Hooked On Nicotine Checklist Research Articles

Adolescent substance use screening in primary care: Validity of computer self-administered versus clinician-administered screening

ABSTRACTBackground: Computer self-administration may help busy pediatricians' offices increase adolescent substance use screening rates efficiently and effectively, if proven to yield valid responses. The CRAFFT screening protocol for adolescents has demonstrated validity as an interview, but a computer self-entry approach needs validity testing. The aim of this study was to evaluate the criterion validity and time efficiency of a computerized adolescent substance use screening protocol implemented by self-administration or clinician-administration. Methods: Twelve- to 17-year-old patients coming for routine care at 3 primary care clinics completed the computerized screen by both self-administration and clinician-administration during their visit. To account for order effects, we randomly assigned participants to self-administer the screen either before or after seeing their clinician. Both were conducted using a tablet computer and included identical items (any past-12-month use of tobacco, alcohol, drugs; past-3-month frequency of each; and 6 CRAFFT items). The criterion measure for substance use was the Timeline Follow-Back, and for alcohol/drug use disorder, the Adolescent Diagnostic Interview, both conducted by confidential research assistant interview after the visit. Tobacco dependence risk was assessed with the self-administered Hooked on Nicotine Checklist (HONC). Analyses accounted for the multisite cluster sampling design. Results: Among 136 participants, mean age was 15.0 ± 1.5 years, 54% were girls, 53% were black or Hispanic, and 67% had ≥3 prior visits with their clinician. Twenty-seven percent reported any substance use (including tobacco) in the past 12 months, 7% met criteria for an alcohol or cannabis use disorder, and 4% were HONC positive. Sensitivity/specificity of the screener were high for detecting past-12-month use or disorder and did not differ between computer and clinician. Mean completion time was 49 seconds (95% confidence interval [CI]: 44–54) for computer and 74 seconds (95% CI: 68–87) for clinician (paired comparison, P < .001). Conclusions: Substance use screening by computer self-entry is a valid and time-efficient alternative to clinician-administered screening.

Prevalence of psychoactive substance use among youth in Rwanda.

BackgroundSubstance use among youth is a significant public health concern worldwide. However, little is known in Rwanda about the prevalence of drug use among youth. The goal of the current study was to assess the prevalence and determinants of substance use among youth in Rwanda.MethodsA cross-sectional home survey was carried out with 2479 Rwandan youth. Youth ranging, in age from 14–35 years, were randomly selected from 20 out of the 30 districts in the country. The youth were interviewed using a questionnaire that included socio-demographic information and self-reported substance use. Misuse and dependence on alcohol, marijuana and tobacco were respectively assessed by the Alcohol Use Disorders Identification Test (AUDIT), the Cannabis Abuse Screening Test (CAST), and the Hooked on Nicotine Checklist (HONC).ResultsOverall, the prevalence rate of substance use over the month prior to the survey was 34% for alcohol, 8.5% for tobacco smoking, 2.7% for cannabis, 0.2% for glue and 0.1% for drugs such as diazepam. 7.46% (one in thirteen) of the youth were alcohol dependent, 4.88% (one in twenty) were nicotine dependent, and 2.54% (one in forty) dependent on cannabis.ConclusionsOur findings demonstrate that tobacco, alcohol, marijuana and other substance use are realities in the daily lives of youth in Rwanda. Further research is needed to monitor the evolution of this phenomenon and its determinants and in order to initiate evidenced-based interventions.

Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers

BackgroundMarijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use. MethodsParticipants were 165 adolescents (13–17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS). ResultsThe adolescent sample (mean age=16.1 years, SD=0.95) averaged 3.0 CPD (SD=3.0) for 1.98 years (SD=1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25–44% of the variance for all four measures of adolescent nicotine dependence. ConclusionsMarijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.

Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status

IntroductionLow socio-economic status (SES) is strongly related to smoking, but studies examining the association of SES with nicotine dependence (ND) are scarce. The aim of this study was to examine the associations of SES and marital status with smoking, multiple measures of ND, and cotinine as a nicotine intake biomarker. MethodsThe sample comprised 1746 ever smokers, sampled from the National FINRISK 2007 Study, who had completed a tobacco specific questionnaire in addition to the standard clinical examination. The Fagerström Test for Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI), the Nicotine Dependence Syndrome Scale (NDSS), and the Hooked On Nicotine Checklist (HONC) were assessed, while plasma cotinine was measured as a biomarker of nicotine exposure in daily smokers. Univariate and multivariate associations were assessed by linear regression and multinomial logistic regression. ResultsIn multivariate models, lower education was associated with higher FTND and HSI, income with HSI, and occupation with HSI (men only), FTND, HONC and NDSS scores. Lower education was related to higher cotinine levels among daily smokers, although the association diminished slightly after adjusting for daily smoking amount. Living without a spouse was associated with daily smoking and higher ND. ConclusionIn this cross-sectional study low SES was linked with higher ND among current smokers, while low SES was associated with higher cotinine levels among daily smokers. Living alone was linked with higher ND. Longitudinal studies are warranted to further explore these associations. As lower SES smokers are more addicted they may need more targeted cessation services to succeed in quitting smoking.

