title: Which Behavior Change Techniques May Help Waterpipe Smokers to Quit? An Expert Consensus Using a Modified Delphi Technique.
abstract: Waterpipe smoking is addictive and harmful. The determinants of waterpipe smoking may differ from those of cigarette smoking; therefore, behavioral approaches to support quitting may also differ between these two tobacco products. While some evidence exists on effective behavioral change techniques (BCTs) to facilitate cigarette smoking cessation, there is little research on waterpipe smoking cessation.
  
  
  
  Twenty-four experts were selected from the author lists of peer-reviewed, randomized controlled trials on waterpipe smoking cessation. They were invited to two rounds of a consensus development exercise using modified Delphi technique. Experts ranked 55 BCTs categorized further into those that promote; "awareness of harms of waterpipe smoking and advantages of quitting" (14), "preparation and planning to quit" (29), and "relapse prevention and sustaining an ex-smoker identity" (12) on their potential effectiveness. Kendall's W statistics was used to assess agreement.
  
  
  
  Fifteen experts responded in round 1 and 14 completed both rounds. A strong consensus was achieved for BCTs that help in "relapse prevention and sustaining ex-smoker identity" (w = 0.7; p < .001) and a moderate for those that promote "awareness of harms of waterpipe smoking and advantages of quitting" (w = 0.6; p < .001) and "preparation and planning to quit" (w = 0.6; p < .001). Providing information on the consequences of waterpipe smoking and its cessation, assessing readiness and ability to quit, and making people aware of the withdrawal symptoms, were the three highest-ranking BCTs.
  
  
  
  Based on expert consensus, an inventory of BCTs ordered for their potential effectiveness can be useful for health professionals offering cessation support to waterpipe smokers.
  
  
  
  Waterpipe smoking is addictive, harmful, and gaining global popularity, particularly among youth. An expert consensus on behavior change techniques, likely to be effective in supporting waterpipe smokers to quit, has practice and research implications. Smoking cessation advisors can use these techniques to counsel waterpipe smokers who wish to quit. Behavioral and public health scientists can also use these to develop and evaluate behavioral support interventions for this client group.
authors: Department of Health Sciences, University of York, York, UK.
authors: Nancy
authors: N
authors: O'Neill
authors: Department of Health Sciences, University of York, York, UK.
authors: Omara
authors: O
authors: Dogar
authors: Department of Primary Care and Public Health, Imperial College London, London, UK.|Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors: Mohammed
authors: M
authors: Jawad
authors: Institute of Psychological Sciences, University of Leeds, Leeds, UK.
authors: Ian
authors: I
authors: Kellar
authors: Department of Health Sciences, University of York, York, UK.
authors: Mona
authors: M
authors: Kanaan
authors: Department of Health Sciences, University of York, York, UK.
authors: Kamran
authors: K
authors: Siddiqi
mesh_terms: D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003697:Delphi Technique; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D000074285:Smokers / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D020340:Tobacco Use Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000517:prevention & control* / Q000523:psychology; D055815:Young Adult