Family Structure and Peer Influences as Correlates of Lifetime Smokeless Tobacco Use Among Undergraduate Students at The University For Development Studies, Ghana: An Analytical Cross-Sectional Study.

Background: Smokeless tobacco (SLT) use is a growing public health concern among young adults in sub-Saharan Africa. Evidence on family-level factors associated with lifetime SLT use among university students in Ghana is lacking. This study estimated the lifetime prevalence of SLT use and identified associated factors, focusing on family structure, among undergraduates at the University for Development Studies (UDS), Tamale, Ghana. Methods: An analytical cross-sectional study was conducted (January-March 2023) among 600 undergraduate students at UDS (response rate 85.7%). Data were collected using a locally adapted WHO student drug-use survey. Subgroup prevalence was calculated with 95% Wilson score confidence intervals. Between-group differences were assessed using the chi-square test or Fisher's exact test where the corresponding expected cell count was fewer than five. Factors associated with lifetime SLT use were identified using Firth penalised logistic regression, with standard logistic and modified Poisson regression as sensitivity analyses. Results: Lifetime SLT prevalence was 9.67% (95% CI: 7.54-12.31%). In the primary multivariable analysis, having friends who used drugs during upbringing (aOR = 1.84; 95% CI: 1.02-3.32; p = 0.043) and having relatives who used drugs during upbringing (aOR = 1.82; 95% CI: 1.01-3.27; p = 0.045) were independently associated with lifetime SLT use. Associations were consistent across all three regression models. Conclusions: Early-life exposure to drug use within peer and family networks is independently associated with lifetime SLT use among university students at UDS, Ghana. Family-based and peer-focused prevention strategies may be useful in reducing SLT use in this context.