Few nicotine dependence measures have been developed for smokeless tobacco (ST) users. Existing measures are limited by the requirement to rate the nicotine content of ST brands for which data is scarce or non-existent. We modified the Fagerström Test for Nicotine Dependence (FTND) for ST users, referred to this scale as the FTND-ST, and evaluated its characteristics in a population of 42 ST users. The correlation between the FTND-ST total score and the serum cotinine concentrations was 0.53 (p<0.001). Internal consistency reliability assessed using the coefficient alpha was 0.47. Correlations and the coefficient alpha are similar to those reported for commonly used nicotine dependence measures. Development and refinement of nicotine dependence measures for ST users are essential steps in order to advance the field of ST research.
