Association of sociodemographic and occupational stress factors with smoking behavior among healthcare professionals: The mediating role of physical exercise

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.