Eliciting preferences for waterpipe tobacco smoking using a discrete choice experiment: implications for product regulation

Abstract

ObjectivesWaterpipe smoking is highly prevalent among university students, and has been increasing in popularity despite mounting evidence showing it is harmful to health. The aim of this study was to measure preferences for waterpipe smoking and determine which product characteristics are most important to smokers.SettingA large university in the Southeastern USA.ParticipantsAdult waterpipe smokers attending the university (N=367).DesignParticipants completed an Internet-based discrete choice experiment to reveal their preferences for, and trade-offs between, the attributes of hypothetical waterpipe smoking sessions. Participants were presented with waterpipe lounge menus, each with three fruit-flavoured options and one tobacco flavoured option, in addition to an opt out option. Nicotine content and price were provided for each choice. Participants were randomised to either receive menus with a text-only health-warning message or no message.Outcome measuresMultinomial and nested logit models were used to estimate the impact on consumer choice of attributes and between-subject assignment of health warnings respectively.ResultsOn average, participants preferred fruit-flavoured varieties to tobacco flavour. They were averse to options labelled with higher nicotine content. Females and non-smokers of cigarettes were more likely than their counterparts to prefer flavoured and nicotine-free varieties. Participants exposed to a health warning were more likely to opt out.ConclusionsFruit-flavoured tobacco and lower nicotine content labels, two strategies widely used by the industry, increase the demand for waterpipe smoking among young adults. Waterpipe-specific regulation should limit the availability of flavoured waterpipe tobacco and require accurate labelling of constituents. Waterpipe-specific tobacco control regulation, along with research to inform policy, is required to curb this emerging public health threat.

Effectiveness of health warnings for waterpipe tobacco smoking among college students

“…The survey included questions measuring basic demographic characteristics, waterpipe use history, current use, attitudes regarding waterpipe, and health warning labels (Salloum et al 2015a). The survey tested text-only warning messages, pictorial labels and the placement (in different locations) of health warnings on a waterpipe device.…”

Young adult waterpipe tobacco users’ perceived addictiveness of waterpipe tobacco

“…Although warning labels could be positioned in a way that waterpipe tobacco users would be more likely to encounter them (e.g. on WTS cafe menus) 63 , research examining alternative message delivery channels appears warranted. Prior studies have indicated that online message delivery 29,30 , and delivery channels such as mobile phone text messaging, may be useful among young adults, because of their nearly ubiquitous use in this population 64 .…”

Worldwide Experienced Policy and Management Interventions in Preventing and Controlling Water Pipe Smoking

“…Tobacco smoking is one of the main preventable causes of diseases and deaths claiming the lives of 7.2 million annually [1,2]. Water Pipe Smoking (WPS) is a culture-based method of tobacco use [3] whose history goes back to 500 years ago; however, it has experienced a worldwide re-emergence since 1990 [4], and is regaining popularity among various populations, especially school and university students. In European countries such as Latvia and Berlin, 23 and 32.2% of school students respectively smoke it.…”

“…There are many reasons for the in cafes to be interested in WPS and include deceptive advertising and diversified incentive services in addition to water pipe. The main reasons include a variety of fruit-flavored tobacco, psychotropic WP, foods, drink, discounts, enjoyable settings, the proximity of WP cafe to the educational, public, sports, and home/residential settings, the opportunity to socialize with friends, tempting decoration, study places for students, live music, variety of games, and the possibility of watching live movie and sports [4,[21][22][23].…”