Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: A systematic review

Validity of epidemiological and clinical studies on waterpipe tobacco smoking depends on the validity of exposure measurement. The primary objective was to systematically review the medical literature for instruments validated for use in epidemiological and clinical research on waterpipe smoking. We designed a comprehensive search strategy and followed standard methodology in selection of studies and data abstraction. We included papers reporting on development and/or validation of survey instruments to measure waterpipe tobacco consumption or related concepts. We also determined the percentage of observational studies of the health effects of waterpipe tobacco smoking and the percentage of studies of prevalence of waterpipe tobacco smoking that have used validated survey instruments. We identified a total of five survey instruments. One instrument was designed to measure knowledge, attitudes, and waterpipe use among pregnant women and was shown to have internal consistency and content validity. Three other instruments were designed to measure waterpipe tobacco consumption; two were reported to have face validity while the third, the Global adult tobacco survey (GATS), was the most detailed instrument but had no validation data published. The fifth instrument, the Lebanon Waterpipe Dependence Scale (LWDS-11), was designed to measure waterpipe dependence and was rigorously developed and validated. Two percent of the studies of health effects and none of the studies of prevalence of waterpipe tobacco smoking have used validated instruments. A number of instruments for measuring the use of and dependence on waterpipe smoking exist. Future research should consider content validity and cross cultural adaptation of these instruments.