A latent class analysis of nicotine-dependence criteria and use of alternate tobacco

Objective: Prior latent class analyses have identified subgroups of smokers that vary by the severity and individual symptoms of nicotine dependence. These analyses have not accounted for the use of alternate tobacco, which is most prevalent among current cigarette smokers. The objective of this study was to determine whether smokers who frequently use other forms of tobacco constitute a latent class characteristic of nicotine-dependence symptoms. Method: Current cigarette smokers (N = 4,517), who had a lifetime history of daily smoking, were selected from Wave III of the National Longitudinal Study of Adolescent Health. A latent class model was based on 10 indicators, which included 6 items from the Fagerstrom Test for Nicotine Dependence and 4 measures of the past-month use of tobacco products (cigarettes, cigars, smokeless tobacco, bidis). Covariates included demographic, psychosocial, smoking-related characteristics, and the use of other substances. Results: One of the five estimated latent classes, which ranked second in severity of nicotine dependence only to the class with the heaviest smokers, consisted of light-to-medium smokers who were the most frequent users of alternate tobacco. Conclusion: Alternate tobacco use is correlated with nicotine dependence among smokers, a factor that should be considered in promoting the substitution of one tobacco product for another.