Background: Waterpipe tobacco smoking (WTS) has recently increased in Iran. There is no valid instrument
to measure the level of nicotine dependence among its consumers. This study was aimed to investigate the
validity and reliability of the Lebanon Waterpipe Dependence Scale-11 (LWDS-11).
Methods: A cross-sectional study was conducted in the year 2017 whereby 367 waterpipe smokers were
recruited from Golestan Province of Iran. LWDS-11 scale is composed of 4 subscales: 1) nicotine dependence,
2) negative reinforcement, 3) psychological craving, and 4) positive reinforcement. The validity of the
questionnaire was examined using construct validity. Reliability of this scale was examined using test-retest
reliability and internal consistency.
Findings: The four-factor model for LWDS [comparative fit index (CFI) = 0.985, Tucker-Lewis index
(TLI) = 0.979, standardised root mean residual (SRMR) = 0.059, root mean square error of approximation
(RMSEA) = 0.049 (0.031, 0.061)] demonstrated good fit to this data. Cronbach’s α was 0.825 for total
scale and it was 0.818, 0.746, 0.624, and 0.670 for each individual subscale. The test-retest reliability of the
scale was 0.925.
Conclusion: All goodness of fit indices (GFIs) represented a good fit of model. The LWDS-11 scale had an
appropriate remarkable validity and reliability for waterpipe consumers to measure the level of nicotine
dependence and it appeared to be likely useful for utilizing in the clinical and epidemiological studies.