# Mediating effect of smoking abstinence self-efficacy on association between health literacy and nicotine dependence of smokers in Qingdao, China

## TL;DR

This study shows that higher health literacy reduces nicotine dependence partly by boosting confidence to quit smoking in Qingdao, China.

## Contribution

It identifies smoking abstinence self-efficacy as a partial mediator between health literacy and nicotine dependence.

## Key findings

- Health literacy is positively linked to smoking abstinence self-efficacy (β = 0.185, p < 0.01).
- Nicotine dependence is negatively correlated with both health literacy (β = -0.289, p < 0.001) and self-efficacy (β = -0.513, p < 0.001).
- Smoking abstinence self-efficacy mediates 24.7% of the total effect between health literacy and nicotine dependence.

## Abstract

Research on the mediating effect of smoking abstinence self-efficacy (SASE) on the relationship between health literacy and nicotine dependence is limited. This study examines the mechanisms through which health literacy influences addictive behavior and provides additional scientific evidence to inform smoking cessation interventions.

A total of 500 participants were recruited from 20 communities in Qingdao between June 2023 and June 2024. Spearman correlation analysis was used to explore relationships between nicotine dependence and other factors. Linear regression analyses were conducted to examine the relationships between health literacy, SASE, and nicotine dependence. Path analysis was performed using AMOS to assess the interactions among nicotine dependence, SASE, and health literacy, with mediation effects tested using the bootstrap method.

After adjusting for potential confounders such as age, marital status, education level, and occupation, path analysis revealed a significant positive correlation between health literacy and SASE in habitual/addictive situations (SASEH; β = 0.185, p < 0.01). Nicotine dependence showed significant negative correlations with both health literacy (β = −0.289, p < 0.001) and SASEH (β = −0.513, p < 0.001). Bootstrap mediation tests confirmed that both the direct and indirect effects were statistically significant, with the mediating effect accounting for 24.7% of the total effect.

SASEH partially mediates the relationship between health literacy and nicotine dependence. Increasing health literacy not only directly reduces nicotine dependence but also improves SASE, which in turn further reduces dependence.