A comparison of the Hooked on Nicotine Checklist and the Fagerström Test for Nicotine Dependence in adult smokers

Diminished autonomy is a core feature common to all forms of dependence involving drugs or behaviors. The Hooked on Nicotine Checklist (HONC) is a reliable and valid measure of diminished autonomy over tobacco. It has not previously been compared with the Fagerström Test for Nicotine Dependence (FTND) in adult smokers. In the present study, 1,130 smokers (M age = 41; M cigs/day = 18.5) completed both measures. Factor analysis yielded one factor for both the HONC and the FTND. Mean HONC score was 7.0, and mean FTND score was 4.6; the measures correlated at r = .44. The HONC had higher internal consistency (alpha = .82) than the FTND (alpha = .61; z(1127) = 7.1, p < .001). The measures correlated similarly with age at smoking onset and days smoked per month, but the FTND correlated higher with cigarette consumption. Subjects who used nicotine replacement therapy or bupropion during an abstinence attempt scored higher on both measures, whereas those who maintained abstinence for at least 3 days scored lower. The HONC has several advantages: (a) It measures a clearly defined construct, and each item has face validity; and it has (b) better psychometric properties, (c) a logical cutpoint (zero symptoms), (d) greater sensitivity to the onset and low levels of dependence, and (e) easily interpretable scores. The HONC is uniquely suited for use with smokers whose cigarette consumption is low.