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Penn State Nicotine Dependence Index

The Penn State Nicotine Dependence Index was developed by Dr. Jonathan Foulds in 2011. This 10-item scale (with scores ranging from 0 to 20) was developed to measure nicotine dependence across all nicotine product types, and an adapted version was the first dependence measure designed to evaluate electronic cigarette dependence.

The index is available for use by clinicians and researchers at other institutions using the proper citation.

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Using the index

Primary citation Expand answer

Foulds J, Veldheer S, Yingst J, Hrabovsky S, Wilson SJ, et al. Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking E-cigarette users. Nicotine Tob Res. 2015 Feb;17(2):186-92. https://doi.org/10.1093/ntr/ntu204

Scoring guide: Cigarettes Expand answer

Scoring: Cigarette Dependence Index

1. How many cigarettes per day do you usually smoke? (reference)

  • 0-4 times/day = 0
  • 5-9 = 1
  • 10-14 = 2
  • 15-19 = 3
  • 20-29 = 4
  • 30 or more = 5

On days that you can smoke freely, how soon after you wake up do you smoke your first cigarette of the day? (reference)

  • Less than 5 minutes = 5
  • 6-15 minutes = 4
  • 16-30 minutes = 3
  • 31-60 minutes = 2
  • 61-120 minutes = 1
  • More than 121 minutes = 0

3. Do you sometimes awaken at night to have a cigarette? (reference)

  • Yes = 1
  • No = 0

4. If yes, how many nights per week do you typically awaken to smoke? (reference)

  • 0-1 nights = 0
  • 2-3 nights = 1
  • 4 or more nights = 2

5. Do you smoke now because it is really hard to quit? (reference)

  • Yes = 1
  • No = 0

6. Do you ever have strong cravings to smoke? (reference)

  • Yes = 1
  • No = 0

7. Over the past week, how strong have the urges to smoke been? (reference)

  • None/Slight = 0
  • Moderate/Strong= 1
  • Very Strong/Extremely Strong = 2

8. Is it hard to keep from smoking in places where you are not supposed to? (reference)

  • Yes = 1
  • No = 0

9. (When you haven’t used tobacco for a while or when you tried to stop smoking:) Did you feel more irritable because you couldn’t smoke? (reference)

  • Yes = 1
  • No = 0

10. Did you feel nervous, restless, or anxious because you couldn’t smoke? (reference)

  • Yes = 1
  • No = 0

Results

  • 0-3 = not dependent
  • 4-8 = low dependence
  • 9-12 = medium dependence
  • 13 or more = high dependence

References

Borland, R, Yong, HH, O’Connor, RJ, Hyland, A, & Thompson, ME. (2010). The reliability and predictive validity of the Heaviness of Smoking Index and its two components: Findings from the International Tobacco Control Four Country study. Nicotine & Tobacco Research, 12(suppl_1), S45-S50. doi:10.1093/ntr/ntq038

Bover, MT, Foulds, J, Steinberg, MB, Richardson, D, & Marcella, SW. (2008). Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome. International Journal of Clinical Practice, 62(2), 182-190. doi:10.1111/j.1742-1241.2007.01653.x

Fidler, JA, Shahab, L, & West, R. (2011). Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerstrom Test for Nicotine Dependence and its components. Addiction, 106(3), 631-638. doi:10.1111/j.1360-0443.2010.03226.x

Wellman, RJ, Savageau, JA, Godiwala, S, Savageau, N, Friedman, K, Hazelton, J, & Difranza, JR. (2006). A comparison of the Hooked on Nicotine Checklist and the Fagerstrom Test for Nicotine Dependence in adult smokers. Nicotine Tob Res, 8(4), 575-580. doi:10.1080/14622200600789965

Scoring Guide: Electronic Cigarettes Expand answer

Scoring: Cigarette Dependence Index

1. How many times per day do you usually use your electronic cigarette? (assume one “time” consists of around 15 puffs, or lasts around 10 minutes) (reference)

  • 0-4 times/day = 0
  • 5-9 = 1
  • 10-14 = 2
  • 15-19 = 3
  • 20-29 = 4
  • 30 or more = 5

On days that you can use your electronic cigarette freely, how soon after you wake up do you first use your electronic cigarette? (reference)

  • Less than 5 minutes = 5
  • 6-15 minutes = 4
  • 16-30 minutes = 3
  • 31-60 minutes = 2
  • 61-120 minutes = 1
  • More than 121 minutes = 0

