Investigators reported a smoking prevalence of 32.2% across three campuses of a large Lebanese university. The survey was delivered electronically to a stratified random sample drawn from an enrolled population of roughly 16,000 students; the instrument included validated items from GATS, YTS and KAP tools. More than half of current smokers—53.4%—reported at least one quit attempt during the previous 12 months, indicating active cessation interest among a substantial subset of users. The questionnaire captured use of combustible cigarettes, waterpipes (shisha), and e-cigarettes/vapes, but the primary outcome was operationalized as a binary tobacco/nicotine-user variable to align with campus-level policy considerations.
The study team observed strong social clustering of tobacco use. Having a family member who smokes was associated with substantially higher odds of student smoking (OR 7.08, 95% CI 2.83–17.69), and the presence of friends who smoke carried an even larger association (OR 12.20, 95% CI 5.48–19.76). Emotional and mental distress also emerged as a key correlate: students reporting social, emotional, or mental distress had increased odds of smoking (OR 4.09, 95% CI 1.74–9.63). The survey asked respondents to identify primary drivers for initiation—social influence, environmental factors and psychological distress—and these self-reported motives mirrored the regression findings, emphasizing interpersonal and affective pathways into tobacco use.
Respondents completed a cumulative knowledge score assessing awareness that smoking causes serious illnesses such as stroke, cardiovascular disease and lung cancer. The authors reported comparative testing of knowledge and policy agreement scores between smokers and nonsmokers, using t tests; specifics of mean scores are available in the published supplement. Attitudinal items measured perceived impacts of a smoke-free campus policy on quality of life and learning, support for restrictions on vaping, and acceptance of bans on on-campus tobacco sales. Agreement with a comprehensive smoke-free mandate was associated with lower odds of being a smoker (adjusted OR 0.58, 95% CI 0.45–0.78). Conversely, perceiving smoking bans as unfair correlated with higher odds of tobacco use (adjusted OR 1.87, 95% CI 1.34–2.61).
The authors used multivariable logistic regression with backward stepwise elimination to identify independent predictors of current tobacco/nicotine use. Variables with p<0.2 from bivariate testing and other candidate confounders were entered into the model. Adjusted odds ratios and 95% confidence intervals were reported for significant predictors. Model performance was assessed with the omnibus test of coefficients, the Hosmer–Lemeshow goodness-of-fit test, and Nagelkerke pseudo-R²; the report emphasizes that the pseudo-R² is presented as an index of relative fit rather than variance explained. The analytic approach aggregated multiple nicotine delivery systems into a single dependent variable to reflect the policy-relevant outcome of any inhaled nicotine on campus grounds.
Authors recommended combining educational outreach with services that address the documented drivers of tobacco use. Specific interventions suggested include awareness programs on harms of tobacco, targeted cessation support for students attempting to quit, and stress-reduction resources—workshops and consultations—designed to interrupt the link between distress and smoking. The study positions a smoke-free campus policy as one component of a broader strategy to lower student smoking rates and reduce secondhand smoke exposure; empirical associations in the data (policy agreement tied to lower odds of smoking) provide policy-relevant signals to university decision-makers.
The authors clarified that the cross-sectional design precludes causal inference: reported associations describe relationships at one time point only. The sample was drawn from a single multicampus university, and while stratified sampling was used, generalizability to other institutions in Lebanon or the region may be limited. The source did not report longitudinal follow-up, objective exposure measures (for example, biochemical validation of tobacco use), or the detailed sample size achieved relative to invitations sent; those specifics must be consulted directly in the published paper and its Supplementary Appendix. Authors recommended further evaluation of smoke-free campus interventions, including prospective studies and implementation assessments, to determine whether policy adoption leads to measurable declines in consumption, secondhand smoke exposure, and tobacco-related harms among students.