Hookahs are water pipes that are used to smoke specially made tobacco that is usually flavored. Other names are waterpipe, sheesha or shisha. Hookah smoking typically takes place in groups, with the same mouthpiece passed from person to person.
What people don't realize, researchers said, is that hookah smoke contains many of the same harmful toxins as cigarette smoke and has been associated with lung cancer, respiratory illness, low birth weight and gum disease. And because of the method of smoking — more puffs, deeper inhalation over longer smoking sessions — hookah smokers may absorb higher concentrations of the same toxins found in cigarette smoke.
The study is the first to rely exclusively on tweets about hookah use. Researchers say they are increasingly turning to social media to study newer trends in substance use because the data is more readily available than results from traditional health surveys.
The researchers have done similar analyses using tweets about alcohol and marijuana. There are more tweets about marijuana (more than 250,000 a day) and alcohol (at least 400,000 a day) than about hookah, but more tweets about hookah than smoking e-cigarettes (1,200 a day).
Researchers collected all tweets containing the terms "hookah" and "shisha" (and alternative spellings) from April to May 2014. Of more than 350,000 such tweets, researchers then analyzed the contents of nearly 40,000 tweets from people they considered the most influential. From that pool, they analyzed a random sample of about 5,000 tweets.
Of those, a majority, or 87 percent, were pro-hookah and included tweets from users and from songs or music. Nearly a quarter were commercial promotions from bars or clubs. Hookah bars are often exempt from indoor-smoking bans enforced in many states and localities, researchers said.
About 15 percent of the pro-hookah tweets mentioned using other substances.
A sample tweet: "I want hookah. Smokin da hookah with good homies. Hookah sounds like a great idea tonight."
Only 7 percent of the tweets were against hookah.
Public health officials should push for hookah bars and clubs to be included in bans on indoor smoking, Krauss said. And get more creative online.
"They need to use Twitter in a more strategic way to get these prevention messages out there," she said.