{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:01:12Z","timestamp":1740128472332,"version":"3.37.3"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Institutes of Health and Fogarty International Center","award":["R01TW010654"],"award-info":[{"award-number":["R01TW010654"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Lebanon has one of the world\u2019s highest waterpipe (WP) consumption rates. Research has documented the effectiveness of implementing pictorial health warning labels (PHWLs) on WP products at encouraging smoking cessation and discouraging youth uptake of smoking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>This study aims to gain insight into key informants\u2019 (KIs) views on the issuance, implementation, and compliance of a decree for PHWLs on WP products. Thirteen KIs (policy makers, media, and international\/local nongovernment organization representatives) were interviewed online and asked about potential barriers and facilitators they saw to issuing and implementing a PHWL decree. They were shown examples of PHWLs and asked about processes needed for implementation and compliance. The policy triangle framework (content, actors, context, and process) was used to interpret findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Although there was clear discrepancy and ambiguousness among the KIs\u2019 views regarding process and actors, there was more consensus and clarity around context and content. Challenges to implementation were: (1) multiple sources of production and supply of WP, (2) uncertainty regarding the responsible actors for each step, (3) prioritization of a tobacco control decree amidst a political and economic crisis, and (4) challenges to practicality of applying PHWL on the WP given its multicomponent nature.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This research provides an in-depth understanding of KI\u2019s views regarding content, actors, context, and process in relation to the issuance, implementation, and compliance to PHWLs on WP products. Noted challenges require careful consideration if progress is to be made to introduce PHWLs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>A growing research base has documented the potential effectiveness of PHWLs on reducing WP consumption. Findings of this study show that implementing PHWLs on WP products requires a distinct understanding of the policy environment and context, as well as content, actors, and processes. Implementing PHWLs on WP tobacco products needs to address the complex nature of WP smoking as a multicomponent tobacco use method.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntae104","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T11:09:50Z","timestamp":1715080190000},"page":"1676-1683","source":"Crossref","is-referenced-by-count":0,"title":["Implementing Pictorial Health Warning Labels on Waterpipe Tobacco Products in Lebanon: A Policy Framework Analysis of Content, Actors, Context, and Process"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8800-5591","authenticated-orcid":false,"given":"Rima","family":"Nakkash","sequence":"first","affiliation":[{"name":"Global and Community Health Department, College of Public Health, George Mason University , Fairfax, VA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-2698","authenticated-orcid":false,"given":"Sanaa","family":"Mugharbil","sequence":"additional","affiliation":[{"name":"Health Promotion and Community Health Department, American University of Beirut , Beirut ,","place":["Lebanon"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5616-9302","authenticated-orcid":false,"given":"Malak","family":"Tleis","sequence":"additional","affiliation":[{"name":"Health Promotion and Community Health Department, American University of Beirut , Beirut ,","place":["Lebanon"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Jaafar","sequence":"additional","affiliation":[{"name":"Health Promotion and Community Health Department, American University of Beirut , Beirut ,","place":["Lebanon"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-9723","authenticated-orcid":false,"given":"Taghrid","family":"Asfar","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Miami , Miami, FL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6126-8420","authenticated-orcid":false,"given":"Wasim","family":"Maziak","sequence":"additional","affiliation":[{"name":"Epidemiology Department, Florida International University , Miami, FL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"issue":"3","key":"2024112205515868500_CIT0001","doi-asserted-by":"crossref","first-page":"e055201","DOI":"10.1136\/bmjopen-2021-055201","article-title":"Prevalence of cigarette and waterpipe tobacco smoking among adults in three Eastern Mediterranean countries: a cross-sectional household survey","volume":"12","author":"Nakkash","year":"2022","journal-title":"BMJ Open"},{"issue":"3","key":"2024112205515868500_CIT0002","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1093\/ije\/dyq002","article-title":"The effects of waterpipe tobacco smoking on health outcomes: a systematic review","volume":"39","author":"Akl","year":"2010","journal-title":"Int J Epidemiol."