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Smoking abstinence expectancies are beliefs about negative and positive short-term psychological and physiological consequences of not smoking. The Smoking Abstinence Expectancies Questionnaire (SAEQ) is a widely used Patient-Reported Outcome Measure (PROM) to assess smoking abstinence expectancies. It has four subscales: negative mood, somatic symptoms, harmful consequences, positive consequences. Although studied from a psychometric perspective, the SAEQ needs further evaluation. Clinimetrics, and its Clinimetric Criteria for Patient-Reported Outcome Measures (CLIPROM), offers a robust method to evaluate the SAEQ. We verified construct validity and sensitivity of the Italian version of the SAEQ applying CLIPROM criteria. A total of 293 adult Italian smokers were consecutively enrolled at two smoking cessation clinics and assessed via the SAEQ. Item Response Theory models (i.e., combining Rasch and Mokken analyses) were used to test construct validity and sensitivity. The total score of the SAEQ was not found to be unidimensional but each SAEQ subscale score was. PSI (0.90) indicated that the total score of the SAEQ could reliably discriminate between respondents with different levels of the trait under assessment, whereas SAEQ subscales on negative mood and harmful consequences could reliably distinguish between different groups but not between different subjects (PSI ranging from 0.77 and 0.78). Overall, the total score of the SAEQ is a sensitive screening PROM and can be used at smoking cessation clinics to discriminate between subjects with different levels of smoking abstinence expectancies. SAEQ subscales should be used to detect severity and subjective burden of a wide range of expected effects of nicotine abstinence.

A number of rating scales evaluating symptoms of nicotine withdrawal have been developed over the years but insufficient attention has been devoted to the assessment of their clinimetric properties. Clinimetrics, the science of clinical measurements, is an innovative approach, particularly useful for assessing the validity of rating scales. This is the first study using clinimetric principles to test the construct validity of the Smoker Complaint Scale (SCS), a self-rating scale specifically developed to assess acute symptoms of nicotine withdrawal. Construct validity was evaluated via Item Response Theory (IRT) models (i.e., combining Rasch and Mokken analyses). A total of 366 subjects (mean age = 34.0, SD = 11.3 years) participated in the study. IRT analyses showed that SCS was a multidimensional measure of symptoms of nicotine withdrawal, including unidimensional subscales, particularly a four-item subscale (the SCS4), which was found to entail the clinimetric property of construct validity. IRT analyses also revealed that affective symptoms of nicotine withdrawal preceded cognitive ones. The SCS should be considered as an item bank, including a particularly valid subscale, the SCS4 that can be used as a screening or outcome measure to evaluate the severity of cognitive and affective symptoms of nicotine withdrawal. SCS4 is a sensitive clinimetric index which differentiates “ceiling symptoms” of nicotine withdrawal (e.g., “feeling slowed down”) from “floor symptoms” of nicotine withdrawal (e.g., “feeling lightheaded”) that emerge in the severe form of nicotine withdrawal.

Nicotine replacement therapy (NRT) is an effective treatment for smokers who want to quit, however, the rates of successful quitting can be improved even more. In this context, nicotine dependence (assessed via the Fagerström Tolerance Questionnaire, FTQ), psychological distress (measured via the Symptom Rating Test, SRT), and personality traits (evaluated via the Adult Eysenck Personality Inventory, AEPI) were evaluated as possible predictors of smoking cessation.A total of 297 cigarette smokers were followed for one year as part of a NRT double-blind, parallel group, randomized trial. Baseline nicotine dependence (weeks 12 and 26: p0.05), AEPI neuroticism (weeks 12 and 52: p0.05), and AEPI psychoticism (weeks 12 and 52: p0.05) scores significantly influenced the outcome of smoking cessation during one-year of follow-up. An increase in psychological distress during follow-up was associated with a lower probability of quitting smoking (p=0.000).Nicotine dependence, neuroticism, psychoticism and, over time, psychological distress were the main factors influencing the long-term outcome (i.e., up to 12 months) of smoking cessation under NRT.

A wide array of biological challenge procedures - including carbon dioxide inhalation, hyperventilation, and breath holding - have been used to model panic in laboratory settings. Originally used to study developmental processes in panic disorder (PD), these procedures, along with nicotine patch administration and self-administered smoking, have recently been applied to help understand the etiology of co-occurring nicotine dependence and PD. The goals of the present paper are to review studies that have employed biological challenges to study the comorbid condition, identify the advantages and limitations of the various procedures, describe desirable outcome measures for use in biological challenges, and present recommendations for future challenge studies in this field. We argue that biological challenges, though in need of standardization, are useful for studying the development, maintenance, prevention, and treatment of comorbid nicotine dependence and PD.