A factor analysis of the fagerstrom tolerance questionnaire

Short Bouts of Physical Activity Are Associated with Reduced Smoking Withdrawal Symptoms, but Perceptions of Intensity May Be the Key

The primary aim of this study was to assess the effectiveness of a short bout (10 min) of moderate-intensity exercise to reduce withdrawal symptomatology, craving and negative affect; while the secondary aim was to assess how the effectiveness of a short bout of moderate exercise can be modulated by the perception of intensity in physically active and low-activity smokers. Fifty low-activity and physically active smokers were recruited (24 male and 26 female) and randomized in three different conditions. Prescribed (objective) moderate intensity (OBJ) and perceived moderate intensity (PER), and passive waiting (PW). After the intervention (T3), smokers reported less desire to smoke in the PER (p < 0.001) and OBJ (p < 0.001) conditions, relative to the PW condition. At T3 smokers in the PER condition reported less negative affect than smokers in the PW condition relative to the baseline (T1) (p < 0.007). Further, smokers in the PER condition reported less negative affect than smokers in the PW condition (p < 0.048). Physically active (PA) smokers perceived less exertion than low-activity (LA) smokers, and the effects were stronger in the PER condition relative to OBJ. Generally, our results suggest that a short bout of moderate exercise helps both LA and PA smokers. These findings provided a novel insight into the psychological mechanisms that affect the efficacy of the exercise in smoking cessation and suggest that exercise should be tailored according to individual perception of intensity.

[Physiological and Psychological Data influencing Pregnant Women Smoking Behavior - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]

Nicotine is the main addictive substance in tobacco and its addictive effects mainly involve dopamine. Nicotine is mainly metabolized (C-oxidation) in the liver to cotinine by the cytochrome P450 enzyme system. Nicotine half-life is short being about 2hours. Nicotine metabolism appears to be increased during pregnancy, mainly due to an increased cytochrome activity and maternal cardiac output. Thus, the smoking behavior of the pregnant woman is subsequently modified with an increase in withdrawal syndromes and an increased desire to smoke. These pharmacological elements should be taken into account when prescribing nicotine replacement therapy. Regarding the markers of tobacco intoxication, there is a good correlation between the importance of smoking and the measurement of expired air carbon monoxide. Although there is no evidence of decreased obstetrical complications related to its use, it is simple and non-invasive and therefore may be useful in routine practice. It gives an instantaneous value of tobacco intoxication, and represents a starting point for dialogue and management and can help to highlight the reality of withdrawal. Regarding the evaluation of tobacco addiction, the most commonly used questionnaires are the Fagerström tests (FTCD, HSI…), which are well correlated with cotinine concentration. However, there is insufficient evidence of their usefulness in reducing tobacco consumption during pregnancy to recommend them in current practice. DSM-V diagnostic criteria for addiction should be known as they can also be used to characterize the intensity of this addiction.

Very-low-nicotine-content cigarettes and dependence among non-daily smokers

BACKGROUND

The US Food and Drug Administration is considering reductions in the nicotine content of cigarettes to reduce smoking and tobacco dependence. A randomized study showed that even non-daily, intermittent smokers (ITS) reduced their cigarette consumption when switched to very-low-nicotine-content cigarettes (VLNCCs). This paper assesses whether switching ITS to VLNCCs results in decreased dependence and whether subsequent cigarette consumption is mediated by decreased dependence.

METHODS

ITS randomized to VLNCCs (n = 118) or normal nicotine content cigarettes (n = 120) completed multiple measures of dependence (Fagerstrom Test of Nicotine Dependence [FTND], Nicotine Dependence Syndrome Scale [NDSS], Wisconsin Inventory of Smoking Dependence Motives [WISDM], and Hooked on Nicotine Checklist [HONC]) at Baseline and 2, 6, and 10 weeks after randomization. A principal component factor score captured common variance among these measures (except FTND). Cigarettes per day (CPD) was assessed by three convergent methods.

