Introduction: Substance use among adolescents is an increasing public health concern. This study investigated the prevalence of substance use and its associated risk and protective factors among high school students in Kerman, Iran.
Methods: This analytical cross-sectional study was conducted from September to December 2025 among 527 students aged 14-19 years, selected through multistage cluster random sampling. Data were collected using a demographic questionnaire, the Cannabis-Alcohol-Tobacco Checklist, and the Risk and Protective Factors for Substance Use Questionnaire. Descriptive and inferential analyses included Chi-squared, independent t-test, one-way ANOVA, and logistic regression. The study was approved by the Ethics Committee of Kerman University of Medical Sciences.
Results: Lifetime, past-12-month, and past-30-day prevalence of substance use were 40.4%, 28.1%, and 16.1%, respectively. Hookah, cigarettes, and alcohol were the most commonly used substances. Prevalence did not differ significantly by sex but was higher among tenth-grade students. Past-30-day use was associated with positive parental attitudes toward substance use (OR = 3.465), low family supervision (OR = 6.047), low school commitment (OR = 5.018), and poor school psychosocial atmosphere (OR = 5.311). Past-12-month use was associated with sensation seeking (OR = 5.581), low family supervision (OR = 9.619), and social environment disorder (OR = 7.617).
Conclusion: Hookah and cigarettes were the most commonly used substances, and use was more frequent in early high school years. These findings support targeted family-, school-, and community-based prevention programs that strengthen supervision, school engagement, and healthy social environments. Multilevel prevention efforts should particularly target family supervision, school connectedness, and the school and community environment during early adolescence.