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the testretest coefficient for the total scale (Spearman's correlation) was r=0.92.82 Validity was explored by examining correlations with exposure to waterpipe smoke toxicants (ie, carbon monoxide (CO) and nicotine) and waterpipe use frequency and significant relationships were found for some but not all factors.82 Based on results with all three samples, the LWDS-11 appeared to have satisfactory psychometric properties and indicated that nicotine/tobacco dependence in waterpipe tobacco smokers can be measured, and, as with cigarette smokers, is multidimensional with aspects related to positive and negative reinforcement.82 A social dimension may be unique to WTS, and those users who are not nicotine/tobacco dependent may be occasional smokers who engage in the behaviour to relax or improve morale.82 A subsequent study on a much larger sample of WTS university students in Lebanon (760 individuals completed the LWDS-1183) confirmed the four dimensions of the scale, though one item (income, see table 2) loaded on psychological craving instead of physiological dependence

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