Background <p>Seasonal influenza remains a significant public health concern worldwide. Although young adults are generally at lower risk of severe outcomes, they play a key role in influenza transmission. Universities in the United Arab Emirates (UAE) are highly multi-ethnic settings where cultural, socioeconomic, and healthcare access factors may influence influenza burden, preventive behaviours, healthcare-seeking, and vaccination uptake. However, data among university students in the UAE remains limited.</p> Methods <p>A cross-sectional, questionnaire-based survey was conducted among university students aged 18 years or older across multiple UAE campuses. The study assessed the burden of influenza-like illness, preventive behaviours, healthcare-seeking patterns, and influenza vaccination uptake, and examined sociodemographic, clinical, and healthcare access factors associated with these outcomes. Associations were assessed using chi-square tests. Binary and multivariable logistic regression analyses were performed to identify independent predictors of healthcare-seeking behaviour and influenza vaccination uptake.</p> Results <p>A total of 963 students participated (median age: 20 years; 51.4% male). Overall, 82.6% reported 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 in the preceding year was 59.2%, while willingness to vaccinate increased to 88.2% if vaccination were free. Despite high awareness, 40.5% believed vaccination reduces natural immunity. In multivariable analysis, healthcare-seeking for influenza was independently associated with health insurance status, illness severity, and symptom duration, while gender, ethnicity, and economic status were not significant after adjustment. Influenza vaccination uptake was independently associated with having health insurance (AOR = 6.51), seeking medical consultation for influenza (AOR = 1.80), belief in individual protection from vaccination (AOR = 27.11), and belief in community-level protection (AOR = 2.95).</p> Conclusion <p>University students in the UAE experience a substantial burden of influenza-like illness, with persistent gaps between awareness and preventive action. Insurance coverage and engagement with healthcare services play a central role in both healthcare-seeking and vaccination uptake, whereas economic status alone does not independently predict these behaviours. University-based public health strategies, including free on-campus vaccination, clinician-led recommendations, and targeted interventions to address misconceptions, may improve vaccine uptake and reduce influenza transmission in this highly mobile, multi-ethnic population.</p>