Development and validation of the Malaysia adolescents e-cigarette survey (MY-ACES)

This study aimed to develop and validate the Malaysia Adolescents E-Cigarette Survey that assess knowledge, beliefs, susceptibility, refusal self-efficacy, refusal skills techniques-intention, and refusal skills techniques-practice.

Multiphase content and construct validity.

The final 59-item My-ACES tool was developed based on an extensive literature review and expert panel review. The tool underwent content validation by an expert panel and was subsequently validated for construct validity and reliability in a sample of 367 Malaysian adolescents, aged 13-17 using a cross-sectional online survey from May to July 2025. Content validity was assessed by the Scale-level Content Validity Index. Construct validity and reliability were analyzed by Exploratory factor analysis, Cronbach's alpha, and Pearson correlations.

The content validity showed that the Scale-level Content Validity Index ranged from 0.86 to 1.00 for consistency, representativeness, relevancy, and clarity, resulting in the final 59-item questionnaire. The construct validity of My-ACES, based on eigenvalues and factor loadings to confirm the six-factor structure (knowledge, beliefs, susceptibility, refusal self-efficacy, refusal skills techniques-intention, and refusal skills techniques-practice) with 70.3% total variance, was acceptable (Kaiser-Meyer-Olkin = 0.93; Bartlett's test of sphericity was significant, p < 0.001). The internal consistency reliability of the six-factor structure was very good, with Cronbach's alpha values ranging from 0.87 to 0.96.

My-ACES is a psychometrically robust, theoretically grounded, and culturally relevant instrument specifically tailored for adolescent e-cigarette-related constructs in Malaysia. Its development provides a critical tool to strengthen public health surveillance, inform prevention and intervention strategies for support Malaysia's Tobacco Endgame 2040. However, causal inference and temporal stability could not be assessed due to the cross-sectional design, warranting future longitudinal and confirmatory validation studies to support its use in routine surveillance and policy monitoring.