A short form of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index in two adult population samples

The Agreement between the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index among Iranian Male Smokers

Background

Nicotine dependence is one of the most significant barriers to smoking cessation. Therefore, measuring this dependence is crucial for effective smoking cessation interventions. The current study aimed to evaluate the degree of agreement between the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) among Iranian smokers.

Methods

We analyzed the data obtained from two previous studies among 580 daily smokers in Iran. Data were collected using the FTND scale. Cohen's kappa was utilized to assess the degree of agreement between HSI and FTND.

Findings

The HSI showed significant agreement with FTND (Cohen's kappa=0.72) in assessing nicotine dependence, with a sensitivity of 88.6% and a specificity of 90.3%.

Conclusion

The HSI is a valid and reliable tool for measuring nicotine dependence, exhibiting significant agreement with FTND. As a result, the HSI can be considered an alternative to the FTND in both clinical and research settings, particularly for heavy smokers.

Smoking cessation and vaccination

A significant proportion of COPD patients (∼40%) continue smoking despite knowing that they have the disease. Smokers with COPD exhibit higher levels of nicotine dependence, and have lower self-efficacy and self-esteem, which affects their ability to quit smoking. Treatment should be adapted to the needs of individual patients with different levels of tobacco dependence. The combination of counselling plus pharmacotherapy is the most effective cessation treatment for COPD. In patients with severe COPD, varenicline and bupropion have been shown to have the highest abstinence rates compared with nicotine replacement therapy. There is a lack of evidence to support that smoking cessation reduction or harm reduction strategies have benefits in COPD patients. The long-term efficacy and safety of electronic cigarettes for smoking cessation need to be evaluated in high-risk populations; therefore, it is not possible to recommend their use for smoking cessation in COPD. Future studies with the new generation of nicotine vaccines are necessary to determine their effectiveness in smokers in general and in COPD patients.

Psychopathic Traits Are Associated with Lifetime History of Nicotine Dependence among Incarcerated Offenders

Background: Individuals scoring high on psychopathy engage in problematic patterns of alcohol and illicit substance use. However, our understanding regarding the association between psychopathy and nicotine use remains limited, which is surprising, given the detrimental consequences associated with such use. Previous studies have observed significant correlations between psychopathic traits (particularly Factor 2 scores assessing lifestyle/behavioral and antisocial traits from the Psychopathy Checklist - Revised [PCL-R]) and increased frequency of nicotine use. However, no study has investigated whether individuals scoring high on psychopathy are characterized by problematic patterns of nicotine use, including lifetime history of nicotine dependence.Objectives: The current study aimed to address this gap, specifically investigating whether PCL-R scores were associated with higher total scores from the Fagerström Test for Nicotine Dependence (FTND).Results: Across both incarcerated men and women, PCL-R total, Factor 2, and Facet 3 (measuring lifestyle/behavioral psychopathic traits) scores were positively correlated with FTND total scores. Additionally, across both samples, hierarchical linear regression analyses revealed these same psychopathy scores remained associated with higher FTND total scores when controlling for additional covariate measures (e.g., age, severity of alcohol and illicit substance use, race, ethnicity, and IQ).Conclusions/Importance: Though associated with small effect sizes, our results support the notion that lifestyle/behavioral psychopathic traits represent a general risk factor for engaging in risky behavior associated with deleterious health consequences, including nicotine use. Our results hold implications for the development of treatment approaches, designed to reduce problematic levels of substance use among individuals scoring high on psychopathy.

Proactive automatised lifestyle intervention (PAL) in general hospital patients: study protocol of a single-group trial

INTRODUCTION

The co-occurrence of health risk behaviours (HRBs, ie, tobacco smoking, at-risk alcohol use, insufficient physical activity and unhealthy diet) increases the risks of cancer, other chronic diseases and mortality more than additively; and applies to more than half of adult general populations. However, preventive measures that target all four HRBs and that reach the majority of the target populations, particularly those persons most in need and hard to reach are scarce. Electronic interventions may help to efficiently address multiple HRBs in healthcare patients. The aim is to investigate the acceptance of a proactive and brief electronic multiple behaviour change intervention among general hospital patients with regard to reach, retention, equity in reach and retention, satisfaction and changes in behaviour change motivation, HRBs and health.

METHODS AND ANALYSIS

A pre-post intervention study with four time points is conducted at a general hospital in Germany. All patients, aged 18-64 years, admitted to participating wards of five medical departments (internal medicine A and B, general surgery, trauma surgery, ear, nose and throat medicine) are systematically approached and invited to participate. Based on behaviour change theory and individual HRB profile, 175 participants receive individualised and motivation-enhancing computer-generated feedback at months 0, 1 and 3. Intervention reach and retention are determined by the proportion of participants among eligible patients and of participants who continue participation, respectively. Equity in reach and retention are measured with regard to school education and other sociodemographics. To investigate satisfaction with the intervention and subsequent changes, a 6-month follow-up is conducted. Descriptive statistics, multivariate regressions and latent growth modelling are applied.

ETHICS AND DISSEMINATION

The local ethics commission and data safety appointee approved the study procedures. Results will be disseminated via publication in international scientific journals and presentations on scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05365269.

Factors associated with dual and polytobacco use among people in residential substance use disorder treatment

BACKGROUND AND OBJECTIVES

Little is known about whether people in substance use disorder (SUD) treatment are at risk for multiple-tobacco use. We examined the factors associated with dual- and polytobacco use among clients in SUD treatment.

METHODS

A cross-sectional survey was conducted in 2019 among 562 clients (M_age  = 39, 74% male) in 20 residential SUD treatment programs in California, USA. The outcomes included single-, dual- (use of two products), and polytobacco use (use of three of more products). Independent variables were nicotine dependence, quitting-related factors, blunt/spliff use, and health-related factors. A multinomial model examined associations between the independent variables and the outcome, controlling for demographics, and time in treatment.

RESULTS

Overall, 32.6%, 18.9%, and 14.0% of the sample were single-, dual-, and polytobacco users, respectively. Factors associated with increased odds of polytobacco use included greater nicotine dependence (adjusted odds ratio [AOR] = 1.60; 95% CI = 1.19, 2.16), ever using e-cigarettes for quitting (AOR = 4.56; 95% CI = 2.23, 9.34), and past 30-day use of blunt/spliff (AOR = 2.96; 95% CI = 1.48, 5.89). Factors associated with increased odds of dual use were ever using e-cigarettes for quitting (AOR = 3.19; 95% CI = 1.79, 5.66) and reporting more mentally unhealthy days (AOR = 1.05; 95% CI = 1.02, 1.07).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

This study extends the literature on tobacco use among people in SUD treatment by revealing the high prevalence of dual- and polytobacco use and the unique characteristics of users. The findings have implications for interventions reducing all types of tobacco use in this understudied population.

Psychometric properties of Fagerstrom Test of Nicotine Dependence: A systematic review

The Fagerstrom test for nicotine dependence (FTND) is a widely used test for assessing physical nicotine dependence. However, there is a need to assess the psychometric properties of FTND to assess its role in treatment outcome studies. The aim of the present investigation was to review the psychometric properties of the FTND. A broad systematic literature search was performed from Pubmed and PsycINFO from 2000 to 2019. The publication language was limited to English. Two review authors performed the study selection and extracted the data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Rayyan software used to screen relevant studies. A total of 1471 articles retrieved from the search, of which 33 studies fulfilled the inclusion criteria. Eleven studies related to testing the reliability of the FTND were analyzed. Twenty-five studies evaluated the Cronbach alpha of the test. Analysis of the studies revealed the questionable psychometric qualities of the adapted versions of the test across different cultures and ethnicity. It also suggested that it may not tap the appropriate constructs that would predict smoking patterns in light smokers, e-cigarette smokers, and smokeless tobacco users. Thus, further research must focus on improving the psychometric properties of FTND to enhance the measurement of nicotine dependence.

