Waterpipe smoking: Construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11)

Abstract

Waterpipe smoking is becoming fashionable in Lebanon, but no studies have studied nicotine dependence related to waterpipe smoking. A score was constructed from 21 items and subsequently submitted to two factor analyses, which led to the extraction of four factors. Reliability and test-retest reproducibility were measured. Convergent construct validity and discriminant validity also were assessed for different smokers' samples. The Lebanon Waterpipe Dependence Scale-11 (LWDS-11) was composed of four subscales, the first representing nicotine dependence, the second negative reinforcement, the third psychological craving, and the fourth positive reinforcement. Internal consistency and test-retest reproducibility were adequate, and the subscales correlated adequately with measurements of nicotine metabolites, exhaled carbon monoxide levels, and the frequency of waterpipe smoking. The LWDS-11 discriminated between mild, moderate, and heavy waterpipe smokers, based on a threshold score of 10. Results were biologically and psychologically sound. This is the first scale to characterize waterpipe dependence. With further improvement and confirmation, it could become a useful clinical and epidemiological tool.

Tobacco-Specific Nitrosamine Exposures in Smokers and Nonsmokers Exposed to Cigarette or Waterpipe Tobacco Smoke

“…Furthermore, they pointed out some factors that may contribute to the lack of a correlation between carcinogenic biomarkers and tobacco consumption in association studies, including degree of smoking inhalation, biomarker metabolism, the time of urine collection relative to smoking, and lack of precision in reporting the number of cigarettes per day that could be due to faulty recall or rounding errors. Interestingly, NNAL levels increased steadily with increasing numbers of hagars consumed in our study, but further research is necessary to adequately characterize the doseresponse relationship, including aspects of dependency as assessed by the recently constructed and validated " Lebanon Waterpipe Dependence Scale " ( Salameh, Waked, & Aoun, 2008 ).…”

The Waterpipe; a New Way of Hooking Youth on Tobacco

“…For example, the only published measure of dependence in waterpipe smokers (Lebanon Waterpipe Dependence Scale; LWDS-11) was derived mainly from the FTND and DSM-IV criteria and without any formative work with waterpipe smokers. 16 As such, tobacco dependence in waterpipe smokers has unique features that continue to be untapped by models and instruments derived from the cigarette literature.…”

The LWDS-10J: Reliability and Validity of the Lebanon Waterpipe Dependence Scale Among University Students in Jordan

“…Although their scale utilized items adapted from the FTND, it also assessed psychosocial factors specific to WTS, which could be related to addiction. Those researchers found promising reliability and validity of this instrument, called the Lebanon Waterpipe Dependence Scale (LWDS), among 306 adult WTS users (mean age = 34 years) (Salameh, Waked, & Aoun, 2008).…”