Tobacco treatment in the setting of lung cancer screening.

PURPOSE OF REVIEW: Lung cancer screening by low-dose CT is an increasingly implemented preventive medicine tool. Screening for lung cancer is incomplete without addressing problematic tobacco use, the greatest modifiable risk factor in the development of lung cancer. This review describes recent work related to lung cancer screening and treatment of tobacco use in that context. RECENT FINDINGS: Implementation of lung cancer screening demonstrates socioeconomic disparities in terms of adherence to screening as well as likelihood of successful tobacco dependence treatment. Active tobacco dependence is a common comorbidity for patients undergoing lung cancer screening. The optimal implementation of tobacco dependence treatment in the context of lung cancer screening is still an area of active investigation. SUMMARY: Treatment of tobacco dependence at time of lung cancer screening is a major opportunity for clinicians to intervene to reduce the major modifiable risk factor for lung cancer, tobacco use. Providing comprehensive tobacco dependence treatment is most effective using combination pharmacologic and behavioral interventions. Practices providing comprehensive treatment will benefit from accurate documentation for billing and coding and supplementing with external resources such as state Quit Lines.

Alcohol and Nicotine Dependence and Time to Death in a General Adult Population: A Mortality Cohort Study.

INTRODUCTION: Findings from general population studies are lacking in regard to the co-occurrence of alcohol and nicotine dependence in relation to later mortality. The aim of this study was to analyze potential interactions of risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and time until the first cigarette is smoked in the morning after awakening in the prediction of mortality. METHODS: This study analyzed a random sample of the general population in Northern Germany, which comprised adults aged 18-64 years. Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning after awakening were assessed for the period of 1996-1997 by applying the Munich-Composite International Diagnostic Interview. Data about all-cause mortality were gathered for the period of 2017-2018 and analyzed using Cox proportional hazards models. RESULTS: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning were associated with each other and predicted the time to death. Among participants with a former alcohol dependence, 29.59% had a current nicotine dependence. Participants who had ever been dependent on alcohol at some point in their life before and currently smoked their first cigarette in the morning within 30 min or less after awakening had a hazard ratio of 5.28 (95% confidence interval: 3.33-8.38) for early death compared to low-risk alcohol consumers who had never smoked. CONCLUSION: Risky alcohol drinking, tobacco smoking, alcohol and nicotine dependence, and the time until the first cigarette in the morning may have a cumulative impact on time to death. The findings suggest that it could be beneficial to provide support for quitting both risky alcohol drinking and tobacco smoking among nondependent individuals in addition to supporting remission from dependence.

Tobacco/nicotine dependence as a risk factor for substance use disorders and related mental health conditions among cancer patients.

BACKGROUND: Cancer patients often face multiple comorbidities and are at risk for various mental health conditions and substance use disorders. Tobacco/nicotine dependence (TND) is a known risk factor for poor health outcomes and has been associated with psychiatric disorders including substance use disorder. However, the specific relationship between TND and the risk of substance use disorder and mental health conditions among cancer patients remains underexplored. This study aimed to assess the association between TND and the risk of comorbid conditions among cancer patients. METHODS: Data were obtained from a database of electronic health records for patients from the University of California health system. The odds for every condition among cancer patients with TND were calculated and compared with those for cancer patients without TND. ORs were adjusted for gender, ethnicity, and race. RESULTS: Three thousand seven hundred and ninety-one cancer patients with TND had 252,619 total conditions, and 51,711 cancer patients without TND had 2,310,880 conditions. After adjusting for confounders, the condition for which TND most exacerbated risk was psychoactive substance-induced organic anxiety disorder (OR = 16.3, p < 0.001). This appeared consistent with the second, third, and fifth most-exacerbated conditions: stimulant use disorder (OR = 12.8, p < 0.001), cocaine induced mental disorder (OR = 11.0, p < 0.001), and cocaine use disorder (OR = 11.0, p < 0.001). Different conditions exacerbated by TND include acute alcoholic intoxication (OR = 11.4, p < 0.001), opioid use disorder (OR = 7.6, p < 0.001), schizoaffective disorder (OR = 7.4, p < 0.001), and cannabis use disorder (OR = 6.3, p < 0.001). CONCLUSIONS: Our findings reveal a strong association between TND and an increased risk of substance use disorder and mental health conditions among cancer patients. Specifically, cancer patients with TND were at an elevated risk for psychoactive substance-induced organic anxiety disorder, stimulant use disorder, and cocaine-related disorders. Additionally, TND was associated with an increased risk of acute alcoholic intoxication, opioid use disorder, schizoaffective disorder, and cannabis use disorder. These findings underscore the need for comprehensive screening and interventions to address TND and comorbid conditions among cancer patients.

