The Johns Hopkins Bloomberg School of Public Health has just published a video, featuring Johanna Cohen, the Bloomberg professor of disease prevention and the director of the school’s Institute for Global Tobacco Control, calling for a “common language” in tobacco control.
“With the introduction and marketing of new nicotine products, it’s not only the marketplace that has diversified,” Cohen says in the video. “The number of terms used to describe these products has expanded significantly as well. Often with word choice that serves tobacco industry interests.”
“Accuracy and consistency,” Cohen continues, “are extremely important because language can shape our thinking, including setting boundaries for discourse and policy options.”
The narrator of the video announces that Cohen and her peers found terms used to describe nicotine products today are too broad, and problematically imply novelty or innovation, or suggest reduced harm. More specifically, Cohen contends that “heat not burn” implies that heated tobacco products are safe (they are safer than cigarettes, though not without any harms), while words like “novel” and “emerging” are really “misrepresentative by nature, as a product is only new for so long.”
What’s regrettable is that there is an important conversation to be had about terminology in the tobacco and nicotine field, but the video misses that opportunity.
She also claims that “alternative”—a synonym for “option”—is actually “problematic,” as it establishes “a choice between two mutually exclusive products” and could bring to mind “something you’d look for in a 1990s record store.” An image of albums including the Smashing Pumpkins’ Siamese Dream helpfully pops up as illustration. The irony that nobody is shopping in a 1990s record store because technology has rendered records obsolete—just as vapes, heated tobacco products and nicotine pouches are doing to combustible cigarettes—does not get mentioned.
Ultimately, Cohen wishes “those communicating about tobacco products, including scientists and public health professionals, to be more careful about the terminology they use and take the time to consider the implications of the words they choose.”
She recommends “using ordinary, precise terms without additional adjectives” to help “establish a common language,” like “e-cigarettes” and “heated tobacco products.”
What’s regrettable is that there is an important conversation to be had about terminology in the tobacco and nicotine field, but the video, from an institution funded by anti-vaping billionaire Michael Bloomberg, misses that opportunity.
In response, Clive Bates, the former director of Action on Smoking and Health (UK), noted that “in the illicit drugs and tobacco fields, language can be weaponized for emotive advocacy purposes by any of the stakeholders and industries involved.” But his suggestions around terminology would differ from Cohen’s. For example, like many in the field, he called for people in tobacco control and public health to consider that “tobacco products”—an umbrella term employed by the narrator in the video—is misleadingly used to refer to products that contain nicotine but not tobacco.
More generally, he said that “loose definitions and language,” like the “youth vaping epidemic” continue to mask “subtleties related to the frequency of use and propensity of tobacco use,” and that “inappropriate conflations” are rampant.
The most obvious example of that last point is probably the labeling of “EVALI” (“E-cigarette, or Vaping Product, Use Associated Lung Injury”), the string of lung diseases that were primarily reported in the summer and fall of 2019. Though the Centers for Disease Control and Prevention (CDC), which named EVALI, identified that the cause was a compound found in some illicit THC cartridges, the agency has still not firmly corrected the record—and it has not, despite numerous pleas from tobacco control experts, changed the name. One study has suggested that legislation borne from misstatements about EVALI and e-cigarettes in Massachusetts ended up increasing cigarette consumption in Boston.
Cohen’s broadest assertion, though, is that many of these terms cause public health experts to do “the tobacco industry’s dirty work for them.” Yet she makes no reference to including consumers in the dialogue. Consumer organizations like INNCO and CASAA, which support rights and access for adults who use safer nicotine to avoid toxic forms of tobacco, have been at the forefront of addressing stigmatizing language, such as avoiding the word “smoker” in favor of person-first terms.
“Using the language of the people using the products, which is typically the terminology most well known, should be their focus.”
“When it comes to language and terminology, it seems to me that people in public health get overly preoccupied with what incumbent tobacco companies are doing, when their actual focus should be on consumers and people who actually use these products,” Danielle Jones, the president of the board of CASAA, told Filter.
“Using the language of the people using the products, which is typically the terminology most well known, should be their focus in order to facilitate clear communication and not confuse people,” she continued. “For instance, not knowing the established terminology when writing survey questions for people who vape can lead to erroneous results if the respondents misunderstand what the researchers are asking.”
“Instead of trying to invent new terms to distance themselves from tobacco companies,” she said, the creators of the video “should focus on learning the language that exists from people who use the products. Tobacco and nicotine research needs to be more user-informed, and terminology is just one example of that.”
Both INNCO and The Influence Foundation, which operates Filter, have received grants from the Foundation for a Smoke-Free World.