HEALTH PERCEPTION, HEALTH BELIEF MODEL-BASED SMOKING CESSATION CONSTRUCTS, AND NICOTINE DEPENDENCE AS PREDICTORS OF INTENTION TO QUIT SMOKING AMONG DEAF AND HARD-OF-HEARING YOUNG ADULTS

Öz

Objective: This study aimed to examine the relationships among health perception, Health Belief Model-Based Smoking Cessation constructs, nicotine dependence, and intention to quit smoking among deaf and hard-of-hearing young adults, and to determine the predictive contribution of these variables to intention to quit smoking. Method: This cross-sectional correlational study included 680 deaf and hard-of-hearing young adults aged 18-25 years. Data were collected using the Fagerström Test for Nicotine Dependence, the Intention to Quit Smoking Scale, the Health Belief Model-Based Smoking Cessation Scale, and the Health Perception Scale. Pearson’s correlation analysis, hierarchical multiple regression, mediation analysis, moderation analysis, and structural equation modelling were performed. Results: Intention to quit smoking was significantly and positively associated with health perception and self-efficacy, and significantly and negatively associated with the HBM-SCS composite score, nicotine dependence, smoking consumption, degree of hearing loss, and perceived barriers (p<.001). The final hierarchical regression model explained 35.6% of the variance in intention to quit smoking (R²=.356). Self-efficacy was a statistically significant mediator of the association between smoking consumption and intention to quit smoking; the indirect effect was -0.50, with a 95% bootstrap confidence interval of [-0.64,-0.37]. Degree of hearing loss significantly moderated the association between smoking consumption and intention to quit smoking (B=-0.12, SE=0.05, t=-2.40, p=.017). The structural equation model demonstrated good fit (χ²/df=2.51, CFI=.962, TLI=.953, RMSEA=.042, SRMR=.035). Conclusion: Health perception, Health Belief Model-Based Smoking Cessation constructs, and nicotine dependence were significantly associated with intention to quit smoking among deaf and hard-of-hearing young adults. Self-efficacy emerged as a significant mediator, whereas degree of hearing loss showed a significant moderating role.

Anahtar Kelimeler

• Hearing Loss
• Nicotine Dependence
• Smoking Cessation
• Self Efficacy

Etik Beyan

This study was reviewed and approved by the Social and Human Sciences Research Ethics Committee of Muğla Sıtkı Koçman University (Protocol No: 260023, Decision No: 45, Date of Approval: 23 February 2026). The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants prior to data collection, and the confidentiality of participant information was strictly maintained.

SAĞIR VE İŞİTME GÜÇLÜĞÜ YAŞAYAN GENÇ YETİŞKİNLERDE SAĞLIK ALGISI, SAĞLIK İNANÇ MODELİ TEMELLİ SİGARA BIRAKMA BİLEŞENLERİ VE NİKOTİN BAĞIMLILIĞININ SİGARAYI BIRAKMA NİYETİNİ YORDAYICI ROLÜ

Öz

Amaç: Bu çalışmanın amacı, sağır ve işitme güçlüğü yaşayan genç yetişkinlerde sağlık algısı, Sağlık İnanç Modeli temelli sigara bırakma bileşenleri, nikotin bağımlılığı ve sigarayı bırakma niyeti arasındaki ilişkileri incelemek ve bu değişkenlerin sigarayı bırakma niyetini yordamadaki katkılarını belirlemekti. Yöntem: Kesitsel ve ilişkisel desende yürütülen bu çalışmaya 18-25 yaş aralığında 680 sağır ve işitme güçlüğü yaşayan genç yetişkin dahil edildi. Veriler, Fagerström Nikotin Bağımlılığı Testi, Sigarayı Bırakma Niyeti Ölçeği, Sağlık İnanç Modeli Temelli Sigara Bırakma Ölçeği ve Sağlık Algısı Ölçeği kullanılarak toplandı. Verilerin analizinde Pearson korelasyon analizi, hiyerarşik çoklu regresyon analizi, aracılık analizi, düzenleyicilik analizi ve yapısal eşitlik modellemesi uygulandı. Bulgular: Sigarayı bırakma niyetinin sağlık algısı ve öz-yeterlik ile pozitif yönde ve istatistiksel olarak anlamlı; SİM-SBÖ bileşik puanı, nikotin bağımlılığı, günlük sigara tüketimi, işitme kaybı düzeyi ve algılanan engeller ile negatif yönde ve istatistiksel olarak anlamlı ilişkili olduğu belirlendi (p<.001). Hiyerarşik regresyon analizinin nihai modeli, sigarayı bırakma niyetindeki toplam varyansın %35,6’sını açıkladı (R²=.356). Öz-yeterliğin, sigara tüketimi ile sigarayı bırakma niyeti arasındaki ilişkide istatistiksel olarak anlamlı bir aracı değişken olduğu saptandı; dolaylı etki −0.50 ve %95 bootstrap güven aralığı [-0.64, -0.37] olarak hesaplandı. İşitme kaybı düzeyinin, sigara tüketimi ile sigarayı bırakma niyeti arasındaki ilişki üzerinde istatistiksel olarak anlamlı bir düzenleyici etkiye sahip olduğu belirlendi (B=-0.12, SE=0.05, t=-2.40, p=.017). Yapısal eşitlik modelinin iyi düzeyde uyum gösterdiği saptandı (χ²/df=2.51, CFI=.962, TLI=.953, RMSEA=.042, SRMR=.035). Sonuç: Sağlık algısı, Sağlık İnanç Modeli temelli sigara bırakma bileşenleri ve nikotin bağımlılığının, sağır ve işitme güçlüğü yaşayan genç yetişkinlerde sigarayı bırakma niyeti ile anlamlı düzeyde ilişkili olduğu belirlendi. Öz-yeterlik, sigara tüketimi ile sigarayı bırakma niyeti arasındaki ilişkide anlamlı bir aracı değişken olarak öne çıkarken, işitme kaybı düzeyinin bu ilişki üzerinde anlamlı bir düzenleyici rol oynadığı saptandı.

