Determinants of smoking in eight countries of the former Soviet Union: results from the living conditions, lifestyles and health study

Spatial disparities in cause-specific mortality in Ukraine: A district-level analysis, 2006-19

Turbulent socio-economic development, recent political challenges, and remarkable regional diversity with deep historical roots make Ukraine an important case study for understanding mortality trends in Eastern Europe. In this paper, we provide the first comprehensive, spatially detailed analysis of cause-specific mortality trends and patterns in Ukraine, focusing on the period 2006-19. We rely on official mortality data and use various demographic and spatial analysis techniques. Our results suggest a notable attenuation of the long-standing West-East and West-South-East mortality gradients. Cardiovascular mortality at older ages largely explains the gap between the vanguard (lowest mortality) and laggard (highest mortality) areas, especially for females and in the most recent period. By contrast, the impact of mortality from external causes has greatly diminished over time. Hotspot analyses reveal strong and persistent clustering of mortality from suicide, HIV, and lung cancer. Further research should focus on in-depth assessment of the mechanisms causing the observed patterns.

Similarities in cardiometabolic risk factors among random male-female pairs: a large observational study in Japan

Background:

Previous observational studies have shown similarities in cardiometabolic risk factors between spouses. It is still possible that this result reflects the age similarity of spouses rather than environmental factors of spouses (e.g. cohabitation effect). To clarify the importance of mate cardiometabolic risk factors for similarity of environmental factors, it is necessary to examine whether they are observed in random male-female pairs while maintaining the age of the spousal pairs. This study aimed to determine whether the similarities found between spousal pairs for cardiometabolic risks were also observed between random male-female pairs.

Methods:

This cross-sectional study included 5,391 spouse pairs from Japan; data were obtained from a large biobank study. For pairings, women of the same age were randomly shuffled to create new male-female pairs of the same age as that of the original spouse pairs. Similarities in cardiometabolic risk factors between the random male-female pairs were analysed using Pearson’s correlation or age-adjusted logistic regression analyses.

Results:

The mean ages of the men and women were 63.2 and 60.4 years, respectively. Almost all cardiometabolic risk factors similarities were not noted in cardiometabolic risk factors, including the continuous risk factors (anthropometric traits, blood pressure, glycated haemoglobin level, and lipid traits); lifestyle habits (smoking, drinking, and physical activity); or diseases (hypertension, type 2 diabetes mellitus, and metabolic syndrome) between the random male-female pairs. The age-adjusted correlation coefficients ranged from − 0.007 for body mass index to 0.071 for total cholesterol. The age-adjusted odds ratio (95% confidence interval) for current drinkers was 0.94 (0.81 − 1.09); hypertension, 1.07 (0.93 − 1.23); and type 2 diabetes mellitus, 1.08 (0.77 − 1.50).

Conclusion:

In this study, few similarities in cardiometabolic risk factors were noted among the random male-female pairs. As spouse pairs may share environmental factors, intervention strategies targeting lifestyle habits and preventing lifestyle-related diseases may be effective.

Time trends in smoking in Russia in the light of recent tobacco control measures: synthesis of evidence from multiple sources

BACKGROUND

The study aims at identifying long-term trends and patterns of current smoking by age, gender, and education in Russia, including the most recent period from 2008 during which tobacco control policies were implemented, and to estimate the impact on mortality of any reductions in prevalence. We present an in-depth analysis based on an unprecedentedly large array of survey data.

METHODS

We examined pooled micro-data on smoking from 17 rounds of the Russian Longitudinal Monitoring Study of 1996-2016, 11 other surveys conducted in Russia in 1975-2017, and two comparator surveys from England and the USA. Standardization by age and education, regression and meta-analysis were used to estimate trends in the prevalence of current smoking by gender, age, and educational patterns.

RESULTS

From the mid-1970s to the mid-2000s smoking prevalence among men was relatively stable at around 60%, after which time prevalence declined in every age and educational group. Among women, trends in smoking were more heterogeneous. Prevalence more than doubled above the age of 55 years from very low levels (< 5%). At younger ages, there were steep increases until the mid-2000s after which prevalence has declined. Trends differed by educational level, with women in the lowest educational category accounting for most of the long-term increase. We estimate that the decline in male smoking may have contributed 6.2% of the observed reduction in cardiovascular deaths among men in the period 2008-16.

CONCLUSIONS

The implementation of an effective tobacco control strategy in Russia starting in 2008 coincided with a decline in smoking prevalence among men from what had been stable, high levels over many decades regardless of age and education. Among women, the declines have been more uneven, with young women showing recent downturns, while the smoking prevalence in middle age has increased, particularly among those with minimal education. Among men, these positive changes will have made a small contribution to the reduction in mortality seen in Russia since 2005.

Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

Purpose

Worldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15-49 years) in Georgia.

Materials and Methods

The study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI).

Results

In the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45-49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45-49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15-24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in "other" ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women's marital or wealth status, place of residence (rural/urban) or place of death.

