Measuring nicotine dependence among high-risk adolescent smokers

doi:10.1016/0306-4603(96)00048-2

Addictive Behaviors

Volume 21, Issue 1, January–February 1996, Pages 117-127

https://doi.org/10.1016/0306-4603(96)00048-2 Get rights and content

Abstract

In the present study we tested our hypothesis that because of the higher prevalence and greater intensity of cigarette smoking among vocational-technical students (N = 110; 51.8% males; mean age 17 years), adolescents might demonstrate the nicotine dependence patterns comparable to those measured in a similar fashion in a group of adult smokers (N = 173; 50% males; mean age 42 years). A modified version of the Fagerström Tolerance Questionnaire (FTQ) utilized in the adolescent sample was coded to make it comparable to the original FTQ used in the adult sample. The tests of item structure and internal consistency of the modified FTQ for adolescents were satisfactory; the overall mean FTQ score correlated significantly with the intensity and duration of smoking. Although the FTQ values were generally lower in the adolescent sample, 20% of students had an overall FTQ score of 6 and above, indicating substantial nicotine dependence (compared to 49% in adults). Reasons for failure of the existing adolescent smoking cessation programs as well as the rationale for adding a nicotine replacement option to the behavioral smoking cessation treatment for a subset of high-risk nicotine-dependent adolescents are discussed.

References (39)

S. Carton et al.
Sensation seeking, nicotine dependence, and smoking motivation in female and male smokers
Addictive Behaviors
(1994)
K.O. Fagerström
Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment
Addictive Behaviors
(1978)
T.J. Glynn et al.
Tobacco-use reduction among high-risk youth: Recommendations of a National Cancer Institute Expert Advisory Panel
Preventive Medicine
(1991)
E. Lichtenstein et al.
Some methodological cautions in the use of the tolerance questionnaire
Addictive Behaviors
(1986)
D.M. Murray et al.
Effects of a state-wide antismoking campaign on mass media messages and smoking beliefs
Preventive Medicine
(1994)
R. Niaura et al.
Matching high- and low-dependence smokers to self-treatment with and without nicotine replacement
Preventive Medicine
(1994)
C.S. Pomerleau et al.
Relationship between Nicotine Tolerance Questionnaire scores and plasma cotinine
Addictive Behaviors
(1990)
C.S. Pomerleau et al.
Reliability of the Fagerström Tolerance Questionnaire and the Fagerström Test for Nicotine Dependence
Addictive Behaviors
(1994)
J.C. Tate et al.
A proposed revision of the Fagerström Tolerance Questionnaire
Addictive Behaviors
(1993)
S.J. Allen et al.
Regression equations for the latent roots of random data correlation matrices with unities in the diagonal
Mttltivariate Behavioral Research
(1984)

T.H. Bell

Vocational Education—Report by the Secretary of Education to the Congress

(1983)

Brown, R. A., Goldstein, M. G., Niaura, R., Emmons, K. M. & Abrams, D. B. (in press). Nicotine dependence: Assessment...

D. Burton

Tobacco cessation programs for adolescents

R.B. Cattell

The scree test for the number of factors

Multivariate Behavioral Research

(1966)

L.J. Cronbach

Coefficient alpha and the internal structure of tests

Psychometrica

(1951)

R. Donnelly Corcoran et al.

Vocational education students: A difficult-to-reach population at risk for smoking-related cancer

Journal of School Health

(1989)

K.O. Fagerström

How to measure nicotine dependence

K.O. Fagerström et al.

Measuring nicotine dependence: A review of the Fagerström Tolerance Questionnaire

Journal of Behavioral Medicine

(1989)

T.F. Heatherton et al.

The Fagerström test for nicotine dependence: A revision of the Fagerström tolerance questionnaire

British Journal of Addiction

(1991)

