The goal of this cross-sectional observational study is to assess the impact of family functioning and peer pressure on nicotine dependence in medical students enrolled at medical colleges in South Punjab, Pakistan (both male and female; aged 18 and older). The main questions it aims to answer are: Does family dysfunction contribute to higher nicotine dependence in medical students? Does peer pressure intensify the effect of family dysfunction on nicotine dependence? Are there gender or academic year differences in smoking status and peer pressure? If there is a comparison group: Researchers will compare students from functional families vs. dysfunctional families to see if nicotine dependence differs, especially under the influence of peer pressure. Participants will: Complete a structured, self-administered questionnaire which includes: The Fagerstrom Test for Nicotine Dependence (FTND) to assess nicotine addiction severity. The Family Assessment Device-General Functioning (FAD-GF) to evaluate family functioning. The Peer Pressure Scale to identify direct and indirect peer pressure. Provide demographic information (age, gender, year of study, smoking status) for descriptive and comparative analyses.
Study Type
OBSERVATIONAL
Enrollment
366
Nishtar Medical University
Multan Khurd, Punjab Province, Pakistan
Nicotine Dependence Score as assessed by the Fagerström Test for Nicotine Dependence (FTND)
Primary Outcome: Nicotine Dependence The primary outcome of this study is the level of nicotine dependence among medical students, measured using the Fagerström Test for Nicotine Dependence (FTND). The FTND provides a continuous score ranging from 0 to 10, based on six items. Three of these items are yes/no questions, scored as 0 (No) and 1 (Yes). The remaining three are multiple-choice questions, scored from 0 to 3. The scores from all six items are summed to calculate the total dependence score. Classification of Nicotine Dependence: 0-2: Very Low 3-4: Low 5: Moderate 6-7: High 8-10: Very High This continuous FTND score will be used to assess the impact of family functioning and peer pressure on the severity of nicotine addiction.
Time frame: Day 1
Prevalence of Dysfunctional Family Functioning as assessed by the Family Assessment Device-General Functioning (FAD-GF)
To evaluate the relationship between family functioning and nicotine dependence, the proportion of medical students reporting dysfunctional family functioning will be assessed. Participants will be provided with the Family Assessment Device - General Functioning subscale (FAD-GF), which includes 12 items designed to measure overall family functioning. Each item will be rated on a 4-point Likert scale, ranging from 1 (Strongly Agree) to 4 (Strongly Disagree). Negatively worded items will require reverse coding to ensure scoring consistency, as higher scores will indicate poorer family functioning. A cutoff mean score of 2.00 will be used to classify family functioning: Mean score ≥ 2.00: Indicative of dysfunctional or unhealthy family functioning Mean score \< 2.00: Indicative of functional or healthy family functioning This classification will allow examination of the association between family functioning status and the severity of nicotine dependence, as measured by
Time frame: Day 1
Prevalence of Peer Pressure Exposure as assessed by the Peer Pressure Scale
Peer pressure will be assessed using the Indicators of Peer Pressure adopted from Subramaniam et al. The questionnaire will contain six questions divided into direct and indirect peer pressure. Students will be asked to answer 'yes' or 'no' to each question. There will be three questions assessing direct peer pressure and three assessing indirect peer pressure. Students who answer 'yes' to any question will be considered to have experienced peer pressure, while those who respond 'no' to all questions will be classified as free from peer pressure.
Time frame: Day 1
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