title: A multiple motive/multi-dimensional approach to measure smokeless tobacco dependence.
abstract: BACKGROUND
  Unlike various research studies conducted to address dependence among smokers, only a few studies have examined smokeless tobacco (ST) dependence. The Fagerström Tolerance Questionnaire (FTQ) and Fagerström Test for Nicotine Dependence (FTND) based scales are the most widely used measures of nicotine dependence for both ST users and smokers. These scales were initially developed to measure physical dependence and tolerance and not to assess other salient dimensions of dependence such as craving, compulsion, or withdrawal, as defined by DSM-IV and ICD-10. The aim of this study is to develop and validate a multidimensional scale that has better content coverage, factor structure, and psychometric properties to measure dependence among ST users.
  
  
  METHODS
  100 adult male smokeless tobacco users were recruited through email distribution lists and community referral. Participants completed three different nicotine dependence questionnaires and provided information related to their tobacco use and demographic characteristics. They also provided a saliva sample for cotinine measurement. In order to develop the new ST scale, subscales and items were selected based on correlation and factor analysis of the modified WISDM-68. Reliability and validity of the new scale, Oklahoma Scale for Smokeless Tobacco Dependence (OSSTD) were also assessed.
  
  
  RESULTS
  The new ST scale identified seven latent constructs including 23 items to measure ST dependence. Internal consistency as measured by Cronbach's coefficient (α=0.925) indicated better reliability of OSSTD than FTND-ST. Concurrent validity of OSSTD as evaluated by comparing it with dependence diagnosis and FTND-ST was affirmative. There was a significant correlation between the OSSTD total score and the cotinine levels and tobacco use characteristics among study participants.
  
  
  CONCLUSIONS
  OSSTD possesses better psychometric properties and provides an effective and efficient tool to measure ST dependence as a multidimensional construct.
authors: Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 4502 East 41st Street, SAC 1G06, Tulsa, OK 74135, USA. Electronic address: Nasir-Mushtaq@ouhsc.edu.
authors: Nasir
authors: N
authors: Mushtaq
authors: Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB-309, Oklahoma City, OK 73104, USA. Electronic address: Laura-Beebe@ouhsc.edu.
authors: Laura A
authors: LA
authors: Beebe
authors: Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB-309, Oklahoma City, OK 73104, USA. Electronic address: Sara-Vesely@ouhsc.edu.
authors: Sara K
authors: SK
authors: Vesely
authors: Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB-309, Oklahoma City, OK 73104, USA. Electronic address: Barbara-Neas@ouhsc.edu.
authors: Barbara R
authors: BR
authors: Neas
mesh_terms: D000328:Adult; D003367:Cotinine / Q000032:analysis; D005163:Factor Analysis, Statistical; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results; D012463:Saliva / Q000737:chemistry; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis*; D014030:Tobacco, Smokeless; D055815:Young Adult
chemical_list: D003367:Cotinine
keywords: Dependence measure; Dependence scale; OSSTD; Oklahoma Scale for Smokeless Tobacco Dependence; Smokeless tobacco; Smokeless tobacco dependence