Developmental Assets in South African Adolescents Exposed to Violence: a Qualitative Study on Resilience.

Violence exposure is associated with psychological and behavioural maladjustment in adolescents. Yet, not all adolescents exposed to violence experience negative symptoms. Resilience is an outcome that is in part determined by multiple protective factors, or developmental assets, that protect adolescents from the negative influence of encountered stressors and allow them to attain positive developmental outcomes. A qualitative study was conducted to acquire an in-depth understanding of the developmental assets across different layers in the ecological system that promote positive psychological and behavioural functioning in South African adolescents exposed to violence. Semi-structured individual interviews were conducted with a multi-ethnic group (black, white, and people of mixed heritage) of South African adolescents (boy: n = 17; girl: n = 13; age: 14-19 years) from seven schools in Cape Town. Adolescents reported both internal and external assets that helped them adaptively cope with violence exposure. The internal assets entailed individual characteristics and skills, including commitment to learning, positive values, positive identity, social competencies, and emotional insight. The external assets were boundaries and expectations, social support from adolescents' peers, family, school, and community, and adolescents' constructive use of time. The findings of the study may inform strengths-based interventions to enhance emotional and behavioural skills in adolescents at risk for violence exposure. Moreover, involving key stakeholders in the interventions from major developmental domains can be particularly helpful to optimise the social support that are needed for adolescents to be resilient.

Violence Exposure in South African Adolescents: Differential and Cumulative Effects on Psychological Functioning.

This study examined the associations between different types of violence victimization and psychological functioning in South African adolescents. Both differential and cumulative effects of violence were investigated. A multi-ethnic (Black, White, people of mixed heritage, and people of Indian/Asian descent) sample of adolescents in secondary schools in the Western Cape Province (N = 1,574; boys = 46.5%, girls = 53.5%; Mage = 16 years) completed a survey on their experiences of exposure to violence (across different contexts and polyvictimization) and their levels of hopelessness, anxiety, depression, perceived stress, and suicidal ideation. The results showed that indirect and direct victimization in the community, and indirect political victimization were consistent predictors for adverse psychological functioning, whereas victimization in home and school contexts did not emerge to be significant. Polyvictimization had a consistent linear effect on psychological symptoms. Interventions in South Africa should focus on addressing the psychological effects of community and political victimization on adolescents. Adopting a holistic treatment approach would be useful to gain a comprehensive understanding of adolescents' victimization experiences and maximize the impact of support to enhance their psychological functioning.

Social network determinants of alcohol and tobacco use: A qualitative study among out of school youth in South Africa.

An important determinant of alcohol and tobacco use is the adolescent's social network, which has not been explored among out of school youth (OSY). OSY are adolescents not currently enrolled in school and have not completed their schooling. This study aims to qualitatively understand how OSY's social networks support or constrain alcohol and tobacco use. Respondent-driven sampling was used to select 41 OSY (aged 13-20 years) for individual in-depth interviews in a South African urban area. The data were analysed using content analysis. Smoking and drinking friends, family close in age to OSY that drank and smoked, and lack of parental support were associated with alcohol and tobacco use among OSY. Household norms, romantic partners and non-smoking or non-drinking friends were suggested to mitigate alcohol and tobacco use. Understanding how the social network of OSY plays a role in alcohol and tobacco use is useful for gaining an insight into the profile of OSY at risk for alcohol and tobacco use. Registration of OSY youth and community-based peer led programmes that include influential OSY family and friends could be beneficial.

Violence typologies and sociodemographic correlates in South African adolescents: a three-wave cross-sectional study.

