Comparing the validity of the Cigarette Dependence Scale and the Fagerström Test for Nicotine Dependence

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Abstract

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.

Introduction

Researchers and clinicians need a valid and reliable instrument to measure dependence on cigarettes. Several instruments are available, including self-administered unidimensional scales such as the Fagerström Test for Nicotine Dependence (FTND) and the Tobacco Dependence Screener (Heatherton et al., 1991, Kawakami et al., 1999), self-administered multidimensional scales such as the Nicotine Dependence Syndrome Scale (NDSS) and the WISDM-68 (Shiffman et al., 2004, Piper et al., 2004), and interviews based on the DSM-IV or ICD-10 definitions of dependence (American Psychiatric Association, 1994, Johnson et al., 1996, World Health Organization, 1992). Deciding which measure to use is made difficult by the lack of consensus about whether dependence is uni- or multidimensional, and by the lack of validation studies for some of the questionnaires (Colby et al., 2000, Piper et al., 2004, Piper et al., 2006). In addition, all the instruments listed above have limitations, and none is generally accepted as valid. In particular, several important aspects of dependence, as defined in DSM-IV and ICD-10, are not covered by FTND (Colby et al., 2000, Piper et al., 2004, Etter et al., 1999, Etter, 2005a, Moolchan et al., 2002). NDSS has also limitations, in particular, it does not cover important aspects of dependence, as defined in DSM-IV and ICD-10, (e.g. unsuccessful efforts to quit, use despite risks, time spent smoking), and NDSS includes several elements that can hardly be considered to reflect dependence (e.g. influence of contextual factors). The WISDM-68 is still in its experimental phase, and it is too long (68 items) for most practical purposes (Piper et al., 2004, Piper et al., 2006). There are only scant validation data for the Tobacco Dependence Screener (Kawakami et al., 1999). Interviews based on the DSM-IV and ICD-10 definitions can be considered a gold standard (e.g. Johnson et al., 1996), but they are expensive to implement and are too long for most clinical or research purposes.

The limitations of available questionnaires justify the development of new instruments. An ideal measure should cover the ICD-10 and DSM-IV definitions of dependence, have good psychometric properties, and it should be brief and self-administered. We recently developed the Cigarette Dependence Scale (CDS-12), a brief, self-administered, unidimensional, continuous measure that reflects DSM-IV and ICD-10 criteria of dependence (Etter et al., 2003, Etter, 2005a, Okuyemi et al., 2007). CDS-12 has a higher test–retest reliability than FTND, a higher internal consistency, is more sensitive to change over time (Etter et al., 2003, Etter, 2005a), and is more strongly related to biochemical markers of exposure to smoke (Okuyemi et al., 2007). However, there are few data on the predictive validity of CDS-12, and this scale has not been compared with DSM-based measures of dependence. The aim of this study was to further document the predictive and construct validity of CDS-12 and to compare it with the most widely used dependence scale: the FTND.

Section snippets

Baseline survey

We posted CDS-12 and FTND together on the internet between May 2004 and March 2007, in French, on the smoking cessation website Stop-tabac.ch. A link to the questionnaire was posted on several pages of this website, which was visited by over 100,000 people per month (Wang and Etter, 2004). The survey also covered motivation to quit smoking, and whether participants smoked every day, occasionally (not daily), or never. We also computed scores for CDS-5 (a subset of five items from CDS-12), and

Participation

There were 13,697 daily smokers at baseline, of whom 5314 (39%) agreed to take part in the follow-up and indicated an e-mail address. Of these, 1113 (21% of 5314) answered the 8-day survey and 435 (8% of 5314) the 6-week survey. Baseline participants were on average 29 years old, 42% were men, they smoked on average 15 cigarettes per day and 86% had a DSM-IV diagnosis of nicotine dependence (presence of three or more criteria in the past year, based on MINI). Participation in the 8-day survey

Discussion

We compared the predictive and construct validity of the Cigarette Dependence Scale and the Fagerström Test for Nicotine Dependence.

Conflict of interest statement

The Institute of Social and Preventive Medicine of the University of Geneva received financial support from Novartis and Pfizer, both producers of nicotine replacement products, to develop internet-based smoking cessation programmes.

Acknowledgement

Vincent Baujard, from the HON Foundation (www.hon.ch) developed the software for data collection.

Funding: No external funding.

References (45)

  • K.S. Okuyemi et al.

    Nicotine dependence among African American light smokers: a comparison of three scales

    Addict. Behav.

    (2007)
  • T.J. Payne et al.

    Assessing nicotine dependence: a comparison of the Fagerstrom Tolerance Questionnaire (FTQ) with the Fagerstrom Test for Nicotine Dependence (FTND) in a clinical sample

    Addict. Behav.

    (1994)
  • C.S. Pomerleau et al.

    Reliability of the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence

    Addict. Behav.

    (1994)
  • A. Radzius et al.

    A factor analysis of the Fagerstrom Tolerance Questionnaire

    Addict. Behav.

    (2001)
  • J. Wang et al.

    Administering an effective health intervention for smoking cessation online: the international users of Stop-Tabac

    Prev. Med.

    (2004)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • L.C. An et al.

    Feasibility of Internet health screening to recruit college students to an online smoking cessation

    Nicotine Tob. Res.

    (2007)
  • N. Breslau et al.

    Predicting smoking cessation and major depression in nicotine-dependent smokers

    Am. J. Public Health

    (2000)
  • S.M. Colby et al.

    Measuring nicotine dependence among youth: a review of available approaches and instruments

    Drug Alcohol Depend.

    (2000)
  • J.F. Etter et al.

    A comparison of the psychometric properties of three cigarette withdrawal scales

    Addiction

    (2006)
  • J.F. Etter

    A self-administered questionnaire to measure cigarette withdrawal symptoms: the Cigarette Withdrawal Scale

    Nicotine Tob. Res.

    (2005)
  • J.F. Etter et al.

    Development and validation of a scale measuring self-efficacy of current and former smokers

    Addiction

    (2000)
  • Cited by (0)

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