Measuring the Single Cigarette Use Phenomenon: Scale Development and Validation

Abstract

The practice of single cigarette use perpetuates normative smoking beliefs and increases smoking propensity among urban, African American smokers. Despite the 2009 Family Smoking Prevention and Tobacco Control Act’s ban of single cigarettes, there is a paucity of research to inform the public about the harms of single cigarettes and regulatory enforcement of their sales by the Food and Drug Administration. This dissertation utilized a mixed-method, three-phase design with primary data collection to: 1) examine the social context, beliefs, and attitudes of loosie use; and, 2) develop and validate two theoretically-based scales (i.e., social context and Health Belief Model) on the purchasing and use of loosies by urban, African American smokers. In Phase I, 25 semi-structured, in-depth interviews were conducted to understand the social context and underlying intrapersonal factors related to loosie use. Qualitative data, analyzed using the Framework Method, informed the development of potential scale items. During Phase II, three expert reviewers and 24 urban, African American loosie users provided feedback and pilot tested the items via the “Think Aloud” method. In Phase III, psychometric data were collected from 122 urban, African American loosie users from the District of Columbia Housing Authority public housing sites. Rigorous exploratory factor analysis and reliability and validity testing were conducted to determine the most parsimonious models for two scales: The Social Context of Loosies Scale (SCL-11) and the Health Belief Model for Loosies Scale (HBML-20). Both scales and their respective subscales demonstrated internal consistency and divergent and convergent validity. To our knowledge, this dissertation research is the first study to utilize semi- structured interviews (Phase I) to examine individualized patterns of loosie use by urban, African Americans and to develop valid scales designed by, and for, urban, African American loosie users (Phase II and Phase III). Given the strong psychometric properties of the scales, they may be used to identify meaningful targets for individual, social, and environmental intervention to prevent and reduce loosie use among this priority population.