Physical activity and nicotine dependence among female college smokers: a serial mediation model of smoking refusal self-efficacy and smokers' identity identification.

Introduction: This study aimed to investigate the association between physical activity and nicotine dependence level among female college smokers, and to examine the Serial Mediation Model of smoking refusal self-efficacy and smokers' identity identification. Methods: A cross-sectional survey was conducted among 673 female college students who were current smokers (defined as smoking at least one cigarette per day in the past 30 days), recruited from 30 universities across various regions of China using stratified random sampling. Participants completed the Physical Activity Rating Scale, the Fagerström Test for Nicotine Dependence, the Smoking Refusal Self-Efficacy Scale, and the Smokers' Identity Identification Scale. Data were analyzed using Pearson correlation and chain mediation analysis (PROCESS Macro Model 6) with 5,000 bootstrap resamples. Results: Physical activity was significantly correlated with lower nicotine dependence level. The indirect association between physical activity and nicotine dependence level through smoking refusal self-efficacy was statistically significant, as was the indirect association through smokers' identity identification, and the sequential indirect association through both mediators. Conclusion: Physical activity is associated with lower nicotine dependence level among female college smokers, and this association operates through indirect pathways via smoking refusal self-efficacy and smoker' identity identification. These findings provide preliminary correlational evidence for the psychological pathways linking physical activity to nicotine dependence level, though longitudinal research is needed to establish causality.