Health at a Glance 2017
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branch 4. Risk factors for health
  branch Smoking and alcohol consumption among children

Smoking and excessive drinking during adolescence have both immediate and long-term health consequences. Establishing smoking habits early on increases the risk of cardiovascular diseases, respiratory illnesses, and cancer (Currie et al., 2012). Smoking during adolescence has immediate adverse health consequences, including addiction, reduced lung function and impaired lung growth, and asthma (Inchley et al., 2016). It is also associated with an increased likelihood of experimenting with other drugs, as well as engaging in other risky behaviours (O'Cathail et al., 2011). Early and frequent drinking and drunkenness is associated with detrimental psychological, social and physical effects, such as dropping out of high school without graduating (Chatterji and DeSimone, 2005).

Results from the Health Behaviour in School-aged Children (HBSC) surveys, a series of collaborative cross-national studies, allow for monitoring of smoking and drinking behaviours among adolescents. Other national surveys, such as the Youth Risk Behavior Surveillance System in the United States, or the Escapad survey in France, also monitor risky behaviours.

Over 15% of 15-year-olds smoke at least once a week in France, Hungary, Italy, Luxembourg, and the Slovak Republic, as well as Lithuania (Figure 4.5). At the other end of the scale, fewer than 5% report weekly smoking in Iceland and Norway. Across the OECD, the average is 12%. On average, boys smoke slightly more than girls, but girls smoke more than boys in twelve countries (Australia, the Czech Republic, Denmark, France, Germany, Hungary, Italy, Luxembourg, the Slovak Republic, Spain, Sweden and the United Kingdom). Gender gaps are particularly high in Israel, as well as Lithuania and the Russian Federation.

Over 30% of 15-year-olds have been drunk at least twice in the Czech Republic, Denmark, Hungary, Slovenia and the United Kingdom, as well as Lithuania (Figure 4.6). In Iceland, Israel, Luxembourg, Switzerland as well as the Russian Federation, rates drop below 15%. Across the OECD, the average is 22.3%, with a small gap between boys (23.5%) and girls (21.2%). Gender disparities, with boys more prone to drink than girls, are especially high in Austria, Hungary, Israel, as well as Lithuania and the Russian Federation (over 5 points). Only in Canada, Sweden and the United Kingdom do girls report repeated drunkenness more often than boys.

Trends for repeated drunkenness and regular smoking in 15-year-olds display similar patterns (Figure 4.7). Both health behaviours are now at their lowest since 1993-94. Regular smoking displays the strongest decrease, as rates in boys and girls more than halved between 1997-98 and 2013-14. The gender gap for drunkenness has also shrunk since the 1990s. All countries present a decrease in regular smoking since 1997-98, exceeding 60% for both boys and girls in Belgium, Canada, Denmark, Ireland, Norway, Sweden and the United Kingdom, and for girls in Austria, Finland and Switzerland. The decreases are weaker for repeated drunkenness, and reach 60% only for boys in Ireland and Sweden. Rates have increased since 1997-98 for girls in the Czech Republic, Estonia, Hungary, Latvia and Poland.

Worldwide, one third of youth experimentation with tobacco occurs as a result of exposure to tobacco advertising, promotion and sponsorship (WHO, 2013). To reduce youth tobacco use, its use in the general population must be denormalised. Young smokers are responsive to policies aiming to reduce tobacco consumption, including excise taxes to increase prices, clean indoor-air laws, restrictions on youth access to tobacco, and greater education about the effects of tobacco (Forster et al., 2007).

Definition and comparability

Estimates for smoking refer to the proportion of 15-year-old children who self-report smoking at least once a week. Estimates for drunkenness refer to the proportions of 15-year-old children who report that they have been drunk twice or more in their lives.

The Health Behaviour in School-aged Children (HBSC) surveys were undertaken every four years between 1993-94 and 2013-14, and include up to 29 OECD countries, Lithuania and the Russian Federation. Data are drawn from school-based samples of 1,500 in each age group (11-, 13- and 15-year-olds) in most countries.



Chatterji, P. and J. DeSimone (2005), “Adolescent Drinking and High School Dropout”, NBER Working Paper, No. w11337, Cambridge, United States.

Currie, C. et al. (eds.) (2012), “Social Determinants of Health and Well-being Among Young People”, Health Behaviour in School-aged Children (HBSC) Study: International Report from the 2009/2010 Survey, WHO Regional Office for Europe, Copenhagen.

Forster, J. et al. (2007), “Policy Interventions and Surveillance as Strategies to Prevent Tobacco Use in Adolescents and Young Adults”, American Journal of Preventive Medicine, Vol. 33, No. 6 (Suppl.), pp. S335-S339.

Inchley, J. et al. (eds.) (2016), “Growing Up Unequal: Gender and Socioeconomic Differences in Young People's Health and Well-being”, Health Behaviour in School-aged Children (HBSC) Study: International Report from the 2013/2014 Survey, WHO Regional Office for Europe, Copenhagen.

O'Cathail, S.M. et al. (2011), “Association of Cigarette Smoking with Drug Use and Risk Taking Behaviour in Irish Teenagers”, Addictive Behaviors, Vol. 36, No. 5, pp. 547-550.

WHO (2013), Report on the Global Tobacco Epidemic, WHO, Geneva.

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4.5. Smoking among 15-year-olds, 2013-14 Figure in Excel
Smoking among 15-year-olds, 2013-14
4.6. Drunkenness among 15-year-olds, 2013-14 Figure in Excel
Drunkenness among 15-year-olds, 2013-14
4.7. Trends in regular smoking and repeated drunkenness among 15-year-olds for selected OECD countries, 1994 to 2014 Figure in Excel
Trends in regular smoking and repeated drunkenness among 15-year-olds for selected OECD countries, 1994 to 2014

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