The Cigarette Withdrawal Scale CWS21

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The Cigarette Withdrawal ScaleCWS-21
Jean-François E T T E R, PhD Institute of
social and preventive medicine Faculty of
Medicine University of Geneva Switzerland
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Background

• 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

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

• Questionnaires sent out by mail to a
  representative population sample in Geneva,
  n2,000
• "Please describe how a smoker feels when he
  is deprived of nicotine"
• 404 answers from smokers and ex-smokers

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Qualitative survey results

• Nervous, impatient 288
• Irritable, bad mood, frustrated 158
• Urgent, strong need to smoke 116
• Somatic signs (various) 91
• Anxiety, fear 72
• Stressed 57
• Difficulty concentrating 51
• Increased appetite 48
• Depressed, sad 29
• Insomnia, fatigue 26

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Methods

• Qualitative data theory (DSM, ICD) 61 items
• 5-point Likert scales (agree-disagree)
• Survey on STOP-TABAC.CH, in French
• N3,050
• Retest after 17 days (n118)
• Follow-up after 41 days (n1,119)

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Results

• 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

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Reliability
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Relapse at 41 days odds ratios
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Change 0-17 days in recent quitters
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Scores for various intervals post-quit
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Conclusions

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

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• STOP-TABAC.CH gt Documents