The HONC measures loss of autonomy over smoking in
adolescents but can be adapted for other addictions. It shows many adolescents
find it difficult to quit long before they are smoking daily.
ASH New Zealand
www.ash.org.nz has administered the
HONC to over 30,000 smokers and ex-smokers at Year 10. The HONC is now
used in 12 languages. Compared with the newer Loss of Autonomy over
Smoking Scale, (www.healthnz.co.nz/AUTOS.htm)
the HONC is a more sensitive
measure of the onset of the loss of autonomy, because the HONC includes
(where the AUTOS does not), an item (for example Q 9 above) to assess
withdrawal-induced craving. A yes for any symptom increases risk of daily
smoking within four years by 6.8 times.1
predicts quitting difficulty and progression to daily smoking2
The HONC score has high predictive value. After 30
months, a HONC score of one compared with a zero score
Increases the chances of a
failed quit attempt 29 times, (excluding question 1 on the same topic).
Increases the chances of
continuing to smoke during those 30 months 44-fold.
increases the likelihood of
being a current smoker by 58-fold.2
documents loss of control by one in four after first cigarette2
After one cigarette, 25%
of year 10 students have an average HONC score of one or more; those who
have smoked 100 cigarettes or more, have an average HONC score over 9.
The HONC measures loss of
autonomy over tobacco. Autonomy over tobacco is lost when quitting
requires an effort or involves discomfort. Loss of autonomy is both
necessary and sufficient to define drug addiction.
CA, Reed G, Difranza JR. Early course of
nicotine dependence in adolescent smokers. Pediatrics 2010 June; 125:
1127-33.Epub 2010 May 3. PMID:
20439592 (4 year follow-up of 6th
R, Wellman R, Laugesen M. DiFranza J.
‘Diminished Autonomy over Tobacco Can Appear With the First
Cigarettes’ Addictive Behaviours 2008. Doi:10.1016/j.addbeh.2007.12.002 http://www.healthnz.co.nz/Addiction1stcigFeb08.pdf
WW, DiFranza JR. The loss of autonomy after
smoking in relation to lifetime cigarette consumption. Addict Behav 2010;35:14-8. Epub
2009 Aug 10. (confirms the New Zealand
study above, by showing diminished autonomy among subjects who had smoked
only 1 or 2 cigarettes.)