Smoking Behavior as Risk for Sleep Disturbance, Self-Control, Depression, Anxiety and Stress

Academy of Education and Social Sciences Review Vol. 5 No. 4 | November, 2025 | 548 - 556 ISSN (p): 2790-8348 | ISSN (e): 2789-6781 DOI: https://doi.org/10.5281/zenodo.17769170 Smoking Behavior as Risk for Sleep Disturbance, Self-Control, Depression, Anxiety and Stress Atiya Khatoon1 (Ph.D) Department of Psychology Federal Urdu University of Arts, Sciences & Technology (FUUAST), Karachi, Pakistan Syed Wajahat Ali Naqvi2 Department of Psychology Federal Urdu University of Arts, Sciences & Technology (FUUAST), Karachi, Pakistan Sabir Shahzad3 College of Clinical Psychology Ziauddin University, Karachi, Pakistan Salman Shahzad4 (Ph.D) Institute of Clinical Psychology University of Karachi, Karachi, Pakistan How to Cite: Khatoon, A., Naqvi, S. W. A., Shahzad, S., & Shahzad, S. (2025). Smoking Behavior as Risk for Sleep Disturbance, SelfControl, Depression, Anxiety and Stress. Academy of Education and Social Sciences Review, 5(4), 548–556. https:// doi.org/10.5281/zenodo.17769170 Publisher’s Note: International Research and Publishing Academy (iRAPA) stands neutral with regard to jurisdictional claims in the published maps and institutional affiliations. Copyright: ©2025 | Academy of Education and Social Sciences Review published by International Research and Publishing Academy (iRAPA) This is an Open Access article published under the Creative Commons Attribution 4.0 International (CC BY 4.0) (https://creativecommons.org/licenses/by/4.0) Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honour or reputation. 07-47-AESSR-6314-1142 Published online: 30 November 2025 View related articles Submit your article to this journal Khatoon, Naqvi, Shahzad & Shahzad Vol. 5 No. 4 (November, 2025) 549 INTRODUCTION Substance use is one of the major public health issues globally, and particularly in Pakistan. Many researches have been conducted, and their results show that substance use especially smoking cigarettes is responsible for many diseases such as; respiratory diseases, cardiovascular diseases, hypertension, diabetes and cancer. The death ratio is also linked with cigarette smoking and there are numbers of people who died due to smoking. Smoking in Pakistan presents a significant public health issue, with approximately 19.1% of adults using tobacco products, including 31.8% of men and 5.8% of women (World Health Organization, 2022). It is a major contributor to chronic diseases such as lung cancer, cardiovascular disorders, and respiratory illnesses, and is associated with mental health conditions such as anxiety and depression due to nicotine dependence and its impact on brain chemistry (Saqib et al., 2018). Economically, smoking imposes a heavy burden on the country, with healthcare costs and productivity losses amounting to over Rs 615 billion yearly 1.4% of Pakistan’s gross domestic product (Nayab et al., 2021). Despite existing tobacco control laws, enforcement remains limited and public awareness is still insufficient. The reasons why young individuals begin to smoke are multifactorial. The biological, genetic, psychological, economic, and social elements that make up this complex system interact with one another (Centers for Disease Control and Prevention, 2002). Some researchers have proposed that individuals experiencing mental health difficulties may resort to cigarette smoking as a means of obtaining temporary relief from psychological distress (Breslau et al., 1991). Conversely, other studies indicate that cigarette smoking can contribute to a range of health problems, including insomnia, heightened stress levels, depression, and anxiety (Breslau & Klein, 1999). Cigarettes contain nicotine along with various other chemical substances that act as sleep-inhibiting agents. The nicotine consumed through smoking disrupts normal sleep patterns, and over time, individuals who develop nicotine dependence are more likely to experience persistent sleep disturbances. The detrimental effects of cigarette smoking on sleep disorders (Liu et al., 2020) and insomnia (Brook et al., 2014; Jaehne et al., 2012) have received more attention since Sabanayagam and Shankar (2011) found that current cigarette smokers were about twice as likely as nonsmokers to report inadequate sleep and rest. Current smokers are more likely to experience symptoms of insomnia, including shorter sleep duration, longer sleep latency, increased rapid eye movement, higher sleep density, more cases of sleep apnoea, and more leg movements during sleep (Jaehne et al., 2012). Furthermore, depression has been linked to an increased risk of nicotine use and cigarette smoking. Depressive symptoms and cigarette smoking can both predict the start and duration of sleep disturbance. Abstract The present study aims to assess risk for mental health problems (i.e., sleep disturbance, low self-control, depression, anxiety, and stress) among