Hepatitis B, C and human immunodeficiency virus knowledge among the general greek population: results from the Hprolipsis nationwide survey.

BACKGROUND: Although several studies on hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV) infection have been conducted in Greece, little is known on the knowledge level of the Greek population towards these three infections. Our aim was to assess the knowledge level of the adult Greek general population about the HBV, HCV and HIV. METHODS: Data were derived from the first general population health survey, Hprolipsis. The sample was selected by multistage stratified random sampling. A standardized questionnaire was administered by trained interviewers during home visits. A knowledge score was constructed based on responses to 17 per infection selected items and categorized in three levels; high (12-17 correct replies) medium (6-11) and low (0-5). Among 8,341 eligible individuals, 6,006 were recruited (response rate: 72%) and 5,878 adults (≥ 18 years) were included in the analysis. The statistical analysis accounted for the study design. RESULTS: Only 30.4%, 21.6%, and 29.6% of the participants had a high overall knowledge level of HBV, HCV and HIV, respectively. These low percentages were mainly attributed to the high levels of misconception about transmission modes (65.9%, 67.2%, and 67.9%, respectively). Results showed that increasing age and living out of the big metropolitan cities were associated with decreased odds of having higher knowledge. Female gender, higher education level, higher monthly family income, higher medical risk score, history of testing and being born in Greece or Cyprus, were associated with increased odds of having higher knowledge. CONCLUSIONS: There are significant knowledge gaps in the Greek general population regarding modes of transmission, preventive measures and treatment availability for HBV, HCV and HIV. There is an urgent need for large scale but also localized awareness activities targeted to less privileged populations, to fill the gaps in knowledge and increase population engagement in preventive measures.

Prevalence and correlates of physical inactivity in adults across 28 European countries.

BACKGROUND: Physical activity/inactivity is impacted by a plethora of intertwined factors. There are a limited number of studies on physical activity/inactivity that provide a European cross-country perspective. This study aims to present the prevalence and correlates of physical activity in adults across the 28 European Union (EU) member states. METHODS: This is a secondary dataset analysis of the Special Eurobarometer 472 data on physical activity. The cross-sectional survey was conducted during December 2-11 in 2017 across 28 European countries. The data consisted of ∼1000 respondents aged ≧15 years per country. The current analysis was restricted to adults aged 18-64 years (n = 19 645). RESULTS: More than one in three (36.2%, 95% CI: 35.1-37.3) adults in the EU were physically inactive, with substantial cross-country differences noted. Women were less likely than men to be adequately or highly physically active (aOR: 0.86, 95% CI: 0.78-0.95). Similarly, adults at the age of 40-54 (aOR: 0.65, 95% CI: 0.52-0.81) and 55-64 (aOR: 0.61, 95% CI: 0.49-0.77) were less likely to have moderate or high levels of physical activity in comparison with those 18-24 years of age. Finally, high SES was positively associated with physical activity (aOR: 1.4, 95% CI: 1.16-1.69). CONCLUSIONS: A notable percentage of adults in Europe are physically inactive. Further research is needed to elucidate the factors behind the cross-country differences and identify potential policy actions that may support adopting a physically active lifestyle and decrease the inequalities related to physical activity across Europe.

Organ donation attitudes and general self-efficacy: exploratory views from a rural primary care setting.

