Assessment of the Extended Theory of Planned Behavior for Nicotine Dependence Prediction: An Application of Path Analysis

Abstract

Background: Given the importance of water-pipe smoking cessation in health improvement, further studies are required to identify the predictors of this behavior. Objectives: This study aimed to examine both one-way direct and indirect effects of the constructs of the extended theory of planned behavior (TPB) on nicotine dependence among women residing in Bushehr, situated in Southwest of Iran. Methods: This cross sectional study was performed in Bushehr province in Southwest of Iran. In this study, 430 women were selected through multistage, stratified, cluster, random sampling and were evaluated using a self-administered questionnaire. Path analysis was applied to estimate the direct and indirect effects of attitude, perceived norms, and personal agency on nicotine dependence. Results: The results demonstrated that extended TPB is a predictor of nicotine dependence (R2, 34%) and intention to quit water-pipe smoking (R2, 40%). According to the results, the modified model was a good fit for the data (RMSEA, 0.05; NFI, 0.97; AGFI, 0.91). Self-efficacy (factor loading, -0.30) and perceived behavioral control (factor loading, -0.17) both directly and indirectly affected nicotine dependence through intention. However, in this study, subjective norms did not predict nicotine dependence. Conclusions: The finding showed that skill-based training should be implemented in interventional programs to increase self-efficacy, alongside policies to constrain access to water-pipe smoking. Therefore, social and cognitive interventions can be effective only in the presence of political changes.