Inequalities in Young People’s Health – World Health Organisation

I promised to have a look at the WHO report that made waves in the media a little while ago. Here’s some of what it says:

Many negative health behaviours such as smoking, alcohol and other drug use can be established during the teenage years, and such behaviours can be mechanisms by which social gradients of health emerge. Children and adolescents are therefore among the most important population groups to target for health promotion and protection. Young people may be particularly vulnerable to the health-impairing effects of inequity as they are unlikely to possess or control much of the wealth or power held by society. This supports a need to perform focused analyses of health inequalities among young people. [page 20]

Injury is the leading cause of acute health problems among adolescents in developed countries, with medical and other consequences of adolescent injury imposing a significant burden on society. Injury can also be interpreted as a marker for high-risk adolescent lifestyles that include multiple risk-taking behaviour and associated health-related consequences. A range of studies have reported on how injury is linked with other risk behaviours such as substance use (drinking, drunkenness, tobacco use and illicit drug use) and truancy. [page 87]

Missing breakfast has been associated with several other health-compromising behaviours, such as higher levels of smoking, alcohol and drug use and more sedentary lifestyles. [page 101]

Early onset of smoking is predictive of alcohol-related problems in late adolescence and young adulthood and later illicit drug use. Early initiation into tobacco use is important not only because it is a predictor of later substance use, but also because it is potentially preventable. [page 131]

There is a strong association between adolescent alcohol misuse and an array of other behaviours or conditions, such as smoking and illegal drug use, risky sexual behaviour, disruptive behaviour, depressive and anxiety disorders, eating disorders and obesity. There is evidence that these behaviours cluster in young people with high-risk lifestyles. [page 147]

The report talks about specific drugs.

Tobacco

The report argues:

a key public health objective is to prevent or at least delay the onset of such smoking behaviour. Indeed, the longer the onset of smoking is delayed, the less likely it is that the person will become addicted.

Early onset of smoking is predictive of alcohol-related problems in late adolescence and young adulthood and later illicit drug use. Early initiation into tobacco use is important not only because it is a predictor of later substance use, but also because it is potentially preventable. [page 131]

Looking at this on a country by country basis the report notes that Welsh young people rank 20th, Scottish 22nd and English 31st in early tobacco use. In terms of regular smoking amongst 15 year olds they report that Scottish young people rank 19th, Welsh 23rd, and English 28th of the nations being scrutinised.

Alcohol

As you may imagine alcohol is an ingrained part of the societies that take make up the focus of this report.

Adolescents have reported positive associations with alcohol, such as reduced social inhibition and greater integration, but most research has focused on the negative, including associations with truancy, falling behind in schoolwork, unplanned and unprotected sexual activity, arguments with friends, destructive behaviour and getting into trouble with the police, as well as a higher risk of alcohol abuse and dependence and cannabis use later in life. [page 139]

Looking at weekly drinking amongst 11 year olds by country English young people rank 10th, Welsh 13th, and Scottish 16th. By the time we get to 15 year olds that has changed significantly, Welsh young people are ranked 3rd, English 4th and Scottish 8th.

In examining what they call drunkenness initiation the authors say:

It appears that specific characteristics of the initiation into alcohol (such as drinking at family gatherings and feeling drunk) and early drinking styles (drunkenness-oriented consumption) are particularly predictive of later problems with alcohol. Concern has been raised over the extent to which early onset of alcohol use operates as a pathway to the use of illicit substances. [page 143]

In country terms English young people rank 4th, Welsh 5th and Scottish 8th on this indicator. Frequency of being drunk is also something they look at and here – the measure is have been drunk at least twice – amongst 11 year olds Welsh children rank 4th, English 7th and Scottish 8th. Amongst 15 year olds the Welsh rank 3rd, English 5th and Scottish 8th.

Cannabis

There’s a discussion of the health impact that cannabis can have on its users, including the rising concern about the association with mental health problems and whether early use is a predictor of longer term problems. The authors also say that cannabis use “appears to be a normative behaviour among adolescents in North America and in several European countries.” However, in moving on to look at regular use they argue:

Although occasional cannabis use may be normative, and there is evidence to suggest that young people who use cannabis in modest doses are better adjusted and have better social skills than non-users or heavy users, frequent use of cannabis is associated with more negative outcomes.Population studies among cannabis users have identified increased rates of externalizing disorders such as juvenile offending and conduct problems and, to a lesser extent, internalizing problems such as psychosis and depression. These problems may both predate and be exacerbated by cannabis use. Along with other substance use (such as tobacco and alcohol), cannabis use has been listed as among the risk factors for psychiatric morbidity.

Interestingly young people from the constituent parts of the UK appear to have a proportionately lower regular use of cannabis than lifetime use. So while Welsh young people aged 15 rank 3rd, Scottish 6th and English 10th (Northern Ireland isn’t mentioned) in lifetime use, when it comes to regular use Welsh young people rank 8th, Scottish 7th, and English 14th.

Filed under: alcohol, cannabis, tobacco, World Health Organisation