Background/Objectives: Healthy diet, regular physical activity (PA), and minimizing sedentary behavior (SB) are crucial in promoting adolescents’ health and well-being. We assessed adherence to PA and SB recommendations among a representative sample of adolescents and explored their relationship with diet and diet-related behaviors. Methods: Data from the Greek arm of the 2017/2018 international Health Behavior in School-Aged Children (HBSC) cross-sectional study were used, including a probability sample of 3357 students (47.6% boys) who were 11, 13, and 15 years old. PA, SB, consumption of food groups/beverages, and diet-related behaviors were self-reported. Multiple logistic regression was used to identify potential associations. Results: Most students failed to meet PA (83.9%) (i.e., ≥1 h of moderate-to-vigorous physical activity/day) and SB (90.2%) (i.e., ≤2 h of screen time/day) recommendations. Daily consumption of fruit and vegetables compared to consumption at ≤1 day/week was associated with increased adherence to PA recommendations (adjusted Odds Ratio (aOR) = 2.26, 95% Confidence Intervals (CI): 1.62–3.17 for fruit; aOR = 1.35, 95%CI: 1.00–1.82 for vegetables). Eating sweets ≤1 day/week vs. every day was associated with higher adherence to SB recommendations (aOR = 2.41, 95%CI: 1.43–4.04). Poor diet quality was related to lower adherence to PA and SB recommendations. Daily breakfast consumption vs. never and abstaining from eating at fast-food restaurants were associated with better adherence to PA and SB recommendations. Rarely eating in front of screens was associated with substantially higher odds of adhering to SB recommendations (aOR = 5.79, 95%CI: 3.67–9.14). Conclusions: Healthier diet/diet-related behaviors were associated with increased PA and reduced SB in this sample of adolescents.

The use of illicit substances is a major public health problem. While individuals with substance use problems primarily seek treatment in specialized treatment programs, the role, exposure, and response of private practice psychiatrists to requests for substance use-related problems remain unclear. This study aims to assess private practice psychiatrists' exposure to and response to treatment requests for substance use-related problems, along with examining the requests' characteristics. A cross-sectional online anonymous survey was administered involving private practice psychiatrists in Greece between January and February 2024. A total of 100 private practice psychiatrists responded to the survey (response rate ~10%; 53.0% male, aged 49.5 (SD=9.3) years, with 13.7 (SD=9.9) years of professional experience, and 59.0% with a private office in the Attica/Athens region. Most participants (84.0%) reported exposure to requests for substance use treatment during the last 12 months, with 69.0% of them (58% of the total) accepting to offer of treatment. The most frequently reported categories of substances included cannabis and cocaine/crack. High rates of comorbidity with problematic alcohol use, multiple substance use, and other mental disorders were also reported. Pharmacotherapy and cognitive behavioral therapy were the treatments most commonly used. Factors associated with accepting to offer treatment included past specialized training in addiction (p<0.001), past or current employment in treatment facilities (p=0.002), self-reported expertise in addictions (p=0.017), previous training during specialty in substance use departments (p=0.001), and use of motivational interviewing (p=0.011). Around 70% of participants who did not accept cases believed patients would be better treated in specialized substance use treatment programs. Among all participants, 63.6% were willing to accept future treatment requests⎯significantly higher percentage (93.1%) among those who had accepted similar requests before, compared to those who had not (19.2%, p<0.001). In conclusion, apart from specialized addiction services, a substantial number of private practice psychiatrists in Greece were also exposed to and accepted treatment requests for illicit substance use-related problems, with most frequently encountering requests related to cannabis and cocaine use. Future research should investigate the characteristics of patients treated for illicit substance use-related issues in private settings and the services provided to them.

BackgroundCompared to the general population, people living in prison are at an increased risk to experience negative (mental) health outcomes. Moreover, delinquency and drug use have many risk factors in common. A need exists for increasing the knowledge about health needs, drug use patterns and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study about wellbeing, drug use and related care in prison.Methods/designA multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, the European Questionnaire on Drug use among people living in Prison, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data regarding health and social reintegration measures in prison is collected through a quantitative survey addressed to the prison authorities.DiscussionThis study protocol presentes a European study which aims to assess drug use among people living in prison and recently released people who use drugs as well as the existing care services in prisons. Hereby, factors related to the prison environment and their needs, both inside and outside prison are taken into account. Importantly, this study protocol describes a methodology which is developed to be executed in different prison settings within different countries simultaneously. Accordingly, for each country the protocol is adjustable to specific national legal requirements, regional differences and distinct local regulations of prison administrations. However, extensive modularity inevitably comes with significant limitations of comparability and generalizability of the results.

