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Fagerstrom Test for Nicotine Dependence
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About Fagerstrom Test for Nicotine Dependence
Scale Name
Fagerstrom Test for Nicotine Dependence
Author Details
Todd F. Heatherton, Lynn T. Kozlowski, Richard C. Frecker, and Karl-Olov Fagerström
Translation Availability
English
Background/Description
The Fagerström Test for Nicotine Dependence (FTND), developed by Heatherton et al. (1991), is a 6-item self-report scale designed to measure the severity of nicotine dependence in adult cigarette smokers. Published in the British Journal of Addiction, it revises the earlier Fagerström Tolerance Questionnaire (1978) by improving psychometric properties and reducing administration time. The FTND assesses key indicators of dependence, including daily cigarette consumption, time to first cigarette after waking, difficulty refraining from smoking, smoking despite illness, and smoking intensity. It is widely used in clinical and research settings to evaluate nicotine dependence and guide cessation interventions.
Participants answer six questions, with four scored on a 4-point scale (0–3) and two on a binary scale (0–1). Total scores range from 0–10, with higher scores indicating greater dependence: 0–2 (very low), 3–4 (low), 5 (moderate), 6–7 (high), 8–10 (very high). The FTND was validated with 100 smokers (mean age ≈ 30–40 years, mixed gender, Canada-based) and further tested in diverse samples (e.g., 254 French smokers, Chabrol et al., 2003). About 50–60% of regular smokers score in the moderate-to-high range. The scale correlates with biochemical markers like cotinine levels (r ≈ 0.40–0.60) and withdrawal severity (r ≈ 0.30–0.50). It is used in clinical psychology, addiction medicine, and public health to assess dependence, predict cessation success, and tailor treatment plans.
Administration, Scoring and Interpretation
- Obtain the scale from Heatherton et al. (1991) or authorized sources (e.g., British Journal of Addiction), ensuring ethical permissions.
- Explain to participants (adult cigarette smokers) that the questionnaire assesses smoking habits and dependence, emphasizing confidentiality and voluntary participation.
- Administer the 6-item scale in a clinical, research, or community setting, using paper or digital formats, with instructions to answer based on current smoking behavior.
- Estimated completion time is 1–2 minutes.
- Ensure a private, supportive environment; provide support resources (e.g., smoking cessation helplines) and adapt for accessibility (e.g., oral administration) if needed.
Reliability and Validity
The FTND demonstrates acceptable psychometric properties (Heatherton et al., 1991; Chabrol et al., 2003). Internal consistency is moderate (Cronbach’s alpha ≈ 0.61–0.67), reflecting the scale’s brevity and diverse item content, based on samples of 100–254 smokers. Test-retest reliability is high (r ≈ 0.85–0.91 over 2–4 weeks).
Convergent validity is supported by correlations with the Nicotine Dependence Syndrome Scale (r ≈ 0.50–0.70) and carbon monoxide levels (r ≈ 0.35–0.55). Criterion validity is evidenced by its ability to predict cessation outcomes and withdrawal severity. Factor analysis suggests a two-factor structure (morning smoking and daytime smoking), though it is scored unidimensionally. Limitations include modest internal consistency and less applicability to non-cigarette tobacco use. Pairing with the Wisconsin Smoking Withdrawal Scale or Brief Questionnaire of Smoking Urges (QSU-Brief) enhances comprehensive assessment.
Available Versions
06-Items
Reference
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & FAGERSTROM, K. O. (1991). The Fagerström test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. British journal of addiction, 86(9), 1119-1127.
Chabrol, H., Niezborala, M., Chastan, E., Montastruc, J. L., & Mullet, E. (2003). A study of the psychometric properties of the Fagestrom Test for Nicotine Dependence. Addictive behaviors, 28(8), 1441-1445.
Important Link
Scale File:
Frequently Asked Questions
What does the Fagerström Test for Nicotine Dependence measure?
It measures the severity of nicotine dependence based on smoking habits and behaviors.
Who is the target population?
Adult cigarette smokers.
How long does it take to administer?
Approximately 1–2 minutes.
Can it inform interventions?
Yes, it assesses dependence to guide smoking cessation treatments.
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