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U.S. Hookah Tobacco Smoking Establishments Advertised on the Internet

  • Brian A. Primack
    Correspondence
    Address correspondence to: Brian A. Primack, MD, PhD, Center for Research on Health Care, 230 McKee Place Suite 600, Pittsburgh PA 15213
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Kristen R. Rice
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Ariel Shensa
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Mary V. Carroll
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Erica J. DePenna
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Rima Nakkash
    Affiliations
    Department of Health Promotion and Community Health, Faculty of Health Sciences, American University, Beirut, Lebanon
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  • Tracey E. Barnett
    Affiliations
    Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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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 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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      References

        • CDC
        Cigarette use among high school students—U.S., 1991–2005.
        MMWR Morb Mortal Wkly Rep. 2006; 55: 724-726
        • Kilmer G.
        • Roberts H.
        • Hughes E.
        • et al.
        • Centers for Disease Control and Prevention (CDC)
        Surveillance of certain health behaviors and conditions among states and selected local areas—Behavioral Risk Factor Surveillance System (BRFSS), U.S., 2006.
        MMWR Surveill Summ. 2008; 57: 1-188
        • National Assocation of Attorneys General
        Cigarette sales in U.S. reach historic 55-year low.
        National Association of Attorneys General, Washington DC2006
        • Primack B.A.
        • Sidani J.E.
        • Agarwal A.A.
        • Donny E.C.
        • Shadel W.G.
        • Eissenberg T.E.
        Prevalence of and associations with waterpipe smoking among U.S. university students.
        Ann Behav Med. 2008; 36: 81-86
        • Smith S.Y.
        • Curbow B.
        • Stillman F.A.
        Harm perception of nicotine products in college freshmen.
        Nicotine Tob Res. 2007; 9: 977-982
        • Smith-Simone S.
        • Maziak W.
        • Ward K.D.
        • Eissenberg T.
        Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples.
        Nicotine Tob Res. 2008; 10: 393-398
        • Primack B.A.
        • Walsh M.
        • Bryce C.
        • Eissenberg T.
        Water-pipe tobacco smoking among middle and high school students in Arizona.
        Pediatrics. 2009; 123: e282-e288
        • Primack B.A.
        • Fertman C.I.
        • Rice K.R.
        • Adachi-Mejia A.M.
        • Fine M.J.
        Waterpipe and cigarette smoking among college athletes in the U.S..
        J Adolesc Health. 2010; 46: 45-51
        • WHO
        TobReg Advisory Note: waterpipe tobacco smoking: health effects, research needs and recommended actions by regulators.
        WHO, Geneva, Switzerland2005
        • Eissenberg T.
        • Shihadeh A.
        Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure.
        Am J Prev Med. 2009; 37: 518-523
        • Katurji M.
        • Daher N.
        • Sheheitli H.
        • Saleh R.
        • Shihadeh A.
        Direct measurement of toxicants inhaled by water pipe users in the natural environment using a real-time in situ sampling technique.
        Inhalation Toxicol. 2010; 22: 1101-1109
        • Shihadeh A.
        • Saleh R.
        Polycyclic aromatic hydrocarbons, carbon monoxide, “tar,” and nicotine in the mainstream smoke aerosol of the narghile water pipe.
        Food Chemical Toxicol. 2005; 43: 655-661
        • Sepetdjian E.
        • Shihadeh A.
        • Saliba N.A.
        Measurement of 16 polycyclic aromatic hydrocarbons in narghile waterpipe tobacco smoke.
        Food Chemical Toxicol. 2008; 46: 1582-1590
        • Barnett T.E.
        • Curbow B.A.
        • Soule Jr, E.K.
        • Tomar S.L.
        • Thombs D.L.
        Carbon monoxide levels among patrons of hookah cafes.
        Am J Prev Med. 2011; 40: 324-328
        • Cobb C.O.
        • Shihadeh A.
        • Weaver M.F.
        • Eissenberg T.
        Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects.
        Nicotine Tob Res. 2010; 13: 78-87
        • El-Nachef W.N.
        • Hammond S.K.
        Exhaled carbon monoxide with waterpipe use in U.S. students.
        JAMA. 2008; 299: 36-38
        • Neergaard J.
        • Singh P.
        • Job J.
        • Montgomery S.
        Waterpipe smoking and nicotine exposure: a review of the current evidence.
        Nicotine Tob Res. 2007; 9: 987-994
        • Maziak W.
        • Rastam S.
        • Ibrahim I.
        • Ward K.D.
        • Shihadeh A.
        • Eissenberg T.
        CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers.
        Nicotine Tob Res. 2009; 11: 806-811
        • Maziak W.
        • Rastam S.
        • Shihadeh A.L.
        • et al.
        Nicotine exposure in daily waterpipe smokers and its relation to puff topography.
        Addict Behav. 2011; 36: 397-399
        • Maziak W.
        • Ward W.D.
        • Eissenberg T.
        Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users.
        Drug Alcohol Depend. 2004; 76: 101-106
        • Ward K.D.
        • Eissenberg T.
        • Rastam S.
        • et al.
        The tobacco epidemic in Syria.
        Tob Control. 2006; 15: 24-29
        • Jabbour S.
        • El-Roueiheb Z.
        • Sibai A.M.
        Narghile (water-pipe) smoking and incident coronary heart disease: a case-control study.
        Ann Epidemiol. 2003; 13: 570
        • Raad D.
        • Gaddam S.
        • Schunemann H.
        • et al.
        Effects of waterpipe tobacco smoking on lung function: a systematic review and meta-analysis.
        Chest. 2011; 139: 764-774
        • Eissenberg T.