INTRODUCTION: Behavioral determinants can enable or hinder motivation towards registration and donorship and, subsequently, action or inertia towards organ donation. Nevertheless, there is limited information about the role of self-efficacy in relation to organ donation awareness and presumed consent among individuals and their families. The aim of this study was to explore knowledge, attitudes and general self-efficacy as behavioral determinants for organ donation among rural primary care attendants, in order to tailor awareness strategies for reversing inertia within an opt-out system. METHODS: This was a prospective face-to-face survey during regularly scheduled appointments of 203 attendants at a rural primary care unit in northern Greece. Responses to a 12-item adapted 'Organ donation awareness' questionnaire measuring knowledge, attitudes and awareness were related to participants' General Self-Efficacy (GSE) Scale score. Hierarchical modelling of a multiple linear regression model was adopted with GSE score added. RESULTS: About one-third of respondents (34.0%) had discussed presumed consent with a partner, family member or friend. More than half (54.2%) were concerned that donated organs might be used without consent for other purposes, such as medical research. A total of 30% found organ donation unacceptable because of religious beliefs. Organ donation awareness was not influenced by respondents' specific characteristics, but was significantly related to the GSE score (standard β=0.155, p=0.033). CONCLUSION: Overall, organ donation perceptions among rural primary care recipients were determined by knowledge of the presumed consent procurement system, pre-conceptions, religious beliefs, altruism and GSE scores. The association of self-efficacy with raised awareness could potentially explain the gap between high intent to consent as a donor and subsequent lack of follow-up action. Further comparative research across behavioral determinants between rural/urban groups is needed in order to tailor awareness strategies suitable for an opt-out system.

Prevalence and determinants of smoking and secondhand smoke exposure in a rural population of central Greece: a cross-sectional study.

INTRODUCTION: Smoking is one of the most important risk factors for heart and lung disease and is responsible for many forms of cancer. The resulting morbidity and mortality weigh heavily upon countries with high prevalence, such as Greece. According to the Global Adult Tobacco Survey (GATS) Greece, 38.2% of Greeks aged ≥15 years, namely 51.2% of men and 25.7% of women, are smokers. Smoking is also common among the young and people of high education. Despite laws prohibiting smoking at indoor places, exposure to environmental tobacco is very high both in private and public places. The study goal was to estimate the prevalence and characteristics of smoking, the level of tobacco exposure and the factors that affect both in a rural population. METHODS: A cross-sectional household study was conducted using the GATS questionnaire in a rural borough of Thessaly, Greece. Eligible participants were permanent residents of the selected villages, aged ≥18 years and they were selected by a combination of stratified sampling with probability proportional to size, random sampling and convenience sampling. Population demographics, current smoking status and tobacco use patterns, exposure to secondhand smoke, attitudes and knowledge on smoking were recorded. Analyses were performed according to the GATS manuals using the SPSS complex samples module. RESULTS: A total of 330 adults participated in the study (168 men, 162 women). The mean age of the sample was 54.2±17.75 years (range 18.5-86.1 years). Smoking prevalence was 32.4%; 46.4% (95% confidence interval (CI) 37.8-55.3%) of men and 17.9% (95%CI 12.0-25.9%) of women were smokers. Smoking was also common among the young, people with secondary education and high school graduates. The manufactured cigarette was the most preferred tobacco product. Daily smokers consumed on average 20.6 (95%CI 17.67-23.52) cigarettes per day. Men smoked more cigarettes and started at an earlier age than women. Overall exposure to environmental tobacco smoke was high among the population. Men, individuals aged 18-24 years and 40-54 years were more exposed than their counterparts. Places where high exposure was recorded included restaurants (80.0%, 95%CI 76.0-83.5%), bars (87.8%, 95%CI 75.7-94.3%) and coffee shops (82.6%, 95%CI 68.4-91.3%). Six out of ten (62.1%, 95%CI 51.7-71.5%) workers were exposed at their workplace and nearly half were exposed on a daily basis. Prevalence of home exposure was 40.4% (95%CI 32.0-49.5%). The multivariate analysis showed that sex and age were independent predictors of current smoking status, while only sex was independently associated with exposure to secondhand smoke. CONCLUSIONS: There are very few studies studying the characteristics of smoking and tobacco exposure exclusively in rural populations in Greece, such as the present study. Both the high prevalence of smoking and the high levels of exposure to tobacco show a population at increased risk for tobacco-related disease. These call for immediate action to reduce smoking prevalence, help smokers quit and protect the health of non-smokers. The present study's conclusions provide the basis for designing local prevention programs and the baseline for monitoring of future trends in the area.

