Campaigns to dissuade students form smoking hookah could be more successful if they made the activity look less romantic and relaxing instead of simply focusing on the health risks involved.

Researchers looked at the events that led up to students smoking hookah for the first time, a University of Pittsburgh Schools of the Health Sciences news release reported.

"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," lead author Jaime Sidani, Ph.D., M.P.H., senior research specialist in the Program for Research on Media and Health (PROMH) at Pitt, said in the news release. "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."

To make their findings the researchers looked at 569 first and second year students from the University of Florida. The participants were surveyed twice over a seven-month period about how they felt about hookah and whether or not they used it.

The team found the students were more likely to participate in hookah if they had a positive attitude about it; hookah is often marketed as being "relaxing, pleasurable, fun and sexual," the news release reported.

"Hookah tobacco smoking does not seem to be hampered by many of the negative social stigmas of cigarette smoking," Dr. 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."

"Clear policy measures addressing the sale and marketing of hookah products and regulation of hookah bars and cafes may be another way to counteract the positive attitudes young adults hold toward hookah smoking," Senior author Brian Primack, M.D., Ph.D., director of PROMH said in the news release.