title: Development and validation of the online social support for smokers scale.
abstract: BACKGROUND
  Social networks play an important role in smoking. Provision of social support during cessation is a cornerstone of treatment. Online social networks for cessation are ubiquitous and represent a promising modality for smokers to receive and provide the support necessary for cessation. There are no existing measures specific to online social support for smoking cessation.
  
  
  OBJECTIVE
  The objective was to develop a measure of social support to be used in online smoking cessation treatment research.
  
  
  METHODS
  Initial items for the Online Social Support for Smokers Scale (OS4) were based on existing theory and scales delineated in various taxonomies. Preliminary field analysis (N = 73) was conducted on 23 initial items to optimize the scale. Further development was conducted on a refined 15-item scale in the context of a large randomized trial of Internet and telephone cessation treatment with follow-ups at 3, 6, 12, and 18 months. In all, 1326 participants were randomized to an enhanced Internet arm that included a large online social network; psychometric analyses employed 3-month follow-up data from those reporting use of the enhanced Internet intervention at least once (n = 873). Items were subjected to a factor analysis, and the internal consistency reliability of the scale was examined along with construct and criterion validity. Other measures used in the study included demographics, nicotine dependence, partner support for cessation, general social support, social integration, stress, depression, health status, online community use, Internet use behaviors, intervention satisfaction, and 30-day point prevalence abstinence.
  
  
  RESULTS
  The final 12-item OS4 scale demonstrated high internal consistency reliability (Cronbach alphas .86-.89) across demographic and smoking strata of interest. The OS4 also demonstrated good construct and criterion validity, with the directionality of the observed associations providing support for most a priori hypotheses. Significant Pearson correlations were observed between the OS4 and the Partner Interaction Questionnaire (PIQ) Positive subscale (ρ = .24, P < .001). As hypothesized, participants with the highest OS4 scores were more likely to have actively participated in the enhanced Internet community and to have high levels of satisfaction with the enhanced Internet intervention. In logistic regression analyses, the OS4 was highly predictive of 30-day point-prevalence abstinence at 6, 12, and 18 months (all P values <.001). The odds of abstinence at 6 months rose by 48% for each standard unit increase in online social support (95% confidence interval [CI] 1.17-1.71), dropping only slightly to 37% at 12 and 18 months (95% CI 1.17-1.59).
  
  
  CONCLUSIONS
  The OS4 is a brief, reliable, and valid instrument for measuring online social support for smoking cessation. Results should be replicated and extended, but this study suggests the OS4 can be used to advance theory, understand mechanisms, and potentially help to improve the tailoring of Internet-based smoking cessation treatments. It can also inspire development of similar measures for other online health-related intervention research.
  
  
  BACKGROUND
  Clinicaltrials.gov #NCT00282009; http://clinicaltrials.gov/ct2/show/NCT00282009 (Archived by WebCite at http://www.webcitation.org/60XNj3xM6).
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington, DC, USA. agraham@legacyforhealth.org
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Graham
authors.forename: George D
authors.initials: GD
authors.lastname: Papandonatos
authors.forename: Hakmook
authors.initials: H
authors.lastname: Kang
authors.forename: Jose L
authors.initials: JL
authors.lastname: Moreno
authors.forename: David B
authors.initials: DB
authors.lastname: Abrams
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D020407:Internet / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results; D016540:Smoking Cessation / Q000379:methods*; D012944:Social Support; D011795:Surveys and Questionnaires / Q000592:standards*; D014029:Tobacco Use Disorder / Q000534:rehabilitation*; D055815:Young Adult