Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Family Medicine and Community Health; Department of Psychiatry; Center for Health Policy and Research

Publication Date


Document Type



Adolescent; *Adolescent Behavior; *Adolescent Psychology; Factor Analysis, Statistical; Female; Humans; Longitudinal Studies; Male; *Personal Autonomy; Prospective Studies; Psychometrics; Questionnaires; Reproducibility of Results; Smoking; Tobacco Use Disorder


Life Sciences | Medicine and Health Sciences | Women's Studies


CONTEXT: There is no validated, theory-based tool for assessing the onset of nicotine dependence. However, the use of all addictive substances can result in a loss of autonomy. We propose that nicotine dependence begins when autonomy is lost, ie, when the sequelae of tobacco use, either physical or psychological, present a barrier to quitting.

OBJECTIVES: To test the autonomy theory of nicotine dependence, and to evaluate the Hooked on Nicotine Checklist (HONC) as a measure of the loss of autonomy over tobacco use.

DESIGN: The psychometric performance and concept validity of the HONC were evaluated in a 30-month prospective longitudinal study of the natural history of tobacco use in a cohort of 679 seventh-grade students.

RESULTS: As hypothesized, endorsement of a single item on the HONC was associated with a failed attempt at smoking cessation (odds ratio [OR], 29; 95% confidence interval [CI], 13-65), continued smoking until the end of follow-up (OR, 44; 95% CI, 17-114), and daily smoking (OR, 58; 95% CI, 24-142). Scores on the HONC correlated with the maximum amount smoked (r = 0.65; PCONCLUSIONS: The data support the autonomy theory that dependence begins with the loss of autonomy. The autonomy theory represents a potentially useful alternative to current concepts of nicotine dependence for adolescents, and the HONC appears to measure lost autonomy in adolescents. Construct validity was demonstrated by its utility in predicting failed cessation and the progression of tobacco use. In addition, the psychometric properties were excellent.

DOI of Published Version



Arch Pediatr Adolesc Med. 2002 Apr;156(4):397-403.

Journal/Book/Conference Title

Archives of pediatrics and adolescent medicine

Related Resources

Link to article in PubMed

PubMed ID