• Brian A Primack, Kristen R Rice, Ariel Shensa, Mary V Carroll, Erica J DePenna, Rima Nakkash, and Tracey E Barnett.
• Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA. bprimack@pitt.edu
• Am J Prev Med. 2012 Feb 1; 42 (2): 150-6.

BackgroundEstablishments dedicated to hookah tobacco smoking recently have proliferated and helped introduce hookah use to U.S. communities.PurposeTo conduct a comprehensive, qualitative assessment of websites promoting these establishments.MethodsIn 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.ResultsThe 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.ConclusionsWebsites 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.Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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