Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Pechacek T[original query] |
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Estimating the Impact of Raising Prices and Eliminating Discounts on Cigarette Smoking Prevalence in the United States.
Marynak KL , Xu X , Wang X , Holmes CB , Tynan MA , Pechacek T . Public Health Rep 2016 131 (4) 536-543 The average retail price per pack of cigarettes is less than $6, which is substantially lower than the $10 per-pack target established in 2014 by the Surgeon General to reduce the smoking rate. We estimated the impact of three cigarette pricing scenarios on smoking prevalence among teens aged 12-17 years, young adults aged 18-25 years, and adults aged ≥26 years, by state: (1) $0.94 federal tax increase on cigarettes, as proposed in the fiscal year 2017 President’s budget; (2) $10 per-pack retail price, allowing discounts; and (3) $10 per-pack retail price, eliminating discounts. We conducted Monte Carlo simulations to generate point estimates of reductions in cigarette smoking prevalence by state. We found that each price scenario would substantially reduce cigarette smoking prevalence. A $10 per-pack retail price eliminating discounts could result in 637,270 fewer smokers aged 12-17 years; 4,186,954 fewer smokers aged 18-25 years; and 7,722,460 fewer smokers aged ≥26 years. Raising cigarette prices and eliminating discounts could substantially reduce cigarette smoking prevalence as well as smoking-related death and disease. © 2016, Association of Schools of Public Health. All rights reserved. |
The African American youth smoking experience: An overview
Garrett BE , Gardiner PS , Wright LT , Pechacek TF . Nicotine Tob Res 2016 18 Suppl 1 S11-5 INTRODUCTION: Beginning in the late 1970s, a very sharp decline in cigarette smoking prevalence was observed among African American (AA) high school seniors compared with a more modest decline among whites. This historic decline resulted in a lower prevalence of cigarette smoking among AA youth that has persisted for several decades. METHODS: We synthesized information contained in the research literature and tobacco industry documents to provide an account of past influences on cigarette smoking behavior among AA youth to help understand the reasons for these historically lower rates of cigarette smoking. RESULTS: While a number of protective factors including cigarette price increases, religiosity, parental opposition, sports participation, body image, and negative attitudes towards cigarette smoking may have all played a role in maintaining lower rates of cigarette smoking among AA youth as compared to white youth, the efforts of the tobacco industry seem to have prevented the effectiveness of these factors from carrying over into adulthood. CONCLUSION: Continuing public health efforts that prevent cigarette smoking initiation and maintain lower cigarette smoking rates among AA youth throughout adulthood have the potential to help reduce the negative health consequences of smoking in this population. IMPLICATIONS: While AA youth continue to have a lower prevalence of cigarette smoking than white youth, they are still at risk of increasing their smoking behavior due to aggressive targeted marketing by the tobacco industry. Because AAs suffer disproportionately from tobacco-related disease, and have higher incidence and mortality rates from lung cancer, efforts to prevent smoking initiation and maintain lower cigarette smoking rates among AA youth have the potential to significantly lower lung cancer death rates among AA adults. |
Smoking-attributable medical expenditures by age, sex, and smoking status estimated using a relative risk approach
Maciosek MV , Xu X , Butani AL , Pechacek TF . Prev Med 2015 77 162-7 OBJECTIVE: To accurately assess the benefits of tobacco control interventions and to better inform decision makers, knowledge of medical expenditures by age, gender, and smoking status is essential. METHOD: We propose an approach to distribute smoking-attributable expenditures by age, gender, and cigarette smoking status to reflect the known risks of smoking. We distribute hospitalization days for smoking-attributable diseases according to relative risks of smoking-attributable mortality, and use the method to determine national estimates of smoking-attributable expenditures by age, sex and cigarette smoking status. Sensitivity analyses explored assumptions of the method. RESULTS: Both current and former smokers ages 75 and over have about 12 times the smoking-attributable expenditures of their current and former smoker counterparts 35 to 54 years of age. Within each age group, the expenditures of formers smokers are about 70% lower than current smokers. In sensitivity analysis these results were not robust to large changes to the relative risks of smoking-attributable mortality which were used in the calculations. CONCLUSION: Sex and age-group specific smoking expenditures reflect observed disease risk differences between current and former cigarette smokers and indicate that about 70% of current smokers' excess medical care costs is preventable by quitting. |
