Knowledge, attitudes, and practices of Chinese college students towards novel psychoactive substances

This study aimed to investigate the knowledge, attitudes, and practices (KAP) among Chinese college students regarding novel psychoactive substances (NPS), where practices specifically refer to behaviors related to NPS access and usage patterns. An online questionnaire was used to collect demographic information and KAP scores from college students. A total of 1,543 participants were recruited using a combination of targeted and convenience sampling. We used a self-designed questionnaire assessing knowledge, attitudes, and practices related to the harmfulness and addictiveness of NPS. The tool demonstrated high internal consistency (Cronbach's α = 0.915). Data were analyzed using SPSS with non-parametric tests, Spearman correlations, and multivariable logistic regression. A total of 1,543 college students were enrolled, of whom 1,465 (94.9%) had received anti-drug education. The median knowledge score was 25 out of 32, and 65.4% correctly identified NPS as drug analogues with strong psychoactive effects. The median attitude score was 46 out of 50, with over 55% of students expressing strong disagreement with NPS use. In terms of practice, over 85% reported never accessing NPS through recreational venues, the Internet, or social contacts. Students older than 18 years were significantly less likely to engage in NPS-related behaviors (OR = 0.2; 95% CI: 0.12-0.34; p < 0.001). Those holding a bachelor's degree or higher also showed lower likelihood of such behaviors (OR = 0.1; 95% CI: 0.10-0.23; p < 0.001). In contrast, students with more positive attitudes towards NPS prevention (attitude score ≥ 46) were more likely to adopt preventive practices (OR = 1.9; 95% CI: 1.28-2.69; p = 0.001). Additionally, an attitude score of ≥ 46 increased the likelihood of safer practices [OR = 1.9; 95% CI: 1.28-2.69; p = 0.001]. Knowledge was positively correlated with attitudes (r = 0.20; p < 0.001), and attitudes were positively correlated with practices (r = 0.29; p < 0.001), supporting the internal consistency of the KAP model. However, the correlation between knowledge and practices was weak and negative (r =-0.05; p = 0.033), suggesting that knowledge alone may not be sufficient to promote preventive behaviors. The study shows that college students have good knowledge, attitudes, and practices regarding NPS, but highlights a need for more practical anti-drug education to improve the application of this knowledge. Not applicable.