The Role of Risk Communication in Predicting Intention to Quit Hookah Smoking

Despite the known harms of hookah smoking, its prevalence is increasing worldwide. Therefore, effective strategies to strengthen cessation efforts are urgently needed. This study aimed to determine the role of risk communication in predicting the intention to quit hookah smoking among Iranian adults.

This cross-sectional study was conducted with 485 hookah smokers aged 18 to 59 years from Kermanshah (western Iran) and Ardabil (northwestern Iran). A cluster sampling method was used to select hookah-smoking venues, and simple random sampling was applied to recruit participants. Data were collected using a demographic form, a questionnaire based on the Extended Parallel Process Model (EPPM), and a health warning questionnaire. Multiple linear regression was used to determine the predictors of intention to quit hookah smoking.

The mean age of participants was 30.24±8.29 years. The health warning was the strongest predictor of the intention to quit hookah smoking (β=0.359, P<0.001). Among EPPM constructs and demographic variables, defensive motivation (β=-0.142, P=0.016), self-efficacy (β=0.139, P=0.016), perceived severity (β=0.128, P=0.032), and age (β=0.140, P=0.009) were significant predictors. The final regression model explained approximately 36% of the variance in intention to quit hookah (Adj-R²=0.356).

The health warning was the strongest predictor of intention to quit hookah smoking, highlighting the importance of targeted risk communication. Defensive motivation, perceived severity, self-efficacy, and age were other significant predictors. Public education programs should focus on increasing perceived severity, enhancing self-efficacy, and reducing defensive motivation, especially targeting younger populations to curb hookah use.