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 Fagerstr?m 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.     

Applicability of the Fagerström Test for Nicotine Dependence in smokers with schizophrenia

Up to 90% of individuals with schizophrenia smoke cigarettes, and many show signs of heavy dependence. Although the severity of nicotine dependence is often measured by the six-item Fagerstrom Test for Nicotine Dependence (FTND), this measure, in its current form, may not be as appropriate in this population--or in others who's smoking is regulated by others--as in the general population due to differences in smoking patterns, living arrangements, and daily routines. These factors may produce an underestimate of nicotine dependence, which may have clinical implications for successful medical detoxification if the FTND scores are used to guide the dosage of nicotine replacement medication. Data indicate poor internal consistency reliability (alpha=.4581) and a factor pattern lacking simple structure (i.e., two nonmeaningful factors/components with substantial cross loadings) when administered to smokers with schizophrenia. Specific examples of problematic items and how these may contribute to an underestimate of tobacco dependence severity are discussed, as well as ways to modify the FTND to be more appropriate for this population.     

The Fagerström Test for Nicotine Dependence in a Dutch sample of daily smokers and ex-smokers

We explored the performance of the Fagerström Test for Nicotine Dependence (FTND) in a sample of 1378 daily smokers and 1058 ex-smokers who participated in a survey study of the Netherlands Twin Register. FTND scores were higher for smokers than for ex-smokers. Nicotine dependence level was not associated with age. FTND score was highly correlated with the maximum number of cigarettes smoked (even after excluding the item ‘number of cigarettes per day’ from FTND), but the FTND score showed a low correlation with age of first cigarette and total number of years smoked. In a subsample of smokers (n=143) and ex-smokers (n=181) the test–retest correlations for the FTND were high. In general, the performance of the FTND in ex-smokers was comparable with that in smokers. These findings suggest the FTND to be a valuable tool for studies of nicotine dependence in large epidemiological samples.     

A psychometric evaluation of the Fagerström Test for Nicotine Dependence in PTSD smokers

Rates of smoking among individuals with psychiatric conditions are greater than rates seen in the general population, yet little is known about the psychometric properties of commonly used nicotine dependence instruments among psychiatric smokers. This study examined the reliability, validity, and factor structure of the Fagerström Test for Nicotine Dependence (FTND) among psychiatric smokers. Results revealed that the FTND had good test–retest reliability, convergent validity, and discriminant validity. A factor-analytic examination converged on a two-factor solution, reflecting two correlated but separate processes related to nicotine dependence. In total, the results revealed that the FTND performs as well—from a psychometric perspective—with psychiatric smokers, as it does with nonpsychiatric smokers.     

An Examination of the Fagerström Test for Nicotine Dependence Among Concurrent Tobacco and Khat Users

Abstract

The current study examined the psychometric properties of the Fagerström Test for Nicotine Dependence (FTND) among tobacco smokers who use khat (Catha edulis), a widely used substance in East Africa and Arabian Peninsula. We also explored gender differences in response to FTND items because little attention has been paid to women's smoking behavior in Middle Eastern societies. A total of 103 (38 women) concurrent users (mean age ± SD: 24.4 ± 5.2) were recruited from two universities in Yemen. An Arabic version of FTND was developed using back-translation method. Chronbach's alpha was used to examine the reliability and principal component analysis was conducted to test the factor structure of the scale. The scale was found to have low internal consistency reliability (Chronbach's α = .58). Two factors were identified, accounting for 57% of the total variance. A series of chi-square analyses found that men indicated more symptoms associated with nicotine dependence than women (ps < .05). Although the poor reliability observed in the present sample argues for a cautious approach when assessing nicotine dependence among khat users, the findings on factor structure and gender differences may provide support for the validity of the scale. Taking into account sociocultural factors associated with patterns of smoking behavior among this population should improve the psychometric properties of FTND.     

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

Few data exist about the Fagerstr?m Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) from population samples. The goal was to prove to what degree (1) a reduced item solution of the FTND and (2) the HSI represent the FTND. Two randomized adult population samples were used from northern Germany. Sample 1 included 1462 and sample 2 included 1042 current daily cigarette smokers aged 20-64 years with FTND data. The results show that four items of the FTND as well as the HSI represent the FTND. It is concluded that both are valid measures of the urge to smoke and the tobacco-smoke-seeking behavior.     

