Tob Induc Dis. 2026 May 28;24. doi: 10.18332/tid/220358. eCollection 2026.
ABSTRACT
INTRODUCTION: Although smoking is not an effective coping mechanism, it is a common behavior among university students experiencing psychological distress, but limited research has examined its psychological determinants in multicultural university settings. This mixed-methods study investigated the relationship between smoking behavior and the mental toughness scale.
METHODS: A convergent mixed-methods cross-sectional study design was conducted between March and June 2025 among 280 immigrant students at the University of Bologna. Eligible participants were students aged 18-30 years, currently enrolled in a study program, able to communicate in English or Italian, and without chronic conditions affecting smoking behavior. Quantitative data assessed demographic characteristics, smoking patterns, and mental toughness, assessed using the Mental Toughness Questionnaire (MTQ-18), which evaluates control, commitment, challenge, self-confidence, and underlying psychological and migration-related stressors. Qualitative data were obtained through semi-structured interviews exploring emotional coping, cultural adaptation, and smoking motivations. Data were analyzed separately and integrated during interpretation.
RESULTS: Among the 280 participants, 42.86% were smokers and 57.14% were nonsmokers. No statistically significant associations were found between smoking status and demographic variables, including gender (χ2=0.66, p=0.417), age (χ2=6.70, p=0.152), parental smoking (χ2=0.00, p=1.000), and sibling smoking (χ2=0.07, p=0.789). Most smokers reported low to moderate cigarette consumption (1-10 cigarettes per day). Across all mental toughness dimensions, smokers demonstrated lower mean scores compared to non-smokers. For instance, overall mental toughness scores were lower among smokers (males: 2.57; females: 2.31) compared to non-smokers (males: 3.84; females: 3.74). Qualitative findings highlighted key psychological stressors, including identity disruption, anxiety, academic pressure, and social isolation, which contributed to smoking behavior as a perceived means of emotional regulation.
CONCLUSIONS: Smoking behavior among immigrant students is shaped primarily by psychological vulnerability and migration-related stress rather than demographic characteristics. Integrating mental health support, stress-management resources, and culturally responsive interventions into smoking prevention programs may be essential for reducing smoking in immigrant student populations.
PMID:42221056 | PMC:PMC13218404 | DOI:10.18332/tid/220358
