Europaudvalget 2018
KOM (2018) 0269
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EUROPEAN
COMMISSION
Brussels, 22.5.2018
SWD(2018) 169 final
PART 4/7
COMMISSION STAFF WORKING DOCUMENT
Situation of young people in the European Union
Accompanying the document
COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN
PARLIAMENT, THE EUROPEAN COUNCIL, THE COUNCIL, THE EUROPEAN
ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE
REGIONS
Engaging, Connecting and Empowering young people: a new EU Youth Strategy
{COM(2018) 269 final} - {SWD(2018) 168 final}
EN
EN
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4. Health and Well-being
EU youth indicators
Obesity
Regular smokers
Drunkenness in the past 30 days
Self-reported cannabis use in the past year
Injuries: self-reported road traffic accidents
Psychological distress
Cause of death of young people
–
suicide
Figures 4-A and 4-B
Figures 4-C and 4-D
Figures 4-E and 4-F
Figures 4-G and 4-H
Figures 4-I and 4-J
Figures 4-K and 4-L
Figures 4-M and 4-N
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4.1. INTRODUCTION
The EU Youth Strategy supports the health and well-being of young people, 'with a focus on the promotion of
mental and sexual health, sport, physical activity and healthy life styles, as well as the prevention and treatment
of injury, eating disorders, addictions and substance abuse' (
1
). The foundations for lifelong good health and
well-being are laid in childhood and adolescence. While young people generally feel healthier than older age
groups, with a large majority of them considering that they are in good or very good health (
2
), young people are
more prone to 'risk behaviour' than older age groups. This is partly related to the normal changes young people
undergo in their physiological and social development, and partly due to the difficulties they face in their
transition to adulthood and independence. Vulnerable groups of young people such as those experiencing
unemployment, poverty or social exclusion may be particularly prone to more serious problems in their physical
and mental health.
This chapter provides a snapshot of the main trends in areas covered by the EU Dashboard of Youth
Indicators (
3
). It is divided into two sub-sections: first, it looks at the main health risks (obesity, substance abuse
and road traffic accidents resulting in injury); and second, it discusses two indicators related to young people's
mental well-being (psychological distress and suicide).
4.2. HEALTH RISKS
Behaviours considered to put young people's health at risk such as smoking, alcohol consumption, drug use,
unhealthy eating, physical inactivity and unsafe sexual practices often cluster together and reinforce each
other (
4
). They are all influenced by social factors such as deprivation and social exclusion, poor access to
education, as well as problematic family, school and living environments (
5
). Moreover, these behaviours do not
only have a strong impact on young people's health and well-being at the time they occur, but they also have
life-long effects (
6
).
Young people are most vulnerable to risk behaviours when their life is in transition (
7
). As they grow up, they
move from childhood to adolescence, from education to work, and from living with their parents to living
independently (Chapter 7). In this context, barriers to accessing higher levels of education, leaving school
prematurely, long periods of unemployment or insecure housing situations all increase the probability of young
people engaging in risk behaviours (
8
). Moreover, these transition periods are becoming longer and more
complex, thereby increasing young people's vulnerability (
9
). This section therefore examines the most
important health risks and looks at young people's susceptibility to 'risk behaviour'.
(
1
)
(
2
)
(
3
)
(
4
)
(
5
)
(
6
)
(
7
)
(
8
)
(
9
)
Council Resolution of 27 November 2009 on a renewed framework for European cooperation in the youth field (2010-2018),
2009/C 311/01.
Source: Eurostat, Statistics on income and living conditions (SILC), 'Self-perceived health' [hlth_silc_01]. Data extracted on
22.06.2017.
European Commission, 2011.
Jackson et al., 2012.
Ibid.; Viner et al., 2012.
Sawyer et al., 2012.
Furlong et al., 2003; Jackson et al., 2012.
Furlong, 2002; Jackson et al., 2012.
Ibid.
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4.2.1. Obesity
Obesity and being overweight are serious health risks. Childhood obesity has lasting consequences, often
lifelong (
10
). In addition to an early onset of chronic diseases and lower life expectation, obese children and
young people will likely experience bullying and poor attainment at school, lower productivity and less
rewarding careers (
11
). This also impacts negatively on national healthcare systems, government budgets and the
productivity of the European economy (
12
).
There are worrying trends surrounding weight issues in Europe and around the world, as more and more people
–
adolescents and young adults among them
–
suffer from health problems related to being obese or
overweight (
13
). Researchers even talk about an 'obesity epidemic' (
14
), which is difficult to halt and results from
a combination of factors such as sedentary lifestyles with low levels of physical activity, as well as unhealthy
food and eating habits (
15
). Young people from lower socio-economic backgrounds are especially vulnerable to
becoming overweight or obese (
16
).
European statistics presented here confirm that obesity is becoming more and more widespread, both among
young people and in the total population. The increase between 2002 and 2008 in the proportion of obese young
people was highlighted in the 2012 Youth Report (
17
). Figure 4-A depicts the continuation of this trend through
to 2014: the proportion of obese young people aged 18-24 increased in almost all countries with available data,
with the biggest increases registered in Bulgaria, Germany and France. The proportion of obese young people
decreased only in four countries: in Belgium, Czech Republic, Spain and Romania. In all four of these, the
proportion of obese young people is below the EU-28 average (5.8 %).
This 5.8 % average obesity rate among young people aged 18-24 in the EU-28 is around one third of the obesity
rate in the total population (15.4 %) (Figure 4-A-b). However, countries vary greatly in this respect. The
smallest difference between the rate for young people and that for the total population is in Ireland. Although
the reliability of the data is low in this case, they indicate that the proportion of obese young people is only
marginally lower than that of the total population. With roughly 1 in 6 young people who could be considered
obese, Ireland is also the country registering the highest proportion of young people with a Body Mass Index
(BMI) of 30 or above (Figure 4-A). Besides Ireland, the proportion of obese young people is also above 10 % in
Malta (12 %) and the United Kingdom (10.8 %). On the other hand, obesity among young people aged 18-24 is
below 3 % in Croatia, Lithuania, Romania and Slovakia.
