Abstract
Background
Smokeless tobacco is considered a significant public health issue worldwide. In low and middle-income countries like Pakistan, its use remains widespread. Moreover, it is also found more commonly in low-income occupational groups, especially rickshaw drivers, due to social acceptance, peer influence, and economic stress. Although drivers were aware of the health risks, misconceptions persisted, such as believing SLT was safer than smoking or helpful for digestion and stress relief. Therefore, this study aimed to explore the Knowledge, Attitudes, and Perceived Health Risks of Smokeless Tobacco Use Among Male Rickshaw Drivers in Urban Lahore.
Methods
This qualitative study involved semi-structured interviews with 13 male rickshaw drivers in Lahore were conducted. Drivers were selected through purposive sampling from various rickshaw stands across Lahore and face-to-face interviews were conducted. Data were collected until thematic saturation was achieved and analyzed through thematic analysis using NVivo software and manual coding to identify key patterns and themes.
Results
The findings revealed that most drivers initiated SLT use during adolescence, primarily due to family habits, peer influence, and workplace culture. Continued use was reinforced by misconceptions such as believing SLT is less harmful than smoking or beneficial for stress and digestion. Drivers said that peer influence, long working hours, and lack of quitting support made it hard for drivers to stop using SLT. Government and media campaigns were widely viewed as ineffective, while drivers suggested that stricter laws, affordable alternatives, and family or community encouragement could help reduce use.
Conclusion:
The study reveals that strong cultural acceptance, financial difficulties, and a lack of quitting support are the main reasons behind smokeless tobacco (SLT) dependence among rickshaw drivers. Targeted interventions focusing on education, workplace awareness, community engagement, and strong policy enforcement are essential to reduce SLT use and prevent its continuation across generations.