Workplace Tobacco Management Project Research Findings (Evaluation) Report by Alcohol Tobacco and Other Drug Association ACT
Changes in nicotine dependence levels (mean Fagerstrom score and by category of dependence)
This section of the findings examines and reports changes in smoking behavior among pilot sites. Measures included the use of the Fagerstrӧm Test for Nicotine Dependence (FTND), self reported addiction and ability to quit (smokers).
The FTND is a six-item questionnaire designed to measure the severity of nicotine dependence. The FTND has both high internal validity and test-retest reliability. The initial version, the Fagerstrom Tolerance Questionnaire (FTQ) was developed in the late 70ʼs (Fagerstrom 1978), with a revised version now more commonly used (Heatherton, Lynn et al. 1991). Since its development the FTND has been used to assess nicotine dependence across a number of intervention studies (Marques-Vidal, Kutalik et al. 2011), and has been used to assess probability of smoking cessation (Kozlowski, Porter et al. 1994).
Two methods of examining dependence are presented. Figure 8 presents the mean Fagerstrom score. The second presents the different categories of dependence (Figure 9). A reliability and factor analysis of the Fagerstrom Test for nicotine dependence is also included in Appendix 4. The reliability analysis shows that the FTND is an acceptable instrument for use amongst this population. The cronbach alpha coefficient of the FTND amongst this population was .705.
Figure 8: WPTMP Smoker mean FTND scores
Nicotine dependence categoriesIn addition to mean FTND scores, FTND categories are used by practitioners to determine the most appropriate level of NRT (patches) to use. Figure 9 shows:
- Rates of high nicotine dependence amongst pilot site smokers is low.
- The dependence profile in the baseline survey was vastly different to the subsequent surveys.
Figure 9: Levels of nicotine dependence by survey period
Changes in levels of dependence categoriesAlso reported (Figure 10), are changes between low, low-moderate and Moderate to high nicotine dependence. Figure 10 shows that:
- At Follow up survey 2 and Final, the proportion of smokers in pilot sites were much more likely to have Low – Low to moderate levels of nicotine dependence when compared with Baseline and Follow up survey 1.
Figure 10: Changes in combined (low-low to moderate and moderate to high) categories of nicotine dependence by survey period
Self reported level of addiction and ability to quit
After the baseline survey, some staff wanted to be able to self identify their level of nicotine addiction (independently of Fagerstrom) and ability to quit. Two additional questions were developed to assess this, the questions were:
1. If you think about how addicted you are to smoking, and 1=not addicted and 7=totally addicted, rate your addiction level.
2. If you think about how hard you think it would be to quit smoking, and 1=not hard at all and 7=impossible, rate how hard it would be for you to quit smoking.
Figure 11 shows that:
- Smokers level of addiction to nicotine has reduced, as has their self assessed ability to quit smoking.
- There appears to be some inconsistency with the level of addiction and ability to quit when compared to mean FTND scores at the same intervals.
Figure 11: Perceived level of addiction and ability to quit amongst smokers
Smokers quit profilesSmokers were asked about wanting to quit, whether they were organising a quit attempt, how many quit attempts they had made in their lifetime and if they had made any quit attempts in the 12 weeks preceding the survey. Figure 12 shows that:
- Consistently, most smokers working in the pilot sites wanted to quit smoking (almost 90 percent at each survey).
- Between 60-70 percent of current smokers in the pilot sites were organising a quit attempt.
- About half of smoker quit attempts (lifetime) occurred during the project.
- On average, just over half of smokers reported reducing their tobacco consumption during the project.
Figure 12: WPTMP smokers quit profile and quit attempts by survey period
Changes in smoking rates amongst smokers
Figure 13 shows that;
- There is a reduction from baseline in the proportion of current smokers from just over 50 percent to 38 percent at follow up survey 2, this however increased again in the final survey to 45 percent.
Figure 13: Pilot site staff smoker profile by survey period