Objective: It is increasingly recognized that tobacco dependence begins in adolescence and that many adolescent smokers are addicted to nicotine. Many youth who smoke report that they want to stop but are unable to do so. Youth become unwittingly trapped by their smoking and often are unable to stop. Existing measures of tobacco dependence fail to capture emerging dependence among those who are beginning to smoke. In addition, measures have failed to tap into the multidimensional aspects of dependence that are particularly important among youth. Tools are required to help youth become aware of the early signs of dependence. The objective of this research was to develop a reliable and valid set of markers of emergent tobacco dependence in youth.
Design: In this research we took on the complex task of developing a measure of tobacco dependence. We take the position that measures are by nature “theory laden” and that the best test of any measure takes place within a context of a theory testing exercise. Thus, this research is directed toward theory and measurement development and testing. The data collection for this research incorporates a cross-sectional survey design.
Population, Sample, Setting, Years: Data collection involved a survey of 3,500 Grade 10 and 11 students attending randomly selected schools in two regions of British Columbia, Canada. Data collection took place in the years 2001 and 2002.
Concept or Variables Studied: The variables measured included history and attitudes toward tobacco use, related psychological and social factors, socio-demographic items and a new multi-item self-report measure of tobacco dependence. The self-report items were developed from a qualitative study of youth smoking. The items fall into five dimensions that embrace five hypothesised aspects of tobacco dependence: social, emotional, empowering, pleasurable and physical dependence. In addition, items that measure repeated behaviour or habituation are included.
Methods: Students completed the self-administered questionnaires during class time. Data was analyzed using exploratory and confirmatory factor analytic procedures.
Findings: The analysis reveals that there are distinct dimensions of tobacco dependence not previously described in the literature. We discuss the dimensionality of the tobacco dependence markers and the relationship of the hypothesised markers of tobacco dependence with other measures of nicotine dependence and self-reports of tobacco use.
Conclusions: Although in the nascent stage of development, the measurement model emerging from this research offers a broader view of tobacco dependence among youth than has been previously described.
Implications: The need to raise awareness among youth about tobacco dependence is particularly pressing. Many youth that smoke indicate that they do not plan to be smokers in five-year’s time; however, when followed five years later, up to 70% of these youth continue to smoke. Tools are required that can identify those youth with signs of emerging tobacco dependence and that can help youth recognize the nature of their dependence. This research takes a step toward developing such a tool. In addition, this research helps to lay a theoretical foundation related to the nature of tobacco dependence in youth. If we are to develop sound interventions to help youth stop smoking we must understand the nature of their tobacco use and dependence.
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