{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T02:51:41Z","timestamp":1790477501884,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T00:00:00Z","timestamp":1669075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIAAA)","award":["R01 AA028224"],"award-info":[{"award-number":["R01 AA028224"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim of the study was to analyze the trends of adolescent substance use in four eastern European countries over the time period from 1994 to 2018. The four countries in focus were selected based on their shared historical backgrounds and major economic and social transformations experienced. Methods: Two decades (1993\/1994\u20132017\/2018) of repeated cross-sectional data from the Estonian, Latvian, Lithuanian, and Polish Health Behaviour in School-aged Children survey were used. Data comprised 42,169 school children 15\u2009years of age (9th grade). The following categories of substance use were included: regular alcohol consumption and drunkenness, tobacco smoking, electronic cigarette smoking, and cannabis use. Trends in substance use over time were tested using Jonckheere\u2019s trend test. Results: Prevalence of substance use among adolescents over time revealed that the Baltic states and Poland have faced relatively different temporal trends. In the Baltic states, there was a general increase during the period of 1994\u20132002, which was followed by a period of peaking or stability between 2002\u20132010, and then decreasing trends of these risky behaviors from 2010 onwards. In Poland, the same period had less consistent patterns, with decreasing trends starting much earlier on. The prevalence of cannabis use, which had been measured since 2006, had its own unique pattern with many fluctuations within and between countries. Conclusions: The findings on the prevalence of substance use among adolescents from 1994 to 2018 revealed that the Baltic states and Poland have faced relatively different temporal trends. These countries might be facing new public health challenges in a near future, e.g., use of electronic cigarettes and cannabis use among adolescents.<\/jats:p>","DOI":"10.3390\/ijerph192315457","type":"journal-article","created":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T08:25:28Z","timestamp":1669105528000},"page":"15457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Trends in Adolescent Substance Use: Analysis of HBSC Data for Four Eastern European Countries, 1994\u20132018"],"prefix":"10.3390","volume":"19","author":[{"given":"Tomas","family":"Vai\u010di\u016bnas","sequence":"first","affiliation":[{"name":"Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"\u017demaitaityt\u0117","sequence":"additional","affiliation":[{"name":"Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8067-8932","authenticated-orcid":false,"given":"Shannon","family":"Lange","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada"},{"name":"Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON M5G 2C1, Canada"},{"name":"Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2040-6900","authenticated-orcid":false,"given":"Mindaugas","family":"\u0160telem\u0117kas","sequence":"additional","affiliation":[{"name":"Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3532-5190","authenticated-orcid":false,"given":"Leila","family":"Oja","sequence":"additional","affiliation":[{"name":"National Institute for Health Development, 11619 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3953-8655","authenticated-orcid":false,"given":"Janina","family":"Petkevi\u010dien\u0117","sequence":"additional","affiliation":[{"name":"Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8476-9911","authenticated-orcid":false,"given":"Anna","family":"Kowalewska","sequence":"additional","affiliation":[{"name":"Department of Biomedical Aspects of Development and Sexology, Faculty of Education, Warsaw University, 00-927 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iveta","family":"Pudule","sequence":"additional","affiliation":[{"name":"Centre for Disease Prevention and Control, 1005 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0420-5850","authenticated-orcid":false,"given":"Jaanika","family":"Piks\u00f6\u00f6t","sequence":"additional","affiliation":[{"name":"National Institute for Health Development, 11619 Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5371-9500","authenticated-orcid":false,"given":"Kastytis","family":"\u0160migelskas","sequence":"additional","affiliation":[{"name":"Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1111\/add.14201","article-title":"\u2018Are the Times A-Changin\u2019? Trends in Adolescent Substance Use in Europe","volume":"113","author":"Kraus","year":"2018","journal-title":"Addiction"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100227","DOI":"10.1016\/j.lanepe.2021.100227","article-title":"Public Health Monitoring of Cannabis Use in Europe: Prevalence of Use, Cannabis Potency, and Treatment Rates","volume":"10","author":"Manthey","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_3","unstructured":"World Health Organization (2016). Growing Up Unequal: Gender and Socioeconomic Differences in Young People\u2019s Health and Well-Being: Health Behaviour in School-Aged Children (HBSC) Study: International Report from the 2013\/2014 Survey, WHO Regional Office for Europe. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/326320."},{"key":"ref_4","unstructured":"\u0160migelskas, K., Luko\u0161evi\u010di\u016bt\u0117, J., Slap\u0161inskait\u0117, A., Vai\u010di\u016bnas, T., Bulotait\u0117, J., \u017demaitaityt\u0117, M., \u0160al\u010di\u016bnait\u0117, L., and Zaborskis, A. (2019). Lietuvos Moksleivi\u0173 Gyvensena ir Sveikata: 2018 m. Situacija ir Tendencijos, HBSC Tyrimas, LSMU. Available online: https:\/\/lsmuni.lt\/media\/dynamic\/files\/19493\/1122finaldakraraportas.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/S0140-6736(17)30819-X","article-title":"Smoking Prevalence and Attributable Disease Burden in 195 Countries and Territories, 1990\u20132015: A Systematic Analysis from the Global Burden of Disease Study 2015","volume":"389","author":"Reitsma","year":"2017","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/MOP.0000000000000456","article-title":"Tobacco, e-Cigarettes, and Child Health","volume":"29","author":"Peterson","year":"2017","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s11882-017-0723-0","article-title":"Tobacco Use and Smoke Exposure in Children: New Trends, Harm, and Strategies to Improve Health Outcomes","volume":"17","author":"Makadia","year":"2017","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1136\/tobaccocontrol-2015-052705","article-title":"Longitudinal Study of e-Cigarette Use and Onset of Cigarette Smoking among High School Students in Hawaii","volume":"26","author":"Wills","year":"2016","journal-title":"Tob. Control."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gallus, S., Borroni, E., Odone, A., van den Brandt, P.A., Gorini, G., Spizzichino, L., Pacifici, R., and Lugo, A. (2021). The Role of Novel (Tobacco) Products on Tobacco Control in Italy. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18041895"},{"key":"ref_10","first-page":"75","article-title":"An update on controversies in e-cigarettes","volume":"36","author":"Bhatt","year":"2020","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/S2213-2600(15)00521-4","article-title":"E-cigarettes and smoking cessation in real-world and clinical settings: A systematic review and meta-analysis","volume":"4","author":"Kalkhoran","year":"2016","journal-title":"Lancet Respir. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1177\/2047487319832975","article-title":"Cardiovascular effects of electronic cigarettes: A systematic review and meta-analysis","volume":"26","author":"Skotsimara","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pedn.2022.01.006","article-title":"Physical and mental health outcomes associated with adolescent E-cigarette use","volume":"64","author":"Livingston","year":"2022","journal-title":"J. Pediatr. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Sassano, M.F., Davis, E.S., Keating, J.E., Zorn, B.T., Kochar, T.K., Wolfgang, M.C., Glish, G.L., and Tarran, R. (2018). Evaluation of e-liquid toxicity using an open-source high-throughput screening assay. PLoS Biol., 16.","DOI":"10.1371\/journal.pbio.2003904"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1002\/mnfr.201100279","article-title":"Acrolein-a pulmonary hazard","volume":"55","author":"Bein","year":"2011","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/alcalc\/agt180","article-title":"Adolescent Alcohol Use: Risks and Consequences","volume":"49","author":"Marshall","year":"2014","journal-title":"Alcohol Alcohol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00127-009-0048-y","article-title":"Adolescent Risk Factors for Excessive Alcohol Use at Age 32 Years. A 16-Year Prospective Follow-up Study","volume":"45","author":"Huurre","year":"2009","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/S0140-6736(18)31310-2","article-title":"Alcohol Use and Burden for 195 Countries and Territories, 1990\u20132016: A Systematic Analysis for the Global Burden of Disease Study 2016","volume":"392","author":"Griswold","year":"2018","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/add.13230","article-title":"Relation between Age of First Drinking and Mental Health and Alcohol and Drug Disorders in Adulthood: Evidence from a 35-Year Cohort Study","volume":"111","author":"Boden","year":"2016","journal-title":"Addiction"},{"key":"ref_20","unstructured":"World Health Organizaton (2020, December 02). Adolescent and Young Adult Health Program. Available online: https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/adolescents-health-risks-and-solutions."},{"key":"ref_21","unstructured":"ESPAD Group (2020, November 05). ESPAD Report 2015: The European School Survey Project on Alcohol and Other Drugs. Available online: www.emcdda.europa.eu."},{"key":"ref_22","unstructured":"ESPAD Group (2020, November 05). ESPAD Report 2019: Results from the European School Survey Project on Alcohol and Other Drugs. Available online: https:\/\/europa.eu\/!Xy37DU."},{"key":"ref_23","unstructured":"Lipari, R.N., Hedden, S.L., and Hughes, A. (2014). Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings, The CBHSQ Report."