Document Type : Original Article


1 Department of Biostatistics and Epidemiology, Faculty of Health, Iran

2 Research Center of Addiction and Behavioral Sciences, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran


BACKGROUND: Prevention of smoking is very important at a young age and during the student
period. Because of the lack of a questionnaire based on the prevention of smoking behavior,
this study was conducted to design and standardize a tool according to the protection motivation
theory (PMT).
MATERIALS AND METHODS: This was an analytical cross‑sectional study where information
and opinions of experts and then designing tools and assessing the face validity in the first phase
and content validity, construct validity, test–retest reliability, and internal consistency of questions
in the second phase were examined. The initial themes and structures were determined based on
the literature Review and the opinion of experts. Three hundred students of Yazd Universities were
selected by cluster sampling and included in the study. All analyses were performed in SPSS and
AMOS software version 24 with a significance level of less than 5%.
RESULTS: The final version of the scale had 39 questions in eight dimensions. The overall Cronbach’s
alpha value was 0.89, and for each dimension, it was more than 0.7. The content validity ratio and
content validity index for the whole tool were 0.87 and 0.94, respectively. The results of confirmatory
factor analysis showed that the latent construct model had good fit (X2/df = 4.31; RMSEA = 0.07;
CFI = 0.94; NFI = 0.92; TLI = 0.91, P < 0.001).
CONCLUSION: In this study, a valid and reliable tool based on PMT to predict smoking behavior
in students was introduced. This tool can be used in interventional and etiological studies. It also
has questions related to the coronavirus disease 2019 (Covid 19) virus and can be used in the
coronavirus pandemic.


