The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis.
The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown.
In the 2015 ESPAD data collection, 96 046 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in addition to country-specific estimates, an average across all participating countries as well as prevalence estimates for two non-ESPAD countries: Spain and the United States. The instruments used in the Spanish and US surveys overlap to a large degree with the ESPAD questionnaire, and the methodology used in all three surveys allows for rough comparisons across the countries.
The ESPAD target population is defined as regular 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. In each participating country, a cluster sampling design was used to sample the target population, except in the Faroes, Iceland, Liechtenstein, Malta, Monaco and Montenegro, where all 1999-born target students were included. Data were collected by self-administered questionnaires. All countries used a paper-and-pencil questionnaire except for Austria, Latvia, Liechtenstein and the Netherlands, where students answered a web-based questionnaire. The students answered the questionnaires anonymously in the classroom. All samples were nationally representative, apart from Belgium (Flanders), Cyprus (government-controlled areas) and Moldova (Transnistria region not included). Sample sizes varied from 316 students in Liechtenstein to 11 822 in Poland.
On average, over 60 % of the students in the participating countries replied that they would find it fairly or very easy (hereafter referred to as easy) to get hold of cigarettes if they wanted to. Students in the Czech Republic were most likely to find it easy (80 %), followed closely by Austria (79 %), Liechtenstein (77 %) and Denmark (76 %). Low figures of perceived availability were found in Moldova (22 %) and in three other countries in the eastern part of Europe: the former Yugoslav Republic of Macedonia (38 %), Romania (37 %) and Ukraine (39 %). Gender differences were negligible at the aggregate level (62 % for boys versus 60 % for girls).
More than one in five ESPAD students (23 %) had smoked cigarettes at the age of 13 or younger. The proportions vary considerably across countries, from 46 % in Estonia and 45 % in Lithuania to 9-13 % in the former Yugoslav Republic of Macedonia, Iceland, Malta and Norway. Both on average and in most individual countries, more boys than girls have smoked cigarettes at the age of 13 or younger. On average, 4 % of the students began smoking cigarettes on a daily basis at the age of 13 or younger. The rates were highest in Estonia and Slovakia (8 % each) and lowest in Norway (1 %).
In general, the results on cigarette smoking among European students can be interpreted as showing positive developments. Today, the majority of adolescents have never smoked (54 %) and less than one quarter (21 %) of the sample can be considered current smokers, i.e. having smoked in the last 30 days. The average lifetime prevalence of cigarette smoking was about the same among boys (47 %) and girls (44 %). More than 10 % of the students reported that they had smoked every day in the last 30 days. Comparatively high percentages of daily smoking were found in Bulgaria, Croatia, Italy, Liechtenstein and Romania (20 % or more). Lower rates were observed in Albania, Iceland, Moldova and Norway (5 % and less).
The trend data indicate an overall decrease in lifetime, last- 30-day and daily cigarette use. Moreover, gender differences have narrowed over time. In 1995, boys showed higher rates than girls with regard to all indicators. In 2015, these differences were no longer apparent or became smaller. However, gender convergence is more marked in prevalence of use, whereas problematic patterns of use (daily smoking, early onset) are still more prevalent among boys.
Alcoholic beverages were perceived to be easily available in most countries. More than three in four students (78 %) stated that alcoholic beverages would be easy to obtain if they wanted to. In the Czech Republic, Denmark and Greece, more than 90 % of the students reported easy access. The lowest proportions were found in Moldova (52 %), the former Yugoslav Republic of Macedonia (53 %) and Romania (60 %). In most countries, perceptions of availability among boys and girls were rather similar.
Nearly half of the students (47 %) reported alcohol use at the age of 13 or younger. The highest proportions were found in Georgia (72 %), the Czech Republic (68 %) and Cyprus (66 %). The countries with the lowest rates were Iceland (14 %) and Norway (19 %). Boys were more likely than girls to have used alcohol at an early age. One in twelve students had experienced intoxication at the age of 13 or younger. The proportion of students reporting intoxication at an early age varied quite substantially across countries: Georgia (22 %) and Estonia (15 %) were at the high end of the scale, and Iceland (2 %) and Belgium (Flanders) (3 %) were at the low end. Higher rates were more likely to be found in the eastern part of Europe.
