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Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use.

ABSTRACT: INTRODUCTION:Despite its known adverse effects on human health, waterpipe smoking is increasing in popularity worldwide. However, compared to cigarettes, regulation of waterpipe product smoking lags behind and presents unique challenges. In search for regulatory options, this systematic review analyzes 36 studies on the differential effects on human health of the waterpipe characteristics including smoking products, heating sources, device components, and packages. METHODS:A systematic review was performed according to PRISMA guidelines, revealing 443 unique citations. After screening, 36 studies were included in the results. Research articles were selected to inform on differential effects caused by product characteristics on adverse health effects, attractiveness, addictiveness and prevalence of waterpipe use. RESULTS:Flavors are the key aspect that defines attractiveness of waterpipe product smoking. All waterpipe products, with or without nicotine, produce toxicants in similar quantities as cigarettes. Heating sources for waterpipe tobacco include charcoals and electrical heating. Both heating sources increase toxicant emissions in different ways. Hoses and mouth tips are device components that are often shared in waterpipe smoking. Sharing influences attractiveness by enriching the social experience. At the same time, it influences the transfer of infectious diseases by bacteria and viruses from one smoker to another. Studies showed that more generic and less attractive packages with health warnings are effective in reducing the attractiveness of waterpipe smoking. CONCLUSIONS:Based on our findings, we advise to include all waterpipe products, tobacco and non-tobacco, with or without nicotine, in tobacco product regulations and smoking bans in order to: ban waterpipe molasses with characterizing flavors or ban the use of flavorings at any level; mandate dissemination of information on all waterpipe tobacco elements to the national regulator; prescribe testing to regulate contents of waterpipe smoking products and heating sources. Moreover, we advise to stimulate research on emissions of waterpipes.

SUBMITTER: Kienhuis AS

PROVIDER: S-EPMC7485441 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use.

Kienhuis Anne S AS Talhout Reinskje R

Tobacco induced diseases 20200825

<h4>Introduction</h4>Despite its known adverse effects on human health, waterpipe smoking is increasing in popularity worldwide. However, compared to cigarettes, regulation of waterpipe product smoking lags behind and presents unique challenges. In search for regulatory options, this systematic review analyzes 36 studies on the differential effects on human health of the waterpipe characteristics including smoking products, heating sources, device components, and packages.<h4>Methods</h4>A syste ...[more]

PMID: 32934615

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Project description:IntroductionWaterpipe (hookah) use is becoming more prevalent in the United States and abroad with potential implications for public health. As waterpipe use rapidly grows in popularity, novel data streams are needed that can help capture and document the social and environmental context in which individuals use, and are marketed, this emerging tobacco product. This study characterized waterpipe-related posts on Instagram in order to inform regulatory and policy activities in the United States.MethodsData were collected from Instagram, an image-based social media site. Inclusion criteria for this study comprised an Instagram post with the hashtag "#hookah" that was accompanied by geo-location metadata demonstrating that the post was inside the contiguous United States. Rules were established for coding themes of images (n = 1705).ResultsSeven percent of images depicted a single person using a waterpipe and/or blowing smoke, 25% depicted two or more persons lounging and/or using a waterpipe, 6% depicted waterpipes, coals or flavored tobacco without people, 18% of images were promotional material for hookah lounges and restaurant/bars/nightclubs referencing hookah in the text or depicting a waterpipe, 25% were non-waterpipe-related promotional material, 1% were sexually explicit material, and 18% other. 31% of all images depicted or referenced alcohol. 30% of posts provided geo-location from a hookah lounge, 56% from a restaurant/bar/nightclub, and 14% from other types of locations.ConclusionsThe cross promotion of waterpipe and alcohol use by hookah lounges, and restaurants/bars/nightclubs suggests that poly-substance use is regularly depicted, and promoted, in nightlife entertainment as well as normalized on Instagram in the United States.ImplicationsIn the US Instagram posts with the hashtag #hookah regularly depicted waterpipe use in conjunction with alcohol use. Instagram's focus on images facilitates picture-based advertising where hookah lounges promote drink specials at the same time nightclubs promote waterpipe specials. Instagram users often document the variety of shapes, sizes, and styles, of waterpipes, suggesting users take pride in their purchases and like to show their customized, and often times elaborate, waterpipes to their followers. Instagram has been underutilized in understanding tobacco related-behaviors and identifying tobacco-related promotional material.

