World statistics from the World Health Organization (WHO) affirm that tobacco is one of the greatest threats to
public health that the world has had to face. It kills more than 8 million people a year, of which more than 7
million are direct consumers and about 890,000 are non-smokers exposed to second-hand smoke(1)
Tobacco use is an addictive habit widespread throughout the world. It is estimated that there are 1.3 billion
smokers in the world and almost 80% of the more than one billion smokers in the world live in low or middle-income
countries, where the burden of morbidity and mortality associated with tobacco is greater(1,2)
One of the trends seen globally is that adolescents are starting to smoke at increasingly younger ages. Thus, it
is observed that in many countries the percentages of adolescents under the age of 15 who habitually smoke are
barely less than the percentage of adults, which constitutes a problem for public health. The prevention of
smoking is, without a doubt, one of the great challenges for health worldwide(3,4)
According to this, in Spain, the prevalence of tobacco consumption in university students at the Jerez campus was
26.3%, a reality associated with a high intellectual load and a high degree of permissiveness regarding cigarette
consumption in these educational institutions. Thus, the role of universities as executing entities of norms and
sanctions to regulate tobacco consumption among university students is decisive in achieving these habits of risk
to public health(5)
Also, smoking is the cause of death of approximately 156,200 people in Brazil, due to diseases associated with
active and passive smokers. According to the National Health Survey, in 2013, 15% (22 million individuals) of the
Brazilian population aged 18 years or older was a smoker. Furthermore, it has been observed that in the Brazilian
context, smoking is frequently acquired during adolescence(6)
In Peru, according to DEVIDA figures, 2.5 million people are smokers. Likewise, the National Institute of
Neoplastic Diseases of Peru indicated that tobacco addiction is responsible for approximately 16,700 deaths a
year. Besides, it favors the development of chronic obstructive pulmonary disease (COPD) as well as cardiovascular
diseases in both men and women. Regarding smoking among university students, 53% of them declare having used
tobacco at some time during the university stage(7)
As mentioned, smoking is a major cause of health loss and premature death in developed countries and represents a
serious threat to public health in developing countries. The university population is not exempt from this risk.
To prevent the acquisition of such a habit, it is necessary to know the factors that trigger it. Therefore, this
research seeks to determine the factors associated with tobacco use in university students in metropolitan Lima
A relational, analytical and cross-sectional study was carried out.
Population and sample size
The population was made up of university students from 5 private universities in Metropolitan Lima: University of
Lima, Norbert Winner University, Ricardo Palma University, Alas Peruanas University, and Peruvian University of
Applied Sciences, with a total of 77 510 students. The sample was obtained through simple probabilistic sampling,
with a 95% CI and was made up of 528 collected surveys, 447 surveys were selected for meeting the inclusion
criteria set forth for the research. University students enrolled during the academic year, present in a certain
classroom at the time of the application of the study instrument and who agreed to answer the questions through of
verbal informed consent were included. The exclusion criteria were university students who were not enrolled
during the 2018 academic year, students who did not answer all the questions on the administered instrument, and
university students belonging to public universities.
Procedures and variables
The Spanish version of the Fagerstrom test was applied, adapted and validated by Arias–Gallegos(8) for the
analysis of the variable smoking. It contains six questions to explore the priority components of tobacco
addiction, the daily urge to smoke, and the number of cigarettes. Likewise, the variables sex, age, social
pressure, and smoking parents were analyzed.
Descriptive data were presented through frequency and percentage tables, as well as through graphs and tables. The
bivariate analysis between the variables age, sex, social pressure, and parental history and tobacco consumption
was performed using the Pearson's X 2 statistical test. The analysis includes the OR measurement of the study
variables, considering a 95% confidence interval. Also, multivariate logistic regression analysis was performed to
assess the possible influence of confounding variables on the results obtained. The collected data were processed
with the SPSS Statistical Package version 22.0
The study was approved and endorsed by the Research Ethics Committee of the Facultad de Medicina Humana of the
Universidad Ricardo Palma.
The Fagerstrom Test was applied to 447 university students from 5 universities in Metropolitan Lima, obtaining as
a result that 73.60% of university students were between 19 to 30 years old, while 26.40% were between 15 to 18
years old. , being the average age of 20 years. Besides, 64.43% of the sample studied were women, and 35.6%, men.
Likewise, 76.29% of university students do not consume tobacco. Of the 23.71% who are smokers, 51.9% are women.
The general characteristics of the study participants are detailed in Table 1
. It is
important to note that 97.17% of young people with a tobacco habit had moderate dependence on tobacco as shown in
, in addition to 98.11% of Students who smoked consumed less than 11 cigarettes a day
and only about 2% between 21-30 per day.
