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Background: Despite the speculations in literature regarding the importance of “social undesirability of hookah smoking”, to our knowledge, no study has yet clearly attempted to define this phenomenon and to make sense of it in terms of the meanings adolescents bring to the concept. The present study was aimed to explore the perceptions of high school students on Social Undesirability of Hookah Smoking (SUoHS).Method: In this qualitative study, 31 students (16 boys and 15 girls) at the range of 15 to 17 years of age in Tabriz, Iran, were invited to participate in semi-structured individual interviews (18 participants) and focus group discussions (FGDs) (13 participants). The data were managed applying MAXQDA-10, and analyzed using interpretative thematic analysis. Results: The SUoHS was viewed at the “highly negative attitude towards hookah smoking and hookah smokers”. The students also explained the SUoHS in “the disvaluing to hookah smoking and smokers in the society”, “the negative attitude towards hookah smokers and their families”, and “the consequences of hookah smoking”. Conclusion: The SUoHS originates from the social context of society, and is rooted from the social values and norms within communities. These social values may affect the attitude and subjective norms of adolescents toward the behavior. Adolescents’ conceptions on SUoHS should be considered while designing hookah smoking prevention/cessation programs with the hope to bridge the gap between their recognition of SUoHS and subsequent behavior change.

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