Chris G Richardson, PhD

ANSS: About

Find out more about the phenomenon of emerging tobacco addiction,tobacco dependence in adolescents, and the development of the ANSS.


Emerging tobacco dependence

Tobacco dependence has traditionally been defined as a physical dependence on nicotine, a stable state in which tobacco users seek to maintain their nicotine intake and avoid withdrawal symptoms (Fagerstrom, Heatherton, & Kozlowski, 1990). What this approach does not address is the dynamic nature of emerging and evolving dependence. In addition to factors related to avoiding nicotine withdrawal, social and psychological factors appear to play a role in establishing and maintaining tobacco dependence, particularly for individuals who are just starting to smoke (Johnson 2003). In order to investigate how such a complex phenomenon emerges over time, researchers need to use an instrument that measures all the important dimensions of individuals’ experiences of tobacco dependence (Johnson et al., 2005).

References:
Fagerstrom, K.O., Heatherton, T. F., & Kazlowski, L. T. (1990). How to measure nicotine dependence. In L. Wilhelmson (Ed.), Smoking as a cardiovascular risk factor: New strategies for smoking cessation (pp. 25-34). Lewiston, NY: Hogrefe & Huber.

Johnson, J. L., Bottorff, J. L., Moffat, B., Ratner, P. A., Shoveller, J. A., & Lovato, C. Y. (2003). Tobacco dependence: Adolescents’ perspectives on the need to smoke. Social Science and Medicine, 56, 1481-1492. Abstract (PubMed)

Johnson, J. L., Ratner, P. A., Tucker, R. S., Bottorff, J. L., Zumbo, B., Prkachin, K. M., & Shoveller, J. (2005). Development of a multidimensional measure of tobacco dependence in adolescence. Addictive Behaviors, 30, 501-505. Abstract (PubMed)


Tobacco dependence and adolescents

Much of the research on tobacco dependence to date has focused on adults. However, it has been suggested that adolescents’ tobacco dependence differs from that of adults, and that measures of dependence developed for adults do not fully capture adolescents’ experiences with tobacco (Colby et al., 2000). Adolescence is a period of high levels of emotional and psychological turbulence and an increasing orientation towards peers, and thus it seems probable that psychosocial and social aspects of tobacco use would play an important role in adolescents’ initiation of tobacco use and progression towards full-fledged dependence. At the same time, the physical and tactile aspects of smoking should not be ignored. Any instrument aimed at measuring tobacco dependence among adolescents should therefore include items that address multiple dimensions of their experiences with tobacco.

References:
Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000). Measuring nicotine dependence among youth: A review of available approaches and instruments. Drug & Alcohol Dependence, 59(suppl. 1), S23-S39. Abstract (PubMed)


Development of the ANSS

The ANSS is a 27-item measure of tobacco dependence specifically in adolescents, with a focus on cigarette smoking. It was developed from data collected through interviews with 74 adolescents aged 13-19 years (Johnson et al., 2003). Five aspects of tobacco dependence emerged from these interviews: a social component (smoking to manage or maintain social connections), a pleasure component (enjoyment of smoking), an empowerment component (smoking provides opportunities to assert independence and a sense of identity, or can give a smoker power over others through the ability to share or withhold cigarettes), an emotional component (in particular, smoking as a protection against negative emotions), and full-fledged dependence (in which smoking is an integral part of an adolescent’s physical and psychological experiences).

An initial version of the ANSS, comprised of 54 items, was included in 2 large surveys of adolescent smoking and health in British Columbia, Canada (the British Columbia Youth Survey on Smoking and Health 1, conducted in 2001/2002, and the British Columbia Youth Survey on Smoking and Health 2, conducted in 2004). The combined sample for the studies was approximately 11,000 high-school-aged youth.

Exploratory and confirmatory factor analyses of the data from these studies supported a multidimensional conceptualization of tobacco dependence; specifically, four factors measuring social, emotional, sensory, and physical dependence. With the elimination of poorly fitting items, the scale was reduced to 34 items (Johnson et al., 2005; Richardson et al., 2007). Additional non-parametric IRT analyses and a consideration of content validity led to the elimination of an additional 7 items, resulting in a 27-item scale. In this version, social dependence and emotional dependence are each measured with 6 items, physical dependence is measured with 10 items, and sensory dependence is measured with 5 items. All responses are rated on a 5 point scale from “agree very strongly” to “disagree very strongly” (Richardson, 2009, unpublished).

References:
Johnson, J. L., Bottorff, J. L., Moffat, B., Ratner, P. A., Shoveller, J. A., & Lovato, C. Y. (2003). Tobacco dependence: Adolescents’ perspectives on the need to smoke. Social Science and Medicine, 56, 1481-1492. Abstract (PubMed)

Johnson, J. L., Ratner, P. A., Tucker, R. S., Bottorff, J. L., Zumbo, B., Prkachin, K. M., & Shoveller, J. (2005). Development of a multidimensional measure of tobacco dependence in adolescence. Addictive Behaviors, 30, 501-505. Abstract (PubMed)

Richardson, C. G., Johnson, J. L., Ratner, P. A., Zumbo, B. D., Bottorff, J. L., Shoveller, J. A., & Prkachin, K. M. (2007). Validation of the Dimensions of Tobacco Dependence Scale for adolescents. Addictive Behaviors, 32, 1498-1504. Abstract (PubMed)