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Modifiers (Noun Strings) 

Modifiers (Noun Strings)

Stacy Christiansen

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Modifiers (Noun Strings)

Although in English nouns can be used as modifiers, overuse of noun modifiers can lead to a lack of clarity. Purists may demand stricter rules on usage, but, as with the use of nouns as verbs (see 11.3, Correct and Preferred Usage, Back-formations), the process of linguistic change is inevitable, and grammatical rigor must be tempered by judgment and common sense.



diabetes patient

patient with diabetes, diabetic patient

depression episode

depressive episode, episode of depression

elderly over-the-counter drug users

elderly users of over-the-counter drugs

In The Careful Writer, Bernstein2 advises the use of no more than 2 polysyllabic noun modifiers per noun for the sake of clarity. However, long noun strings are sometimes difficult to avoid. If several of the attributive nouns are read as a unit, the use of more than 2 may not compromise clarity, especially in scientific or technical communications. Thus, noun strings may be more acceptable, for the sake of brevity, if the terms have been previously defined without noun strings. Some acceptable examples appear below:

community hospital program

nicotine replacement program

physician provider organization

placebo pain medication

risk factor surveillance system

proficiency testing program

baseline CD4 cell counts

clinical research organization

sudden infant death syndrome

community outreach groups

If there is a possibility of ambiguity, hyphens may be added for clarity (large-vessel dissection) (see Temporary Compounds in 8.3.1, Punctuation, Hyphens and Dashes, Hyphen).

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