Abstract
INTRODUCTION: Smoking remains a major preventable cause of mortality, posing a significant public health challenge globally. Healthcare professionals (HCPs), despite their pivotal role in promoting health, exhibit notable smoking behaviors influenced by occupational stress and sociodemographic factors. This study investigates these relationships and examines the mediating role of physical exercise in smoking behaviors among HCPs in Pakistan. METHODS: A cross-sectional study was conducted among 302 HCPs (medical doctors and dentists) recruited using a snowball sampling technique in Pakistan from March to July 2024. Data were collected using a self-administered online questionnaire assessing sociodemographic and occupational factors, smoking status and frequency, physical exercise, sleep quality, job satisfaction, and perceived stress. Smoking behavior was analyzed as current, past, or never smokers. Mediation analysis evaluated the role of physical exercise in the association between occupational stress and smoking behavior. RESULTS: Nearly half (49.3%) of participants were current smokers, with 36.7% smoking 6-20 cigarettes daily and 60.2% of the participants experiencing moderate to high levels of perceived stress. Higher smoking prevalence was associated with gender, frequent night shifts, longer working hours, low job satisfaction, frequent insomnia, and high perceived stress (p<0.05). Regular physical exercise (52.0%) emerged as a significant protective factor against smoking, with those exercising three or more times per week being significantly less likely to smoke (OR=0.05; 95% CI: 0.03-0.09, p<0.001). Mediation analysis showed that physical exercise partially mediated the relationship between perceived stress and smoking (indirect effect = -3.67, p<0.001), with a reduced direct effect of perceived stress on smoking after controlling for exercise (B= -1.56, SE=0.22, p<0.001). CONCLUSIONS: Occupational stress, coupled with sociodemographic and work-related factors, drives smoking behaviors among Pakistani HCPs. Physical exercise serves as a protective factor, mediating the relationship between perceived stress and smoking. Workplace interventions promoting stress management, physical activity, and job satisfaction are recommended to reduce smoking rates and foster healthier behaviors among HCPs, improving public health outcomes.