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Rose JS, Dierker LC, Selya AS, Smith PH. Integrative Data Analysis of Gender and Ethnic Measurement Invariance in Nicotine Dependence Symptoms. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:748-760. [PMID: 29396761 DOI: 10.1007/s11121-018-0867-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Little research has evaluated whether conflicting evidence for gender and racial/ethnic differences in nicotine dependence (ND) may be attributed to differences in psychometric properties of ND symptoms, particularly for young Hispanic smokers. Inadequate racial/ethnic diversity and limited smoking exposure variability has hampered research in young smokers. We used integrative data analysis (IDA) to pool DSM-IV ND symptom data for current smokers aged 12-25 (N = 20,328) from three nationally representative surveys (1999, 2000 National Surveys on Drug Use and Health (NSDUH) and Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Moderated nonlinear factor analysis (MNLFA) tested symptom measurement invariance in the pooled sample containing greater ethnic and smoking exposure variability. There was study noninvariance for most symptoms. NESARC participants were more likely to report tolerance, using larger amounts or for longer periods, inability to cut down/quit, and more time spent smoking at higher levels of ND severity, but reported emotional/physical health problems at lower ND severity. Four symptoms showed gender or race/ethnicity noninvariance, but observed differences were small. An ND severity factor score adjusting for symptom noninvariance related to study membership, gender, and race/ethnicity did not differ substantively from traditional DSM-IV diagnosis and number of endorsed symptoms in estimated gender and race/ethnicity differences in ND. Results were consistent with studies finding minimal gender and racial/ethnic differences in ND, and suggest that symptom noninvariance is not a major contributor to observed differences. Results support IDA as a potentially promising approach for testing novel ND hypotheses not possible in independent studies.
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Affiliation(s)
- Jennifer S Rose
- Department of Psychology, Wesleyan University, 207 High St., Middletown, CT, 06457, USA.
| | - Lisa C Dierker
- Department of Psychology, Wesleyan University, 207 High St., Middletown, CT, 06457, USA
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McMahon K, Hoertel N, Peyre H, Blanco C, Fang C, Limosin F. Age differences in DSM-IV borderline personality disorder symptom expression: Results from a national study using item response theory (IRT). J Psychiatr Res 2019; 110:16-23. [PMID: 30579046 DOI: 10.1016/j.jpsychires.2018.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
Limited literature suggests that there may be age-related differences in borderline personality disorder (BPD) symptom expression. The present study used item response theory (IRT) methods to examine whether there are age differences in the likelihood of endorsing DSM-IV symptoms of BPD, when equating for levels of BPD symptom severity. Data were drawn from a nationally representative survey of adults in the US (n = 34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found that 7 out of the 9 DSM-IV symptoms of BPD were age invariant. However, there were statistically and clinically significant differences between the oldest and youngest age groups in two BPD symptoms: oldest adult women were less likely to report suicidal/self-harm behavior than the youngest adult women across levels of BPD severity and unstable/intense interpersonal relationships discriminated BPD severity better in the youngest age group compared to the oldest age group in both genders. Overall, our findings indicate substantial age-related differences in BPD symptom expression. Mental health care providers should be alert to these two age-related differences in BPD symptom expression when making assessment and treatment decisions across adult age groups.
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Affiliation(s)
- Kibby McMahon
- Department of Psychiatry and Behavioral Sciences, Duke University, 2213 Elba Street, Durham, NC, 27710, USA; Psychology and Neuroscience, Duke University, Durham, NC, 27710, USA.
| | - Nicolas Hoertel
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Pôles de recherche et d'enseignement supérieur Sorbonne Paris Cité, Paris, France
| | - Hugo Peyre
- Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Laboratoire de Sciences Cognitives et Psycholinguistique, Département d'Etudes Cognitives, Ecole Normale Supérieure, EHESS, CNRS, PSL University, 75005, Paris, France; INSERM UMR, 1141, Paris Diderot University, Paris, France
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Caitlin Fang
- Department of Psychiatry and Behavioral Sciences, Duke University, 2213 Elba Street, Durham, NC, 27710, USA
| | - Frédéric Limosin
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Pôles de recherche et d'enseignement supérieur Sorbonne Paris Cité, Paris, France
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Hoertel N, Peyre H, Lavaud P, Blanco C, Guerin-Langlois C, René M, Schuster JP, Lemogne C, Delorme R, Limosin F. Examining sex differences in DSM-IV-TR narcissistic personality disorder symptom expression using Item Response Theory (IRT). Psychiatry Res 2018; 260:500-507. [PMID: 29291575 PMCID: PMC6002876 DOI: 10.1016/j.psychres.2017.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/25/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022]
Abstract
The limited published literature on the subject suggests that there may be differences in how females and males experience narcissistic personality disorder (NPD) symptoms. The aim of this study was to use methods based on item response theory to examine whether, when equating for levels of NPD symptom severity, there are sex differences in the likelihood of reporting DSM-IV-TR NPD symptoms. We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). There were statistically and clinically significant sex differences for 2 out of the 9 DSM-IV-TR NPD symptoms. We found that males were more likely to endorse the item 'lack of empathy' at lower levels of narcissistic personality disorder severity than females. The item 'being envious' was a better indicator of NPD severity in males than in females. There were no clinically significant sex differences on the remaining NPD symptoms. Overall, our findings indicate substantial sex differences in narcissistic personality disorder symptom expression. Although our results may reflect sex-bias in diagnostic criteria, they are consistent with recent views suggesting that narcissistic personality disorder may be underpinned by shared and sex-specific mechanisms.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
| | - Hugo Peyre
- Assistance Publique Hôpitaux de Paris (APHP), Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Pierre Lavaud
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, ML, USA
| | - Christophe Guerin-Langlois
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Margaux René
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France
| | - Jean-Pierre Schuster
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Cédric Lemogne
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Richard Delorme
- Assistance Publique Hôpitaux de Paris (APHP), Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
| | - Frédéric Limosin
- Assistance Publique Hôpitaux de Paris (APHP), Western Paris University Hospitals, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Differences in symptom expression between unipolar and bipolar spectrum depression: Results from a nationally representative sample using item response theory (IRT). J Affect Disord 2016; 204:24-31. [PMID: 27318596 PMCID: PMC6447294 DOI: 10.1016/j.jad.2016.06.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The inclusion of subsyndromal forms of bipolarity in the fifth edition of the DSM has major implications for the way in which we approach the diagnosis of individuals with depressive symptoms. The aim of the present study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression severity, there are differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) between subjects with and without a lifetime history of manic symptoms. METHODS We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS The items sadness, appetite disturbance and psychomotor symptoms were better indicators of depression severity in participants without a lifetime history of manic symptoms, in a clinically meaningful way. DSM-IV symptoms of MDE were substantially less informative in participants with a lifetime history of manic symptoms than in those without such history. LIMITATIONS Clinical information on DSM-IV depressive and manic symptoms was based on retrospective self-report CONCLUSIONS The clinical presentation of depressive symptoms may substantially differ in individuals with and without a lifetime history of manic symptoms. These findings alert to the possibility of atypical symptomatic presentations among individuals with co-occurring symptoms or disorders and highlight the importance of continued research into specific pathophysiology differentiating unipolar and bipolar depression.
