A new Nationwide Children’s Hospital study finds a huge increase in nicotine pouch ingestion among children under the age of 6.
The study examined data from the National Poison Data System from 2010 to 2023.
WOSU’s Debbie Holmes spoke with Natalie Rine, a pharmacist and director of the Central Ohio Poison Center at Nationwide Children’s Hospital. Rine co-authored the study.
Debbie Holmes: The study found that nicotine pouch ingestion increased by 763% between 2020 and 2023. That's an astounding figure. Why did the huge jump occur? Do we know?
Natalie Rine: It is a pretty huge jump, like you mentioned. I think like most things, products come in and out of popularity and nicotine pouches, I think, were captured as something that was a very popular product at that time. They've been on the market since around 2014, but really rose in popularity in the U.S. starting in 2019. So, you can see that very large increase in exposures to these products.
Debbie Holmes: How many kids then would that be?
Natalie Rine: For our study, we looked at the rate of ingestions per 100,000 people in the U.S. So, for these products in 2020, that rate was 0.48 ingestion for every 100,000 people. And then in 2023, that rate rose to 4.14 ingestions for every 100,000 people in the United States, so that's a pretty big increase.
Debbie Holmes: And we're talking about children specifically...what were those physical results then for the children affected?
Natalie Rine: One of the good things about this study is that most nicotine ingestions were associated with little or no side effects or bad outcomes, but there was a small subset of patients that had a pretty serious medical outcome and there were two fatalities in the study.
Debbie Holmes: What exactly is in the nicotine pouch?
Natalie Rine: These are tiny pouches. They're sold in a can and come in about a can of 20. So, it's a small white pouch and it contains nicotine powder with some flavor to it.
Debbie Holmes: How do the children get the nicotine pouches?
Natalie Rine: Hard to say exactly how kids got into these things. It's not surprising that kids like to explore their environment, see what's out there, so if there are items that are within their easy reach or something that looks attractive or interesting to them, it's not uncommon for them to explore what those things are. Sometimes it's products like these nicotine products. It could be some other chemical medication. But kids just like to explore their environments. And if it's there with easy access, then they sometimes will look into those things.
Debbie Holmes: Well more boys, 55%, than girls ingested the nicotine. Why do you think that was the case?
Natalie Rine: It's really hard to say. I don't know that we were expecting to see that one way or another. Just one of the things that the study found is that this just happened that boys looked at these products more than the girls did.
Debbie Holmes: Children ingesting nicotine in liquid form increased by 450% from 2010 to 2015 and then decreased by 45% from 2015 to 2023. Was the drop from parents and guardians perhaps being more aware and proactive in hiding their nicotine from children? Or what do you think led to the drop?
Natalie Rine: I certainly think that could be part of it. You know, I think as more data has come out to show that the liquid nicotine product specifically could, you know, potentially cause harm to children. One of the things that happened in 2015, there was some legislation that required child-resistant packaging of liquid nicotine. While I can't say that's exactly what caused a pretty significant drop in those exposures, I do think the timeline aligns nicely and is at least partially probably helpful for why those exposures came down.
Debbie Holmes: What are your recommendations then on how to protect children?
Natalie Rine: I think one of the first things we want to do is education (and explain to children) that these products can cause harm. So, listening to stories like this and getting news out about research is certainly helpful. But for parents, if they're going to have nicotine products in the home, because of course the best way is to just not have them in the home at all, but for the parents that want to use these products, really the biggest thing is just storing them safely. Making sure they're kept up high and away in a locked cabinet, ideally in a lock box or a drawer.
