| کلیدواژههای انگلیسی مقاله |
Prevalence, Students, medical, Alcoholic beverages, Smoking, Substance-related disorders, What&,rsquo s Known Studies conducted in Iran have reported a wide range of cigarette smoking prevalence among medical students, with rates varying from 10.5% to 46.7%. Regarding alcohol consumption, prevalence rates of 18.3%, 19.9%, and 13% have been reported among medical students in Iran. What&,rsquo s New The lifetime prevalence of substance use was 27.5% for alcoholic beverages and 26.7% for tobacco products. Significant associations were identified between substance use and the students&,rsquo stage of training, economic status, history of mental illness, history of substance use in family and friends, electronic device use, and satisfaction with their major. IntroductionThe issue of alcohol, smoking, and substance (ASS) is a complex global health issue with extensive detrimental consequences for individuals, families, and society. According to the World Health Organization (WHO), smoking is the second leading cause of death worldwide. 1, Tobacco use is estimated to cause more than six million deaths annually, a figure forecast to rise to over eight million by 2030. 2, Similarly, alcohol consumption is a significant risk factor for physical and mental disorders and is also associated with various cancers and other health-related fatalities. 3, The rising prevalence of ASS use among university students is a growing concern, particularly among medical students, who are expected to uphold high standards as future advocates and promoters of well-being. 4, A study in Iran reported prevalence rates of 14% for smoking, 9% for alcohol use, and 11% for drug use. 5, Epidemiological studies indicated that young people and university students have a higher prevalence of illicit ASS use than other age groups. 6, Among medical students specifically, previous studies in Iran showed a wide variation in ASS use prevalence, ranging from 10.5% to 46.7%. 7, , 8, A meta-analysis of Iranian university students reported one-year prevalence rates of 23% (95% CI, 8-39) for alcohol consumption, 21% (95% CI, 6-37) for cigarette smoking, and 14% (95% CI, 10-18) for other substance use. 9, Furthermore, factors such as stress, academic pressure, peer influence, and social norms have been identified as contributors to increased smoking and drug use among medical students. Personal characteristics, such as sex, age, and a family history of substance use, were also found to be associated with these behaviors. 10, , 11, The harmful effects of ASS involvement on students&,rsquo health, academic performance, and well-being are well-documented. 12, Investigating the situation is therefore essential for informed planning. Epidemiological studies are widely considered the foundational step for designing preventive programs. By examining the prevalence, patterns, and associated factors, we can gain valuable insights into these behaviors among medical students. The resulting data are instrumental for developing targeted interventions and prevention strategies to promote healthier lifestyles. Given the varied findings of previous research and growing concern about ASS use among medical students, a detailed exploration in this field is warranted. This study was conducted at Shiraz University of Medical Sciences in southern Iran, which has a large and diverse student population that enhances the generalizability of the findings. The university&,rsquo s prominent role in regional medical education further supports the reliability and applicability of the results to similar contexts and populations. 