Design and participants
This cross-sectional descriptive study was done on 721 students of Universities in Hamadan, Iran who were recruited through a stratified random sampling procedure between May and June 2020. Hamadan City is located in the west of Iran. It has four state universities, including Bu-Ali Sina University, Hamadan University of Medical Sciences, Hamadan University of Applied Sciences & Technology, and the Hamadan University of Technology. Moreover, it has some non-governmental universities, such as Islamic Azad University Hamadan Branch and Hamadan Payam Noor University [34]. Therefore, the number of students in each school of the University was obtained by proportional assignment of students to the school (i.e., the school with the largest number of students, the largest number of students assigned) after coordinating with university officials and the research units were rationed. Then, the samples were randomly collected. The word informed consent was obtained from all students; they were informed about the confidentiality of the information and the project’s purpose, and only if they would like they were enrolled in the study. The Ethics Committee approved this study with all consent processes at Hamadan University of Medical Sciences.
Data collection and measurements
Data collection tools included a researcher-made four-part questionnaire, socio-demographic questions, PMW structures based on PWM-based literature, and studies [29, 35] status of drug use behavior and substance abuse media literacy (SAML) questions.
Demographic information questionnaire consists of (age, gender, marital status, the field of study and educational status, parents’ residence status, education, and the status of using social networks apps and computers, and motivation to use social networks apps with ten questions.
Also, ten questions about the status of substance use as a high-risk behavior checklist were used to collect data on their use of cigarettes and the type of substance and other drugs in him/ the form of three-choice questions (never, sometimes, and always) [11].
Besides, PWM constructs were assessed using the PWM scale for drug use risk behaviors. It was compiled of 21 items and seven subscales as follows:
Positive attitude toward drug use (7 items, e.g., “If I take drugs, it will help me to increase my concentration.”) scored on a 5-point Likert scale with answers ranging from ‘strongly disagree’ to ‘strongly agree.’ The scores of this construction ranged from 7 to 35. The highest score in this section indicated a positive attitude toward drug use.
Negative attitude toward drug use (3 items, e.g., “If I take drugs, I will waste my money.”) scored on a 5-point Likert scale with answers ranging from ‘strongly disagree’ to ‘strongly agree.’ The scores of this construction ranged from 3 to 15. The highest score in this section indicated a positive attitude towards drug use.
Subjective norms focused on normative beliefs and motivation to comply (2 items, e.g., normative beliefs: “My best friend’s opinion about drugs is that I am….…”; which were rated on a 5-point scale ‘I should not use at all to ‘I must consume’; 2 other items about motivation to comply scored on a 5-point Likert scale "I think my best friend views, I have to accept drugs” with answers ranging from ‘strongly disagree’ to ‘strongly agree’. The Subjective norms structure scores ranged from 4 to 20 [36].
Prototypes about drug use presented positive drug user images and non-drug user images (7 items in terms of inexperienced and naive, self-confidence, independence, attractiveness, and selfishness. This construct was rated on a 5-point Likert scale from ‘very much’ to ‘never. A higher score indicated the subject’s positive prototype towards drug use student/healthy student.
Behavioral willingness includes a scenario in which a student thinks that he/she is among her friends who use drugs and persuade her/him to drug use. In this section, the student’s feedback to this scenario was evaluated following four feedbacks: (1) I take the drugs and use one or more of them; (2) I use drugs with my friends until the end; (3) I thank them and I refuse to drug use, and (4) I leave that place. The answers were measured on a 5-point Likert scale ranging from ‘never’ to ‘very much. The scores ranged from 4 to 20, respectively. A higher score indicated a greater willingness for drug use [36].
Behavioral intention to drug use with two questions which show the intention to drug use in the next month and then 6 months later (e.g.: ‘I may use drugs in the next month’). The scores ranged from 2 to 10, with a higher score indicating a student’s higher intention to drug use.
Also, the question about the status of drug users /herself was used with yes/no questions [11].
In section four, substance abuse media literacy (SAML) in students was evaluated with 13 questions and scored on a 5-point Likert scale with answers ranging from ‘strongly disagree’ to ‘strongly agree.’ The scores of this construction ranged from 13 to 65. The highest score in this section indicated higher media literacy related to substance use [33]. It is essential to be mentioned that there are several general and specific tools to measure media literacy. Each of these tools has introduced dimensions for media literacy. These tools suffer from their narrow scopes and lack of any instrument targeted at measuring media literacy in specific issues to assess the medial literacy holistically in terms of multidimensional skill. Moreover, the multidimensional specific media literacy measure SAML has been mainly neglected. Although some studies have been conducted using the researcher-made questionnaire about media literacy in Iran [9, 37, 38].
Hence, Based on the previous study, the SAML scale, which included 13 items, was evaluated, was a valid and reliable tool, and now is suitable and acceptable for present studies [33]. Also, this scale was supported in previous research [39,40,41] and developed based on the qualitative analysis of the exploration of substance abuse media literacy among students [15].
The inclusion criteria were being a student of one of the universities in the city of Hamadan, being interested in participating in the study, ability to respond and take part in the study, and access to the Internet and social networks such as what’s app, telegram, and Instagram and YouTube.
Questionnaires were completed through self-report by students who had informed consent to study.
Structural Equation Modeling (SEM) is a technique used to specify, estimate, and evaluate models of linear models among a set of observed variables in terms of an often smaller number of unobserved variables. SEM may be used to build or test the theory. The SPSS software version 23 and a structural equations partial least squares’ confirmatory composite approach (PLS) version 3 was used to analyze the data. Also, PLS (Partial Least Squares) are less prone to type I error and better suited for small, non-normal datasets often collected for initial tests of relationships. Partial Least Squares, which focuses on the analysis of variance, can be carried out using Smart PLS and WarpPLS, etc. [42].