Anahtar Kelimeler

• İşitme Kaybı
• Nikotin Bağımlılığı
• Sigarayı Bırakma
• Öz-yeterlik

Etik Beyan

Bu araştırma, Muğla Sıtkı Koçman Üniversitesi Sosyal ve Beşerî Bilimler Araştırma Etik Kurulu tarafından değerlendirilmiş ve etik açıdan uygun bulunmuştur (Karar No: 45, Protokol No: 260023, Karar Tarihi: 23.02.2026). Araştırma sürecinde Helsinki Bildirgesi ilkelerine uyulmuş, katılımcılardan araştırma öncesinde bilgilendirilmiş gönüllü onam alınmış ve elde edilen verilerin gizliliği korunmuştur.

Kaynakça

1. Cho ER, Brill IK, Gram IT, Brown PE, Jha P. Smoking cessation and short- and longer-term mortality. NEJM Evid. 2024;3(3):EVIDoa2300272.
2. Selim S, Sülükçüler S. A duration analysis of factors influencing the duration of smoking: the case of Turkey. J Addict. 2023;24(4):475-486.
3. Arslan R, Ergüder T. Changes in tobacco use and associated risk factors: an evaluation of findings from the Turkey Household Health Survey on the prevalence of risk factors for non-communicable diseases 2017-2023 (WHO STEPS). Turk J Tob Control. 2025;5(3):134-144.
4. Mahajan SD, Homish GG, Quisenberry AJ. Multifactorial etiology of adolescent nicotine addiction: a review of the neurobiology of nicotine addiction and its implications for smoking cessation pharmacotherapy. Front Public Health. 2021;9:664748.
5. Verdejo-Garcia A, Garcia-Fernandez G, Dom G. Cognition and addiction. Dialogues Clin Neurosci. 2019;21(3):281-290.
6. Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav. 1978;3(3-4):235-241.
7. Bulut IT, Arslan CE. An investigation of the relationship between tobacco use, difficulties in emotion regulation and levels of psychological well-being. Curr Addict Res. 2024;8(1):34-44.
8. Ünübol H, Hızlı Sayar G. Psychological factors associated with smoking and quitting: addiction map of Turkey study. Neuropsychiatr Dis Treat. 2019;15:1971-1982.

