title: Development and validation of a 21-item challenges to stopping smoking (CSS-21) scale.
abstract: OBJECTIVE
  Identification of challenges associated with quitting and overcoming them may improve cessation outcomes. This study describes the development and initial validation of a scale for measuring challenges to stopping smoking.
  
  
  METHODS
  The item pool was generated from empirical and theoretical literature and existing scales, expert opinion and interviews with smokers and ex-smokers. The questionnaire was administered to smokers and recent quitters who participated in a hospital-based smoking cessation trial. Exploratory factor analysis was performed to identify subscales in the questionnaire. Internal consistency, validity and robustness of the subscales were evaluated.
  
  
  RESULTS
  Of a total of 182 participants with a mean age of 55 years (SD 12.8), 128 (70.3%) were current smokers and 54 (29.7%) ex-smokers. Factor analysis of the 21-item questionnaire resulted in a 2-factor solution representing items measuring intrinsic (9 items) and extrinsic (12 items) challenges. This structure was stable in various analyses and the 2 factors accounted for 50.7% of the total variance of the polychoric correlations between the items. Internal consistency (Cronbach's α) coefficients for the intrinsic and extrinsic subscales were 0.86 and 0.82, respectively. Compared with ex-smokers, current smokers had a higher mean score (± SD) for intrinsic (24.0 ± 6.4 vs 20.5 ± 7.4, p=0.002) and extrinsic subscales (22.3 ± 7.5 vs 18.6 ± 6.0, p=0.001).
  
  
  CONCLUSIONS
  Initial evaluation suggests that the 21-item challenges to stopping smoking scale is a valid and reliable instrument that can be used in research and clinical settings to assess challenges to stopping smoking.
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mackinnon
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Billie
authors.initials: B
authors.lastname: Bonevski
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Abramson
authors.affiliation: Pharmacy Department, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Simone
authors.initials: S
authors.lastname: Taylor
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia Pharmacy Department, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Poole
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia Pharmacy Department, Barwon Health, Geelong, Victoria, Australia.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Weeks
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia Pharmacy Department, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dooley
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
authors.forename: Johnson
authors.initials: J
authors.lastname: George
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000379:methods*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Smoking; challenges; reliability; tool; validity