Factors Associated With Cigarette Smoking Based on the Integrated Model of Protection Motivation Theory With Health Literacy

Background: Although researchers have performed several smoking-related investigations, limited achievements have been found in decreasing rates of smoking because most of them were not implemented based on the appropriate theory. This study aimed to apply the structural equation modeling (SEM) method to examine the relationships between protection motivation theory (PMT) constructs, health literacy, and smoking behavior among university students. Methods: In the current cross-sectional investigation, 542 students of Mashhad Universities of Applied Sciences were collected using cluster sampling on August 2022. The data collection tools were sociodemographic, PMT, and health literacy questionnaires. The collected data were analyzed using SPSS 24. Moreover, the SEM was implemented by applying Amos. Pearson correlation examination was performed to study the relationships between behavior and other variables. Moreover, SEM was performed using Amos 18, and several indexes were calculated, including chi-square/degrees of freedom (χ2 /df), goodness of fit index, root mean square error of approximation, comparative fit index, and Tucker Lewis index. Results: The resulting of the smoking behavior model demonstrated an acceptable fit with the studied data. Smoking behavior was significantly associated with higher intention extrinsic and intrinsic rewards and the perceived cost and lower response efficacy, self-efficacy, and perceived vulnerability; nonetheless, intention and self-efficacy had more effects, respectively (P<0.05). Conclusion: It can be more beneficial to increase the people’s self-efficacy in order to further trust themselves so that they can successfully avoid smoking via reinforcement of the coping skills.