The spiritual health of parents and their role in preventing children’s addiction using the theory of planned behavior

ABSTRACT

The research population for this cross-sectional study consisted of 1424 Shiraz-based parents of first-year secondary students who were chosen randomly. An online questionnaire with three sections for demographic data, the theories of planned behaviour, and a questionnaire about spiritual well-being served as the data gathering tools. A significance level of p < 0.05 was taken into account when analysing the obtained data using SPSS 26 and independent t, Pearson correlation coefficient, and linear regression. The average parent participating in this study had two children, and the average age was 40. In addition to having average scores for attitude, subjective norms, and perceived behavioural control, parents also had average spiritual health. Parents’ behavioural intentions and their spiritual well-being were significantly correlated. Except for perceived behavioural control, there was a significant association between conduct and all of the theory of planned behaviour’s dimensions and a significant relationship between intention and all of them.

KEYWORDS:

• Attitude
• theory of planned behavior
• parents
• drug addicts
• primary prevention
• spirituality

Introduction

One of the biggest issues facing the world today is addiction, which is also one of the four crises of the century (Goodarzi et al., 2011; Sarrami et al., 2013). Currently, it is regarded as one of the most significant social, health, and political concerns worldwide (Moghadam et al., 2009). One of the major issues in society and the root of the wastage of labour, energy, and both real and human capital is the overuse of tobacco, alcohol, and narcotics (Sharifi et al., 2012). The most blatant sign of addiction is obsessive drug usage, despite harm to the user’s mind, body, and life. This behaviour is connected to the negative effects of losing control and a high drug appetite (Crews, 2023). Early adulthood and adolescence are high-risk developmental stages for using tobacco, alcohol, and illegal drugs. Due to the immediate consequences of acute intoxication (such as injury, assault, and death) and the significant contribution of drug usage throughout life to the global burden of disease, drug use during adolescence and the early years of adulthood are of growing concern (Maggs et al., 2023).

Around the world, more than 30 million people have a recognized substance use disorder. More than 40 million people age 12 or older in the United States alone will battle with substance misuse at some point in their lives, according to the Substance Misuse and Mental Health Services Administration’s 2020 National Survey (Combs, 2023). 52.5% of high school pupils in Ethiopia reported using drugs regularly (Melkam et al., 2023). In addition, a study on adolescents and young adults in India aged 13 to 23 found that boys (34.11%) were far more likely than girls (6.65%) to take drugs. The prevalence of smoking, hookah, alcohol, and drugs was found to be 11.8%, 20.5%, 15.5%, and 8.8%, respectively, in a survey done on Iranian students (Maurya & Maurya, 2023). In a study conducted on Iranian students, the results showed the prevalence of smoking, hookah, alcohol, and drugs at 11.8%, 20.5%, 15.5%, and 8.8%, respectively (Vakili et al., 2023). In a different review, substance abuse (1.8–31.1%), hookah smoking (59–6.9%), and cigarette smoking (10.9–44.1%) were all reported (Yazdanparast et al., 2023). The propensity to consume drugs is not monocausal, like other social phenomena, and is influenced by a variety of individual, family, social, economic, political, and cultural factors (Aghabakhshi et al., 2009).

People’s health can be significantly and in many ways impacted by substance usage. Substance abuse can have a substantial negative impact on mental health in addition to the physical side effects, and an increased risk of chronic diseases (Chang et al., 2022). People who struggle with substance abuse may experience social isolation, prejudice, and stigma, which can cause psychological discomfort and a sense of estrangement (Chang et al., 2020; Chang et al., 2022). This phenomenon can also interfere with sleep cycles, resulting in insomnia or other sleep disorders, which can worsen mental health problems and lower general wellbeing (Chang et al., 2023; Chen et al., 2022). When these elements come together, it can seriously lower someone’s quality of life and make it more difficult for them to go about their everyday lives and keep up positive relationships (Lin et al., 2016; Saffari et al., 2022).

The family not only influences a child’s physical development but also their psychological, social, and spiritual growth (Piko & Kovács, 2010). The presence of drug addicts in the family, family conflicts and a lack of affection in the emotional bonds of the family, a lack of self-control and proper parental supervision, the use of inappropriate educational methods, divorce, and separation are all family factors associated with substance abuse in developed countries. It influences adolescent drug addiction. Family factors that influence drug abuse in Iran include drug abuse history as a child, addiction in one or more family members, marital issues, low socioeconomic status, the emotional climate of the family, parenting techniques, and teenagers’ attitudes towards parental acceptance of drug use. One of the most significant elements in substance misuse is family factors. This underlines the importance of the parent-child relationship, parent-parent interactions, parenting strategies, and sibling relationships in this situation (Shariat et al., 2023).

