- Title
- Development and evaluation of a measure to assess dependence on khaini use
- Creator
- Thawal, Vaibhav
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- In spite of the high prevalence of smokeless tobacco (SLT) use in Southeast Asia, there has been a significant gap in research on addiction perceptions relating to SLT in this region. Dependence on SLT and its measurement in Southeast Asia has also been under-researched relative to combustible tobacco (CT). This thesis examined the addiction perceptions of tobacco users and its relationship with cessation behaviours. This thesis also focused on understanding dependence on a type of SLT: khaini. A scale to assess dependence on khaini use was developed and its psychometric properties evaluated. Chapter 1 provided an overview of the literature on SLT use. This included health effects, prevalence, type and forms of SLT use, patterns of use, chemical composition; knowledge and perceptions of tobacco use; addiction and dependence on SLT; tobacco dependence (models and theories of dependence, need for measuring dependence, methods of assessing dependence on tobacco); application of existing scales in South Asian countries like India; need for understanding SLT use in India and the lack of culturally appropriate SLT dependence measures for use in India. Chapter 1 identified where there was a need for further research and described the aims of the thesis. Chapter 2 explored the perception of personal addiction on tobacco use (CT or SLT) and perceptions of addictiveness of CT and SLT products using a cross-sectional survey among participants (n=607) visiting an outpatient department of a tertiary care hospital in India. The odds of perceived addiction were found to be significantly lower among SLT users compared to CT users [OR (95% CI): 0.57 (0.37, 0.89) p = 0.01]. Participants with secondary education and above had significantly higher odds of perceived addiction compared to participants with no formal education [OR (95% CI): 1.68 (1.09, 2.58) p = 0.02] and an increase in odds of perceived addiction was seen as age increased [OR (95% CI): 1.02 (1.00, 1.03) p = 0.01]. The odds of perceiving SLT products to be addictive was significantly lower among SLT users [OR (95% CI): 0.48 (0.30, 0.75) p = 0.002)] compared to CT users. The odds of perceiving SLT products to be addictive was significantly lower [(OR (95% CI): 0.35 (0.18, 0.67) p = 0.002)] among females compared to males. Participants with secondary education and above had significantly higher odds of perceiving CT [OR (95% CI): 1.80 (1.17, 2.77) p = 0.008)] and SLT products [OR (95% CI): 1.98 (1.20, 3.30) p = 0.008)] to be addictive compared to those with no schooling. Chapter 3 studied the relationship between the addiction perceptions and cessation behaviours (past quit attempts, intention and self-efficacy to quit) using a cross-sectional survey among participants (n=607) visiting an outpatient department of a tertiary care hospital in India. Participants who reported being a little addicted [AOR (95%CI): 2.75 (1.83,4.11) p < 0.0001] or quite addicted [AOR (95% CI): 2.93 (1.53,5.62) p < 0.001] had significantly higher odds of making a past quit attempt compared to those who perceived they were 'not addicted at all’. SLT users compared to CT users [AOR (95% CI): 0.64 (0.41,0.99) p = 0.047] and women compared to men [AOR (95% CI): 0.46 (0.26, 0.81) p = 0.0068] had significantly lower odds of making a past quit attempt. Participants with a secondary and above education level had significantly higher odds of a past quit attempt compared to those with no formal education [(AOR (95%CI) :2.36 (1.45,3.83) p = 0.0005]. There was a statistically significant decrease in the odds of intention to quit as age increased by one year [(AOR (95% CI): 0.98 (0.97,0.99) p = 0.0018]. Participants who identified themselves as 'a little addicted' [(AOR (95%CI): 0.28 (0.14,0.55) p = 0.0003], 'quite addicted' [(AOR (95%CI): 0.16 (0.07,0.39) p < 0.0001] or ‘very addicted’ [(AOR (95% CI): 0.09 (0.04,0.19) p < 0.0001] had significantly lower odds of self-efficacy to quit compared to those who perceived they were 'not addicted at all'. Chapter 4 described a systematic review of SLT dependence scales and evaluation of the psychometric properties of the scales using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) standard. The databases MEDLINE, CINAHL, PsycINFO, EMBASE and SCOPUS were searched, and sixteen studies were eligible for assessment. Eleven studies were conducted in the USA, two in Taiwan, one each in Sweden, Bangladesh and Guam. Of the sixteen measures identified, none of them measures were rated as ‘A’ (can be recommended for use) on the COSMIN tool primarily due to limitations in structural validity and internal consistency. Nine measures (FTND-ST, FTQ-ST-9, FTQ-ST-10, OSSTD, BQDS, BQDI, HONC, AUTOS and STDS) were rated as ‘B’: defined by the COSMIN tool as having potential for assessing dependence although further assessment of psychometric properties is needed. Four measures, MFTND-ST, TDS, GN-STBQ and SSTDS that had high quality evidence for an insufficient measurement property were rated as ‘C’ and were not supported for use as per COSMIN standards. The remaining three brief measures HSTI, STDI and ST-QFI (consisting of less than 3 items) were rated inconclusive due to the inability to assess structural validity (i.e., minimum of 3 items required for factor analysis). Chapter 5 described the development of a scale to assess dependence on khaini use and evaluated its reliability and validity in an Indian population. The recommended three-phase method involved 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. Cognitive interviews and pre-testing were conducted with 20 khaini users to assess content validity and a cross-sectional survey with 323 khaini users was conducted to determine the factor structure of the draft scale. The final version of the Khaini Smokeless Tobacco Dependence Scale (KSLTDS) had 20 items. Exploratory factor analysis indicated an acceptable goodness of fit for a three-factor structure with physical, psychological and sociocultural behavioural sub-scales. The KSLTDS showed evidence of acceptable criterion validity with cotinine (ρ = 0.43, p = 0.0002), and convergent validity with the FTND-ST measure (ρ = 0.51, p < 0.0001) and frequency of khaini use (ρ = 0.38, p < 0.0001). The KSLTDS sub-scales (α = 0.87 - 0.90) showed acceptable internal consistency. Chapter 6 presented a discussion of the key findings of the thesis; limitations of the studies; implications for tobacco prevention and cessation programs and tobacco control policies and recommendations for future research.
- Subject
- tobacco control; smokeless tobacco; India; addiction perceptions; Khaini Smokeless Tobacco Dependence Scale; psychometric properties; cessation; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1477583
- Identifier
- uon:50003
- Rights
- Copyright 2023 Vaibhav Thawal
- Language
- eng
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