Students are being swayed by relaxing and fun perceptions of hookah and ignoring health harms of the device, according to a recent study.

Researchers from the University of Pittsburgh School of Medicine found that educational campaigns meant to dissuade college students from initiating hookah tobacco smoking may be more successful if they combat positive perceptions of hookah use as attractive and romantic, rather than focusing solely on the harmful components of hookah tobacco smoke.

"It was surprising to learn that college students, even when they were aware of the health dangers associated with hookah tobacco smoking at baseline, still went on to use a hookah for the first time," Jaime Sidani, lead author of the study and a senior research specialist in the Program for Research on Media and Health (PROMH) at Pitt, said in a statement. "However, students who had less positive attitudes toward hookah smoking were significantly less likely to initiate. This suggests that countering positive attitudes may be at least as effective as emphasizing harm in preventing initiation of hookah tobacco smoking."

For the study, researchers analyzed a sample of more than 500 first- and second-year students at the University of Florida who were surveyed twice over a seven-month period about their attitudes, knowledge and behaviors regarding hookah smoking. During that time, 13 percent of the students initiated hookah tobacco use.

They found that the students were more likely to use hookah if they had positive attitudes toward hookah smoking -- which is frequently promoted as relaxing, pleasurable, fun and sexual - and if they thought it was a socially acceptable practice among their peers.

"Hookah tobacco smoking does not seem to be hampered by many of the negative social stigmas of cigarette smoking," Sidani said. "If educational programs can help students to cut through the positive portrayals and marketing of hookah smoking, it may be possible to make hookah smoking less attractive and socially acceptable, resulting in less initiation."

The findings will be published in the June issue of the journal Nicotine & Tobacco Research.