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.