Development and Psychometric a Questionnaire on Obscenity Measuremen of Cigarette and Hookah Smoking in Adolescents: An Exploratory Sequential Mixed Methods Design

Abstract

Introduction: Considering the increasing trend of smoking and hookah use among Iranian adolescents, evidence on the relationship between obscenity and adolescents’ tendency toward smoking and hookah use, and lack of appropriate instruments for them measurement, the present study aimed to develop a questionnaire for measuring smoking and hookah use obscenity among adolescents in order to prevent youth and adolescents' tendency to smoking and hookah use by measuring obscenity of them and finally reducing the rate of smoking and hookah use in the country. Methods: This study has conducted from 2017 to 2018 in Tabriz, Iran, using an exploratory sequential mixed methods design. To develop a questionnaire for measuring smoking and hookah use obscenity among adolescents. The first stage is a qualitative study with a content analysis approach. In the qualitative part, to explain the concept of obscenity and develop the items of the questionnaires, semi-structured interviews were conducted with 18 students, and a focus group discussion was held with 13 students (in three groups of 4-5). Then, the psychometrics of the questionnaires were examined based on face validity, content validity, construct validity, predictive validity, internal consistency, and repeatability.

Results: Content analysis of the data resulting from interviews explained the concept of hookah use from the viewpoint of students in three themes: the negative value of hookah use and hookah users in society, negative attitude toward hookah users and their families, outcomes of hookah use and cigarette use in three themes: negative valuation of the Society for cigarette use and smokers, negative attitude toward cigarette users, and outcomes of cigarette use. The cigarette and hookah obscenity questionnaires were developed with 22 and 21 items based on the results of qualitative data analysis (interviews with and sentences uttered by students on the topic). In terms of face and content validity, experts offered some modifications that were applied in the questionnaires and the qualitative results of face and content validity were confirmed. In the construct validity, the Kaiser-Meyer-Olkin (KMO), with 0.93 for the smoking questionnaire and 0.95 for the hookah questionnaire and the significance of Bartlett’s test of sphericity (p < 0.001) demonstrated that the data are appropriate for factor analysis. Confirmatory factor analysis (CFA) showed that the χ2/df ratio is 3.792 for the four-factor structure of the hookah obscenity questionnaire and 3/911 for the five -factor structure of the cigarette obscenity questionnaire. The fit indices of hookah obscenity structural model (GFI=0.88, AGFI=0.85, NFI=0.88, IFI=0.91, CFI=0.91, RFI=0.87, RMSEA=0.070) and cigarette obscenity (GFI=0.88, -AGFI=0.85, NFI=0.87, IFI=0.90, CFI=0.90, RFI=0.85, RMSEA=0.072) are satisfactory. The minimum and maximum values of Cronbach’s alpha and the intraclass correlation (ICC) for the constructs in the hookah questionnaire was (0.81, 0.93) and (0.79, 0.92), and cigarette (0.77-0.90) and (0.80-0.91) respectively. Based on the results, there was a significant relationship between the obtained obscenity values and the students’ smoking and hookah use behaviors (P < 0.001).

Conclusion: The validity and reliability of the questionaires were appropriate; therefore, they can be used in future studies as a suitable tools for measuring the obscenity of smoking and hookah used in Iranian adolescents.