Attitudes, beliefs, and knowledge of substance use amongst youth in the Eastern Mediterranean region: A systematic review

•This review targets the attitudes of youth in the EMR towards substance use.•A largely negative social perception of substance use was common in all studies.•The role of religion in shaping attitudes or preventing misuse was prominent.•Poor mental health awareness is a significant contributor of the youth perception.•There is an unmet need for validated culturally sensitive assessment surveys. Substance use has a tremendous impact on the burden of disease. This is particularly true in the Eastern Mediterranean region (EMR), where many countries serve as suppliers of drugs. As risk perception and frequency of use are inversely correlated, targeting perception during adolescence becomes essential for prevention. In this study, we systematically reviewed the literature on attitudes, beliefs, and knowledge of substance use amongst youth in the EMR. We reviewed quantitative articles addressing attitudes, beliefs, and knowledge of youth aged between 13 and 25 years towards substance use in the EMR. We searched MEDLINE, PubMed, Cochrane, PsycInfo, and PsycArticles then applied a duplicate independent method for study selection and screening. Two reviewers completed data abstraction and a narrative summary of findings. Our search generated 12,810 articles. Five cross-sectional studies were eligible (two analytic and three descriptive). The analytic studies described a significant correlation between intention to use and both attitudes and subjective norms. The descriptive studies portrayed a negative attitude towards use with a low threshold for considering it as serious. Beliefs pertaining to reasons for use included stress and sleeping, whereas thoughts on treatment were restricted to traditional methods based on personal resilience and religious support. Knowledge about substance use symptoms, withdrawal, and treatment was low. Our review ascertains the role of sociocultural moral prohibition and awareness of mental health as major influencers in shaping the perception of substance use. Further research is needed to elaborate culturally-tailored survey tools.