3. Do you sometimes awaken at night to use your electronic cigarette? (reference)

  • Yes = 1
  • No = 0

4. If yes, how many nights per week do you typically awaken to do so? (reference)

  • 0-1 nights = 0
  • 2-3 nights = 1
  • 4 or more nights = 2

5. Do you use an electronic cigarette now because it is really hard to quit? (reference)

  • Yes = 1
  • No = 0

6. Do you ever have strong cravings to use an electronic cigarette? (reference)

  • Yes = 1
  • No = 0

7. Over the past week, how strong have the urges to use an electronic cigarette been? (reference)

  • None/Slight = 0
  • Moderate/Strong= 1
  • Very Strong/Extremely Strong = 2

8. Is it hard to keep from using an electronic cigarette in places where you are not supposed to? (reference)

  • Yes = 1
  • No = 0

9. (When you haven’t used an electronic cigarette for a while or when you tried to stop using one:) Did you feel more irritable because you couldn’t use an electronic cigarette? (reference)

  • Yes = 1
  • No = 0

10. Did you feel nervous, restless, or anxious because you couldn’t use an electronic cigarette? (reference)

  • Yes = 1
  • No = 0

Results

  • 0-3 = not dependent
  • 4-8 = low dependence
  • 9-12 = medium dependence
  • 13 or more = high dependence

References

Borland, R, Yong, HH, O’Connor, RJ, Hyland, A, & Thompson, ME. (2010). The reliability and predictive validity of the Heaviness of Smoking Index and its two components: Findings from the International Tobacco Control Four Country study. Nicotine & Tobacco Research, 12(suppl_1), S45-S50. doi:10.1093/ntr/ntq038

Bover, MT, Foulds, J, Steinberg, MB, Richardson, D, & Marcella, SW. (2008). Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome. International Journal of Clinical Practice, 62(2), 182-190. doi:10.1111/j.1742-1241.2007.01653.x

Fidler, JA, Shahab, L, & West, R. (2011). Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerstrom Test for Nicotine Dependence and its components. Addiction, 106(3), 631-638. doi:10.1111/j.1360-0443.2010.03226.x

Wellman, RJ, Savageau, JA, Godiwala, S, Savageau, N, Friedman, K, Hazelton, J, & Difranza, JR. (2006). A comparison of the Hooked on Nicotine Checklist and the Fagerstrom Test for Nicotine Dependence in adult smokers. Nicotine Tob Res, 8(4), 575-580. doi:10.1080/14622200600789965

Psychometric evaluation of the Penn State Nicotine Dependence Index Expand answer
  1. Foulds J, Veldheer S, Yingst J, Hrabovsky S, Wilson SJ, et al. Development of a questionnaire for assessing dependence on electronic cigarettes among a large sample of ex-smoking E-cigarette users. Nicotine Tob Res. 2015 Feb;17(2):186-92. https://doi.org/10.1093/ntr/ntu204
  2. Foulds J, Veldheer S, Hrabovsky S, Yingst J, Sciamanna C, et al. The effect of motivational lung age feedback on short-term quit rates in smokers seeking intensive group treatment: A randomized controlled pilot study. Drug Alcohol Depend. 2015 Aug 1;153:271-7.
  3. Morean, ME, Krishnan-Sarin, S, Sussman, S, Foulds, J, Fishbein, H, Grana, R, … O’Malley, SS. (2018). Development and psychometric validation of a novel measure of sensory expectancies associated with E-cigarette use. Addict Behav. doi:10.1016/j.addbeh.2018.08.031
  4. Morean, ME, Krishnan-Sarin, S, Sussman, S, Foulds, J, Fishbein, H, Grana, R, & O’Malley, SS. (2019). Psychometric Evaluation of the E-cigarette Dependence Scale. Nicotine Tob Res, 21(11), 1556-1564. doi:10.1093/ntr/ntx271
  5. Piper, ME, Baker, TB, Benowitz, NL, Smith, SS, & Jorenby, DE. (2019). E-cigarette Dependence Measures in Dual Users: Reliability and Relations with Dependence Criteria and E-Cigarette Cessation. Nicotine Tob Res. doi:10.1093/ntr/ntz040
Recent publications using the Penn State Nicotine Dependence Index Expand answer