Blood donation knowledge and attitudes among undergraduate health science students: A cross-sectional study.

Awareness towards blood donation can be empowered by health professionals' role-modelling. We aimed to assess knowledge and attitudes among Greek undergraduate medical laboratory students. A questionnaire was distributed to 330 students (response rate: 88.7%). Overall, 24% had donated blood at least once, with males 4.62 times more likely to be donors. Voluntary, non-remunerated blood donors were more likely to be repeaters. A quarter of all students were inclined to offer blood for monetary reward, with men more prone to accept payment. There is a need to campaign health science students during formal education through need-based as well as altruistic 'smart' messages.

Medical supplies shortages and burnout among greek health care workers during economic crisis: a pilot study.

Greece has been seriously affected by the economic crisis. In 2011 there were reports of 40% reduction to public hospital budgets. Occasional shortages of medical supplies have been reported in mass media. We attempted to pivotally investigate the frequency of medical supplies shortages in two Greek hospital units of the National Health System and to also assess their possible impact on burnout risk of health care workers. We conducted a cross-sectional study (n=303) of health care workers in two Greek hospitals who were present at the workplace during a casually selected working day (morning shift work). The Maslach Burnout Inventory (MBI) was used as the measure of burnout. An additional questionnaire was used about demographics, and working conditions (duration of employment, cumulative night shifts, type of hospital including medical supplies shortages and their impact on quality of healthcare. The prevalence of emotional exhaustion, depersonalization and low personal accomplishment was 44.5%, 43.2% and 51.5%, respectively. Medical supply shortages were significantly associated with emotional exhaustion and depersonalization. This finding provides preliminary evidence that austerity has affected health care in Greece. Moreover, the medical supply shortages in Greek hospitals may reflect the unfolding humanitarian crisis of the country.

Organ donation knowledge and attitudes among health science students in Greece: emerging interprofessional needs.

BACKGROUND: The impact of presumed consent on donation rates has been widely debated. In June 2013 Greece adopted a 'soft' presumed consent law for organ and tissue donation, where relatives' approval is sought prior to organ removal. AIMS: To report on the knowledge, attitudes and concerns of undergraduate students, enrolled in three health science disciplines, in regards to organ donation and presumed consent. METHODS: Undergraduate junior and senior health science students [medical (MS), nursing (NS) and medical laboratory students (MLS)] were recruited from higher education settings in Thessaly, Greece. Dichotomous questions, previously used, were adopted to assess knowledge, attitudes and concerns towards organ donation, together with questions regarding the recent presumed consent legislation. RESULTS: Three hundred seventy-one out of 510 students participated in the study (response rate: 72.7%). Only 3.6% of NS, 8.7% of MS and 3.2% of MLS carried a donor card. Although over 78% in all groups knew that it was possible to leave kidneys for transplant after death, only 10% to 39% considered themselves well-informed. NS were more likely to consider opting-out (21.5%), followed by MLS (17.9%) and MS (10.9%). Respondents were more likely to refuse organ removal upon death when expressing one of the following views: a) opposing a system making it lawful to take kidneys from an adult who has just died, unless forbidden while alive [Odds ratio (OR) 95% Confidence Interval (CI): 2.96 (1.48-5.93), p=0.002], b) worrying about their kidneys being removed after death [OR, 95% CI: 3.37 (1.75-6.49), p=<0.001] and c) believing that an intact body was needed after death [OR, 95% CI: 4.23 (2.15-8.31), p<0.001]. CONCLUSION: Health science students, soon to become healthcare professionals, demonstrated limited awareness in regards to the newly reformed organ donation system. Identified knowledge deficits and concerns could have far-reaching implications in terms of conveying a clear message and shaping the public's stand. The feasibility and effectiveness of a joint inter-professional curriculum on organ and tissue donation issues across all three health science disciplines, addressing common themes and concerns deserves further study.

Influenza Vaccination Practices and Perceptions Among Young Athletes: A Cross-Sectional Study in Greece.

BACKGROUND: Influenza vaccination among athletes is a crucial area in sports medicine. This descriptive, cross-sectional study aims to explore the vaccination practices and intentions regarding influenza vaccines among young athletes. METHODS: A structured, questionnaire-based study was conducted among students from the National School of Sports in Greece. The survey was conducted over the period of April to May 2023. Overall, 138 participants participated in the study. RESULTS: More than half of the participants had received a flu vaccine in the past, but only 12.3% were vaccinated against influenza for 2022-2023. The main reasons seemed to be the lack of time (40.6%) and the idea that influenza does not lead to any serious health threats for the participants (36.2%). The main factor that affected their decision to get the flu vaccine or not was the need for more information regarding influenza vaccination (79%). CONCLUSIONS: The recent study showed low vaccination coverage among people of young age participating in sports activities. The qualitative views of the participants highlighted the significance of the lackof a well-organized information program provided by health professionals and coaches.

The Impact of the COVID-19 Pandemic on Elite Swimmers and Water Polo Players: Lessons for the Future.

BACKGROUND: The COVID-19 pandemic has disrupted global daily life, including the world of elite athletes. This paper examines the multifaceted impact the COVID-19 pandemic had on elite swimmers and water polo athletes, specifically their mental health, their concerns over the virus, their intentions of getting vaccinated, and sleep disturbances that they may have faced. METHODS: We conducted a cross-sectional study on elite swimmers and water polo players, using an anonymous questionnaire. RESULTS: A total of 200 elite athletes participated. The majority of the participants reported a negative impact on their mental health, screened positive for insomnia (n = 107 (53.5%), with females (n = 101; 57.7%), swimmers (n = 100, 66.7%), and university students (n = 71, 71.7%) being more vulnerable (p < 0.001). Concerns about contracting the disease especially during important training or tournament periods and potential career disruption also affected their psychological well-being. While the majority (75%) had the intention of getting vaccinated, an alarming percentage was yet uncertain over its decision. CONCLUSIONS: This study highlights the significant psychological distress faced by elite aquatic athletes during the pandemic. It emphasizes the difficulties faced by elite swimmers and water polo athletes and determines not only the importance of addressing the vaccination intentions of athletes, but also how critical it is to confront the challenges they face both for their personal health and for the restoration of world sports to their pre-pandemic state. More large-scale studies are required to inform policies targeted at minimizing disruption to the athletes' career, provision of information on preventive measures and vaccination, and improvement in psychological well-being in case of similar major public health issues in the future. Additionally, this study calls for further research to explore the unique challenges faced by aquatic athletes, such as those related to their training environments and fear of contagion, to better support them in future public health crises.

Respiratory tract mortality in cement workers: a proportionate mortality study.

BACKGROUND: The evidence regarding the association between lung cancer and occupational exposure to cement is controversial. This study investigated causes of deaths from cancer of respiratory tract among cement workers. METHODS: The deaths of the Greek Cement Workers Compensation Scheme were analyzed covering the period 1969-1998. All respiratory, lung, laryngeal and urinary bladder cancer proportionate mortality were calculated for cement production, maintenance, and office workers in the cement industry. Mortality from urinary bladder cancer was used as an indirect indicator of the confounding effect of smoking. RESULTS: Mortality from all respiratory cancer was significantly increased in cement production workers (PMR = 1.91; 95% CI 1.54 to 2.33). The proportionate mortality from lung cancer was significantly elevated (PMR = 2.05; 95% CI 1.65 to 2.52). A statistically significant increase in proportionate mortality due to respiratory (PMR = 1.7; 95% CI 1.2 to 2.34). and lung cancer (PMR = 1.67;95% CI = 1.15-2.34) among maintenance workers has been observed. The PMR among the three groups of workers (production, maintenance, office) did differ significantly for lung cancer (p = 0.001), while the PMR for urinary bladder cancer found to be similar among the three groups of cement workers. CONCLUSION: Cement production, and maintenance workers presented increased lung and respiratory cancer proportionate mortality, and this finding probably cannot be explained by the confounding effect of smoking alone. Further research including use of prospective cohort studies is needed in order to establish a causal association between occupational exposure to cement and risk of lung cancer.

