The effects of an education program on hookah smoking cessation in university students: an application of the Health Action Process Approach (HAPA)

Hookah smoking is a harmful practice which has become increasingly popular among
university students.
Methods: This quasi-experimental study was conducted on 150 male undergraduate students, who were regular
hookah smokers, from Jan 2014 to Sept 2016. The participants were randomly selected and assigned to
intervention (n = 75) and control groups (n = 75). A self-administered questionnaire was utilized to measure
baseline demographic information and HAPA constructs. The primary outcome was an improvement in
behavioral intention for quitting hookah, and the secondary outcome was successful abstinence from tobacco
use.
Results: The motivational phase constructs (one month after the intervention) and the volitional phase constructs
(six months after the intervention) except for recovery self-efficacy were significantly higher in the intervention
group compared to the control group. Six months after the intervention, 26 (44.1%) intenders (participants who
intended to quit hookah) in the intervention group quitted hookah while only three (9.4%) intenders in the
control group did the same. Twelve months after the intervention, the number of students who successfully
quitted hookah was significantly higher in the intervention group (19 out of 71) compared to the control group
(6 out of 67).
Conclusion: HAPA is a useful model that can be applied in education programs to increase the rate of
hookah smoking cessation in university students.