Protocol for expansion of an existing national monthly survey of smoking behaviour and alcohol use in England to Scotland and Wales: The Smoking and Alcohol Toolkit Study

Background The Smoking and Alcohol Toolkit Study (STS/ATS) in England has delivered timely insights to inform and evaluate strategies aimed at reducing tobacco smoking- and alcohol-related harm. From the end of 2020 until at least 2024 the STS/ATS is expanding to Scotland and Wales to include all constituent nations in Great Britain. Expanding data collection to Scotland and Wales will permit the evaluation of how smoking and alcohol related behaviours respond to divergent policy scenarios across the devolved nations. Methods The STS/ATS consists of monthly cross-sectional household interviews (computer or telephone assisted) of representative samples of adults in Great Britain aged 16+ years. Commencing in October 2020 each month a new sample of approximately 1700 adults in England, 450 adults in Scotland and 300 adults in Wales complete the survey (~n = 29,400 per year). The expansion of the survey to Scotland and Wales has been funded for the collection of at least 48 waves of data across four years. The data collected cover a broad range of smoking and alcohol-related parameters (including but not limited to smoking status, cigarette/nicotine dependence, route to quit smoking, prevalence and frequency of hazardous drinking, attempts and motivation to reduce alcohol consumption, help sought and motives for attempts to reduce alcohol intake) and socio-demographic characteristics (including but not limited to age, gender, region, socio-economic position) and will be reviewed monthly and refined in response to evolving policy needs and public interests. All data analyses will be pre-specified and available on a free online platform. A dedicated website will publish descriptive data on important trends each month. Discussion The Smoking and Alcohol Toolkit Study will provide timely monitoring of smoking and alcohol related behaviours to inform and evaluate national policies across Great Britain.

Heaviness of Smoking Index versus Fagerstrom Test for Nicotine Dependence among Current Smokers of Ahmedabad City, India

BACKGROUND

The purpose of this research was to compare Heaviness of Smoking Index (HSI), high early smoking, and heavy smoking with the Fagerstrom Test for Nicotine Dependence (FTND) and further to evaluate the sensitivity of HSI, high early smoking, and heavy smoking among existing smokers.

METHODS

A cross sectional study was conducted by using FTND questionnaire among 200 existing smokers. The cut-off point for HSI was kept at 4; high early smokers and heavy smokers were classified as those individuals who smoked within 30 minutes after waking up and individuals who smoked 30 cigarettes or more daily, respectively. Receiver-operating characteristic (ROC) analysis and Cohen's Kappa statistics were evaluated.

FINDINGS

A significant agreement was observed between the HSI and the FTND, having Kappa value of 0.70, with good sensitivity of 78.16% and specificity as high as 91.15%. The ROC analysis confirmed that a cut-off score of 4 for HSI was suitable. Agreement between FTND and high early smoking was observed to be moderate (Kappa = 0.47, P < 0.001), while very low agreement (Kappa = 0.19, P < 0.001) was observed for FTND and heavy smoking.

CONCLUSION

Results show that HSI is an effective tool which can be substituted for the conventional FTND by the clinicians, psychotherapists, and investigators in health research.

Methadone maintenance treatment in Ho Chi Minh City, Vietnam: Multidimensional measure of adherence and associated factors

Medication adherence has become a major concern in methadone maintenance treatment (MMT) worldwide, but little is known about this in Vietnam. This study aimed to identify adherence level among outpatients at district clinics in Vietnam. A cross-sectional study of 450 MMT outpatients was conducted at three clinics in Ho Chi Minh City (HCMC). Participants underwent face-to-face interviews using a structured questionnaire. Adherence was measured based on both the number of doses missed under Vietnam Ministry of Health criteria and the level of perceived adherence using a visual analogue scale. The prevalence of adherence based on these measures was 61.8% and 80.9%, respectively. Significantly higher level of adherence was found in young participants who had used drug for a longer period of time, had comorbidity, were on antiretroviral therapy and satisfied with MMT service time. However, lower odds of adhering to MMT were found in participants with higher educational level who were married, spent more than 30 min to go to the clinic and currently used illicit drug. In conclusion, despite a relatively high prevalence of adherence, there were a large number of MMT non-adherence patients in HCMC. Interventions are needed to improve adherence and to enhance MMT programmes in Vietnam.

Smoking Cessation/Vaccinations

More than one-third of patients with chronic obstructive pulmonary disease (COPD) continue to smoke cigarettes despite knowing they have the disease. This behavior has a negative impact on prognosis and progression, as repeated injury enhances the pathobiological mechanisms responsible for the disease. A combination of counseling plus pharmacotherapy is the most effective cessation treatment of smokers with COPD, and varenicline seems to be the most effective pharmacologic intervention. Preventing exacerbations in patients with COPD is a major goal of treatment, and vaccination against influenza and pneumococcus is an effective preventive strategy to achieve this goal.

Smoking characteristics and alcohol use among women in treatment for alcohol use disorder

BACKGROUND

Understanding the association between smoking and alcohol use among women may help inform the delivery of targeted interventions to address both of these health behaviors.

METHODS

This study analyzed data from N = 138 women enrolled in a randomized clinical trial comparing female-specific individual versus group cognitive-behavior therapy for alcohol use disorder (AUD). We assessed cigarette use patterns, participants' interest in quitting smoking and motivation to quit smoking during treatment for AUD, and examined the relationship between smoking and alcohol use before and during alcohol treatment.

RESULTS

Over a third of the sample reported smoking cigarettes at baseline (N = 47, 34.1%), with the majority of smokers reporting daily cigarette use. At baseline, those who smoked reported a high interest in quitting smoking M = 7.8 out of 10 (SD = 2.7), although most believed they should quit smoking only after achieving some success in quitting drinking (50.0%). However, participants who smoked cigarettes (compared to non-smokers) reported more alcohol abuse and dependence symptoms (p = .001), lower rates of completing the alcohol treatment (p = .03), attended significantly fewer treatment sessions (p = .008), and consumed significantly more drinks per day on average both at baseline (p = .002) and during the treatment period (p = .04).

CONCLUSIONS

Findings suggest that women with AUD who also smoke cigarettes have greater difficulty engaging in or responding to treatment for their alcohol use. However, these participants reported high interest in quitting smoking but low perceived readiness during AUD treatment, suggesting that motivational interventions should be considered that could take advantage of the opportunity to treat women for both of these co-occurring behaviors while in treatment.

Fagerström Test and Heaviness Smoking Index. Are they Interchangeable as a Dependence Test for Nicotine?

Objective: The purpose of this study was to evaluate the degree of agreement between the Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) in daily smokers admitted to smoking cessation clinics from National Healthcare System in Spain and Argentine Republic. Material and methods: An observational, longitudinal, multicenter study (prospective cohort) conducted in smoking clinics in daily clinical practice. The patients were consecutively included as they attended the consultations. The statistical analysis was descriptive, and correlation and concordance tests as well as analysis and regression models were used. Results: In total, 308 subjects were included [161 women (52.3%)], with a mean age of 51.4 (10.8) years. We found an absence of agreement and the existence of a proportional difference between both tests [Regression coefficient for global series: 0.55 (0.52-0.59) p < .001]. This difference increased as the value of the FTCD score increased; that is, the higher the value of the FTCD score was, the greater the difference in relation to the value of the HSI score. Likewise, Cohen's kappa concordance coefficient, according to various combinations of categorization of both tests, showed that the agreement between these variables was only good. Approximately 20% of the subjects were not classified with the same degree of dependence by the two tests. Thus, a classification mismatch existed. Conclusions: We found an absence of agreement between both tests. These data imply that we should not substitute one test for the other when we analyze nicotine dependence in a population of smokers.

Anxiolytic consumption is associated with tobacco smoking and severe nicotine dependence. Results from the national French medical students (BOURBON) study

Tobacco smoking remains common among medical students, something which may impact on their abililty to promote smoking cessation during their future careers.