(
10
)
(
11
)
(
12
)
(
13
)
(
14
)
(
15
)
(
16
)
(
17
)
WHO Regional Office for Europe, 2017.
See for example WHO Regional Office for Europe, 2014.
OECD, 2016.
Ibid.
See for example Roberto et al., 2015.
WHO Regional Office for Europe, 2017.
Ibid.
European Commission, 2012a.
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Figure 4-A:
Proportion of young people aged 18-24 with a Body Mass Index of 30 or above (obesity level), by
country, 2008 and 2014
%
%
EU youth indicator
Figure 4-A-b:
Obesity by age,
EU-28 average, 2014
%
%
Notes:
The Body Mass Index (BMI) is calculated by dividing body weight (in kilograms) by height (in
metres) squared. A person is considered overweight if he or she has a body mass index greater than or
equal to 25. Obesity is the condition of severe overweight where a person has a body mass index equal
to or greater than 30 (
18
).
The first wave of EHIS (EHIS wave 1 or EHIS round 2008) was conducted between 2006 and 2009. The
second wave (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More
specifically, while fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium
and the United Kingdom, and in 2015 in Denmark, Germany, Ireland, Italy, Iceland and Norway.
Data have low reliability for Ireland.
Source:
Eurostat, European Health Interview Survey (EHIS),
2014: [hlth_ehis_bm1e], 2008: [hlth_ehis_de1]. Data extracted on 23/05/2017.
Obesity among 25-29 year-olds is higher than for 18-24 year-olds. In 2014, on average in the EU-28, 8.9 % of
25-29 year-olds could be considered obese (Figure 4-A-b). Countries follow roughly the same pattern in this
regard: there are more obese young people in the 25-29 age group than among 18-24 year-olds, but still fewer
than within the total population. In 2014, obesity within the 25-29 age group was the highest in Malta (20.2 %),
Ireland (16.5 %), Iceland (14.5 %) and the United Kingdom (14 %) (
19
).
Obesity of young people is a
growing
concern
across
As mentioned above, obesity is partly linked to unhealthy eating habits, such
Europe, partly linked to
as excessive consumption of foods high in fat, salt and sugar as well as low
unhealthy eating habits such
consumption of fruit and vegetables (
20
). Looking at the countries at the two
as low levels of fruit and
extremes, this relationship is partly supported by data on the frequency of
vegetable consumption.
21
fruit consumption ( ). Ireland, Malta and the United Kingdom are among the
countries with a relatively high percentage (above the EU-28 average of 11.1 %) of young people aged 15-24
reporting that they never or only occasionally consume fruit (though other countries are also on this list, most
notably France and Belgium). At the same time, in Croatia, Latvia, Lithuania and Slovakia, the proportion of
young people never or only occasionally consuming fruit is among the lowest in Europe, below 5.5 %.
(
18
)
(
19
)
(
20
)
(
21
)
Source: Eurostat Health Glossary (Eurostat, 2017d).
Source: Eurostat, European Health Interview Survey (EHIS), 'Body mass index (BMI)' [hlth_ehis_bm1e]. Data extracted on
23/.05/2017.
WHO Regional Office for Europe, 2017.
Source: Eurostat, European Health Interview Survey (EHIS), 'Frequency of fruit and vegetables consumption' [hlth_ehis_fv1e].
Data extracted on 23/05/2017. According to this dataset, in Ireland, 19.7 % of young people aged 15-24 never or only occasionally
eat fruit.
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Nevertheless, it also has to be noted that not every country with a high percentage of young people who never,
or only occasionally consume fruit have a high obesity ratio (see, for example, Belgium), so eating habits are
only one factor among many contributing to obesity in young people. However, it is still of concern that as a
general pattern, the proportion of young people aged 15-24 consuming fruit or vegetables at least once a day is
around 10 percentage points lower than that of the total population in the EU-28 (
22
). This pattern holds true in a
large majority of European countries.
Though socio-economic background is a stronger predictor of obesity than gender, gender differences in the
proportion of obese young people aged 18-24 are prominent in some European countries (Figure 4-B). On
average in the EU-28, young women and men have similar obesity rates, with young women being slightly more
affected than men. However, countries show diverse gender patterns when it comes to obesity: while more than
twice as many young women as young men are obese in Belgium, Czech Republic and Denmark, the opposite is
true in Greece and Slovakia.
Figure 4-B:
Gender differences in the proportion of obese young people aged 18-24, 2014
%
Obesity among young men is at least twice as
high as among young women
Obesity among young men is higher than
among young women, but less than twice as
high
Similar proportions of obesity in young men
and women
Obesity among young women is higher than
among young men, but less than twice as
high
Obesity among young women is at least twice
as high as among young men
Data not collected
EU youth indicator
Data have low reliability for Ireland.
Notes:
The second wave of EHIS (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More specifically, while
fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium and the United Kingdom, and in 2015 in Denmark,
Germany, Ireland, Italy, Iceland and Norway.
Obesity in young men and women was regarded as similar if the male/female ratio was between 0.85 and 1.15.
Source:
Own calculation based on Eurostat, European Health Interview Survey (EHIS), [hlth_ehis_bm1e]. Data extracted on 23.05.2017.
Such diverse patterns of gender difference could be partly due to multiple lifestyle differences between women
and men: while women are more likely to have a healthy diet (young women consume more fruit and vegetables
than young men in almost every European country (
23
)), they engage in less physical activity than their male
peers (
24
). Differences between young men and women not engaging in any physical activity are especially
striking in south-eastern European countries, where young people in general tend to be less active. In Greece,
(
22
)
(
23
)
(
24
)
Ibid.
