The Importance of Health Warning Labels on Hookah Products

The Tobacco Control experts at the "Hookah and E-Cigarette Health Communication Group", headquartered in Florida, are collaborating to understand the impact of health warning labels on reducing the use of Hookah among young people. The first phase of this important research is about to conclude. The University of Miami and Florida International University are leading this effort with legal guidance from experts across the country.

There is a large amount of misinformation regarding the dangers of smoking hookah that the public, especially young people, are not aware of. Additionally, since hookah use often takes place in hookah lounges and restaurants, where employees prepare and serve the hookah, patrons may not see warning labels on the packaging. These lounges also benefit from a lack of regulation and oversight, which limits the impact of local policies in providing important health information to consumers.

The reality is that using hookah is dangerous and addictive. Evidence shows that hookah smoking is becoming increasingly common among young people in the United States, with a majority of recent smokers reporting sporadic use within the past 30 days. In Florida, hookah smoking is on the rise, especially among young individuals. Data from the Florida Youth Tobacco Survey reveals that in 2021, hookah smoking surpassed cigarette smoking among high school students, trailing only behind e-cigarettes and cigars.

Although many users believe it to be less harmful, research suggests that hookah smoke contains many of the same harmful components found in cigarette smoke, such as nicotine, tar, and heavy metals. Both hookah and cigarette smoke contain several known toxic substances that can cause lung cancer, bladder cancer, and oral cancer. In a typical one-hour hookah session, smokers inhale 100-200 times the smoke of a single cigarette.

Shisha smoking could also pose a risk to non-users. Even after the smoke has gone through the water, shisha smoke can still increase levels of toxic substances. Secondhand smoke from shisha could potentially pose a health risk to non-smokers. It contains tobacco smoke as well as smoke from the heat source used in shisha, such as charcoal.

The societal appeal of hookah, particularly among teenagers and young adults, should not be underestimated. Dr. Taghrid Asfar, Associate Professor of Epidemiology at the Miller School of Medicine's Department of Public Health Sciences, explains that hookah lounges are attractive to young consumers because they can hang out with friends, it's relatively inexpensive, considered a low-risk activity, and still has a trendy element. It's crucial that consumers understand the high-risk of addiction and health consequences associated with these products. Research on health warning labels will aid in effectively communicating these risks.

One of the most successful tobacco control strategies for conveying smoking-related risks is the use of health warning labels. Research consistently shows a correlation between health warning labels and a decrease in smoking rates, smoking-related illnesses, and deaths. Given this information, our project emphasizes the importance of developing new health warning labels for waterpipe products, not only to increase awareness at the local level, but also at the national and international level. Examining the impact of health warning labels can help advance risk communication and present innovative ideas to decision-makers.

The first round of research on the attitudes and behaviors of college students towards hookah and health warning labels is nearing completion, with a study set to be released in September 2022. The first research project, "Development and Testing of Water Pipe-Specific Health Warning Labels for Young Adults in Florida," is being funded by the James and Esther King Biomedical Research Program at the Florida Department of Health. The project aims to develop and test a set of picture health warning labels for hookah products.

Dr. Wasim Maziak, a professor in the Department of Epidemiology at Florida International University, has stated that a focus group has tested health warning labels and confirmed that people lack awareness of the risks associated with using hookah. Furthermore, when hookah users see these warning labels, their behavior changes, particularly their usage of the product decreases. This supports the viewpoint that warning labels need to be present on hookah devices themselves.

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