Wars, pandemics, and disasters that cause societal instability are referred to as "Big Events" and have been associated with outbreaks of infectious diseases. At the initiation of the 2008 severe economic recession in Greece (the last Big-Event before the pandemic), a hepatitis C virus (HCV) outbreak emerged among people who inject drugs (PWID) in 2009, which was the root of the 2010 Human Immunodeficiency Virus (HIV) outbreak. The HCV-outbreak was not detected, while that of HIV was identified in mid-2011. Given that HCV and HIV share common transmission routes, the HIV-interventions directly reduced the HIV-incidence by 78% and indirectly HCV-incidence by 64.8%. This study aims to assess what would have been the course of the two outbreaks, and their economic consequences if the 2009 HCV-outbreak had been timely detected. A published, stochastic, dynamic model was used to simulate HCV and HIV transmission among PWID (Gountas et al. IJDP 2020, Gountas et al. PLOS 2021). The model was calibrated to reproduce the observed epidemiological parameters among PWID of Athens, Greece. The time-horizon of the analysis was 2002-2019 to capture second-order transmission effects. Under the status-quo scenario, the cumulative HCV and HIV cases were 6480 (95% CrI: 6000, 6900) and 1360 (95% CrI: 400, 2600), respectively. If the HCV outbreak had been detected and integrated interventions had been initiated in 2009 or 2010, 440 and 970 new HCV cases and 740 and 1110 new HIV cases could have been averted by 2019, respectively. Concerning the costs of treating the new cases for both diseases, the existence of an efficient notification system would have saved €40.9-65.8 million by 2019. An accurate automated outbreak detection system among PWID is a cost-saving investment. During the COVID-19 pandemic, which is the current Big Event, HIV/HCV surveillance should be more intense to timely detect new outbreaks.

Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages.

Background: In March 2020 home confinement was imposed to Greek residents as a measure to abate the COVID-19 pandemic. This study aims to elucidate changes in physical activity (PA) levels that occurred during confinement in a collegiate population in Greece. Methods: 565 collegiate students and staff participated in a retrospective cross-sectional online survey measuring PA related behaviours before and during the confinement period using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Results: The overall activity (IPAQ-SF MET-min score) decreased in the confinement- compared to the pre-confinement period [Md (Q1:Q3) pre vs. during: 2464 (1160; 5126) vs. 2247 (1074; 3999), p<0.001], driven exclusively by males (p<0.001) and the younger age group (18-31 years; p=0.003). Sitting increased in the total sample, including in each gender and age-group (all p<0.001). Compared to pre-confinement period, during confinement the odds of being in the ‘medium’ or ‘high’ moderate- to- vigorous PA group were 41% higher in females (aOR = 1.41, 95% CI=1.11-1.80, p=0.006) and 33% lower in males (aOR=0.67, 95% CI=0.50-0.88, p=0.005). Conclusion: There is a gendered pattern in observed changes in PA during the Covid-19 home confinement in the collegiate population, with females being those favored in comparison to males. Article visualizations:

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006-2020; n = 52,368 HIV+/-; n = 47,268 HCV+/-). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52-2.42). Pooled PR was 1.66 (95% CI 1.38-1.98), giving a PAR of 25.8% (95% CI 16.7-34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17-2.91). Pooled PR was 1.42 (95% CI: 1.28-1.58) and PAR 16.7% (95% CI: 11.8-21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release ('throughcare').

Introduction In 2009 and 2010, Athens, Greece experienced a hepatitis C virus (HCV) and a Human Immunodeficiency Virus (HIV) outbreak among People Who Inject Drugs (PWID), respectively. The HCV outbreak was not detected, while that of HIV was identified in 2011. The integrated HIV-interventions, launched in early 2012, managed to reduce directly the HIV incidence and indirectly the HCV incidence. This study aims to assess what would have been the course of the HIV outbreak and its associated economic consequences if the 2009 HCV outbreak had been detected and integrated interventions had been initiated 1- or 2-years earlier. Methods The model was calibrated to reproduce the observed HIV epidemiological and clinical parameters among PWID of Athens, Greece. We examined the effect of the 1- or 2-years earlier detection scenarios, the 1-year later detection, the non-detection scenario, and compared them to the status quo scenario. Results Cumulative HIV cases, under the status-quo scenario during 2009-2019, were 1360 (90% Credible intervals: 290, 2470). If the HCV outbreak had been detected 1- or 2- years earlier, with immediate initiation of integrated interventions, 740 and 1110 HIV cases could be averted by 2019, respectively. Regarding the costs, if there was an efficient notification system to detect the HCV outbreak 1 or 2 years earlier, 35.2-53.2 million euros could be saved compared to the status quo by 2019. Conclusions If the HCV outbreak had been detected and promptly addressed, the HIV outbreak would have been prevented and 35.2-53.2 million euros could have been saved.

Prevalence of diet-related behaviors (i.e., breakfast consumption, eating with the family) and their asso-ciation with a 17-point diet quality score, constructed on the basis of reported frequency (in days/week) of vegetable, fruit, sweets and sugar-sweetened beverages consumption, was investigated among 3525 adolescents (51.5% girls) aged 11, 13 and 15 years, who were participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) cross-sectional study, during 2018. Almost one-third (32.9%) of the sample had breakfast ≤1 day/weekdays, 20.2% rarely ate with the family, 26.1% had a meal while watching TV ≥5 days/week, 31.7% had a snack in front of a screen ≥5 days/week and 24.1% ate in fast-food restaurants at least once/week. Multivariable ordinal logistic regression revealed that eating breakfast ≤1 day/weekdays compared to 4–5 days/weekdays (Odds ratio (OR): 1.56, 95% con-fidence interval (CI): 1.34–1.82), eating rarely with the family compared to almost every day (OR: 1.35, 95% CI: 1.13–1.60) and eating in fast-food restaurants ≥2 times/week vs. rarely (OR: 4.59, 95% CI: 3.14–6.70) were associated with higher odds of having poor diet quality. High frequency of having meals/snacks in front of a screen/TV was also associated with poor diet quality. Efforts to prevent or modify these behav-iors during adolescence may contribute to healthier diet.

People who inject drugs (PWID) comprise one of the major transmission risk groups for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In 2011, Athens experienced a large HIV outbreak among PWID. Significant public health interventions were implemented in response to the HIV outbreak. The aims of this study were to estimate the indirect effects of the HIV interventions on HCV infection and to evaluate the concept of the association between HCV and HIV infections in the case of Athens. A dynamic, stochastic, individual-based model was developed to simulate HCV transmission among PWID. We calibrated the model to reproduce the observed HCV prevalence among PWID in Greece. Two years prior to the HIV outbreak, an undetected HCV outbreak has occurred. In 2009, the incidence of HCV infection increased from 640 (495, 842) cases in 2008 to 1260 (1060, 1500). The mean time from initiation of injecting drug use to HCV acquisition decreased from 29 months in 2008 to 13 months in 2009. After HIV interventions, HCV incidence declined by 64.8% in 2012, compared to 2009. The averted HCV incidence cases attributed to the HIV-implemented interventions were 2200 (1950, 2480), during 2012-2015. The cumulative number incident HCV cases in Athens during 2002-2015 was about 9900 (7800, 12 100). Our results highlight that before the 2011 HIV outbreak in Athens, an HCV outbreak occurred in 2009. Prevention measures for HIV that took place in the Athens metropolitan area in 2012 reduced significantly the incidence of HCV.

BACKGROUND AND AIMS Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross-country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on-/off-line mode and to examine the association with individual and family characteristics and substance use. DESIGN Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study, a survey using self-administered anonymous questionnaires. SETTING Thirty-three European countries. PARTICIPANTS Sixteen-year-old-year-old students (n = 93 875; F = 50.8%). MEASUREMENTS The primary outcome measure was prevalence of past-year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring). FINDINGS A total of 22.6% of 16-year-old students in Europe gambled in the past year: 16.2% on-line, 18.5% off-line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39-1.53), life-time use of inhalants (OR = 1.57, 95% CI = 1.47-1.68) and other substances (OR = 1.78, 95% CI = 1.65-1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18-1.35), going out at night (OR = 1.32, 95% CI = 1.26-1.38), participating in sports (OR = 1.30, 95% CI = 1.24-1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79-0.86), parents' monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77-0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84-0.94). CONCLUSIONS Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money.

