‘It’s not what you’d term normal smoking’: A qualitative exploration of language used to describe Heated Tobacco Product (HTP) use and associated user identity: A qualitative exploration of language used to describe Heated Tobacco Product (HTP) use and associated user identity

Background and Aims. Tobacco and nicotine marketplaces have diversified over the past decade, including with the introduction of Heated Tobacco Products (HTPs), such as the brand IQOS. HTPs typically heat tobacco to generate an aerosol that is inhaled. HTP nomenclature is lacking, and how HTP users define and identify themselves remains understudied. Research in this area is important because language can construct identity, and identity can shape behaviour. This study aimed to explore users’ language choice when describing IQOS use, and how language relates to user identity.
Methods. Qualitative interviews in London, UK, with 30 adult current and former IQOS users. Analyses were guided by Iterative Categorization.
Results. Overall, participants expressed confusion and a lack of suitable terminology for how to describe IQOS use. Verbs such as ‘heating’ and ‘IQOSing’ were rarely endorsed. Most often, participants reverted to ‘smoking’ when describing IQOS use and commonly referred to HEETS (tobacco sticks) as ‘cigarettes.’ Yet, the lack of combustion, electronic device, ‘cleaner’ experience, and perceived reductions in health risks led some to frame IQOS as distinct from smoking. ‘Vaping’ was generally considered inappropriate for describing IQOS use. Participants also manipulated language to suit their circumstances and manage their identity: while some IQOS users embraced the terms ‘smoking’ and ‘smoker,’ most were eager to distinguish between using IQOS and being labelled ‘a smoker’ due to the associated negative connotations and to align with perceptions of IQOS use as a ‘better’, less harmful behaviour. Instead, when describing their identity, IQOS users more willingly identified as ‘vapers,’ or ‘ex-smokers,’ or created new identities (e.g., ‘HEET user’).
Conclusions. People who use or have used IQOS (a HTP brand) are ambiguous about IQOS terminology. 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 which may influence smoking cessation. Clear terminology must be used in surveys and by healthcare professionals when asking about cigarette smoking and e-cigarette and HTP use.