The meta‐analyses on tobacco and cannabis use highlighted significant associations between NEET status and the consumption of each product. However, no significant association was found for CUD. Subgroup analyses stratified by comparison group showed that young people with NEET status have significantly higher current tobacco use compared with students, but no significant difference when compared with employed youth. The observed variation in the prevalence of substance use across NEET profiles, ranging from 27% to 56% for current tobacco use, underscores the importance of not considering NEET youth as a homogenous population, with important implications for prevention or care interventions.

The main findings, showing elevated substance use among NEET individuals, align with previous evidence and support the hypothesis of an association between NEET status and substance use, with substance use acting either as a cause or as a consequence of NEET status [19, 20]. These findings should, however, be interpreted in light of the broader policy context surrounding substance use over the period covered by the included studies. Over the past two decades, several countries in Europe, North America and more broadly across the OECD have implemented increasingly comprehensive tobacco control policies [40], rooted in the WHO Framework Convention on Tobacco Control adopted in 2003 [41], including raising the minimum sales age [42, 43, 44], smoking bans in public places, restrictions on advertising and increased taxation on tobacco products [45, 46, 47]. These policies may have contributed to a significant decline in tobacco use among adolescents and young adults in many high‐income countries. However, the literature highlights that this overall decrease has not been evenly distributed across social groups. Socio‐economic inequalities in smoking persist, and in some cases have widened, with young people from more disadvantaged backgrounds remaining more likely to use tobacco than their more advantaged peers [48, 49, 50]. Our findings corroborate this trend: NEET individuals exhibit significantly higher tobacco use than their non‐NEET counterparts, highlighting these inequalities and the need for tailored smoking prevention and cessation interventions. In addition, recent policy developments regarding cannabis, such as legalisation or decriminalisation in some countries, may also have influenced the patterns of substance use among young people; however, current evidence does not consistently indicate a clear effect on youth cannabis consumption [51, 52, 53].

Taken together, these elements highlight the importance of considering both the socio‐economic context and the policy environment when interpreting trends in substance use among young people.

At the individual level, young people with NEET status face multiple stressors, including economic precarity, uncertainty about their future, and social stigmatisation, which may increase their susceptibility to substance use. Research demonstrates that youth with NEET status are more likely to experience anxiety disorders, behavioural problems or depression [25, 54]. In this context, substance use, especially of cannabis, may serve as a maladaptive coping strategy for managing daily stress, escaping problems or regulating emotions [55, 56]. On the other hand, cannabis use during adolescence and early adulthood has been identified as a risk factor for developing psychiatric disorders [57]. Structural factors further compound these risks, as youth with NEET status often experience limited access to healthcare services and social support networks [21, 58, 59, 60]. Given the higher prevalence of substance use and mental health issues among young people with NEET status compared with their employed or student peers, and considering these access barriers, it highlights a significant public health challenge for healthcare systems and policymakers.

Our quantitative findings lack information on the motivations and context of use among youth with NEET status. Understanding motives for consumption is essential to consider prevention perspectives. According to the Marijuana Motives Measure (MMM) developed by Simons et al., cannabis use responds to specific needs, resulting in five types of motivations for consumption: coping (managing negative emotions); social (enhancing social interactions); conformity (peer pressure and integration); enhancement (seeking positive emotions); and expansion (of the mind) [61]. Cannabis use patterns vary according to the underlying motivations, with coping‐motivated use typically occurring in more solitary contexts [62, 63, 64]. This may be particularly prevalent in NEET youth, who experience greater mental health challenges than their employed or student peers [21, 24]. Solitary consumption is particularly concerning given its specific associated risks: it is linked to stronger coping motives [65] and is prospectively associated with a greater likelihood of developing CUD, even after controlling for quantity and frequency of use [66]. The elevated risk may stem from the absence of social comparison—individuals cannot gauge their consumption against peers, potentially leading to more severe consequences [67].

In parallel, the socio‐economic context also influences risk profiles. Adolescents from families of higher socio‐economic status, despite sometimes having similar consumption rates, generally benefit from social and familial support (family supervision, access to care) that reduces negative consequences compared with youth from disadvantaged backgrounds [68]. Young people with NEET status, who often come from these disadvantaged backgrounds, present increased vulnerability to the deleterious consequences of substance use, regardless of the quantities consumed [69].

