Novel Insights into Young Adults’ Perceived Effectiveness of Waterpipe Tobacco-Specific Pictorial Health Warning Labels in Lebanon: Implications for Tobacco Control Policy

Abstract

This study aims to explore the perceived effectiveness of waterpipe (WP) tobacco specific health warning labels (HWLs) among young adult WP smokers and nonsmokers in Lebanon. Before participating in focus group discussions, participants (n = 66; WP smokers n = 30; nonsmokers n = 36; age 18–33) completed a brief survey to rate the effectiveness of 12 HWLs’ and rank them according to four risk themes (WP health effects, WP harm to others, WP-specific harm, and WP harm compared to cigarettes). Differences in HWLs ratings by WP smoking status were examined and the top-ranked HWL in each theme were identified. HWLs depicting mouth cancer and harm to babies were rated as the most effective by both WP smokers and non-smokers. WP smokers rated HWLs which depicted harm to children and infants as more effective than non-smokers. The top-ranked HWLs for perceived overall effectiveness were those depicting “oral cancer”, “harm to babies”, “orally transmitted diseases” and “mouth cancer”. HWLs depicting oral lesions and harm to babies were rated as most effective, while HWLs showing the harmful effects of WP secondhand smoke on infants and children were rated as less effective by nonsmokers compared to smokers. Our study provides evidence on the potential effectiveness of HWLs for further evaluation in Lebanon and the Eastern Mediterranean region. The results will inform and guide the development and implementation of tobacco control policy.

Tobacco package health warnings: a global success story

“…170 Some studies have considered warning options for the device itself in addition to packaging. [171][172][173][174][175] Turkey has required a rotated series of health warnings to be displayed on waterpipe devices in public settings such as cafes/restaurants [176][177][178] (figure 4), but this has not been enforced. Nigerian regulations include health warnings on waterpipe devices, but compliance levels have not been confirmed.…”

“…Waterpipe smoking is popular in certain countries, and with specific population groups in some other countries 170. Some studies have considered warning options for the device itself in addition to packaging 171–175. Turkey has required a rotated series of health warnings to be displayed on waterpipe devices in public settings such as cafes/restaurants176–178 (figure 4), but this has not been enforced.…”

Impact of pictorial health warning labels on smoking beliefs and perceptions among waterpipe smokers: an online randomised cross-over experimental study

“…Subsequently, a Delphi study was conducted among international experts in tobacco control to reach a consensus on the top 13 HWLs for further development and testing 26. These 13 HWLs were further refined and adapted to young adults (waterpipe smokers and non-smokers) in Lebanon through a focus group study that included a rating exercise 33. The HWLs were modified based on participants’ feedback, and the top four HWLs in terms of overall effectiveness were selected and tested in this experimental study (see online supplemental efigure 1).…”