OBJECTIVES:

Nicotine dependence is a primary driver of tobacco-use behavior, a fact supported primarily by research historically focused on cigarette smokers. Currently, there are no generally accepted self-report instruments available to measure dependence in a directly comparable way across different tobacco and nicotine-containing products (TNP). As part of the ABOUT Toolbox (Assessment of Behavioral OUtcomes related to Tobacco and nicotine products) initiative, we developed a new fit-for-purpose instrument.

METHODS:

We initially developed a conceptual framework based on expert opinion, literature review, and concept elicitation/cognitive interviews with TNP users (n=40). This led to the development of initial content for a draft instrument, which was subsequently field tested in a cross-sectional survey of TNP users (n=2,434) to guide scale formation and establish psychometric properties (e.g., acceptability, reliability, construct validity, and concurrent validity). For both qualitative and quantitative studies, the sample was recruited in order to have an equal number of single tobacco product users (i.e., balanced across cigarettes, cigar/cigarillos, e-cigarettes, smokeless tobacco, and other TNPs) and poly-users.

RESULTS:

The conceptual framework included symptoms representing lack of control, which was postulated to be the core concept of dependence. Qualitative data suggested that all tobacco users, regardless of type, characterized dependence “severity” in terms of the intensity, frequency, or duration of need or desire for TNPs and the inability to curb those without TNP use. This resulted in a 19-item draft instrument that was well understood across TNP users. In the field testing, all respondents but one completed all items in the questionnaire, supporting the acceptability of the instrument.

CONCLUSIONS:

While the psychometric validation of the ABOUT-Dependence instrument is ongoing and will be presented in full, acceptability data, along with cognitive debriefing of the measure, provide the first evidence that the standardized measurement of dependence across different TNPs and use behaviors is achievable.