Anastasios Fotiou

Economic Recession and Emergence of an HIV-1 Outbreak among Drug Injectors in Athens Metropolitan Area: A Longitudinal Study

Background During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Methods Our study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008–2012). Results IDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998–2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in “new” drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008–2012 (economic recession) compared with 2002–2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008–2012 and 1998–2007, respectively. The coverage of harm reduction services was low throughout the study period. Conclusions Scaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.

Prevalence, Patterns, and Correlates of Tranquilizer and Sedative Use Among European Adolescents

PURPOSE To examine the prevalence, patterns, and correlates of nonmedical use of tranquilizers or sedatives in 85,000 adolescent students from 31 European countries participating in the European School Survey on Alcohol and Other Drugs (ESPAD) in 2003. METHODS Surveys in each country followed a standardized protocol. Logistic regression analysis was performed to identify sociodemographic and risk behavior correlates of medical and nonmedical tranquilizer or sedative use. RESULTS Lifetime nonmedical tranquilizer or sedative use was reported by 5.6% overall. Medical tranquilizer or sedative use multiplies the odds of nonmedical use by 10.7 (95% confidence interval 9.1-12.5) for boys and 7.2 (6.3-8.3) for girls. Nonmedical tranquilizer or sedative use is also associated with the use of tobacco (odds ratio 1.3, 1.1-1.5), alcohol (1.3, 1.2-1.5), and illicit drugs (3.5, 3.1-3.9). Further correlates are truancy (1.4, 1.2-1.6), tranquilizer or sedative use by friends (6.0, 5.5-6.7) and siblings (2.7, 2.2-3.4), and dissatisfaction with relationships with parents. Medical tranquilizer or sedative use shares to a large extent the same correlates. CONCLUSIONS Findings indicate similarities in adolescent tranquilizer or sedative use between Europe and United States. The implications of the results for prevention policies are discussed.

Decrease in Adolescent Cannabis Use From 2002 to 2006 and Links to Evenings Out With Friends in 31 European and North American Countries and Regions

OBJECTIVE To compare adolescent cannabis use between 2002 and 2006 and to investigate links to the frequency of evenings spent out with friends. DESIGN The Health Behavior in School-Aged Children study, an international study carried out in collaboration with the World Health Organization/Europe. SETTING A total of 31 mostly European and North American countries and regions. PARTICIPANTS A total of 93 297 students aged 15 years. OUTCOME MEASURE Cannabis use in the last 12 months in relation to the mean frequency of evenings out with friends per week. RESULTS A decrease in the prevalence of cannabis use was found in most of the 31 participating countries and regions. The most marked decreases were found in England, Portugal, Switzerland, Slovenia, and Canada. Increases occurred only in Estonia, Lithuania, Malta, and among Russian girls. The more frequently adolescents reported going out with their friends in the evenings, the more likely they were to report using cannabis. This link was consistent for boys and girls and across survey years. Across countries, changes in the mean frequency of evenings spent out were strongly linked to changes in cannabis use. CONCLUSIONS The findings are consistent with the hypothesis that by going out less frequently in the evenings with friends, adolescents had fewer opportunities to obtain and use cannabis. Future research is needed to learn more about the nature of evenings out with friends and related factors that might explain changes in adolescent cannabis use over time.

Homelessness and Other Risk Factors for HIV Infection in the Current Outbreak Among Injection Drug Users in Athens, Greece

Objectives. We examined HIV prevalence and risk factors among injection drug users (IDUs) in Athens, Greece, during an HIV outbreak. Methods. We used respondent-driven sampling (RDS) to recruit 1404 IDUs to the Aristotle intervention in August to October 2012. We interviewed participants and tested for HIV. We performed bivariate and multivariate analyses. Results. Estimated HIV prevalence was 19.8% (RDS-weighted prevalence = 14.8%). Odds of infection were 2.3 times as high in homeless as in housed IDUs and 2.1 times as high among IDUs who injected at least once per day as among less frequent injectors (both, P < .001). Six percent of men and 23.5% of women reported transactional sex in the past 12 months, and condom use was low. Intercourse with non-IDUs was common (53.2% of men, 25.6% of women). Among IDUs who had been injecting for 2 years or less the estimated incidence rate was 23.4 new HIV cases per 100 person-years at risk. Conclusions. Efforts to reduce HIV transmission should address homelessness as well as scaling up prevention services, such as needle and syringe distribution and other risk reduction interventions.

Family, School and Health in Children and Adolescents Findings from the 2006 HBSC Study in Greece

The association between family, school and subjective health was examined in a large representative sample of Greek children and adolescents (N = 3034). We hypothesized that (a) family and school factors are associated with health, even after controlling for gender and economic status; (b) family and school factors are directly related to satisfaction with life and health complaints, but indirectly to self-rated health. According to the findings, family and school factors were related to subjective health, even though this relation was weakening with age. Family and school factors were associated with self-rated health through health complaints and life satisfaction.

