{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:43:30Z","timestamp":1792691010591,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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\u201317.69) or friends (OR 12.20, 95% C.I (5.48\u201319.76)) who smoke, as well as experiencing social, emotional, or mental distress (OR 4.09, 95% C.I (1.74\u20139.63)). 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\u20130.78)), whereas the perceived unfairness of smoking bans on campuses was associated with increased odds of smoking (OR 1.87, 95% C.I (1.34\u20132.61)).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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\u2019 smoking rates, mitigate peer influence and foster healthier campus environments.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0361138","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:25:06Z","timestamp":1792689906000},"page":"e0361138","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and determinants of tobacco use among university students in Lebanon: Implications for smoke-free campus policies"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9829-235X","authenticated-orcid":true,"given":"Mohamad Ali","family":"Hijazi","sequence":"first","affiliation":[{"name":"Beirut Arab University","place":["Beirut, Lebanon"],"department":["Head of Pharmaceutical Sciences Department, Faculty of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4245-9699","authenticated-orcid":true,"given":"Deema","family":"Rahme","sequence":"additional","affiliation":[{"name":"Beirut Arab University","place":["Beirut, Lebanon"],"department":["Faculty of Pharmacy"]},{"name":"INSPECT-LB (Institut National de Sant\u00e9 Publique, d\u2019\u00c9pid\u00e9miologie Clinique Et de Toxicologie-Liban)","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Jammoul","sequence":"additional","affiliation":[{"name":"Beirut Arab University","place":["Beirut, Lebanon"],"department":["Faculty of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Al Jawiche","sequence":"additional","affiliation":[{"name":"Beirut Arab University","place":["Beirut, Lebanon"],"department":["Faculty of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2299-1242","authenticated-orcid":true,"given":"Mohamad","family":"Alameddine","sequence":"additional","affiliation":[{"name":"Sharjah University","place":["Sharjah, United Arab Emirates"],"department":["Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"2","key":"pone.0361138.ref001","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1136\/tobaccocontrol-2021-056535","article-title":"Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action","volume":"31","author":"X Dai","year":"2022","journal-title":"Tob Control"},{"key":"pone.0361138.ref002","unstructured":"Tobacco. Accessed 2024 Apr 16. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco"},{"issue":"8","key":"pone.0361138.ref003","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1080\/08870446.2017.1325890","article-title":"Tobacco smoking: Health impact, prevalence, correlates and interventions","volume":"32","author":"R West","year":"2017","journal-title":"Psychology & Health"},{"key":"pone.0361138.ref004","unstructured":"Health Effects | Smoking and Tobacco Use | CDC. https:\/\/www.cdc.gov\/tobacco\/basic_information\/health_effects\/index.htm. Accessed 2024 April 16."},{"issue":"6","key":"pone.0361138.ref005","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1200\/JCO.2013.50.9695","article-title":"Second-hand smoke as a predictor of smoking cessation among lung cancer survivors","volume":"32","author":"L Eng","year":"2014","journal-title":"J Clin Oncol"},{"key":"pone.0361138.ref006","article-title":"A review of the effects of nicotine on social functioning","author":"LM Martin","year":"2018","journal-title":"Psychological Bulletin"},{"key":"pone.0361138.ref007","doi-asserted-by":"crossref","first-page":"100302","DOI":"10.1016\/j.lanepe.2021.100302","article-title":"Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England","volume":"14","author":"KE Philip","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"pone.0361138.ref008","doi-asserted-by":"crossref","DOI":"10.1192\/bjp.bp.109.074880","article-title":"Cigarette smoking and depression: A question of causation","author":"MR Munaf\u00f2","year":"2010"},{"issue":"1","key":"pone.0361138.ref009","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1136\/tobaccocontrol-2016-053305","article-title":"Global economic cost of smoking-attributable diseases","volume":"27","author":"M Goodchild","year":"2018","journal-title":"Tob Control"},{"issue":"2","key":"pone.0361138.ref010","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/CEJ.0b013e32835645fa","article-title":"Why do smokers start?","volume":"22","author":"R Muttarak","year":"2013","journal-title":"Eur J Cancer Prev"},{"issue":"7","key":"pone.0361138.ref011","first-page":"3483","article-title":"Reasons and motivations for cigarette smoking and barriers against quitting among a sample of young people in Jeddah, Saudi Arabia","volume":"17","author":"M Baig","year":"2016","journal-title":"Asian Pac J Cancer Prev"},{"key":"pone.0361138.ref012","doi-asserted-by":"crossref","unstructured":"Vijayaraghavan M, San Z, General F, King BA. Advancing housing and health: Promoting smoking cessation in permanent supportive housing relationship among homelessness, housing, and smoking. 