Prevalence and determinants of tobacco use among university students in Lebanon: Implications for smoke-free campus policies

Abstract

Background The tobacco epidemic is a global public health threat, with addiction often starting in the early adulthood stage of life. The Middle East Region is slow in adopting smoke-free campus policies, and few studies have examined smoking attitudes and behaviors among university students and their perspective on such policies. Objective The objective of this study was to determine the perceptions, knowledge, attitudes, and behaviors toward smoking (used to denote using any tobacco products) and smoke-free campus policies among university students aged between 17 and 30 years old at a large multicampus academic institution in Lebanon. Methods The study utilized a comprehensive cross-sectional study design. The questionnaire used in this study included validated tools for assessing smoking behaviors, such as the Global Adult Tobacco Survey (GATS); the Youth Tobacco Survey (YTS); and the Smoking Knowledge, Attitudes, and Practices (KAP) survey, as well as sections for investigating attitudes toward smoking and the smoke-free campus policy. Results This study reports an alarming prevalence of smoking on campuses (32.2%), with more than half of the surveyed smokers reporting attempts to quit smoking in the past 12 months (53.4%). The factors significantly associated with smoking included having family (OR 7.08, 95% C.I (2.83–17.69) or friends (OR 12.20, 95% C.I (5.48–19.76)) who smoke, as well as experiencing social, emotional, or mental distress (OR 4.09, 95% C.I (1.74–9.63)). Further analysis revealed that agreement with a smoke-free university policy was a significant factor associated with reduced odds of smoking (OR 0.58 95% C.I (0.45–0.78)), whereas the perceived unfairness of smoking bans on campuses was associated with increased odds of smoking (OR 1.87, 95% C.I (1.34–2.61)). Conclusions The results highlight a promising window of opportunity to implement evidence-based interventions to support students in quitting smoking. Interventions include educational programs to raise awareness of the dangers of tobacco use and programs to break the association between exposure to stress and smoking. Such programs could include a combination of awareness programs and organizing stress-reducing services, workshops, and consultations. Because the design is cross-sectional, these findings describe associations rather than causal effects; they nonetheless support the further evaluation of smoke-free campus policies as one component of a broader strategy to lower students’ smoking rates, mitigate peer influence and foster healthier campus environments.