Association of health warning labels and motivation to quit waterpipe tobacco smoking among university students in the Eastern Mediterranean Region

Abstract

INTRODUCTION This study aimed to determine associations between health warning label content and motivation to quit waterpipe smoking by gender and smoking location. METHODS Convenience samples of university students in three Eastern Mediterranean countries -Egypt (n=442), Jordan (n=535) and Palestine (n=487) -completed an online survey assessing health warning labels. Multinomial logit regression models were conducted to determine the association between different variables, particularly gender and smoking location, with motivation to quit. RESULTS In Palestine, female smokers were more motivated to quit waterpipe smoking when seeing textual warning labels related to children (T2) and pregnancy (T6) [T2: 1.8 (95% CI: 1.1-2.8), T6: 2.7 (95% CI: 1.6-4.3)] compared to males. Similar results were found in Jordan [T2: 1.6 (95% CI: 1.0-2.6), T6: 1.8 (95% CI: 1.1-3.0)]. As for the smoking location, home-only smokers in Palestine were more likely to quit in response to the following warnings: waterpipe smoking is addictive T1: 2.3 (95% CI: 1.4-3.7), harmful for children T2: 2.3 (95% CI: 1.4-4.1), harmful for the baby during pregnancy T6: 2.4 (95% CI: 1.3-4.3), and to believe that quitting reduces the health risks T9: 1.8 (95% CI: 1.0-3.1). These results were not found in Jordan nor Egypt. Smokers reported that the most noticeable location of a HWL on a waterpipe device is the mouthpiece. CONCLUSIONS A better understanding of motivation to quit and its association with various warnings and smoking location could guide countries on which warnings to require in legislation and where best to require them particularly in relation to location.

Factors contributing to the rising prevalence of waterpipe smoking dependence among university students: a cross-sectional study

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Adapting waterpipe-specific pictorial health warning labels to the Tunisian context using a mixed method approach

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Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations

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“…The guiding document for global tobacco control regulation is the Framework Convention on Tobacco Control (FCTC), the world’s first global health treaty, which includes evidence-based policy recommendations translated through required ‘articles’. Research evidence and reports from the Conference of the Parties (COP) to the FCTC on global regulatory practices have documented potentially effective regulatory practices for WTS,11–14 such as using waterpipe-specific health warning labels. As a result, global health guidance is emerging on WTS-specific policies 15–18…”