Conclusion

Age, ethnicity, education, and employment were found to be strong independent predictors of young women's NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women's survival during and beyond reproduction.

Smoking and Religion: Untangling Associations Using English Survey Data

While factors affecting smoking are well documented, the role of religion has received little attention. This national study aims to assess the extent to which religious affiliation is associated with current-smoking and ever-smoking, controlling for age, sex, ethnicity and socio-economic status. Variations between adult and youth populations are examined using secondary analysis of individual-level data from 5 years of the Health Survey for England for adult (aged >20, n = 39,837) and youth (aged 16-20, n = 2355) samples. Crude prevalence statistics are contrasted with binary logistic models for current-smoking and ever-smoking in the adult and youth samples. Analyses suggest that Muslims smoke substantially less than Christians. Highest levels of smoking characterise people not professing any religion. Associations between smoking and the Muslim religion attenuate to statistical insignificance in the face of ethnic and socio-economic factors. An association between smoking and the absence of a religious affiliation is sustained. An understanding of the association between smoking and religion is essential to the development of tobacco control programmes.

Tobacco Use Worldwide: Legislative Efforts to Curb Consumption

Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest global public health challenges. Additionally, secondhand smoke, which was declared carcinogenic by the International Agency for Research on Cancer in 2004, is a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as smoking bans, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030, as 80% of the projected tobacco-related deaths will occur in low and middle-income countries.

Tobacco Use Worldwide: Legislative Efforts to Curb Consumption

Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest public health challenges. Secondhand smoke, declared carcinogenic by the International Agency for Research on Cancer in 2004, is also a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as a combination of smoke-free laws, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030 as 80% of the projected tobacco-related deaths will occur in low- and middle-income countries.

Tobacco Use Worldwide: Legislative Efforts to Curb Consumption

Tobacco smoking is recognized as a major preventable cause of disease worldwide and is linked to 6 million deaths annually, 30% of which are due to cancer. The negative health consequences of smoking currently represent one of the greatest public health challenges. Secondhand smoke, declared carcinogenic by the International Agency for Research on Cancer in 2004, is also a major source of morbidity and premature death in nonsmokers, particularly children. Negative health effects associated with exposure to secondhand smoke have been well documented and include lung cancer, cardiovascular disease, asthma, and other respiratory diseases. International and national policies to implement cost-effective strategies to curtail smoking will have a significant impact on population health and will protect nonsmokers. Effective interventions, such as a combination of smoke-free laws, tobacco price increases, easy access to tobacco cessation treatments, and anti-tobacco media campaigns, should continue. Reducing tobacco use would be a major step towards the goal of decreasing health disparities by 2030 as 80% of the projected tobacco-related deaths will occur in low- and middle-income countries.

Anti-smoking policy in Russia: Relevant factors and program planning

In this paper, we consider anti-smoking policy in Russia and the socioeconomic factors that influence an individual's decision to smoke. Among various factors, we investigate the individual time preferences of Russians. To estimate individual time preferences, we use an experiment in which survey respondents are given hypothetical money prizes. We find that being middle-aged, being unmarried and having parents who smoke are positively correlated with both men and women's likelihood of taking up smoking in Russia. We consider the possible endogeneity of an individual's health status and find a positive relationship between smoking and the time preferences of Russians. Our findings confirm that decisionmakers should devote their efforts primarily to developing restrictive anti-smoking policy. The choice of policy measures should be guided by the individual characteristics of target population groups. Social advertising, public lectures and preventive care should be actively engaged in forming public attitudes towards smoking.

Parental transmission of smoking among middle-aged and older populations in Russia and Belarus

OBJECTIVES

The very high rates of smoking among men and the rapid changes among women in the Post-Soviet countries mean that this region offers an opportunity to understand better the intergenerational role of parental influences on smoking.

METHODS

In this study, we exploit a unique data set, the PrivMort cohort study conducted in 30 Russian and 20 Belarusian towns in 2014-2015, which collects information on behaviours of middle-aged and older individuals and their parents, including smoking. We explored the associations between smoking by parents and their offspring using multiply imputed data sets and multilevel mixed-effect Poisson regressions.

RESULTS

Adjusting for a wide array of social origin, socio-demographic, and socio-economic variables, our analysis suggests that sons of regularly smoking fathers have prevalence ratios of 1.35 [95% confidence intervals (CI) 1.21-1.50] and 1.39 (CI 1.23-1.58) of smoking, while the figures for daughters of regularly smoking mothers are 1.91 (CI 1.40-2.61) and 2.30 (CI 1.61-3.28), respectively, in Russia and Belarus.

CONCLUSIONS

Intergenerational paternal and maternal influences on smoking should be taken into account in studies seeking to monitor the rates of smoking and the impact of tobacco control programmes.

