Words matter: descriptors for nicotine that comes from tobacco and descriptors for synthetic nicotine that is created in a laboratory differentially impact understanding of nicotine source and risk perceptions.

Background: Nicotine products increasingly contain synthetic nicotine made in a lab (NML), not from tobacco. 'Tobacco-free nicotine' is most often used to describe NML commercially, but other descriptors are emerging (eg, 'non-tobacco,' 'zero-tobacco'). We examined whether terms for NML differentially impact public understanding of nicotine source or risk perceptions relative to each other and to terms for describing nicotine from tobacco (NFT) as 'tobacco-derived.'

Methods: From December 2022 to April 2023, 1000 participants aged 13 and older completed an online survey (mean age: 33.02 (SD=18.15) years, 50.5% female, 16.6% Hispanic, 67.4% White and 79.8% with current tobacco use). Participants read 11 terms describing nicotine and reported on perceived nicotine source (ie, NML, NFT) and addictiveness. Rank-ordered harm was included as a sensitivity analysis.

Results: Significant differences were observed among terms (eg, 'zero tobacco nicotine' and 'no tobacco nicotine' were rated as least addictive overall). 'NML' and 'NFT' adequately conveyed nicotine source and were rated as conveying comparable, yet high addictiveness, making them the optimal terms.

Conclusions: Many terms for NML and NFT are differentially related to understanding nicotine source and risk perceptions even though no existing research indicates that NML and NFT differ meaningfully from each other on characteristics like addictiveness. In the absence of prohibiting product differentiation by nicotine source, regulatory agencies should promote using the terms 'Nicotine from Tobacco' and 'Nicotine Made in a Lab' and investigate whether products using descriptors conveying reduced harm (eg, 'zero-tobacco,' 'no-tobacco,' 'non-tobacco') should require review as Modified Risk Tobacco Products.