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.

For professional reference, research, and education only. Not for diagnosis or medical advice.

What does the EDS measure?

The E-cigarette Dependence Scale (EDS) measures how dependent a person is on their e-cigarette. Its authors 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 [1].

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 do you give the EDS?

  • Format: self-report questionnaire.
  • Versions: 22, 8 or 4 items. The 4-item version is recommended for efficiency [1].
  • 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 [1]. A later study used the 4-item version with Canadian youth aged 16 to 24 who vaped at least monthly [2].

How do you score and interpret the EDS?

Higher scores indicate greater e-cigarette dependence. When the 4 items are summed, the possible range is 0 to 16 [2].

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 no bands are applied here. 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 [1]:

  • 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: all three versions were internally consistent, and they correlated strongly with one another.
  • 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 [2], 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 of a SOAP note, along with vaping frequency and nicotine strength. Repeat with the same version to track change.

For other substance use, the DAST-10 screens drug use; the PHQ-9 covers depression at intake.

The EDS is adapted from PROMIS item bank content. Check the copyright holder's terms before clinical or commercial use.

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.

Related

FAQ

  • 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.

References

    1. 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.
    2. 2.Pienkowski M, Chaiton M, Dubray J, Schwartz R. E-Cigarette Dependence in Youth. Nicotine Tob Res. 2022;24(7):1089-1094.

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