Screening adolescents for nicotine dependence: the Hooked On Nicotine Checklist

Abstract

Purpose: To evaluate the Hooked On Nicotine Checklist's (HONC) internal consistency, reliability over time, correlation with self-described smoking behavior, and to compare the results with previous studies of the onset of nicotine dependence in youths.

Methods: Ninth-grade students were recruited from a regional school district. Subjects (Ss; n = 371; 91% of the 9th-grade class) were 48.8% male, 97% white, aged 13.8-15.6 years. Ss self-administered a questionnaire on smoking experiences. The HONC was completed by 88 (23.7%) who had puffed on a cigarette at least once; 74 were retested 2 weeks later. Responding "yes" to any of the 10 HONC items indicates nicotine dependence (ND); the number of items endorsed indicates the degree of its severity.

Results: The internal consistency of the HONC is high overall (alpha = 0.90; n = 88), and test-retest reliability for the entire HONC is excellent (intraclass correlation = 0.88, p <.001). Individual items generally showed good to excellent reliability over time (Median Yules' Y = 0.71, range = 0.41-0.82). HONC scores were strongly correlated with self-reported smoking (r = 0.70, p <.001, n = 88).

Conclusions: Adding the HONC to routine adolescent health examinations, health classes, and prevention programs may make adolescents more aware of their symptoms of ND and enable intervention before ND progresses.