Greece is among the countries hit most severely by the recent global economic recession. Given that poverty early in life can have long-lasting implications, investigation of the recession's impact on adolescents' well-being is critical for guiding relevant policies and interventions. We examined its impact on adolescents' lives in Greece and trends in well-being indicators before and during the crisis. Data were drawn from three successive waves (2006, 2010 and 2014) of the HBSC survey in Greece. Stratified probability samples of between 3500 and 4200 students aged 11, 13 and 15 years completed anonymous questionnaires in their classrooms. Data were analysed by X-2 tests and logistic regression taking account of the complex survey design. Latent class analysis (LCA) of the repercussions of the crisis perceived by adolescents such as parental unemployment, fights within the family and constraints on going on holidays was conducted. Student's life satisfaction has fallen. Older students reported effects of the crisis more than younger ones. While cannabis use increased among boys, smoking and alcohol consumption decreased in both genders. Logistic regression including the latent classes showed that reporting more repercussions of the economic crisis was associated with more cannabis use and smoking among students of both genders, and more alcohol consumption among boys. The findings enhance our understanding of the impact of the economic crisis on adolescents and families in Greece. These data can aid in shaping policies to protect families and their offspring from the repercussions of adverse economic conditions.

INTRODUCTION:We conducted a pilot study to: 1) obtain feedback from prevention practitioners in terms of their satisfaction, knowledge, and self-efficacy following exposure to the Tobacco Treatment Guidelines for Adolescents (TOBg Guidelines); and 2) examine the effectiveness of a school-based intervention based on the TOBg Guidelines on quit rates among a sample of adolescent tobacco users.METHODS:Two parallel studies were conducted. In Study 1, prevention practitioners were exposed to a 1-day training in the TOBg Guidelines with assessment occurring before, immediately after, and at 6 months following the training. In Study 2, participating adolescent smokers were exposed to a 3-session group-based smoking cessation intervention that drew on the TOBg Guidelines and was delivered by practitioners trained in Study 1. The primary outcome measure was self-reported smoking status assessed at 1 month and at 6 months following baseline.RESULTS:A total of 18 prevention practitioners and 65 adolescent tobacco users participated in the pilot study. The majority of practitioners reported high rates of satisfaction with the TOBg Guidelines and indicated that the guidelines positively influenced the manner in which they addressed tobacco use with adolescents. Prevention practitioners' self-efficacy for intervening with adolescent smokers was also significantly increased following exposure to the TOBg Guidelines and training. Among adolescents exposed to the school-based intervention, 62.5% and 23.1% had reduced smoking by 50% or more at 1 month and at 6 months follow-up, respectively. No significant change in smoking abstinence was documented.CONCLUSIONS:The TOBg Guidelines for adolescent smokers were well received by prevention practitioners and were feasible to implement in a real-world school setting.

HCV/HIV coinfection in people who inject drugs is a public health issue, which presents a variety of challenges to healthcare providers. The determinants of HCV/HIV coinfection in this population are nonetheless not well known. The aim of the present study is to identify the factors associated with HCV/HIV coinfection in people who inject drugs and enter drug-related treatment.

BackgroundThere 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).MethodsWe 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.FindingsIn 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.InterpretationGiven 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.

December 2013 saw the end of ‘Aristotle’—a ‘seek, test, treat, and retain’ intervention. ‘Aristotle’ was co-funded by the European Social Fund and national resources, and was implemented by the Department of Hygiene, Epidemiology, and Medical Statistics of Athens University Medical School and the Organization against Drugs as a response (along with other responses) to an HIV outbreak in Athens (Sypsa et al., 2015). In 2011, the number of newly diagnosed HIV infections among people who inject drugs was 16 times higher than in 2010 (Nikolopoulos et al., 2015; Paraskevis et al., 2013). ‘Aristotle’ contributed significantly to the containment of the outbreak (Sypsa et al., July 20-25 2014), worked jointly with other multidisciplinary interventions in the area, e.g. Transmission Reduction Intervention Project (TRIP; see Friedman et al., 2014), and gained European and international recognition (‘Reacting to an outbreak,’ 2014). In early 2015, the epidemic has substantially receded even though the number of new HIV diagnoses has not decreased to the preoutbreak levels yet. Although ‘Aristotle’ was a successful, integrated intervention which effectively reduced drug use-related harm, the odds that the program will continue are very low given the lack of ongoing funding. A number of critical questions need to be explored:

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.