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Sex differences in DSM-IV posttraumatic stress disorder symptoms expression using item response theory: A population-based study. J Affect Disord 2015; 187:211-7. [PMID: 26342916 PMCID: PMC4587310 DOI: 10.1016/j.jad.2015.07.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Whether there are systematic sex differences in posttraumatic stress disorder (PTSD) symptom expression remains debated. Using methods based on item response theory (IRT), we aimed at examining differences in the likelihood of reporting DSM-IV symptoms of PTSD between women and men, while stratifying for major trauma type and equating for PTSD severity. METHOD We compared data from women and men in a large nationally representative adult sample, the National Epidemiologic Survey on Alcohol and Related Conditions. Analyses were conducted in the full population sample of individuals who met the DSM-IV criterion A (n=23,860) and in subsamples according to trauma types. RESULTS The clinical presentation of the 17 DSM-IV PTSD symptoms in the general population did not substantially differ in women and men in the full population and by trauma type after equating for levels of PTSD severity. The only exception was the symptom "foreshortened future", which was more likely endorsed by men at equivalent levels of PTSD severity. LIMITATIONS The retrospective nature of the assessment of PTSD symptoms could have led to recall bias. Our sample size was too small to draw conclusions among individuals who experienced war-related traumas. CONCLUSIONS Our findings suggest that the clinical presentation of PTSD does not differ substantially between women and men. We also provide additional psychometric support to the exclusion of the symptom "foreshortened future" from the diagnostic criteria for PTSD in the DSM-5.
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Shmulewitz D, Greene ER, Hasin D. Commonalities and Differences Across Substance Use Disorders: Phenomenological and Epidemiological Aspects. Alcohol Clin Exp Res 2015; 39:1878-900. [PMID: 26332166 DOI: 10.1111/acer.12838] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/07/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although psychoactive substances vary in many ways, they have important commonalties, particularly in their ability to lead to an addiction syndrome. The field lacks an updated review of the commonalities and differences in the phenomenology of alcohol, cannabis, tobacco, stimulants, opioids, hallucinogens, sedatives/tranquilizers, and inhalants and their related substance use disorders (SUDs). METHODS DSM-IV and DSM-5 SUD diagnostic criteria were reviewed, as was evidence from recent epidemiological and clinical research: psychometric studies (test-retest reliability, latent trait analysis); physiological indicators (tolerance, withdrawal); prevalence and age of onset. Information was incorporated from previous reviews, PubMed and Scopus literature searches, and data from large U.S. national surveys. RESULTS Empirical evidence in the form of test-retest reliability and unidimensionality supports use of the same DSM-IV dependence or DSM-5 SUD diagnostic criteria across substances. For most substances, the criteria sets were generally most informative in general population samples at moderate-to-severe levels of SUD. Across substances, 2 criteria (tolerance and use in hazardous situations) were identified as functioning differently in population subgroups. Since substances have different pharmacological effects, withdrawal is assessed using substance-specific symptoms, while tolerance is not; issues remain with the assessment of tolerance. Alcohol, tobacco, and cannabis were consistently identified as the substances with earliest onset of use, highest prevalence of lifetime use, and highest prevalence of lifetime disorder. CONCLUSIONS Despite differences between psychoactive substances, the generic DSM criteria set appears equally applicable across substances. Additional studies of tolerance and hazardous use will be useful for future nosologies. Alcohol, cannabis, and tobacco are the substances with the greatest public health impact due to the high prevalence and early onset of their use, and the potential all 3 substances have to lead to addiction.
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Affiliation(s)
- Dvora Shmulewitz
- Department of Psychiatry, Columbia University, New York City, New York.,New York State Psychiatric Institute, New York City, New York
| | - Emily R Greene
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
| | - Deborah Hasin
- Department of Psychiatry, Columbia University, New York City, New York.,New York State Psychiatric Institute, New York City, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
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Hoertel N, López S, Peyre H, Wall MM, González-Pinto A, Limosin F, Blanco C. Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT). Depress Anxiety 2015; 32:129-40. [PMID: 25424539 PMCID: PMC4314431 DOI: 10.1002/da.22334] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Whether there are systematic differences in depression symptom expression during pregnancy, the postpartum period and outside these periods (i.e., outside the peripartum period) remains debated. The aim of this study was to use methods based on item response theory (IRT) to examine, after equating for depression severity, differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) in women of childbearing age (i.e., aged 18-50) during pregnancy, the postpartum period and outside the peripartum period. METHODS We conducted these analyses using a large, nationally representative sample of women of childbearing age from the United States (n = 11,256) who participated in the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS The overall 12-month prevalence of all depressive criteria (except for worthlessness/guilt) was significantly lower in pregnant women than in women of childbearing age outside the peripartum period, whereas the prevalence of all symptoms (except for "psychomotor symptoms") was not significantly different between the postpartum and the nonperipartum group. There were no clinically significant differences in the endorsement rates of symptoms of MDE by pregnancy status when equating for levels of depression severity. CONCLUSIONS This study suggests that the clinical presentation of depressive symptoms in women of childbearing age does not differ during pregnancy, the postpartum period and outside the peripartum period. These findings do not provide psychometric support for the inclusion of the peripartum onset specifier for major depressive disorder in the DSM-5.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA., Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France., INSERM UMR 894, Psychiatry and Neurosciences Center; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Saioa López
- Hospital Universitario de Alava (Santiago). Biomedical Research Centre in Mental Health Net (CIBERSAM). Department of Psychiatry. Vitoria, Spain
| | - Hugo Peyre
- Assistance Publique Hôpitaux de Paris (APHP), Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France. 6. Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, CNRS, EHESS, Paris, France
| | - Melanie M. Wall
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA., Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - Ana González-Pinto
- Hospital Universitario de Alava (Santiago). Biomedical Research Centre in Mental Health Net (CIBERSAM). Department of Psychiatry. Vitoria, Spain
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France., INSERM UMR 894, Psychiatry and Neurosciences Center; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA
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Hoertel N, Peyre H, Wall MM, Limosin F, Blanco C. Examining sex differences in DSM-IV borderline personality disorder symptom expression using Item Response Theory (IRT). J Psychiatr Res 2014; 59:213-9. [PMID: 25258339 DOI: 10.1016/j.jpsychires.2014.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/20/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
Limited literature suggests that there may be differences in how women and men experience borderline personality disorder (BPD) symptoms. The aim of the current study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of BPD symptom severity, there are sex differences in the likelihood of reporting DSM-IV BPD symptoms. We conducted these analyses using a large, nationally representative sample from the USA (n = 34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Data from women and men were compared. There were statistically and clinically significant sex differences for 3 out of the 9 DSM-IV BPD symptoms. We found that women were more likely to experience suicidal/self-mutilation behavior, affective instability and chronic feelings of emptiness and tended to be less likely to endorse impulsivity at lower levels of borderline personality disorder severity than men, while affective instability and chronic feelings of emptiness appeared to be significantly less discriminant in terms of severity in men than in women. There were no significant differences between women and men on the remaining DSM-IV symptoms. Overall, our findings indicate substantial sex differences in borderline personality disorder symptom expression. Although our results may reflect sex-bias in diagnostic criteria, they are in keeping with recent arguments suggesting that BPD could be understood as a clinical phenomenon that may partially differ in men and women.
