title: U.S. hookah tobacco smoking establishments advertised on the internet.
abstract: BACKGROUND
  Establishments dedicated to hookah tobacco smoking recently have proliferated and helped introduce hookah use to U.S. communities.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA. bprimack@pitt.edu
authors.forename: Brian A
authors.initials: BA
authors.lastname: Primack
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Rice
authors.forename: Ariel
authors.initials: A
authors.lastname: Shensa
authors.forename: Mary V
authors.initials: MV
authors.lastname: Carroll
authors.forename: Erica J
authors.initials: EJ
authors.lastname: DePenna
authors.forename: Rima
authors.initials: R
authors.lastname: Nakkash
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Barnett
mesh_terms: D000329:Advertising; D020407:Internet / Q000706:statistics & numerical data*; D012147:Restaurants / Q000706:statistics & numerical data; D012907:Smoking; D014481:United States