Development and Validation of a Questionnaire to Assess Secondary Food Habits Associated With Smoking

Food intake patterns among smokers represent a complex behavioral phenomenon, wherein, beyond general dietary habits, smokers often engage in specific food consumption during or immediately after smoking episodes. These "secondary food substances" include sugary products such as chocolates, candies, sweeteners, and chewing gum, menthol-based items, hot and cold beverages, carbonated drinks, mouth fresheners, and occasionally smokeless tobacco products. Such practices may be driven by factors including the desire to mask the odor or taste of smoke, sensory gratification, cravings, accessibility, peer influence, and media exposure.

This study aimed to develop a valid and reliable questionnaire for assessing secondary food consumption behavior during or immediately after smoking.

A systematic approach was adopted to design a structured questionnaire that focused on secondary food habits associated with smoking episodes. Item generation was based on a literature review and behavioral constructs related to secondary food substance use. The construct includes five categories: types of secondary food substances; frequency of use; reasons for using such food substances; attempts to quit; and craving, tolerance, and dependence developed toward the food substances. The entire set of items was refined and validated through focus group discussions, content validity, construct validity, internal consistency, and test-retest reliability.

The questionnaire comprised 10 items and demonstrated excellent content validity, with an overall Content Validity Index of 0.97. All items exhibited factor loadings above 0.50, confirming satisfactory construct validity. Itemwise correlation coefficients ranged from 0.11 to 0.81, indicating acceptable internal consistency. Furthermore, the intraclass correlation coefficient values ranged from 0.72 to 0.91, reflecting high test-retest reliability of the instrument.

Secondary food consumption habits associated with smoking may contribute to additional dependencies and adversely affect nutritional health, thereby compounding the harmful effects of the primary habit, smoking. The present study addresses a critical gap in the literature by introducing a dedicated assessment tool to systematically evaluate these behaviors, with potential applications in research and behavioral interventions.