Progressive levels of physical dependence to tobacco coincide with changes in the anterior cingulum bundle microstructure.

BackgroundThe tobacco withdrawal syndrome indicates the development of neurophysiologic dependence. Clinical evidence indicates that neurophysiologic dependence develops through a set sequence of symptom presentation that can be assessed with a new 3-item survey measure of wanting, craving, and needing tobacco, the Level of Physical Dependence (PD). This study sought to determine if advancing neurophysiologic dependence as measured by the Level of PD correlates with characteristics of white matter structure measured by Fractional Anisotropy (FA).MethodsDiffusion-MRI based FA and diffusion tensor imaging probabilistic tractography were used to evaluate 11 smokers and 10 nonsmokers. FA was also examined in relation to two additional measures of dependence severity, the Hooked on Nicotine Checklist (HONC), and the Fagerström Test for Nicotine Dependence (FTND).ResultsAmong smokers, FA in the left anterior cingulate bundle (ACb) correlated negatively with the Level of PD (r = −0.68, p = 0.02) and HONC scores (r = −0.65, p = 0.03), but the correlation for the FTND did not reach statistical significance (r = −49, p = 0.12). With advancing Levels of PD, the density of streamlines between the ACb and precuneus increased (r = −0.67, p<0.05) and those between the ACb and white matter projecting to the superior-frontal cortex (r = −0.86, p = 0.0006) decreased significantly.ConclusionsThe correlations between neural structure and both the clinical Level of PD survey measure and the HONC suggest that the Level of PD and the HONC may reflect the microstructural integrity of white matter, as influenced by tobacco abuse. Given that the Level of PD is measuring a sequence of symptoms of neurophysiologic dependence that develops over time, the correlation between the Level of PD and neural structure suggests that these features might represent neuroplastic changes that develop over time to support the development of neurophysiologic dependence.

Diurnal Evening Type is Associated with Current Smoking, Nicotine Dependence and Nicotine Intake in the Population Based National FINRISK 2007 Study

AIMS: To examine whether smoking habits, nicotine dependence (ND) and plasma cotinine levels differ by diurnal type. DESIGN: Data originated from the national FINRISK 2007 survey. Regression analyses were calculated to examine the association between diurnal type and smoking status, ND, and nicotine intake. PARTICIPANTS: 7091 FINRISK participants with smoking and diurnal type information and a subset of 1746 ever smokers with detailed smoking, and ND assessments. MEASUREMENTS: Diurnal type assessed with a six-item sum scale was categorized as morning, intermediate and evening type. Smoking status was determined as current (daily or occasional), former, and never smokers. ND was measured with the Fagerström Test for Nicotine Dependence (FTND), the Hooked on Nicotine Checklist (HONC), and the Nicotine Dependence Syndrome Scale (NDSS). For current smokers, plasma cotinine was analyzed as biochemical measurement of nicotine intake. FINDINGS: Evening type was associated with current smoking (OR=1.66, 95% CI 1.40, 1.97). A significant association with diurnal type was seen for FTND among men (beta= -0.46, 95% CI -0.72, -0.21), sexes combined for HONC (beta= -0.31, 95% CI -0.52, -0.11) and NDSS (beta= -0.86, 95% CI -1.43, -0.29) and for cotinine among men (beta= -0.73, 95% CI -1.16, -0.29). Adjustment for depressive symptoms attenuated the association of diurnal type with NDSS to be non-significant. CONCLUSIONS: Diurnal type was associated with multiple ND measures and nicotine intake, interestingly more so among men. Evening type persons are at higher risk of dependence, but depressive symptoms attenuates this association clearly.

The assessment of tobacco dependence in young users of smokeless tobacco

IntroductionAs 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...

