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.