According to Dr. Raymond Niaura of Brown University in Providence, R.I., it is important to determine the point at which a teenage smoker becomes dependent on tobacco, in order to fight teen smoking. But, he said, "One potential problem with tobacco use as a marker for dependence is that patterns of use by adolescents are remarkably variable and unstable, difficult to measure with fine degrees of precision and may not be of great prognostic value in terms of predicting future entrenched tobacco involvement," said Niaura.

Dr. Suzanne M. Colby, also of Brown University, said assessment tools that are specifically designed for teenagers are needed. "It should be developmentally appropriate, and this is an area where our current measurement approaches fall very short. Most of our measurement approaches derive originally from measures on adult smokers," she said.

Colby said measurement challenges must be addressed in order to speed progress towards teen tobacco-cessation programs. "Almost all researchers are adapting the measures in their own way. And what that results in is as many nicotine dependence measures as there are researchers, and that keeps us from moving ahead because we can't compare across studies."

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