biostudies-literatureBen Mansour NFogarty International Centere0279014https://www.ebi.ac.uk/biostudies/studies/S-EPMC10038263biostudies-literatureUnknown18(3)<h4>Background</h4>Waterpipe (WP) use is rapidly increasing among young people worldwide due to the widespread misperception that it is safer than cigarette smoking. Health warning labels (HWLs) can effectively communicate tobacco-related health risks but have yet to be developed for WP. This study aimed to optimize and adapt a set of 16 pictorial WP-specific HWLs, developed by an international Delphi study, to the Tunisian context. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes.<h4>Methods</h4>Using a mixed method approach, we conducted ten focus groups combined with a survey among young WP users and nonusers (N = 63; age 18-34 years). In the survey, participants rated the HWLs on several communication outcomesPloS oneAdapting waterpipe-specific pictorial health warning labels to the Tunisian context using a mixed method approach.PMC10038263R01TW010654Sassi Mahfoudh ASchmidt MAsfar TBen Youssef SBen Mansour ND Ward KRejaibi SBen Romdhane HMaziak WfalseAdapting waterpipe-specific pictorial health warning labels to the Tunisian context using a mixed method approach.<h4>Background</h4>Waterpipe (WP) use is rapidly increasing among young people worldwide due to the widespread misperception that it is safer than cigarette smoking. Health warning labels (HWLs) can effectively communicate tobacco-related health risks but have yet to be developed for WP. This study aimed to optimize and adapt a set of 16 pictorial WP-specific HWLs, developed by an international Delphi study, to the Tunisian context. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes.<h4>Methods</h4>Using a mixed method approach, we conducted ten focus groups combined with a survey among young WP users and nonusers (N = 63; age 18-34 years). In the survey, participants rated the HWLs on several communication outcomes2023-01-01T00:00:00Z20232025-04-18T17:17:41.22Z2025-04-07T04:50:36.369ZS-EPMC100382633696180610.1371/journal.pone.0279014