In all ESPAD countries except Iceland (35 %), 50 % or more of the students have drunk alcohol at least once during their lifetime. The ESPAD average was 80 % (range: 35-96 %). The highest rates of lifetime alcohol prevalence (93 % or more) were found in the Czech Republic, Greece and Hungary. In addition to Iceland, countries with relatively low rates (60 % or less) were Albania, the former Yugoslav Republic of Macedonia and Norway. A total of 13 % of the students reported having been intoxicated during the last 30 days. Denmark scored highest, with almost one third of the students (32 %). Countries with levels of 10 % or less were Albania, Estonia, the Faroes, the former Yugoslav Republic of Macedonia, Georgia, Greece, Iceland, Moldova, Montenegro, Norway, Portugal, Sweden and Ukraine. On average, slightly more boys (13 %) than girls (12 %) reported that they had been intoxicated during the last 30 days.
Students who reported alcohol use in the last 30 days drank alcohol on an average of 5.4 occasions. Students from Cyprus and Liechtenstein consumed alcohol on 8.2 and 9.1 occasions, respectively, and students from Estonia, Finland, Iceland, Lithuania, Moldova, Norway and Sweden drank alcohol on four or fewer occasions on average. In most countries, boys who drank did so more frequently than girls, with a difference of up to three occasions or more in the last 30 days in Bulgaria and the former Yugoslav Republic of Macedonia. Every third student (35 %) reported heavy episodic drinking in the past month. This drinking pattern was found more often in Austria, Cyprus and Denmark, where it was reported by about every second student. The lowest figures were found in Norway (19 %) and Iceland (8 %). The difference between boys and girls was about 5 percentage points on average, with generally higher percentages for boys. Students drank an average of 4.7 centilitres of ethanol on the last drinking day. Drinking volume was highest in Denmark (9.3 centilitres), Estonia (6.2 centilitres), Sweden (6.1 centilitres), Finland and Ireland (6.0 centilitres each), and lowest in Moldova (2.1 centilitres) and Romania (2.8 centilitres). Boys reported higher volumes than girls, with significant differences in most countries. On average, beer (35 %) and spirits (34 %) were the preferred alcoholic beverages. In Albania (68 %), Belgium (Flanders) (58 %), the former Yugoslav Republic of Macedonia (54 %), Romania (52 %) and Poland (52 %), more than half of the students preferred beer. Spirits were preferred in Malta (60 %), Portugal (53 %), Slovakia (53 %), France (48 %) and Monaco (48 %). A preference for wine was found in Ukraine (44 %), Moldova (41 %) and Georgia (39 %), and for alcopops in Liechtenstein (36 %). In Denmark, Estonia, the Faroes, Ireland, Norway and Sweden, cider accounted for approximately one quarter or more of total alcohol consumption. In these countries, cider was the second preferred alcoholic beverage next to beer or spirits.
Despite the continued high rates of alcohol use, in particular of heavy alcohol use, temporal trends over the past two decades indicate a positive development, with an overall decrease in lifetime and last-30-day use of alcohol between 1995 and 2015 from 89 % to 81 % and from 56 % to 47 %, respectively. Most interestingly, both lifetime and last-30- day prevalence decreased markedly after a peak in 2003. Unfortunately, changes in heavy episodic drinking were less pronounced and only observed among boys, with overall rates declining from 36 % to 35 % over the past 20 years.
Illicit drug use
About three in ten students (30 %) rated cannabis to be easily available. In the Czech Republic (50 %), more students than in any other ESPAD country reported easy access. High proportions were also found in Slovenia (45 %), as well as in Bulgaria and Liechtenstein (44 % each). The countries with the lowest perceived availability of cannabis were Moldova (5 %) and Ukraine (11 %). Boys were more likely than girls to consider cannabis to be easily available (32 % versus 29 %).
