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

Objectives: To describe and characterize social media content in relation to waterpipe smoking using qualitative methods.

Study design: Exploratory qualitative design.

Methods: A 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.

Results: Over 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.

Conclusions: Waterpipe smoking may be normalized as an enjoyable activity in this online environment, posing a challenge for public health.