Associations Between Self-Efficacy, Stress, Anxiety, Depression, and Smoking Dependence

Abstract

Background: Smoking remains a prevalent health issue, particularly among adults in low- and middle-income countries. Psychological factors such as stress, anxiety, depression, and self-efficacy are believed to influence smoking behavior and nicotine dependence, especially during periods of societal disruption such as the COVID-19 pandemic.

Objective: This study aimed to examine the relationship between self-efficacy, psychological distress (stress, anxiety, and depression), and the level of smoking dependence among adult smokers in the community surrounding Sukawarna Public Health Centre, Indonesia.

Methods: A cross-sectional study was conducted from May to July 2022, involving 171 adult smokers aged 26–45 years selected through random sampling. Data were collected using validated instruments: the Indonesian version of DASS-21 for stress, anxiety, and depression; SEQ-12 for self-efficacy; and the CDS-12 for smoking dependence. Statistical analysis included descriptive statistics, Spearman correlation, Mann–Whitney U test, and multiple linear regression.

Results: Most participants were male (88.3%), with a mean age of 31.9 years and an average smoking duration of 14.3 years. Moderate levels of stress and anxiety were reported by a significant portion of respondents. Smoking dependence was positively associated with age, smoking duration, stress, anxiety, and depression, while self-efficacy showed a significant negative correlation (p < 0.05). Gender differences in dependence levels were also statistically significant.

Conclusion: Smoking dependence among adults is influenced by both psychological and demographic factors. Higher stress, anxiety, and depression levels are linked to greater dependence, whereas stronger self-efficacy is associated with reduced smoking dependence. Interventions that address emotional well-being and enhance self-efficacy may support smoking reduction efforts, particularly during public health crises.