Social and Cognitive Determinants of Cigarette, E-Cigarette, Heated Tobacco Product and Hookah Use Among University Students in Armenia: A Cross-Sectional Study

INTRODUCTION Tobacco products have diversified globally in the past decade. This poses particular risk for young adults and those in low-and middle-income countries (LMICs) with high tobacco use prevalence. This study assessed factors associated with distinct tobacco product use and use intentions among university students in Armenia.

Methods

In Spring 2025, a cross-sectional electronic survey was conducted among students aged 18–30 years from four universities in Armenia, assessing: past-month use and next-year use intention (yes, no) for cigarettes, e-cigarettes, heated tobacco products (HTPs), and hookah (dependent variables); and sociodemographic, perceptions, marketing exposure, parents’/friend’s use, and restriction knowledge (independent variables). Multivariable binary logistic regression analyses were conducted for all outcomes.

Results

A total of 505 university students, mean age 20.7 years (SD=2.1) and 57.8% female, completed the survey. Past-month use was: 19.0% cigarettes, 9.7% e-cigarettes, 6.3% HTPs, and 5.5% hookah. Use intentions were: 32.9% cigarettes, 23.7% e-cigarettes, 20.1% HTPs, and 27.8% hookah. Male sex was associated with all past-month use outcomes. Lower perceived addictiveness was associated with cigarettes (AOR=0.43; 95% CI: 0.29–0.65), HTP (AOR=0.42; 95% CI: 0.26–0.68), and hookah use (AOR=0.60; 95% CI: 0.36–1.00). Greater social acceptability and restriction knowledge were associated with cigarette use; greater perceived harm was associated with HTP use (AOR=2.03; 95% CI: 1.13–3.62); and peer e-cigarette use was associated with e-cigarette use (AOR=2.43; 95% CI: 1.06–5.58). Any past-month use was associated with all use intentions. Male sex was associated with cigarette and hookah use intentions. Social acceptability and marketing exposure were associated with e-cigarette use intentions; peer use of e-cigarettes and lower perceived addictiveness were associated with cigarette use intentions, while social acceptability was associated with hookah use intentions.

Conclusions

In this sample, tobacco use and use intentions were associated with several demographic, social, and cognitive factors. These findings support further longitudinal research among Armenian university students