A comparison of three smokeless tobacco dependence measures

Smokeless tobacco (ST) use is associated with tobacco dependence and long-term adverse health consequences. Clinical and research tools that can accurately assess ST dependence are needed to improve research and treatment of ST users. Measures of ST dependence have been developed to address this need. We used data from a study evaluating the effectiveness of bupropion sustained release for the treatment of ST use (N=225) to compare the Fagerström Tolerance Questionnaire for Smokeless Tobacco (FTQ-ST) users, the Severson Smokeless Tobacco Dependency Scale (SSTDS), and the Glover-Nilsson Smokeless Tobacco Behavioral Questionnaire (GN-STBQ). We observed that despite the intention of the scale: (1) all scales were significantly correlated with ST cans consumed per week; (2) the FTQ-ST was significantly correlated with serum nicotine and cotinine concentrations and craving; (3) the GN-STBQ and SSTDS were significantly associated with both craving and withdrawal; and (4) none of the scales were significantly associated with ST abstinence. When all of the scales were entered simultaneously in a multivariable analysis, the SSTDS was the only scale independently associated with withdrawal and craving. As when used with cigarette smokers, the FTQ-ST appeared to measure the construct of physical dependence. The GN-STBQ and SSTDS, designed to measure broader constructs of dependence, were found to predict both withdrawal and craving which may be advantageous in clinical settings. The GN-STBQ and the FTQ-ST did not contribute significantly to the prediction of withdrawal and craving beyond what was accomplished using the SSTDS. The use of the scales is discussed in terms of clinical usefulness and how each scale might assess differing aspects of tobacco dependence.