1. Smoking Cessation Aides and Cigarette Substitutes : New Products, New Dangers Angela Shepard, MD

2. Cigarettes Everyone understands that cigarettes are unhealthy Everyone understands that cigarettes are unhealthy As parents, we keep those products away from our children As parents, we keep those products away from our children At our schools no smoking policies clearly prohibit them At our schools no smoking policies clearly prohibit them They are easily recognized, so we can confiscate them They are easily recognized, so we can confiscate them

3. Nicotine Dangers In 2007, 6,724 tobacco-related poisonings were reported among children five and under. In 2007, 6,724 tobacco-related poisonings were reported among children five and under. Small children can experience nausea and vomiting from as little as 1 mg of nicotine. Small children can experience nausea and vomiting from as little as 1 mg of nicotine. New candy flavored products (many of which look like gum or candy) present increased poisoning risk to small children. New candy flavored products (many of which look like gum or candy) present increased poisoning risk to small children. Young adults may not view these products as harmful. Young adults may not view these products as harmful. An article in April’s Pediatrics journal “Unintentional Childhood Poisonings Through Ingestion of Conventional and Novel Tobacco Products” highlights this danger. An article in April’s Pediatrics journal “Unintentional Childhood Poisonings Through Ingestion of Conventional and Novel Tobacco Products” highlights this danger.

4. Questions Do you know what these nicotine containing products look like? Do you know what these nicotine containing products look like? Does your school policy address smoking cessation products or other nicotine containing products? Does your school policy address smoking cessation products or other nicotine containing products?

5. Commit Lozenge Can be a useful anti-smoking aid but does contain 2 - 4 mg nicotine (depending on strength purchased) Can be a useful anti-smoking aid but does contain 2 - 4 mg nicotine (depending on strength purchased) Comes in cherry, mint, original and now cappuccino flavor Comes in cherry, mint, original and now cappuccino flavor

6. Nicorette Every kid loves gum, but this one contains 2 - 4 mg nicotine (depending on the strength purchased) Every kid loves gum, but this one contains 2 - 4 mg nicotine (depending on the strength purchased) Comes in “six great tasting flavors” Comes in “six great tasting flavors” White Ice Mint White Ice Mint Cinnamon Surge Cinnamon Surge Fruit Chill Fruit Chill FreshMint FreshMint Mint Mint Original Original

7. Camel Orbs – “Dissolvable Tobacco” This product is designed to deliver tobacco by dissolving in your mouth and then being absorbed This product is designed to deliver tobacco by dissolving in your mouth and then being absorbed Contains 1 mg of nicotine per pellet Contains 1 mg of nicotine per pellet The company has also launched The company has also launched Camel Strips (containing 0.6 mg of nicotine per strip) Camel Strips (containing 0.6 mg of nicotine per strip) Camel Sticks (containin Camel Sticks (containin 3.1 mg of nicotine per stick) Available in flavors Available in flavors “mellow” (cinnamon) “mellow” (cinnamon) “fresh” (mint) “fresh” (mint)

8. Comparative Size of Orbs

9. Ariva Dissolvable tablet of compressed tobacco powder with sweeteners and other flavorings Dissolvable tablet of compressed tobacco powder with sweeteners and other flavorings Resembles a brand of popular breath mints Resembles a brand of popular breath mints Contains 1.5 mg nicotine Contains 1.5 mg nicotine Available in wintergreen, java and original Available in wintergreen, java and original

10. Everyone’s favorite role model, Lindsay Lohan, with Ariva.

11. Stonewall Stonewall is marketed as Stonewall is marketed as the “heavy duty” version of Ariva (Seeks to attract those who like chew instead of those who admire Paris Hilton) It contains 4 mg of nicotine It contains 4 mg of nicotine

12. Chew and Snuff Old fashioned chew and snuff have been rejuvenated with slick marketing and fun flavors.

13. Hookahs Hookah smoking has been used by a surprising number of kids and young adults Hookah smoking has been used by a surprising number of kids and young adults The tobacco comes in a The tobacco comes in a variety of flavors like … The links below explains why The links below explains why hookah smoking may actually pose greater health risks than cigarettes. http://www.health.harvard.edu/press_releases/dangers-of-hookah-smoking http://www.webmd.com/smoking-cessation/news/20100510/hookahs-safer- than-cigarettes-thats-a-pipe-dream?src=RSS_PUBLIChttp://www.webmd.com/smoking-cessation/news/20100510/hookahs-safer- than-cigarettes-thats-a-pipe-dream?src=RSS_PUBLIC

14. Take home lesson… Be aware of new products that may be marketed to your students or your children. Be aware of new products that may be marketed to your students or your children. Make sure that your school policies adequately address these new products. Make sure that your school policies adequately address these new products. Keep any tobacco or smoking cessation products away from children of any age. Keep any tobacco or smoking cessation products away from children of any age.