Assess Nicotine Dependence Research Articles

Can Urinary Cotinine Predict Nicotine Dependence Level in Smokers?

Although nicotine dependence plays a role as a main barrier for smoking cessation, there is still a lack of solid evidence on the validity of biomarkers to determine nicotine dependence in clinical settings. This study aimed to investigate whether urinary cotinine levels could reflect the severity of nicotine dependence in active smokers. Data regarding general characteristics and smoking status was collected using a self-administered smoking questionnaire. The Fagerstrom test for nicotine dependence (FTND) was used to determine nicotine dependence of the participants, and a total of 381 participants were classified into 3 groups of nicotine dependence: low (n=205, 53.8%), moderate (n=127, 33.3%), and high dependence groups (n=49, 12.9%). Stepwise multiple linear regression model and receiver operating characteristic (ROC) curves analyses were used to determine the validity of urinary cotinine for high nicotine dependence. In correlation analysis, urinary cotinine levels increased with FTND score (r=0.567, P<0.001). ROC curves analysis showed that urinary cotinine levels predicted the high-dependence group with reasonable accuracy (optimal cut-off value=1,000 ng/mL; AUC=0.82; P<0.001; sensitivity=71.4%; specificity=74.4%). In stepwise multiple regression analysis, the total smoking period (β=0.042, P=0.001) and urinary cotinine levels (β=0.234, P<0.001) were positively associated with nicotine dependence, whereas an inverse association was observed between highest education levels (>16 years) and nicotine dependence (β=-0.573, P=0.034). The results of this study support the validity of using urinary cotinine levels for assessment of nicotine dependence in active smokers.

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

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.

Assessment of Nicotine Dependence among Smokers in a Selected Rural Population in Kerala, India

An attempt was made to understand the nicotine dependence of smokers selected for an ongoing smoking cessation intervention programme in rural Kerala, India. Data were collected from resident males in the age group of 18 to 60 years from 4 randomly allocated community development blocks of rural Thiruvananthapuram district (2 intervention and 2 control groups). Trained accredited social health activist workers were utilised to collect data from all groups through face to face interview. Nicotine dependence among participants was assessed by means of the six-item Fagerstrom Test for Nicotine Dependence (FTND) translated into the local language. The internal consistency of FTND was computed using Cronbach's alpha coefficient. Criterion validity (concurrent) was assessed by correlations of nicotine dependence scores with age at initiation of smoking and cumulative smoking volume in pack-years. Among the 928 smokers identified, 474 subjects were in the intervention area (mean age =44.6 years, SD =9.66 years) and 454 in the control area (mean age= 44.5 years, SD =10.30 years). The overall FTND score among current daily smokers was 5.04 (SD: 5.05). FTND scores in the control and intervention areas were 4.75 (SD: 2.57) and 4.92 (SD: 2.51) respectively. The FTND scores increased with age and decreased with higher literacy and socioeconomic status. The average FTND score was high among smokers using both bidi and cigarettes (mean 6.10, SD 2.17). Internal consistency analysis yielded a Cronbach's alpha coefficient of 0.70 in a subsample of 150 subjects, a moderate result. The association of the scale was strongest, with the number of pack-years smoked (rho = 0.677, p < 0.001). A moderate level of nicotine dependence was observed among smokers in the current study. Tobacco cessation strategies could be made more cost effective and productive if a baseline assessment of nicotine dependence is completed before any intervention.

