Multiple Risk Introduction

Participating in risk taking behaviours is natural and essential for child and youth development. For most, this will be low risk, but for a small number of young people, adolescence can cause harm and impact wellbeing. 

Risk behaviours are usually considered individually. It is widely recognised that behaviours often interact and develop as a response to life circumstances. Read more here.

Many risk behaviours tend to cluster together, particularly in young people from the most socio-economically deprived backgrounds. Those young people engaged in multiple risk behaviours are therefore impacted by greater inequalities in health and wellbeing and this poses increasing concern for those who are more vulnerable.  

Several factors have been identified that can protect children and young people or, alternatively, can put them at risk during this stage. These factors relate to different personal and environmental factors, for example; personal assets, the community, school, family, peer groups and individual characteristics. 

Early initiation of risky behaviours, such as smoking or alcohol use, is linked with other risk-taking behaviours in later teenage years, such as sexual risk taking and binge drinking. Traditional risk behaviours, such as drinking alcohol or taking drugs, are being complicated by other harmful behaviours, for example self-harm, online gambling, sexting, and increased use of social media and handheld devices. This poses increasing concern for those who are more vulnerable.

Multiple Risk Health and Wellbeing Information

There are a number of risk-taking behaviours that young people engage with, which may have an impact on their health and wellbeing. Glasgow City Health Improvement have created a booklet which provides a snapshot of these behaviours in relation to young people living in Glasgow. The data has been taken from Scotland's School Health and Wellbeing Census 2021/22. Click here to view the booklet. 

In addition, we have also noted areas for consideration in relation to particular health topics below. 


Glasgow City Health Improvement Quit Your Way team undertook a consultation with young people to hear their views on Vaping. Click here   to see their responses.  

There are particular considerations for engaging with young people on the topic of vaping. ASH Scotland have shared information to highlight the key evidence, concerns and advice that will benefit anyone working with children and young people. Click here  to view on the ASH Scotland website. 

Please see the Multiple Risk Curricular Resources tab below to view Glasgow City Health Improvement's Lesson Plan on Vaping which is suitable for S1-S3.

Sexual Health

Prior to COVID, Gonorrhoea infection was higher for men, Chlamydia was higher for women and nationally there was a downward trend in unplanned pregnancies. A national survey carried out with staff working directly with young people found that some young people continued to have sexual intercourse during COVID-19 and there had been an increase in the use of pornography with 16 year olds having seen pornography in the last two weeks. Young Scot reported that children and young people had heightened support needs in terms of their mental health during this time. Online child sexual abuse has been reported to have increased during the pandemic with young people not realising they are being filmed on their phones. 

For many young people the risk of unplanned pregnancies, STI’s and lack of support for their parenting role will have been an increasing issue. We know that the earlier young people engage in sexual activities the higher the risk to their wellbeing.

For more information specific to sexual health, click here   to view the 'Relationships and Sexual Health’ section of this app.

For further information on sexual health, click here to visit the Sandyford website. This will direct you to the young people section which promotes healthy sexual health and wellbeing and has a focus on healthy relationships, condom service, sexual exploitation, pornography, challenging myths, consent, knowing when you are ready to have sex, sexting and sexualisation.

Mental Health and Wellbeing

For information on mental health and wellbeing, please click here  to view the ‘Mental Health and Wellbeing’ section.

Physical Activity and Nutrition

Consumption of energy drinks may also be considered alongside Multiple Risk behaviours in children and young people. Over consumption of Caffeinated Energy Drinks (CED's) may be associated with other risks to health and can impact on both physical and mental health. We have included more information on this in our infographic here

For information on physical activity and nutrition, please click here  to view the ‘Physical Activity & Nutrition’ section. 

Multiple Risk and Education

Young people taking part in multiple risk behaviours are more likely to have poorer educational attainment than their peers. This can result in leaving school early without going on to further education, training or employment. Early intervention and prevention can improve educational attainment and long term outcomes for young people.

