Main trends in the health conditions of young people
 

Young people see the promotion of healthy lifestyles as one of the most important areas of youth policy, as indicated by the results of the Analysis of needs of young people conducted by the Ministry of Sports and Youth and Centre for Democracy and Human Rights in June 2020. This is consistent with the legal framework as the Law on youth (Official Gazette of Montenegro, Nos. 025/19 of 30 April 2019 and 4 027/191 of 17 May 2019) prescribes that it is a public interest in the field of youth policy to promote healthy lifestyles among youth.
 

In line with that, data on youth health are collected through different research and data collection mechanisms, both through participation in international research studies and studies conducted by the Institute for Public Health and other actors. The National Youth Strategy 2017-2021 recognizes that it is especially important that the health condition of young people be monitored in all segments, following international indicators.
 

Insights into significant trends concerning the health risk behaviors of young people have been gathered via participation in the European School Survey Project on Alcohol and Other Drugs (ESPAD) on substance use among 15-16-year-old students in the period from 2008 to 2019. The results show that, in the period from 2008 to 2019, there was a slight increase in tobacco smoking among adolescents (last-30-day), from 7% in 2008 to 10% in 2019. Increasing rates from the 2008 prevalence of lifetime use of cannabis (from 3% in 2008 to 9% in 2019) and the prevalence of lifetime use of illicit drugs other than cannabis (from 3% in 2008 to 5% in 2019) were also observed. Prevalence of current (last-30-day) use of alcohol showed a continuous increase from 32% in 2008 to 38% in 2019. Moreover, adolescents perceived that the risk of tobacco smoking and alcohol consumption was lower than it is. Close to 50% of students believe that the risk in occasional smoking is small. Similarly, 42% of them believe that drinking one or two drinks every day is only slightly risky.
 

The ESPAD study also revealed that gambling has become popular among adolescents. Almost every third student had gambled for money in the previous 12 months and 35% of them engaged in excessive gambling activity, which is the highest percentage registered among countries that have participated in the survey.
When it comes to nutrition, according to the results of the the Institute of Public Health of Montenegro (IPH) research on the prevalence of obesity in children aged 7 years in Montenegro (the aim of the research is the implementation of the Childhood Obesity Surveillance Initiative - COSI), almost a fifth of girls and boys have excessive body fat mass, and a little under a fifth of them are obese.  The same percentage of girls as boys are overweight, while almost every fifth boy (16,1%) and every tenth girl (10,5%) are obese. According to the parents' statements, almost half of the children consume fruit every day, around 38% of dairy products, almost a quarter of vegetables, meat and whole milk, and only 1.1% of children consume fish. Every tenth child (13.7%) consumes sweets every day, while 8.4% of children eat salty snacks. Only 3.3% of parents state that their children eat fast food.
 

Furthermore, the results of the Montenegro Nutrition Survey (MONS) showed that among children 6–23 months of age, 75 per cent had ever been breastfed, but only 45 per cent were put to the breast within one hour of delivery. Regarding complementary feeding, the majority of children have diets that meet the minimum criterium for diversity and meal frequency, but the compound indicator “minimum acceptable diet” is found only in about one half of children. Anaemia is found in 13 per cent of children aged 6–59 months, more than 40 per cent of children are iron-deficient and nearly all anaemic children have concurrent iron deficiency. Among non-pregnant women, more than 75 per cent have a minimally diverse diet, and more than 25 per cent are anaemic. Among pregnant women, the prevalence of minimum dietary diversity is 87 per cent, which is notably higher than in non-pregnant women. Further, pregnant women have a high prevalence of elevated triglycerides (45%), and approximately 63 per cent have an elevated triglyceride/HDL ratio. In addition, approximately 9 per cent of pregnant women are hypertensive. 
 

When it comes to reproductive health, a recent research study indicates that the level of awareness of the importance of contraception among young people is low – more than half of the respondents did not use contraception, or only used it sometimes (Youth Study 2018/19). According to the data from the same study, in total, 13.9% of young people said they did not know much about contraception.
The European Parliamentary Forum on Sexual and Reproductive Rights (EPF) published the new edition of the Atlas of European Contraception Policies, where Montenegro ranks 41st out of 46 countries where data from this area has been researched and collected, with a percentage index of 45.7%. The research shows that within the Montenegro national health system there is no possibility of reimbursement of costs related to contraceptives, and that reimbursement is not possible even under special conditions for young people aged 19 to 25 and for vulnerable categories of society. Furthermore, no long-acting reversible contraceptive (LARC) is available within the national health system.
 

When it comes to the availability of reproductive health products, menstrual products are especially important for women. Survey conducted by the NGO CAZAS in which over 1,100 schoolgirls and students from all over Montenegro participated, showed that 25% of them could not afford menstrual hygiene products (pads, tampons, menstrual cups, etc.), as and medications for menstrual pain and cycle regulation.
 

Youth mental health has recently been recognized as an important topic. A survey concerning the impact of the Covid-19 pandemic on the needs of young people conducted in the period April-May 2020 showed that young people believe that paying attention to mental health is essential (26% young people surveyed in June 2020 said that this was a priority) but that they lack access to sufficient psychological support.
 

As stated in the National Youth Strategy 2017-2021, the analysis of planned activities from the action plans of strategic documents related to the mental health of young people are not implemented according to the planned dynamics, because a competent multi-sectoral approach to implementation has not been achieved. Mental health centers in health centers are staffed, spatially and technically equipped to implement activities to improve the mental health of young people, from the aspect of health care, but it is necessary to ensure the complete integration of all other social sectors in this process.

Main concepts
 

The Institute for Public Health defines health following the World Health Organization definition as a state of physical, mental and social well-being and not merely the absence of disease. A similar definition is applied in the education materials used for teaching the subject “healthy lifestyles” in the secondary education curriculum, where health is defined as physical, mental, social and economic well-being.
 

A healthcare system is defined by the Law on health protection (Zakon o zdravstvenoj zaštiti) (Official Gazette of Montenegro, Nos. 03/2016, 39/2016, 2/2017, 44/2018, 24/2019, 82/2020 and 8/2021) as an organized and comprehensive activity of society to achieve the highest possible level of maintaining the health of citizens. It is a set of measures and activities to maintain, protect and improve the health of citizens, prevent and combat disease and injury, for early detection of disease and timely treatment and rehabilitation.