Psychometric properties of smokeless tobacco dependence measures: A COSMIN systematic review.

BACKGROUND: A comprehensive assessment of the quality of the psychometric properties of smokeless tobacco (SLT) dependence measures is necessary to help researchers and health professionals decide on the most appropriate measure to use when assessing dependence and planning cessation treatment. The aim of this systematic review was to identify and critically appraise measures for assessing dependence on SLT products. METHODS: The study team searched MEDLINE, CINAHL, PsycINFO, EMBASE and SCOPUS databases. We included English-language studies describing the development or psychometric properties of an SLT dependence measure. Two reviewers independently extracted data and appraised risk of bias using the rigorous Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. RESULTS: Sixteen studies assessing 16 unique measures were eligible for assessment. Eleven studies were conducted in the United States; two in Taiwan and one each in Sweden, Bangladesh, and Guam. Of the sixteen measures, none of the measures was rated as "A" (can be recommended for use) as per COSMIN standards primarily due to limitations in structural validity and internal consistency. Nine measures (FTND-ST, FTQ-ST-9, FTQ-ST-10, OSSTD, BQDS, BQDI, HONC, AUTOS and STDS) were rated as "B": having potential for assessing dependence, although further assessment of psychometric properties is needed. Four measures, MFTND-ST, TDS, GN-STBQ and SSTDS having high quality evidence for an insufficient measurement property were rated as "C" and were not supported for use as per COSMIN standards. The remaining three brief measures HSTI, ST-QFI and STDI (consisting of <3 items) were rated inconclusive due to the inability of assessment of structural validity (minimum 3 items required for factor analysis), which is a prerequisite for assessment of internal consistency per the recommendations by the COSMIN framework. CONCLUSION: Further validation is required for the current tools that assess dependence on SLT products. Given the concerns related to the structural validity of these tools, a need may also exist to develop new measures for use by clinicians and researchers for assessing dependence on SLT products. PROSPERO: CRD42018105878.

Nicotine Dependence among College Students Uninterested in Smoking Cessation during the COVID-19 Pandemic: A Cross-Sectional Survey.

This study investigated nicotine dependence among Japanese university students who had reached the smoking age (20 years or older) by the time of the coronavirus disease 2019 (COVID-19) pandemic and examined factors that encourage early smoking cessation. Social dependence on nicotine was evaluated using the Kano Total Social Nicotine Dependence Level (KTSND), and physiological dependence was evaluated using the Fagerström Nicotine Dependence Index (FTND). Of the 356 college students who smoked (4.4% of the total), 182 (51.1%) stated that they were not interested in quitting. Furthermore, 124 (68.1%) of those with no interest in quitting smoking were aware that smoking is a high-risk factor for COVID-19, and 58 (31.9%) were unaware. The group not aware of this risk had significantly higher KTSND scores than the group aware of it. The examination of cigarette type that indicated the users of non-conventional cigarette products and dual-user groups scored significantly higher than the cigarette group on FTND items. Overall, the smokers scored above the normal range for social nicotine dependence, suggesting the need to reduce nicotine dependence to encourage college students who continue to smoke to quit smoking.

[Study of correlation between different scales that measure smoking dependence]. / Estudio de correlación entre diferentes escalas que miden la dependencia al tabaquismo.

OBJECTIVE: To analyze the correlation between the degrees of smoking dependence, measured with the Fagerström Test Nicotine Dependence (FTND), Glover-Nilsson Smoking Behavioral Dependence (GN-SBQ) and a measure of self-perceived-dependence (SPD). DESIGN: Cross-sectional descriptive observational study. SITE: Urban primary health-care center. PARTICIPANTS: Men and women between 18 and 65 years old, daily smokers, selected by non-random consecutive sampling. INTERVENTIONS: Self-administration of various questionnaires though an electronic device. MAIN MEASUREMENTS: Age, sex and nicotine dependence assessed by: FTND, GN-SBQ and SPD. Statistical analysis, with SPSS 15.0: descriptive statistics, Pearson correlation analysis and conformity analysis. RESULTS: Two hundred fourteen smokers were included, 54.7% were women. Median age 52 years (range: 27-65). Depending on the test used, different results of the high/very high degree of dependence were found: FTND 17.3%, GN-SBQ 15.4% and SPD 69.6%. A moderate magnitude (r≈0.5) correlation between the 3 test was found. When assessing concordance, comparing the FTND with SPD, 70.6% of smokers didn't coincide in the severity of dependence, reporting a milder degree of dependence with the FTND than with SPD. Comparing GN-SBQ versus FTND, showed conformity in 44.4% of patients while in 40.7%, the FTND underestimated the severity of dependence. Likewise, when comparing SPD with the GN-SBQ, in the 64% GN-SBQ underestimates, while in 34.1% smokers conformity was demonstrated. CONCLUSIONS: The number of patients who consider their SPD to be high/very high was four times higher compared to the GN-SBQ or the FNTD; the latter, being the most demanding, categorizing patients with very high dependence. Requiring a FTND score greater than 7 to prescribe drugs for smoking cessation may exclude subsidiary patients from receiving treatment.