},{"key":"ref_24","first-page":"1","article-title":"Cannabis Use and Cannabis Use Disorder","volume":"7","author":"Connor","year":"2021","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1017\/S0033291716003172","article-title":"Assessing Causality in Associations between Cannabis Use and Schizophrenia Risk: A Two-Sample Mendelian Randomization Study","volume":"47","author":"Gage","year":"2016","journal-title":"Psychol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/epirev\/mxr017","article-title":"Marijuana Use and Motor Vehicle Crashes","volume":"34","author":"Li","year":"2011","journal-title":"Epidemiol. Rev."},{"key":"ref_27","unstructured":"National Academies of Sciences E and Medicine (2017). Health and Medicine Division. Board on Population Health and Public Health Practice. Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, National Academies Press."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.jadohealth.2020.03.014","article-title":"Enhancing Understanding of Adolescent Health and Well-Being: The Health Behaviour in School-Aged Children Study","volume":"66","author":"Inchley","year":"2020","journal-title":"J. Adolesc. Health"},{"key":"ref_29","unstructured":"IBM Co. (2019). IBM SPSS Statistics for Windows, Version 26.0, IBM Co."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lunneborg, C.E. (2005). Jonckheere\u2014Terpstra Test. Encyclopedia of Statistics in Behavioral Science, John Wiley & Sons.","DOI":"10.1002\/0470013192.bsa324"},{"key":"ref_31","first-page":"797","article-title":"Alcohol Consumption and Alcohol Policy in Estonia 2000\u20132017 in the Context of Baltic and Nordic Countries","volume":"39","year":"2019","journal-title":"Drug Alcohol Rev."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rehm, J., \u0160telem\u0117kas, M., Ferreira-Borges, C., Jiang, H., Lange, S., Neufeld, M., Room, R., Casswell, S., Tran, A., and Manthey, J. (2021). Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000\u20132019. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052419"},{"key":"ref_33","unstructured":"Maresso, A., Mladovsky, P., Thomson, S., Sagan, A., Karanikolos, M., Richardson, E., Cylus, J., Evetovits, T., Jowett, M., and Figueras, J. (2022, April 05). The impact of the crisis on the health system and health in Estonia, Economic Crisis, Health Systems and Health in Europe: Country Experience, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK447834\/."},{"key":"ref_34","unstructured":"Orro, E., Hein, P., Martens, K., Josing, M., Reiman, M., and Konjunktuuriinstituut, E. (2022, April 08). Alcohol Market, Consumption and Harms in Estonia Yearbook 2010, Available online: https:\/\/tai.ee\/sites\/default\/files\/2021-03\/130319842457_Alkoholi_turg_tarbimine_ja_kahju_eestis_aastaraamat_2010_alcohol_market_consumption_and_harms_in_Estonia_yearbook_2010_est_eng.pdf."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Mi\u0161\u010dikien\u0117, L., Midttun, N.G., Galkus, L., Belian, G., Petkevi\u010dien\u0117, J., Vaitkevi\u010di\u016bt\u0117, J., and \u0160telem\u0117kas, M. (2020). Review of the Lithuanian Alcohol Control Legislation in 1990\u20132020. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103454"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1093\/alcalc\/agr001","article-title":"Decline in alcohol consumption in Estonia: Combined effects of strengthened alcohol policy and economic downturn","volume":"46","author":"Lai","year":"2011","journal-title":"Alcohol Alcohol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"122","DOI":"10.5114\/jhi.2019.91380","article-title":"The alcohol crisis in Polish public health","volume":"5","year":"2019","journal-title":"J. Health Inequal."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1093\/eurpub\/ckab180","article-title":"Electronic Cigarette Use Among Adolescents In 17 European Study Sites: Findings From The Global Youth Tobacco Survey","volume":"32","author":"Tarasenko","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_39","unstructured":"(2022, April 11). WHO Framework Convention on Tobacco Control. Available online: https:\/\/www.who.int\/fctc\/text_download\/en\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"80","DOI":"10.5114\/jhi.2019.87841","article-title":"Development of Tobacco Control in Lithuania and Changes in Indicators Related to Tobacco Use","volume":"5","year":"2019","journal-title":"J. Health Inequal."},{"key":"ref_41","unstructured":"Tobacco Act (2022, October 26). RT I, Available online: https:\/\/www.riigiteataja.ee\/en\/eli\/525032015017\/consolide."},{"key":"ref_42","unstructured":"(2022, October 28). Law On the Handling of Tobacco Products, Herbal Products for Smoking, Electronic Smoking Devices and Their Liquids. Available online: https:\/\/likumi.lv\/ta\/en\/en\/id\/282077."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/15457\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:24:16Z","timestamp":1760145856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/15457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,22]]},"references-count":42,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192315457"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192315457","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,22]]}}}