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Addict Behav. 2014 Jun;39(6):1066-74. doi: 10.1016/j.addbeh.2014.02.012. Epub 2014 Mar 3.

Behavioral cessation treatment of waterpipe smoking: The first pilot randomized controlled trial.

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Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA.
Syrian Center for Tobacco Studies, Aleppo, Syria.
Syrian Center for Tobacco Studies, Aleppo, Syria; Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
Syrian Center for Tobacco Studies, Aleppo, Syria; Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA. Electronic address:



Waterpipe use has increased dramatically in the Middle East and other parts of the world. Many users exhibit signs of dependence, including withdrawal and difficulty quitting, but there is no evidence base to guide cessation efforts.


We developed a behavioral cessation program for willing-to-quit waterpipe users, and evaluated its feasibility and efficacy in a pilot, two arm, parallel group, randomized, open label trial in Aleppo, Syria. Fifty adults who smoked waterpipe ≥3 times per week in the last year, did not smoke cigarettes, and were interested in quitting were randomized to receive either brief (1 in-person session and 3 phone calls) or intensive (3 in-person sessions and 5 phone calls) behavioral cessation treatment delivered by a trained physician in a clinical setting. The primary efficacy end point of the developed interventions was prolonged abstinence at three months post-quit day, assessed by self-report and exhaled carbon monoxide levels of <10 ppm. Secondary end points were 7 day point-prevalent abstinence and adherence to treatment.


Thirty percent of participants were fully adherent to treatment, which did not vary by treatment group. The proportions of participants in the brief and intensive interventions with prolonged abstinence at the 3-month assessment were 30.4% and 44.4%, respectively. Previous success in quitting (OR=3.57; 95% CI=1.03-12.43) predicted cessation. Higher baseline readiness to quit, more confidence in quitting, and being unemployed predicted a better adherence to treatment (all p-values <0.05).


Brief behavioral cessation treatment for waterpipe users appears to be feasible and effective.


Behavioral treatment; Cessation; Randomized controlled trial; Waterpipe

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