DOI: 10.14704/nq.2017.15.2.1070

Psychometric Properties of the Persian version of the Fagerstrom Test for Nicotine Dependence in Patients with Opioid Use Disorder / Cigarette Smokers Under Methadone Maintenance Treatment

Soleimani Robabeh, Jalali Mir Mohammad, Fallahi Mahnaz, Zamiri Akhlaghi Amir


The purpose of this study was the verification of the usefulness of the Persian version of the Fagerstrom Test for Nicotine Dependence (FTND) in patients with opioid use disorder /cigarette smokers undergoing methadone maintenance treatment. 354 patients with opioid use disorder / cigarette smokers at the Shafa Hospital, Guilan University of Medical Sciences participated in this study and took the Persian version of the FTND. The gold standard was the nicotine dependence criteria of the DSM-5. By DSM-5, 92.1% of smokers were diagnosed as dependent, while only 64% were diagnosed as dependent by FTND. In confirmatory factor analysis of the FTND, our results showed the two-factor solution providing the best fit. Three and four items were loaded on Factor 1 and Factor 2, respectively. One item (time to first cigarette) was load on both factors. After rescoring item 4, model fit showed better absolute fit than original model (χ2/df=1.55, P=0.10). Cronbach’s alpha coefficient of the FTND was 0.71. This study showed the validity and reliability of the Persian version of the FTND. Our results confirmed the usefulness of the FTND to identify individuals who have the greatest risk for disease and to assess of programs for smoking cessation.


Nicotine dependence; Psychometrics; Fagerstrom; Confirmatory factor analysis; opioid use disorder

Full Text:

Full Text PDF


American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®), American Psychiatric Pub; 2013.

Breslau N, Johnson EO. Predicting smoking cessation and major depression in nicotine-dependent smokers. American Journal of Public Health 2000; 90(7): 1122-27.

Breteler MH, Hilberink SR, Zeeman G, Lammers SM. Compulsive smoking: the development of a Rasch homogeneous scale of nicotine dependence. Addictive Behaviors 2004; 29(1):199-205.

Browne MW. Asymptotically distribution‐free methods for the analysis of covariance structures. British Journal of Mathematical and Statistical Psychology 1984; 37(1): 62-83.

Browne MW, Cudeck R, Bollen KA, et al. Alternative ways of assessing model fit, SAGE; 1993.

Buckley TC, Mozley SL, Holohan DR, Walsh K, Beckham JC, Kassel JD. A psychometric evaluation of the Fagerström Test for Nicotine Dependence in PTSD smokers. Addictive behaviors 2005; 30(5): 1029-33.

Burling AS, Burling TA. A comparison of self-report measures of nicotine dependence among male drug/alcohol-dependent cigarette smokers. Nicotine & Tobacco Research 2003; 5(5): 625-33.

Byrne BM. Structural equation modeling with AMOS: Basic concepts, applications, and programming, Routledge; 2016.

Chung T, Martin CS, Maisto SA, Cornelius JR, Clark DB. Greater prevalence of proposed DSM‐5 nicotine use disorder compared to DSM‐IV nicotine dependence in treated adolescents and young adults. Addiction 2012; 107(4): 810-18.

Colby SM, Tiffany ST, Shiffman S, Niaura RS. Measuring nicotine dependence among youth: a review of available approaches and instruments. Drug and Alcohol Dependence 2000; 59: 23-39.

Etter JF, Duc TV, Perneger TV. Validity of the Fagerstrom test for nicotine dependence and of the Heaviness of Smoking Index among relatively light smokers. Addiction 1999; 94(2): 269-81.

Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive behaviors 1978; 3(3): 235-41.

Guydish J, Passalacqua E, Tajima B, Chan M, Chun J, Bostrom A. Smoking prevalence in addiction treatment: a review. Nicotine & Tobacco Research 2011; 13(6): 401-11.

Haddock CK, Lando H, Klesges RC, Talcott GW, Renaud EA. A study of the psychometric and predictive properties of the Fagerström Test for Nicotine Dependence in a population of young smokers. Nicotine & Tobacco Research 1999; 1(1): 59-66.

Heatherton TF, Kozlowski LT, Frecker RC, FAGERSTROM KO. The Fagerström test for nicotine dependence: A revision of the Fagerstrom Tolerance Questionnaire, Addiction. 1991; 86(9): 1119-27.

Hoyle RH. Handbook of structural equation modeling, Guilford Press; 2012.

Huang CL, Lin HH, Wang HH. The psychometric properties of the Chinese version of the Fagerstrom Test for Nicotine Dependence. Addictive Behaviors 2006; 31(12): 2324-7.

Hughes JR, Oliveto AH, Riggs R, Kenny M, Liguori A, Pillitteri JL, MacLaughlin MA. Concordance of different measures of nicotine dependence: two pilot studies. Addictive Behaviors. 2004; 29(8): 1527-39.

John U, Meyer C, Schumann A, Hapke U, Rumpf HJ, Adam C, Alte D, Lüdemann J. A short form of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index in two adult population samples. Addictive behaviors. 2004; 29(6): 1207-12.

Johnson JL, Ratner PA, Tucker RS, Bottorff JL, Zumbo B, Prkachin KM, Shoveller J. Development of a multidimensional measure of tobacco dependence in adolescence. Addictive Behaviors. 2005; 30(3): 501-15.

Lemon SC, Friedmann PD, Stein MD. The impact of smoking cessation on drug abuse treatment outcome. Addictive Behaviors. 2003; 28(7): 1323-31.

