Introduction:
Outdoor smoke-free regulations reduce exposure to secondhand smoke (SHS) and help to denormalize tobacco use. As future key agents in health promotion, nursing students’ attitudes should agree with tobacco-control policies. Our objective was to assess nursing students’ exposure to SHS in nursing schools, to explore their perception towards compliance with the existing smoke-free regulations in acute hospitals, and to describe their support for banning smoking in indoor and outdoor areas of hospital and university campuses.

Material and Methods:
Cross-sectional multicenter study conducted in 2015-2016 in all 15 university nursing schools in Catalonia, Spain. A questionnaire gathered information about SHS exposure, awareness of the smoke-free regulation in acute hospitals, and support for smoke-free policies in hospitals and university campuses. We performed descriptive analyses and calculated adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI).

Results:
From 4381 respondents, 99.1% had seen people smoking in outdoor areas of their university campuses, and 75.2% were exposed to SHS on the campus (6.0% indoors and 69.2% outdoors). Near 60% were aware of the smoking regulation in force in acute hospitals. Support for indoor smoke-free regulation in hospitals was widespread (98.7%), while it was lower (64.8%) for outdoor areas. About 33% supported regulating outdoor healthcare university campuses to make them smoke-free, being higher among those in the third year of training as compared to the first-year students (aPR: 1.41; 95% CI: 1.24-1.62), among never smokers (41.4%; aPR: 2.84; 95% CI: 2.21-3.64) compared to smokers, and among those who were aware of the regulation (38.4%; 95% CI: 1.37-1.75).

Conclusions:
SHS exposure on university campuses is high. Nursing students express low support for strengthening outdoor smoking bans on hospital and university campuses. Measures aiming to increase their support should be implemented.