The research team drew on validated instruments to characterize smoking behavior and attitudes, including the Global Adult Tobacco Survey, the Youth Tobacco Survey, and a Smoking Knowledge, Attitudes, and Practices questionnaire, supplemented with sections probing views on smoke-free campus policies. Among students who reported smoking, more than half, 53.4 percent, said they had tried to quit within the past 12 months, a detail the authors interpret as a promising opening for cessation support delivered directly on campus.

Statistical analysis identified several factors significantly associated with smoking. Students with family members who smoked had more than seven times the odds of smoking themselves, with an odds ratio of 7.08 and a 95 percent confidence interval of 2.83 to 17.69. The influence of peers was even stronger: having friends who smoke was associated with an odds ratio of 12.20, with a confidence interval of 5.48 to 19.76. Experiencing social, emotional, or mental distress roughly quadrupled the odds of smoking, at an odds ratio of 4.09 and a confidence interval of 1.74 to 9.63.

Attitudes toward smoke-free policies themselves tracked closely with smoking status. Students who agreed with a smoke-free university policy had lower odds of smoking, with an odds ratio of 0.58 and a 95 percent confidence interval of 0.45 to 0.78. Conversely, students who perceived campus smoking bans as unfair showed increased odds of smoking, with an odds ratio of 1.87 and a confidence interval of 1.34 to 2.61. The authors suggest these associations point to policy attitudes as both a marker of smoking behavior and a potential lever for intervention.

The Middle East region has been slow to adopt smoke-free campus policies, and few studies have examined how university students in the region view such measures. By documenting both smoking prevalence and student perspectives on restrictions, the study offers institutions in Lebanon and neighboring countries a baseline for designing campus-level tobacco control programs.

Based on the findings, the authors propose a combination of evidence-based interventions: educational programs to raise awareness of the dangers of tobacco use, and programs designed to break the association between exposure to stress and smoking. The latter could include stress-reducing services, workshops, and consultations, alongside awareness campaigns, targeting the distress-related pathway identified in the analysis.

The researchers caution that the cross-sectional design means the findings describe associations rather than causal effects. The survey captures a single point in time, so it cannot establish whether family and peer smoking, distress, or policy attitudes cause students to smoke, or whether smokers perceive policies differently after taking up the habit. Even so, the authors argue that the results support further evaluation of smoke-free campus policies as one component of a broader strategy to lower smoking rates, mitigate peer influence, and foster healthier campus environments.

With more than half of student smokers already reporting quit attempts in the past year, the study frames university campuses in Lebanon as a window of opportunity: a setting where cessation support, stress management resources, and clear smoke-free policies could reach young adults at a stage when intervention may prevent decades of nicotine dependence.

Subject of Research: Smoking prevalence and smoke-free campus policy attitudes among university students in Lebanon

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

Article References: Hijazi, M. A., Rahme, D., Jammoul, D., Al Jawiche, L., & Alameddine, M. (2026). Prevalence and determinants of tobacco use among university students in Lebanon: Implications for smoke-free campus policies. PLOS One, 21(10), e0361138. https://doi.org/10.1371/journal.pone.0361138

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0361138

Keywords: tobacco use, university students, Lebanon, smoke-free campus policies, cross-sectional study, smoking prevalence, peer influence, stress and smoking, smoking cessation, public health, odds ratio, tobacco control