smokers and non-smokers from different academic institutions in Karachi, Pakistan. To assess variables, the Pittsburgh Sleep Symptoms Questionnaire (PSSQ-I), Brief Self-Control Scale (BSCS), and Depression, Anxiety, and Stress Scale (DASS-21) were used. Logistic regression analyses indicated that individuals with smoking behaviour are at greater risk for sleep disturbance, heightened vulnerability for loss of self-control and mental health disturbances (i.e. depression, anxiety, and stress) as compared to their counterparts (non-smokers). It shows that individuals who smoke could suffer from health issues. These findings suggest that smoking behaviour is closely associated with an increased risk of both mental and physical health problems. Further, the present study provides valuable insights into the detrimental psychological consequences of cigarette smoking and underscores the need for early detection and identification of individuals at risk for smoking behaviours, and designing and implementing evidence-based interventions and preventive strategies to address this public health issue. Future research may further explore the causal mechanisms underlying the relationship between smoking and mental health issues, as well as potential moderating factors such as age, duration of smoking, and social influences. Keywords Anxiety Depression Self-control Sleep disturbance Smoking, Stress 550 Smoking Behavior as Risk for Sleep Disturbance, Self-Control, Depression, Anxiety and Stress Vol. 5 No. 4 (November, 2025) Smoking and excessive drinking have been linked to depression as two of the main health risk factors for morbidity and early death globally (Trosclair & Dube, 2010). Researchers showed that smokers, particularly heavy smokers, had greater levels of stress, depression and anxiety symptoms, and unpleasant life events than non-smokers. Anxiety is also the main element which comes out because of cigarette smoking. Anxiety-prone people smoke significantly more frequently, and other studies have also linked smoking cigarettes to mental health conditions (Dome et al., 2010). Numerous psychological and social elements that could contribute to the association between anxiety and cigarette smoking have been examined in a substantial amount of study (Morissette et al. 2007). According to other research, smoking cigarettes has an impact on behaviour and can impair selfcontrol. Numerous studies have found a connection between smoking and perceived self-control, both through cross-sectional and longitudinal study (Wills & Dishion, 2004). Perceived self-control predicts lower rates of smoking and other substance use, according to several research. According to a study by Pahl et al. (2011), smoking is substantially linked to a lack of self-control. The current study aims to investigate the mental health risk (i.e. insomnia, self-control, depression, stress, and anxiety) associated with smoking behaviour in Pakistan. The uniqueness of this study is to see whether smoking behaviour is a risk for mental health issues. There is a dearth of research on the risk and health consequences associated with smoking behaviours in Pakistan. Identifying the risk and health consequences associated with smoking can help health professionals to identify and detect the problem at an early stage and develop and design evidence-based prevention interventions. LITERATURE REVIEW There is numerous research evidence which found the linkage of smoking with insomnia. Researchers discovered that smoking cigarettes has a detrimental impact on sleep disruption (Liu et al., 2013). According to the research study conducted by Sabanayagam and Shankar (2011), current cigarette smokers were almost twice as likely to report not getting enough sleep and rest as non-smokers. According to Brook et al. (2015), those who currently smoke have a higher chance of experiencing insomnia, which manifests as shorter sleep duration, more bouts of sleep apnoea, and greater leg movements as they sleep. Major depressive disorder (MDD) was diagnosed in 39 percent of young adult smokers with moderate nicotine dependence, compared to 19.2 percent of moderately dependent smokers and 10.1 percent of non-dependent smokers (Breslau et al., 1991). Another study found a strong association between daily smoking and mental health difficulties (John et al., 2004). Furthermore, some studies found a link between smoking and anxiety (Mykletun et al., 2008). Psychosocial association and substance use were found to be significantly correlated in Pakistani studies. Shahzad et al. (2022) found a strong negative correlation between cognitive emotion control and mental health issues such as depression, anxiety, and stress, and a favourable correlation with self-esteem. Similar results were obtained by researchers (Shahzad et al., 2023), who found a strong correlation between depression and emotion regulation in people with substance use disorders. A most recent study