2020.","DOI":"10.1177\/0033354920922374"},{"key":"pone.0361138.ref013","doi-asserted-by":"crossref","DOI":"10.18332\/tpc\/143329","article-title":"Impact of comprehensive smoke-free policy compliance on SHS exposure and health condition of the Georgian population","author":"G Bakhturidze","year":"2021"},{"key":"pone.0361138.ref014","author":"TW Wang","year":"2017"},{"issue":"2","key":"pone.0361138.ref015","doi-asserted-by":"crossref","first-page":"202520","DOI":"10.1016\/j.jeph.2024.202520","article-title":"What are the effects of smoke-free and tobacco-free university campus policies, and how can they be assessed? A systematic review","volume":"72","author":"E Gnonlonfin","year":"2024","journal-title":"J Epidemiol Popul Health"},{"key":"pone.0361138.ref016","doi-asserted-by":"crossref","first-page":"36","DOI":"10.18332\/tid\/133751","article-title":"Evaluating a tobacco-free university policy: A repeated cross-sectional survey of faculty and staff in Lebanon","volume":"19","author":"D Farran","year":"2021","journal-title":"Tob Induc Dis"},{"key":"pone.0361138.ref017","doi-asserted-by":"crossref","DOI":"10.3389\/ijph.2021.614602","article-title":"Influence of a university tobacco-free policy on the attitudes, perceptions of compliance, and policy benefit among the university students: A pre-post investigation","volume":"66","author":"M Chaaya","year":"2021","journal-title":"Int J Public Health"},{"key":"pone.0361138.ref018","unstructured":"Lebanon Demographics 2023 (Population, Age, Sex, Trends) - Worldometer. https:\/\/www.worldometers.info\/demographics\/lebanon-demographics\/#google_vignette. Accessed 2024 May 5."},{"key":"pone.0361138.ref019","unstructured":"Lebanon Has the Highest Smoking Rate in the Middle East. https:\/\/themedialine.org\/top-stories\/lebanon-has-the-highest-smoking-rate-in-the-middle-east\/. Accessed 2024 May 5."},{"key":"pone.0361138.ref020","unstructured":"Lebanon has highest smoking rate in the Middle East: Tobacco Atlas 2022. https:\/\/www.thenationalnews.com\/uae\/health\/2022\/05\/29\/tobacco-atlas-2022-call-for-tighter-controls-to-stub-out-smoking-in-middle-east\/. Accessed 2024 April 16."},{"issue":"9","key":"pone.0361138.ref021","doi-asserted-by":"crossref","first-page":"5679","DOI":"10.3390\/ijerph19095679","article-title":"Smoking behavior among adolescents: The lebanese experience with cigarette smoking and waterpipe use","volume":"19","author":"M Akel","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0361138.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0189829","article-title":"Socioeconomic differences in smoking in Jordan, Lebanon, Syria, and Palestine: A cross-sectional analysis of national surveys","volume":"13","author":"S Abdulrahim","year":"2018","journal-title":"PLoS One"},{"key":"pone.0361138.ref023","unstructured":"Homepage | Institute for Health Metrics and Evaluation. https:\/\/www.healthdata.org\/. Accessed 2024 April 16."},{"issue":"1","key":"pone.0361138.ref024","first-page":"1","article-title":"The economics of tobacco in Lebanon: An estimation of the social costs of tobacco consumption","volume":"24","author":"J Chaaban","year":"2023","journal-title":"Journal of Public Health"},{"issue":"6","key":"pone.0361138.ref025","doi-asserted-by":"crossref","DOI":"10.26719\/2021.27.6.535","article-title":"COVID-19, the economic crisis, and the Beirut blast: What 2020 meant to the Lebanese health-care system","volume":"27","author":"G Mjaess","year":"2021","journal-title":"East Mediterr Health J"},{"key":"pone.0361138.ref026","unstructured":"List of Accredited Private Universities and University Institutes or Colleges by the Ministry of Education and Higher Education. https:\/\/help.unhcr.org\/lebanon\/en\/list-of-accredited-private-universities-and-university-institutes-or-colleges-by-the-ministry-of-education-and-higher-education\/. Accessed 2024 June 11."},{"key":"pone.0361138.ref027","unstructured":"Noncommunicable Disease Surveillance, Monitoring and Reporting. https:\/\/www.who.int\/teams\/noncommunicable-diseases\/surveillance\/systems-tools\/global-adult-tobacco-survey\/questionnaire. Accessed 2024 April 22."},{"key":"pone.0361138.ref028","unstructured":"Youth Tobacco Survey (YTS) Data. https:\/\/chronicdata.cdc.gov\/Survey-Data\/Youth-Tobacco-Survey-YTS-Data\/4juz-x2tp\/data. Accessed 2024 April 22."},{"issue":"2","key":"pone.0361138.ref029","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1177\/002204260903900207","article-title":"Development of the smoking knowledge, attitudes, and practices (S-KAP) instrument","volume":"39","author":"KL Delucchi","year":"2009","journal-title":"J Drug Issues"},{"key":"pone.0361138.ref030","unstructured":"IBM SPSS Statistics Base. https:\/\/www.ibm.com\/docs\/en\/SSLVMB_27.0.0\/pdf\/en\/IBM_SPSS_Statistics_Base.pdf. Accessed 2024 June 11."