The assessment of tobacco dependence in young users of smokeless tobacco

UMMS Affiliation

Department of Family Medicine and Community Health

Publication Date


Document Type



Adolescent; Tobacco, Smokeless; Tobacco Use Disorder


Community Health and Preventive Medicine | Preventive Medicine | Primary Care | Substance Abuse and Addiction


Introduction: As 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.

Methods: In 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.

Results: The reliability (Cronbach's alpha) 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 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.

Conclusions: The 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.

DOI of Published Version



Tob Control. 2012 Sep;21(5):471-6. doi: 10.1136/tc.2011.043810. Epub 2011 Jun 28.

Journal/Book/Conference Title

Tobacco control

Related Resources

Link to Article in PubMed