WHO: New Data From Health Behaviour in School-Aged Children (HBSC) Study Reveals Concerning Trends in Adolescent Substance Use

Across Europe, central Asia and Canada, a concerning picture of adolescent substance use emerges from a new WHO/Europe report. With over half of 15-year-olds surveyed say they experimented with alcohol and a shocking 1 in 5 having recently used e-cigarettes, the risks to young people are clear. The new data from the Health Behaviour in School-aged Children (HBSC) study also highlights a narrowing gender gap in substance use, as girls’ substance use keeps rising to the level of boys’ substance use.

These findings emphasize the need for prevention strategies. The long-term consequences of these trends are significant and serious.

Societies and policy makers need to pay attention to these alarming findings, according to a media release by the World Health Organization (WHO).

Overview of major findings regarding harmful substances

The new report, Volume 3 in the series, presents findings from the HBSC survey on adolescent substance use, focusing on cigarette smoking and use of electronic cigarettes, alcohol and cannabis. Substance use remains a crucial public health problem among adolescents. It is a vital area for young people’s health, well-being and life prospects.

The report examines substance use measures from the 2021/2022 Health Behaviour in School-aged Children (HBSC) survey, focusing on cigarette smoking, e-cigarette use, alcohol consumption and alcohol inebriation, and cannabis use (only measured among 15-year-olds). The measures capture lifetime use and current use (use within the last 30 days). The report pays special attention to changes in gender differences over time, to better target policies and interventions to support young people in preventing and quitting substance use. 

Research shows that young people are very sensitive to substances such as alcohol because their brains are still developing, increasing the risk to develop alcohol use disorder and addiction. The consequences are costly for adolescents, youth, and society as a whole, and can lead to physical and mental illness, educational underachievement and diminished life chances in adulthood. 

Despite declines in the use of substances (such as alcohol consumption and cigarette smoking) in recent years, some data suggest that the coronavirus disease 2019 (COVID-19) pandemic may have caused a new increase in use.

Prevalence of alcohol use

Alcohol is the most frequently consumed harmful substance among adolescents, with 57% of 15-year-olds surveyed saying they have tried alcohol at least once and nearly 4 in 10 (37%) reporting they have consumed alcohol in the past 30 days.

Notably, 63% of adolescents have not consumed alcohol in the past month.

Rising numbers of e-cigarette users

Use of e-cigarettes has surpassed conventional cigarettes in numbers of users, with 32% of 15-year-olds surveyed reporting e-cigarette use at some point and 20% in the past 30 days.

Cannabis use trends

Cannabis use shows a slight decrease, with the percentage of 15-year-olds who have ever used cannabis falling from 14% in 2018 to 12% in 2022.

Narrowing gender gap

The disparity in substance use between genders is rapidly closing, with girls equalling or surpassing boys in rates of smoking, alcohol consumption and e-cigarette use by the age of 15. Of particular concern is evidence that alcohol use may be increasing again among girls in some countries and regions and the high rates of electronic cigarette use, which requires urgent policy action. 

Overview of major findings regarding alcohol

Alcohol is by far the most commonly used harmful 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 consuming alcohol in the past 30 days (36% of boys and 38% of girls). 

Furthermore, recent patterns reveal that the incidence of alcohol inebriation within the past 30 days also increases with age, jumping from 5% among 13-year-olds to an alarming 15% among 15-year-olds, highlighting an urgent need for targeted intervention strategies to curb this growing issue of underage alcohol use.

