As shisha smoking is increasing globally, the need for a critical action to control shisha smoking consumption becomes crucial. Despite the success of cigarette warning labels in increasing smokers' awareness of the negative health effects of smoking and in motivating smokers to quit, nothing is known about the potential impact health warning labels may have on shisha users. The current study investigated the perception of effectiveness of text-only versus graphic warning among shisha smokers. This study sought to examine the impact of viewing health warning labels on perceived susceptibility and severity of shisha smoking health hazards, on motivating intentions to quit, and on changing the pattern of shisha smoking. Eligible participants first completed an online baseline questionnaire, and were then randomly assigned to one of three conditions:a control condition, in which they viewed nutrition labels (n=100) , or one of two experimental groups in which they viewed Text- only warning labels (n=117), or they viewed Graphic warning labels (n=125). In each of these three conditions, participants viewed six health warning labels and rated them using likert scale questions immediately following each label. Two weeks later, participants were invited to complete an online follow-up questionnaire. The findings indicate that Graphic tobacco warnings grab participants' attention and elicit unfavourable emotional reactions. Although there was a relatively little impact of viewing health warnings on subsequent shisha use, Graphic warnings significantly improved some of the participants' health knowledge .In addition, Graphic warnings significantly increased smokers' beliefs that shisha is harmful to health and dangerous to non-smokers. Patterns of the findings revealed that quit intentions were relatively higher among those who viewed Graphic warning labels. To our knowledge, this study is the first to examine the effect of health warnings on shisha smokers. Overall, findings provide modest support for the efficcacy of shisha warnings on establised users. Findings imply that packaging and labelling policies for shisha and shisha products require additional development. Further examination of specific themes and contents of health warnings directed specifically to shisha smokers in different cultural settings will be critical to ensure the relevance of health warnings in distinct cultural settings.

As shisha smoking is increasing globally, the need for a critical action to control shisha smoking consumption becomes crucial. Despite the success of cigarette warning labels in increasing smokers' awareness of the negative health effects of smoking and in motivating smokers to quit, nothing is known about the potential impact health warning labels may have on shisha users. The current study investigated the perception of effectiveness of text-only versus graphic warning among shisha smokers. This study sought to examine the impact of viewing health warning labels on perceived susceptibility and severity of shisha smoking health hazards, on motivating intentions to quit, and on changing the pattern of shisha smoking. Eligible participants first completed an online baseline questionnaire, and were then randomly assigned to one of three conditions:a control condition, in which they viewed nutrition labels (n=100) , or one of two experimental groups in which they viewed Text- only warning labels (n=117), or they viewed Graphic warning labels (n=125). In each of these three conditions, participants viewed six health warning labels and rated them using likert scale questions immediately following each label. Two weeks later, participants were invited to complete an online follow-up questionnaire. The findings indicate that Graphic tobacco warnings grab participants' attention and elicit unfavourable emotional reactions. Although there was a relatively little impact of viewing health warnings on subsequent shisha use, Graphic warnings significantly improved some of the participants' health knowledge .In addition, Graphic warnings significantly increased smokers' beliefs that shisha is harmful to health and dangerous to non-smokers. Patterns of the findings revealed that quit intentions were relatively higher among those who viewed Graphic warning labels. To our knowledge, this study is the first to examine the effect of health warnings on shisha smokers. Overall, findings provide modest support for the efficcacy of shisha warnings on establised users. Findings imply that packaging and labelling policies for shisha and shisha products require additional development. Further examination of specific themes and contents of health warnings directed specifically to shisha smokers in different cultural settings will be critical to ensure the relevance of health warnings in distinct cultural settings.

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Waterpipe tobacco smoking has migrated from being a custom of some cultures to becoming a staple around college campuses. The social nature and flavored tobacco encourage initiation in this tobacco naïve age group. The study was a sequential mixed method design, employing primary data collection and analysis of a random sample of university students who live on campus at a single university. The study involved observations (N=6), intercept interviews with smokers and nonsmokers (N=63), three focus groups (N=31), and an online survey (N=288). Findings were centered on the constructs of the Theory of Reasoned Action by Ajzen and Fishbein (1975), who propose there are specific precursors that lead to intention to perform a behavior. The data suggested that attitudes were more positively correlated with intention to smoke waterpipe tobacco than subjective norm. Attitude is influenced by outcome expectancies. The data suggest that positive outcome expectancies are influenced primarily by the social nature of hookah smoking and other perceived positive benefits. Negative health effects and family/culture were also influential, albeit to a lesser extent. Development of interventions focused on an attitudinal shift may help to decrease uptake and continuation of waterpipe tobacco smoking in this population.