The Roswell eND scale: Brief, valid assessment of nicotine dependence adults seeking to discontinue e-cigarette use.

BACKGROUND: Most adults who regularly use e-cigarettes or Electronic Nicotine Delivery Systems (ENDS) desire to discontinue use. ENDS use can result symptoms of nicotine withdrawal and dependence which can make it more difficult to discontinue use. Brief, valid assessment of nicotine dependence among adults who use ENDS is needed to guide treatment for nicotine dependence in this group. We sought to develop a brief, valid instrument to measure nicotine dependence among adults seeking to discontinue ENDS in a busy Quitline. METHODS: In this cross-sectional design, we examined content, construct, and concurrent validity of the Roswell ENDS Nicotine Dependence Scale (Roswell eND Scale) and the Penn State E-Cigarette Dependence Index (Penn State eCDI). Participants who called the New York Quitline from November 2019 to June 2020 seeking to discontinue ENDS use were invited to participate. Construct validity was examined with exploratory and confirmatory factor analyses. Instrument and factor scores were then correlated with cotinine, a biomarker of nicotine exposure. RESULTS: All participants (n = 209) were highly dependent and co-used combustible cigarettes to varying degrees. Both instruments demonstrated content validity and construct validity, however only the 5-item Roswell eND Scale demonstrated criterion-related validity by showing a significant positive correlation with salivary cotinine levels. CONCLUSIONS: The 5-item Roswell eND Scale can briefly and effectively assess nicotine dependence among treatment-seeking adults who co-use ENDS and cigarettes. These preliminary psychometric findings have the potential to be generalizable to other adults seeking to discontinue ENDS use, many of whom currently or formerly smoked cigarettes.

Examination of the impact of myblu electronic nicotine delivery system e-liquid nicotine strength on self-reported measures of dependence.

BACKGROUND: Greater nicotine delivery is associated with higher nicotine concentrations in electronic nicotine delivery system (ENDS) liquids. However, there is a current debate as to whether this leads to increased dependence and mitigates ENDS public health potential. METHODS: Self-reported dependence among users of myblu ENDS containing different nicotine concentrations was examined with data from a multiwave cross-sectional survey of US young adults and adults. Questions examined responses related to dependence measures and participants' most often used myblu ENDS nicotine concentration (low: 0%, 1% and 1.2%; medium: 2%, 2.4% and 2.5%; or high: 3.6% and 4%). RESULTS: A global general linear model using nicotine concentration, age and days myblu that was used in the past 30 revealed a significant difference in PROMIS scores among nicotine concentration groups (F = 4.07, p = 0.02). However, pairwise comparisons to examine which specific groups differed significantly from others showed no significant differences. Logistic regression demonstrated that strong past 30-day cravings to use myblu among participants using high or medium nicotine concentrations were not significantly different from those using a low concentration (ORs 0.66 [0.42, 1.03], p = 0.07 and 0.95 [0.49, 1.82], p = 0.98, respectively). Time to daily first use for high or medium nicotine concentration users was not significantly different from those using a low concentration (ORs 0.89 [0.70, 1.14], p = 0.35 and 0.84 [0.57, 1.25], p = 0.40, respectively). CONCLUSIONS: Use of myblu ENDS with different nicotine concentrations is not associated with differing levels of dependence. Our findings contradict the notion that high ENDS e-liquid nicotine levels generate increased dependence.

Evaluation of the Psychometric Properties of Dependence Measures for Exclusive Electronic Cigarette Users.