Source: Eurostat, European Health Interview Survey (EHIS), 'Frequency of fruit and vegetables consumption' [hlth_ehis_fv1e].
Data extracted on 23/05/2017.
Source: Eurostat, European Health Interview Survey (EHIS), 'Time spent on health-enhancing (non-work-related) aerobic physical
activity' [hlth_ehis_pe2e]. Data extracted on 23/05/2017.
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Spain, Romania and Turkey, the proportion of young women aged 15-24 spending no time on health-enhancing
(non-work-related) aerobic physical activity is 20 percentage points or more higher than that of young men. At
the other extreme, young people are engaged in physical activities to a greater extent in Nordic countries, and
differences between men and women tend to be much smaller in this region. In Denmark, Estonia, Sweden and
Iceland, the proportion of young women not engaging in any physical activity is even lower than that of young
men (
25
).
In addition to differences in diet and physical activity, studies have shown the importance of socio-cultural
factors in influencing gender differences in obesity ratios. These include the cultural association between
obesity and social status among men (for example in Greece), and the different cultural norms or standards of
beauty that result in pressure on women to be thin (
26
).
4.2.2. Substance abuse
Young people
–
especially in adolescence
–
are particularly vulnerable to substance use and its related disorders.
Late adolescence and young adulthood is often described as the age of 'experimentation', when young people try
new substances, often without becoming addicted to them or misusing them (
27
). However, as mentioned above,
the insecurity experienced in this transition period, together with factors such as unemployment, deprivation, an
insecure family environment or peer pressure all increase the likelihood of risk behaviour. Therefore, for some
young people, experimentation might turn into excessive use, bringing physical, mental and social risks (
28
).
This sub-section looks into the three main forms of substance abuse: regular smoking, excessive drinking and
cannabis consumption.
a) Smoking
Smoking is a well-known health risk and is the leading cause of preventable death (
29
). As with most risk
factors, tobacco use is also influenced by socio-economic factors, with
The proportion of people
young people from disadvantaged backgrounds being more vulnerable (
30
).
smoking daily has been steadily
decreasing, though not in all
The proportion of people smoking daily has been steadily decreasing since
countries and not for every
the beginning of the 2000s in almost all European countries with available
group.
31
data ( ), pointing towards the effectiveness of anti-smoking campaigns and
smoke-free spaces legislation (
32
). This trend is confirmed by the last two rounds of the European Health
Interview Survey (EHIS), which is the data source used to calculate the EU youth indicator (
33
). As Figure 4-C
depicts, the proportion of daily smokers in the 15-24 age group decreased between 2008 and 2014 in almost all
countries with available data, the only exception being Slovakia. In the 25-29 age group, increases in regular
(
25
)
(
26
)
(
27
)
(
28
)
(
29
)
(
30
)
(
31
)
(
32
)
(
33
)
Ibid.
Kanter and Caballero, 2012.
WHO Regional Office for Europe 2016, p. 157.
Ibid.
WHO Regional Office for Europe 2016, p. 147.
Ibid.
European Commission 2016b, p. 231.
See e.g. WHO, 2014a.
Eurobarometer surveys (see Special Eurobarometers 429 (2015) and 458 (2017) on the Attitudes of Europeans towards tobacco and
electronic cigarettes) show a recent rise in young smokers in the 15-24 age group. However, these surveys do not make it possible
to follow changes in the proportions of daily and occasional smokers separately over time.
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smoking took place only in France, Hungary, Austria and Slovakia (
34
). The proportion of daily smokers among
young people was the lowest in Norway, both in absolute terms and in comparison to Norway's total population.
Figure 4-C:
Proportion of daily smokers among young people aged 15-24, by country, 2008 and 2014
%
%
EU youth indicator
Figure 4-C-b:
Daily smokers
by age, EU-28 average, 2014
%
%
Notes:
The first wave of EHIS (EHIS wave 1 or EHIS round 2008) was conducted between 2006 and
2009. The second wave (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More
specifically, while fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium
and the United Kingdom, and in 2015 in Denmark, Germany, Ireland, Italy, Iceland and Norway.
Data have low reliability for Belgium (2008 and 2014), France (young people aged 25-29, 2008) and
Poland (2008).
Source:
Eurostat, European Health Interview Survey (EHIS),
2014: [hlth_ehis_sk3e], 2008: [hlth_ehis_de3]. Data extracted on 31/05/2017.
However, a relatively large percentage of young people still smoke daily in (at least some) European countries.
In 2014, 15.5 % of young people aged 15-24 and 24.6 % of 25-29 year-olds smoked daily in the EU-28 on
average (Figure 4-C-b). As Figure 4-C also depicts, the proportion of young people aged 15-24 smoking daily
was relatively high in Hungary (27.2 %), Austria (26.8 %) and France (22.2 %). In these three countries, the
proportion of 15-24 year-olds smoking daily was larger than the proportion of daily smokers in the total
population (
35
).
The overrepresentation of young people among daily smokers is on the other hand quite clear in the 25-29 age
group: in almost all European countries, a larger proportion of young people aged 25-29 smoke daily in
comparison with the proportion in the total population (
36
).
(
34
)
(
35
)
(
36
)
Source: Eurostat, European Health Interview Survey (EHIS), 'Daily smokers of cigarettes' [hlth_ehis_sk3e]. Data extracted on
31/05/2017.
Ibid.
Ibid.
