Short communicationThe Fagerström Test for Nicotine Dependence in a Dutch sample of daily smokers and ex-smokers
Introduction
For both clinical practice and for research on smoking, it is useful to have a measure of the degree of nicotine dependence, which can be used in large epidemiological samples. To assess nicotine dependence, structured interviews like the DSM-IV can be used or, alternatively, self-report measures of nicotine dependence, such as the Fagerström Tolerance Questionnaire (FTQ). The FTQ was developed in 1978 (Fagerstrom, 1978), and a revised version was published in 1991: the Fagerström Test for Nicotine Dependence (FTND), (Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991). The FTND consists of six items, which all loaded on a single factor. The internal consistency was 0.61. Fagerstrom et al. (1996) compared the FTND data of treatment and population studies. FTND scores ranged from 5.15 to 6.55 in treatment samples, and lower FTND scores, ranging from 3.07 to 4.30, were found in population samples of current smokers. More recent studies have found comparable, or even lower, scores in population-based samples, ranging from 1.84 to 3.2 Etter et al., 1999, John et al., 2003.
There are few longitudinal studies that collected FTND data, but the test–retest correlations in those studies were high, ranging from .85 in a French sample to .88 in an American sample Etter et al., 1999, Pomerleau et al., 1994. As far as we know, there are no publications on the performance of the FTND in ex-smokers. It might be useful to have a measure of the degree of nicotine dependence for all participants who ever smoked (independent of their current smoking status). For example, genetic studies assume that there is an underlying liability for nicotine dependence. If there is an underlying (genetic) liability for nicotine dependence, then, the exclusion of the ex-smokers can cause bias and can decrease the sample size unnecessary in, for example, family studies of (genetic) influences on nicotine dependence.
We assessed the performance of the FTND in a sample of daily smokers (n=1378) and a sample of ex-smokers (n=1058) aged 16 years and older. Retest data were available for 324 participants.
Section snippets
Methods
As part of a longitudinal survey study of the Netherlands Twin Register, smoking data were collected in 6792 participants in 2000 (Boomsma et al., 2002). There were 3939 (58.5%) nonsmokers, 1732 (25.7%) current smokers, and 1058 (15.7%) ex-smokers. FTND data were available for 1378 daily smokers (584 men, mean age=30.3, S.D.=9.0, and 794 women, mean age=30.6, S.D.=10.4) and for 1058 ex-smokers who reported on the period they smoked the heaviest (368 men, mean age=38.6, S.D.=14.3, and 690 women,
Results
For smokers, the mean score of the FTND was significantly higher for men than for women, respectively, 3.02 and 2.77 (t=2.02, df=1376, p=.041). Post hoc analysis showed that men reported significantly higher values on the item ‘number of cigarettes per day’ (Mann–Whitney test; P=.006); scores on the other five items were not different for men and women. For ex-smokers, the FTND scores in men were also higher than the FTND scores in women, but differences were not statistically significant
Discussion
The FTND scores in the sample of daily smokers were comparable with those in other population studies Fagerstrom et al., 1996, John et al., 2003. Our finding that males scored higher on the FTND than females did was also in line with those studies. Interestingly, post hoc analyses in the present study showed that the gender differences were limited to one of the six items: the number of cigarettes per day. Studies have shown that cigarette nicotine dose may be less important for the reinforcing
Acknowledgements
This study was funded by grants 985-10-002 (NWO) and 3100-0038-16333 (NIDA/ZONMW).
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