PURPOSE: Current USPHS tobacco treatment guidelines suggest clinicians identify and treat tobacco use at every visit. Unfortunately, there is a paucity of guidance on response to worsening “control” over abstinence. Available measures of compulsion to smoke are cumbersome to score, therefore infeasible for use within clinical settings. We previously reported the development and construct validation of a brief instrument with potential utility in guiding tobacco use treatment interventions by physicians. We now describe the criterion validity of our instrument, compared to other well-accepted measures of control.
METHODS: From an initial pool of 40 candidate items, we identified 15 that are easily administered, relevant, and important in guiding treatment decisions. We administered these, along with the Questionnaire of Smoking Urges (QSU-short), to a group of 34 smokers currently receiving treatment. In addition, treating physicians were asked to estimate degree of the patients’ control over abstinence using five-point Likert scale responses. Individual items were correlated to both criteria, and items with Pearson's coefficients (R) above 0.6 were retained as informative. Correlation between criteria was performed to assess independence.
RESULTS: Six items met the definition of informative. Two items, related to intensity of urges and number of cigarettes smoked per day, were removed to form independent subjective and objective measures of control. The remaining four items related to urgency to smoke, constitute a simple scale that, in aggregate, displays good correlation with both QSU-short (R 0.68, p<0.001) and physician assessment of control (R 0.76, p<0.001). To further improve ease of use, scale scoring was transformed into a dichotomous point assignment, while retaining good correlation characteristics (R 0.63 and 0.68, p<0.001).
CONCLUSION: Existing measures of control over abstinence are very precise but impractical. Conversely, clinical judgment may be accurate but is hard to quantify. This four-item scale, easy to use and score, and accurately identifies level of control over abstinence.
CLINICAL IMPLICATIONS: This scale may serve as a useful tool in guiding treatment decisions during a physician guided cessation attempt.
DISCLOSURE: Frank Leone, No Financial Disclosure Information; No Product/Research Disclosure Information