Studies have also indicated that drug misuse is more common among teenagers and young people who are less guided and supervised by their parents, indicating that parenting style or how they are guided and monitored can be considered preventative factors for drug abusers (Miller & Plant, 2010). Therefore, independent of parents’ beliefs and behaviours towards drug misuse, the social bond theory offers a clear theoretical relationship between attachment to parents and decreased engagement with drug usage. The findings of the study by Meldrum and his associates also point to a strong correlation between parental attachment and a decline in drug usage (Meldrum et al., 2023). The findings of the study by Pasman et al. also suggested that children’s drug usage is predicted by the nature of their relationships with their parents (Pasman et al., 2023). Numerous hypotheses stress biological, psychological, and societal reasons to explain drug use and substance misuse across the lifetime (Maggs et al., 2023).

A higher power must be believed in and communicated with in order to have faith and a sense of purpose in life. In fact, spiritual health has a calming impact, combats stress, and promotes physical and mental health through actions like abstaining from alcohol and tobacco usage, increasing physical exercise, finding meaning and purpose in life, holding onto hope, and being optimistic. The belief that a person’s religion gives them regarding drug usage is one of the many origins of the unfavourable attitude towards drug abuse. Religion can affect drug use and freedom from it by establishing an internal moral order through the creation of laws (Gaston & Cramp, 2011). Models and ideas can serve as a roadmap for educational activities that explain how to prevent addiction.

Planners may wonder why people do not exhibit the intended behaviours. Health and health promotion might provide an explanation. What elements should be taken into account when evaluating programmes, as well as how behaviours should be altered (Machaka-Mare et al., 2023). The theory of planned behaviour (TPB) was therefore applied in this investigation. This theory contends that three primary factors – attitude, mental norm, and comprehension of behaviour control – have a significant impact on people’s intentions and meanings when engaging in a behaviour (Najafi et al., 2023). The TPB has been applied in numerous studies to explain and forecast substance misuse (Fiegel & Frank, 2023; Luecha et al., 2023; Machaka-Mare et al., 2023). This study aims to ascertain spiritual health and the role of parents in the prevention of children’s addiction using the TPB in light of the statistics of addiction in Iran, the capacity of the TPB to explain and understand the undesirable behaviours of people, and the significance of parent-centred prevention in many health-related behaviours, especially drug addiction.

Materials and methods

Research design and sampling

The research population for this cross-sectional survey consisted of 1424 Shiraz, Iran-based parents who were chosen at random using a multi-stage selection technique. After consulting the Shiraz Department of Education and working with the Research Council Secretariat to perform a study in three of Shiraz’s four educational districts, comprising districts one, two, and three, parents of children were asked to participate in filling out the questionnaire in four steps by calling or visiting the secondary schools (7th, 8th, and 9th grade). With their cooperation, the school’s executive director or administrators sent a message to groups of parents of students in WhatsApp messages with a link to the survey, asking them to participate in the study if they had given their consent and met the entry requirements. 2358 out of the 3018 parents who got the questionnaire consented to participate and respond. 1509 of these respondents, or 64%, completed the questionnaire’s questions.

Only the responses of 1424 people were included in this study since 16 parents who did not live in Shiraz and 69 parents who had a history of addiction in their family were eliminated. Each respondent could send their response to the questionnaire just once, due to the way it was created.

Inclusion and exclusion criteria

Being a Shiraz resident, abstaining from drug use, not having a child who was addicted, and giving your agreement were requirements for enrolment in the study. Refusal to participate in the study, addiction to oneself, one’s spouse, or one’s children, as well as moving away from Shiraz, were the requirements for withdrawal from the study.

Data gathering tool

The questionnaire for the study was made available online due to the COVID lockdown. Three sections make up this questionnaire:

Part 1 of the questionnaire asks about demographic details like age, number of children, relationship to the student’s family, education level, tenancy status, marital status, occupation, head of household, child’s gender and grade, history of addiction, and participation in religious practices like fasting or prayer.

