Social media is giving researchers insight into the rising use of hookah, according to a study from USC. Hookah, smoked through a water pipe and also known as shisha, has harmful health effects similar to cigarettes. But as cigarette use declined between 2005 and 2015 in the U.S, hookah use increased.
New data from social media documents thousands of people using hookah in social settings and nightlife establishments using social media to promote hookah use.
Investigators from the Keck School of Medicine of USC analyzed Instagram to capture and document the social and environmental context in which individuals use and are marketed hookah-related products.
"By focusing on social media data, we can quickly discover emerging problems posed to public health, directly observing what the public is experiencing, doing and thinking almost in real-time," said Jon-Patrick Allem, lead author of the study and a postdoctoral scholar research associate at the Keck School of Medicine of USC.
Hookah on Social Media
The study, published Jan. 11 in Nicotine & Tobacco Research, describes how the researchers analyzed posts on Instagram between Feb. 19 and May 19, 2016, by combining the hashtag #hookah with a geo-location inside the contiguous U.S.
Their analysis of more than 5,000 posts determined overarching themes within the images. More than a third were promotional material for hookah lounges, restaurants, bars and nightclubs, while a quarter depicted people lounging and using a hookah. Other themes included photos of a person blowing smoke or of stylized pipes.
Hookah promotion on social media was not surprising, said Jennifer Unger, study co-author and a professor of preventive medicine at the Keck School of Medicine of USC. However a third of the images showcased or referenced alcohol, suggesting nightlife entertainment regularly depicts and promotes using multiple substances -- "a clear justification for a public health response."
"Instagram's focus on images facilitates picture-based advertising where hookah lounges promote drink specials at the same time nightclubs promote hookah specials," said Kar-Hai Chu, co-author of the study and a former research scientist at USC. "Our findings could be of great importance to public health as tobacco use facilitates greater intake of alcohol and vice versa."
A Public Health Response
Researchers did not find promotional material discouraging hookah use in their data. "Instagram users may see pictures of their friends and family enjoying themselves in social settings where hookah use is a focus," said Tess Boley Cruz, co-author and an assistant professor of clinical preventive medicine at the Keck School of Medicine of USC. "Given the potential diffusion of such images through social media, it will be important for tobacco control researchers to develop programs to combat the positive imagery, and potential normalization, of hookah use on Instagram."
The study raises concern about particular U.S. tobacco control laws, which allow hookah to be used inside certain establishments. "The removal of policy exceptions in the U.S. would likely prevent hookah use from being part of nightlife promotion and entertainment in the future," Allem said.
The research was funded by the National Cancer Institute and the FDA Center for Tobacco Products (Grant P50CA180905).