conducted by researchers (i.e. Azam et al., 2025) found the role of peer pressure in substance use, and they found its significant association with substance use. Researchers went on to clarify that the relationship between peer pressure and substance use is partially mediated by psychological suffering. People who engage in delinquent behaviour are more likely to consume drugs. A study conducted by Shahzad and Yasmin (2015) found that those delinquents who use drugs showed higher levels of aggression than non-users. A most recent qualitative study conducted in Pakistan by Asif et al. (2024) revealed that the main reasons for individuals dying by suicide was drug overdose, family issues or attitude of the community. Results further found that those who died by suicide were perceived to be impulsive and lacked self-control, with underlying psychological distress in the deceased. One of the studies conducted on adolescents indicated the association of alcohol use with internalizing (i.e. depression and anxiety) and externalizing (i.e. aggression and delinquent) behaviours and attention problems (Shahzad et al., 2020). These studies were conducted in Pakistan and found a significant link of Khatoon, Naqvi, Shahzad & Shahzad Vol. 5 No. 4 (November, 2025) 551 substance use with mental health issues. According to Billings and Moos (1984), smokers especially heavy smokers had higher stress levels, symptoms of anxiety and depression, and negative life experiences than non-smokers. Numerous psychological and social elements that could contribute to the association between anxiety and cigarette smoking have been examined in a substantial amount of study. Research that demonstrates how smoking practices may be influenced by psychological variables. Compared to non-smokers, smokers typically exhibit lower levels of self-control and future orientation (Adams & Nettle, 2009). According to other studies, those who lack self-control are more prone to smoke, and smokers can successfully lower their intake and stop by receiving training to improve self-control (Muraven et al., 1999). Effective self-control has been associated with traits including a positive outlook, more interest in school, and less negative life events that are believed to guard against substance dependence. Recent studies have found a connection between early initiation of substance use or smoking and self-control mechanisms (Moffitt et al., 2011). Objectives The primary purpose of this study was: • To determine whether smoking cigarettes increases the risk of mental and emotional health problems, including sleep disturbances, a lack of self-control, and increased symptoms of stress, anxiety, and depression in both smokers and nonsmokers. There are few studies in Pakistan that focus on the prevalence and association of substance use with psychosocial problems; however, there is limited research which focuses on the risk associated with smoking behaviours. Identifying and detecting these patterns and risk associated with smoking behaviour establishes a ground work on designing and implementing evidence-based interventions in smoking cessation programs, which not only help individuals and families but also communities and country in improving health and wellbeing. Research Question • Do individuals who smoke cigarettes have a higher risk of experiencing mental health problems (i.e., insomnia, low self-control, depression, anxiety, & stress) compared to non-smokers? Hypothesis H1: Individuals who smoke cigarettes are at greater risk for mental health problems (i.e. insomnia, self-control, depression, anxiety & stress) as compared to those who don’t smoke. METHODOLOGY The sample consisted of 200 male participants ages between 20-40 years (Mage= 29.88 SD=6.21). Sample was further divided into two groups (smoker=100, non-smokers=100), and they were recruited from different academic institutions in Karachi, Pakistan using purposive sampling technique. Instruments Socio-Demographic Information Form Participants completed a socio-demographic form that gathered essential background details, including individual’s age, education, gender, socioeconomic status, and marital status, etc. Pittsburgh Sleep Symptoms Questionnaire-Insomnia A comprehensive systematic review and meta-analysis of 37 psychometric studies have substantiated the Pittsburgh Sleep Quality Index (PSQI) (as used in the study by Trapp et al., 2021) as a reliable and valid instrument for assessing sleep quality across various populations. The PSQI demonstrates satisfactory internal consistency, with Cronbach’s alpha coefficients consistently exceeding 0.70, indicating that 552 Smoking Behavior as Risk for Sleep Disturbance, Self-Control, Depression, Anxiety and Stress Vol. 5 No. 4 (November, 2025) the items within the index cohesively measure the construct of sleep quality. The PSQI’s capacity to accurately measure sleep quality is bolstered by its strong construct validity, as