Latent profile analysis of tobacco dependence, illness perception and dental healthcare engagement among Nigerian smokers in a high-burden setting

Abstract Background Dental clinics are high-yield but underutilized platforms for tobacco cessation in low- and middle-income countries (LMICs). However, limited evidence exists on how patient-level factors, such as nicotine dependence, illness perception (especially oral health consequences), and motivational readiness, influence engagement with cessation services in resource-constrained settings. This study aimed to examine how these factors influence engagement with tobacco cessation services among smokers attending Nigerian dental clinics, with a particular focus on the role of oral health-related perceptions. Methods We analyzed cross-sectional data from 164 adult smokers in a Tertiary Dental Clinic in Lagos, Nigeria. Measures included nicotine dependence indicators, perceived oral and systemic health effects of smoking, readiness to quit (0–10 scale), prior quit attempts, and willingness to use multiple smoking cessation methods. Latent profile analysis was used to identify dependence–engagement phenotypes. Chi-square tests were used to examine the sociodemographic and social exposure differences across clusters. Multivariable logistic regression identified independent predictors of high healthcare engagement, defined as the willingness to use four or more cessation methods. Results Three distinct dependence–engagement clusters were identified. Cluster 1 (high dependence/low engagement; 29.3%) had the highest cigarette use (21.4 ± 4.8 cigarettes/day), frequent early‑morning smoking (75% within 30 min of waking), low oral health awareness (52.1%), and the lowest readiness to quit (5.2 ± 1.8). Cluster 2 (moderate dependence/receptive; 41.5%) showed moderate use (15.2 ± 3.6/day), higher oral illness perception (82.4%), and strong acceptance of dentist cessation advice (94.1%). Cluster 3 (low dependence/proactive; 29.3%) had the lowest use (9.8 ± 3.2/day), minimal early smoking (8.3%), near‑universal harm recognition (95.8%), full willingness to accept dentist guidance (100%), and the highest readiness to quit (8.2 ± 1.3). Household smoking exposure differed by cluster ( p = 0.032), being highest in Cluster 1 (45.8%) and lowest in Cluster 3 (20.8%).In the multivariable analysis, high healthcare engagement was independently predicted by readiness to quit ≥ 7 (adjusted odds ratio [aOR] 7.22; 95% CI 3.62–14.40), perception of oral health effects (aOR 6.84; 95% CI 2.95–15.86), prior quit attempts (aOR 5.68; 95% CI 2.87–11.24), education beyond secondary level (aOR 3.12; 95% CI 1.42–6.85), and annual income >₦70,000 (aOR 2.56; 95% CI 1.24–5.28). Living with non-smokers showed a borderline association with engagement (aOR 2.45 [95% CI 0.98–6.14] ). Conclusions Illness perception, particularly recognition of oral health consequences, and motivational readiness are the strongest determinants of willingness to engage in multiple cessation modalities. Dental clinics in LMICs represent a high-potential setting for stratified tobacco cessation interventions, especially when counselling emphasizes oral health harms and is supported by referral pathways and strategies addressing socioeconomic and household-level influences.