Risk factors associated with nicotine dependence in a sample of Romanian pregnant smokers

To fill the gap in assessing nicotine dependence during pregnancy in an unexplored population in Central and Eastern Europe and to analyze the associations of maternal characteristics and prenatal risk factors with moderate-heavy nicotine dependence among pregnant smokers. A questionnaire was applied to pregnant smokers in Romania to assess nicotine dependence and other related risks poorly documented in Central and Eastern Europe. The response rate was >80% and the valid sample included 137 pregnant smokers. Descriptive statistics and logistic regressions were used to assess nicotine dependence and to analyze the associations of maternal characteristic and prenatal risk factors with moderate-heavy nicotine dependence. Approximately 43% of the pregnant smokers in our sample (59 of 137) had moderate to heavy nicotine dependence. Depressive symptoms were associated with moderate-heavy nicotine dependence among pregnant smokers (OR=3.07, p<0.05). Women carrying an unwanted pregnancy had higher odds of moderate-heavy nicotine dependence (OR=2.59, p<0.05) compared to other pregnant women. High stress, lack of social support, and socioeconomic status were not associated with nicotine dependence. A large proportion of women had moderate-heavy nicotine dependence in a sample of Romanian pregnant smokers. The more dependent pregnant smokers were more likely to have depressive symptoms. Prenatal care should include brief nicotine dependence assessments and mental health screening and referrals for pregnant women who smoke. Special and intensive efforts, including psychosocial components, may be needed for the nicotine dependent pregnant smokers.

Spanish Adaptation of the NDSS (Nicotine Dependence Syndrome Scale) and Assessment of Nicotine-Dependent Individuals at Primary Care Health Centers in Spain

The availability of adequate instruments for the assessment of nicotine dependence is an important factor that is relevant in the area of tobacco addiction. In this study, we present a Spanish validation of the Nicotine Dependence Syndrome Scale (NDSS) (Shiffman, Waters, & Hickcox, 2004). The sample was composed ofpatients, all daily smokers, who visited their General Practitioner (GP) at five Primary Health Care Centers in different cities of Spain (N = 637). The results indicated adequate reliability for the general factor that assesses nicotine dependence (NDSS-Total) (Cronbach's alpha = .76). Factor analysis confirms the five factors of the original validation: Drive, Continuity, Stereotypy, Priority, and Tolerance. It must be noted that reliability is adequate for the first, and moderate or low for the rest. The NDSS-T and its scales correlate significantly with the Fagerström Test for Nicotine Dependence (FTND), with the nicotine dependence criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as assessed through the Structured Clinical Interview for DSM-IV (SCID), with carbon monoxide levels in expired air (CO), and with the number of cigarettes smoked. The ROC curve indicates that the NDSS-T has a score of .79 which is under the curve (.69 for the FTND), thus the prediction of nicotine dependence is adequate. We conclude that this instrument is useful (in terms of its total score NDSS-T) for assessing nicotine dependence for Spanish smokers (in Spain), as has been found in other countries, language groups, and cultures.

Does Breath Carbon Monoxide Measure Nicotine Dependence?

ABSTRACT The aim of the current study was the examination of exhaled breath carbon monoxide levels as a predictor for heaviness of smoking. In this regard, nicotine dependence was assessed among a representative sample of 1,870 Austrian male military conscripts in a cross-sectional setting. Participants completed the Heaviness of Smoking Index (a brief questionnaire for assessment of nicotine dependence), and their expired breath carbon monoxide levels were measured. The performance of carbon monoxide as a predictor of dependence levels was examined by means of Receiver-Operating-Characteristic Curve Analysis. Area Under the Curve, as well as sensitivity and specificity, were reported for each carbon monoxide cut-off level. The authors demonstrate that exhaled carbon monoxide levels serve as a satisfactory means to discriminate between smokers and non-smokers, yielding optimal discrimination at a cut-off level ⩾ 5.5 parts per million (ppm), with a sensitivity of 95% and a specificity of 83%. However, the results indicate that carbon monoxide levels do not discriminate adequately between different levels of severity of nicotine dependence. The study demonstrates exhaled carbon monoxide as a useful marker of smoking status but not of nicotine dependence.

