Introduction:
"Hookah" or waterpipe smoking is becoming popular among youth. It is addictive and associated with multiple, long-term, adverse health outcomes. Availability of flavored hookah, increasing social acceptability, influence of tobacco industry and misconceptions about hookah have contributed to its increasing use among youth. Many adolescents from urban slums of Mumbai do not know that hookah contains tobacco. The aim of the study was to assess the prevalence of hookah and factors associated with its cessation among adolescents from slums of Mumbai.

Methods:
LifeFirst is a tobacco/areca-nut dependence treatment program implemented in 40 schools in slum areas of Mumbai in 2017-18. 4302 students of 7th-9th grades attended orientation sessions about tobacco products including hookah and their harmful effects. Students were informed about the availability of a cessation service and encouraged to register voluntarily for six theme-based group sessions conducted over six months. At the end of the six sessions, cessation outcomes were recorded.

Results:
Of the 1441 students registered for tobacco/areca-nut cessation, 6% were current hookah users (3% of boys and 7% of girls). 65% of them initiated hookah use because of curiosity and 25% due to peer influence. Of the current hookah users, 8% smoked hookah daily. At the end of six sessions, 54% of the hookah users reported stopping smoking hookah while the abstinence was 72% among the rest of the students.

Conclusions:
Hookah smoking is prevalent among school-going adolescents from slums of Mumbai and school-based cessation programs are required to increase awareness and support them to quit.