Introduction 1 2 3 4 5 6 7 8 9 10 11 14 15 19 20 22 23 24 16 25 The aim of this study was: (a) to identify the characteristics of Web sites with information on smoking cessation for teenagers that ranked in the top 30 positions in a typical Web search on popular search sites and (b) to evaluate the association between those characteristics and the position ranking for sites that are of direct relevance to smoking cessation for teenagers. The findings are relevant for improving consumer access to health information. Methods This study was carried out from May 2003 through June 2003. Web sites with information on smoking cessation for teenagers were identified with 4 popular search sites using a specific search term. The characteristics of the identified sites were collected with a Web-site characteristic checklist; 2 raters evaluated each Web site independently (details below). Search Protocol Table 1 27 28 29 30 31 32 Checklist of Web-Site Characteristics Table 2 33 34 35 siteURL Statistical Analysis P Results Table 3 Characteristics of the 14 Relevant Web Sites Table 2 Essential-Characteristic Category 36 The correlation between the 2 raters ranged from 1.00 for 2 characteristics (presence of phone number or mailing address and presence of material in video or audio format) to 0.19 for indication of sponsorship. The median correlation was 0.69 for the 15 characteristics evaluated by both raters. P Enhancement-Characteristic Category P P P P Technical-Characteristic Category P P P Discussion The key finding of this study was that using simple search terms on popular search sites to look for information on smoking cessation for teenagers, less than half (14 of 30) of the sites found were of direct relevance. The remaining sites were study reports, news, and hyperlinks. 37 9 10 38 39 Of public health concern was the finding that 3 sites were commercial sites and 2 of them were linked back to a single online drug store using a page-redirect spamming technique. With page redirection, an optimized page with unique and specific terms is submitted to search sites with the single purpose of ranking high on a specific topic. However, anyone clicking the link to this page is automatically sent to a real destination page, which often contains material unrelated to the initial search terms. For example, one site used "what-happens-to-your-body-when-you-quit-smoking.htm" as the name of its Web page. However, this page contains no information on smoking cessation. Instead, it is a page with a JavaScript that immediately redirects visitors to an online drug store. Several important associations were found between Web-site characteristics and position ranking in the top 30 search results. These results can be used for optimizing site development in future smoking-cessation Web sites. Essential-Characteristic Category As an example of how these results can be used, of the 6 items in the essential-characteristic category, readability (lower grade level) was associated with higher position ranking. The lack of search box, navigational menu, privacy statement, or disclaimer, or the presence of broken links, was not uncommon, but their absence was not associated with lower position ranking. Enhancement-Characteristic Category 18 5 8 Technical-Characteristic Category P 40 41 P 42 P 43