Assessment of the Extended Theory of Planned Behavior for Nicotine Dependence Prediction: An Application of Path Analysis

Background Given the importance of water-pipe smoking cessation in health improvement, further studies are required to identify the predictors of this behavior. Objectives This study aimed to examine both one-way direct and indirect effects of the constructs of the extended theory of planned behavior (TPB) on nicotine dependence among women residing in Bushehr, situated in Southwest of Iran. Methods This cross sectional study was performed in Bushehr province in Southwest of Iran. In this study, 430 women were selected through multistage, stratified, cluster, random sampling and were evaluated using a self-administered questionnaire. Path analysis was applied to estimate the direct and indirect effects of attitude, perceived norms, and personal agency on nicotine dependence. Results The results demonstrated that extended TPB is a predictor of nicotine dependence (R2, 34%) and intention to quit water-pipe smoking (R2, 40%). According to the results, the modified model was a good fit for the data (RMSEA, 0.05; NFI, 0.97; AGFI, 0.91). Self-efficacy (factor loading, -0.30) and perceived behavioral control (factor loading, -0.17) both directly and indirectly affected nicotine dependence through intention. However, in this study, subjective norms did not predict nicotine dependence. Conclusions The finding showed that skill-based training should be implemented in interventional programs to increase self-efficacy, alongside policies to constrain access to water-pipe smoking. Therefore, social and cognitive interventions can be effective only in the presence of political changes.