Hepatitis B virus infection and waste collection: prevalence, risk factors, and infection pathway.

BACKGROUND: Waste collectors have a potential risk of infectious diseases. The aim of the study was to assess; the prevalence of hepatitis B (HBV), risk factors for infection and possible ways of virus transmission among municipal solid waste workers (MSWWs) in a municipality of central Greece. METHODS: A cross-sectional study was conducted among the employees of a municipality in Central Greece. The prevalence of an HBV infection biological marker (anti-Hbc) and its association with exposure to waste, socio-demographic factors, and history of occupational injuries with sharp objects/needle sticks was examined among 208 employees. RESULTS: The prevalence of HBV infection among the municipal waste collectors was 23%. Logistic regression analysis showed that exposure to waste (OR = 4.05;95%CI = 1.23-13.33) and age (OR = 5.22;95% CI = 1.35-20.1) were independently associated with the anti-Hbc positivity. Moreover, waste collectors who reported occupational injuries with needle sticks were at higher risk of HBV infection (RR = 2.64; 95% CI = 1.01-6.96). CONCLUSIONS: Occupational exposure to waste is a possible risk factor for HBV infection. Occupational injury with sharp instruments could be a means of hepatitis B virus transmission. Immunization of MSWWs and adoption of more safe ways for waste collection could be considered in order to control the risk of HBV infection.

Prevalence and Predictors of COVID-19 Vaccination Acceptance among Greek Health Care Workers and Administrative Officers of Primary Health Care Centers: A Nationwide Study Indicating Aspects for a Role Model.

Background: Τhe study aims to identify factors associated with COVID-19 vaccine acceptance and to investigate knowledge and perceptions of Primary Health Care Centers (PHCC) personnel, who acted as pioneers in the national COVID-19 vaccination strategy. Methods and Materials: A nationwide cross-sectional survey was conducted by distributing an online anonymous questionnaire comprising 25 questions during the first semester of 2021. Results: Approximately 85.3% of the 1136 respondents (response rate 28.4%) were vaccinated or intended to be. The acceptance of seasonal flu vaccine (aOR: 3.29, 95%CI: 2.08−5.20), correct COVID-19 vaccine knowledge (aOR: 8.37, 95%CI: 4.81−14.59) and lack of concern regarding vaccine novelty (aOR: 6.18, 95%CI: 3.91−9.77) were positively correlated with vaccine acceptance. Vaccinated respondents were more likely to be physicians (aOR: 2.29, 95%CI: 1.03−5.09) or administrative staff (aOR: 2.65, 95%CI: 1.18−5.97) compared to nursing stuff. Reasons for vaccine hesitancy included inadequate information (37.8%) and vaccine safety (31.9%). Vaccine acceptance was strongly correlated (Spearman's correlation coefficient r = 0.991, p < 0.001) between PHCC personnel and the general population of each health district. Conclusions: COVID-19 vaccine acceptance among PHCC personnel in Greece was comparably high, but specific groups (nurses) were hesitant. As the survey's target population could serve as a role model for the community, efforts should be made to improve COVID-19 vaccine acceptance.

Pesticide exposure and lymphohaematopoietic cancers: a case-control study in an agricultural region (Larissa, Thessaly, Greece).

