Examining the effect of waterpipe specific pictorial health warning labels among young adults in Lebanon and Tunisia: Protocol of a factorial experiment study design

Rime Jebai; Taghrid Asfar; Rima Nakkash; Sara Chehab; Habiba Ben Romdhane; Wasim Maziak

doi:10.1016/j.conctc.2021.100797

Examining the effect of waterpipe specific pictorial health warning labels among young adults in Lebanon and Tunisia: Protocol of a factorial experiment study design

Contemp Clin Trials Commun. 2021 Jun 8:23:100797. doi: 10.1016/j.conctc.2021.100797. eCollection 2021 Sep.

Authors

Rime Jebai¹, Taghrid Asfar^{2

3

4}, Rima Nakkash⁵, Sara Chehab⁵, Habiba Ben Romdhane⁶, Wasim Maziak^{1

3}

Affiliations

¹ Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
² Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
³ Syrian Center for Tobacco Studies, Aleppo, Syria.
⁴ Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
⁵ Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
⁶ Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine, University of Tunis El Manar, Tunisia.

Abstract

Waterpipe tobacco smoking (WTS) has increased substantially in the Eastern Mediterranean Region (EMR), affecting young adults who perceive waterpipe as safer than cigarette smoking. Applying pictorial health warning labels (HWLs) on tobacco products has been effective in communicating health risks associated with tobacco smoking. However, there are few experimental studies that examined pictorial HWLs specific to WTS. Methods/design: This report describes the design and protocol of the first factorial experimental study that aims to test the effectiveness of pictorial HWLs based on their placement on waterpipe device, tobacco, and charcoal packages among young adult smokers and non-smokers residing in Lebanon and Tunisia. After completing a baseline assessment, participants will be randomly assigned to 3 experimental conditions in a 3 (HWL: pictorial HWL on tobacco package vs. pictorial HWL on 3 placements [device, tobacco, and charcoal packages] vs. text-only HWL on tobacco package) x 4 (pictorial HWLs) x 2 (waterpipe smokers vs. non-smokers) factorial design. We will use a within/between-subject design, where pictorial HWLs and time (pre vs. post-exposure) are the within-subject factors and waterpipe smoking status as the between-subjects factor. Participants will complete post-exposure measures that include attention, perceived harm, intention to quit (smokers) or initiate smoking (non-smokers). Discussion: This is the first international study examining the placements of pictorial HWLs using efficient within/between subject design. Findings will provide additional evidence to convince policymakers to consider three placements of HWLs specific to WTS as a promising regulatory target to curb WTS.

Keywords: AUB, American University of Beirut; EMR, Eastern Mediterranean Region; Experimental study; FCTC, Framework Convention on Tobacco Control; HWL, Health Warning Label; Health warning label; IRB, Institutional Review Board; NIH, National Institutes of Health; Tobacco packaging; WTS, Waterpipe Tobacco Smoking; Waterpipe; Young adults.

Grants and funding

R01 TW010654/TW/FIC NIH HHS/United States