Abstract: In the past decade waterpipe smoking (WP; hookah) has become the No. 1 tobacco use method
among youth in the Eastern Mediterranean Region (EMR), yet evidence-based solutions to the WP epidemic
continue to lag behind. This is mainly due to 2 factors; 1) the mismatch of policy solutions derived from
cigarettes to local tobacco use methods such as the WP; and 2) the lack of understanding of local tobacco
control (TC) policy environment and challenges to implementation. On the other hand, the WHO’s Framework
Convention on Tobacco Control (FCTC) ratified by most countries in the EMR provides an opportunity to
address WP smoking in the region. Supported by program TOBAC since its beginning in 2002, our team at the
Syrian Center for Tobacco Studies (SCTS) has been on the forefront of characterizing the WP epidemic and its
health and addictive properties. Such groundwork has prepared us to plan for the next stage of translating
evidence into policy to support EMR efforts to control the WP epidemic. Given the widespread misperceptions
that WP is less harmful and addictive than cigarettes, and the value of health warning labels (HWLs) in
communicating smoking-related risks, the development of HWLs is a priority for WP control. Developing HWLs
for the WP however, requires their adaptation to its unique multi-part context comprised of tobacco, device and
charcoal, while implementation of WP-HWLs requires an understanding of the local policy environment, and
strong national partnerships. Building on our ongoing collaboration with Lebanon (American University of
Beirut) and Tunisia (University of Tunis), we want to assist these countries in developing and implementing
effective HWLs for the WP and in building their national capacity in TC policy research. We will apply a mixed
method approach to develop and test HWLs with the involvement of members of the target population
comprised mostly of young adults (18-25 years). We will also study the structure and functioning of local health
systems in Tunisia and Lebanon, so we can propose a clear roadmap for the implementation of WP-HWLs,
and establish partnerships among researchers and policymakers than can facilitate such implementation. This
application represents our team’s continuing leadership in responding to the WP epidemic, and in
strengthening TC capacity in the EMR. It will help Tunisia and Lebanon, and perhaps other countries develop
effective HWLs for WP, and equip them with the means to implement them successfully.
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