Disclosure Slide 1. Funding: Florida Department of Health, James & Esther King Biomedical Research Award Grant Number: 20K10 Grant Title: Developing and testing waterpipespecific health warning labels targeting young people in Florida
2. Industry funding: N/A 3. Off-label medication uses discussed: N/A
2
Perceived Effectiveness of Waterpipe-specific Health Warning Labels among Young Adults in The US: Results from an Online Survey Taghrid Asfar MD, MSPH; Michael Schmidt, PhD; Alejandra Casas, BS; Olusanya J. Oluwole, MPH; Laura McClure L, MSPH; Richard J. Thurer, MD; Ian Abrams BA; Wei Li, MPH; Zoran Bursac, PhD, MPH; Wasim Maziak, MD, PhD Presenter: Alejandra Casas, BS, MPH Candidate Department of Public Health Sciences University of Miami Miller School of Medicine 3
SRNT 2022 Meeting March 17, 2022, 4:45 PM-6:15 PM Poster Session Number: POS4 Poster Number: 063
4
Background
Waterpipe smoking has increased dramatically among young adults in the United States mainly due to the misperception that it is safer than cigarette smoking. Mounting evidence show that waterpipe smoking is addictive and harmful. Pictorial health warning labels are effective in communicating smoking-related risks. 5
Objectives § Rating and ranking 24 waterpipe pictorial health warning labels among young adults to select the most effective labels for further testing and development. § Labels are divided into six themes: Ø Theme 1: Addiction Ø Theme 2: Waterpipe harm compared to cigarettes Ø Theme 3: Waterpipe harm to others Ø Theme 4: Waterpipe health effects Ø Theme 5: Quitting waterpipe Ø Theme 6: Waterpipe specific harms
6
Theme 1 Addiction
7
Theme 2 Waterpipe Harm Compared to Cigarettes
8
Theme 3 Waterpipe Harm to Others
9
Theme 4 Waterpipe Health Risks
10
Theme 5 Quitting Waterpipe Smoking
11
Theme 6 Waterpipe Specific Harm
12
Methods § We conducted an online survey among regular waterpipe smokers. § We used a 1-10 scale, where participants ranked labels in each Participants N= 44 theme and rated them on several communication outcomes: Ø Risk perceptions Ø Intention to quit Ø Preventing youth from starting WP use Ø Overall effectiveness
§ ANOVA or Kruskal-Wallis tests used to test differences in effectiveness between labels within each theme.
Gender
Age
Females: 58.5% Males: 41.5% 21-35 years old
§ Friedman test (p<0.05) to evaluate difference in label rankings within each theme. 13
Methods Smoking Status
Baseline demographic distribution Variable
N (%)
Variable
N (%)
All
44 (100)
All
44 (100)
Age (Mean [SD])
26.4 [6.6]
Age started smoking waterpipe (Mean [SD])
18.8 [3.6]
Gender
Yes
Female
24 (58.5)
Male
17 (41.5)
Ethnicity Black/African American
9 (22.0)
White/Caucasian
23 (56.1)
Hispanic
Have you smoked hookah in the past 6 months?
19 (46.3)
39 (95.1)
Which statement best describes your hookah smoking in the past 6 months Smoke hookah less than once a week
28 (68.3)
Smoke hookah at least once a week, but not everyday
10 (24.4)
Compared to cigarettes, how harmful do you think the waterpipe is? Less harmful
13 (31.7)
Equally harmful
16 (39.0)
More harmful
7 (17.1)
Have you ever smoked cigarettes, even one or two puffs? Yes
20 (48.8)
Do you currently smoke or vape an e-cigarette? Yes
26 (63.5)
Not at all
15 (36.6)
Have you ever used marijuana, marijuana concentrates, marijuana waxes, THC, or hash oils in an e-cigarette? Yes
23 (56.1) 14
Results Top Rated Label Theme 2: Waterpipe Harm Compared to Cigarettes “Like cigarettes, chemicals in hookah smoke can cause cancer” Label
Effectiveness in making people think about the health risks of WP smoking Mean P (SD)
Effectiveness in motivating smokers to quit smoking or think about quitting WP Mean (SD) P
1.000
8.54 (1.25)
Effectiveness in helping to prevent youth from starting WP smoking Mean (SD)
0.101
8.23 (1.75)
P
Overall, how effective is this warning?
Mean (SD)
0.006
8.33 (1.77)
P
Label ranked most effective N (%)
<0.0001
8.49 (1.50)
28 (71.8)
15
Results Top Rated Label Theme 4: Waterpipe Health Risks “Chemicals in hookah smoke can cause serious lung disease” Label
Effectiveness in making people think about the health risks of WP smoking Mean P (SD)
Effectiveness in motivating smokers to quit smoking or think about quitting WP Mean (SD) P
0.072
8.23 (1.46)
Effectiveness in helping to prevent youth from starting WP smoking
Overall, how effective is this warning?
Mean (SD)
Mean (SD)
0.003
8.08 (1.68)
P <0.0001
7.90 (1.70)
P
Label ranked most effective N (%)
<0.0001
8.03 (1.55)
8 (20.5)
16
Results Top Rated Label Theme 5: Quitting Waterpipe Smoking “Smoking during pregnancy can harm your baby. Time to quit hookah: 877-U-CAN-NOW” Label
Effectiveness in making people think about the health risks of WP smoking Mean P (SD)
Effectiveness in motivating smokers to quit smoking or think about quitting WP Mean (SD) P
0.272
7.00 (1.69)
Effectiveness in helping to prevent youth from starting WP smoking
Overall, how effective is this warning?
Mean (SD)
Mean (SD)
0.0757
6.72 (1.81)
P 0.0809
5.08 (2.28)
P
Label ranked most effective N (%)
0.0016
6.51 (1.70)
16 (41.0)
17
Results Top Rated Label Theme 6: Waterpipe Specific Harm “Smoking hookah can cause mouth disease” Label
Effectiveness in making people think about the health risks of WP smoking Mean P (SD)
Effectiveness in motivating smokers to quit smoking or think about quitting WP Mean (SD) P
0.059
8.10 (1.60)
Effectiveness in helping to prevent youth from starting WP smoking
Overall, how effective is this warning?
Mean (SD)
Mean (SD)
0.009
7.95 (1.67)
P 0.0004
7.51 (1.88)
P
Label ranked most effective N (%)
0.0036
7.90 (1.59)
20 (51.3)
18
Overall Top 3 Ranked Labels in Terms of Overall Effectiveness 71.8%
53.9%
51.3%
19
Conclusion
20