OBJECTIVES

To determine the prevalence of smoking and consumption among French medical students and explore the link between both the presence of psychosocial factors and consumption of psychotropic medication and the severity of nicotine dependence and daily smoking behavior.

METHODS

Medical students were recruited from 35 French universities of medicine through administration mailing lists and social networks, between December 13, 2016 and May 15, 2017. Data was collected via anonymized Internet questionnaire which included questions regarding current daily tobacco smoking behaviors. Severe nicotine dependence was defined by a short Fagerström test equal or >4.

RESULTS

10,985 medical students with a mean aged of 21.8 years (+/-3.3) were included, 31.6% of which were male. 2078 (18.9%) were identified as current daily tobacco smokers and 59 (2.8%) were classed as having severe nicotine dependence. In multivariate analyses, tobacco smoking was independently associated with anxiolytic consumption, alcohol use disorder, cannabis use disorder, financial difficulties, and history of sexual and physical assault. Severe nicotine dependence was independently associated with anxiolytic consumption, cannabis use disorder, domestic violence, physical assault and financial difficulties.

CONCLUSION

Tobacco smoking has been found in almost one on 5 medical students and is associated with anxiolytic consumption as well as professional and personal factors.

IntEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): protocol for a randomised and controlled, multicentre, acceptability, feasibility and implementation trial

BACKGROUND

People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to  13.6 years compared to people without depression/anxiety. However, this group of smokers is motivated to quit, and as a result of quitting smoking, their depression/anxiety is likely to improve. In England, people with depression/anxiety are referred to a primary care-based psychological therapies service known as 'Improving Access to Psychological Therapies' (IAPT), which could offer smoking cessation treatment as part of usual care but currently does not. In this study, we aim (1) to establish the feasibility and acceptability of delivering a smoking cessation treatment alongside IAPT usual care and (2) to establish the feasibility of a multi-centre randomised trial to compare the combined smoking cessation and IAPT treatment to usual IAPT treatment alone.

METHODS

A randomised and controlled, multi-centre trial to test the acceptability, feasibility and implementation of smoking cessation treatment as offered alongside usual IAPT care, compared to usual care alone, with nested qualitative methods. We will include adult daily smokers with depression/anxiety, who would like help to quit smoking and are about to start IAPT treatment. Follow-up will be conducted at 3-months after baseline. The main outcome will be retention in the smoking cessation treatment. Secondary outcomes are smoking-related (biochemically-verified 7-day point prevalence smoking cessation, number of cigarettes smoked per day, Heaviness of Smoking Index), mental health-related (PHQ-9), service-related (number of 'Did Not Attends', number of planned and completed IAPT sessions), acceptability and feasibility (participant and clinician acceptability and satisfaction of intervention as assessed by questionnaires and qualitative interviews, interviews will also explore acceptability and feasibility of data collection procedures and impact of smoking cessation treatment on usual care and mental health recovery) and implementation-related (intervention delivery checklist, qualitative analysis of intervention delivery).

DISCUSSION

If the intervention is shown to be acceptable, feasible and suitably implemented, we can conduct a randomised controlled trial. In a future trial, we would examine whether adding smoking cessation treatment increases smoking abstinence and improves depression and anxiety more than usual care, which would lead to long-term health improvement.

TRIAL REGISTRATION

ISRCTN99531779.

Comorbid tobacco and other substance use and symptoms of anxiety and depression among hospitalised orthopaedic trauma patients

BACKGROUND

No study has examined the prevalence of tobacco, other substance use, and symptoms of anxiety and depression, and rates of comorbidities among the orthopaedic trauma population, despite the impact they have on recovery from surgery. This study aims to 1) describe the rates of symptoms and substance use; 2) compare rates of symptoms and substance use among smokers versus non-smokers; and 3) examine the relationship between symptoms and substance use with smoking status.

METHODS

A cross-sectional survey of orthopaedic trauma patients was conducted in two Australian public hospitals. Demographic characteristics, smoking status, alcohol consumption, recent cannabis use, and symptoms of anxiety and/or depression were examined. Differences between current and non-smokers were compared using Pearson Chi² tests. Multivariate logistic regression explored variables related to tobacco smoking.

RESULTS

Eight hundred nineteen patients participated. Over one-fifth (21.8%) identified as a current smoker, half (51.8%) reported consuming alcohol at hazardous levels in the last 12 months, and about 10% stated that they had used cannabis in the last 30 days (9.7%), or experienced symptoms of either anxiety (12.4%), or depression (12.9%) in the last two weeks. Over one-fifth of current tobacco smokers (21.8%) reported drinking heavily in the last 12 months and using cannabis recently. Males, with a lower educational attainment, who were unmarried, had used cannabis recently, and report drinking heavily were more likely to be current smokers.

CONCLUSIONS

Health behaviour interventions addressing comorbidities are warranted among the orthopaedic trauma population given the high rate of comorbidity and impact these may have on recovery.

Relationship between Tobacco Use and Health-Related Quality of Life (HRQoL) among Clients in Substance Use Disorders Treatment

We examined relationships of smoking status and tobacco-related variables with health-related quality of life (HRQoL), a metric of disease burden, among clients in substance use disorders (SUDs) treatment. Participants (N = 2,068; 46.6% female) completed surveys reporting demographics, smoking status, and past-month days they experienced physical and/or mental health distress. Smokers (n = 1,596; 77.2% of sample) answered questions on tobacco-related variables. Multinomial regression models assessed relationships between tobacco-related variables (smoking status, nicotine dependence, menthol smoking, electronic-cigarette use, health concerns, and cost as reasons affecting reducing/quitting smoking, past and future quit attempts) with HRQol in four categories (good health, physical health distress, mental health distress, or both physical and mental health distress). Current smokers were more likely than former smokers to report frequent physical and mental health distress than good health (OR = 1.97, 95% CI = 1.16, 3.34), as were smokers with higher nicotine dependence (OR = 1.18, 95% CI = 1.03, 1.35). Smokers reporting both frequent physical and mental health distress were more sensitive to cigarettes' cost (OR = 1.56, 95% CI = 1.06, 2.29), and less likely to use e-cigarettes (OR = 0.59, 95% CI = 0.38, 0.94). Findings of poor HRQoL among nicotine-dependent smokers with additional SUDs strengthen the imperative to provide smoking cessation interventions in addictions treatment.

Health, risk behaviour and consumption of addictive substances among physicians - results of an online survey

Background

Previous studies were able to show that hazardous alcohol and substance abuse among physicians is not rare. Currently no recent data to detect risk groups are available either on the prevalence of hazardous drinking disorders and risky health behaviour among physicians or on influencing factors (age, gender, role, institution, specialization, working hours).

Methods

A 42-item online questionnaire was distributed to 38 university hospitals, 296 teaching hospitals and 1290 physicians in private practice. The questionnaire addressed health behaviour and alcohol/substance consumption as well as demographic and work-related properties.

Results

Out of 1338 a total of 920 questionnaires could be evaluated. 90% of physicians estimate their health status as satisfying. 23% of doctors consume hazard quantities of ethanol, 5% are nicotine addicted, and 8% suffer from obesity. Childlessness (p = 0,004; OR = 1,67; KI = 1,17-2,37) for both genders and the role of a resident for females (p = 0,046, OR = 3,10, KI = 1,02-9,40) poses a risk factor for hazardous alcohol consumption. Weekly working hours of more than 50 h (p = 0,009; OR = 1,56; KI = 1,12-2,18) and a surgical profession (p < 0,001; OR = 2,03; KI = 1,47-2,81) may also be a risk factor towards hazardous and risky health behaviour.

Conclusion

A more structured and frequently repeated education on help offerings and specific institutions for addicted and risk groups seems essential.

Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol

(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18⁻29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.

