Learning Objective #1: Understand the reliability of the Chinese version of Fagerstrom Tolerance Questionnaire (FTQ)

Learning Objective #2: Understand the validity of the Chinese version of FTQ

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Background: Fagerstrom Tolerance Questionnaire (FTQ) is used to assess adult smokers' nicotine dependence in the "Smoking Cessation Clinical Treatment Plan", a program that provides financial support for nicotine replacement therapy (NRT) in Taiwan. However, FTQ is not verified for the usefulness in a sample of Taiwanese smokers. Objectives: In this study, we aimed to test how exhaled carbon monoxide (CO) and saliva cotinine were correlated with each FTQ item in Chinese version and present relationship among interrelated items by factor analysis. Methods: A translation of FTQ and the validity of language equivalence were conducted. One hundred and twenty smokers were administered the translated version of FTQ and currently both biomarkers were collected. Findings: Question 5 (smoke more in the morning) was suggested to revise the description of the rest of day in Chinese to match the meaning of the original question in English. The Chinese version had moderate reliability (Cronbach Alpha: 0.63). Two FTQ items (question 7: nicotine yield; question 8: inhalation) performed poorly on construct reliability test. Factor I was loaded by question 3 (which cigarette would you most hate to give up), 1 (time to the first cigarette of the day), 4 (cigarettes per day), 5, 2 (difficulty refraining from smoking), 6 (smoke if ill) and factor 2 was separately loaded by question 7 and 8. Question 7 and 8 did not have significant correlation with both biomarkers. Additionally, Question 2 did not have significant correlation with exhaled CO. Total FTQ scores were significantly correlated with both biomarkers. Saliva cotinine explained 27% of FTQ variance. Exhaled CO explained 41% of FTQ variance. Conclusions: Total FTQ scores and several of the individual items were significantly correlated with both biomarkers. However, question 2, 7, and 8 should be revised to improve the reliability and validity of the Chinese version.