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Ethics code: IR.BUMS.REC.1402.151


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dashgard A, alinegad M, daliri M, khajavi robayat P, taheri N K. Investigation of the Prevalence of Stress, Anxiety, and Depression and Their Association with Self-Reported Tobacco Use among Students. Mod Care J 2026; 23 (3) :1-11
URL: http://mcj.bums.ac.ir/article-1-637-en.html
1- Instractor, Department of nursing, Qaen School of Nursing and Midwifery, Birjand University of Medical Sciences, Qaen, Iran
2- Instructor, Qaen School of Nursing, Birjand University of Medical Sciences, Qaen, Iran
3- PhD Candidate in Epidemiology, Student Research Committee, Kerman University of Medical Sciences, Kerman
4- Operating room student, Student Research Committee, Qaen School of Nursing and Midwifery, Birjand University of Medical Sciences, Qaen, Iran
5- Assistant Professor, Department of Nursing, Qaen School of Nursing and Midwifery, Birjand University of Medical Sciences, Qaen, Iran , NarjesTaheri_1361@yahoo.com
Abstract:   (94 Views)
Introduction: Tobacco use and psychological disorders remain major public‑health challenges worldwide, particularly among young adults. University students may be uniquely vulnerable due to academic pressures and social transitions.
Objectives: This study assessed the prevalence of stress, anxiety, and depression among university students in Qaen, Iran, and examined their associations with self-reported tobacco use.
Methods: A cross-sectional study was conducted among 226 students enrolled at five universities in Qaen County, South Khorasan Province, Iran, in 2023. Participants were selected using multistage random sampling proportional to university enrollment. Psychological symptoms were assessed using the Depression, Anxiety, and Stress Scale, and demographic, academic, health-related, and tobacco-use information was collected using a structured questionnaire. Factors associated with self-reported tobacco use were examined using multivariable logistic regression.
Results: Of the 226 participants, 57.1% were male, and the mean age was 22.41 ± 4.39 years. The prevalence of any level of depression, anxiety, and stress symptoms was 61.5%, 83.6%, and 34.1%, respectively. Self-reported tobacco use was reported by 23.0% of students, with hookah being the most commonly reported form. In the multivariable logistic regression analysis, male sex (adjusted odds ratios [AOR] = 3.29, 95% confidence interval [CI]: 1.06–10.14), older age (AOR = 1.14, 95% CI: 1.02–1.29), history of physical or mental illness (AOR = 5.77, 95% CI: 1.56–21.28), and moderate (AOR = 10.75, 95% CI: 1.15–100.03) and severe anxiety symptoms (AOR = 24.76, 95% CI: 2.32–264.44) were significantly associated with self-reported tobacco use.
Conclusions: Psychological distress, particularly anxiety, was significantly associated with self-reported tobacco use among university students. These findings suggest that students reporting higher levels of psychological distress may be considered a priority group for mental health support and tobacco-use prevention programs. However, the cross-sectional nature of this study does not allow causal inferences.

