Smoking is responsible for numerous diseases, including some cancers, cardiovascular and respiratory diseases. Smoking initiation and habits often develop during adolescence and early adulthood, and early onset of tobacco consumption has been associated with higher risks of dependency. Although the legal age for tobacco sales varies between 18 and 21 in most OECD countries, average smoking initiation starts before the age of 18 in many countries (Reitsma et al., 2021[1]).
In 2022, 15% of 15‑year‑olds reported smoking cigarettes at least once in the past month on average across OECD countries (Figure 4.7). This proportion reached a high of more than one in four in Hungary and Italy as well as accession countries Bulgaria and Croatia, compared to a rate lower than one in ten in Iceland, Canada, Ireland, Norway and Portugal. On average across OECD countries, a slightly greater proportion of girls (15%) than boys (14%) reported smoking in 2022.
Smoking rates among 15‑year‑olds have decreased in 27 out of 28 OECD countries since 2014. However, the decrease was generally more pronounced between 2014 and 2018 than between 2018 and 2022. This slowdown has been in part related to the COVID‑19 pandemic and the increasing use of e‑cigarettes.
At the same time, use of e‑cigarettes among 15‑year‑olds has increased. Adolescent e‑cigarette use is a concerning trend, as evidence indicates that e‑cigarette use is associated with a heightened risk of initiating tobacco smoking among adolescents and young adults (O’Brien et al., 2021[2]). In 2022, 20% of 15‑year‑olds reported using an e‑cigarette in the past month on average across OECD countries (Figure 4.8). Countries including Lithuania, Hungary and Poland as well as accession country Bulgaria have e‑cigarette use rates exceeding 30%, compared to less than 10% in Portugal and the Netherlands. In most countries, e‑cigarette use is more prevalent among girls (21%) than boys (18%), with particularly large gaps in Estonia, Ireland and the United Kingdom.
OECD countries have implemented a wide range of policies that have been effective in reducing tobacco smoking among young people. These include raising the legal age for purchasing tobacco products, increasing tobacco taxation, introducing smoking bans in public places and restricting advertising. To address rising e‑cigarette use among adolescents, countries have recently tightened regulation of public indoor vaping bans, advertising restrictions, and product standards such as health warnings and labelling. Several countries – including Belgium, France and the United Kingdom – have also enacted bans on the sale of disposable e‑cigarettes, which are particularly popular among younger users. In an effort to create a future tobacco-free generation, the United Kingdom has introduced a new bill to control tobacco and vapes. This includes a progressive age‑based sales ban and the extension of outdoor smoke‑free restrictions (e.g. outside schools and hospitals).
Cannabis use reflects another trend of substance‑related risk behaviours among adolescents. On average across OECD countries, 7% of 15‑year‑olds reported cannabis use at least once in the past month in 2022 (Figure 4.9). This proportion ranged from over 10% of adolescents in Canada, Poland and Italy as well as accession country Bulgaria, to lower than 5% in Iceland, Portugal and Denmark, as well as accession country Romania. Since 2014, cannabis use among 15‑year‑olds has decreased in around 40% of OECD countries, while it increased in over 50% of countries. France, Denmark and Spain experienced the most substantial decreases, whereas Austria, Finland and Sweden exhibited the largest increases. The prevalence of cannabis use reveals gender disparities: boys are more likely (8%) than girls (6%) to report cannabis use. OECD countries have implemented diverse preventive measures to reduce cannabis use in adolescents, such as public education campaigns or legal age restrictions for cannabis possession or purchase.