Meneses-Gaya IC, Zuardi AW, Loureiro SR, Crippa JA. Psychometric properties of the Fagerström test for nicotine dependence. Jornal Brasileiro de Pneumologia 2009; 35(1): 73-82.

Moolchan ET, Radzius A, Epstein DH, Uhl G, Gorelick DA, Cadet JL, Henningfield JE. The Fagerstrom Test for Nicotine Dependence and the Diagnostic Interview Schedule: do they diagnose the same smokers?. Addictive Behaviors 2002; 27(1): 101-13.

Muthén LK, Muthén BO. How to use a Monte Carlo study to decide on sample size and determine power. Structural equation modeling 2002; 9(4): 599-620.

Mwenifumbo JC, Tyndale IV RF. DSM-IV, ICD-10 and FTND: discordant tobacco dependence diagnoses in adult smokers. J Addict Res Ther 2011; 2: 1.

Okuyemi KS, Pulvers KM, Cox LS, Thomas JL, Kaur H, Mayo MS, Nazir N, Etter JF, Ahluwalia JS. Nicotine dependence among African American light smokers: A comparison of three scales. Addictive Behaviors 2007; 32(10): 1989-2002.

Payne TJ, Smith PO, McCracken LM, McSherry WC, Antony MM. Assessing nicotine dependence: A comparison of the Fagerström Tolerance Questionnaire (FTQ) with the Fagerström Test for Nicotine Dependence (FTND) in a clinical sample. Addictive Behaviors 1994; 19(3): 307-17.

Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: The use of factor analysis for instrument development in health care research, Sage; 2003.

Piper ME, McCarthy DE, Baker TB. Assessing tobacco dependence: a guide to measure evaluation and selection. Nicotine & Tobacco Research 2006; 8(3): 339-51.

Pomerleau CS, Carton SM, Lutzke ML, Flessland KA, Pomerleau OF. Reliability of the Fagerstrom tolerance questionnaire and the Fagerstrom test for nicotine dependence. Addictive Behaviors 1994; 19(1): 33-39.

Radzius A, Epstein DH, Gorelick DA, Cadet JL, Uhl GE, Moolchan ET, Gallo JJ. A factor analysis of the Fagerström Test for Nicotine Dependence (FTND). Nicotine & Tobacco Research 2003; 5(2): 255-60.

Richardson CG, Ratner PA. A confirmatory factor analysis of the Fagerstrom Test for Nicotine Dependence. Addict Behav 2005;30(4):697-709.

Richardson CG, Ratner PA. A confirmatory factor analysis of the Fagerstrom Test for Nicotine Dependence. Addictive Behaviors 2005; 30(4): 697-709.

Sarbandi F, Niknami S, Hidarnia A, Hajizadeh E, Azaripour Masooleh H, Eslampanah Nobari S. Psychometric properties of the Iranian version of the fagerstrom test for nicotine dependence and of heaviness of smoking index. Journal of Research and Health 2015; 5(1): 96-103.

Schroeder SA. A 51-year-old woman with bipolar disorder who wants to quit smoking. JAMA 2009; 301(5): 522-31.

Shadel WG, Shiffman S, Niaura R, Nichter M, Abrams DB. Current models of nicotine dependence: what is known and what is needed to advance understanding of tobacco etiology among youth. Drug and Alcohol Dependence 2000; 59: 9-22.

Shiffman S, Waters AJ, Hickcox M. The nicotine dependence syndrome scale: a multidimensional measure of nicotine dependence. Nicotine & Tobacco Research 2004; 6(2): 327-48.

Weinberger AH, Reutenauer EL, Allen TM, Termine A, Vessicchio JC, Sacco KA, Easton CJ, McKee SA, George TP. Reliability of the fagerström test for nicotine dependence, minnesota nicotine withdrawal scale, and tiffany questionnaire for smoking urges in smokers with and without schizophrenia. Drug and Alcohol Dependence. 2007; 86(2): 278-82.

Wellman RJ, DiFranza JR, Pbert L, Fletcher KE, Flint A, Young MH, Druker S. A comparison of the psychometric properties of the hooked on nicotine checklist and the modified Fagerström tolerance questionnaire. Addictive Behaviors 2006; 31(3): 486-95.

Mohammad RHA, Masood Y, Hadi P, Karim H, Javaher K, Monireh Y, Lida B, Prevalence and Risk Factors of Oligospermia in Infertile Men. Journal of Clinical and Diagnostic Research 2014; 8(9): FC11-FC13. DOI: 10.7860/JCDR/2014/8611.4887.

Mohammad Reza Hafeziahmadi, Mojgan Javedani, Bahare Ghiasi, Samiramis Ghavam, (2017). Investigation Of The Relationship Between Phase Angle And Micro-Albuminuria In Type 2 Diabetic Patients With A History Of More Than 5 Years Of The Disease In Ilam Province, Iran, Acta Medica Mediterranea, 2017, 33: 357.

Ahmadi MR, Javedani M, Ghiasi B, Ghavam S. Investıgatıon of the relatıonshıp between phase angle and mıcro-albumınurıa ın type 2 dıabetıc patıents wıth a hıstory of more than 5 years of the dısease ın Ilam Provınce, Iran. Acta Medıca Medıterranea 2017; 33(2):351-7.

Mohammad AK, Javedani M. An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate–metformin in patients with polycystic ovary syndrome. Fertility and sterility 2010; 94(1): 216-20.

Supporting Agencies

Funding for this study was provided by the Guilan University of Medical Sciences (GUMS), Iran (grants number 93121101).

| NeuroScience + QuantumPhysics> NeuroQuantology :: Copyright 2001-2019