Table 1. General characteristics of the university students studied according to tobacco
|Yes n (%)
||No n (%)
|15 to 18 years
|19 to 30 years old
Figure 1. Percentage of tobacco consumption in students from different private universities in
In the bivariate analysis, a statistically significant association was found between male sex and smoking, with a
p-value = 0.01 and an RP = 1.67 with a 95% CI [1.03–2.23]. In the same way, an association was evidenced between
the variable smoker parents and tobacco consumption, obtaining a value of p = 0.00 and an RP = 2.53 with 95% CI
[1.62 - 3.52]. No association was found between the variables age and social pressure with smoking. Table 2
details the respective p and RP values for each of the variables studied. Besides,
the adjusted RP value obtained from the multivariate logistic regression is shown comparatively.
Table 2. Bivariate and multivariate analysis between the study variables and tobacco
consumption of students from different universities in Metropolitan Lima.
Confidence Interval to 95%
The present study revealed that the prevalence of smoking was 23.71% of a total of 447 students from five private
universities in Peru. Furthermore, according to the Fagerstrom Test applied to this same group of university
students, 97.17% of student smokers have moderate tobacco consumption and only 2.83% use cigarettes significantly.
Similar results were obtained by Fernández Cernuda(9)
in a study of prevalence carried
out in Spain on tobacco consumption in students of health sciences from academic schools of nursing and
physiotherapy, in which it was shown that the prevalence of tobacco consumption in 727 participating university
students it was 21.6%. However, in this research, the Fagerstrom Test evidenced a low dependence on nicotine in
the group of smoking students from both academic schools, which could be due to the differences between the
The sociodemographic factors addressed in this study were: age, sex, and social pressure. Regarding age, although
the majority of university students studied were adults, 30.7% were adolescents, of whom 29.6% smoked.
Furthermore, there was no statistically significant association between age and smoking (p> 0.05). Similarly,
Muñóz – Pintado(10)
through a study carried out in Spain, found that university
students started tobacco use, generally during adolescence. Furthermore, the author found no significant
association between the variable age and tobacco consumption. These data not only support the results obtained in
our study but also maintain that smoking may be consolidated at the university stage.
On the other hand, our study demonstrated a statistically significant association between sex and smoking.
According to this, the male sex would be more predisposed to acquire the smoking habit and to consolidate it
during the university stage. This result could be explained according to the socialization process, which has the
family as its main agent, which not only dictates rules of conduct but also assigns roles according to gender. All
this makes both men and women learn and assume differentiated roles, often imposed by the society that is
currently in the process of change(11)
. Similarly, Cheesman and Suárez in a study of
347 students from a university in Guatemala, argued that the probability of acquiring smoking in the
aforementioned population was significantly influenced by sex, evidencing that cigarette consumption is more
prevalent among male students(12)
. The aforementioned supports what was obtained in
On the other hand, 68% of university students who participated in the present study reported not having felt
pressured by their peers to consume tobacco, besides, no significant association was found between the variables
social pressure and smoking habit (p> 0.05). On the contrary, different authors showed in their studies that
having smoking friends increases the probability of acquiring the tobacco habit among young university students,
frequently among those who are adolescents, thus finding a statistically significant association between the
. These data do not support the
results obtained through our study, however, it must be taken into account that the populations studied have
different characteristics, environments and social realities that could explain the difference in the results.
Finally, of the total of university students who participated in our research, 22.54% have smoking parents
(mother, father or both). Our study revealed that this background represented a factor associated with an
increased risk for students to acquire smoking. Accordingly, Chessman and Suárez, mentioned above, argued that
students who had smoking parents had a higher risk of becoming tobacco users during the university stage,
confirming the results obtained in our research(12)
The university environment deserves special attention, and both students who use tobacco and those who do not, are
part of a population with wide possibilities of being intervened. Subsequent studies could provide results that
show both differences and similarities regarding the acquisition of smoking among groups of students from public
and private universities. Some variables that could be included in future research could be the university
context, the level of knowledge about the health consequences of tobacco consumption and family pathological
history, such as lung cancer, from prolonged tobacco use(14-16)
It is important to characterize the population group, in order to generate differential prevention strategies
according to sex and thus increase their effectiveness(17)
. The authors recommend
using the results of this research to sensitize and educate the university population in self-care and the
prevention of risky behaviors that lead to smoking, in order to contribute to the universities in setting out
guidelines that allow for healthy and comprehensive development of the young people.
The prevalence of tobacco consumption in the group of university students object of this investigation was 23.71%
with respect to the total. Additionally, male students smoked more frequently and are generally teenagers. Male
sex and having parents who smoked were significantly associated with an increased risk of acquiring smoking. There
was no association between peer pressure and smoking in university students studied.
Authorship contributions: The authors participated in the genesis of the idea, project design, data
collection and interpretation, analysis of results and preparation of the manuscript of the present research
Funding: Financed by a grant from the Ricardo Palma University, within the Call for the 2018 Annual
Conflict of interest: The authors declare that they have no conflict of interest in the publication of
Received: January 10, 2020
Approved: March 20, 2020
Correspondence: Lucy Correa López.
Address: INICIB, Facultad de Medicina Humana, Pabellón J, Edificio Administrativo, 2do piso. Avenida
Benavides 5440, Surco, Lima - Perú.
Telephone: 01 264 0177