Research articleU.S. Hookah Tobacco Smoking Establishments Advertised on the Internet
Introduction
Although cigarette use has declined substantially over the past 2 decades,1, 2, 3 smoking tobacco with a hookah (water pipe, narghile, or shisha-pipe) is an emerging trend in the U.S.4, 5, 6, 7, 8 The WHO estimates that one hookah tobacco smoking session delivers 50–100 times the smoke volume of a single cigarette.9, 10 Further, the smoke from one hookah session contains about 40 times the tar,11, 12 30 times the carcinogenic polycyclic aromatic hydrocarbons,13 two times the nicotine,11, 12 and ten times the carbon monoxide11, 12, 14 of the smoke from a single cigarette. Hookah smokers are exposed to these toxicants when they smoke,15, 16, 17, 18, 19 and blood nicotine levels of daily hookah tobacco users are similar to those of an individual who smokes ten cigarettes per day.11, 12, 17 These data are consistent with preliminary reports linking hookah tobacco smoking to cancer, cardiovascular disease, decreased pulmonary function, and nicotine dependence.20, 21, 22, 23 Despite these reports, many individuals continue to perceive hookah tobacco smoking as having low potential for harm and addictiveness.4, 6, 7, 24, 25
Although definitive population-based studies are lacking, localized samples suggest ever-use prevalence of 20%–40%.4, 6, 24 Additionally, hookah tobacco use may be increasing.4, 6, 24 One reason is that it may have more aesthetic appeal than cigarette use. The tobacco used in hookahs is generally flavored and sweetened, resulting in a sweet-smelling smoke, and the hookah pipes are often made of intricately carved glass and polished metal.9, 17, 26, 27 Another reason may be the recent proliferation of establishments that are dedicated to hookah tobacco smoking and are helping to introduce the practice to U.S. communities.28, 29, 30 Yet another reason may be the manner in which hookah use is advertised.
In the past, increases in cigarette smoking have often been fueled by well-funded marketing promotions,31, 32, 33 but this currently does not appear to be the case with hookah tobacco use. Because many experts consider a website to be a crucial element of the marketing of a new business,34 especially if the business targets young and socially connected individuals,29 it may be helpful to determine how many websites are dedicated to advertising hookah smoking establishments and what types of messages they are providing. This information, which has not been published previously, may help researchers and practitioners understand the appeal of hookah use and ultimately help them develop intervention programs to reduce the use of all forms of tobacco consumption. Therefore, the purpose of the present study was to conduct a systematic, comprehensive, qualitative assessment of websites advertising hookah tobacco smoking establishments in the U.S.
Section snippets
Website Search and Sample Determination
To access the universe of websites representing major hookah tobacco smoking establishments, the research team performed a search similar to the type that commonly is used in systematic reviews of the medical and public health literature.35, 36, 37 In June 2009, two members of the team searched google.com, yahoo.com, and bing.com, because at that time these three search engines accounted for more than 95% of all U.S. searches. Each of these engines uses a proprietary algorithm to prioritize
Characteristics of the Sample
In the sample of 144 websites, hookah establishments were present in all regions of the U.S. Per capita representation (Figure 2) was highest in four western states (California, Nevada, Arizona, and Colorado); two southern states (Florida and Georgia); two midwestern states (Illinois and Indiana); and three states in the mid-Atlantic and northeast (Virginia, New York, and Massachusetts).
Characteristics of the Hookah Establishments
Of the 144 establishments, 114 (79%) served food; 59 (41%) served alcohol; 68 (47%) were full-service
Discussion
These findings demonstrate that hookah tobacco smoking establishments are promoted on the Internet, with representation from all U.S. regions. Hookah establishments commonly offered food, alcohol, and popular social activities such as dancing. Although only 26% of the websites mentioned the word tobacco on the opening page, this page was used more frequently to promote flavorings, pleasure, relaxation, product quality, and cultural and social aspects of hookah tobacco smoking. No websites
Conclusion
This analysis of 144 websites representing hookah tobacco smoking establishments suggests that these establishments, which exist in all geographic areas of the U.S., tend to promote themselves as highly social, cultural, and fun places for young people to relax and enjoy themselves. The promotional materials of the establishments de-emphasize age limits, health warnings, and even that tobacco is involved in hookah smoking. These findings suggest that health education and policy changes are
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2019, Social Science and MedicinePrevalence and harm perceptions of hookah smoking among U.S. adults, 2014–2015
2017, Addictive BehaviorsCitation Excerpt :Consistent with the literature (Barnett, Smith, et al., 2013; Cavazos-Rehg et al., 2015; Salloum et al., 2015), the results of the current study show that ever hookah smoking is more common among young, educated, non-heterosexual, and other, non-Hispanic, adults. The popularity of hookah smoking among young and college-educated adults is emphasized by the strategic placement of hookah establishments in close proximity to college campuses (Kates et al., 2016), exposure to online and social media advertisement (Krauss et al., 2015; Primack et al., 2012), and the use of flavors attractive to young people (Akl et al., 2015). Concurrent with past research (Blosnich, Jarrett, & Horn, 2011; Johnson et al., 2016; Salloum et al., 2015), our findings suggest that non-heterosexual adults are at higher risk of smoking hookah.
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