For young people with NEET status, these risk factors may be compounded by their documented higher levels of social isolation [70], which could potentially increase the likelihood of solitary use that escapes the usual social control of family and peers. This combination of socio‐economic vulnerability and potential solitary use patterns requires particular attention in prevention and intervention strategies.

This meta‐analysis revealed that young people with NEET status had similar tobacco use rates to those of employed peers, but significantly higher rates than students. These results are consistent with existing literature linking lower educational attainment and socio‐economic status to increased smoking prevalence, both common among young people with NEET status [71, 72, 73]. The lower prevalence of tobacco use among students may reflect multiple protective factors: structured environments with smoking restrictions [74]; greater access to university health services, including prevention initiatives [75]; and, importantly, evolving social norms that increasingly discourage tobacco use within academic settings [76]. A recent longitudinal study demonstrated significant increases in support for tobacco‐free campus policies among university students over time [76], with over 86% of students reporting that smoking is discouraged among their peers in some university contexts.

The absence of significant differences in tobacco use between young people with NEET status and their employed peers could reflect the fact that employed youth may work in blue‐collar or service sector jobs that typically require lower educational qualifications, environments where the prevalence of tobacco use has been reported as higher compared with white‐collar or academic settings [77, 78]. The similar consumption rates, despite different financial capacities, raise questions about access and affordability. While employed youth have regular income to purchase tobacco, young people with NEET status may access tobacco through alternative means, potentially exposing them to less regulated and potentially more toxic products obtained through informal networks [79].

Subgroup analyses by gender did not reveal significant differences in tobacco use among young people with NEET status, though these results warrant cautious interpretation owing to the limited number of available studies. This finding is particularly noteworthy when contrasted with the general population, where gender differences in substance use patterns are well documented. Existing literature highlights that young men have higher tobacco use and overall substance consumption than young women [39, 80]. For young people with NEET status, the absence of significant gender differences may suggest an equalisation of substance use risks across the genders. In fact, unemployed youth of both genders were found to have higher levels of tobacco use compared with same‐age peers [81, 82]. Among young women specifically, prolonged unemployment has been identified as a risk factor for developing tobacco use [83], and unemployment is also associated with smoking persistence and lower cessation rates, partly because of reduced access to social and economic resources compared with young men [84]. These factors have been suggested to intensify the use of tobacco as a coping strategy for managing the material and psychosocial stressors related to their gender [84].

Regarding gender aspects of cannabis use, we were unable to conduct analyses in subgroups owing to a lack of available data. Recent research indicates that cannabis use is positively associated with traditional masculine norms, where regular use among boys is perceived as ‘cool’, while habitual use among girls is described as inappropriate [85, 86, 87]. Girls and women who use cannabis are therefore more likely to experience stigma and discrimination compared with men, often being stereotyped as ‘rebellious’ or ‘irresponsible’ [88]. Pregnant women or mothers, a subgroup also present among young people with NEET status, may be particularly affected by gendered discrimination related to substance use according to the broader literature. Evidence from general population studies suggests that care provision for this group is frequently oriented towards foetal or child health, which tends to reduce women to their reproductive roles instead of acknowledging their own health and rights as equally central, particularly in relation to the adverse effects of substance use [86, 89]. However, whether these dynamics apply specifically to NEET young women with family responsibilities remains to be examined empirically.

Age also represents a critical factor in understanding tobacco and cannabis use among young people with NEET status. The NEET definition spans a broad age range [7, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28], encompassing individuals facing very different developmental and social circumstances. Under the age of 25 years, individuals are still undergoing brain development, and substance use during this period has been shown to be especially detrimental, with an increased risk of dependence [90, 91]. Conversely, individuals aged over 25 years and those experiencing prolonged NEET status face elevated rates of anxiety and depression symptoms, and longitudinal evidence suggests that this is associated with a higher likelihood of persistent NEET status over time [24, 92]. Although accounting for age seems, therefore, crucial to understanding the differential impact of consumption patterns and designing tailored interventions, meta‐analyses conducted within this study faced significant limitations in examining age‐specific trends, as many of the included studies used broad age categories (e.g. 10‐year spans) and did not provide substance use data disaggregated by age. Future research should explore age‐specific patterns and the transition from experimentation to regular use among young people with NEET status to inform developmentally appropriate interventions.