Trial Outcomes & Findings for Reactions to Warnings on Hookah Ads (NCT NCT03723616)

NCT ID: NCT03723616

Last Updated: 2025-12-18

Results Overview

Participants rated on 7-point bipolar scales the extent each ad made them feel not at all anxious/very anxious, not at all worried/very worried, not at all fearful/very fearful and good /bad. Reported as a composite score created by averaging the items. Mean scores range from 1 to 7 where higher mean values represent more negative emotional reactions to viewing the ad.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

2588 participants

Primary outcome timeframe

up to 45 minutes

Results posted on

2025-12-18

Participant Flow

Participants were randomized to one of three health warning label (HWL) arms in a 1:2:2 ratio: 1) ads only, 2) ads with text HWLs only, and 3) ads with text + graphic HWLs within the Social Allure Ads and Product Ads groups.

Participant milestones

Participant milestones
Measure
Social Allure Ads Only
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Overall Study
STARTED
317
618
618
207
415
414
Overall Study
COMPLETED
300
602
598
201
402
401
Overall Study
NOT COMPLETED
17
16
20
6
13
13

Reasons for withdrawal

Reasons for withdrawal
Measure
Social Allure Ads Only
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Overall Study
Attempted to take the survey as both a smoker and a susceptible non-smoker.
17
16
20
6
13
13

Baseline Characteristics

Reactions to Warnings on Hookah Ads

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Social Allure Ads
n=1500 Participants
Participants were randomized to one of three health warning label (HWL) arms in a 1:2:2 ratio: 1) ads only, 2) ads with text HWLs only, and 3) ads with text + graphic HWLs within the Social Allure Ads group. Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads
n=1004 Participants
Participants were randomized to one of three health warning label (HWL) arms in a 1:2:2 ratio: 1) ads only, 2) ads with text HWLs only, and 3) ads with text + graphic HWLs within the Product Ads group. Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Total
n=2504 Participants
Total of all reporting groups
Age, Continuous
24.73 years
STANDARD_DEVIATION 3.49 • n=47 Participants
24.67 years
STANDARD_DEVIATION 3.46 • n=41 Participants
24.71 years
STANDARD_DEVIATION 3.48 • n=88 Participants
Sex: Female, Male
Female
711 Participants
n=47 Participants
523 Participants
n=41 Participants
1234 Participants
n=88 Participants
Sex: Female, Male
Male
789 Participants
n=47 Participants
481 Participants
n=41 Participants
1270 Participants
n=88 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
247 Participants
n=47 Participants
167 Participants
n=41 Participants
414 Participants
n=88 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
1232 Participants
n=47 Participants
810 Participants
n=41 Participants
2042 Participants
n=88 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
21 Participants
n=47 Participants
27 Participants
n=41 Participants
48 Participants
n=88 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
24 Participants
n=47 Participants
12 Participants
n=41 Participants
36 Participants
n=88 Participants
Race/Ethnicity, Customized
Asian
168 Participants
n=47 Participants
104 Participants
n=41 Participants
272 Participants
n=88 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
5 Participants
n=47 Participants
1 Participants
n=41 Participants
6 Participants
n=88 Participants
Race/Ethnicity, Customized
Black or African American
165 Participants
n=47 Participants
110 Participants
n=41 Participants
275 Participants
n=88 Participants
Race/Ethnicity, Customized
White
1010 Participants
n=47 Participants
683 Participants
n=41 Participants
1693 Participants
n=88 Participants
Race/Ethnicity, Customized
Middle Eastern
17 Participants
n=47 Participants
12 Participants
n=41 Participants
29 Participants
n=88 Participants
Race/Ethnicity, Customized
More than one race
90 Participants
n=47 Participants
55 Participants
n=41 Participants
145 Participants
n=88 Participants
Race/Ethnicity, Customized
Unknown or Not Reported
21 Participants
n=47 Participants
27 Participants
n=41 Participants
48 Participants
n=88 Participants
Region of Enrollment
United States
1500 Participants
n=47 Participants
1004 Participants
n=41 Participants
2504 Participants
n=88 Participants