BACKGROUND: Violence victimisation and violence perpetration may co-occur in adolescents. Understanding the sociodemographic correlates of the independent and joint profiles of victimisation and perpetration may inform preventive interventions. This study examined the associations of sociodemographic factors with four violence typologies, namely, 1) non-involvement in both victimisation and perpetration, 2) victims only, 3) perpetrators only, and 4) victim-perpetrators. Trends in the prevalence of the four violence typologies over the three survey years were also examined. METHODS: We used data from the three nationally representative South African Youth Risk Behaviour Surveys conducted in 2002, 2008, and 2011 and included a multi-ethnic sample of adolescents (n = 30,007; boy: 46.9%, girls: 53.1%; M age = 16 years, SD = .06). RESULTS: The sample consisted of 8030 (30.8%) adolescents who had non-involvement in both victimisation and perpetration, 8217 were victims only (29.8%), 2504 were perpetrators only (9.0%), and 7776 were victim-perpetrators (24.6%). Logistic regression analyses showed that being a girl increased the odds of non-involvement (OR: 1.47, 99% CI: 1.36-1.58) and being victims only (OR: 1.90, 99% CI: 1.76-2.05). Being a boy increased the odds of being perpetrators only (OR: 0.42, 99% CI: 0.37-0.47) and victim-perpetrators (OR: 0.51, 99% CI: 0.47-0.55). Adolescents who did not have an absent mother had higher odds of non-involvement (OR: 0.78, 99% CI: 0.62-0.97). Lower monthly allowance increased the odds of victimisation only (OR: 0.99, 99% CI: 0.97-1.00), whereas higher monthly allowance increased the odds of perpetration only (OR: 1.05, 99% CI: 1.03-1.08). Trend analysis showed that between 2002 to 2011, there was an increase in the prevalence of non-involvement in adolescents (p < .001), a decrease in the prevalence of victims only (p < .05) and victim-perpetrators (p < .001), and no changes in the prevalence of perpetrators only (p > .05). CONCLUSIONS: Sociodemographic factors are uniquely associated with different violence typologies suggesting the need for tailored interventions to target adolescents with differed risks to violence victimisation and perpetration. Strengthening family relations, particularly between mother and child, may protect adolescents from the experiences of victimisation and perpetration.

Exposure to violence across multiple contexts and health risk behaviours in South African adolescents: the moderating role of emotion dysregulation.

Objective: The association between violence exposure and health risk behaviours in South African adolescents, and the moderating role of emotion dysregulation were investigated. Design: A multi-ethnic sample of adolescents (N = 925: boy: 47.3%, girl: 52.7%, M age = 16 years, SD = 1.54) completed a survey. Main outcome measures: Violence exposure across different contexts (home-, school-, community-, political victimisation), emotion dysregulation (inability to regulate sadness and anger) and a composite measure of health risk behaviours (smoking, substance use, risky sexual behaviour) were examined. Results: Boys reported more risk behaviours than girls, t (844) = 5.25, p < 0.001. Direct community victimisation was a predictor for boys' risk behaviours, B = 0.22, p < 0.001. Indirect school victimisation and direct community victimisation were predictors for girls' risk behaviours, B's = 0.19, p's < 0.01. Girls reported higher emotion dysregulation than boys, t (748) = -2.95, p < 0.01. Only for girls, emotion dysregulation moderated the associations of indirect home victimisation, B = 16, p < 0.01, and direct community victimisation, B = 15, p < 0.05, with risk behaviours. Conclusion: Interventions may target emotion regulation skills, particularly for girls, to enhance resilience to the negative effects of violence on behaviours.

Cigarette smoking and reasons for leaving school among school dropouts in South Africa.

BACKGROUND: School dropouts are at heightened risk of tobacco use compared to in-school learners. School dropouts are described as those not currently enrolled in school for the academic year, have not completed their schooling, and are between 13 and 20 years old. This paper examines the relationship between reasons for leaving school and past month cigarette smoking, taking into account gender differences. METHODS: Multiple logistic regression was used to analyse survey data (n = 4185). Geographical location was also incorporated into the analysis as effect moderators. RESULTS: Although no significant main effects between reasons for leaving school and tobacco use were found, results showed that those who leave school early smoke more. When examining interaction effects with gender, leaving school due to 'not being able to pay for school fees' was significantly associated with smoking, but only among girls residing in urban areas (OR = 0.327, p = .023). CONCLUSIONS: More research is needed to understand why learners leave school and their subsequent tobacco use. This knowledge will help researchers identify and target those students that are at risk for dropping out of school and using tobacco.

Intimate Partner Violence and Its Association With Self-Determination Needs and Gender-Power Constructs Among Rural South African Women.

