Chih-Ling Huang

Psychometric Testing of the Chinese Version of the Hooked on Nicotine Checklist in Adolescents

PURPOSE To examine the psychometric properties of the Hooked on Nicotine Checklist (HONC) on a Taiwanese sample. The HONC as a measure of nicotine dependence in adolescents is in worldwide use. Less is known regarding its psychometric properties for a Chinese population. METHODS A cross-sectional, descriptive study was conducted from January to May 2008 with 373 male adolescent smokers aged 15 to 20 years. The criterion validity of the Chinese HONC was determined using the Fagerstrom Test of Nicotine Dependence (FTND) and saliva cotinine. Because the responses to the items are dichotomous, the validity and factorial structures were examined using tetrachoric and biserial techniques by PRELIS 2 and LISREL 8.7. RESULTS Most of interitem correlations are between 0.3 and 0.7. Each item is highly associated with the full scale (r > .7). The HONC total score is significantly associated with the FTND (r=.58, p < .01) and with saliva cotinine levels (r=.27, p < .05). Confirmatory factor analyses were performed to compare the relative fit of three competing models. The three-correlated factor model has a better fit than other models, according to the cutoff criteria for relatively good fit. The coefficient alpha of the full scale is .83. CONCLUSIONS The Chinese version of the HONC is a reliable and valid measure of tobacco dependence in adolescent smokers. Studies involving female adolescent and younger smokers will be needed to evaluate the applicability of the scales to the different genders and age populations.

Effects of Interaction Between Dopamine D2 Receptor and Monoamine Oxidase A Genes on Smoking Status in Young Men.

Although the effect of gene–gene interaction on nicotine–dopamine metabolism for smoking behavior has been reported, polymorphisms of dopamine D2 receptor (DRD2) and monoamine oxidase A (MAOA) have not been simultaneously examined among smokers. In this study, 481 young Taiwanese men completed a self-report questionnaire on smoking status, and data were obtained on polymorphisms of DRD2 rs1800497, DRD2 rs1079597, MAOA rs309850, and MAOA rs1137070, urinary nicotine, and urinary cotinine. In a comparison of 261 current smokers and 220 never smokers, odds ratios (ORs) for the development of smoking in all genotypes were not statistically significant. Among smokers with DRD2 rs1079597 GG//MAOA rs309850 3-repeat, the OR of heavier smoking was 2.67 times higher (95% confidence interval [CI]: [1.08, 6.59], p = .031) and the score on the Fagerstrom test for nicotine dependence was higher (4.26 vs. 2.83) than in those with DRD2 rs1079597 AA//MAOA rs309850 3-repeat. Adjusted urinary cotinine concentration was significantly different between those two groups (median value: 95.83 ng/μl vs. 133.24 ng/μl, respectively, p = .045). These findings suggest that the interaction of DRD2 rs1079597 and MAOA rs309850 3-repeat affects smoking intensity in young Taiwanese men.

The Development of a Chinese-Language Instrument to Measure Social Smoking Motives Among Male Taiwanese Smokers:

Purpose: The purpose of this study was to develop a scale to measure the social smoking motives of adult male smokers using a Chinese social context. Design: Three phases were conducted between February 2006 and May 2009. First, the initial instrument development was guided by a literature review, interviews with smokers, and item analysis. Second, the validity and reliability of the refined scale were tested. The factor structures of the Social Smoking Measures (SSM-12) scale were validated. Results: The final scale consists of 12 items. Two factors that account for 49.2% of the variance emerged from the exploratory factor analysis. Cronbach’s alpha was .88, and test–retest reliability was .82. The results of the confirmatory factor analysis indicated that the SSM model was a two-correlated factor. Conclusion: Field testing revealed the SSM-12 to be a reliable and valid Chinese-language instrument to measure social smoking motives, which can be used to guide nursing interventions that support culturally and socially appropriate smoking cessation programs.