RESULTS

Switching ITS to VLNCCs reduced dependence on all measures except the WISDM Secondary Dependence Motives and HONC. Except for the effects on the factor score, these effects of VLNCCs could be accounted for by contemporaneous CPD. Week-2 dependence measures did not prospectively predict weeks 3-4 CPD, once antecedent dependence and CPD were accounted for. "Cheating" among participants who appear to have smoked conventional cigarettes did not affect the findings.

DISCUSSION

Among ITS, switching to VLNCCs results in reduced tobacco dependence. However, the reductions in dependence appear to be secondary to effects on cigarette consumption, and do not appear to be an independent predictor or cause of reduced cigarette consumption.

Nicotine Dependence Measures for Perinatal Women

This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.

The effect of nucleus accumbens lesions on appetite, sexual function, and nicotine dependence in recovering heroin addicts

The nucleus accumbens (NAc) is a key part of the neural circuitry that creates reward, pleasure and motivation that facilitates human feeding, sexual and smoking behaviors. In the brain reward system, the NAc is a crucial component responsible for natural and drug-induced reinforcement behaviors. Yet it is unclear whether NAc is indispensible for all reward behaviors in human beings. The present study aimed to investigate the long-term effects of NAc ablation on sexual function, appetite, and nicotine dependence level in chronic heroin users. Eighteen former heroin-dependent patients (male) with bilateral NAc ablation via stereotactic radiofrequency surgery for alleviating drug psychological dependence were recruited. Their postoperative time ranged from 12 to 103 months. All subjects received MRI scans for assessing the accuracy of the lesion site. Evaluation of appetite, sexual function, and nicotine dependence were measured using the Simplified Nutrition Appetite Questionnaire, the Brief Sexual Function Inventory, and the Fagerström Test for Nicotine Dependence, respectively. After precluding the potential confounding variables, such as drug use (dosage and duration), post-operation duration, age, body-weight, marital status and education level, ANOVA with repeated measures revealed that the NAc ablation improved the patients’ appetite, sexual drive and sexual satisfaction. Yet there was no change in male erectile function, ejaculatory function, or nicotine dependence levels compared to the preoperative. These may suggest that although NAc is a key part of the neural circuitry, the NAc surgical lesions left the fundamental aspects of natural and drug-induced reinforcement and motivation almost intact.

[Tests for evaluating tobacco dependence]

The primary reason why there is such a heavy burden of tobacco smoking induced illness and death is dependence on nicotine which makes it difficult for smokers to quit. For clinical or research purposes, the degree of dependence, the intensity of the withdrawal syndrome and/or craving have been evaluated by different scales. This review provides a list of questionnaires that are used in smoking cessation. It pays particular attention to the validated and translated resources that are available in French. Research should be conducted in order to provide French speaking smoking cessation specialists with all the relevant scales allowing better evaluation of tobacco dependence.

Associations between health care factors and self-reported health status among individuals with diabetes: results from a community assessment

To identify the influence of select health care variables on self-reported physical and mental health status of individuals with diabetes. Data from the 2006 Brazos Valley Health Status Assessment (BVHSA) were analyzed. Aspects of health care were defined through exploratory factor analysis. Structural equation modeling was used to create relationships between health care aspects, personal characteristics of the participants, and self-reported physical and mental health status of individuals with diabetes. The significant predictors of self-reported physical health status were the number of co-morbid chronic diseases (β = 0.27, P = .002), and medical system access (β = -0.20, P = .035). The significant predictor of self-reported mental health status was the number of co-morbid chronic diseases (β = 0.35, P < .001). Self-reported physical (β = 0.27, P = .028) and mental (β = 0.29, P = .020) health status were both predictive of physician communication of mental health issues. Communication about mental health issues strongly relates to both self-reported physical and mental health status and should be an important part of physicians' care for individuals with diabetes. Further, the nuances of medical system access for diabetes care should be further examined.

Failure to report attempts to quit smoking

INTRODUCTION

Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year.

METHODS

The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16 years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year.

RESULTS

There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported.

CONCLUSION

A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids.

