This study was the first to apply the LWDS-11 to non-Arabic-speaking sample, and it highlights the need for further refinement of measures of dependence in waterpipe tobacco smokers that are generalisable and usable across cultures.90 As noted elsewhere,91 there is a growing need for waterpipe-specific measures of dependence that are validated for use in other populations where WTS is common.92 One article explicitly discussed nicotine/tobacco dependence and WTS without reference to the LWDS-11.32 Here, two instruments commonly used to assess dependence in tobacco cigarette smokers, the Fagerstrm Test for Nicotine Dependence (FTND;93) and the negative affect, addiction and stimulation subscales of the Horn-Waingrow Reasons for Smoking (RFS;94) scale were modified by substituting the word shisha for cigarette as necessary.32 One hundred and fifty-four Egyptian men who were exclusive waterpipe smokers responded to the modified instruments that were administered via interview
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