A qualitative study on the determinants of smoking behaviour among adolescents in South Africa

Background: Increasing adolescent smoking rates have highlighted the need for smoking cessation programmes for adolescents. Aim: The aim of this study was to explore adolescent opinions' on the determinants of smoking, with a focus on smoking cessation. Methods: Nine focus group discussions were conducted with grade 8 and 9 school-going smokers and ex-smokers in the Southern Cape Karoo Region, South Africa. Six schools were purposively selected based on their locality (urban or rural) and ethnicity ("black", "white", and "coloured"). The groups were homogenous in terms of gender and ethnicity. Data was analysed thematically. Results: The majority of the participants declared their intention to stop smoking in the future. They reported multiple quit attempts of short duration. They perceived quitting as a difficult process and that only a few of their friends wanted to stop smoking. Participants believed that they were not addicted to nicotine even though they reported nicotine withdrawal symptoms. While "coloured" and "black" participants reported their smoking peers as obstacles to quitting, their "white" counterparts emphasized that they smoked by choice and that they would support friends who wanted to stop smoking. Conclusion: This study shows that the psychosocial determinants of tobacco use may vary substantially between ethnic groups and cultural contexts. A long-term strategy of poverty reduction that would create greater perceived future prospects is an important consideration for interventions in developing countries. The manifestation of withdrawal symptoms, indicative of nicotine addiction, is a common and significant hindrance for smoking cessation among these adolescents.