Development and validation of a 21-item challenges to stopping smoking (CSS-21) scale

Dennis Thomas, Andrew J. Mackinnon, Billie Bonevski, Michael J. Abramson, Simone Taylor, Susan G Poole, Gregory R. Weeks, Michael J. Dooley, Johnson George

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13 Citations (Scopus)


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.

Original languageEnglish
Article numbere011265
Number of pages8
JournalBMJ Open
Issue number3
Publication statusPublished - 2016

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