Nicotine and the developing human: a neglected element in the electronic cigarette debate
England LJ , Bunnell RE , Pechacek TF , Tong VT , McAfee TA . Am J Prev Med 2015 49 (2) 286-93 The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale. |
Annual healthcare spending attributable to cigarette smoking: an update
Xu X , Bishop EE , Kennedy SM , Simpson SA , Pechacek TF . Am J Prev Med 2014 48 (3) 326-33 BACKGROUND: Fifty years after the first Surgeon General's report, tobacco use remains the nation's leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking-attributable costs in the U.S. PURPOSE: To update annual smoking-attributable healthcare spending in the U.S. and provide smoking-attributable healthcare spending estimates by payer (e.g., Medicare, Medicaid, private insurance) or type of medical services. METHODS: Analyses used data from the 2006-2010 Medical Expenditure Panel Survey linked to the 2004-2009 National Health Interview Survey. Estimates from two-part models were combined to predict the share of annual healthcare spending that could be attributable to cigarette smoking. The analysis was conducted in 2013. RESULTS: By 2010, 8.7% (95% CI=6.8%, 11.2%) of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year. More than 60% of the attributable spending was paid by public programs, including Medicare, other federally sponsored programs, or Medicaid. CONCLUSIONS: These findings indicate that comprehensive tobacco control programs and policies are still needed to continue progress toward ending the tobacco epidemic in the U.S. 50 years after the release of the first Surgeon General's report on smoking and health. |
Estimation of cigarette smoking-attributable morbidity in the United States
Rostron BL , Chang CM , Pechacek TF . JAMA Intern Med 2014 174 (12) 1922-8 IMPORTANCE: Cigarette smoking has been found to harm nearly every bodily organ and is a leading cause of preventable disease, but current estimates of smoking-attributable morbidity by condition for the United States are generally unavailable. OBJECTIVE: To estimate the burden of major medical conditions attributable to cigarette smoking in the United States. DESIGN, SETTING, AND PARTICIPANTS: The disease burden of smoking was estimated using population-attributable risk calculations, taking into account the uncertainty of estimates. Population estimates came from 2009 US Census Bureau data and smoking prevalence, disease prevalence, and disease relative risk estimates came from National Health Interview Survey data for surveyed adults from 2006 through 2012. National Health and Nutrition Examination Survey spirometry data obtained from medical examination of surveyed adults from 2007 through 2010 was used to adjust for underreporting of chronic obstructive pulmonary disease. Exposures: Smoking status was assessed from self-reported National Health Interview Survey data. MAIN OUTCOMES AND MEASURES: The number of adults 35 years and older who had had a major smoking-attributable disease by sex and condition and the total number of these conditions were estimated for the United States in 2009. RESULTS: Using National Health Interview Survey data, we estimated that 6.9 million (95% CI, 6.5-7.4 million) US adults had had a combined 10.9 million (95% CI, 10.3-11.5 million) self-reported smoking-attributable medical conditions. Using chronic obstructive pulmonary disease prevalence estimates obtained from National Health and Nutrition Examination Survey self-reported and spirometry data, we estimated that US adults had had a combined 14.0 million (95% CI, 12.9-15.1 million) smoking-attributable conditions in 2009. CONCLUSIONS AND RELEVANCE: We estimate that US adults have had approximately 14 million major medical conditions that were attributable to smoking. This figure is generally conservative owing to the existence of other diseases and medical events that were not included in these estimates. Cigarette smoking remains a leading cause of preventable disease in the United States, underscoring the need for continuing and vigorous smoking-prevention efforts. |
Are tobacco control policies effective in reducing young adult smoking?