Repérer les comportements addictifs chez les adolescents : enquête en milieu lycéen

French epidemiological data show that adolescents today experiment with tobacco at an earlier age than in the 1990s. Half of them combine tobacco consumption with other psychoactive products such as alcohol or cannabis. Tobacco consumption usually begins in adolescence and early smoking initiation is related to stronger nicotine dependence and problems quitting in adulthood. Occasional tobacco consumption rapidly leads to nicotine dependence. The national smoking cessation questionnaire is a tool to assess addictive behaviors among adolescents. It includes validated scales such as the loss of autonomy over tobacco and psychological evaluation. The aim of this school-based study was to assess addictive behaviors among adolescents (specifically loss of autonomy over tobacco) and psychological profile. Data were collected from a cross-sectional study conducted in a high school in the Paris metropolitan area (Nogent-sur-Marne) in 2007 by the smoking cessation team of the Albert-Chenevier Hospital. Three hundred adolescents filled in a questionnaire concerning tobacco, alcohol, and cannabis consumption as well as their psychological profile. Loss of autonomy over tobacco use was evaluated with the Hooked on Nicotine Checklist (HONC). Anxiety and depressive disorders were identified using the Hospital Anxiety and Depression scale (HAD). Self-administered questionnaires were anonymously completed in the classroom by 151 girls and 149 boys aged 15-16 years (mean, 15.4 years): 34% of the adolescents smoked and most of them smoked at least one cigarette a day; 38% had used cannabis at least once in their life and one-third of them smoked more than 10 cannabis joints per month. Adolescents who frequently smoked cannabis had started smoking tobacco earlier than the other smokers (mean, 11.7 years versus 13.2 years). Adolescents often used different tobacco products. Manufactured cigarettes were the most frequently used, followed by shisha (waterpipe) and hand-rolled cigarettes. Among those who only smoked shisha, 76% had declared being non-smokers. Alcohol was the first psychoactive drug experimented by these adolescents; 73% had used alcohol at least once in their life and 10% used alcohol several times a week. According to the HONC, 94% of the smokers had lost control of their tobacco consumption. Concerning anxiety and depressive disorders, anxiety and depression scores were higher among smokers than non-smokers. Less than 6% of never-smokers had a depression score greater than 8 compared to 26% of adolescents smoking cannabis more than 10 times a month. The rapidity of the loss of autonomy among young smokers emphasizes the need for early interventions for tobacco prevention and cessation among adolescents. Tobacco use was often associated with anxiety and depressive symptoms, suggesting a need for professional support. The national smoking cessation questionnaire may be helpful in pediatric wards and consultations.

Smoking behaviours and contextual influences on adolescent nicotine dependence

The objectives of the study were to analyse nicotine-dependence patterns among secondary school students in New Zealand (NZ), and identify factors associated with levels of nicotine dependence. This study uses data from the 2004 Youth Lifestyle Study, a survey of Year 10 and 12 students from randomly selected schools in NZ. The analysis included 625 current adolescent smokers. Nicotine dependence was measured with the Hooked on Nicotine Checklist (HONC). Potential dependence-associated factors studied include: socio-demographic factors; smoking behaviours; and smoking contexts. A large percentage (87.9%) of the current adolescent smokers reported at least one HONC symptom, with a mean HONC score of 4.9 out of a possible 10. Multivariate analyses identified: school decile; age at which started smoking monthly; lifetime cigarette consumption; and peers smoking as statistically significant predictors of nicotine dependence. Adolescent smokers are very likely to become dependent on nicotine. Students from the highest school decile had markedly lower HONC scores. Earlier onset of monthly smoking, heavier overall consumption and peers smoking were associated with higher HONC scores. These findings provide important insights into factors that may need to be modified to help reduce nicotine dependence among adolescents.

What is the significance of experiencing relaxation in response to the first use of nicotine?

Individuals who feel relaxed the first time they inhale from a cigarette are more likely to develop nicotine dependence. To determine if the relaxation response is associated only with specific aspects of dependence, a survey was administered to 1405 adolescents aged 14–18 years (mean 15.8 years) from four schools in Massachusetts. Nicotine dependence was measured with the Diagnostic and Statistical Manual (DSM-IV), and the loss of autonomy over tobacco was measured with the Hooked on Nicotine Checklist (HONC) and the Autonomy Over Smoking Scale. A feeling of relaxation was reported by 39.4% of 439 youth who had inhaled from a cigarette. Relaxation was associated with increased risk of current smoking (odds ratio (OR) = 5.7, p < 0.001), daily smoking (OR = 5.7, p < 0.001), a loss of autonomy on the HONC (OR = 5.0, p < 0.001), and a DSM-IV diagnosis (OR = 2.4, p < 0.02). In regression analyses, relaxation was not associated with psychological reliance on tobacco after controlling for nicotine withdrawal symptoms, and cue-induced craving. This study extends the literature by demonstrating that relaxation is associated with DSM-IV nicotine dependence, nicotine withdrawal, and aspects of cue-induced craving.