Reliability of the Fagerström Test for Nicotine Dependence, Minnesota Nicotine Withdrawal Scale, and Tiffany Questionnaire for Smoking Urges in smokers with and without schizophrenia

Few studies have examined the psychometrics of smoking-related behavioral measures in schizophrenia and questions have been raised about the applicability to smokers with schizophrenia. We examined the reliability of the Fagerström Test for Nicotine Dependence (FTND), Minnesota Nicotine Withdrawal Scale (M-NWS), and the Tiffany Questionnaire for Smoking Urges (TQSU) for smokers with schizophrenia (SS; n = 151) and nonpsychiatric smokers (CS; n = 181) recruited into three studies with similar inclusion criteria. SS and CS did not differ on a number of demographic and smoking variables (e.g., age). SS reported higher carbon monoxide (CO) levels, plasma cotinine levels, FTND, M-NWS, and TQSU Factor 1 scores. The internal consistencies (Cronbach's α) of the smoking measures were found to be high and comparable between diagnostic groups for the FTND, M-NWS total scores, and TQSU Factor 2 (all α's > 0.70) but higher for the CS than SS for the TQSU Factor 1 (0.86 versus 0.79). Test–retest correlations were lower for SS than CS on the FTND (0.65 versus 0.82), TQSU Factor 1 (0.65 versus 0.79), and TQSU Factor 2 (0.69 versus 0.81), but did not differ between diagnostic groups for M-NWS (0.58 versus 0.64). Our findings suggest that these measures may be reliable for use in smokers with schizophrenia.     

Cognitive interviews for measurement evaluation of the Fagerström Test for Nicotine Dependence (FTND) in smokers with schizophrenia spectrum disorders

People diagnosed with schizophrenia have among the highest known rates of tobacco use. While the Fagerström Test for Nicotine Dependence (FTND) is the most widely used measure of nicotine dependence, recent research has questioned its applicability for individuals with schizophrenia. The current study employed cognitive interviews to evaluate the FTND with smokers diagnosed with schizophrenia spectrum disorders, recruited from an acute inpatient psychiatry setting, and a comparison group of smokers recruited from the community. The groups were comparable on tobacco use variables and FTND scores. Detailed qualitative cognitive interviews indicated all subjects understood the FTND items. For both groups, the FTND missed nocturnal smoking, reported as weekly by 80% of patients and 47% of controls. Finishing other people's cigarettes also was under-reported on the FTND. Restrictions to smoking were common across groups. The cognitive interview methodology proved useful for understanding how individuals interpreted and answered the FTND items. Overall, the qualitative findings identified limitations in the FTND for both groups, with the limitations generally more pronounced among patients with schizophrenia.     

Resequencing of Nicotinic Acetylcholine Receptor Genes and Association of Common and Rare Variants with the Fagerstr?m Test for Nicotine Dependence

Common single-nucleotide polymorphisms (SNPs) at nicotinic acetylcholine receptor (nAChR) subunit genes have previously been associated with measures of nicotine dependence. We investigated the contribution of common SNPs and rare single-nucleotide variants (SNVs) in nAChR genes to Fagerström test for nicotine dependence (FTND) scores in treatment-seeking smokers. Exons of 10 genes were resequenced with next-generation sequencing technology in 448 European-American participants of a smoking cessation trial, and CHRNB2 and CHRNA4 were resequenced by Sanger technology to improve sequence coverage. A total of 214 SNP/SNVs were identified, of which 19.2% were excluded from analyses because of reduced completion rate, 73.9% had minor allele frequencies <5%, and 48.1% were novel relative to dbSNP build 129. We tested associations of 173 SNP/SNVs with the FTND score using data obtained from 430 individuals (18 were excluded because of reduced completion rate) using linear regression for common, the cohort allelic sum test and the weighted sum statistic for rare, and the multivariate distance matrix regression method for both common and rare SNP/SNVs. Association testing with common SNPs with adjustment for correlated tests within each gene identified a significant association with two CHRNB2 SNPs, eg, the minor allele of rs2072660 increased the mean FTND score by 0.6 Units (P=0.01). We observed a significant evidence for association with the FTND score of common and rare SNP/SNVs at CHRNA5 and CHRNB2, and of rare SNVs at CHRNA4. Both common and/or rare SNP/SNVs from multiple nAChR subunit genes are associated with the FTND score in this sample of treatment-seeking smokers.     

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 Fagerstr?m 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.     

