Abstract
Background: The World Health Organization recommends adopting smoke-free campuses (SFCs), and in 2024, the European Council has urged Member States to implement smoke-free policies on educational premises. However, unlike North America, Australia and New-Zealand, Europe has been slow to adopt SFCs. In France, the EHESP School of Public Health became the first SFC in 2018. This research assessed students' support for this SFC policy since its implementation and examined associated factors.
Methods: An online cross-sectional study was conducted annually from 2018 to 2025. The dependent variable was students' support for the SFC policy, measured using a four-point Likert scale ranging from strong opposition to strong support. Explanatory variables included tobacco use behaviors, knowledge of tobacco's dangers, and sociodemographic characteristics. An ordered logit regression model was applied to account for the ordinal nature of the outcome variable. Explanatory variables were introduced sequentially to evaluate their incremental contribution.
Results: The sample comprised 2,532 students with a 56.97% overall response rate. Support for the SFC policy was nearly universal (96.7% - 91.4% among students who smoked), exceeding levels reported outside Europe. Smoking status, demographic factors, and time were significantly associated with it. Current smoking or vaping, or ever smoking were negatively associated with support. Support increased between 2018 and 2025. Being a woman, an aspiring public servant, or older in age positively influenced it. Knowledge of tobacco's dangers showed no significant association with support.
Conclusions: Most research on SFC policies has been conducted in settings with low smoking prevalence where SFCs are typical. Our study is the first to assess support in a country where SFC policies were not yet widespread. The high level of support observed should encourage the broader implementation of SFCs in France and across other European countries.