Validating the Modified Fagerström Test for Nicotine Dependence in the Context of Smokeless Tobacco: An Indian Perspective

Abstract Background: Categorizing nicotine dependency among smokeless tobacco (SLT) users in India by the modified Fagerstrom test for nicotine dependence (FTND) scale is not always straightforward. Objectives: The objective of this study is to revise and validate the modified FTND scale for SLT in the Indian scenario. Materials and Methods: The Revised modified FTND (FTND-R) was developed by modifying questions(Q) 2 and 4 of the existing modified FTND scale. Concurrent validation was performed by simultaneously filling out both scales in 152 tobacco users. Results: A significant association was observed between Q2 of both scales, but not for Q4. Q2 revealed minimal tobacco juice swallowing (1/152 users). Using Q4, 45.9% shifted from high to moderate dependence, and 27.4% shifted from moderate to low dependence. A strong correlation existed between both scales. Conclusion: The modified FTND-R demonstrated strong concurrent validity and improved relevance for SLT users.