Journal of Clinical and Diagnostic Research, 2018, Oct, Vol-12(10):LC04-LC08 4 4 DOI: 10.7860/JCDR/2018/34524.12157 Original Article Public Health Section Predictors of Past Quit Attempts and Length of Abstinence among Waterpipe Smokers in Lebanon INTRODUCTION The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region. Many waterpipe smokers falsely consider that waterpipe smoking is a less dangerous and toxic alternative to cigarettes [1]. This evidence validates the extensive potential damage of waterpipe smoking, as well as its addictive nature. Previous findings estimating the economic burden of major cancer due to smoking in Iran showed that smoking was responsible for 16.5% of cancer deaths, 17.2% of years of potential life lost and 21% of the cost of productivity [2,3]. A waterpipe session consistently implicates almost 200 puffs, with an average puff volume exceeding 500 mL among actual waterpipe tobacco smokers in real life situations [4], much more than the quantity inhaled by cigarette smokers (500-600 mL of smoke) [5,6]. Smoking cessation among adult smokers is critically imperative to improving public health initiatives since about 50% of smokers die from tobacco-related diseases [4-6]. It is a difficult and complex process, and smokers use many methods and approaches to achieve cessation. Many theoretical models have identified a number of variables that influence smoking cessation such as intentions, self-efficacy, and vulnerability [7,8]. Pictorial graphic warnings have more influence on the behaviour of waterpipe smokers (reducing/quitting smoking) than textual warning, especially among females and highly motivated smokers. A previous attempt to quit has been reported as a significant predictor of an intention to quit tobacco smoking. Encouraging waterpipe smokers to try stopping, even once, could improve their chance of actually quitting in the future. Successful quitting is often defined by the length of abstinence, with typical criterion lengths ranging from one to six months. There is not much information available on the percentage of current smokers that attained these thresholds and relapsed afterward. To the best of the authors’ knowledge, no studies were done previously in Lebanon concerning quit attempts among waterpipe smokers. The purpose of this study was to evaluate the main factors associated with the number of past quit attempts and their length of abstinence among Lebanese Waterpipe Smokers. MATERIALS AND METHODS This was a cross-sectional study conducted in five outpatient clinics located in five hospitals in Lebanon, between March 2014 and March 2015, where there are physicians (pulmonologists in particular) who are interested in smoking cessation and who apply smoking cessation methods. This study included waterpipe adult smokers age ≥18 years. The Lebanese University Investigational Review Board waived approval of the study since it is an observational non- invasive study that respects participants’ autonomy and anonymity. Study Participants A standardised questionnaire was completed in the waiting rooms of respiratory outpatient clinics. The study first targeted the first eligible person entering the clinic and consenting to take part in the study. Healthy individuals were included, provided they were current waterpipe smokers “defined as currently smoking ≥1 waterpipe per week”. The interview was carried out by trained pharmacists and nurses. A verbal consent was given by participants in order to be included in the study. Study Tool and Variables The pretested questionnaire from the standardised questionnaire of the ISAAC [9] was given to all participants. It was adapted to local Arabic language; validation details of the translated questionnaire are presented in previous studies [10]. Sociodemographic characteristics, including age categorised into ≤45 years and >45 years, gender, place of residence, employment status, educational level {low education (illiterate, primary, complementary, secondary NELLY LAYOUN 1 , SOUHEIL HALLIT 2 , MIRNA WAKED 3 , ZEINA AOUN BACHA 4 , ALAIN LEVEQUE 5 , MICHELE DRAMAIX 6 , PASCALE SALAMEH 7 Keywords: Intention to quit, Motivation, Narguileh, Quit attempt, Readiness to quit, Shisha ABSTRACT Introduction: The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region, with a false belief that waterpipe is less dangerous and toxic compared to cigarettes. Aim: To assess factors associated with the quit attempts and their past length of abstinence in a Lebanese sample of waterpipe smokers. Materials and Methods: A cross-sectional study was conducted between March 2014 and March 2015 involving 127 patients. A questionnaire was completed by each participant; Quit attempts, real quit attempt durations and the intention to seriously quit waterpipe smoking in 2 months were assessed. Two forward logistic regressions were performed, taking into account the variables in the bivariate analysis that showed a p-value <0.2. Results: Past attempt to quit waterpipe smoking was significantly higher among smokers who had cough and expectoration for more than 3 weeks (OR=8.2), at higher stages of readiness to quit (OR=2.78) and being highly motivated (OR=2.27). A longer duration of abstinence to smoke waterpipe was higher among waterpipe smokers less than 45 years (OR=6.85), who considered it very important to report health warning on tumbac packages (OR=3.09) and with a low waterpipe dependence (OR=2.13). Conclusion: Health care professionals should play an important role in explaining the side effects of waterpipe smoking in order to decrease dependence.