},{"key":"pone.0361138.ref031","article-title":"Smoking tobacco prevalence among college students in the Kingdom of Saudi Arabia: Systematic review and meta-analysis","author":"SA Alotaibi","year":"2019","journal-title":"International Society for the Prevention of Tobacco Induced Diseases"},{"key":"pone.0361138.ref032","article-title":"Prevalence of cigarette smoking among college students in Iran: An updated systematic review and meta-analysis of observational studies","author":"M Khodadost","year":"2020","journal-title":"Med J Islam Repub Iran"},{"issue":"3","key":"pone.0361138.ref033","doi-asserted-by":"crossref","first-page":"583","DOI":"10.31557\/APJCP.2020.21.3.583","article-title":"The Prevalence of Smoking (Cigarette and Waterpipe) among University Students in Some Arab Countries: A systematic review","volume":"21","author":"AMA Nasser","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"pone.0361138.ref034","author":"LT SteadLF","year":"2017"},{"issue":"7","key":"pone.0361138.ref035","doi-asserted-by":"crossref","first-page":"3381","DOI":"10.3390\/ijerph18073381","article-title":"The Frequency of Use and Harm Perception of Heated Tobacco Products (HTPs): The 2019 Cross-Sectional Survey among Medical Students from Poland","volume":"18","author":"P Majek","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0361138.ref036","first-page":"381","article-title":"Designing an educational campaign intervention on smoking preventive behaviors in students: A protocol","volume":"10","author":"SSM Mahmoodabad","year":"2021","journal-title":"J Educ Health Promot"},{"issue":"5","key":"pone.0361138.ref037","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jadohealth.2016.01.012","article-title":"Adolescents\u2019 perceptions of health risks, social risks, and benefits differ across tobacco products","volume":"58","author":"M Roditis","year":"2016","journal-title":"Journal of Adolescent Health"},{"issue":"5","key":"pone.0361138.ref038","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare11050771","article-title":"Prevalence of use and knowledge about tobacco products and their harmful effects among university students in Southern Croatia","volume":"11","author":"D Istenic","year":"2023","journal-title":"Healthcare"},{"issue":"10","key":"pone.0361138.ref039","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0222572","article-title":"The impact of peer pressure on cigarette smoking among high school and university students in Ethiopia: A systemic review and meta-analysis","volume":"14","author":"CT Leshargie","year":"2019","journal-title":"PLoS One"},{"issue":"3","key":"pone.0361138.ref040","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.18203\/2394-6040.ijcmph20220685","article-title":"Campus administrator perceptions of the effectiveness of tobacco-free policies in California universities","volume":"9","author":"HK Agroia","year":"2022","journal-title":"Int J Community Med Public Health"},{"issue":"8","key":"pone.0361138.ref041","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1080\/07448481.2020.1711763","article-title":"Effects of a campus-wide tobacco-free policy on tobacco attitudes, norms and behaviors among students, staff and faculty","volume":"69","author":"RJ Wray","year":"2021","journal-title":"J Am Coll Health"},{"key":"pone.0361138.ref042","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1472-6882-7-2","article-title":"A pilot study on mindfulness based stress reduction for smokers","volume":"7","author":"JM Davis","year":"2007","journal-title":"BMC Complement Altern Med"},{"key":"pone.0361138.ref043","article-title":"Cognitive behavioral and mindfulness-based interventions for smoking cessation: A review of the recent literature","author":"C Vinci","year":"2020","journal-title":"Curr Addict Rep"},{"issue":"10","key":"pone.0361138.ref044","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1080\/10826084.2023.2215311","article-title":"Feasibility and efficacy of a brief mindfulness-based smoking intervention delivered via the internet: A randomized controlled trial","volume":"58","author":"MB Schmidt","year":"2023","journal-title":"Subst Use Misuse"},{"issue":"8","key":"pone.0361138.ref045","doi-asserted-by":"crossref","first-page":"4340","DOI":"10.3390\/ijerph18084340","article-title":"Comparison of the effectiveness of an abbreviated program versus a standard program in mindfulness, self-compassion and self-perceived empathy in tutors and resident intern specialists of family and community medicine and nursing in Spain","volume":"18","author":"L\u00c1 P\u00e9rula-de Torres","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"9","key":"pone.0361138.ref046","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1093\/ntr\/ntaa057","article-title":"Effectiveness of mindfulness-based relapse prevention program as an adjunct to the standard treatment for smoking: A pragmatic design pilot study","volume":"22","author":"IC Weiss de Souza","year":"2020","journal-title":"Nicotine Tob Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0361138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:25:13Z","timestamp":1792689913000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0361138"}},"subtitle":[],"editor":[{"given":"Jad","family":"El Masri","sequence":"first","affiliation":[{"name":"Dana-Farber Cancer Institute, Harvard Medical School and THE Broad Institute of MIT and Harvard","place":["LEBANON"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0361138","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]}}}