Poison Control Centers' Data Puts E-Cigarette Exposure Risk in Perspective

The journal Pediatrics recently reported that “there were more than 8,200 calls to US poison centers regarding exposures to liquid nicotine and e-cigarettes among children younger than 6 years of age from January 2012 through April 2017, averaging 129 calls each month or more than 4 a day.” (here) As I previously noted (here), annual exposures (which were 1,548 according to the Pediatrics article) should be considered in appropriate perspective. 

While the journal article acknowledged that e-cigarette exposures “decreased by about 20% from 2015 to 2016,” its senior author called for additional regulation.  If children’s exposure to products should guide regulatory priorities, the following chart from the American Association of Poison Control Centers (2016 report available here) may be instructive.

Non-Pharmaceutical Exposures Reported To Poison Control Centers in the U.S., 2016
Product Category	Number Among Children Under 6 Years	Number Among All Ages	Deaths Per 100,000 Exposures*
Cosmetics, personal care products	136,004	180,065	3
Household cleaners	111,445	179,828	13
Foreign bodies	65,864	90,667	1
Pesticides	33,458	77,573	22
Plants	27,565	45,150	24
Arts, crafts, office supplies	20,096	27,319	0
Deodorizers	17,398	21,266	14
Essential oils (clove, etc.)	13,264	18,997	0
Tobacco	11,358	13,319	0
Cigarettes	6,331	6,699	--
E-Cigarettes	2,075	2,827	--
Chewing tobacco	1,220	1,357	--
Other	1,732	2,436	--
Foods, additives, spoilage	10,839	33,909	9
Alcohols	9,562	22,289	117
Chemicals	9,328	33,910	80
Gasoline, other hydrocarbons	8,821	27,807	76
Bites, venom	6,708	46,989	15
Paint, strippers	6,601	12,238	0
Batteries	5,483	9,651	41
Adhesives, glue	4,692	9,622	0
Fumes, vapors	3,673	31,337	214
Fertilizers	2,759	4,590	80
Other	35,859	94,024	44
All	540,777	980,550	26

* All Ages

Of the half million exposures among children under 6 years of age recorded by poison control centers in 2016, 45.8% involved cosmetics, personal care products or household cleaners, while e-cigarettes accounted for just 0.4%. 

Looking at product-related deaths per 100,000 exposures, rates were highest for fumes and vapors (which included carbon monoxide) and for alcohols, but there were no deaths recorded for tobacco exposures, including e-cigarettes.

Public health generally and children’s health in particular may benefit from regulatory reform that is keyed to demonstrated risk exposure.

Reality Bites the Dust in New Smokeless Tobacco Study

It’s surprising what passes for “science” in some journals today.  Chemical Research in Toxicology has published a study from the University of California’s Berkeley and San Francisco campuses making this extraordinary claim: “Children living with smokeless tobacco [ST] users may be exposed to carcinogenic tobacco-specific nitrosamines [TSNAs] via contact with contaminated dust and household surfaces.”

The research was an offshoot from a larger effort looking for an environmental cause of childhood leukemia.  Families who participated in the study were divided into three groups: non-users of tobacco, smokers and ST users.  The contents of dust bags from their household vacuum cleaners were analyzed for NNN and NNK, two TSNAs that are considered to be causes of cancer.

Almost every household – even those with no tobacco users – had NNN and NNK in their dust, but researchers found “higher” levels of these agents in every gram of dust from an ST home – about 5 to 10 nanograms.  Keep in mind that a nanogram is one billionth of a gram, and a gram is less than four one-hundredths of an ounce. 

Each gram of moist snuff contains about 5-10 micrograms of NNN/NNK, about 1,000 times higher than the dust in this study (see my previous blog entry).  At one can a day (32 grams), the typical ST user is exposed to 32,000 times more NNN and NNK than the hypothetical child who eats a gram of dust every day.  It is well established that long-term use of ST even at that level is not associated with a significant increase in risk for ANY cancer.      

The California exposure data may be accurate, but the findings are of no practical consequence, other than to serve as fodder for hyperbolic anti-tobacco claims.

Poisoning Public Health Issues: Chapter 2

Three years ago I discussed an unfounded claim by Harvard University’s Dr. Gregory Connolly that smokeless tobacco products are a major cause of poisoning among American children (here).  A recent press release from the Kentucky Regional Poison Control Center (here) has a similar ring, with the headline, “E-cigarettes cause alarming increase in calls to poison control center.”  The center based its claim on the fact that it received 39 calls in 2013, compared to nine in 2012. 

In context, the figures pack none of the headline’s punch.

At my request, the Center provided some additional information:

“24 of the 39 cases are exposures to children (less than 6 years)… Most exposures were small and did not lead to symptoms.  Those individuals that did develop symptoms were monitored at home by the [Kentucky Regional Poison Control Center] through follow-up calls.  Only two patients were recommended to go to the emergency department: 1 dermal exposure and 1 ingestion.  Both patients saw symptom resolution in less than 8 hours.”

To place the Kentucky e-cigarette poison alert in focus, I reviewed the American Association of Poison Control Centers’ latest (2012) report (read it here). 

It turns out that tobacco products accounted for only about 1.3% of the over 581,000 cases of exposure to non-pharmaceutical agents of all kinds in children less than 6 years of age in 2012. That’s 7,480 cases. Here’s a table of some of the more common exposures:

Non-pharmaceutical Exposure Cases Among Children Under 6 Years Old, 2012
Product Category	Number of Exposures
Cosmetics and personal care products	156,623
Household cleaners	106,582
Foreign bodies	77,905
Pesticides	36,056
Plants	30,690
Arts, crafts, office supplies	21,146
Deodorizers	19,153
Alcohols	11,443
Gasoline, other hydrocarbons	10,572
Food additives, spoilage	10,547
Bites, venom	8,777
Tobacco products	7,480
Essential Oils (clove, etc)	7,446
Paint, paint strippers	7,192
Adhesives, glue	5,863
Batteries	5,116
Chemicals	3,923
Fertilizers	3,054
Everything else	51,351
Total	580,919

 

Of the tobacco product exposures, cigarettes were the most common, at 53%, while smokeless products accounted for 16%.  Only 172 incidents (2%) involved e-cigarettes.

Many consumer products pose potential danger, especially to young children.  However, when put into perspective with exposures to cosmetics, household cleaners, paint and paint strippers and fertilizers, the selective reporting of poison control information about e-cigarettes is meaningless.