INTRODUCTION: Extant electronic cigarette (ECIG) dependence measures are largely adapted from those designed for cigarette smoking, though few have been evaluated for their psychometric properties. AIMS AND METHODS: Never-smoking ECIG users (N = 134) participating in an online survey completed four dependence measures: Penn state electronic cigarette dependence index (PSECDI), e-cigarette dependence scale (EDS-4), diagnostic and statistical manual for tobacco use disorder (DSM-5), and Glover Nilsson behavioral questionnaire (GNBQ). They also reported on their ECIG use characteristics (eg, behaviors and reasons). RESULTS: Internal consistency was highest for the EDS-4 (Cronbach's α = 0.88) followed by the GNBQ (α = 0.75), PSECDI (α = 0.72), and DSM (α = 0.71). Confirmatory factor analyses revealed a single-factor structure for the PSECDI, EDS-4, and GNBQ. For the DSM-5, however, two items did not load significantly (ECIG use interferes with responsibilities; reduce/give up activities because of ECIG use). Significant correlations were observed between all measures and the number of ECIG use days/week and/or years using ECIGs, as well as between DSM-5 scores and the number of ECIG quit attempts and initiation age. Endorsement of using ECIGs because "I like flavors" was correlated positively with DSM-5 and GNBQ scores. CONCLUSIONS: All dependence measures evaluated herein demonstrated adequate reliability and construct validity. Future work should focus on determining which aspects of dependence are those that are unique to ECIG use, and subsequently developing a more comprehensive measure of ECIG dependence. IMPLICATIONS: The measures assessed herein-PSECDI, EDS-4, DSM-5, and GNBQ-demonstrated adequate to good reliability and construct validity among a sample of never-smoking ECIG users. The dependence domains covered across measures were related yet distinct. Findings demonstrate the need for future evaluation of these different domains to determine which are the most salient characteristics of ECIG dependence.

Documento de consenso sobre asma y tabaquismo del Foro Autonómico de Asma de la SEPAR / Consensus document on asthma and smoking of the Regional Asthma Forum of SEPAR

La prevalencia de tabaquismo activo en adultos con asma es similar ala de la población general. El tabaquismo se asocia con un peor control clínico de la enfermedad, una disminución acelerada de la función pulmonar y una respuesta irregular a la terapia con glucocorticoides. El consumo de tabaco impacta negativamente en la calidad devida de los pacientes asmáticos y provoca un incremento en el númerode visitas y de hospitalizaciones por exacerbaciones. Además, el tabaquismo aumenta el riesgo de cáncer de pulmón, comorbilidades cardiovasculares y muerte en pacientes asmáticos. A pesar de todo ello,las guías actuales del manejo del asma no incluyen recomendacionesespecíficas para el manejo de los pacientes asmáticos fumadores. Poreste motivo, se procedió a una revisión narrativa de la literatura paraun consenso mediante metodología de grupo nominal desarrolladaa lo largo del año 2019 para extraer recomendaciones prácticas quepermitieran mejorar el diagnóstico y el tratamiento del asma en fumadores, así como el tratamiento del tabaquismo en asmáticos. Lasconclusiones y recomendaciones fueron validadas en el congreso nacional de la SEPAR del mismo año. Entre las más relevantes, se incidió en la necesidad de abordar el tabaquismo en las personas conasma mediante consejo sanitario, tratamiento farmacológico y terapiaconductual, al ser un factor que impacta negativamente en la sintomatología, el pronóstico y la respuesta al tratamiento del asma. En elfumador con sospecha de asma, se debe evaluar la presencia de enfisema y el diagnóstico diferencial de otras enfermedades y considerarel impacto del tabaquismo en el resultado de las pruebas diagnósticas.También se concluye que el hábito tabáquico reduce la respuesta altratamiento con corticoides inhalados, por lo que se recomienda terapia combinada con broncodilatadores. (AU)

The prevalence of active smoking in adults with asthma is similar inthe total population. Smoking is associated with worse clinical control of the disease, a rapid reduction of lung function and a variableresponse to corticoids. Tobacco consumption negatively affects thequality of life of asthmatic patients as well as increasing the numberof medical visits and hospital admissions due to exacerbations. Moreover, smoking entails a higher risk of developing lung cancer, cardiovascular comorbidities and death in asthmatic patients. Nevertheless,current asthma guidelines do not include specific recommendationson the management of smoking asthmatic patients and the treatmentof the smoking habit in this subpopulation. For this reason, a narrativereview of the literature was carried out for consensus using a nominalgroup methodology developed throughout 2019 to extract practicalrecommendations that would allow the diagnosis and treatment ofasthma in smokers, as well as the treatment of smoking in asthmatics,to be improved. The conclusions and recommendations were validated at the SEPAR national congress of the same year. Among the mostrelevant, the need to address smoking in people with asthma throughhealth advice, pharmacological treatment and behavioral therapy wasemphasized, as this is a factor that negatively impacts the symptoms,prognosis and response to asthma treatment. In smokers with suspected asthma, the presence of emphysema and the differential diagnosisof other diseases should be evaluated and the impact of smoking onthe result of diagnostic tests should be considered. It is also concluded that smoking reduces the response to treatment with inhaled corticosteroids, which is why combined therapy with bronchodilators isrecommended (AU)

