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University of Pittsburgh Schools of the Health Sciences

More than Half of Hookah Tobacco Websites Don’t Include the Word “Tobacco,” Pitt-led Study Finds

PITTSBURGH, Jan. 30, 2012 – Of the growing number of businesses promoting hookah tobacco smoking on the Internet, fewer than 1 percent included a tobacco-related warning about the practice on the first page of their websites, according to a University of Pittsburgh School of Medicine study available online in the American Journal of Preventive Medicine. The study also found that, while cigarette-related web pages often are required to verify users’ ages, none of the hookah tobacco web pages required any type of age verification. Researchers say the findings suggest more health education may be valuable in countering misinformation about smoking tobacco through hookahs.

Brian Primack, M.D., Ph.D.,  associate professor of medicine and pediatrics at Pitt’s School of Medicine, who led the study, said many websites stated or implied that smoking tobacco through the pipes was safer than cigarette smoking. In fact, only 26 percent of the websites included the word “tobacco” somewhere on opening web pages.

“Hookah tobacco smoking is growing in popularity in the United States, but many people are unaware of the health risks. It’s believed that one session of smoking tobacco through a hookah can deliver about 50 to 100 times the smoke volume, 40 times the tar and twice the nicotine usually delivered by a single cigarette,” Dr. Primack said. “Hookah smoking has been linked to serious diseases like cancer and cardiovascular disease, and people should be aware of these risks.”

The researchers examined the contents of U.S.-based websites that promote hookah smoking establishments. They scrutinized 144 websites and coded them for their content and format. Researchers found many of the hookah businesses had similar characteristics that glamorized hookah tobacco smoking as a fun, social activity: 79 percent served food, 41 percent served alcohol, 53 percent offered dancing and 37 percent offered live music. Many also had a social media presence, with 31 percent having Facebook pages and 15 percent having Twitter.

“Many people seem to have the misconception there is no tar or nicotine associated with this type of tobacco use. I think we need to step up our educational efforts to help them understand what the risks may be,” Dr. Primack said.

Collaborators on the study include Kristen R. Rice, M.P.H.; Ariel S. Shensa, M.S.; Mary V. Carroll, B.A.; and Erica J. DePenna, all of the University of Pittsburgh School of Medicine; Rima Nakkash, Dr.P.H., M.P.H., American University, Beirut, Lebanon; and Tracey Barnett, Ph.D., University of Florida.

The study was funded by the National Cancer Institute.

A video of Dr. Primack discussing the research is available at

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