Europe/Central Asia: Alarming consumption of alcohol, tobacco and e-cigarettes among 11-15 year olds

According to a report[1] The widespread use of alcohol and e-cigarettes among adolescents is “alarming” and measures are recommended to limit access, according to a report released on April 25 by the World Health Organization (WHO) Regional Office for Europe. Drawing on data from surveys of 280,000 young people aged 11, 13 and 15 in Europe, Central Asia and Canada, the WHO said the report paints a “worrying picture” of substance use among young people.

The Health Behaviour in School-aged Children (HBSC) study is a large-scale school-based survey conducted every four years in collaboration with the WHO Regional Office for Europe. HBSC data are used at national/regional and international levels to gain new insights into adolescent health and well-being, understand the social determinants of health, and inform policy and practice to improve the lives of young people.

The study describes the situation of the consumption of addictive substances by adolescents (smoking, use of electronic cigarettes, alcohol consumption, drunkenness and cannabis consumption), the role of gender, age and social inequalities, as well as the evolution of the consumption of these substances by adolescents over time.

Alcohol consumption is very common among adolescents

Alcohol is by far the most commonly used substance among adolescents. More than half (57 %) of 15-year-olds have tried alcohol at least once (56 % of boys and 59 % of girls), and nearly 40 % reported drinking alcohol in the past 30 days (36 % of boys and 38 % of girls).

Approximately one in ten adolescents (9 %) across all age groups have experienced a major intoxication event (at least twice) in their lifetime. This rate increases alarmingly from 5 % at age 13 to 20 % at age 15, demonstrating an escalating trend in alcohol misuse among youth. Furthermore, recent trends reveal that the incidence of experiencing intoxication in the past 30 days also increases with age, from 5 % among 13-year-olds to an alarming 15 % among 15-year-olds. These data highlight the urgent need for targeted intervention strategies to address the growing problem of underage drinking.

In France, the results show that alcohol consumption is very normalized, even among pre-adolescents since 25% of boys and 17% of girls aged 11 have already drunk alcohol; 49% of boys and 41% of girls at 13 years old and 62% of girls and 59% of boys at 15 years old. Concerning consumption in the last 30 days, it is almost 10% among boys/girls aged 11, 20% among 13 year olds and 38% among 15 year olds. Finally, 6% of 11-15 year olds reported having been drunk at least twice in their life (1.5% of 11 year olds: 3% at 13 years old and 13.5% at 15 years old).

Smoking remains high but is declining among adolescents with geographic disparities

Overall, 13% of boys and girls reported lifetime cigarette smoking in 2022 (compared to 17% in 2018), and 8% reported past-30-day cigarette smoking. The prevalence of lifetime and past-30-day cigarette use increased significantly with age among boys and girls in all countries and regions except Armenia and Tajikistan.

Among 11-year-olds, 5 % boys and 3 % girls reported having smoked in their lifetime, ranging from less than 1 % girls in Ireland to 18 % boys in Bulgaria. Among 13-year-olds, 10 % boys and 11 % girls reported having ever smoked cigarettes, with the lowest prevalence among girls in Tajikistan (1 %) and the highest among boys in Lithuania (24 %). A quarter of 15-year-olds had ever smoked (24% boys and 26% girls), with the highest prevalence among girls in Denmark (Greenland) (64%) and the lowest (less than 1%) among girls in Tajikistan.

In France, experimentation and consumption in the last 30 days also increases with age. 5% of boys and 2% of girls aged 11 reported having already smoked; 13% of boys and 10% of girls for 13-year-olds and 25% of girls and 22% of boys at 15 years old.

Regarding tobacco use in the last 30 days: 1% of girls and 2% of boys aged 11 are concerned; 4% of girls and 6% of boys aged 13 and 13% of girls and 11% of boys aged 15.

E-cigarette use outpaces smoking among teens

The report also highlights the increased use of vaping products among adolescents. While smoking is declining, the report notes that many have adopted e-cigarettes, which have supplanted the use of manufactured cigarettes among adolescents. Across all ages, more than one in six adolescents (18-30) reported using an e-cigarette at least once in their life, and 10-30 did so in the past 30 days.

E-cigarette use increases significantly with age, among both boys and girls, and in almost all countries and regions. Among boys, lifetime e-cigarette use increased from 6 % among 11-year-olds to 16 % and 31 % among 13- and 15-year-olds, respectively. A similar trend was observed among girls (4 %, 16 % and 33 % among 11-, 13- and 15-year-olds, respectively). Lifetime use is highest in Lithuania, with a prevalence of almost 60 % among both sexes at age 15.

Among 15-year-olds, the prevalence of current use varies considerably across countries and regions, ranging from 2 % among boys and less than 1 % among girls in Tajikistan to 34 % and 36 % among boys and girls, respectively, in Lithuania.

In Western Europe, France, Switzerland and the United Kingdom are the countries where vaping consumption among 11-15 year olds is highest. In France, 7% of boys and 5% of girls aged 11 reported having vaped; 21% of boys and 17% of girls aged 13 and 37% of girls and 35% of boys aged 15. Consumed this product in the last 30 days: 2% of girls and 4% of boys aged 11; 10% of girls and 11% of boys aged 13 and 20% of girls and 17% of boys aged 15.

Urgent action needed, WHO says

These results highlight the extent to which addictive substances such as alcohol and tobacco and nicotine products are available to minors and normalized. They show the urgency of implementing more protective public policies for children and young people and thus strengthening prevention policies.

Despite the decline in tobacco use in recent decades, the survey results show that the prevalence of tobacco use among adolescents remains too high. The WHO Framework Convention on Tobacco Control contains a set of mutually reinforcing measures to reduce tobacco use, and WHO reiterates that Parties to the treaty must take action. WHO also said that urgent action is needed to address the growing prevalence of e-cigarette use among young people, which now exceeds the prevalence of tobacco use in many countries and regions. The growing popularity of e-cigarettes among adolescents could threaten the progress made in tobacco control in recent decades. This underlines the urgent need to develop comprehensive strategies to reduce their use among young people. WHO believes that vaping devices should be regulated in the same way as tobacco products, including in terms of taxation and advertising.

Finally, alcohol remains the most commonly consumed substance by adolescents. Continued action to reduce its consumption is needed, particularly among girls, among whom recent increases have been observed in several countries and regions. The authors recommend, among other things, raising the legal age for purchasing these drinks in some countries and implementing a ban on sales to minors, increasing taxes on alcoholic beverages and banning their advertising altogether.

Keywords: Europe, Central Asia, Canada, youth, adolescents, alcohol, tobacco, vaping, electronic cigarettes, substances, addiction

©Tobacco Free Generation

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[1] 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 Behavior in School-aged Children international report from the 2021/2022 survey. Volume 3. Copenhagen: WHO Regional Office for Europe; 2024. License: CC BY-NC-SA 3.0 IGO.