Table 1.

Focus Group Themes, Subthemes and Example Narratives

Specific Themes	Example Narrative
Social Appeal  Bonding  Acceptable	“Something my friends are doing so that’s why I’m going.”
	“If my friends are going, I’ll hang out with them, you know like, it’s not really that I necessarily - oh yeah I really want to smoke right now.”
	“It is kind of like a bonding activity, people like to bond over it.”
	“Like, it’s like acceptable in your social world. Like it’s acceptable.”
Physical Attractiveness  Appealing  Attractive	“But, yeah, so, but I mean, I would also say, I guess maybe, the foreign aura around it gives it a positive, like, appeal.”
	“Even like aesthetically, like it’s just cooler.”
	“There’s a very strong aesthetic appeal to them.”
	“I feel like enticing or attractive maybe.”
Pleasant Smoke  Flavors/Taste  Tricks	“Well that’s like, one thing with hookah is, you know, I love it, but you give me like a cigar or something, and I can’t stand it cause it’s hot smoke. It’s like I don’t like the taste of hot smoke, but there is something about the hookah when you get the flavored tobacco and it’s been cooled through the water, it’s smooth.”
	“I like that you can do tricks and techniques.”
	“Yeah, but you have so many… you can have like watermelon. You can mix watermelon and apple.”
	“I’m just saying like as a female, there are flavors that I can feel attracted to, but I feel like they’re made for me. That I can do this too.”
Comparison to Cigarettes  Process  Access  Acceptability  Repercussions	“I feel like it’s less harsh. Like the smoke is less harsh than a cigarette.”
	“And kind of on another note, the smoke, the smell isn’t as bad as say like smoking a cigar or a cigarette. It definitely doesn’t linger as long or anything like that.”
	“I think less unattractive and less offensive than cigarettes.”
	“Like, in the sense of like why is somebody smoking hookah, because usually people smoke like cigarettes to calm them down or something, but there’s like a lot of different reasons to smoke hookah.”
	“You can buy hookahs in gas stations. Yeah, there’s whole stores that you can, so it’s very popular. Yeah, very accessible, that’s the word.”
Relaxing  Atmosphere  Calming  Buzz	“I like the French inhale, certain ways to make the nicotine go straight to your head. Give you like the strong buzz or head rush.”
	“It’s like a volume, like a great volume of smoke too at one time and that’s what really produces the head high.”
	“I’m trying to think of a word for the atmosphere, cause usually it’s like in a really dark, like kind of laid back with music atmosphere.”
	“Chill feeling, different feeling, relaxing feeling, it’s a calming feeling, it’s a fun feeling, feeling like you’re doing something special.”
Deterrents  Harm  Chemicals	“Yeah if the coal’s been burning too long and the shisha gets scorched, it’s like it it gets real harsh.”
	“Once all the tobacco all gets burnt up it’s like you’re just smoking ash. It makes you cough hard.”
	“Toxins? I guess just the nicotine even though it’s not up there. Whatever other chemicals that are in the smoke.”

Note: Unshaded text represent positive outcomes and shaded text represent negative outcomes.