title: 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: BACKGROUND
  Among 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.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  A 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.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN registry ISRCTN59207794; http://www.isrctn.com/ISRCTN59207794 (Archived by WebCite at http://www.webcitation.org/6VkYOBNOJ).
authors.affiliation: Bar Ilan University, Faculty of Medicine in the Galilee, Safed, Israel. jamanh.essa-hadad@mail.biu.ac.il.
authors.forename: Jumanah
authors.identifier: http://orcid.org/0000-0002-9981-5482
authors.initials: J
authors.lastname: Essa-Hadad
authors.forename: Shai
authors.identifier: http://orcid.org/0000-0001-5471-5034
authors.initials: S
authors.lastname: Linn
authors.forename: Sheizaf
authors.identifier: http://orcid.org/0000-0002-0937-5621
authors.initials: S
authors.lastname: Rafaeli
mesh_terms: D000293:Adolescent; D000328:Adult; D018912:Arabs; D005246:Feedback; D005260:Female; D017144:Focus Groups; D006801:Humans; D033182:Intention; D020407:Internet; D007557:Israel; D008297:Male; D010865:Pilot Projects; D012907:Smoking / Q000208:ethnology; D016540:Smoking Cessation / Q000208:ethnology / Q000379:methods*; D000074606:Smoking Prevention; D013334:Students; D011795:Surveys and Questionnaires; D014495:Universities; D055815:Young Adult
keywords: Arabs in Israel; Web-based intervention; nargila smoking; smoking cessation; tailored feedback; university students