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Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire

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Abstract

In the last decade, the importance of nicotine in maintaining smoking and in cessation difficulty has been acknowledged. Consequently, this has led to efforts to measure nicotine dependence. This paper focuses on a widely used, paper-and-pencil test of nicotine dependence- the Fagerstrom Tolerance Questionnaire (FTQ). The findings indicate that the FTQ correlates with other proposed measures of nicotine dependence (carbon monoxide, nicotine, and cotinine levels). The connection between FTQ scores and withdrawal symptoms is weak. In clinic outcome trials, the FTQ predicted success where no pharmacologic treatment was involved, while nicotine replacement appeared to mask the relation between FTQ scores and outcome. However, the FTQ may predict outcome with nicotine replacement as a function of dose. In placebo-controlled, nicotine replacement trials, FTQ scores were related to success by treatment. Problems with the FTQ are described with focus on item difficulties and analyses of the scale.

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References

  • Areechon, W. (1987). Smoking cessation with nicotine chewing gum. Presented at the 6th World Conference on Smoking and Health, November 9–11, Tokyo.

  • Blondal, T. (1987). Smoking and chewing gum. Presented at the 6th World Conference on Smoking and Health, November 9–11, Tokyo.

  • Brantmark, B., Ohlin, P., and Westling, W. H. (1973). Nicotine-containing chewing gum as an antismoking aid.Psychopharmacology 31: 191–200.

    Google Scholar 

  • Christen, A. G., MacDonald, J. L., Olson, B. L., Brook, C. A., and Stookey, G. K. (1984). Efficacy of nicotine chewing gum in facilitating smoking cessation.J. Am. Dent. Assoc. 106: 594–597.

    Google Scholar 

  • DeWit, H., and Camic, P. M. (1986). Behavioral and pharmacological treatment of cigarette smoking: End of treatment comparisons.Addict. Behav. 11: 331–335.

    PubMed  Google Scholar 

  • Edman, B., Elfverson, M. L., Fagerlund, I., and Hallin, L. Kort och lang behandlingstid med Nicorette, Unpublished report.

  • Fagerstrom, K.-O. (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment.Addict. Behav. 3: 235–241.

    PubMed  Google Scholar 

  • Fagerstrom, K.-O. (1980). Physical dependence on nicotine as a determinant of success in smoking cessation.World Smoking Health 5: 22–23.

    Google Scholar 

  • Fagerstrom, K.-O. (1982a). A comparison of psychological and pharmacological treatment in smoking cessation.J. Behav. Med. 5: 343–351.

    PubMed  Google Scholar 

  • Fagerstrom, K.-O. (1982b). Effects of a nicotine-enriched cigarette on nicotine titration, daily cigarette consumption, and levels of carbon monoxide, cotinine and nicotine.Psychopharmacology 77: 164–167.

    PubMed  Google Scholar 

  • Fagerstrom, K.-O. (1984). Effects of nicotine chewing gum and follow-up appointments in physician-based smoking cessation.Prev. Med. 13: 517–527.

    PubMed  Google Scholar 

  • Fagerstrom, K.-O. (1988). Efficacy of nicotine chewing gum: A review. In Pomerleau, O., and Pomerleau, C. (eds.),Nicotine Replacement: A Critical Evaluation, A. R. Liss, New York.

    Google Scholar 

  • Fagerstrom, K.-O., and Bates, S. (1981). Compensation and effective smoking by different nicotine-dependent smokers.Addict. Behav. 6: 331–336.

    Google Scholar 

  • Gunn, R. C. (1984). Predicting withdrawal symptoms in smokers attending cessation clinics. Paper presented at the American Psychological Association Meeting.

  • Hall, S. M., and Killen, J. D. (1985). Psychological and pharmacological approaches to smoking replase prevention. In Grabowski, J., and Hall, S. M. (eds.),Pharmacological Adjuncts in Smoking Cessation, NIDA Research Monograph 53 (pp. 131–143). U.S. Department of Health and Human Services, Washington, D.C.

