摘要：Objectives. We compared prevalence rates and correlates of substance use among high school students in South Africa and the United States. Methods. We used weighted data from 2 nationally representative surveys of high school students. We conducted bivariate and multivariate analyses and examined between-country differences in rates and correlates of substance use were examined. Results. Rates of past-month alcohol and marijuana use were lower among South African students than among US students, but rates of illicit hard drug use were higher. Correlates of use in the 2 countries differed. For example, female gender was protective against tobacco, alcohol, and marijuana use in South Africa, whereas in the United States it was protective only against marijuana use. Black race/ethnicity was associated with lower rates of past-month cigarette and alcohol use in both countries, but the protective effect for alcohol use was stronger in South Africa. Conclusions. Crosscultural studies can elucidate common and culturally unique pathways to drug use. Our results can inform future research, policies, and behavioral interventions in South Africa. Alcohol and tobacco use and use of other drugs are major sources of morbidity and mortality worldwide, 1 , 2 and early initiation of these behaviors accelerates their associated risks. In many developing countries, historically lower levels of use have begun to rise, and understanding and preventing problem drug use is a priority. 1 For example, freedom of choice and economic development are increasing in South Africa, but the resulting increase in disposable income may have the unintended consequence of increasing substance use. If rising substance use rates are to be prevented, an understanding of the prevalence and determinants of substance use is essential. During the 1990s, there were global increases in substance use among adolescents 3 – 5 ; however, most of the data from that period were derived from studies conducted in economically advantaged countries, particularly Australia, the countries of western Europe, and the United States. It may be useful to compare prevalence rates and correlates of substance use in a developed country with a vast research base, such as the United States, with rates and correlates in a developing country, such as South Africa, that is undergoing a major social and economic transition. In addition, comparisons between South Africa and the United States may be cogent because of the numerous parallels in the social experiences of Black and White residents of the 2 countries. 6 For example, just as the deleterious effects of slavery and social injustice have affected the health status of Blacks in the United States, the social injustice imposed by apartheid may have lingering effects on the health of Blacks in South Africa. Similarly, the process of social liberation itself can lead to added public health challenges, including higher substance use rates, related to increased economic opportunity and disposable income. Finally, given that the US civil liberties experience predates the South African transition, which officially began in 1994, an examination of the US experience may inform drug control policies in South Africa. Crossnational comparisons are possible when common survey methods and measures are used. In an initiative cosponsored by the US Centers for Disease Control and Prevention and South Africa’s National Department of Health, the US Youth Risk Behavior Survey (YRBS) instrument and methodology were implemented in South Africa, 7 providing data for such a comparison. We compared YRBS prevalence rates and correlates of substance use among South African and US high school students in grades 9 through 11. We had 2 goals. Our first objective was to compare rates of past-month alcohol use, past-month heavy alcohol use, past-month cigarette use, past-month marijuana use, and lifetime illicit drug use among high school students in South Africa to those among high school students in the United States. Our second objective was to compare associations in the 2 countries between substance use and selected sociodemographic factors that have been shown to be related to substance use in the United States and other developed countries (i.e., age, race/ethnicity, gender, grade, and academic performance).
