title: Hookah-Related Twitter Chatter: A Content Analysis.
abstract: BACKGROUND
  Hookah smoking is becoming increasingly popular among young adults and is often perceived as less harmful than cigarette use. Prior studies show that it is common for youth and young adults to network about substance use behaviors on social media. Social media messages about hookah could influence its use among young people. We explored normalization or discouragement of hookah smoking, and other common messages about hookah on Twitter.
  
  
  METHODS
  From the full stream of tweets posted on Twitter from April 12, 2014, to May 10, 2014 (approximately 14.5 billion tweets), all tweets containing the terms hookah, hooka, shisha, or sheesha were collected (n = 358,523). The hookah tweets from Twitter users (tweeters) with high influence and followers were identified (n = 39,824) and a random sample of 5,000 tweets was taken (13% of tweets with high influence and followers). The sample of tweets was qualitatively coded for normalization (ie, makes hookah smoking seem common and normal or portrays positive experiences with smoking hookah) or discouragement of hookah smoking, and other common themes using crowdsourcing.
  
  
  RESULTS
  Approximately 87% of the sample of tweets normalized hookah use, and 7% were against hookah or discouraged its use. Nearly half (46%) of tweets that normalized hookah indicated that the tweeter was smoking hookah or wanted to smoke hookah, and 19% were advertisements/promotions for hookah bars or products.
  
  
  CONCLUSIONS
  Educational campaigns about health harms from hookah use and policy changes regarding smoke-free air laws and tobacco advertising on the Internet may be useful to help offset the influence of pro-hookah messages seen on social media.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Box 8134, St. Louis, MO 63110. Email: kraussm@psychiatry.wustl.edu.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Krauss
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis.
authors.forename: Shaina J
authors.initials: SJ
authors.lastname: Sowles
authors.affiliation: Seattle Children's Research Institute, Center for Child Health Behavior and Development, Seattle, Washington.
authors.forename: Megan
authors.initials: M
authors.lastname: Moreno
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis.
authors.forename: Kidist
authors.initials: K
authors.lastname: Zewdie
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grucza
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bierut
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cavazos-Rehg
mesh_terms: D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D010565:Persuasive Communication; D036301:Qualitative Research; D012907:Smoking / Q000009:adverse effects / Q000523:psychology*; D040241:Social Marketing; D061108:Social Media / Q000706:statistics & numerical data*