Electronic Theses and Dissertations



Document Type


Degree Name

Doctor of Philosophy


Social & Behavioral Sciences

Committee Chair

Kenneth Ward

Committee Member

Satish Kedia

Committee Member

Brook Harmon

Committee Member

George Relyea


Introduction: Waterpipe smoking has become a global phenomenon in recent years, especially among adolescents. Some users exhibit symptoms of nicotine dependence (dependence), but instruments have not been developed to assess dependence in this population. This dissertation utilized 28 self-report items related to multiple features of dependence that were generated by work conducted at the Syrian Center for Tobacco Studies (SCTS). These 28 items were used to develop and psychometrically evaluate an adolescent-specific waterpipe dependence instrument.Methods: From a five wave (two year) school-based cohort study of 498 8th and 9th grade students in Beirut, Lebanon, 192 current (past month) waterpipe smokers responded to the 28 dependence items at Waves 2-5 along with several tobacco use- and quitting-related measures. Exploratory and confirmatory factor analyses (EFA and CFA) were applied to capture the most relevant aspects of dependence. Psychometric characteristics of the resulting instrument were assessed including internal consistency, convergent validity, discriminant validity, concurrent validity, and predictive validity. Result: The EFA yielded a single factor, 13 item solution (named the SCTS-13) that explained 91% of the total variance in responses, had excellent internal consistency (Cronbachs alpha= 0.87), and captured several positive reinforcement-, negative reinforcement, and social/cognitive-related features of dependence. The CFA indicated good model fit across several fit indices (SRMSR = 0.06, RMSEA = 0.08, CFI = 0.91). Convergent validity was indicated by moderately high correlations between the SCTS-13 and the Lebanon Waterpipe Dependence Scale 10J as well as the Hooked on Nicotine Checklist. Discriminant validity was indicated by low positive correlations with depression and perceived stress instruments. Concurrent and predictive validity were confirmed by statistically significant associations (p < .05) between the SCTS-13 and several dependence-related outcomes, including perceived addiction, average number of waterpipes smoked per month, current frequency of smoking, increased frequency of smoking over time, longer average duration of smoking sessions, and smoking alone (vs. socially).Conclusions: The SCTS-13 instrument showed promising reliability and validity to assess nicotine dependence among adolescent waterpipe smokers. Use of such validated instrument will help behavioral scientists understand the development of nicotine dependence among waterpipe use, and will help clinicians target cessation interventions to nicotine dependence status.


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Library Comment

Dissertation or thesis originally submitted to ProQuest