Influenza burden, preventive behaviours, and vaccination uptake among multi-ethnic university students in the United Arab Emirates: a cross-sectional study

Background Seasonal influenza remains a significant public health concern worldwide. Although young adults are generally considered at lower risk for severe outcomes, they play a critical role in influenza transmission. University environments in the United Arab Emirates (UAE) are highly multiethnic, hosting student populations with diverse cultural beliefs and health practices that may influence the disease burden. As data on influenza prevalence, preventive behaviours, and healthcare-seeking behaviours among multiethnic university students in the UAE are limited, this study aimed to assess these aspects. Methods A cross-sectional, questionnaire-based survey was conducted among university students aged ≥ 18 years across multiple campuses in Ajman, Sharjah, and Dubai, to collect sociodemographic characteristics, influenza history and severity, healthcare-seeking behaviour, preventive practices, vaccination status, financial aspects to vaccination access, and perceptions regarding vaccine effectiveness and safety. Descriptive statistics summarized participant characteristics, and chi-square tests assessed associations. Binary and multivariable logistic regression analyses identified independent predictors of healthcare-seeking behaviour and influenza vaccination uptake. Results A total of 963 students participated (median age: 20 years; 51.4% male), representing diverse ethnic backgrounds. Overall, 82.6% reported experiencing influenza-like illness in the past five years, with significant variation by ethnicity and gender. Nearly half (47.6%) reported attending university while symptomatic. Influenza vaccination coverage last year was 59.2%, and 88.2% reported willingness to vaccinate if provided free of charge, although 40.5% believed vaccination reduces natural immunity. Gender and ethnicity were significant predictors of healthcare-seeking behaviour in the crude model; however, in multivariable analyses, illness severity and symptom duration remain the strongest predictors. Influenza vaccination uptake was independently associated with seeking medical consultation (adjusted odds ratio [AOR] = 1.96), belief in individual protection from vaccination (AOR = 15.68), belief in community-level protection (AOR = 3.21), and perceived public health importance of vaccination (AOR = 2.51). Conclusion Marked ethnic differences exist in influenza burden and clinical experience among UAE university students, and gaps persist between knowledge and preventive action. With clinician endorsement, addressing misconceptions, and improving access to on-campus vaccination, influenza prevention may be enhanced in this high-risk, socially mobile population, ultimately reducing community influenza transmission.