Dissertation Defense Announcement

School of Public Health announces the Final Dissertation Defense of

Mohammad Masudul Alam

for the Degree of Doctor of Philosophy

June 19, 2019 at 10:00 AM in Robison Hall

Advisor: Kenneth D. Ward

Psychometric evaluation of a theoretically-derived waterpipe nicotine dependence instrument

ABSTRACT: Tobacco smoking using a waterpipe has become a global phenomenon in recent years, especially among adolescents. Some users exhibit symptoms of nicotine dependence, but instruments have 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) to develop and psychometrically evaluate an adolescent-specific waterpipe dependence instrument. A school-based cohort of 498 8th and 9th grade students in Beirut, Lebanon who smoked waterpipe was assembled and tracked every six months over two years. Exploratory and confirmatory factor analyses were applied to capture the most relevant aspects of dependence. Several psychometric characteristics were then assessed on the resulting instrument including internal consistency, convergent validity, discriminant validity, concurrent validity, and predictive validity. The exploratory factor analysis yielded a single factor, 13 item solution (named the SCTS-13) that explained 68% of the total variance in responses, had excellent internal consistency (Cronbach's alpha= 0.87), and captured several positive reinforcement-, negative reinforcement, and social/cognitive-related features of dependence. The confirmatory factor analysis indicated good model fit across several fit indices (Standardized Root Mean Square Residual = 0.06, Root Mean Square Error Approximation = 0.08, CFI = 0.91). Convergent validity was indicated by moderately high correlations of the SCTS-13 with the Lebanon Waterpipe Dependence Scale – 10J and 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) of the SCTS-13 with 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). The SCTS-13 instrument showed promising reliability and validity to assess nicotine dependence among adolescent waterpipe smokers that can be an important component for effective control of the growing global public health problem of waterpipe tobacco smoking.