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Vol. 60. Issue 5.
Pages 279-284 (May 2024)
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Vol. 60. Issue 5.
Pages 279-284 (May 2024)
Original Article
Adaptation and Validation of the Hooked on Nicotine Checklist (HONC) with Spanish Adolescents
Nuria García-Couceiroa,b, Sion Kim-Harrisc, Patricia Gómezd,e, Manuel Isornaf, Antonio Riale,
Corresponding author

Corresponding author.
a Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Galicia, Spain
b Nursing, Management and Care Research Group (AC23), Institute for Health Research (IDIS), University Clinical Hospital of Santiago (SERGAS), Galicia, Spain
c Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
d Scientific and Technical Advice Unit (Avalia-t) of the Galician Agency for Health Knowledge Management (ACIS), Galicia, Spain
e Department of Social, Basic and Methodological Psychology, University of Santiago de Compostela, Galicia, Spain
f Department of Psycho-Socio-Educational Analysis and Intervention, University of Vigo, Galicia, Spain
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Figures (2)
Tables (6)
Table 1. Spanish HONC Final Version.
Table 2. Percentage of Affirmative and Negative Responses for Each HONC Item Obtained in the Pilot Test (Self-administered Version and Interview).
Table 3. Percentage of Affirmative and Negative Responses to Each HONC Item Obtained in the Empirical Validation Process (n=235).
Table 4. Descriptive Data for the HONC Total Score.
Table 5. Consistency of HONC Items.
Table 6. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) Calculated for the Different Cut-off Points of the HONC.
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The expansion of new tobacco consumption formats and electronic vapor products threatens to reverse the trend of declining smoking rates that had been observed among younger people in recent decades. Early detection in the health sector requires screening tools that have been adapted and validated in our context. This study aims to translate, culturally adapt, pilot and empirically validate the Hooked on Nicotine Checklist (HONC) with Spanish adolescents.


The process of translation and cultural adaptation included the following stages: direct translation, synthesis of translations, back translation, consolidation with a committee of experts and pre-test, along with a cognitive interview, which served as pilot testing. Empirical validation was conducted with a sample of 1027 adolescents aged between 12 and 18 (M=15.40; SD=1.638).


The results obtained confirm that the HONC is a brief, clear and easy-to-understand tool, with appropriate psychometric properties. A Cronbach's alpha value of 0.90 was obtained. Sensitivity, specificity, PPV and NPV indices reached values of 0.56, 0.94, 0.79 and 0.83, respectively. Cut-off point 1 is the one reaching the best balance between the two values. CFA showed a model good overall fit.


This study makes the Spanish version of the HONC available to researchers and clinicians, so that it can be used with sufficient psychometric guarantees.

Early detection
Tobacco use


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