Prevalence and determinants of substance use among university students in Saudi Arabia: a nationwide online cross-sectional study.

BACKGROUND

Substance use among university students is a growing public health concern, particularly in sociocultural contexts where reporting may be constrained by sociocultural stigma. National data on substance use patterns and determinants among university students in Saudi Arabia remain limited. This study aimed to determine the prevalence and determinants of substance use among a multi-regional sample of university students in Saudi Arabia.

METHODS

A nationwide online cross-sectional study using convenience sampling was conducted among university students in Saudi Arabia between 1 November and 30 December 2025. Data were collected using an anonymous online questionnaire adapted from the Arabic version of the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST v3.0), restricted to lifetime substance use items. A total of 744 students from more than ten universities across all regions of the country participated. Descriptive analyses, bivariate analyses, and multivariable logistic regression were conducted using R version 4.3.3 to identify factors associated with lifetime tobacco use. Statistical significance was set at a two-sided p value of <0.05.

RESULTS

The lifetime prevalence of any substance use, including tobacco, was 45%. Tobacco was the most commonly reported substance (30.0%). Excluding tobacco, 15% of participants reported lifetime use of at least one non-tobacco substance (participants could report more than one substance), most frequently sedatives and sleeping pills (14.0%) and cannabis (9.7%). Marked gender differences were observed among substance users, with males demonstrating higher use of tobacco, cannabis, alcohol, and amphetamine-type stimulants, while sedative use was more prevalent among females. In multivariable analysis, older age, male gender, enrollment in non-medical faculties, and peer pressure were independently associated with higher odds of lifetime tobacco use, whereas higher academic performance was associated with lower odds.

CONCLUSION

Substance use is relatively common among university students in Saudi Arabia and exhibits distinct gender-specific patterns. These findings should be interpreted in light of the use of lifetime measures, which limit assessment of current use and severity. Targeted, culturally sensitive prevention strategies addressing tobacco use, academic environments, and peer influence are needed.