Farrelly MC , Loomis BR , Kuiper N , Han B , Gfroerer J , Caraballo RS , Pechacek TF , Couzens GL . J Adolesc Health 2014 54 (4) 481-6 PURPOSE: We examined the influence of tobacco control program funding, smoke-free air laws, and cigarette prices on young adult smoking outcomes. METHODS: We use a natural experimental design approach that uses the variation in tobacco control policies across states and over time to understand their influence on tobacco outcomes. We combine individual outcome data with annual state-level policy data to conduct multivariable logistic regression models, controlling for an extensive set of sociodemographic factors. The participants are 18- to 25-year-olds from the 2002-2009 National Surveys on Drug Use and Health. The three main outcomes are past-year smoking initiation, and current and established smoking. A current smoker was one who had smoked on at least 1 day in the past 30 days. An established smoker was one who had smoked 1 or more cigarettes in the past 30 days and smoked at least 100 cigarettes in his or her lifetime. RESULTS: Higher levels of tobacco control program funding and greater smoke-free-air law coverage were both associated with declines in current and established smoking (p < .01). Greater coverage of smoke-free air laws was associated with lower past year initiation with marginal significance (p = .058). Higher cigarette prices were not associated with smoking outcomes. Had smoke-free-air law coverage and cumulative tobacco control funding remained at 2002 levels, current and established smoking would have been 5%-7% higher in 2009. CONCLUSIONS: Smoke-free air laws and state tobacco control programs are effective strategies for curbing young adult smoking. |
CDC Grand Rounds: global tobacco control
Asma S , Song Y , Cohen J , Eriksen M , Pechacek T , Cohen N , Iskander J . MMWR Morb Mortal Wkly Rep 2014 63 (13) 277-80 During the 20th century, use of tobacco products contributed to the deaths of 100 million persons worldwide. In 2011, approximately 6 million additional deaths were linked to tobacco use, the world's leading underlying cause of death, responsible for more deaths each year than human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis, and malaria combined. One third to one half of lifetime users die from tobacco products, and smokers die an average of 14 years earlier than nonsmokers. Manufactured cigarettes account for 96% of all tobacco sales worldwide. From 1880 to 2009, annual global consumption of cigarettes increased from an estimated 10 billion cigarettes to approximately 5.9 trillion cigarettes, with five countries accounting for 58% of the total consumption: China (38%), Russia (7%), the United States (5%), Indonesia (4%), and Japan (4%). Among the estimated 1 billion smokers worldwide, men outnumber women by four to one. In 14 countries, at least 50% of men smoke, whereas in more than half of these same countries, fewer than 10% of women smoke. If current trends persist, an estimated 500 million persons alive today will die from use of tobacco products. By 2030, tobacco use will result in the deaths of approximately 8 million persons worldwide each year. Yet, every death from tobacco products is preventable. |
Per-pack price reductions available from different cigarette purchasing strategies: United States, 2009-2010
Pesko MF , Xu X , Tynan MA , Gerzoff RB , Malarcher AM , Pechacek TF . Prev Med 2014 63 13-9 OBJECTIVE: Following cigarette excise tax increases, smokers may use cigarette price minimization strategies to continue their usual cigarette consumption rather than reducing consumption or quitting. This reduces the public health benefits of the tax increase. This paper estimates the price reductions for a wide-range of strategies, compensating for overlapping strategies. METHOD: We performed regression analysis on the 2009-2010 National Adult Tobacco Survey (N=13,394) to explore price reductions that smokers in the United States obtained from purchasing cigarettes. We examined five cigarette price minimization strategies: 1) purchasing discount brand cigarettes, 2) using price promotions, 3) purchasing cartons, 4) purchasing on Indian reservations, and 5) purchasing online. Price reductions from these strategies were estimated jointly to compensate for overlapping strategies. RESULTS: Each strategy provided price reductions of between 26 to 99 cents per pack. Combined price reductions were possible. Additionally, price promotions were used with regular brands to obtain larger price reductions than when price promotions were used with generic brands. CONCLUSION: Smokers can realize large price reductions from price minimization strategies, and there are many strategies available. Policymakers and public health officials should be aware of the extent that these strategies can reduce cigarette prices. |
