Validation of Arabic Questionnaire on Impact of Gulf Council Countries Cigarette Package Warning Labels

Background: A standard Arabic questionnaire concerning the effect of health warnings on cigarette package labels is lacking in the Arabic world. This questionnaire may be useful to assess smokers' awareness of cigarette package warnings and the health risks of smoking. The aims of the current study are (i) To develop a new Arabic questionnaire that can assess the impact of cigarette package warnings on smokers relative to their awareness of the health risks of smoking, (ii) to assess its reliability, and (iii) to assess construct validity using factor analysis. Materials and Methods: A pilot cross-sectional study, including 447 Saudi smokers, was used because Gulf Council Countries (GCC) countries enforce graphic health warnings on all cigarette packages. A standard Arabic questionnaire was developed by the Ministry of Health, Saudi Arabia to measure the impact on smokers relative to the GCC graphic health warnings on cigarette packages. The questionnaire included nine items. Results: The results suggest that the questionnaire is reliable and internally consistent with Cronbach's alpha of 0.89, 0.90, and 0.92 for Picture 1 "Early Death," Picture 2 "Secondhand smoking," and Picture 3 "Diseases," respectively. The factor analysis resulted in a two-factor solution accounting for the Picture 1 "Early Death" and Picture 2 "Secondhand smoking;" however, the Picture 3 "Diseases" resulted in only a one-factor solution. Conclusions: The study suggests that the questionnaire regarding Arabic health warnings on cigarette packages is valid and reliable to communicate the health risks of smoking among smokers. Accordingly, we recommend a community-based study to include a large number of smokers across all GCC countries to assess smokers' awareness of package warnings and the health risks of smoking.