In this issue of Pediatrics, a prospective longitudinal study by Han et al reveals that the recent surge in disposable “e-cigarettes” has led to more frequent and persistent nicotine exposure among adolescents and young adults.1  An overlooked factor that drives the popularity of these nicotine products among youth is the pervasive use of tobacco-industry-popularized terminology. In response to a steady decline in cigarette sales, transnational tobacco corporations are diversifying their nicotine product lines. Their professed goal, emphasized via intensive advertising and public relations campaigns, is to offer their customers who smoke “reduced risk” alternatives. However, many of these products have become popular among nonsmoking adolescents and young adults and are potential gateways to nicotine dependence.

Seeking to achieve a more permissive milieu regarding perceived tobacco- and nicotine-related risks, the industry has worked to popularize benign-sounding nomenclature for newly popular tobacco products with the goal of encouraging consumers, potential consumers, and regulators to perceive them as safe. Many such terms have become normalized, with the industry-promoted descriptors widely adopted by consumers, the media, and even authors of scientific publications. Our purpose is to identify deceptive jargon and propose potential terminologies for use by scholars, editors, regulators, educators, and the media to better convey the risks of nicotine addiction and its consequences for health (Table 1).

Among adolescents, the term “vaping” implies that the device merely produces harmless water vapor or steam when it is actually a mixture of nicotine and flavoring chemicals in a vehicle of propylene glycol and glycerin.2,3  The term is used as a noun (“vapor”), verb (vaping), and adjective (“vape stick,” “vape juice,” “vape store”). To many, the term vaping sounds like innocent fun, whereas the more accurate “nicotine inhaling” better conveys the potential dangers. These products could be called e-cigarettes or “e-cigs,” which some view as preferable because it associates these addictive products with cigarettes, which are widely perceived as harmful.4  However, today, most of these devices have form factors (shape, size, use of electronics) that are notably different from cigarettes. Because many young users are unaware that these products contain nicotine, some have advocated using the term “electronic nicotine delivery systems.” However, this phrase is commonly abbreviated as “ENDS,” an abbreviation that inappropriately implies tobacco cessation efficacy. A more apt descriptor, such as “nicotine device,” emphasizes the essential point that these are addictive products. In describing e-cigarette emanations, rather than vapor, some authors use the more technically accurate term “aerosol,” a suspension of particles or droplets in the air; however, this is not in common use among users.5  Whether the inhaled plume is called aerosol, vapor, or “mist” is less important than including the word nicotine (eg, “nicotine aerosol”).

Many nicotine devices aerosolize liquids. Rather than use the industry-favored innocent-sounding terms “e-juice” and “e-liquid,” the use of the term “nicotine liquid” is preferable because it emphasizes the addictive potential of these products.

“Heat-Not Burn” is a marketing slogan that was introduced by Philip Morris International in promoting its IQOS product.6  In these products, shredded tobacco leaves are heated so that they smolder rather than combust; therefore, they are more accurately referred to as “heated tobacco.” With the phrase “not burn,” coupled with advertising terms such as “clean” and “steam,” marketers seek to differentiate heated tobacco products from smoking. Because IQOS advertisements often convey tobacco cessation claims and carry the letter “Q” stylized into the shape of a tobacco leaf, observers have suggested that the brand name represents an abbreviation of “I Quit Ordinary Smoking,” which the company denies. IQOS employs a tobacco-containing shortened cigarette consumable, which Philip Morris International calls HEETS or HeatSticks. These would be more accurately referred to as tobacco sticks.7  Heated tobacco products are often marketed as “smoke free” although their aerosols contain chemicals indicative of pyrolysis and thermogenic degradation. The use of the descriptor “free” in marketing a tobacco product reassures users by implying that they are free of harmful substances, which is analogous to the use of “fat free” for foods.

The tobacco industry refers to this class of oral nicotine products (eg, pouches, gums, lozenges or tablets, toothpicks) as “modern oral nicotine” to distinguish them from conventional oral tobacco products (eg, dip, snuff, snus, chewing), which contain parts of the tobacco plant (eg, leaves and stems). The term “modern,” when applied to an emerging product category, offers a positive connotation of increased safety, potentially increasing their appeal to adolescents and young adults. Also, modern, when applied to an emerging product category, will obviously diminish in appropriateness over time.

The sales leader in this category is nicotine pouches, which are placed under the lip in the manner of snus. These contain an inert carrier substance doped with nicotine, whereas snus contain tobacco leaves. The industry often refers to these products as “white pouches,” a moniker evocative of cleanliness and purity. A better nomenclature for these would be “nicotine pouches,” and other newly popular oral products would be better known as “nicotine lozenges,” “nicotine gums,” etc.

By using nontobacco-sourced nicotine, purveyors of some e-cigarettes and nicotine pouches claim that their products are “tobacco-free.” Of course, they are not addiction-free. Some jurisdictions define all forms of nicotine, regardless of their source, as tobacco products. Products with nontobacco-sourced nicotine need to specify its origin (eg, synthetic, genetically modified plant species) and carry nicotine addiction warning labels. They should not imply that nontobacco-sourced nicotine is healthier or less addictive.

The marketing term “tobacco leaf-free” has also been used by nicotine pouch brands. Because these pouches contain tobacco-derived nicotine, they are clearly tobacco products and should be labeled accordingly. The use of the term free is inappropriate for nicotine products because it connotes freedom from harm.