Understanding lifetime and past-month alcohol use prevalence

• 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. 
• Overall, 35% of adolescents reported drinking alcohol in their lifetime, and 20% in the last 30 days. Lifetime and current alcohol use increased with age for both girls and boys (except in Tajikistan). 
• Among 11-year-olds, 18% of boys and 13% of girls reported consuming alcohol in their lifetime.
• Prevalence of alcohol use was 33% for 13-year-olds and 57% for 15-year-olds (56% for boys and 59% for girls).
• Lifetime alcohol use varied greatly across countries and regions. Tajikistan showed the lowest prevalence in all age groups for both boys (1%) and girls (under 1%), while United Kingdom (England) reported the highest prevalence for 11-year-olds (35% for boys and 34% for girls) and 13-year-olds (50% boys and 57% girls). The highest prevalence for 15-year-olds (83% for boys and 84% for girls) was observed in Denmark. 
• Among 11-year-olds, 8% of boys and 5% of girls reported consuming alcohol at least once in the past 30 days. Prevalence increased with age to 16% of boys and 16% of girls at age 13 and 36% of boys and 38% of girls at 15.
• Current alcohol use also varied widely across countries and regions. At age 11, prevalence ranged from fewer than 1% of girls in Ireland and Tajikistan to 20% of boys in Bulgaria and the Republic of Moldova. At age 13, it ranged from under 1% of boys and girls in Tajikistan to 32% of boys in Bulgaria and girls in United Kingdom (England). The highest prevalence among 15-year-olds was observed in Denmark (68% for boys and 69% for girls) and the lowest in Tajikistan (under 1% for both boys and girls). 
• Eleven-year-old boys were more likely than girls to report consuming alcohol in their lifetime in 26 countries and regions and 13-year-old boys in seven, but at age 15 the reverse was found, with girls more likely to report consuming alcohol in 13 countries and regions and boys in only three.
  • Gender differences in current use also varied between ages 11 and 15. Prevalence of current alcohol use at age 11 was higher among boys than girls in half of the countries and regions. At age 13, only 10 countries and regions showed significant gender differences, and in six of these, current alcohol use was higher among girls. The opposite trend for 15-year-olds was observed in 12 of the 15 countries and regions in which there was a gender difference, with more girls using alcohol in the past 30 days. 
• Overall lifetime alcohol use in boys decreased between 2018 and 2022, particularly among 15-year-olds. Conversely, an increase was observed among girls (except for 15-year-olds).
  • While the proportion of current alcohol users did not change among 11- and 13-year-old boys, there was a small but significant decrease among 15-year-old boys. Current alcohol use nevertheless increased among girls in all age groups.
• Socioeconomic differences were seen in both lifetime and current alcohol use. Lifetime alcohol use was more common in boys from high-affluence families in half of the countries and regions and in 18 for girls.
  • On average, current use was higher among adolescents from high-affluence families for both boys (23% high affluence versus 17% low) and girls (22% high versus 18% low), except in Tajikistan (boys) and Slovakia (girls), where the opposite pattern was found.
  • Differences of more than 10 percentage points in current alcohol use between high- and low-affluence families were found for both genders in Austria, Bulgaria, Germany and Netherlands (Kingdom of the), for boys only in Belgium (Flemish), Belgium (French), Finland and Poland, and for girls only in France, Italy and United Kingdom (Wales). 

Understanding alcohol inebriation among adolescents

• 9% of adolescents reported having experienced alcohol inebriation at least twice in their lifetime, and 7% in the last 30 days. 
• Being alcohol inebriated increased with age, with the biggest difference being seen between the ages of 13 and 15.
  • At age 11, 2% of boys and 1% of girls reported having been alcohol inebriated at least twice in their lifetime.
  • This increased to 5% of 13-year-old boys and girls, and 20% of 15-year-old boys and girls.
  • Variation across countries and regions was wide, however, ranging from a lowest prevalence of 1% across all age groups to 9% at age 11, 15% at age 13 and 46% at age 15. 
• Fewer than 5% of 11-year-old adolescents reported alcohol inebriation at least once in the past 30 days, but this rose at age 15 to 16% of boys and 15% of girls. 
• Gender differences in lifetime alcohol inebriation between ages 11 and 15 changed. Gender differences were seen in 13 countries and regions at age 11, with boys showing higher prevalence of lifetime alcohol inebriation than girls in all. At age 13, boys showed higher prevalence of lifetime alcohol inebriation in only four countries and regions and girls in three. 
• As with alcohol consumption (lifetime and current), a reversed gender pattern was seen at age 15: in six of the 11 countries and regions that showed gender differences, more girls than boys had been alcohol inebriated at least twice in their lifetime. 
• Between 2018 and 2022, the overall prevalence of lifetime alcohol inebriation did not change for 11- and 13-year-old boys and decreased for 15-year-old boys.
  • In contrast, there was a significant increase among 13- and 15-year-old girls. A similar pattern was seen for alcohol inebriation in the past 30 days among girls. 
• Being alcohol inebriated at least twice in their lifetime was more prevalent in adolescents from high-affluence families for both boys (12% from high-affluence families versus 9% from low) and girls (10% high versus 9% low), although the differences were less pronounced than for alcohol consumption.
  • The largest socioeconomic difference in lifetime alcohol inebriation was seen for both genders in Belgium (French) and among boys from Austria and Bulgaria (a difference of more than 10 percentage points).
  • The opposite pattern was seen in Canada and Cyprus, where boys from less affluent families were more likely to have been alcohol inebriated at least twice in their lifetime compared to those with high affluence. Similar patterns were observed among girls in Hungary, Ireland, Lithuania and Slovakia.
  • Alcohol inebriation in the last 30 days was also more common in boys and girls from high-affluence families in 11 and 10 countries and regions respectively. Adolescents from low-affluence families were more likely to report alcohol inebriation in the last 30 days in five countries and regions for boys and five for girls. 

These findings highlight how available and normalized alcohol is, showing the urgent need for better policy measures to protect children and young people from harms caused by alcohol. 

Gender gap narrows in adolescent substance use: girls catching up to boys

Substance use has traditionally been more prevalent among boys, and the HBSC 2021/2022 findings confirm a well established gender difference, with higher prevalence in boys than girls among 11-year-olds. 

By the age of 13, however, gender differences diminish or even disappear in many countries and regions.

Among 15-year-olds, girls often reported more frequent substance use than boys. While this pattern has been known for cigarette smoking in many countries and regions for about two decades, especially among 15-year-olds, it is a new phenomenon for behaviours related to other substances (such as alcohol consumption and alcohol inebriation) in most countries and regions; historically, prevalence for these behaviours has been higher among boys than girls.

The HBSC 2021/2022 survey highlights this gender reversal for several substances in many countries and regions, showing a significantly higher prevalence in girls from the age of 13.

The study unveils a significant shift in adolescent substance use patterns, challenging traditional gender norms. 

The closing of historical gender gaps in substance use, especially among older adolescents, calls for the development of prevention strategies that are sensitive to the unique experiences and needs of both boys and girls. Tailored interventions that consider these evolving dynamics are crucial for effective prevention.

Prevention measures are needed to protect the health of adolescents

Some countries and regions showed significantly lower substance use than most others for both genders and across all age groups, but particularly among 15-year-olds. Kazakhstan, Kyrgyzstan and Tajikistan were the only countries with a prevalence of under 10% for boys and girls for current alcohol consumption and under 5% for alcohol inebriation in the past 30 days, with the average HBSC prevalence among 15-year-olds being around 40% and 15% respectively.

At the other end of the spectrum, the countries and regions with the highest current substance use among 15-year-olds were Denmark (Greenland) for cigarette smoking (37% in boys and 52% in girls), Lithuania for e-cigarette use (about 35% in both genders), Denmark for alcohol consumption and alcohol inebriation in the past 30 days (about 70% and 34% respectively in both genders), and for cannabis use, Bulgaria for boys (19%) and Canada for girls (15%).  

Data from the HBSC 2021/2022 survey confirm past trends, with a sharp and significant increase in substance use with age for boys and girls and in all countries and regions except Tajikistan. The increase in prevalence with age is observed for both lifetime and current substance use, with the largest increase generally seen between the ages of 13 and 15. 

To reduce the use of alcohol, nicotine and tobacco products, and prevent their uptake by young people, comprehensive measures, outlined in various international treaties and WHO recommendations, must be urgently implemented. These include but are not limited to:

• implementing effective pricing policies (such as minimum pricing and increasing excise taxes and prices) that will impact the affordability of alcohol, tobacco and e-cigarette products, particularly to young people; 
• limiting the availability of nicotine and tobacco products and alcohol, for example through reduced hours or locations of sale, and the enforcement of minimum legal ages for purchasing such products;
• strengthening enforcement mechanisms for existing laws (such as minimum legal ages for purchasing alcohol or tobacco products) and effective implementation of health policies; 
• banning all flavouring agents, including menthol and synthetic menthol analogues in all nicotine and tobacco products; and
• enforcing a comprehensive ban on advertising, promotion and sponsorship opportunities on mainstream and social media. 

Alcohol is still the most commonly used substance among adolescents. Ongoing action to reduce its use is necessary, particularly among girls, in whom recent increases have been observed in several countries and regions. The availability of alcohol-free beverages has increased during the last decade, but little is known about potential pathways from alcohol-free drinks towards consumption of alcoholic drinks. This area requires further research and monitoring. 

The widespread use of harmful substances among children in many countries across the European Region – and beyond – is a serious public health threat,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe, as per the WHO Europe media release.

Considering that the brain continues to develop well into a person’s mid-20s, adolescents need to be protected from the effects of toxic and dangerous products. Unfortunately, children today are constantly exposed to targeted online marketing of harmful products, while popular culture, like video games, normalizes them. WHO/Europe is working with countries to ensure all young people, everywhere, get the best possible start in life. This means protecting them from toxic and addictive products that could affect their quality of life in the years ahead.”

Dr Hans Henri P. Kluge, WHO Regional Director for Europe

Suggested citation

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.

For further reading: Previous HSBC results

WHO Europe: More Adolescents Report Mental Health Concerns

About the HSBC

The Health Behaviour in School-aged Children (‎HBSC)‎ study is a large school-based survey carried out 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 young people’s lives. The 2021/2022 HBSC survey data are accompanied by a series of volumes that summarize the key findings around specific health topics. This report, Volume 3 in the series, focuses on adolescent substance use, using the unique HBSC evidence on adolescents aged 11, 13 and 15 years across 44 countries and regions in Europe, central Asia and Canada. It describes the status of adolescent substance use (‎cigarette smoking, electronic cigarette use, alcohol consumption, drunkenness and cannabis use)‎, the role of gender, age and social inequality, and how adolescent substance use has changed over time. Findings from the 2021/2022 HBSC survey provide an important evidence benchmark for current research, intervention and policy-planning.