AWARENESS OF THE ADVERSE EFFECTS OF SMOKING ON THE GASTROINTESTINAL TRACT AMONG AL-SHAM PRIVATE UNIVERSITY STUDENTS: A CROSS-SECTIONAL STUDY

Background: Tobacco use remains a major public health concern among young adults, while awareness of its gastrointestinal consequences is often less developed than awareness of its respiratory and cardiovascular effects. This study aimed to assess smoking behaviors, gastrointestinal symptoms, and awareness of the adverse effects of smoking on the gastrointestinal tract among university students.
Methods: A descriptive cross-sectional study was conducted among 700 students at Al-Sham Private University, Syria, between July 25 and August 8, 2026. Participants were recruited using convenience sampling and completed a structured self-administered questionnaire assessing sociodemographic characteristics, tobacco-use patterns, secondhand smoke exposure, knowledge of gastrointestinal effects, gastrointestinal symptoms, medication use, sources of health information, and smoking-cessation intentions. Descriptive statistics were used to summarize the data, and associations between academic discipline and smoking-related knowledge and behaviors were assessed using appropriate statistical tests. A P-value <0.05 was considered statistically significant.
Results: Among the 700 participants, 28% were current smokers and 23% reported occasional or social smoking. Conventional cigarettes were the most frequently reported tobacco product (57%), followed by waterpipe (47%) and electronic cigarettes (16%). Secondhand smoke exposure was common, with many participants reporting several hours of exposure per day. Awareness was highest regarding the association between smoking and gastrointestinal malignancies (79%) and lower esophageal sphincter dysfunction and reflux (69%), but was substantially lower for Crohn’s disease (43%) and pancreatic dysfunction (48%). Medical students demonstrated significantly greater awareness of several gastrointestinal effects of smoking than students from non-medical disciplines. Gastrointestinal symptoms were reported daily by 7% of participants and several times per week by 23%. Approximately 29% of all participants (representing 57% of smokers) reported that their gastrointestinal symptoms became worse during or after smoking. Social media and the internet were the most commonly reported sources of health information (88%), followed by physicians (79%).
Conclusion: The study identified a substantial burden of tobacco exposure and important gaps in students’ knowledge regarding the gastrointestinal consequences of smoking, particularly Crohn’s disease and pancreatic dysfunction. Medical students generally demonstrated better knowledge than students from non-medical disciplines, while smoking was more common among males. University-based interventions combining evidence-based health education, smoke-free policies, accessible cessation counseling, and targeted digital campaigns may improve awareness and support tobacco-cessation behaviors among young adults.