Objective To understand the prevalence and influencing factors of nicotine dependence among rural elderly of Han, Dai, Hani, and Bai ethnicity in Yunnan province, to provide a reference for developing strategies to alleviate nicotine dependence symptoms in the population.

Methods A face-to-face survey was conducted among 5 800 residents aged ≥ 60 years recruited by multistage stratified random sampling from the above four ethnic groups in rural areas of Yunnan province from July 2021 to May 2022. The Fagerstrm Test of Nicotine Dependence (FTND), the Social Support Rating Scale (SSRS) developed by Chinese scholars, and a self-developed questionnaire were used in the study. A composite socioeconomic status (SES) score was constructed using principal component analysis, and the factors influencing nicotine dependence among these ethnic groups were analyzed using structural equation modeling (SEM).

Results Of the 5 642 participants finally included in the analysis, 935 (16.57%) were classified as having nicotine dependence, and the prevalence of nicotine dependence among participants from Han, Dai, Hani, and Bai ethnic groups was 17.34%, 11.64%, 16.41%, and 20.87%, respectively, with a significant difference in prevalence among ethnic groups (χ² = 44.410, P < 0.001). The results of the SEM analysis indicated that gender, ethnicity, SES, and smoking cessation attempt had both direct and indirect effects on nicotine dependence, with overall standardized path coefficients of – 0.33, – 0.03, 0.08, and – 0.06, respectively. Gender had an indirect effect through number of cigarettes smoked per day, while ethnicity and attempt to quit smoking influenced nicotine dependence indirectly through social support, and SES had indirect effects through both social support and number of cigarettes smoked per day, with standardized path coefficients of – 0.07, – 0.01, – 0.01, and 0.03, respectively. Social support and number of cigarettes smoked per day had direct effects on nicotine dependence, with standardized path coefficients of – 0.06 and 0.18, respectively.

Conclusion There are significant ethnic differences in nicotine dependence among rural elderly in Yunnan province, especially among males, those with a higher number of cigarettes smoked per day, at a higher SES, having a lower score of social support, those who have not tried to quit smoking, and the Bai minority group, highlighting the need for targeted prevention and control measures.