Effect of the first federally funded US antismoking national media campaign
McAfee T , Davis KC , Alexander RL Jr , Pechacek TF , Bunnell R . Lancet 2013 382 (9909) 2003-11 BACKGROUND: Every year, smoking kills more than 5 million people globally, including 440,000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign. METHODS: We undertook baseline and follow-up surveys of nationally representative cohorts of adult smokers and non-smokers. The national effect of the Tips campaign was estimated by applying rates of change in the cohort before and after the campaign to US census data. FINDINGS: 3051 smokers and 2220 non-smokers completed baseline and follow-up assessments. 2395 (78%) smokers and 1632 (74%) non-smokers recalled seeing at least one Tips advertisement on television during the 3-month campaign. Quit attempts among smokers rose from 31.1% (95% CI 30.3-31.9) at baseline to 34.8% (34.0-35.7) at follow-up, a 12% relative increase. The prevalence of abstinence at follow-up among smokers who made a quit attempt was 13.4% (95% CI 9.7-17.2). Nationally, an estimated 1.64 million additional smokers made a quit attempt, and 220,000 (95% CI 159,000-282,000) remained abstinent at follow-up. Recommendations by non-smokers to quit grew from 2.6% at baseline to 5.1% at follow-up, and the prevalence of people talking with friends and family about the dangers of smoking rose from 31.9% (95% CI 31.3-32.5) to 35.2% (34.6-35.9), resulting in an estimated 4.7 million additional non-smokers recommending cessation services and more than 6 million talking about the dangers of smoking. INTERPRETATION: The high-exposure Tips media campaign was effective at increasing population-level quit attempts. The growth in smokers who quit and became sustained quitters could have added from a third to almost half a million quality-adjusted life-years to the US population. Expanded implementation of similar campaigns globally could accelerate progress on the WHO Framework Convention on Tobacco Control and reduce smoking prevalence globally. FUNDING: CDC, US Department of Health and Human Services. |
Cigarette price-minimization strategies by U.S. smokers
Xu X , Pesko MF , Tynan MA , Gerzoff RB , Malarcher AM , Pechacek TF . Am J Prev Med 2013 44 (5) 472-6 BACKGROUND: Smokers may react to cigarette excise tax increases by engaging in price-minimization strategies (i.e., finding ways to reduce the cost of cigarette smoking) rather than by quitting or reducing their cigarette use, thereby reducing the public health benefits of such tax increases. PURPOSE: To evaluate the state and national prevalence of five common cigarette price-minimization strategies and the size of price reductions obtained from these strategies. METHODS: Using data from the 2009-2010 National Adult Tobacco Survey, the prevalence of five common price-minimization strategies by type of strategy and by smoker's cigarette consumption level were estimated. The price reductions associated with these price-minimization strategies also were evaluated. Analyses took place in November 2012. RESULTS: Approximately 55.4% of U.S. adult smokers used at least one of five price-minimization strategies in the previous year, with an average reduction of $1.27 per pack (22.0%). Results varied widely by state. CONCLUSIONS: Cigarette price-minimization strategies are practiced widely among current smokers, and resulting price reductions are relatively large. Policies that decrease opportunities to effectively apply cigarette price-minimization strategies would increase the public health gains of cigarette excise tax increases. |
The influence of television advertisements on promoting calls to telephone quitlines
