Impact of Waterpipe Tobacco Pack Health Warnings on Waterpipe Smoking Attitudes: A Qualitative Analysis among Regular Users in London.
BACKGROUND
Despite the rise in prevalence of waterpipe tobacco smoking, it has received little legislative enforcement from governing bodies, especially in the area of health warning labels.


METHODS
Twenty regular waterpipe tobacco smokers from London took part in five focus groups discussing the impact of waterpipe tobacco pack health warnings on their attitudes towards waterpipe smoking. We presented them with existing and mock waterpipe tobacco products, designed to be compliant with current and future UK/EU legislation. Data were analysed using thematic analysis.


RESULTS
Participants felt packs were less attractive and health warnings were more impactful as health warnings increased in size and packaging became less branded. However, participants highlighted their lack of exposure to waterpipe tobacco pack health warnings due to the inherent nature of waterpipe smoking, that is, smoking in a café with the apparatus already prepacked by staff. Health warnings at the point of consumption had more reported impact than health warnings at the point of sale.


CONCLUSIONS
Waterpipe tobacco pack health warnings are likely to be effective if compliant with existing laws and exposed to end-users. Legislations should be reviewed to extend health warning labels to waterpipe accessories, particularly the apparatus, and to waterpipe-serving premises.
Department of Primary Care and Public Health, Imperial College London, Hammersmith W6 8RP, UK ; Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, Hampshire SO16 6YD, UK.
Mohammed
M
Jawad
School of Medicine and Dentistry, Barts and the London, Whitechapel E1 2AD, UK.
Ali
A
Bakir
School of Medicine and Dentistry, Barts and the London, Whitechapel E1 2AD, UK.
Mohammed
M
Ali
Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
Aimee
A
Grant
D001294:Attitude to Health; D054626:Consumer Health Information / Q000706:statistics & numerical data; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D008131:London / Q000208:ethnology; D008297:Male; D010865:Pilot Projects; D011356:Product Labeling / Q000706:statistics & numerical data*; D019064:Product Packaging / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D062789:Tobacco Products; D055815:Young Adult