This study aimed to identify psychosocial correlates of intimate partner violence (IPV) by using constructs derived from the self-determination theory (SDT) and gender-power scales. Cross-sectional data (N = 238) were collected from women in the Eastern Cape, South Africa, and were used to test a structural equation model (SEM). The majority (87%) of the participants reported having sexual partners in the past 3 months, and in terms of IPV victimization, 36% and 26% of women had ever experienced verbal and physical abuse, respectively. Bivariate correlations showed that autonomy and beliefs about gender equality (BGE) were strongly associated with IPV. This finding was also confirmed in the SEM analysis, which indicated that autonomy had a direct effect on IPV suggesting that women who are in relationships that allow them to make decisions along with their partners possibly experience less IPV. In addition BGE, which was hypothesized to play a mediating role showed a significant direct association with IPV, suggesting that women who are aware of their rights may experience less IPV by choosing partners who do not espouse hegemonic masculinities or strong patriarchal beliefs. Our findings suggest that it would be important to incorporate decision-making skills and human rights awareness in future community-based sexual health and reproductive rights interventions.

Understanding the role played by parents, culture and the school curriculum in socializing young women on sexual health issues in rural South African communities.

BACKGROUND: the decline in South Africa's HIV infection rates especially among young women is encouraging. However, studies show that the 15-24-year-old cohort remains vulnerable. As they still report early sexual debut, being involved in sexual partnerships with older men as well as having unprotected sex. These risky sexual behaviors may be linked to factors such as the parent-child sexual health communication and the timing of the first talk. The quality of sexual health information received in school may also be important for enhancing healthier sexual behaviors. AIMS AND OBJECTIVES: to investigate the what, when and how sexual health communication occurs in rural South African families and to determine whether such communication patterns have changed over time. We also wanted to get an in-depth understanding of the roles played by culture, sexual health education and peers in the socialization of young women on sexual matters. METHODS: a purposive sample of (n = 55) women who were 18-35 years old was selected and interviewed in focus group discussions (FGDs). RESULTS: the FGD findings show that parent-child communication on sexual matters in rural communities is limited to messages that warn against pregnancy. It is also laden with cultural idioms that are not well explained. The school sexual health curriculum also fails to adequately equip adolescents to make informed decisions regarding sexual matters. All this seems to leave room for reception of misguided information from peers. CONCLUSIONS: findings highlight a need for designing interventions that can create awareness for parents on the current developmental needs and sexual behavior of adolescents. For adolescents programs would need to focus on providing skills on personal responsibility, and how to change behavior to enhance sexual health.

High school suicide in South Africa: teachers' knowledge, views and training needs.

BACKGROUND: Suicidal ideation and attempted suicide are a huge problem in South Africa, especially in the rural areas. Previous research has emphasized the importance of the ability of school professionals to identify young people who are at risk of committing suicide. The objectives of this study were to assess the knowledge of teachers with regard to identifying the warning signs of suicidal behaviour, assessing the type of information they give to students in the class after a suicide of one of their class mates, and assessing their views and training needs on the prevention of suicidal behaviour in students. METHODS: Five focus group discussions were conducted with 50 high school teachers in Limpopo Province, South Africa. All focus group discussions were audio-taped, transcribed verbatim, and then analysed using an inductive approach. RESULTS: The results demonstrate that teachers lack knowledge of the warning signs of suicidal behaviour among students. They also report that they do not know how to support students in the event of attempted or completed suicide of another student. The school curriculum is perceived as lacking information on suicide and suicidal behaviour. CONCLUSIONS: Teachers in Limpopo Province need to be trained to identify students at risk, and to respond to situations by referring individuals at risk to appropriate mental health professionals. School-based suicide prevention programmes that are based on theory and evidence should be developed. These programmes should include teacher training to help teachers to identify symptoms of psychosocial problems that might lead to suicide, develop their skills in handling such problems, and help students to cope with their emotions after a suicide incident in the class or at school.

Self-determination and gender-power relations as predictors of condom use self-efficacy among South African women.

This article identifies correlates of condom use self-efficacy using concepts from self-determination theory and gender-power measures. A cross-section of Xhosa-speaking women (n = 238) from Eastern Cape, South Africa, was used to conduct bivariate correlations and multivariate linear regression analyses. Gender equality beliefs and HIV knowledge were positively associated with condom use self-efficacy generally and in risky situations. Condom use self-efficacy generally was also positively associated with power balance attitudes, negative beliefs about intimate partner violence, and positive growth perspective, while the association with hopeless personal perspective was negative. Surprisingly, lack of social support was positively associated with condom use self-efficacy in risky situations. The predictors of condom use self-efficacy identified in this study that may serve as change objectives for future sexual health promotion interventions.

High school students' knowledge and experience with a peer who committed or attempted suicide: a focus group study.

