Although the Fagerstr？m Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) are widely used, there is a uncertainty regarding what is measured by these scales. We examined associations between these instruments and items assessing different aspects of dependence. Adult current smokers ( , mean age 33.3 years, 61.9% female) completed a web-based survey comprised of items related to demographics and smoking behavior plus (1) the FTND and HSI; (2) the Autonomy over Tobacco Scale (AUTOS) with subscales measuring Withdrawal, Psychological Dependence, and Cue-Induced Cravings; (3) 6 questions tapping smokers’ wanting, craving, or needing experiences in response to withdrawal and the latency to each experience during abstinence; (4) 3 items concerning how smokers prepare to cope with periods of abstinence. In regression analyses the Withdrawal subscale of the AUTOS was the strongest predictor of FTND and HSI scores, followed by taking precautions not to run out of cigarettes or smoking extra to prepare for abstinence. The FTND and its six items, including the HSI, consistently showed the strongest correlations with withdrawal, suggesting that the behaviors described by the items of the FTND are primarily indicative of a difficulty maintaining abstinence because of withdrawal symptoms. 1. Introduction Tools for the assessment of nicotine dependence are important for clinical research. The most widely used measure is the Fagerstr？m Test for Nicotine Dependence (FTND, Table 1) [1]. Despite its widespread use over two decades, the literature reflects uncertainty regarding what aspects of nicotine dependence are tapped by the FTND [2]. Fagerstr？m recently proposed changing the name to the Fagerstr？m Test for Cigarette Dependence, to reflect both the instrument’s concentration on cigarette smoking and general understanding that tobacco dependence is driven by factors in addition to nicotine [3]. Table 1: The Fagerstr？m Test for Nicotine Dependence (FTND). The FTND correlates poorly with a diagnosis of nicotine dependence based on the International Classification of Diseases-10 , the Diagnostic and Statistical Manual-III , and the DSM-IV [4]. It correlates well with CO and cotinine levels, but these are not themselves specific measures of addiction [5–7]. The FTND correlates with various withdrawal symptoms [5, 7], strength of urges to smoke [8], and self-rated addiction [4, 9, 10]. Moolchan et al. suggested that the FTND taps mainly into nicotine withdrawal [9]. There has been a recent interest in the Heaviness of Smoking Index (HSI), which
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