Factors associated with anti opium attitude and opium refusal self efficacy among Iranian adults in a cross sectional study

Opium use is a persistent public health concern. Cognitive–behavioral factors, including awareness, anti-opium attitudes, and opium-refusal self-efficacy, are potentially associated with opium-related decision-making. This study aimed to assess these constructs and identify factors associated with them among Iranian adults. A total of 308 adults aged 18 years and older participated in this cross-sectional online study in Sabzevar, Iran. Participants were recruited through social media using non-probability convenience sampling. Data were collected using a validated researcher-developed questionnaire assessing demographics, awareness, anti-opium attitude, and opium-refusal self-efficacy toward opium use (Cronbach’s α: 0.76–0.85). Independent t-test/ANOVA and multivariable linear regression were used for analysis. Awareness did not differ across participant characteristics ( P > 0.05). However, opium users had significantly lower anti-opium attitudes ( P < 0.001) and opium-refusal self-efficacy ( P < 0.001) scores than non-substance users. In adjusted analyses, higher awareness and non‑use of opium were significantly associated with stronger anti-opium attitudes (Adjusted R²=0.215, P < 0.001). Opium-refusal self-efficacy was positively associated with anti-opium attitude ( B = 0.194, 95% CI: [0.13,0.25], P < 0.001) and marital status (being married), but negatively associated with current opium use and retirement (Adjusted R²=0.221, P < 0.001). Our findings suggest that opium‑use prevention strategies should not rely solely on increasing awareness of harms but also focus on strengthening anti‑opium attitudes and refusal self‑efficacy. Interventions that address permissive beliefs about opium while enhancing individuals’ confidence to refuse use may provide a more effective approach to prevention.