The effect of cigarette smoking on radiographic bone healing after elective foot surgery

This study aims to compare radiographic healing rates of Austin bunionectomies in smokers, nonsmokers, and secondhand smokers. Delayed bone healing has been linked to cigarette smoking previously, but no study is known to have examined smoking in relation to elective foot surgery. We hypothesized that smoking will delay bone healing after elective foot surgery. Surgical patients were placed into 1 of 3 cigarette smoking-related groups. Nicotine dependence was measured by the standardized modified Fagerström est and a urine cotinine test. Bone healing was determined via examination of postsurgical radiographs. Outcomes were assessed with 1-way analyses of variance. Forty-six patients were prospectively evaluated. There were 17 smokers, 12 secondhand smokers, and 17 nonsmokers. Healing time after Austin bunionectomy was 69 days (SD = 26.0), 120 days (SD = 55.3), and 78 days (SD = 19.1) in nonsmokers, smokers, and secondhand smokers, respectively. It was noted that as urine cotinine number increased, the healing time also increased (Pearson correlation = -.314, P < .01). The same was noted with the score associated with the Fagerström questionnaire, showing an increase in healing time with an increase in score (Pearson correlation = -.128, P < .05). The osteotomy of a smoker took 1.73 times longer to reach radiographic bone consolidation than that of a nonsmoker. This equates to a 42% increase in time to bone healing in the smoking patient. Increased healing time was also correlated to increased urine cotinine and a higher Fagerström number. Smoking is shown to delay radiographic healing.

LEVEL OF CLINICAL EVIDENCE

2.

Psychometric properties of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68): a replication and extension

Introduction The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), a relatively new measure, assesses nicotine dependence in terms of distinct motivations for smoking. We examined psychometric properties of the WISDM-68 in a population-based sample that is on average older and includes heavier smokers than the original sample used for the validation of the instrument. Methods Participants were adult regular smokers (N = 431) who were offspring of pregnant women enrolled in the New England sites of the National Collaborative Perinatal Project (1959-1966). We examined the internal consistency of the WISDM-68's 13 subscales, replicated and extended the confirmatory factor analysis (CFA) by Piper et al., assessed the interdependence of the subscales, examined the association between smoking heaviness and subscale scores, and conducted additional validation tests. Results Internal consistency for WISDM's 13 subscales ranged from 0.78 for the Tolerance to 0.89 for the Cognitive Enhancement and Affiliative Attachment subscales. Similar reliabilities were obtained for demographic and smoking-relevant subgroups. CFAs suggest that a 13-factor model fit our data better than a single-factor model and better than an empirically derived 10-factor model. Regression models supported the validity of the 13 subscales, although follow-up analyses suggested possibility of maintaining WISDM's 13-factor structure with fewer than 68 items. Conclusion The WISDM-68 consists of 13 internally consistent subscales. The independence of the majority of the subscales supports the perspective that nicotine dependence is a heterogeneous construct.

Differential item functioning of the English and Chinese versions of the Fagerstrom Test for Nicotine Dependence

Different language versions of the Fagerstrom Test for Nicotine Dependence (FTND) have been developed, but no studies have evaluated measurement equivalence between the respective non-English and English versions. We investigated differential item functioning (DIF) of the English and Chinese versions using a multidimensional item response theory approach. A community sample of 409 American smokers completed the English version (n=241) and the Chinese version (n=168). Results indicated two correlated dimensions (morning and daytime nicotine dependence) of the FTND and one item (difficult to refrain) showing significant large DIF, suggesting respondents using the Chinese version were more likely to endorse this item and report more difficulty to refrain from smoking at various public places even after controlling for the nicotine dependence level. However, the impact of this DIF item was found negligible on the scale level, suggesting the acceptability of conducting scale-level analysis using both language versions. Further analysis revealed that the reliabilities of two dimensions did not meet the commonly accepted standard. Suggestions were made to improve scale reliabilities of the FTND.

Comparing the validity of the Cigarette Dependence Scale and the Fagerström Test for Nicotine Dependence

BACKGROUND

We compared the validity of the Cigarette Dependence Scale (CDS-12) and of the Fagerström Test for Nicotine Dependence (FTND) in daily cigarette smokers.

