Secondhand Smoke Exposure Among University Students in the United Arab Emirates: Knowledge as a Correlate of Protective Behavior-A Cross-Sectional Study.

Secondhand smoke exposure (SHSE) remains a major environmental health risk among university students, particularly in socially shared settings. In the United Arab Emirates, culturally embedded practices such as shisha and midwakh use, combined with variable policy enforcement, sustain persistent exposure. This cross-sectional study examined SHSE-related knowledge and protective health behaviors among 360 university students and their sociodemographic correlates, using a self-report questionnaire with documented internal consistency in comparable populations. Data were analyzed using SPSS version 28. SHSE was highly prevalent, occurring mainly in public and university settings; knowledge was moderate and protective behavior varied. Knowledge emerged as a moderate-to-strong correlate of protective behavior (r = 0.70, p < 0.001, R2 = 0.49). Age, employment, marital status, and number of children were associated with knowledge; age, gender, marital status, and income, but not employment, remained associated with behavior after adjusting for knowledge. Confirmatory factor analysis showed poor absolute fit for both the one- and two-factor solutions, and the behavioral-response factor did not satisfy the Fornell-Larcker criterion (√AVE = 0.750 < latent r = 0.836), providing only partial support for the empirical distinctiveness of the two constructs. Bootstrapped mediation analysis shows that knowledge partially mediated the employment-behavior association (~62% of the total effect); employment status was not, however, independently associated with behavior once knowledge was included, so this pathway is reported as hypothesis-generating. Still, more than a quarter of participants reported poor protective behavior, suggesting that unmeasured social and environmental factors, and possible overlap between the two constructs, may influence this relationship. Findings support integrated interventions combining health education, policy enforcement, and culturally tailored strategies.