The second component was a questionnaire based on Mirzaei et al.‘s study (Mirzaei-Alavijeh et al., 2014) and the TPB’s constructs. A 7-point Likert scale with the options ‘strongly agree’ to ‘strongly disagree’ was used to rate the items for attitude structure, subjective norms, and perceived behavioural control. Utilizing a 5-point Likert scale with five questions ranging from ‘very little’ to ‘very much,’ behavioural intention structure was evaluated. Nine yes-or-no questions were included in the behaviour structure. Higher scores indicated a better level for attitude, subjective norms, perceived behavioural control, behavioural intention, and behaviour, which ranged from 4 to 28, 2 to 14, 5 to 25, and 0 to 9, respectively.

Both quantitative and qualitative techniques were used to evaluate the validity of the questionnaire. The face validity and qualitative section of the questionnaire were tested by 12 experts who were not affiliated with the study team. The quantitative part of the validity was quantitatively verified using the content validity ratio and content validity index.

The questionnaire was constructed with three spectrums in mind: ‘the item is necessary, the item is useful, and the item is not necessary.’ These specialists made up the board of experts that determined the content validity ratio, which was used to quantify the content validity index. Each item was ultimately found to be greater than 0.56 using the Lawshe table index, and the questions deemed relevant were retained for additional examination.

Internal consistency techniques were applied to gauge the tool’s dependability. 30 participants who met the eligibility requirements were given the questionnaire in this study. The results of the analysis using SPSS 26 showed that the alpha coefficient Cronbach’s for attitude, subjective norms, perceived behavioural control, behavioural intention, behaviour, and the entire questionnaire were 0.76, 0.86, 0.81, and 0.82, respectively.

The Spiritual Health Questionnaire, developed by Polotzin and Ellison in 1982, made up the third section of the survey. The questionnaire consists of 20 questions, of which 10 assess the respondent’s religious health and the remaining 10 assess their existential health. The responses to the questions are given on a 6-point Likert scale, with 1 being fully opposed to 6, 2 being somewhat opposed to 3, 4 being somewhat in agreement with 5, and 6 being completely in agreement.

Separately, the range of the religious and existential health scores was 10 to 60. The religious and existential health subgroups are not levelled, and the results are used to make decisions. The resultant score correlates with the level of religious and existential wellness. These two subgroups are added together to determine the spiritual health score, which has a range of 20–120. Between 20 and 40, medium between 41 and 99, and high between 100 and 120, there are three levels of spiritual wellness.

According to previous studies, the reliability of the questionnaire was assessed with Cronbach’s alpha of 82% (Abbasi et al., 2014). Also, in Fatemi et al.‘s research the validity of the questionnaire after translation into Farsi was determined through content validity. After being translated into Farsi in the research of Fatemi et al., the validity of the questionnaire was determined through content validity (Fatemi et al., 2006).

Data analysis

The collected data were analysed using SPSS version 26 software and descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (independent t, Pearson correlation coefficient, and linear regression). Structural equation modelling (SEM) was used to investigate the relationships between the structures of the TPB and spiritual health (Weston & Gore, 2006). The significance level was considered to be p < 0.05.

Results

Before performing the statistical tests and checking the study hypotheses, the normality of the data was evaluated by the Kolmogorov-Smirnov test, and their normality was confirmed. The average number of children of parents participating in this research was two, and the average age of parents was 40 years. Other demographic variables are listed in Table 1.

Table 1. Frequency distribution of the participants according to demographic variables (n = 1424).

Variable		Frequency	Percentage
Family relationship with the student	Mother	1263	88.7%
	Father	161	11.3%
Level of education	Illiterate	6	0.4%
	Elementary school	58	4.1%
	Secondary school	122	8.6%
	High school	70	4.9%
	High school diploma	550	38.6%
	Associate Degree	127	8.9%
	Bachelor’s degree	361	25.4%
	Masters’ degree and higher	129	9.1%
	Seminary education	1	0.1%
Tenancy status	Owner	745	52.3%
	Tenant	602	42.3%
	Living with the parents	77	5.4%
Living in Shiraz	Yes	1424	100.0%
Marital status	Married	1358	95.4%
	Widowed	24	1.7%
	Divorced	42	2.9%
Occupation	Government employee	169	11.9%
	Private employee	52	3.7%
	Housewife	1001	70.3%
	Retired	47	3.3%
	Physician	11	0.8%
	Engineer	14	1.0%
	Manual worker	20	1.4%
	Self-employed	57	4.0%
	Other	53	3.7%
Head of the household	Yes	264	18.5%
	No	1160	81.5%
Grade of the child	7^th	533	37.4%
	8^th	424	29.8%
	9^th	467	32.8%
Gender of the child	Boy	641	45.0%
	Girl	783	55.0%
History of addiction in child	No	1424	100.0%
Praying	Yes	1115	78.3%
	No	309	21.7%
Fasting	Yes	1217	85.5%
	No	207	14.5%

The average scores of spiritual health of parents participating in the research were at an average level. The average score of parents’ attitude, subjective norms, and the average score of parents’ perceived behavioural control regarding addiction prevention behaviour in children were all at an average level. The average score of parents’ intention regarding the preventive behaviour of addiction in their children was average and slightly higher than average, and the average score of parents’ behaviour regarding the preventive behaviour of addiction was lower than average (Table 2).

