Journal of Community Health (2020) 45:176–182

https://doi.org/10.1007/s10900-019-00709-7

ORIGINAL PAPER

Prevalence of Substance Abuse (Tobacco, Alcohol, Narcotics

and Psychotropic Drugs) and Its Relationship to Family Factors
in Pre‑university Male Students in Shiraz 2017–2018
Ghazanfar Rafiee1 · Jamshid Ahmadi2 · Farkhondeh Rafiee3

Published online: 30 August 2019

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Teenagers are valuable resources in communities and they are faced with multiple risk factors. Factors such as family attach-
ment, devotion to family, parent’s educational level, and parental support are the protective factors against high-risk behaviors.
The purpose of this study was to determine the prevalence of drug use among pre-university students and its relationship with
familial factors. 1000 Fourth grade high-school male students were randomly selected during 6 months in four districts of
Shiraz City during 2017–2018. 14% of the participants were current smokers, 13.5% had a history of alcohol consumption,
and 1% used psychotropic drugs, respectively. Moreover 59% of the participants who had consumed alcohol were cigarette
smokers as well. 4.5% of them used all the three substances such as alcohol, tobacco and psychotropic drugs. Children whose
parents do not set clear regulations or do not control their children are at higher risk of drug abuse.

Keywords  Prevalence · Substance abuse · Family factors · Students

Background type of drugs including; cigarettes and marijuana. Risk

Teenagers are valuable resources in communities and due
to their age and developmental characteristics they are
faced with multiple risk factors. Family is the fundamental
factor for psychological and economical support for teens
which provides a sense of belonging and identity for them
[1]. Adolescence period is a critical point where alcohol
consumption and drug abuse becomes more prevalent.
People, who consume too much alcohol, usually use other
* Farkhondeh Rafiee
F.rafeie654@tvu.ac.ir
Ghazanfar Rafiee
Rafieegh@sums.ac.ir
Jamshid Ahmadi
Ahmadij@sums.ac.ir
1 have changed the families’ balance and function. Other
Substance Abuse Research Center, Department of Medical
and Surgical Nursing, Nursing and Midwifery School, Shiraz
University of Medical Sciences, Shiraz, Iran
2
Substance Abuse Research Center, Department of Psychiatry,
Shiraz University of Medical Sciences, Shiraz, Iran
3
Department of Architecture, Faculty of Fazl, Neyriz Branch,
Technical & Vocational University, Neyriz, Fars, Iran
factors are divided into hereditary, psychological, envi-
ronmental, social, and phenotypic types. Environmental
risk factors associated with family characteristics include
family function, family practices and child mistreatment
and also other underlying factors, such as peer groups,
substance availability and opportunity [2, 3]. Results of
other studies have shown that factors such as family attach-
ment, devotion to family, parent’s educational level, fam-
ily’s religious values, and parental support are the protec-
tive factors against high-risk behaviors. In addition, age,
family history of high-risk behaviors and parental attitude
towards anti-social behavior can lead to an increase in
risky behaviors. According to Iranian traditional culture,
family plays an important role in adolescents’ education
and guidance. There are many competing institutions such
as schools and peers, internet and satellite programs in
terms of values and ideals which are likely to be different,
studies have shown that when young people become older,
they are inclined toward risky behaviors. This variable
can be considered as a good indicator for adolescents’
high risk behaviors. Adolescents who do not adhere to
the family rules are in favor of riskier behaviors. In fami-
lies in which parents resort to risky behavior inside and

