The mediating role of smoking cessation motivation in overcoming nicotine dependence and cessation challenges among male smokers: A mixed study

Background: Nicotine dependence and smoking-related behaviors remain significant public health challenges worldwide. In the Arab region, limited studies explore the factors influencing nicotine addiction and smoking cessation, especially regarding gender differences and psychological factors such as stress and coping strategies. Aim: This study aims to explore the level of nicotine dependence among smokers in Egypt, examine the relationship between nicotine dependence and smoking cessation, and identify the psychological and coping factors that influence smoking behaviors. Methods: A mixed-methods convergent parallel design was used. The quantitative component included a cross-sectional survey with 327 adult smokers, using the 21-item challenges to stopping smoking (CSS-21) scale, the Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ), and the French Smoking Cessation Motivation Scale (F-SCMS). Descriptive and inferential statistics, including Pearson's correlation and regression analyses, were used to analyze the data. The qualitative component involved semi-structured interviews with 19 smokers, which were analyzed thematically. The study adhered to the STROBE and COREQ guidelines for reporting. Results: The survey revealed that 60 % of participants were categorized as highly nicotine dependent, with a mean CSS-21 score of 3.4 ± 0.8. A significant positive correlation was found between nicotine dependence and coping strategies (r = 0.45, p < 0.01). Psychological stress was identified as a major barrier to smoking cessation (t = 2.3, p = 0.03). Qualitative data indicated that smokers often experienced stress-related triggers, with coping mechanisms ranging from avoidance to smoking as a means of stress relief.