Abstract

Tobacco use is a prevalent public health issue, particularly in rural regions like Larkana, Sindh, Pakistan, where smoking is deeply embedded in cultural and social practices. This study investigates the role of smoking as a coping mechanism for stress relief among Larkana's residents. A mixed-methods approach was utilized, combining quantitative data from 300 participants with qualitative insights from interviews with 10 individuals. The quantitative findings show that 45% of the participants were current smokers, with 63% of smokers citing stress relief as the primary reason for their habit. Social acceptance was another contributing factor, reported by 33% of participants. Smoking emerged as the most preferred coping method (mean score: 4.2), while exercise (2.5) and meditation (2.1) were less favored. A regression analysis identified significant predictors of smoking behavior, including age (B = 0.10, p = 0.013), education level (B = -0.25, p < 0.001), cultural practices (B = 0.35, p < 0.001), and folk beliefs (B = 0.30, p < 0.001). These factors explained 45% of the variation in smoking behavior (R² = 0.45). Thematic analysis from qualitative data revealed that smoking is not only a stress management tool but also a social practice deeply embedded in the community’s cultural norms. The study highlights the importance of developing public health interventions that consider both the health risks and the psychological, social, and cultural factors driving smoking behavior. Tailored strategies focused on stress management and culturally appropriate alternatives could effectively reduce tobacco use in similar settings.