#Hookah, #Shisha, #Narghile: The Portrayal of #Waterpipe Smoking on Instagram

Background: In the last 25 years, rates of waterpipe tobacco smoking have sharply increased in the United States and other Western countries. At the same time, social media platforms such as Instagram have become a popular way to portray content related to waterpipe smoking. Thus, public health researchers have become interested in the potential relationship between the portrayal of waterpipe smoking on social media and the attitudes of users toward the activity. Objective: This study aims to examine the portrayal of waterpipe smoking on Instagram, a popular social media platform for adults in the U.S. Methods: A total of 1,000 Instagram posts were analyzed in a quantitative content analysis focusing on descriptive engagement frequencies as well as on key variables of the framework of the Theory of Reasoned Action (TRA). Results: Waterpipe smoking was portrayed in a consistently positive manner and health risks were rarely mentioned. Of the TRA constructs, a positive attitude toward waterpipe smoking was present in the majority of posts, and subjective norms were present in more than 20% of posts. Conclusion: In a content analysis of 1,000 Instagram posts, waterpipe smoking was portrayed in a consistently positive manner, often in a context of relaxation and fun. Considering the increasing popularity of waterpipe smoking and the lack of displayed concern for the known negative health effects, this is an important issue for public health practitioners to be aware of and address on Instagram.