Trial reportAddictive behaviors2026
Effect of graphic warning label on acute changes in waterpipe tobacco smoking behavior, biomarkers of exposure and harm, and subjective effects in a randomized trial.
Trial report in Addictive behaviors, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
18 authors.
Funding
Abstract
introductionWaterpipe (WP) smoking is commonly misperceived as less harmful than cigarette smoking. Graphic warning labels (GWLs) may correct misperceptions and reduce WP smoking. We determined the impact of a GWL placed on a WP on short-term smoking behaviors and other outcomes among young adults who smoke WP.
methodsYoung adults, ages 21-35 years, who smoke WP were randomized to a control (Visit1 = Blank, Visit2 = Blank label) or experimental (Visit1 = Blank, Visit2 = GWL, Visit3 = GWL) group. Participants smoked a research-grade WP in the lab ad lib to satiation, for a maximum of 60 min, for up to 3 visits, each separated by a week. Puffing topography was measured continuously throughout the session. Exhaled CO, harm perceptions, and subjective effects were measured before and after each smoking session. Outcome data were analyzed using linear mixed models to account for incomplete, repeated measurements.
resultsThere were no significant differences in study outcomes within and between assigned groups, except for the following from Visit1 and Visit3 in the GWL group: 1) a reduction in puff volume (p = 0.048); 2) a reduction in good taste and calmness (p = 0.027 and 0.007, respectively); and 3) a reduction in being confused after smoking (p = 0.042).
conclusionsGWLs on WPs may not be the sole effective tool for reducing the harm from WP smoking. More research is needed to determine if WP interventions aimed at improving population health should include a wider variety of tools, such as education, cessation services, and product standards that limit the appealing aspects of WP tobacco.
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