Ginestet Cedric E, Mitchell Kathryn, Wellman Nigel
Department of Epidemiology and Public Health, Imperial College London, UK.
Nicotine Tob Res. 2008 May;10(5):833-41. doi: 10.1080/14622200802023874.
A considerable number of daily tobacco users do not fulfill the DSM-IV and ICD-10 diagnostic criteria for nicotine dependence (ND). This suggests that such a diagnostic boundary may be arbitrary. This paper addresses this question empirically by comparing the viability of two models, respectively hypothesizing a dimensional and a categorical latent structure of ND. An epidemiological sample of 6,926 individuals was selected from a cross-sectional probabilistic stratified sampling design. All participants having smoked in the past 30 days were included in the study. Half of this sample was used to select appropriate composite indicators of tobacco consumption. A factor analysis with oblique PROMAX rotation was used as well as the MAXCOV (Maximum Covariance) procedure to identify indicators that maximized between-class distance, and minimize within-class variance. The remaining half of the sample was submitted to a set of three mathematically independent taxometric procedures: Mean Above Minus Below A Cut (MAMBAC), MAXCOV and Maximum Eigenvalues (MAXEIG). In line with the original hypothesis, the results supported a dimensional latent structure for ND. These findings are discussed in terms of their clinical implications for the validation of adequate screening procedures and the etiology and maintenance of ND.
相当一部分日常烟草使用者未达到DSM-IV和ICD-10中尼古丁依赖（ND）的诊断标准。这表明这样的诊断界限可能是任意的。本文通过比较两个模型的可行性，分别假设ND的维度潜在结构和类别潜在结构，以实证方式解决了这个问题。从横断面概率分层抽样设计中选取了一个包含6926人的流行病学样本。过去30天内有吸烟行为的所有参与者都被纳入研究。该样本的一半用于选择合适的烟草消费综合指标。使用了具有斜交PROMAX旋转的因子分析以及MAXCOV（最大协方差）程序来识别能最大化组间距离并最小化组内方差的指标。样本的另一半接受了一组三个数学上独立的分类分析程序：均值高于减去低于切点法（MAMBAC）、MAXCOV和最大特征值法（MAXEIG）。与原假设一致，结果支持ND的维度潜在结构。本文从这些结果对适当筛查程序的验证以及ND的病因和维持的临床意义方面进行了讨论。
