Indicators of Dependence for Different Types of Tobacco Product Users: Descriptive Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study

Drug Alcohol Depend. 2017 Sep 1;178:257-266. doi: 10.1016/j.drugalcdep.2017.05.010. Epub 2017 Jun 28.


Background and aims: With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products.

Participants: A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products.

Findings: This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n=8689), e-cigarette only (n=437), cigar only (traditional, cigarillo, or filtered) (n=706), hookah only (n=461), smokeless tobacco only (n=971), cigarette plus e-cigarette (n=709), and multiple tobacco product users (n=2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean=0.0, SD=1.0), we observed a range of TD with hookah (mean=-1.71) and cigar (mean=-1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean=0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p<0.001), e-cigarette only (p<0.002), cigar (p<0.001), hookah only (p<0.001), and smokeless tobacco users (p<0.001).

Conclusion: The PATH Study Adult Wave 1 Questionnaire provided psychometrically valid measures of TD that enables future regulatory investigations of nicotine dependence across tobacco products.

Keywords: E-cigarette dependence; Item response theory; Nicotine dependence; Poly-tobacco dependence.

MeSH terms

  • Adult
  • Electronic Nicotine Delivery Systems / methods
  • Electronic Nicotine Delivery Systems / statistics & numerical data
  • Humans
  • Psychometrics
  • Surveys and Questionnaires
  • Tobacco Products / statistics & numerical data*
  • Tobacco Use / epidemiology*
  • Tobacco Use Disorder / epidemiology*
  • Tobacco, Smokeless / statistics & numerical data*