BACKGROUND: Tobacco use causes 1.35 million deaths annually in India, with diverse and dominant non-cigarette tobacco products complicating dependence assessment. Existing tools, like the Fagerstrom Test for Nicotine Dependence, lack cultural adaptability for India. This study aimed to develop and validate the Tobacco Dependence Scale in Hindi (TDS-Hindi), specifically tailored to Indian users.
METHODS: A cross-sectional study was conducted with 300 adult tobacco users (re-test among 60 users) in Ranchi, India. Phase-I involved tool development through literature review and expert consultation, while Phase-II included translation, pre-testing, and data collection through a community survey. The six-item TDS-Hindi was evaluated using exploratory factor analysis (EFA), reliability testing, and validation against International Classification of Diseases (ICD-11) criteria.
RESULTS: Content validation showed an S-CVI of 0.945 and I-CVR ranging from 0.67 to 1.00, indicating strong expert agreement. Scree plot and EFA revealed a two-factor structure capturing nicotine dependence's multidimensionality. The tool achieved high test-retest reliability (0.88) and moderate internal consistency (Cronbach’s alpha: 0.55). Six-item scale (minimum score ‘0’ and maximum score ‘12’) high accuracy in classifying nicotine dependence, with an Area Under Curve of 0.901 (95%CI: 0.858,0.943, p<0.001), sensitivity of 84.5%, and specificity of 82.8%. Dependence levels were categorized as low (0-4), moderate (5-7), and high (8-12), with 86% of high-dependence cases showing concordance with ICD-11 criteria.
CONCLUSIONS: TDS-Hindi is a reliable, valid, and culturally adapted tool for assessing tobacco dependence in India. It can be a valuable resource for healthcare professionals to assess both cigarette and non-cigarette tobacco users in India, where Hindi is commonly spoken. Longitudinal evaluations with biomarkers across larger populations is essential to confirm its clinical applicability.