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Young men are particularly prone to daily smoking
–
with more of them
smoking on a daily basis than young women in almost all countries with
available data (Figure 4-D). On average in the EU-28, while 17.4 % of
young men aged 15-24 were smoking daily in 2014, only 13.5 % of young
women of the same age were doing so. The differences are especially
pronounced moving from west to east and north to south (Figure 4-D). The
biggest gender differences are in Czech Republic, Cyprus, Lithuania,
Romania and Turkey, where young men are more than twice as likely to
smoke daily as young women (in Turkey, this ratio is 5 to 1).
Young men are much more likely
to be habitual smokers than
young
women.
However,
differences between women and
men are narrowing in some
countries,
with
increasing
proportions of female daily
smokers.
Figure 4-D:
Gender differences in the proportion of daily smokers among young people aged 15-24, 2014
%
Proportion of daily smokers among young
men is more than five times larger than
among young women
Proportion of daily smokers among young
men is more than the double of the proportion
of daily smokers among young women
EU youth indicator
Daily smoking among young men is
considerably higher than among young
women
Daily smoking among young men is
somewhat higher than among young women
Similar proportions of young men and women
smoke daily
Daily smoking among young women is
somewhat higher than among young men
Data not available/not collected
Notes:
The second wave of EHIS (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More specifically, while
fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium and the United Kingdom, and in 2015 in Denmark,
Germany, Ireland, Italy, Iceland and Norway.
Daily smoking among young men is regarded as 'considerably higher' than among young women where the male/female ratio is between
1.5 and 2; it is regarded as 'somewhat higher' if the ratio is between 1.15 and 1.5; and regarded as 'similar' if the ratio is between 0.85
and 1.15.
Source:
Own calculation based on Eurostat, European Health Interview Survey (EHIS), [hlth_ehis_sk3e]. Data extracted on 31/05/2017.
The only country with more young female daily smokers than male is Ireland. However, while the total
proportion of regular smokers aged 15-24 only increased in Slovakia between 2008 and 2014, the proportion of
young female daily smokers increased in more countries: in Belgium (1.8 p.p.), Estonia (0.3 p.p.), Latvia
(2.4 p.p.), Slovenia (0.8 p.p.) and Slovakia (2.6 p.p.). In contrast, the proportion of young male daily smokers
only increased in Czech Republic (0.7 p.p.) and Slovakia (1.7 p.p.) (
37
).
(
37
)
Source: Eurostat, European Health Interview Survey (EHIS), 'Daily smokers of cigarettes' [hlth_ehis_sk3e] and [hlth_ehis_de3].
Data extracted on 31/05/2017.
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b) Alcohol consumption
Alcohol is one of the most widely available and most commonly used psychoactive substances (
38
). However,
drinking alcohol, especially frequent drinking and drunkenness is not without health risks. Apart from being
connected to hundreds of medical conditions and diseases, it can have 'adverse psychological, social and
physical health consequences, including academic failure, violence, accidents, injury, use of other substances
and unprotected sexual intercourse' (
39
). Not only the volume of alcohol consumed but also consumption
patterns play an important role in this respect; for example, heavy episodic drinking (or 'binge drinking') is
particularly risky for young people. Therefore it is important to pay attention to the drinking habits of young
people, especially in the youngest age groups.
Figure 4-E depicts the proportion of students turning 16 in the year of data collection who reported having been
drunk at least once during the preceding 30 days. Data is from the European School Survey Project on Alcohol
and Other Drugs (ESPAD).
Figure 4-E:
Proportion of students turning 16 who reported having been drunk at least once during the past
30 days, by country, 2011 and 2015
%
%
EU youth indicator
Notes:
The ESPAD target population is defined as students who turn 16 in the calendar year of the survey and are present in the classroom
on the day of the survey. Students who were enrolled in regular, vocational, general or academic studies were included, excluding those
who were enrolled in either special schools or special classes for students with learning disorders or severe physical disabilities.
Belgium: Data collection was limited to the Flemish Community of Belgium.
Germany (2011): Data collection was limited to five out of sixteen states (Bundesländer): Bavaria, Berlin, Brandenburg, Mecklenburg-
Western Pomerania and Thuringia.
Spain: Data is from the Spanish national school survey. Nevertheless, since the instruments used in the Spanish survey overlap to a large
degree with the ESPAD questionnaire, the methodology used allows for rough comparisons across countries.
United Kingdom (2011): Limited comparability of data due to the low school-participation rate.
Source:
ESPAD Reports 2011 and 2015.
The figure shows a rather encouraging trend between 2011 and 2015: no country has registered a significant
increase in the proportion of students reporting recent incidents of intoxication (
40
). In addition, there have been
substantial decreases in the proportion of students reporting on their recent drunkenness in several countries,
especially in Ireland, Spain and Slovakia. Nevertheless, incidents of intoxication are still relatively common in
Denmark, with almost one third of students experiencing drunkenness in the 30 days preceding the data
(
38
)
(
39
)
(
40
)
WHO Regional Office for Europe 2016, p 157.
Ibid.
According to the ESPAD report, only differences more than ± 3 percentage points should be considered as a 'real difference' (The
ESPAD Group 2016, p. 27).
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collection. Other countries with a relatively high proportion of students (around or over 20 %) reporting
intoxication are Spain, Hungary and Austria.
Fewer 16 year-olds report recent
Figure 4-F looks at gender differences in the reported incidence of
incidents of intoxication than four
drunkenness. As the figure depicts, in general, boys and girls report recent
years ago. Boys report more
incidents of drunkenness than
incidents of drunkenness in similar proportions in many of the European
girls, though gender differences
countries with available data. Nevertheless, there are more countries where
are relatively small in many
incidents of intoxication are reported more often by boys than girls.
countries.
Moreover, in Cyprus, Romania, Albania and Montenegro, boys are more
than twice as likely to report drunkenness as girls (in Montenegro, this ratio is 3 to 1). As is evident from the
map, the geographical patterns are similar to those for daily smoking habits (Figure 4-D), but are less
pronounced.
