Khadijeh Keshavarzian - Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
Haidar Nadrian - Department of Health Education and Promotion, School of Health AND Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Hamid Allahverdipour - Department of Health Education and Promotion, School of Health AND Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
Asghar Mohammadpoorasl - Department of Statistics and Epidemiology, School of Health AND Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran

Background: The worldwide trend of hookah use among adolescents is increasing, and literature shows arelationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack ofappropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed todevelop an instrument to measure hookah smoking obscenity among adolescents.Methods: In this methodological study, a sequential exploratory design was used to conduct the study fromFebruary ۲۰۱۷ to July ۲۰۱۸ on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semistructured individual interviews (with ۱۸ students) and a focus group discussion (FGD) (with ۱۳ students) toexplain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We thenexamined the psychometric properties of the HSOS based on face, content, construct and predictive validitiesas well as internal consistency and repeatability.Findings: The HSOS was developed with ۲۱ items based on the results of qualitative data analysis. Applyingconfirmatory factor analysis (CFA), the χ۲/degree of freedom (df) ratio was found to be ۳.۷۹۲ for the fourfactor structure of the questionnaire and the fit indices of this structural model were satisfactory. The valuesof Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged۰.۸۱-۰.۹۳ and ۰.۷۹-۰.۹۲, respectively.Conclusion: We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may beapplied by school healthcare providers and health practitioners to find valid and reliable data on theobscenity of hookah smoking when developing hookah smoking prevention/cessation interventions amongadolescents.

Methadone, Opium dependence, Intensive care units