Effectiveness of health warnings for waterpipe tobacco smoking among college students

Int J Public Health. 2016 Jul;61(6):709-715. doi: 10.1007/s00038-016-0805-0. Epub 2016 Mar 14.


Objectives: Youth have the misperception that waterpipe smoking is less harmful than cigarettes despite the evidence that it is associated with nicotine dependence and many of the diseases caused by cigarettes. There is a pressing need to identify effective health warnings that increase awareness about the harmful effects of waterpipe smoking. Our objective was to test the effectiveness of various health warning messages and their location on waterpipe devices.

Methods: Adult waterpipe smokers from a large US university (N = 367) completed an internet-based survey that tested the effect of text-only and pictorial health warning labels and their location on different parts of waterpipe smoking devices.

Results: Text-only messages and pictorial labels warning about harm to children were the most effective in motivating waterpipe smokers to think about quitting. In terms of warning label location, the base, mouthpiece and stem are all equally noticeable locations.

Conclusions: This is the first study to test waterpipe-specific warning labels and location on the waterpipe device. Placing waterpipe-specific labels on waterpipe devices may be an effective policy tool to curb waterpipe smoking.

Keywords: Hookah; Shisha; Warning labels; Waterpipe.

MeSH terms

  • Adolescent
  • Attitude to Health
  • Awareness
  • Cross-Sectional Studies
  • Female
  • Humans
  • Internet
  • Male
  • Product Labeling / methods*
  • Smoking / adverse effects*
  • Smoking / psychology
  • Smoking Cessation
  • Smoking Prevention
  • Surveys and Questionnaires
  • Tobacco / adverse effects*
  • Tobacco Use Disorder / prevention & control
  • Universities
  • Young Adult