title: Effectiveness of health warnings for waterpipe tobacco smoking among college students.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Islam
authors.affiliation: Department of Health Outcomes and Policy, and Institute for Child Health Policy, University of Florida College of Medicine, PO Box 100177, Gainesville, FL, 32610-0177, USA. rsalloum@ufl.edu.
authors.forename: Ramzi G
authors.initials: RG
authors.lastname: Salloum
authors.affiliation: Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Rima
authors.initials: R
authors.lastname: Nakkash
authors.affiliation: Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.|Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
authors.affiliation: Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D001364:Awareness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011356:Product Labeling / Q000379:methods*; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000517:prevention & control; D014495:Universities; D055815:Young Adult; D014026:Nicotiana
keywords: Hookah; Shisha; Warning labels; Waterpipe