Newer-generation nicotine products are often described in their marketing as advanced and even pioneering. Because today’s digitally savvy adolescents and young adults are drawn to new technologies, such marketing descriptors have a special appeal to underage users and should not be used. The high-nicotine product JUUL described itself as a disruptive, revolutionary, high-tech product (the iPhone of e-cigarettes), which is one important factor in stimulating a surge in youth use.

Menthol cigarettes have been removed from the market in 2 US states (Massachusetts, California), the European Union, the United Kingdom, and Canada. The industry has introduced new “non-menthol” cigarettes (eg, Newport, Camel, Kool) infused with cooling agents. Using the marketing term nonmenthol conveys to the consumer that they are appealingly flavored menthol substitutes. The industry’s obvious goal is to subvert menthol bans in a transparent effort to retain their former menthol-brand smokers. Logically, the term nonmenthol could apply to any tobacco product not containing the chemical, making it meaningless except as a deceptive marketing ploy.

Through their promotional efforts, tobacco manufacturers and retailers have achieved the widespread adoption of benign and reassuring terminology for newly popularized nicotine products. Because of their entrenchment, replacing these terms with nomenclature that more accurately conveys health risks, especially dependence, will be a challenge. To counter tobacco industry marketing, it would be helpful if scholars, regulators, and legislators consistently avoided language that implies reduced risk or reduced harm unless such reductions have been established scientifically and published in the peer-reviewed scientific literature. The authors and editors of scholarly publications understandably seek guidance concerning the most appropriate nomenclature to use for novel nicotine delivery systems. Journal editorial boards should consider adopting terminology guidelines.

Because the authors of popular media reports consistently use terms such as vaping, vape sticks, and vape stores, when asked to comment, tobacco experts should point out that these products are not “just vapor” and ask that reporters emphasize nicotine in their reporting.

Educating adolescents and young adults about the dangers of nicotine addiction is of foremost importance. Industry-proffered language permeates conversations about vaping among adolescents and young adults. Although educators need to use popular terms to be understood, they should try to change the narrative by emphasizing terminology that includes the word nicotine (eg, nicotine device, nicotine liquid, nicotine aerosol, nicotine pouch, “nicotine e-cigarette”). As a practical matter, to collect valid data, youth nicotine product use surveys need to employ popular vernacular while also including more accurate terms to increase their reach.

The use of precise tobacco product language is especially important in tobacco product regulation and legislation.8  In addition, regulators should consider restraining the tobacco industry from using implicit or explicit reduced-risk language unless the product has been permitted to do so after a thorough examination of the scientific evidence.

The primary purpose of this article has been to identify tobacco-industry-promoted language that should be avoided as a public health imperative. We propose some alternative terms to use, notably the routine inclusion of the word nicotine, because the delivery of this addictive chemical is the central purpose of these products. However, what is needed is for responsible organizations, such as the American Academy of Pediatrics, the American Medical Association, and the American Lung Association, to convene a body of experts to formulate an alternative nomenclature framework for emerging tobacco products and promulgate its adoption for widespread use.

Drs Jackler and Halpern-Felsher contributed to writing this article, and both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2023-063430.

FUNDING: No external funding.

CONFLICT OF INTEREST DISCLOSURES: Both Drs Jackler and Halpern-Felsher have served as paid experts in litigation against e-cigarette companies and as unpaid scientific advisors and expert witnesses regarding some tobacco-related policies. 

1
Han
D-H
,
Harlow
AF
,
Feldstein Ewing
SW
, et al
.
Disposable e-cigarette use and subsequent use patterns in adolescents and young adults
.
Pediatrics
.
2024
;
153
(
4
):
e2023063430
2
Gorukanti
A
,
Delucchi
K
,
Ling
P
, et al
.
Adolescents’ attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation
.
Prev Med
.
2017
;
94
:
65
71
3
Haggart
K
,
Robertson
L
,
Blank
ML
, et al
.
It’s just steam: a qualitative analysis of New Zealand ENDS users’ perceptions of secondhand aerosol
.
Tob Control
.
2021
;
30
(
1
):
30
35
4
Cross
K
,
Wu
J
,
Roberts
ME
,
Ferketich
AK
.
The relationship of the terms vape and e-cigarette with newspaper content
.
Am J Public Health
.
2019
;
109
(
10
):
1462
1464
5
Kalan
EM
,
Lazard
AJ
,
Sheldon
JM
, et al
.
Terms tobacco users employ to describe e-cigarette aerosol
.
Tob Control
.
2023
;
33
(
1
):
15
20
6
Jackler
RK
,
Ramamurthi
D
,
Axelrod
AK
, et al
;
Stanford University
. Global marketing of IQOS: the Philip Morris campaign to popularize “Heat-Not-Burn” tobacco. SRITA Research Paper.
7
East
KA
,
Miller
CR
,
Hitchman
SC
, et al
.
‘It’s not what you’d term normal smoking’: a qualitative exploration of language used to describe heated tobacco product use and associated user identity
.
Addiction
.
2023
;
118
(
3
):
533
538
8
Lempert
LK
,
Grana
R
,
Glantz
SA
.
The importance of product definitions in US e-cigarette laws and regulations
.
Tob Control
.
2016
;
25
(
e1
):
e44
e51