Article Text
Abstract
Introduction Understanding product development and marketing strategies of transnational tobacco companies (TTCs) has been of vital importance in developing an effective tobacco control policy. However, comparatively little is known of the waterpipe tobacco industry, which TTCs have recently entered. This study aimed to gain an understanding of waterpipe tobacco products and marketing strategies by visiting a waterpipe trade exhibition.
Methods In April 2014, the first author attended an international waterpipe trade exhibition, recording descriptions of products and collecting all available marketing items. We described the purpose and function of all products, and performed a thematic analysis of messages in marketing material.
Results We classified waterpipe products into four categories and noted product variation within categories. Electronic waterpipe products (which mimic electronic cigarettes) rarely appeared on waterpipe tobacco marketing material, but were displayed just as widely. Claims of reduced harm, safety and quality were paramount on marketing materials, regardless of whether they were promoting consumption products (tobacco, tobacco substitutes), electronic waterpipes or accessories.
Conclusions Waterpipe products are diverse in nature and are marketed as healthy and safe products. Furthermore, the development of electronic waterpipe products appears to be closely connected with the electronic cigarette industry, rather than the waterpipe tobacco manufacturers. Tobacco control policy must evolve to take account of the vast and expanding array of waterpipe products, and potentially also charcoal products developed for waterpipe smokers. We recommend that tobacco substitutes be classified as tobacco products. Continued surveillance of the waterpipe industry is warranted.
- Advertising and Promotion
- Electronic nicotine delivery devices
- Harm Reduction
- Non-cigarette tobacco products
- Tobacco industry
Statistics from Altmetric.com
- Advertising and Promotion
- Electronic nicotine delivery devices
- Harm Reduction
- Non-cigarette tobacco products
- Tobacco industry
Introduction
Little is known about the product development and marketing strategies of the waterpipe (shisha, narghile, hookah) tobacco industry. This is disconcerting considering that the current prevalence is over 20% among 13–15-year-olds in Lebanon, the West Bank, Estonia and Latvia.1 Although the industry is still in its infancy, London has an estimated 400 waterpipe-serving premises.2 A Lebanese study found that waterpipe industry products were non-compliant with the health warning label and advertising requirements of the WHO FCTC.3 ,4
Questions about the waterpipe industry strategies are warranted considering the recent investment by transnational tobacco companies (eg, Japan Tobacco International) in the waterpipe sector5 and related industries, including electronic cigarettes (e-cigarettes).6 ,7
The 1st International Hookah Fair took place in April 2013 and was visited by over 4000 delegates worldwide. The exhibition aimed to give “an overview of the great diversity that waterpipes can nowadays offer” and “to develop both business and private contacts”.8 In April 2014, MJ visited the 2-day ‘2nd International Hookah Fair’8 in Germany. Open to the general public, it attracted 7133 delegates worldwide and intended to facilitate business-to-business and business-to-customer trade. This second iteration included a ‘vapour fair’; a trade exhibition for e-cigarettes. This article documents the product range and marketing strategies from this fair.
Methods
Sample
Our sample included all exhibitors displaying waterpipe smoking products and related accessories. The researcher introduced himself as a student writing a dissertation on the waterpipe industry.
Data collection
We sequentially attended each exhibition stand, recording information by observation, collection and discussion. Without a priori product selection criteria, we first ascertained the purpose and function of each waterpipe product through dialogue with exhibitors. Informed consent was not sought in order to protect the researcher from unknown threats of disclosure as a tobacco control researcher. No covert audio/video recording took place and field notes contained no identifiable data. Second, we asked for and collected all available marketing materials. This study was approved by the Imperial College Research Ethics Committee.
Data analysis
We categorised product data as follows: waterpipe consumption products (tobacco, tobacco substitutes), waterpipe accessories (apparatuses, charcoals, other), electronic waterpipes and other products. We classified ‘e-liquids’, the substance found in e-cigarettes,9 under ‘other products’. We described each product's purpose and function.
Using the product categorisation scheme, we conducted a content analysis on each marketing item, recording the main product advertised, as well as any other advertised products. One researcher thematically analysed all marketing items using Braun's six phases.10 We took a theoretical perspective deductively from studies reporting on e-cigarette and waterpipe advertisements.11 ,12
Results
Setting
The exhibition was divided into three areas: the hookah fair (ground floor), shisha lounge (first floor) and vapour fair (second floor). A promotional video was posted shortly after the exhibition.13 There were 43 exhibitors in the hookah fair and 54 in the vapour fair. Delegates sampled products in the shisha lounge.
Waterpipe consumption products
Tobacco
All brands were flavoured and sold either as prepared (tobacco mixed with molasses) or unprepared tobacco (loose/dry containers of tobacco with bottles of molasses sold separately). Both types of waterpipe tobacco are used in the same way, packed into the head of the smoking apparatus and covered with pierced aluminium foil.