BACKGROUND: Suicide is a major public health problem for adolescents in South Africa, and also affects those associated with them. Peers become more important during adolescence and can be a significant source of social support. Because peers may be the first to notice psychological problems among each other, the present study's objectives were to assess students' knowledge about suicide, perceived risk factors, signs of poor mental health in adolescents who committed suicide, students' awareness of available mental health care and resources, and beliefs about prevention. METHODS: This qualitative study used focus group discussions to elicit the thoughts and feelings of high school students who had a peer who committed or attempted suicide. Peers and class mates of suicide attempters and suicide completers were identified with the help of a social worker and school management and were invited to participate. All focus group discussions were audio taped and analyzed. A total of 56 adolescents (13-19 years of age) from Limpopo schools in South Africa participated in six focus group discussions. The data were analyzed by NVivo version 8, using an inductive approach. RESULTS: Participants reported to be affected by the suicide attempt or completed suicide. They felt guilty about their failure to identify and prevent the suicide and displayed little knowledge of warning signs for suicidal behaviour. They identified several risk factors for the suicide of their peers, such as poor relationship issues, teenage pregnancy, punishment, and attention seeking behaviour. Resources for students with mental health problems and survivors of suicide attempts were not perceived to be available at schools and elsewhere. CONCLUSION: School-based suicide prevention programs based on theory and evidence are necessary. Such interventions should also focus on detection of mental health problems by peers. Counseling services for students with mental health problems and suicide survivors should be available and made known to students at risk and peers.

Prevalence and correlates of smokeless tobacco use among grade 8-11 school students in South Africa: a nationwide study.

INTRODUCTION: Smokeless tobacco in South Africa is commonly used in the form of snuff or chewing tobacco. This paper reports its use among secondary school students and provides evidence of its association with demographic characteristics, tobacco smoking, and socioeconomic status. METHODS: Data were derived from a nationally representative study conducted in 2008 among 10,270 grade 8-11 students from 192 schools in South Africa. Data were collected with self-administered questionnaires. Multiple logistic regression analyses were used to examine correlates of past-month smokeless tobacco use. RESULTS: Nationally, 12.4% of students used smokeless tobacco such as chewing tobacco or snuff in the month preceding the survey, with significantly higher rates among males (13.6%) than females (10.6%). Smokeless tobacco use differed between racial groups, with African (12.8%) and colored (11.7%) students having the highest rates of past-month use. Grade 8 students (15.3%) reported significantly higher rates of use than grade 11 students (9.1%). Current cigarette smokers (21.3%) reported a higher prevalence of smokeless tobacco use than noncurrent smokers (10.1%). Logistic regression of past-month smokeless tobacco use showed significant associations with race, grade, school socioeconomic level, urbanicity, current cigarette smoking, and having first smoked a cigarette before the age of 10 years. CONCLUSIONS: These findings provide evidence for policy makers and program developers to develop targeted and tailored interventions for young people regarding smokeless tobacco use.

Psychosocial correlates of suicidal ideation in rural South African adolescents.

Suicide is a prevalent problem among young people in Southern Africa, but prevention programs are largely absent. This survey aimed to identify the behavioral and psychosocial correlates of suicidal ideation among adolescents in Limpopo. A two-stage cluster sample design was used to establish a representative sample of 591 adolescents. Bivariate correlations and multiple linear regression analyses were conducted. Findings show that suicidal ideation is prevalent among adolescents. The psychosocial factors perceived social support and negative feelings about the family and the behavioral factors forced sexual intercourse and physical violence by the partner were found to increase the risk of suicidal ideation. Depression mediated the relationship between these psychosocial and behavioral risk factors and suicidal ideation. This study increased our understanding of the psychosocial and behavioral predictors of adolescent suicidal ideation. The findings provide target points for future intervention programs and call for supportive structures to assist adolescents with suicidal ideation.

Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys.

