The Agreement between the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index among Iranian Male Smokers

Document Type : Original Article

Authors

1 Department of Public Health, School of Health, Research Center for Environmental Contaminants, Abadan University of Medical Sciences, Abadan, Iran

2 Department of Public Health, Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran

10.34172/ahj.1493

Abstract

Background: Nicotine dependence is one of the most significant barriers to smoking cessation. Therefore, measuring this 
dependence is crucial for effective smoking cessation interventions. The current study aimed to evaluate the degree of agreement 
between the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) among Iranian smokers.
Methods: We analyzed the data obtained from two previous studies among 580 daily smokers in Iran. Data were collected using 
the FTND scale. Cohen’s kappa was utilized to assess the degree of agreement between HSI and FTND.
Findings: The HSI showed significant agreement with FTND (Cohen’s kappa=0.72) in assessing nicotine dependence, with a 
sensitivity of 88.6% and a specificity of 90.3%. 
Conclusion: The HSI is a valid and reliable tool for measuring nicotine dependence, exhibiting significant agreement with FTND. 
As a result, the HSI can be considered an alternative to the FTND in both clinical and research settings, particularly for heavy 
smokers.

Highlights

Bagher Pahlavanzade: (Google Scholar) (PubMed)

Abdurrahman Charkazi: (Google Scholar) (PubMed)

Keywords


1. Institute for Health Metrics and Evaluation (IHME). Findings 
from the Global Burden of Disease Study 2017. IHME; 2018.
2. World Health Organization (WHO). WHO Global Report on 
Trends in Prevalence of Tobacco Smoking 2000-2025. WHO; 
2018.
3. Riazi-Isfahani S, Abdi Z, Sheidaei A, Ahmadnezhad E. 
Prevalence of tobacco use in adults; 2016 nationally 
representative household survey in Iran. Int J Prev Med. 
2022;13:104. doi: 10.4103/ijpvm.IJPVM_514_20.
4. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. 
The Fagerström test for nicotine dependence: a revision 
of the Fagerström tolerance questionnaire. Br J Addict. 
1991;86(9):1119-27. doi: 10.1111/j.1360-0443.1991.tb01879.x .
5. Glover ED, Nilsson F, Westin A, Glover PN, Laflin MT, Persson 
B. Developmental history of the Glover-Nilsson smoking 
behavioral questionnaire. Am J Health Behav. 2005;29(5):443-
55. doi: 10.5555/ajhb.2005.29.5.443.
6. Etter JF. A comparison of the content-, construct- and predictive 
validity of the cigarette dependence scale and the Fagerström 
test for nicotine dependence. Drug Alcohol Depend. 
2005;77(3):259-68. doi: 10.1016/j.drugalcdep.2004.08.015.
7. Wellman RJ, DiFranza JR, Savageau JA, Godiwala S, Friedman 
K, Hazelton J. Measuring adults’ loss of autonomy over nicotine 
use: the Hooked on Nicotine Checklist. Nicotine Tob Res. 
2005;7(1):157-61. doi: 10.1080/14622200412331328394.
8. Fagerstrom KO, Heatherton TF, Kozlowski LT. Nicotine addiction 
and its assessment. Ear Nose Throat J 1990;69(11):763-5. 
9. Fagerstrom KO, Heatherton TF, Kozlowski LT. Nicotine addiction 
and its assessment. Ear Nose Throat J. 1990;69(11):763-5.
10. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson 
J. Measuring the heaviness of smoking: using self-reported 
time to the first cigarette of the day and number of cigarettes 
smoked per day. Br J Addict. 1989;84(7):791-9. doi: 10.1111/
j.1360-0443.1989.tb03059.x.
11. Kozlowski LT, Porter CQ, Orleans CT, Pope MA, Heatherton 
T. Predicting smoking cessation with self-reported measures 
of nicotine dependence: FTQ, FTND, and HSI. Drug 
Alcohol Depend. 1994;34(3):211-6. doi: 10.1016/0376-
8716(94)90158-9.
12. Burling AS, Burling TA. A comparison of self-report measures 
of nicotine dependence among male drug/alcohol-dependent 
cigarette smokers. Nicotine Tob Res. 2003;5(5):625-33. doi: 
10.1080/1462220031000158708.
13. Kõks G, Tran HD, Ngo NB, Hoang LN, Tran HM, 
Ngoc TC, et al. Cross-sectional study to characterise 
nicotine dependence in central Vietnamese men. 
Subst Abuse. 2019;13:1178221818822979. doi: 
10.1177/1178221818822979.
14. Diaz FJ, Jané M, Saltó E, Pardell H, Salleras L, Pinet C, et al. A 
brief measure of high nicotine dependence for busy clinicians 
and large epidemiological surveys. Aust N Z J Psychiatry. 
2005;39(3):161-8. doi: 10.1080/j.1440-1614.2005.01538.x.
15. Pérez-Ríos M, Santiago-Pérez MI, Alonso B, Malvar A, Hervada 
X, de Leon J. Fagerstrom test for nicotine dependence vs heavy 
smoking index in a general population survey. BMC Public 
Health. 2009;9:493. doi: 10.1186/1471-2458-9-493.
16. Lim KH, Cheong YL, Sulaiman N, Yah XY, Mahadzir ME, Lim 
JH, et al. Agreement between the Fagerström test for nicotine 
dependence (FTND) and the heaviness of smoking index (HSI) 
for assessing the intensity of nicotine dependence among 
daily smokers. Tob Induc Dis. 2022;20:105. doi: 10.18332/
tid/155376.
17. Charkazi A, Shahnazi H, Berdi Ghourchaei A, Mirkarimi K. 
Smoking behaviors in Iranian male students: an application of 
transtheoretical model. J Educ Health Promot. 2012;1:22. doi: 
10.4103/2277-9531.99954.
18. Charkazi A, Bahador E, Moudi M, Shahnazi H, Orouji 
MA, Habibi A, et al. Smoking decisional balance and its 
relationship with stages of change among smokers. J Health 
Care. 2013;15(3):64-70. [Persian].
19. Sharifirad GR, Charkazi A, Mirkarimi K, Seyyedghasemi 
N, Shahnazi H, Hajili Davaji F, et al. Application of 
transtheoretical model to determination of smoking behavior. 
J Gorgan Univ Med Sci. 2016;18(3):103-10. [Persian].
20. Sharifirad GR, Eslami AA, Charkazi A, Mostafavi F, Shahnazi 
H. The effect of individual counseling, line follow-up, and free 
nicotine replacement therapy on smoking cessation in the 
samples of Iranian smokers: examination of transtheoretical 
model. J Res Med Sci. 2012;17(12):1128-36.
21. John U, Meyer C, Schumann A, Hapke U, Rumpf HJ, Adam 
C, et al. A short form of the Fagerström test for nicotine 
dependence and the heaviness of smoking index in two adult 
population samples. Addict Behav. 2004;29(6):1207-12. doi: 
10.1016/j.addbeh.2004.03.019.
22. Lim KH, Idzwan MF, Sumarni MG, Kee CC, Amal NM, Lim 
KK, et al. Heaviness of smoking index, number of cigarettes 
smoked and the Fagerstrom test for nicotine dependence 
among adult male Malaysians. Asian Pac J Cancer Prev 
2012;13(1):343-6. doi: 10.7314/apjcp.2012.13.1.343.
23. Chabrol H, Niezborala M, Chastan E, de Leon J. Comparison 
of the heavy smoking index and of the Fagerström test 
for nicotine dependence in a sample of 749 cigarette 
smokers. Addict Behav. 2005;30(7):1474-7. doi: 10.1016/j.
addbeh.2005.02.001.
24. de Leon J, Diaz FJ, Becoña E, Gurpegui M, Jurado D, GonzalezPinto A. Exploring brief measures of nicotine dependence for 
epidemiological surveys. Addict Behav. 2003;28(8):1481-6. 
doi: 10.1016/s0306-4603(02)00264-2.