Screening adolescents for nicotine dependence: the Hooked On Nicotine Checklist

J Adolesc Health. 2004 Sep;35(3):225-30. doi: 10.1016/j.jadohealth.2003.10.004.


Purpose: To evaluate the Hooked On Nicotine Checklist's (HONC) internal consistency, reliability over time, correlation with self-described smoking behavior, and to compare the results with previous studies of the onset of nicotine dependence in youths.

Methods: Ninth-grade students were recruited from a regional school district. Subjects (Ss; n = 371; 91% of the 9th-grade class) were 48.8% male, 97% white, aged 13.8-15.6 years. Ss self-administered a questionnaire on smoking experiences. The HONC was completed by 88 (23.7%) who had puffed on a cigarette at least once; 74 were retested 2 weeks later. Responding "yes" to any of the 10 HONC items indicates nicotine dependence (ND); the number of items endorsed indicates the degree of its severity.

Results: The internal consistency of the HONC is high overall (alpha = 0.90; n = 88), and test-retest reliability for the entire HONC is excellent (intraclass correlation = 0.88, p <.001). Individual items generally showed good to excellent reliability over time (Median Yules' Y = 0.71, range = 0.41-0.82). HONC scores were strongly correlated with self-reported smoking (r = 0.70, p <.001, n = 88).

Conclusions: Adding the HONC to routine adolescent health examinations, health classes, and prevention programs may make adolescents more aware of their symptoms of ND and enable intervention before ND progresses.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Female
  • Humans
  • Male
  • Massachusetts / epidemiology
  • Nicotine
  • Psychometrics / instrumentation*
  • Schools
  • Self-Assessment*
  • Smoking / epidemiology
  • Smoking / psychology*
  • Students / psychology
  • Surveys and Questionnaires*
  • Tobacco Use Disorder / epidemiology
  • Tobacco Use Disorder / psychology*


  • Nicotine