Farrelly M , Mann N , Watson K , Pechacek T . Health Educ Res 2012 28 (1) 15-22 The aim of the study was to assess the relative effectiveness of cessation, secondhand smoke and other tobacco control television advertisements in promoting quitlines in nine states from 2002 through 2005. Quarterly, the number of individuals who used quitlines per 10 000 adult smokers in a media market are measured. Negative binomial regression analysis was used to link caller rates to market-level exposure to tobacco control television advertisements overall and by message theme. The relationship between caller rates and advertising exposure was positive and statistically significant (P < 0.001). Advertisements that focus on promoting cessation (P < 0.001), highlighting the dangers of secondhand smoke (P = 0.037), and all other tobacco countermarketing advertisements (P = 0.027) were significantly associated with quitline caller rates. For every 10% increase in exposure to cessation, secondhand smoke and other tobacco countermarketing advertisements, caller rates increased by 1.1, 0.2 and 0.4%, respectively. Caller rates significantly increased in quarters when cigarette excise tax increased (P < 0.001) and when the percentage of the population covered by comprehensive smoke-free air laws increased (P = 0.022). Although advertisements promoting cessation are the most effective in driving quitline use, other topics, such as messages highlighting the dangers of secondhand smoke, also prompt their quitlines. |
News media outreach and newspaper coverage of tobacco control
Pederson LL , Nelson DE , Babb S , London J , Promoff G , Pechacek T . Health Promot Pract 2012 13 (5) 642-7 INTRODUCTION: Little is known about the impact of media outreach on news media coverage of tobacco control. METHODS: Media outreach data were obtained from the Centers for Disease Control and Prevention's Office on Smoking and Health (CDC/OSH) from 2003 to 2006; one to six types of outreach activities for 50 scientific publications were performed during 35 discrete time periods. The authors analyzed quantitatively and qualitatively 205 newspaper articles generated based on the CDC/OSH scientific publications. RESULTS: Media coverage of specific CDC/OSH-related tobacco themes was highest for disparities (100%) and tobacco statistics (98%). More outreach activities increased the likelihood of moderate pickup of the number of themes in newspaper articles (odds ratio = 2.0, 95% confidence interval = 1.5-2.8), but there appeared to be a ceiling effect. Certain types of outreach were more strongly associated with front page and headline coverage. CONCLUSIONS: The extent and type of outreach were associated with increased newspaper coverage but the relationship is not necessarily straightforward. Additional research is needed to better understand relationships between scientific findings, outreach, and news media coverage of tobacco. |
Cigarette smoking - United States, 1965-2008
Garrett BE , Dube SR , Trosclair A , Caraballo RS , Pechacek TF . MMWR Suppl 2011 60 (1) 109-13 Cigarette smoking remains the leading cause of preventable morbidity and mortality in the United States, resulting in an estimated 443,000 premature deaths and $193 billion in direct health-care expenditures and productivity losses each year (1). The prevalence of cigarette smoking among youth and adult smokers has declined, but that decline has stalled during the past 5 years among adults (2,3). Despite overall declines in cigarette smoking, disparities in smoking and other tobacco use still persist among certain racial/ethnic minority groups, particularly among American Indians/Alaska Natives (AI/ANs) (4). In addition to racial/ethnic disparities in cigarette smoking, other groups have higher prevalence of cigarette smoking, with higher use reported among persons with low socioeconomic status; persons with histories of mental health and substance abuse conditions; the lesbian, gay, bisexual, and transgender community; and persons living in the South and Midwest regions of the United States (5--7). | | Each day in the United States, approximately 3,900 persons aged 12--17 years smoke their first cigarette, and an estimated 1,000 adolescents become daily cigarette smokers (8). The vast majority of persons who begin smoking during adolescence are addicted to nicotine by age 20 (9). Among youth, factors associated with smoking include low socioeconomic status, low academic achievement (e.g., poor grades and absenteeism), high-risk sexual behavior, and use of alcohol and other drugs (9,10). As with adult smoking, racial/ethnic differences in cigarette smoking exist among youth smokers, with AI/ANs having the highest prevalence of cigarette smoking, particularly among females. In comparison, youth smoking among black females has consistently been lower and has declined during past years. These declines have contributed to the overall lower prevalence of cigarette smoking among black youth smokers (2). |
