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Validity of the timeline followback among treatment-seeking smokers in Germany

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Abstract

Few studies have assessed the convergent validity of the timeline followback for smoking (TLFB-S) among treatment-seeking smokers, and there are no studies assessing its discriminant validity. Further, no studies to date have documented the psychometric properties of the TLFB in the German population. The aim of this study was therefore to test the convergent and discriminant validity of the TLFB-S among adult, treatment-seeking smokers in Germany. In the context of a smoking cessation trial, participants (N = 268) completed sociodemographic, TLFB-S and other, self-aggregated, single-item (SA) smoking measures at pretreatment. During the 12-month posttreatment period, participants completed TLFB-S and biochemically validated SA measures of smoking intensity and abstinence at regular intervals. Discriminant validity analyses showed no significant associations for substance-use and sociodemographic variables and measurement discrepancy between TLFB-S and SA measures of pretreatment smoking intensity. Convergent validity analyses indicated that TLFB-S and SA measures of smoking intensity were in high agreement at both pretreatment and posttreatment. Finally, there was high concordance between TLFB-S and SA measures of abstinence at both 1- and 12-month posttreatment. This study replicated and extended the current literature on the TLFB and showed that, even across cultures, it can be a valid measure of various smoking-related variables.

Introduction

Valid measurement of smoking variables is vital to the assessment of treatment and natural recovery outcomes. Recommendations in the literature (Hughes et al., 2003, Ossip-Klein et al., 1986, Velicer et al., 1992, West et al., 2005) typically focus on “self-aggregated” summary scores, which participants calculate and estimate themselves at discrete timepoints (e.g., 12-month continuous abstinence, mean smoking intensity in the past month). Although such single-item measures are considered to be the “gold-standard,” they assess limited aspects of smoking behavior and fail to provide the detail necessary for more dynamic and longitudinal evaluations of smoking behavior (Colder et al., 2006, Piasecki et al., 2002).

The timeline followback for smoking (TLFB-S), on the other hand, is a calendar that can assess daily smoking intensity (Sobell and Sobell, 1992). Because it allows for continuous assessment of smoking behavior, it provides more detail for longitudinal analyses than discrete assessment windows, and allows for more flexible aggregation by the researcher than self-aggregated, single-item measures. That said, the TLFB yields more or less valid data depending on the substance and population with which it is used (Hersh et al., 1999, Searles et al., 2000). Thus, the psychometric properties of the TLFB must be established for specific substances and populations to fully realize its measurement potential.

Psychometric properties typically include assessments of reliability (i.e., measurement consistency) and validity (i.e., evidence a measure represents the underlying construct of interest with minimal error and bias). Two studies have shown that the TLFB-S can validly measure aggregate smoking intensity (Gariti et al., 1998), and daily use (Toll et al., 2005). Becoña and Míguez (2006) documented concordance between posttreatment TLFB-S reports of abstinence and carbon monoxide measures; however, this analysis only involved a small subset (26  n  34) of the overall study sample. There are also no studies of discriminant validity of the TLFB-S. Finally, although the TLFB has been used to measure alcohol use in German populations (Arndt et al., 2002, Croissant et al., 2008), there are presently no studies featuring the TLFB-S in a German sample. Thus, despite its promising psychometric properties, there are gaps in the international literature on the validity of the TLFB-S in assessing pre- and posttreatment smoking outcome variables.

The current study aimed to augment the international literature on the validity of the TLFB-S and served as the first psychometric study of the TLFB in the German population. First, we the tested discriminant validity (i.e., lack of correlation between target variable and unrelated constructs) of TLFB-S assessments of pretreatment smoking intensity. Next, we tested convergent validity (i.e., significant, positive correlation between the target variable and similar constructs) of TLFB-S assessments of pre- and posttreatment smoking intensity (i.e., number of cigarettes smoked per day), as well as posttreatment abstinence. It was expected that the TLFB-S would evince acceptable psychometric properties, as shown in the English-language literature.

Section snippets

Participants

Participants (N = 268) were adult, regular smokers who had provided written, informed consent to participate in a smoking cessation research trial conducted at a university hospital in Germany (Batra et al., submitted for publication) (see Table 1 for sample description).

Measures

The Sociodemographic and Smoking Baseline Questionnaire (SSBQ) consists of single items assessing sociodemographic information and self-aggregated baseline smoking intensity; duration; quit attempts; and lifetime, regular,

Results

Discriminant validity analyses indicated no significant associations for measurement discrepancy between SSBQ and TLFB assessments of pretreatment smoking intensity and gender, age, educational status, employment status, nationality (German vs. other), alcohol dependence (AUDIT), level of nicotine dependence (FTND), or lifetime, regular use of illegal drugs (n = 253; ps > .11).

Convergent validity analyses indicated that TLFB-S and SSBQ mean smoking intensity measures for 1-month pretreatment

Discussion

This study tested discriminant and convergent validity of the TLFB-S in a sample of adult, treatment-seeking German smokers participating in a smoking cessation trial. Discriminant validity was supported in the current findings: there were no significant associations for measurement discrepancy between TLFB-S and self-aggregated measures of pretreatment smoking intensity and the sociodemographic and substance-use variables hypothesized to be unrelated to this measurement discrepancy. Findings

Role of funding source

Funding for this study was provided by grant #01 EB 0110 from the German Federal Ministry of Education and Research and the Ministry of Science, Research and the Arts of Baden-Württemberg to Anil Batra. Susan E. Collins’ time was largely supported by an NIAAA Institutional Training Grant (T32AA007455) awarded to Mary E. Larimer at the University of Washington.

The NIAAA, the German Federal Ministry of Education and Research, and the Ministry of Science, Research and the Arts of Baden-Württemberg

Contributors

Susan E. Collins, Ph.D., developed the current study idea, design and methodology. She recruited and trained research assistants to collect and enter the data and conducted the main statistical analyses for the current study. Dr. Collins drafted most of the manuscript.

Sandra Eck, a research assistant on this project, helped collect and enter these data and oversaw other research assistants working on the project in this capacity. She also conducted the literature review and contributed valuable

Conflict of interest

In the past, Anil Batra has accepted funding for smoking cessation research and contributions to regional advisory boards from GlaxoSmithKline, Pfizer Consumer Health Care, Pfizer, Pharmacia GmbH, and Sanofi Aventis. However, the current study was not funded by any of these companies. All other authors declare that they have no conflicts of interest.

Acknowledgments

The authors would like to thank Maria Caspary, Andrea Doebler, M.A., Martina Epple, M.A., Evelyn Kick, M.A., Matthias Pforr, M.A., Carolin Ruf, M.A., and Silja Sauer for their help in entering and managing participant data. Thanks also to Prof. Dr. Gerhard Buchkremer, who has facilitated departmental support for and provided general guidance to the Smoking Cessation Research Group.

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    1

    Present address: Addictive Behaviors Research Center, University of Washington, Box 351629, Seattle, WA 98195, United States. Tel.: +1 206 543 4460; fax: +1 206 685 1310.

    2

    Iris Torchalla is now at the BC Centre of Excellence for Women's Health, E311 – 4500 Oak Street, Vancouver, BC V6H 3N1. Tel. 604-875-2633.

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