Perception is often at least as important as reality in forming policy-makers’ and the public’s opinion where novel nicotine products are concerned – and, to a lesser extent, in the public-health debate, too.
But there’s a persistent problem with terminology. Words are used without definition; deliberate partisan distortion, or accidental miscomprehension can easily result. Even scientific researchers can’t always agree on precisely what a term like “smoking” actually means.
So, in the hopes that 2024, starting with the World Health Organization’s COP10, will be bathed in the light of clarity, here are some areas where we really need to be careful not just what we say, but how we say it.
We all know what an e-cigarette is…or do we? Sometimes the term covers everything that heats a liquid to produce an inhalable, nicotine-containing vapour; but some people use “vape” to refer to simpler models like disposables, and reserve “e-cigarette” for more sophisticated models.
It’s also not completely unheard-of, especially in the media, for heated tobacco products to also be referred to as e-cigarettes. And similar confusion can be found between the terms “snus” and “pouch”.
That vaping (or heated tobacco use) is not “smoking” should be self-evident, but still that word gets used. More subtly, what do we mean when we say a person “vapes” or “smokes”? Do we mean they do it once a month at a party, or every quarter of an hour? Researchers – whether scientists or investigators of the industry like my colleagues at Tamarind Intelligence – are generally careful to put some precision behind such terminology, but politicians, pressure groups and the like often aren’t.
This is particularly important when it comes to youth. What are we most worried about: the one-off user, the rare but regular user, or the frequent user? (“All of the above” is not a helpful answer.) If we don’t really define what we’re trying to stop, it’s hard to target interventions effectively.
For that matter, expressions like “youth” and “young people” can be vague, too. Are we talking about schoolkids? Or people under the legal age to buy tobacco products? (As in the US, they’re not always exactly the same groups.) Are we worried about 23-year-olds? Are we more worried about 11-year-olds than 17-year-olds? The terms can be so broad that what is understood might not be what is meant.
On a more technical level, there are pitfalls in talking about nicotine as well – specifically, nicotine content. Do we mean the amount of nicotine that a product contains? Or the amount that it emits? Or the quantity absorbed by the body? (An egregious example: “…contains as much nicotine as X packets of cigarettes”.)
Flavours, too, are constantly discussed but very rarely defined outside of the most specialist circles. Leaving aside the oddity that talk of “flavours” always excludes tobacco and often also menthol (though both undeniably are flavours in the normal sense of the word), there’s an ontological dimension to this one.
Is a flavour inherent in a certain combination of ingredients added to a product? Or is it defined by the sensation that a user receives? Or is it even defined by the description of the product (its name, for instance), rather than what it actually is?
This may sound abstruse, but it’s not just counting the number of angels that can dance on the head of a unicorn milkshake. If we want to control flavours, we need to know what we are aiming to control, and very often that might in reality be the presentation – the marketing – of a given flavour, rather than its physical basis or its effect on the user’s taste buds.
Speaking of prohibitions…
Talk of bans should nearly always be qualified with modifiers, too.
Complete, across-the-board bans on every aspect of novel nicotine products (sale, possession, use) are pretty rare, yet any significant restriction is often characterised casually as a “ban”, especially in news reporting but sometimes in advocacy as well.
This is why you’ll read one source saying “X countries have banned e-cigarettes!” while another says “Z countries have banned e-cigarettes!”, and they’re both right in a way, but also both wrong.
And finally…risk, of course
Is there a risk? Sure, there’s a risk. In almost anything. Which is why talking about “risks” in the use of novel nicotine products, without at least a single preceding adjective, is unhelpful. (So, of course, is talking about “risk-free”, though at least that doesn’t happen nearly as often.)
It’s patently clear that in any aspect of life a continuum of risk exists – we recognise that playing badminton is less risky than free climbing, which is why we don’t describe the totality of sports as “risky” or “non-risky”. Refusing to recognise it where novel nicotine products are concerned is blinkered or wilful; by all means argue that everything is at the dangerous end, if you want, but at least acknowledge the hypothetical possibility of a safer one.
It helps, too, to define in general terms what the risk involves. Is it a risk of disease now? Of sickness in the future? Of addiction? Of progress to other products?
Realistically, I don’t expect all of us to adopt crystalline precision overnight. Even less do I expect us to agree. But if we at least all understood the same thing from a phrase like “banning flavours to reduce risk to youth”, that would be a start.
– Barnaby Page ECigIntelligence staff
Photo: Emily Morter