Smoking in childhood and adolescence has both immediate and long-term health consequences. The immediate adverse health consequences of smoking include addiction, reduced physical fitness and endurance, and asthma, while early onset of smoking habits increase children’s long-term risk of cardiovascular diseases, respiratory illnesses and cancer. Children who smoke are also more likely to experiment with alcohol and illicit drugs.

Tobacco consumption is the largest avoidable health risk in the European Union and the most significant cause of premature death, with over 300 000 deaths per year according to IHME estimates (IHME, 2018). Around half of smokers die prematurely, dying 14 years earlier on average. It is a major risk factor for at least two of the leading causes of mortality, circulatory diseases and cancer, and an important risk factor for many serious respiratory diseases.

Alcohol use in adolescence continues to be very common in Europe, with beer being by far the most popular alcoholic beverage, even though the percentage of 15-16 year olds reporting heavy episodic drinking has come down at least slightly in recent years in several countries (ESPAD, 2016).

Alcohol-related harm is a major public health concern in the European Union, both in terms of morbidity and mortality. Alcohol was the third leading risk factor for disease and mortality after tobacco and high blood pressure in Europe in 2012, and accounted for an estimated 7.6% of all men’s deaths and 4.0% of all women’s deaths (WHO, 2014). High alcohol intake is associated with increased risk of heart diseases and stroke, as well as liver cirrhosis and certain cancers, but even moderate alcohol consumption increases the long-term risk of developing such diseases. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairments. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide, and suicide, particularly among young people.

Adolescence is a period of experimentation sometimes linked to engagement in risky behaviour, including the use of illicit substances such as cannabis being by far the most “popular” drug. Frequent and heavy cannabis use during adolescence is linked to an increased risk of dependence and neurobiological problems (WHO, 2016).

The use of illicit drugs remains an important public health issue in Europe. Over a quarter of adults in the European Union aged 15-64, or over 92 million people, have used illicit drugs at some point in their lives. In most cases, they have used cannabis, but some have also used cocaine, amphetamines, ecstasy and other drugs (EMCDDA, 2018). The use of illicit drugs, particularly among people who use them regularly, is associated with higher risks of cardiovascular diseases, mental health problems, accidents, as well as infectious diseases such as HIV. Illicit drug use is a major cause of mortality among young adults in Europe, both directly through overdose and indirectly through drug-related diseases, accidents, violence and suicide.

Children who are overweight or obese are at a greater risk of poor health in adolescence as well as in adulthood. Obesity among children is also often related to psychosocial problems such as poor self-esteem, bullying at school, underachievement at school, eating disorders, and depression, leading to health and economic problems in adulthood.

Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, and some forms of cancer. As obesity is associated with higher risks of chronic illnesses, it is linked to significant additional health care costs as well as substantial indirect costs due to lower employment and loss of work productivity (OECD/EU, 2016).

Environmental degradations, in particular air pollution and extreme weather conditions due at least partly to climate change, expose people to health risk and excess mortality.