Efficacy of School Based Waterpipe Smoking Cessation Intervention to address the waterpipe strain of global tobacco epidemic

Background: Tobacco use, particularly waterpipe use, has increased significantly among adolescents particularly in Jordan making them a high risk population. Yet no waterpipe cessation interventions have been developed to date for adolescents.

Method: We aim to conduct a randomized controlled trial among Jordanian school students to test the efficacy of behavioral counseling-based waterpipe cessation intervention delivered by school counselors adapted from the 5A’s guidelines originally developed for cigarette smokers, compared to an information only control condition.  A cluster random sampling methodology will be employed to recruit study participants from eight schools in the Zarqa First Educational District. Study participants will include students enrolled in grades 9–12 who have reported currently smoking waterpipe, and assessments will be conducted at baseline, and 1-, 3-, and 6-month follow-ups. Intention to treat analyses will be conducted to determine the impact of the intervention on waterpipe smoking abstinence, and further validated with biological cotinine levels.

Results: For study power of 80%, we plan to recruit 27 students per school with a total study population of 216 school students. We hypothesize that we will find a significant impact (p<0.05) of the intervention compared to the control condition, evidenced by reduced waterpipe smoking rates and increased abstinence rates at 1-, 3- and 6-month follow-up and results validated using cotinine levels.

Conclusion: This is the first school-based smoking cessation intervention targeted towards adolescent waterpipe smokers. Study findings will help understand the need for tailored behavioral interventions targeting young adolescents to prevent the rising waterpipe tobacco epidemic.