Pre-adolescence and the transition from primary to secondary school are key periods to strengthen protective factors and reduce exposure to risk. 

Priorities for Multiple Risk Work

Glasgow City HSCP Health Improvement have identified the following priorities in relation to multiple risk work with children, young people and families in Glasgow:

Signposting individuals to relevant services

Supporting staff to identify people at risk

Reduced the harm caused to individuals, familied and communities from multiple risk behaviours


Tackling Stigma

The Scottish Government have identified Tackling Stigma as one of the cross cutting priorities in Scotland’s National Drugs Mission Plan 2022-2026 . The National Stigma Action Plan encourages organisations to consider how we can work together and individually to create a stigma-free Scotland.

Stigma often acts as a barrier to accessing support and treatment, impacts personal relationships, results in people being socially excluded and can often increase risk and harm. Addressing Stigma is vital to enabling people to access the support and treatment and to ultimately reduce drug related deaths in Scotland. 

Stigma is the negative perceived beliefs, thoughts and opinions towards a particular circumstance, quality or person. 

Stigma intersects with other axes of disempowerment and marginalisation in ways which create further disadvantage. This remains a universal problem for people who use drugs, people in recovery and their families. 

In 2016, just less than half (44%) of respondents to the ‘Public Attitudes in Scotland towards people with a history of drug dependence survey’ agreed that those with a history of drug dependence are a burden on society. 

Leading a more informed and compassionate approach, using people first language, promoting social inclusion and social justice are all crucial to mitigate the impact of stigma and reducing health inequalities for people affected by drugs. 


Public Health Scotland National Incident - STI's and Gonorrhoea

Public Health Scotland have established a National Incident Management Team to respond to the significant increase in diagnoses of sexually transmitted infections, especially Gonorrhoea, observed in young people across Scotland. Cases of gonorrhoea were steadily increasing prior to the COVID-19 pandemic but have increased rapidly since the end of 2021. There has been an 80% increase in infections among young men and women aged under 20 between 2018 and 2022. A briefing has been issued to the Association of Directors of Education (ADES) by Public Health Scotland for distribution. You can view the briefing here . Secondary schools should prioritise learning about sexually transmitted infections for third and fourth level learners as part of the delivery of Relationships, Sexual Health and Parenthood (RSHP) education as early as possible. Please see Relationship and Sexual Health page for additional information. Click here to view. 

Multiple Risk Curricular Resources

The following resources have been developed and/or quality assured by the Glasgow City HSCP Health Improvement Team. 

Multiple Risk - Which Way Resource

Stage: P7 & S2

Description: The Which Way S2 resource is designed to encourage learners to discuss and think more carefully about risk, risk taking behaviours and the decisions that they make. The learners will consider the factors that influence their decision making and how they can manage and cope when making personal decisions. Learners are encouraged through activities to think about how their personal opinions, attitudes and emotions can impact the choices they make. Activities have been designed to incorporate discussion on who and where they can go to for health and support with regards to their health and wellbeing. Learners are encouraged to identify where and who they can go to in their community for support and advice.

Please note: this resource is currently unavailable. Which Way is under review by the Glasgow City HSCP Health Improvement Team. A revised version will be linked here once available.

Substance Misuse Toolkit

Stage: Primary School

Description: A range of activities are provided which include interactive quizzes, paired working and individual learning. Some lesson plans have follow-up activities to further develop children's learning on the topic. 

Link to resource: Substance Misuse Toolkit 

This toolkit is currently under review by NHS GGC. Please continue to use the current version where appropriate and a revised toolkit will be linked here once available. 

Tobacco resources

Access the following tobacco resources by clicking here 

Jenny and the Bear

Stage: Primary 1 

Description: The Jenny and the Bear resource is a story which is part of a coordinated programme and aims to increase awareness about the effects of second hand smoke on children and what parents/carers can do to ensure their children are not exposed to its harmful effects. The programme consists of a story being read to the class followed by a classroom activity to agree a name for the bear in the story, which is then entered into a competition to win a Teddy Bear mascot for the classroom. All children who take part in the programme will be given a booklet version of the story to take home.

