Prevalence and determinants of tobacco, e-cigarettes, and cannabis use among nursing students: A multicenter cross-sectional study

Nurse Educ Today. 2019 Mar;74:61-68. doi: 10.1016/j.nedt.2018.11.018. Epub 2018 Dec 7.


Background: Nurses are important agents in public health, which includes being active in tobacco control. Studies show that nurses who smoke are less inclined to offer smoking cessation aid. Nursing students, as the future labor force of nursing, are one of the key groups to monitor.

Objectives: To identify the prevalence and determinants of use of several tobacco products, e-cigarettes, and cannabis among nursing students in Catalonia.

Design: Cross-sectional multicenter study.

Settings: 15 university nursing schools in Catalonia (Spain) in 2015-2016.

Participants: Nursing students attending class at the day of the survey.

Methods: An anonymous, self-administered questionnaire based on the Global Health Professional Survey was designed. The questions included information on consumption of several tobacco products (manufactured cigarettes, roll your own cigarettes, etc.), e-cigarettes, and cannabis. We estimated the prevalence of use (%) and computed multilevel logistic regressions models, at two levels, to calculate the odds ratios (OR) and their corresponding 95% confidence intervals (CI), adjusting for several individual sociodemographic variables and the nursing school as a grouping variable.

Results: 4381 students participated in the study (57.2% of Nursing students in Catalonia at the time of the survey). 29.7% (95%CI: 27.2-32.2) were smokers (18.4% daily and 11.3% occasionally). 66.4% smoked manufactured cigarettes, 47.0% roll your own cigarettes, 10.0% waterpipe, and 0.4% e-cigarettes. The main predictors of smoking were: being ≥25 years (OR = 2.57, 95%CI: 2.03-3.26) and belonging to other Spanish regions (OR = 1.82, 95%CI: 1.30-2.54). 71.5% had low nicotine dependence as defined by the Heavy Smoking Index. Among 11.5% (95%CI: 10.6-12.4) of students used cannabis (daily or occasionally), and men presented higher odds of use (OR = 2.81, 95%CI: 2.11-3.73) than women.

Conclusions: Tobacco and cannabis use is high among nursing students. It is necessary to carry out early tobacco and cannabis cessation programs among young nursing students.

Keywords: Cannabis; Education; Nursing; Public health; Students; Tobacco.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Marijuana Smoking / epidemiology*
  • Prevalence
  • Risk Factors
  • Smoking / epidemiology*
  • Spain / epidemiology
  • Students, Nursing / psychology*
  • Students, Nursing / statistics & numerical data
  • Tobacco Use Disorder / epidemiology*
  • Young Adult