Waterpipe smoking: the pressing need for risk communication

ABSTRACT

Introduction: Waterpipe (WP) smoking is an important public health problem that is rapidly evolving globally. Much of WP spread among youth is perpetuated by a misperception of reduced harms compared to cigarettes. Increasing awareness about WP smoking harms through health warning labels (HWLs) represents a promising policy and regulatory strategy to curb WP smoking.

Areas covered: Peer-reviewed publications indexed in PubMed and CINAHL were searched in March 2019. This review focuses on the current knowledge of WP smoking characteristics, its spread and patterns of use globally, and some of the major WP-related health effects. This knowledge is utilized to advance a promising policy and regulatory avenue to curb WP smoking by increasing awareness of its potential harms through HWLs. It also addresses product configuration and unique features that influence the adaptation of HWLs for WP smoking.

Expert opinion: HWLs are effective in communicating smoking-related risks to WP smokers in a way that affects their smoking behavior and experience as well as interest in quitting. Although based on limited data, the WP device appears to be a promising location for HWLs as it offers prolonged contact with smokers and those surrounding them.

KEYWORDS:

• Waterpipe
• health warning labels
• tobacco

Article highlights

• Waterpipe (WP) has become a global public health phenomenon attracting an increasing number of youth who are not fully aware of its risks to their and others’ health.

• WP smoking is addictive, its smoke contains much of the same toxicants found in cigarette smoking and carries similar risks to those associated with cigarette smoking such as lung cancer, respiratory and cardiovascular disease.

• Health warning labels (HWLs) are effective in communicating smoking-related risks to correct misperceptions about WP harms. Developing WP-specific HWLs is a promising policy to curb WP smoking, but its implementation needs to take into consideration WP configuration, components, marketing, and its social context.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work is supported by the National Institutes of Health (NIH) and Fogarty International Center (R01TW010654), however the funding sources had no role in the preparation of this review or the decision to submit for publication.