Patterns of Hookah Use and Digital Advertisement Exposure Among Adults in Saudi Arabia

Background: This study investigates how social media influences perceptions and behaviors towards hookah among the adult Saudi population, focusing on the exposure to tobacco advertisements on various digital platforms. It aims to understand the potential role of social media in shaping hookah-related attitudes and practices. Also, there was no research on the frequency of smoking advertisements in Saudi Arabia. We hypothesize that hookah smokers in Saudi Arabia face more content of tobacco in social media. Methods: This cross-sectional study employed a self-administered questionnaire to collect data. The target sample size was set at 600 participants. Recruitment was achieved through a combination of convenience sampling, online outreach, and the snowball technique. The study subjects were the adult Saudi population. Also, they were be separated into three groups hookah smokers, non-smokers. and other smokers of different devices. Also, this study had an IRB from King Abdullah International Medical Research Center. Results: In a survey of 614 participants, predominantly male 70.7% and within the 21-30 age bracket 44.1%, a majority single 67.9%, the study revealed varied educational backgrounds, with most holding either a high school diploma or a bachelor’s degree. Health profiles showed 80.9% without diagnosed diseases, though asthma was reported by 13.3%. Smoking behaviors indicated 36.2% were smokers, predominantly of cigarettes, followed by e-cigarettes and hookah. Interestingly, exposure to tobacco-related information and advertising was limited; only 38% had encountered cigarette warnings and a mere 6.4% for hookah, with 69.5% not seeing any tobacco ads online. On social media, there was low engagement with tobacco content, particularly on Instagram, TikTok, and Twitter, but 77.3% never actively engaged with such posts. Conclusions: The study found that a significant percentage of participants reported noticing various forms of marketing and promotion for different nicotine products, including advertisements on the internet, low prices drawing their attention, and receiving free gifts or special offers. Statistically significant differences were found between smokers and non-smokers in their exposure to internet advertising, price promotions, special offers, and seeing social media posts about nicotine products. This confirms that our hypothesis is correct, and that social media use influences the higher consumption of hookah.