Cigarettes smoked per day among high school students in the U.S., 1991-2009
Jones SE , Kann L , Pechacek TF . Am J Prev Med 2011 41 (3) 297-9 BACKGROUND: Recent declines in current cigarette smoking among youth are encouraging, but less is known about the trends in the number of cigarettes smoked per day among youth. PURPOSE: This study examined trends in the number of cigarettes smoked per day among U.S. high school students during 1991-2009. METHODS: Nationally representative data from the 1991-2009 national Youth Risk Behavior Surveys (YRBS) were analyzed in 2010. The YRBS is a biennial, school-based survey representative of 9th- through 12th-grade students in the U.S. Each survey year, students completed anonymous, self-administered questionnaires that included identically worded questions about cigarette use. The number of cigarettes smoked per day on smoking days was categorized as light smoking (<1-5 cigarettes per day); moderate smoking (6-10 cigarettes per day); and heavy smoking (≥11 cigarettes per day). Sample sizes ranged from 10,904 to 16,410. Overall response rates ranged from 60% to 71%. RESULTS: During 1991-2009, among current cigarette users overall, light smoking increased from 67.2% to 79.4% and heavy smoking decreased from 18.0% to 7.8%. These trends were found among female and male students overall and white students. Among Hispanic students, light smoking remained stable, but heavy smoking significantly increased from 3.1% in 1991 to 6.4% in 2009. The prevalence of light, moderate, and heavy smoking did not change during 1991-2009 among black students. CONCLUSIONS: The finding that during 1991-2009 light smoking increased and heavy smoking decreased among current cigarette users is encouraging; however, even light smoking is detrimental to health and efforts to reduce all cigarette use should continue. |
Health economics of cardiovascular disease: defining the research agenda
Ferdinand KC , Orenstein D , Hong Y , Journigan JG , Trogdon J , Bowman J , Zohrabian A , Kilgore M , White A , Mokdad A , Pechacek TF , Goetzel RZ , Labarthe DR , Puckrein GA , Finkelstein E , Wang G , French ME , Vaccarino V . CVD Prev Control 2011 6 (3) 91-100 BACKGROUND: When allocating limited resources, public and private sector leaders in health policy consider both the health and economic value of new measures for cardiovascular disease (CVD) prevention. The ability to develop and prioritize policy measures is hindered by important gaps in health economics data. METHODS AND RESULTS: The Policy Research Implementation Group (PRIG) of the National Forum for Heart Disease and Stroke Prevention convened a symposium to develop priorities for research on the economics of CVD primary prevention and elimination of CVD disparities. Suggested top opportunities include expanded CVD surveillance, advances in evaluation and economic modeling of primary prevention, and use of behavioral economics to identify new prevention strategies. Enhanced policy, funding, and leadership support are vital to realizing this research agenda. CONCLUSIONS: Targeted research on the health and economic value of CVD prevention, especially to eliminate CVD disparities, would bolster the justification for increased investment in cardiovascular health. 2011 Published by Elsevier Ltd. on behalf of World Heart Federation. |
Why behavioral and environmental interventions are needed to improve health at lower cost
Milstein B , Homer J , Briss P , Burton D , Pechacek T . Health Aff (Millwood) 2011 30 (5) 823-32 We used a dynamic simulation model of the US health system to test three proposed strategies to reduce deaths and improve the cost-effectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. Although coverage and care save lives quickly, they tend to increase costs. The impact of protection grows more gradually, but it is a critical ingredient over time for lowering both the number of deaths and reducing costs. Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent. |
Unintentional child poisonings through ingestion of conventional and novel tobacco products
Connolly GN , Richter P , Aleguas Jr A , Pechacek TF , Stanfill SB , Alpert HR . Pediatrics 2010 125 (5) 896-9 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. CONCLUSION: 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. |
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