The perceived availability of other illicit drugs was relatively low: ecstasy (12 %), cocaine (11 %), amphetamine (9 %), methamphetamine (7 %) and crack (8 %). In Bulgaria (e.g. amphetamine 23 %, methamphetamine 17 %), illicit drugs were perceived as more easily available than elsewhere in Europe. The perceived availability of ecstasy was highest in Bulgaria, the Czech Republic and Ireland (20 % or more), whereas for cocaine it was highest in Bulgaria, Ireland, Liechtenstein and Poland (17-19 %). Countries with the lowest perceived availability of nearly all illicit drugs were the Faroes, Finland, Georgia, Moldova and Ukraine.
On average, 3 % of the students reported that they had first used cannabis at the age of 13 or younger. The highest proportions were found in Monaco (8 %), France and Liechtenstein (6 % each). Rates of early onset of amphetamine/methamphetamine use were lower (1 % on average), with the highest proportions in Bulgaria (3 %) and Cyprus (2 %). Boys were more likely than girls to have used cannabis, amphetamine/methamphetamine, ecstasy or cocaine/crack at the age of 13 or younger.
Lifetime use of illicit drugs varied considerably across the ESPAD countries. In the Czech Republic, 37 % of the students reported having used any illicit drug at least once, which was more than twice the average of 18 %. Students in Bulgaria, France, Liechtenstein and Monaco also exhibited high levels of drug use experience (30-32 %). Particularly low levels (10 % or less) of illicit drug use were noted in Albania, Cyprus, the Faroes, Finland, the former Yugoslav Republic of Macedonia, Iceland, Moldova, Montenegro, Norway, Sweden and Ukraine. In all ESPAD countries apart from the Czech Republic, prevalence rates were higher among boys than girls. On average, 21 % of boys and 15 % of girls have tried illicit drugs at least once during their lifetime.
A general upward trend between 1995 and 2003 can be seen in the prevalence of illicit drug use. Since 2003, the prevalence has remained largely unchanged.
The most prevalent illicit drug in all ESPAD countries was cannabis. On average, 16 % of the students have used cannabis at least once in their lifetime. The country with the highest prevalence was the Czech Republic (37 %). High prevalence rates (30 % or more) were also reported in France, Liechtenstein and Monaco. The lowest levels of cannabis use (4-7 %) were reported in Albania, Cyprus, the Faroes, the former Yugoslav Republic of Macedonia, Iceland, Moldova, Norway and Sweden. On average, more boys than girls reported lifetime cannabis use (19 % versus 14 %). On average, 7 % of the students had used cannabis in the last 30 days. Cannabis use in the last month was highest in France (17 %), Italy (15 %) and the Czech Republic (13 %). Cannabis use in the last 30 days was also reported by more boys than girls (8 % versus 5 %). Among students who had used cannabis in the last 12 months, the drug was used on average on 8.9 occasions, with higher frequencies in France, Iceland, Ireland, Italy and the Netherlands (11.5 or more times). Low frequencies of cannabis use were found in the Faroes and Moldova (3.6 or fewer times). Reported frequency of use was higher among boys than among girls.
Trends in cannabis use indicate a general increase in both lifetime and last-30-day use between 1995 and 2015, from 11 % to 17 % and from 4 % to 7 %, respectively, with prevalence peaking in 2003 and slightly decreasing thereafter.
On average, 1-2 % of the ESPAD students have used an illicit drug other than cannabis at least once. After cannabis, the most frequently tried illicit drugs are ecstasy, amphetamine, cocaine and LSD or other hallucinogens. Less frequently tried illicit drugs were methamphetamine, crack, heroin and GHB (1 % lifetime prevalence). At the country level, rates of 5 % or more were found in Bulgaria (ecstasy, amphetamine, methamphetamine, cocaine) and Poland (LSD or other hallucinogens).
Other substance use
Across the ESPAD countries, 4 % of the students reported lifetime experience with new psychoactive substances (NPS), with the highest rates in Estonia and Poland (10 % each) and the lowest rates in Belgium (Flanders), Denmark, Finland, Norway and Portugal (1 % each). The average prevalence of lifetime use of NPS was slightly higher among boys (5 %) than girls (4 %). On average, 3 % of the students had used NPS in the last 12 months, with the highest prevalence in Bulgaria, Croatia, Estonia, Ireland, Italy and Poland (5-8 %) and lowest in Belgium (Flanders), Denmark, the Faroes, Finland, the former Yugoslav Republic of Macedonia, Moldova, the Netherlands, Norway and Portugal, all at 1 %. Generally, differences in NPS use in the last 12 months between boys and girls were small.