Tobacco substitutes
All brands were flavoured, claiming to contain no tobacco and encompassing different types of products. These included ‘steam stones’ (flavoured synthetic stones14), ‘shisha fruits’ (chemically processed pieces of fruit15) and ‘hookah gels’ (flavoured paste16). Waterpipe tobacco substitutes were used in the same way as waterpipe tobacco.
Waterpipe accessories
Apparatuses
These greatly differed in size (18–78 cm in height) and decoration. The number of possible hose attachments ranged from one to four. Several expensive, ‘limited edition’ apparatuses, made specifically for the exhibition, were on display.
Charcoals
Three main types of charcoal included ordinary charcoal briquettes, charcoal briquettes made from coconut shell or bamboo, and quick-lighting charcoal discs. All three types were intended to be ignited and placed above pierced aluminium foil in waterpipe apparatuses to heat the underlying consumption products.
Other
Other waterpipe accessories included a range of charcoal ignition devices (small grills), plastic containers filled with packets of ice which surround a portion of the hose in order to cool down the smoke, and “harm reduction” products such as disposable waterpipe hoses and mouthpiece filters.
Electronic waterpipes
These could be classified into five subcategories based on table 1. Electrically-heated ceramic waterpipe heads replace charcoal as the heating element, and the waterpipe is used in the conventional way.
Electronic waterpipe heads replace both the charcoal and tobacco by using e-liquids. No water is used at the base of the apparatus. The technology used is similar to that of e-cigarettes, that is, they use cartomisers (components containing a cartridge to hold e-liquids) and an atomiser to vaporise the e-liquid.
Electronic waterpipe apparatuses contain an e-cigarette-like device at the end of the hose, powered by a battery inside the apparatus or an external power source. Vapour is generated from the end of the hose, as opposed to from the head of the apparatus in an electronic waterpipe head.
‘Shisha pens’ appear and function identically to e-cigarettes, except that the liquids used in them generally do not contain nicotine. ‘Shisha hoses’ are larger devices, approximately 12 inches in length, which work in a similar way. ‘Shisha hoses’ are available both in disposable and refillable product variants.
Other products
Other products found at the exhibition included e-liquids, flavoured cigarettes, flavoured roll-your-own tobacco, cigarette papers (not sold in conjunction with waterpipe products), and bongs (glass devices similar to a waterpipe apparatus, used for recreational drug use).
Marketing items
Characteristics of marketing items
Thirty-six exhibitors distributed 52 unique waterpipe-specific marketing items advertising a total of 95 products. Most marketing items were written in English only (n=20, 38.5%), mixed English/German (n=15, 28.8%) and German only (n=11, 21.1%). Others were written in English/Italian/Spanish (n=2), Arabic/English (n=1), Arabic/German (n=1), Dutch/English (n=1) and Arabic/English/German (n=1). Over half of the marketing items were from exhibitors based in Germany (n=29, 55.8%), the remainder from elsewhere in Europe (n=10, 19.2%), the Middle East (n=4, 7.7%), Asia (n=3, 5.8%) and the USA (n=2, 3.8%). The remaining four items (7.7%) had no clear country of origin. References to a website were found on most (n=47, 90.4%) items and links to social media were found on 34.6% (n=18) of items.
Ninety-five products were found on 52 marketing items (table 2). Most of the marketing items contained only one (n=25, 48.1%) or two (n=18, 34.6%) advertised products. There were 13 ‘other products’ found on marketing items, which included e-cigarettes or e-liquids (n=6), bongs (n=3), car accessories (n=1) and candles (n=1). Only 2 (3.8%) of the marketing items had a health warning reference: one on an advertised tobacco product, and the other as a small-print text warning at the foot of an A4 flyer. With the exception of one catalogue from a distributor, no marketing material included both electronic waterpipe products and waterpipe tobacco products.
Thematic analysis
Fourteen themes were identified and 169 incidences of these themes were coded in 52 marketing items (see table 3). We did not find overlapping messages in this analysis. The most common themes were describing waterpipe as a healthier alternative (n=35, 20.7%), describing its flavours (n=30, 17.8%), describing aspects of safety and quality (n=21, 12.4%) and describing its smell, taste and cleanliness (n=18, 10.7%).
Vague references to waterpipe as a healthier alternative were consistent between and within product categories (see box 1), although the comparator product was not specified, begging the question: healthier than what? Both electronic waterpipe companies and waterpipe tobacco substitute companies substantiated their health claims by comparing their product with waterpipe tobacco products. Charcoal companies that sold coconut shell or bamboo briquettes regularly claimed their product was healthier than traditional charcoal briquettes or quick-lighting charcoal discs.
