E8-LWDS: Factorial Structure and Psychometric Properties of the Lebanese Waterpipe Dependence Scale-11 in 1490 Egyptian Waterpipe Tobacco Smokers—A Critical Approach

Abstract

Introduction: There is no universal scale for assessing waterpipe tobacco (WT) dependence. We examined the factorial structure and psychometric properties of the Waterpipe Dependence Scale-11 (LWDS-11) among Egyptian WT smokers. Methods: We administered the LWDS-11 during face-interview questionnaires in two cross-sectional surveys among 1490 current WT smokers recruited via purposive quota sampling. Exploratory factor analysis was performed on half of the sample. Confirmatory factor analysis of the resulting model was done using structural equation modelling on the other half. Scale reliability was examined. We assessed convergent construct validity using regression models to examine the association between the adapted dependence scale and factors conceptually expected to be associated with WT dependence. Results: Exploratory factor analysis of the scale yielded eight items (E8-LWDS) supporting a three-factor structure: physical dependence (three items); psychological dependence (three items); and psychological craving (two items). Cronbach’s α were 0.635 for the total scale and 0.823, 0.654, and 0.785 for the three subscales. E8-LWDS was confirmed to have good model fit (comparative fit index = 0.995; root mean squared error of approximation = 0.027). E8-LWDS was independently associated with daily WT smoking, rural residence, being a skilled worker, non-exclusive WTS, smoking ≥ eight WT hagars/day, and measures of perceived behavioral control (self-reported addiction to WT, perceived ability to quit, and previous quit attempts). Conclusion: E8-LWDS showed adequate psychometric properties among this sample of Egyptian current WT smokers, which makes it appropriate for use by researchers and practitioners. Adding items related to perceived behavioral control might enhance the scale robustness.

Health and economic impacts of introducing specific excise tax to waterpipe tobacco in Egypt: a simulation model of simple and mixed tax policy approaches

“…Therefore, we could only use data presented in the published STEPS Report10 and its associated STEPS databook provided by WHO. Accordingly, we resorted to two sources for presenting the latest available data on these model parameters: STEPS for national waterpipe tobacco smoking prevalence10 and the recently published survey for market shares and market share prices 15 25–28. The latter survey did not aim to measure waterpipe tobacco smoking prevalence, but it measured several aspects of waterpipe tobacco smoking behaviour,15 25–28 noting that the sample of current waterpipe tobacco smokers in the latter survey (n=1490) was 5 times larger15 25–28 than the sample in STEPS (4.5% current waterpipe tobacco smoking prevalence×6680 total sample in SETPS; ie, n~300 current waterpipe tobacco smokers only) 10…”

“…We took market share and price data from a recently published cross-sectional survey that was conducted between 2015 and 2017 among 1490 adult (aged ≥18 years) waterpipe tobacco smokers living in Cairo and a rural area in the Nile Delta 15 25–28. The survey captured the self-reported usual waterpipe tobacco smoking location, the average number of waterpipe tobacco 20 g units smoked per day and the average daily waterpipe tobacco expenditure (in EGP) 15 25–28…”