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Participants rated on 7-point bipolar scales the extent each ad made them feel not at all anxious/very anxious, not at all worried/very worried, not at all fearful/very fearful and good /bad. Reported as a composite score created by averaging the items. Mean scores range from 1 to 7 where higher mean values represent more negative emotional reactions to viewing the ad.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Emotional Reactions to Ads
2.81 score on a scale
Standard Error 0.08
3.46 score on a scale
Standard Error 0.06
3.74 score on a scale
Standard Error 0.06
2.83 score on a scale
Standard Error 0.10
3.60 score on a scale
Standard Error 0.07
4.03 score on a scale
Standard Error 0.07

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Participant rated on 9-point bipolar scale an ad's portrayal of WTS. The five attributes that tapped cognitions were: safe/unsafe, healthy/unhealthy, useful/useless, harmful/beneficial, and wise/foolish. The five attributes that captured affect were: pleasant/unpleasant, nice/nasty, enjoyable/not enjoyable, satisfying/unsatisfying, gratifying/revolting. Reported as a composite score created by averaging the items. The mean scores could range from 1 to 7 where a higher mean score reflects a more negative attitude towards WTS.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Attitudes Toward Waterpipe Tobacco Smoking (WTS) as Measured by Questionnaire
3.79 score on a scale
Standard Error 0.08
4.59 score on a scale
Standard Error 0.06
4.84 score on a scale
Standard Error 0.06
3.87 score on a scale
Standard Error 0.10
4.88 score on a scale
Standard Error 0.07
5.31 score on a scale
Standard Error 0.07

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Two items from the University of North Carolina (UNC) short reactance scale were asked from 1=strongly disagree to 7=strongly agree: "This ad is trying to manipulate me", and "This ad annoys me." Reported as a composite score created by averaging the items. Mean scores can range from 1 to 7. A higher mean score reflect higher reactance, meaning that participants felt more reactance (e.g., felt their freedoms were being taken away).

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Reactance to Ads
3.87 score on a scale
Standard Error 0.08
3.99 score on a scale
Standard Error 0.06
3.91 score on a scale
Standard Error 0.06
3.47 score on a scale
Standard Error 0.10
3.79 score on a scale
Standard Error 0.07
3.82 score on a scale
Standard Error 0.07

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Participants used a three-item measure as a gestalt assessment of how well an ad dissuaded WTS. The three items, rated from 1=strongly disagree to 7=strongly agree were: "This ad discourages me from wanting to smoke waterpipe tobacco", "This ad makes me concerned about the health effects of smoking waterpipe tobacco", and "This ad makes smoking waterpipe tobacco seem unpleasant to me". Reported as a composite score created by averaging the items. The mean score could ranged from 1 to 7. A higher mean score reflects that the ad was more effective at dissuading WTS.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Perceived Effectiveness of Health Warnings
2.89 score on a scale
Standard Error 0.09
3.88 score on a scale
Standard Error 0.06
4.13 score on a scale
Standard Error 0.06
3.09 score on a scale
Standard Error 0.11
4.15 score on a scale
Standard Error 0.07
4.46 score on a scale
Standard Error 0.07

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Participants were asked, "To what extent did this ad affect your desire to smoke waterpipe tobacco?" from 1=Reduced my desire a lot to 7=Increased my desire a lot. Mean scores could range from 1 to 7. A higher mean score reflects that the ad increased a participant's desire to smoke waterpipe tobacco.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Ad Effect on Desire to Smoke
4.37 score on a scale
Standard Error 0.08
4.07 score on a scale
Standard Error 0.06
3.89 score on a scale
Standard Error 0.06
4.70 score on a scale
Standard Error 0.10
4.03 score on a scale
Standard Error 0.07
3.79 score on a scale
Standard Error 0.07

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Only applicable to social allure ad participants who completed the study.

Participants who completed the social allure study were asked, "If the activities in the ad were to take place in a location near you, how likely are you to participate in those activities?". Response options were: 1=No chance, 2=Very unlikely, 3=Unlikely, 4=Moderately likely, 5=Likely, 6=Very Likely, and 7=Certain to happen. Mean scores could range from 1 to 7. A higher mean score reflects a higher probability that the participant would participate in the event depicted in the ad.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Ad Effect on Event Participation
3.58 score on a scale
Standard Error 0.09
3.52 score on a scale
Standard Error 0.06
3.43 score on a scale
Standard Error 0.06

PRIMARY outcome

Timeframe: up to 45 minutes

Population: Only applicable to product ad participants who completed the study.