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Affiliation(s)
- Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute/ Columbia University, New York, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
| | - Hugo Peyre
- Assistance Publique Hôpitaux de Paris (APHP), Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, CNRS, EHESS, Paris, France
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute/ Columbia University, New York, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute/ Columbia University, New York, USA
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Mathew AR, Wahlquist AE, Garrett-Mayer E, Gray KM, Saladin ME, Carpenter MJ. Affective motives for smoking among early stage smokers. Nicotine Tob Res 2014; 16:1387-93. [PMID: 24924155 PMCID: PMC4207875 DOI: 10.1093/ntr/ntu093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/05/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND As most smokers initiate smoking during adolescence, assessment of smoking motives that underlie trajectories of dependence is critical for both prevention and cessation efforts. In the current study, we expected participants with higher nicotine dependence would smoke (a) less for positive reinforcement (PR) and (b) more for negative reinforcement (NR) motives. We secondarily assessed the relative contribution of PR to NR motives across levels of dependence. METHODS Data were drawn from a study on cue-elicited craving among occasional versus daily adolescent smokers aged 16-20 years (N = 111). Smoking motives were assessed in relation to 3 commonly used measures of nicotine dependence: (a) Fagerström Test for Nicotine Dependence (FTND), (b) Autonomy over Smoking Scale (AUTOS), and (c) Nicotine Dependence Syndrome Scale (NDSS). RESULTS Compared to occasional smokers, daily smokers had significantly higher scores on each dependence measure and endorsed more prominent NR smoking motives. Each measure of nicotine dependence was strongly associated with NR motives for smoking, although measures differed in their association with PR motives. As expected, the FTND, AUTOS, and NDSS each significantly predicted smoking motive difference score (PR - NR), such that higher dependence was associated with more prominent NR motives for smoking. CONCLUSIONS Results are consistent with our understanding of dependence and provide further support for 3 common measures of nicotine dependence among early stage smokers.
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Affiliation(s)
- Amanda R Mathew
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC;
| | - Amy E Wahlquist
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Michael E Saladin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Clark MA, Rogers ML, Boergers J, Kahler CW, Ramsey S, Saadeh FM, Abrams DB, Buka SL, Niaura R, Colby SM. A transdisciplinary approach to protocol development for tobacco control research: a case study. Transl Behav Med 2013; 2:431-40. [PMID: 24073144 DOI: 10.1007/s13142-012-0164-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The increasing complexity of scientific problems related to lifestyle risk factors has prompted substantial investments in transdisciplinary or team science initiatives at the biological, psychosocial, and population levels of analysis. To date, the actual process of conducting team science from the perspectives of investigators engaged in it has not been well documented. We describe the experience of developing and implementing data collection protocols using the principles of transdisciplinary science. The New England Family Study Transdisciplinary Tobacco Use Research Center was a 10-year collaboration involving more than 85 investigators and consultants from more than 20 disciplines as well as more than 50 research staff. We used a two-phase process in which all the study personnel participated in the developing and testing of 160 instruments. These instruments were used in 4,378 assessments with 3,501 participants. With substantial effort, it is possible to build a team of scientists from diverse backgrounds that can develop a set of instruments using a shared conceptual approach, despite limited or no experience working together previously.
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Affiliation(s)
- Melissa A Clark
- Department of Epidemiology, Program in Public Health, Brown University, Providence, RI USA ; Center for Population Health and Clinical Epidemiology, Program in Public Health, Brown University, 121S. Main Street, 6th Floor, Providence, RI 02912 USA
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Hasin DS, O’Brien CP, Auriacombe M, Borges G, Bucholz K, Budney A, Compton WM, Crowley T, Ling W, Petry NM, Schuckit M, Grant BF. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry 2013; 170:834-51. [PMID: 23903334 PMCID: PMC3767415 DOI: 10.1176/appi.ajp.2013.12060782] [Citation(s) in RCA: 802] [Impact Index Per Article: 72.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available.
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12
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Rose JS, Dierker LC, Hedeker D, Mermelstein R. An integrated data analysis approach to investigating measurement equivalence of DSM nicotine dependence symptoms. Drug Alcohol Depend 2013; 129:25-32. [PMID: 23021772 PMCID: PMC3567239 DOI: 10.1016/j.drugalcdep.2012.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Research identifying nicotine dependence (ND) symptoms most appropriate for measurement of adolescent ND and invariant across the range of smoking exposure is hampered by limited sample size and variability of smoking behavior within independent studies. Integrative data analysis, the process of pooling and analyzing data from multiple studies, produces larger and more heterogeneous samples with which to evaluate measurement equivalence across the full continuum of smoking quantity and frequency. METHODS Data from two studies were pooled to obtain a large sample of adolescent and young adult smokers with considerable variability in smoking. We used moderated nonlinear factor analysis, which produces study equivalent ND scores, to simultaneously evaluate whether 14 DSM ND symptoms had equivalent psychometric properties (1) at different levels of smoking frequency and (2) across a continuous range of smoking quantity, after accounting for study differences. RESULTS Nine of 14 symptoms were equivalent across levels of smoking frequency and quantity in probability of endorsement at different levels of ND and in ability to discriminate between levels of ND severity. A more precise ND factor score accounted for study and smoking related differences in symptom psychometric properties. CONCLUSIONS DSM-IV symptoms may be used to reliably assess ND in young populations across a wide range of smoking quantity and frequency and within both nationally representative and geographically restricted samples with different study designs. Symptoms shared across studies produced an equivalently scaled ND factor score, demonstrating that integrating data for the purpose of studying ND in young smokers is viable.
