8)

    View all citing articles on Scopus

    Some of the content of this manuscript has been presented as a poster at the Annual Meeting of the Society for Research on Nicotine and Tobacco on February 17, 2011 and as an abstract in the book of abstracts provided to the registered meeting attendees.

    View full text