Toward a more systematic assessment of smoking: development of a smoking module for PROMIS®

The aim of the PROMIS® Smoking Initiative is to develop, evaluate, and standardize item banks to assess cigarette smoking behavior and biopsychosocial constructs associated with smoking for both daily and non-daily smokers.

We used qualitative methods to develop the item pool (following the PROMIS® approach: e.g., literature search, "binning and winnowing" of items, and focus groups and cognitive interviews to finalize wording and format), and quantitative methods (e.g., factor analysis) to develop the item banks.

We considered a total of 1622 extant items, and 44 new items for inclusion in the smoking item banks. A final set of 277 items representing 11 conceptual domains was selected for field testing in a national sample of smokers. Using data from 3021 daily smokers in the field test, an iterative series of exploratory factor analyses and project team discussions resulted in six item banks: Positive Consequences of Smoking (40 items), Smoking Dependence/Craving (55 items), Health Consequences of Smoking (26 items), Psychosocial Consequences of Smoking (37 items), Coping Aspects of Smoking (30 items), and Social Factors of Smoking (23 items).

Inclusion of a smoking domain in the PROMIS® framework will standardize measurement of key smoking constructs using state-of-the-art psychometric methods, and make them widely accessible to health care providers, smoking researchers and the large community of researchers using PROMIS® who might not otherwise include an assessment of smoking in their design. Next steps include reducing the number of items in each domain, conducting confirmatory analyses, and duplicating the process for non-daily smokers.