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

Aims   To compare the properties of four measures of dependence to nicotine/tobacco, the 12-item Cigarette Dependence Scale (CDS-12), the six-item Fagerström Test of Nicotine Dependence (FTND) and two shorter versions of the same measures.
Methods   In a cross-sectional telephone survey of smokers in a representative general population sample in Norway, we compared the measures. We assessed (i) internal consistency reliability with Cronbach's α; (ii) compared item scores; and (iii) tested the validity of the questionnaires. Test–retest reliability was assessed in a smaller convenience sample.
Results   Among 1265 respondents (64%), 290 (23%) were daily smokers and included in further analysis. Their mean age was 42 years [standard deviation (SD) 15] and 46% were female. They smoked on average 13 cigarettes per day (SD 6). Internal consistency reliability was 0.61 for the FTND ( n  = 267) and 0.81 for the CDS-12 ( n  = 266). Score distributions suggested a floor effect for the FTND. Test–retest reliability was 0.90 for the FTND and 0.97 for the CDS-12 ( n  = 31). The correlation between the scale scores and a question about the maximum willingness to pay for a cigarette after not smoking all day was 0.36 ( P  < 0.001) for the FTND ( n  = 262) and 0.45 ( P  < 0.001) for the CDS-12 ( n  = 263). There was little difference in the associations of the two scales or their abbreviated versions with external variables.
Conclusions   Telephone administration was acceptable for both questionnaires, and we have established population reference values for the four scales. The questionnaires were associated with each other and showed similar properties. The findings support the construct validity of the scales.     

中文版尼古丁依赖检测量表信度和效度的初步研究

目的 评估中文版尼古丁依赖检测量表在中国尼古丁依赖者中的信度和效度.方法 收集2008年11月至2009年7月于中山医院吸烟及其相关疾病门诊就诊相关个人信息例如年龄、性别、吸烟时间、每日吸烟量、有无戒烟史等,并完成尼古丁依赖检测量表.随机抽取样本60例,并对尼古丁依赖检测量表进行信度和效度进行统计.结果 本研究克隆巴赫a系数=0.658,与国外许多研究相一致,但低于理想的0.7.量表中各项目并未能覆盖DSM-Ⅳ中对物质依赖以及尼古丁戒断的重要诊断标准,缺乏内容效度,通过因子分析提取得两个因子,两个因子方差的累积贡献率为58.767%.结论 中文版尼古丁检测量表是一份信度和效度可自我测评量表,但仍需作进一步修改以更能在中国戒烟治疗和科研上发挥更大作用.     

Further evidence for an association between the gamma-aminobutyric acid receptor A, subunit 4 genes on chromosome 4 and Fagerström Test for Nicotine Dependence

Aims   A previous association analysis identified polymorphisms in gamma-aminobutyric acid receptor A, subunit 4 ( GABRA4 ) and GABRA2 to be associated with nicotine dependence, as assessed by a score of 4 or more on the Fagerström Test for Nicotine Dependence (FTND). In the present report, we extend the previous study by expanding our genotyping efforts significantly for these two genes.
Design   In 1049 cases (FTND of 4 or more) and 872 controls (smokers with FTND of 0) from the United States and Australia, we examine the association between 23 GABRA4 and 39 GABRA2 recently genotyped single nucleotide polymorphisms (SNPs) and nicotine dependence using logistic regression-based association analyses using the genomic analysis package PLINK.
Results   Two and 18 additional SNPs in GABRA4 and GABRA2 , respectively, were associated with nicotine dependence. The SNPs identified in GABRA4 ( P -value = 0.002) were restricted to introns 1 and 2, exon 1 and the 5' end of the gene, while those in GABRA2 localized to the 3' end of the gene and spanned introns 9–3, and were in moderate to high linkage disequilibrium (as measured by r ²) with each other and with previously studied polymorphisms.
Conclusion   Our findings demonstrate consistently the role of GABRA4 and GABRA2 in nicotine dependence. However, further research is needed to identify the biological influence of these intronic variations and to isolate functionally relevant polymorphisms neighboring them.     

A comparison of the Fagerstr?m Test for Nicotine Dependence and smoking prevalence across countries.

AIMS: To examine the correlation between the Fagerstr?m Test for Nicotine Dependence (FTND) score and smoking prevalence across countries. DESIGN: Cross-sectional study. SETTING: Fifteen studies from 13 countries with FTND score data. PARTICIPANTS: Samples of smokers were identified through systematic literature searches, web queries and colleagues. Smokers were considered representative of their country's smoking population if they were drawn from population-based sources, were not seeking smoking cessation treatment and did not have significant comorbidities. Smoking prevalence data were derived from the study itself or the country's population rate of daily smoking for the study year. MEASUREMENTS: A Pearson correlation coefficient was used to examine the direction and magnitude of the correlation between FTND score and smoking prevalence across countries. FINDINGS: FTND scores ranged from 2.8 to 4.6. Smokers in Germany and Norway had the lowest FTND scores, while smokers in Sweden and the United States had the highest FTND scores. The prevalence of daily smoking in these countries was very different: 37% and 30% in Germany and Norway, 19% and 16% in the United States and Sweden, respectively. An inverse correlation towards higher FTND scores in countries with lower smoking prevalence was found (r=-0.73, P=0.001). Current smokers had higher FTND scores than former smokers. CONCLUSIONS: The significant inverse correlation between FTND score and smoking prevalence across countries and higher FTND score among current smokers supports the idea that remaining smokers may be hardening. Less dependent smokers may quit more easily and remaining dependent smokers may need more intensive treatment.     

