title: The relationship between nicotine dependence scores and biomarkers of exposure in adult cigarette smokers.
abstract: BACKGROUND
  Tobacco dependence is a multidimensional phenomenon. The Fagerström Test for Nicotine Dependence (FTND) is a widely administered six-item questionnaire used as a measure of nicotine dependence. It has been suggested that this test may not represent the entire spectrum of factors related to dependence. Also the relationship of this test with biomarkers of exposure to cigarette smoke has not been extensively studied.
  
  
  METHODS
  Data from a multi-center, cross-sectional, ambulatory study of US adult smokers (the Total Exposure Study, TES) was analyzed. The FTND score and a number of additional questions related to smoking behavior, from an adult smoker questionnaire (ASQ) completed by 3585 adult smokers in the TES were analyzed. The 24-h urine nicotine equivalents, serum cotinine and blood carboxyhemoglobin were measured as biomarkers of exposure (BOE) to nicotine and carbon monoxide. Cigarette butts returned were collected during the 24-h urine collection period.
  
  
  RESULTS
  The FTND showed moderate correlations with BOE, while selected questions from ASQ although statistically significant, had weaker correlations. FTND scores showed substantially weaker correlations without the question about cigarettes smoked per day (CPD). CPD and time to first cigarette (TTFC) had the most impact on BOE.
  
  
  CONCLUSIONS
  Additional questions from ASQ did not appear to contribute towards refining the FTND test. The correlation of the FTND scores with nicotine and carbon monoxide seems to be primarily driven by CPD. CPD and TTFC were the most important factors correlating with exposure.
authors.affiliation: Altria Client Services, Research Development and Engineering, 601 E. Jackson Street, Richmond, VA 23219, USA. raheema.s.muhammadkah@altria.com
authors.forename: Raheema S
authors.initials: RS
authors.lastname: Muhammad-Kah
authors.forename: Angela D
authors.initials: AD
authors.lastname: Hayden
authors.forename: Qiwei
authors.initials: Q
authors.lastname: Liang
authors.forename: Kimberly
authors.initials: K
authors.lastname: Frost-Pineda
authors.forename: Mohamadi
authors.initials: M
authors.lastname: Sarkar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002263:Carboxyhemoglobin / Q000032:analysis; D003367:Cotinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000652:urine; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D009538:Nicotine; D002263:Carboxyhemoglobin; D003367:Cotinine