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Journal of Community Health (2020) 45:176–182 177
outside of home, their children are at higher risk for show-
ing high-risk behaviors. Since teenagers see their parents
every day and try to mimic their parents’ behavior, those
adolescents whose parents use drugs are more inclined
toward risky behaviors. Several studies have shown that
there is a negative relationship between the mother’s edu-
cational level and high-risk behaviors. Higher literacy is
likely associated with employment. Those working moth-
ers who spend less time on psychological support, moni-
toring and encouraging their children school activities may
cause their children risky behaviors. Mothers with higher
education level have less influence on their children’s risky
behaviors. This issue can be related to the lack of spending
adequate amount of time with their children [1].
When we aim to investigate about the factors related to
legal and illegal drug use amongst adolescents, family scru-
tiny is important. Studies have shown that permissive par-
ents are an an important predictors of drug use. Studies have
also shown that children interpret the lack of parent’s resist-
ance as a predestined agreement or disagreement. Therefore,
children whose parents do not have clear guidelines, or do
not control the use of substances by their children, may think
that their parents’ attitudes towards the substance abuse are
more permissive than preventive [3]. Both parents and peers
have powerful effects on children’s decisions on using or not
using drugs [4]. Studies show that peer-pressure in an impor-
tant predictor of alcohol use and smoking in order to satisfy
friendship between them. The weak performance of family
and peer’s effects may cause the adolescents to use drugs
[5]. Interactions with peers that use drug enables teens to
see drug use patterns, learn and have positive attitude about
the use of drugs and access to them [6]. According to the
theory of social control, evidence shows that close emotional
relationship between parents and children, directly or indi-
rectly prevents using drug by influencing the peer selection
[7]. Although most teenagers are prone to risky behaviors,
factors such as social activities, good relationship with par-
ents and parental support may protect the teenagers against
tendency toward risky behaviors. Amongst these factors,
social and familial factors are considered more important
[8]. Children with a strong emotional bond with their fam-
ily members are less likely to be deviated. Children whose
parents do not ordain clear rules against the use of alcohol,
are at higher risk for alcohol abuse. Parents who do not have
a bond with their children or there are some animosities
between them are at more risk of alcohol and other drug
abuse. However, getting a positive feedback, encouragement
and affection from parents produces a lower risk of alcohol
use by adolescents [9]. It is noted that the main problem
in every part of the world is related to legal drugs, such as
tobacco, alcohol, and emotional disorders drugs [10]. Sub-
stance abuse is the main concern all over the world and prob-
ably has some negative effects on health [11].
The important role of the family and environment on the
tendency of adolescent toward risk behaviors and thein-
creased level of this problem among Iranian adolescents
has caused many scientists to focus on this important social
issue. Although there are several studies in this field, pub-
lished articles often have only focused on the risk factors
among Iranian students [1].
Objectives
Due to the effect and importance of substance abuse on the
health and economy of the community and starting the use
of these materials from adolescence period, and the need
for planning and preventive measures in this age group, this
study was performed to determine the prevalence of drug
use among secondary and pre-university students and its
relationship with familial factors.
Methods
This practical cross-sectional study was performed to
determine the prevalence of tobacco use, alcohol, narcot-
ics, psychoactive drugs and associated familial factors
among fourth grade high-school male students in 6 months
in four districts of Shiraz City. The study population con-
sisted of fourth grade high-school male students study-
ing in Shiraz City high-schools during 2017–2018. For
this study, stratified random sampling was used, and the
sample size was 1000. Multiple stage sampling was done
through three stages. Of the four school districts of Shiraz,
three schools with lower population district and four with
higher population district were chosen. From the above-
mentioned schools, two pre-university grade classes were
randomly selected. In total, 1000 students were recruited.
The validity of structured-researcher questionnaire was
determined through consultation with experts, psycholo-
gists and psychiatrists and its reliability through pre-test-
ing in a small sample of students by assessing the internal
consistency (Cronbach’s alpha 0.68), respectively and then
used for the study. This questionnaire consisted of three
parts. The first section was about demographic characteris-
tics of the participants; the second part contained 20 ques-
tions about related family factors; and the third section
questions were related to various substances of tobacco,
alcohol, drugs and psychoactive drugs. After coordination
with the general education department and the four dis-
tricts and taking permission from them, the schools were
selected. The questionnaires were distributed among the
students during class hours. The participants were asked
to refrain from writing their names on the questionnaire.
