Fags, booze and drugs - on top of poor diets - still lead to chronic illness among many young people on the margins of school and their communities, a Scottish Executive health consultation confirms.
The vulnerable, excluded and poor are most at risk and are falling way behind rising standards of health among the majority. Scotland is matching life expectancy levels seen in the best performing European countries more than 30 years ago, but thousands of young people in deprived areas are missing out.
Looked-after children, young people leaving care, the homeless and travellers, and young offenders all feature in the highest risk categories.
Ill-health patterns are set in childhood and the Executive's more medically related health targets for children and young people, launched this week, reaffirm many of the policies recommended last April by the more broadly based Health for all Children (HALL 4) strategy.
Media reports earlier this week suggested ministers were set to introduce obesity tests for all children as they enter primary school but the policy of general health screening is already being implemented by several health boards and is based on the recommendations from HALL 4.
The latest health statistics from the Children and Young People's Health Support Group confirm the reality of harsh lives for many:
* The incidence of diabetes in children has trebled in the past 30 years, while that of cancer among children has risen by more than 20 per cent in 20 years. Up to 30 per cent of girls and 35 per cent of boys aged between two and 15 are overweight or obese. At age 12, 11 per cent are classed as severely obese.
* Four times as many five-year-olds from deprived communities have unrestorable tooth decay, often leading to extractions.
* Current estimates suggest up to 60,000 children have a drug-abusing parent and that up to 100,000 are affected by parental misuse of alcohol.
* Within the 11,000 looked-after children, more than 40 per cent have emotional or mental health problems. Up to 10 per cent of young people have clinically diagnosed mental health disorders (page five).
* A further 7,000 young people have "complex needs" and one in three of babies born with very low weights will be disabled, half of them severely.
* Along with the rest of Britain, Scotland continues to have the highest rate of teenage pregnancy in western Europe, with more than 40 per cent of conceptions terminated. Girls in areas of deprivation are three times more likely to become pregnant. They are 10 times more likely to become mothers because terminations are less likely in poorer areas .
The Executive says it is already acting on key aspects of the report such as nutrition, obesity and physical fitness and has issued advice for teachers and parents. The health-promoting schools unit is tackling some of the issues.
In the report last April, the Executive picked up the challenge of rising obesity, a health concern common to industrialised countries. "The question of body weight, obesity and body image is a complex question for children and young people, and they require sophisticated support that ensures the relationship they have with food and physical activity remains as positive as possible," it stated.
Health screening from an early age is designed to identify disabilities and disorders.
Delivering a Healthy Future: An Action Framework for Children and Young People's Health in Scotland: Draft Consultation. Released this week by the Scottish Executive.