Prevalence and patterns of tobacco, alcohol, and drug use among Iranian adolescents: A meta-analysis of 58 studies Alireza Ansari-Moghaddam a , Fatemeh Rakhshani a,b , Fariba Shahraki-Sanavi a, ⁎, Mahdi Mohammadi a , Mahmodreza Miri-Bonjar a , Nour-Mohammad Bakhshani a a Health Promotion Research Center, Epidemiology & Biostatistics Department, Zahedan University of Medical Sciences, Doctor Hesabi Square, Zahedan 9817667993, Iran b Shahid Beheshti University of Medical Sciences, District 1, Daneshjou Blvd., Tehran 1983963113, Iran abstract article info Article history: Received 31 May 2015 Received in revised form 22 November 2015 Accepted 22 November 2015 Available online 1 December 2015 Keywords: Smoking Drinking Drug use Adolescents Iran Adolescence is the critical age when adopting high-risk and health-threatening behaviors including smoking, drug and alcohol use is at its peak. Accordingly, this meta-analysis aimed to provide comprehensive nationwide estimates of tobacco, alcohol, and drug use among Iranian adolescents; and to compare their habits with other societies. Electronic databases, including PubMed, Medline, Embase, Google scholar and National Persian databases of SID, Magiran, and IranMedex were utilized in identifying relevant articles. The included studies were those having publications of quantitative estimates and standard errors of the prevalence of cigarette and drug use among 14–19-year-old high school students in Iran from 2000 to 2014. Random-effects meta-analyses were done in- cluding a total of 80,588 high school students. The most common drugs among adolescents in Iran were hallucinogens [25.3% (95% CI: 23.9–26.8)], sleeping pills and tranquilizers [25% (95% CI: 24–26.1)], hookah [23.1% (95% CI: 22.2–23.9)], opiates [22% (95% CI: 21.3– 22.7)] and central nervous system (CNS) stimulants [20.1% (95% CI: 19.1–21.1)]. Furthermore, overall estimates for cigarette smoking, alcohol and chewing tobacco/Pan/Nas in the participants were 16.8% (95% CI: 16.4–17.2), 14.7% (95% CI: 14.2–15.3) and 10.0% (95% CI: 8.7–11.4), respectively. However, there was some heterogeneity in the pattern of drug use across the country (P b 0.01). Additionally, the risk of smoking, drinking and drug use by boys was considerably greater than girls. Moreover, data showed a varying trend of drug use over three studied periods of time. In conclusion, a diverse pattern and trend of tobacco smoking, alcohol drinking and drug use among adolescents in Iran was verified. Therefore, preventive and control measures (i.e. education) provided in schools should be compatible with age groups, with emphasis being laid on pattern of use in different parts of the country. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction The abusive use of drugs, tobacco, cigarette, alcohol and other tradi- tional and newly emerging addictive products has become a major pub- lic health concern around the world(Aarons et al., 1999; Bauman & Phongsavan, 1999; Cuijpers, 2002; Faggiano et al., 2010; Hong, Lee, Grogan-Kaylor, & Huang, 2011). Currently, about one billion people (about one-seventh of the world's population) smoke cigarettes, and this number is anticipated to rise to 1.5–1.9 billion by 2025 (Guindon & Boisclair, 2003). Furthermore, a recent report by the United Nations Office of Drugs and Crime (UNODC) showed that 5% of the world's population used illicit drugs in 2010. This office also estimated global cost of drug abuse at 0.3%–0.4% of the worlds' gross domestic product (GDP) (Chakravarthy, Shah, & Lotfipour, 2013). Cigarettes, tobacco and alcohol are among the most common drugs used across the word, and their usage varies across different regions of the world. Interestingly, although drug abuse and smoking show a fairly stable or reducing trend in many developed countries, they are rapidly increasing in developing countries. Thus, in the next few years, the major burden of drug abuse and smoking will be imposed on these countries, which are less equipped to cope with these challenges (Hickman et al., 2014; Melotti et al., 2011; Mesic et al., 2013; Moeini, Poorolajal, & Gharghani, 2012; Rajabizadeh et al., 2011). On the contrary, studies suggest that the habits and eventually the addiction to smoking by many adults begin in adolescence. Consequent- ly, the age range of 10–20 years is very crucial and plays a determinant role in adopting high-risk and health-threatening behaviors. Generally, the first adolescence years is characterized with biological, cognitive, so- cial and emotional changes which affect the choice of behavior. During this stage, more time is spent outside academic setting and home with Children and Youth Services Review 60 (2016) 68–79 ⁎ Corresponding author. E-mail addresses: ansaryalireza@yahoo.com (A. Ansari-Moghaddam), rakhshanif@gmail.com (F. Rakhshani), faribasanavi@gmail.com (F. Shahraki-Sanavi), memohammadi@yahoo.com (M. Mohammadi), m.miribonjar@gmail.com (M. Miri-Bonjar), nmbs14@yahoo.com (N.-M. Bakhshani). http://dx.doi.org/10.1016/j.childyouth.2015.11.018 0190-7409/© 2015 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth