A Web-Based Program to Increase Knowledge and Reduce Cigarette and Nargila Smoking Among Arab University Students in Israel: Mixed-Methods Study to Test Acceptability

Abstract

BackgroundAmong Arab citizens in Israel, cigarette and nargila (hookah, waterpipe) smoking is a serious public health problem, particularly among the young adult population. With the dramatic increase of Internet and computer use among Arab college and university students, a Web-based program may provide an easy, accessible tool to reduce smoking rates without heavy resource demands required by traditional methods.ObjectiveThe purpose of this research was to examine the acceptability and feasibility of a pilot Web-based program that provides tailored feedback to increase smoking knowledge and reduce cigarette and nargila smoking behaviors among Arab college/university students in Israel.MethodsA pilot Web-based program was developed, consisting of a self-administered questionnaire and feedback system on cigarette and nargila smoking. Arab university students were recruited to participate in a mixed-methods study, using both quantitative (pre-/posttest study design) and qualitative tools. A posttest was implemented at 1 month following participation in the intervention to assess any changes in smoking knowledge and behaviors. Focus group sessions were implemented to assess acceptability and preferences related to the Web-based program.ResultsA total of 225 participants—response rate of 63.2% (225/356)—completed the intervention at baseline and at 1-month poststudy, and were used for the comparative analysis. Statistically significant reductions in nargila smoking among participants (P=.001) were found. The intervention did not result in reductions in cigarette smoking. However, the tailored Web intervention resulted in statistically significant increases in the intention to quit smoking (P=.021). No statistically significant increases in knowledge were seen at 1-month poststudy. Participants expressed high satisfaction with the intervention and 93.8% (211/225) of those who completed the intervention at both time intervals reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. This was further emphasized in the focus group sessions.ConclusionsA tailored Web-based program may be a promising tool to reduce nargila smoking among Arab university students in Israel. The tailored Web intervention was not successful at significantly reducing cigarette smoking or increasing knowledge. However, the intervention did increase participants’ intention to quit smoking. Participants considered the Web-based tool to be an interesting, feasible, and highly acceptable strategy.Trial RegistrationTrial Registration: ISRCTN registry ISRCTN59207794; http://www.isrctn.com/ISRCTN59207794 (Archived by WebCite at http://www.webcitation.org/6VkYOBNOJ).

The impact of a brief cessation induction intervention for waterpipe tobacco smoking: A pilot randomized clinical trial

“…Similarly, Asfar and colleagues (Asfar, Al Ali, Rastam, Maziak, & Ward, 2014) documented promising 3-month abstinence rates (30 and 44%) in response to both brief (1 in-person, 3 phones sessions) and intensive (3 in-person, 5 phone sessions) WP interventions, respectively. Finally, in an uncontrolled online study, Essa-Hadad and colleagues (2015) found that participants decreased WP smoking from baseline to one-month follow-up in response to video- and text-based health information. Collectively, these data show promise for WP-specific interventions.…”

Social characteristics associated with disparities in smoking rates in Israel

“…Recently, a feasibility study tested the effect of web-based intervention aimed to increase knowledge and reduce cigarette and nargila smoking among Arab university students, of whom one-fifth were smokers. The intervention was well-accepted, increased the proportion of students in the contemplation phase, but was not associated with cigarette smoking cessation after 1 month [45]. We are not aware of other studies evaluating the efficacy of smoking prevention/cessation interventions among low SES groups, immigrants and ethnic minority groups in Israel.…”

Systematic review of interventions aimed at reducing hookah pipe use: Implications for practitioners and clinicians

“…The studies showed that the interventions were contextualised for these continents and settings. Of the 10 studies, 7 focused on the efficacy of the intervention, [27][28][29][30][31][32][33] 2 on the feasibility of the intervention, [34,35] and 1 on describing the intervention. [36] Fifty percent (n=5) of the studies were of randomised controlled design, 30% (n=3) pre-test and post-test design, and 20% (n=2) quasi-experimental design.…”

“…[27,29] The reasons for focusing on adolescents were that the period of adolescence has been identified as a higher risk factor for hookah pipe use than any other age group [29] and that smoking often starts during adolescence. [27] Some studies focused on adult smokers and included college or university students [30,33,35] and adults. [28,31,32,34,36] Table 2 describes each intervention in terms of the RE-AIM framework.…”

“…Participants were recruited through physician referrals, word of mouth, newspaper adverts, [34] flyers, announcements, internet messages, social media, and entering college or university classes. [35] Participants were also recruited door-to-door [36] and via advertisements at the hospital where the study was conducted. [31] Four studies made reference to their exclusion criteria, [29,31,32,34] which were mainly severe medical conditions and inability to understand consent procedures.…”