Tobacco use kills more than 500,000 people in the United States each year. Although the use of cigarettes has declined, the use of other tobacco products has remained steady. Waterpipe smoking is a common form of tobacco smoking after cigarettes in the U.S. In fact, in 2007 the American Lung Association issued a policy alert to warn consumers about this first new tobacco trend of the 21st century (American Lung Association, 2007). Few studies have been conducted on waterpipe smoking to investigate its harmful effects. Furthermore, no known studies have evaluated treatments for smoking cessation in waterpipe smokers. This study aims to test the role of contingency management (CM) in promoting abstinence from waterpipe smoking for 5 weeks verified by salivary cotinine and to characterize self-reported nicotine withdrawal symptoms. Based on the alarming growth rate over a short period of time in waterpipe tobacco smoking, there is a critical need for clinical research to investigate treatment modalities targeting smoking cessation for waterpipe smokers. Given the evidence for the role of CM in promoting abstinence from many types of drug use, investigation of the utility of CM for waterpipe smoking cessation is important and timely. Although Nicotine Replacement Therapy is the mainstay treatment for treating nicotine dependence delivered through cigarettes, the intermittent use patterns that characterize waterpipe smoking suggest that CM may be more effective in promoting waterpipe smoking cessation. The evidence based knowledge generated in this study may assist in the translation of the treatment program into public health practice.

Contingency Management (CM) has been used successfully to treat tobacco addiction. CM is a powerful drug abuse treatment modality for facilitating change in drug use behaviors. The utility of CM as a treatment for waterpipe smoking is logical, but needs to be evaluated as a tool in the treatment of waterpipe smoking. The primary objective of this research plan is to test the role of CM in promoting abstinence from waterpipe tobacco smoking. The specific aims of the research include: specific aim 1: Conduct a feasibility study to test if CM promotes abstinence from nicotine delivered through waterpipe; specific aim 2: Characterize self-reported nicotine withdrawal symptoms. A randomized clinical trial involving eligible participants who are randomly assigned with equal allocation to either Contingency Management (CM) or Fixed Rate Control (FRC) will be conducted. A 2-group (CM versus FRC) x 10 (repeated measures) mixed-model design will be used. Participants in this study will be followed for 5 weeks during which smoking abstinence will be measured 10 times. Reinforcement in the form of monetary payment delivered contingent on the participant's salivary cotinine will be provided

Inclusion Criteria:

• Must be18 years and older
• Smoked waterpipe average of >12 times per month for 2 years

Exclusion Criteria:

• Smokes cigarettes (self-report)
• Uses any tobacco product (self-report)
• Uses illicit drugs (urine analysis for toxicology)
• Interested in quitting waterpipe smoking (self-report)