Cultural Intervention Strategies for Substance Use Prevention: A Social-Ecological Model for Iranian University Students

Abstract

This study aimed to identify and explain the components and levels of culturally informed intervention strategies for preventing substance use among Iranian university students within a social-ecological framework. This qualitative study employed thematic analysis. Participants were 11 key informants, including psychology faculty members, university counseling center staff, university administrators, and behavioral science researchers, who were recruited through purposive snowball sampling until data saturation was reached. Data were collected through semi-structured interviews lasting approximately 20–40 minutes. The interviews were transcribed, coded, and analyzed according to the social-ecological framework. Expert review and peer debriefing were also used to enhance the credibility of the extracted themes. The thematic analysis yielded four overarching themes, seven organizing themes, and eleven basic themes. The four overarching intervention levels were individual, interpersonal, university-community, and societal. Individual-level strategies emphasized coping skills, stress management, self-regulation, self-esteem enhancement, and modification of attitudes toward substance use. Interpersonal strategies included effective parental monitoring, family and peer support, participation in health-promoting student groups, and constructive group activities. At the university-community level, cultural festivals promoting substance-free lifestyles and the use of student and university media for prevention messaging emerged as central strategies. At the societal level, television, radio, and broader media campaigns designed to normalize substance-free lifestyles were identified. Favorable socioeconomic conditions and an adequate standard of living also emerged as contextual prerequisites that could strengthen the effectiveness and sustainability of cultural prevention programs. Effective substance use prevention among university students requires a coordinated multilevel approach that simultaneously addresses individual competencies, family and peer relationships, the university environment, broader social norms, and supportive socioeconomic conditions.