Table 2. Mean constructs of the TPB and spiritual health.

Theory of planned behavior and spiritual health	Mean	SD	Minimum	Maximum
Attitude	13.35	2.15	4	28
Subjective norms	14.30	2.84	4	28
Perceived behavioral control	6.50	2.25	2	14
Behavior	3.60	1.34	0	9
Intention	12.50	5.18	5	25
Spiritual health	74.38	5.60	37	101
Religious health	38.35	3.23	18	55
Existential health	36.02	3.76	19	54

According to the results, there was no significant relationship between the spiritual health of parents and their behaviour in preventing addiction in their children. In addition, no significant relationship was observed between spiritual health and attitude, subjective norms, or perceived behavioural control. While, there was a significant relationship between spiritual health and the structure of behavioural intention. Moreover, the constructs of attitude, subjective norms, perceived behavioural control, and behavioural intention had a significant correlation with other constructs of the TPB (Table 3).

Table 3. Correlations between the constructs of the TPB with each other and spiritual health.

Constructs	Attitude	Subjective norms	Perceived behavioral control	Behavior	Intention	Spiritual health
Attitude	1	r = 0.335 P-value = 0.001	r = 0.085 P-value = 0.001	r = 0.099 P-value = 0.001	r = 0.110 P-value = 0.001	r = 0.004 P-value = 0.880
Subjective norms	r = 0.335 P-value = 0.001	1	r = 0.085 P-value = 0.001	r = 0.096 P-value = 0.001	r = 0.219 P-value = 0.001	r = 0.015 P-value = 0.556
Perceived behavioral control	r = 0.085 P-value = 0.001	r = 0.085 P-value = 0.001	1	r = 0.004 P-value = 0.873	r = 0.138 P-value = 0.001	r = 0.046 P-value = 0.085
Behavior	r = 0.099 P-value = 0.001	r = 0.096 P-value = 0.001	r = 0.004 P-value = 0.873	1	r = 0.331 P-value = 0.001	r = 0.050 P-value = 0.059
Intention	r = 0.110 P-value = 0.001	r = 0.219 P-value = 0.001	r = 0.138 P-value = 0.001	r = 0.331 P-value = 0.001	1	r = 0.062 P-value = 0.019
Spiritual health	r = 0.004 P-value = 0.880	r = 0.015 P-value = 0.556	r = 0.046 P-value = 0.085	r = 0.050 P-value = 0.059	r = 0.062 P-value = 0.019	1

Univariate linear regression was used to determine the predictability of the constructs of the TPB and spiritual health. According to the findings, subjective norms and perceived behavioural control were predictors of people’s intentions, and behavioural intention is also a predictor of behaviour. According to Figure 1, attitude with a rate of 0.112, subjective norms with a rate of 0.184, perceived behavioural control with a rate of 0.131, and spiritual health with a rate of 0.061 have an effect on intention. The effectiveness of intention on behaviour was 0.341, which indicates a high degree of predictability. The predictive value of spiritual health on behaviour was 0.087, and the predictive value of perceived behavioural control on behaviour was 0.082 (Figure 1).

Figure 1. Determining the predictive value of the structures of the TPB and spiritual health (SEM report).

In examining the relationship between intention and demographic variables, it was found that there was a significant correlation only between intention and gender of the child (Pearson correlation coefficient) (p < 0.05).

