Validation and modification of the Chinese version of the smoking self-efficacy questionnaire (CSEQ-12) in a sample of community-dwelling Chinese smokers in Hong Kong

Self-efficacy to resist smoking is an important construct in smoking cessation, which predicts successful quitting and hence is usually inquired into by smoking cessation questionnaires. The Smoking Self-Efficacy Questionnaire (SEQ-12) was designed to measure smokers' self-efficacy to resist smoking in situations associated with temptation to smoke and with relapse in terms of internal and external stimuli. Previous studies have shown that the Chinese version of the scale (CSEQ-12), with a minor modification to item 6 ('Urge to smoke') as an indicator for the external rather than the internal stimuli subscale, has good psychometric properties among Chinese smokers with heart diseases. However, the scale has not been tested on Chinese smokers in the community. In addition, from practical experience of providing smoking cessation counseling to Chinese smokers, we have found that many smokers report 'being invited by others to smoke' is the situation where they are more likely to smoke. This study aims to examine further the psychometric properties of the CSEQ-12, using a sample of smokers recruited from the community, and to evaluate the appropriateness of the additional item 'Being invited by others to smoke'(item 13) for Chinese smokers. A convenience sample of Chinese smokers (n'309) was recruited via posters and referrals from friends and non-governmental organizations in Hong Kong between February and December 2010. Data from 305 respondents who completed all 12 items of the scale plus the additional item were used in the current analysis. We examined the scale's factorial structure and the appropriateness of adding item 13 by confirmatory factor analysis (CFA), reliability by Cronbach alpha, and concurrent validity by correlations with the stage of readiness to quit and nicotine dependency. The CFA results revealed that a modified two-factor model provided an excellent fit to the data, with item 12 ('When drinking coffee or tea') replaced with item 13 ('Being invited by others to smoke'). The factorial structure of the modified 12-item CSEQ was stable across the two gender samples. Internal consistency coefficients were greater than 0.7 for both external and internal stimuli subscales, and were thus acceptable. Scores on self-efficacy to resist smoking showed significant positive associations with stage of readiness to quit, but their associations with the Fagerström Test of Nicotine Dependency (FTND) score were not significant. We concluded that the Chinese version of the Smoking Self-Efficacy Questionnaire, with further modification of replacing the item 'When drinking coffee or tea' with a new item 'Being invited by others to smoke', is a valid and reliable instrument to assess the selfefficacy of a community-dwelling sample of Chinese smokers.