},{"issue":"1","key":"2024112205515868500_CIT0003","first-page":"32","article-title":"The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis","volume":"46","author":"Waziry","year":"2017","journal-title":"Int J Epidemiol."},{"issue":"5","key":"2024112205515868500_CIT0004","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1093\/heapol\/czy023","article-title":"The passage of tobacco control law 174 in Lebanon: reflections on the problem, policies and politics","volume":"33","author":"Nakkash","year":"2018","journal-title":"Health Policy Plan."},{"key":"2024112205515868500_CIT0005","doi-asserted-by":"crossref","DOI":"10.1596\/35626","volume-title":"Lebanon Economic Monitor, Spring 2021: Lebanon Sinking (to the Top 3)","author":"World","year":"2021"},{"issue":"5","key":"2024112205515868500_CIT0006","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1136\/tc.2010.037630","article-title":"Health warning messages on tobacco products: a review","volume":"20","author":"Hammond","year":"2011","journal-title":"Tob Control."},{"issue":"41","key":"2024112205515868500_CIT0007","first-page":"1","article-title":"Impact of tobacco-pack pictorial warnings on youth and young adults: a systematic review of experimental studies","volume":"17","author":"Francis","year":"2019","journal-title":"Tob Induc Dis"},{"issue":"9","key":"2024112205515868500_CIT0008","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1093\/ntr\/ntac053","article-title":"\u201cScary and effective, definitely pushes me to quit smoking\u201d: developing waterpipe pictorial health warnings targeting young adults in Lebanon","volume":"24","author":"Asfar","year":"2022","journal-title":"Nicotine Tob Res."},{"issue":"3","key":"2024112205515868500_CIT0009","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1136\/tc.2009.031773","article-title":"Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories","volume":"19","author":"Nakkash","year":"2010","journal-title":"Tob Control."},{"issue":"6","key":"2024112205515868500_CIT0010","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1136\/tobaccocontrol-2021-057202","article-title":"Impact of pictorial health warning labels on smoking beliefs and perceptions among waterpipe smokers: an online randomised cross-over experimental study","volume":"32","author":"Jebai","year":"2022","journal-title":"Tob Control."},{"issue":"4","key":"2024112205515868500_CIT0011","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/heapol\/9.4.353","article-title":"Reforming the health sector in developing countries: the central role of policy analysis","volume":"9","author":"Walt","year":"1994","journal-title":"Health Policy Plan."},{"issue":"13","key":"2024112205515868500_CIT0012","doi-asserted-by":"crossref","first-page":"7189","DOI":"10.3390\/ijerph18137189","article-title":"Novel insights into young adults\u2019 perceived effectiveness of waterpipe tobacco-specific pictorial health warning labels in Lebanon: implications for tobacco control policy","volume":"18","author":"Nakkash","year":"2021","journal-title":"Int J Environ Res Public Health."},{"issue":"2","key":"2024112205515868500_CIT0013","doi-asserted-by":"crossref","first-page":"100797","DOI":"10.1016\/j.conctc.2021.100797","article-title":"Examining the effect of waterpipe specific pictorial health warning labels among young adults in Lebanon and Tunisia: protocol of a factorial experiment study design","volume":"29","author":"Jebai","year":"2021","journal-title":"Contemp Clin Trials Commun"},{"issue":"2","key":"2024112205515868500_CIT0014","first-page":"1","article-title":"A Delphi study among international expert panel to develop waterpipe-specific health warning labels","volume":"29","author":"Asfar","year":"2018","journal-title":"Tob Control."},{"key":"2024112205515868500_CIT0015","first-page":"ntad223","article-title":"Effects of pictorial health warning labels on intention to quit waterpipe in Lebanon: a mediation analysis","author":"Jebai","year":"2023","journal-title":"Nicotine Tob Res."},{"key":"2024112205515868500_CIT0016","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S1479-3709(07)11003-7","article-title":"Qualitative content analysis","volume-title":"Empirical Methods for Bioethics: A Primer","author":"Forman","year":"2007"},{"key":"2024112205515868500_CIT0017","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s00038-014-0616-0","article-title":"Health system challenges of NCDs in Tunisia","volume":"60","author":"Romdhane","year":"2015","journal-title":"Int J Public Health."