Improving behaviours, declining awareness: paradox in adolescent substance use in Ukraine during war

Background

Public health efforts to reduce adolescent substance use typically target both behaviour and risk awareness. However, crisis settings may disrupt these dynamics. Since 2022, Ukraine has experienced large-scale social disruption due to russia’s invasion. This study examines trends in substance use behaviours and risk perception among adolescents using 2024 data from the European School Survey Project on Alcohol and Other Drugs.

Methods

A cross-sectional school-based survey was conducted in 2024 among adolescents aged 14-17 years (n = 8,819) across 20 regions of Ukraine using standardised ESPAD methodology. Indicators included tobacco, alcohol and illicit drug use, perceived availability of substances, and awareness of associated health risks. Results were compared with previous survey waves, particularly 2019.

Results

Substantial improvements in behavioural indicators were observed. The proportion of adolescents who had never smoked increased to 71.7% (from 49.5% in 2019), and perceived availability of cigarettes decreased (33.7% vs 43.8%). Similar downward trends were noted for alcohol and cannabis availability. In contrast, awareness of health risks declined. The proportion recognising risks of occasional smoking dropped from 82.4% in 2019 to 63.3% in 2024, and approximately one in four adolescents reported not knowing the risks of regular tobacco or e-cigarette use. Despite reduced access and use, significant gaps in risk perception persist.

Conclusions

Findings reveal a paradox of improving behavioural outcomes alongside declining risk awareness among adolescents. This divergence suggests that reductions in substance use may not be accompanied by strengthened health literacy. Public health responses should complement behavioural interventions with targeted efforts to improve risk perception, particularly in crisis-affected settings.

Key messages

• Adolescent substance use behaviours are improving, while awareness of associated risks is declining in Ukraine during war.

• Declining risk awareness among adolescents highlights gaps in prevention and the need for more effective health education strategies in crisis settings.