Strength of Urges to Smoke As a Measure of Severity of Cigarette Dependence: Comparison with the Fagerström Test for Nicotine Dependence and Its Components

Aims: Measuring the strength of urges to smoke during a normal smoking day among smokers in a culture where smoking is restricted could provide a good measure of the severity of cigarette dependence. An important criterion for a measure of cigarette dependence is how well it predicts failure of attempts to stop smoking. This study compared ratings of Strength of Urges to Smoke (SUTS) with the Fagerström Test of Nicotine Dependence (FTND) and its components, including the Heaviness of Smoking Index (HSI).

Design: A longitudinal study involving a household survey of a representative sample of adult smokers at baseline and 6-month follow-up by postal questionnaire.

Setting: England.

Participants: A total of 15,740 smokers aged 16 and over underwent the baseline interview; 2593 were followed-up 6 months later, of whom 513 reported having made a quit attempt following the baseline survey but at least 1 month prior to the follow-up.

Measurements: SUTS, FTND, HSI, cigarettes per day, time to first cigarette, age, social grade and gender were measured at baseline. Quit attempts since the baseline assessment and self-reported abstinence were measured at 6-month follow-up.

Findings: In logistic regressions, all dependence measures predicted success of subsequent quit attempts, but SUTS had the strongest association (beta for SUTS, FTND and HSI: 0.41: P < 0.001, 0.13: P = 0.005, and 0.19: P = 0.003, respectively). In multiple logistic regressions when SUTS was entered as a predictor of abstinence, together with other dependence measures, it remained as the only predictive dependence measure.

Conclusions: A simple rating of strength of urges on a normal smoking day appears to be a good predictor of at least short-term quit success in English smokers and as such may be a useful measure of cigarette addiction.