Figure 4-F:
Gender differences in the proportion of students turning 16 who reported having been drunk at
least once during the past 30 days, 2015
Boys report recent incidents of intoxication
more than twice as often as girls
Boys report recent incidents of intoxication
more often than girls, but less than twice as
often
Similar proportions of boys and girls report
recent incidents of intoxication
Girls report recent incidents of intoxication
more often than boys
Data not collected
EU youth indicator
Source:
Own calculation based on ESPAD Report 2015.
Notes:
The ESPAD target population is defined as students who turn 16 in the calendar year of the survey and are present in the classroom
on the day of the survey. Students who were enrolled in regular, vocational, general or academic studies were included, excluding those
who were enrolled in either special schools or special classes for students with learning disorders or severe physical disabilities.
Spain: Data is from the Spanish national school survey. Nevertheless, since the instruments used in the Spanish survey overlap to a large
degree with the ESPAD questionnaire, the methodology used allows for rough country comparisons.
The proportions of boys and girls reporting recent incidents of intoxication were regarded as similar if the boy/girl ratio was between 0.85
and 1.15.
Besides recent incidents of intoxication, another important indicator on alcohol consumption which is highly
relevant for young people is related to experiencing heavy episodic drinking. In the European Union, 15.4 % of
15-19 year-olds reported monthly experiences of heavy episodic drinking in 2014, but this proportion was over
40 % in Denmark and Norway, and over 30 % in Belgium and Austria (
41
). Regarding gender differences, 15-19
year-old boys reported monthly episodes of heavy drinking more frequently than their female peers. Differences
are greatest in Croatia, Cyprus, Hungary, Poland and Turkey. On the other hand, higher proportions of 15-19
(
41
)
Source: Eurostat, European Health Interview Survey (EHIS), 'Frequency of heavy episodic drinking' [hlth_ehis_al3e]. Data
extracted on 25/10/2017.
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year-old girls than boys experience heavy episodic drinking every month in Denmark, the United Kingdom and
Iceland (
42
).
c) Cannabis use
This section focuses on cannabis, the most popular drug used by young people. Though it can be harmless when
consumed in moderation, cannabis use is a known risk factor for mental disorders (
43
). As with other forms of
substance abuse, cannabis use is also linked to experiences of insecurity in young adulthood: for example,
increasing unemployment rates among young people in recent periods have
Young people are more likely
been associated with increasing levels of cannabis consumption (
44
).
to use cannabis than older age
Young people are more prone to using cannabis than older age groups:
groups. Young men are more
prone to substance use than
according to national surveys collected by the EMCDDA, in all countries
young women.
with available data, the likelihood of using cannabis decreases with age.
Thus, young people aged 15 to 24 are much more likely to use this substance than older age groups (Figure 4-
G). In addition, cannabis use is associated with the other two most common forms of substance abuse: those
who drink and smoke more are also more likely to use illicit drugs, mostly cannabis (
45
).
Figure 4-G:
Prevalence of cannabis use in the past 12 months, by country and by age, year of the last
available national survey
%
%
EU youth indicator
Aged 15-24
Aged 15-34
Aged 15-64
Notes:
LU: 1998; EL: 2004; HU: 2007; AT, EE: 2008; SK: 2010; IE, LV, TR: 2011; BG, DE, HR, CY, LT, PT, SI: 2012; BE, DK, ES, MT, RO:
2013; CZ, FR, IT, NL, PL, FI, SE, UK, NO: 2014.
United Kingdom: Data are for England and Wales only.
Source:
EMCDDA.
As Figure 4-G depicts, the proportion of young people using cannabis in the past 12 months is the highest in
France (27.1 %), Czech Republic (26.8 %) and Denmark (23.9 %). Data for these countries are all based on
relatively recent national surveys. The greatest differences between cannabis use among young adults and that
of the wider population (between 15 and 64 years of age) are in Hungary, where young adults are more than
four times more likely to have used cannabis in the past year than the wider adult population. The differential is
also high in Croatia and Romania at three-and-a-half times.
Given that data presented on Figure 4-G have different reference years for different countries, it is difficult to
draw conclusions on recent trends in cannabis consumption. Nevertheless, ESPAD reports can provide some
insight into the changes in cannabis consumption among 16 year-old students. According to ESPAD data, the
(
42
)
(
43
)
(
44
)
(
45
)
Source: Eurostat, European Health Interview Survey (EHIS), 'Frequency of heavy episodic drinking' [hlth_ehis_al3e]. Data
extracted on 25/10/2017.
WHO Regional Office for Europe 2016, p. 169.
Ayllón and Ferreira-Batista, 2017.
See e.g. Mattick et al., 2017.
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12-month prevalence of cannabis consumption increased significantly in Bulgaria, Croatia, Italy and
Liechtenstein, while decreased in Belgium (Flemish Community), Denmark, France, Hungary, Latvia and
Iceland (
46
).
As with regular smoking, men are more prone to cannabis use than women in all countries with available data
(Figure 4-H). Nevertheless, geographical patterns are less clear-cut. Gender differences are the largest again in
Turkey, though cannabis consumption is very low for both men and women. Young men are more than twice as
likely to use cannabis as young women in Estonia, Ireland, Greece, Cyprus, Lithuania, Hungary and Poland.
Differences are the smallest in Belgium.
Figure 4-H:
Gender differences in the prevalence of cannabis use in the past 12 months among young people
aged 15-24, year of the last available national survey
Proportion of cannabis users among young
men is more than five times larger than
among young women
Proportion of cannabis users among young
men is more than the double of the proportion
of cannabis users among young women
Cannabis use was considerably higher among
young men than among young women
Cannabis use was somewhat higher among
young men than among young women
Data not available/not collected
EU youth indicator
Source:
EMCDDA.