Trade Winds

Stage: Primary 5 to Primary 7

Description: Trade Winds is an interdisciplinary resource pack which extends across all curricular areas and correlated with 44 Level 2 experiences and outcomes. It offers a holistic approach to tobacco education that goes beyond health and explore issues that are relevant to young people.

Please note: this resource is currently unavailable. Trade Winds is under review by NHS GGC. A revised version will be linked here once available.

Tobacco-free Secondary Schools

Stage: Secondary School

Description: This guide to becoming a Tobacco-free School has been published by ASH Scotland, and is intended to support a school through the steps required to become tobacco-free. It explains the background, why it is important and key issues. 

Vaping and young people 

Stage: S1 - S3

Description: This resource was created by the North West Health Improvement Team, on behalf of Glasgow City HSCP Health Improvement. It covers the health effects of vaping, peer pressure and environmental harms.

Vaping and Young people Teachers Notes

Vaping Lesson Plan

Vaping Lesson Plan Presentation

Other Resources for Multiple Risk

It is important when considering multiple risk that we keep abreast of any emerging local trends and consider suitable targeted prevention messages. There is a wealth of information available on young people and risk behaviours in Scotland, and more specifically within Glasgow. In addition, there are a number of organisations responsible for collating a range of data and statistics with regard to national and local risk behaviour information, public health challenges and trends. We have outlined some additional resources for information below. Some of these are for educators learning and others can be used to support education and activities with learners. Educators should also consider resources outlined within the other health priority sections to support learning around multiple risk (e.g. mental health, RSHP, vulnerability, stigma etc.)



Public Health Scotland

Prevention in public health is about keeping people healthy and avoiding the risk of poor health, illness, injury, and early death. Find out more by clicking here

Public Health Scotland (PHS) provide an overview of alcohol, drug, mental health and well being, sexual health and young people related research. Click here  to visit the PHS website for further information. 

The Adolescent Brain

UNICEF: Advances in neuroscience reveal that the adolescent brain is still a work in progress, offering a crucial second window of opportunity to influence the development of children in their second decade of life. Learn more and access resources from UNICEF by clicking here

BBC Learning (6 minute English): Until recently, it was thought that human brain development was all over by early childhood but research in the last decade has shown that the adolescent brain is still changing into early adulthood. This programme delves inside the teenage brain, hears from an expert and teaches some useful vocabulary along the way to stretch your own brain! Watch the short video from BBC by clicking here


Substance use

Public Health Scotland - Substance use

Information on treatment, prevention, surveillance, data and intelligence, MERR and our national mission in relation to substance use in Scotland. Click here to view. 

Glasgow Centre for Population Health (GCPH)

GCPH research resources include alcohol work and mental health profiles. It also includes alcohol and drugs data for Greater Glasgow and Clyde, Glasgow City and neighbourhoods. GCPH developed the Children and Young People's Health Profiles (2016) which provide a comprehensive overview of health and wellbeing in Glasgow. In themselves they do not measure risk but do report on several of the known indicators for risk taking. Click here  to visit the GCPH website for further information. 

