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Substance use

Adolescence is a crucial developmental stage characterised by both exploration and vulnerability, where the introduction to substances such as alcohol, cigarettes, e-cigarettes, and cannabis can profoundly impact long-term health and social outcomes. This period is not only about personal choice but is also shaped by broader social, cultural, and environmental factors. The Health Behaviour in School-aged Children study offers insights into the patterns and contexts of substance use, emphasising the importance of understanding these behaviours within the complexities of adolescent life.

Recognising the multifaceted nature of adolescent substance use is essential for developing targeted public health interventions that effectively address these issues. This involves considering the broader social determinants of health and implementing policies that reduce harm and provide supportive environments for young people. The findings from the HBSC study contribute to this comprehensive approach, helping to shape policies that support healthy development and prevent the long-term harms of substance use.

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Key Findings

  • Adolescents’ current use of all substances (except cannabis, questions on which were presented only to 15-year-olds) increased sharply with age in almost all countries and regions.
  • Substance use was generally higher in boys than girls at age 11, while the gender gap tended to narrow or disappear from age 13.
  • A quarter of 15-year-olds had smoked in their lifetime, and 15% had smoked at least once in the past 30 days.
  • More than 30% of 15-year-olds had used electronic cigarettes (e-cigarettes) during their lifetime and 20% had used them in the past 30 days.
  • Lifetime alcohol use was reported by 57% of 15-year-olds and past-30-day use by just under 40%, with higher prevalence in girls.
  • One in five 15-year-olds had been drunk at least twice in their lifetime, with no significant gender differences in most countries and regions.
  • The prevalence of both lifetime and current cannabis use was higher among boys than girls at age 15 (13% versus 11% for lifetime use and 8% versus 5% for current use).
  • Between 2018 and 2022, there was an overall increase in current alcohol use and drunkenness among older girls. In contrast, a decrease in alcohol use was observed among 15-year-old boys.
  • A decrease in current smoking since 2018 was also observed among 15-year-old boys.
  • Socioeconomic differences in substance use varied by substance type. Cigarette smoking showed higher prevalence among adolescents from low-affluence families, while e-cigarette use, alcohol consumption and drunkenness were more prevalent among high-affluence adolescents.
  • Data from the 2022 survey confirm wide variability in substance use among countries and regions.
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Cite this data

Charrier L, van Dorsselaer S, Canale N, Baska T, Kilibarda B, Comoretto RI et al. A focus on adolescent substance use in Europe, central Asia and Canada. Health Behaviour in School-aged Children international report from the 2021/2022 survey. Volume 3. Copenhagen: WHO Regional Office for Europe; 2024. Licence: CC BY-NC-SA 3.0 IGO

Youth Commentary

“"I think the biggest health concern facing young people today is vapes. I think that they should either make vapes less accessible, take the nice flavours out of them, or ban them."”

Girl, Ireland

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