title: A qualitative study of methamphetamine initiation in Cape Town, South Africa.
abstract: BACKGROUND
  Despite a significant rise in methamphetamine use in low- and middle-income countries, there has been little empirical examination of the factors that contribute to individuals' initiation of methamphetamine use in these settings. The goal of this study was to qualitatively examine factors associated with methamphetamine initiation in South Africa.
  
  
  METHODS
  In-depth interviews were conducted with 30 active methamphetamine users (13 women and 17 men) in Cape Town, South Africa. Interviews included narrative descriptions of the circumstances surrounding methamphetamine initiation. Interviews were audio recorded, transcribed, and translated. Transcripts were analyzed with document memos, data display matrices, and a constant comparison technique to identify themes.
  
  
  RESULTS
  On average, participants began regularly using methamphetamine around age 21 and had used for seven years. Four major themes emerged related to the initiation of methamphetamine use. The prevalence of methamphetamine users and distributors made the drug convenient and highly accessible to first time users. Methamphetamine has increased in popularity and is considered "trendy", which contributes to social pressure from friends, and less often, family members to initiate use. Initiation is further fueled by a lack of opportunities for recreation and employment, which leads to boredom and curiosity about the rumored positive effects of the drug. Young people also turn to methamphetamine use and distribution through gang membership as an attempt to generate income in impoverished communities with limited economic opportunities. Finally, participants described initiating methamphetamine as a means of coping with the cumulative stress and psychological burden provoked by the high rates of violence and crime in areas of Cape Town.
  
  
  CONCLUSIONS
  The findings highlight the complex nature of methamphetamine initiation in low- and middle-income countries like South Africa. There is a need for community-level interventions to address the availability and perceived normality of methamphetamine use, and to provide young people opportunities for recreation. On an individual level, addressing mental health and misconceptions about the dangers and benefits of methamphetamine could ameliorate willingness for initiation. Potential points of intervention include mass media campaigns and school-based interventions to raise awareness of the physical and social impacts of methamphetamine, and structural interventions to create safer neighborhoods, provide opportunities for employment and recreation, and expand mental health services to improve emotional health and coping skills.
authors.affiliation: Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Duke Global Health Institute, 310 Trent Drive, 333 Trent Hall, Box 90519, Durham, NC 27708, USA. Electronic address: andrea.hobkirk@duke.edu.
authors.forename: Andréa L
authors.initials: AL
authors.lastname: Hobkirk
authors.affiliation: Duke University, Duke Global Health Institute, 310 Trent Drive, Trent Hall, Room 330, Durham, NC 27708, USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, Medical Research Council of South Africa, P.O. Box 19070, Tygerberg, Cape Town 7505, South Africa.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Myers
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Duke Global Health Institute, 310 Trent Drive, 335 Trent Hall, Box 90519, Durham, NC 27708, USA.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D003415:Crime / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage* / Q000600:supply & distribution; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology*; D014754:Violence / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D008694:Methamphetamine
keywords: Methamphetamine; Prevention; Qualitative research; South Africa; Substance use