Cigarette dependence questionnaire: development and psychometric testing with male smokers

AIM This paper is a report of a study conducted to develop and test a theoretically derived Cigarette Dependence Questionnaire for adult male smokers. BACKGROUND Fagerstrom questionnaires have been used worldwide to assess cigarette dependence. However, these assessments lack any theoretical perspective. A theory-based approach is needed to ensure valid assessment. METHODS In 2007, an initial pool of 103 Cigarette Dependence Questionnaire items was distributed to 109 adult smokers in Taiwan. Item analysis was conducted to select items for inclusion in the refined scale. The psychometric properties of the Cigarette Dependence Questionnaire were further evaluated 2007-08, when it was administered to 256 respondents and their saliva was collected and analysed for cotinine levels. Criterion validity was established through the Pearson correlation between the scale and saliva cotinine levels. Exploratory factor analysis was used to test construct validity. Reliability was determined with Cronbachs alpha coefficient and a 2-week test-retest coefficient. RESULTS The selection of 30 items for seven perspectives was based on item analysis. One factor accounting for 44.9% of the variance emerged from the factor analysis. The factor was named as cigarette dependence. Cigarette Dependence Questionnaire scores were statistically significantly correlated with saliva cotinine levels (r = 0.21, P = 0.01). Cronbachs alpha was 0.95 and test-retest reliability using an intra-class correlation was 0.92. CONCLUSION The Cigarette Dependence Questionnaire showed sound reliability and validity and could be used by nurses to set up smoking cessation interventions based on assessment of cigarette dependence.

Psychometric Evaluation of the Cigarette Withdrawal Scale (Chinese Version) in Male Smokers in Taiwan.

Background: Symptoms of smoking withdrawal are a central feature of nicotine dependence. A valid and reliable measure of these symptoms is important to better understand nicotine dependence and to develop effective interventions. Purpose: The objective of this study was to examine the validity and reliability of the Chinese version of the Cigarette Withdrawal Scale (CWS-C). Methods: This study conducted cross-sectional surveys in two phases. In the first phase, exploratory factor analysis was used to test the underlying factor structure, the criterion validity, and the reliability of the CWS-C. A reliability test was conducted to assess the internal consistency and stability of the instrument. In the second phase, confirmatory factor analysis validated the factor model that had been proposed in earlier empirical research. The total sample size used in analysis was 497. Results: The CWS-C achieved a level of efficacy that was similar to the English version. Exploratory factor analysis showed that the six factors of the instrument accounted for 80.3% of the variance. The full scale and all of the subscale items, with the exception of the appetite–weight gain subscale (r = .12, p = .09), were significantly associated with the Fagerstrom Test for Nicotine Dependence (r = .25–.50, p < .05). The Cronbach’s alpha of the full scale was .93, with retest coefficient of .84. Confirmatory factor analysis confirmed that the CWS-C had six correlated factors. Field testing showed that the CWS-C is a reliable and valid Chinese-language instrument for assessing the symptoms of cigarette withdrawal. Conclusions/Implications for Practice: The CWS-C performed well in terms of reliability and validity in several tests conducted on male Taiwanese smokers. Accurate measurement is expected to help health professionals better understand smoker quitting patterns and the severity of withdrawal symptoms and to develop improved withdrawal-symptom treatment interventions.

Development and psychometric evaluation of the psychological cigarette dependence scale for male smokers in taiwan.

