EDS: E-Cigarette Dependence Scale
The EDS (E-cigarette Dependence Scale) is a self-report questionnaire of e-cigarette dependence, adapted from the PROMIS Nicotine Dependence item bank and published in 22-, 8- and 4-item versions (Morean et al., 2019). No published severity cutoffs.
What the EDS measures
The E-cigarette Dependence Scale (EDS) measures how dependent a person is on their e-cigarette. Morean and colleagues (2019) built it by adapting the PROMIS Item Bank v1.0 (Smoking: Nicotine Dependence for All Smokers) for e-cigarettes, so its content mirrors the PROMIS measure developed for cigarette dependence.
Items cover automatic or compulsive vaping, prioritising vaping over other activities, vaping ahead of situations where it is not allowed, and craving and urges when unable to vape.
How to administer the EDS
- Format: self-report questionnaire.
- Versions: 22, 8 or 4 items. The 4-item version is recommended for efficiency (Morean et al., 2019).
- Response scale: each item is rated 0 (never), 1 (rarely), 2 (sometimes), 3 (often) or 4 (almost always).
- Who it is for: the validation sample was 1,009 adults who used e-cigarettes at least weekly, including exclusive e-cigarette users and people who also smoke cigarettes. Pienkowski et al. (2022) later used the 4-item version with Canadian youth aged 16 to 24 who vaped at least monthly.
EDS scoring and interpretation
Higher scores indicate greater e-cigarette dependence. When the 4 items are summed, the possible range is 0 to 16 (Pienkowski et al., 2022).
There are no published cutoffs or severity categories for the EDS. Neither the original validation study nor the youth study defines a threshold for "low", "moderate" or "high" dependence, so HiBoop does not apply bands. Use the score to:
- track change in the same person over time (for example, across a quit attempt);
- compare against the person's own vaping frequency and e-liquid nicotine strength, which the EDS tracked in validation.
Psychometric properties
In the adult validation sample (Morean et al., 2019):
- Structure: all three versions had confirmable, internally consistent latent structures that were measurement-invariant by sex, race, daily versus non-daily use, nicotine versus nicotine-free e-liquid, and current cigarette smoking.
- Internal consistency: Cronbach's alpha 0.98 (22 items), 0.93 (8 items) and 0.86 (4 items).
- Convergent validity: correlated with the Penn State Electronic Cigarette Dependence Index and with time to first e-cigarette in the morning.
- Criterion validity: related to vaping frequency, e-liquid nicotine concentration and e-cigarette quit attempts. Daily users, nicotine e-liquid users and cigarette smokers scored higher than their counterparts.
In Canadian youth aged 16 to 24 (Pienkowski et al., 2022), the 4-item EDS had alpha 0.84 and showed convergent and concurrent validity against time to first vape, vaping frequency and nicotine concentration.
Limitations
- No published cutoffs, so scores cannot be classified as mild, moderate or severe.
- Self-report; responses can be affected by recall and social desirability.
- The original validation was in adults recruited for an anonymous online survey; evidence in younger adolescents is limited.
- It measures dependence, not a diagnosis. A positive picture still needs clinical assessment.
EDS vs the Fagerström Test (FTND)
Many people who vape have never smoked combustible cigarettes. The FTND assumes cigarette-specific behaviours (cigarettes per day, the first cigarette after waking) that do not map onto vaping, so it is a poor fit for people whose main nicotine use is an e-cigarette. Use the EDS for anyone whose primary or exclusive nicotine use is through e-cigarettes or vaping devices.
Documenting EDS results in clinical notes
Record the version used (4, 8 or 22 items) and the score in the Objective section, along with vaping frequency and nicotine strength. Repeat with the same version to track change.
Copyright and use
The EDS is adapted from PROMIS item bank content. Check the copyright holder's terms before clinical or commercial use.
Automate EDS scoring in your clinic
HiBoop delivers the EDS alongside the DAST-10 and PHQ-9 as a linked substance use and mental health intake battery, with automated scoring and longitudinal tracking.
This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Frequently Asked Questions
How many items does the EDS have?
Morean et al. (2019) evaluated three versions: 22, 8 and 4 items. All three performed well, and the authors found little benefit of the longer versions over the 4-item EDS, which they describe as an efficient assessment of e-cigarette dependence.
Is the EDS self-report or clinician-administered?
Self-report. The person rates how often each statement applies to them on a 5-point scale from 0 (never) to 4 (almost always).
Does the EDS have a severity cutoff score?
No. The validation study did not publish cutoffs or severity categories. Higher scores indicate greater dependence, and the scale is best used to compare a person's scores over time alongside clinical judgement.
Can the EDS diagnose nicotine dependence?
No. The EDS quantifies e-cigarette dependence but does not diagnose a disorder. A diagnosis requires a clinical evaluation against established criteria such as DSM-5.
Why use the EDS instead of the Fagerström Test for Nicotine Dependence (FTND) for people who vape?
The FTND was built for combustible cigarettes and asks about cigarettes per day and the first cigarette of the morning, which do not map cleanly onto vaping. The EDS was adapted specifically for e-cigarette use and validated in people who vape, including exclusive e-cigarette users and dual users.
Bill this assessment
In the US, the EDS: E-Cigarette Dependence Scale is usually billed under these CPT codes. Payer rules vary.
Using this assessment in practice
For clinicians
Send it as a gentle check-in before the session. The score is waiting when you open the chart, and the trend builds itself.
For individuals
This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
References
- 1.Morean ME, Krishnan-Sarin S, Sussman S, Foulds J, Fishbein H, Grana R, O'Malley SS. Psychometric evaluation of the E-cigarette Dependence Scale. Nicotine Tob Res. 2019;21(11):1556-1564. Erratum in: Nicotine Tob Res. 2020;22(11):2123.View source
- 2.Pienkowski M, Chaiton M, Dubray J, Schwartz R. E-Cigarette Dependence in Youth. Nicotine Tob Res. 2022;24(7):1089-1094.View source
Last reviewed: Jun 3, 2026
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