Elsevier

Addictive Behaviors

Volume 30, Issue 3, March 2005, Pages 575-579
Addictive Behaviors

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The Fagerström Test for Nicotine Dependence in a Dutch sample of daily smokers and ex-smokers

https://doi.org/10.1016/j.addbeh.2004.05.023Get rights and content

Abstract

We explored the performance of the Fagerström Test for Nicotine Dependence (FTND) in a sample of 1378 daily smokers and 1058 ex-smokers who participated in a survey study of the Netherlands Twin Register. FTND scores were higher for smokers than for ex-smokers. Nicotine dependence level was not associated with age. FTND score was highly correlated with the maximum number of cigarettes smoked (even after excluding the item ‘number of cigarettes per day’ from FTND), but the FTND score showed a low correlation with age of first cigarette and total number of years smoked. In a subsample of smokers (n=143) and ex-smokers (n=181) the test–retest correlations for the FTND were high. In general, the performance of the FTND in ex-smokers was comparable with that in smokers. These findings suggest the FTND to be a valuable tool for studies of nicotine dependence in large epidemiological samples.

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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