Measures of nicotine dependence in adolescents: An update of the evidence 2000–2010

UMMS Affiliation

Department of Family Medicine and Community Health

Publication Date


Document Type



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


Nicotine withdrawal and the compulsion to use tobacco resulting from withdrawal form the core clinical features of nicotine dependence (ND). However, some ND measures show little or no content overlap with these clinical features. Our objective was to review the content and psychometric properties of available measures of ND for youth. A literature search identified 27 English language articles published in 2000–2010 that evaluated ND measures in adolescents or young adults. A consensus process among the authors was used to establish if each item in each measure assessed withdrawal or compulsion, or if the item tapped other aspects of cigarette smoking including tolerance, harm, triggers for smoking, cigarette use patterns, prioritizing smoking, perceived utility, or attitudes about smoking. Out of 14 measures identified, three (Hooked on Nicotine Checklist, Latency to Withdrawal, Withdrawal Symptom Cluster) measured the core clinical features of ND; six (Autonomy Over Smoking Scale, DSM IV, Dimensions of Tobacco Dependence Scale, ICD-10 Tobacco Dependence, ND/Cravings Symptom Cluster, Nicotine Dependence Syndrome Scale) measured withdrawal/compulsion and other aspects of smoking; and five (Fagerström Test for Nicotine Dependence, Modified Fagerström Tolerance Questionnaire, Nicotine Dependence Scale for Adolescents, Self-Medication Symptom Cluster, Stanford Dependence Index) had few or no withdrawal/compulsion indicators. Existing measures vary widely in the degree to which they assess the known clinical features of ND. Attempts to assess ND indirectly in youth by measuring other aspects of smoking may result in inaccuracy if items are endorsed for reasons other than ND. No existing measure assesses the full spectrum of clinically recognized features of ND.

DOI of Published Version



Contreras, G. A., O’Loughlin, J. O., Rodriguez, D., Wellman, R. J., & DiFranza, J. R. (2010). Measures of nicotine dependence in adolescents: An update of the evidence 2000-2010. Journal of Pediatric Biochemistry, 1, 143-164. doi:10.3233/JPB20100011

Journal/Book/Conference Title

Journal of Pediatric Biochemistry