METHODS

Internet survey in 2004-2007. Eight days and 6 weeks after answering these two dependence questionnaires, participants indicated their smoking status and answered the Cigarette Withdrawal Scale and the Smoking Self-Efficacy Questionnaire. We used the Mini International Neuropsychiatric Interview (MINI) to assess nicotine dependence as defined in DSM-IV.

RESULTS

There were 13,697 participants at baseline, 1113 (8%) after 8 days and 435 (3%) after 6 weeks. CDS-12, but not FTND, predicted smoking cessation after 8 days (odds ratio=1.20 per standard deviation unit, p=0.03) and 6 weeks (odds ratio=1.34, p=0.01). In participants who had quit smoking after 8 days, CDS-12 was a better predictor of craving (beta=0.30, p<0.001), than FTND (beta=0.14, p<0.01). After 8 days, self-efficacy in quitters was predicted by CDS-12 (beta=-0.16, p=0.02), but not by FTND (beta=-0.05, p=0.3). CDS-12 was more strongly associated than FTND with DSM-defined dependence measured by MINI: area under the Receiver Operating Characteristic (ROC) curve=0.72 (95% confidence interval=0.70-0.73). For FTND, the area under ROC=0.64 (0.63-0.66).

CONCLUSIONS

CDS-12 performed better than FTND on tests of predictive and construct validity.

Attention Deficit Hyperactivity Disorder Symptoms Predict Nicotine Dependence and Progression to Regular Smoking from Adolescence to Young Adulthood

OBJECTIVE

To examine the association between retrospectively reported attention deficit hyperactivity disorder (ADHD) symptoms and progression to smoking and the association with nicotine dependence.

METHODS

Study sample consisted of a nationally representative cohort of U.S. adolescents (n = 13,494). Logistic regression was used to examine ADHD symptoms from both the inattentive (IN) and hyperactive-impulsive (HI) domains and smoking trajectories. Linear regression was used to examine nicotine dependence.

RESULTS

HI symptoms were associated with progression from nonsmoking to regular smoking (OR = 1.14, 95% CI = 1.07-1.21), and with progression from experimentation to regular smoking (OR = 1.16, 95% CI = 1.08-1.26). IN and HI symptoms were associated with nicotine dependence among current smokers (IN: beta = 0.17, SE = 0.03, p < 0.0001; HI: beta = 0.10, SE = 0.04., p < .001).

CONCLUSIONS

These results have important implications for the development of prevention and treatment modalities.

Psychometric evaluation of the Chinese version of the Fagerstrom Tolerance Questionnaire as a measure of cigarette dependence

AIM

The aim of this study is to estimate the psychometric properties of the Chinese version of the Fagerstrom Tolerance Questionnaire as a measure of nicotine dependence.

BACKGROUND

The Chinese Fagerstrom Tolerance Questionnaire has been used in smoking cessation programmes in Taiwan. However, the psychometric properties of the Chinese version have not been tested.

METHODS

A cross-sectional, descriptive study was conducted from June 2004 to July 2005 with 247 adult smokers. The criterion validity of the Chinese Fagerstrom Tolerance Questionnaire was determined using two biomarkers (exhaled CO and saliva cotinine levels). Because the responses to the items are dichotomous or nominal, the validity and factorial structures were examined using tetrachoric techniques. Construct reliability was evaluated to accommodate the lack of tau-equivalence assumed in computing Cronbach's alpha.

FINDINGS

The item 'smoke more in the morning' was not statistically significantly correlated with either biomarker because many participants expressed the desire to smoke after meals instead of in the morning. The items 'nicotine yield' and 'inhalation' performed poorly in terms of criterion validity and construct validity. This evidence supports modification of the Chinese version of the Fagerstrom Tolerance Questionnaire to the six-item Fagerstrom Test for Nicotine Dependence. In addition, the item 'difficulty refraining from smoking in forbidden places' had relatively poor psychometric performance. The reason may be culturally specific, having to do with the relative lack of forbidden places and restrictions on tobacco use in Taiwan. The predictive ability of the Chinese version of the Fagerstrom Tolerance Questionnaire for biomarkers is higher than the English version. The reliability coefficient (0.65) was higher than Cronbach's alpha, but did not meet the satisfactory standard of 0.70.