Notes:
LU: 1998; EL: 2004; HU: 2007; AT, EE: 2008; SK: 2010; IE, LV, TR: 2011; BG, DE, HR, CY, LT, PT, SI: 2012; BE, DK, ES, MT, RO:
2013; CZ, FR, IT, NL, PL, FI, SE, UK, NO: 2014.
The prevalence of cannabis use in the past year among young men is regarded as 'considerably higher' than among young women if the
male/female ratio was between 1.5 and 2; and it is regarded as 'somewhat higher' if the ratio was between 1.15 and 1.5.
(
46
)
Source: ESPAD reports 2011 and 2015 (Hibell et al., 2012 and The ESPAD Group, 2016).
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4.2.3. Road traffic accidents resulting in injury
Risk behaviours affecting young people include dangerous driving or driving without due care and attention.
These can be operationalised by looking at road traffic accidents resulting in injury. Young people are much
more prone to having such accidents than older generations, due to a mixture of different factors such as
inexperience, more risk-taking, as well as having a tendency to drive at night, under the influence of drugs and
alcohol, or letting themselves be distracted, for example by mobile
Though the proportion of
phones (
47
). In fact, injuries resulting from road accidents are the leading
young people involved in road
cause of death and disability among young people (
48
). As Figure 4-I-b
traffic accidents decreased in
shows, in 2014, in the EU-28 on average, 2.8 % of young people aged 15-24
many countries, they are still
overrepresented among people
reported a road traffic accident resulting in injury, while this proportion is
reporting related injuries.
2.3 % among 25 to 29 year-olds and only 1.7 % within the total population.
Young men are more prone to
risky behaviour than young
Young people's likelihood of being involved in road traffic accidents
women.
resulting in injury however varies quite substantially among European
countries. While over 5 % of young people aged 15-24 reported such accidents in Slovenia and Iceland, this
proportion remained below 1 % in Bulgaria, Czech Republic, Romania and Slovakia.
Figure 4-I:
Young people aged 15-24 reporting a road traffic accident resulting in injury, by country, 2008 and
2014
%
%
EU youth indicator
Figure 4-I-b:
People reporting a road
accident, by age, EU-28 average, 2014
%
%
Notes:
Refers to the proportion of young people who reported injuries occurring in the past year
from road accidents.
The first wave of EHIS (EHIS wave 1 or EHIS round 2008) was conducted between 2006 and
2009. The second wave (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and
2015. More specifically, while fieldwork was carried out in 2014 in most countries, it took place in
2013 in Belgium and the United Kingdom, and in 2015 in Denmark, Germany, Ireland, Italy,
Iceland and Norway.
Source:
Eurostat, European Health Interview Survey (EHIS), 2014: [hlth_ehis_ac1e],
2008: [hlth_ehis_st2].
Regarding the changes in reported road traffic accidents resulting in injury between 2008 and 2014, information
is relatively limited as data is available only for 14 countries. Nevertheless, as Figure 4-I depicts, existing data
(
47
)
(
48
)
European Commission, 2017i and 2017a.
WHO Regional Office for Europe 2009, p. 36.
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4
shows relatively large decreases in such accidents in a number of countries. The proportion of young people
aged 15 to 24 reporting these types of accidents decreased by more than 3 percentage points in Czech Republic,
Malta and Slovenia. However, in Slovenia, while the involvement of young people in such accidents decreased
substantially in the 20-24 age group, it increased among the younger age group, the 15-19 year-olds (
49
). In
addition, the proportion of road traffic accidents resulting in injury among young people aged 15-24 increased in
Belgium and Turkey, mostly within the 20-24 age group.
As with substance abuse, gender patterns are relatively clear in this area (Figure 4-J). In general, young men are
more involved in road traffic accidents resulting in injury than young women in European countries. In the EU-
28, 3.3 % of young men aged 15-24 reported such accidents, in contrast to the 2.4 % of young women. As
Figure 4-J shows, young men are twice or more likely to report road traffic accidents resulting in injury in eight
countries, and no young women reported such accidents in Greece. Gender differences are the largest in Greece,
Spain, Croatia, Latvia and Turkey. More young women reported these types of accidents in Belgium, Cyprus
and Iceland. In fact, in Belgium and Cyprus, the gender gap reversed since 2008: in both countries, while the
proportion of young men aged 15-24 decreased between 2008 and 2014, the proportion of young women
reporting such accidents increased (
50
).
Figure 4-J:
Gender differences among young people aged 15-24 reporting road traffic accidents resulting in
injury, 2014
%
Only young men reported road traffic
accidents resulting in injury in the sample
Young men reported more than twice as many
road traffic accidents resulting in injury as
young women
Young men reported more road traffic
accidents resulting
in injury
than young
women, but less than twice as many
Similar proportions of young men and women
reported road traffic accidents resulting in
injury
Young women reported more road traffic
accidents resulting in injury
Data not collected
EU youth indicator
Notes:
The second wave of EHIS (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More specifically, while
fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium and the United Kingdom, and in 2015 in Denmark,
Germany, Ireland, Italy, Iceland and Norway.
The proportions of young men and women reporting road traffic accidents are regarded as 'similar' if the male/female ratio was between
0.85 and 1.15.
Source:
Own calculation based on Eurostat, European Health Interview Survey (EHIS), [hlth_ehis_ac1e].
(
49
)
(
50
)
Source: Eurostat, European Health Interview Survey (EHIS), 'Persons reporting an accident resulting in injury' [hlth_ehis_ac1e]
and 'People reporting having had an accident' [hlth_ehis_st2]. Data extracted on 07/06/2017.
Source: Eurostat, European Health Interview Survey (EHIS), 'Persons reporting an accident resulting in injury' [hlth_ehis_ac1e]
and 'People reporting having had an accident' [hlth_ehis_st2]. Data extracted on 07/06/2017.