Assessment of nicotine dependence among adolescent and young adult smokers: A comparison of measures

Introduction Tobacco use often starts in adolescence, yet assessment of dependence among adolescent smokers remains a challenge, particularly given the potential discord between self-reports of smoking behavior and actual use. We could find no prior study, among adolescents, that directly compares the association between objective biomarkers of tobacco exposure (e.g., cotinine) and multiple measures of dependence. This study examined the concurrent validity of two common dependence measures: the Fagerström Test for Nicotine Dependence (FTND) and the Hooked on Nicotine Checklist (HONC). We further examined the FTND by removing the one item on cigarettes smoked per day. Methods Based within a parent clinical trial for adolescent smoking cessation, eligible participants were 12–21 years old, smoking ≥ 5 cigarettes per day on average, and with urine cotinine > 100 ng/ml at baseline. Results are based on participants who completed each measure and who provided a urine cotinine sample at baseline (N = 73). Results Results showed that the FTND was associated with cotinine (p < 0.001; R 2 = 0.25), and that this relationship held true for the revised FTND as well (p < 0.001; R 2 = 0.18). However, the HONC was only marginally associated with cotinine (p = 0.06; R 2 = 0.09). Discussion Our results suggest that the FTND may be better associated with actual smoking behavior in adolescents as compared to the HONC. Pending replication, our data provide caution with regard to assessment of nicotine dependence at least among established adolescent smokers who have more entrenched smoking behavior.

Symptoms of nicotine dependence in a cohort of Swedish youths: a comparison between smokers, smokeless tobacco users and dual tobacco users

To determine whether symptoms of nicotine dependence, addiction and withdrawal symptoms differ between exclusive smokers, exclusive snus (moist snuff) users and dual users. A cross-sectional survey of a cohort subsample. Setting County of Stockholm, Sweden. Current exclusive smokers (n = 466), exclusive snus users (n = 209) and dual users (n = 144), mean age 17.6 years. Self-reported life-time experience of nicotine dependence and withdrawal symptoms in periods of discontinued tobacco use. Selected items from the modified Fagerstöm Tolerance Questionnaire (mFTQ), the Hooked on Nicotine Checklist (HONC) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The odds ratio of endorsing each of four mFTQ items as well as the HONC item investigating the risk of feeling addicted to tobacco was two to five-fold higher for exclusive snus users and for dual users compared to exclusive smokers. One DSM-IV item (difficult to refrain from use) was elevated among dual users compared to smokers. Dual users reported the highest prevalence of any withdrawal symptom in contrast to exclusive snus users, who reported a lower risk of withdrawal symptoms compared to exclusive smokers. Smokeless tobacco users show symptoms of nicotine dependence at least as frequently as cigarette smokers. Symptoms of nicotine dependence and of withdrawal during quit attempts are particularly frequent in the subgroup of users who combine smokeless tobacco with smoking.

Psychometric Testing of the Chinese Version of the Hooked on Nicotine Checklist in Adolescents

Purpose To examine the psychometric properties of the Hooked on Nicotine Checklist (HONC) on a Taiwanese sample. The HONC as a measure of nicotine dependence in adolescents is in worldwide use. Less is known regarding its psychometric properties for a Chinese population. Methods A cross-sectional, descriptive study was conducted from January to May 2008 with 373 male adolescent smokers aged 15 to 20 years. The criterion validity of the Chinese HONC was determined using the Fagerstrom Test of Nicotine Dependence (FTND) and saliva cotinine. Because the responses to the items are dichotomous, the validity and factorial structures were examined using tetrachoric and biserial techniques by PRELIS 2 and LISREL 8.7. Results Most of interitem correlations are between 0.3 and 0.7. Each item is highly associated with the full scale (r > .7). The HONC total score is significantly associated with the FTND (r = .58, p < .01) and with saliva cotinine levels (r = .27, p < .05). Confirmatory factor analyses were performed to compare the relative fit of three competing models. The three-correlated factor model has a better fit than other models, according to the cutoff criteria for relatively good fit. The coefficient alpha of the full scale is .83. Conclusions The Chinese version of the HONC is a reliable and valid measure of tobacco dependence in adolescent smokers. Studies involving female adolescent and younger smokers will be needed to evaluate the applicability of the scales to the different genders and age populations.