BACKGROUND: The causality of lymphohaematopoietic cancers (LHC) is multifactorial and studies investigating the association between chemical exposure and LHC have produced variable results. The aim of this study was to investigate the relationships between exposure to pesticides and LHC in an agricultural region of Greece. METHODS: A structured questionnaire was employed in a hospital-based case control study to gather information on demographics, occupation, exposure to pesticides, agricultural practices, family and medical history and smoking. To control for confounders, backward conditional and multinomial logistic regression analyses were used. To assess the dose-response relationship between exposure and disease, the chi-square test for trend was used. RESULTS: Three hundred and fifty-four (354) histologically confirmed LHC cases diagnosed from 2004 to 2006 and 455 sex- and age-matched controls were included in the study. Pesticide exposure was associated with total LHC cases (OR 1.46, 95% CI 1.05-2.04), myelodysplastic syndrome (MDS) (OR 1.87, 95% CI 1.00-3.51) and leukaemia (OR 2.14, 95% CI 1.09-4.20). A dose-response pattern was observed for total LHC cases (P = 0.004), MDS (P = 0.024) and leukaemia (P = 0.002). Pesticide exposure was independently associated with total LHC cases (OR 1.41, 95% CI 1.00 - 2.00) and leukaemia (OR 2.05, 95% CI 1.02-4.12) after controlling for age, smoking and family history (cancers, LHC and immunological disorders). Smoking during application of pesticides was strongly associated with total LHC cases (OR 3.29, 95% CI 1.81-5.98), MDS (OR 3.67, 95% CI 1.18-12.11), leukaemia (OR 10.15, 95% CI 2.15-65.69) and lymphoma (OR 2.72, 95% CI 1.02-8.00). This association was even stronger for total LHC cases (OR 18.18, 95% CI 2.38-381.17) when eating simultaneously with pesticide application. CONCLUSIONS: Lymphohaematopoietic cancers were associated with pesticide exposure after controlling for confounders. Smoking and eating during pesticide application were identified as modifying factors increasing the risk for LHC. The poor pesticide work practices identified during this study underline the need for educational campaigns for farmers.

Employment and suicidal rates during economic recession: A country-targeted integrative review.

BACKGROUND: The economic crisis' effects on suicide rates for countries undergoing or exiting austerity measures have been widely debated. This integrative review aimed to identify, appraise, and synthesize available evidence of employment status effect on suicide mortality rates in Greece during the recent economic recession period. METHODS: A literature review of studies evaluating suicides in the general Greek population, as well as across age and gender groups, in relation to employment during the economic crisis period was performed. PubMed electronic database was searched for relevant articles published in English or Greek language from 2009 up to February 2020. Appraisal was carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines. RESULTS: A total of 24 articles met all inclusion criteria with 20 of them at level IV, 2 at level VII, and 2 at level VIII. A total of 18 studies reported increase of suicide rates during the economic recession period. About 12 studies examined the co-relation between unemployment and suicide rate, with ten studies showing a positive correlation. Moreover, thirteen studies reported data on the effect of gender and age variables on suicide rates. CONCLUSION: Evidence shows that suicide mortality rates in Greece increased after the eruption of economic recession, particularly after the implementation of radical austerity measures (2011-2014). This increase was positively correlated with unemployment and was more prominent among males of working age. Further in depth epidemiological research of regional variations in terms of profile and contributing or enabling factors of suicidal behavior is needed.

Burnout and associated factors among Greek substance use disorder treatment providers during economic crisis.

Crisis and austerity in Greece could have influenced the risk of burnout among substance use disorder treatment providers. We aimed to investigate the prevalence of burnout and its associated factors among Greek substance use disorder treatment providers during economic crisis. A cross-sectional study was conducted in 2016. In particular, employees at the substance use treatment program of Athens (n = 180), a branch of the Greek Organization against Drugs were invited to participate. Almost all participants reported medical supplies shortages related to the economic crisis. Increasing job demands, staff reduction and limited job autonomy were independent risk factors for burnout. These factors are crisis-related. In conclusion, we found high rates of burnout among substance abuse treatment personnel in Greece. These respondents are a bellwether of the effects of economic crisis. Economic crisis can produce a profound negative effect on health care.