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Affiliation(s)
- Jennifer S. Rose
- Psychology Department, Wesleyan University, Middletown, CT 06459
| | - Lisa C. Dierker
- Psychology Department, Wesleyan University, Middletown, CT 06459
| | - Donald Hedeker
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608
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Duncan AE, Lessov-Schlaggar CN, Sartor CE, Bucholz KK. Differences in time to onset of smoking and nicotine dependence by race/ethnicity in a Midwestern sample of adolescents and young adults from a high risk family study. Drug Alcohol Depend 2012; 125:140-5. [PMID: 22564873 PMCID: PMC3700542 DOI: 10.1016/j.drugalcdep.2012.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether race/ethnicity was associated with time to smoking initiation and time from first cigarette to onset of DSM-IV nicotine dependence (ND) after adjusting for familial and individual psychosocial risk factors. METHODS Cox proportional hazards models with time-dependent covariates were used to analyze data from 1376 offspring aged 12-33 years from 532 families at high risk for substance use problems due to paternal alcohol problems and 235 low risk families. Fifty-six percent of the sample self-identified as African-American (AA) and 44% were mainly of European descent. RESULTS Controlling for covariates, AAs began smoking at older ages (HR=0.58; 95% CI: 0.48-0.70) and had longer times between smoking initiation and onset of ND compared to non-AAs (HR=0.25, 95% CI: 0.16-0.39 for ND onset occurring <18 years and HR=0.49, 95% CI: 0.30-0.80 for ND onsets ≥ age 18). After additionally controlling for number of cigarettes smoked daily, the racial/ethnic effects for onset of ND were attenuated, but remained statistically significant for ND onset <18 (HR=0.34, 95% CI: 0.19-0.61); however, the estimate was no longer significant for later ND onset (HR=0.84, 95% CI: 0.50-1.41). CONCLUSIONS AA adolescents and young adults initiate smoking at older ages and have longer transition periods between initiation and onset of ND compared to non-AAs, even after controlling for many relevant psychiatric and psychosocial covariates; however, racial/ethnic differences in time to onset of nicotine dependence in late adolescence and young adulthood may be explained by differences in daily quantity smoked.
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Affiliation(s)
- Alexis E. Duncan
- The Brown School, Washington University, St. Louis, MO 63130,Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110,Correspondence to: Alexis E. Duncan, Ph.D., The Brown School, Washington University in St. Louis, One Brookings Drive, Box 1196, St. Louis, MO 63130, USA, 314-935-6758 (phone), 314-935-6758 (fax);
| | | | - Carolyn E. Sartor
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06516
| | - Kathleen K. Bucholz
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
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Agrawal A, Verweij KJH, Gillespie NA, Heath AC, Lessov-Schlaggar CN, Martin NG, Nelson EC, Slutske WS, Whitfield JB, Lynskey MT. The genetics of addiction-a translational perspective. Transl Psychiatry 2012; 2:e140. [PMID: 22806211 PMCID: PMC3410620 DOI: 10.1038/tp.2012.54] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 05/30/2012] [Indexed: 12/16/2022] Open
Abstract
Addictions are serious and common psychiatric disorders, and are among the leading contributors to preventable death. This selective review outlines and highlights the need for a multi-method translational approach to genetic studies of these important conditions, including both licit (alcohol, nicotine) and illicit (cannabis, cocaine, opiates) drug addictions and the behavioral addiction of disordered gambling. First, we review existing knowledge from twin studies that indicates both the substantial heritability of substance-specific addictions and the genetic overlap across addiction to different substances. Next, we discuss the limited number of candidate genes which have shown consistent replication, and the implications of emerging genomewide association findings for the genetic architecture of addictions. Finally, we review the utility of extensions to existing methods such as novel phenotyping, including the use of endophenotypes, biomarkers and neuroimaging outcomes; emerging methods for identifying alternative sources of genetic variation and accompanying statistical methodologies to interpret them; the role of gene-environment interplay; and importantly, the potential role of genetic variation in suggesting new alternatives for treatment of addictions.
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Affiliation(s)
- A Agrawal
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO 63110, USA.
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15
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Chung T, Martin CS, Maisto SA, Cornelius JR, Clark DB. Greater prevalence of proposed DSM-5 nicotine use disorder compared to DSM-IV nicotine dependence in treated adolescents and young adults. Addiction 2012; 107:810-8. [PMID: 22092543 PMCID: PMC3290741 DOI: 10.1111/j.1360-0443.2011.03722.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Compared to DSM-IV nicotine dependence, proposed DSM-5 nicotine use disorder (NUD) would lower the threshold from three to two symptoms, and increase the number of criteria used for diagnosis from seven to 11. The impact of the proposed changes on nicotine disorder prevalence and the concurrent validity of diagnostic criteria were examined. DESIGN Cross-sectional survey to compare DSM-IV and proposed DSM-5 algorithms. SETTING AND PARTICIPANTS Adolescent (n = 179) and young adult (n = 292) past-year cigarette users recruited from addictions treatment. MEASUREMENTS Semi-structured clinical interview to evaluate DSM-IV nicotine dependence, and 10 of the 11 proposed DSM-5 NUD criteria; 30-day time-line follow-back; and the Fagerström Test for Nicotine Dependence (FTND). FINDINGS Prevalence of proposed DSM-5 NUD (two-symptom threshold) was much higher (adolescents: 68.7%, young adults: 86.0%) than DSM-IV nicotine dependence (33.0% and 59.6%, respectively), although prevalence of DSM-5 severe NUD (four-symptom threshold) was similar to DSM-IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM-5 severe NUD diagnosis (four symptoms) but not for the moderate NUD (two symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new craving item, but not for the proposed interpersonal problems and hazardous use items. CONCLUSIONS The proposed DSM-5 nicotine use disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity.
