Rob Calder talks to Dr Katie East on Addiction Audio, the podcast from Addiction journal, about people who use heated tobacco products and the language they choose to describe those products. Katie explains why there is ambiguity around the nomenclature and how this may have implications for healthcare interventions.
Katie’s research was published in Addiction in September 2022 and explored the terminology used by 30 people in London to describe heated tobacco products. She joined Rob for an episode of Addiction Audio, and they began by defining ‘heated tobacco products’ – what they are and what they’re not, what they do and what they don’t do.
Katie: “IQOS is a heated tobacco product, which means that it’s an electronic device which heats a stick of tobacco to produce an aerosol, which users can inhale. It is a purported by the tobacco industry to be less harmful than smoking because there is no combustion, so there’s no burning. It is heated at a lower temperature, and as we know most of the harms of smoking are caused by combustion. IQOS specifically is produced by Philip Morris International, which is the tobacco company. There are other brands…IQOS is the most popular one in the UK.”
Rob: “[So, ] unlike vaping, it has tobacco in it? And unlike smoking, it doesn’t burn that tobacco?”
Katie: “Correct.”
All of the participants in Katie’s research were current or former smokers, and many had used ‘IQOS’ (the most popular brand of heated tobacco products in the UK) to transition away from smoking. Katie explained that listening to how people identify and describe their current behaviours is important because it can be indicative of future behaviours. For example, if people identify as ‘smokers’, they may be more likely to continue smoking, whereas if people identify as ‘ex-smokers’, they may be less likely to relapse.
Original article: ‘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. By Katherine East and colleagues. Published in Addiction (2022).
Generally, Katie found little agreement in what to call heated tobacco products and how to identify as someone who used them. IQOS user? Ex-smoker? Heater? None of these terms seemed ideal.
“IQOS-ing. IQOS-er. It doesn’t trip off the tongue very easily.”
Overall, Katie found that the language used by participants situated them closer to smoking than vaping. For example, many said that they ‘smoked’, and felt this was accurate enough because heated tobacco products contained tobacco, as do cigarettes. In some circumstances, participants also saw this as easier than explaining what heated tobacco products were. Also, interestingly, participants tended to refer to the sticks that go into IQOS devices to release the tobacco as ‘cigarettes’, rather than their official term ‘Heets’. On the other hand, participants tended to have a negative view of vaping and did not align themselves (or heated tobacco products) with vaping. The exception to this was in situations where vaping was seen as more socially acceptable than smoking.
“Participants in this study commonly referred to IQOS use as ‘smoking’ for lack of a more suitable term, but also resisted being labelled as ‘smokers’ – a choice that may influence smoking cessation.”
Finally, Katie talked about the implications that her research might have for healthcare settings, such as GP surgeries. She said that if healthcare professionals do not know or think about how people who use heated tobacco products identify, they may fail to accurately measure heated tobacco use within their local populations and consequently fail to engage people who use heated tobacco products in relevant interventions.
“One important thing that came up in the paper was about how healthcare professionals and clinicians refer to people who use IQOS. Because if you go to a GP surgery, often you get asked, ‘Are you a smoker?’ For people who use IQOS they didn’t know whether they identified as a smoker if they used a heated tobacco product because there’s no combustion, so there’s no smoke. But would they be considered a smoker?”
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