Acceptability of COVID-19 Vaccination among Greek Health Professionals.

Health Care Workers are at the front line of the fight against Covid-19. The aim of this study was to evaluate the acceptability of vaccination against COVID-19 among health professionals (physicians, dentists, pharmacists) two weeks prior to the start of the Greek vaccination campaign against COVID-19. A cross-sectional online survey was conducted over the period 15-22 December 2020 in 340 health professionals in Central Greece. We found a high level of acceptance for COVID-19 vaccine (78.5%) and a high vaccination coverage for the influenza vaccine (74%). Age > 45 years (OR = 2.01; 95% C.I. = 2.01-4.3), absence of fear over vaccine safety (OR = 4.09; 95% C.I. = 1.36-12.3), and information received from the Greek public health authorities (OR = 11.14; 95% C.I. = 5.48-22.6), were factors independently associated with the likelihood of COVID-19 vaccination acceptance. Our study indicates a high level of the COVID-19 vaccination acceptance among physicians, dentists and pharmacists. Nevertheless, several interventions can be implemented to increase acceptance of vaccine among health-care workers (HCWs) and could be especially directed at younger and vaccine-hesitant health care workers due to fear of vaccine side-effects. Last, our results provide some evidence that receiving vaccine-related information from the Greek Center for Diseases Control (E.O.D.Y.) could reduce the drivers of hesitancy and enhance the acceptability of COVID-19 vaccination.

Prevalence of Electronic Cigarette Use and its Determinants among 13-to-15-Year-Old Students in Greece: Results from the 2013 Global Youth Tobacco Survey (GYTS).

Electronic cigarette use has increased over the past decade. Its potential role in smoking cessation, in addiction and as a 'gateway' to tobacco smoking is subject to intense research. This cross-sectional study, carried out in 2013, aims to present the habits of students aged 13-15 in Greece with regard to e-cigarettes and investigate potential risk factors and the relationship between e-cigarettes, tobacco smoking and other nicotine products. It is the first such study to be carried out in Greece. The survey was based on the standardized methodology of the Global Youth Tobacco Survey. All potential associations were investigated using multiple logistic regression. In total 2.8% of the 4096 participating students were current e-cigarette users and 12.3% of them were ever users. E-cigarette use was associated with male gender, being older, current use of combustible tobacco products and e-cigarette use in the family. Ever e-cigarette use, being older, female gender and higher pocket money were associated with an increased susceptibility to tobacco smoking. E-cigarette prevalence in Greece in 2013 was similar to that of other, developed countries. The smoking and vaping habits of adolescents must be monitored in order to assess trends over time and whether any policy alterations are necessary.

Prevalence and determinants of current cigarette smoking and secondhand smoking among Greek adolescents: the Global Youth Tobacco Survey (GYTS) 2013 study.

OBJECTIVES: Smoking prevalence in Greece is considered high within the European Union and the collection of evidence on tobacco use among adolescents is of vital importance in order to develop effective smoking prevention and cessation programmes. DESIGN: Cross-sectional. SETTING: Greece. PRIMARY AND SECONDARY OUTCOME MEASURES: Global Youth Tobacco Survey (GYTS) is a national representative, paper-and-pencil, cross-sectional, school-based study of students at ages 13-15 years. The survey employed a multistage cluster sample design with schools selected proportional to enrolment size. Finally, 4618/5127 students aged 13-15 years participated in the survey. The school response rate was 98.1%, the student response rate was 90.1% and the overall response rate was 88.4%. RESULTS: The prevalence of current cigarette smoking was estimated at 10.1% (10.4% in GYTS 2005) and of exposure to secondhand smoking in public places at 67.4% (94.1% in GYTS 2005). The vast majority of the adolescents (82.1%) supported the banning of smoking inside enclosed public places. Most of the current smokers (90.8%) were not prevented/refused purchase because of their age according to existing law. Multivariate analysis showed that peer influence (OR=48.32; 95% CI 36.2 to 64.48), pocket money (OR=2.63; 95% CI 1.28 to 3.41), increasing age (OR=2.35; 95% CI 1.63 to 3.39) and low educational level of father (OR=2.82; 95% CI 1.7 to 4.68) were risk factors independently associated with current cigarette smoking. CONCLUSIONS: Despite the existence of strict laws related to tobacco control, exposure to secondhand smoking among Greek students remained high even when compared with GYTS in 2005. This is likely a result of weak enforcement, what is really missing is the enforcement of the related legislation.

