The attendance paradox: schools as ambivalent spaces of adolescent substance use.

Background: 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 ("Cool Lip") 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. Methodology: 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. Results: Five themes were identified. In contrast to the global pattern, substance-using students were consistently described as regular attendees-the 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 "social elements" who might subsequently influence younger peers. Discussion: 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.