Assessment of nicotine dependence among adolescent and young adult smokers: A comparison of measures

Introduction Tobacco use often starts in adolescence, yet assessment of dependence among adolescent smokers remains a challenge, particularly given the potential discord between self-reports of smoking behavior and actual use. We could find no prior study, among adolescents, that directly compares the association between objective biomarkers of tobacco exposure (e.g., cotinine) and multiple measures of dependence. This study examined the concurrent validity of two common dependence measures: the Fagerström Test for Nicotine Dependence (FTND) and the Hooked on Nicotine Checklist (HONC). We further examined the FTND by removing the one item on cigarettes smoked per day. Methods Based within a parent clinical trial for adolescent smoking cessation, eligible participants were 12–21 years old, smoking ≥ 5 cigarettes per day on average, and with urine cotinine > 100 ng/ml at baseline. Results are based on participants who completed each measure and who provided a urine cotinine sample at baseline (N = 73). Results Results showed that the FTND was associated with cotinine (p < 0.001; R 2 = 0.25), and that this relationship held true for the revised FTND as well (p < 0.001; R 2 = 0.18). However, the HONC was only marginally associated with cotinine (p = 0.06; R 2 = 0.09). Discussion Our results suggest that the FTND may be better associated with actual smoking behavior in adolescents as compared to the HONC. Pending replication, our data provide caution with regard to assessment of nicotine dependence at least among established adolescent smokers who have more entrenched smoking behavior.

An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospital

To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used. From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.

Abstract 979: Understanding the relationship between race and nicotine dependence

Abstract Background: Mounting evidence continues to demonstrate that nicotine dependence is a growing public health issue among current smokers. While duration of smoking, number of cigarettes smoked per day (CPD) and cessation attempts are common indicators of nicotine dependence, African Americans tend to smoke less cigarettes per day (CPD; 10 or less), initiate smoking at a later age and experience greater failed quit attempts, compared to whites, yet develop nicotine dependence. However, no previous study has examined the possibility that race differences in the social context which African Americans and non-Hispanic whites live may contribute to disparities and the persistence of nicotine dependence. Social class and immediate personal interactions occurs in various social contexts, including the living space, workplace, institutions or other physical environments. This project examines the contributions of demographic, behavioral and environmental factors as social contextual factors that contribute to smoking behavior and the persistence of nicotine dependence. Objective: We examined race disparities in nicotine dependence among 761 African American and white current smokers living in similar social and environmental risk exposures and compared these estimates to 1461 black and white current smokers in a national sample of adults aged 20 and over. Methods: Data was assessed from Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB; 2003) and National Health and Nutritional Examination Survey (NHANES; 2001-2004) to determine if race disparities in nicotine dependence would be attenuated in EHDIC-SWB. Time to first cigarette was used to assess nicotine dependence. Logistic regression was used to assess the association between race and nicotine dependence, controlling for known confounders. Results: In multivariate analysis, race differences in nicotine dependence were greater among African-Americans in a representative sample of US adults. African Americans in a national sample have a lower odds of nicotine dependence (OR = 0.8; 95% CI 0.46, 0.93) compared to whites. However, no race difference were detected among participants in the EHDIC-SWB study (0.87; 95% CI 0.62, 1.22). Conclusions: Examination of social and environmental factors may reveal important insights into the nature of inequalities between black and white adults in health outcomes such as nicotine dependence. Our results highlight the importance of examining social contextual factors and suggest that the promotion of targeted interventions may reduce the prevalence of nicotine dependence among current smokers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 979.