9. Airagnes G, Sánchez-Rico M, Deguilhem A, et al. Nicotine dependence and incident psychiatric disorders: prospective evidence from a US national study. Mol Psychiatry. 2025;30(3):1080-1088.
10. Perry CL, Creamer MR, Chaffee BW, et al. Research on youth and young adult tobacco use, 2013-2018, from the FDA-NIH Tobacco Centers of Regulatory Science. Nicotine Tob Res. 2020;22(7):1063-1076.
11. Söyler S, Yorulmaz M. An examination of the effects of health literacy, health beliefs and health-seeking behaviour on the intention to quit smoking: a cross-sectional study. Cag Univ J Soc Sci. 2024;21(2):21-36.
12. Zhao X, Dichtl FF, Foran HM. Predicting smoking behavior: intention and future self-continuity among Austrians. Psychol Health Med. 2022;27(5):1042-1051.
13. Saleem MA, Shafiq A, Afzal H, Khalid A, Nguyen N. Addiction or social need: towards a model to predict smoking cessation intentions. J Soc Mark. 2023;13(2):295-322.
14. Gallus S, Cresci C, Rigamonti V, et al. Self-efficacy in predicting smoking cessation: a prospective study in Italy. Tob Prev Cessat. 2023;9:15.
15. Akbari M, Rahmani M, Safiadin MSN, Forootan R, Mansueto G. Metacognitive beliefs and addictions: a systematic review and meta-analysis with emphasis on the mediating role of desire thinking. Addict Behav. 2026;175:108613.
16. Oo MZ, Tint SS, Panza A, et al. Effectiveness of a Health Belief Model-based integrated health education and mobile phone SMS intervention on health knowledge, perception, and self-efficacy toward smoking: a quasi-experimental study among industrial workers in Myanmar. BMC Public Health. 2025;25:1562.
17. Abbadi A, Alnahar J, Zoghoul S, et al. Waterpipe nicotine dependence and depressive symptoms among adolescent waterpipe and dual users. J Environ Public Health. 2020;2020:2364571.
18. Thomas JE, Pasch KE, Marti CN, Loukas A. Depressive symptoms prospectively increase risk for new onset cigarette and ENDS dependence symptoms. Addict Behav. 2024;148:107870.
19. Udeanu A, Garcia-Fernandez G, Morán ML, García-Aller JA, Fernández E, Gómez LE. Addictive behaviors among people with intellectual disability: an umbrella review. Clin Psychol Rev. 2026;124:102701.
20. Meng M, Hediger H, de Spindler A, Händler-Schuster D. Health issues of young adults with hearing loss or deafness: a basis for the development of a chatbot. Z Evid Fortbild Qual Gesundhwes. 2024;190-191:20-28.
21. Gur K, Dolaner G, Turan SR. Health literacy of hearing-impaired adolescents, barriers and misunderstandings they encounter, and their expectations. Disabil Health J. 2020;13(4):100929.
22. Bouclaous C, Rachid M, Echtay L, Abdallah R, Abdelrazzak A, Chakas L. A qualitative study on deaf individuals' access to health knowledge and services in Lebanon. Public Health. 2025;246:105830.
23. Pratte MM, Brodeur M, Perron ME, Hudon C. Access to healthcare services for the Deaf: a scoping review of reviews. Health Expect. 2026;29(1):e70554.
24. Terry J, Meara RH, England R. They still phone even though they know I'm deaf”: exploring experiences of deaf people in health services in Wales, UK. J Public Health (Oxf). 2024;46(3):e520-e527.
25. Sönmez ÖF. Tobacco control in Turkey: a brief overview of achievements, challenges and future prospects. Tob Prev Cessat. 2025;11:7.
26. Çelik Keçili M. Socioeconomic and demographic disparities shape smoking intensity and cessation in Turkish households using the health survey. Discov Public Health. 2026;23(1):609.
27. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström test for nicotine dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991;86(9):1119-1127.
28. Uysal MA, Kadakal F, Karşidağ Ç, Bayram NG, Uysal Ö, Yılmaz V. Fagerström test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks. 2004;52(2):115-121.
29. Söyler S, Yorulmaz M. Development, validity, and reliability of the Intention to Quit Smoking Scale. Gümüşhane University Journal of Health Sciences. 2024;13(2):626-634.
30. Kurcer MA, Erdogan Z. Development of the Smoking Cessation Scale According to the Health Belief Model. Acibadem University Health Sciences Journal. 2020;11(3):464-470.
31. Diamond JJ, Becker JA, Arenson CA, Chambers CV, Rosenthal MP. Development of a scale to measure adults' perceptions of health: preliminary findings. J Community Psychol. 2007;35(5):557-561.
32. Kadıoğlu H, Yıldız A. Validity and reliability of the Turkish translation of the Health Perception Scale. Turkiye Klinikleri J Med Sci. 2012;32(1):47-53.
33. Doran N, Gonzalez MR, Courtney KE, et al. Social cognitive influences associated with susceptibility to nicotine and tobacco use in youth in the Adolescent Brain Cognitive Development (ABCD) Study. J Stud Alcohol Drugs. 2025;86(4):521-529.
34. Kaufman AR, Dwyer LA, Land SR, Klein WMP, Park ER. Smoking-related health beliefs and smoking behavior in the National Lung Screening Trial. Addict Behav. 2018;84:27-32.
35. Andriana F, Umaroh AK. Factors related to adolescent smoking cessation intentions based on the Theory of Health Belief Model. HEARTY. 2026;14(3):770-779.
36. Setyoadi S, Aisyana L, Sari EK, Ismail DDSL. Impact of perceived vulnerability and benefits on adolescent smoking cessation motivation. J Rural Community Nurs Pract. 2025;3(1):16-32.
37. Sheeran P, Maki A, Montanaro E, et al. The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: a meta-analysis. Health Psychol. 2016;35(11):1178-1188.
38. Herrmann AK, Cowgill B, Guthmann D, et al. Developing and evaluating a school-based tobacco and e-cigarette prevention program for deaf and hard-of-hearing youth. Health Promot Pract. 2024;25(1):65-76.
39. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1-55.
40. Sayın SE, Çapik C. The effect of Health Belief Model-based creative drama education on health locus of control and smoking perception in adolescents: a randomized controlled trial. Public Health Nurs. 2025;42(3):1343-1353.