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

Nicotine Tob Res. 2008 Jan;10(1):149-58. doi: 10.1080/14622200701767753.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Behavior, Addictive / diagnosis*
  • Behavior, Addictive / psychology
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Lebanon
  • Male
  • Psychometrics
  • Quality of Life
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Smoking*
  • Surveys and Questionnaires*
  • Tobacco Use Disorder / classification
  • Tobacco Use Disorder / diagnosis*