Denial of smoking‐related risk among pregnant smokers

To examine pregnant women's denial of risk, tobacco dependence and their partner's smoking status on smoking behavior during pregnancy. Cross-sectional design with convenience sampling. Data collection was carried out in hospitals and antenatal clinics in Budapest and 12 other Hungarian cities. A total of 406 adult pregnant women (mean age: 28.2 years; SD = 5.6) with a mean gestational age of 23.3 weeks ranging from 4 to 40 (SD = 8.9). Pregnant women were enrolled in the study by midwives and home-care attendants. Smoking status was assessed by self-report questions. Further measures included the Fagerstrom Test of Nicotine Dependence to assess nicotine dependence, and the Wisconsin Inventory of Smoking Dependence Motives to assess the motivational background of smoking. Risk perception was assessed by Haslam and Draper's (2000) 12-item risk perception questionnaire. Prevalence of occasional and daily smokers was 21.7 and 29.3%, respectively. Some 59.7% of the pregnant women have a partner who smokes. Daily smokers had a higher level of risk denial than occasional or non-smokers (Welch F = 91.607; p < 0.001). Current smokers also had a higher denial than temporary quitters (t = -3.153; p = 0.003). Denial of risk correlated significantly with nicotine dependence (r = 0.30) and the main motivational factors (r = 0.34-0.48). A multinomial logistic regression model of denial of risk concurrently predicted women's smoking status (p = 0.001), even when controlling for age, education, partner's smoking status and parity. A higher level of risk denial seems to be one of the major determinants of women's smoking status during pregnancy.

Propiedades psicométricas de la Escala del Síndrome de Dependencia de la Nicotina (NDSS) en una muestra de fumadores que solicitan tratamiento por su dependencia del alcohol

The assessment of nicotine dependence with brief instruments is of great relevance for the better detection of this disorder. Here we present the results with the Nicotine Dependence Syndrome Scale (NDSS) by Shiffman, Waters and Hickcox (2004) in a sample of 183 patients treated at an Alcohol Dependence Unit who were also cigarette smokers. The results indicate that the general factor which evaluates nicotine dependence (NDSS-T) has good reliability (Cronbach's alpha = 0.80). Factor analysis identifies four of the five factors proposed in the original version, those of drive, priority, continuity and stereotypy. Reliability of the scales derived ranges from very good (0.80) to moderate (0.63). The NDSS-T correlates significantly with the Fagerström Tolerance Questionnaire (FTQ), with the DSM-IV criteria for nicotine dependence assessed through the SCID, and with the number of cigarettes smoked per day. The ROC curves indicate an NDSS-T score of 0.80 under the curve (0.70 for the FTND), showing that it adequately predicts nicotine dependence. This study confirms the utility of this new instrument for assessing nicotine dependence in smokers who also abuse or depend upon alcohol.

Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey

BackgroundThe Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND.MethodsA survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures of sensitivity, specificity and predictive values were calculated. Concordance between the tests was also established (Cohen's kappa).ResultsCohen's kappa showed good agreement between measures (Kappa = 0.7); specificity values were also high (Sp = 96.2%). Sensitivity analysis in females (Se = 62.3%) did not show good agreement.ConclusionsThe HSI can be used as a reasonably good screening test in order to identify daily smokers with high nicotine dependence. Nevertheless, for populations or subpopulations having low nicotine dependence, such as women, the FTND is more reliable.

Is the Fagerström Test for Nicotine Dependence a good instrument to assess tobacco use in patients with schizophrenia?

Although the FTQ is considered to be adequate to assess nicotine dependence due to its extensive use, it suffers from significant psychometric shortcomings, such as low internal consistency and poor criterion validity. To address these problems, the Fagerstrom Test for Nicotine Dependence (FTND) was developed.

Transdisciplinary Tobacco Use Research Centers: Research achievements and future implications

The University of Wisconsin Transdisciplinary Tobacco Use Research Center (TTURC) has focused on several linked topics: (a) improving our assessment and understanding of nicotine dependence, (b) exploring factors that cause or modulate relapse risk, (c) identifying genetic influences on nicotine dependence and cessation success, and (d) testing smoking cessation interventions and determining their mechanisms of action. This developmental research effort produced a new questionnaire that is now being widely used to assess nicotine dependence: the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), which has good psychometric properties and is appropriate for use with a broad range of smokers (men and women, ethnic minorities; Piper et al., 2004). This work also produced direct evidence that nicotine dependence is indeed multidimensional, revealing which aspects of dependence are most associated with heightened relapse risk, withdrawal severity, and heavy smoking (Piper et al.).

