1. The Cigarette Withdrawal Scale CWS-21 Jean-François E T T E R, PhD Institute of social and preventive medicine Faculty of Medicine University of Geneva Switzerland

3.  Valid measurement is essential to science  Comprehensive validation studies are lacking, for most withdrawal scales  Available scales were developed in UK or USA, and may not reflect situation in other countries  Some widely used scales are not recent: - Minnesota Withdrawal Scale (Hughes) = 1986 - Shiffman-Jarvik = 1976 Background

4. To develop and assess the validity of a new, self-administered scale measuring cigarette withdrawal symptoms, using state-of-the-art psychometric methods Objective

5.  Questionnaires sent out by mail to a representative population sample in Geneva, n=2,000  "Please describe how a smoker feels when he is deprived of nicotine"  404 answers from smokers and ex-smokers Qualitative survey: methods

6.  Nervous, impatient 288  Irritable, bad mood, frustrated158  Urgent, strong need to smoke116  Somatic signs (various)91  Anxiety, fear72  Stressed57  Difficulty concentrating51  Increased appetite48  Depressed, sad29  Insomnia, fatigue26 Qualitative survey: results

7.  Qualitative data + theory (DSM, ICD) = 61 items  5-point Likert scales (agree-disagree)  Survey on STOP-TABAC.CH, in French  N=3,050  Retest after 17 days (n=118)  Follow-up after 41 days (n=1,119) Methods

8.  21-item scale  6 dimensions, cover DSM-IV and ICD-10  Sound factor structure (bootstrap resampling)  Depression-Anxiety  Craving  Irritability- Nervousness-Impatience  Appetite-Weight Gain  Insomnia  Difficulty Concentrating Results

10. Reliability

12. Relapse at 41 days: odds ratios

13. Change 0-17 days in recent quitters

14. Scores for various intervals post-quit

16.  CWS-21 is a reliable withdrawal scale,  performed well on tests of construct validity,  is sentitive to change over time  predicts relapse Conclusions

17.  STOP-TABAC.CH => Documents Get these slides and CWS-21 at: