{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:37Z","timestamp":1789711777675,"version":"4.0.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescent substance use in India has become a significant public health challenge. It is increasingly characterized by a shift toward easily concealed smokeless tobacco pouches (\u201cCool Lip\u201d) and inhalants, which fall outside awareness-based school prevention frameworks. School absenteeism has been identified in the global literature as the key behavioral indicator of adolescent substance use, based on the assumption of a relatively stable home environment. This assumption may not hold in low-income urban government schools in India, where the Right of Children to Free and Compulsory Education (RTE) Act, 2009, legally requires that every child enrolled be retained. This study investigates this question from the perspective of government school teachers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>Semi-structured in-depth interviews were conducted with twenty-one government school teachers, headmasters, and physical education instructors across 16 schools in Chennai district, Tamil Nadu, India. Data were analyzed using reflexive thematic analysis in combination with a six-step conceptual model development process, with theoretical frameworks introduced only after the inductive generation of themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five themes were identified. In contrast to the global pattern, substance-using students were consistently described as regular attendees\u2014the Attendance Paradox. The substance landscape has shifted toward easy-to-hide substances, reshaped by post-pandemic mask use and digital peer coordination through mobile phones acquired for online learning. Teachers described a porous school perimeter where making complaints was perceived as personally risky, thereby sustaining institutional silence. Family conditions were an expression of economic precarity, not parental neglect. Teachers prioritized relational inclusion over exclusionary discipline because they perceived that excluding students could increase their vulnerability to becoming \u201csocial elements\u201d who might subsequently influence younger peers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The findings are synthesized into the Institutional Ambivalence Model (IAM), an empirically grounded conceptual model that explains the Attendance Paradox by showing how urban government schools simultaneously function as spaces of care and exposure. The model thereby extends sociological ambivalence from individual social roles to institutions. Policy implications support reintegration-first approaches, attention to post-pandemic digital coordination, and safer perimeter-reporting channels over attendance monitoring or exclusionary discipline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1920425","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:53Z","timestamp":1789709813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The attendance paradox: schools as ambivalent spaces of adolescent substance use"],"prefix":"10.3389","volume":"14","author":[{"given":"A.","family":"Abinaya","sequence":"first","affiliation":[{"name":"School of Social Sciences and Languages, VIT University Chennai","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Vijayalakshmi","sequence":"additional","affiliation":[{"name":"School of Social Sciences and Languages, VIT University Chennai","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s11920-022-01338-z","article-title":"Substance use among youth during the COVID-19 pandemic: a systematic review","volume":"24","author":"Layman","year":"2022","journal-title":"Curr Psychiatry Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1080\/10826084.2019.1686021","article-title":"The relationship between school absenteeism and substance use: an integrative literature review","volume":"55","author":"Gakh","year":"2020","journal-title":"Subst Use Misuse"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.15288\/jsad.2010.71.115","article-title":"Truancy and escalation of substance use during adolescence","volume":"71","author":"Henry","year":"2010","journal-title":"J Stud Alcohol Drugs"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1002\/yd.23320019204","article-title":"Zero tolerance, zero evidence: an analysis of school disciplinary practice","volume":"2001","author":"Skiba","year":"2001","journal-title":"New Dir Youth Dev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1177\/0011392120985865","article-title":"The politics of deferral: denaturalizing the \u201ceconomic value\u201d of children\u2019s labor in India","volume":"70","author":"Balagopalan","year":"2022","journal-title":"Curr Sociol"},{"key":"ref6","volume-title":"The Right of Children to Free and Compulsory Education Act, 2009","year":"2009"},{"key":"ref7","volume-title":"Magnitude of Substance Use in