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4.3. MENTAL WELL-BEING
The transition from childhood to adulthood and the societal and family pressures that young people face in such
contexts also influence their mental health. Though mental and psychological distress are still less prevalent
among young people than older age groups, special attention has to be paid to young people and the factors
which increase their vulnerability. As with risk behaviour, mental health is also influenced by the socio-
economic conditions of young people's lives
–
their level of social exclusion and degree of poverty (
51
). As this
report also shows, young people can experience periods of unemployment and social exclusion in the current
economic climate, which certainly influences their mental health and psychological well-being.
4.3.1. Psychological distress
The EU Dashboard of Youth Indicators (
52
) includes an indicator on psychological distress to assess the mental
health and well-being of young people. However, this indicator was not included in the 2014 round of the
European Health Interview Survey (EHIS). Instead, for the first time, the EHIS survey included questions
making it possible to evaluate the severity of respondents' symptoms of depression (
53
). Depression is a mental
illness, potentially a serious health condition. Depression is the leading cause of ill health and disability
worldwide; at worst, it can lead to suicide (
54
). Looking at the proportion of young people experiencing
moderate to severe symptoms of depression therefore provides important input into understanding the mental
health conditions of young generations.
Figure 4-K shows the proportion of the population that was experiencing moderate to severe symptoms of
depression. In the EU-28, 4.9 % of young people (from both the 15-24 and 25-29 age groups) show moderate to
severe symptoms of depression, while this proportion is 6.3 % within the total population. However, differences
between countries are enormous: while more than 10 % of young people aged 15-24 report moderate to severe
symptoms of depression in Germany (11.5 %), Ireland (13 %), Luxembourg (11.3 %) and Iceland (15.6 %), the
proportions are below 1 % in Czech Republic (0 %), Greece (0.8 %), Croatia (0.7 %), Cyprus (0.3 %), Lithuania
(0.5 %) and Slovakia (0.5 %).
(
51
)
(
52
)
(
53
)
(
54
)
WHO and Calouste Gulbenkian Foundation, 2014.
European Commission, 2011.
Symptoms of depression are evaluated based on eight specific questions defined on the basis of the Diagnostic and Statistical
Manual of Mental Disorders
–
Fourth Edition (DSM-IV). Respondents had to evaluate how frequently they experience the
following feelings: A. Little interest or pleasure in doing things; B. Feeling down, depressed or hopeless; C. Trouble falling or
staying asleep, or sleeping too much; D. Feeling tired or having little energy; E. Poor appetite or overeating; F. Feeling bad about
yourself or that you are a failure or have let yourself or your family down; G. Trouble concentrating on things, such as reading the
newspaper or watching television; H. Moving or speaking so slowly that other people could have noticed. Or the opposite - being
so fidgety or restless that you have been moving around a lot more than usual (Eurostat 2013, pp. 51-53).
WHO, 2017.
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Figure 4-K:
Proportion of population experiencing moderate to severe symptoms of depression, by country
and by age, 2014
%
%
Aged 15-24
Aged 25-29
Total population
Notes:
The second wave of EHIS (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More specifically, while
fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium and the United Kingdom, and in 2015 in Denmark,
Germany, Ireland, Italy, Iceland and Norway.
The figure covers symptoms of varying degrees of severity: moderate, moderately severe and severe.
Source:
Eurostat, European Health Interview Survey (EHIS), [hlth_ehis_mh2e].
At EU level there is no difference between the younger and older youth cohorts in the proportions experiencing
symptoms of depression, and both these groups suffer less in comparison to the total population. At the
individual country level the picture varies, although some geographical differences do emerge: young people
seem to be relatively more vulnerable than the general population in the Nordic countries (Denmark, Finland,
Sweden, Iceland and Norway), as well as in Germany, Ireland, Luxembourg and Slovenia. As Chapter 7 will
show, in most of these countries, young people (especially women) leave the parental household and start an
independent life at a relatively early age, which can make them more vulnerable (Figure 7-A). On the other
hand, the proportion of young people experiencing moderate to severe symptoms of depression is relatively low
in some southern and eastern European countries, both compared to the European average and to the total
population within the same country.
More than twice as many young women as young men report that they suffer
from moderate to severe symptoms of depression in Europe. As Figure 4-L
shows, this is also true for a large majority of European countries. In Denmark,
for example, 15.6 % of young women aged 15-24 report moderate to severe
symptoms of depression, while the same proportion among young men is 2 %.
Yet, these differences could be partly due to men underreporting their
symptoms (
55
).
More than twice as many
young women as young
men report that they suffer
from moderate to severe
symptoms of depression in
Europe.
(
55
)
Dallas, M.E., 2015.
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Figure 4-L:
Gender differences in the proportion of young people aged 15-24 experiencing moderate to severe
symptoms of depression, 2014
%
Only women were in the sample OR more
than five times as many young women as
young men reported such symptoms
More than twice as many young women as
young men reported such symptoms
More young women than young men reported
such symptoms, but less than twice as many
Similar proportions of young women and men
reported such symptoms
More young men reported such symptoms
Data not available/not collected
Notes:
The second wave of EHIS (EHIS wave 2 or EHIS round 2014) was conducted between 2013 and 2015. More specifically, while
fieldwork was carried out in 2014 in most countries, it took place in 2013 in Belgium and the United Kingdom, and in 2015 in Denmark,
Germany, Ireland, Italy, Iceland and Norway.
The figure covers symptoms of varying degrees of severity: moderate, moderately severe and severe.
The proportions of young women and men experiencing moderate to severe symptoms of depression are regarded as similar if the
female/male ratio was between 0.85 and 1.15.
