From Knowledge to Attitude: Design and Initial Validation of Scales for Assessing Psychoactive Substance Consumption Among University Students

Riwa Kfoury^1,2,3*Pascale Salameh^4,5,6,7Helene Peyriere^1,8

• ¹Pathogenesis and Control of Chronic and Emerging Infections, Montpellier, France
• ²School of Medicine, Saint George University of Beirut, Beirut, Lebanon
• ³School of Pharmacy, Lebanese International University, Beirut, Lebanon
• ⁴School of Pharmacy, Universite Libanaise, Beirut, Lebanon
• ⁵Institut National de Sante Publique d'Epidemiologie Clinique et de Toxicologie, Beirut, Lebanon
• ⁶University of Nicosia Medical School, Nicosia, Cyprus
• ⁷School of Medicine, Lebanese American University - Byblos Campus, Byblos, Lebanon
• ⁸Medical Pharmacology, and Toxicology Department, Universite de Montpellier, Montpellier, France

Background: The misuse of psychoactive substances among university students has emerged as a pressing public health issue, particularly in Lebanon, where research on this phenomenon is limited. This study aimed to develop and validate scales that assess knowledge and attitudes towards Psychoactive Substance Consumption (PSC), evaluate their psychometric properties, identify factors associated with these scores, and explore the relationship between knowledge, attitudes, and PSC among university students. Methods: This cross-sectional study surveyed 414 university students from 29 institutions across Lebanon during the 2023-2024 academic year using an anonymous self-administered questionnaire. Participants were recruited via email from three prominent universities with initial Institutional Review Board (IRB) approval, and the sample was expanded through snowballing due to IRB challenges caused by economic and political crises. Exploratory Factor Analysis (EFA) was performed using SPSS to evaluate construct validity, and reliability was assessed by calculating Cronbach's alpha. Results: EFA identified two factors for the knowledge scale with eigenvalues over 1, explaining 51.4% of the variance. The model demonstrated adequacy, with a Kaiser-Meyer-Olkin (KMO) measure of 0.864, a significant Bartlett's test of sphericity, and a high reliability (Cronbach's alpha = 0.829). Similarly, the attitude scale items converged over two factors, explaining 58.8% of the variance, with a KMO of 0.850, a significant Bartlett's test of sphericity, and good reliability (Cronbach's alpha = 0.826). The study found that greater knowledge was associated with students who had higher grades and those who were aware of the availability of psychoactive substances in nasal inhalation form. However, knowledge showed no significant correlation with attitudes (r = -0.027, p = 0.583). The multivariate analysis identified several predictors influencing knowledge and attitudes towards PSC, including academic year, financial status changes, presence of mental illness, and family history of substance-related issues. Conclusions: The scales developed in this study demonstrated strong reliability and validity, positioning them as effective tools for assessing knowledge and attitudes associated with psychoactive substance consumption among university students. The multivariate results underscore the impact of academic, socioeconomic, and mental health factors, suggesting the need for interventions that specifically address these determinants.