Paper
Saturday, July 24, 2004
Effects of Smoking and Depression in Arab-American Youth: Is the Ces-D an Appropriate Measure in This Population?
Linda Weglicki, PhD, MSN, Virginia Rice, PhD, and Thomas Templin, PhD. College of Nursing, Adult Health, Wayne State University, Detroit, MI, USA
| Learning Objective #1: Describe the importance of establishing cultural equivalence of study measures among different cultural groups |
| Learning Objective #2: Describe the appropriate statistical techniques in establishing cultural equivalence of study measures for use in different cultural groups |
BACKGROUND/OBJECTIVE: The Center for Epidemiologic Studies Depression Scale (CES-D) is a self-report scale designed to measure depressive symptomatology in the general population including adolescents. The relationship between tobacco use and depression is well established. However, studies have not looked at this relationship among immigrant populations. Instruments translated from the language of the culture in which it was developed into languages of different cultures must employ strong methodologic safeguards to ensure equivalence of versions. PURPOSE: This paper presents assessment of conceptual and measurement equivalence of the CES-D adapted for Arab American youth. DESIGN AND POPULATION: A convenience sample of 1372 Arab American 14-18 year olds completed questionnaires in the initial phase of this theory-driven randomized clinical trial. The sample was equal across genders; 51% percent were immigrants. Self-reported cigarette smoking was related to age (p < .0001); from 1% at age 14 to 12% at age 18; 24.8% reported using the narghile. METHODS: Conceptual equivalence was established by qualitative methods: back-translation and focus groups. Psychometric evaluation was established with multi-group confirmatory factor analysis with means structures. FINDINGS: Comparative item analysis revealed that the factor structure is similar in both English and Arabic versions. Unrestricted factor analysis resulted in a two-factor structure including Depressive Affect and Negative Outlook (CFI=.965; REMSI=.041) indicating that the CES-D is a culturally appropriate measure among Arab American youth. Youth reporting tobacco use (past 30 days) had significantly (p<.001) more depressive symptomatology (Effect size=0.65 ). CONCLUSION: Establishing conceptual equivalence prior to evaluating differences is a necessary first step in cross cultural research to ensure the validity of conclusions. IMPLICATIONS: While this study established the CES-D as an appropriate measure for depressive symptomatology among Arab American youth, the use of previously established cutoff scores as a measure was not supported and is therefore not appropriate in Arab American youth.
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