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National Cancer Institute

Hooked on Nicotine Checklist (HONC)

DiFranza et al

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Brief Description: The HONC is a 10-item instrument used to determine the onset and strength of tobacco dependence. The HONC is designed to identify the point at which an adolescent has lost full autonomy over their use of tobacco. This is defined by the authors as occurring when the sequelae of tobacco use, either physical or psychological, present a barrier to quitting. A positive response to any HONC item signals a loss of autonomy and the onset of dependence. The number of positive responses is proposed to reflect the degree of dependence. Although the HONC has only been used with adolescents so far, the authors will be testing its utility for adult smokers in the near future.
Target Population: Adolescents (ages 12-15)
Administrative Issues: 10 item checklistSelf-administered
No training required
Scoring Information: Minimal time required; a total score is calculated by summing the number of positive responses.
The number of positive responses reflects the degree of dependence.
Norms based on American adolescents (ages 14-15, 9th grade)
Psychometrics: Reliability studies completed:
Test-retest: one week kappa = .61; two week kappa = .75
Internal consistency (Cronbach's alpha = .91)
Evidence of content and construct validity provided in referenced articles.
Clinical Utility of Instrument: The HONC identifies youth for whom help and encouragement with cessation would be appropriate. In treatment, the HONC can also be used to signal the loss of autonomy, the onset of dependence, and the degree of dependence.
Research Applicability: The HONC has been used in research to identify nicotine dependent adolescent smokers and provide information on the onset and their degree of dependence.
Copyright, Cost, and Source Issues: No cost.
Web page (
University of Massachusetts Medical School
Source Reference: DiFranza, J.R., Savageau, J.A., Fletcher, K., Ockene, J.K., Rigotti, N.A., McNeill, A.D., Coleman, M., & Wood, C. (2002). Measuring the loss of autonomy over nicotine use in adolescents. Archives of Pediatric and Adolescent Medicine, 156, 397-403.
SupportingĀ References:

O'Loughlin, J., Tarasuk, J., DiFranza, J., & Paradis, G. (in press). Measurement of nicotine dependence: Reliability of selected measures among adolescents. Annals of Epidemiology.

O'Loughlin J, DiFranza J, Tarasuk J, Meshefedjian G, McMillan-Davey E, Paradis G, Tyndale R, Clarke P, Hanley J. (2002). Assessment of nicotine dependence symptoms in adolescents: a comparison of five indicators. Tobacco Control, 11, 354-360.

Wellman, R. J., DiFranza, J. R., Savageau, J. A., Godiwala, S., Friedman, K., Hazelton, J. (in press). Measuring adults' loss of autonomy over nicotine use: The Hooked on Nicotine Checklist. Nicotine & Tobacco Research.

Author: Joseph DiFranza, M.D.
Contact Information: Department of Family Medicine and Community Health
University of Massachusetts Medical School
55 Lake Avenue
Worcester, Massachusetts 01655
Phone: (508) 856-5658
Fax: (508) 856-1212
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