A measure of nicotine dependence for smokeless tobacco users.

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.