Research Laboratory on cardiovascular disease Epidemiology and Prevention, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
National Institute of Public Health, Tunisia.
PLoS One. 2023 Mar 24;18(3):e0279014. doi: 10.1371/journal.pone.0279014. eCollection 2023.
Waterpipe (WP) use is rapidly increasing among young people worldwide due to the widespread misperception that it is safer than cigarette smoking. Health warning labels (HWLs) can effectively communicate tobacco-related health risks but have yet to be developed for WP. This study aimed to optimize and adapt a set of 16 pictorial WP-specific HWLs, developed by an international Delphi study, to the Tunisian context. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes.
Using a mixed method approach, we conducted ten focus groups combined with a survey among young WP users and nonusers (N = 63; age 18-34 years). In the survey, participants rated the HWLs on several communication outcomes (e.g., reaction, harm perception, effectiveness) and were then instructed to view all HWLs in each theme and rank them in the order of overall perceived effectiveness, from the most to the least effective. Afterward, participants provided in-depth feedback on HWLs and avenues for improvement. Mean effectiveness rating scores and percentages of participants' top-ranked HWLs were calculated. Discussions were audio-taped, transcribed verbatim, and analyzed thematically.
The top-ranked HWLs were those showing oral cancers, orally transmitted diseases, and a sick child. Focus group discussion illustrated that these selections were based on participants' reactions to the direct impact of WP on a person's physical appearance and evoking guilt over children's exposure to WP smoke. Suggestions for improvement highlighted the need to use the local dialect and more affirmative statements (e.g., avoiding "may" or "can").
This study is the first in North Africa to attempt to advance HWLs policy as the World Health Organization recommended. The results of this study can be used as a basis for implementing WP-specific health messages in the Eastern Mediterranean Region.
由于普遍存在水烟（WP）比吸烟更安全的误解，WP 在全球年轻人中的使用呈快速增长趋势。健康警示标签（HWL）可以有效地传达与烟草相关的健康风险，但尚未针对 WP 开发。本研究旨在优化和调整一组由国际 Delphi 研究开发的 16 张 WP 特定 HWL，使其适用于突尼斯的情况。HWL 分为四个主题：WP 健康风险、WP 对他人的危害、WP 特定危害以及 WP 与香烟相比的危害。
采用混合方法，我们进行了十次焦点小组讨论，并对 WP 使用者和非使用者（N=63；年龄 18-34 岁）进行了一项调查。在调查中，参与者对 HWL 的几项传播效果（例如，反应、危害感知、效果）进行了评分，然后被指示查看每个主题中的所有 HWL，并按照总体感知效果从最有效到最不有效的顺序对其进行排序。之后，参与者对 HWL 提供了深入的反馈和改进建议。计算了 HWL 的平均有效评分和参与者排名最高的 HWL 的百分比。讨论内容进行了录音、逐字转录，并进行了主题分析。
排名最高的 HWL 是显示口腔癌、口腔传播疾病和生病儿童的 HWL。焦点小组讨论表明，这些选择是基于参与者对 WP 对个人外表的直接影响的反应以及对儿童暴露于 WP 烟雾的内疚感。改进建议强调需要使用当地方言和更肯定的陈述（例如，避免使用“可能”或“可以”）。
这是北非首次尝试按照世界卫生组织的建议推进 HWL 政策。本研究的结果可作为在东地中海地区实施 WP 特定健康信息的基础。