Participants who completed the social allure study were asked, "How likely are you to buy the product in the ad?". Response options were: 1=No chance, 2=Very unlikely, 3=Unlikely, 4=Moderately likely, 5=Likely, 6=Very Likely, and 7=Certain to happen. Means scores could range from 1 to 7. A higher mean score reflects that the study participant would have a higher probability of purchasing the product depicted in the ad.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Ad Effect on Product Purchase
4.04 score on a scale
Standard Deviation 0.13
3.51 score on a scale
Standard Deviation 0.09
3.38 score on a scale
Standard Deviation 0.09

SECONDARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Participants responded to three questions tapping perceived personal risk, "What do you think is your chance of getting a serious smoking-related disease in your lifetime, such as cancer, lung disease or heart disease, if you do not quit waterpipe tobacco smoking?" (1=No chance to 7=Certain to happen), "How worried are you about getting a serious smoking-related disease in your lifetime, such as cancer, lung disease, or heart disease, if you do not quit waterpipe tobacco smoking?" (1=Not at all worried to 7=Extremely worried, and "Your 'gut feeling' tells you that you are hurting your health when you smoke waterpipe tobacco?" (1=Strongly disagree to 7=Strongly agree). Reported as a composite score created by averaging the items. Mean scores could range from 1 to 7. A higher mean score reflects a higher overall belief that one is at higher risk for the negative health effects of smoking waterpipe tobacco.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Perceived Risk as Measured by Questionnaire
4.71 score on a scale
Standard Error 0.07
4.93 score on a scale
Standard Error 0.05
5.03 score on a scale
Standard Error 0.05
4.73 score on a scale
Standard Error 0.10
4.98 score on a scale
Standard Error 0.07
4.90 score on a scale
Standard Error 0.07

SECONDARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Four 7-point bipolar scales tapped views on WTS: negative/positive, dislike/like, bad/good, undesirable/desirable. Reported as a composite score created by averaging the items. The mean scores range from 1 to 7. A higher mean score reflect a more positive overall attitudes towards smoking waterpipe tobacco.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Global Attitude on Waterpipe Tobacco Smoking (WTS)
4.14 score on a scale
Standard Error 0.10
3.83 score on a scale
Standard Error 0.07
3.61 score on a scale
Standard Error 0.07
4.39 score on a scale
Standard Error 0.12
3.85 score on a scale
Standard Error 0.08
3.79 score on a scale
Standard Error 0.09

SECONDARY outcome

Timeframe: up to 45 minutes

Population: Participants who completed the study.

Assessed from 1=Not at all strong to 7=Extremely strong by, "How strong is your urge to smoke waterpipe tobacco right now?" Mean scores range from 1 to 7. A higher mean score reflects the participant had a stronger urge to smoke waterpipe tobacco.

Outcome measures

Outcome measures
Measure
Social Allure Ads Only
n=300 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement.
Social Allure Ads With Text-only Health Warning Labels (HWLs)
n=602 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)
n=598 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad.
Product Ads Only
n=201 Participants
Behavioral: Ads Only Participants will view 2 ads without replacement. Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad. Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text-only Health Warning Labels (HWLs)
n=402 Participants
Behavioral: Ads with text-only health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Product Ads With Text + Graphic Health Warning Labels (HWLs)
n=401 Participants
Behavioral: Ads with text + graphic health warning labels (HWLs) Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four product ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different product ad.
Urge to Smoke
3.34 score on a scale
Standard Error 0.12
3.28 score on a scale
Standard Error 0.08
3.06 score on a scale
Standard Error 0.08
3.82 score on a scale
Standard Error 0.14
3.29 score on a scale
Standard Error 0.10
3.27 score on a scale
Standard Error 0.10

SECONDARY outcome

Timeframe: up to one hour

Population: This outcome measure required participants meeting in person with a lab researcher. However, due to COVID, where a policy was implemented on campus to not allow in-person visits for research studies, this was not possible. Hence, no data were collected and will not be collected in the future.

Participants were going to be positioned to view several ads, and with an apparatus, track their visual movements.

Outcome measures

Outcome data not reported

Adverse Events

Social Allure Ads Only

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Social Allure Ads With Text-only Health Warning Labels (HWLs)

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Social Allure Ads With Text + Graphic Health Warning Labels (HWLs)

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Product Ads Only

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Product Ads With Text-only Health Warning Labels (HWLs)

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Product Ads With Text + Graphic Health Warning Labels (HWLs)

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Isaac Lipkus Reiner, Ph.D.

Duke University

Phone: 919-668-2348

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place