Resveratrol inhibits nicotine-induced conditioned place preference in mice

Abstract Nicotine addiction leads to in a huge burden on public health and the economy worldwide. Resveratrol (3,5,4'-tetrahydroxystilbene) is the most well-known polyphenolic stilbenoid. Resveratrol was shown to exhibit positive effects on numerous mechanisms that are important for drug and substance addiction. Thus, this study aimed to examine the effect of resveratrol on nicotine addiction. Intraperitoneal (i.p.) treatment with nicotine (0.5 mg/kg) significantly enhanced time spent in the nicotine-paired compartment. Resveratrol (50 and 75 mg/kg, i.p.) and varenicline (2 mg/kg, i.p.) co-administered with nicotine during the 3-day conditioning period effectively diminished the acquisition of nicotine-induced conditioned place preference (CPP). On the other hand, the administration of resveratrol (50 and 75 mg/kg, i.p.) and varenicline (2 mg/kg, i.p.) decreased the low dose (0.1 mg/kg, i.p.) nicotine-induced reinstatement. The results suggest that resveratrol and varenicline inhibit the acquisition and reinstatement of nicotine's reward properties. Resveratrol displayed similar results in the CPP phases as obtained with the reference drug varenicline. In conclusion, resveratrol could be beneficial as an adjuvant pharmacotherapy for nicotine addiction; however, more investigation is needed to completely explain this property.

S3 Guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" - Short Version.

INTRODUCTION: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. METHODS: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. RESULTS: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms.

Measuring Nicotine Dependence Among Adolescent and Young Adult Cigarillo Users.

INTRODUCTION: Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users. AIMS AND METHODS: Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14-28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning, and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption. RESULTS: Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the item response theory fit criteria. Two PROMIS items had nonignorable differential item functioning. The pool of 40 items had good score reliability for a range of 2 SDs. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p < .001; R2 = 0.33. CONCLUSIONS: This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users. IMPLICATIONS: This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.

Nicotine Dependence from Different E-Cigarette Devices and Combustible Cigarettes among US Adolescent and Young Adult Users.

E-cigarettes, the most popular tobacco product among adolescents, vary widely in design and nicotine composition; thus, different devices may have different addictive potential. However, few studies examine levels of nicotine dependence across devices among adolescent and young adult (AYA) e-cigarette users. To assess the extent of nicotine dependence among US AYA (ages 13-24) by e-cigarette device type, we conducted a large, national, cross-sectional survey (n = 4351) and used the Hooked on Nicotine Checklist (HONC) to assess levels of nicotine dependence among those who had used disposable, pod-based, and/or mods/other e-cigarette devices in the past 30 days. We also examined HONC scores among those who had used combustible cigarettes in the past 30 days, whether with or without using e-cigarettes. Patterns of nicotine dependence were comparable across those who had used a combustible cigarette and/or e-cigarette in the past 30 days, with 91.4% of combustible cigarette users, 80.7% of disposable e-cigarette users, 83.1% of pod-based e-cigarette users, and 82.5% of mods/other e-cigarette users showing signs of nicotine dependence, as measured by endorsing at least one HONC symptom. This pattern persisted when analyses were restricted to e-cigarette only users, with more than 70% of all e-cigarette only past-30-day users endorsing at least one HONC symptom, across all types of devices. A thorough understanding of the extent and presentation of nicotine dependence among AYA will help researchers, public health officials, and clinicians recognize and manage AYA nicotine dependence.

Managing missing items in the Fagerström Test for Nicotine Dependence: a simulation study.

