Comparative Evaluation of Salivary Cotinine and Psychological Nicotine Dependence Among Adolescent Smokeless Tobacco Users

Background: Adolescent use of smokeless tobacco poses a serious public health concern due to its long-term effects on brain development and increased risk of nicotine dependence. Nicotine exposure during adolescence contributes to greater vulnerability to addiction and long-term behavioral and cognitive consequences. Assessing both biochemical and psychological markers of dependence is essential for developing targeted prevention and cessation strategies. Objective: To compare salivary cotinine levels with self-reported psychological nicotine dependence among adolescent smokeless tobacco users and evaluate their readiness to quit. Methods: This cross-sectional study was conducted among adolescents aged 13 to 18 years. Nicotine dependence was measured using the Fagerström Test for Nicotine Dependence (FTND) and the Contemplation Ladder. Salivary cotinine was assessed using a non-invasive saliva test kit. Participants were grouped into tobacco users and non-users. Statistical analysis was performed using the Mann-Whitney U test and Kruskal-Wallis test, with significance set at p<0.05. Results: The mean salivary cotinine level among tobacco users was 124.36 ng/mL, compared to 49.58 ng/mL in non-users. Among the 52 tobacco users, 36.5% showed very high dependence on the FTND scale. On the Contemplation Ladder, 86% had no intention of quitting, while only 0.3% indicated readiness to quit. Despite elevated cotinine levels in users, no statistically significant correlation was found between cotinine concentration and FTND scores (p = 0.620). Conclusion: Adolescents using smokeless tobacco exhibited higher biochemical markers of nicotine exposure and psychological dependence compared to non-users. However, the absence of a significant correlation between salivary cotinine and self-reported dependence suggests that adolescent nicotine addiction is influenced by multiple factors. These findings highlight the need for comprehensive cessation strategies that integrate both behavioral and biochemical interventions, particularly for youth with low motivation to quit.