Self-perceived impact of COVID-19 and risk behaviors among adolescents: Results from the HBSC 2021/22 study in 21 European countries.

Aims: To investigate adolescents' perception of the impact of the COVID-19 pandemic on several aspects of their lives (mental health, well-being, family situation, peers, school, dieting, and physical activity) in relation to risk behaviors such as smoking, alcohol use, drunkenness, and cannabis use.

Methods: Data were used from the Health Behaviour in School-aged Children (HBSC) study conducted in 2021/2022, comprising 106,221 adolescents aged 11-15 (50.9% females) from 21 European countries. The data analysis plan involved Multilevel Generalized Latent Class Analysis (GLCA) models, latent class membership, and substance use behaviors, with alcohol consumption, smoking, drunkenness, and cannabis use as distal outcomes.

Findings: GLCA identified 14 % of the adolescents as negatively or very negatively impacted by the pandemic and 42 % with a positive or very positive impact. The remaining 44 % of adolescents were not attributed with either a negative or positive impact. In the first group, girls, older adolescents, and adolescents from less affluent families were overrepresented. The negatively impacted group was particularly prevalent (>25 %) in countries such as Hungary, Cyprus, Greece, and Poland. Negatively impacted adolescents exhibited a higher risk of smoking, drunkenness, and cannabis use compared to their peers in the positively impacted group after adjusting for sex, age, and family wealth.

Conclusions: Results of the 2021/22 HBSC study highlighted an elevated level of substance use among adolescents who perceived a stronger negative impact of the COVID-19 pandemic on their lives. These findings indicate that the pandemic has put a particular strain on girls, older and less wealthy adolescents. They highlight the need for special attention and tailor-made interventions to deal with stressful future events that may impact on the life and mental health of these adolescents.