Heaviness of Smoking Index, Number of Cigarettes Smoked and the Fagerstrom Test for Nicotine Dependence Among Adult Male Malaysians

K.H Lim,K Gurpreet,K.K Lim,M.G Sumarni,N.M Amal,M Feisul Idzwan,C.C Kee

doi:10.7314/apjcp.2012.13.1.343

K.H Lim, K Gurpreet + Show 5 more

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https://doi.org/10.7314/apjcp.2012.13.1.343

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Abstract

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

Highlights

The level of nicotine dependence is important in assessing the effectiveness of smoking prevention and control programmes ( Breslau et al, 2001) There are several scales available for measuring addiction level such as the Fagerström Tolerance of Nicotine Dependence (FTND) (Heatherton et al, 1991), the Cigarette Dependence Scale (CDS) ( Etter, 2005) and the Nicotine Dependence Syndrome Scale ( Shiffman et al, 2004)
The heaviness of smoking index (HSI), cigarettes per day (CPD) and the FTND were administered to 316 adult Malaysian male, daily smokers aged between 25-64 years old in the Malaysian NCD Surveillance-1 Survey using a two-stage stratified random sampling of enumeration blocks and living quarters, via an interview based on a validated questionnaire
The findings indicate that the HSI can be used as an alternative to the FTND in screening for high nicotine dependence among daily smokers in large population-based studies, while CPD may not be a suitable alternative to the FTND

Summary

Introduction

The level of nicotine dependence is important in assessing the effectiveness of smoking prevention and control programmes ( Breslau et al, 2001) There are several scales available for measuring addiction level such as the Fagerström Tolerance of Nicotine Dependence (FTND) (Heatherton et al, 1991) , the Cigarette Dependence Scale (CDS) ( Etter, 2005) and the Nicotine Dependence Syndrome Scale ( Shiffman et al, 2004). The Heaviness of Smoking Index (HSI), a subset of the FTND, has been suggested as an alternative to the FTND. It comprises of only two items which are “time to first cigarette upon waking” and the “quantity of cigarettes smoked in a day”. Its use in Malaysia has not been examined Another method that has been used is based exclusively on the number of cigarettes smoked in a day (Cigarettes per day, CPD), a type of qualitative measure that has been used in many population-based studies (de Leon et al, 2003; Institute Public Health, 2008)

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