Work

Effect of graphic warning label on acute changes in waterpipe tobacco smoking behavior, biomarkers of exposure and harm, and subjective effects in a randomized trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: • This is the first reported randomized, controlled laboratory waterpipe (WP) smoking study of graphic warning labels (GWLs). • Two weekly exposures to a GWL on the hose did not reduce toxicant exposure, puffing behavior and positive experience from WP smoking. • GWLs on the WP hose may not be the sole effective tool for influencing smoking behavior of established waterpipe smokers. Waterpipe (WP) smoking is commonly misperceived as less harmful than cigarette smoking. Graphic warning labels (GWLs) may correct misperceptions and reduce WP smoking. We determined the impact of a GWL placed on a WP on short-term smoking behaviors and other outcomes among young adults who smoke WP. Young adults, ages 21–35 years, who smoke WP were randomized to a control (Visit1 = Blank, Visit2 = Blank label) or experimental (Visit1 = Blank, Visit2 = GWL, Visit3 = GWL) group. Participants smoked a research-grade WP in the lab ad lib to satiation, for a maximum of 60 min, for up to 3 visits, each separated by a week. Puffing topography was measured continuously throughout the session. Exhaled CO, harm perceptions, and subjective effects were measured before and after each smoking session. Outcome data were analyzed using linear mixed models to account for incomplete, repeated measurements. There were no significant differences in study outcomes within and between assigned groups, except for the following from Visit1 and Visit3 in the GWL group: 1) a reduction in puff volume (p = 0.048); 2) a reduction in good taste and calmness (p = 0.027 and 0.007, respectively); and 3) a reduction in being confused after smoking (p = 0.042). GWLs on WPs may not be the sole effective tool for reducing the harm from WP smoking. More research is needed to determine if WP interventions aimed at improving population health should include a wider variety of tools, such as education, cessation services, and product standards that limit the appealing aspects of WP tobacco.

Source: Addictive Behaviors

DOI: 10.1016/j.addbeh.2025.108520