This cross-sectional study determined whether various factors, such as parental behavior, attitude, and knowledge and sibling and peer behaviors, were associated with smoking and drinking among early adolescents in the Republic of Vanuatu. For this purpose, logistic regression analysis was used to determine the relative importance of the factors as well as the influences of the parents/guardians, siblings, and peers. The participants consisted of 157 seventh- and eighth-grade adolescents (mean age = 13.3 years; 52.2% girls), including their parents/guardians, from three public schools in Vanuatu. According to the results, the proportions of smokers and drinkers among the adolescents were 12.7% each, while the majority of the parents/guardians disapproved of underage smoking and drinking. In addition, peer influences (i.e., regularly smoking and/or drinking and offering tobacco and/or alcohol) was significantly associated with ever smoking and drinking, whereas parental and sibling influences did not have a significant impact on ever smoking and drinking. In sum, being given tobacco or alcohol from peers had the strongest association with ever smoking and drinking among the adolescents in this study. Thus, future school-based intervention programs should focus on enhancing early adolescents’ life skills, including the ability to resist offers of tobacco and/or alcohol from their peers.

Background Underage smoking and drinking are public health issues in Vanuatu. This study aims to describe the behavior, knowledge, attitudes, and perceptions of parents, siblings, and peers regarding smoking and drinking among urban and rural public-school students in Vanuatu. Methods This cross-sectional study included 358 students (urban, 217; rural, 141; aged 12–14 years) from the public schools in Efate Island, Vanuatu. Data were collected using self-administered questionnaires. Chi-square and Mann–Whitney U tests were used to determine the rural–urban differences. Results Urban students showed a higher prevalence of ever smoking (13.5%), ever drinking (16.9%), intention to smoke (11.1%), and intention to drink (14.0%) compared to rural students (10.3%, 8.3%, 5.8%, and 9.5%, respectively); although a significant difference was only observed in the prevalence of ever drinking. Urban students were more likely to be aware of the health hazards of substance use and showed higher self-efficacy to refuse tobacco and alcohol compared to rural students. Parents in rural areas were less likely to talk about the health hazards of substance use with their children and were more likely to offer tobacco or alcohol to them compared to parents in urban areas. Conclusions The results provide evidence of rural–urban differences in the behavior, attitude, knowledge, and perceptions of parental behavior regarding smoking and drinking. The findings suggest that issues related to underage smoking and drinking differ between urban and rural students. Future intervention programs for reducing underage smoking and drinking should be adapted in recognition of urban and rural differences.