Association of withdrawal features with nicotine dependence as measured by the Fagerström Test for Nicotine Dependence (FTND)

The aim of this study was to advance our understanding of how nicotine dependence level, defined by the Fagerström Test of Nicotine Dependence (FTND), relates to nicotine withdrawal features. We classified nicotine dependence in two categories, 1) low dependence (LD; FTND < 4) and 2) high dependence (HD; FTND ≥ 4). A sample of 241 smokers was recruited via newspaper ads and public notices. Using a multivariate response model with adjustments for age, sex, age at first cigarette, race, and current or lifetime depression, we observed a small to modest statistically robust association between nicotine dependence level and withdrawal features such as, irritation/anger (adjusted relative risk, aRR = 1.2; 95% CI 1.0, 1.3); nervousness (aRR = 1.3; 95% CI 1.1, 1.6); restlessness (aRR = 1.2; 95% CI 1.1, 1.4); difficulty concentrating (aRR = 1.3; 95% CI 1.1, 1.7); and trouble sleeping (aRR = 1.8; 95% CI 1.2, 2.6). Our findings are consistent with the inference that the FTND measures “physiological dependence” and that multidimensional approaches are needed to capture the full range of smoking phenotypology.     

Screening and Diagnosis of “Alcohol Abuse and Dependence” in Older Adults

A literature review reveals that research is warranted to improve screening for “alcohol abuse” in older adults and women. An examination of diagnostic criteria for “alcohol abuse dependence” reveals that older adults provide unique challenges to classification systems. There is a need to evaluate the sensitivity and specificity of several new screening instruments for the identification of “alcohol abuse” in the elderly. Routine screening of elderly and women presenting in primary care settings should be a priority for researchers and clini cians.     

Drug-scene roles and HIV risk among Puerto Rican injection drug users in East Harlem,New York and Bayamón,Puerto Rico

This article describes and compares distributions of drug-scene roles, frequency of engaging in role behaviors, and relationships of role-holding to high-risk behaviors and sexual partnerships among Puerto Rican injection drug users in New York and Puerto Rico. For this study 561 street-recruited injection drug users in East Harlem, New York, and 312 in Bayamón, Puerto Rico were asked the number of days (in the last 30) in which they earned money or drugs in each of seven drug-scene roles; and about behaviors and egocentric risk partner characteristics in the last 30 days. East Harlem subjects were more likely to get resources by selling drugs and syringes, and buying drugs for someone else; Bayamón subjects were more likely to be "hit doctors," buy needles for others, operate a shooting gallery, or escort others to shooting galleries. All roles were part-time except shooting gallery management in East Harlem. About 27% of respondents at each site engaged in two or more roles. Many roles were associated with increased odds of injecting more than twice a day, receptive syringe sharing, distributive syringe sharing, receptive paraphernalia sharing, and having a drug-injecting sex partner. Drug-scene role structures vary between cities. Most roles are part-time pursuits. Role-holders have higher-risk behaviors and sexual partnerships than other drug injectors. Although further research is needed, drug-scene role-holders should be targeted for interventions to affect their own risk and their communications with others.     

Do Reductions in the Tar and Nicotine Yields of Cigarettes Help to Explain Recent Reductions in Lung Cancer Rates in Young Men and Women in the United States?

Between 1985 and 2000, lung cancer rates in U.S. men and women aged 35–54 yr have declined. To investigate whether these declines can adequately be explained by changes in smoking prevalence, consumption, and duration, or if changes in tar and nicotine yields also contributed, two model-fitting approaches were used. Both approaches used individual person National Health Interview Survey data on smoking prevalence, age of starting and time of quitting, and national estimates of consumption per smoker and yields. Both approaches compared observed rates (by sex and age) relative to 1985, with those predicted after successively including various smoking variables into the model, making varying allowance for compensation for reduced yield. Approach A was simpler, based on mean smoking statistics estimated separately for current and former smokers. Approach B used the multistage model and individual smoking histories to estimate risk. Both approaches showed observed declines in risk were (except for men aged 35–39 yr) clearly greater than predicted based only on prevalence, consumption, and duration. Including yield generally improved the fit. At younger ages, models assuming substantial compensation (consistent with evidence from studies relating nicotine yield and intake) fitted well, but at age 50–54 yr in both sexes and age 45–49 yr in women, the decline was better fitted by models assuming little compensation. The conclusions were not sensitive to the precise parameter values assumed in the modeling. Interpretation is not straightforward, but the findings suggest declines in yields have contributed to the recent declines in rates in young U.S. men and women.     

