Introduction:
Youth are the most affected group of the epidemic of tobacco waterpipe smoking. Dependence on waterpipe smoking is well demonstrated by researchers. Yet no studies were reported on waterpipe smoking cessation interventions among youth. The current study aims to evaluate the effectiveness of a culturally adapted, school-based 5As-guided counseling intervention for waterpipe smoking cessation.

Material and Methods:
A Randomized Clinical Trial [RCT] was conducted to test the effectiveness of a behavioral counseling waterpipe smoking cessation intervention among youth in Jordan. Eight schools (4 intervention, 4 control) in Jordan were school students who reported current waterpipe smoking were recruited to participate in the study. School counselors served as the study Interventionist. Waterpipe smoking abstinence was assisted at study entry (baseline) and at 1-, 3-, and 6-month follow-up to assess the short and long term effect of the intervention.

Results:
The final sample consisted of 185 participants (48% boys and 51% girls). The majority were 10th or 11th graders with a small percentage of 12th grade students. A decrease in number of times for waterpipe smoking is observed between pre- and post- intervention among participants. Smoking waterpipe two times or more weekly decreased for current smoking between pre- and post- intervention (27.6%, 23.3% respectively). Results of waterpipe smoking dependence level indicated a slight change between pre-, and post- intervention nicotine levels as indicated in Figure 6. A decrease is observed in high dependence level, while other categories did not show any change except an increase in the moderate dependence category.

Conclusions:
This is the first reported study of waterpipe smoking cessation intervention among adolescents. Our study demonstrated that behavioral counseling is effective in decreasing waterpipe smoking habits among youth.

Funding:
Study was funded by the American University of Beirut, Lebanon.