Psychometric Validation of the ABOUT–Dependence : A Fit-for-Purpose Instrument to Assess Global Dependence on Tobacco and Nicotine Products
Presented at SRNT 2019
* This author is not affiliated with PMI.
BACKGROUND: Past research focusing on cigarette smokers has supported the position that nicotine dependence is a primary driver of tobacco use behavior. However, there is a dearth of widely accepted self-report instruments to measure dependence in a directly comparable way across the growing range of tobacco and nicotine-containing products (TNP). As part of the ABOUT Toolbox (Assessment of Behavioral OUtcomes related to Tobacco and nicotine products) initiative, we developed a new instrument following best-practice scale development guidelines.
METHODS: The content of the ABOUT-Dependence instrument was constructed based on information from literature review, expert opinion, and qualitative interviews with TNP users. A first-draft version of the items was field tested in a cross-sectional survey (n=2,434) to guide scale formation and establish psychometric properties (e.g., reliability, construct, and concurrent validity). For both qualitative and quantitative studies, the sampling frame included equal numbers of single tobacco product users (e.g., balanced across cigarettes, cigars, e-cigarettes, smokeless tobacco, and other TNP) and polyusers.
RESULTS: Psychometric evaluation of the first-draft version led to a 16 and 12-item versions of ABOUTDependence instrument consisting of three main sub-concepts: urgency to use (two items), attitudinal evaluation (7/5 items) and behavioral evaluation (7/5 items). Findings also supported the summation of items to form a subscale score for each of the multi-item domains. Validity of the new instrument was supported by correlations with existing dependence measures (e.g., Fagerström Test for Nicotine Dependence) and discrimination between heavy and light users, indicative of known groups validity. Intra-class correlations showed very good test-retest reliability. Differential item functioning analysis confirmed the stability of the instrument across single and poly-users, types of tobacco products, and key socio-demographics.
CONCLUSIONS: The ABOUT-Dependence is a psychometrically sound instrument that may be used in clinical and population-based studies to assess dependence on the whole spectrum of TNP products and users.