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

Abstract

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. 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. 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. 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. 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.