Socio-ecological influences of adolescence marijuana use initiation: Qualitative evidence from two illicit marijuana-growing communities in South Africa

BACKGROUND: Adolescence has been identified as a critical risk period for substance use initiation, such as marijuana. Although several factors have been cited for adolescent marijuana use, those that influence initiation, especially in an African setting where illicit marijuana activities are rife, have not been contextually explored. AIM: We ascertained the factors that influence adolescent marijuana use initiation in two marijuana-growing communities in the Eastern Cape province of South Africa, based on the constructs of the socio-ecological model. SETTING: The study was conducted in two selected illicit marijuana growing communities in the Ingquza Hill Local Municipality of the Eastern Cape province of South Africa. METHODS: Focus group discussions (FGDs) were conducted among 37 participants, grouped into four focus groups. Purposive and snowball sampling techniques were used to select the communities and participants, respectively. An FGD guide was used to collect the data. The data were analysed using thematic content analysis approach and presented under various themes. RESULTS: Twelve influences of adolescent marijuana use initiation, grouped under three main levels of socio-ecological influence, personal characteristics (curiosity, shyness and fulfilment of personal need), micro-level influences (peer pressure, negative school climate, presence of marijuana in households and parental or sibling marijuana use) and macro-level influences (child labour, poverty, presence of marijuana in communities, presence of negative adult role models and breakdown in communal restrictions against marijuana use), were found. CONCLUSION: Health promotion programmes, targeting socio-ecological motives of adolescent marijuana use initiation in the two communities, should be intensified to break the cycle of adolescent marijuana use. Also, alternative livelihood schemes should be implemented in the affected communities to break the cycle of illegal marijuana cultivation that promotes adolescent marijuana use.