Nicotine dependence among African American light smokers: A comparison of three scales

Approximately 50% of African American (AA) smokers are light smokers (smoke ≤ 10 cigarettes a day), yet this group is understudied despite being at-risk of smoking-related death and disease. This study is a secondary analysis of data from a clinical trial that assessed the efficacy of nicotine gum and counseling for smoking cessation among African American light smokers. The purpose of the current paper was to assess nicotine dependence among participants enrolled in the clinical trial using three measures of nicotine dependence. The Cigarette Dependence Scale (CDS), the Fagerstrom Test for Nicotine Dependence Scale (FTND), and the Nicotine Dependence Syndrome Scale (NDSS) were administered to 700 participants (67% female; mean age = 45 years). Exhaled carbon monoxide (CO) and serum cotinine were assessed. The CDS showed the strongest association with biochemical markers (r = 0.28 for cotinine and 0.25 for CO). Factor analysis of the NDSS revealed five factors: drive, priority, tolerance, continuity, and stereotypy. Compared to those who smoked 1-5 CPD, smokers who averaged 6-10 CPD scored higher on all three dependence (p < 0.001) and two biochemical measures (p < 0.001), and on three of the five NDSS subscales (Drive, p < 0.001; Stereotypy, p < 0.01; and Tolerance, p < 0.01). Given the different domains tapped by each instrument, the use of multiple measures might yield the most comprehensive assessment of nicotine dependence. Results suggest the validity of these scales for African American light smokers and point to the need for sensitivity to differential levels of nicotine dependence among subgroups of light smokers.