Most of the 12,000 hookah-related tweets posted each day on Twitter portray hookah smoking in a positive light, and that has public health experts worried. They say all those positive tweets could feed the false assumption that it’s less harmful than smoking traditional cigarettes.
Hookah smoking has increased in popularity, particularly among young adults, in recent years. It involves inhaling specially flavored tobacco from a waterpipe. The tobacco is heated with charcoal and smoke travels through the water and out a hose with a mouthpiece used to inhale the smoke.
During hookah sessions, people tend to inhale more deeply, says Melissa J. Krauss, a research statistician in the psychiatry department at Washington University in St. Louis.
“We know it’s harmful, but there is a misconception that because the smoke is going through water, the toxins are filtered out and it’s a cleaner way to smoke. But that is not true.
The World Health Organization has reported that one session of smoking hookah can be as bad for you as smoking 100 cigarettes because hookah smokers tend to smoke longer and inhale very deeply.”
For a new study, published in the journal Preventing Chronic Disease, researchers tracked tweets related to hookah smoking for a month in 2014—more than 358,000 in all. Of those tweets, they analyzed a random sample of 5,000 to see what people were saying. About 87 percent of the sample tweets said positive things about hookah smoking while only 7 percent were negative.
“Nearly 90 percent of these tweets normalized or promoted hookah smoking,” Krauss says. “Those who sent the tweets often said they were smoking hookah or wanting to, or the tweets advertised hookah bars, hookah lounges, and hookah products.”
Tweet what you like
The researchers looked at tweets believed to have the greatest likelihood of being influential—tweets with large numbers of followers and other indicators suggesting they had received significant attention.
Researchers are increasingly turning to social media to study trends in substance use because data is readily available and young people are likely to be engaged. Krauss and colleagues have previously analyzed tweets about marijuana and alcohol.
“As with those studies, we found that the vast majority of tweets essentially encouraged substance use,” she says. “As we found with alcohol and marijuana, when people feel compelled to tweet about something, it’s usually because they like it.”
Because Twitter’s influence is new in the realm of public health, it isn’t yet clear how to respond to such messages, Krauss says. In the past, public health officials have mounted successful campaigns to inform people about dangers associated with cigarette smoking and to urge them to quit.
“Public health experts need to learn how to create an influential presence on social media and find the best strategies to spread their messages. But we aren’t there yet.”
The National Institute on Drug Abuse of the National Institutes of Health funded the work.