Using an item response model to examine the nicotine dependence construct as characterized by the HONC and the mFTQ among adolescent smokers

Despite efforts to operationalize the nicotine dependence syndrome among adolescents, little is known regarding the relative severity of dependence symptoms assessed by different measures. The current study utilized a nonparametric item response model to assess the unidimensionality of the nicotine dependence construct and relative severity of dependence symptoms characterized by the Hooked on Nicotine Checklist (HONC) and the modified Fagerström Questionnaire (mFTQ) in a sample of 109 adolescent smokers (58% female) participating in a prospective investigation of smoking self-change efforts. It was hypothesized that symptoms assessed by the HONC would be associated with lower levels of nicotine dependence severity than symptoms assessed with the mFTQ. Results indicated that HONC and mFTQ items could be linked to a single latent construct. Most HONC items captured variability at the lower range and mFTQ items made discriminations at the middle and higher end of the dependence severity continuum. Findings suggest the HONC and mFTQ may provide complementary information in assessing nicotine dependence levels in adolescent regular smokers and have implications for symptoms expression in youth.

Factorial and convergent validity of nicotine dependence measures in adolescents: Toward a multidimensional approach

The present study investigated the possibility of forming a multidimensional scale for the measurement of nicotine dependence among adolescents, based on the modified Fagerström Tolerance Questionnaire (mFTQ) and the Hooked on Nicotine Checklist (HONC). A survey was conducted among 33 Dutch secondary schools, resulting in 2,041 smokers who completed the questionnaire. Motivation to quit and number of quit attempts were assessed and used as convergent construct variables for the construct of nicotine dependence. The findings show that combining the items of the mFTQ and the HONC results in three distinct dimensions: behavioral aspects of nicotine dependence, craving, and nervousness during abstinence. We examined this new multidimensional model in a second sample using confirmatory factor analysis. The new multidimensional measure fitted the data satisfactorily and showed good psychometric properties. Results of this study support the notion that nicotine dependence among adolescents is multidimensional.

Influence parentale (dépendance tabagique et styles éducatifs) sur la consommation et la dépendance tabagique de leur adolescent

To study the influence of parenting styles and of parental smoking and nicotine dependence on their adolescent children's tobacco use. This study, conducted in 2005, included 542 students from a French high school and 312 of their parents. The student sample had a mean age of 17 and 66% girls (n=360). Tobacco consumption and dependence were assessed for parents and students by the Fagerström test for nicotine dependence (FTND) and for the students only by the Hooked on Nicotine Checklist (HONC). Students were also asked about use of other psychoactive substances and completed the Authoritative Parenting Index (API). Parenting styles were classified as authoritative, authoritarian, indulgent, or neglectful. Although 70% of the girls and 72% of the boys had tried smoking, only 12.5% were daily smokers. The mean FTND score was 1.3 (n = 156 respondents), and the mean HONC score 3.9 (n = 160). Fathers smoked more than mothers and had a higher mean FTND score: 2.8 (n = 35) versus 1.7 (n = 32) for mothers. Tobacco use by each parent was correlated with that of the other (r=0.49, p<0.001). Adolescents' tobacco consumption was correlated with that of their parents, especially their father and especially for boys (r=0.86, p<0.01). Age at starting smoking was associated with a young mother (r=0.60, p<0.001), while dependence (FTND) was associated with a young father. More broadly, tobacco dependence was associated with both parents' consumption and dependence, especially among girls. The use of other psychoactive substances was also associated with parental tobacco dependence, especially that of fathers and especially for boys. Inebriation and marijuana use in girls were also associated with maternal tobacco dependence, but less significantly. An authoritative parenting style tended to be associated with their children's less frequent tobacco consumption and less severe dependence, whereas neglectful and indulgent styles were associated with more frequent consumption and greater dependence; the age at which boys began smoking daily was linked to a maternal neglectful style, and a paternal authoritarian style was associated with paternal tobacco dependence in boys and maternal dependence in girls. We also found this type of correlation for other psychoactive substances, in particular, for inebriation and cannabis use, which decreased in families with an authoritative parenting style. This style appears protective.

