Tobacco use patterns and the social environment among university students in southern Ecuador

Tobacco use remains a public health concern, particularly among young people, due to their greater vulnerability to smoking initiation and maintenance, as well as the emergence of new nicotine delivery devices that have diversified patterns of tobacco and nicotine use.

This study aimed to describe tobacco use and identify the sociodemographic, family, and social factors associated with current tobacco use among university students in southern Ecuador.

An observational, analytical, cross-sectional study was conducted in two universities in southern Ecuador. A non-probability convenience sampling approach was used. Of the 9,228 questionnaires collected, 9,091 complete records were included in the analysis. Descriptive analyses, chi-square tests, and multivariable binary logistic regression were performed, with adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) reported.

The mean age of the participants was 21.1 ± 2.9 years, and the mean age at smoking initiation among current tobacco users was 17.1 ± 2.3 years. Conventional cigarettes were the most frequently used tobacco product (96.5%), although 38.7% of participants reported using two or more tobacco products. Tobacco use was predominantly occasional, with only 6.0% reporting daily use. In the adjusted model, having a best friend who used tobacco (aOR = 3.08; 95% CI: 2.73-3.48), close friends who used tobacco (aOR = 2.34; 95% CI: 2.04-2.68), a sibling who used tobacco (aOR = 1.44; 95% CI: 1.26-1.64), a romantic partner who used tobacco (aOR = 1.37; 95% CI: 1.19-1.58), and classmates who used tobacco (aOR = 1.35; 95% CI: 1.21-1.50) were independently associated with current tobacco use. Female sex (aOR = 0.34; 95% CI: 0.31-0.38) and being exclusively engaged in academic studies (aOR = 0.81; 95% CI: 0.71-0.91) were associated with a lower likelihood of current tobacco use.

Tobacco use among university students was primarily associated with smoking behaviors within peer networks, particularly those of best friends and close friends. These findings support the need for university-based prevention strategies targeting the social environment, group norms, and peer influence.