Development and Validation of the Stress Burden of Electronic Cigarette Smoking Scale (SBECSS) Among Adult Dual Users

The present study aimed to develop and evaluate the preliminary validity of the Stress Burden of Electronic Cigarette Smoking Scale (SBECSS), a new measure designed to assess the level of stress burden associated with the co-occurring perceptions of electronic cigarette (e-cigarette) use and efforts to quit within an individual.

To achieve this, 400 adult dual users of combustible cigarettes and e-cigarettes (52.8% female; 90% non-Hispanic White; M_age = 37.8, SD = 9.7) participated in an online survey. Items were developed in accordance with the operational definition, reviewed by field experts, and evaluated post-data collection for inter-item correlations and theoretical alignment.

Confirmatory factor analysis was conducted to compare the unidimensional, two-factor correlated, second order, and bifactor models. Factor analysis supported a unidimensional factor structure (X²[170] = 343.557, p < 0.001; RMSEA = 0.051 [90% CI: 0.043, 0.059], p = 0.413; CFI = 0.970; SRMR = 0.021), and measurement invariance was supported across sex. The SBECSS demonstrated construct validity with measures of e-cigarette related and affective processes.

These findings suggest that the SBECSS is a reliable and valid tool for measuring and understanding the stress burden of using or quitting e-cigarettes among dual tobacco users.