        • Ward K.D.
        • Smith-Simone S.
        • Maziak W.
        Waterpipe tobacco smoking on a U.S. college campus: prevalence and correlates.
        J Adolesc Health. 2008; 42: 526-529
        • Aljarrah K.
        • Ababneh Z.Q.
        • Al-Delaimy W.K.
        Perceptions of hookah smoking harmfulness: predictors and characteristics among current hookah users.
        Tob Induc Dis. 2009; 5: 16
        • Maziak W.
        • Ward K.D.
        • Afifi Soweid R.A.
        • Eissenberg T.
        Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic.
        Tob Control. 2004; 13: 327-333
        • Knishkowy B.
        • Amitai Y.
        Water-pipe (narghile) smoking: an emerging health risk behavior.
        Pediatrics. 2005; 116: e113-e119
      1. Hookah cafes on the rise.
        • Lewin T.
        Collegians smoking hookahs · · · filled with tobacco.
        The New York Times. 2006, Apr 19;
        • Maziak W.
        The global epidemic of waterpipe smoking.
        Addict Behav. 2011; 36: 1-5
        • Balbach E.D.
        • Gasior R.J.
        • Barbeau E.M.R.J.
        Reynolds' targeting for African Americans: 1988–2000.
        Am J Public Health. 2003; 93: 822-827
        • Pierce J.P.
        • Choi W.S.
        • Gilpin E.A.
        • Farkas A.J.
        • Berry C.C.
        Tobacco industry promotion of cigarettes and adolescent smoking [comment] [published erratum appears in JAMA 1998;280(5):422].
        JAMA. 1998; 279: 511-515
        • Wakefield M.A.
        • Durkin S.
        • Spittal M.J.
        • et al.
        Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence.
        Am J Public Health. 2008; 98: 1443-1450
        • Richmond R.
        Small businesses need to have a vibrant web presence.
        The Wall Street Journal. 2006, Sep 25;
        • Bonakdar R.A.
        Herbal cancer cures on the Web: noncompliance with The Dietary Supplement Health and Education Act.
        Fam Med. 2002; 34: 522-527
        • Ribisl K.M.
        • Kim A.E.
        • Williams R.S.
        Web sites selling cigarettes: how many are there in the USA and what are their sales practices?.
        Tob Control. 2001; 10: 352-359
        • Weber K.
        • Story M.
        • Harnack L.
        Internet food marketing strategies aimed at children and adolescents: a content analysis of food and beverage brand web sites.
        J Am Diet Assoc. 2006; 106: 1463-1466
        • Madan A.
        • Frantzides C.
        • Pesce C.
        The quality of information about laparoscopic bariatric surgery on the Internet.
        Surg Endosc. 2003; 17: 685-687
        • Gordon J.
        • Barot L.
        • Fahey A.
        • Matthews M.
        The Internet as a source of information on breast augmentation.
        PlastReconstr Surg. 2001; 107: 171-176
        • Leighton H.
        • Srivastava J.
        First 20 precision among World Wide Web search services.
        J Am Soc Information Sci. 1999; 50: 870-881
        • Crabtree B.F.
        • Miller W.L.
        Doing qualitative research.
        3rd ed. Sage, Newbury Park CA1992
        • Miller W.L.
        • Crabtree B.F.
        Primary care research: a multi typology and qualitative road map.
        in: Crabtree B.F. Miller W.L. Doing qualitative research. Sage, London, UK1992
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Thomas J.
        • Harden A.
        Methods for the thematic synthesis of qualitative research in systematic reviews.
        BMC Med Res Methodol. 2008; 8: 45
        • Hammal F.
        • Mock J.
        • Ward K.D.
        • Eissenberg T.
        • Maziak W.
        A pleasure among friends: how narghile (waterpipe) smoking differs from cigarette smoking in Syria.
        Tob Control. 2008; 17: e3
        • Nakkash R.
        • Khalil J.
        • Afifi R.A.
        The rise in narghile (shisha, hookah) waterpipe tobacco smoking: a qualitative study of perceptions of smokers and non smokers.
        BMC Public Health. 2011; 11: 315
        • Roskin J.
        • Aveyard P.
        Canadian and English students' beliefs about waterpipe smoking: a qualitative study.
        BMC Public Health. 2009; 9: 10
        • Khalil J.
        • Heath R.L.
        • Nakkash R.T.
        The tobacco health nexus?.
        Tob Control. 2009; 18: 420-421
        • Rastam S.
        • Ward K.D.
        • Eissenberg T.
        • Maziak W.
        Estimating the beginning of the waterpipe epidemic in Syria.
        BMC Public Health. 2004; 4: 32
        • Petty R.E.
        • Cacioppo J.T.
        Communication and persuasion: central and peripheral routes to attitude change.
        Springer-Verlag, New York NY1986
        • Gerbner G.
        • Gross L.
        • Morgan M.
        • Signorielli N.
        Living with television: The dynamics of the cultivation process.
        in: Bryant J. Zillman D. Perspectives on media effects. Lawrence Erlbaum Associates, Hilldale NJ1986: 17-40
        • Nakkash R.
        • Khalil J.
        Health warning labelling practices on narghile and related accessories (shisha, hookah) waterpipe tobacco products.
        Tob Control. 2010; 19: 235-239
        • Oregon Health Authority
        Oregon tobacco facts & laws.
        Department of Human Services, Portland OR2011
        • Barnett T.E.
        • Curbow B.A.
        • Weitz J.R.
        • Johnson T.M.
        • Smith-Simone S.Y.
        Water pipe tobacco smoking among middle and high school students.
        Am J Public Health. 2009; 99: 2014-2019