Background: Nicotine addiction among medical students is concerning, as these future healthcare providers are expected to model healthy lifestyle choices. While family and peer influences on smoking are well established globally, they remain underexplored in Punjab’s cultural setting. This study aims to investigate the impact of family functioning and peer pressure on nicotine dependence among medical students in South Punjab. Materials and methods: A descriptive-analytic cross-sectional study was conducted from May to July 2025 among medical students enrolled in medical colleges in South Punjab using a structured, self-administered questionnaire. Nicotine dependence was assessed using the Fagerström Test for Nicotine Dependence, family functioning using the Family Assessment Device-General Functioning subscale, and peer pressure using a structured Indicators of Peer Pressure questionnaire. This study employed convenience sampling, and the data were analyzed using descriptive statistics, chi-square tests, independent sample t -test, and two-way ANOVA using SPSS version 26. Results: Among 366 students, 16.1% were smokers. Family functioning and peer pressure showed a significant interaction ( P = 0.044), and nicotine dependence was significantly higher among students from dysfunctional families who also experienced peer pressure ( P = 0.022). Males were more likely to smoke ( P < 0.001) and to experience peer pressure ( P < 0.001), and peer pressure varied by year of study ( P = 0.028). Conclusion: There is a need for targeted smoking cessation and gender-focused interventions among medical students, considering the interplay of family dysfunction and peer pressure. Further research is needed to confirm these findings and inform effective interventions.
Malik et al. (Fri,) studied this question.