Properties of the Cigarette Dependence Scale and the Fagerstr?m Test of Nicotine Dependence in a representative sample of smokers in Norway

AIMS: To compare the properties of four measures of dependence to nicotine/tobacco, the 12-item Cigarette Dependence Scale (CDS-12), the six-item Fagerstr?m Test of Nicotine Dependence (FTND) and two shorter versions of the same measures. METHODS: In a cross-sectional telephone survey of smokers in a representative general population sample in Norway, we compared the measures. We assessed (i) internal consistency reliability with Cronbach's alpha; (ii) compared item scores; and (iii) tested the validity of the questionnaires. Test-retest reliability was assessed in a smaller convenience sample. RESULTS: Among 1265 respondents (64%), 290 (23%) were daily smokers and included in further analysis. Their mean age was 42 years [standard deviation (SD) 15] and 46% were female. They smoked on average 13 cigarettes per day (SD 6). Internal consistency reliability was 0.61 for the FTND (n = 267) and 0.81 for the CDS-12 (n = 266). Score distributions suggested a floor effect for the FTND. Test-retest reliability was 0.90 for the FTND and 0.97 for the CDS-12 (n = 31). The correlation between the scale scores and a question about the maximum willingness to pay for a cigarette after not smoking all day was 0.36 (P < 0.001) for the FTND (n = 262) and 0.45 (P < 0.001) for the CDS-12 (n = 263). There was little difference in the associations of the two scales or their abbreviated versions with external variables. CONCLUSIONS: Telephone administration was acceptable for both questionnaires, and we have established population reference values for the four scales. The questionnaires were associated with each other and showed similar properties. The findings support the construct validity of the scales.     

Concordance between Cigarette Smoking and the Modified Fagerström Tolerance Questionnaire in Controlled Studies of ADHD

Our objective was to compare scores on a smoking questionnaire to a diagnosis of cigarette smoking. As part of follow‐ups in studies of ADHD, we assessed for cigarette smoking using structured interviews and the modified Fagerström Tolerance Questionnaire (mFTQ). Data were obtained from 162 subjects (mean = 19.2 yrs). ROC analysis and kappa coefficients revealed that a cutoff score of 3 on the mFTQ showed the strongest agreement with a full diagnosis of cigarette smoking (kappa = 0.68). Clinicians and researchers using the mFTQ in adolescents and young adults should consider a cutoff score of 3 to be indicative of cigarette smoking.     

Risk Factors for Alcohol Dependence: A Questionnaire Survey

Several factors, known to associate with alcoholism, have not been studied together earlier as determinants of alcohol dependence, and taking into account possible interactions. A representative sample of 302 male and 312 female Finns, aged 19 to 81 years, answered a computerized questionnaire in January 1996. The diagnosis of alcohol dependence was based on the ICD-10 criteria. There were 66 (10.8%) subjects with current (past 12-month) ICD-10 alcohol dependence. After adjusting for other potential correlates in logistic regression analysis, alcohol dependence was more common among subjects high on both asocial behavior and on thinking that his or her behavior is determined mainly by chance or by other people (external control) than among the rest [odds ratio (OR) 4.4; 95% confidence interval (95% Cl) 1.8–10.91. Likewise, alcohol dependence was more common among subjects who recalled that they were highly stimulated when intoxicated by alcohol (OR 3.4; 95% CI 1.9–6.0). High predisposition to anxiety associated strongly with alcohol dependence among males (OR 13.8; 95% CI 4.4–43.1), but not among females (OR 25; 95% CI 0.7–9.1). Several of the aforementioned correlates may be modifiable risk factors for alcohol dependence.     

Development of a Questionnaire to Measure Alcohol Dependence

This paper is an interim report describing the development of a 15-item, self-completion questionnaire designed to measure Alcohol Dependence. Some measures of reliability are also presented.     

