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. 2012 Feb;42(2):150-6.
doi: 10.1016/j.amepre.2011.10.013.

U.S. hookah tobacco smoking establishments advertised on the internet

Brian A Primack  1 , Kristen R Rice, Ariel Shensa, Mary V Carroll, Erica J DePenna, Rima Nakkash, Tracey E Barnett
Affiliations

U.S. hookah tobacco smoking establishments advertised on the internet

Brian A Primack et al. Am J Prev Med. 2012 Feb.

Abstract

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 κ = 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.

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Figures

Figure 1
Figure 1
Website selection Note: Although some websites did not meet inclusion criteria for more than one reason, each website was assigned a primary reason for exclusion. These numbers represent websites excluded for the primary reasons listed.
Figure 2
Figure 2
Concentration of the 144 U.S. hookah tobacco establishments with stand-alone websites described in this study
See this image and copyright information in PMC

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