Abstract
Waterpipe tobacco smoking (WTS) is spreading worldwide. Research has indicated health consequences of WTS similar to cigarettes. Prevalence of WTS is high among young people. In Lebanon, current use rates of 35% have been documented among 13–15 year olds. We evaluated a school-based intervention. Method: We conducted a randomized-controlled-trial of a theory-informed WTS intervention. The intervention consisted of ten sessions based on social cognitive theory and the social influences approach. Thirty-one schools participated: 14 intervention and 17 control; a total of 1279 students completed pre and post assessments. We measured knowledge, attitudes and self-reported behaviors related to WTS using Chi-square tests and regression analyses to compare results between the two study arms. Results: The intervention increased knowledge of intervention group compared to control group participants—about WTS constituents and health consequences; and shifted attitudes of intervention group participants to be even more unfavorable towards WTS. We found no impact of the intervention on WTS behaviors. Discussion: The effectiveness of the intervention on knowledge and attitudes supports previous research. The lack of intervention effect on behavior is not surprising given the timing of the post assessment immediately after the intervention, and the social context that was supportive of waterpipe use.
Highlights
Despite misconceptions that it is safer than cigarettes [1,2], waterpipe tobacco smoking (WTS) has been linked to a variety of short term and long-term health consequences, including respiratory illness, cancer, cardiovascular diseases, and mental ill health [3,4,5,6,7,8]
With the above limitations in mind, we developed a Waterpipe tobacco smoking (WTS) intervention that was theory-based, with higher intervention dose than previous interventions; and tested its effectiveness in changing knowledge, attitude and behavior, using a robust randomized controlled trials (RCT) evaluation design of a nationwide representative sample of school students in 6th and 7th grades in Lebanon
This Lebanon RCT was a part of a larger research project that included a similar intervention in Qatar [50]
Summary
Despite misconceptions that it is safer than cigarettes [1,2], waterpipe tobacco smoking (WTS) has been linked to a variety of short term and long-term health consequences, including respiratory illness, cancer, cardiovascular diseases, and mental ill health [3,4,5,6,7,8]. Prevalence is especially high among young people [13,14,15]. In some global regions such as the Eastern. Mediterranean region, current WTS rates (smoking at least once in the past month) reach 37% among. WTS patterns among young people indicate mostly intermittent use; with 55%–78% reporting WTS once a month or less [14,18,19,20]
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