13, Therefore, this study aimed to investigate the prevalence of ASS use and its related risk factors among medical students in southern Iran in 2024.Participants and Methods Study Design This cross-sectional study was conducted in 2024 among medical students at Shiraz University of Medical Sciences in Shiraz, southern Iran. A total of 360 students were recruited. The study protocol was approved by the Ethics Committee of Shiraz University of Medical Sciences (code, IR.SUMS.MED.REC.1403.245). All participants provided written informed consent, and the study adhered to ethical principles to ensure participant confidentiality and privacy. Participants Eligible participants were medical students enrolled at Shiraz University of Medical Sciences for at least 3 months. Students at the residency level or above, transfer students, and those with incomplete or defective data were excluded from the study. Instruments Data were collected using a written questionnaire consisting of three parts, demographic information, the World Health Organization&,rsquo s alcohol, smoking, and substance involvement screening test (ASSIST), and questions on factors associated with substance use. The ASSIST instrument investigated involvement with various substances, including tobacco products, alcoholic beverages, opioids, cannabis, amphetamine-type stimulants, sedative or sleeping pills, inhalants, hallucinogens, cocaine, and other substances, collectively referred to as ASS in this study. The questions covered the frequency of ASS use over the past 3 months and lifetime use. The instrument also assessed several domains, including the desire to use, the impact of use on health, social, legal, or financial aspects, concern from close relations, difficulties in performing expected tasks, unsuccessful efforts to quit or reduce use, and any history of intravenous drug use. 14, The ASSIST questionnaire included questions with numerically scored response options. Questions 2-5 assessed the frequency of substance use, with response options of &,ldquo never&,rdquo , &,ldquo once or twice&,rdquo , &,ldquo monthly&,rdquo , &,ldquo weekly&,rdquo , or &,ldquo daily or almost daily&,rdquo . The scores for each question were as follows, Q2, 0, 2, 3, 4, 6 Q3, 0, 3, 4, 5, 6 Q4, 0, 4, 5, 6, 7 Q5, 0, 5, 6, 7, 8. Questions 6 and 7 ask about experiencing problems related to substance use, with the options, &,ldquo no, never&,rdquo (score 0), &,ldquo yes, but not in the past 3 months&,rdquo (score 3), or &,ldquo yes, in the past 3 months&,rdquo (score 6). The interviewer recorded the scores for questions 2 to 7, which were subsequently totaled for each substance to generate an overall risk score. This score was categorized into three risk levels, &,ldquo Low&,rdquo (a score of 3 or less, or 10 or less for alcohol), &,ldquo moderate&,rdquo (4-26, or 11-26 for alcohol), and &,ldquo high&,rdquo (27 or higher). The ASSIST instrument has undergone three primary stages of testing, confirming its reliability, validity in international contexts, and its suitability for integration into brief intervention strategies. 15, , 16, Additionally, Hooshyari and colleagues assessed the validity and reliability of the Persian translation of this test in Iran, reporting a Cronbach&,rsquo s alpha between 0.79 and 0.95 for the entire test and its subscales, indicating high internal consistency. 