evidenced by significant correlations with related concepts such as anxiety and sadness and weak connections with irrelevant notions. Furthermore, the score exhibits strong known-group validity, successfully distinguishing between healthy controls and patients with known sleep disorders, proving its utility in detecting sleep dysfunctions. Factor analyses have revealed discrepancies in the PSQI’s dimensional structure and these differences do not jeopardize the test’s overall psychometric validity. Brief-Self Control Scale Malouf et al. (2014) presented a 13-item Brief Self-Control Scale (BSCS) self-report tool for evaluating individual differences in trait self-control. While maintaining psychometric robustness, this reduced version of the 36-item Self-Control Scale (SCS) offers a more effective way of measurement. Cronbach’s alpha coefficients in the original studies were 0.83 and 0.85, indicating that the BSCS has strong internal consistency and approximately equals the complete SCS’s alpha of 0.89. Furthermore, the BSCS has good construct validity, indicating its capacity to properly measure self-control, as seen by strong correlations with related constructs such as anxiety and depression and weak correlations with other constructs. Its utility in diagnosing self-control dysfunctions is bolstered by the index’s outstanding known-group validity, which successfully distinguishes people with known self-control deficits from healthy controls. Depression Anxiety and Stress Scale Lovibond and Lovibond (1995) developed the Depression, Anxiety, and Stress Scale (DASS-21), comprising 21 items, a self-report measure for assessing the severity of stress, anxiety, and depression symptoms over the previous week. The seven items in each of the three subscales are rated on a 4-point Likert scale, with 0 indicating “not at all applicable” and 3 indicating “very much or most of the time applicable.” The DASS-21 has demonstrated robust psychometric properties across diverse populations. In our sample, the internal consistency was excellent, with Cronbach’s alpha coefficients of 0.89 for the Depression subscale, 0.82 for the Anxiety subscale, and 0.84 for the Stress subscale, indicating high reliability. These findings align with previous studies reporting Cronbach’s alpha values ranging from 0.81 to 0.92 for the DASS-21 subscales, further supporting its reliability as a screening tool for emotional distress. Additionally, the DASS-21 has shown strong construct validity, with significant correlations to other established measures of psychological distress, such as the Beck Depression Inventory and the Beck Anxiety Inventory. These psychometric strengths underscore the DASS-21’s utility in both clinical and research settings for the assessment of depression, anxiety, and stress symptoms. Procedure Before executing the study, the researchers got approval from the Ethical Review Committee (ERC) of their respective institute. After the formal approval, researchers formally invited the participants to engage in the study on a voluntary basis. After the initial invitation, they were requested to fill the consent form and researchers made them understand about the study’s objectives and plan. Those who were willing and signed the consent form were further evaluated to see if they met the pre-requisite criteria. Those who met the criteria were included in the study and all the questionnaires (PSSQ I, BSCS & DASS21) were filled out individually. They were briefed that if they want to withdraw their participation at any stage then can do so without any penalty. During the administration of Questionnaires, researchers maintained the respect and dignity of participants. Ethical Considerations Participants were clearly informed about their freedom to withdraw at any point during the survey, without facing any negative consequences. They were assured that their data would be erased upon completion of the study and would not be shared with anyone. Researchers maintained the ethical standards by addressing risks, emphasizing participant liberty, and safeguarding data integrity throughout the study. Khatoon, Naqvi, Shahzad & Shahzad Vol. 5 No. 4 (November, 2025) 553 Statistical Analysis The Statistical Package of Social Science (SPSS) was used to analyse the data. The data was initially summarized using descriptive statistics. The key hypotheses were tested by inferential statistics. RESULTS & FINDINGS Table 1 Descriptive Characteristics of Participant Demographic Variables N % Marital Status Single 89 44.5 Married 98 49.0 Divorced 11 5.5 Separated 02 1.0 Cigarette Smoking Yes 105 52.5 No 95 47.5 Having Psychiatric Issues Yes 14 7.0 No 184 92.0 Table 2 Logistic regression predicting smoking status Predictors B SE OR 95% CI for OR p Self-control -.103 .019 1.108 1.069, 1.149 < .001 Insomnia .076 .015 1.078 1.048, 1.110 < .001 Depression .214 .036 1.239 1.155, 1.329 < .001 Anxiety .249 .039 1.283 1.188, 1.386 < .001 Stress .204 .036 1.227 1.143, 1.316 < .001 Note: N = 200. OR = Odds Ratio. CI = confidence interval. SE = standard error To investigate the smoking behaviour as a risk factor for mental health issues, logistic regression analysis was performed. Findings showed that smoking was substantially more likely to have lower selfcontrol (B = -0.103, OR = 1.108, p <.001). Further, individuals with smoking behaviour have higher levels of insomnia (B = 0.076, OR = 1.078, p < .001), depression (B = 0.214, OR = 1.239, p < .001), anxiety (B = 0.249, OR = 1.283, p < .001), and stress (B = 0.204, OR = 1.227, p < .001) as compared to individuals with non-smoking behaviour. Discussion The results of this study offer compelling proof of the mental health issues associated with cigarette smoking. Individuals who smoke cigarettes are at risk of diminished self-control, indicating that they have difficulty in controlling their impulse. This is in line with earlier studies showing that a lack of self-control makes people more susceptible to addictive habits, such as smoking (De Ridder et al., 2012). Furthermore, they found that those who smoke are at a higher risk for disturbance, depression, anxiety, stress, and sleep. The self-medication theory, which holds that people frequently turn to drugs like nicotine to deal with psychological distress, is supported by these findings (Khantzian, 1997). Smokers usually have lower self-control and are more prone to stress, anxiety, depression, and sleeplessness. People with a history of chronic heavy smoking and persistent depression were much more likely to have low perceived self-control and lower well-being in adulthood, according to longitudinal data from a cohort of people aged 14 to 32 (Brook et al., 2015). Stress also emerged as a key predictor, reinforcing the notion that tobacco is commonly used as a maladaptive coping strategy during periods of heightened stress (Parrott, 1999). These findings suggest that individuals experiencing greater psychological distress and sleep problems are at an increased risk of engaging in smoking behaviour, potentially using it as a coping mechanism. The strong association between mental health variables and smoking underscores the importance of addressing psychological well-being in smoking prevention and cessation programs. 554 Smoking Behavior as Risk for Sleep Disturbance, Self-Control, Depression, Anxiety and Stress Vol. 5 No. 4 (November, 2025) CONCLUSION The findings of this study support the view that individuals who smoke often exhibit poor self-control and are more likely to experience insomnia, depression, anxiety, and stress. This could be due to emotional dysregulation and reduced adaptive coping skills. People without these abilities may try to alleviate their pain. Smoking is known to be a gateway to other substances and to increase sensitivity to other drugs thus, the smoking pattern does not end here, and individuals who smoke cigarettes suffer from other serious health-related issues. Limitation The study’s cross-sectional methodology only records one incident, making it hard to determine causality or timing correlations between smoking and mental health concerns. This is one of the study’s major limitations. The reliance on self-report measures for sleep, self-control, and mental health raises concerns about recall bias and social desirability effects. Additionally, the relatively small (N = 200) sample size restricts generalizability, limiting the applicability of findings to broader populations. Implications These insights suggest evidence-based preventive interventions aimed at promoting positive mental health and reducing the risk of smoking behaviours. Identifying the risk could help professionals in designing and implementing interventions to improve healthy behaviour, which could positively improve their sleep patterns, and self-control, resulting in improved mental health and wellbeing. Addressing these issues at an early stage through cognitive-behavioural skills training enhances coping strategies, improves sleep quality, and manages stress, anxiety, and related patterns. Competing Interest The authors declare no conflict of interest. Authors’ Biography 1 Atiya Khatoon (Ph.D) is an Assistant Professor at the Department of Psychology, Federal Urdu University of Arts, Sciences & Technology (FUUAST), Karachi, Pakistan. She obtained her Doctorate in Arts from Federal Urdu University of Arts, Sciences & Technology (FUUAST), Karachi, Pakistan. 2 Syed Wajahat Ali Naqvi is a Research Scholar at the Department of Psychology, Federal Urdu University of Arts, Sciences & Technology (FUUAST), Karachi, Pakistan. He completed his Bachelors of Psychology from Federal Urdu University of Arts, Sciences & Technology (FUUAST), Karachi, Pakistan. 3 Sabir Shahzad is a Lecturer at the College of Clinical Psychology, Ziauddin University, Karachi, Pakistan. 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