title: A brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys.
abstract: OBJECTIVE
  It is important to perform a routine screening of nicotine dependence in psychiatric patients. The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. The Heavy Smoking Index (HSI) is a briefer measure including only two FTND items (time to first cigarette of day and number of daily cigarettes). In a prior study comparing HSI with FTND, a high HSI (score > or = 4) was a good and briefer alternative for detecting high nicotine dependence. The goals of this study were: (i) to compare the effectiveness of the HSI with the effectiveness of Items 1 and 4 alone for the screening of high nicotine dependence; (ii) to investigate the optimality of 4 as a cut-off score for the HSI so that the HSI can be used as a binary indicator of high nicotine dependence; and (iii) to compare the sensitivity and specificity of four indexes of high nicotine dependence, namely 'High HSI', 'Very Early Smoking', 'Heavy Smoking' and 'High in Either Item'.
  
  
  METHODS
  The FTND was administered to 819 current daily smokers from a general population survey. As in a prior study, an FTND score > or = 6 was considered the reference or 'gold standard' test for detecting high nicotine dependence. Receiver-operating characteristic analyses were performed.
  
  
  RESULTS
  This new study using more sophisticated statistical methodology verified that a cut-off of 4 for the HSI is appropriate and that the 'high' HSI has good sensitivity and specificity even across different population subclassifications.
  
  
  CONCLUSIONS
  With four questions (smoking, daily smoking, time to first cigarette of day and number of daily cigarettes) and minimal calculations, it may be possible to screen whether a smoker has high nicotine dependence. If other studies in other populations and settings verify this finding, this brief measure might be an ideal screening instrument for busy clinicians, epidemiologists developing questionnaires for health surveys and psychiatric researchers.
authors.affiliation: Mental Health Research Center at Eastern State Hospital, Lexington, KY 40508, USA. jdeleon@uky.edu
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Diaz
authors.forename: Mireia
authors.initials: M
authors.lastname: Jané
authors.forename: Esteve
authors.initials: E
authors.lastname: Saltó
authors.forename: Hélios
authors.initials: H
authors.lastname: Pardell
authors.forename: Lluís
authors.initials: L
authors.lastname: Salleras
authors.forename: Cristina
authors.initials: C
authors.lastname: Pinet
authors.forename: Jose
authors.initials: J
authors.lastname: de Leon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data*; D010819:Physician's Role; D011594:Psychometrics / Q000706:statistics & numerical data; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D013030:Spain; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology