The mean number of items
endorsed in the earlier version (maximum 15) by adolescents were:
for Never smoked <0.1; one puff, 0.2; a few cigarettes, 1.5;
less than daily, 5.5; daily smokers 11.3 items.
Higher AUTOS scores are
associated with a young age of starting to smoke, lifetime
consumption, cigarettes per day, smoking frequency, and history
of failed cessation. It applies to non-daily smokers, daily
smokers, adolescents and adults at any stage in their smoking
After quitting, AUTOS can
chart regained autonomy, but some never regain this fully.
Autonomy over tobacco is
lost when quitting requires an effort or involves discomfort.
Loss of autonomy is both necessary and sufficient to define drug
Smoking (AUTOS) scale is a customized symptom checklist
for assessing (loss of ) autonomy over
tobacco use in smokers of all ages, symptoms increasing when
taking up smoking, decreasing on quitting.
It improves upon
the Hooked on Nicotine Checklist (HONC) by (1) measuring symptom
intensity; (2) allowing for the evaluation of changing symptoms
during uptake, during smoking and after quitting. (3) providing the ability to independently assess
withdrawal, cue-induced craving and psychological dependence on
scored as follows: Describes me… not at all-0; a
little-1; pretty well-2;
very well-3. An item score >0 indicated
endorsement. The instrument is scored by summing the number of
symptoms endorsed. Average intensity of symptoms was calculated
by summing the symptom intensities of the endorsed items and
dividing by the number of symptoms endorsed.
An advantage of the autonomy concept over
dependence as defined in the current psychiatric diagnostic
criteria is that it provides insight into why smokers who do not
meet diagnostic criteria for dependence so often fail at their
attempts to quit. AUTOS could be used in clinical practice to
identify obstacles to cessation in any smoker.
* Latency To Needing a Cigarette. This shortens dramatically
from 10 days among those who have smoked under 100 cigarettes in
their lifetime, to 2 hours for those who have smoked over 100 in
WW, Morello P, Gershenson
B, DiFranza JR. Development of a
measure of the latency to needing a cigarette.
J Adolesc Health 2011 Apr: 48: 338-43.
initial scale, the Hooked on Nicotine Checklist (HONC) proved
useful in studying addiction in adolescent smoking.. (See Scragg, DiFranza, Laugesen, Wellman 2008 at http://www.healthnz.co.nz/Addiction1stcigFeb08.pdf)
Further publications include:
DiFranza J. A new approach to the diagnosis of tobacco addiction.
Addiction 2010 Mar; 105:381-2. www.healthnz.co.nz/Addiction
DiFranza JR, Wellman RJ, Ursprung WW, Sabiston
C. The autonomy over smoking scale. Psychol Addict Behav
2009;23:656-65.PMID: 20025371 [PubMed
- indexed for MEDLINE]