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Article Types: Research Article | Subject: Community and Health Education
Received: 2026/06/9 | Accepted: 2026/08/18 | Published: 2026/09/2

References
1. WHO Organization. WHO global report on trends in prevalence of tobacco use 2000-2024 and projections 2025-2030. 2025 Oct 6 [cited 2025]. Available from. [Link]
2. King JL, Reboussin BA, Spangler J, Cornacchione Ross J, Sutfin EL. Tobacco product use and mental health status among young adults. Addict Behav. 2018 Feb; 77:67-72. [PubMed ID:28965069]; [PubMed Central ID: PMC5701872]. [DOI:10.1016/j.addbeh.2017.09.012]
3. Stevenson J, Miller CL, Martin K, Mohammadi L, Lawn S. Investigating the reciprocal temporal relationships between tobacco consumption and psychological disorders for youth: an international review. BMJ Open. 2022 Jun;12(6): e055499. [PubMed ID:35697442]; [PubMed Central ID: PMC9196180]. [DOI:10.1136/bmjopen-2021-055499]
4. Wang N, Dove MS, Tong EK. Serious psychological distress and higher associations with tobacco and cannabis use among college students in the United States. Prev Med. 2024 Aug; 185:108041. [PubMed ID:38866211]. [DOI:10.1016/j.ypmed.2024.108041]
5. Colyer-Patel K, Kuhns L, Weidema A, Lesscher H, Cousijn J. Age-dependent effects of tobacco smoke and nicotine on cognition and the brain: A systematic review of the human and animal literature comparing adolescents and adults. Neurosci Biobehav Rev. 2023 Mar; 146:105038. [PubMed ID:36627063]. [DOI:10.1016/j.neubiorev.2023.105038]
6. Littlecott HJ, Moore GF, Evans RE, Melendez-Torres GJ, McCann M, Reed H, et al. Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research. BMC Public Health. 2023;23(1):424. [PMID: 36869343]; [PMCID: PMC9983235]. [DOI:10.1186/s12889-022-14727-z]
7. Ghaffari R, Osouli Tabrizi S, Abdolalipour S, Mirghafourvand M. Prevalence of cigarette smoking among Iranian medical students and its relationship with mental health. Int. j. health prom. & educ. 2022; 64(3):1-12 [DOI:10.1080/14635240.2022.2138719]
8. Barati M, Allahverdipour H, Hidarnia A, Niknami S. Predicting tobacco smoking among male adolescents in Hamadan City, west of Iran in 2014: an application of the prototype willingness model. J Res Health Sci. 2015;15(2):113-8. [PMID: 26175295]. [URL: https://pubmed.ncbi.nlm.nih.gov/26175295]
9. Makvandi Z, Sharifi M, Barati M. Assessment of Factors Associated with Hookah Consumption Among College Students of Asad Abad City Base on The Theory of Planned Behavior (TPB) in 2015-2016. Iran J Health Educ Health Promot .2018;5(4):270-9. [Persian] [DOI:10.30699/acadpub.ijhehp.5.4.270]
10. Bashirian S, Barati M, Mohammadi Y, Mostafaei H. Factors associated with hookah use among male high school students: the role of demographic characteristics and hookah user and non-user prototypes. J Res Health Sci. 2016;16(4):217 -223. [PMID: 28087855]; [PMCID: PMC7189923]. [Link]
11. Zaheri H, Raziani Y, Khademi N, Moradi Y, Shahriari H, Ghanei‐Gheshlagh R. Prevalence of hookah smoking among Iranian pupils and university students: An updated systematic review and meta‐analysis. Clin Respir J. 2022 Jun. ;16(6):425-440. [PMID: 35665461]; [PMCID: PMC9366573]. [DOI:10.1111/crj.13511]
12. Essadi A, Aissaoui H, Yeznasni A, Lekfif A, Sebbar S, Atassi M, et al. Psychoactive substance use and associated factors among Mohammed first university students, Oujda, Morocco: a cross-sectional study. BMC Public Health. 2024 Jul;24(1):1961. [PubMed ID:39044213]; [PubMed Central ID: PMC11264429]. [DOI: 10.1186/s12889-024-19507-5] [DOI:10.1186/s12889-024-19507-5]
13. Mamun MA, Roy N, Gozal D, Almerab MM, Hossain MS, Al Mamun F. Prevalence and associated factors of cigarette smoking and substance use among university entrance test-taking students: A GIS-based study. PLoS One. 2024 Aug;19(8): e0308697. [PubMed ID:39173000]. [PubMed Central ID: PMC11341027]. [DOI: 10.1371/journal.pone.0308697] [DOI:10.1371/journal.pone.0308697]
