Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa, OK.
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Nicotine Tob Res. 2021 Jun 8;23(7):1224-1229. doi: 10.1093/ntr/ntaa269.
The objective of the study was to assess the psychometric properties of the Severson 7-item Smokeless Tobacco Dependence Scale (SSTDS).
Data from 95 male exclusive smokeless tobacco (ST) users were obtained through a self-administered mail survey to evaluate the reliability and validity of the SSTDS. Reliability of the scale was assessed by measures of internal consistency including Cronbach's coefficient alpha and item-total correlation. Other ST dependence scales and salivary cotinine concentration were used to evaluate concurrent validity. Structure model of the scale was ascertained by exploratory factor analysis. Overall accuracy and optimal cutoff score were obtained to evaluate SSTDS as a screening tool for ST dependence.
The SSTDS had high reliability as assessed by the internal consistency coefficient (ordinal α = 0.83). SSTDS total score was significantly correlated with Fagerström Test for Nicotine Dependence for ST users-FTND-ST (r = 0.42) and modified Tobacco Dependence Screener-TDS (r = 0.58). Exploratory factor analysis of the SSTDS identified two underlying factors measuring distinct dimensions of dependence. With reference to TDS based dependence diagnosis, SSTDS demonstrated good diagnostic accuracy (area under the curve: 0.82, 95% confidence interval: 0.74-0.90). Salivary cotinine concentration was not associated with the total score of the SSTDS; however, at an optimal cutoff score of SSTDS >9, everyday ST users classified as dependent had significantly higher cotinine concentration.
SSTDS is a reliable measure of dependence that has higher concurrent validity and reliability as compared with other commonly used ST dependence scales. Further research is needed using a larger and more diverse sample of ST users to unequivocally establish the validity of the scale.
ST dependence has multiple aspects that can be best studied by multidimensional dependence scales. The study findings validate that the SSTDS measures not only the physical dependence but also the behavioral and psychological dimensions of dependence. Good psychometric properties, diagnostic accuracy, and multidimensional structure of SSTDS indicate that it may serve as an effective tool in assessing ST dependence in clinical and research settings.
本研究旨在评估 Severson 7 项无烟气烟草依赖量表（SSTDS）的心理测量特性。
通过自我管理的邮件调查，获得了 95 名男性专用无烟烟草（ST）使用者的数据，以评估 SSTDS 的信度和效度。量表的信度通过内部一致性的衡量指标进行评估，包括 Cronbach 的系数 alpha 和项目总分相关。其他 ST 依赖量表和唾液可替宁浓度用于评估同时效度。通过探索性因素分析确定量表的结构模型。总体准确性和最佳截断分数用于评估 SSTDS 作为 ST 依赖的筛查工具。
SSTDS 的内部一致性系数（有序α=0.83）评估结果显示其具有较高的可靠性。SSTDS 总分与 ST 使用者 Fagerström 尼古丁依赖测试-ST（FTND-ST）（r=0.42）和改良烟草依赖筛查器-TDS（r=0.58）显著相关。SSTDS 的探索性因素分析确定了两个潜在因素，分别测量依赖的不同维度。参考 TDS 依赖诊断，SSTDS 显示出良好的诊断准确性（曲线下面积：0.82，95%置信区间：0.74-0.90）。唾液可替宁浓度与 SSTDS 的总分无关；然而，在 SSTDS>9 的最佳截断分数下，被归类为依赖的每日 ST 用户的可替宁浓度显著更高。
SSTDS 是一种可靠的依赖测量工具，与其他常用的 ST 依赖量表相比，具有更高的同时效度和可靠性。需要进一步研究，使用更大和更多样化的 ST 用户样本，以明确该量表的有效性。
ST 依赖具有多个方面，最好通过多维依赖量表进行研究。研究结果验证了 SSTDS 不仅测量了生理依赖，还测量了行为和心理依赖的维度。SSTDS 具有良好的心理测量特性、诊断准确性和多维结构，表明它可能成为评估临床和研究环境中 ST 依赖的有效工具。
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