CONCLUSION

The Chinese version of the Fagerstrom Tolerance Questionnaire is a fairly reliable and valid scale, but needs to be revised to accommodate cross-cultural differences.

Predictors of pretreatment attrition from smoking cessation among pre- and postmenopausal, weight-concerned women

The present study sought to determine whether postcessation weight gain concerns influenced pretreatment attrition differently for pre- versus postmenopausal women smokers. Participants were pre- and postmenopausal women smokers drawn from two clinical trials for smoking cessation and weight gain prevention [the Smoking Treatment/Obesity Prevention (STOP) studies]. Predictors of attrition from baseline assessment visits prior to entering smoking cessation treatment were identified among these women. Pretreatment attrition was significantly higher among the premenopausal women. The premenopausal women had significantly higher weight concern but lower restraint and disinhibition than the postmenopausal women. Weight concern explained variance in treatment attrition from the programs, while controlling for variables such as Body Mass Index (BMI), smoking rate, number of years smoking, nicotine dependence level, dietary restraint, disinhibition, and hunger, such that the higher the weight concern, the more likely women were to drop out of treatment programs prior to a quitting attempt.

Workplace smoking policies in Taiwan and their association with employees' smoking behaviours

BACKGROUND

The implementation of worksite smoking policies has shown significant effects on reducing employees' smoking consumption and protecting non-smoking workers. However, there are no data about workplace smoking policies in Taiwan. The purpose of this study was to document the status of worksite smoking policies in Taiwan and its potential impact on employees' smoking behaviours.

METHODS

A two-stage investigation was conducted. The first stage was to examine the current status of workplace smoking policies and the second was to evaluate the relationship between workplace smoking policies and employees' smoking behaviours. After two follow-ups in each stage, 264 companies and 1141 employees returned their questionnaires.

RESULTS

Workplace smoking policies were associated with types of businesses and size of workplaces. Only approximately half of manufacturing and service companies have implemented a prohibitive smoking policy. Large facilities (>750 employees) were more likely to implement a prohibitive policy (57%). Employees in workplaces with a prohibitive policy had lower prevalence of smoking and cigarette consumption, and less exposure to passive smoking. Although most smokers agreed with banning smoking in their work environment, no difference in interest in participating in cessation programs was found.

CONCLUSIONS

Significant associations were found between workplace smoking policies and employees' smoking behaviours. Results of the study provide basic information for designing more refined smoking policies in the workplace in Taiwan.

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.

Multidimensional assessment of nicotine dependence in adolescents

Despite the critical importance of adolescent smoking, the assessment of nicotine dependence during this developmental period has been the subject of relatively little research. In this study, 301 adolescents (ages 12 through 18 years) reporting daily smoking were recruited for a project on alcohol use disorders (AUDs). The sample included 140 females and 161 males, 251 subjects from clinical and 50 from community sources, and 176 subjects with AUDs at the baseline assessment. Subjects were evaluated with the Nicotine Dependence Syndrome Scale (NDSS), the Fagerstrom Test for Nicotine Dependence (FTND) and a determination of average number of cigarettes per day (cigarettes/day). A varimax factor analysis of 27 NDSS items revealed four factors: (1) Drive/Tolerance (13 items; Cronbach alpha = 0.91); (2) Continuity (five items; Cronbach alpha = 0.67); (3) Priority (three items; Cronbach alpha = 0.64); (4) Stereotypy (five items; Cronbach alpha = 0.66). The NDSS total score, refined by the removal of four items, was also examined (23 items; Cronbach alpha = 0.90). Predicting cigarettes/day at follow-up, initial smoking rate was the best predictor, with the FTND and NDSS Total score showing significant and similar predictive validity. The NDSS Total showed incremental validity in the prediction of smoking progression in a model including demographic characteristics, initial smoking rate and FTND. The findings suggest that the NDSS has acceptable psychometric properties when applied to adolescents, complementing smoking rate and FTND in a multidimensional smoking assessment.