Item Response Theory analysis of Fagerström Test for Cigarette Dependence

INTRODUCTION

The Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) are the gold standard measures to assess cigarette dependence. However, FTCD reliability and factor structure have been questioned and HSI psychometric properties are in need of further investigations. The present study examined the psychometrics properties of the FTCD and the HSI via the Item Response Theory.

METHODS

The study was a secondary analysis of data collected in 862 Italian daily smokers. Confirmatory factor analysis was run to evaluate the dimensionality of FTCD. A Grade Response Model was applied to FTCD and HSI to verify the fit to the data. Both item and test functioning were analyzed and item statistics, Test Information Function, and scale reliabilities were calculated. Mokken Scale Analysis was applied to estimate homogeneity and Loevinger's coefficients were calculated.

RESULTS

The FTCD showed unidimensionality and homogeneity for most of the items and for the total score. It also showed high sensitivity and good reliability from medium to high levels of cigarette dependence, although problems related to some items (i.e., items 3 and 5) were evident. HSI had good homogeneity, adequate item functioning, and high reliability from medium to high levels of cigarette dependence. Significant Differential Item Functioning was found for items 1, 4, 5 of the FTCD and for both items of HSI.

CONCLUSIONS

HSI seems highly recommended in clinical settings addressed to heavy smokers while FTCD would be better used in smokers with a level of cigarette dependence ranging between low and high.

Cigarette Smoking Behaviors and Beliefs in Persons Living With Hepatitis C

Background and Rationale

Tobacco use is common among persons living with hepatitis C (PLHC), yet little is known about their smoking behaviors and beliefs. Modern hepatitis C treatment offers a unique opportunity to intensively engage this population about other health risks, including smoking.

Main Results

Seventy-seven tobacco users (40 hepatitis C virus [HCV] seropositive and 37 HCV seronegative) enrolled in an interview study in a New York City clinic. The mean age was 51.6, 57.1% were male, 40.3% Latino, and 49.4% black. 67.5% were single and 18.2% were employed. HCV+ smokers differed from HCV- smokers in having a higher prevalence of illicit substance use, depression, and hypertension. PLHC smokers were highly motivated to quit, with 52.5% stating an intention to quit within 30 days. Most of the PLHC smokers had used cessation-directed pharmacotherapy, but almost none had tried a quitline or a quit smoking website. PLHC smokers scored higher on the intrapersonal locus of control subscale. Almost a quarter (22.5%) believed that smoking "helped fight the HCV."

Conclusions

PLHC smokers have a high burden of psychiatric and substance use comorbidity. They exhibit characteristics that distinguish them from uninfected smokers, and many harbor false beliefs about imagined benefits of smoking. They are highly motivated to quit but underutilize cessation aids. Without aggressive intervention, smoking-related morbidity will likely mute the health benefits and longevity gains associated with hepatitis C treatment. Research such as this may prove useful in guiding the development of future tobacco treatment strategies.

Implications

This is the first paper to examine, in detail, sociobehavioral correlates of tobacco use in PLHC. PLHC are recognized by the Department of Health and Human Services as a high-priority health disparities population. We are not aware of any tobacco treatment services designed specifically for PLHC. The first step in designing an intervention is defining the characteristics of the target group. Our findings will begin to address this need, and may prove useful in optimizing tobacco treatment strategies for smokers living with hepatitis C.

Adapting the ASSIST model of informal peer-led intervention delivery to the Talk to FRANK drug prevention programme in UK secondary schools (ASSIST + FRANK): intervention development, refinement and a pilot cluster randomised controlled trial

Background

Illicit drug use increases the risk of poor physical and mental health. There are few effective drug prevention interventions.

Objective

To assess the acceptability of implementing and trialling two school-based peer-led drug prevention interventions.

Design

Stage 1 – adapt ASSIST, an effective peer-led smoking prevention intervention to deliver information from the UK national drug education website [see www.talktofrank.com (accessed 29 August 2017)]. Stage 2 – deliver the two interventions, ASSIST + FRANK (+FRANK) and FRANK friends, examine implementation and refine content. Stage 3 – four-arm pilot cluster randomised control trial (cRCT) of +FRANK, FRANK friends, ASSIST and usual practice, including a process evaluation and an economic assessment.

Setting

Fourteen secondary schools (two in stage 2) in South Wales, UK.

Participants

UK Year 8 students aged 12–13 years at baseline.

Interventions

+FRANK is a UK informal peer-led smoking prevention intervention provided in Year 8 followed by a drug prevention adjunct provided in Year 9. FRANK friends is a standalone informal peer-led drug prevention intervention provided in Year 9. These interventions are designed to prevent illicit drug use through training influential students to disseminate information on the risks associated with drugs and minimising harms using content from www.talktofrank.com. Training is provided off site and follow-up visits are made in school.

Outcomes

Stage 1 – +FRANK and FRANK friends intervention manuals and resources. Stage 2 – information on the acceptability and fidelity of delivery of the interventions for refining manuals and resources. Stage 3 – (a) acceptability of the interventions according to prespecified criteria; (b) qualitative data from students, staff, parents and intervention teams on implementation and receipt of the interventions; (c) comparison of the interventions; and (d) recruitment and retention rates, completeness of primary, secondary and intermediate outcome measures and estimation of costs.

Results

+FRANK and FRANK friends were developed with stakeholders [young people, teachers (school management team and other roles), parents, ASSIST trainers, drug agency staff and a public health commissioner] over an 18-month period. In the stage 2 delivery of +FRANK, 12 out of the 14 peer supporters attended the in-person follow-ups but only one completed the electronic follow-ups. In the pilot cRCT, 12 schools were recruited, randomised and retained. The student response rate at the 18-month follow-up was 93% (1460/1567 students). Over 80% of peer supporters invited were trained and reported conversations on drug use and contact with trainers. +FRANK was perceived less positively than FRANK friends. The prevalence of lifetime illicit drug use was 4.1% at baseline and 11.6% at follow-up, with low numbers of missing data for all outcomes. The estimated cost per school was £1942 for +FRANK and £3041 for FRANK friends. All progression criteria were met.

Conclusions

Both interventions were acceptable to students, teachers and parents, but FRANK friends was preferred to +FRANK. A limitation of the study was that qualitative data were collected on a self-selecting sample. Future work recommendations include progression to a Phase III effectiveness trial of FRANK friends.

Trial registration

Current Controlled Trials ISRCTN14415936.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 7. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer). Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK CRC, is gratefully acknowledged.

Smoking, Quitting, and the Provision of Smoking Cessation Support: A Survey of Orthopaedic Trauma Patients

OBJECTIVE

This study investigates orthopaedic trauma patients smoking cessation history, intentions to quit, receipt of smoking cessation care during hospital admission, and patient-related factors associated with receipt of smoking cessation care.

METHODS

An online cross-sectional survey of orthopaedic trauma patients was conducted in 2 public hospitals in New South Wales, Australia. Prevalence of smoking and associated variables were described. Logistic regressions were used to examine whether patient characteristics were associated with receipt of smoking cessation care.

RESULTS

Eight hundred nineteen patients (response rate 73%) participated. More than 1 in 5 patients (21.8%) were current smokers (n = 175). Of the current smokers, more than half (55.3%) indicated making a quit attempt in the last 12 months and the majority (77.6%) were interested in quitting. More than a third of smokers (37.4%) were not advised to quit; 44.3% did not receive any form of nicotine replacement therapy; and 24.1% reported that they did not receive any of these 3 forms of smoking cessation care during their admission. Provision of care was not related to patient characteristics.

