Table 1

Questionnaire items and response categories for five nicotine dependence (ND) symptom indicators

Hooked on Nicotine Checklist (HONC)

1. In the past 3 months, did you seriously try to quit smoking completely and forever? (yes, I quit completely and have remained non-smoking ever since; I never tried to quit; yes, I tried to quit but failed)

2. Do you smoke cigarettes now because it is really hard to quit? (other/I don’t know/I smoke so little; I don’t know because I have never tried to quit; no; sometimes; often/always)

3a. How physically addicted to smoking cigarettes are you? (not at all, a little, quite, very)

3b. How mentally addicted to smoking cigarettes are you? (not at all, a little, quite, very)

4. Do you ever have strong cravings to smoke cigarettes? (no; not often/not strong; often/not strong or not often/strong; often/strong)

5. How often have you felt like you really need a cigarette? (never, rarely, sometimes, often)

6. Do you find it difficult not to smoke in places where it’s not allowed (at a movie theatre, at home if your parents don’t know you smoke)? (not at all difficult/I don’t know, a bit difficult, very difficult)

Think about the times you have cut down or stopped using cigarettes or when you haven’t been able to smoke for a long period (like most of the day). How often did you experience the following . . .? (never, rarely, sometimes, often)

7. Trouble concentrating

8. Feeling irritable or angry

9. Feeling a strong urge or need to smoke

10. Feeling nervous, anxious or tense

ICD-10 tobacco dependence syndrome

(1) A strong desire or sense of compulsion to take tobacco: (4 items)

1. Have you ever had strong cravings to smoke cigarettes? (no, yes)

2. How physically/mentally addicted to smoking are you? (not at all addicted, a little addicted, quite addicted, very addicted)

3. How often have you felt like you really need a cigarette? (never, rarely, sometimes, often)

4. Do you find it difficult not to smoke in places where it’s not allowed (at a movie theatre, at home if your parents don’t know you smoke)? (not at all difficult/I don’t know, a bit difficult, very difficult)

(2) Difficulties in controlling tobacco taking behaviour in terms of its onset, termination, or levels of use: (2 items)

2. Do you smoke cigarettes now because it is really hard to quit? (other/I don’t know/I smoke so little; I don’t know because I have never tried to quit; no; sometimes; often/always)

(3) A physiological withdrawal state when tobacco use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for tobacco; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms: (4 items)

Now think about the times when you have cut down or stopped using cigarettes or when you haven’t been able to smoke for a long period (like most of the day). How often did you experience the following . . .? (never, rarely, sometimes, often)

1. Feeling irritable or angry

2. Feeling restless/Feeling nervous, anxious or tense

3. Trouble concentrating

4. Feeling a strong urge or need to smoke

(4) Evidence of tolerance, such that increased doses of tobacco are required in order to achieve effects originally produced by lower doses: (2 items)

How true are each of the following statements for you?

1. Compared to when I first started smoking, I need to smoke a lot more now to be satisfied. (not at all true, a bit true, very true)

2. Compared to when I first started smoking, I can smoke much more now before I start to feel nauseated or ill. (I’ve never felt nauseated or ill from smoking, not at all true, a bit true, very true)

(5) Progressive neglect of alternative pleasure or interests because of tobacco use, increased amount of time necessary to obtain or take the substance or to recover from its effects: (4 items)

How true are each of the following statements for you? (not at all true, a bit true, very true):

1. I spend a lot of time getting cigarettes (going out of my way to a store where I know they will sell to me; trying to find someone who will buy them for me)

2. I’ve stopped hanging out with certain people because of my smoking

3. I avoid going to a friend’s house where you’re not allowed to smoke even though I might enjoy hanging out with him/her

4. I have cut down or stopped physical activities or sports because of my smoking

(6) Persisting with tobacco use despite clear evidence of overtly harmful consequences, such as depressive mood states consequent to periods of heavy substance use, or drug related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm: (2 items)

How true are each of the following statements for you? (not at all true, a bit true, very true):

1. In situations where I need to go outside to smoke, it’s worth it even in cold or rainy weather

2. If you are sick with a bad cold or sore throat, do you smoke? (no, I don’t have to, I smoke so little; no, I stop smoking when I’m sick; yes, but I cut down on the amount I smoke; yes, I smoke the same amount as when I am sick)

ND/cravings

2. How often do you have cravings to smoke cigarettes? (never, very rarely, sometimes, often, very often)

3. How physically addicted to smoking cigarettes are you? (not at all, a little, quite, very)

4. How mentally addicted to smoking cigarettes are you? (not at all, a little, quite, very)

5. How often have you felt like you really need a cigarette? (never, rarely, sometimes, often)

6. Do you find it difficult not to smoke in places where it’s not allowed (at a movie theatre, at home if your parents don’t know you smoke)? (not at all difficult/don’t know, a bit difficult, very difficult)

7. If you are sick with a bad cold or sore throat, do you smoke? (no, I don’t have to, I smoke so little; no, I stop smoking when I’m sick; yes, but I cut down on the amount I smoke; yes, I smoke the same amount when I am sick)

8. How deeply do you usually inhale the smoke? (into my mouth; into my throat; into my lungs shallow; into my lungs deep)

9. How true is the following statement for you? Cigarettes are good for dealing with boredom (not at all true, a bit true, very true)

10. Do you smoke cigarettes now because it is really hard to quit? (I don’t know/I smoke so little/I quit; no, it is not hard to quit; never tried to quit/I don’t want to quit; yes (sometimes, often/always))

11. On the days that you smoke, when do you usually smoke your first cigarette of the day? (right when I wake up, in the morning, later or another time)

How true are each of the following statements for you? (not at all true, a bit true, very true)

12. I often run out of cigarettes quicker than I thought I would

13. I spend a lot of time getting cigarettes (going out of my way to a store where I know they will sell to me; trying to find someone who will buy them for me)

14. I spend a lot of time smoking cigarettes (chain smoking, smoking a lot throughout the day)

15. When you see other kids your age smoking cigarettes, how easy is it for you not to smoke? (very easy, quite easy, a bit difficult, very difficult)

16. How often do you smoke cigarettes when you are alone? (never, sometimes, often/always)

Withdrawal symptoms: Think about the times when you have cut down or stopped using cigarettes or when you haven’t been able to smoke for a long period (like most of the day). How often did you experience the following? (never, rarely, sometimes, often)

1. Feeling irritable or angry

2. Feeling restless

3. Feeling nervous, anxious, or tense

4. Trouble concentrating

5. Feeling a strong urge or need to smoke

6. Trouble sleeping

Self medication: How true are each of the following statements for you? (not at all true, a bit true, very true)

1. I can function much better in the morning after I’ve had a cigarette

2. When I’m feeling down, a cigarette makes me feel good

3. A cigarette gives me energy when I’m tired

4. Smoking cigarettes calms me down when I feel nervous

5. Smoking cigarettes helps me concentrate on my homework

6. Smoking cigarettes relieves tension when I am stressed