Nicotine Dependence and Loss of Autonomy among Greek Adolescent Smokers: A Countrywide Cross-Sectional Study.

Nicotine dependence is one of the main reasons for the continuation of smoking among adolescents. Loss of autonomy (LOA) is a measure of dependence. This study is the first to investigate LOA and its determinants among Greek adolescents. In 2013, 13-to-15-year-old middle-school students were selected by multi-stage clustered sampling. LOA was evaluated with the Hooked-on-Nicotine Checklist (HONC). Multiple univariate analysis was used to assess the association between adolescent demographics, smoking habits, and loss of autonomy. Three-hundred thirty-nine current smokers responded to the questionnaire (response rate: 82.3%). Of these respondents, 51.2% were male and 88.8% reported at least one LOA symptom. The mean HONC score was 4.13/10 (95% CI: 3.82-4.45). Higher scores were negatively associated with lower smoking frequency (cumulative odds ratio (cOR): 0.240, 95% CI: 0.144-0.400) and positively associated with lower age at first cigarette (cOR: 2.29, 95% CI: 1.38-3.82). Female gender was significantly associated with the prevalence but not the degree of LOA. Overall, the prevalence and the degree of nicotine dependence among adolescent smokers in Greece is similar to other countries. Frequent smoking and initiation of smoking at a younger age are linked to nicotine dependence, although it was not possible to make causal inferences. The relationship between nicotine dependence and gender remains unclear.

Prevalence of tobacco use, exposure to secondhand smoke and knowledge on smoking cessation among students of health professions in Central Greece: a cross-sectional study.

OBJECTIVES: The aim of this study was to assess the prevalence of tobacco use and exposure to secondhand smoke among students of health professions (SHPs) and determine possible risk factors for current smoking. In addition, we sought to investigate the level of students' knowledge regarding smoking cessation. DESIGN: Cross-sectional. SETTING: Central Greece. PARTICIPANTS: A convenient sample of 822 SHP volunteers were used, composed of 365 medical students, 123 students from a biochemistry department, 71 students from a nursing department, 176 from medical laboratory department and 84 students from a veterinary medicine department. PRIMARY AND SECONDARY OUTCOME MEASURES: We investigated the prevalence of current smoking and secondhand smoke, their determinants and SHP's knowledge and attitudes regarding smoking cessation. Univariate and logistic regression statistical analysis were used in order to identify risk factors associated with current smoking. RESULTS: The prevalence of current smoking was estimated at 23.5% (95% CI 20.7% to 26.5%), while 49% of current smokers reported they wanted to quit smoking. The prevalence of current e-cigarette use was 1.2%. In addition, 96.5% (95% CI 94.9% to 97.5%) of SHP have been exposed to secondhand smoke at least 1 day per week. Logistic regression analysis showed that increasing age (p<0.001), alcohol consumption (p<0.001) and exposure to secondhand smoke in the home (p<0.001) were independent risk factors for current smoking. Notably, only 11.6% of the participants had learnt about methods to be used for smoking cessation. CONCLUSIONS: Our results underline the need for integrated tobacco control initiatives that should discourage tobacco use among SHP, promote smoke free schools of health science, and implement programs that train SHP in effective cessation-counseling techniques.