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Affiliation(s)
- Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA, USA.
| | - Christopher S. Martin
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | | | - Jack R. Cornelius
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Duncan B. Clark
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
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16
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Baker TB, Breslau N, Covey L, Shiffman S. DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5. Addiction 2012; 107:263-75. [PMID: 21919989 PMCID: PMC3246568 DOI: 10.1111/j.1360-0443.2011.03657.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This paper aims to identify appropriate criteria for tobacco dependence assessment, evaluate relevant research and suggest revisions that may be incorporated into DSM-5. METHODS Desirable conceptual and psychometric features of tobacco dependence assessments were identified, including the types of outcomes against which such assessment should be validated. DSM-IV criteria were matched against these criteria and compared with other dependence measures. RESULTS DSM-IV criteria were found to be ambiguous, little used in tobacco research, and have relatively low predictive validity. Other dependence measures were found to have greater validity in the prediction of important dependence features such as relapse likelihood. Strength of urges to smoke on typical smoking days and during abstinence, markers of nicotine intake or frequency of smoking and latency to smoke soon after waking were found to be useful dependence measures. CONCLUSION The use and utility of DSM-5 will be enhanced by eliminating most DSM-IV criteria and adding new ones based on smoking pattern, smoking heaviness, and the severity of craving during periods of smoking and withdrawal.
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Affiliation(s)
- Timothy B. Baker
- Department of Medicine, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
| | - Naomi Breslau
- Department of Epidemiology, Michigan State University
| | - Lirio Covey
- Professor of Clinical Psychology in Psychiatry, Columbia University Medical Center, Research Scientist, New York State Psychiatric Institute
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17
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Difranza JR, Wellman RJ, Savageau JA. Does progression through the stages of physical addiction indicate increasing overall addiction to tobacco? Psychopharmacology (Berl) 2012; 219:815-22. [PMID: 21779781 DOI: 10.1007/s00213-011-2411-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 07/01/2011] [Indexed: 11/27/2022]
Abstract
RATIONALE With physical addiction to tobacco, abstinence triggers a desire to smoke. As physical addiction advances, the desire to smoke changes in quality and intensity from wanting, to craving, to needing. A prior study in adolescents suggested that this progression signifies increasing addiction. OBJECTIVE We sought to determine if the sequential appearance of wanting, craving and needing provides an indication of the intensity of other markers of tobacco addiction including psychological and behavioral indicators. METHODS A web-based survey was completed by 422 smokers ages 18-78 years. Subjects were assigned to one of four qualitatively distinct stages of physical addiction based on their most advanced symptom: 1-none, 2-wanting, 3-craving, or 4-needing. Using linear Chi square and ANOVA, we determined if higher stages were associated with higher levels of tobacco addiction on more than a dozen measures. RESULTS 16.8% of subjects were in stage 1, 26.1% in stage 2, 17.1% in stage 3 and 40.0% in stage 4. Each step up in stage was associated with higher levels of addiction as measured by the Fagerström Test for Nicotine Dependence, the Hooked on Nicotine Checklist, the Autonomy over Tobacco Scale, and higher levels of psychological dependence, duration of tobacco use, frequency of tobacco use, daily cigarette consumption, and 10 additional measures. CONCLUSIONS In this cross-sectional study, each sequential stage of physical addiction was associated with higher levels of every indicator of addiction. The data suggest that the stages of progression of physical addiction provide a global indication of the severity of tobacco addiction.
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Affiliation(s)
- Joseph R Difranza
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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18
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Strong DR, Schonbrun YC, Schaffran C, Griesler PC, Kandel D. Linking measures of adult nicotine dependence to a common latent continuum and a comparison with adolescent patterns. Drug Alcohol Depend 2012; 120:88-98. [PMID: 21855236 PMCID: PMC3540800 DOI: 10.1016/j.drugalcdep.2011.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 05/20/2011] [Accepted: 07/03/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND An ongoing debate regarding the nature of nicotine dependence (ND) is whether the same instrument can be applied to measure ND among adults and adolescents. Using a hierarchical item response model (IRM), we examined evidence for a common continuum underlying ND symptoms among adults and adolescents. METHOD The analyses are based on two waves of interviews with subsamples of parents and adolescents from a multi-ethnic longitudinal cohort of one thousand and thirty-nine 6-10th graders from the Chicago Public Schools (CPS). Adults and adolescents who reported smoking cigarettes the last 30 days prior to waves 3 and 5 completed three common instruments measuring ND symptoms and one item measuring loss of autonomy. RESULTS A stable continuum of ND, first identified among adolescents, was replicated among adults. However, some symptoms, such as tolerance and withdrawal, differed markedly across adults and adolescents. The majority of mFTQ items were observed within the highest levels of ND, the NDSS items within the lowest levels, and the DSM-IV items were arrayed in the middle and upper third of the continuum of dependence severity. Loss of autonomy was positioned at the lower end of the continuum. We propose a ten-symptom measure of ND for adolescents and adults. CONCLUSIONS Despite marked differences in the relative severity of specific ND symptoms in each group, common instrumentation of ND can apply to adults and adolescents. The results increase confidence in the ability to describe phenotypic heterogeneity in ND across important developmental periods.
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Affiliation(s)
- David R Strong
- Brown University, Butler Hospital, Providence, RI 2906, United States. david
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19
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Shmulewitz D, Keyes KM, Wall MM, Aharonovich E, Aivadyan C, Greenstein E, Spivak B, Weizman A, Frisch A, Grant BF, Hasin D. Nicotine dependence, abuse and craving: dimensionality in an Israeli sample. Addiction 2011; 106:1675-86. [PMID: 21545668 PMCID: PMC3163441 DOI: 10.1111/j.1360-0443.2011.03484.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS Evidence-based changes planned for Diagnostic and Statistical Manual 5th edition (DSM-5) substance use disorders (SUDs) include combining dependence and three of the abuse criteria into one disorder and adding a criterion indicating craving. Because DSM-IV did not include a category for nicotine abuse, little empirical support is available for aligning the nicotine use disorder criteria with the DSM-5 criteria for other SUDs. DESIGN Latent variable analyses, bootstrap tests and likelihood ratio tests were used to explore the unidimensionality, psychometric properties and information of the nicotine criteria. SETTING AND PARTICIPANTS A sample of household residents selected from the Israeli population register yielded 727 life-time cigarette smokers. MEASUREMENTS DSM-IV nicotine dependence criteria and proposed abuse and craving criteria, assessed with a structured interview. FINDINGS Three abuse criteria (hazardous use, social/interpersonal problems and neglect roles) were prevalent among smokers, formed a unidimensional latent trait with nicotine dependence criteria, were intermixed with dependence criteria across the severity spectrum and significantly increased the diagnostic information over the dependence-only model. A craving criterion was shown to fit well with the other criteria. CONCLUSION Similar to findings from research on other substances, nicotine dependence, abuse and craving criteria appear to derive from a common underlying dimension. The results support alignment of nicotine criteria with those for alcohol and drug use disorders in Diagnostic and Statistical Manual 5th edition.
