Abstract:
The ongoing public health crisis of substance use among school adolescents and young
adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug
abuse management in schools. In view of no tangible progress to reduce substance use in high schools
in the country, we conducted a cross-sectional quantitative study aimed at investigating substance
use among adolescents and young adults in the four public high schools selected through multistage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics,
household socio-demographics, and related factors were collected via a validated self-administered
questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included
402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the
last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%)
and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to
eliminate stress, especially in social events, on the streets, and at home, and reported negative
physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths.
Hierarchical logistic regression showed that the likelihood of substance use was three times in a
particular high school (S4) (AOR = 3.93, 95%CI: 1.72–8.99), twice among the grade 12s (AOR = 2.73,
95%CI: 1.46–5.11), over twenty times in the communities with substance availability (AOR = 22.45,
95%CI: 2.75–183.56), almost ten times among AYAs participating in recreational/sports activities
(AOR = 9.74, 95%CI: 4.21–22.52), and twice likely to happen in larger households (AOR = 2.96,
95%CI: 1.57–5.58). Prevention and intervention efforts should consider these specific health concerns
to develop targeted strategies for mitigating substance use and its adverse consequences in this
vulnerable population towards achieving the United Nations’ Sustainable Development Goal Target
3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic
drug abuse and the harmful use of alcohol.
