Development and Validation of the Smoker Self-Stigma Questionnaire.

INTRODUCTION: Researchers have become increasingly concerned with the stigmatizing impact that regulations and policies aimed to curve down cigarette smoking may have on smokers. Given the lack of psychometrically validated tools available to assess smoking stigma, we developed and evaluated the Smoker Self-Stigma Questionnaire (SSSQ). AIMS AND METHODS: A total of 592 smokers recruited through Amazon's Mechanical Turk (MTurk) completed an online, Qualtrics survey that included 45 items developed and vetted by tobacco-research experts. The items were assigned a priori to three, theoretical stigma factors or domains (enacted, felt, and internalized). We first conducted a confirmatory factor analysis (CFA) on the responses from one-half of the participants with the goal of distilling the 45-item pool to an 18-item instrument with 6 items per factor. A promising, 18-item, three-factor measure was then cross-validated with the second half of the sample. RESULTS: The second CFA yielded excellent fit indices, as well as adequate and significant factor loadings. Subscale scores obtained from the separated factors differentially predicted nicotine dependence and motivation to quit cigarettes, providing convergent and discriminant validity for the SSSQ and its proposed, three-factor structure. CONCLUSIONS: Overall, the SSSQ fills an important research gap by providing a psychometrically sound measure that investigators can use to study smoking stigma. IMPLICATIONS: Prior research on smoking self-stigma has used a wide variety of psychometrically invalid measures and reported inconsistent findings. This is the first study that presents a measure of smoking self-stigma that is not a merely and arbitrary adaptation of a mental illness stigma measure, but that is theoretically driven and created from a large and comprehensive pool of items vetted by tobacco-research experts. Having demonstrated and then cross-validated its excellent psychometric properties, the SSSQ provides the field with a promising tool to assess, investigate, and replicate the causes and effects of smoking self-stigma.