Sabrina Molinaro is the Director of the Laboratory of Epidemiology and Health Services Research at the Institute of Clinical Physiology of the National Research Council (IFC-CNR) in Italy.
Over the years, she has conceived and led more than 50 research projects, including both competitive (European and national) calls and institutional collaborations with the Presidency of the Council of Ministers, Regional and Public Authorities, and Health Agencies. She has also coordinated several collaborative projects with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the Pompidou Group of the Council of Europe.
Since 2016, she has coordinated the ESPAD (European School Survey Project on Alcohol and Other Drugs), a transnational study involving 49 countries across Europe in partnership with EMCDDA, aimed at monitoring risk behaviours and substance use among adolescents. She has authored more than 180 peer-reviewed scientific publications in international journals.
What do the trends presented in the ESPAD Report tell us about why young people take risks today?
Sabrina Molinaro: The last ESPAD survey we conducted was in 2024, and for the first time, we gathered data from 37 countries across Europe. This marked the largest sample size in our study so far. The European School Survey Project on Alcohol and Other Drugs was established in 1995. What does that mean? Essentially, we are looking at three generations: Gen X, then Gen Y, and now Gen Z. There are many differences among these three groups. From the 2024 data, the most significant change was in illegal substance use, with a noticeable decrease recorded over the last year use. If you say, ‘last year use’, it implies that someone has touched the substance once or more during that year. We are not necessary referring to heavy users. They might have used more than once, but most likely they haven’t — and thankfully, most only have limited contact with the substance. This indicates very low-level use, which suggests that the availability of these substances will decrease. We can confidently say that the primary reason for this decline is reduced cannabis use, which surprised us. Why? It could have been expected an increase in cannabis use among 16-year-olds in some countries in the 2024 data, especially since the last data collection was in 2019 and there has been ongoing regulation in some countries since then. For instance, Germany was among the first to start decriminalising cannabis use, along with Malta and other European countries. However, in this country, we have observed a drop in last year use indicator . The reason for this is unclear, but it could be due to two possible factors.
One reason could be that the lockdown has significantly impacted how they spend time together. In 2024, they probably went out less than they did in 2019. Furthermore, the fact that the decrease is associated with occasional use suggests that these young individuals likely consumed cannabis mainly during parties or social outings with friends. Consequently, now that they spend more time at home, they are probably less likely to use cannabis in those environments.
Another reason could be attributable to the percentage of active compounds in cannabis. We know from the EUDA ( European Union Drugs Agency) that the active component, THC, and others, have been increasing over the past 10 years. Possibly, some young people find this kind of substance much stronger now, at least stronger than in the past, and there isn’t a significant difference between using cannabis or other substances. This could be another reason for the decline in the use of these substances, though we don’t know for sure yet; it is something that needs further discussion and study.
Our findings show a complete change in alcohol consumption patterns among females. Since 2019, the prevalence of intoxication among females 16-years old has surpassed that of the male population. This is an unusual trend; previously, only some northern European countries showed higher female intoxication rates, while southern and central European countries typically saw higher male prevalence. Recently, many countries have reported higher intoxication rates among females. Currently, we lack a definitive explanation, but this shift might relate to different social habits. However, more research is needed for clarity. Our role as epidemiologists is to observe these changes; understanding the underlying reasons requires further investigation by sociologists and clinicians.
We notice a decline in illegal substance use, an increase in alcohol intoxication among females, and a notable rise in E-tobacco and E-nicotine use. All data were collected simultaneously, so it’s impossible to determine causality, whether one factor leads to another. This pattern is interesting because, over the past 20 years, tobacco use has been decreasing, but recently, new nicotine and tobacco products, like electronic cigarettes, heat-not-burn devices, and nicotine pouches, have entered the market. For example, nicotine pouches, small products placed in the mouth with high nicotine content, have become legal in many European countries, including Italy, where they started selling them last year. Similar products with more tobacco than nicotine are also available in northern Europe. These developments have led to a resurgence in all forms of tobacco and nicotine use, reversing the decline seen over two decades. Additionally, the use of sedatives or tranquillisers without a medical prescription is rising across Europe. While under medical supervision, these drugs can be beneficial; however, their improper use, especially by teenagers, poses serious risks. The pattern of female use appears higher than that of male, highlighting their increased vulnerability. Overall, these trends point to complex challenges in adolescent health and substance use behaviours.
How can prevention respond better to new issues like prescription drugs and online addiction?
Sabrina Molinaro: Social media addiction is higher among females, particularly 16-year-old girls. In general, it seems that 16-year-old girls are more inclined to problematic behaviours than in the past. However, gambling and gaming are more prevalent among males. This year, gambling rates are at an all-time high, including problematic gambling identified through psychometric scales, suggesting this could become a significant issue across Europe.
Certainly, this generation is facing a specific historical crisis, but if you look at the past, entire generations have faced significant challenges. For Generation X, for instance, they were young, they confronted issues like thermonuclear threats during the Cold War, Chernobyl, and many other problems. Similarly, earlier generations dealt with concerns about ozone depletion and various crises. Every generation encounters critical times.
