The assessment of tobacco dependence in young users of smokeless tobacco

• Published in: Tobacco control Vol. 21; no. 5; pp. 471 - 476
• Main Authors: DiFranza, Joseph R, Sweet, Michael, Savageau, Judith A, Ursprung, W W Sanouri
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.09.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: addiction; Adolescent; Adolescent Behavior; Adolescents; Adult; Behavior, Addictive; Child; Cigarette smoking; Cigarettes; dependence; Female; Florida - epidemiology; Habits; Health Surveys; Humans; Male; Nicotine; Nicotine dependence; Nursing students; P values; Personal Autonomy; Pleasure; Psychometrics; Quantitative psychology; smokeless tobacco; smokeless tobacco products; Smoking; Smoking - epidemiology; Smoking - psychology; Smoking Cessation; Students; Substance Withdrawal Syndrome; Tobacco; Tobacco chewing; Tobacco Products - adverse effects; Tobacco Use Disorder - complications; Tobacco Use Disorder - epidemiology; Tobacco, Smokeless - adverse effects; Young Adult; Florida
• ISSN: 0964-4563; 1468-3318
• DOI: 10.1136/tc.2011.043810

IntroductionAs all published measures of dependence for users of smokeless tobacco (dippers) have poor reliability, in the present work the Hooked on Nicotine Checklist (HONC) and the Autonomy Over Smoking Scale (AUTOS) were evaluated for use with this population. Dippers and smokers were also compared in relation to dependence, the pleasure derived from using tobacco and the latency to the onset of withdrawal.MethodsIn 2010, an anonymous self-completed paper survey was administered to 1541 students of mixed race and ethnicity in grades 9–12 (mean age 15.9 years) in a Florida high school where students used cigarettes and smokeless tobacco.ResultsThe reliability (Cronbach's α) for the HONC was 0.90 for smokers (n=139) and 0.91 for dippers (n=85), and for the AUTOS was 0.94 for smokers and dippers. Dippers and smokers did not differ significantly in relation to scores on the HONC, AUTOS, latency to withdrawal onset or pleasure derived from smoking. One or more symptoms on the HONC were reported by 56% of dippers and 57% of smokers with <100 lifetime uses of their favoured tobacco product, and by 91% of dippers and 91% of smokers with ≥100 lifetime uses (not significant). Greater lifetime use was associated with a significantly shorter latency to withdrawal for smokers and dippers.ConclusionsThe HONC and AUTOS are highly reliable measures of dependence for adolescent users of cigarettes and smokeless tobacco. Using these measures and other indicators, no meaningful differences in dependence were found between dippers and smokers at comparable levels of lifetime use.