Optimizing risk messages to promote waterpipe tobacco cessation in young adults

Project Summary Waterpipe tobacco is one of the most commonly used tobacco products among U.S. young adults. Waterpipe tobacco exposes users to high levels of carcinogens and other harmful toxicants, can lead to long-term addiction, and is associated with cancer and other negative health outcomes. Despite this evidence, young adults do not view waterpipe tobacco as harmful or addictive, beliefs representing unique motives that drive the high prevalence of waterpipe use. Waterpipe tobacco intervention research has focused on clinical cessation interventions among older, dependent users. These interventions likely have limited impact among young adults because their use of clinical cessation interventions is low and they do not view themselves to be in need of such cessation supports. Our research indicates public health messages conveying harms and addictiveness of waterpipe tobacco can shift young adult waterpipe tobacco users' perceptions and motivate cessation. This study builds from our preliminary work and addresses a critical gap in this research area by adapting messaging strategies that have been successful for addressing cigarette smoking to optimize their impact on young adults' waterpipe tobacco use. We will rigorously examine the effects of messages conveying harms and addictiveness of waterpipe tobacco using text and visual imagery and delivered by mobile phone multimedia messaging service (MMS) among young adults ages 18 to 30 who use waterpipe tobacco. Our approach leverages online crowdsourcing for message refinement and interactive mobile technology to engage with participants, deliver MMS messages, and test added effects of personally tailored MMS content. Participants will complete baseline measures, receive basic messages on harms and addictiveness of waterpipe tobacco, and be randomized to three conditions: 1) a control condition receiving no additional messaging, 2) an untailored MMS condition, or 3) a tailored MMS condition. For 1-month, those assigned to MMS conditions will receive text message prompts on two days each week delivered to their mobile phones via an interactive messaging system to assess waterpipe tobacco perceptions and behavior. After responding to prompts, participants will receive MMS messages on harms and addictiveness of waterpipe tobacco. For the tailored MMS condition, message content will be personalized to responses to baseline measures and dynamically through the interactive text message exchanges during the intervention period. Waterpipe tobacco use and hypothesized mediators will be reassessed 1-, 3-, and 6-months post-baseline. Our study will generate critically needed data on the effects of mobile MMS and tailored MMS message content to inform waterpipe tobacco use interventions. Our study directly addresses National Cancer Institute tobacco control research priorities and the findings can be translated to population intervention efforts by the NCI, Food and Drug Administration public education about the harms of waterpipe tobacco, and other targeted interventions.