14. Todorović I, Cheng F, Stojisavljević S, Marinković S, Kremenović S, Savić P, et al. Prevalence of Cigarette Smoking and Influence of Associated Factors among Students of the University of Banja Luka: A Cross-Sectional Study. Medicina (Kaunas). 2022 Mar ;58(4). [PubMed ID:35454341]; [PubMed Central ID: PMC9025883]. [DOI:10.3390/medicina58040502]
15. Sadeghi F, Alizadeh A, Hosseinzadeh F, Negarandeh R. Prevalence of smoking among Iranian university students: a systematic review and meta-analysis. BMC Public Health. 2025 Feb;25(1):760. [PMID: 39994690]; [PMCID: PMC11852886]. [DOI:10.1186/s12889-025-21842-0]
16. Mehri A, Rezvani Ghalhari M, Mazaheri-Tehrani A, Bashardoust P, Mohammadi M, Dehghani R. Prevalence of smoking and its related factors among students of Kashan university of medical sciences. Iran J Health Environ. 2023;16(3):565-78. [Persian]. [URL: https://ijhe.tums.ac.ir/article-1-6790-en.pdf]
17. Bulfone G, Ingravalle F, Scerbo F, Mazzotta R, Simonelli I, Pancaldi A, et al. Substance use and academic performance among university students: systematic review and meta-analysis. BMC Med Educ. 2025;25(1):959. [PubMed ID:40597168]. [PubMed Central ID: PMC12211851].ذ [DOI:10.1186/s12909-025-07530-y]
18. Agyapong-Opoku G, Agyapong B, Obuobi-Donkor G, Eboreime E. Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature. Behav Sci (Basel). 2023 Dec;13(12) :1002. [PubMed ID:38131858]. [PubMed Central ID: PMC10740739]. [DOI:10.3390/bs13121002]
19. Askarian F, SHAKERI MT, Ghavami V, JAMALI J. The relationship between internet addiction and anxiety, stress, and depression in students of Mashhad University of Medical Sciences. Medical Journal of Mashhad university of Medical Sciences (MJMS). 2020 ;62(5.1):1866-1903. [Persian]. [DOI: 10.22038/mjms.2020.15617]
20. Barnett P. The efficacy of psychological interventions for university students: a systematic review and meta-analysis. European Psychiatry. 2023;66(S1): S17-S17. [DOI: 10.1192/j.eurpsy.2023.72] [DOI:10.1192/j.eurpsy.2023.72]
21. Mahdavinoor SMM, Moghimi B, Mollaei A, Teimouri M, Abedi Yarandi MS, Loveneh Nasab P, et al. Prevalence and factors related with depression in Iranian university students: a large sample cross-sectional study. Middle East Current Psy. 2025;32(1):24. [DOI:10.1186/s43045-025-00517-x]
22. Novin MH, Shokri S, Eslamdoust-Siahestalkhi F, Pourramzani A. Frequency of Smoking, Alcohol Consumption, and Substance Use in Relation to General Health Indicators in Guilan University of Medical Sciences. Addict Health. 2023;15(4):266-74. [PubMed ID:38322482]. [PubMed Central ID: PMC10843355]. [DOI:10.34172/ahj.2023.1432]
23. Organization WH. Depression disorder (depressive). 2025 August 29. [cited 2025]. Available from: [Link]
24. Lin ZZ, Cai HW, Huang YF, Zhou LL, Yuan ZY, He LP, et al. Prevalence of depression among university students in China: a systematic review and meta-analysis. BMC Psychol. 2025;13(1):373. [PubMed ID:40217329]. [PubMed Central ID: PMC11992738]. [DOI: 10.1186/s40359-025-02688-y]. [DOI:10.1186/s40359-025-02688-y]
25. Jafari N, Bakhshi E, Moradi A, Asadi H, Kalantari R, NADERI M. Assessment of demographic and job-related stressors on depression, stress and anxiety in employees of Islam Abad Gharb Health Centers. Journal of Health. 2018;9(4):403-13. [DOI:10.29252/j.health.9.4.403]
26. Samani S, Jokar B. validity and reliability of short version of anxiety, depression, stress scale. J Social Sci Humanities Shiraz University. 2007;26(3):65-77. [URL: https://www.sid.ir/paper/642839/en]
