Adolescent substance use is associated with a number of pressing problems on the public health agenda, including an increased risk of contracting sexually transmitted diseases, teenage pregnancy, violence-related injuries, depression, homicide, sexual assault, and accidental death. Teenage substance use remains high in South Africa, with a prevalence of smoking and alcohol binge-drinking estimated at 18.5% and 23% respectively. A previous quantitative cross-sectional analysis of data from a study cohort from which this study’s sample was drawn, demonstrated an association between adolescents’ sense of coherence (SOC) – a measure of coping ability – and smoking. The current study, using a qualitative approach, thus sought to gain more insight into adolescent substance use, particularly smoking, and to better understand how it may relate to coping. A mixed method sampling strategy was used in selecting 22 research participants between the ages of 16 and 19 in two high schools in Pretoria. They were then interviewed individually by an interviewer blinded to their SOC level and substance use status as documented in the quantitative survey in which this study builds on. The interviews were transcribed in full and a content analysis strategy was used in the analysis of the data. The results obtained were then merged with participants’ substance use status and SOC levels. Of the 22 participants, 6 had strong SOC and had never used substances; 8 had weak SOC and were current substance users. The other 8 also had weak SOC but were not current substance users. Further analysis of the results showed that adolescents’ substance use is associated with stress and coping as they (substance users) reported using substances in attempting to manage stressful life events. Of the 8 current substance users, 7 reported avoidance-oriented (disengagement) coping styles. Five of the 7 reported load imbalance such as academic and social pressures and distress (e.g. schoolwork overload, peer demands, and family problems) as a reason for using substances. The non-substance using adolescents with weak SOC reported strong social support, especially family and peer support in coping with life stressors. Hence, substances were more likely to make up for compromised coping where contextuallevel risk factors (demands/stressors) exceeded coping resources such as social support. Also, of the 8 substance users- in addition to stress related reasons for using substances- 4 reported sensation seeking, whilst 2 reported curiosity/experimentation- which are all non-stress related. Furthermore, although family and peer support were observed to be complementary in most cases, the reliance on peers for support was stronger amongst those whom family support was considered weak, which presented the context for social/peer pressure and vulnerability to substance use. The study findings suggest family support as a moderator of the influence of the adolescents’ inability to cope with stress (or have low SOC) on smoking behaviour. On the other hand, a close relationship was observed between strong SOC and using engagement coping responses and reporting family and school support as sources of support. Notably, all the participants with strong SOC reported that they had never used substances despite being equally affected by life stressors. The implications of the findings are also discussed, especially as related to enhancing SOC. More practically, in addition to providing life skills training to educate adolescents about substance use, school-based programmes could incorporate the notion of stress and coping in helping adolescents to develop desirable and effective coping strategies to deal with social demands as well as adopting advantageous lifestyles to meet their needs for stimulation and adventure (sensation seeking and experimentation). On the whole, the enhancement of social support and adolescents’ connectedness to various social systems may be the key to substance use prevention among South African adolescents.

Youth smoking is an important aspect of tobacco research as most adult smokers first experiment with and initiate tobacco use during their adolescence. Policy makers and researchers have given youth smoking issues a significant amount of attention over the last 20 years and this has led to significant reductions in youth smoking prevalence in New Zealand. More recently the decline in youth smoking prevalence has reached a plateau. Evidence now shows that while overall smoking prevalence has reduced, inequalities between ethnic and social groups has actually increased. This is an international trend. Young people living in low socioeconomic status areas and belonging to minority ethnic groups are at much higher risk of being a current smoker than their less deprived peers. A number of overseas studies have investigated the spatial relationship between aspects of the neighbourhood environment and adolescent smoking behaviour in an attempt to identify the most at risk groups. In particular the effect of neighbourhood socioeconomic status and the degree of access to tobacco outlets is believed to influence adolescent smoking behaviour. In New Zealand analysis of this type has mainly focused on adult smoking behaviour and the effect of tobacco outlet access is as yet unstudied. This study examines the effect of neighbourhood and high school socioeconomic status on adolescent smoking behaviour, attitudes and beliefs in Christchurch. Using information from the 2006 New Zealand Census, spatial variations in reported neighbourhood smoking prevalence have been examined. In addition, analysis of responses to smoking questions in the 2008 Year 10 In-depth Survey have been carried out show how school socioeconomic status can influence underlying attitudes and beliefs young people hold towards smoking and tobacco products. Spatial analysis has also been performed on the census dataset to investigate the relationship between neighbourhood access to tobacco outlets and youth smoking behaviour after controlling for neighbourhood deprivation. To supplement each of these quantitative data sources, focus group interviews were carried out at two high schools (one low and one high socioeconomic status). Findings from these interviews are presented as further insight into adolescent attitudes and beliefs towards smoking. Results of this research show that there is a socioeconomic effect at both a neighbourhood and school level on all adolescent smoking behaviours, attitudes and beliefs examined, except for smoking cessation. There is also evidence of greater access to tobacco outlets in low socioeconomic neighbourhoods but not so around high schools. Increased access to tobacco outlets is linked to increased adolescent smoking prevalence, more so among females than males, but this relationship disappeared in age groups 20 and above.

Tobacco use and the associated health risks are a major public health concern. Research suggests that parents’ own tobacco use, caregiver-adolescent antismoking communication, and parenting practices (e.g., prompting, parental monitoring) may work to influence adolescents’ tobacco-related attitudes and behavioral outcomes (e.g., refusal efficacy, intentions to use and actual use). Although historically African American adolescents have exhibited lower rates of tobacco use than their racial/ethnic counterparts, there is growing evidence to suggest that this may be changing because of increased use of tobacco products and/or underreporting of the use of alternative tobacco products or ATPs (e.g., cigars, cigarillos), among this population. The present study recruited a community-based sample of 101 urban African American caregivers that smoke (M = 41.1/SD = 9.9), and their adolescents between the ages of 12-17 (M = 14.4/SD = 1.9) to examine how caregiver tobacco-related messages (both verbal and non-verbal) shape adolescents’ tobacco attitudes, and behaviors. Dyads completed paper-pencil surveys separately and were compensated for their time and effort. A majority of the caregivers were single and living in low-income and public housing communities. Results from the analyses revealed high rates of adolescent tobacco use (lifetime) of both cigarettes and alternative tobacco products, and prompting (e.g., caregivers’ request that adolescents retrieve, buy, or smoke tobacco products with them). The findings also showed that all of the caregiver variables including: prompting, monitoring, as well as caregiver antismoking messages together impacted adolescents’ tobacco-related outcomes including their attitudes about tobacco, refusal efficacy and their intentions to use (at six months and adulthood), and their actual use. These findings underscore the need for more tobacco education that includes not only adolescents, but also parents, and other important caregivers (e.g., extended kin/family members) that helps increases knowledge surrounding the dangers of parental prompting, the importance of parental monitoring of youths whereabouts and peers, as well as parent-adolescent antismoking communication in reducing the prevalence of adolescent smoking/tobacco use (including the use of ATPs). This study also highlights the need for tobacco control and policies that limit adolescents’ exposure and access to tobacco products particularly among African Americans living in disadvantaged neighborhoods.