Before distributing the questionnaires, the students were
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178
ensured that their information would remain confidential
and their participation was completely voluntary in the
study. Ethics approval for gathering data obtained from
Research Ethics Board of the Shiraz University of Medi-
cal Sciences. In addition, before gathering data, informed
consent to participate in this study was obtained from the
participants. After gathering the data, they were analyzed
using SPSS (Statistical Package for the Social Sciences),
version 18. Descriptive statistics methods and frequency
distribution tables were used for describing the character-
istics of the subjects, and to determine the related familial
factors, Chi square and Fisher’s exact tests were used.
Results
According to the results, 14% of the participants were cur-
rent smokers, 13.5% had a history of alcohol consumption,
and 1% used psychotropic drugs, respectively. Among the
consumers, 80% had been used cigarette smokers and 78%
of them had consumed alcohol. 59% of the participants
who had consumed alcohol were cigarette smokers as well.
4.5% of the consumers used all the three substances such
as alcohol, tobacco and psychotropic drugs. One partici-
pant, in addition to cigarette and alcohol, used narcotic
drugs. Results showed that the fathers of 69% of those who
had consumed tobacco and alcohol were self-employed
and the mothers of 85% of them were housewives. The
father’s education level in 73% of them and mother’s
education level in 72% of them were diploma and under-
diploma. 61% of the consumers spent their money eco-
nomically. The fathers of 63% of them did not know that
their off-spring used substance, and financial resource for
purchasing the substances in 64% of them was the pocket
money.
Chi square test showed that the proportion of unfriendly
relationship between the parents and participants, receiv-
ing no emotional support from parents, having addicted
friends, attending the events and parties without their par-
ents’ permission, using drug as offered at parties by friends,
and performing no rituals like prayer were higher among
the consumers than non-consumers (P < 0.001). In addi-
tion, the average economic condition, permissive parenting
style, addicted parents were higher amongst the consumers
in comparison to non-consumers (P < 0.05). The difference
was not significant regarding having authoritarian parent-
ing style variable between consumers and non-consumers’
groups (P > 0.05, Table 1). 14% and 13.5% of the partici-
pants were current tobacco smokers and alcohol users. 80%
and 78% of them used only cigarette and alcohol, respec-
tively. 59% of the participants who had consumed alcohol
smoked cigarette as well.
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Journal of Community Health (2020) 45:176–182
Discussion
In studies conducted in different parts of Iran, the preva-
lence of smoking among adolescents in Tehran was 28.2%,
Tabriz 12.6%, Esfahan 8.7%, Kerman 11.4, Hormozgan
8.7%, Zahedan 25.2%, and 13.8% in Shiraz [12, 13]. It
seems that the prevalence of cigarette smoking among high
school students in Shiraz is close to other cities in Iran
with minor differences. Alcohol is considered illegal in
Iran and its use is restricted for all age groups. Unfortu-
nately, this situation has not prevented the use of alcohol
by adolescents and, in fact, alcohol is the most common
illegal drug among Iranian high school students aged
22–20.
The results of this study also showed that 60% of
consumers declared that if their friends offered them to
use drug, they would use it. In addition, the results also
showed that the friends of 84.3% of those who consumed
the drugs were also drug users, and there was a significant
correlation between the frequency of this variable in con-
suming and non-consuming individuals (Table 1). These
results confirm that perhaps peer pressure is an important
factor for drug consumption among the consumers. Having
friends who smoke tobacco is one of the identified pre-
dictors of smoking among adolescents. Why some young
adults are affected by the behavior of their friends can be
related to the teenager’s negative self-perception. Ado-
lescents who suffer from low self-esteem or depressive
symptoms have a negative attitude about themselves and
consider their worth relative to others. A large scale study
conducted in this area has shown that having friends who
smoke is associated with smoking throughout adolescence
[14].
Studies have shown that the peer influence is the strong-
est predictor of alcohol consumption among adolescents
and this shows that teenagers are easily susceptible to
peer’s pressure, encouragements, and attitudes. It was
reported that the students who had relationship with peers
who used more alcohol consumed more alcohol than those
whose friends did not use drugs [15]. Researchers have
found that the main reason for the fact that most students
are invited to substance abuse, particularly alcohol con-
sumption, is peer pressure. The effect of peers for the ado-
lescents of especially poor families with permissive par-
enting style is more influential [16]. Parents’ opposition to
delinquency and drug use can neutralize peer pressure and
prevent them from attracting adolescents toward such
activities [17]. In another study, it was found that relation-
ship with deviant peers is related to alcohol and drug use
seriously [18]. On the other hand, teenagers who get friend
with each other may have common features related to the
use of addictive substances. Due to the growing
Journal of Community Health (2020) 45:176–182 179

Table 1  Frequency distribution Related factors Number % P value

of the factors associated with
drug use in subjects The moderate economic condition < 0.05
 Consumers 61 45
 Non-consumers 418 49
Unfriendly relationship between the subjects and their father < 0.001
 Consumers 41 30
 Non-consumers 78 9
Unfriendly relationship between the subjects and their mother < 0.001
 Consumers 23 17
 Non-consumers 44 5
Lack of emotional support from father < 0.001
 Consumers 51 38
 Non-consumers 102 12
Lack of emotional support from mother < 0.001
 Consumers 20 15
 Non-consumers 4 0.5
Permissive parenting style < 0.05
 Consumers 67 50
 Non-consumers 325 38
Authoritative parenting style < 0.05
 Consumers 36 27
 Non-consumers 170 20
Having an addicted father < 0.05
 Consumers 42 31
 Non-consumers 62 12
Having an addicted friend < 0.001
 Consumers 117 84
 Non-consumers 344 40
Attending the parties without the parents’ knowledge permission < 0.001
 Consumers 24 18
 Non-consumers 33 4
Consuming substances after their friends’ offer at parties 59 < 0.001
 Consumers 80 10
 Non-consumers 90
Not doing rituals such as prayer < 0.001
 Consumers 53 39
 Non-consumers 112 13

consumption of tobacco and alcohol among students, hold-
ing a comprehensive preventive program in this field is
essential and should be a concern for administrators and
families. In preventive programs, it is recommended that
relationship with addicted peers should be studied as a
critical and target group. The results of the current study
showed that the fathers of 31.1% of those who used drugs
were substance users, and there was a significant relation-
ship between the frequency of this variable in consumer
and non-consumer participants (Table 1). Parental sub-
stance use is of a particular concern and is a risk factor for
their children. Substance use among the wife and children
of the drug consumers, compared to the general
population, is higher [12]. Due to both environmental and
genetic factors in the family, children of addicted parents
are the most risky group for alcohol and substance abuse
[19]. There is a strongrelationship between drug use by the
parents and that by their teens. Usually, if parents use drug
their children would use drug sooner or later [20]. It is
more likely that the teens who use drugs most probably
have one or more parents who also use drugs [21]. Recent
studies strongly suggest genetic factors, especially for
early onset alcoholism, among men. Children of alcoholic
parents, compared with children of non-alcoholic ones,
have a four times greater risk for alcohol use. Children of
alcoholic parents, compared wit h children of

