Kudos to Isaac Lipkus, professor, and his entire team for the submission of a subcontract proposal to The Ohio State University on their NIH R01 application entitled: "Efficacy of a Tailored mHealth Messaging Cessation Intervention for Waterpipe Tobacco Smoking in Young Adults." This proposal requests funding for a five-year period with a start date of September 1, 2021.

Waterpipe (i.e., hookah, narghile, shisha) tobacco smoking among U.S. young adults is a major concern for tobacco control, cancer prevention, and public health. Young adults comprise the majority of waterpipe tobacco smokers, and the prevalence of waterpipe tobacco smoking is highest in this age group. Waterpipe tobacco smoking poses risks of health harm and addiction, it increases the risk of using other forms of tobacco (i.e., cigarette smoking), and it accelerates tobacco dependence. Multiple factors contribute to waterpipe tobacco smoking among young adults, but research consistently demonstrates that misperceptions about the risks of waterpipe tobacco are a major driver of waterpipe tobacco smoking in this population.

Unfortunately, there is extremely limited evidence for cessation interventions targeting young adult waterpipe tobacco smokers, especially interventions targeting commonly held misperceptions about risks and models leveraging communication technology to integrate seamlessly into young adults’ daily lives. Many young adult waterpipe tobacco smokers are also poly tobacco users (i.e., using ≥1 other tobacco product), and it is unclear if waterpipe tobacco smoking interventions affect other tobacco use outcomes among poly users. We systematically developed and rigorously tested an interactive, personally tailored, mobile messaging (i.e., mHealth) cessation intervention for young adult waterpipe tobacco smokers in a randomized trial (n=349) comparing the tailored intervention, an untailored intervention, and a no intervention control. The tailored intervention nearly doubled cessation at 6 months compared to the control, and at interim time points the tailored intervention significantly increased hypothesized intervention mediators, such as risk perceptions. We also observed reductions in cigarette smoking and past 30-day use of little cigar/cigarillo and electronic cigarette in response to the tailored intervention.

In this study, we will conduct a 2 arm, parallel group randomized controlled trial that is powered to test the long-term effects of our tailored mHealth intervention on waterpipe tobacco smoking cessation at 12 months. We will also examine intervention effects on frequency of use and cessation of cigarette smoking, little cigars/cigarillos, electronic cigarettes, and other tobacco products. In a subsample of participants, we will collect biomarkers of exposure (expired CO, cotinine, NNAL) to biochemically verify these cessation outcomes across products.

Our study is highly significant because it addresses critical gaps in waterpipe tobacco cessation research by examining long-term outcomes for an interactive, tailored mHealth intervention designed for young adult waterpipe smokers. It advances the field of tobacco cessation research broadly by examining if an intervention for a single tobacco product (waterpipe) impacts other tobacco product use in a population where poly use is prevalent. Our intervention is highly disseminable and, if successful, our proposed trial will provide the robust evidence needed to support work to disseminate and implement this scalable mHealth model.