Intergenerational Mobility in Relative Educational Attainment and Health-Related Behaviours

Research on intergenerational social mobility and health-related behaviours yields mixed findings. Depending on the direction of mobility and the type of mechanisms involved, we can expect positive or negative association between intergenerational mobility and health-related behaviours. Using data from a retrospective cohort study, conducted in more than 100 towns across Belarus, Hungary and Russia, we fit multilevel mixed-effects Poisson regressions with two measures of health-related behaviours: binge drinking and smoking. The main explanatory variable, intergenerational educational mobility is operationalised in terms of relative intergenerational educational trajectories based on the prevalence of specified qualifications in parental and offspring generations. In each country the associations between intergenerational educational mobility, binge drinking and smoking was examined with incidence rate ratios and predicted probabilities, using multiply imputed dataset for missing data and controlling for important confounders of health-related behaviours. We find that intergenerational mobility in relative educational attainment has varying association with binge drinking and smoking and the strength and direction of these effects depend on the country of analysis, the mode of mobility, the gender of respondents and the type of health-related behaviour. Along with accumulation and Falling from Grace hypotheses of the consequences of intergenerational mobility, our findings suggest that upward educational mobility in certain instances might be linked to improved health-related behaviours.

[Economic factors and gender differences in the prevalence of smoking among adults]

This article presents a study that seeks to identify the relevant economic variables in the prevalence of smoking in a group of 37 countries. The chosen methodology was to estimate multiple linear regression using the least square approach. The econometric exercise is performed by gender, seeking to examine whether there are different motivations for cigarette smoking among the adult population of men and women. The results show that although taxation is a common element in the decision of both sexes, the decision to smoke among women is also sensitive to price and other social and cultural factors. These factors were based on the fact that women who live in countries that are part of the Organization for Economic Cooperation and Development reveal a significantly higher prevalence of cigarette consumption. The evidence presented in this study, therefore, reinforces the perception that taxation is in fact a crucial tool in the control of smoking, but in the specific case of women, higher prices and the promotion of greater equality with men, are also important.

Prevalence of smoking and its associated factors with smoking among elderly smokers in Malaysia: findings from a nationwide population-based study

BACKGROUND

The determination of smoking prevalence and its associated factors among the elderly could provide evidence-based findings to guide the planning and implementation of policy in order to will help in reducing the morbidity and mortality of smoking-related diseases, thus increase their quality of life. This paper describes the rate of smoking and identifies the factor(s) associated with smoking among the elderly in Malaysia.

METHODS

A representative sample of 2674 respondents was obtained via a two-stage sampling method in proportion to population size. Face-to-face interviews were conducted using a set of standardized validated questionnaire. Data was weighted by taking into consideration the complex sampling design and non-response rate prior to data analysis. Univariable and multivariable logistic regression were used to determine the factor/s associated with smoking.

RESULTS

The prevalence of non-smokers, ex-smokers and current smokers among Malaysians aged 60 years and above were 36.3 % (95 % CI = 32.7-39.8), 24.4 % (95 % CI = 21.2-27.5) and 11.9 % (95 % CI = 9.5-14.3), respectively. Current smokers were significantly more prevalent in men (28.1 %) than in women (2.9 %), but the prevalence declined with advancing age, higher educational attainment, and among respondents with known diabetes, hypertension and hypercholesterolemia. Multivariable analysis revealed that males (aOR, 18.6, 95 % CI 10.9-31.9) and other Bumiputras (aOR 2.58, 95 % CI 1.29-5.15) were more likely to smoke. in addition, elderly with lower educational attainment (aOR, 1.70, 95 % CI 1.24-7.41) and those without/unknown hypertension also reported higher likelihood to be current smokers (aOR 1.98, 95 % CI 1.35-2.83). However, there were no significant associations between respondents with no/unknown diabetes or hypercholesterolemia with smoking.

CONCLUSIONS

In short, smoking is common among elderly men in Malaysia. Therefore, intervention programs should integrate the present findings to reduce the smoking rate and increase the smoking cessation rate among the elderly in Malaysia and subsequently to reduce the burden of smoking-related disease.

A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014

Objective

To systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries.

Data Sources

Five databases, Medline, Embase, Africa-wide Information, Cinahl Plus, and Global Health were searched using a systematic search strategy. There were no language restrictions.

Study Selection

26 included studies measured current smoking prevalence in nationally representative adult populations in sub-Saharan African countries.

Data Extraction

Study details were independently extracted using a standard datasheet. Data on tobacco control policies, taxation and trends in prices were obtained from the Implementation Database of the WHO FCTC website.

Results

Studies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents.

Conclusion

Smoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority.

