title: Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: evidence from cross-sectional surveys.
abstract: OBJECTIVE
  To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia.
  
  
  METHODS
  IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation.
  
  
  RESULTS
  A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n = 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity.
  
  
  CONCLUSIONS
  Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.
authors.affiliation: Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia. sigrid.vorobjov@tai.ee
authors.forename: Sigrid
authors.initials: S
authors.lastname: Vorobjov
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: Katri
authors.initials: K
authors.lastname: Abel-Ollo
authors.forename: Ave
authors.initials: A
authors.lastname: Talu
authors.forename: Kristi
authors.initials: K
authors.lastname: Rüütel
authors.forename: Anneli
authors.initials: A
authors.lastname: Uusküla
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000328:Adult; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D003710:Demography; D004957:Estonia / Q000453:epidemiology; D005260:Female; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology