the Shisha No thanks project
The objectives of the Shisha No thanks were to highlight and raise awareness among young people (18-35 years old) from an Arabic-speaking background about the health risks of waterpipe smoking and to encourage discussion about stopping or reducing smoking. water pipe. The project ran from October 2019 to June 2020, primarily in the South East, South West and West areas of Sydney, Australia, where a higher proportion of people identify as of Arab origin. The project was run by a local government health district (South East Sydney Local Health District), in partnership with a community organization (Lebanese Muslim Association) and was funded by the Cancer Institute NSW (a government cancer agency). the cancer).
Shisha No thanks was a co-design project that involved the project team working closely with the community partner organization, community members, community champions and health professionals to identify key messages and strategies for awareness campaign. The project team worked throughout the process to ensure that the campaign was conducted with respect for the community and was culturally appropriate.
Campaign resources were developed from the community co-design workshops and evidence-based research, and included a campaign video,  an extensive collection of social media content (such as short video clips, memes and graphics) and a series of fact sheets for young people, pregnant women and families, community workers and healthcare professionals , which were available in English and Arabic  (See Fig. 1 and Appendix 1 for examples).
These campaign resources were released to the community via the campaign website  and social media accounts (Facebook,  instagram  and YouTube ). The project also engaged the community through local media coverage (English and Arabic speaking media; television, radio and online), participating in community events (e.g. exhibitions and information days) and by organizing information sessions for community workers.
Study design, participants and data collection
The impact evaluation used a cohort design to measure pre- and post-project awareness among the target audience. A community panel was recruited through the Lebanese Muslim Association communication channels (email newsletter, social media accounts), community champions and flyers at events (see Appendix 2 for examples of recruiting materials). Participants had to be between the ages of 18 and 35 and smoke a waterpipe or know someone who does. Potential participants were asked to complete an online recruitment survey to confirm their eligibility for the study, provide demographic details (including waterpipe smoking activity), and cell phone number (see Appendix 3 for the recruitment survey).
Participants then received a weekly text message with a survey question about their knowledge and attitudes towards waterpipe smoking. As most young people frequently use their mobile phones every day, an SMS survey has proven to be an effective way to easily reach the target audience. Participants received a set of 8 questions before the start of the project, with 1 question sent per week for 8 weeks from August to October 2019. Then the same 8 questions were sent towards the end of the project, again with 1 question sent per week for 8 weeks from January-March 2020. In the meantime, participants received other questions related to waterpipe smoking in order to maintain communication between participants and the project. (See Appendix 4 for survey questions). This approach of sending out one question per week was chosen to reduce the perceived burden of answering survey questions. Key participant recruitment materials and all data collection surveys were produced in English and Arabic, and participants were given the option to choose to receive text messages in English or Arabic.
The SMS survey questions were adapted from the Cancer Institute NSW Tobacco Tracking Survey  and the Syrian Center for Tobacco Studies survey of hookah and waterpipe users . Questions focused on participants’ awareness of messages about the harms of smoking, attitudes about the health effects of smoking, intention to reduce smoking, community conversations about smoking, and awareness of smoking services. aid in quitting smoking. The questions were designed to be short and succinct to fit the SMS format, and were either multiple choice answers or free text short answers.
Participants were reimbursed for their participation in the study with three electronic vouchers of 50 AUD. The survey used the Qualtrics platform which has the ability to send SMS messages to the mobile phone number of study participants.
Data extracted from Qualtrics was entered into an Excel spreadsheet file. The data was then analyzed using IBM SPSS Statistics v26. For the 8 questions asked before and after the project, only paired data (i.e. data where the participant answered the same question at baseline and after the campaign) were used for analysis and reported. . Given the paired nature of the data, binary categorical responses were analyzed using McNemar’s test, [25, 26] and non-parametric scale data were analyzed using the Wilcoxon Signed Rank test . A subgroup analysis was also performed based on age group, gender, and waterpipe use. For the 6 questions that were asked only once (in the intervening period), a descriptive analysis was performed.