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20
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Dierker LC, Rose JS, Donny E, Tiffany S. Alcohol use as a signal for sensitivity to nicotine dependence among recent onset smokers. Addict Behav 2011; 36:421-6. [PMID: 21232875 DOI: 10.1016/j.addbeh.2010.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/18/2010] [Accepted: 12/02/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study evaluated the association between alcohol use, abuse and dependence and cigarette smoking to determine whether alcohol may signal greater sensitivity to nicotine dependence at very low levels of smoking. METHOD Data were drawn from five annual National Surveys on Drug Use and Health and included individuals age 12 to 21 who reported first exposure to smoking within the past two years and smoking at least once in the past month. RESULTS Both alcohol abuse and alcohol dependence were associated with increased likelihood of symptoms that seem to tap tolerance for nicotine. These included items such as "the amount you smoke has increased"; "needing to smoke a lot more now in order to be satisfied"; and "smoking much more before starting to feel anything". Alcohol dependence, but not abuse was associated with the remaining symptoms, "after not smoking for a while, needing to smoke to feel less restless and irritable"; "craving cigarettes after not smoking for a while"; and "worrying about running out of cigarettes". All associations were not better accounted for by either alcohol use or amount smoked. CONCLUSION If causally associated, treatment of alcohol-use disorders may prevent or reduce the early emergence of nicotine dependence symptoms among new smokers, very early in the smoking uptake process. If instead alcohol disorders are a signal of sensitivity for nicotine dependence best accounted for by a third variable, then adolescents with alcohol dependence and/or abuse during early exposures to smoking represents an important subgroup that may benefit from interventions directly targeting this association.
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Affiliation(s)
- Lisa C Dierker
- Department of Psychology, Wesleyan University, Middletown, CT 06459, USA.
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21
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DiFranza JR, Ursprung WWS, Contreras GA. Assessment of Tobacco Addiction in Adolescents. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2011. [DOI: 10.2753/imh0020-7411400104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Joseph R. DiFranza
- a Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
| | - W. W. Sanouri Ursprung
- a Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
| | - Gisèle A. Contreras
- b Department of Social and Preventive Medicine, University of Montreal, Montreal
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Conway KP, Levy J, Vanyukov M, Chandler R, Rutter J, Swan GE, Neale M. Measuring addiction propensity and severity: the need for a new instrument. Drug Alcohol Depend 2010; 111:4-12. [PMID: 20462706 PMCID: PMC2930133 DOI: 10.1016/j.drugalcdep.2010.03.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 03/01/2010] [Accepted: 03/02/2010] [Indexed: 11/17/2022]
Abstract
Drug addiction research requires but lacks a valid and reliable way to measure both the risk (propensity) to develop addiction and the severity of manifest addiction. This paper argues for a new measurement approach and instrument to quantify propensity to and severity of addiction, based on the testable assumption that these constructs can be mapped onto the same dimension of liability to addiction. The case for this new direction becomes clear from a critical review of empirical data and the current instrumentation. The many assessment instruments in use today have proven utility, reliability, and validity, but they are of limited use for evaluating individual differences in propensity and severity. The conceptual and methodological shortcomings of instruments currently used in research and clinical practice can be overcome through the use of new technologies to develop a reliable, valid, and standardized assessment instrument(s) to measure and distinguish individual variations in expression of the underlying latent trait(s) that comprises propensity to and severity of drug addiction. Such instrumentation would enhance our capacity for drug addiction research on linkages and interactions among familial, genetic, psychosocial, and neurobiological factors associated with variations in propensity and severity. It would lead to new opportunities in substance abuse prevention, treatment, and services research, as well as in interventions and implementation science for drug addiction.
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Affiliation(s)
- Kevin P Conway
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-9589, USA.
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Shmulewitz D, Keyes K, Beseler C, Aharonovich E, Aivadyan C, Spivak B, Hasin D. The dimensionality of alcohol use disorders: results from Israel. Drug Alcohol Depend 2010; 111:146-54. [PMID: 20537809 PMCID: PMC3884677 DOI: 10.1016/j.drugalcdep.2010.04.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/19/2010] [Accepted: 04/21/2010] [Indexed: 01/07/2023]
Abstract
AIMS To prepare for DSM-V, the structure of DSM-IV alcohol dependence and abuse criteria and a proposed additional criterion, at-risk drinking, require study in countries with low per-capita consumption, and comparison of current and lifetime results within the same sample. We investigated DSM-IV Alcohol Use Disorder (AUD) criteria in Israel, where per-capita alcohol consumption is low. METHODS Household residents selected from the Israeli population register (N=1338) were interviewed with the AUDADIS. Item response theory analyses were conducted using MPlus, and diagnostic thresholds were examined with the kappa statistic. RESULTS Dependence and abuse criteria fit a unidimensional model interspersed across the severity continuum, for both current and lifetime timeframes. Legal problems were rare and did not improve model fit. Weekly at-risk drinking reflected greater severity than in U.S. samples. When dependence and abuse criteria were combined, a diagnostic threshold of > or =3 criteria produced the best agreement with DSM-IV diagnoses (kappa>0.80). CONCLUSION Consistent with other studies, alcohol dependence and abuse criteria reflected a latent variable representing a single AUD. Results suggested little effect in removing legal problems and little gained by adding weekly at-risk drinking. Results contribute to knowledge about AUD criteria by examining them in a low-consumption country.
