DSM-IV nicotine dependence symptom characteristics for recent-onset smokers

Introduction: This study evaluated how well DSM-IV nicotine dependence symptoms measure an underlying dependence construct for recent-onset daily and nondaily smokers. Methods: Based on a nationally representative sample of 2,758 recent-onset adolescent smokers from the National Surveys on Drug Use and Health, we used multiple group item response theory analysis to assess 7 symptoms representing DSM-IV diagnostic features of nicotine dependence. Results: After controlling for age, gender, current smoking quantity, and length of smoking exposure, all 7 DSM-IV symptoms were invariant across nondaily and daily smokers and discriminated well among levels of the nicotine dependence construct. Symptoms most likely to be endorsed at lower levels of the dependence construct included spending more time getting, using, or getting over the effects of smoking and wanting or trying to stop or cut down. Symptoms most likely to be endorsed only at higher levels of the construct included giving up important activities and emotional/psychological and health problems related to smoking. DSM-IV symptoms were most precise for moderately high levels of the dependence construct and less precise for lower levels for both nondaily and daily smokers. Discussion: DSM-IV nicotine dependence symptoms appear to have desirable psychometric properties for measuring a nicotine dependence construct among recent-onset adolescent smokers at both daily and nondaily levels, providing justification for the use of these symptoms in a measure that aims to evaluate the full continuum of nicotine dependence severity in this population.