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.
Highlights
As part of the focus groups (FG), we conducted a brief individual survey to (1) examine differences in health warning labels (HWLs) ratings on four outcomes
Lebanon suffers from considerable waterpipe (WP) smoking among young adults
Cigarette specific health warning labels have been evaluated in the Lebanese context [16], to date this has not extended to waterpipe-specific HWLS
Summary
Waterpipe (WP) smoking continues to increase globally, and more so in the Eastern. Mediterranean Region (EMR) [1,2]. As in most countries in the region, WP smoking has become the number one tobacco use method among young adults in Lebanon [3]. Among a sample of 1680 adults (50% females; 64% less than 45 years), WP smoking in Lebanon was 39.5% in 2019, three-times higher than in Jordan and Palestine As for youth, in a review of WP prevalence and trends, current use was the highest among Lebanese youth (37.2% in 2008), and having ever used was the highest among Lebanese youth in 2002 and Lebanese university students in 2005 (both 65.3%) [3]
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