Tobacco packaging and labelling policies 
in countries of the Eastern Mediterranean and Western Pacific Regions:
Post-deadline assessment of the time-bound measures of WHO FCTC Article 11

Mostafa, Aya; Kashiwabara, Mina

doi:10.18332/tpc/66793

Cited by 6 publications

(9 citation statements)

References 22 publications

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“…These countries have approved the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), with the exception of OPT. Still, the enforcement of the WHO FCTC is low in most countries 36 with more emphasis on text health warnings 37 . Thus, immediate action is needed, similar to cigarette control regulations, targeting bans on advertisement and sales to minors, taxation, warning labels, and smoke-free indoor air policies, to control WTS 38 .…”

Section: Discussionmentioning

confidence: 99%

Harm perceptions of waterpipe tobacco smoking among university students in five Eastern Mediterranean Region countries: A cross-sectional study

et al. 2018

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INTRODUCTION Waterpipe tobacco smoking (WTS) continues to be very common in the Eastern Mediterranean Region (EMR), partially because of cultural acceptance but also because of misconceptions of its harm. This paper aimed to describe the beliefs towards waterpipe harm of university students who smoked waterpipe in five EMR countries. METHODS This study was conducted in 2016 across five EMR countries: Egypt, Jordan, Occupied Palestinian Territories, Oman and United Arab Emirates (UAE). Participants were recruited from among university students in each country. Students’ characteristics, smoking behavior, flavor preference and knowledge of WTS harm were collected using an internet-based survey. Participants were included if they were ever waterpipe tobacco smokers and between 18 and 29 years of age. Bivariate analyses assessed variations in student-perceived WTS harm across the countries. Linear regression analysis was used to assess WTS perceived harm differences between students in the different countries. RESULTS A total of 2 544 university students participated from the five countries. Among ever smoking students, 66% reported WTS in the past 30 days, with the highest proportions (40%) from Occupied Palestinian Territories (OPT) and (41%) Jordan. Dual smoking of waterpipe and cigarettes was highest among students from Egypt. Most participants from the five countries had high level of perceived harm related to WTS during pregnancy. Less than 50% of the students believed that WTS could lead to the death of the smoker, can be harmful for non-smokers and have an addictive effect. Female students, those older than 22 years, and those who didn’t smoke waterpipe in the last 30 days significantly had a higher level of WTS perceived harm. Participating students believed that cigarettes are more addictive and contain more nicotine compared to waterpipe. CONCLUSIONS Misperceptions of waterpipe harm are common among university students in the five EMR countries. Immediate public health action is needed, including enforcement of waterpipe tobacco control regulations along with awareness campaigns.

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Section: Discussionmentioning

confidence: 99%

Harm perceptions of waterpipe tobacco smoking among university students in five Eastern Mediterranean Region countries: A cross-sectional study

et al. 2018

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“…Tobacco product health warnings can increase awareness of smoking’s risks, foster cessation and deter initiation 12. Egypt, a signatory country to the WHO Framework Convention on Tobacco Control (FCTC), has applied a set of four generic pictorial health warnings (PHWs) to the lower front and back half of waterpipe tobacco packs (WTPs) since 2008,13 but these still depict colourful fruits and flavours in brand imagery 14. Furthermore, WT use differs from cigarette smoking and involves multiple components, including tobacco, charcoal and a device 11.…”

Section: Introductionmentioning

confidence: 99%

Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers’ and non-smokers’ responses

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“…Egypt was one of the first countries in the EMR to introduce a textual health warning on all tobacco products in 1981, 24 years prior to ratifying the WHO FCTC [33]. In 2002, the textual warning was required to occupy at least 30% of the main display areas of the tobacco pack.…”

Section: Introductionmentioning

confidence: 99%

“…In 2002, the textual warning was required to occupy at least 30% of the main display areas of the tobacco pack. By 2008, in line with the WHO FCTC guidelines, Egypt employed a set of four generic PHWs that appear on the bottom 50% of the front and back of all tobacco packs; these PHWs carry relevant textual warnings, the quitline number (16805) with an additional standard textual warning beneath it: “smoking damages health and causes death”; and are rotated every two years [33]. However, WTPs still depict colourful fruits and flavours using brand imagery.…”

Section: Introductionmentioning

confidence: 99%

Do pictorial health warnings on waterpipe tobacco packs matter? Recall effectiveness among Egyptian waterpipe smokers & non-smokers

et al. 2018

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IntroductionDespite the global rise in waterpipe tobacco smoking (WTS), the effectiveness of waterpipe tobacco health warnings remain understudied, especially in countries with high WTS rates. Egypt has been employing waterpipe tobacco labelling for a decade, however, their effectiveness is unknown. Our overall aim was to measure the effectiveness of pictorial health warnings (PHWs) on waterpipe tobacco packs (WTPs) through participant memory recall and to investigate whether they induced behavioural responses in waterpipe smokers and deterred uptake of WTS in non-smokers, examining the differentials of effectiveness among socio-demographic subgroups.Subjects and methodsWe conducted two surveys including 1490 adult current waterpipe smokers, 73 former waterpipe smokers, and 451 non-smokers in Cairo and a rural village in Egypt between 2015–2017. Participants who noticed PHWs on WTPs were asked questions about salience, communication of health risks, public support, cognitive processing, and self-reported behavioural responses (current waterpipe smokers: reduce consumption, forgo a smoke, quit attempts; former waterpipe smokers: quit; non-smokers: deter WTS initiation). Univariate and multivariable statistical analyses were performed.ResultsParticipants’ mean age was 35 years, mostly males (90.4%), waterpipe smokers (74.0%) and rural residents (59.3%). Approximately two-thirds of participants noticed PHWs on WTPs. Salience was significantly less among females, urban residents and participants with high literacy. More than three-quarters of participants reported that WTS health risks were communicated through the warnings. At least half of participants cognitively processed the warnings: 56.3% thought of the warnings when WTPs were out of sight; non-smokers understood the warnings (83.2%) and discussed them with others (90.3%) significantly more than current (76.0% and 72.5%, respectively) and former waterpipe smokers (81.0% and 61.9%, respectively). Participants reported that PHWs on WTPs motivated 58.5% of waterpipe smokers to think about quitting; 64.5% to reduce their consumption; 42.2% to forgo a smoke; 24.5% to attempt to quit; 57.1% of former waterpipe smokers to successfully quit; and 59.3% of non-smokers to remain smoke-free.ConclusionsFindings suggest that inserting PHWs on WTPs is an effective waterpipe tobacco labelling policy. Countries with similarly high rates of WTS should consider adopting WTP PHWs within a comprehensive regulatory framework.

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Tobacco packaging and labelling policies in countries of the Eastern Mediterranean and Western Pacific Regions: Post-deadline assessment of the time-bound measures of WHO FCTC Article 11

Cited by 6 publications

References 22 publications

Harm perceptions of waterpipe tobacco smoking among university students in five Eastern Mediterranean Region countries: A cross-sectional study

Harm perceptions of waterpipe tobacco smoking among university students in five Eastern Mediterranean Region countries: A cross-sectional study

Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers’ and non-smokers’ responses

Do pictorial health warnings on waterpipe tobacco packs matter? Recall effectiveness among Egyptian waterpipe smokers & non-smokers

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