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Waterpipe Warning Placement and Risk Perceptions: An Eye Tracking Study

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Objectives: The purpose of this study was to select a health warning message location on a waterpipe (WP) that both attracted visual attention and conveyed the risks associated with WP smoking. Methods: During June through November 2019, we conducted a within-subjects randomized experiment (N = 74) using eye tracking equipment to examine visual attention to 3 placements of a health warning on the WP (stem, water bowl, hose). We asked young adult ever WP users 3 questions about WP harm perceptions. We used generalized linear mixed models to examine the amount of fixation time spent on the placement locations; we used repeated measures ANOVA to model changes in harm perceptions. Results: There were statistically significant differences across all 3 placement locations; regardless of place, all HWLs attracted a comparable amount of visual attention. Absolute WP harm perceptions significantly increased following the experiment and remained significantly higher at the one-week follow-up, compared to baseline. Conclusions: Warnings on WPs attracted visual attention and increased harm perceptions, and those harm perceptions remained high one week after the experiment. Findings indicate the value of including a warning on the WP device, and underscore the necessity and effectiveness of those health warnings to combat WP harm misperceptions.
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Keywords: ADDICTION; HEALTH COMMUNICATIONS; HEALTH POLICY; SMOKING AND HEALTH; TOBACCO CONTROL; WATERPIPES

Document Type: Research Article

Affiliations: 1: Elizabeth G. Klein, Associate Professor, The Ohio State University College of Public Health, Columbus, OH, United States;, Email: [email protected] 2: Mahmood A. Alalwan, Student Research Assistant, The Ohio State University College of Public Health, Columbus, OH, United States 3: Michael L. Pennell, Associate Professor, The Ohio State University College of Public Health, Columbus, OH, United States 4: David Angeles, Graduate Research Assistant, The Ohio State University, Columbus, OH, United States 5: Marielle C. Brinkman, Senior Research Scientist, The Ohio State University College of Public Health, Columbus, OH, United States 6: Brittney Keller-Hamilton, Research Scientist, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States 7: Megan E. Roberts, Assistant Professor, The Ohio State University College of Public Health, Columbus, OH, United States 8: Paul Nini, Professor, The Ohio State University, Columbus, OH, United States 9: Amy K. Ferketich, United States, Professor, The Ohio State University College of Public Health, Columbus, OH, United States

Publication date: January 1, 2021

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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