The Prevalence of Substance Use Among Students and Associated Factors: A Systematic Review With Narrative Synthesis

Substance use is a major public health and social problem that affects individuals of all ages, particularly adolescents and young adults, across every society. School as an educational environment can be suitable for education and orientation towards substances.

Online databases, including Web of Science, Scopus, and Embase, and domestic databases, including SID, Magiran, and RICeST, were systematically searched from 2003 to now using Persian and English languages. Through narrative synthesis of prevalence data from 35 studies, we investigated the patterns of substance use among Iranian school students by province, gender, and substance type.

Narrative synthesis of 35 cross-sectional studies (total n ≈ 45,000) showed wide variation in lifetime prevalence: any substance use 1.4-55.9% (median ≈ 20%), cigarette smoking 0.4-32.7% (median ≈ 15%), alcohol 6.8-37.7% (median ≈ 13%), hookah up to 59%. Rates were consistently higher among boys than girls and in southeastern provinces like Kerman and Zahedan, located near the Afghanistan border, a major source and transit route for opiates.

The findings indicate the necessity of implementing and developing comprehensive primary prevention strategies and policies based on different cultures, regions, geographies, ages, and ethnicities. Also, the educational content of textbooks on planning life success skills in the educational system can be effective in solving this problem.