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Drug Alcohol Depend. 2017 Sep 1;178:257-266. doi: 10.1016/j.drugalcdep.2017.05.010. Epub 2017 Jun 28.

Indicators of dependence for different types of tobacco product users: Descriptive findings from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) study.

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Department of Family Medicine and Public Health, University of California, 9500 Gilman Drive, MC 0631 La Jolla, San Diego, 92093-0631, CA, United States. Electronic address: dstrong@ucsd.edusdd.
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, D.C., United States.
Westat, Rockville, MD, United States.
National Institute on Drug Abuse (NIDA/NIH), Bethesda, MD, United States.
Kelly Government Solutions, Rockville, MD, United States; Center for Tobacco Products, FDA, Silver Spring, MD, United States.
Center for Tobacco Products, FDA, Silver Spring, MD, United States.
Medical University of South Carolina, United States.
Roswell Park Cancer Institute, Buffalo, NY, United States.



With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products.


A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products.


This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n=8689), e-cigarette only (n=437), cigar only (traditional, cigarillo, or filtered) (n=706), hookah only (n=461), smokeless tobacco only (n=971), cigarette plus e-cigarette (n=709), and multiple tobacco product users (n=2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean=0.0, SD=1.0), we observed a range of TD with hookah (mean=-1.71) and cigar (mean=-1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean=0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p<0.001), e-cigarette only (p<0.002), cigar (p<0.001), hookah only (p<0.001), and smokeless tobacco users (p<0.001).


The PATH Study Adult Wave 1 Questionnaire provided psychometrically valid measures of TD that enables future regulatory investigations of nicotine dependence across tobacco products.


E-cigarette dependence; Item response theory; Nicotine dependence; Poly-tobacco dependence

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