Given the recent rise in hookah smoking among youth and college students, a team of researchers from Florida International University, the University of Wisconsin, the University of Miami, the Syrian Center

for Tobacco Studies, and the University of Pittsburgh randomly selected 279 posts from 11,517 posts tagged #hookah or #shisha within a four-day period. Out of the reviewed hookah-related posts:
  • 99.6% indicated positive sentiments towards hookah use
  • Only one post (0.4%) mentioned negative health effects associated with hookah use
  • 63.8% were promotional in nature
  • Most posts were associated with nightlife, community, and hookah identity

The authors wrote, "A growing body of evidence suggests that hookah smoking can lead to nicotine dependence and many other known smoking-related illnesses such as cancer, cardiovascular disease, and respiratory disease."

The researchers also noted that 10% of all posts used the hashtag #HookahAddiction, signaling that nicotine addiction is not perceived as a health risk that would discourage potential users, but instead referred to ironically or as a "badge of honor." The researchers commented that policymakers and others should explore approaches for reducing the number of promotional posts, for example, by creating campaigns to counter-market positive themes presented on social media.

"This study represents an important step in identifying hookah-related themes on Instagram and demonstrates the value in using data from this social platform to complement and extend our understanding of health behaviors," wrote authors Ben Taleb et al. "These findings can inform the design of future tobacco control media campaigns aimed at countering the normalization of hookah use on social media."

The research also suggests that this is a global phenomenon, with a majority of the posts coming from Russia (38.5%), the United States (18.6%), and Germany (10.7%).