Background Impulsivity is a formidable cause of waterpipe tobacco smoking among youth, however, it is understudied among African youth. Using PRIME behavioural theory, this study aimed to develop a model that examines the motivators of impulsivity to smoke waterpipe tobacco in linkage to the moderating role of social media normalisation of waterpipe tobacco, specifically among youth in Nigeria who smoke waterpipe tobacco. Methods Data were drawn from 695 respondents who smoke waterpipe tobacco across six Nigerian universities in the South-West zone using the chain-referral sampling procedure. Descriptive analyses of the obtained data were carried out using the Statistical Package for Social Sciences (SPSS) version 25. The constructs in the developed model were validated through Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS version 3. Results Among Nigerian youth who smoke waterpipe tobacco, intention (β = 0.442, P < 0.001) was the strongest motivator of impulsivity to smoke waterpipe tobacco as compared to positive evaluations (β = 0.302, P < 0.001). In addition, social media normalisation of waterpipe tobacco acted as a moderator that strengthened the relationship between intention and impulsivity (β = 0.287, P < 0.01), as well as, between positive evaluations and impulsivity (β = 0.186, P < 0.01) among youth. Conclusion Intention greatly instigates Nigerian youth’s impulsivity to smoke waterpipe tobacco, and social media normalisation of waterpipe tobacco also considerably increases their impulsivity to smoke waterpipe tobacco. Youth-focused educational waterpipe tobacco cessation-oriented programmes that utilise diverse constructive-based learning approaches like illustrative learning and counselling, can help to enlighten and encourage Nigerian youth on the importance of shunning the desirability to smoke waterpipe tobacco.

Background: Impulsivity is a formidable cause of waterpipe tobacco smoking among the youths, however, it is less well studied among African youths. Using PRIME behavioural theory, this study aimed to develop a model that examines the motivators of impulsivity to smoke waterpipe tobacco in linkage to the moderating role of social media normalisation of waterpipe tobacco among youths in Nigeria. Methods: Data were drawn from 695 youths who smoke waterpipe tobacco across six Nigerian universities in the south-west zone using the chain-referral sampling procedure. Descriptive analyses of the obtained data were carried out using the Statistical Package for Social Sciences (SPSS) version 25. The constructs in the developed model were validated through Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS version 3.Results: Among the Nigerian youths who smoke waterpipe tobacco, intention (β=0.442, P<0.001) is the strongest motivator of impulsivity to smoke waterpipe tobacco as compared to positive evaluations (β=0.302, P<0.001). Additionally, social media normalisation of waterpipe tobacco acts as a moderator that strengthens the relationship between intention and impulsivity (β=0.287, P<0.01) as well as between positive evaluations and impulsivity (β=0.186, P< 0.01) among the youths.Conclusion: Willingness greatly instigates the Nigerian youths’ impulsivity to smoke waterpipe tobacco, and social media normalisation of waterpipe tobacco also considerably increases their impulsivity to smoke waterpipe tobacco. Youth-focused educative waterpipe tobacco cessation-oriented programmes that will utilise diverse constructive-based learning approaches like illustrative learning and counselling, are needed to enlighten and encourage the Nigerian youths on the importance of shunning the desirability to smoke waterpipe tobacco.

Despite the danger of shisha smoking, the freedom provided by social media means, pro-shisha smoking content can be freely shared across the platform. This could have a negative impact on youth who are frequent users of social media. They are often associated with the shisha smoking habit. Hence, this paper systematically synthesized the findings of the earlier literature related to the portrayal of shisha smoking on social media. This was performed to provide insight pertaining to the issue, which contributes to public health intervention and also for future research. Search for relevant literature was conducted using academic search engines including Google Scholar, PubMed, Web of Science, Science Direct, Scopus, and the Cochrane Library. The literature was qualitatively and thematically synthesized. The results of this review indicated that, shisha smoking is commonly portrayed as a social activity that is fun, relaxing, and desirable. At the individual level, it was also found that, social media serves as a platform for youth to express shisha smoking attitude. The findings of this review can enhance the understanding of how the portrayal of shisha smoking on different social media platforms may be interfering with public health cessation intervention. This study adds to the present knowledge with regard to the portrayal of shisha smoking on social media.