Fagerström Test for Nicotine Dependence (FTND) is the most commonly used measure of dependence among tobacco users. Psychometric properties of FTND have been validated among cigarette smokers, but the reliability and validity of its variant for smokeless tobacco (ST) users (FTND-ST) is not well documented. The objective of the present study is to evaluate reliability, construct validity, and structure model of FTND-ST. Data from 95 exclusive ST users living in Oklahoma were used for this study. Participants completed a self-administered mail survey including FTND-ST and other questionnaires. Measures of internal consistency, Cronbach’s coefficient α and item-total correlation were estimated to evaluate reliability of the FTND-ST. To ascertain the factor structure of the scale, confirmatory factor analysis was performed. We examined concurrent and construct validity with correlation and regression analysis. Salivary cotinine concentration was used as a criterion variable. The FTND-ST demonstrated good reliability with acceptable Cronbach’s coefficient (α = 0.72) and significant item-total correlations. Study findings showed that FTND-ST had positive significant association with salivary cotinine concentration (r = 0.61, p <.0001) and Tobacco Dependence Screener (r = 0.44, p < .0001). Results of factor analysis support a unidimensional factor structure of FTND-ST. The FTND-ST demonstrated good psychometric properties. The unidimensional structure of the scale indicates that it measures single clearly defined aspect of dependence, physical dependence. Given its good reliability and demonstrated construct validity, FTND-ST is a useful measure of dependence among ST users. Because of the paucity of ST dependence research, there are limited studies evaluating ST dependence measures. Although the FTND was exclusively developed for cigarette smoking, it has been adapted for ST users in the form of FTND-ST. This is the first study to examine reliability, concurrent and construct validity, and structure model of FTND-ST among regular ST users. Findings suggest that the FTND-ST measures physical aspect of dependence. Good psychometric properties of FTND-ST and its orientation as a continuous scale indicate that FTND-ST is a useful measure of dependence among ST users.

Background. The current study describes concurrent use of cigarettes and smokeless tobacco (CiST) among males and females and evaluates factors associated with CiST use.Methods. Cross-sectional data were drawn from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Weighted stratified analyses were performed to find associations between CiST use and sociodemographic factors by gender. CiST users were compared to three different tobacco use groups: nonusers, exclusive smokers, and exclusive ST users.Results. Younger age and heavy alcohol consumption were consistently associated with increased odds of CiST use among both males and females, and regardless of comparison group. Among males, education was inversely related to CiST use, and these findings were consistent in all three comparisons. Among women, those unable to work or out of work were more likely to be CiST users, which was consistent across comparisons. American Indian females had higher odds of CiST use than White females when nontobacco users or smokers were the comparison group.Conclusion. This study identified sociodemographic characteristics associated with CiST use, and differences in these associations among women and men. Additionally, this study highlights the need to carefully consider what comparison groups should be used to examine factors associated with CiST use.

Factors associated with cotinine concentrations have been studied in smokers. Based on these studies, cotinine is recommended as a biomarker to assess severity of tobacco dependence. Evidence of association between cotinine concentrations and various factors among smokeless tobacco (ST) users is limited and mostly comes from tobacco cessation studies. The present study describes the relationship of salivary cotinine concentrations to sociodemographic factors, tobacco use characteristics, and ST products among ST users. Data are from a community-based sample of 95 current adult ST users. Study participants provided a saliva sample for cotinine analysis and completed a mail survey that included questionnaires regarding sociodemographic information, tobacco use characteristics, and tobacco dependence measures. Crude and adjusted associations between cotinine and other variables were calculated. Age, years of ST use, cans per week, and swallowing of tobacco juices were significantly associated with salivary cotinine concentrations in the multiple regression model. Fine-cut ST products resulted in higher cotinine concentrations as compared with long-cut ST products when adjusted for age and tobacco use characteristics (p = .029). The Fagerström Test for Nicotine Dependence for ST users (r = .58, p < .0001) and the modified Tobacco Dependence Screener (r = .24, p < .0001) were both correlated with cotinine concentration. The findings suggest some similarities in the determinants of cotinine concentrations in ST users and smokers. Swallowing of tobacco juices and type of ST product are unique to ST users and are associated with higher cotinine concentrations.

Background Despite ongoing global efforts for tobacco control, low-income countries with struggling economies have challenges to effectively implement tobacco policies and programs. Due to the complexity of the tobacco control issue and lack of comprehensive policies, tobacco use is increasing in Pakistan. Objective The aim of this study was to assess the effect of taxes on tobacco demand in Pakistan. Methods Various surveillance indicators of tobacco use were assessed from 2001 to 2009. Price elasticities of cigarette demand in Pakistan were investigated. Results During 2003–2009, annual per capita cigarette consumption increased by 30%. Analysis of economic data indicated that a 10% increase in cigarette prices would lead to 4.8% decrease in cigarette consumption while controlling for per capita income in the short term. The long-term price elasticities of cigarette demand were estimated at −1.17. The estimations provided support for myopic addiction model for cigarette consumption in Pakistan. Conclusions Increasing tobacco taxes would have a significant impact on tobacco consumption in Pakistan. Cigarette consumption could decrease by 11.7% in the long term if there was a 10% increase in its price. The results of this study should benefit policymakers as it provides information on the characteristics of the cigarette consumption and cigarette demand function that may help in planning tobacco control strategies in low-income and middle-income countries.