BACKGROUND: Attempted and completed suicide constitute a major public health problem among young people world-wide, including South Africa (SA). Suicide attempt and completed suicide increase during the adolescent period. One in 5 adolescents considers attempting suicide, but statistics are frequently unreliable. METHODS: Data for this study were derived from the 2002 and 2008 South African Youth Risk Behaviour Surveys (YRBS). The study population comprised grades 8, 9, 10 and 11 students in governmental schools in the nine provinces of SA (N = 10,699 in 2002 and 10,270 in 2008). Key outcome measures were suicide ideation and suicide attempts. RESULTS: Of the total sample, 18% of the students in 2002 and 19% in 2008 reported to have seriously considered and/or made a plan to commit suicide during the past six months (Suicide ideation), whereas 18.5% of students in 2002 and 21.8% in 2008 reported that they had attempted suicide at least 1 time during the past six months. On both suicide measures girls have higher prevalence scores than boys, and older school learners score higher than younger learners. In addition, 32% of the learners reported feelings of sadness or hopelessness. These feelings contributed significantly to the explanation of suicide ideation and suicide attempt next to being the victim or actor in violent acts and illegal substance use. CONCLUSION: The prevalence of suicide ideation and suicide attempts among South African adolescents is high and seems to be influenced by a wide spectrum of factors at the demographic, psychological and behavioural level. Hence, more research is needed to determine the behavioural and psychological determinants of suicide among youngsters in order to develop comprehensive intervention strategies for suicide prevention and care.

Psychosocial correlates of condom use consistency among Isixhosa-speaking women living with HIV in the Western Cape Province of South Africa.

Many HIV-positive South African women continue to have unprotected sex. The aim of this cross-sectional study was to assess correlates of condom use consistency among Xhosa-speaking HIV-positive women in South Africa. One hundred and twenty women were recruited from five primary care clinics and completed a questionnaire. Regression analyses indicated that assertive negotiation and self efficacy for condom use were proximal correlates of condom use consistency. Mediation analyses showed that self-efficacy for assertive negotiation is a distal correlate of condom use consistency.We propose a framework of correlates of condom use consistency to inform future intervention development.

Condom use promotion among isiXhosa speaking women living with HIV in the Western Cape Province, South Africa: a pilot study.

The prevalence of HIV infection continues to increase among women in South Africa while there are few interventions specifically targeting condom use promotion in this population. We report the results of an experimental pilot study of a health education intervention aimed at enhancing coping skills and consistent condom use among HIV-positive women attending primary health clinics in the Western Cape province of South Africa. One hundred and twenty women were randomised into the intervention condition or a control condition. Both groups completed an interviewer administered questionnaire that included measures of self-esteem, attitude towards condom use, and self-efficacy towards condom use and negotiating condom use, and provided vaginal swab specimen at baseline and three months after the intervention. Tests for intervention effects at three months while controlling for baseline revealed that only self-esteem was significantly higher in the intervention group relative to the control group. No significant differences were found on measures of coping skills and condom use behaviour. Importantly, incidence for Chlamydia Trachomatis, Neisseria Gonorrhea and Trichomona vaginalis during the study period were significantly lower in the intervention group than the control group. These results are strong indications that this intervention could serve as a basis for the development of potentially effective interventions to reduce STI-related sexual risk behaviours among HIV-positive black women in South Africa.

Longitudinal association of smoking-related attitude to oral health with adolescents' smoking onset.

OBJECTIVE: The negative oral health effects of smoking, such as stained teeth, gum infection, and bad breath may be more salient to adolescents, and therefore, more important expectancies for adolescent smokers and nonsmokers alike. Informed by the social cognitive theory, this prospective study sought to determine the role of smoking-related attitude to oral health on smoking onset among adolescents over a 12-month interval. METHOD: This prospective study involved a community sample of 422 nonsmoking eighth graders selected from three public schools in the capital city of South Africa. Data were collected through a questionnaire, which included a 5-point Likert-scale-type question on dental disease belief related to smoking (smoking causes plaque and bad breath) and an affective evaluation of this effect (bad breath causes peer rejection). The product of these two later variables was used to compute an attitude score. Higher scores represent a more favorable oral health attitude. Health-risk behaviors recorded included past month smoking and alcohol use. RESULTS: The mean age of the participants was 13.9 years at baseline. At 1-year follow-up, 11.4 percent (n = 48) of nonsmokers at baseline had initiated smoking. Compared to nonsmokers, current smokers were more likely to report frequent bleeding gums (51.2 versus 33.1 percent; P = 0.02), but there was no significant difference in proportions brushing twice daily (64.4 versus 56.5 percent; P = 0.30). In addition to the independent influence of peers and binge drinking, smoking-related attitude to oral health significantly influenced smoking onset. CONCLUSION: The study findings support the development of smoking prevention programs that include restructuring of cognitions about the oral health outcomes of smoking.

Longitudinal association of adolescents' sense of coherence with tooth-brushing using an integrated behaviour change model.