The Role of Genetics in Nicotine Dependence: Mapping the Pathways from Genome to Syndrome

Nicotine dependence continues to be a major public health problem worldwide and there is unequivocal evidence that genetics play a substantial role in its etiology. This review provides an overview of the evidence for genetic influences and recent advances in the field. Traditional quantitative genetics studies have revealed nicotine dependence is heritable and molecular genetics studies are providing increasing evidence that the genes responsible for nicotine’s pharmacokinetics and pharmacodynamics are particularly important. Despite considerable progress, a number of significant complexities and challenges remain. These include determining the specificity of genetic influences and clarifying the role of interactive contributions. One promising strategy for addressing these issues is an intermediate phenotype approach that attempts to identify the intervening proximal mechanisms that confer differential genetic risk. Understanding these mechanisms may permit more precision in understanding genetic influences and may also identify novel targets for intervention or prevention.     

The Severity of Alcohol Dependence Questionnaire: Its Use,Reliability and Validity

The clinical value of assessing degree of alcohol dependence is discussed in relation to goals of treatment. Further information is then provided on the use, reliability and validity of an instrument designed for this purpose -the SADQ. ‘Norms’ for SADQ scores from three samples of problem drinkers are given. Data indicating that individual items, sections and also the total scores of the SADQ have consistently high test-retest reliability coefficients are presented. A study is described in which a degree of construct validity is established by relating SADQ scores to one important component of the alcohol dependence syndrome [2]-narrowing of drinking repertoire. In addition, it is shown that SADQ scores have low, but significant, correlations with indicators of withdrawal severity for individuals treated at a Detoxification Unit. SADQ scores failed to correlate with indices of liver functioning. These results are discussed and it is concluded the SADQ is a quick, reliable and valid instrument.     

The Validity of the Short Alcohol Dependence Data (SADD) Questionnaire: a short self-report questionnaire for the assessment of alcohol dependence

The evidence for the unitary nature of alcohol dependence is discussed and the usefulness of existing instruments to measure dependence is reviewed. Three separate studies are presented that support the validity of SADD. Several measures of construct and concurrent validity are investigated including comparison with the SADQ and EADS. Attention is drawn to the discriminating characteristics of SADD in the mild/moderate dependence range.     

Nicotine Dependence Treatment During Inpatient Treatment for Other Addictions: A Prospective Intervention Trial

This study assessed the effect of treating nicotine dependence in smokers undergoing inpatient treatment for other addictions. It was a prospective, nonrandomized, controlled trial with a 1-year outcome. The subjects were smoking patients (50 controls, 51 in intervention group) in an inpatient addictions treatment unit in a medical center. The enrollment of subjects was sequential: controls were enrolled first, after a 6-week washout period, intervention subjects were enrolled. Controls received usual care, and the intervention group received nicotine dependence treatment consisting of a consultation, 10 intervention sessions, and a structured relapse prevention program. Smoking cessation rate and abstinence from alcohol or other drug use were the main outcome measures. The confirmed smoking cessation rate at 1 year was 11.8% in the intervention group and 0.0% in the control group ( p = 0.027). Nicotine dependence intervention did not seem to interfere with abstinence from alcohol or other drugs (1-year relapse rate was 31.4% in the intervention group and 34.0% in controls). In this study, nicotine dependence treatment provided as part of addictive disorders treatment enhanced smoking cessation and did not have a substantial adverse effect on abstinence from the nonnicotine drug of dependence.     

The Contribution of Pavlovian Conditioning to Drug Tolerance and Dependence

A progressively smaller response to a drug over repeated administrations defines tolerance. While traditional views of tolerance have assumed that the physiological changes underlying tolerance result simply from past exposure to the drug per se, it has become increasingly apparent that environmental cues present at the time of drug administration contribute to tolerance. The contribution of such drug-predictive environmental cues has been incorporated in a Pavlovian conditioning model of tolerance. The present paper summarizes data supporting the conditioning analysis of tolerance. The relevance of this analysis for the management of tolerance in clinical settings, and for drug withdrawal symptoms, is discussed.     

Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis

Fagerstom Test for Nicotine Dependence (FTND) has often been used as a measure of physical dependence on nicotine. In this study, we aimed to verify the usefulness of FTND and Heaviness of Smoking Index (HSI) in a sample of Turkish smokers and present relationship among interrelated items in our Turkish version of FTND by factor analysis. One hundred sixty nine smokers, 104 (61.5%) males, 65 (38.5%) females smoker were administered the Turkish translation of FTND. Fifty-two current smokers selected randomly from 169 were administered the questionnaire for test- retest reliability analysis. The Turkish version of FTND had moderate reliability (Cronbach alpha: 0.56). One FTND item (question 3: hate- most to give up) performed poorly on construct reliability tests. Factor 1 was loaded by questions 1 (first cigarette after awakening), 4 (number of cigarettes per day), 5 (smoking status during the first hours), 6 (smoking if ill), 2 (refrain from smoking in forbidden places) and factor 2 was separately loaded by question 3. Question 3 did not have significant correlation with the total score and the response to this question was significant between test and retest. The Turkish version of FTND may become a measuring tool in the assessment of smoking cessation programs. However, question 3 must be used attentively and preferably an explanation should be made to enable a clear understanding of the question to the Turkish smokers as they take the test.