A sweeping survey of nearly 114,000 15- and 16-year-olds across 37 European countries has revealed a compelling shift in adolescent behavior. While traditional forms of substance use—such as alcohol and illegal drugs—are steadily declining, vaping is surging, bringing new challenges and opportunities for tobacco harm reduction advocates.
The 2023 European School Survey Project on Alcohol and Other Drugs (ESPAD), which has been monitoring youth habits for over three decades, paints a nuanced picture of substance use in today’s youth. Cigarette smoking has fallen substantially since the 1990s, yet recent data reveals that daily smoking is rising among younger girls—a concerning trend in an otherwise optimistic trajectory.
Vaping, by contrast, has seen a sharp upward trend. According to the survey, 44% of students reported having tried e-cigarettes at least once, and 22% are regular users—up from 14% just five years ago. This increase in regular use signals a normalization of vaping among youth, likely driven by accessibility, peer influence, and product appeal. Many respondents cited ease of access as a major factor, underscoring the urgent need for better regulation and responsible retail practices, rather than prohibition, which often fuels black-market alternatives.
In contrast to nicotine use, alcohol consumption among European teens is waning. Binge drinking and overall alcohol intake have steadily declined over the past two decades. Nonetheless, countries like Denmark, Germany, and Austria still report high levels of heavy teen drinking. Alarmingly, one-third of students had their first alcoholic drink by age 13, indicating a need for continued educational efforts.
Illicit drug use is also on the decline, with cannabis—still the most popular illegal substance—dropping to its lowest level since 1995, now reported by only 12% of teens. On the otherhand, harder drugs like ecstasy, cocaine, and amphetamines are being used by roughly 2% of students. While a troubling rise in non-medical use of prescription medications—including tranquilizers and painkillers—suggests that while some risks fade, others are emerging.
The vape regulations paradox
According to Statistics Canada, only 7.2% of youth aged 12 to 17 reported vaping in the past month in 2023—a nearly 50% drop from its 2019 peak. Yet, restrictive policies remain on the table, often spurred by misinterpreted or misrepresented data. Health Canada itself has advised caution in comparing recent data with older surveys due to major methodological changes. Nonetheless, flawed comparisons persist, distorting the policy debate.
Groups like the Canadian Vaping Association (CVA) have called for a shift away from punitive measures and toward a harm reduction framework. With 4.6 million Canadians still smoking, and 82% of adult vapers being former smokers, the CVA urges the protection of adult access to safer alternatives. Specialty vape shops, with their strict age-verification practices, are cited as key allies in balancing youth protection with adult harm reduction.
However, the harm reduction narrative has recently been challenged in New Zealand, where a new study published in Lancet Regional Health – Western Pacific reported that the decline in youth smoking slowed significantly after vaping became widespread post-2010. Researchers analyzing data from nearly 700,000 students concluded that, had pre-vaping trends continued, the proportion of adolescents who had ever smoked would be nearly half what it is today. This claim of course, not only directly contradicts findings by countless major studies worldwide, but also real-world data from countries like Sweden and the UK.
Nicotine in transition
Meanwhile, nicotine pouches (NPs)—the smokeless, tobacco- free little oral products—have also emerged as a newer, potentially safer alternative. Though current use is relatively low in most countries, nicotine pouches are experiencing a rapid growth, much like vaping did a decade ago. And naturally, this has health professionals divided: some view pouches as a promising cessation aid due to their combustion-free nature, while others warn about their potential appeal to nicotine-naïve youth.
A recent U.S.-based study using data from the PATH (Population Assessment of Tobacco and Health) survey found that NP usage was concentrated among young adult males with prior smoking or vaping history. Fewer than 1% of adolescents reported trying pouches, and just over 3% of adults had used them.
Mental health, nicotine use and the real risks we should be talking about
Another factor which begs to be considered in nicotine use patterns is mental health. While several studies have indicated a link between mental health and nicotine consumption, a recent study by the University of Michigan found that adolescents with multiple ADHD symptoms were significantly more likely to use tobacco and nicotine products. Once again, this highlights the need for integrated strategies that address nicotine consumption and substance use at the core, by focusing less on the behaviour and more on the drivers behind it.
Youth use data that should shape regulation
The message for policymakers is clear: while concern over youth nicotine use is justified, reactionary bans risk undermining adult cessation efforts. Data-driven, proportionate regulation—grounded in harm reduction—offers a more effective path. Public health strategies must protect youth without closing doors for adult smokers seeking safer alternatives.
As trends shift and new products emerge, continued surveillance, responsible regulation, and honest public discourse will be crucial. The ultimate goal remains unchanged: reducing the toll of smoking-related illness and death—without sacrificing innovation or falling prey to panic-driven policy.
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