Many Hookah Manufacturers Have Not Complied with FDA-Mandated Nicotine Warning Labels

February 7, 2024

In August 2018, the U.S. Food and Drug Administration mandated that all hookah (also known as waterpipe tobacco or shisha) manufacturers include a nicotine warning on their packaging to communicate the harms of the tobacco in their products. 

However, a new study shows that only half of the hookah packages assessed included the required nicotine warnings and that hookah companies’ compliance with this federal regulation remained low, according to new research led by Boston University School of Public Health (BUSPH).

The study was published online Feb. 2, 2024, in JAMA Network Open.

Jennifer Ross, Ph.D., associate professor of health law, policy and management at BUSPH and study lead, collaborated with Wake Forest University School of Medicine and East Carolina University for the study.

“This is the first study to assess compliance with the federal law on hookah warnings, and our results show that many brands are not in compliance,” said Erin Sutfin, Ph.D., professor of social sciences and health policy at Wake Forest University School of Medicine and the study’s senior author. “The ultimate goal of warnings is to provide information about health harms of product use directly to consumers so they can make informed decisions. We hope these findings are useful to the FDA and will promote enforcement action against non-compliant companies.”

Read the full release from BUSPH.

This research was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA239192. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.