Reliability and validity of Kano Test for Social Nicotine Dependence (KTSND), and development of its revised scale assessing the psychosocial acceptability of smoking among university students.

PURPOSE: To examine reliability and validity of Kano Test for Social Nicotine Dependence (KTSND), a scale assessing the psychosocial acceptability of smoking, and to develop a new version when validity or reliability of KTSND was not acceptable. METHODS: We carried out a self-administered cross-sectional survey on undergraduate university students. The participants completed the KTSND, and supplemented three questions on the attitudes toward tobacco control policies and smoking states. Using daily smokers, we examined the relationship between the KTSND and Fagerström Test for Nicotine Dependence (FTND). In each study, we examined test-retest reliability and construct validity, discriminant and convergent validity, and factor validity. RESULTS: Although the KTSND had high internal consistency (Cronbach's a 0.82) and high test-retest reliability (r=0.72), the results of factor analysis were unacceptable; we expected three factors to be extracted, however, only two factors of "Overestimate of smoking usefulness" and "Allege smoking as a taste and/or culture" were extracted. Using the Kano's Test for Assessing Acceptability of Smoking (KTAAS), the new version of KTSND in which a question was replaced with another one, the third factor of "Neglect of harm of tobacco smoking" was extracted adding to the above-mentioned two. KTAAS had also both high internal consistency (Cronbach's alpha 0.82) and test-retest reliability (r=0.66). Overall, the KTSND and the KTAAS score differed according to smoking states, and the nonsmokers' scores were the lowest. CONCLUSION: The KTSND was a popular questionnaire in Japan, however, its validity assessed using factor analysis was not acceptable, while KTAAS had sufficient reliability and validity, and might assess the cognition and attitude affirming or accepting tobacco smoking among university students.

[Questionnaire polls on health awareness of second-hand smoking exposure among non- and ex-smoker school teachers].

An accurate education of the harmful health effects of second-hand smoke on young people is important, and school teachers play a critical role. We polled school teachers about health awareness of second-hand smoking and the effectiveness of 4 methods of protecting against second-hand smoke. Self-reporting questionnaires were given to 452 non-smoker and ex-smoker subjects. To evaluate social nicotine dependence, we used the Kano Test for Social Nicotine Dependence (KTSND) questionnaire. Of 364 teachers (80.5%) who answered and were at risk of second-hand smoke exposure, 39.6% had respiratory symptoms, and 34.9% answered "ignore" or "slightly anxious" about second-hand smoking. The mean KTSND scores of those who answered "extremely anxious", "moderately anxious", "slightly anxious", and "ignore second-hand smoking" were 10.5 +/- 5.7, 12.3 +/- 6.0, 14.7 +/- 5.8, and 18.4 +/- 4.9, respectively. The KTSND scores of teachers who answered "ignore second-hand smoke" were higher than those of teachers who answered "anxious". The scores were also higher in subjects who believe second-hand smoke can be avoided by the recommended protective measures, than in subjects who know that avoidance is impossible, indicating that these teachers accepted smoking behavior. These results suggest that non-smoking and ex-smoking teachers with high KTSND scores might underestimate the health hazards of second-hand smoke, and overestimate the recommended protective measures. Therefore, re-education about awareness of the harmful effects of second-hand smoke should be given to them.

Validity and reliability of Kano Test for Social Nicotine Dependence.

PURPOSE: "Social nicotine dependence" is a newly-coined phrase for describing a psychological and psychosocial state associated with smoking. That new dependence is defined as a misperception of smoking caused by smokers' attempts, for example, to deny the ill effects of tobacco and/or to justify themselves by regarding smoking as acceptable cultural and social behavior. It can be quantified by a 10-item questionnaire, the Kano Test for Social Nicotine Dependence (KTSND). We examined the internal consistency as well as the criterion-related and construct validity and factor structure of KTSND. METHODS: Self-administered questionnaires including the KTSND, smoking status, and stages in quitting smoking only for current smokers were collected from 666 industrial workers. RESULTS: The internal consistency of the KTSND assessed by Cronbach's alpha coefficient was 0.77. In addition, we found that an 8-item combination from among 10 items had a higher coefficient of 0.80. KTSND scores differed among three groups of smoking status as a criterion. Factor analysis clarified two potential factors: "an overestimation of smoking's effects to enhance physical and mental status" and "an insistence on smoking as acceptable cultural and social behavior." CONCLUSION: The KTSND proved to be valid in terms of the internal consistency and the inclusion of two key aspects of the misperception of smoking.