A measure of nicotine dependence for smokeless tobacco users

Amy K. Ferketich, Alvin G. Wee, Jennifer Shultz, Mary Ellen Wewers

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


The objective of the present study was to examine the properties of a modification of the Fagerström Test of Nicotine Dependence in a large sample of smokeless tobacco (ST) users. The subjects for this study included 256 males who were recruited for a tobacco cessation intervention that involved a visit with a dentist and advice to quit smoking during the exam. At baseline, the modified dependence scale was administered to the participants and a saliva sample was collected to measure cotinine. The correlation between the total score and salivary cotinine was moderate among the ST only users (r = 0.34), whereas it was lower (r = 0.19) among the ST + cigarette users. Among ST only users, the coefficient alpha was 0.40; however it was considerably higher among the ST + cigarettes group (alpha = 0.61). In both cases, the coefficient alpha was lower than the recommended value of 0.70. Future research should focus on refining questionnaires that more precisely measure nicotine dependence in smokeless tobacco users.

Original languageEnglish (US)
Pages (from-to)1970-1975
Number of pages6
JournalAddictive Behaviors
Issue number9
StatePublished - Sep 2007

Bibliographical note

Funding Information:
This study was supported by a grant from the National Institutes of Health (R01 DE13926). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.


  • Dependence measure
  • Nicotine
  • Smokeless tobacco

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