    Google Scholar 

  • Hall, S. M., Herning, R. I., Reese, T. J., Benowitz, N. L., and Jacob, P. (1984). Blood cotinine levels as indicators of smoking treatment outcome.Clin. Pharmacol. Ther. 6: 810–814.

    Google Scholar 

  • Harackiewicz, J. M., Blair, L. W., Sansone, C., Epstein, J. A., and Stuckell, R. N. (1988). Nicotine gum and self-help manuals in smoking cessation: An evaluation in a medical context.Addict. Behav. 13: 319–330.

    PubMed  Google Scholar 

  • Henningfield, J. E. (1984). Pharmacological basis and treatment of cigarette smoking.J. Clin. Psychiat. 45: 24–34.

    Google Scholar 

  • Henningfield, J. E., London, E. D., and Jaffe, J. H. (1987). Nicotine reward: Studies of abuse liability and physical dependence potential. In Engel, J., and Oreland, R. (eds.),Brain Reward Systems and Abuse, Raven Press, New York.

    Google Scholar 

  • Hjalmarson, A. I. M. (1984). Effect of nicotine chewing gum in smoking cessation.JAMA 252: 2835–2838.

    PubMed  Google Scholar 

  • Hughes, J. R. (1984). Identification of the dependent smoker: Validity and clinical utility.Behav. Med. Abstr. 5: 202–204.

    Google Scholar 

  • Hughes, J. R., and Hatsukami, D. K. (1985). Short-term effects of nicotine gum. In Grabowski, J., and Hall, S. M. (eds.),Pharmacological Adjuncts in Smoking Cessation.NIDA Research Monograph 53, Department of Health and Human Services, U.S. Government Printing Office, Washington, D.C.

    Google Scholar 

  • Hughes, J. R., and Hatsukami, D. K. (1986). Signs and Symptoms of Tobacco Withdrawal.Arch. Gen. Psychiatr. 43: 289–294.

    PubMed  Google Scholar 

  • Hughes, J. R., Katsukami, D., Pickens, R. W., Krahn, D., Malin, S., and Luknic, A. (1984). Effect of nicotine on the tobacco withdrawal syndrome.Psychopharmacology 83: 82–87.

    PubMed  Google Scholar 

  • Ikard, F. F., and Tomkins, S. (1973). The experience of affect as a determinator of smoking behavior: A series of validity studies.J. Abnorm. Psychol. 81: 172–181.

    PubMed  Google Scholar 

  • Ikard, F. F., Green, D., and Horn, D. (1969). A scale to differentiate between types of smoking as related to the management of affect.Int. J. Addict. 4: 649–659.

    Google Scholar 

  • Jarvik, M. E., and Schneider, N. G. (1984). Degree of addiction and effectiveness of nicotine gum therapy for smoking.Am. J. Psychiat. 141: 790–791.

    PubMed  Google Scholar 

  • Jerome, A., Bigelow, G. E., Burling, T. A., Baile, W. F., and Gottlieb, S. (1984). In-hospital predictors of post-hospital smoking outcomes following myocardial infarction.Behav. Med. Update Annu. Meet. Addend. 2: 33–35.

    Google Scholar 

  • Kabat, C. G., and Wynder, E. L. (1987). Determinants of quitting smoking.Am. J. Pub. Health 77: 1301–1305.

    PubMed  Google Scholar 

  • Kornitzer, M., Kittel, F., Dramaix, M., and Bourdoux, P. (1987). A double-blind study of 2 mg vs. 4 mg nicotine chewing gum in an industrial setting.J. Psychosom. Res. 31: 171–176.

    PubMed  Google Scholar 

  • Lichtenstein, E., and Mermelstein, R. J. (1986). Some methodological cautions in the use of the Tolerance Questionnaire.Addict. Behav. 11: 439–442.

