THE ASSOCIATION OF ADOLESCENT SMOKING WITH STRESS AND COPING IN PRETORIA HIGH SCHOOLS: A QUALITATIVE STUDY
Oscar Reno O’Hara
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Public Health (Health Policy and Management). Johannesburg, 2008.
DECLARATION I declare that this research report is my own unaided work. It is being submitted for the degree of Master of Public Health at the University of the Witwatersrand, Johannesburg. It has not been submitted for any other degree at Wits, nor at any other university, before. I have not fabricated data or falsified results and no portions or elements of another person’s work have been taken as my own. Credits accurately reflect the individuals, organizations and/or institutions concerned.
………………………………………………………… 16th September ………..day of……………………..2008
To all the youth and the children of the universe…preserve and celebrate your natural gift of youthfulness, strength and good health. As the days unfold on your life’s journey, remember that the world is waiting for you to bring fourth all that you are, in the way that only you can. You hold the key to your own destiny and you hold a promise for a healthier generation and planet- a better future for yourself and your own children.
ABSTRACT 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 substances4 reported sensation seeking,...