Portrayal of waterpipe (shisha, hookah, nargile) smoking on Twitter: a qualitative exploration

- Waterpipe smoking is increasing among adolescents.
- We characterized tweets from Twitter posts relating to waterpipe smoking for a 1 week period in 2014.
- Over half (59%) of all tweets were positive about waterpipe smoking.
- Twitter users described: where they smoked waterpipe, products they consumed alongside waterpipe and who they were with.
- The majority of photographs posted alongside '#hookah' had been taken inside and contained nobody or one person.

ObjectivesTo describe and characterize social media content in relation to waterpipe smoking using qualitative methods.Study designExploratory qualitative design.MethodsA representative sample of pre-existing social media content from Twitter relating to waterpipe smoking and written in the English language was collected during a 1 week period in July 2014. A total of 9671 tweets were collected; duplicates and retweets were removed leaving 4439 unique tweets. Data were analyzed semiotically (positive, negative, positive and negative, no sentiment, unclassifiable) and thematically. Photographs attached to tweets written by individual users indexed using #hookah (n = 299) were subjected to content analysis.ResultsOver half of all tweets were positive about waterpipe smoking (59%), with 3% negative, 21% lacking sentiment and 17% unclassifiable. However, there were variations by likely author of tweet, with 91% of tweets from individual users classified as positive. Twitter users focused on their emotional experience, location, other products they were consuming alongside waterpipe smoking, and who they were with. Analysis of photographs highlighted a high degree of synergy between text and visual representations of waterpipe smoking, and two thirds of photographs contained at least part of a waterpipe.ConclusionsWaterpipe smoking may be normalized as an enjoyable activity in this online environment, posing a challenge for public health.