Young Minds Guide for Young People: Drugs and Alcohol

A guide containing the facts on drugs and alcohol, how they can affect your mental health, and advice on what to do if you need support. You can access the guide here

The Alcohol Education Trust 

The Alcohol Educational Trust have developed a range of alcohol education resources for children with Special Educational Needs or English as a Second Language. You can access them here

'Things I wish someone had told me about Booze': for young people, by young people

For stages S1 - S6: A leaflet developed in partnership with young people by Glasgow City Youth Health Service, Media Co-op and Young Movers (YoMo). The leaflet provides information for young people around alcohol and harms from alcohol. You can view the leaflet here

GCA - Alcohol Unit Guidelines

It’s not recommended that you drink any more than 14 units of alcohol per week, spread evenly over 3-4 days with at least a couple of alcohol-free days per week. Glasgow Council on Alcohol have a helpful guide that explains the Alcohol Unit Guidelines. You can view the guidelines here 

Alcohol Focus Scotland

Local Profiles: Alcohol Focus Scotland has developed local profiles demonstrating the high level of alcohol harm within Scotland’s 32 local authorities. The local area profiles highlight the number of people drinking over the recommended low-risk guidelines, the number of hospital admissions and deaths as a result of alcohol, and the cost of alcohol harm to the public purse, among other key facts. You can view the profiles here

Alcohol and Young People: Alcohol Focus Scotland provide information and a useful fact sheet on the impacts of alcohol use for young people, both direct and indirect. Click here to view. 


Tobacco and Vaping

ASH Scotland 

ASH Scotland have information and resources on their website to support children, young people and families to reduce the harm from smoking.  You can access the website here. 


Gambling harms

Gambling Education Toolkit

The Gambling Education Toolkit provides free resources and information about youth Gambling and Gambling Harms for Secondary Schools. It is designed for practitioners who work with young people in health and education settings. You can browse and read through the key information of each chapter and look at individual activities, but you will also have the option of downloading each section or the entire toolkit, for free. Click here  to access the toolkit

Gambling Education Hub CPD

The Scottish Gambling Education Hub provides free training sessions on youth gambling and gambling harms. The training sessions are open to practitioners who engage with young people under the age of 25 and/or with parents and carers, across a variety of health and education settings. Each CPD session supports participants to: increase their awareness regarding gambling and its impact on young people’s health and wellbeing; better understand about gambling harms and the relationship between gambling and other risk-taking behaviours; recognise the signs and consequences of gambling harms; increase their knowledge of resources available; find information on additional support and specialised services; explores ways to include gambling in the range of issues that services already address; strengthen their skills and confidence to deliver gambling education and prevention activities. Sessions can also cover other gambling-related topics, such as the links between gambling and gaming. Find out more and access the CPD calendar here   

Trust Me Film

The Trust Me film and resources were developed by Fast Forward. The film and resources are designed for practitioners who work with young people in health and education settings, particularly secondary schools. You can watch the film and access the resources here   

Multiple Risk Strategy/Policy Links

The Glasgow City HSCP Health Improvement Team have pulled together a list of key strategy and policy links regarding children and young people. These documents should be used to inform planning and delivery within your classroom and school community. These documents are a useful resource to build a knowledge base around current priorities and work around multiple risk in Glasgow and across Scotland. Please note that clicking on these documents will take you to external websites.


Alcohol Framework 2018: Preventing Harm

Drug Deaths Taskforce response: cross government approach 

Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016

National Strategy to Reduce Gambling Harms

NHS Greater Glasgow and Clyde Mental Health Improvement Framework (2012) - Mental Health Improvement and Early Intervention for Children and Young People  

Outcomes framework and supporting guidance for Pregnancy and Parenthood in Young people Strategy in Scotland (2016)  

Pregnancy and Parenthood in Young People Strategy   

Preventing offending: getting it right for children and young people.  

Raising Scotland’s tobacco-free generation: our tobacco control action plan 2018

Rights, Respect and Recovery: action plan

Rights, Respect and Recovery: alcohol and drug treatment strategy 

Scotland’s National Drugs Mission Plan 2022-2026

Smoking Prohibition (Children in Motor Vehicles) (Scotland) Act 2016   

The Scottish Governments Mental Health Strategy (2017-2027) - a 10 year vision

‘What works’ in drug education and prevention? (2016) 

Young people experiencing harms from alcohol and drugs: literature and evidence review

Editorial Information

Last reviewed: 31/03/2023