Binge Drinking in African American Males From Adolescence to Young Adulthood: The Protective Influence of Religiosity,Family Connectedness,and Close Friends’ Substance Use

We examined the contribution of culturally relevant protective factors (i.e., adolescent religiosity, family connectedness, and perceived close friends’ substance use) to the probability of young adult binge drinking among African American males. Participants (n = 1,599) drawn from the National Longitudinal Study of Adolescent Health were high school age adolescents (14–18 years, M = 16) at Wave 1 and young adults (18–26, M = 22) at Wave 3. Adolescent binge drinking was associated with all three protective factors. Perceived close friends’ substance use in adolescence was a protective factor in later binge drinking during young adulthood, and was moderated by age such that the effect was stronger for younger adolescents. Implications for culturally relevant research and prevention are discussed.     

The Pharmacokinetics of Pancuronium in Infants,Children and Adults

研究观察年龄对潘库溴铵药代动力学的影响。选择２４例施择期整形外科手术的患者，根据年龄分成三组：１组为５例婴幼儿，年龄０．７５～２．９５岁；２组为１３例儿童，年龄４～１４岁；３组为６例成人，年龄１６～２７岁。静注潘库溴铵１００μｇ／ｋｇ后用改良荧光法测定其血浓度。潘库溴铵的体内过程能用二室开放模型完整描述，年龄愈小，分布容积愈大，血浆清除率愈高，潘库溴铵的血药浓度愈低。Ｖ１（中央室分布容积）、Ｖ２（周边室分布容积）、Ｖｄｓｓ（稳态分布容积）、Ｃｌ（血浆清除率）和ＡＵＣ（曲线下面积）在三组间有明显差别。１组的Ｔ１／２β和ＭＲＴ明显比２、３组长，但Ｔ１／２α和Ｋ２１在三组间无明显差别。     

Childhood Adversity Increases Risk for Nicotine Dependence and Interacts with α5 Nicotinic Acetylcholine Receptor Genotype Specifically in Males

The relative importance of specific genetic and environmental factors in regulating nicotine dependence (ND) risk, including the effects on specific forms of childhood adversity on smoking risk, have been understudied. Genome-wide association studies and rodent models have demonstrated that the α5 nicotinic acetylcholine receptor gene (CHRNA5) is important in regulating nicotine intake. Childhood adversity increases the methylation level of the CHRNA5 promoter region in European Americans (EAs), an effect that was observed only in males (Zhang et al, submitted for publication). In view of this potential sex difference in the effects of early life experience on smoking, we investigated the presence of a sex-specific gene-by-environment effect of this marker on ND risk. A nonsynonymous SNP in CHRNA5 previously associated to ND and several related traits, rs16969968, was genotyped in 2206 EAs (1301 men and 905 women). The main and interactive effects of childhood adversity and rs16969968 genotype on diagnosis of ND and ND defined by dichotomized Fagerstrom test for ND (FTND) scores were explored. Men and women were analyzed separately to test for sex differences. Childhood adversity significantly increased ND risk in both sexes, and the effect in women was twice than that in men. Significant interactive effects of childhood adversity and rs16969968 genotype were observed in men (ND: OR=1.80, 95% CI=1.18–2.73, P=0.0044; FTND: OR=1.79, 95% CI=1.11–2.88, P=0.012). No interaction was found in women. This study provides evidence of a sex-specific gene × environment effect of CHRNA5 and childhood adversity on the risk for ND.     

Does change in readiness influence retention among African American women and men in substance abuse treatment?

ABSTRACT

African Americans are less likely than other racial groups to engage in and complete outpatient substance abuse treatment. The current study, conducted as a secondary analysis of a multisite randomized clinical trial, examined whether readiness to change (RTC) over time influences retention and whether gender moderates the relationship between changes in RTC and retention among 194 African American women and men. Participants completed the University of Rhode Island Change Assessment at baseline and at the end of the 16-week study. Findings revealed a significant relationship between RTC over time and retention. Specifically, the more RTC increased throughout the 16-week study, the longer participants remained in treatment. In addition, gender moderated the relationship between changes in RTC and retention, with a stronger association between changes in RTC and retention among men relative to women. One approach to improving substance abuse treatment retention rates is to focus on increasing RTC during treatment, especially among African American men.