Evaluating E-Cigarette Addiction in Thailand: Validation of Dependence Assessment Tools for Policy and Clinical Use

Phoomjai Sornsenee; Supinya Sono; Napakkawat Buathong; Katti Sathaporn; Arisa Rodjanasuwan; Kanes Waewsak; Pimrapus Klinchoo; Purit Vejmanas; Sirisopha Ekarattanawong; Waritsara Jewkay

doi:10.31584/jhsmr.20251150

Authors

Phoomjai Sornsenee Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Supinya Sono Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Napakkawat Buathong Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Katti Sathaporn Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Arisa Rodjanasuwan Medical Student, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Kanes Waewsak Medical Student, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Pimrapus Klinchoo Medical Student, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Purit Vejmanas Medical Student, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Sirisopha Ekarattanawong Medical Student, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
Waritsara Jewkay Medical Student, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.20251150

Keywords:

cultural adaptation, e-FTCD, electronic cigarette dependence, PS-ECDI, Thailand

Abstract

Objective: To adapt and validate the Penn State Electronic Cigarette Dependence Index (PS-ECDI) and the e-cigarette version of the Fagerström Test for Cigarette Dependence (e-FTCD) for use in Thailand and to assess the current status of e-cigarette addiction among Thai users.
Material and Methods: A systematic process of translation, cultural adaptation, and pilot testing of the PS-ECDI and e-FTCD was followed. Expert panel reviews, back-translation, and cognitive interviews were conducted to ensure cultural relevance and clarity. The instruments were administered to 193 Thai e-cigarette users. Internal consistency was assessed using Cronbach’s alpha and validity was evaluated through correlation with the Substance Use Disorder Screening Test (SUDST). The current status of e-cigarette addiction was analyzed.
Results: The culturally adapted PS-ECDI demonstrated strong internal consistency, with a Cronbach’s alpha of 0.87 and a robust correlation with SUDST. The e-FTCD had a Cronbach’s alpha of 0.57. E-cigarette addiction was highly prevalent in the sample, with 65% of users exhibiting signs of dependence. Younger age, male sex, and concurrent use of other substances were significantly associated with higher levels of e-cigarette addiction.
Conclusion: Culturally adapted and validated tools are essential to measure e-cigarette dependence in Thailand. The validated PS-ECDI is a reliable instrument for health professionals and policymakers to assess e-cigarette dependence, facilitating the development of culturally informed public health interventions and regulatory frameworks. Further refinement of the e-FTCD is necessary to enhance its reliability. The high prevalence of e-cigarette addiction among Thai users underscores the need for targeted public health interventions.

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