CONCLUSIONS

The prevalence of smoking among the sample was high. Respondents were interested in quitting; however, the provision of care during admission was low. Smoking cessation interventions need to be developed to increase the provision of care and to promote quit attempts in this Australian population.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Evaluating the role of smokeless tobacco use indices as brief measures of dependence

INTRODUCTION

There is considerable interest in using brief measures of dependence for evaluation and treatment of tobacco dependence. The Heaviness of Smoking Index (HSI) is a validated measure of dependence among cigarette smokers. However, a similar index has not been studied among ST users. The aim of this study is to develop similar ST use indices and evaluate their utility as concise dependence measures. Time to first chew/dip of the day (TTFD), number of cans of ST used per week (CPW), and number of dips/chews per day (DPD) were used to create three ST use indices; heaviness of ST use index (HSTI), ST dependence index (STDI), and ST quantity frequency index (ST-QFI).

METHODS

The study was based on data collected from a community based sample of exclusive ST users living in Oklahoma. Participants completed the self-administered survey which included dependence scales and questionnaires to measure sociodemographic factors and tobacco use characteristics. Saliva samples were obtained to measure cotinine concentration. Method of scoring for TTFD and DPD was similar to the scoring scheme employed for HSI items. DPD was transformed by a series of statistical tests into a three category scoring variable. Concurrent validity and reliability of the ST use indices were evaluated and overall accuracy of ST use indices was assessed. Level of agreement between the ST use indices and Fagerström Test for Nicotine Dependence for ST users (FTND-ST) was calculated to find the extent these indices were equivalent to FTND-ST in measuring dependence.

RESULTS

ST use indices were significantly correlated with FTND-ST. ST users who had higher HSTI or STDI scores were more likely to have Tobacco Dependence Screener (TDS) based dependence diagnosis (OR: 1.50, 95%CI: 1.12, 2.02 and OR: 1.53, 95%CI: 1.16, 2.02, respectively). Study findings showed that all ST use indices were predictors of cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that STDI had acceptable reliability. At the optimal cutoff scores, both HSTI and STDI had good level of agreement with FTND-ST (k=0.81, p<0.0001 and k=0.71, p≤0.0001, respectively).

CONCLUSIONS

Components of physical dependence are interrelated and each ST use item, TTFD, CPW, and DPD, explains a different dependence feature. Significant association of HSTI and STDI with other tobacco dependence measures and FTND-ST suggests that these indices are valuable brief measures of dependence among ST users and can be used as a substitute for FTND-ST, similar to HSI in smoking dependence studies. A concise dependence measure like HSTI or STDI has reduced response burden and is an effective tool in clinical and research setting.

Combination nicotine replacement therapy: strategies for initiation and tapering

Several studies and meta-analyses have demonstrated the efficacy of combination nicotine replacement therapy (NRT) for patients who wish to quit smoking. However, there is limited guidance with respect to initiation and tapering of combination NRT. We attempt to review the evidence and rationale behind combination NRT, present the dosing used in combination NRT studies, and propose a step-down approach for tapering of combination NRT with integration of behavioral strategies.

A genome-wide analysis in cluster headache points to neprilysin and PACAP receptor gene variants

Background

Cluster Headache (CH) is a severe primary headache, with a poorly understood pathophysiology. Complex genetic factors are likely to play a role in CH etiology; however, no confirmed gene associations have been identified. The aim of this study is to identify genetic variants influencing risk to CH and to explore the potential pathogenic mechanisms.

Methods

We have performed a genome-wide association study (GWAS) in a clinically well-defined cohort of 99 Italian patients with CH and in a control sample of 360 age-matched sigarette smoking healthy individuals, using the Infinium PsychArray (Illumina), which combines common highly-informative genome-wide tag SNPs and exonic SNPs. Genotype data were used to carry out a genome-wide single marker case-control association analysis using common SNPs, and a gene-based association analysis focussing on rare protein altering variants in 745 candidate genes with a putative role in CH.

Results

Although no single variant showed statistically significant association at the genome-wide threshold, we identified an interesting suggestive association (P = 9.1 × 10⁻⁶) with a common variant of the PACAP receptor gene (ADCYAP1R1). Furthermore, gene-based analysis provided significant evidence of association (P = 2.5 × 10⁻⁵) for a rare potentially damaging missense variant in the MME gene, encoding for the membrane metallo-endopeptidase neprilysin.

Conclusions

Our study represents the first genome-wide association study of common SNPs and rare exonic variants influencing risk for CH. The most interesting results implicate ADCYAP1R1 and MME gene variants in CH susceptibility and point to a role for genes involved in pain processing. These findings provide new insights into the pathogenesis of CH that need further investigation and replication in larger CH samples.

Electronic supplementary material

The online version of this article (doi:10.1186/s10194-016-0705-y) contains supplementary material, which is available to authorized users.

Smoking dependence in 18 European countries: Hard to maintain the hardening hypothesis

OBJECTIVE

When the prevalence of smoking decreases in a population, there is a hypothesis-the so-called "hardening hypothesis"-that the remaining smokers form a subgroup of "hardcore smokers." Our aims were to test the hardening hypothesis and to analyze the determinants of high dependence taking into account both individual and country-level characteristics.

METHOD

Within the Pricing Policies and Control of Tobacco in Europe (PPACTE) project, we conducted a face-to-face survey on smoking between January and July 2010 in 18 European countries, including 2882 male and 2254 female smokers with complete information on smoking dependence. The Heaviness of Smoking Index (HSI) was used as a measure of tobacco dependence. We correlated smoking prevalence and dependence using the country as unit of analysis. Moreover, we fitted multilevel logistic regression models.

RESULTS

Country-specific prevalence of smoking was positively, although not significantly, correlated with the proportion of highly tobacco-dependent smokers (overall rsp=0.203, p=0.419), both in men (rsp=0.235, p=0.347) and women (rsp=0.455, p=0.058). Using individual-level analysis, high dependence was positively related to age, and, although not significantly, to smoking prevalence, and inversely related to level of education. The lack of a smoking ban at home was positively related to smoking dependence.

CONCLUSIONS

Using both ecological and individual-level analyses, the relations between smoking prevalence and HSI were not significant, but in the opposite direction as compared to that assumed by the "hardening hypothesis." Therefore, our data provide empirical evidence against this theory, thus supporting the feasibility of an endgame strategy.

E-Cigarette Awareness, Perceptions and Use among Community-Recruited Smokers in Hong Kong

BACKGROUND

Electronic cigarettes (e-cigarettes) are being increasingly used. We examined the correlates associated with e-cigarette awareness, use and perceived effectiveness in smoking cessation among Chinese daily smokers in Hong Kong.

METHODS

Daily smokers (N = 1,307) were recruited to a community-based randomised controlled trial ('Quit to Win') in 2014. Socio-demographic characteristics, conventional cigarette smoking status, nicotine addiction level, quit attempts, quit intention, e-cigarette awareness, use and perceived effectiveness on quitting were reported at baseline and 1-week follow-up. Multivariate logistic regression was used to identify factors associated with e-cigarette awareness, use and perceived effectiveness in quitting.

RESULTS

Most smokers (82.6%, 95% CI 80.2%-84.9%) had heard about e-cigarettes, and 13.3% (11.3%-15.5%) ever used e-cigarettes. Most users (74.1%) and non-users (91.2%) did not perceive e-cigarettes as effective in quitting. Being younger and having a larger family income were associated with e-cigarette awareness. Being younger, a tertiary education and a stronger addiction to nicotine were associated with e-cigarette use, which was itself associated with lower levels of intention to quit and had no association with attempts to quit (P for trend 0.45). E-cigarette use, the last quit attempt being a month earlier, having made a quit attempt lasting 24 hours or longer and perceiving quitting as important were all associated with the perceived effectiveness of e-cigarettes in quitting (all P <0.05).

CONCLUSIONS

Among community-recruited smokers who intended to quit, awareness of e-cigarettes was high, but most did not perceive e-cigarettes as effective in quitting. Correlates concerning e-cigarette perceptions and use will help to inform prospective studies, public education and policy on controlling e-cigarettes.