India","author":"Ambekar","year":"2019"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"79","DOI":"10.4103\/0970-258X.326747","article-title":"Substance use and its associated factors among school students","volume":"34","author":"Batra","year":"2021","journal-title":"Natl Med J India"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e0003647","DOI":"10.1371\/journal.pgph.0003647","article-title":"Explanatory models of illicit drug use in adolescents: a qualitative study from India","volume":"4","author":"Biswal","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3187","DOI":"10.31557\/APJCP.2023.24.9.3187","article-title":"Pattern of smokeless tobacco initiation and use among school going adolescents in Delhi, India: a mixed method study","volume":"24","author":"Sharma","year":"2023","journal-title":"Asian Pac J Cancer Prev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0001724","DOI":"10.1371\/journal.pgph.0001724","article-title":"How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement","volume":"3","author":"Dsouza","year":"2023","journal-title":"PLoS Glob Public Health"},{"key":"ref12","year":"2024"},{"key":"ref13","volume-title":"State of Tamil Nadu and ORS 2024. CRL OP (MD) No. 14942 of 2024","author":"Aunestraja","year":"2024"},{"key":"ref14","year":"2022"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"427","DOI":"10.4103\/psychiatry.IndianJPsychiatry_43_19","article-title":"School-based substance use disorder prevention in India: a brief appraisal","volume":"62","author":"Pattojoshi","year":"2020","journal-title":"Indian J Psychiatry"},{"key":"ref16","volume-title":"Guidelines for Tobacco-Free Educational Institutions (ToFEI)","year":"2019"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/09075682221149570","article-title":"On the banality of attrition in the lives of chronically marginalized children","volume":"30","author":"Balagopalan","year":"2023","journal-title":"Childhood"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/S0955-3959(02)00007-5","article-title":"The \u201crisk environment\u201d: a framework for understanding and reducing drug-related harm","volume":"13","author":"Rhodes","year":"2002","journal-title":"Int J Drug Policy"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.drugpo.2008.10.003","article-title":"Risk environments and drug harms: a social science for harm reduction approach","volume":"20","author":"Rhodes","year":"2009","journal-title":"Int J Drug Policy"},{"key":"ref20","first-page":"3","volume-title":"Sociological Ambivalence and Other Essays","author":"Merton","year":"1976"},{"key":"ref21","volume-title":"The Managed Heart: Commercialization of Human Feeling","author":"Hochschild","year":"1983"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.tate.2018.05.008","article-title":"Emotion regulation in teachers: the \u201cwhy\u201d and \u201chow.\u201d","volume":"74","author":"Taxer","year":"2018","journal-title":"Teach Teach Educ"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1080\/13562517.2021.1989580","article-title":"Pedagogies of mattering: re-conceptualising relational pedagogies in higher education","volume":"29","author":"Gravett","year":"2024","journal-title":"Teach High Educ"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"102558","DOI":"10.1016\/j.ijer.2025.102620","article-title":"Relational pedagogy for inclusion in (in)action: exploring relational encounters in teaching and learning at a rural small school in India","volume":"131","author":"Parvez","year":"2025","journal-title":"Int J Educ Res"},{"key":"ref25","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-69909-7_3470-2","volume-title":"Thematic Analysis: A Practical Guide","author":"Braun","year":"2022"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"16094069231205789","DOI":"10.1177\/16094069231205789","article-title":"A step-by-step process of thematic analysis to develop a conceptual model in qualitative research","volume":"22","author":"Naeem","year":"2023","journal-title":"Int J Qual Methods"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual Health Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1186\/s12889-021-11911-5","article-title":"Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India","volume":"21","author":"Srivastava","year":"2021","journal-title":"BMC Public Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"554","DOI":"10.5005\/jp-journals-10005-1977","article-title":"Evaluation of various factors which motivate children in ashram schools of central India region to consume tobacco products","volume":"14","author":"Sharma","year":"2021","journal-title":"Int J Clin Pediatr Dent"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1920425\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:55Z","timestamp":1789709815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1920425\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":29,"alternative-id":["10.3389\/fpubh.2026.1920425"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1920425","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"article-number":"1920425"}}