Development and Psychometric Evaluation of a Novel Measure of Nicotine E-cigarette Withdrawal for Use With Adolescents and Young Adults

Introduction: Nicotine withdrawal is a well-established construct that prompts continued nicotine product use and contributes to failed cessation efforts. Despite ongoing public health concerns about nicotine e-cigarette use in adolescents and young adults (AYAs), no psychometrically sound measure of nicotine e-cigarette withdrawal exists for this population. Aims and Methods: A mixed methods approach comprising a literature review to identify existing nicotine withdrawal items; subject matter expert feedback on existing items and novel item generation; cognitive interviews assessing the measure's instructions, items, and response options; and a large quantitative validation survey (N=997) was employed to develop the novel retrospective measure of nicotine e-cigarette withdrawal. Results: A 25-item solution comprising four subscales - negative affect, negative physical symptoms, craving, and appetite/food - and an overall withdrawal score was supported. Internal reliability was excellent (mean alpha=0.91), and scalar measurement invariance was reached for all subgroups tested (eg, sex, age, exclusive e-cigarette use vs. dual tobacco product use, and daily vs. non-daily nicotine vaping). Overall withdrawal and its subscales evidenced concurrent validity with time to first vape in the morning, e-cigarette dependence, and previous vaping cessation attempts, although not each subscale was associated with each outcome. Importantly, cross-sectional incremental validity analyses indicated that retrospective withdrawal accounted for variance in each outcome above and beyond e-cigarette dependence. Conclusions: The novel retrospective AYA Nicotine E-cigarette Withdrawal Scale (AYA NEWS) evidenced strong psychometric properties for use in this population. Future research can determine whether the AYA NEWS can be used to assess acute e-cigarette nicotine withdrawal. Implications: While e-cigarette use remains the most prevalent form of nicotine product use among AYAs, there are limited options for psychometrically sound measures of e-cigarette-related constructs in this population. Withdrawal from nicotine is associated with failed cessation attempts and continued use of nicotine-containing products, making it a critical construct within tobacco-related research. This study outlines the development and preliminary psychometric evaluation of a novel, retrospective measure of nicotine e-cigarette withdrawal. Study findings support using the Adolescent and Young Adult Nicotine E-cigarette Withdrawal Scale (NEWS) to assess retrospective withdrawal from nicotine e-cigarettes in young people.