Prevalence, knowledge, attitudes, and practices regarding cognitive enhancer use in a convenience sample of university students in Syria: a cross-sectional study

Evidence on cognitive enhancer (CE) use among Middle Eastern university students remains limited, and no prior published study has characterized CE use in Syria. We assessed lifetime use, knowledge, attitudes, and use practices in a convenience sample of Syrian university students. A cross-sectional online survey was conducted among 707 students recruited using convenience and snowball sampling. The questionnaire used a broad intention-based definition of CE use and assessed factual knowledge, academic pressure, permissive attitudes, and use patterns. Multivariable logistic regression examined factors associated with lifetime use. 14.6% (103/707) reported lifetime CE use. Under the broad intention-based definition, 10.9% of the total sample reported supplement/natural-type CE use, 2.4% high-dose caffeine-product use, and 2.3% medication-type CE use; 2.0% specifically reported prescription stimulant use. Among lifetime users, use was commonly exam-related, and 29.1% reported adverse effects. In adjusted analyses, self-reported ADHD (AOR = 3.70; 95% CI: 1.18–11.55), personally knowing a CE user (AOR = 4.35; 95% CI: 2.73–6.93), and a higher permissiveness attitude score (AOR = 2.42; 95% CI: 1.72–3.41) were associated with lifetime CE use. Knowledge and academic-pressure scores were not independently associated with lifetime use. In this recruited sample, lifetime CE use was associated with peer exposure and permissive attitudes, whereas measured knowledge and academic pressure were not independently associated. The difference between overall CE use and medication-type use highlights the importance of distinguishing product classes when studying cognitive enhancement. Longitudinal and more representative studies are needed to clarify these associations and their generalizability. In this convenience sample of university students in Syria, 14.6% reported lifetime use of a broadly defined cognitive enhancer; medication-type CE use was much less common (2.3%), including prescription stimulant use in 2.0%.Lifetime CE use was independently associated with personally knowing a CE user and greater permissiveness toward CE use; measured academic pressure and factual knowledge were not independently associated after adjustment.The findings support distinguishing CE product classes and suggest that student-facing safety information, pharmacist counseling, and interventions addressing social norms may be useful. In this convenience sample of university students in Syria, 14.6% reported lifetime use of a broadly defined cognitive enhancer; medication-type CE use was much less common (2.3%), including prescription stimulant use in 2.0%. Lifetime CE use was independently associated with personally knowing a CE user and greater permissiveness toward CE use; measured academic pressure and factual knowledge were not independently associated after adjustment. The findings support distinguishing CE product classes and suggest that student-facing safety information, pharmacist counseling, and interventions addressing social norms may be useful.