Delphi study among international expert panel to develop waterpipe-specific health warning labels

Area of Science:

• Public Health
• Tobacco Control
• Health Communication

Background:

• Waterpipe (WP) smoking prevalence is rising globally, often driven by misperceptions of lower harm compared to cigarettes.
• Health warning labels (HWLs) are crucial for communicating smoking risks and correcting these misperceptions.
• Developing WP-specific HWLs is a priority for effective WP control.

Purpose of the Study:

• To systematically develop and evaluate the most effective WP-specific health warning labels (HWLs).
• To address the misperception that waterpipe smoking is less harmful than cigarette smoking.
• To provide evidence-based HWLs for global WP control policies.

Main Methods:

• A panel of WP science experts developed 28 candidate HWLs across five themes.
• A three-round Delphi study involving an international expert panel reached consensus on the most effective HWLs.
• Interquartile deviations assessed agreement, and median ranked tied HWLs.

Main Results:

• Consensus was reached on 13 key WP-specific HWLs from the initial 28 candidates.
• Highly agreed-upon labels focused on oral/heart disease, newborn harm, and inhaled smoke volume.
• Results highlight specific risks associated with waterpipe use compared to cigarettes.

Conclusions:

• This study is the first to systematically develop WP-specific HWLs using scientific evidence and expert consensus.
• The selected HWLs can be adapted to different national contexts and refined with user feedback.
• These labels offer a vital tool for public health initiatives aimed at reducing waterpipe smoking.