Margreet de Looze is an Assistant Professor of Interdisciplinary Social Science at Utrecht University. Her research examines how social and cultural contexts shape young people’s health and well-being, with a particular focus on adolescent substance use, mental health, and sexual health. Over the past 17 years, her interdisciplinary and cross-national research has documented how adolescent health has changed over time across Europe and how societal factors — such as cultural values, national alcohol and tobacco control policies, and gender inequality — affect young people’s well-being. Margreet has been actively involved in the international Health Behaviour in School-aged Children (HBSC) study from the start of her career, including serving as editor of the HBSC/WHO international report and later as chair of the network’s Gender Inequalities group. Her expertise is regularly shared through collaborations with the WHO, OECD, and European Commission.
What explains the drop in adolescents’ drinking and smoking across Europe?
Margreet de Looze: This drop appears to be largely driven by major shifts in young people’s social worlds and the norms that guide their behaviour. One of the most powerful changes has been a decline in unstructured, in-person socialising—teenagers simply spend less time ‘hanging out’ than a generation ago, reducing natural opportunities to experiment with cigarettes or alcohol. This shift reflects broader societal trends such as more intensive parenting, greater academic pressure, and rising risk awareness.
At the same time, strong tobacco control measures — especially those targeting norms around smoking, such as smoke-free laws — were implemented, which helped transform smoking from something socially acceptable to something increasingly stigmatised. For alcohol, policy changes vary a bit more across countries, but norms have also shifted dramatically. Non-drinking, for example, is now perceived a more ‘normal’ by many teenagers. Partly in response to new research on the effects of alcohol on the developing brain, and to rising youth drinking rates in the 1990s and early 2000s, parents in many countries have become more restrictive. In the Netherlands, for example, parents tend to supply alcohol less often to their children and set clearer expectations, making access more difficult and signalling that drinking is less acceptable than it once was. These evolving norms within families and peer groups—combined with reduced opportunities for unsupervised socialising—help explain why drinking has fallen even in countries where policy remained stable. Together, these broad cultural shifts, strengthened tobacco controls, and behaviour-specific changes have moved in the same direction, producing a remarkable Europe-wide decline in adolescent smoking and drinking.
Your research shows that teens are spending less unstructured time with friends. How much has this reduced the opportunities for experimenting with drugs?
Margreet de Looze: It is likely that this has contributed to the drop, as adolescents typically use substances when they spend unstructured time with peers.
There are existing gender differences in substance use. What might explain why girls are now reporting higher levels of certain risks?
Margreet de Looze: Historically, boys were far more likely than girls to smoke, drink or get drunk, but that gap has narrowed, and in some countries even reversed, because the social norms that shape boys’ and girls’ behaviour have changed.
In one of our studies, we looked at the impact of national-level gender equality on the gender gap in adolescent substance use. In countries with high gender inequality, traditional gender roles remain strong: substance use is still viewed as a ‘masculine’ and socially unacceptable behaviour for girls, and parents tend to monitor daughters more closely, limit their freedom, and create fewer opportunities for them to access alcohol or cigarettes. As countries become more gender equal, these constraints weaken. Girls gain more independence, face fewer practical barriers, and experience less social pressure to conform to traditional expectations of ‘proper’ female behaviour. As a result, their substance use begins to resemble that of boys. This shift is consistent with broader global patterns showing that as gender roles become less restrictive, boys’ and girls’ health behaviours increasingly converge.
At the same time, the industries that sell alcohol and tobacco have aggressively gender-targeted girls and young women. Marketing strategies link substance use with empowerment, confidence, body image and modern femininity — whether through fashion-driven social-media campaigns, women-only promotions or products designed specifically for girls, such as menthol cigarettes or fruit-flavoured drinks. These commercial pressures interact with growing gender equality to produce a rise in girls’ engagement in traditionally ‘masculine’ risk behaviours.
Thus, while increased gender equality has brought many positive outcomes, it may have also unintentionally widened girls’ exposure to harmful health behaviours. This highlights the need for prevention strategies that account for changing gender norms, as well as the specific ways industries target girls.
What about mental health and gender differences?
Margreet de Looze: In many countries, mental health problems have long been more prevalent among adolescent girls than boys. In recent years, mental health problems have been rising, especially among girls, which has further intensified this gender gap. Our research shows that schoolwork pressure has increased in recent years, especially among girls. This may partly explain why mental health problems increased more sharply among girls. Furthermore, we are currently looking into two other hypotheses, namely that girls were more strongly affected by the social restrictions during the COVID-19 pandemic and that girls are disproportionately impacted by social media use, particularly through mechanisms such as social comparison, body-image pressure, and disrupted sleep. Research on these two hypotheses is still ongoing.
How is problematic social media use connected to substance use patterns among young people? What can be done to address the issue?
Margreet de Looze: I have not investigated this myself, but I do know that problematic social media use is linked to more mental health problems.
Looking ahead, what new challenges in substance abuse do you believe we should prepare for in the next decade?
Margreet de Looze: One challenge I think we really need to prepare for is the cyclical way societies tend to respond to youth substance use. When we see increases in substance use among adolescents, governments invest in prevention and intervention programs. But as soon as the numbers start to decline, that support often gets scaled back. Predictably, the downward trend reverses, and we find ourselves reacting to the same problem again.
What we need to remember is that every year, a new group of 11-, 12-, and 13-year-olds enters adolescence. If we don’t consistently equip each new cohort with the skills and support they need to make healthy choices, we risk repeating the same pattern. Sustainable, long-term investment in prevention is crucial — otherwise we will keep rediscovering the same problem every few years.
Furthermore, the rise in vaping among young people is alarming and calls for evidence-based action from policymakers. Even in countries where vaping is officially banned, many adolescents find ways to bypass these restrictions. Our research on tobacco use through the MPOWER study suggests that the most effective approach might be to focus on changing social norms around vaping, helping young people to perceive it as less attractive/acceptable rather than just prohibited.