Effect of a Digital Social Media Campaign on Young Adult Smoking Cessation

INTRODUCTION

Social media (SM) may extend the reach and impact for smoking cessation among young adult smokers. To-date, little research targeting young adults has been done on the use of SM to promote quitting smoking. We assessed the effect of an innovative multicomponent web-based and SM approach known as Break-it-Off (BIO) on young adult smoking cessation.

METHODS

The study employed a quasi-experimental design with baseline and 3-month follow-up data from 19 to 29-year old smokers exposed to BIO (n = 102 at follow-up) and a comparison group of Smokers' Helpline (SHL) users (n = 136 at follow-up). Logistic regression analysis assessed differences between groups on self-reported 7-day and 30-day point prevalence cessation rates, adjusting for ethnicity, education level, and cigarette use (daily or occasional) at baseline.

RESULTS

The campaign reached 37 325 unique visitors with a total of 44 172 visits. BIO users had significantly higher 7-day and 30-day quit rates compared with users of SHL. At 3-month follow-up, BIO participants (32.4%) were more likely than SHL participants (14%) to have quit smoking for 30 days (odds ratio = 2.95, 95% CI = 1.56 to 5.57, P < .001) and BIO participants (91%) were more likely than SHL participants (79%) to have made a quit attempt (odds ratio = 2.69, 95% CI = 1.03 to 6.99, P = .04).

CONCLUSION

The reach of the campaign and findings on quitting success indicate that a digital/SM platform can complement the traditional SHL cessation service for young adult smokers seeking help to quit.

Psychometric Characteristics of the Brief Wisconsin Inventory of Smoking Dependence Motives Among a Nonclinical Sample of Smokers

INTRODUCTION

Attempts to validate the Brief Wisconsin Inventory of Smoking Dependence Motives (WISDM) have produced mixed results. The objectives for the current research were to (1) evaluate the test-retest reliability, internal consistency, and concurrent validity for each of the motive scales (2) evaluate three models to determine fit based on previous research: (i) 11-factor model, (ii) 11-factor model with four error covariances specified by previous research, and (iii) 11-factor model with two higher order primary and secondary dependence motive factors, and (3) evaluate the discriminant and convergent validity of the Brief WISDM scales.

METHODS

Smoking adults aged 18-65 completed a survey about their smoking behaviors and nicotine dependence with a web-based instrument that was administered at a 3-month test-retest interval. Psychometric properties and test-retest reliability were evaluated for each instrument. The 11-factor Brief WISDM was evaluated with confirmatory factor analyses; the scales were evaluated for convergent and discriminant validity.

RESULTS

The Brief WISDM demonstrated good to excellent test-retest reliability. Confirmatory factor analysis showed the model with the second order primary and secondary dependence motive factors demonstrated the best fit for the data at both administrations. Discriminant validity issues were present for most of the primary dependence motive scales.

CONCLUSIONS

To date, the theoretically derived smoking motives for the Brief WISDM have demonstrated mixed support when submitted to confirmatory factor analysis. While these scales tap critical motives of nicotine dependence, further refinement of primary dependence motives is necessary to ensure each latent variable assesses a unique construct.

The reach ratio--a new indicator for comparing quitline reach into smoking subgroups

INTRODUCTION

There is growing concern about population disparities in tobacco-related morbidity and mortality. This paper introduces the reach ratio as a complementary measure to reach for monitoring whether quitline interventions are reaching high risk groups of smokers proportionate to their prevalence in the population.

METHODS

Data on smokers were collected at intake by 7 Canadian provincial quitlines from 2007 to 2009 and grouped to identify 4 high risk subgroups: males, young adults, heavy smokers, and those with low education. Provincial data are from the Canadian Tobacco Use Monitoring Survey. Reach ratios (ReRas), defined as the proportion of quitline callers from a subgroup divided by the proportion of the smoking population in the subgroup, and 95% confidence intervals were calculated for the subgroups. A ReRa of 1.0 indicates proportionate representation.

RESULTS

ReRas for male smokers and young adults are consistently less than 1.0 across all provinces, indicating that a lower proportion of these high-risk smokers were receiving evidence-based smoking cessation treatment from quitlines. Those with high levels of tobacco addiction and less than high school education have ReRas greater than 1.0, indicating that a greater proportion of these smokers were receiving cessation treatments.

CONCLUSION

ReRas complement other measures of reach and provide a standardized estimate of the extent to which subgroups of interest are benefiting from available cessation interventions. This information can help quitline operators, funders, and policymakers determine the need for promotional strategies targeted to high risk subgroups, and allocate resources to meet program and policy objectives.

Nicotine dependence and biochemical exposure measures in the second trimester of pregnancy

Introduction:

The Heaviness of Smoking Index (HSI) is validated to measure nicotine dependence in nonpregnant smokers, and in these smokers, mean salivary and serum cotinine levels are related by a ratio of 1.25. However, as nicotine metabolism increases during gestation, these findings may differ in pregnancy. We investigated the validity of HSI in pregnancy by comparing this with 3 biochemical measures; in a search for a less-invasive cotinine measure in pregnancy, we also explored the relationship between mean blood and salivary cotinine levels.

Methods:

Cross-sectional analyses using baseline data from the Smoking, Nicotine, and Pregnancy Trial. Participants were 16–46 years old, 12–24 weeks gestation, smoked more than 5 cigarettes per day, and had exhaled carbon monoxide (CO) readings of at least 8 ppm. Linear regression was used to examine correlations between HSI and blood cotinine and salivary cotinine and exhaled CO. Correlation between blood and salivary cotinine was investigated using linear regression through the origin.

Results:

HSI scores were associated with blood cotinine (R² = 0.20, n = 662, p < .001), salivary cotinine (R² = 0.11, n = 967, p < .001), and exhaled CO (R² = 0.13, n = 1,050, p < .001). Salivary and blood cotinine levels, taken simultaneously, were highly correlated (R² = 0.91, n = 628, p < .001) and the saliva:blood level ratio was 1.01 (95% CI 0.99–1.04).

Conclusions:

Correlations between HSI and biochemical measures in pregnancy were comparable with those obtained outside pregnancy, suggesting that HSI has similar validity in pregnant smokers. Salivary and blood cotinine levels are roughly equivalent in pregnant smokers.

Heaviness of smoking index, number of cigarettes smoked and the Fagerstrom test for nicotine dependence among adult male Malaysians

Two methods of identifying smokers with high nicotine dependence, the heaviness of smoking index (HSI) and number of cigarettes per day (CPD) were compared with the Fagerstrom test for nicotine dependence (FTND). The HSI, CPD and the FTND were administered to 316 adult Malaysian male, daily smokers aged between 25-64 years old in the Malaysian NCD Surveillance-1 Survey using a two-stage stratified random sampling of enumeration blocks and living quarters, via an interview based on a validated questionnaire. The cut-off point for classification of high nicotine dependence on the HSI was a score of four or higher, and for the heavy smoking category, smoking more than 20 cigarettes per day. Classification using each method was compared with classification by the FTND (score of six or more) as the reference standard. Sensitivity, specificity and kappa statistics for concordance between both measures and the FTND were evaluated. The HSI gave a similar prevalence rate of high nicotine dependence as the FTND. There was substantial agreement between the HSI and the FTND (kappa=0.63.), with moderate sensitivity (69.8%) and high specificity (92.5%). However, prevalence of high nicotine dependence using the CPD was 7% lower than the FTND. The heavy smoking category also showed fair agreement with the FTND (kappa=0.45) and moderate sensitivity (67.0%), but specificity was high (86.9%). The findings indicate that the HSI can be used as an alternative to the FTND in screening for high nicotine dependence among daily smokers in large population-based studies, while CPD may not be a suitable alternative to the FTND.

A comparison of the autonomy over tobacco scale and the Fagerström test for nicotine dependence

The autonomy over tobacco scale (AUTOS) is a 12-item theory-based instrument used to measure tobacco dependence in smokers. It provides separate measures of three factors that make smoking cessation more difficult: withdrawal symptoms, psychological dependence, and cue-induced urges to use tobacco. We compared the internal reliability and concurrent validity of the AUTOS to those of the Fagerström test for nicotine dependence (FTND). Adult current smokers (n=422; 62% female; 86.8% white; mean age 33.3 years, SD=13.7; 57% daily smokers) completed an anonymous web-based survey that included the AUTOS, the FTND and 11 smoking-related behavioral measures. Cronbach's α was .94 for the AUTOS and α>.75 for each of the 3 subscales; α=.73 for the FTND. The AUTOS and its subscales correlated with all measures of concurrent validity (r=.70 between AUTOS & FTND). The AUTOS correlated better than the FTND with the Hooked on Nicotine Checklist, the longest period of abstinence, latency to wanting, percentage of time a person smokes because of momentary need, pleasure from smoking, days smoked per month, and concern about deprivation. The measures showed similar correlations with the latencies to craving and needing. The FTND correlated better with the duration of smoking and cigarettes smoked per day. Based on these results and those from prior studies, we conclude that the AUTOS offers researchers a valid and highly reliable, theory-based measure that is more versatile in its applications than the FTND.

Culture and smoking among Vietnamese Americans in central Massachusetts

The study was conducted (a) to assess use of any smoking cessation medications, (b) to identify factors associated with smoking, and (c) to assess knowledge of the health effects of smoking and attitudes toward smoking and seeking help for quitting among Vietnamese Americans. This is a descriptive study conducted with a nonrepresentative sample of 163 Vietnamese Americans. Current and former smokers constituted 24.4% and 25.6% of men and 1.2% and 3.5% of women, respectively. Of 20 current smokers, 17 (85%) reported use of cessation medications in their past quit attempts. Acculturation was the only significant correlate of ever smoking (vs. never smoking) in multivariate logistic regression analyses. Men who were less acculturated had more than 5 times the odds of being ever smokers (odds ratio = 5.33, 95% confidence interval = 1.37-20.78) compared with more acculturated men. Most participants had correct knowledge of the health effects of smoking regardless of age, education level, and smoking status. Attitudes toward smoking differed by age and education level but not by smoking status. Nurses working with Vietnamese Americans should be aware of the high rate of smoking among male immigrants and provide smoking cessation interventions.

A standardized transcutaneous electric acupoint stimulation for relieving tobacco urges in dependent smokers

The efficacy of acupuncture in smoking cessation, and its effect on the urge to smoke are unclear. We evaluated the effect of a standardized protocol of transcutaneous electric acupoint stimulations (TEAS) on alleviating the urge to smoke. Ninety-eight smokers were recruited in two double-blind studies. Participants abstained from smoking for 26 h, and were randomized to receive TEAS alternating between 2 and 100 Hz at four acupoints (LI4 and PC8, PC6 and TE5) at four different intensities (10, 5, Intermittent 5 or 0 mA). The urge to smoke was assessed by the Questionnaire of Smoking Urges (QSU-Brief). In Experiment 1, the 10 mA group (n = 20) was compared with the 5 mA group (n = 20); the increase in smoking urges did not differ significantly. Considering the possibility that 5 mA may be an active intervention, in Experiment 2, a true placebo (0 mA), and a proxy of placebo [Intermittent 5 mA (i5 mA)] were compared with 10 mA TEAS. In this experiment, 10 mA (n = 20) TEAS showed a tendency to alleviate smoking urges compared with 0 mA (n = 16), and i5 mA (n = 19) TEAS. Only when the data of smokers with Fagerstöm Test for Nicotine Dependence score ≥5 were analyzed that the difference between the 10 mA group and the control group (0 and i5 mA) became significant. Based on these preliminary findings, we conclude that TEAS applied on the skin may antagonize the increase in urge to smoke in abstinent-dependent smokers. It seems warranted to assess the efficacy of TEAS in smoking cessation clinical trials involving a larger population of dependent smokers.

Nicotine dependence among Chinese city dwellers: a population-based cross-sectional study

INTRODUCTION

Although nicotine addiction is thought to be the primary driver of tobacco smoking, few studies have examined nicotine dependence among Chinese mainland smokers.

METHODS

A population-based cross-sectional study was designed. Subjects (4735) aged 15 years and older residents were drawn from six cities in China through a multistage systematic sampling procedure. Nicotine dependence of respondents was assessed in a face-to-face interview using the 6-item Mandarin Chinese version of the Fagerström Test for Nicotine Dependence (FTND). A multilevel regression model, accounting for cluster sampling, was used to identify correlates of dependence.

RESULTS

Among females, only 4.2% (n = 115) were smokers (2.5% daily, 1.7% occasional). Subsequent analysis focused on males, of whom 50.8% (n = 1477) were smokers (38.9% daily, 11.9% occasional). The average FTND score was 2.89 (95% CI: 2.77-3.01) among all current smokers. Daily smokers had a significantly higher FTND score (3.49, 95% CI: 3.35-3.63) than occasional smokers (1.12, 95% CI: 0.98-1.26) (p < .01). Of all smokers, 27.1% were considered dependent based on FTND ≥ 4. Among daily smokers, FTND scores were negatively associated with age at smoking initiation, education, and self-efficacy for quitting smoking. FTND was associated (negatively) with income among occasional smokers only. There were regional differences in FTND scores among daily smokers.

CONCLUSIONS

Cigarette smoking is highly prevalent among Chinese males but rare among Chinese females. Occasional smoking is also common among males. Only 3.3% of occasional male smokers appear dependent by FTND criteria. Dependence varies by smoking history and demographics. These findings have implications for design and implementation of smoking cessation interventions.

Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey

BACKGROUND

The Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND.

METHODS

A survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures of sensitivity, specificity and predictive values were calculated. Concordance between the tests was also established (Cohen's kappa).

RESULTS

Cohen's kappa showed good agreement between measures (Kappa = 0.7); specificity values were also high (Sp = 96.2%). Sensitivity analysis in females (Se = 62.3%) did not show good agreement.

CONCLUSIONS

The HSI can be used as a reasonably good screening test in order to identify daily smokers with high nicotine dependence. Nevertheless, for populations or subpopulations having low nicotine dependence, such as women, the FTND is more reliable.

Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships

INTRODUCTION

This study explored predictors of smoking quit attempts in a sample of low-income smoking mothers who participated in a randomized trial of a 6-month, 14-session counseling intervention to decrease their children's secondhand smoke exposure (SHSe) and eliminate smoking.

METHODS

Measures were taken at baseline and at 3, 6, 12, and 18 months on 150 mothers who exposed their children (aged <4 years) to > or = 10 cigarettes/week in the home. Reported 7-day quits were verified by saliva cotinine or urine anabasine and anatabine levels.

RESULTS

There were few quits longer than 6 months. Mothers in the counseling group reported more 24-hr quits (p = .019) and more 7-day quits (p = .029) than controls. Multivariate modeling revealed that having quit for at least 24 hr in the year prior to baseline and the number of alternative cessation methods ever tried were predictive of the longest quit attempt during the 18-month study. Mothers in the counseling group who at baseline felt SHSe posed a health risk for their children or who at baseline had more permissive home smoking policies had longer quit attempts.

DISCUSSION

Results confirm that attempts to quit smoking predict additional quit attempts. This suggests that practice may be necessary for many people to quit smoking permanently. Findings of interaction analyses suggest that participant factors may alter the effects of treatment procedures. Failure to account for or employ such factors in the analysis or design of community trials could confound the results of intervention trials.

Psychometric properties of the Fagerström Test for Nicotine Dependence

OBJECTIVE

The Fagerström Test for Nicotine Dependence (FTND) is a screening instrument for physical nicotine dependence and is extensively used in various countries. The objective of the present report was to review articles related to the psychometric properties of the FTND.