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180
non-alcoholic fathers, have a four times greater risk for
alcohol consumption [22]. Parents have a strong influence
on the children’s life. They can have a key role through
words and actions in children’s alcohol use. The research
shows that the more the parents talk with their children
about the dangers of alcohol and other substances, the less
it is likely that children experience drug. Preventive pro-
grams for enhancing communication skills between par-
ents and children and improving other family skills are
increasingly designed [17]. 30.5% of those who consumed
substance had no friendly relationship with their father and
16.8% of them had no relationship with their mother.
38.1% the fathers of those who used drugs and 15% of
their mothers did not support their children emotionally
and there was a significant correlation between the fre-
quency of these variables among the consumers and non-
consumer (Table 1). Studies have shown that adolescents
with low parental bonds are 11 times more likely to drink
alcohol [23]. Students who are alcohol or drug abusers are
influenced by the amount of attachment to their parents
and commitment to traditional activities. Attachment is the
degree of mental or emotional attachment or affection to
parents while seeing them as a role model. According to
the theory of social attachment, people with strong attach-
ment are less likely to be attracted to deviant behaviors
[15]. Adolescence is the period of psychological pressure,
and researches have shown that teens with the lack of
social support tend to smoke and use drugs [24]. While
most of the social environment and peer influence is often
considered as the influencing factors in the decision made
by a person to use the drug legally or illegally, studies
show that the lack of family bonds are predictors of the use
of alcohol by adolescences. Parents may not have the same
effect on their children’s drug use. Research shows that to
be close to the mother, not the father, predicts the adoles-
cents’ alcohol consumption. On the other hand, studies
show that the higher level of support from both fathers and
mothers is combined with lower levels of alcohol and ille-
gal drug consumption. Adolescents with strong family
bonds are less likely to have friends who use substance
[25]. The fathers of 50% of those who had consumed alco-
hol provided their children with a lot of independence and
freedom and believed in the permissive parenting style and
there was a significant relationship between the frequency
of this variable in consuming and non-consuming indi-
viduals (Table 1). The effects of the parents’ attitude on
the children drug use behaviors may be important as much
as the parental real drug abuse [26]. The family is consid-
ered as the basic and most important factor in drug abuse.
One of the most important family factors that affect the
child development is parenting style [27]. The impact of
family factors should not be disregarded. Researchers have
determined parental support and control as two parental
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Journal of Community Health (2020) 45:176–182
complementary components. Support includes nurture,
attachment, acceptance, and love, while control includes
setting regulation, supervision and control. More parental
controlling takes place as parents’ awareness of their chil-
dren’s friends, the places they go, and their activities [25].
Parents who adequately support and control their adoles-
cence may prevent early starting of alcohol from happen-
ing in their life. When children are too attached to their
parents, the attachment relationship may enhance the
effectiveness of control over alcohol use in adolescents
[15]. A teenager who realizes that her/his parents are leni-
ent about the drug use is more likely to use drugs [26]. The
method of permissive parental style is associated with
adolescents’ crime and violence. Poor control, neglect and
indifference are all parts of the permissive parenting style
that has a specific role in the crime and deviant behavior;
as a result, these people tend toward deviant behaviors
such as the drug and alcohol use; atypical behaviors; and
shaky, emotional and criminal acts [27]. Several studies
have shown that the more the parents are liberal about their
children’s drug use, the more their children are likely to
consume alcohol, cigarettes or cannabis [28]. Appropriate
parenting behavior, such as authoritative parenting style
due to sufficient control and support which creates a safe
and reliable environment, is one of the fundamental condi-
tions for the healthy growth of individuals. A person who
is in this situation acts independently; is self-confident,
realistic and powerful can have a friendly relationship with
his/her friends; and is happy and energetic with peers.
Therefore, he/she is able to cope better with stressful situ-
ations and is less prone to risky behaviors. In contrast,
weak parenting styles, such as authoritative and permissive
parenting styles, have not been desirable and people are
susceptible to high-risk behaviors [27]. Parental controls
may both prevent the use of drugs and alcohol and delay
the onset age of starting the use of such materials. Chil-
dren whose overall behaviors are controlled by their par-
ents have lower levels of alcohol, tobacco and cannabis
usage. Authoritative parenting style includes relatively
higher parent–child relationship and parental controls and
it has been shown that it is more promising against the
substance abuse. In general, studies show the importance
of proper balance between two fundamental features of
parental controls and affection of authoritative parenting
style [28]. Theoretically, since attitudes and behaviors of
both family and peer relationships are learned, their rela-
tionship is important for the use of young people. In the
families who use alcohol, adolescents may see alcohol