    PubMed  Google Scholar 

  • Lombardo, T. W., Hughes, J. R., and Fross, J. D. (1988). Failure to support the validity of the Fagerstrom Tolerance Questionnaire as a measure of tolerance to nicotine.Addict. Behav. 13: 87–90.

    PubMed  Google Scholar 

  • Lowenthal, H., and Davies, N. (1976). Pleasure, addiction and habit: Factors in verbal report of factors in smoking behavior.J. Abnorm. Psychol. 83: 478–488.

    Google Scholar 

  • McIntyre, K.-O. (1981).Predicting Abstinence from Smoking Using Measures of Self-Efficacy and Physical Dependence, Thesis, Department of Psychology, University of Oregon, Eugene.

    Google Scholar 

  • McKennell, A. C. (1970). Smoking motivation factors.Br. J. Soc. Clin. Psychol. 9: 8–22.

    PubMed  Google Scholar 

  • McNabb, McK. E. (1985). Nicotine tolerance questionnaire scores and plasma nicotine: no correlation.Addict. Behav. 10: 329–332.

    PubMed  Google Scholar 

  • Melin, B. (1984). Effekter av tva olika administrationstider av nikotintuggummi vid rokavvanjning. Report from the Institute of Applied Psychology, University of Uppsala, Sweden.

    Google Scholar 

  • Nordenskjold, E. (1983). Smoking cessation with nicotine chewing gum. Reported at the 5th World Conference on Smoking & Health, Winnipeg, Canada.

  • Opinion Research Corporation (1988).Nicorette and Smokers' Dependence, ORC, Princeton, N.J.

    Google Scholar 

  • Pinto, R. P., Abrams, B. B., Monti, P. M., and Jacobus, S. I. (1987). Nicotine dependence and likelihood of quitting smoking.Addict. Behav. 12: 371–374.

    PubMed  Google Scholar 

  • Pomerleau, O. F., and Pomerleau, C. S. (1988).Nicotine Replacement: A Critical Evaluation, Alan R. Liss, New York.

    Google Scholar 

  • Pomerleau, O. F., Fertig, J. B., and Shanahan, S. (1983). Nicotine dependence in cigarette smoking: An empirically based multivariate model.Pharm. Biochem. Behav. 19: 291–299.

    Google Scholar 

  • Pomerleau, C., Pomerleau, O. F., Majchrezak, M. I., Kloska, D. D., and Malakuti, R. (in press). Relationship between nicotine tolerance questionnaire score s and plasma cotinine.Addict. Behav.

  • Rose, J. E., and Hickman, C. S. (1987). Citric acid aerosol as a potential smoking cessation aid.Chest 92: 1005–1008.

    PubMed  Google Scholar 

  • Russell, M. A. H., Peto, J., and Patel, U. A. (1974). The classification of smoking by factorial structure of motives.J. Roy. Stat. Soc. Assoc. 137: 313–333.

    Google Scholar 

  • Schneider, N. G. (1986). Use of 2 mg and 4 mg nicotine gum in an individual treatment trial. In Ockene, J. K. (ed.),Pharmacological Treatment of Tobacco Dependence: Proceedings of the World Congress, Institute for the Study of Smoking Behavior and Policy, Harvard University, Cambridge, Mass.

    Google Scholar 

  • Schneider, N. G., Jarvik, M. E., and Forsythe, A. B. Nicotine vs. placebo gum in the alleviation of withdrawal during smoking cessation.Addict. Behav. 9: 149–156.

  • Schneider, N. G., Jarvik, M. E., Forsythe, A. B., Reed, L. L., Elliot, L. M., and Schweiger, A. (1983). Nicotine gum in smoking cessation: A placebo-controlled, double-blind trial.Addict. Behav. 8: 253–261.