A cross-sectional study examining youth smoking rates and correlates in Tbilisi, Georgia

Georgia has high smoking rates; however, little is known about the prevalence and correlates of youth smoking. We conducted a secondary data analysis of a 2010 cross-sectional survey of 1,879 secondary and postsecondary school students aged 15 to 24 years in Tbilisi, Georgia, examining substance use, perceived risk, and recreational activities in relation to lifetime and current (past 30 days) smoking. Lifetime and current smoking prevalence was 46.1% and 22.6%, respectively. In secondary schools, lifetime smoking correlates included being male, consuming alcohol, lifetime marijuana use, and lower perceived risk (P's ≤ .001). Correlates of current smoking among lifetime smokers included being male, consuming alcohol, lifetime marijuana use, lower perceived risk, less frequently exercise, and more often going out (P's < .05). In postsecondary schools, lifetime smoking correlates included being male, consuming alcohol, lifetime marijuana use, lower perceived risk, more often going out, and recreational internet use (P's < .0). Correlates of current smoking among lifetime smokers included being male (P's = .04), consuming alcohol, marijuana use, lower perceived risk, and more often going out (P's < .05). Tobacco control interventions might target these correlates to reduce smoking prevalence in Georgian youth.

Can tobacco control be transformative? Reducing gender inequity and tobacco use among vulnerable populations

Tobacco use and exposure is unequally distributed across populations and countries and among women and men. These trends and patterns reflect and cause gender and economic inequities along with negative health impacts. Despite a commitment to gender analysis in the preamble to Framework Convention on Tobacco Control there is much yet to be done to fully understand how gender operates in tobacco control. Policies, program and research in tobacco control need to not only integrate gender, but rather operationalize gender with the goal of transforming gender and social inequities in the course of tobacco control initiatives. Gender transformative tobacco control goes beyond gender sensitive efforts and challenges policy and program developers to apply gender theory in designing their initiatives, with the goal of changing negative gender and social norms and improving social, economic, health and social indicators along with tobacco reduction. This paper outlines what is needed to progress tobacco control in enhancing the status of gendered and vulnerable groups, with a view to reducing gender and social inequities due to tobacco use and exposure.

Results of the Global Youth Tobacco Survey and implementation of the WHO Framework Convention on Tobacco Control in the WHO Eastern Mediterranean Region (EMR) countries

We used Global Youth Tobacco Survey (GYTS) data collected over time to monitor articles of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in WHO Eastern Mediterranean Region (EMR).

METHODS

The GYTS is a school-based survey, conducted in 23 countries in WHO EMR countries from 1999-2008.

RESULTS

The prevalence of current smokeless tobacco use was high compared to cigarette use in all countries. In general, the following changes were observed between baseline and repeated surveys: in five countries fewer youth supported a ban on smoking in public places. In four countries more youth saw actors smoking on TV and were exposed to second-hand smoke (SHS) outside of home. Fewer youth were offered free cigarettes in ten countries; in eight countries youth saw less advertisement on TV; in seven countries youth had fewer items with a tobacco logo, discussed more reasons for smoking and dangers of smoking, and were less exposed to SHS at home; in six countries youth saw less advertisement at sports events.

CONCLUSION

The GYTS data can be used for monitoring, evaluation of national tobacco control plans and defining future directions for tobacco control.

Multilevel analysis of the determinants of smoking and second-hand smoke exposure in a tobacco-cultivating rural area of southwest China

OBJECTIVES

To examine contextual and individual demographical predictors of smoking and exposure to second-hand smoke (SHS) in a tobacco-cultivating rural area of southwest China.

METHODS

A cross-sectional survey of 4070 consenting individuals aged 18 years or more was conducted in 2010. Information on demographical characteristics, tobacco smoking status and SHS exposure were obtained by a standard questionnaire. Multilevel logistic regression was used to model the variation in prevalence of smoking and SHS exposure.

RESULTS

In the study population, the prevalence rates of smoking and exposure to SHS were 63.5% and 74.7% for men, and 0.6% and 71.2% for women, respectively. Men were more likely to use tobacco than women: OR 8.27, 95% CI (4.83 to 10.97). Age was inversely associated with the probability of tobacco use (OR 0.98, 95% CI 0.97 to 0.99), and exposure to SHS (OR 0.97, 95% CI 0.96 to 0.99). Individual educational level was inversely associated with smoking, but showed no association with exposure to SHS. Adults who did not grow tobacco were less likely to consume tobacco (OR 0.75, 95% CI 0.57 to 0.99) and to be exposed to SHS (OR 0.76, 95% CI 0.58 to 0.99). Living in a high-income community was associated with a low rate of current smoking (OR 0.66, 95% CI 0.57 to 0.77) and SHS exposure (OR 0.58, 95% CI 0.52 to 0.65).

CONCLUSIONS

Future interventions to reduce smoking and exposure to SHS in China should focus more on tobacco farmers, less-educated individuals and on poor rural communities.

Changing patterns of fruit and vegetable intake in countries of the former Soviet Union

OBJECTIVE

To assess how the frequency of low fruit and vegetable consumption has changed in countries of the former Soviet Union (FSU) between 2001 and 2010 and to identify factors associated with low consumption.

DESIGN

Cross-sectional surveys. A standard questionnaire was administered at both time points to examine fruit and vegetable consumption frequency. Logistic regression analysis was used to examine the relationship between demographic, socio-economic and health behavioural variables and low fruit and vegetable consumption in 2010.

