Tobacco industry marketing strategies that affect perception and use of waterpipe in Ukraine
BACKGROUND: According to Global Adult Tobacco Survey conducted in Ukraine in 2010, only 31% of adults pointed to health hazards of waterpipe smoking while corresponding levels for cigarettes were much higher. Higher prevalence of use was found in young urban adults with university education. Students lifestyle surveys revealed that up to 70% of students had smoked waterpipe at least once in their lifetime. Thus we aimed to clarify possible mechanisms in charge of widespread use and favorable attitude of young adults towards waterpipe smoking by means of a qualitative study.
METHODS: Semistructured interviews were conducted with 27 university students in Kiev city. Respondents were 11 males and 16 females aged 17-26 years. Convenience sampling was applied. Questions encompassed personal experience of, attitudes towards, and perception of waterpipe smoking.
RESULTS: Waterpipe is perceived by students as a safer alternative of cigarettes. Less irritating smoke is taken as a sign of no adverse health impact. Students are attracted by sweet smell and taste of tobacco smoke produced by waterpipe. Those who had observed the waterpipe tobacco packages reported that they bear pictures of fruit and create perception of a healthy product inside. On some packages, health warnings and the information regarding content are either absent or written in a language customers cannot read. Tobacco and accessories were reported to have been displayed in most attractive places in supermarkets.
CONCLUSIONS: The study reveals the necessity to strengthen the awareness campaign depicting the devastating consequences of waterpipe use. To close the existing loopholes, the Ukrainian legislation needs to require health warnings on waterpipe packages which differ from those on cigarette packs, ban of tobacco products display at the points of sales, and ban of fruity additives to tobacco.
Akl, E. A., Gunukula, S. K., Aleem, S., Obeid, R., Jaoude, P. A., Honeine, R., & Irani, J. (2011). The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review. BMC Public Health, 11(1), 244.
Aljarrah, K., Ababneh, Z. Q., & Al-Delaimy, W. K. (2009). Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users. Tobacco Induced Diseases, 5(1), 16.
Andreeva, T. I. (2010). Nargile smoking as a new risk factor for tuberculosis spread in Ukraine (in Ukrainian). In T. Semigina (Ed.), Conteraction of socially insecure illnesses: Ukrainian experience (pp. 107-119). Kyiv; National University of Kyiv-Mohyla Academy: Pulsary.
Andreeva, T. I. (2012). Prevalence of waterpipe smoking among university students in Russia and Ukraine is threatening. Tobacco Control and Public Health in Eastern Europe, 2(Supplement 1, 2nd conference 'Economics, sociology, theory and practice of public health'), s51. doi: 10.6084/m9.figshare.92813
Asfar, T., Ward, K. D., Eissenberg, T., & Maziak, W. (2005). Comparison of patterns of use, beliefs, and attitudes related to waterpipe between beginning and established smokers. BMC Public Health, 5(1), 19.
Cavus, U. Y., Rehber, Z. H., Ozeke, O., & Ilkay, E. (2010). Carbon monoxide poisoning associated with narghile use. Emergency Medicine Journal, 27(5), 406-406.
Eissenberg, T., Ward, K. D., Smith-Simone, S., & Maziak, W. (2008). Waterpipe tobacco smoking on a US College campus: prevalence and correlates. Journal of Adolescent Health, 42(5), 526-529.
El-Nachef, W. N., & Hammond, S. K. (2008). Exhaled carbon monoxide with waterpipe use in US students. JAMA: the journal of the American Medical Association, 299(1), 36-38.
Grekin, E. R., & Ayna, D. (2008). Argileh use among college students in the United States: an emerging trend. J Stud Alcohol Drugs, 69(3), 472-475.
Hammal, F., Mock, J., Ward, K., Eissenberg, T., & Maziak, W. (2008). A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria. Tob Control, 17(2), e3-e3.
Hookah Smoking - A Growing Threat to Public Health. (2010). from http://www.lung.org/
Khalil, J., Heath, R. L., Nakkash, R. T., & Afifi, R. A. (2009). The tobacco health nexus? Health messages in narghile advertisements. Tob Control, 18(5), 420-421.
Knishkowy, B., & Amitai, Y. (2005). Water-pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 116(1), e113-e119.
Lewis, M. J., & Wackowski, O. (2006). Dealing with an innovative industry: a look at flavored cigarettes promoted by mainstream brands. Am J Public Health, 96(2), 244-251. doi: 10.2105/AJPH.2004.061200
Martinasek, M. P. (2011). Understanding the Psychosocial Aspects of Waterpipe Smoking Among College Students. University of South Florida.
Maziak, W. (2010). Commentary: The waterpipe—a global
epidemic or a passing fad. Int J Epidemiol, 39(3), 857-859.
Mirahmadizadeh, A., & Nakhaee, N. (2008). Prevalence of waterpipe smoking among rural pregnant women in Southern Iran. Medical Principles and Practice, 17(6), 435-439.
Nakkash, R., & Khalil, J. (2010). Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories. Tob Control, 19(3), 235-239.
Noonan, D. (2010). Exemptions for hookah bars in clean indoor air legislation: A public health concern. Public Health Nursing, 27(1), 49-53.
Partial guidelines for implementation of articles 9 and 10 of the WHO Framework Convention on Tobacco Control: Regulation of the contents of tobacco products and of tobacco product disclosures. Retrieved June 11, 2013, from http://who.int/entity/fctc/guidelines/Guidelines_Articles9and10_COP5.pdf
Primack, B. A., Sidani, J., Agarwal, A. A., Shadel, W. G., Donny, E. C., & Eissenberg, T. E. (2008). Prevalence of and associations with waterpipe tobacco smoking among US university students. Annals of Behavioral Medicine, 36(1), 81-86.
Roskin, J., & Aveyard, P. (2009). Canadian and English students' beliefs about waterpipe smoking: a qualitative study. BMC Public Health, 9(1), 10.
Smith, S. Y., Curbow, B., & Stillman, F. A. (2007). Harm perception of nicotine products in college freshmen. Nicotine & Tobacco Research, 9(9), 977-982.
Ukraine Global Adult Tobacco Survey country report. (2010). Kiev: Ministry of Health of Ukraine.
WHO. (2005). Waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators. Geneva, Switzerland: World Health Organization.
WHO. (2013a). Fact sheet N°339: Tobacco from http://www.who.int/mediacentre/factsheets/fs339/en/index.html
WHO. (2013b). Waterpipe tobacco use. from http://www.emro.who.int/fr/health-topics/tobacco/waterpipe-tobacco-use/All-Pages.html
Wolfram, R. M., Chehne, F., Oguogho, A., & Sinzinger, H. (2003). Narghile (water pipe) smoking influences platelet function and (iso-) eicosanoids. Life sciences, 74(1), 47-53.
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