    PubMed  Google Scholar 

  • Schwartz, J. L. (1987).Review and Evaluation of Smoking Cessation Methods: The United States and Canada, 1978–1985, National Institutes of Health Publication No. 87-2940, U.S. Department of Health and Human Services, Washington, D.C.

    Google Scholar 

  • Shifiman, S. (in press). “Clippers”: Individual differences in tobacco dependence.Psychopharmacology (in press).

  • Stitzer, M. L., and Gross, J. (1988). Smoking replase: The role of pharmacological and behavioral factors: In Pomerleau, O. F., and Pomerleau, C. S. (eds.),Nicotine Replacement: A Critical Evaluation, Alan R. Liss, New York.

    Google Scholar 

  • Surgeon General (1987).Surgeon General's Report 1987: The Health Consequences of Smoking: Nicotine Addiction, U.S. Department of Health and Human Services, Rockville, Md.

    Google Scholar 

  • Tomkins, S. (1966). Psychological model for smoking behavior.Am. J. Pub. Health. 56: 217–220.

    Google Scholar 

  • Tonnesen, P. (1988). Dose and nicotine dependence as determinants of nicotine gum efficacy. In Pomerleau, O. F., and Pomerleau, C. S. (eds.),Nicotine Replacement: A Critical Evaluation, Alan R. Liss, New York.

    Google Scholar 

  • Tonnesen, P., Fryd, V., Hansen, M., Helsted, I., Gunnersen, A. B., Forchhammer, H., and Stockner, M. (1988a). Effect of nicotine chewing gum in combination with group counselling on the cessation of smoking.N. Engl. J. Med. 318: 15–18.

    PubMed  Google Scholar 

  • Tonnesen, P., Fryd, V., Hansen, M., Helsted, I., Gunnersen, A. B., Forchhammer, H., and Stockner, M. (1988b). Two and four mg nicotine chewing gum and group counselling in smoking cessation.Addict. Behav. 13: 17–27.

    PubMed  Google Scholar 

  • Tonnesen, P., Fryd, V., Hansen, M., Helsted, I., Gunnersen, A. B., Forchhammer, H., and Stockner, M. (1988c). Nicotine chewing gum and group counselling in smoking cessation: correspondence.N. Engl. J. Med. 319: 49.

    PubMed  Google Scholar 

  • Vanbrabant, J. (1985).Smoking Cessation with General Practitioners with Nicotine Chewing Gum, Report, Union Chimique Belge, Brussels.

    Google Scholar 

  • Wesnes, K., and Warburton, D. M. (1984). Effects of scopolamine and nicotine on human rapid information processing performance.Psychopharmacology 82: 147–150.

    PubMed  Google Scholar 

  • West, R. J. (1984). Psychology and pharmacology in cigarette withdrawal.Psychosom. Res. 28: 379–386.

    Google Scholar 

  • West, R. J. (1988). Nicotine: A dependence-producing substance. In Pomerleau, O. F., and Pomerleau, C. S. (eds.),Nicotine Replacement: A Critical Evaluation, Alan R. Liss, New York.

    Google Scholar 

  • West, R. J., and Russell, M. A. H. (1985). Pre-abstinence smoke intake and smoking motivation as predictors of severity of cigarette withdrawal symptoms.Psychopharmacology 87: 334–336.

    PubMed  Google Scholar 

  • West, R. J., Jarvis, M. J., Russell, M. A. H., Carruthers, M. E., and Feyerabend, C. (1984). Effect of nicotine replacement on the cigarette withdrawal syndrome.Br. J. Addict. 79: 215–219.

    PubMed  Google Scholar 

  • Williams, D. G. (1979). Different cigarette smoker classification factors and subjective states in acute abstinence.Psychopharmacology 64: 231–235.

    PubMed  Google Scholar 

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Fagerstrom, K.O., Schneider, N.G. Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. J Behav Med 12, 159–182 (1989). https://doi.org/10.1007/BF00846549

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