Thawal Vaibhav P, Paul Christine, Nolan Erin, Tzelepis Flora
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
Hunter Medical Research Institute, Newcastle, Australia.
Tob Induc Dis. 2023 Mar 15;21:40. doi: 10.18332/tid/160073. eCollection 2023.
Khaini is a smokeless tobacco (SLT) product commonly used in the South-Asian region. It is the most common smokeless tobacco product used in India, having a prevalence of 11.2% and is used by 104.1 million adults. No scales exist to assess khaini dependence. Existing scales available to assess dependence on smokeless tobacco products are not ideal as these are adapted from cigarette dependence scales and developed for western populations. This study aimed to develop a khaini dependence scale and assess its reliability and validity.
Recommended methods for scale development were followed for item development, scale development and scale evaluation. Scale development was guided by a theoretical framework, a review of existing scales and in-depth interviews with 21 khaini users recruited from a tertiary care hospital in Mumbai, India. The process involved the identification of domains for dependence and the development of an item pool. Cognitive interviews and pre-testing were conducted with 20 khaini users to assess content validity. A cross-sectional survey with 323 khaini users was conducted, and Exploratory Factor Analysis (EFA) was used to determine the factor structure of the draft scale. The content validity, criterion validity (by cross-referencing with the cotinine level of users), convergent validity and internal consistency of the new scale were assessed.
The final version of the Khaini SLT Dependence Scale (KSLTDS) had 20 items. EFA indicated an acceptable goodness of fit for a three-factor structure with physical, psychological and sociocultural-behavioral sub-scales. It showed evidence of acceptable criterion validity with cotinine (ρ=0.43, p=0.0002), convergent validity with FTND-ST (ρ=0.51, p<0.0001) and frequency of khaini use (ρ=0.38, p<0.0001). The sub-scales (α=0.87-0.90) showed acceptable internal consistency.
The psychometric evaluation of the KSLTDS showed preliminary validity and reliability for assessing dependence on khaini, and therefore, it is appropriate for clinical and research purposes. Re-validation studies are required with various khaini user populations.
嚼烟是一种在南亚地区常用的无烟烟草产品。它是印度使用最普遍的无烟烟草产品，患病率为11.2%，有1.041亿成年人使用。目前尚无评估嚼烟依赖的量表。现有的用于评估无烟烟草产品依赖的量表并不理想，因为这些量表是从香烟依赖量表改编而来，且是为西方人群开发的。本研究旨在开发一种嚼烟依赖量表，并评估其信度和效度。
在项目开发、量表开发和量表评估过程中遵循了推荐的量表开发方法。量表开发以理论框架、对现有量表的回顾以及对从印度孟买一家三级护理医院招募的21名嚼烟使用者进行的深入访谈为指导。该过程包括确定依赖领域和开发项目池。对20名嚼烟使用者进行了认知访谈和预测试，以评估内容效度。对323名嚼烟使用者进行了横断面调查，并使用探索性因子分析（EFA）来确定量表初稿的因子结构。评估了新量表的内容效度、效标效度（通过与使用者的可替宁水平交叉参照）、收敛效度和内部一致性。
嚼烟无烟烟草依赖量表（KSLTDS）的最终版本有20个项目。探索性因子分析表明，具有身体、心理和社会文化行为子量表的三因子结构具有可接受的拟合优度。它显示出与可替宁有可接受的效标效度（ρ=0.43，p=0.0002），与FTND-ST有收敛效度（ρ=0.51，p<0.0001）以及与嚼烟使用频率有收敛效度（ρ=0.38，p<0.0001）。子量表（α=0.87 - 0.90）显示出可接受的内部一致性。
KSLTDS的心理测量学评估显示出在评估嚼烟依赖方面的初步效度和信度，因此，它适用于临床和研究目的。需要对不同的嚼烟使用者群体进行再验证研究。
