니코틴 의존도 평가검사로서 Heavy Smoking Index (HSI)의 유용성
The Usefulness of Heavy Smoking Index as a Test for Nicotine Dependence
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연구배경: 니코틴 의존도를 평가하는데 널리 이용되는 Fagerstrom의 니코틴 의존도 설문지(Fagerstrom test of nicotine dependence, FTND)는 6개 설문으로 이루어져 있어, 외래환자나 대규모 역학조사 등에 일상적으로 적용하기엔 어려운 점이 있었다. 이에 FTND의 두 가지 설문항목으로 이루어진 Heavy smoking index (HSI)의 유용성과 흡연 관련인자와의 상관관계에 대해 알아보고자 하였다. 방법: 일개 보건소의 금연클리닉을 등록한 943명의 성인흡연자를 대상으로 하였다. FTND 한국어판 설문지를 이용하여 니코틴 의존도를 조사하고, FTND의 두가지 설문문항(하루 중 첫 담배를 피우는 시간, 하루 중 흡연량)으로 이루어진 HSI의 민감도, 특이도, FTND와의 일치도를 구하였다. 하루 중 평균 흡연량, 총 흡연기간, 첫 흡연시작시기를 조사하여 상관관계를 알아보았다. 결과: FTND 총점 6점 이상을 기준으로, HSI 4점 이상인 경우 두 측정방식 사이의 일치도는 높았다(kappa=0.74). HSI의 민감도는 88.0%이고 특이도는 86.5%였다. 결론: HSI의 유용성은 높았고, 타당도가 검증되면 외래진료에서 간편하고 비교적 정확하게 니코틴 의존도를 예측할 수 있는 척도로서 활용될 수 있다.
Abstract
The Usefulness of Heavy Smoking Index as a Test for Nicotine DependenceSung Ki Lee, M.D., Hyuk Jung Kweon, M.D., Dae Jun Lim, M.D.*, Kyong Rae Kim, M.D.**, Hyun Hee Mo, M.D.***, Hyun Jin Do, M.D., Seung Won Oh, M.D., Youl Lee Lym, M.D., Jae Kyung Choi, M.D., Hee Kyung Joh, M.D., Dong Yung Cho, M.D. Background: The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. Its completion require a few minutes, but such time may be too much for busy clinicians and large epidemiologic surveys. The goals of this study was to compare the sensitivity and the specificity of Heavy Smoking Index (HSI) of high nicotine dependence. Methods: The FTND was administered to 943 current smokers from a smoking-cessation clinic in Gwangjin-gu, Seoul. The HSI which combines two items of the FTND (the number of cigarettes per day and the time of the first cigarette of the day) was compared to the FTND. We measured cigarette per day, duration of smoking, and age of smoking initiation. Results: A cutoff score equal or greater than 4 on the HSI detected a similar rate of nicotine dependence as a cutoff score equal or greater than 6 on the FTND. The HSI showed a sensitivity of 88.0% and a specificity of 86.5%. The concordance between the two instruments was high (kappa= 0.74). Conclusion: The HSI was proven to be very useful. If HSI had a proper validity, the HSI can be a good standard of high nicotine dependence for busy clinician and epidemiologists. (J Korean Acad Fam Med 2008;29:405-411)
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