A comparison of the content-, construct- and predictive validity of the cigarette dependence scale and the Fagerström test for nicotine dependence

BACKGROUND

Research showed that the widely used Fagerstrom test for nicotine dependence (FTND) does not cover important aspects of dependence. A new test, the cigarette dependence scale (CDS-12), covers the main elements in DSM-IV and ICD-10 definitions of dependence. We compared the psychometrics of CDS-12, FTND, and CDS-5 and the heaviness of smoking index (HSI), which are short versions of CDS-12 and FTND, respectively.

METHODS

Internet survey in 2002-2003. Participants were invited one month after answering the first survey to answer a second survey on smoking status and withdrawal symptoms.

RESULTS

Eight hundred two smokers answered both surveys. Cronbach's alpha coefficients were higher for CDS-12 (0.91) and CDS-5 (0.77) than for FTND (0.68) and HSI (0.63). Among 231 smokers who quit smoking at follow-up, higher baseline CDS-12 scores predicted higher withdrawal ratings at follow-up, for all withdrawal symptoms except appetite. FTND and HSI predicted higher craving in quitters, but did not predict the intensity of other withdrawal symptoms. Neither CDS-5, FTND or HSI predicted smoking cessation, but higher CDS-12 scores marginally predicted smoking cessation at follow-up (area under the receiver operating characteristic (ROC) curve = 0.55, 95% confidence interval = 0.51-0.59).

CONCLUSIONS

CDS-12 had better content validity and internal consistency than FTND and was a slightly better predictor of withdrawal symptoms. Unexpectedly, higher (not lower) CDS-12 scores predicted subsequent smoking cessation, perhaps because endorsement of some CDS-12 items implies accepting that one is dependent, which in turn could reflect motivation to quit. CDS-12 may represent an alternative to FTND for measuring cigarette dependence.

Understanding factors that influence smoking uptake

OBJECTIVE

To explore relationships between patterns of smoking uptake and social context and attitudinal variables.

DESIGN

Cross sectional survey.

SETTING

Public schools in Tucson, Arizona and Albuquerque, New Mexico.

PARTICIPANTS

982 children in grades 6-9 (ages 11-15 years).

MAIN OUTCOME MEASURES

Items measuring smoking history, nicotine dependence and quit attempts, susceptibility to smoking in the future, smoking norms, use of other tobacco products, attitudes toward smoking, and demographic characteristics.

RESULTS

Overall, 43% of children had smoked a cigarette and 57% had never used them. Ever smokers lived in social contexts with more smoking and where smoking was normative. Among never users, 25% are susceptible to smoking; these children have positive attitudes toward smoking, do not feel social pressure to stay off cigarettes, and had more friends who smoked. Among ever users, 36% were currently smoking in the past 30 days. Current users also lived in social context with more smoking and had positive attitudes toward smoking. Most users had tried to stop smoking. Only 9% of current users smoked daily; 29% had not smoked a whole cigarette. Greater cigarette consumption was associated with more favourable attitudes toward smoking. Most of past users were in early uptake: 95% had smoked less than 100 cigarettes but 49% were susceptible to smoking again.

CONCLUSIONS

There is promise in differentiating subgroups among the never, past and current use of cigarettes. Susceptibility within each of these groups was associated with similar patterns of attitudes and social context. These patterns in smoking uptake need to be confirmed prospectively.

A preliminary investigation of early smoking initiation and nicotine dependence in Korean adults

BACKGROUND

Few studies have investigated the association between age at smoking initiation and Fagerström test for nicotine dependence (FTND) in adulthood. The goal of this study was to develop the Korean version of FTND (FTND-K) and to examine the relationship between age at smoking initiation and nicotine dependence.