Discussion

The goal of the current study was to evaluate spiritual well-being and the role that parents play in shielding their kids from addiction using the idea of planned behaviour. The average spiritual health of the parents participating in the research was at an average level, which is consistent with the results of the studies of Malmir et al (Malmir et al., 2023). The spiritual well-being of pupils was rated as medium or high in Rezaei et al. s study (Rezaei et al., 2015). The study by Salehi et al. revealed that the spiritual health of the caregivers ranged from average to high. They are particularly important in developing the child’s mental stability and his attachment to family and home. The lack of harmony in families could be the cause of the rise of many deviant youngsters and those who go on to conduct various crimes as adults. Youth who practice high levels of spirituality exhibit fewer dangerous behaviours (Wallace & Forman, 1998). A recent study in the United States revealed the value of religion in boosting health and lowering dangerous behaviours among students in the 12th grade. Teenagers who said that religion was important and that they actively participated in their religion yet exhibited less dangerous habits, including smoking, consuming alcohol, and having sex (Wallace & Forman, 1998). And the schools that provided more religious background added to this effect at the individual level. Additionally, this influence was enhanced at the individual level by schools that offered a stronger religious foundation. Research of adolescents in Central American nations revealed that protective variables, such as a person’s ‘belief in God’ and their parents religiosity, have an impact on lowering adolescent alcohol and drug consumption (Kliewer & Murrelle, 2007). Therefore, it would seem that an effective way to stop kids from abusing drugs is to improve parents’ spiritual well-being.

In this study, parents’ attitude (which includes positive or negative evaluation of parents about the occurrence of behaviour), were significantly correlated with their subjective norms, perceived behavioural control, and their intentions, towards their children’s addiction. The study by Zapolski et al. showed a relationship between parents’ attitudes towards drug abuse by children and children’s addiction (Zapolski et al., 2019). Parental Factors and Adolescent Smoking Behaviour, a study at the Institute of Family Studies and Child Care at the University of Nijmegen in the Netherlands, demonstrated how parental knowledge indirectly influences behaviour through attitude, self-efficacy, and subjective norms. It influences how young people start smoking (Taremian et al., 2012). Parents can take an important step to stop their kids from abusing drugs by changing their own attitudes (Hurley et al., 2019).

Subjective norms were also significantly in correlation with attitude, perceived behavioural control, and behaviour. This means that the social pressures and mental norms of parents to prevent children’s tendency to addiction are similar to their attitudes. In the study of Mohammadi Zeydi et al., in the application of the TPB in the prevention of substance abuse, the subjective norms of adolescent boys in the prevention of substance abuse before and after the intervention are high (Mohammadi Zeydi & Pakpour-Hagiagha, 2016), which can be due to the difference in the group population under study. In Tapera et al. s study, there was a strong association between having a parent or guardian, caregiver, or close friend who smoked and being a smoker. Most students (57%) stated that adults had talked to them about the harmful effects of smoking (Tapera et al., 2020). In the study of Nawi et al., maternal smoking prior to childbirth was one of the familial risk factors for teenage addiction (Nawi et al., 2021). The study by Harakeh et al. demonstrated that attitude, self-efficacy, and subjective norms are three mechanisms through which parents knowledge indirectly influences teenagers’ smoking behaviour (Harakeh et al., 2004). In the present study, strengthening this structure in parents can be an effective step in preventing children from committing drug abuse.

In the current study, parents’ perceived behavioural control about their children’s preventative behaviour was correlated with their attitude, subjective norms, and intention. This finding indicates that it is equally easy or difficult to protect children from developing addiction tendencies. Shek et al. showed the relationship between parents’ perceived behavioural control and drug abuse in their children (Shek et al., 2020). Perceived behavioural control, according to Tavousi et al.‘s research, is the best indicator of behaviour (Tavousi et al., 2009). As a result, the findings seem to support the idea that one of the most effective ways to stop kids from abusing drugs is to reinforce this structure in parents.

The parents’ intentions for their children’s behaviour in terms of addiction prevention was significantly in relationship with their behaviour and spiritual health. The behavioural intention and conduct of dads in preventing children’s propensity for addictive substances were examined in the study by Mirzaei et al. In the behavioural intention section, it was discovered that speaking correctly and logically and establishing a sincere relationship with children had higher scores, and that the structure of behavioural intention was 64.04 points away from the highest score that could be achieved (Mirzaei et al., 2013). The adoption of preventative practices by children is correlated with parents’ behavioural goals, according to numerous studies (Achuthan et al., 2022; Doherty et al., 2022). The findings thus seem to suggest that it is possible to stop kids from abusing drugs by supporting this structure in parents.

In this study, the parents’ behaviours in terms of preventing addiction was notably influence by their intentions towards it. Additionally, the average score of parents’ behaviour was between a medium and low level, according to the results. Thus, parents generally perform and behave poorly in preventing their children’s propensity for addiction. In the study by Mirzaei et al., it was also discovered that the behaviour section’s behaviour structure received 68.11% of the highest possible score (Mirzaei et al., 2013). The conduct of adolescents in the study by Mohammadi Zeydi et al. to prevent drug misuse was low prior to the intervention and average following it (Mohammadi Zeydi & Pakpour-Hagiagha, 2016). The findings thus seem to suggest that a successful step might be taken to stop kids from abusing drugs by strengthening this structure in parents.