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Citation Excerpt :
Measures ranged from two to 25 items. Three measures, the Hooked On Nicotine Checklist (DiFranza, 2002), the Fagerström Test for Nicotine Dependence (FTND) (Heatherton et al., 1991), and the Modified Fagerström Tolerance Questionnaire (mFTQ) (Prokhorov et al., 1996) were rated as having excellent overall psychometric properties. Five measures were rated as “good” and seven were rated as “adequate.”
Self-report measures can improve evidence-based assessment practices in substance use disorder treatment, but many measures are burdensome and costly, limiting their utility in community practice and non-specialty healthcare settings. This systematic review identified and evaluated the psychometric properties of brief, free, and readily accessible self-report measures of substance use and related factors.
We searched two electronic databases (PsycINFO and PubMed) in May 2021 for published literature on scales, measures, or instruments related to substance use, substance use treatment, and recovery, and extracted the names of all measures. Measures were included if they were: (1) brief (25 items or fewer), (2) freely accessible in a ready-to-use format, and (3) had published psychometric data.
An initial search returned 411 measures, of which 73 (18%) met criteria for inclusion. Included measures assessed a variety of substances (e.g., alcohol, nicotine, opioids, cannabinoids, cocaine) and measurement domains (e.g., use, severity, expectancies, withdrawal). Among these measures, 14 (19%) were classified as psychometrically “excellent,” 27 (37%) were rated as “good,” 32 (44%) were “adequate.”
Despite the shift toward evidence-based assessment in substance use disorder treatment in the last twenty years, key areas of public health concern are lacking pragmatic, psychometrically valid measures. Among the brief measures we reviewed, less than a fifth met criteria for psychometric “excellence” and most of these instruments fell into one measurement domain: screening for problematic substance use. Future research should focus both on improving the evidence base for existing brief self-report measures and creating new low-burden measures for specific substances and treatment constructs.
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Alcohol, nicotine, and marijuana are the three most widely used substances among adolescents and young adults, with co-use of multiple substances being common. Few longitudinal studies have examined risk factors of alcohol, marijuana, and nicotine poly-substance use. We examined frequency of alcohol, marijuana, and cigarette poly-substance use over time and how key risk factors contribute to this substance use during adolescence and young adulthood.
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Depression, anxiety, negative mood regulation expectancies, and GPA all significantly influence both initial and longitudinal levels of substance use across adolescence and young adulthood. Our findings underscore the importance of identifying and treating youth with depression and anxiety symptoms, as well as providing resources early for those struggling in school in order to help with substance use prevention and intervention efforts.
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Impairments in feedback processing, often associated with risk-taking behavior, may have implications for development of substance abuse in adolescents. The most commonly used substances by adolescents include tobacco and cannabis, with some individuals using both substances, potentially heightening risk. Our objective was to examine feedback processing and impulsivity in adolescents who smoke cigarettes and use cannabis daily (N = 21), comparing them with adolescents who smoke cigarettes daily and use cannabis occasionally (N = 18) and non-smoking (N = 27) adolescents. To do this, the Balloon Analog Risk Task (BART) with concurrent EEG was used to measure risk-related feedback processing, and impulsivity was measured using the Barratt's impulsiveness scale (BIS-11). It was found that adolescent daily tobacco/cannabis smoking was associated with higher BIS-11 scores, shortened feedback-related-negativity (FRN) latencies and reduced P300 amplitudes. In addition, FRN latencies during win conditions were inversely associated with tobacco-use severity, indicated by scores on the Fagerstrom Test for Nicotine Dependence (FTND), and with BIS-11 scores. Adolescents with concurrent tobacco and cannabis use show altered feedback processing and higher impulsivity. Future work should disentangle whether the effect reflects risk, consequences of use or both.
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Differences in corticostriatal neural activity during feedback processing of rewards and losses have been separately related to cannabis and tobacco use but remain understudied relative to co-use in adolescents. Using high-density EEG (128 electrode system, 1000 Hz sampling), we examined event-related potentials (ERPs) elicited by monetary reward, neutral, and loss feedback during performance on a non-learning four-choice guessing task in a sample of non-deprived daily-cigarette-smoking adolescents (n = 36) who used tobacco and cannabis regularly (TC adolescents), and non-smoking healthy control adolescents (HCs) (n = 29). Peak amplitudes and latencies of mediofrontal ERPs indexing feedback-related negativities (FRNs) were used as outcomes in repeated-measures ANOVAs. No differences in FRNs were observed between TC and HC adolescents. Within TC adolescents, cannabis-use and tobacco-use variables had distinct relationships with the FRN, with cannabis-related problem severity being positively correlated with FRN amplitude during reward feedback and tobacco-related problem severity being negatively correlated with FRN latency during non-loss feedback (i.e., reward and neutral). These findings suggest that co-occurring cannabis and tobacco use may have dissociable relationships with feedback processing relating to each drug and support an incentive salience model of addiction severity related to cannabis use in adolescents.
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Previous research has demonstrated how negative affect (i.e., depression, anxiety, stress) is often a correlate of and precursor to nicotine dependence. Although recent evidence shows a gradual decline in tobacco use in the United States, subgroups that report higher levels of negative affect may continue to be at risk of becoming dependent on nicotine. One high-risk subgroup is students who attend alternative high schools. The current longitudinal investigation examined the effect of negative affect on nicotine dependence in this youth population.
1060 students from 29 alternative high schools in Southern California completed a series of attitudinal and behavioral measures once per year over a three-year period. The main outcome was nicotine dependence i.e., feeling a strong urge to use nicotine products or experiencing withdrawal symptoms after a period of abstinence, measured using a version of the Fagerstrom Tolerance Questionnaire designed for adolescents. A latent growth curve model was utilized to examine the effect of negative affect on nicotine dependence during this timeframe.
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^☆: This research was supported in part by the following grants: CA50087, HL323I8, ACS PBR-70, and ACS PBR-70-A.

^∗: The authors would like to thank Cheryl L. Perry, PhD. for her helpful comments on an earlier draft of this manuscript.

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Measuring nicotine dependence among high-risk adolescent smokers☆

Abstract

Addictive Behaviors

Addictive Behaviors

Preventive Medicine

Addictive Behaviors

Preventive Medicine

Preventive Medicine

Addictive Behaviors

Addictive Behaviors

Addictive Behaviors

Regression equations for the latent roots of random data correlation matrices with unities in the diagonal

Mttltivariate Behavioral Research

Vocational Education—Report by the Secretary of Education to the Congress

Tobacco cessation programs for adolescents

The scree test for the number of factors

Multivariate Behavioral Research

Coefficient alpha and the internal structure of tests

Psychometrica

Vocational education students: A difficult-to-reach population at risk for smoking-related cancer

Journal of School Health

How to measure nicotine dependence

Measuring nicotine dependence: A review of the Fagerström Tolerance Questionnaire

Journal of Behavioral Medicine

The Fagerström test for nicotine dependence: A revision of the Fagerström tolerance questionnaire

British Journal of Addiction