17, For the present study, content validity was assessed using the content validity ratio (CVR) and content validity index (CVI). Fifteen experts, including physicians and sociologists with relevant research experience, reviewed the items. They rated each item on a three-point scale for essentiality. Based on Lawshe&,rsquo s table, a minimum CVR threshold of 0.51 was applied, calculated using the formula, CVR=(Ne-N/2)/(N/2)Where Ne is the number of experts rating the item as &,ldquo essential&,rdquo . Items with a CVR below this threshold were eliminated, resulting in a final CVR of 0.75 for the remaining items. To assess relevance, experts also scored items on a four-point scale. The CVI was calculated as the average of these scores across items, yielding a value of 0.85. All items were retained after this process, as a CVI above 0.80 is generally considered acceptable. Face validity was confirmed by experts in substance use, who verified that the questions accurately reflect students&,rsquo experiences with substance-related issues. The overall content validity assessment confirmed that the questionnaire comprehensively addresses key aspects of substance use. Experts validated that the items covered critical dimensions of substance use, enhancing the questionnaire&,rsquo s reliability and effectiveness in capturing relevant data for the study.The use of electronic cigarettes and vapes was investigated using specific survey questions. Participants were asked to report the frequency of their use both over their lifetime and within the past 3 months. Sampling Process A stratified random sampling method was employed. The student population was divided into strata based on their academic year (basic sciences, pre-clinic, and clinic) to ensure representation across key subgroups. A random sample was then selected from each stratum. The sample size was calculated using the following formula, n=Z2P(1&,minus P)/d2With a 95% confidence level (Z), an expected prevalence (P) of 40% derived from a pilot study, and a precision (d) of 0.05. The Kaiser-Meyer-Olkin measure of sampling adequacy was above 0.7, confirming the sample&,rsquo s suitability for factor analysis. Data were collected via paper-based, self-administered surveys, distributed in lecture halls during class time. The surveys took approximately 10-15 min to complete. To ensure anonymity and confidentiality, completed surveys were deposited by students into a sealed ballot box, and researchers had no access to participant identities. Participation was voluntary, and students could withdraw at any time without penalty. Due to a low percentage of missing data (&,lt 2%), a complete case analysis (listwise deletion) was performed, resulting in the exclusion of six participants from the final analysis. Statistical Analysis Data were screened and cleaned to ensure they met the necessary assumptions for statistical analysis. This process included an evaluation of missing data, outliers, multicollinearity, and distribution normality. Descriptive statistics were computed, with continuous variables summarized using mean and standard deviation, and categorical variables using relative frequencies. For univariate analysis, the Chi square test was employed to compare groups. All variables showing a statistically significant association in the univariate analysis at a P&,lt 0.20 were included in the logistic regression models. This approach was used to identify factors associated with the outcomes while controlling for potential confounders. The threshold for statistical significance was set at P&,lt 0.05. All analyses were performed using SPSS software (version 26, SPSS Inc., USA).ResultsThis study included 360 medical students, with a mean age of 22.62&,plusmn 3.02 years 51.9% were men and 48.1% were women. Among the participants, 42.5% reported lifetime ASS use, while 33.6% reported ASS use within the past 3 months (table 1,).Variablesn (%) N=360Use during lifetimeUse during the past 3 monthsYes n (%)No n (%)cOR (CI 95%)P valueaOR (CI 95%)P valueYes n (%)No n (%)cOR (CI 95%)P valueaOR (CI 95%)P valueSexFemale173 (48.1)62 (35.8)111 (64.2)1.00.014*1.00.05448 (27.7)125 (72.3)1.00.023*1.00.70Male187 (51.9)91 (48.7)96 (51.3)1.6 (1.1-2.5)1.6 (0.9-2.7)73 (39.0)114 (61.0)1.6 (1.1-2.5)1.6 (0.9-2.7)Stage of studentBasic sciences188 (52.2)65 (34.6)123 (65.4)1.00.014*1.0&,lt 0.001*52 (27.7)136 (72.3)1.0&,lt 0.001*1.00.002*Pre-clinic95 (26.4)37 (38.9)58 (61.1)1.0 (0.6-1.8)1.1 (0.6-2.0)0.71928 (29.5)67 (70.5)1 (0.6-1.8)1 (0.5-1.8)0.989Clinic77 (21.4)51 (66.2)26 (33.8)2.9 (1.7-5.1)3.4 (1.7-6.7)&,lt 0.001*41 (53.2)36 (46.8)2.9 (1.7-5.1)2.9 (1.5-5.5)0.001*Living placeWith parents176 (48.9)76 (43.2)100 (56.8)1.00.798 58 (33.0)118 (67.0)1.00.796 Dormitory184 (51.1)77 (41.8)107 (58.2)0.9 (0.6-1.4) 63 (34.2)121 (65.8)1.1 (0.6-1.6) Being nativeYes169 (46.9)77 (45.6)92 (54.4)1.00.269 58 (34.3)111 (65.7)1.00.789 No191 (53.1)76 (39.8)115 (60.2)0.7 (0.5-1.2) 63 (33.0)128 (67.0)0.9 (0.6-1.4) Family economic statusLower than average14 (3.9)7 (50.0)7 (50.0)1.00.045*1.00.040*4 (28.6)10 (71.4)1.00.726 Average level262 (72.8)101 (38.5)161 (61.5)0.6 (0.2-1.8)0.7 (0.2-2.3)0.57186 (32.8)176 (67.2)1.2 (0.3-4) Higher than average84 (23.3)45 (53.6)39 (46.4)1.1 (0.3-3.5)1.5 (0.4-5.3)0.51831 (36.9)53 (63.1)1.4 (0.4-5) Family quarrelLow126 (35.0)48 (38.1)78 (61.9)1.00.215..36 (28.6)90 (71.4)1.00.1371.00.613High234 (65.0)105 (44.9)129 (55.1)1.3 (0.8-2.1) 85 (36.3)149 (63.7)1.4 (0.8-2.2)1.1 (0.6-2.0)Family supportLow77 (21.4)44 (57.1)33 (42.9)1.00.003*1.00.11035 (45.5)42 (54.5)1.00.013*1.00.247High283 (78.6)109 (38.5)174 (61.5)0.4 (0.2-0.7)0.6 (0.3-1.1)86 (30.4)197 (69.6)0.5 (0.3-0.8)0.6 (0.3-1.2)Recent mental illnessNever74 (20.6)21 (28.4)53 (71.6)1.00.010*1.00.12517 (23.0)57 (77.0)1.00.016*1.00.134Moderate203 (56.4)89 (43.8)114 (56.2)1.9 (1.1-3.5)1.7 (0.8-3.5)0.11867 (33.0)136 (67.0)1.6 (0.8-3)1.4 (0.6-2.9)0.345High83 (23.1)43 (51.8)40 (48.2)2.7 (1.3-5.2)2.3 (1.03-5.3)0.042*37 (44.6)46 (55.4)2.6 (1.3-5.3)2.3 (0.9-5.4)0.055History of ASS use in the familyNo284 (78.9)104 (36.6)180 (63.4)1.0&,lt 0.001*1.00.10778 (27.5)206 (72.5)1.0&,lt 0.001*1.00.048*Yes76 (21.1)49 (64.5)27 (35.5)3.1 (1.8-5.3)1.6 (0.8-3.1)43 (56.6)33 (43.4)3.4 (2-5.8)1.8 (1.02-3.3)History of ASS use in friends No150 (41.7)36 (24.0)114 (76)1.0&,lt 0.001*1.0&,lt 0.001*24 (16.0)126 (84.0)1.0&,lt 0.001*1.0&,lt 0.001*Yes210 (58.3)117 (55.7)93 (44.3)3.9 (2.5-6.3)4 (2.2-7.2)97 (46.2)113 (53.8)4.5 (2.6-7.5)4.1 (2.2-7.5)Satisfaction with majorVery satisfied138 (38.3)52 (37.7)86 (62.3)1.00.008*1.00.06043 (31.2)95 (68.8)1.00.022*1.00.126Satisfaction on an average level165 (45.8)66 (40.0)99 (60.0)1.1 (0.6-1.7)0.8 (0.5-1.5)0.64249 (29.7)116 (70.3)0.9 (0.5-1.5)0.7 (0.4-1.2)0.261Partly unsatisfied37 (10.3)25 (67.6)12 (32.4)3.4 (1.5-7.4)3 (1.1-7.8)0.020*20 (54.1)17 (45.9)2.5 (1.2-5.4)1.9 (0.7-4.7)0.163Completely unsatisfied20 (5.6)10 (50.0)10 (50.0)1.6 (0.6-4.2)1.2 (0.3-3.7)0.7279 (45.0)11 (55.0)1.8 (0.6-4.6)1.4 (0.4-4.3)0.555Physical activityInactive78 (21.7)37 (47.4)41 (52.6)1.00.1471.00.76327 (34.6)51 (65.4)1.00.397 Moderate234 (65.0)91 (38.9)143 (61.1)0.7 (0.4-1.1)0.7 (0.4-1.4)0.46274 (31.6)160 (68.4)0.8 (0.5-1.5) Active48 (13.3)25 (52.1)23 (47.9)1.2 (0.5-2.4)0.8 (0.3-1.9)0..68220 (41.7)28 (58.3)1.3 (0.6-2.8) SleepAppropriate238 (66.1)98 (41.2)140 (58.8)1.00.478 74 (31.1)164 (68.9)1.00.1581.00.934Inappropriate122 (33.9)55 (45.1)67 (53.9)1.1 (0.7-1.8) 47 (38.5)75 (61.5)1.3 (0.8-2.1)1.0 (0.5-1.8)Electronic device and social network useAppropriate214 (59.4)77 (36.0)137 (64.0)1.00.002*1.00.13357 (26.6)157 (73.4)1.0&,lt 0.001*1.00.043*Inappropriate146 (40.6)76 (52.1)70 (47.9)1.9 (1.2-2.9)1.4 (0.8-2.4)64 (43.8)82 (56.2)2.1 (1.3-3.3)1.7 (1.01-2.9)*Factors that were statistically significant (P&,lt 0.05) cOR=Crude odds ratio aOR=Adjusted odds ratio ASS, Alcohol, smoking, and substance |