| Summary: | Background
Waterpipe smoking
originated in the Eastern Mediterranean region. It is highly prevalent among
university students, and has been increasing in popularity despite mounting
evidence showing it is harmful to health. The aim of this study was to measure
preferences for waterpipe smoking and determine which product characteristics
are most important to smokers.
Methods
Participants in 5
countries (Egypt, Jordan, Oman, Palestine, and UAE) completed an Internet-based
discrete choice experiment to reveal their preferences for, and trade-offs
between, the attributes of hypothetical waterpipe smoking sessions.
Participants were presented with waterpipe lounge menus, each with 6 fruit-flavored
options and 1 tobacco flavored option, in addition to an opt out option.
Participants were randomized to either receive menus with a pictorial+text
health-warning message or no message. Multinomial and nested logit models were
used to estimate the impact on consumer choice of attributes and
between-subject assignment of health warnings respectively.
Results
On average,
participants preferred fruit-flavored varieties to tobacco flavor. They were
averse to options labelled with higher nicotine content. Females and
non-smokers of cigarettes were more likely than their counterparts to prefer flavored
and nicotine-free varieties. Participants exposed to a health warning were more
likely to opt out.
Conclusions
Fruit-flavored tobacco
and lower nicotine content labels, two strategies widely used by the industry,
increase the demand for waterpipe smoking among young adults.
Waterpipe-specific regulation should limit the availability of flavored
waterpipe tobacco and require accurate labelling of constituents. Waterpipe-specific
tobacco control regulation, along with research to inform policy, is required
to curb this emerging public health threat.
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