Validating the Waterpipe Addiction, Craving, and Anticipation Scale: An Exploratory Factor Analysis

Objectives: Waterpipe smoking is increasingly becoming a public health threat due to its appealing features and misperceptions of its harmful effects. Tools assessing waterpipe addiction are essential for understanding waterpipe smokers' behaviors and designing effective smoking cessation plans. This study aimed to develop and validate the Waterpipe Addiction, Craving, and Anticipation Scale (WACAS) and describe the specific patterns and multidimensional aspects of waterpipe smoking behavior. Methods: A cross-sectional study was conducted to develop the WACAS based on previously published smoking assessment tools. Snowball sampling was used to recruit 107 waterpipe smokers. Several procedures were performed to examine the scale's validity, including construct and convergent validity. Known-group validity was examined using trend analysis, while path analysis was conducted to confirm the theoretical framework. Results: The WACAS showed high construct validity (generating 6 factors) and internal consistency, with excellent convergent and known-group validity. It could distinguish between various behavioral expressions of waterpipe smoking, that is, addiction, craving, and anticipation of smoking outcomes, which were initially conceptualized in the theoretical framework. Conclusions: The WACAS developed in this study is a comprehensive scale comprising 6 factors that distinguish between different behavioral expressions among waterpipe smokers. It captures a unique waterpipe-specific mode of craving explained by anticipation of outcomes and addictive behaviors, confirming the theoretical framework. The scale demonstrated strong validity and reliability. Nevertheless, further refinement and external validation are recommended to establish WACAS as a robust tool for a broad-scope evaluation of waterpipe smoking.