METHODS

This investigation used data from 268 current smokers who visited the Center for Cancer Prevention and Early Detection in the National Cancer Center, Korea. The internal consistency of the FTND-K was assessed by Cronbach's coefficient alpha. Pearson's correlation coefficients were used to assess the relationships between the FTND-K sum scores and urinary cotinine levels. One-way analysis of variance (ANOVA) and t-tests were used to assess differences in the FTND-K sum score between groups. Factor associated with nicotine dependence were identified through stepwise multiple logistic regression analysis.

RESULTS

The standardized Cronbach's alpha of FTND-K was 0.72. A significant positive correlation was seen between the FTND-K sum score and urinary cotinine level (correlation coefficient = 0.49, P < 0.05). Age at smoking initiation had a significant association with the FTND-K sum score in univariate analysis. In multivariate analysis, nicotine dependence was higher in smokers that started smoking cigarettes at 19 years or earlier than in those that started at 25 years or later (OR = 11.25, 95% CIs, 1.46-97.10).

CONCLUSIONS

The FTND-K is a valid assessment tool of nicotine dependence with acceptable levels of internal consistency and close correlation to urinary cotinine level. The finding that those who initiate smoking at an early age tend to be more nicotine dependent underscores and reinforces the public health significance of delaying smoking onset.

The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia

The purpose of this study was to determine the effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. This was a longitudinal study and sixty-eight schizophrenic patients were assigned to 8 weeks of a nicotine-patch therapy program or a control group. The generalized estimating equation analysis revealed that there were significant reductions in the subjects' nicotine dependence (Fagerstrom Tolerance Questionnaire), the number of cigarettes per day, and CO levels over an 8-week period of nicotine-patch therapy and 3-month follow-up. The point-prevalence rates of abstinence from smoking were an abstinence of 26.9% at 8 weeks and 26.9% at a 3-month follow-up. At the 3-month follow-up, the rate of continuous smoking abstinence in the nicotine-patch group was 23.1%.

Craving for cigarettes among low and high dependent smokers: impact of norharman

Besides nicotine, other chemicals in tobacco smoke, such as norharman, may contribute to the addictive properties of cigarettes. More specifically, elevated blood plasma levels of norharman may reduce feelings of craving among tobacco-dependent individuals. To test this hypothesis, plasma concentrations of norharman were measured in 38 male smokers (at least 15 cigarettes per day) at three time-points on 3 different days spread over a 4-month period. The first measurement (T0) was conducted in the morning at 8.30 a.m., after 12 hours of smoking abstinence. The T1 and T2 measurements were conducted at 13.00 p.m. and 16.30 p.m., during a period of ad libitum smoking (after the T0 measurement, participants were not restricted in their smoking behaviour). At each of the nine time-points, craving was assessed by means of a shortened version of the Questionnaire of Smoking Urges. The Fagerström Test of Nicotine Dependence was used to obtain an indication of nicotine dependence. The results showed that, after a period of smoking abstinence, craving was stronger in those with a high tobacco dependence than in those with a low tobacco dependence. After resumption of smoking, craving declined to a similar low level in both low and high dependent smokers. Measurements during periods of ad libitum smoking indicate that plasma levels of norharman are related negatively to craving among low nicotine-dependent smokers, but not among high dependent smokers.

The Modified Reasons for Smoking Scale: factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers

AIMS

To assess the validity of the French version of the Modified Reasons for Smoking Scale (MRSS), and to identify which smoking patterns differentiate male and female smokers, which are related to tobacco dependence (as assessed by the Fagerström Test for Nicotine Dependence, FTND), to mood (Beck Depression Inventory II), to affect (Positive and Negative Affect Schedule) and which are predictors of successful quitting.

PARTICIPANTS

Three hundred and thirty smokers [(mean +/- SD) aged 40 +/- 9 years, 145 (44%) women, mean FTND score: 6.2 +/- 2], candidates for a smoking cessation programme and smoking at least 15 cigarettes/day.

