Examining the Effect of Pictorial Health Warning Labels in Communicating Health Risks of Waterpipe Tobacco Smoking among Young Adults

Authors

Rime JebaiFollow

Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Wasim Maziak

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Miguel Angel Cano

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Zoran Bursac

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Wensong Wu

Fourth Advisor's Committee Title

Committee member

Fifth Advisor's Name

Taghrid Asfar

Fifth Advisor's Committee Title

Committee member

Sixth Advisor's Name

Rima Nakkash

Sixth Advisor's Committee Title

Committee member

Keywords

Waterpipe tobacco smoking, health warning label, young adults, experimental study

Date of Defense

5-26-2023

Abstract

Waterpipe (WP) tobacco smoking is prevalent among young people in Lebanon, who often perceive it as less harmful than cigarette smoking. Pictorial health warning labels (HWLs) serve as an effective population-wide strategy for communicating health risks associated with tobacco use and could be applied to WP. This dissertation examines the effect of exposure to WP-specific pictorial HWLs and their placements on WP parts (device, tobacco, and charcoal packages) on health communication and tobacco control outcomes. An online cross-over experimental study was conducted in 2021 among young adults in Lebanon. Participants observed 3 conditions of HWLs in random order: pictorial HWLs on the tobacco package, pictorial HWL on all WP’s parts, and text-only HWL on the tobacco package, completing assessments after each exposure.

The first study assessed the effect of exposure to pictorial vs. text-only HWLs on tobacco packages and pictorial HWLs on tobacco packages vs. on all WP’s parts on health communication outcomes (i.e., attention, warning reactions) among 276 WP smokers. This study demonstrated that pictorial HWLs on tobacco packages induced higher attention (p= 0.011), cognitive elaboration (p=0.021), and negative affect reactions (p

The second study compared non-smokers (n=127) to WP smokers’ (n=276) reactions to pictorial HWLs vs. text-only on tobacco package and their placements on WP parts. Using linear mixed model analysis, our findings suggest that the association between exposure to pictorial HWLs on the tobacco packages vs. text-only and reported attention (β=0.54 [95% CI:0.25,0.82]), cognitive elaboration (0.31[0.05,0.58]), and social interaction (0.41[0.18,0.65]) were stronger among non-smokers compared to smokers.

The third study explored how pictorial HWLs vs. text-only induce higher quit intention among young adult WP smokers. Using serial mediation, we identified that exposure to pictorial HWLs vs. text-only influenced intention to quit via attention and negative affect (17.28% of the total effect) and negative affect and cognitive elaboration (21.53% of the total effect).

These results offer insights for policymakers on implementing pictorial HWLs specific to WP to deter use, reduce smoking, and curb tobacco-related morbidity and mortality. Emphasizing attention-grabbing, emotionally evocative, and cognitively persuasive HWLs is crucial.

Identifier

FIDC011115

ORCID

https://orcid.org/0000-0002-9265-1323

Previously Published In

Jebai R, Asfar T, Nakkash R, Chehab S, Wu W, Bursac Z, Maziak W. Impact of pictorial health warning labels on smoking beliefs and perceptions among waterpipe smokers: an online randomised cross-over experimental study. Tob Control. 2022 Apr 20:tobaccocontrol-2021-057202. doi: 10.1136/tobaccocontrol-2021-057202. Epub ahead of print. PMID: 35444030; PMCID: PMC9582042.

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.0 License.

Recommended Citation

Jebai, Rime, "Examining the Effect of Pictorial Health Warning Labels in Communicating Health Risks of Waterpipe Tobacco Smoking among Young Adults" (2023). FIU Electronic Theses and Dissertations. 5459.
https://digitalcommons.fiu.edu/etd/5459