Young girls in the UK drink, smoke and vape more than boys, a major study suggests.
England is also "top of the charts" globally for child alcohol abuse, according to the World Health Organisation (WHO) research of 44 countries.
In one of the largest studies of its kind, researchers examined data on 280,000 children aged 11, 13 and 15.
They found girls in the UK aged 13 and 15 tend to be drinking, smoking and vaping more than boys.
And two-fifths of girls in England and Scotland have vaped by age 15, higher than in other countries such as France, Germany and Spain.
Researchers also found 30% of 15-year-old girls and 17% of 15-year-old boys in England had vaped in the past 30 days.
Again, this was higher than children in several other countries, including Ireland, Canada, Portugal, Spain and Denmark.
The study found girls were more likely to have used a vape by 15 than the average for all 44 countries studied - with vaping having now overtaken smoking.
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Children aged 11 and 13 in England were also the most likely to have ever drunk alcohol compared with youngsters in all the other countries.
And compared to other European nations, rates of drunkenness in the UK were high, particularly among girls.
England tops the global chart at age 11, with 34% of girls and 35% of boys saying they have drunk alcohol, according to the WHO research.
By 13, this rises to 57% of girls and 50% of boys - which again puts it top of all other nations studied.
At age 15, 53% of girls said they had drunk alcohol in the previous 30 days, compared with 39% of boys.
More than 4,000 children in England, and about the same number in Scotland, were surveyed - as well as a sample from Welsh schools.
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Children in Scotland and Wales were also more likely to have smoked cannabis than those in many other countries, with both in the top five globally.
Data shows 15-year-old boys in Scotland have the highest rates overall for boys (23%), with only girls in Canada scoring higher (25%).
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'A little bit concerning'
Dr Jo Inchley, international coordinator for the study from the University of Glasgow, said some of the data was "a little bit concerning".
"Vaping in the UK is higher than the average across all the countries that took part in the survey as a whole," she said.
"So there's two areas for concern.
"One is that our levels are higher than elsewhere in Europe and, secondly, it looks like the trends are worsening quite substantially over a relatively short period of time in the UK."
A government spokesperson said: "The health advice is clear - smoking, vaping and underage drinking can be damaging for young people and their development.
"That is why there are age restrictions on the sale of these products.
"As a government, we are creating the UK's first smoke-free generation.
"Our landmark Tobacco and Vapes Bill will make it an offence to sell tobacco products to anyone born after 1 January 2009 and includes powers to limit flavours, packaging and displays of vapes to reduce the appeal to children."
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