Using qualitative research to inform survey development on nicotine dependence among adolescents

Researchers interested in measuring tobacco use and dependence among youth face several formidable challenges. These challenges include: most existing measures have been developed for adult samples and may not be suitable for adolescent respondents; surveys must be relevant to different youth subcultures and to both genders; questions must be developmentally appropriate and not perceived as judgmental or condescending; and the multidimensional nature of nicotine dependence in youth must be recognized and measured. This paper demonstrates how researchers can address these challenges by using qualitative techniques to obtain information on youth tobacco consumption, and then using this information to inform the development of quantitative instruments. A case study is presented where a measure of tobacco dependence originally developed for adults is adapted for use with adolescents. A seven-step formative research process is outlined, consisting of gathering information in open-ended interviews, conducting follow-up research, modification of questionnaire items and addition of new items based on the information gathered, constructing a reliable instrument that is readable and acceptable to youth, reducing the length of this instrument without significantly hurting reliability and validity, conducting additional follow-up research involving case studies, and examining cultural differences. Following a formative research process like this one will help tobacco researchers gain a better understanding of how nicotine dependence develops.