BACKGROUND: Tobacco use is a significant global public health issue, increasingly affecting low- and middle-income countries. In culturally sensitive contexts like Lebanon, self-reported smoking may be unreliable, particularly among socially restricted groups such as women and youth. This study aims to evaluate the discrepancy between perceived and actual dependence on cigarettes and waterpipes in the Lebanese population and its association with social desirability, while also examining gender differences and patterns among self-identified non-smokers and younger individuals. METHODS: A cross-sectional study was conducted between February and March 2025, enrolling a total of 377 participants. Data were collected through an online self-administered survey distributed via Google® Forms, using previously validated scales for smoking dependence and social desirability assessment. RESULTS: The present study showed a substantial gap between self-perception and actual nicotine dependence among Lebanese youth and young adults: despite scoring high on the Lebanese Cigarette Dependence and Waterpipe Dependence scales, 10.6% of cigarette smokers and 28.6% of waterpipe smokers did not perceive themselves as dependent. Underestimation of tobacco dependence was more prominent among waterpipe smokers; according to the model, it was overall associated with higher waterpipe dependence (ORa = 1.24; 95% Confidence Interval (CI) 1.14-1.34) and cigarette dependence (ORa = 1.12, 95% CI 1.08-1.18), more smokers at home (ORa = 1.53; 95% CI 1.24-1.90), depression (ORa = 6.44; 95% CI 1.38-30.08), and social desirability components, mainly the reversed independent thinking (ORa = 1.09; 95% CI 1.00-1.18). Underestimation of cigarette and waterpipe dependence was linked to lower virtuous perfectionism in both sexes. Additionally, males living outside Beirut were more likely to underestimate waterpipe dependence, while in females, underestimation was also associated with depression. CONCLUSION: These findings should be interpreted within Lebanon's unique cultural and religious context. Given the important role of social and psychological factors in tobacco dependence underestimation, future interventions should go beyond physical health messaging. Targeted campaigns should encourage self-awareness, challenge conformity, and embrace acknowledging addiction and seeking help. TRIAL REGISTRATION: Not applicable.
Karam et al. (Fri,) studied this question.