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With marketing of alcohol and nicotine delivery products to youth, legalization of cannabis, and the crisis in prescription pain medication use, there are new opportunities to have conversations with youth about substance use and pregnancy, with the aim of reducing the harms and improving their overall health.

What do we know about youth understanding of substance use and pregnancy?

Existing research and data on youth behaviour provide a window.

One U.S. study showed a relationship between pregnancy and prior substance use among adolescents, and among younger adolescents in particular.

  • 59% of pregnant teens and 35% of nonpregnant teens reported having used substances in the previous 12 months.
  • Some substance use continued in pregnancy particularly among younger pregnant adolescents ages 12-14. (1)

The McCreary Centre Society conducts an adolescent health survey in BC every 5 years. The 2018 evaluation is underway, but findings from 2013 indicated a number of factors related to youth substance use and pregnancy.

Those at higher risk for harmful alcohol use include:

  • Youth in rural areas
  • Youth who were born in Canada
  • Youth who were employed
  • Youth living in poverty
  • Youth experiencing abuse or violence
  • Sexual minority youth
  • Peer relationships have risks in terms of starting drinking earlier and binge drinking particularly when friend groups are large.

Those at greater risk of being involved in a pregnancy include:

  • Youth who first had sex before their 14th birthday
  • Youth in rural areas
  • Youth who had been in government care. Among these youth, girls were more likely than boys to be have been involved in a pregnancy
  • Youth who had been physically abused
  • Youth who had been sexually abused. Among these youth, males who were more likely to have been involved in a pregnancy.

The Ontario Student Drug Use and Health Survey (OSDUHS) from 2017 shows that:

  • 17% of youth have participated in binge drinking and 16% cannot remember what happened during that time
  • Boys are more likely to use e-cigarettes and all forms of tobacco, over-the-counter cold/cough medications, energy drinks, cannabis, and psychedelics
  • Girls are more likely to use prescription opioids for pain relief and tranquilizers medically

IMPART info sheet on “Youth, Gender and Substance Use” recaps how the harms of early substance use are gender-specific.

How do we approach building awareness and prevention?

Opening “Doorways to Conversation” about substance use and pregnancy allows for brief interventions and support for youth as well as women and girls. Many providers think that they need to have appropriately tested screening tools along with the knowledge, skills and confidence to conduct them. As one United Nations study found, less than 30% of health providers routinely screened youth for substance use for these reasons.(2)

Trauma-informed, culturally relevant, and gender-specific relational approaches build trusting relationships that can support youth who may be dealing with more complex issues like violence and abuse, gender identity, or the foster care system.

Promising Approaches for Reaching Youth on Substance Use and Pregnancy

Here are some current promising approaches to improving youth understanding of substance use and pregnancy in Canada.

Projects like “Let’s Get Real About Drinking Alcohol” are trainings for youth focusing on the interconnection of substance use, safe sex, birth control, and drinking during pregnancy. You can view a webcast about the project here.
This handout offers conversation starters on substance use for group facilitators. Girls Action Foundation “Take Care” program provides a curriculum and resources for facilitators of girls’ groups to promote critical thinking about healthy living including substance use and sexuality.
Canadian Centre on Substance Use and Addiction (CCSA) has created a low-risk drinking guide for youth.

Online sexual health resources for youth:

Teen Health Source Native Youth Sexual Health Network

  1. Christopher P. Salas-Wright, Michael G. Vaughn, Jenny Ugalde, Jelena Todic. Substance Use and Teen Pregnancy in the United States: Evidence from the NSDUH 2002–2012. Addictive Behaviors, 2015; DOI: 10.1016/j.addbeh.2015.01.039
  2. Chakravarthy, B., Shah, S., & Lotfipour, S. (2013). Adolescent drug abuse – Awareness & prevention. The Indian Journal of Medical Research, 137(6), 1021–1023.


The Center of Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health have created a  Girls, Women and Alcohol infographic.

The Center on Alcohol Marketing and Youth monitors the marketing practices of the alcohol industry and their effects on American youth

Also possibly of interest, the Center held a webcast in December on “Virginia Slims in a Bottle: Girls, Women and Alcohol Marketing” which can now be viewed on YouTube. Speakers included Ann Dowsett Johnston, author of Drink: The Intimate Relationship Between Woman and Alcohol (see post here about her series in the Toronto Star in 2011 on women and alcohol).

For more on alcohol marketing targeted at girls and women, see earlier posts:


Risky drinking declining faster in girls than boys?

Last week, German Health Minister Daniel Bahr (FDP) and the Federal Centre for Health Education (BzgA) announced a country-wide decline in binge drinking in teenagers and provided an update on the “Alkohol? Kenn dein Limit” campaign.

In 2009, BZgA started a campaign called “Alkohol? Kenn dein Limit” (Alcohol? Know your limit), with financial support from an association of private health insurance companies (about 50 million Euros over three years). The campaign focuses on 16-20 year olds and aims to reduced  binge drinking and risky patterns of alcohol use by increasing awareness about the risks and dangers of alcohol misuse. The campaign includes billboards, TV and cinema ads, brochures, and Facebook.

A year before the campaign started, researchers found that 20% of teenagers (ages 12-17) said they drank five alcoholic drinks or more once a month or more. A recent survey in 2011 suggests that this figure has dropped to approximately 15%. Health Minister Daniel Bahr reports that alcohol is the most widely used substance in Germany; in 2010, approximately 26,000 teenagers between 16 and 20 had been treated in hospital for acute alcohol poisoning.

Interestingly, there appears to be sex differences in the overall decline in teenagers. The decline appears primarily related to changes in drinking practices of girls and in 12-15 year old boys. In 2008, 34% of girls reported drinking more than five drinks at a time once a month; in 2011, this decreased to 22%. There was little change in rates for 16-17 year old boys, who drink the most (almost half drink 5 or more drinks once a month or more).

In the age 18-25 group, more than 50% of young men reported drinking more than five drinks in one night during the previous month – twice that of young women.

Due to these reported sex differences in drinking practices, the next stages of the campaign (which is currently planned to continue for another year) will switch its strategy and use different messages, images and design to target girls versus boys. Check out the campaign website here to take a look. The website does include information/brochures for download on pregnancy and alcohol although this is not a focus in the campaign.

Germany’s 2012 National Drug Strategy includes goals related to reducing the frequency of binge drinking among children and adolescents and abstinence from alcohol during pregnancy. Learn more here.

For more coverage of the campaign, see:

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD