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

Taghrid Asfar, Radwan Al Ali, Samer Rastam, Wasim Maziak, Kenneth D. Ward

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background: 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. Methods: 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. Results: 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). Conclusions: Brief behavioral cessation treatment for waterpipe users appears to be feasible and effective.

Original languageEnglish (US)
Pages (from-to)1066-1074
Number of pages9
JournalAddictive Behaviors
Issue number6
StatePublished - Jun 2014


  • Behavioral treatment
  • Cessation
  • Randomized controlled trial
  • Waterpipe

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health


Dive into the research topics of 'Behavioral cessation treatment of waterpipe smoking: The first pilot randomized controlled trial'. Together they form a unique fingerprint.

Cite this