Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization.
Methods:
Reliability was tested by examining Cronbach’s α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255).
Results:
The reliability analysis yielded a Cronbach’s α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale.
Conclusion:
The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.
AgakuI. T.AlpertH. R. (2015). Trends in annual sales and current use of cigarettes, cigars, roll-your-own tobacco, pipes, and smokeless tobacco among US adults, 2002–2012. Tobacco Control, 25, 451–457.
2.
American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and statistical manual of mental disorders, text revision. Author.
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publication.
4.
AnantharamanD.ChabrierA.GaborieauV.FranceschiS.HerreroR.RajkumarT.…McKayJ. D. (2014). Genetic variants in nicotine addiction and alcohol metabolism genes, oral cancer risk and the propensity to smoke and drink alcohol: A replication study in India. PLoS One, 9, e88240.
5.
AubinH.-J.RollemaH.SvenssonT. H.WintererG. (2012). Smoking, quitting, and psychiatric disease: A review. Neuroscience & Biobehavioral Reviews, 36, 271–284.
6.
BlebilA.HassaliM.SulaimanS. S.DujailiJ.ZinA. (2013). Translation and validation process for the Minnesota Nicotine withdrawal scale to the Malay language. Value in Health, 16, A237.
7.
ChandraP. S.CareyM. P.CareyK. B.JairamK.GirishN.RudreshH. (2005). Prevalence and correlates of tobacco use and nicotine dependence among psychiatric patients in India. Addictive Behaviors, 30, 1290–1299.
EtterJ. F.HughesJ. R. (2006). A comparison of the psychometric properties of three cigarette withdrawal scales. Addiction, 101, 362–372.
10.
FagerstromK.-O.SchneiderN. G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12, 159–182.
11.
FioreM. C.JaénC. R.BaileyW. C.BennettG.BenowitzN. L.ConnellM.…WilliamsC. (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update: A US public health service report. American Journal of Preventive Medicine, 35, 158–176.
12.
FuS. S.McFallM.SaxonA. J.BeckhamJ. C.CarmodyT. P.BakerD. G.JosephA. M. (2007). Post-traumatic stress disorder and smoking: A systematic review. Nicotine & Tobacco Research, 9, 1071–1084.
HughesJ. R.HatsukamiD. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289–294.
15.
JanssenE. M.McGintyE. E.AzrinS. T.Juliano-BultD.DaumitG. L. (2015). Review of the evidence: Prevalence of medical conditions in the United States population with serious mental illness. General Hospital Psychiatry, 37, 199–222.
16.
JhanjeeS.JainR.JainV.GuptaT.MittalS.GoelzP.SchnollR. A. (2015). Evaluating the effects of varenicline on craving, withdrawal, and affect in a randomized, double-blind, placebo-controlled clinical trial of varenicline for smokeless tobacco dependence in India. Journal of Psychoactive Drugs, 47, 325–330.
17.
KimS. S.GulickE. E.KimS.SeoH. (2007). Psychometric properties of the Minnesota nicotine withdrawal scale: A Korean version. Journal of Nursing Measurement, 15, 121.
18.
KotlyarM.LindgrenB. R.VuchetichJ. P.LeC.MillsA. M.AmiotE.HatsukamiD. K. (2017). Timing of nicotine lozenge administration to minimize trigger induced craving and withdrawal symptoms. Addictive Behaviors, 71, 18–24.
19.
KrauthD.ApollonioD. E. (2015). Overview of state policies requiring smoking cessation therapy in psychiatric hospitals and drug abuse treatment centers. Tobacco Induced Diseases, 13, 33.
20.
KruegerR. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926.
21.
LasserK.BoydJ. W.WoolhandlerS.HimmelsteinD. U.McCormickD.BorD. H. (2000). Smoking and mental illness: A population-based prevalence study. Journal of the American Medical Association, 284, 2606–2610.
22.
LawrenceD.MitrouF.ZubrickS. R. (2009). Smoking and mental illness: Results from population surveys in Australia and the United States. BMC Public Health, 9, 285.
23.
Lê CookB.WayneG. F.KafaliE. N.LiuZ.ShuC.FloresM. (2014). Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation. Journal of the American Medical Association, 311, 172–182.
24.
MichopoulosI.RizosE.GournellisR.KarvouniA.KotsioumpaI.DouzenisA. (2015). Smoking reduction in psychiatric inpatients is feasible: Results from a 12-month prospective study. Annals of General Psychiatry, 14, 4.
25.
OkoliC. T.Al-MrayatY. D.SheltonC. I.JrKharaM. (2018). A retrospective analysis of the association between providing nicotine replacement therapy at admission and motivation to quit and nicotine withdrawal symptoms during an inpatient psychiatric hospitalization. Addictive Behaviors, 85, 131–138.
26.
OkoliC. T.SengS. (2019). Correlates of tobacco use and consumption among hospitalized psychiatric patients. Western Journal of Nursing Research, 41, 1121–1136.
27.
OrtizG.SchachtL.LaneG. M.Jr (2013). Smoking cessation care in state-operated or state-supported psychiatric hospitals: From policy to practice. Psychiatric Services, 64, 666–671.
28.
PatnodeC. D.HendersonJ. T.ThompsonJ. H.SengerC. A.FortmannS. P.WhitlockE. P. (2015). Behavioral counseling and pharmacotherapy interventions for Tobacco cessation in adults, including pregnant women: A review of reviews for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 163, 608–621.
29.
PettM. A.LackeyN. R.SullivanJ. J. (2003). Making sense of factor analysis: The use of factor analysis for instrument development in health care research. Sage.
30.
PoirierM.-F.CanceilO.BayléF.MilletB.BourdelM.-C.MoattiC.…Attar-LévyD. (2002). Prevalence of smoking in psychiatric patients. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 26, 529–537.
31.
ProchaskaJ. J.DasS.Young-WolffK. C. (2017). Smoking, mental illness, and public health. Annual Review of Public Health, 38, 165–185.
32.
ProchaskaJ. J.GillP.HallS. M. (2004). Treatment of tobacco use in an inpatient psychiatric setting. Psychiatric Services, 55, 1265–1270.
33.
ProchaskaJ. J.HallS. E.DelucchiK.HallS. M. (2014). Efficacy of initiating tobacco dependence treatment in inpatient psychiatry: A randomized controlled trial. American Journal of Public Health, 104, 1557–1565.
34.
RubinsteinM. L.BenowitzN. L.AuerbackG. M.MoscickiA.-B. (2009). Withdrawal in adolescent light smokers following 24-hour abstinence. Nicotine & Tobacco Research, 11, 185–189.
35.
ShiffmanS. M.JarvikM. E. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35–39.
36.
SmithP. H.HomishG. G.GiovinoG. A.KozlowskiL. T. (2014). Cigarette smoking and mental illness: A study of nicotine withdrawal. American Journal of Public Health, 104, e127–e133.
37.
SmithP. H.MazureC. M.McKeeS. A. (2014). Smoking and mental illness in the US population. Tobacco Control, 23, e147–e153.
38.
SoysterP.AnzaiN. E.FromontS. C.ProchaskaJ. J. (2016). Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization. Preventive Medicine, 92, 176–182.
39.
StreckJ. M.HeilS. H.HigginsS. T.BunnJ. Y.SigmonS. C. (2018). Tobacco withdrawal among opioid-dependent smokers. Experimental and Clinical Psychopharmacology, 26, 119–124.
40.
TollB. A.O’malleyS. S.McKeeS. A.SaloveyP.Krishnan-SarinS. (2007). Confirmatory factor analysis of the Minnesota nicotine withdrawal scale. Psychology of Addictive Behaviors, 21, 216.
41.
UssherM.EtterJ.-F.GiatrasN.ColemanT. (2012). Tobacco withdrawal symptoms and urges to smoke in pregnant versus non-pregnant smokers. Addictive Behaviors, 37, 1353–1357.
42.
WaltzC. F.StricklandO. L.LenzE. R. (2010). Measurement in nursing and health research (5th ed.). Springer Publishing.
43.
WeinbergerA. H.ReutenauerE. L.AllenT. M.TermineA.VessicchioJ. C.SaccoK. A.…GeorgeT. P. (2007). Reliability of the Fagerström test for nicotine dependence, Minnesota nicotine withdrawal scale, and tiffany questionnaire for smoking urges in smokers with and without schizophrenia. Drug & Alcohol Dependence, 86, 278–282.
44.
WelschS. K.SmithS. S.WetterD. W.JorenbyD. E.FioreM. C.BakerT. B. (1999). Development and validation of the Wisconsin Smoking Withdrawal Scale. Experimental and Clinical Psychopharmacology, 7, 354.
45.
WestR.HajekP. (2004). Evaluation of the mood and physical symptoms scale (MPSS) to assess cigarette withdrawal. Psychopharmacology, 177, 195–199.
46.
WestR.UssherM.EvansM.RashidM. (2006). Assessing DSM-IV nicotine withdrawal symptoms: A comparison and evaluation of five different scales. Psychopharmacology, 184, 619–627.
47.
WilliamsS. C.HafnerJ. M.MortonD. J.HolmA. L.MilbergerS. M.KossR. G.LoebJ. M. (2009). The adoption of smoke-free hospital campuses in the United States. Tobacco Control, 18, 451–458.