OBJECTIVE: To determine the association between adolescents' sense of coherence (SOC) and their tooth-brushing behaviour. METHODS: This 18-month longitudinal study involved a representative sample of 8th-graders (n = 1025) from 11 randomly selected public high schools in the Limpopo Province, South Africa. Data collected by means of a self-administered questionnaire included respondents' socio-demographic profiles, vulnerability to depression, smoking status, dental treatment attendance pattern, frequency of and motivation for tooth-brushing. Based on the responses to the question on readiness to change brushing behaviour and in line with the integrated change model, respondents were also categorized as being in the pre-contemplation, contemplation or preparation/action stages. Respondents' SOC was measured using a six-item adapted Antonovsky SOC scale. Data analysis included chi-squared analysis, t-tests and step-wise multiple logistic regression. RESULTS: At baseline, 72.6% (n = 744) of the respondents reported that they were not consistently brushing twice daily. Of those who did not brush twice daily and were followed up on (n = 578), those living with their mother at baseline not only presented with a greater increase in their SOC over time (follow-up minus baseline), but they were also more likely to be brushing twice daily at the time of the follow-up (15.4% versus 10.6%; P = 0.04). Adding baseline intention state to a multivariate model attenuated the influence of baseline SOC to a statistically insignificant level. However, increasing within-subject SOC changes (beta = 0.16; P < 0.01), living with the mother (beta = 0.11; P < 0.05), smoking (beta = -0.14; P < 0.05), being depression vulnerable (beta = -0.23; P < 0.01) and in the preparation/action stage (beta = 0.13; P < 0.05) remained associated with the transition to twice-daily tooth-brushing. CONCLUSIONS: In planning oral health promotion interventions, it should be considered that children's psychological predisposition and family environment might significantly influence their tooth-brushing behaviour.

Correlates of risky sexual behaviors in recently traditionally circumcised men from initiation lodges in the Eastern Cape, South Africa.

This exploratory quantitative study examines past risky sexual behaviors among young men who were circumcised as part of a rite of passage to adulthood embedded within a cultural and traditional belief system in the Eastern Cape Province in South Africa. Following permission from the Eastern Cape House of Traditional Leaders (ECHOTL), individual face-to-face interviews using a structured questionnaire were conducted among 114 initiates. The mean age of the participants was 18.9 years, ranging from 15 to 32 years old. About 79.8% reported already having had sex with a woman prior to initiation. Of those, 89% reported that they ever used condoms when having sex, and 61% reported consistent use. Logistic regression analysis showed that consistent condom use increased with higher educational levels. Those involved in other risky health behaviors (specifically, smoking) were also more likely to report inconsistent condom use. Most participants had positive beliefs about male circumcision and STI/HIV transmission. This study provides a first look at the sexual behaviors of young men at the time of their initiation in adulthood, a process that is intended to make it socially acceptable to initiate sexual relations and highlights a major public health challenge in integrating the protective health benefits of circumcision with indigenous cultural practices.

Adolescents' sense of coherence and smoking as longitudinal predictors of self-reported gingivitis.

OBJECTIVE: This study sought to determine the influence of sense of coherence (SOC), a personal stress-coping resource, and smoking on the self-reported gingival health of a cohort of rural black South African adolescents. METHODS: This 18-month study involved a three-wave survey of a representative sample of eighth graders from 11 randomly selected high schools in the Limpopo province, South Africa (n=970). Using a generalized estimating equation model, we examined the correlates of recent gingivitis, defined as self-reporting frequent gingival bleeding (GB). Explanatory variables included baseline socio-economic status, age, gender, plaque levels, toothbrushing frequency, tobacco use status and SOC levels. RESULTS: Among our sample, 74.6% reported experiencing gingivitis at some point during follow-up, while 41.9% reported frequent GB at the last survey. Factors that were positively associated with recent gingivitis include living in poor households [odds ratio (OR)=1.49; p<0.01], having higher plaque levels (OR=1.18; p=0.04) and smoking regularly (OR=1.57; p=0.04). Self-reporting gingivitis was negatively associated with being female (OR=0.76; p=0.02) and having a higher SOC (OR=0.96; p<0.001). CONCLUSIONS: Adolescent smoking and SOC levels are independent predictors of self-reported gingivitis. Therefore, in addition to plaque control, smoking prevention and the teaching of stress-coping skills may be important interventions for promoting adolescents' gingival health.