Measuring dependence in smokeless tobacco users

Addict Behav. Jul-Aug 1995;20(4):443-50. doi: 10.1016/0306-4603(95)00013-3.


Two scales based on the Fagerstrom Tolerance Questionnaire were developed to measure dependence in smokeless tobacco users. The total score for both scales correlated positively with saliva cotinine levels in subjects, and several individual items produced equally positive correlations. Regression analyses yielded two subsets of three items from each scale that predicted cotinine level. Reports of using smokeless tobacco within 30 min of waking served as a predictor in both models. For the purposes of measuring smokeless tobacco dependence, attention should be given to individual items correlated with saliva cotinine levels that could be used to determine the direction of cessation efforts. Future research should also develop additional items specific to the use of snuff or chewing tobacco and eliminate questions not contributing to the overall scale.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cotinine / pharmacokinetics
  • Double-Blind Method
  • Drug Tolerance
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nicotine / administration & dosage
  • Personality Assessment / statistics & numerical data
  • Plants, Toxic*
  • Psychometrics
  • Reproducibility of Results
  • Saliva / chemistry
  • Substance Abuse Detection
  • Tobacco Use Disorder / classification
  • Tobacco Use Disorder / diagnosis*
  • Tobacco Use Disorder / rehabilitation
  • Tobacco, Smokeless*
  • Treatment Outcome


  • Nicotine
  • Cotinine