Family and Peer Influences on Nicotine Dependence in Medical Students of South Punjab

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.

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

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.