Screening adolescents for nicotine dependence: the Hooked On Nicotine Checklist

UMMS Affiliation

Department of Family Medicine and Community Health

Publication Date


Document Type



Adolescent; Adolescent Behavior; Female; Humans; Male; Massachusetts; Nicotine; Psychometrics; *Questionnaires; Schools; *Self-Assessment; Smoking; Students; Tobacco Use Disorder


Community Health and Preventive Medicine | Pediatrics | Preventive Medicine | Primary Care | Psychiatry and Psychology | Psychology | Substance Abuse and Addiction


PURPOSE: To evaluate the Hooked On Nicotine Checklist's (HONC) internal consistency, reliability over time, correlation with self-described smoking behavior, and to compare the results with previous studies of the onset of nicotine dependence in youths.

METHODS: Ninth-grade students were recruited from a regional school district. Subjects (Ss; n = 371; 91% of the 9th-grade class) were 48.8% male, 97% white, aged 13.8-15.6 years. Ss self-administered a questionnaire on smoking experiences. The HONC was completed by 88 (23.7%) who had puffed on a cigarette at least once; 74 were retested 2 weeks later. Responding "yes" to any of the 10 HONC items indicates nicotine dependence (ND); the number of items endorsed indicates the degree of its severity.

RESULTS: The internal consistency of the HONC is high overall (alpha = 0.90; n = 88), and test-retest reliability for the entire HONC is excellent (intraclass correlation = 0.88, p < .001). Individual items generally showed good to excellent reliability over time (Median Yules' Y = 0.71, range = 0.41-0.82). HONC scores were strongly correlated with self-reported smoking (r = 0.70, p < .001, n = 88).

CONCLUSIONS: Adding the HONC to routine adolescent health examinations, health classes, and prevention programs may make adolescents more aware of their symptoms of ND and enable intervention before ND progresses.


Addiction, Nicotine dependence, Tobacco, Youth

DOI of Published Version



J Adolesc Health. 2004 Sep;35(3):225-30. Link to article on publisher's site

Journal/Book/Conference Title

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

Related Resources

Link to Article in PubMed