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Affiliation(s)
- Dvora Shmulewitz
- New York State Psychiatric Institute, New York, New York 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
| | - Katherine Keyes
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | - Cheryl Beseler
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA,Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE 68198, USA,Department of Environmental, Agricultural and Occupational Health Sciences, Omaha, NE 68198, USA
| | - Efrat Aharonovich
- New York State Psychiatric Institute, New York, New York 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
| | | | - Baruch Spivak
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 69978
| | - Deborah Hasin
- New York State Psychiatric Institute, New York, New York 10032, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
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Rose JS, Dierker LC. An item response theory analysis of nicotine dependence symptoms in recent onset adolescent smokers. Drug Alcohol Depend 2010; 110:70-9. [PMID: 20236773 PMCID: PMC2931274 DOI: 10.1016/j.drugalcdep.2010.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 01/25/2010] [Accepted: 02/06/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Given absence of a "gold standard" for measuring self-reported nicotine dependence, particularly among less experienced smokers, there is a need to evaluate existing measures to determine how well symptoms measure the underlying nicotine dependence construct and whether symptoms function differently for less experienced smokers. Study aims were to determine (1) likelihood of endorsement of individual symptoms at different levels of a nicotine dependence construct and the ability of symptoms to discriminate between different levels of this construct and (2) whether these symptom properties varied between nondaily and daily smokers. METHODS We used multiple group item response theory analysis to evaluate nicotine dependence symptoms from the nicotine dependence syndrome scale based on a nationally representative sample of 8081 recent onset adolescent smokers from the national surveys on drug use and health. RESULTS After controlling for age, gender, smoking quantity and length of smoking exposure, symptoms assessing tolerance were invariant across nondaily and daily smokers, and discriminated well between levels of the nicotine dependence construct. However, the majority of symptoms functioned differently for nondaily and daily smokers. These symptoms did not discriminate as well between levels of the nicotine dependence construct and were more likely to be endorsed at lower levels of this construct for daily smokers. DISCUSSION A measure that encompasses a range of symptoms tapping different aspects of smoking may be ideally suited for nondaily adolescent smokers, while an ideal measure of nicotine dependence for daily smokers might also include more core diagnostic features of nicotine dependence such as withdrawal and tolerance.
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Affiliation(s)
- Jennifer S Rose
- Department of Psychology, Wesleyan University, 237 High St., Middletown, CT 06459, USA.
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Strong DR, Cameron A, Feuer S, Cohn A, Abrantes AM, Brown RA. Single versus recurrent depression history: differentiating risk factors among current US smokers. Drug Alcohol Depend 2010; 109:90-5. [PMID: 20074868 PMCID: PMC2890270 DOI: 10.1016/j.drugalcdep.2009.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 12/03/2009] [Accepted: 12/04/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The strong relationship between persistent tobacco use and Major Depressive Disorder (MDD) has motivated clinical trials of specialized treatments targeting smokers with a history of MDD. Meta-analyses suggest positive responses to specialized treatments have been observed consistently among smokers with history of recurrent rather than a single episode of MDD. Approximately 15% of current US smokers have a history of recurrent MDD. Little is known about the risk factors that contribute to persistent smoking and differentiate these at-risk smokers, US. METHODS The National Comorbidity Survey - Replication (NCS-R) included a survey of 1560 smokers participants aged 18 and older in the United States. Lifetime history of MDD was categorized according to chronicity: no history (No MDD), single episode (MDD-S) and recurrent depression (MDD-R). The relationship between the chronicity of MDD, smoking characteristics, cessation history, nicotine dependence, comorbidity with psychiatric disorders, and current functional impairments were examined. RESULTS MDD-R smokers reported fewer lifetime cessation efforts, smoked more cigarettes, had higher levels of nicotine dependence, had higher rates of comorbid psychiatric disorders and greater functional impairment than smokers with No MDD. MDD-S smokers were not consistently distinguished from No MDD smokers on cessation attempts, level of daily smoking, nicotine dependence or functional impairment indices. CONCLUSIONS The study highlights the importance of chronicity when characterizing depression-related risk of persistent smoking behavior. Although, clinical trials suggest MDD-R smokers specifically benefit from specialized behavioral treatments, these services are not widely available and more efforts are needed to engage MDD-R smokers in efficacious treatments.
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Affiliation(s)
- David R. Strong
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
| | - Amy Cameron
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA 01610 USA
| | - Shelley Feuer
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
| | - Amy Cohn
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, 607 Allison Road, Piscataway, New Jersey 08854 USA
| | - Ana M. Abrantes
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
| | - Richard A. Brown
- Butler Hospital, The Warren Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI, 02906 USA
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Saha TD, Compton WM, Pulay AJ, Stinson FS, Ruan WJ, Smith SM, Grant BF. Dimensionality of DSM-IV nicotine dependence in a national sample: an item response theory application. Drug Alcohol Depend 2010; 108:21-8. [PMID: 20045597 PMCID: PMC3321925 DOI: 10.1016/j.drugalcdep.2009.11.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/03/2009] [Accepted: 11/06/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Research focusing on the development of a dimensional representation of DSM-IV nicotine dependence is scarce and prior research has not assessed the role of nicotine use criteria in that a dimensional representation, nor the invariance of the DSM-IV nicotine dependence criteria across important population subgroups. METHODS Using a large, representative sample of the U.S. population, this study utilized item response theory (IRT) analyses to explore the dimensionality of DSM-IV nicotine dependence criteria and several candidate criteria for cigarette use among past-year cigarette smokers (n=10,163). RESULTS Factor analyses demonstrated the unidimensionality of nicotine dependence criteria and IRT analyses demonstrated good fit of the observed responses and the underlying, unobserved latent trait of dependence severity. The model containing all seven DSM-IV dependence criteria, along with the consumption criterion of smoking at least a quarter of a pack of cigarettes in a day in the past year, was identified as the best-fitting model. No differential criterion functioning was shown across sex, race-ethnicity, and age subgroups. DISCUSSION Major implications of this study are discussed in terms of the addition of a dimensional representation of nicotine dependence to pre-existing categorical representations of the disorder in the DSM-V, and the need for a nicotine consumption criterion to improve representations of nicotine dependence severity.
