Smokeless, flavored tobacco products that look like candy and come in packages shaped like cell phones may be contributing to accidental poisonings in very young children, new research suggests.
Nicotine-laced pellets, strips and sticks that dissolve completely in the user’s mouth — dubbed “tobacco candy” by critics — have joined chewing tobacco and snuff to become the second-most common cause of unintentional tobacco ingestion in kids younger than 6.
Between 2006 and 2008, nearly 1,800 U.S. youngsters — almost 600 a year —accidentally consumed smokeless tobacco products, according to an analysis of 13,705 tobacco-related reports to the nation’s poison control centers. That’s a fraction of the nearly 3,600 poisonings a year that involved cigarettes and filter tips, but it worries authors of the new study published in the journal Pediatrics.
"Novel smokeless tobacco products, including dissolvable, compressed tobacco products ... are now of major concern, with their discreet form, candy-like appearance and added flavorings that may be attractive to children," the authors write.
Potential poisonings add to the growing list of worries from those who fear that tobacco makers thwarted by anti-smoking laws are trying to peddle their addictive products to a new generation of users. Tasty flavors and packaging that resembles Tic Tac mints could be a powerful draw to young users, critics say.
“Our response has been one of dismay,” said Cathryn Cushing, a spokeswoman for the Oregon Tobacco Prevention & Education Program. Oregon is one of three states, along with Ohio and Indiana, tapped as a test market for Camel Orbs, tobacco pellets that contain mint and other pleasant flavors.
“They lost the battle of second-hand smoke and they’re trying to make up for that.”
Not so, said a spokesman for R.J. Reynolds Tobacco Company, which makes Orbs along with Camel Strips and Camel Sticks. David P. Howard, director of communications, said the firm is only trying to offer an alternative for legal smokers who can’t or don’t want to quit and who prefer to enjoy tobacco use without violating laws or social norms.
"They provide adult tobacco consumers options to do it without bothering others," said Howard, who noted that the products are not only smokeless, but also spit-less and litter-free.
The Camel products are packaged in child-resistant packages, sold only to adults 18 and older, and marketed on websites that include strict age verification safeguards, he said.
"Adult tobacco consumers should be diligent about keeping tobacco and all nicotine products away from children," said Howard, who added that other household items, such as vitamins and cosmetics, poison far more children each year.
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But that doesn’t convince public health officials like Alfred Aleguas Jr., managing director of the Northern Ohio Poison Center and co-author of the Pediatrics study. Even a single Orb, which contains about 1 milligram of nicotine, is enough to sicken a small child, he said, adding that a handful of pellets potentially could be lethal.
A 3-year-old in Oregon ingested Orbs last summer, according to the state’s poison center. In Indiana, two toddlers suffered mild poisoning after ingesting “snus,” small packages of flavored smokeless tobacco.
“To have this be relatively new on the market and to already have exposure, I think that’s significant,” said Aleguas.
Snus is among several products marketed in the past few years by Reynolds and Philip Morris USA as the tobacco makers expanded their smokeless holdings in response to a changing climate.
Smoking rates down, tobacco consumption up
Cigarette consumption has plummeted in the United States, even as smokeless tobacco consumption has gone up. Howard estimated that cigarette volumes have fallen between 10 percent and 11 percent in recent years, while the smokeless tobacco market has risen between 5 percent and 6 percent.
Between 1996 and 2006, the average per-capita number of cigarettes smoked fell from 2,355 a year to 1,650 a year, according to the United States Department of Agriculture. During that same period, consumption of snuff rose from .31 pounds to .38 pounds a year.
Critics charge that attracting young users through more palatable smokeless tobacco products is the goal of the new marketing efforts. In the U.S., 13.4 percent of high school boys and 2.3 percent of high school girls use smokeless tobacco, according to the Campaign for Tobacco-Free Kids, based in Washington, D.C.
Slick advertisements for Camel Orbs, Camel Sticks and Camel Strips appear to directly target high school students and pre-teens said Terry E. Pechacek, associate director for Science in the Office on Smoking and Health at the Centers for Disease Control and Prevention in Atlanta.
"Underage children are being reached by this advertising," said Pechacek, who co-authored the new study. "They can use it in school settings, they can use it around their parents, they can use it in other social settings."
Howard denied that the tobacco firm targets young users.
At issue, of course, is the health harm from tobacco use. Because there’s no burning, the risk of lung cancer may be lower with smokeless products, but the products are linked to oral cancers, gum disease, nicotine addiction and heart disease. Even the Camel site carries a bold reminder that the dissolvable products can cause mouth cancer.
"All tobacco products carry risk," Howard said. "We are marketing them as tobacco products."
Another worry, Pechacek said, is that two-thirds of young smokeless tobacco users are increasingly combining the products with cigarettes, and more than half of users aged 12 to 17 are using both.
"The real potential is that those types of dual users, if they maintain that pattern, may have lifelong risks very similar to smokers," he said.
The new products didn't sit well with Ohio Sen. Sherrod Brown and Oregon Sen. Jeff Merkley, who were outraged when Camel Orbs were test-marketed in their states.
“Tobacco candies are clearly designed to appeal to children through both packaging and taste,” Merkley said in a press release. “Congress and the FDA must act quickly to ensure our children do not become victims of the tobacco companies’ latest efforts to hook new generations of Americans on deadly products.”
Together, Brown and Merkley authored an amendment that was included in groundbreaking legislation last year that gave the FDA new power to regulate tobacco products. It put dissolvable tobacco on the inaugural agenda of the Tobacco Products Scientific Advisory Committee, which met for the first time last month. The committee must issue a report on the public health impact of the products within two years, according to the new law.
On Monday, Sen. Frank R. Lautenberg of New Jersey called on FDA Commissioner Margaret Hamburg to consider banning sales of dissolvable tobacco products until the health effects on children and teens are better understood.
In the meantime, the good news for anti-tobacco groups is that interest in the new smokeless products, which retail for between $4 and $5 a pack, hasn’t set sales on fire. Howard says the company is optimistic about early response, but there are no immediate plans to roll out the product nationwide.
“For a tobacco product, it’s been quite slow,” said Tim Cote, vice president of marketing for Plaid Pantry, based in Beaverton, Ore., a grocery chain that first sold Orbs.
“While we carry them, they’re an item that would be borderline dropped,” Cote said. “How good has the trial been? Not very good.”
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