Delphi study among international expert panel to develop waterpipe-specific health warning labels

Abstract

BackgroundWaterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control.MethodsA panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median.ResultsStarting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP’s harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes.ConclusionThis study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP’s harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.

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

“…Similar effects of warnings related to child health have been observed among cigarette smokers 29 . These findings are in accordance with a recent international expert panel consensus, where labels related to waterpipe’s harmful effects on newborn children were identified as being among the most effective at communicating WTS-related risks 30 . Furthermore, our results show that the motivation to quit in response to text warning labels was significantly higher among females than males for text warnings related to harm to children or during pregnancy.…”

Male students’ experiences on predictors of waterpipe smoking reduction: A qualitative study in Iran

“…It is estimated that approximately 100 million people, particularly teenagers, use this kind of smoking 4 . Since the period 2009-2016, studies reporting on WPS indicated a 0.4% to 2.9% annual increase in current WPS in the Eastern Mediterranean and European Regions, and 0.3% to 1.0% increase in the USA [5][6][7] . Population data indicate that from 3.3% to 7.5% of US youths have tried waterpipe 8 .…”

Health communication research in the Arab world: A bibliometric analysisHealth communication research in the Arab world: A bibliometric analysis

“…Some collaborative efforts between researchers from different Arab states addressed common health concerns, like smoking and viral infections. With smoking rates being among the highest worldwide in the Arab world, one study focused on health warning labels that are waterpipe-specific; researchers from Lebanon, Syria and Tunisia contributed in the process 37. Scientific evidence about the waterpipe's harmful effects and the importance of tobacco control were emphasised in the labelling strategies 37.…”