Determinants of nicotine dependence levels among adults in Al Baha region, Saudi Arabia 2025: an analytical cross-sectional study

Background Understanding nicotine dependence determinants is vital for effective tobacco control. This study estimated tobacco use prevalence, assessed dependence levels, and identified behavioral determinants among adults in Al Baha, Saudi Arabia.Methods A cross-sectional study was conducted (January – April 2025) among 439 adults. Dependence was measured using the validated ABOUT scale (0–50). Multivariable linear regression identified independent determinants of dependence.Results Prevalence of current tobacco/nicotine use was 41.9% (n = 184). Among users, cigarettes were most common (44.0%), followed by smokeless tobacco (21.1%), multi-product use (17.1%) electronic cigarettes (9.7%), and waterpipe (8.0%). Among the 147 current users who completed the ABOUT scale, the mean dependence score was 26.1 ± 8.7. E-cigarette users exhibited the highest dependence (31.0 ± 8.3), significantly exceeding waterpipe users (18.0 ± 6.4, p < 0.01). Multivariable analysis identified an explicit dose-response relationship, with the model explaining 27% of variance (Adjusted R2 = 0.270). Independent determinants included: younger initiation age (β = −0.62, p < 0.001), product switching (β = +3.20, p < 0.05), heavy cigarette use (≥11 cigarettes/day: β= +5.75 to +7.63, p < 0.01), and heavy smokeless use (≥11 times/day: β= +7.58, p < 0.01).Conclusions Nicotine dependence is primarily driven by behavioral factors. Prevention should target youth before age 18, with cessation protocols tailored to product switching and consumption intensity.