International Journal of Public Health

, Volume 61, Issue 6, pp 709–715 | Cite as

Effectiveness of health warnings for waterpipe tobacco smoking among college students

  • Farahnaz Islam
  • Ramzi G. SalloumEmail author
  • Rima Nakkash
  • Wasim Maziak
  • James F. Thrasher
Original Article



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.


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.


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.


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.


Waterpipe Hookah Shisha Warning labels 



Dr. Salloum was supported by the Office of the Vice President for Research at the University of South Carolina (ASPIRE Program) Grant 35,849. Dr. Maziak is funded by National Institute on Drug Abuse (NIDA) Grant R01 DA035160.


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Copyright information

© Swiss School of Public Health (SSPH+) 2016

Authors and Affiliations

  • Farahnaz Islam
    • 1
  • Ramzi G. Salloum
    • 2
    Email author
  • Rima Nakkash
    • 3
  • Wasim Maziak
    • 4
    • 5
  • James F. Thrasher
    • 6
  1. 1.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  2. 2.Department of Health Outcomes and Policy, and Institute for Child Health PolicyUniversity of Florida College of MedicineGainesvilleUSA
  3. 3.Department of Health Promotion and Community Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
  4. 4.Department of Epidemiology, Stempel College of Public Health and Social WorkFlorida International UniversityMiamiUSA
  5. 5.Syrian Center for Tobacco StudiesAleppoSyria
  6. 6.Department of Health, Promotion, Education and Behavior, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA

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