Drug Use in the General Population of Greece over the Last 20 Years: Results from Nationwide Household Surveys

The evolution of the drug use epidemic in Greece (prevalence and incidence of use of illicit drugs and illicit use of psychoactive pharmaceuticals) over a 20-year period is presented taking into account the sociocultural context and policies. Data were drawn from face-to-face household surveys carried out in 1984, 1998 and 2004 on national stratified probability samples of approximately 4,000 participants aged 12–65 years. After a large increase in lifetime illicit drug use prevalence from 4.0% in 1984 to 12.2% in 1998, the phenomenon seems to have taken a downward turn, to 8.6% in 2004. The incidence of illicit drug use remained unchanged between 1998 and 2004 in adolescents, declined in the young adult group (18–24 years) and dropped sharply at older ages. Cannabis accounts for almost all the total prevalence of illicit drug use; other illicit drugs have lifetime prevalence below 1%. The large gender differences in illicit drug use have narrowed over the years, especially in the younger age groups, although males remain far more heavily involved in illicit drug use than females. The lifetime prevalence of unprescribed use of pharmaceuticals has decreased markedly over the last 20 years from 13.5 to 9.1% following a stricter policy on prescribing. A narrowing of gender differences was also observed here, although females continue to predominate. Findings from the Greek general population surveys have had an impact on drug policy in the past and continue to represent an important input to policy formulation.

National Income Inequality and Declining GDP Growth Rates Are Associated with Increases in HIV Diagnoses among People Who Inject Drugs in Europe: A Panel Data Analysis

Background There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA). Methods We used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated. Findings In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested. Interpretation Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.

Polydrug use by European adolescents in the context of other problem behaviours

Aim Previous studies of the association between polydrug use and other risk behaviours have generally been limited to specific substances and a small number of behaviours. The aim of this study is to obtain better insight into polydrug use (comprising legal and illegal substances: tobacco, alcohol, tranquillisers/sedatives, cannabis, and other illegal drugs) and its association with co-occurring problem behaviours drawn from various broad domains (sexual, aggressive, delinquent, school achievement, relationships) among European adolescents. Methods Data were obtained from 101,401 16-year-old students from 35 European countries participating in the 2011 ESPAD survey. Associations between polydrug use and other problem behaviours were examined by multinomial and binary logistic regression analyses. Results Tranquillisers/sedatives appeared among the commonest combinations in the polydrug use pattern, especially for females. A strong trend was found between levels of involvement with polydrug use and other problem behaviours for both genders. The highest associations with polydrug use were for problems with the police, risky sexual behaviour and skipping school. Gender differences showed higher prevalences among boys than girls of problem behaviours of aggressive, antisocial type, while girls prevailed over boys in relationship problems. Conclusion An incremental relationship exists between the level of involvement with polydrug use and the co-occurrence of problem behaviours. Preventative interventions should consider the misuse of tranquillisers/sedatives within the context of polydrug use by adolescents and expand their target groups towards multiple problem behaviours.

Early Adolescent and Peer Drinking Homogeneity Similarities and Differences Among European and North American Countries

This study examined associations between perceived peer and adolescent alcohol use in European and North American countries. Self-reported monthly alcohol use and adolescents’ report of their peers’ alcohol use were assessed in nationally representative samples of students aged 11.5 and 13.5 years (n = 11,277) in Greece, Scotland, Switzerland, and the United States who participated in the 2005/2006 Health Behavior in School-Aged Children survey. Cross-national associations between perceived peer and adolescent alcohol use were examined using logistic regressions and interactions by gender and country. Perceived peer and adolescent alcohol use were positively associated in all countries, but the association was notably weaker in Greece than in Scotland (boys), and in Greece compared to Switzerland (girls). Further examination of the underlying processes that explain stronger and weaker associations between perceived peer and adolescent alcohol use in some settings could guide the development of effective, culture-specific interventions.

Adolescents’ medicine use for headache: secular trends in 20 countries from 1986 to 2010

BACKGROUND This study reports secular trends in medicine use for headache among adolescents in 20 countries from 1986 to 2010. METHODS The international Health Behaviour in School-aged Children (HBSC) survey includes self-reported data about medicine use for headaches among nationally representative samples of 11-, 13- and 15-year-olds. We included 20 countries with data from at least three data collection waves, with a total of 380 129 participants. RESULTS The prevalence of medicine use for headaches varied from 16.5% among Hungarian boys in 1994 to 62.9% among girls in Wales in 1998. The prevalence was higher among girls than boys in every country and data collection year. The prevalence of medicine use for headaches increased in 12 of 20 countries, most notably in the Czech Republic, Poland, Russia, Sweden and Wales. CONCLUSION The prevalence of medicine use for headaches among adolescents is high and increasing in many countries. As some medicines are toxic this may constitute a public health problem.