consumption and gain favorable attitudes toward the use
of alcohol, and they themselves start the use of alcohol.
Likewise, if their friends drink alcohol, teens are likely to
get a positive social reinforcement from friends to drink
alcohol [7]. 38.9% of those who consumed substances
Journal of Community Health (2020) 45:176–182 181
perform no religious rituals such as praying, and there was
a positive correlation between the frequency of this vari-
able in non-user individuals (Table 1). Studies show that
students participating in religious groups are determinant
in terms of social obligations. Being active in religious
activities prevents other types of social needs, especially
those who might ignore religious traditions and injunc-
tions. If a student attends a mosque on Friday, he may not
appear in pubs to drink alcohol. Commitment to religious
groups also prevents negative behaviors like going to
houses for the weekend or taking improvised road trips
[15]. 45.4% of the consumers were from a middle income
family, and there was a positive significant correlation
between the existence of this variable in consumer and
non-consumer individuals (Table 1). There is evidence
indicating that adolescences who spend a lot of money use
more alcohol. In addition, the increasing use of alcohol
among Finnish youth has been found to have a close rela-
tionship with their increasing trend in their spending [3].
Study Limitations
One of the limitations in this study was that the real preva-
lence of drug use amongst the investigated students was
higher than the values obtained in this study. It seems that
our society’s cultural and the stigma of drug use might
explain why this high prevalence was not evident. The other
reason for this discrepancy was that some drug users did
not declare that they used drugs, because they assumed that
perhaps their parents would find out that they were taking
drugs. Others felt embarrassed about declaring that they
were drug users, and also when some of the students heard
that the questionnaire was about substance abuse, they did
not fill it out. Consequently, due to these limitations, low
consumer participation is acceptable. Another limitation was
that the researchers felt extensive range of drugs was the
strength of this study; however, it would have been better if
the legal and illegal substances such as cigarettes, alcohol
from psychoactive drugs were separated from each other.
Conclusion
Children whose parents do not set clear regulations or do
not control their children are at higher risk of drug abuse.
Parents who are relatively less affectionate and supporttheir
children less emotionally, their children are at a higher risk
of alcohol and other drugs consumption. There are young
people who reject the values and standards of the family
for the benefit of the peer group. This event happens more
for young people who come from permissive style fami-
lies. The adolescents in families with balanced rules and
independence spend more time at home. When parent–teen
relationship is in a low quality, the influence of peers gets
stronger. Children whose psychological needs are not satis-
fied by their parents probably seek joy from peers, a situation
that may cause their tendency toward drug abuse in order to
be accepted by peers.
Acknowledgements  The authors would like to thank all the people
who helped to conduct this study. The authors wish to thank Dr. Nas-
rin Shokrpour and Mr. H. Argasi at the Research Consultation Center
(RCC) of Shiraz University of Medical Sciences for his invaluable
assistance in editing this manuscript.
Author contributions  GH R as a corresponding author designed the
study, conducted the statistical analysis and revised the study critically
for important intellectual content. J A wrote the first and final draft of
manuscript and interpreted data of the study. F R has been involved
in drafting and revising the manuscript and approved the final version
of the manuscript.
Funding  This study was supported by Shiraz University of Medical
Sciences. Funding support did not have any involvement in submit the
article for publication.
Compliance with Ethical Standards 
Conflict of interest  The authors declare that they have no conflict of
interest.
Ethical Approval  Ethics approval for gathering data was provided from
Research Ethics Board of the Shiraz University of Medical Sciences.
Informed Consent  Before gathering the data, all participants provided
written informed consent for participation and publication of this study.
References
1. Haghdoost, A., Abazari, F., Abbaszadeh, A., & Dortaj, R. E.
(2014). Family and the risky behaviors of high school students.
Iranian Red Crescent Medical Journal, 16(10), e15931.
2. Thatcher, D. L., & Clark, D. B. (2008). Adolescents at risk for
substance use disorders. Alcohol Research and Health, 31(2),
I68–I76.
3. Ahlstrom, S. (2002). Family practices and adolescent use of legal
and illegal drugs: A review. Nordisk Alkohol & Narkotikatidskrift,
19, 76–82.
4. Mays, S. A. (2007). The Influence of parental monitoring and peer
deviance on substance use among middle school students. VCU
Thesis and Dissertation. Virginia Commonwealth University.
5. Wu, C. S., Wong, H. T., Shek, C. H., & Loke, A. Y. (2014). Multi-
dimensional self-esteem and substance use among Chinese ado-
lescents. Substance Abuse Treatment, Prevention, and Policy,
9(42), 1–8.
6. Beyers, J. M., Toumbourou, J. W., Catalano, R. F., Arthur, M. W.,
& Hawkins, J. D. (2004). A cross-national comparison of risk and
protective factors for adolescent substance use: The United States
and Australia. Journal of Adolescent Health, 35(1), 3–16.
7. Bahr, S. J., Hoffmann, J. P., & Yang, X. (2005). Parental and
peer influences on the risk of adolescent drug use. The Journal of
Primary Prevention, 26(6), 529–551.
8. Panaghi, L., Mohammadi, S., Poshtmashhadi, M., Zadehmoham-
madi, A., & Ahmadabadi, Z. (2013). High risk behaviors among
13