1. Fischer‑Preßler D, BonarettiD, FischbachK. Aprotection‑motivation
perspective to explain intention to use and continue to use mobile
warning systems. Bus Inf Syst Eng 2022;64:167–82.
2. Anbari‑Nogyni Z, Bidaki R, Madadizadeh F, Sangsefidi ZS,
Fallahzadeh H, Karimi‑Nazari E, et al. Relationship of zinc status
with depression and anxiety among elderly population. Clin Nutr
ESPEN 2020;37:233‑9.
3. Yach D. Foundation for a smoke‑free world. Lancet
4. Zhou W, Liu G, Hung RJ, Haycock PC, Aldrich MC, Andrew AS,
et al. Causal relationships between body mass index, smoking
and lung cancer: Univariable and multivariable Mendelian
randomization. Int J Cancer 2021;148:1077‑86.
5. Dhar U, Nagarajappa R, Satyarup D, Jena M, Mohapatra A.
Tobacco smoking and cardiovascular diseases: A review. Indian
J Forensic Med Toxicol 2020;14:8981.
6. Ahmed N, Maqsood A, Abduljabbar T, Vohra F. Tobacco smoking
a potential risk factor in transmission of COVID‑19 infection. Pak
J Med Sci 2020;36:S104‑7.
7. Rutledge SM, Asgharpour A. Smoking and liver disease.
Gastroenterol Hepatol 2020;16:617.
8. Hamzeh B, Farnia V, Moradinazar M, Pasdar Y, Shakiba E,
Najafi F, et al. Pattern of cigarette smoking: Intensity, cessation,
and age of beginning: Evidence from a cohort study in West
of Iran. Substance abuse treatment, prevention, and policy
9. Bahariniya S, Madadizadeh F. Alcohol: A double‑edged sword
in the fight against COVID‑19. Health Scope 2021;10:e113136.
10. Sohn K. Relationship of smoking to hypertension in a developing
country. Glob Heart 2018;13:285‑92.
11. Organization. WH. Tobacco control [Online]. 2020. Available
12. Ehsani‑Chimeh E, Sajadi HS, Behzadifar M, Aghaei M,
Badrizadeh A, Behzadifar M, et al. Current and former smokers
among adolescents aged 12–17 years in Iran: A systematic review
and meta‑analysis. BMC Public Health 2020;20:55.
13. Wang PW, Ahorsu DK, Lin CY, Chen IH, Yen CF, Kuo YJ, et al.
Motivation to have covid‑19 vaccination explained using an
extended protection motivation theory among university students
in china: The role of information sources. Vaccines 2021;9:380.
14. Ansari‑Moghaddam A, Seraji M, Sharafi Z, Mohammadi M,
Okati‑Aliabad H. The protection motivation theory for predict intention of COVID‑19 vaccination in Iran: A structural equation
modeling approach. BMC Public Health 2021;21:1‑9.
15. Yahaghi R, Ahmadizade S, Fotuhi R, Taherkhani E, Ranjbaran M,
Buchali Z, et al. Fear of COVID‑19 and perceived COVID‑19
infectability supplement theory of planned behavior to explain
Iranians’ intention to Get COVID‑19 vaccinated. Vaccines
16. Lwin MO, Stanaland AJ, Chan D. Using protection motivation
theory to predict condom usage and assess HIV health
communication efficacy in Singapore. Health Commun
17. Zakipour M, Hajalizadeh K, Sirfi MR, Nikparvar M, Abedini S.
The Effect of the Intervention Based on protection theory on the
drug compliance of the patients with ischemic heart disease.
Med J Mashhad University Med Sci 2021;64. doi: 10.22038/
18. Shakibazadeh E, Sabouri M, Mohebbi B, Tol A, Yaseri M. Validity
and reliability properties of the Persian version of perceived health
competence scale among patients with cardiovascular diseases.
J Educ Health Promot 2021;10:19.
19. Mohebbi B, Sabouri M, Tol A. Application of health education
and promotion theory‑based interventions on patients with
cardiovascular disease: A systematic review. J Educ Health
Promot 2021;10:236.
20. Leigh L, Taylor C, Glassman T, Thompson A, Sheu JJ.
A cross‑sectional examination of the factors related to emergency
nurses’ motivation to protect themselves against an Ebola
infection. J Emerg Nurs 2020;46:814‑26.
21. Bashirian S, Jenabi E, Khazaei S, Barati M, Karimi‑Shahanjarini A,
Zareian S, et al. Factors associated with preventive behaviours of
COVID‑19 among hospital staff in Iran in 2020: An application of
the Protection Motivation Theory. J Hosp Infect 2020;105:430‑3.
22. Greening L. Adolescents’ cognitive appraisals of cigarette
smoking: An application of the protection motivation theory 1.
J Appl Soc Psychol 1997;27:1972‑85.
23. Thrul J, Stemmler M, Bühler A, Kuntsche E. Adolescents’
protection motivation and smoking behaviour. Health Educ Res
24. Bahariniya S, Ezatiasar M, Madadizadeh F. A brief review of
the types of validity and reliability of scales in medical research.
J Community Health Res 2021;10:100‑2.
25. Ghanbari‑Firoozabadi M, Mirzaei M, Nasab MV, Grace SL,
Okati‑Aliabad H, Madadizadeh F, et al. Cross‑cultural adaptation
and psychometric validation of the Persian version of the Cardiac
Rehabilitation Barriers Scale (CRBS‑P). BMJ Open 2020;10:e034552.
26. Taherzadeh CK, Madadizadeh F. Guideline for selecting types
of reliability and suitable intra‑class correlation coefficients in
clinical research. J Biostat Epidemiol 2021;7:305‑9.
27. Durkin K, Williford DN, Turiano NA, Blank MD, Enlow PT,
Murray PJ, et al. Associations between peer use, costs and benefits,
self‑efficacy, and adolescent E‑cigarette use. J Pediatr Psychol
28. Madadizadeh F, BahrampourA, Mousavi SM, MontazeriM. Using
advanced statistical models to predict the non‑communicable
diseases. Iran J Public Health 2015;44:1714‑5.
29. Madadizadeh F, Asar ME, Bahrampour A. Quantile regression
and its key role in promoting medical research. Iran J Public
Health 2016;45:116‑7.
30. Taherzadeh CK, Madadizadeh F. Popular statistical tests for
investigating the relationship between two variables in medical
research. J Community Health Res 2020;9:1‑3.
31. Xiao H, Li S, Chen X, Yu B, Gao M, Yan H, et al. Protection
motivation theory in predicting intention to engage in protective
behaviors against schistosomiasis among middle school students
in rural China. PLoS neglected tropical diseases 2014;8:e3246.
32. Nerini A, Matera C, Policardo GR, Di Gesto C. Containment
measures against COVID‑19 in Italy: The role of protection
motivation and values. J Hum Behav Soc Environ 2021:1‑14. doi: