A measure of illness awareness in individuals with nicotine dependence – Nicotine Use Awareness and Insight Scale (NAS)

Abstract

Abstract Introduction Impaired illness awareness or the inability to recognize that one has a dependence on nicotine may be a major barrier to seeking cessation treatment. To better understand the role of impaired illness awareness on treatment seeking behavior and clinical outcomes in individuals with nicotine dependence, we developed and examined the psychometric properties of a novel scale measuring illness awareness. Methods We developed the Nicotine Use Awareness and Insight Scale (NAS), a 7-item self-report measure to assess the theoretical construct of illness awareness in individuals with dependence on nicotine. Data from participants 18 years of age or older were collected via a web-based survey company, Dynata. Participants with moderate dependence on nicotine were included, defined by a score of 4 or more on the Fagerström Test for Cigarette Dependence (FTCD) or the FTCD adapted for electronic cigarettes (eFTCD). Results A total of 100 participants (mean (SD) age=49.1 (16.1), 52% women) that met the inclusion criteria for either FTCD (n=50) or eFTCD (n=50) were studied. The NAS demonstrated good convergent (r=.74, p<0.001) and discriminant validity (r=.03, p=0.786). It also demonstrated good internal consistency (Cronbach’s alpha=0.78) and one-month test-retest reliability (intra-class correlation=0.86). An exploratory factor analysis yielded retention of two components. Conclusions This study provides initial support for the validity and reliability of the NAS, a scale measuring impaired illness awareness in individuals with dependence on nicotine. The NAS can be used in research and clinical practice to evaluate the impact of impaired illness awareness in seeking nicotine cessation treatment. Implications Impaired illness awareness or the inability to recognize that one is dependent on nicotine may be a barrier to seeking cessation treatment. The Nicotine Use Awareness and Insight Scale (NAS) is a novel scale to assesses subjective illness awareness in individuals with dependence on nicotine. This study provides initial support for the psychometric validity and reliability of the NAS. NAS demonstrated good convergent and discriminant validity with measures of illness recognition and affect states, respectively, internal consistency, and test-retest reliability. The NAS can be used in research and clinical practice to evaluate the impact of impaired illness awareness on treatment and clinical outcomes.