Based on this research, it was found that there was a significant relationship between spiritual health and behavioural intention; however, no significant relationship was found between spiritual health and behaviour. Contrary to what was thought to be a significant relationship between the spiritual health of parents and their behaviour to prevent addiction in their children, it was shown in Nadimi’s research (Nadimi, 2015) that religion and religious institutions can prevent drug abuse and recovery from it. Young adults who practice high levels of spirituality have fewer dangerous behaviours (Wallace & Forman, 1998). According to a study conducted on teens in Central American nations, protective variables, such as one’s own ‘belief in God’ and their parents’ religiosity, have an impact on lowering alcohol intake and drug addiction (Kliewer & Murrelle, 2007). The self-perception of ‘religious reason’ serves as a compelling defence against partaking in abnormal behaviours like drug misuse (De Micheli & Formigoni, 2002). The findings of this study, in contrast to many others before it, showed a lack of association in this area and only a strong association between spiritual well-being and aim. This variation and lack of a link between spiritual well-being and behaviour can be traced to the period of time the research was conducted. And the differences between the study’s groups and participants, as well as any other relevant factors that might provide ideas for future research.

In this study, attitude, subjective norms, perceived behavioural control, and spiritual health had an effect on the level of intention, and the predictive power of subjective norms was higher than others. The results showed the direct predictability of spiritual health on behaviour and the direct predictability of perceived behavioural control on behaviour. In the study of Mirzaei et al. (Mirzaei et al., 2013), the results showed that the structure of behavioural intention plays an important role in the formation of preventive behaviour. In the studies based on this theory, the role of behavioural intention in predicting the desired behaviour has been mentioned many times. Therefore, the results of using the TPB and measuring the spiritual health of parents to explain and predict behaviours and parents’ prevention of children’s addiction are suggested for future studies.

Limitations

The results of the study were based on a self-report questionnaire, which suggests that more objective methods, such as observation, should be employed to gather information in future studies. This is just one of the limitations of the current study. The fact that the current study is theoretically grounded and concentrates on a vulnerable group of pupils is one of its many advantages. In some earlier studies, the TPB was only used to examine the role of parents in preventing children from becoming addicted; however, in this study, the spiritual well-being of parents was also examined, and after doing so, the role of parents in preventing children from becoming addicted was also examined. The TPB has been studied in relation to the prevention of childhood addiction.

It is advised to look into and contrast the level of spiritual health that existed in various time periods, among various people, and among various age groups, as well as the effects of the level of spiritual health and its relationship with desired behaviours in people (including healthy behaviours) or risky behaviours like alcoholism, drug addiction, sexual relations, etc. in various time periods.

Conclusion

According to the findings of the current study, parents’ perceived behavioural control, attitude, and subjective norms all have average scores, as do their scores for spiritual health. Parents’ behavioural intentions and their spiritual well-being are significantly correlated. Apart from perceived behavioural control, there is a significant association between intention and every construct of the TPB as well as a significant relationship between behaviour and every construct of the same theory. Therefore, it is recommended that future research employ the TPB to explain and forecast the importance of spiritual well-being and parental involvement in shielding kids against addiction. Additionally, the university’s health vice chancellor’s programmes for training medical students, the anti-narcotics headquarters, and the education department all recommend using this model in planning and developing effective interventions to prevent addiction among school students (in planning and education in the form of health and education plans and counselling), health education and school health units, and mental health.

Abbreviations

TPB

=

Theory of Planned Behavior

Author’s contributions

AKHJ, RZ, AK, FM and TR assisted in conceptualization and design of the study, oversaw data collection, conducted data analysis and drafted the manuscript. AKHJ and TR conceptualized and designed the study, assisted in data analysis and reviewed the manuscript. AKHJ, RZ, AK, FM and TR assisted in study conceptualization and reviewed the manuscript. All authors read and approved the final manuscript.

Ethical approval and consent to participate

Ethical approval was obtained from the Human Research Ethics Committee at the Shiraz university of medical sciences. All study participants provided written informed consent. Permission was also obtained to digitally record all interview. Confidentiality and anonymity were ensured. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analysed during the current study are publicly available from the corresponding author on reasonable request.