Protocol - Heaviness of Smoking Index

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The Heaviness of Smoking Index is a two-item self-report measure including questions on time to first cigarette and number of cigarettes smoked per day, which was derived from the Fagerström Test for Nicotine Dependence. These items are used to assess heaviness of cigarette smoking, which may be related to dependence on tobacco and association with biochemical measures of dependence.

Specific Instructions

Respondents are asked these questions only if they are a current every-day smoker or current some-day smoker based on responses to the adult Cigarette - Smoking Status protocols.

As a subset of the Fagerström Test for Nicotine Dependence (FTND), the two questions from the Heaviness of Smoking Index (HSI) are also included in the PhenX measure Cigarette Nicotine Dependence, which can be found in the Alcohol, Tobacco and Other Substances research domain. Therefore, selecting these two protocols together will result in duplicated questions. The two-question HSI may be used in situations when a shorter alternative to the FTND is needed due to space or time limitations.

This measure is intended for use only with cigarettes and, due to floor effects, may be a less valid measure of nicotine dependence in lighter smokers in the general population. Although there is no accepted definition of what constitutes a lighter smoker, the Smoking Cessation, Harm Reduction, and Biomarkers Working Group suggests a definition could be smoking fewer than 10 cigarettes per day.




1. At present, how long after waking do you wait before having your first cigarette?

1 [ ] Within 5 minutes [3 points]

2 [ ] 6-30 minutes [2 points]

3 [ ] 31-60 minutes [1 point]

4 [ ] over 60 minutes [0 points]

2. How many cigarettes per day do/did you smoke?

1 [ ] 10 or less [0 points]

2 [ ] 11-20 [1 point]

3 [ ] 21-30 [2 points]

4 [ ] 31 or more [3 points]

Note on how to score the results:

  • A six-point scale is calculated from the time to first cigarette after waking (3, 2, 1, or 0 points) and number of cigarettes smoked per day (0, 1, 2, or 3 points).
  • Sum the points for each round of 2 questions asked.
  • Nicotine dependence is categorized into a three-category variable: low (0-1), medium (2-4), and high (5-6).
Personnel and Training Required


Equipment Needs


Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire




Adult (aged 18-86) and current smokers

Selection Rationale

The Heaviness of Smoking Index is easy to administer, short in length, valid, and reliable, providing a simple way for clinicians looking to assess dependence to classify smokers.


English, Other languages available at source

Human Phenotype Ontology Addictive behavior HP:0030858 HPO
Derived Variables


Process and Review

Not Applicable

Protocol Name from Source

Heaviness of Smoking Index (HSI)


Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., Rickert, W., & Robinson, J. (1989). Measuring the heaviness of smoking: Using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. British Journal of Addiction, 84(7), 791-799.

National Institute on Drug Abuse (NIDA) Data Share Website. (2016).Heaviness of Smoking Index.Rockville, MD: National Institutes of Health: National Institute on Drug Abuse (Scoring Instructions).

General References

Bierut, L. J., Madden, P. A., Breslau, N., Johnson, E. O., Hatsukami, D., Pomerleau, O. F., Swan, G. E., Rutter, J., Bertelsen, S., Fox, L., Fugman, D., Goate, A. M., Hinrichs, A. L., Konvicka, K., Martin, N. G., Montgomery, G. W., Saccone, N. L., Saccone, S. F., Wang, J. C., Chase, G. A., Rice, J. P., & Ballinger, D. G. (2007). Novel genes identified in a high-density genome wide association study for nicotine dependence. Human Molecular Genetics, 16(1), 24-35.

Etter, J. F., Duc, T. V., & Perneger, T. V. (1999). Validity of the Fagerström test for nicotine dependence and of the Heaviness of Smoking Index among relatively light smokers. Addiction, 94(2), 269-281.

John, U., Meyer, C., Schumann, A., Hapke, U., Rumpf, H. J., Adam, C., Alte, D., & Lüdemann, J. (2004). A short form of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index in two adult population samples. Addictive Behaviors, 29(6), 1207-1212.

Kozlowski, L. T., Porter, C. Q., Orleans, C. T., Pope, M. A., & Heatherton, T. (1994). Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI. Drug and Alcohol Dependence, 34(3), 211-216.

Schnoll, R. A., Goren, A., Annunziata, K., & Suaya, J. A. (2013). The prevalence, predictors and associated health outcomes of high nicotine dependence using three measures among US smokers. Addiction, 108(11), 1989-2000.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX330201020000 How many cigarettes per day do/did you smoke? N/A
PX330201010000 At present, how long after waking do you more
wait before having your first cigarette? show less
Smoking Cessation, Harm Reduction and Biomarkers
Measure Name

Heaviness of Smoking - Cigarettes

Release Date

February 23, 2021


Self-report questions are used to assess the heaviness of smoking cigarettes.


This measure can be used as an indicator of nicotine dependence and is associated with physiological measures of dependence such as carbon monoxide and cotinine levels.


Heaviness of Smoking Index, HSI, Smoking Cessation, Harm Reduction, and Biomarkers, heaviness of smoking, time to first cigarette, TTF, number of cigarettes smoked per day, CPD, smoking, dependence

Measure Protocols
Protocol ID Protocol Name
330201 Heaviness of Smoking Index

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