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Affiliation(s)
- Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA
| | - Wilson M. Compton
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., M.S. 9589, Bethesda, MD 20892-9589, USA
| | - Attila J. Pulay
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA
| | - Frederick S. Stinson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA
- Corresponding author at: Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Room 3077, 5635 Fishers Lane, M.S. 9304, Rockville, MD 20852-9304, USA. Tel.: +1 301 443 3306; fax: +1 301 443 1400. (B.F. Grant)
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Rose JS, Dierker LC. DSM-IV nicotine dependence symptom characteristics for recent-onset smokers. Nicotine Tob Res 2010; 12:278-86. [PMID: 20061343 PMCID: PMC2825105 DOI: 10.1093/ntr/ntp210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 12/10/2009] [Indexed: 11/14/2022]
Abstract
INTRODUCTION This study evaluated how well DSM-IV nicotine dependence symptoms measure an underlying dependence construct for recent-onset daily and nondaily smokers. METHODS Based on a nationally representative sample of 2,758 recent-onset adolescent smokers from the National Surveys on Drug Use and Health, we used multiple group item response theory analysis to assess 7 symptoms representing DSM-IV diagnostic features of nicotine dependence. RESULTS After controlling for age, gender, current smoking quantity, and length of smoking exposure, all 7 DSM-IV symptoms were invariant across nondaily and daily smokers and discriminated well among levels of the nicotine dependence construct. Symptoms most likely to be endorsed at lower levels of the dependence construct included spending more time getting, using, or getting over the effects of smoking and wanting or trying to stop or cut down. Symptoms most likely to be endorsed only at higher levels of the construct included giving up important activities and emotional/psychological and health problems related to smoking. DSM-IV symptoms were most precise for moderately high levels of the dependence construct and less precise for lower levels for both nondaily and daily smokers. DISCUSSION DSM-IV nicotine dependence symptoms appear to have desirable psychometric properties for measuring a nicotine dependence construct among recent-onset adolescent smokers at both daily and nondaily levels, providing justification for the use of these symptoms in a measure that aims to evaluate the full continuum of nicotine dependence severity in this population.
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Affiliation(s)
- Jennifer S Rose
- Psychology Department, 207 High Street, Wesleyan University, Middletown, CT 06459, USA.
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McBride O, Strong DR, Kahler CW. Exploring the role of a nicotine quantity-frequency use criterion in the classification of nicotine dependence and the stability of a nicotine dependence continuum over time. Nicotine Tob Res 2010; 12:207-16. [PMID: 20081041 PMCID: PMC2825099 DOI: 10.1093/ntr/ntp196] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 11/20/2009] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study investigated (a) the utility of a cigarette quantity-frequency (QF) use criterion as an indicator for nicotine dependence (ND) and (b) the stability of the ND continuum of severity over time. METHOD Data from individuals who smoked cigarettes in the year prior to both time points of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed (n = 6,185). The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV Version (AUDADIS-IV) assessed for DSM-IV ND and nicotine use. Three QF criteria were created to represent daily consumption of > or = 5 cigarettes, > or = 10 cigarettes, or > or = 20 cigarettes. Confirmatory factor analysis and item response theory analysis were used to explore the latent structure of ND. Differential item functioning (DIF) analysis investigated the stability of the ND continuum over time. RESULTS A one-factor model, representing the DSM-IV conceptualization of ND, was an acceptable fit to the data at both time points. The inclusion of QF criteria decreased the fit of the one-factor model of ND. DIF in the severity and discrimination parameters of the diagnostic criteria was evident across the time points of the survey. DISCUSSION Although QF of cigarette use is related to ND, it appears to be a separate construct. Researchers using the AUDADIS-IV should be aware that the characteristics of the DSM-IV ND criteria do vary slightly across time, even though the changes appear to be relatively small and of minor clinical or practical significance.
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Affiliation(s)
- Orla McBride
- School of Psychology, University of Ulster at Magee Campus, Northland Road, Co. Londonderry BT48 7JL, Northern Ireland.
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Rose JS, Dierker LC, Donny E. Nicotine dependence symptoms among recent onset adolescent smokers. Drug Alcohol Depend 2010; 106:126-32. [PMID: 19765916 PMCID: PMC2815034 DOI: 10.1016/j.drugalcdep.2009.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 07/22/2009] [Accepted: 08/01/2009] [Indexed: 10/20/2022]
Abstract
The present study examined the prevalence of individual nicotine dependence symptoms among recent onset smokers across the continuum of nondaily and daily cigarette smoking behavior in a nationally representative sample of recent onset smokers from the National Surveys on Drug Use and Health (NSDUH). Rates of endorsement for 17 symptoms drawn primarily from the Nicotine Dependence Symptom Scale (Shiffman et al., 2004) were calculated for four levels of nondaily (smoked 1-3, 4-10, 11-20, or 21-29 days in the past 30 days) and daily (smoked 1, 2-5, 6-15, or >15 cigarettes per day in the past 30 days) smoking. Logistic and linear regression analyses with polynomial contrasts controlling for age, gender, length of exposure, and smoking quantity tested trends in symptom endorsement across levels of smoking. Significant linear and quadratic trends indicated that increasing rates of endorsement differed most between the lowest levels of nondaily and daily smoking. Results suggest that, for some, infrequent smoking may not represent benign experimentation. Recognizing early symptoms of nicotine dependence may assist in early identification and intervention of those at risk for heavier smoking in the future. Adolescents can be taught to recognize the early symptoms of nicotine dependence to increase awareness of the rapidity at which these symptoms may appear.
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Affiliation(s)
- Jennifer S Rose
- Wesleyan University, Psychology Department, 207 High Street, Middletown, CT 06459, USA.
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Abstract
AIMS To determine whether there is a sequence in which adolescents experience symptoms of nicotine dependence (ND) as per the DSM-IV. DESIGN A two-stage design was implemented to select a multi-ethnic target sample of adolescents from a school survey of 6th-10th graders from the Chicago Public Schools. The cohort was interviewed at home five times with structured computerized interviews at 6-month intervals over a 2-year period. PARTICIPANTS Subsample of new tobacco users (n = 353) who had started to use tobacco within 12 months prior to wave 1 or between waves 1 and 5. MEASUREMENTS AND STATISTICAL METHODS: Monthly histories of DSM-IV symptoms of ND were obtained. Log-linear quasi-independence models were estimated to identify the fit of different cumulative models of progression among the four most prevalent dependence criteria (tolerance, impaired control, withdrawal, unsuccessful attempts to quit), indexed by specific symptoms, by gender and race/ethnicity. FINDINGS Pathways varied slightly across groups. The proportions who could be classified in a progression pathway not by chance ranged from 50.7% to 68.8%. Overall, tolerance and impaired control appeared first and preceded withdrawal; impaired control preceded attempts to quit. For males, tolerance was experienced first, with withdrawal a minor path of entry; for females withdrawal was experienced last, tolerance and impaired control were experienced first. For African Americans, tolerance by itself was experienced first; for other groups an alternative path began with impaired control. CONCLUSIONS The prevalence and sequence of criteria of ND fit our understanding of the neuropharmacology of ND. The order among symptoms early in the process of dependence may differ from the severity order of symptoms among those who persist in smoking.
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Affiliation(s)
- Denise B. Kandel
- Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, NY 10032,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Mei-Chen Hu
- Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, NY 10032
| | - Kazuo Yamaguchi
- Department of Sociology, University of Chicago, 1126 East 59 St., Chicago, IL 60637
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