Tobacco Cultivation with Socioenvironmental Health Implications in Livelihood Vulnerability of Khyber Pakhtunkhwa Pakistan

Introduction: In Pakistan, particularly in Khyber Pakhtunkhwa (KPK), tobacco farming is a significant cash crop that both sustains rural livelihoods and poses significant health and socio-environmental problems. Although it generates revenue and jobs, a high reliance on tobacco production has resulted in health hazards, ecological degradation, and heightened susceptibility to livelihood threats. Methods The socio-environmental effects of tobacco cultivation in KPK were investigated in this study using a mixed-methods methodology. Quantitative data from a survey of 300 farmers was examined using regression analysis, indices (EDI, HRI), and descriptive statistics. Ten key informant interviews also provided qualitative insights that were triangulated with survey results and subjected to theme analysis. Results Regression analysis revealed that livelihood vulnerability was decreased by sustainable practices (β = -0.195, p < 0.001) and increased by ecological impacts (β = 0.401, p < 0.001) and health hazards (β = 0.370, p < 0.001). Deforestation (β = 0.397), pesticide use (β = 0.394), and fertilizer use (β = 0.310) were the main causes of ecological deterioration (all p < 0.001). Long working hours (β = 0.196), leaf touch (β = 0.343), and pesticide exposure (β = 0.384) were associated with health hazards, whereas protective gear decreased risks (β = -0.163, p < 0.01). Qualitative results validated policy gaps, ecological harm, and tobacco dependence. Conclusion Because tobacco production in KPK combines income dependence with environmental degradation and occupational health risks, it makes livelihood vulnerability worse. Despite the short-term financial gain, the long-term effects compromise environmental sustainability and household resilience. Reducing vulnerability and improving the welfare of farming communities requires promoting crop variety, sustainable agricultural methods, safeguards, and legislative changes.