Background: The influence of psychological factors on cigarette dependence often surpasses the direct effects of the nicotine itself. Researcher opinions on the nature and extent of psychological contributors to cigarette dependence vary widely. Purpose: This study develops and psychometrically tests the Psychological Cigarette Dependence Scale (PCDS) for male smokers in Taiwan. Methods: The PCDS was developed using domain identification, individual interviews for item generation, expert reviews, and testing for construct validity and instrument stability. After initial item analysis, the PCDS was tested for concurrent and construct validity and reliability on 256 adult male smokers recruited from community centers, trade and business organizations, private companies, and factories in southern Taiwan. Participants were limited to adult men because female smokers are a small (4.1%) proportion of the female population in Taiwan and thus are difficult to recruit in statistically significant numbers. Results: Exploratory factor analysis showed that lifelong binding and health concerns are the two predominating factors addressed by the 37-item PCDS. The PCDS correlated positively with the Fagerstrom questionnaire (r = .54, p < .01). Cronbach’s alpha was .94, and test–retest reliability (intraclass coefficient) was .77 (N = 28). Conclusions/Implications for Practice: Preliminary evidence suggests that this scale is a valid measure of psychological cigarette dependence. Assessment results may help nursing professionals focus on smoking cessation interventions that are tailored to the patterns and severity of patients’ psychological cigarette dependence.

Effects of a Nurse-Led, Stage-Matched, Tailored Program for Smoking Cessation in Health Education Centers: A Prospective, Randomized, Controlled Trial:

The purpose of this study was to examine the effectiveness of a stage-matched intervention performed at outpatient clinics. Participants were randomly assigned to an intervention group (IG) or usual care group (UCG). The trial was targeted on smoking patients with coronary heart disease or diabetes. After completing the 3-month intervention, both groups received a telephone follow-up at 6 months. This analysis showed that the outcomes of the IG for the 7-day point prevalence (PP) of abstinence (odds ratio [OR] = 2.00; p = .001) and 30-day PP (OR = 2.27; p = .004) at 6 months were significantly better than the UCG. Stage of change (OR = 4.06; p < .001) and decreased daily cigarette consumption by 50% at 6 months (OR = 2.26; p = .019) outcomes also improved significantly. The preliminary results showed that a nurse-led cessation intervention in clinics may be an effective approach to help outpatients quit smoking.

Using the Short-Form Cigarette Dependence Questionnaire in a Busy Clinical Practice

The aim of this study was to refine the long version of the Cigarette Dependence Questionnaire (CDQ-29) that includes 29-items by removing some redundant questions, and then examining the predictive utility of the resulting scale in terms of its ability to explain saliva cotinine level, and testing the measurement structure of the remaining items. Across three diverse independent samples of smokers, we developed a one-factor CDQ-12 that showed good internal consistency and concurrent validity that was comparable with the CDQ-29. The proposed model was a good fit for the data. The reliability coefficient was .92, and the score of the 12-item CDQ had a moderate correlation with the total score of cigarette withdrawal (r = .63, p < .01). The CDQ-12 is a reliable and valid Chinese-language instrument to assess cigarette dependence, which can be used to guide nursing interventions that support culturally and socially appropriate smoking cessation programs.

A path model of smoking behaviour among senior high school students in Taiwan

Objective: The purpose of this study was to explore the ways in which social smoking expectations mediate the relationship between adolescent smoking behaviour and the smoking behaviour of family and peers. Design: Descriptive, cross-sectional survey. Setting: Taiwan, Republic of China. Method: The participants were 921 senior high school students who completed a questionnaire to measure smoking status, family and peer smoking and social smoking expectations. The survey was conducted from November to December in 2009. Structural equation modelling was performed to test a mediation model. Analysis was performed using PRELIS 2 and LISREL 8.7 software. Results: After adjusting for students’ gender, age and school type, it is clear that social expectations mediate the relationship between sibling smoking, peer smoking and adolescent smoking. The path coefficients of sibling and peer smoking on social expectations in the mediator model were moderate, β = .15–.41, p < .05, but the coefficient of social expectations on adolescent smoking was strong, β = .95, p < .001. The total indirect effects between exogenous latent variables and adolescent smoking were .54, indicating a strong association that, in this model, is explained by the mediation of social expectations. Conclusion: Determining the mechanisms that influence adolescent smoking is of scientific interest because knowledge of these mechanisms is a prerequisite for the development of recommendations aimed at prevention. With this knowledge, health professionals can develop smoking-prevention policies and education programmes based on reducing the mediating effect of social smoking expectations on the relationship of family smoking and peer smoking with adolescent smoking.