Shisha-Tabak benötigt im Vergleich zur Zigarette höhere Konzentrationen des Feuchthaltemittels Glycerin. Seit Mai 2016 ist die bis dahin gültige Limitierung von Feuchthaltemitteln in Tabak auf 5 % aufgehoben. Derzeit ist das toxikologische Profil des Glycerins jedoch noch nicht hinreichend erforscht. Ziel dieser Arbeit war es, Glycerin auf mögliche zyto- und genotoxische Effekte zu untersuchen, um so das Gefährdungspotenzial durch Glycerin im Shisha-Tabak zu beurteilen und die tabakkontrollpolitische Situation in Deutschland zu diskutieren. Dafür wurden Lymphozyten sowie Nasenschleimhautzellen von 10 Patienten für eine Stunde Glycerin (0,001 mol/l bis 6,0 mol/l) exponiert. Durch den Trypanblau-Ausschlusstest wurden die Zellen auf Zytotoxizität, mittels Einzelzellgelelektrophorese (Comet Assay) und Mikrokern-Test auf Genotoxizität untersucht. Im Trypanblau-Ausschlusstest traten bei Lymphozyten sowie nasalen Mukosazellen signifikante Vitalitätsabfälle ab Glycerin-Konzentrationen von 1,0 mol/l auf. Im Comet Assay konnten für beide Zellgruppen signifikante Unterschiede des Olive Tail Moments (OTM) ab 1,0 mol/l nachgewiesen werden. Beim Mikrokern-Test zeigten sich keine signifikanten Zunahmen der Mikrokern-Anzahl. Es konnten zyto- und genotoxische Effekte ab Konzentrationen von 1,0 mol/l nachgewiesen werden. Dies überschreitet die reale Glycerin-Belastung im Hauptstromrauch der Shisha jedoch deutlich. Dennoch handelt es sich bei Genotoxizität um ein stochastisches Risiko. Ebenso sind toxische Effekte, beispielsweise durch Erhitzung, bereits bei geringeren Konzentrationen denkbar. Für eine umfangreichere Beurteilung von Feuchthaltemitteln im Shisha-Tabak sind weitere Untersuchungen indiziert. Darüber hinaus besteht enormer Handlungsbedarf zur weiteren Einführung tabakkontrollpolitischer Maßnahmen in Deutschland. / Shisha tobacco has a higher amount of glycerol than cigarette tobacco. Moreover, new legislation in Germany cancels the old limitation of humectants in shisha tobacco. Although higher amounts of glycerol in tobacco are expected, the knowledge of the toxicological profile of glycerol regarding human cells is incomplete. Aim of the study was to test glycerol for cytotoxic and genotoxic effects and to discuss the risk of humectants in shisha tobacco and the situation of German tobacco control. Lymphocytes and nasal mucosa cells of 10 patients were exposed to different glycerol levels (0.001 mol/l to 6.0 mol/l). Cytotoxic effects were examined by trypan blue exclusion test, genotoxic effects by comet assay and micronucleus test. The trypan blue exclusion test revealed significant cytotoxic effects on lymphocytes and nasal mucosa cells for glycerol concentrations of 1.0 mol/l and higher. In the comet assay a significant DNA damage could be shown for glycerol levels of 1.0 mol/l and higher. No significant micronucleus formation was monitored. While the geno- and cytotoxicity were seen in concentrations of glycerol clearly exceeding the concentrations in main stream smoke of shishas, genotoxicity is a stochastic risk occurring even at subtoxic levels. Furthermore, toxicity in lower levels could result from tobacco combustion or interactions with other smoke components. For an extensive evaluation of the risks of humectants in shisha tobacco further studies are needed. In addition, there is an enormous need for introducing further measures of tobacco control policy in Germany.