BACKGROUND: The Fagerström Test for Nicotine Dependence (FTND) is frequently used to assess the level of smokers' nicotine dependence; however, it is unclear how to manage missing items. The aim of this study was to investigate different methods for managing missing items in the FTND. METHODS: We performed a simulation study using data from the Arizona Smokers' Helpline. We randomly sampled with replacement from the complete data to simulate 1000 datasets for each parameter combination of sample size, proportion of missing data, and type of missing data (missing at random and missing not at random). Then for six methods for managing missing items on the FTND (two involving no imputation and four involving single imputation), we assessed the accuracy (via bias) and precision (via bias of standard error) of the total FTND score itself and of the regression coefficient for the total FTND score regressed on a covariate. RESULTS: When using the total FTND score as a descriptive statistic or in analysis for both types of missing data and for all levels of missing data, proration performed the best in terms of accuracy and precision. Proration's accuracy decreased with the amount of missing data; for example, at 9% missing data proration's maximum bias for the mean FTND was only - 0.3%, but at 35% missing data its maximum bias for the mean FTND increased to - 6%. CONCLUSIONS: For managing missing items on the FTND, we recommend proration, because it was found to be accurate and precise, and it is easy to implement. However, because proration becomes less accurate with more missing data, if more than ~ 10% of data are missing, we recommend performing a sensitivity analysis with a different method of managing missing data.

Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use.

BACKGROUND: DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis. METHODS: The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses. RESULTS: DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner. CONCLUSION: DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.

Construct validity of the Cigarette Ratings Scale and associations with tobacco use and product feature outcomes.

BACKGROUND: Subjective ratings are inconsistently associated with behavioral outcomes such as tobacco use and there is no current standard. The Cigarette Ratings Scale is an ideal measure for further evaluation because it has been widely used in tobacco regulatory science and tobacco industry research. PURPOSE: This study investigated the construct validity of the Cigarette Ratings Scale and associations with tobacco use and product feature outcomes. METHODS: Using secondary analysis of baseline data from five research trials, we conducted an exploratory factor analysis in one sample and validated the factor solution in a second sample. We then examined the relationship of the averaged subscales with tobacco outcomes and cigarette product features among current adult cigarette smokers (N = 752) who smoked ≥ 5 cigarettes daily for ≥ 5 years. RESULTS: The results supported a three-factor solution: 1. Product harshness evaluation, 2. Smoking satisfaction, and 3. Positive sensory experience. Multivariable general linear models indicated that cigarettes per day was associated with a lower harshness rating b = -0.29 (95% CI: -0.51, -0.07) and higher positive sensory experience b = 0.32 (95% CI: 0.08, 0.56). FTND average dependence scores were associated with a more positive sensory experience b = 1.08 (95% CI: 0.28, 1.89). CO boost was associated with smoking satisfaction b = 0.77 (95% CI: 0.30, 1.26). CONCLUSIONS: The Cigarette Ratings Scale subscales were primarily associated with behavioral outcomes, biological exposure, and nicotine dependence. This can help addiction efforts to determine how subjective evaluations of tobacco products relate to use behaviors.

A Measure of Illness Awareness in Individuals With Nicotine Dependence-Nicotine Use Awareness and Insight Scale.

INTRODUCTION: Impaired illness awareness or the inability to recognize that one has a dependence on nicotine may be a major barrier to seeking cessation treatment. To better understand the role of impaired illness awareness on treatment-seeking behavior and clinical outcomes, we developed and examined the psychometric properties of a novel scale measuring illness awareness in individuals with dependence on nicotine. AIMS AND METHODS: We developed the Nicotine Use Awareness and Insight Scale (NAS), a 7-item self-report measure to assess the theoretical construct of illness awareness in individuals with dependence on nicotine (www.illnessawarenessscales.com). Data from participants 18 years of age or older were collected via a web-based survey company, Dynata. Participants with moderate dependence on nicotine were included, defined by a score of four or more on the Fagerström Test for Cigarette Dependence (FTCD) or the FTCD adapted for electronic cigarettes (eFTCD). RESULTS: A total of 100 participants (mean [SD] age = 49.1 [16.1] years, 52% women) that met the inclusion criteria for either FTCD (n = 50) or eFTCD (n = 50) were included. The NAS demonstrated good convergent (r = .74, p < .001) and discriminant validity (r = .03, p = .786). It also demonstrated good internal consistency (Cronbach's alpha = 0.78) and one-month test-retest reliability (intra-class correlation = 0.86). An exploratory factor analysis yielded the retention of two components. CONCLUSIONS: The NAS is a novel scale to asses illness awareness in individuals with dependence on nicotine. This study provides initial support for the psychometric validity and reliability of NAS. IMPLICATIONS: The NAS may be used in research and clinical practice to evaluate the impact of impaired illness awareness on treatment-seeking behavior and clinical outcomes.