Do you want the good news or the bad? On the two most fundamental behaviors for health and longevity, American kids are the worst in the world on one and the best on another. In the area we are most preoccupied with, psychoactive substance use, we are very bad on one and good on another - but there are reasons to question the good one.

Here's the really bad news: overall, American kids are hurting.

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The Stanton Peele Addiction Website, June 19, 2008. This blog post also appeared on Stanton's Addiction in Society blog at

American Kids Health Alert

Results of the World Health Organization's international survey, Health Behaviour in School-Aged Children (HBSC) - comparing 11, 13, and 15-year-old children in 40 North American and European countries - are just in (a three-year embargo is placed on these data, but I have connections). How are we doing?

The two most important things young people can do for life-long health are to maintain age-appropriate weight, and not to smoke. We're the best in the world on one, worst on the other. Can you guess which is which?

I guess you want the bad news first - American kids are the fattest in the world. They rank number one in obesity/overweight among 11- and 13-year-olds, and are just barely edged out by Malta in the 15-year-old category. For the youngest kids in the survey, overweight/obesity figures range from 6% for the Netherlands and Switzerland to 29% in the U.S.

Somehow, all those soccer leagues, low-fat foods, and dieticians in American schools don't add up to trim - or even normal-weight - children.

On the good side, the United States has the fewest 15-year-olds who smoke at least once a week - 8%. Our anti-smoking messages presenting hard information about realistic health issues have gotten through.

Now, for what really concerns Americans about their kids - intoxication. Despite claims by the Drug Czar and other government officials that we have put the bite on illicit drug use, American 15-year-olds are fifth (31%) in having used marijuana, and third (14%) in regular use. Worse, although HBSC does not measure use of pharmaceuticals, there is every reason to suspect that American kids are at the top of the list in this category.

The good news is that the U.S. is near the bottom of the list of drunkenness for 15-year-olds - 36th (Greece and Israel are two of the four nations with lower rates). The problem here is that, while America's distinctive efforts to ban underage drinking seem to result in delayed drunkenness, American youth frequently get drunk by their late teens, when about 40% binge drink regularly.

Worse, at the age of 21, half of American young people binge regularly. Amazingly, according to the U.S. National Survey on Drug Use and Health, fully a quarter of Americans of this age are classifiable as suffering from substance (mostly alcohol) abuse or dependence. So, delaying drunkenness seems only to mean that kids start binge drinking with a vengeance in late adolescence.

I believe the only solution for this aberrant drinking - and many other addictive behaviors American youths display - is to prepare them with the values, skills, and outlooks that prevent addiction altogether.

Okay, now the most disturbing news about kids' health in our country. Among 11-year-olds, the U.S. ranked third worst in kids rating their health as fair or poor (22%); among 13-year-olds, there is a jump to 29% of American girls rating their health this way; at 15 years of age, American youths are still in the top ten among Western nations in fair-poor health ratings (including 28% of girls). Among 11-year-olds, Americans rank sixth in terms of kids reporting multiple health complaints; among 15-year-olds, they are seventh in such complaints.

Despite our preoccupation with diet, exercise, and health care, American kids are consistently at the bottom of countries in overall health - and this includes Bulgaria, Slovakia, Croatia, Scotland and many other nations considerably less wealthy than we are and reputed to have poor national health conditions. Money and school programs cannot create a healthy nation.