Drs. Rao, Hammen, and Poland Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDrs. Rao, Hammen, and Poland ReplyUMA RAO M.D.CONSTANCE L. HAMMEN Ph.D.RUSSELL E. POLAND Ph.D.,UMA RAO M.D.Search for more papers by this authorCONSTANCE L. HAMMEN Ph.D.Search for more papers by this authorRUSSELL E. POLAND Ph.D.Search for more papers by this author,Published Online:1 Jul 2009https://doi.org/10.1176/appi.ajp.2009.09030349rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We appreciate the comments by Drs. Schütz and Sepehry. We agree with their statement that cigarette smoking is frequently associated with alcohol and drug use disorders and that it also may be a “gateway drug” to other substance use disorders. For example, in one review article (1) , the investigators reported that the prevalence of smoking in individuals with substance use disorder exceeded 75%. We also agree that most psychiatric instruments, including K-SADS-PL, do not assess nicotine dependence. Nicotine dependence was not assessed in our study. However, cigarette consumption was documented both at intake and during follow-up assessments. Some of these data were presented at a scientific meeting (2) . Specifically, 20.5% of adolescents in the sample reported a lifetime history of smoking, and 9.9% reported current smoking at intake. Of the adolescents who had follow-up data, 28.6% reported smoking during follow-up. Consistent with previous reports, there was a higher prevalence of smoking in adolescents who reported drug or alcohol use than those without a history of drug or alcohol use, both at baseline and follow-up (three- to four-fold higher). At intake, adolescents who smoked and adolescents who did not smoke did not differ significantly with respect to HPA activity (the primary predictor variable of substance use disorder during follow-up). When follow-up clinical data were incorporated, subjects who smoked persistently (those who smoked at both baseline and follow-up) had significantly higher HPA activity than subjects who did not smoke (2) . In addition, adolescents who did not smoke at baseline but initiated smoking during follow-up and continued to smoke regularly had higher HPA activity (measured at baseline) compared with non-smokers. These data suggest that elevated HPA activity might serve as a vulnerability marker for both nicotine-related as well as non-nicotine-related substance use disorders. It was not possible to examine cigarette smoking as a potential mediator/moderator of the relationship between HPA activity and the development of substance use disorder because the onset of smoking did not always precede the initiation of alcohol or drug use. Again, there was a high co-occurrence of smoking and non-nicotine substance use at both baseline and follow-up. In our article, the effect of prior substance use on the development of substance use disorder was examined. Although prior substance use had a significant influence on the development of substance use disorder, the effects of HPA activity and stressful life experiences persisted after accounting for the effect of prior substance use. We agree with Drs. Schütz and Sepehry that future investigations should include more careful assessments of nicotine use. Such studies also should examine the complex relationships among nicotine use, neurobiological markers, psychosocial factors, and clinical outcomes.Dallas, Tex.The author’s disclosures accompany the original article.This letter (doi: 10.1176/appi.ajp.2009.09030349r) was accepted for publication in March 2009.

Perceived Accessibility of Cigarettes Among Youth: A Prospective Cohort Study

The accessibility of tobacco for youth is difficult to measure, partly because of the varied sources of cigarettes. Perceptions about the accessibility of cigarettes assesses availability from all potential sources and has been found to predict future smoking. This study examines the determinants of perceived accessibility from the perspective of a longitudinal study. Data were derived from the second Development and Assessment of Nicotine Dependence in Youth study, a 4-year longitudinal study of 1246 sixth-grade students who underwent up to 11 in-person interviews from 2002 to 2006. Perceived accessibility was assessed prospectively by asking students whether they agreed or disagreed with the statement It would be easy for me to get a cigarette. At baseline, the average age was 12 years; 85% had never before smoked; more than 21% perceived that cigarettes were easy to obtain. Perceived accessibility increased over the 4 years among the cohort. Youth with friends who smoked or whose parents allowed the watching of R-rated movies were more likely to perceive easy accessibility of cigarettes. Among nonsmokers, there was a dose-response relationship between perceived accessibility and exposure to smoking in the family environment. Nonsmokers who knew commercial sources of cigarettes also had higher perceived accessibility. Several potentially preventable exposures to tobacco in the family and social environment contribute to confidence among some youth that cigarettes are easy to obtain. Further studies are needed to determine if modifying these factors (e.g., through programs to reduce the exposure of youth to tobacco products in the home) might reduce perceived accessibility.