I think it’s impressive how digital everything is these days. This generation has greater access to information than ever before, which makes them more aware of the world around them. I guess this means they’re feeling more pressure to perform better than ever before. It’s like they’re feeling more anxious because they need to perform. They believe they must perform much better than they currently do. However, I think this is partly natural when you are at a critical crossroads. These 16-year-olds probably need to adapt to a different world. Today, they do not just live their real lives, but also maintain a parallel online existence, which can be stressful. Sometimes, we observe that some young people withdraw from their offline life and focus solely on their online experiences, retreating from everyday problems and only engaging with virtual issues like cyberbullying or online relationships.
How can prevention be adapted to address gender differences more effectively?
Sabrina Molinaro: I believe it is important to develop specific strategies for both females and males, but I am not entirely sure what those should be. This is something for a prevention specialist to determine. What they need to do is to completely change the approach used in the past, for various reasons. Previously, peer influence was a major risk factor for many risky behaviours. Since younger people now spend less time face-to-face and more time online, they probably require a different approach to prevention. They need to stay connected, develop practical skills, and improve their ability to focus on particular activities. This is difficult in an age of multitasking, with numerous distractions such as screens and notifications.
Regarding AI at the moment, I am beginning to explore some experiences involving chatbot use in prevention programmes that could be interesting. We know that coaching in learning activities or prevention efforts can be beneficial for young people, although I believe it would be better to have human coaching rather than AI coaching. However, some colleagues and clinicians strongly believe that AI coaching can also help people, such as in quitting smoking or changing certain risky behaviours.
What role, if any, could AI play in prevention or mental health support for young people?
Sabrina Molinaro: From an epidemiological perspective, we currently lack data on AI’s impact. Personally, I believe we need to find ways to use AI constructively to benefit young people without fostering dependence. Many young individuals turn to AI to find quick solutions, which is not only an issue for them but also a concern for older generations. For example, when I ask my students to prepare slides, they return with trendy designs and all the information, but with incorrect references. Despite my advice to verify references, they often misunderstand, leading to repeated errors. This could become a future challenge.
Therefore, it might be necessary to develop an ontology within AI systems or even certified AI for research or other fields. Without this, in ten years, we risk an overwhelming increase in AI-generated papers. In education, if students rely on AI to produce work faster than they can think, it could hinder skill development. However, if young people do not learn to develop their own thoughts and skills, it could cause serious problems.
What role should families, peers, and communities play in prevention efforts?
Sabrina Molinaro: That’s a good question. I believe that currently, family influence is one of the most important factors we need to focus on. Why? Recent findings suggest that in the new generation, parental influence appears to be stronger than peer influence. What does this mean? It indicates that if parents don’t oppose or are aware that their children use substances, the risk of substance use increases significantly, more so than if all friends are users.
This makes sense because the younger generation tends to go out less than in the past. Previously, it was common for them to use substances like sedatives, tranquillisers, or e-cigarettes more openly. Now, they seem to use illegal substances less often because they have to seek out pushers, which has changed after the pandemic.
We should wait for the next data collection to see if this is just a temporary trend caused by the lockdown, with initial decreases followed by normalisation as young people go out and socialise again. However, we still don’t know whether behavioural differences are mainly due to variations in going out, whether they stay home more or socialise in different environments, or if online life plays a larger role now compared to the past.
How can young people be motivated to use technology in healthier ways, not just spend less time online?
Sabrina Molinaro: Certainly. If they have an alternative, they probably go out often. And what we found in a study that we published some years ago was that it was about gaming and developing addiction. What we found was that in countries where the welfare state provides families and pupils with access to money and free activities, without having to spend all their salary on things like sport or theatre activities, the gaming addiction was much lower. For example, in countries like Sweden or northern European countries, the level of gaming addiction was significantly lower than in Italy or Romania, where nothing is free.
If you want to go out during the week as a young person, someone needs to drive you somewhere. Your family must work for you. Plus, everything is very expensive. We need to develop alternatives, and these alternatives should be distinct; they don’t need to involve only sport. Of course, sports activities are very important, but they are not the only option. Not everyone is suited for sport; some might be better suited for artistic or creative fields. There are many different possibilities.
What should Europe’s next big prevention priority be to protect young people over the next decade?
Sabrina Molinaro: What we must definitely do is capitalise on the digitalisation of these young people, and we need to formulate a strategy to protect them from the risks linked to AI and other digital factors. These issues appear highly dangerous in this century. Meanwhile, we probably need to put greater emphasis on health literacy concerning substance use risks than in the past.
Historically, we only devised programmes focusing on the risks of cannabis and alcohol use, but now we face the use of new psychoactive substances, sedatives, tranquilizers without medical prescription, and new devices for tobacco and nicotine consumption. We must work more on this and develop strategies to guide them effectively and helpfully. Old-fashioned prevention programmes, which merely try to explain risks in traditional ways, are no longer appropriate. Currently, they are not an effective approach to reach them. Therefore, this is likely the primary challenge we face in the next decade.