Hookah smoking is becoming increasingly popular worldwide, especially among young adults. The growth of social media has also enabled sharing of opinions, experiences, and marketing related to hookah via user-generated content.
To evaluate the portrayal and promotion of hookah on Instagram and to highlight public health challenges created by this content.
A qualitative content analysis was performed on a sample of 301 Instagram posts made with the hashtags #hookah or #shisha in October 2016.
Of the 301 coded posts, 279 were relevant to hookah. These posts were most commonly made by hookah lounges/bars (29.2%) and individual users (27.6%). Posters were most commonly from Russia (38.5%), the United States (18.6%), and Germany (10.7%). A total of 63.8% of the posts were promotional in nature; 19.7% of posts contained hashtags that expressed hookah identity or community (e.g., #hookahlife); 35.5% of posts associated nightlife activities with hookah smoking and 33.0% portrayed hookah smoking as a social activity. Only one post (0.4%) mentioned that hookah might have negative health effects. Likes were more common on posts depicting novel rather than traditional hookah designs ( p = .027).
Images from Instagram may help in understanding health behaviors such as hookah smoking. Our results suggest that domestic and international hookah promotion is common on Instagram. Instagram posts cast hookah in an overwhelmingly positive light and may normalize hookah use through associations with nightlife, community, and hookah identity. Policy makers and researchers should explore approaches for reducing the volume of promotional posts and tailoring counter-marketing to the specific themes presented on social media.
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 August 2018.
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#7,953,036
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#670
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#104,808
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Outputs of similar age from Health Education & Behavior
#8
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Altmetric has tracked 30,071,199 research outputs across all sources so far. This one has received more attention than most of these and is in the 71st percentile.
So far Altmetric has tracked 1,687 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.1. This one has gotten more attention than average, scoring higher than 57% of its peers.
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We're also able to compare this research output to 21 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 52% of its contemporaries.
