Adapting waterpipe-specific pictorial health warning labels to the Tunisian context using a mixed method approach.

BACKGROUND: 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. METHODS: 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 outcomes (e.g., reaction, harm perception, effectiveness) and were then instructed to view all HWLs in each theme and rank them in the order of overall perceived effectiveness, from the most to the least effective. Afterward, participants provided in-depth feedback on HWLs and avenues for improvement. Mean effectiveness rating scores and percentages of participants' top-ranked HWLs were calculated. Discussions were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS: The top-ranked HWLs were those showing oral cancers, orally transmitted diseases, and a sick child. Focus group discussion illustrated that these selections were based on participants' reactions to the direct impact of WP on a person's physical appearance and evoking guilt over children's exposure to WP smoke. Suggestions for improvement highlighted the need to use the local dialect and more affirmative statements (e.g., avoiding "may" or "can"). CONCLUSIONS: This study is the first in North Africa to attempt to advance HWLs policy as the World Health Organization recommended. The results of this study can be used as a basis for implementing WP-specific health messages in the Eastern Mediterranean Region.

Bibliometrics of Tunisian publications in preventive and community medicine, indexed in the Medline database (1975-2014).

INTRODUCTION: With the aim of rebuilding the memory of the specialty of Preventive Medicine and Community Medicine (MPC) in Tunisia, through its indexed scientific publications, the objective of this work was to describe the thematic and methodological profile of indexed scientific research, of this specialty over four decades. METHODS: This is a descriptive bibliometric study of MPC articles, indexed in the Medline database over a 40-year period (1975-2014), and based on their Medline Material Safety Data Sheets (MSDS). All articles of which the first and / or last authors were MPC university hospital teachers, in one of Tunisia's four faculties of medicine, were included. The themes of the publications were defined through the major keywords (Majr), and categorized according to the following five groups: "non-communicable diseases", "communicable diseases", "violence and traumatisms", "management of health services" and "Research and pedagogy". RESULTS: Among 1664 articles captured by the Medline-based documentary request, 594 had as their first authors, teachers of the MPC specialty and 365 articles were eligible for study. The productivity of the specialty of MPC increased from 29 publications between 1975 and 1984, to 167 between 2005 and 2014. The magazine "La Tunisie Médicale" published 37.6% of the articles of this specialty. Four out of ten MPC papers referred to hospital structures and 35% of them were cross-sectional observational studies. Over the decades, an increase in research topics related to "non-communicable diseases" versus "communicable diseases" has been noted in MPC. CONCLUSION: In Tunisia, research in MPC has been relatively prolific and globally consistent with the health needs of the population (impacted by the epidemiological transition). The orientation of research projects towards community-based proposals, of high methodological level and mobilizing multidisciplinary teams, would be necessary for the improvement of the quality and relevance of publications in MPC.