DEVELOPMENT AND VALIDATION OF THE NICOTINE VAPING DECISIONAL BALANCE SCALE

Vaping nicotine is a growing public health issue, especially among adolescents and young adults (Murthy, 2017; Virgili et al., 2022). Understanding young people's motivations for vaping nicotine will inform effective prevention and intervention strategies. Decisional balance (DB) is a decision-making model that assumes that behavior is influenced by the balance of potential pros and cons of the consequences of engaging in the behavior (Janis and Mann, 1977). DB measures have been developed and validated for various health-related behaviors including cigarette smoking, yet no measure exists for vaping. In this three-phase mixed methods study a nicotine vaping decisional balance scale (NVDB) was developed. In Phase I, an 87-item pilot measure was developed based on open-ended responses from 180 young adults about the pros and cons of vaping nicotine, along with a literature review, and an expert review. In Phase II, the scale was administered to 616 young adults and an exploratory factor analysis (EFA) was conducted. Items that did not load well on a discrete factor, had little variability, were highly redundant, or were highly correlated were omitted. In Phase III, 665 young adults completed the revised 41-item DB along with other measures. After principal axis factoring with varimax rotation and item analysis, 10 pros and 10 cons were retained. A 2-factor solution consisting of Vaping Pros and Vaping Cons accounted for 60% of the variance. Cons were subtracted from pros to create a DB score, with positive scores reflecting greater importance of pros relative to cons. As predicted, lifetime e-cig users (n = 368) had significantly higher DB scores than never users (n = 297). Among e-cig users, DB scores were significantly correlated with e-cig use frequency, dependence scores, prior quit attempts, quitting confidence, desire to quit and quitting intentions. Among never users, DB scores were significantly associated with intentions to try an e-cig. The newly developed 20-item NVDB scale may inform both prevention and treatment and be used in both research and applied settings.