FINDINGS

Factor analysis of the 21-item scale gave the optimal fit for a seven-factor model, which accounted for 62.3% of the total variance. The following factors were identified: 'addictive smoking', 'pleasure from smoking', 'tension reduction/relaxation', 'social smoking', 'stimulation', 'habit/automatism' and 'handling'. The 'addictive smoking' score increased in a dose-dependent manner with number of cigarettes smoked per day; the 'habit/automatism' score was significantly higher, with more than 20 cigarettes per day than with < or = 20 cigarettes per day. The reasons for smoking were different for males and females: females scored higher on 'tension reduction/relaxation', 'stimulation' and 'social smoking'. A high level of dependence (FTND > or = 6) was associated with significantly higher scores only on 'addictive smoking', the association being stronger in females. Time to first cigarette after awakening was associated with higher 'addictive smoking' and 'habit/automatism' (P < 0.001). In a multivariate logistic regression, failed quitting was predicted by higher habit/automatism score (odds ratio = 1.44, 95% CI = 1.06-1.95, P = 0.02) and greater number of cigarettes smoked per day (odds ratio = 1.03, 95% CI = 1.01-1.06, p = 0.03).

CONCLUSIONS

The questionnaire yielded a coherent factor structure; women smoked more for tension reduction/relaxation, stimulation and for social reasons than men; addictive smoking and automatic smoking behaviour were similar in both sexes and were associated strongly with a high level of nicotine dependence; the 'habit/automatism' score predicted failure to quit over and above cigarettes per day.

A study of the psychometric properties of the Fagestrom Test for Nicotine Dependence

A factor analysis of 772 Fagestrom Test for Nicotine Dependence (FTND) was performed in a population of French workers with STATISTICA software, utilizing tetrachoric correlations to account for the dichotomous responses of the FTND. Confirmatory factorial analysis found the two-factor solution recently proposed for the FTND to be unsatisfactory. An exploratory factorial analysis concluded that the best solution was monofactorial when Item 3 was deleted. A confirmatory factorial analysis of the FTND provided support for this monofactorial solution. With the deletion of Item 3, the FTND achieved a high internal consistency (Cronbach's alpha=.86). Thus, a revision of the FTND with the exclusion of Item 3 is proposed. This revised form of the FTND appears to assess a unidimensional construct indicating robust construct validity.

The Fagerstrom Test for Nicotine Dependence and the Diagnostic Interview Schedule: do they diagnose the same smokers?

Two common assessment tools for nicotine dependence are the Fagerstrom Test for Nicotine Dependence (FTND) and the Nicotine Dependence section of the Diagnostic Interview Schedule [(DIS)-III-R or -IV based on the Diagnostic and Statistical Manual (DSM)-III-R and -IV, respectively]. The FTND emphasizes morning smoking and overall "heaviness" of smoking. The DSM emphasizes adverse consequences, desire to cut down, and mood changes during withdrawal. We tested (1) how the DSM-III-R diagnosis of Nicotine Dependence is related to FTND score; and (2) how the (a) DSM-III-R or (b) elevated FTND score is related to longer smoking histories, greater psychiatric symptomatology, and tobacco liking scores. Retrospective chart reviews were conducted on 370 smokers, the majority (55.9%) of whom had a current DSM-III-R diagnosis of Substance Dependence other than nicotine. All subjects had completed the FTND, the DIS-III-R, the Symptom Checklist-90-Revised (SCL-90-R), and a survey on drug liking. Agreement statistics were calculated between the DSM-II-R diagnosis of Nicotine Dependence and various cutoff scores values that were assigned as thresholds for nicotine dependence on the FTND. At no cutoff score did the two instruments reliably agree; the highest kappa (at a cutoff of FTND > or = 7) was 0.205. At cutoffs above 5, the FTND diagnosed fewer cases than the DSM-III-R. Multiple regression analysis showed that DSM diagnosis was associated with greater psychiatric symptomatology on the SCL-90-R, while FTND scores were associated with greater tobacco liking. The FTND and the DSM-III-R appear to measure different aspects of the tobacco dependence process. Specifically, the FTND may provide a stronger measure of physical dependence, while the DSM may tap other domains such as awareness of dependence, behaviors resulting from that awareness, and psychiatric symptomatology. Disagreements between the FTND and the DSM are likely to become greater with the changes in the DSM-IV.