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Sylvester Researcher Addressed the Alarming Health Risks of Hookah Smoking and Vaping in Preparation for World No Tobacco Day

In preparation for World No Tobacco Day 2023, observed on May 31st, Taghrid Asfar, M.D. at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, and her Hookah and E-cigarettes Health Communication Group are shedding light on the alarming health risks associated with hookah smoking and vaping, commonly known as e-cigarette smoking. The research team aims to leverage the power of pictorial health warning labels as a strategic tool to combat the rise of hookah smoking and vaping.

“It is alarming to note that hookah smoking has emerged as a significant public health issue, especially among young people globally, largely due to the misguided belief that it is safer than traditional cigarette smoking,” said Dr. Asfar, associate professor in the Division of Epidemiology and Population Health Sciences in the Department of Public Health Sciences.

The research team's main goal is to disseminate vital information about the health risks linked to hookah smoking and vaping while emphasizing the crucial role of pictorial health warning labels in curbing their use. The target audience includes young people, both hookah and vape users and nonusers. 

“With the prevalence of these ‘gateway’ tobacco products among young individuals, it has become imperative to address the lack of awareness regarding their addictive nature and potential harms,” said Dr. Asfar.

“We want to increase awareness, prevent and reduce initiation, and promote cessation among these groups,” she continued.

Vaping has become the leading tobacco/nicotine product among young individuals in the United States. Vape marketing claims, such as product safety, play a pivotal role in driving uptake and use among young people, ultimately leading to nicotine dependence and an increased risk of cigarette smoking initiation.

The Food and Drug Administration (FDA) mandates that tobacco packages must display a conventional text-based health warning label that reads, "WARNING: This product contains nicotine. Nicotine is an addictive chemical." Dr. Asfar asserts that while this requirement represents a commendable initial measure, there is growing evidence suggesting that pictorial health warning labels have a more significant impact in decreasing smoking rates and mitigating the associated health risks and fatalities.

By incorporating visual elements alongside textual information, and presenting them in a large and vibrant format, pictorial health warning labels possess a distinct capacity to convey compelling messages instantly. Pictorial labels enhance the effectiveness of tobacco warning messages, fostering greater awareness and promoting healthier choices among consumers.

Motivated by this knowledge, the research team has undertaken the mission to develop and rigorously test evidence-based pictorial health warning labels for both hookah and e-cigarettes, aiming to rectify the misperception surrounding these products. 

Employing the Delphi method – a research technique used to gather expert opinions and reach a consensus on a specific topic – the research team involved tobacco control experts in the development of health warning labels. By engaging in multiple rounds of feedback and evaluation, the experts helped identify 24 effective health warning labels, categorized into six themes (T): T1-Addiction, T2-Harm compared to cigarettes, T3-Harm to others, T4-Health effects, T5-Quitting, and T6-Specific harms. 

mouth cancer from smoking

Health warning labels created by Dr. Asfar and the research team.

The labels were then further tested in focus groups with young adult hookah users to gather additional insights and preferences where participants expressed that the rankings were primarily influenced by the labels' ability to elicit shock, fear, disgust, and concern about the adverse consequences of hookah smoking. 

Feedback from the participants suggested improvements such as using shorter text, incorporating statistics, and providing a source of information, such as the Centers for Disease Control and Prevention (CDC). Recommendations were made to prominently display health warning labels on the hookah device. pregnancy harm due to smoking

The research team has also developed other 24 health warning labels for vapes corresponding to three themes (T): T1- Toxicity (e.g., harmful chemicals), T2- Health risks (e.g., harmful effects on the lungs, vape-specific harm such as explosion and poisoning), and T3-Vape specific themes including vapes’ effect on smoking cessation, vapes’ effects on smoking initiation, and industry-promoted misconceptions (e.g., the safety of the product). These labels are currently undergoing testing among young people to ensure their efficacy. 

tobacco industry leaders

lung disease due to smoking

In today's era dominated by social media and digital communications, the Hookah and E-cigarettes Health Communication Group recognizes the need to leverage these platforms on World No Tobacco Day to raise awareness about the significance of pictorial health warning labels. 

By promoting public health, reducing tobacco-related harms, and empowering individuals to make healthier choices, these labels can play a pivotal role in safeguarding the well-being of individuals and communities worldwide. “Our community can work together towards implementing policy changes and educating society on the health risks of hookah smoking and vaping,” said Dr. Asfar.

Written by Deycha Torres Hernández
Published on May 24, 2023