Exhibit 20 - Nicotine Dependency Screening Tool.pdf
PDF 2 MB Posted
- Solicitation number
- BPM055260
- Issued by
- Baltimore City, Maryland
About this file
This is a Nicotine Dependence Screening Tool (NDST) exhibit document associated with a state and local contract opportunity (Solicitation #: BPM055260). The NDST is a brief, evidence-based assessment instrument designed to screen for nicotine dependence among adolescents and adults who use cigarettes and/or e-cigarettes. The tool is adapted from established clinical instruments including the Fagerstrom Test for Nicotine Dependence (FTND), the Modified Fagerstrom Tolerance Questionnaire (mFTQ), and the E-Cigarette Fagerstrom Test of Cigarette Dependence (eFTCD). The screening tool contains 15 questions divided into two sections—one for traditional cigarette smoking and one for vaping—with respondents answering based on their usage patterns and behaviors. The instrument is formatted to be administered with a header containing fields for respondent name, SID/DOC number, and OPS reference information, with a development date of January 2026.
The NDST utilizes a point-based scoring system with responses weighted from zero to four points depending on the question and answer selected. Smoking dependence is scored on a scale of 0–11 points, while vaping dependence is scored on a scale of 0–14 points. The tool classifies dependence levels into five categories: very low dependence (0–2 points), low dependence (3–4 points), moderate dependence (5–7 points), high dependence (8–10 points), and very high dependence (11+ points). The instrument references three peer-reviewed clinical studies published between 1991 and 2020 that validate its reliability and effectiveness. No pricing, contract terms, set-asides, or procurement timelines are specified in this exhibit document, as it functions as a supporting technical exhibit defining the assessment methodology to be utilized under the contract.
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Text version
First Name Last Name SID/DOC#
OPS.XXX-XXX (Dev. 01/2026)
Nicotine Dependence Screening Tool (NDST) The Nicotine Dependence Screening Tool (NDST) is a brief, evidence-based instrument designed to assess nicotine dependence among adolescents and adults who smoke cigarettes and/or use e-cigarettes (vaping). Adapted from the Fagerström Test for Nicotine Dependence (FTND), the Modified Fagerström Tolerance Questionnaire (mFTQ) for adolescents, and the E-Cigarette Fagerström Test of Cigarette Dependence (eFTCD).
Instructions: Please select the best answer for each question.
1. Do you smoke cigarettes or use any tobacco products?
*Such as cigarettes, cigars, cigarillos, hookahs, chewing tobacco, snuff, snus, dissolvables, or nicotine pouches.
Yes → Proceed to questions 2 –7 No → Skip to question 8
2. How soon after waking do you smoke your first cigarette?
After 60 minutes (0)
31–60 minutes (1)
6–30 minutes (2)
Within 5 minutes (3)
12. How many vaping sessions/pods/cartridges do you use per day?
1 vaping session (0)
2 vaping sessions or ½ pod (1)
3–5 vaping sessions or 1 pod (2)
6–9 vaping sessions or 1.5–2 pods (3)
10+ vaping sessions or >2 pods (4)
13. Do you vape more frequently during the first hours after waking than during the rest of the day?
No (0)
Yes (1)
3. Do you find it difficult to refrain from smoking in places where it is forbidden (e.g., school, work, public transport)?
No (0)
Yes (1)
14. Do you smoke/vape even when you are so ill that you are in bed most of the day?
No (0)
Yes (1)
4. Which cigarette would you hate most to give up?
The first one in the morning (1)
All others (0)
5. How many cigarettes do you usually smoke per day?
Less than 5 cigarettes (0)
5–10 cigarettes (1)
11–20 cigarettes (2)
21–30 cigarettes (3)
31+ cigarettes (4)
15. On a typical day, how many puffs do you take?
Fewer than 50 puffs (0)
50–99 puffs (1)
100–199 puffs (2)
200 or more puffs (3)
NDST Score
Cigarettes:
6. Do you smoke more frequently during the first hours after waking than during the rest of the day?
No (0)
Yes (1)
7. Do you smoke even when you are so ill that you are in bed most of the day?
No (0)
Yes (1)
Vapes:
Total Score Dependence
0-2 Very low dependence 3-4 Low dependence 5-7 Moderate dependence 8-10 High dependence
11+ Very high dependence
8. Do you use a vaping device containing nicotine and/or flavored nicotine products?
*Such as e-cigs, mods, pod devices like JUUL, disposable vapes like Puff Bar, vape pens, or e-hookahs.
No → Proceed to questions 9 –15 Yes → Stop here (Score = 0, No nicotine dependence)
Scoring:
Add up the points from all items answered.
If both cigarettes and vaping are used, score them separately.
Possible Range:
Smoking: 0–11 for items 2, 3, 4, 5, 6, 7.
Vaping: 0–14 for items 9, 10, 11, 12, 13, 14, 15.
9. How soon after waking do you vape?
After 60 minutes (0)
31–60 minutes (1)
6–30 minutes (2)
Within 5 minutes (3)
References:
Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. Br J Addict, 86(9): 1119–1127.
10. Do you find it difficult to refrain from vaping in places where it is forbidden (e.g., school, work, public transport)?
No (0)
Yes (1)
11. Which vape session would you hate to give up the most?
The first one in the morning (1)
All others (0)
Piper ME, Baker TB, Benowitz NL, Smith SS, Jorenby DE. (2020). E-cigarette dependence measures in dual users: reliability and relations with dependence criteria and e-cigarette cessation. Nicotine Tob Res, 22(5): 756–763.
Prokhorov AV, Pallonen UE, Fava JL, Ding L, Niaura R. (1996). Measuring nicotine dependence among high-risk adolescent smokers. Addictive Behaviors, 21(1): 117–127.
DPDS - SUDTS (Pre-Trial) Solicitation #: BPM055260 Exhibit 20.
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