Psychometric properties of the Fagerström Test for Nicotine Dependence

The Fagerström Test for Nicotine Dependence (FTND) is a screening instrument for physical nicotine dependence and is extensively used in various countries. The objective of the present report was to review articles related to the psychometric properties of the FTND. A systematic search for articles published up through December of 2007 was carried out in various electronic databases. The following search terms were used: 'Fagerström Test for Nicotine Dependence'; 'FTND'; 'psychometric'; 'validity'; 'reliability'; 'feasibility'; and 'factors'. We included articles published in English, Spanish or Portuguese and in which the psychometric properties of the FTND were evaluated. Twenty-six studies related to the psychometric properties of the FTND were identified in the indexed literature. Analysis of the studies confirmed the reliability of the FTND for the assessment of nicotine dependence in different settings and populations. Further validation studies using previously validated instruments as a comparative measure are needed before the extensive use of the FTND can be justified on the basis of its psychometric qualities.

P01-21 The fagerström test for nicotine dependence in Lithuanian adult smokers

Nicotine dependence meets the criteria for a psychiatric diagnosis, and has been referred to as “the most prevalent, most deadly, most costly, yet most treatable of all psychiatric disorders”. Fagerström test for nicotine dependence is an instrument often used to assess nicotine dependence. In the last decade, the importance of the level of nicotine dependence and difficulties in cessation has been acknowledged. Therefore it is important to know the level of nicotine dependence for choosing nicotine replacement as a function of dose.Objective:The aim of the study was to evaluate nicotine dependence among Lithuanian adult smokers, according to gender, age, and former quit attempts.Methods:The study analyses data of Lithuanian adult population health behavior surveys, performed in period of 1994- 2006. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering smoking habits. Nicotine dependence was assessed with Fagerström test for nicotine dependence (FTND).Results:Among Lithuanian regular smokers aged 20-64 in both genders dominated low level of nicotine dependence (56, 9 % of smokers). High level of nicotine dependence was observed in 2, 4 % of smokers. The men presented higher dependence on nicotine than women. Older smokers presented higher dependence on nicotine than young smokers.

Perceived accessibility as a predictor of youth smoking.

Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths. This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002-2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the baseline interview in 2002 were eligible for inclusion in this report. The outcomes for this study were the onset of smoking initiation and regular tobacco use. At baseline 1,027 students had never smoked cigarettes, and 168 had previously initiated smoking. During the 4 years of the study, 177 students newly initiated smoking, and 109 became regular smokers. In unadjusted city-stratified Cox proportional hazard models, perceived accessibility increased the risk for smoking initiation among nonsmokers and regular smoking among all participants in a dose-response fashion. Perceived accessibility also increased the risk for smoking progression among initiators in a dose-response fashion. The associations between perceived accessibility and smoking were robust to adjustment for peer and parental smoking. Youths with both perceived accessibility and peer-smokers had a higher risk of regular smoking and progression after initiation than either factor alone. These associations were stable to adjustment for potential confounders other than peer smoking. Perceived accessibility increases the risk for smoking among youths and has a stronger effect among those with peer smokers. There may be a role for identifying this group of youths for targeted interventions in child health care settings. Perceived accessibility should be carefully considered and measured in smoking intervention programs for teens.

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 ( β = 0.30, p < 0.001), than FTND ( β = 0.14, p < 0.01). After 8 days, self-efficacy in quitters was predicted by CDS-12 ( β = −0.16, p = 0.02), but not by FTND ( β = −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.