Assessment of Nicotine Dependence among Smokers in a Selected Rural Population in Kerala, India

Objectives: An attempt was made to understand the nicotine dependence of smokers selected for an ongoingsmoking cessation intervention programme in rural Kerala, India.
Methods: Data were collected from residentmales in the age group of 18 to 60 years from 4 randomly allocated community development blocks of ruralThiruvananthapuram district (2 intervention and 2 control groups). Trained accredited social health activistworkers were utilised to collect data from all groups through face to face interview. Nicotine dependence amongparticipants was assessed by means of the six-item Fagerström Test for Nicotine Dependence (FTND) translatedinto the local language. The internal consistency of FTND was computed using Cronbach’s alpha coefficient.Criterion validity (concurrent) was assessed by correlations of nicotine dependence scores with age at initiation ofsmoking and cumulative smoking volume in pack-years.
Results: Among the 928 smokers identified, 474 subjectswere in the intervention area (mean age =44.6 years, SD =9.66 years) and 454 in the control area (mean age= 44.5years, SD =10.30 years). The overall FTND score among current daily smokers was 5.04 (SD: 5.05). FTND scoresin the control and intervention areas were 4.75 (SD: 2.57) and 4.92 (SD: 2.51) respectively. The FTND scoresincreased with age and decreased with higher literacy and socioeconomic status. The average FTND score washigh among smokers using both bidi and cigarettes (mean 6.10, SD 2.17). Internal consistency analysis yieldeda Cronbach’s alpha coefficient of 0.70 in a subsample of 150 subjects, a moderate result. The association of thescale was strongest, with the number of pack-years smoked (rho = 0.677, p < 0.001).
Conclusion: A moderatelevel of nicotine dependence was observed among smokers in the current study. Tobacco cessation strategiescould be made more cost effective and productive if a baseline assessment of nicotine dependence is completedbefore any intervention.