Source:
Own calculation based on Eurostat, European Health Interview Survey (EHIS), [hlth_ehis_mh2e].
4.3.2. Suicide
The most serious outcome of mental suffering is suicide. After road accidents, suicide is the second leading
cause of death among 15-29 year-olds (
56
). As with depression, however, the differences between countries are
quite significant. Suicide rates are by far the highest in Lithuania, where every 26 in 100 000 young people aged
15 to 24 committed suicide in 2014 (Figure 4-M). Although suicide rates are more or less stable in the EU-28,
with a rate around 6.5 per 100 000, Lithuania saw a relatively large increase in crude death rates by intentional
self-harm among 15-24 year-olds between 2011 and 2014 (from 19.5 to 26.3 per 100 000 inhabitants). The other
two Baltic States and Ireland also register comparatively high suicide rates. At the same time, suicide rates are
relatively low (below 5 per 100 000 inhabitants) in southern countries such as Greece, Spain, Italy, Cyprus and
Portugal. In addition, Norway, which was among the countries with relatively high youth suicide rates in 2011,
now registers crude death rates by intentional self-harm comparable to southern Europe.
(
56
)
WHO, 2014b.
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Figure 4-M:
Death by intentional self-harm among young people aged 15-24, crude death rate (per 100 000
inhabitants), by country, 2011 and 2014
EU youth indicator
Figure 4-M-b:
Death by intentional self-harm, by age, EU-28 average, per
100 000 inhabitants, 2014
Notes:
Liechtenstein: data are confidential.
Source:
Eurostat, [hlth_cd_acdr2]
As Figure 4-M-b illustrates, across Europe, suicide rates generally increase with age. However, there are a few
exceptions. In Ireland, for example, crude death rates by suicide are higher in both the 15-24 and 25-29 age
groups than within the total population; while in Estonia, Cyprus and Finland, young people aged 25-29 are
more prone to commit suicide than older
–
or younger
–
groups (
57
). In these three countries, suicide rates
among 25-29 year-olds were higher in 2014 than in 2011; in Estonia, the rate almost doubled in this period (
58
).
Despite depression being more commonly reported among women than
among men, young men are much more likely to commit fatal suicide
than young women (Figure 4-N). While only 2.7 in 100 000 women
aged 15 to 24 died due to intentional self-harm in 2014, the rate is more
Young men commit suicide in larger
proportions than young women.
Suicide rates increased substantially
among young men in Lithuania,
while they decreased in Norway.
than three times higher
10 per 100 000
among young men. As
Figure 4-N depicts, female to male ratios are especially high in central and eastern Europe, where in many
countries, young men are more than five times as likely to commit suicide as young women.
However, higher crude death rates by intentional self-harm among men does not mean that men are more likely
than women to attempt suicide. In fact, data and estimates show the opposite: non-fatal suicide attempts are
more common among women (
59
). One reason for such a difference is that men tend to choose more lethal
suicide methods (
60
).
(
57
)
(
58
)
(
59
)
(
60
)
Source: Eurostat, 'Causes of death (intentional self-harm)
–
Crude death rate' [hlth_cd_acdr2]. Data extracted on 07/06/2017.
Ibid.
See e.g. Mergl et al., 2015.
Ibid.
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Figure 4-N:
Gender differences in the proportion of young people aged 15-24 whose death is caused by
intentional self-harm, 2014
Per 100 000
More than five times as many young men
commit suicide as young women
More than twice as many young men commit
suicide as young women
More young men than young women commit
suicide, but less than twice as many
Similar proportions of young women and men
commit suicide
Data not available/not collected
EU youth indicator
Notes:
Malta and Liechtenstein: data are confidential.
Source:
Own calculation based on Eurostat, [hlth_cd_acdr2].
The proportions of young women and men committing suicide are regarded as similar if the male/female ratio was between 0.85 and 1.15.
Gender differences are not only evident in crude death rates in a given year; changes over time are also more
prominent among men. In fact in the countries where bigger changes took place, these changes occurred mostly
among men: suicide rates increased primarily among men in Estonia, Croatia and Lithuania (in Estonia, suicide
rates even decreased among young women aged 15-24); while they decreased principally among young men in
Finland and Norway (
61
). Fluctuations in suicide rates of young women are less pronounced.
CONCLUSION
This chapter has provided a snapshot of young people's health based on selected indicators of health risks and
mental well-being. In many respects, it shows a reassuring picture: there is a decreasing trend in the proportions
of young people smoking regularly, reporting recent incidents of intoxication or reporting road accidents
resulting in injury. However, this is not true for obesity: the proportion of obese young people has increased in
the majority of countries with available data. In addition, differences between countries are quite substantial for
most health indicators, with some countries showing a relatively large proportion of young people at risk.
Young men are much more prone to risk-taking than young women (
62
). There are more young men among
regular smokers and cannabis users; more of them report recent drunkenness; and more of them are involved in
road accidents resulting in injury. When they attempt to take their own life, men are more likely to choose more
lethal methods. The over-representation of young men among risk-takers tends to be particularly pronounced in
southern and eastern Europe. However, differences between women and men are narrowing in several countries,
especially when it comes to drinking or smoking habits.
While young men are more prone to risk-taking, young women are slightly more affected by obesity, and much
more affected by mental health issues. More than twice as many young women as young men report suffering
(
61
)
(
62
)
Source: Eurostat, 'Causes of death (intentional self-harm) - Crude death rate' [hlth_cd_acdr2]. Data extracted on 07/06/2017.
For potential explanations, see e.g. the meta-analysis by Byrnes, Miller and Schafer, 1999.
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from at least moderate symptoms of depression in Europe. Young people are affected especially in countries
where they are expected to start an independent life earlier. As Chapter 7 will show, this opens the door to
vulnerability on several fronts, which in turn influences the mental well-being of young people.
74