METHODS

A systematic search for articles published up through December of 2007 was carried out in various electronic databases. The following search terms were used: 'Fagerström Test for Nicotine Dependence'; 'FTND'; 'psychometric'; 'validity'; 'reliability'; 'feasibility'; and 'factors'. We included articles published in English, Spanish or Portuguese and in which the psychometric properties of the FTND were evaluated.

RESULTS

Twenty-six studies related to the psychometric properties of the FTND were identified in the indexed literature. Analysis of the studies confirmed the reliability of the FTND for the assessment of nicotine dependence in different settings and populations.

CONCLUSIONS

Further validation studies using previously validated instruments as a comparative measure are needed before the extensive use of the FTND can be justified on the basis of its psychometric qualities.

Psychometric qualities of the Brazilian versions of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index

INTRODUCTION

This study examined the psychometric properties of the Brazilian versions of the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI).

METHODS

The test-retest reliability of the FTND was assessed in a sample of 61 smoking university students, with a 15-day interval between assessments. The interrater reliability was examined in 30 smoking patients of a psychosocial care center for alcohol and drug users (PCC-AD). The reliability coefficient was estimated by the kappa and intraclass correlation coefficients. The predictive validity, internal consistency, and factor structure of the FTND and the HSI were evaluated by factor analysis in 271 smokers treated at an emergency unit and at the PCC-AD. The gold standard was the nicotine dependence criteria of DSM-IV, as assessed by the Structured Clinical Interview for DSM-IV.

RESULTS

The FTND showed high reliability, with correlation coefficients of .92 for test-retest reliability and .99 for interrater reliability. Both the FTND and the HSI presented high levels of sensitivity and specificity. The internal consistency evaluation yielded a Cronbach's alpha coefficient of .83 for the FTND and of .56 for the HSI. An exploratory factor analysis found 2 factors in the FTND, which were validated by a confirmatory factor analysis.

DISCUSSION

The results obtained in this study confirm the validity and reliability of the Brazilian versions of the FTND and the HSI.

Properties of the Cigarette Dependence Scale and the Fagerström Test of Nicotine Dependence in a representative sample of smokers in Norway

AIMS

To compare the properties of four measures of dependence to nicotine/tobacco, the 12-item Cigarette Dependence Scale (CDS-12), the six-item Fagerström Test of Nicotine Dependence (FTND) and two shorter versions of the same measures.

METHODS

In a cross-sectional telephone survey of smokers in a representative general population sample in Norway, we compared the measures. We assessed (i) internal consistency reliability with Cronbach's alpha; (ii) compared item scores; and (iii) tested the validity of the questionnaires. Test-retest reliability was assessed in a smaller convenience sample.

RESULTS

Among 1265 respondents (64%), 290 (23%) were daily smokers and included in further analysis. Their mean age was 42 years [standard deviation (SD) 15] and 46% were female. They smoked on average 13 cigarettes per day (SD 6). Internal consistency reliability was 0.61 for the FTND (n = 267) and 0.81 for the CDS-12 (n = 266). Score distributions suggested a floor effect for the FTND. Test-retest reliability was 0.90 for the FTND and 0.97 for the CDS-12 (n = 31). The correlation between the scale scores and a question about the maximum willingness to pay for a cigarette after not smoking all day was 0.36 (P < 0.001) for the FTND (n = 262) and 0.45 (P < 0.001) for the CDS-12 (n = 263). There was little difference in the associations of the two scales or their abbreviated versions with external variables.

CONCLUSIONS

Telephone administration was acceptable for both questionnaires, and we have established population reference values for the four scales. The questionnaires were associated with each other and showed similar properties. The findings support the construct validity of the scales.

The relationship between smokers' motivation to quit and intensity of tobacco control at the population level: a comparison of five European countries

Background

Smoking prevalence differs significantly across Europe. In addition, there are considerable differences in tobacco control activities across European countries. The relationship between prevalence and policy is under-researched. The present analysis examines the motivation to change smoking behaviour across 5 different European countries that differ considerably in their tobacco control activities.

Methods

A population-based, representative survey of 1750 smokers, aged 16–59, from 5 different European countries (Germany, Greece, Poland, Sweden, UK) was used. Demographic variables, smoking status and the motivation to stop smoking were assessed. Motivation was assessed as, first, intending to quit (using the stages of change plus a modified stage for Precontemplation), and second, the desire to quit.

Results

The majority of smokers want to stop smoking (73.5%), while only 35.0% want to stop definitely. Across countries, 10.2% definitely do not want to stop.

Most of the smokers can be categorised in the Precontemplation stage (between 62.6% and 77.7% depending on the country), one of the stages of change categories. The relationship between the stages of change and the country under examination is statistically significant (chi-square = 43.466, p < 0.001). In countries with a high level of tobacco control, the proportion of people in Precontemplation is lower than in countries with low tobacco control activity.

Conclusion

There are differences in the stages of change between the countries under examination. However, the categorisation of the countries into low, medium and high tobacco control activity used in this analysis does not explain these differences. Most smokers want to stop smoking, but a high proportion cannot indicate a time-frame when this is going to happen. Tobacco control efforts or other kinds of support might encourage these smokers to actually try to stop. Longitudinal studies at the population level are needed to assess, relate or monitor tobacco control activities and the intention to stop.

The anesthesia preoperative assessment: an opportunity for smoking cessation intervention

Smoking is the single most cause of preventable disease and premature death in the United States. We discuss potential hazards that the anesthesiologist should be aware of when caring for patients who abuse tobacco. A review of recent preoperative smoking cessation initiatives is also provided in addition to recommendations on how anesthesiologists may use the preoperative visit as an opportunity to play a more active role in reducing the burden of tobacco-related disease.

CYP2A6 polymorphisms are associated with nicotine dependence and influence withdrawal symptoms in smoking cessation

CYP2A6 is the main enzyme that catalyzes nicotine into cotinine. Interindividual differences in nicotine metabolism result at least partially from polymorphic variation of CYP2A6 gene. In this study, we evaluated the influence of CYP2A6 polymorphisms on clinical phenotypes of smoking, such as smoking habit and withdrawal symptoms. Japanese smokers (n = 107) were genotyped for CYP2A6*1, *4 and *9. Consistent with the previous reports, CYP2A6 genotypes have a tendency to correlate with the number of cigarettes per day and with daily intake of nicotine. Interestingly, CYP2A6 high-activity group (CYP2A6*1/*1, *1/*9, *1/*4, *9/*9) smoked the first cigarette of the day earlier than low-activity group (CYP2A6*4/*9, *4/*4), indicating more remarkable nicotine dependence. Furthermore, nicotine withdrawal symptoms were more serious in smoking cessation in CYP2A6 high-activity group. Collectively, CYP2A6 genotypes are related with nicotine dependence, influencing smoking habits and withdrawal symptoms in quitting smoking. It is proposed that individualized smoking cessation program could be designed based on CYP2A6 genotypes.

Consistency or change in nicotine dependence according to the Fagerström Test for Nicotine Dependence over three years in a population sample

The goal was to determine whether nicotine dependence levels remain consistent or change over three years. From a population- based sample of 4075 residents aged 18-64, drawn at random, data of 696 individuals was used, who had smoked cigarettes for 21 years on average. Nicotine dependence was assessed by the Fagerström Test for Nicotine Dependence (FTND) at baseline, and 30 and 36 months later. In addition, nicotine dependence and alcohol dependence were diagnosed according to the American Psychiatric Association (DSM-IV). We found an increase in the FTND over 36 months. Subgroups were revealed with sustained high, increasing, decreasing, and sustained low rates of the FTND sum score. Male gender, age at onset of smoking 15 years or younger, DSM-IV nicotine dependence, and DSM-IV alcohol dependence at baseline predicted a sustained high FTND. We conclude that nicotine dependence is increasing even after many years of smoking in an adult population sample.