The purpose of this study was to assess the test-retest stability of the Fagerstrom Tolerance Questionnaire (FTQ) in two samples: (a) paid subjects in an American laboratory; data were collected via telephone screen and subsequently via questions embedded in a written history; and (b) smokers hospitalized for depression in Paris; data were collected via a written questionnaire upon admission and again after 3 weeks of treatment for depression. Reliability data are also presented for a recently revised version of the FTQ, the Fagerstrom Test for Nicotine Dependence (FTND), and compared with FTQ data collected in a subsample of subjects in the American database who received both versions of the questionnaire. Both the FTQ (in both samples) and the FTND proved to be highly reliable. The validity of the scales, using cotinine, number of years smoked, and the "addictive" factor on the Classification of Smoking by Motives questionnaire as criterion variables, was also supported. No relationship between FTQ score and severity of depression was detected in either sample. Internal consistency was somewhat higher for the FTND than for the FTQ, replicating previous findings in the literature.

Background Web-based programs for health promotion, disease prevention, and disease management often experience high rates of attrition. There are 3 questions which are particularly relevant to this issue. First, does engagement with program content predict long-term outcomes? Second, which users are most likely to drop out or disengage from the program? Third, do particular intervention strategies enhance engagement?Objective To determine: (1) whether engagement (defined by the number of Web sections opened) in a Web-based smoking cessation intervention predicts 6-month abstinence, (2) whether particular sociodemographic and psychographic groups are more likely to have lower engagement, and (3) whether particular components of a Web-based smoking cessation program influence engagement.Methods A randomized trial of 1866 smokers was used to examine the efficacy of 5 different treatment components of a Web-based smoking cessation intervention. The components were: high- versus low-personalized message source, high- versus low-tailored outcome expectation, efficacy expectation, and success story messages. Moreover, the timing of exposure to these sections was manipulated, with participants randomized to either a single unified Web program with all sections available at once, or sequential exposure to each section over a 5-week period of time. Participants from 2 large health plans enrolled to receive the online behavioral smoking cessation program and a free course of nicotine replacement therapy (patch). The program included: an introduction section, a section focusing on outcome expectations, 2 sections focusing on efficacy expectations, and a section with a narrative success story (5 sections altogether, each with multiple screens). Most of the analyses were conducted with a stratification of the 2 exposure types. Measures included: sociodemographic and psychosocial characteristics, Web sections opened, perceived message relevance, and smoking cessation 6-months following quit date.Results The total number of Web sections opened was related to subsequent smoking cessation. Participants who were younger, were male, or had less formal education were more likely to disengage from the Web-based cessation program, particularly when the program sections were delivered sequentially over time. More personalized source and high-depth tailored self-efficacy components were related to a greater number of Web sections opened. A path analysis model suggested that the impact of high-depth message tailoring on engagement in the sequentially delivered Web program was mediated by perceived message relevance.Conclusions Results of this study suggest that one of the mechanisms underlying the impact of Web-based smoking cessation interventions is engagement with the program. The source of the message, the degree of message tailoring, and the timing of exposure appear to influence Web-based program engagement.

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Background-Initial trials of web-based smoking-cessation programs have generally been promising. The active components of these programs, however, are not well understood. This study aimed to (1) identify active psychosocial and communication components of a web-based smokingcessation intervention and (2) examine the impact of increasing the tailoring depth on smoking cessation.

Because initial reinforcement consequences set the stage for subsequent nicotine use, elucidation of the contribution of environmental and inherited factors is crucial to an understanding of nicotine dependence as well as of individual differences in susceptibility to cigarette smoking. A review of some recent animal research and laboratory studies of smokers and never-smokers suggests that vulnerability to nicotine dependence is related to high initial sensitivity to nicotine and that the development of acute pharmacodynamic tolerance in these individuals--particularly to effects of nicotine that are toxic or aversive--may be an adaptation for protecting homeostasis.

People who become highly dependent cigarette smokers appear to have more pleasurable sensations at their initial exposure to tobacco; unpleasant reactions to the first cigarette do not seem to protect against subsequent smoking.

Differences among adult women smokers with differing levels of concern about post-cessation weight gain were investigated in a national random-digit-dialing survey. To avoid defining weight concerns in terms of possible etiologies or contributory factors, respondents were stratified using a single item querying concern about post-cessation weight gain; 39% described themselves as very concerned (VC), 28% as somewhat concerned (SC), and 33% as not concerned (NC). Significant between-groups differences were detected for measures of weight and body image, eating patterns and weight control practices, and nicotine dependence, but not for depression. Differences, primarily between VC and NC, were also detected for several weight-related smoking variables, including importance of weight as a factor in initiation, smoking as a weight control strategy, increased appetite and weight gain as withdrawal symptoms, willingness to gain weight upon quitting, self-efficacy about relapse in the face of weight gain, and readiness to quit smoking. Most differences persisted even after adjusting for body mass index and nicotine dependence. Although the importance of thinness was rated higher by weight-concerned women, the difference did not reach significance. Rather, what differentiated groups was the importance of overall body image, suggesting a larger pattern of preoccupation with body image that may not be captured by queries about weight concerns alone. We conclude that weight-concerned women smokers will be especially unlikely to seek treatment or attempt self-quitting; and that redirecting attention to other aspects of body image is likely to be more helpful than attempting to divert attention away from body image.