182
Iranian adolescents: Evaluating the proportion of family factors.
Practice in Clinical Psychology, 1(1), 33–40.
9. Kusmierski, S., Nichols, J., & Mcdonnell, R. (2001). Do parenting
styles influence alcohol use and binge drinking during high school
and college. UW-La Crosse Journal of Undergraduate Research,
4, 63–70.
10. De Abarca, A. M., & Pillon, S. C. (2008). Nursing students’ per-
ception regarding predicting factors of drugs use. Revista Latino-
Americana de Enfermagem, 16(especial), 607–613.
11. Mohammad, H., Nazir, A., Ghader, Z.-B., & Shirazi, H. R. G.
(2012). Opiate and alcohol abuse and related factors in Yasouj
University of Medical Sciences (south of Iran). Life Science Jour-
nal, 9(3), 1195–1198.
12. Momtazia, S., & Rawson, R. A. (2010). Substance abuse among
Iranian high school students. Current Opinion in Psychiatry,
23(3), 221–226.
13. Ahmadi, J., & Hasanim, M. (2003). Prevalence of substance use
among Iranian high school students. Addictive Behaviors, 28,
375–379.
14. Tucker, J. S., Edelen, M. O., & Go, M. H. (2012). Resisting smok-
ing when a best friend smokes: Do intrapersonal and contextual
factors matter? Journal of Research on Adolescence, 22(1),
113–122.
15. Onongha, G. I. (2012). The influence of some factors on alcohol
use and abuse among education students of Osun State University,
Nigeria. International Journal of Humanities and Social Science,
2(11), 276–283.
16. Abikoye, G. E., Sholarin, A. M., & Adekoya, J. A. (2014). Par-
enting styles and peer-pressure as predictors of substance abuse
among university students. Psychology and Behavioral Sciences,
3(2), 55–59.
17. Reno, J., Holder, E. H., Marcus, D., & Leary, M. L. (2000).
Promising strategies to reduce substance abuse (pp. 1–90). U.S.
Department of Justice, Office of Justice Programs. https:​ //ojp.gov/
docs/psrsa​.pdf. Accessed 28 Aug 2019.
18. McBride, A. A., Joe, G. W., & Simpson, D. (1991). Prediction of
long-term alcohol use, drug use, and criminality among inhalant
users. Hispanic Journal of Behavioral Sciences, 13, 315–323.
19. Kumpfer, K. L. (1999). Outcome measures of interventions in the
study of children of substance-abusing parents. Pediatrics Supple-
ment, 103(5pt2), 1128–1144.
13
Journal of Community Health (2020) 45:176–182
20. Fawzy, F. I., Coombs, R. H., & Gerber, B. (1983). Generational
continuity in the use of substances: The impact of parental sub-
stance use on adolescent substance use. Addictive Behaviors, 8,
109–114.
21. Skiffington, E. W., & Brown, P. M. (1981). Home, and school
factors related to eleventh graders’ drug attitudes. International
Journal of the Addictions, 16(5), 879–892.
22. Goodwin, D. W. (1985). Alcoholism and genetics: The sins of the
fathers. Archives of General Psychiatry, 42, 171–174.
23. Hahm, H. C., Lahiff, M., & Guterman, N. B. (2003). Acculturation
and parental attachment in Asian-American adolescents’ alcohol
use. Journal of Adolescent Health, 33(2), 119–129.
24. Kann, L., Kinchen, S. A., Williams, B. I., Ross, J. G., Lowry,
R., Grunbaum, J. A., et al. (2000). Youth risk behavior surveil-
lance—United States, 1999. State and local YRBSS Coordinators.
Journal of School Health, 70(7), 271–285.
25. Mercyhurst College Civic Institute. (2009). Family ties: How par-
ents influence adolescent substance use. Report from the Mercy-
hurst College Civic Institute (Vol. 1, No. 1, pp. 1–6). http://www.
teapp​oyo.com/bibli​ograf​i a/Civic​%20Ins​titut​e.%20Fam​ily%20Tie​
s-%20how​%20par​ents%20inf​l uenc​e%20ado​lesce​nt%20sub​stanc​
e%20abu​se..pdf. Accessed 28 Aug 2019.
26. McDermott, D. (1984). The relationship of parental drug use and
parents’ attitude concerning adolescent drug use to adolescent
drug use. Adolescence, 19(73), 89–97.
27. Ahmadi, V., Ahmadi, S., Dadfar, R., Nasrolahi, A., Abedini, S.,
& Azar-Abdar, T. (2014). The relationships between parenting
styles and addiction potentiality among students. The Journal of
Paramedical Sciences, 5(3), 1–5.
28. Becoña, E., Martínez, Ú., Calafat, A., Fernández-Hermida, J. R.,
Juan, M., Sumnall, H., et al. (2013). Parental permissiveness,
control, and affect and drug use among adolescents. Psicothema,
25(3), 292–298.
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