Waterpipe as a healthy product
“…our goal is to have our patrons with not only the best but the healthiest forms of smoking hookah.” (Mahroosh, waterpipe tobacco company)
“…it is possible to enjoy your shisha without tobacco and side effects like nicotine or tar…” (Shiazo, waterpipe tobacco substitute company)
“Besides the convenient usage and the health benefits there are many more advantages of using Shiazo as an alternative for tobacco.” (Shiazo, waterpipe tobacco substitute company)
“Shisha Fruit contains no tobacco and no nicotine and is therefore less harmful to use.” (Shisha Fruit, waterpipe tobacco substitute company)
”The safer shisha experience.” (Diamond Mist, electronic waterpipe company)
“less ash, no fumes, no smell, low emissions” (Tom Cococha, charcoal company)
“does not contain any chemical substances like you would find them in quick lighting charcoal.” (Cocobrico, charcoal company)
Discussion
This study gives insight into the rapidly evolving range of waterpipe industry products and their associated marketing messages. Waterpipe consumption products, accessories and electronic waterpipe products all promoted harm reduction claims, despite evidence of a harmful toxicological profile of tobacco substitutes17 ,18 and charcoal types.19 Electronic waterpipe products and waterpipe tobacco products were rarely placed together on the same marketing item. We hypothesise that waterpipe tobacco companies either do not produce electronic waterpipe products or choose to brand and market them distinctly. Given the similarities, the growing electronic waterpipe market may instead be thought of as an offshoot of the e-cigarette industry.
Implications for policy
Health policymakers should be aware of the expanding range of waterpipe products available, which should be classified in order to facilitate effective regulation. We recommend that electronic waterpipe products containing e-cigarette-like technology should be classified as electronic nicotine delivery systems as opposed to waterpipe tobacco products. The marketing of electronic products as waterpipes may be a marketing tactic to promote e-cigarette devices to a different audience, or to create confusion in current policy debates, as each would require a different regulatory framework due to how and where it is smoked and by whom (eg, youth, disadvantaged populations).
We recommend that waterpipe tobacco substitutes be classified as tobacco products due to the known chemical composition of smoke they produce,17 ,18 the fact that they are marketed alongside tobacco products, and observations that products claiming to be tobacco substitutes may nevertheless contain tobacco.2 ,17 This echoes similar calls for paan and paan masala (local forms of chewed tobacco inherent to south Asia) to be considered smokeless tobacco products, even if they do not contain tobacco.20
Considering that the marketing claims of charcoal companies may directly promote the use of tobacco, these should also be addressed in a regulatory framework.
Implications for research
The array of products between and within categories may complicate tobacco surveillance. For example, participants completing tobacco surveys may confuse ‘shisha pens’ (an e-cigarette) with ‘shisha’ (traditional waterpipe). Validated survey questions must make these differences clear.
More research about the waterpipe tobacco and electronic waterpipe industries is warranted, including studies of their structure, ownership and effects of their expansion in terms of the larger tobacco product universe.
Additional research may seek to contextualise current entries by the tobacco industry into the waterpipe market by examining their historical interest in this field. The Legacy Tobacco documents library may be valuable for examining past developments in this area.
Strengths and limitations
To the best of our knowledge, this is the first study to provide insight into a waterpipe trade exhibition. We systematically collected product information and marketing items, and analysed them using a methodological framework consistent with previous studies. As a descriptive, thematic study with a limited sample coded by one researcher, no generalisable conclusions can be drawn. Owing to the exploratory, time-constrained and resource-constrained nature of the study we did not calculate product frequencies and instead relied on researcher observations.
Conclusions
This trade exhibition featured a range of waterpipe products, mainly marketed as healthy and safe. Electronic waterpipe products should be considered as part of the wider e-cigarette category, not as part of the waterpipe industry. Waterpipes should be addressed by policymakers in a robust, legal framework.
What this paper adds
What is already known on the subject
Understanding the modus operandi of cigarette companies, especially product development and marketing strategies, can inform tobacco control policy.
One cigarette company recently purchased the second largest waterpipe tobacco company.
Waterpipe prevalence is growing worldwide and their industry products are generally non-compliant with tobacco control policy.
What important gaps in knowledge exist on this topic
Little is known about the products and marketing strategies of the waterpipe tobacco industry.
There is a lack of understanding about effective waterpipe tobacco interventions and policy regimes.
What this study adds
We are able to categorise waterpipe products and hypothesise that electronic waterpipe products are highly similar to electronic cigarettes, with manufacturers closely connected to the electronic cigarette industry.
We show that claims of reduced harm are present on marketing material across tobacco, tobacco substitute, electronic and charcoal companies.
References
Footnotes
Contributors MJ, EAA and RTN conceptualised the study and drafted the study protocol. MJ collected data. MJ and BH performed data analysis. MJ wrote the first draft of the manuscript. All authors read and approved the final version of the manuscript.
Funding BHs’ research was partially supported by the National Cancer Institute of the National Institutes of Health under award number R01CA091021. The content is solely the responsibility of the authors. This study was funded by the Clinical Research Institute at the American University of Beirut.
Competing interests None declared.
Ethics approval Imperial College Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All marketing material are available as scanned copies on request.