Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries

Bibliographic Data

ID22945292
AuthorsRamzi G Salloum (0000-0002-8139-2418, University of Florida, corresponding author), Rima Nakkash (0000-0001-8800-5591, American University of Beirut), Niveen M E Abu-Rmeileh (0000-0003-0831-9692, Birzeit University), Randah R Hamadeh (0000-0002-4205-1354, Arabian Gulf University), Muhammad W Darawad (0000-0003-3314-7933, School of Nursing, The University of Jordan, Queen Rania Street, 11942 Amman, Jordan), Khalid A Kheirallah (Jordan University of Science and Technology), Khalid Kheirallah (0000-0003-4504-4472, Jordan University of Science and Technology), Yahya Al‐Farsi (0000-0002-0302-7132, Sultan Qaboos University), Yahya Al-Farsi (Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 35, 123, Al Khod, Muscat, Oman), Afzalhussein Yusufali (0000-0003-3378-2646, Hatta Hospital, Dubai Health Authority and Dubai Medical College, 35th Street, PO Box 2017, Dubai, United Arab Emirates), Justin Thomas (0000-0002-6496-6387, Zayed University), Aya Mostafa (0000-0002-2803-2608, Ain Shams University), Mohamed Salama (0009-0000-9950-3342, Mansoura University), Lama El Kadi (0000-0003-4800-3932, American University of Beirut), Sukaina Alzyoud (0000-0002-6593-4993, Hashemite University), Nihaya Al-Sheyab (0000-0002-6106-1099, Jordan University of Science and Technology), James F Thrasher (0000-0001-6418-4863, University of South Carolina)
Year2019
Volume34
Issue6
Pages1157-1166
Publication date2019-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Promotion International (JOURNAL)
Journal identifiersISSN: 0957-4824 • E-ISSN: 1460-2245
PublisherOxford University Press (OUP) (PUBLISHER)
DOI10.1093/heapro/day084
PMID30412234
OpenAlexW2899987738
LanguageEN
Citations received9
References cited24

The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18–29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults.

Environmental health · Geography · Logistic regression · Multinomial logistic regression · Nicotine · Public health · Smoke · Tobacco control · Demography · Economic and Environmental Valuation · Medicine · Organic Food and Agriculture · Smoking Behavior and Cessation