Determinants and motivational factors of smoking behavior among healthcare workers: A cross-sectional study

INTRODUCTION Tobacco use among healthcare workers (HCWs) undermines their role as health advocates and presents a significant public health issue. Despite their professional knowledge, smoking remains prevalent among HCWs, especially in low-and middle-income countries. This study aimed to evaluate the prevalence, patterns, determinants, and motivational factors for smoking cessation among HCWs in Kirkuk, Iraq. METHODS A cross-sectional study was conducted from January to August 2025 involving 1618 HCWs employed in hospitals and primary healthcare centers throughout Kirkuk Governorate, Iraq. Data were gathered using a structured, validated self-administered questionnaire that assessed sociodemographic characteristics, use of any tobacco product, smoking behaviors, perceptions, and motivations for quitting. A multistage cluster sampling method was employed, and the sample size was calculated with a design effect of 1.5. Descriptive statistics, chi-squared tests, and binary and ordinal logistic regression analyses were used to identify predictors of smoking behavior. Principal component analysis (PCA) with Varimax rotation was conducted to uncover underlying factors influencing cessation motivation. RESULTS Among the 1618 participants, mean age of 35.7 ± 9.7 years, 54.8% were female. The overall smoking prevalence was 13.5%, while 2.9% were former smokers. Smoking was strongly associated with being