Project description:IntroductionThis study investigated the immediate effects of brief education messages delivered online about harms and addictiveness of waterpipe tobacco use among young adult waterpipe users aged 18 to 30 years.MethodsParticipants (n = 327, mean age 24.8 years, 62.1% male, 77.6% white, 67.8% used waterpipe monthly, 26.4% weekly, 5.8% daily) were recruited online and randomized to one of three experimental conditions: (1) Control condition viewing no messages; (2) Harms condition viewing messages about harms of waterpipe tobacco; (3) Harms and addiction condition viewing messages about harms and addictiveness of waterpipe tobacco. Outcomes included perceived harm and addictiveness of waterpipe, worry about harm and addiction, and desire to quit.ResultsCompared to the control condition, participants in the harms condition reported significantly greater perceived harm and addictiveness of waterpipe relative to cigarettes, perceived risk of harm and addiction, worry about harm and addiction, and desire to quit. There were few significant differences in these outcomes between participants in the harms condition and the harms and addiction condition. Mediation analyses suggest waterpipe tobacco use harm messages may increase desire to quit by producing greater worry about harm and addiction.ConclusionsBrief education messages about waterpipe tobacco use harm increased young adult's perceptions of harm and addictiveness of waterpipe tobacco use and generated stronger desire to quit. The waterpipe tobacco use addiction messages tested had little added impact. Studies should prospectively examine the real-world impact of waterpipe tobacco use harm messages and investigate more effective strategies for designing addiction messages.ImplicationsThis study demonstrates that brief education messages about waterpipe tobacco use harm can increase young adult waterpipe tobacco user's perceptions of harm and addictiveness of waterpipe tobacco use and generate stronger desire to quit. The findings indicate messages on addictiveness of waterpipe tobacco use have no added impact on these outcomes.

Project description:IntroductionE-cigarettes are increasingly being marketed as containing tobacco-free nicotine (TFN). There is no data examining use of TFN e-cigarettes by young adults and how use may differ from non-TFN e-cigarettes. The current study aims to characterize young adult TFN e-cigarette use and examine differences between those who report using TFN and non-TFN e-cigarettes.MethodU.S. young adults (18-25) with lifetime e-cigarette use (n = 927) were recruited via online panels in Fall 2021 and answered questions about TFN and non-TFN e-cigarettes. Participants were categorized by lifetime TFN e-cigarette use status (yes vs. no; 34% yes). Bivariate comparisons examined differences in e-cigarette characteristics (device type, flavors, nicotine concentration) between the TFN and non-TFN groups. Binary logistic regression models examined associations between lifetime frequency of vaping (<100 vs. ≥100 times), and other tobacco product, cannabis, and/or alcohol use and lifetime TFN e-cigarette use (yes vs. no). Adjusted models include age, race/ethnicity, vaping onset age, and sex.ResultsIn multivariable adjusted models, lifetime TFN e-cigarette use was associated with younger age, greater lifetime vaping, and nicotine pouch use. Young adults who used TFN e-cigarettes were more likely to report fruit, mint, menthol, and beverage flavors and know their e-liquid nicotine concentration compared with those who used non-TFN e-cigarettes.ConclusionAmong young adults who have used e-cigarettes, more frequent e-cigarette use and use of nicotine pouches, which can also contain TFN, were associated with TFN e-cigarette use. Understanding behaviors and characteristics of those using TFN e-cigarettes is critical to regulation of TFN containing products.ImplicationsThis study characterizes young adults who report experience with tobacco free nicotine (TFN) e-cigarettes and compares them to those who have not used TFN e-cigarettes. Young adults with more frequent e-cigarette use and use of nicotine pouches are more likely to report TFN e-cigarette use.

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Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use.

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Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use.

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