},{"issue":"100016","key":"2024112205515868500_CIT0018","first-page":"1","article-title":"Health policy triangle framework: narrative review of the recent literature","volume":"1","author":"O\u2019Brien","year":"2020","journal-title":"Health Policy Open"},{"issue":"8","key":"2024112205515868500_CIT0019","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1080\/17441692.2013.830756","article-title":"Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries","volume":"8","author":"Phillimore","year":"2013","journal-title":"Glob Public Health"},{"key":"2024112205515868500_CIT0020","doi-asserted-by":"crossref","first-page":"52","DOI":"10.14196\/mjiri.32.52","article-title":"Application of policy analysis frameworks in tobacco control research: a systematic review of qualitative literature","volume":"32","author":"Arabloo","year":"2018","journal-title":"Med J Islam Repub Iran"},{"volume-title":"Legislation by Country: Lebanon","year":"2019","author":"Campaign for Tobacco Free Kids","key":"2024112205515868500_CIT0021"},{"issue":"12","key":"2024112205515868500_CIT0022","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1093\/ntr\/nty135","article-title":"Hookah use among US youth: a systematic review of the literature from 2009 to 2017","volume":"21","author":"Cooper","year":"2019","journal-title":"Nicotine Tob Res."},{"issue":"6","key":"2024112205515868500_CIT0023","doi-asserted-by":"crossref","first-page":"6115","DOI":"10.3390\/ijerph120606115","article-title":"Waterpipe smoking and regulation in the United States: a comprehensive review of the literature","volume":"12","author":"Haddad","year":"2015","journal-title":"Int J Environ Res Public Health."},{"issue":"3","key":"2024112205515868500_CIT0024","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1136\/tobaccocontrol-2018-054249","article-title":"Graphic health warnings on tobacco packets and containers: compliance status in Bangladesh","volume":"28","author":"Rahman","year":"2019","journal-title":"Tob Control."},{"key":"2024112205515868500_CIT0025","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1007\/s10900-010-9350-6","article-title":"Barriers to adopting and implementing local-level tobacco control policies","volume":"36","author":"Satterlund","year":"2011","journal-title":"J Community Health."},{"issue":"6","key":"2024112205515868500_CIT0026","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1136\/tobaccocontrol-2013-051536","article-title":"Implementation of graphic health warning labels on tobacco products in India: the interplay between the cigarette and the bidi industries","volume":"24","author":"Sankaran","year":"2015","journal-title":"Tob Control."},{"issue":"1","key":"2024112205515868500_CIT0027","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1186\/s12889-022-13531-z","article-title":"The Lebanese Regie state-owned tobacco monopoly: lessons to inform monopoly-focused endgame strategies","volume":"22","author":"Alaouie","year":"2022","journal-title":"BMC Public Health"},{"issue":"64","key":"2024112205515868500_CIT0028","first-page":"1","article-title":"Setting the policy agenda for graphic health warning labels: an analysis of online news media coverage in South Korea, 2016","volume":"18","author":"Hwang","year":"2020","journal-title":"Tob Induc Dis"},{"issue":"1","key":"2024112205515868500_CIT0029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.11648\/j.ajtas.20160501.11","article-title":"Comparison of convenience sampling and purposive sampling","volume":"5","author":"Etikan","year":"2016","journal-title":"Am J Theor Appl Stat."},{"issue":"S1","key":"2024112205515868500_CIT0030","doi-asserted-by":"crossref","first-page":"23","DOI":"10.31557\/APJCP.2020.21.S1.23","article-title":"Tobacco industry fingerprints on delaying implementation of pictorial health warnings in the Western Pacific","volume":"21","author":"Tan","year":"2020","journal-title":"Asian Pac J Cancer Prev."},{"issue":"1","key":"2024112205515868500_CIT0031","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1080\/2159676X.2017.1393221","article-title":"Generalizability in qualitative research: misunderstandings, opportunities and recommendations for the sport and exercise sciences","volume":"10","author":"Smith","year":"2018","journal-title":"Qual Res Sport Exerc Health"}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntae104\/57577483\/ntae104.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/26\/12\/1676\/59834787\/ntae104.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/26\/12\/1676\/59834787\/ntae104.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T05:54:42Z","timestamp":1732254882000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/26\/12\/1676\/7666098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,7]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,5,7]]},"published-print":{"date-parts":[[2024,11,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntae104","relation":{},"ISSN":["1469-994X"],"issn-type":[{"type":"electronic","value":"1469-994X"}],"subject":[],"published-other":{"date-parts":[[2024,12]]},"published":{"date-parts":[[2024,5,7]]}}}