Abstract: In the past decade waterpipe smoking (WP; hookah) has become the No. 1 tobacco use methodamong youth in the Eastern Mediterranean Region (EMR), yet evidence-based solutions to the WP epidemiccontinue to lag behind. This is mainly due to 2 factors; 1) the mismatch of policy solutions derived fromcigarettes to local tobacco use methods such as the WP; and 2) the lack of understanding of local tobaccocontrol (TC) policy environment and challenges to implementation. On the other hand, the WHO’s FrameworkConvention on Tobacco Control (FCTC) ratified by most countries in the EMR provides an opportunity toaddress WP smoking in the region. Supported by program TOBAC since its beginning in 2002, our team at theSyrian Center for Tobacco Studies (SCTS) has been on the forefront of characterizing the WP epidemic and itshealth and addictive properties. Such groundwork has prepared us to plan for the next stage of translatingevidence into policy to support EMR efforts to control the WP epidemic. Given the widespread misperceptionsthat WP is less harmful and addictive than cigarettes, and the value of health warning labels (HWLs) incommunicating smoking-related risks, the development of HWLs is a priority for WP control. Developing HWLsfor the WP however, requires their adaptation to its unique multi-part context comprised of tobacco, device andcharcoal, while implementation of WP-HWLs requires an understanding of the local policy environment, andstrong national partnerships. Building on our ongoing collaboration with Lebanon (American University ofBeirut) and Tunisia (University of Tunis), we want to assist these countries in developing and implementingeffective HWLs for the WP and in building their national capacity in TC policy research. We will apply a mixedmethod approach to develop and test HWLs with the involvement of members of the target populationcomprised mostly of young adults (18-25 years). We will also study the structure and functioning of local healthsystems 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. Thisapplication represents our team’s continuing leadership in responding to the WP epidemic, and instrengthening TC capacity in the EMR. It will help Tunisia and Lebanon, and perhaps other countries developeffective HWLs for WP, and equip them with the means to implement them successfully.