27. Ahmed LA, Verlinden M, Alobeidli MA, Alahbabi RH, AlKatheeri R, Saddik B, et al. Patterns of tobacco smoking and nicotine vaping among university students in the United Arab Emirates: a cross-sectional study. Int J Environ Res Public Health. 2021;18(14):7652. [PMID: 34300103]; [PMCID: PMC8306162]. [DOI:10.3390/ijerph18147652]
28. Alves RF, Precioso J, Becoña E. Smoking behavior and secondhand smoke exposure among university students in northern Portugal: Relations with knowledge on tobacco use and attitudes toward smoking. Pulmonology. 2022;28(3):193-202. [PMID: 32444313]. [DOI:10.1016/j.pulmoe.2020.03.004]
29. Ramón-Arbués E, Gea-Caballero V, Granada-López JM, Juárez-Vela R, Pellicer-García B, Antón-Solanas I. The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students. Int J Environ Res Public Health. 2020;17(19). [PubMed ID:32987932]; [PubMed Central ID: PMC7579351] [DOI:10.3390/ijerph17197001] [DOI:10.3390/ijerph17197001]
30. Fauzi MF, Anuar TS, Teh LK, Lim WF, James RJ, Ahmad R, et al. Stress, Anxiety and Depression among a Cohort of Health Sciences Undergraduate Students: The Prevalence and Risk Factors. Int J Environ Res Public Health. 2021;18(6) :3269. [PubMed ID:33809939]; [PubMed Central ID: PMC8004268 [DOI:10.3390/ijerph18063269] . [DOI:10.3390/ijerph18063269] [PMID] [PMCID]
31. Chauhan P, Katkuri S. Prevalence of depression, anxiety, stress, and substance use among medical undergraduates. MRIMS J Health Sci. 2021 Jul;9(3) :116-21 . [DOI:10.4103/mjhs.mjhs_19_21]
32. Mirza AA, Milaat WA, Ramadan IK, Baig M, Elmorsy SA, Beyari GM, et al. Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study. Neurosciences (Riyadh). 2021;26(2):141-51. [PubMed ID:33814366]. [PubMed Central ID: PMC8024138]. [DOI:10.17712/nsj.2021.2.20200127]
33. Windarwati HD, Megananda NK, Nova R, Kusumawati MW, Ati NAL. Stress, anxiety, and depression with potential adolescent drug abuse: a cross-sectional study. Jurnal Keperawatan. 2021;13(1):191-202. [DOI:10.32583/keperawatan. v13i1.1184] . [DOI:10.32583/keperawatan]
34. Esmaeelzadeh S, Moraros J, Thorpe L, Bird Y. The association between depression, anxiety and substance use among Canadian post-secondary students. Neuropsychiatr Dis Treat. 2018; 14:3241-51. [PubMed ID:30538482]; [PubMed Central ID: PMC6260190]. [DOI:10.2147/ndt. s187419] . [DOI:10.2147/NDT.S187419]
35. Patil SP, Sadhanala S, Gokhe SSB. Study of depression, anxiety and stress among undergraduate medical students of A teaching medical institution. Natl J Community Med. 2018;9(08):566-9. [Link] [DOI:10.18203/2394-6040.ijcmph20173655]
36. Melaku L, Bulcha G, Worku D. The Prevalence and Severity of Depression, Anxiety, and Stress among Medical Undergraduate Students of Arsi University and Their Association with Substance Use, Southeast Ethiopia. Educ Res Int. 2021; 2021:9936157. [DOI:10.1155/2021/9936157]
37. Sumbe A, Wilkinson AV, Clendennen SL, Bataineh BS, Sterling KL, Chen B, et al. Association of tobacco and marijuana use with symptoms of depression and anxiety among adolescents and young adults in Texas. Tob Prev Cessat. 2022; 8: 3. [PMID: 35128214]; [PMCID: PMC8792993]. [DOI:10.18332/tpc/144500]
38. Garey L, Olofsson H, Garza T, Shepherd JM, Smit T, Zvolensky MJ. The role of anxiety in smoking onset, severity, and cessation-related outcomes: A review of recent literature. Curr Psychiatry Rep. 2020;22(8):38. [DOI: 10.1007/s11920-020-01160-5] [DOI:10.1007/s11920-020-01160-5]
39. Wangdi K, Jamtsho T. Drug use among teenagers and young adults in Bhutan. Indian J Psychol Med. 2019;41(6):535-40. [PMID: 31772440]; [PMCID: PMC6875841.] [DOI:10.4103/IJPSYM.IJPSYM_348_19]
40. Teh CK, Ngo CW, binti Zulkifli RA, Vellasamy R, Suresh K. Depression, anxiety and stress among undergraduate students: A cross sectional study. Open J. Epidemiol. 2015;5(04):260-8. [DOI:10.4236/ojepi.2015.54030]

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