A comparison of the Hooked on Nicotine Checklist and the Fagerström Test for Nicotine Dependence in adult smokers

Diminished autonomy is a core feature common to all forms of dependence involving drugs or behaviors. The Hooked on Nicotine Checklist (HONC) is a reliable and valid measure of diminished autonomy over tobacco. It has not previously been compared with the Fagerström Test for Nicotine Dependence (FTND) in adult smokers. In the present study, 1,130 smokers (M age = 41; M cigs/day = 18.5) completed both measures. Factor analysis yielded one factor for both the HONC and the FTND. Mean HONC score was 7.0, and mean FTND score was 4.6; the measures correlated at r = .44. The HONC had higher internal consistency (alpha = .82) than the FTND (alpha = .61; z(1127) = 7.1, p < .001). The measures correlated similarly with age at smoking onset and days smoked per month, but the FTND correlated higher with cigarette consumption. Subjects who used nicotine replacement therapy or bupropion during an abstinence attempt scored higher on both measures, whereas those who maintained abstinence for at least 3 days scored lower. The HONC has several advantages: (a) It measures a clearly defined construct, and each item has face validity; and it has (b) better psychometric properties, (c) a logical cutpoint (zero symptoms), (d) greater sensitivity to the onset and low levels of dependence, and (e) easily interpretable scores. The HONC is uniquely suited for use with smokers whose cigarette consumption is low.

A comparison of the psychometric properties of the hooked on nicotine checklist and the modified Fagerström tolerance questionnaire

We compared the psychometric properties of the Hooked on Nicotine Checklist (HONC) and the Modified Fagerström Tolerance Questionnaire (MFTQ). Adolescent current smokers ( n = 215) completed both instruments three times, at baseline and 6- and 12-month follow-up. Internal consistency of the HONC was high ( α = 0.92), as was its stability over the follow-up interval (intraclass correlation (ICC) = 0.93 over 6 months and 0.91 over 1 year). Internal consistency of the MFTQ was acceptable ( α = 0.83), and its stability over the follow-up interval was similar to that reported previously (ICC = 0.79 at 6 months and 0.76 at 1 year). The HONC predicted smoking at both follow-up points, while the MFTQ did so only at 6 months. The HONC compared favorably with the MFTQ in all respects. The most important advantage of the HONC is that it is measuring a clearly defined concept, diminished autonomy over tobacco, which begins when the sequelae of tobacco use present a barrier to quitting.

Measuring adults' loss of autonomy over nicotine use: The Hooked on Nicotine Checklist

The Hooked on Nicotine Checklist (HONC) is a 10-item screening tool originally developed to assess loss of autonomy over tobacco in adolescent smokers. A smoker's endorsement of any item indicates some loss of autonomy, and the sum of endorsed items indicates the degree to which autonomy has been lost. This study extends the HONC to adult smokers. Self-administered questionnaires were completed by a convenience sample of 1,102 adults who were recruited in their natural environments while observed smoking. Subjects were mostly experienced smokers who consumed a mean of 17.5 cigarettes per day and had smoked an average of 20.9 years. HONC scores ranged from 0 to 10, with a mean of 7.1. The HONC appears to measure a single dimension. Internal HONC consistency was high (alpha = .83), and interitem correlations were low to moderate. HONC scores correlated positively with levels of current and peak lifetime cigarette consumption. The HONC scores of heavy, moderate, and light smokers differed significantly in the expected direction. Subjects with higher HONC scores were more likely to report a shorter duration of abstinence and greater use of pharmacological aids when quitting. The HONC appears to be psychometrically sound in both adolescents and adults. It is a reliable and valid measure of lost autonomy for both novice and experienced smokers, and it allows for comparisons between these populations.

Trait anxiety and nicotine dependence in adolescents: A report from the DANDY study

The Revised Children's Manifest Anxiety Scale (RCMAS) and the Hooked on Nicotine Checklist (HONC) were used to measure trait anxiety and tobacco dependence in a population of 581 adolescents. Smokers demonstrated higher mean RCMAS scores (9.3, S.D.=6.5) than nonsmokers did (7.4, S.D.=6.2, t=−3.7, P<.001). Participants with symptoms of tobacco dependence had higher RCMAS scores (mean=11.6, S.D.=6.0, n=115) than did the participants without symptoms (mean=7.8, S.D.=6.0, n=177, t=−5.3, P<.001). Scores on the RCMAS and the HONC correlated positively ( n=292, r=.32, P<.001). Participants who had felt relaxed in response to their first exposure to nicotine were also more likely to develop dependence and to report that stress caused cravings or a need to smoke. Trait anxiety and relaxation in response to the first dose of nicotine were unrelated and appear to be independent risk factors for the development of nicotine dependence and a reliance on tobacco to cope with stress.