The average prevalence of lifetime inhalant use was 7 %, with large differences between countries. The country with the highest rate was Croatia (25 %), followed by Slovenia (14 %). The lowest prevalence rates (1-2 %) were found in the Faroes, the former Yugoslav Republic of Macedonia and Moldova. The average prevalence of lifetime inhalant use among ESPAD students was the same for boys and girls. The use of inhalants shows generally stable lifetime prevalence rates over the observed period. The gender-specific trends reveal a narrowing of the gender gap, with rates among boys slightly decreasing but rather unchanged rates among girls.
Lifetime use of tranquillisers or sedatives without prescription was most prevalent in Poland (17 %) and the Czech Republic (16 %). The lowest level of non-prescription use of tranquillisers or sedatives (1-2 %) was reported by students from Denmark, the Faroes, Moldova, Romania and Ukraine. On average, slightly more girls than boys reported use of tranquillisers or sedatives without prescription (8 % versus 5 %). Use of painkillers to get high was reported by 4 % of the girls and 3 % of the boys on average. Over the past two decades, the lifetime prevalence rates for tranquillisers or sedatives show a slightly downward trend, with rather parallel trends for boys and girls.
Conditional probabilities of substance use
Among the users across all countries who have used cigarettes at least once, 93 % have also used alcohol, 32 % cannabis, 12 % inhalants, 10 % tranquillisers or sedatives and 8 % NPS. Almost every student (87 % or more) that has used a licit or illicit substance also reported having used alcohol. Conversely, not every student who has tried alcohol has tried another substance. Among students who have used alcohol, 54 % have also used cigarettes, 19 % cannabis, 9 % inhalants, 7 % tranquillisers or sedatives and 5 % or less NPS or other illicit drugs. Of the students that have used cannabis, 91 % have also used cigarettes, 96 % alcohol, 18 % inhalants, 20 % NPS and 16 % tranquillisers or sedatives. Around one in ten has used ecstasy, cocaine, LSD or other hallucinogens (11 % each), painkillers (10 %) or amphetamines (9 %). Among the students who have used NPS, about a quarter have also used inhalants (26 %) or tranquillisers or sedatives (25 %) and around three quarters (74 %) have used cannabis.
Internet use, gaming, gambling
Overall, the students stated that they had used the internet on average on 5.8 days within the last 7 days. The frequency of use was lower in Albania, Bulgaria, the former Yugoslav Republic of Macedonia, Georgia, Montenegro, Romania and Ukraine. Students in Denmark (6.8 days), Iceland (6.7 days), Finland, the Netherlands, Sweden (6.6 days each) and Estonia (6.5 days) were online every day of the week. No gender differences were observed. On average, 78 % of the students had used the internet for social media activities on 4 or more days in the last week and this was the predominant internet activity in all countries, with between 58 % (Albania) and 94 % (Finland) of students reporting this activity.
More than one in five students (23 %) regularly (at least four times in the last 7 days) used the internet for online gaming. Nearly half of the students from Denmark played regularly online (45 %). Regular online games were not so common in Georgia (13 %), the former Yugoslav Republic of Macedonia and Moldova (16 % each). More boys (39 %) than girls (7 %) reported playing online.
On average, 14 % of the students reported gambling for money at least once in the last 12 months, and 7 % gambled frequently (2-4 times a month or more often). The highest rates of students with gambling experience (30 %) and frequent gambling (16 %) in the last 12 months were found in Greece. Between a fifth and a quarter of the students in Cyprus, Finland, Montenegro and Slovenia reported gambling experience, and more than one in ten students in Finland and Ireland gambled frequently. In all countries, considerably more boys than girls have gambling experience (23 % versus 5 % on average) or gambled frequently (12 % versus 2 %) in the last 12 months.