title: The assessment of tobacco dependence in young users of smokeless tobacco.
abstract: BACKGROUND
  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 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.
  
  
  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.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655, USA. difranzj@ummhc.org
authors.forename: Joseph R
authors.initials: JR
authors.lastname: DiFranza
authors.forename: Michael
authors.initials: M
authors.lastname: Sweet
authors.forename: Judith A
authors.initials: JA
authors.lastname: Savageau
authors.forename: W W Sanouri
authors.initials: WW
authors.lastname: Ursprung
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D016739:Behavior, Addictive; D002648:Child; D005260:Female; D005431:Florida / Q000453:epidemiology; D006184:Habits; D006306:Health Surveys; D006801:Humans; D008297:Male; D026684:Personal Autonomy; D057181:Pleasure; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation; D013375:Substance Withdrawal Syndrome; D062789:Tobacco Products / Q000009:adverse effects*; D014029:Tobacco Use Disorder / Q000150:complications / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D055815:Young Adult