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Background
Establishments dedicated to hookah tobacco smoking recently have proliferated and helped introduce hookah use to U.S. communities.
Purpose
To conduct a comprehensive, qualitative assessment of websites promoting these establishments.
Methods
In June 2009, a systematic search process was initiated to access the universe of websites representing major hookah tobacco smoking establishments. In 2009-2010, codebook development followed an iterative paradigm involving three researchers and resulted in a final codebook consisting of 36 codes within eight categories. After two independent coders had nearly perfect agreement (Cohen's ¦Ê = 0.93) on double-coding the data in the first 20 % of sites, the coders divided the remaining sites and coded them independently. A thematic approach to the synthesis of findings and selection of exemplary quotations was used.
Results
The search yielded a sample of 144 websites originating from states in all U.S. regions. Among the hookah establishments promoted on the websites, 79 % served food and 41 % served alcohol. Of the websites, none required age verification, <1 % included a tobacco-related warning on the first page, and 4 % included a warning on any page. Although mention of the word tobacco was relatively uncommon (appearing on the first page of only 26 % sites and on any page of 58 % of sites), the promotion of flavorings, pleasure, relaxation, product quality, and cultural and social aspects of hookah smoking was common.
Conclusions
Websites may play a role in enhancing or propagating misinformation related to hookah tobacco smoking. Health education and policy measures may be valuable in countering this misinformation.
