(CE) by university students. Evidence suggests students who use CEs tend to perceive them as effective, but whether CEs
improve cognition in healthy individuals is unclear and any drug use carries a risk of harm. Two previous studies have investigated
the prevalence of use in Australian university student samples and neither assessed university system factors which may
contribute to use. Design and Methods. During 2016, a convenience sample of 2133 18–29-year-old students across all
five Western Australian universities completed a quantitative anonymous web survey targeting both users and non-users
of CE. Results. Of the final sample, 7.9% reported use of a prescription drug for CE purposes in the last 12 months.
Prescription CE use was predicted by greater frequency of illicit drug use and among students who reported they had not had a
take-home exam in the last 12 months. Rates of use and predictors of over the counter (28.6%) and illicit drugs (2.4%) were
predicted by different individual and contextual factors. There were high rates of reporting positive effects from CE use, but
although negative effects were reported less commonly, they were not trivial. Discussion and Conclusions. These findings
have implications for university policy and university health services raising the issue with students and potentially providing
clinical interventions addressing CE use. Further research should include representative samples and address both system and
individual variables in understanding patterns of CE use among students. [250 words]