title: Evaluating screening performances of the Fagerstrom tolerance questionnaire, the Fagerstrom test for nicotine dependence and the heavy smoking index among Taiwanese male smokers.
abstract: OBJECTIVE
  To compare screening performances of the Fagerstrom Tolerance Questionnaire (FTQ), the Fagerstrom test for nicotine dependence (FTND) and the Heavy Smoking Index (HSI) with a view to determining the optimum cutoff scores using biomarkers as standards.
  
  
  BACKGROUND
  Previous studies proposed inconsistent cutoff scores for the FTQ, the FTND as signalling nicotine dependence and these scores were established by applying diverse standards.
  
  
  METHODS
  Receiver operating characteristic (ROC) analyses were used in pursuit of the study's objectives. Two hundred and forty-five male smokers were recruited in 2005 from among those attending public health stations in southern Taiwan. The three self-report measures of nicotine dependence were compared with the saliva cotinine and expired carbon monoxide (CO). The expired CO level was tested by means of a Micro Smokerlyzer, while salivary cotinine was analysed using an enzyme-linked immunosorbent assay.
  
  
  RESULTS
  The areas under the ROC curves for the FTQ, the FTND and the HSI were 0.71, 0.76 and 0.76 for the salivary cotinine and 0.71, 0.79 and 0.80 for the exhaled CO respectively. The sensitivity and specificity of the FTND and the HSI were slightly greater than those for the FTQ. The optimum cutoff scores for the FTQ, the FTND and the HSI as screening tools to establish nicotine dependence would be 5+, 4+ and 3+ respectively.
  
  
  CONCLUSIONS
  The results indicate that the FTND and the HSI may be more efficacious than the FTQ in assessing nicotine dependence. Further research is needed to confirm these findings, especially among female smokers and for nicotine substitution trials. Relevance to clinical practice. To decrease tobacco-attributable morbidity and mortality, nurses and healthcare professionals need to implement effective smoking cessation interventions. The FTND and the HSI as well as their cutoff scores will be suitably used to assess nicotine dependence in these interventions.
authors.affiliation: Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chih-Ling
authors.initials: CL
authors.lastname: Huang
authors.forename: Hsi-Hui
authors.initials: HH
authors.lastname: Lin
authors.forename: Hsiu-Hung
authors.initials: HH
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009538:Nicotine; D011581:Psychological Tests; D011594:Psychometrics; D012372:ROC Curve; D012907:Smoking / Q000453:epidemiology* / Q000401:mortality; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D009538:Nicotine