SETTING

Nationally representative population samples from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine.

SUBJECTS

Adults aged 18 years and older.

RESULTS

Between 2001 and 2010 notable changes occurred in fruit and vegetable consumption in many countries resulting in a slight overall deterioration in diet. By 2010 in six countries about 40% of the population was eating fruit once weekly or less often, while for vegetables the corresponding figure was in excess of 20% in every country except Azerbaijan. A worse socio-economic situation, negative health behaviours (smoking and alcohol consumption) and rural residence were all associated with low levels of fruit and vegetable consumption.

CONCLUSIONS

International dietary guidelines emphasise the importance of fruit and vegetable consumption. The scale of inadequate consumption of these food groups among much of the population in many FSU countries and its link to socio-economic disadvantage are deeply worrying. This highlights the urgent need for a greater focus to be placed on population nutrition policies to avoid nutrition-related diseases in the FSU countries.

Hazardous alcohol consumption is associated with increased levels of B-type natriuretic peptide: evidence from two population-based studies

Russia has very high mortality from cardiovascular disease (CVD), with evidence that heavy drinking may play a role. To throw further light on this association we have studied the association of alcohol with predictors of CVD risk including B-type natriuretic peptide (BNP). Levels of BNP increase primarily in response to abnormal cardiac chamber wall stretch which can occur both as a result of atherosclerosis as well as due to other types of damage to the myocardium. No previous population-based studies have investigated the association with alcohol. We analysed cross-sectional data on drinking behaviour in 993 men aged 25-60 years from the Izhevsk Family Study 2 (IFS2), conducted in the Russian city of Izhevsk in 2008-2009. Relative to non-drinkers, men who drank hazardously had an odds ratio (OR) of being in the top 20 % of the BNP distribution of 4.66 (95 % CI 2.13, 10.19) adjusted for age, obesity, waist-hip ratio, and smoking. Further adjustment for class of hypertension resulted in only slight attenuation of the effect, suggesting that this effect was not secondary to the influence of alcohol on blood pressure. In contrast hazardous drinking was associated with markedly raised ApoA1 and HDL cholesterol levels, but had little impact on levels of ApoB and LDL cholesterol. Similar but less pronounced associations were found in the Belfast (UK) component of the PRIME study conducted in 1991. These findings suggest that the association of heavy drinking with increased risk of cardiovascular disease may be partly due to alcohol-induced non-atherosclerotic damage to the myocardium.

Predictors of success for smoking cessation at the workplace: a longitudinal study

BACKGROUND

The effectiveness of worksite interventions to reduce smoking is debatable.

OBJECTIVES

A comprehensive smoking cessation intervention was implemented in a community of more than 17,000 employees at three different health care companies. The primary endpoint was abstinence at 24 months (self-reported and confirmed by exhaled carbon monoxide ≤ 6 parts per million). Predictors of long-term abstinence were analysed by multivariable regression analysis.

METHODS

The study was designed as an investigator-initiated and investigator-driven, open, multicentre, cohort study; 887 smokers were enrolled in the programme. The intervention included intensive individual counselling as well as nicotine replacement and/or bupropion according to individual preferences. Re-interventions for relapse were offered during the 24-month follow-up.

RESULTS

The abstinence rate was 37% at 24 months and did not differ among the various medication groups (p > 0.05 for all). Predictors of successful cessation were higher age (odds ratio, OR 1.47, 95% confidence interval, CI 1.08-2.00, p < 0.01), breathlessness on exertion (OR 2.26, 95% CI 1.1-4.9, p = 0.03), and a higher educational level (OR 1.81, 95% CI 1.06-3.09, p = 0.03). Higher Fagerström (OR 0.76, 95% CI 0.59-0.97, p < 0.01) and craving scores (OR 0.75, 95% CI 0.63-0.89, p < 0.01), chronic sputum production (OR 0.52, 95% CI 0.31-0.87, p = 0.01) and use of antidepressants (OR 0.54, 95% CI 0.32-0.91, p = 0.02) were associated with ongoing smoking.

CONCLUSION

A comprehensive smoking cessation intervention at the workplace achieves high, stable, long-term abstinence rates. Elderly, well-educated employees with breathlessness on exertion have higher odds of quitting smoking. In contrast, those with high physical dependency and more intense craving, and those reporting use of antidepressant medication or sputum production have poorer chances to quit.

Health and health systems in the Commonwealth of Independent States

The countries of the Commonwealth of Independent States differ substantially in their post-Soviet economic development but face many of the same challenges to health and health systems. Life expectancies dropped steeply in the 1990s, and several countries have yet to recover the levels noted before the dissolution of the Soviet Union. Cardiovascular disease is a much bigger killer in the Commonwealth of Independent States than in western Europe because of hazardous alcohol consumption and high smoking rates in men, the breakdown of social safety nets, rising social inequality, and inadequate health services. These former Soviet countries have embarked on reforms to their health systems, often aiming to strengthen primary care, scale back hospital capacities, reform mechanisms for paying providers and pooling funds, and address the overall shortage of public funding for health. However, major challenges remain, such as frequent private out-of-pocket payments for health care and underdeveloped systems for improvement of quality of care.

Changes in smoking prevalence in 8 countries of the former Soviet Union between 2001 and 2010

OBJECTIVES

We sought to present new data on smoking prevalence in 8 countries, analyze prevalence changes between 2001 and 2010, and examine trend variance by age, location, education level, and household economic status.

METHODS

We conducted cross-sectional household surveys in 2010 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. We compared smoking prevalence with a related 2001 study for the different countries and population subgroups, and also calculated the adjusted prevalence rate ratios of smoking.

RESULTS

All-age 2010 smoking prevalence among men ranged from 39% (Moldova) to 59% (Armenia), and among women from 2% (Armenia) to 16% (Russia). There was a significantly lower smoking prevalence among men in 2010 compared with 2001 in Belarus, Kazakhstan, Kyrgyzstan, and Russia, but not for women in any country. For all countries combined, there was a significantly lower smoking prevalence in 2010 than in 2001 for men aged 18 to 39 years and men with a good or average economic situation.

CONCLUSIONS

Smoking prevalence appears to have stabilized and may be declining in younger groups, but remains extremely high among men, especially those in lower socioeconomic groups.

Degree of urbanization and gender differences in substance use among Slovak adolescents

OBJECTIVES

Substance use among adolescents varies with gender and between countries. Urbanization may contribute to this. The aim of our study is to explore the association between the degree of urbanization and gender differences in adolescent smoking, binge drinking, and cannabis use.

METHODS

A cross-sectional questionnaire survey of Slovak adolescents was used (N = 3,493; mean age = 14.33), stratified by degree of urbanization. The effects of gender and urbanization of the area and their interaction on substance use (smoking, binge drinking, and cannabis) were analyzed using a logistic regression model adjusted for age.

RESULTS

Gender and area and their interaction had statistically significant (p < 0.01) associations with substance use. The lower the urbanization of the area, the less riskily females behaved. An exception was found in the case of binge drinking where the results of the interaction of gender and degree of urbanization were not significant for the second least urbanized area.

CONCLUSIONS

Prevalence rate of substance use among girls increased along with an increasing degree of urbanization, while the prevalence rate of substance use among boys remained constant.

Health care reform in the former Soviet Union: beyond the transition

OBJECTIVE

To assess accessibility and affordability of health care in eight countries of the former Soviet Union.

DATA SOURCES/STUDY SETTING

Primary data collection conducted in 2010 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia, and Ukraine.

STUDY DESIGN

Cross-sectional household survey using multistage stratified random sampling.

DATA COLLECTION/EXTRACTION METHODS

Data were collected using standardized questionnaires with subjects aged 18+ on demographic, socioeconomic, and health care access characteristics. Descriptive and multivariate regression analyses were used.

PRINCIPAL FINDINGS

Almost half of respondents who had a health problem in the previous month which they viewed as needing care had not sought care. Respondents significantly less likely to seek care included those living in Armenia, Georgia, or Ukraine, in rural areas, aged 35-49, with a poor household economic situation, and high alcohol consumption. Cost was most often cited as the reason for not seeking health care. Most respondents who did obtain care made out-of-pocket payments, with median amounts varying from $13 in Belarus to $100 in Azerbaijan.

CONCLUSIONS

Access to health care and within-country inequalities appear to have improved over the past decade. However, considerable problems remain, including out-of-pocket payments and unaffordability despite efforts to improve financial protection.

Is income or employment a stronger predictor of smoking than education in economically less developed countries? A cross-sectional study in Hungary

Background

In developed European countries in the last phase of the smoking epidemic, education is a stronger predictor of smoking than income or employment. We examine whether this also applies in economically less developed countries.

Methods

Data from 7218 respondents in the 25-64 age group came from two National Health Interview Surveys conducted in 2000 and 2003 in Hungary. Independent effects of educational level, income and employment status were studied in relation to smoking prevalence, initiation and continuation for all age groups combined and separately for 25-34, 35-49 and 50-64 years old. Absolute levels were evaluated by using age-standardized prevalence rates. Relative differences were assessed by means of logistic regression.

Results

Education and income, but not employment, were associated with equally large differences in smoking prevalence in Hungary in the 25-64 age group. Among men, smoking initiation was related to low educational level, whereas smoking continuation was related to low income. Among women, low education and low income were associated with both high initiation and high continuation rates. Considerable differences were found between the age groups. Inverse social gradients were generally strongest in the youngest age groups. However, smoking continuation among men had the strongest association with low income for the middle-aged group.

Conclusions

Patterns of inequalities in smoking in Hungary can be best understood in relation to two processes: the smoking epidemic, and the additional effects of poverty. Equity orientated tobacco control measures should target the low educated to prevent their smoking initiation, and the poor to improve their cessation rates.

A review of the impacts of tobacco industry privatisation: Implications for policy

State-owned tobacco companies, which still account for 40% of global cigarette production, face continued pressure from, among others, the International Monetary Fund (IMF), to be privatised. This review of available literature on tobacco industry privatisation suggests that any economic benefits of privatisation may be lower than supposed, because private owners avoid competitive tenders (thus underpaying for assets), negotiate lengthy tax holidays and are complicit in the smuggling of cigarettes to avoid import and excise duties. It outlines how privatisation leads to increased marketing, more effective distribution and lower prices, creating additional demand for cigarettes among new and existing smokers, leading to increased cigarette consumption, higher smoking prevalence and lower age of smoking initiation. Privatisation also weakens tobacco control because private owners, in their drive for profits, lobby aggressively against effective policies and ignore or overturn existing policies. This evidence suggests that further tobacco industry privatisation is likely to increase smoking and that instead of transferring assets from state to private ownership, alternative models of supply should be explored.

The International Monetary Fund and Tobacco: A Product like Any Other?

The International Monetary Fund (IMF) has promoted the lifting of trade restrictions on tobacco and the privatization of state-owned tobacco industries as part of its loan conditions. Growing evidence shows that tobacco industry privatization stimulates tobacco consumption and smoking prevalence in borrowing countries. Privatized tobacco companies make favorable tobacco control policies a condition of their investment and lobby aggressively against further control measures. This, along with increased efficiency of the private sector, leads to increases in marketing, substantial reductions in excise taxes, drops in cigarette prices, and overall rises in sales of cigarettes. The actions of the IMF have therefore led to substantially greater use of tobacco, a product that kills half of its consumers when used as intended, with little evidence of economic gain.

The social and economic determinants of smoking in Moscow, Russia

BACKGROUND

Despite a high prevalence of smoking for decades, recent research has documented an increase in the rates of both male and female smoking in post-Soviet Russia. As yet, however, little research has taken place on smoking at the subnational level. The current study addresses this deficit by examining smoking in Moscow -- the city that has been at the forefront of the entry into the Russian market of transnational tobacco corporations (TTCs) in the transition period.

METHODS

Data were obtained from the Moscow Health Survey 2004 -- a stratified random sample of 1190 people representative of Moscow's larger population. Information was obtained about subjects' smoking habits and age of smoking initiation.

RESULTS

The prevalence of smoking was high among both men (55.5%) and women (26.9%), with significantly higher rates in the younger age groups. There was also a high prevalence of smoking initiation before age 15 years, especially in the youngest women (18-30 years). Logistic regression analysis showed that respondents' age, binge drinking, locus of control and economic situation were important determinants of smoking.

CONCLUSIONS

Although lifestyle factors seem to underpin the generally high levels of smoking, other things, such as its high prevalence in the younger generations and the factors associated with smoking (locus of control), nevertheless suggest that the TTCs may have played an important role in the spread of smoking in transitional Russia's changing social environment.

Psychological distress and dietary patterns in eight post-Soviet republics

The purpose of this study is to examine the relationship between psychological distress and dietary consumption patterns in the former Soviet Union. Data are cross-sectional and were collected in 2001 from a large representative sample (n = 18,428) of respondents age 18 years and over in eight former Soviet republics. Sociodemographic covariates and psychological distress predictors were analyzed using ordinal logistic regression models to estimate multivariate correlations with the frequency of meat, fish, vegetable, fruit, and animal fat consumption among men and women in these eight regions. Results show that psychological distress exhibits statistically significant, negative associations with all dietary consumption indicators for both men and women. Social class predictors display consistent positive correlations with food consumption outcomes, emphasizing the potential importance of this concept in the dynamic relationship between diet and psychological distress. Higher reported levels of psychological distress are associated with the less frequent consumption of all types of food products in this analysis. Several possible interpretations are discussed, and we explore the probable multidimensional theoretical mechanisms that can help explain the complex relationships among distress, food insecurity, and dietary patterns in these eight republics of the former USSR. The general and practical significance of these findings is also discussed, along with suggested directions for future research and potential dietary intervention strategies.

The specter of post-communism: women and alcohol in eight post-Soviet states

Because men have borne the heaviest burden of premature mortality in the former Soviet Union, women have for the most part been overlooked in studies of the health crisis in this part of the world. A considerable body of research points to alcohol consumption among males as a primary lifestyle cause of premature mortality. However, the extent to which alcohol use has penetrated the female population following the collapse of communism and how this consumption is associated with other social factors is less well-understood. Accordingly, this paper investigates alcohol consumption in eight republics of the former USSR - Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine using data collected in 2001. More specifically, discussion of gender role transformations and the historical experiences of women during the Soviet era emphasize two potentially important social influences examined in this analysis: psychological distress and Soviet political ideology. Findings suggest that distress is only weakly statistically associated with frequent drinking behavior among women, but results for political ideology show that this factor is statistically and significantly associated with drinking behaviors. Alcohol consumption was not particularly common among women under communism, but trends have been changing. Our discussion suggests that, after the collapse of the Soviet state, women are more able to embrace behavioral practices related to alcohol, and many may do so as an overt rejection of traditional Soviet norms and values. Findings are also discussed within the context of current epidemiological trends and future research directions in these eight republics.

Changes in smoking prevalence in Ukraine in 2001-5

OBJECTIVES

To analyse trends in smoking prevalence in Ukraine from three surveys conducted in 2001-5, and to explore correlates of observed changes, in order to estimate the stage of tobacco epidemic in Ukraine.

DESIGN

Repeated national interview surveys in Ukraine in 2001, 2002 and 2005.

MAIN OUTCOME MEASURE

Prevalence of current smoking among the population aged > or = 15 years.

RESULTS

The age-standardised prevalence of current smoking in Ukrainian men was 54.8% in 2001 and 66.8% in 2005. Among Ukrainian women, prevalence increased from 11.5% in 2001 to 20.0% in 2005. ORs for yearly increase in prevalence were estimated as 1.164 (95% CI 1.111 to 1.220) for men and 1.187 (1.124 to 1.253) for women, which implies that, on average, 3-4% of men and 1.5-2% of women living in Ukraine join the smoking population each year.

CONCLUSIONS

In Ukraine, smoking prevalence is increasing in most population groups. Among men, the medium deprivation group with secondary education has the highest smoking prevalence. Among women, while the most educated, young and those living in larger cities are the leading group for tobacco use, other groups are also increasing their tobacco use. Tobacco promotion efforts appear to have been significantly more effective in Ukraine than smoking control efforts. The decrease in real cigarette prices in Ukraine in 2001-5 could be the main factor explaining the recent growth in smoking prevalence.

Association of cigarette smoking and depressive symptoms in a forensic population

The link between mental health issues and smoking has been an important area of investigation. However, little is known about this association in a general adult, male forensic population. The aim of this study was to identify demographic and clinical (depression and anxiety) variables that predict smoking in a forensic population. A large cohort of 353 inmates in a high-security prison underwent a psychiatric interview, including administration of the Montgomery-Asberg Rating Scale for Depression (MADRS) and Hamilton's Rating Scale for Anxiety (HAM-A). Multiple regression analysis suggested that younger age and higher depression scores might predict the amount of daily smoking in this population. In contrast, anxiety symptoms were not an independent predictor for smoking in our study. These findings support the need for additional research to focus on those factors associated with smoking in forensic populations. Psychiatric screening for younger male individuals in forensic settings and targeted cognitive-behavioral interventions to treat depressed smokers may ameliorate the smoking abstinence rate in prisons.

Trends in the prevalence of smoking in Russia during the transition to a market economy

BACKGROUND

Changes in smoking, particularly an increase in women, were predicted to follow the aggressive campaigns of multinational tobacco companies in transitional Russia. However, such changes have not yet been demonstrated unequivocally.

OBJECTIVE

To examine smoking trends by gender, education and area of residence.

METHODS

Data from 10 rounds of the Russia Longitudinal Monitoring Survey (1992-2003), consisting of more than 3000 men and 4000 women in each round, were used. The mean reported ages of first smoking in current smokers were compared between 10-year birth cohorts.

RESULTS

Between 1992 and 2003, smoking prevalence doubled among women from 6.9% (95% CI 6.3% to 7.6%) to 14.8% (13.9% to 15.7%) and increased among men from 57.4% (95% CI 56.0% to 58.8%) to 62.6% (61.1% to 64.1%). In both sexes, the rise was significantly greater in the least educated, markedly so in women (a doubling vs a 1.5-fold rise in the most educated). Although prevalence of smoking among women was considerably higher in Moscow and St Petersburg than in rural areas, the dramatic threefold increase in prevalence in rural women was significantly greater than in the main cities (36%, p<0.001). The mean age of first smoking was significantly lower in women born after 1960, but in men it was stable between cohorts.

CONCLUSIONS

For the first time, it has been shown unequivocally that smoking among women increased markedly during the transition to a market economy in Russia. The already high prevalence of smoking among men has continued to rise. These changes are likely to reflect the activity of the tobacco industry and provide further evidence of the harms of privatisation. Effective tobacco control policies are urgently needed.

Smoking initiation and nicotine dependence symptoms in Ukraine: findings from the Ukraine World Mental Health survey

OBJECTIVES

Cigarette smoking is a major cause of morbidity and mortality in former Soviet countries. This study examined the personal, familial and psychiatric risk factors for smoking initiation and development of nicotine dependence symptoms in Ukraine.

STUDY DESIGN

Cross-sectional survey.

METHODS

Smoking history and dependence symptoms were ascertained from N=1711 adults in Ukraine as part of a national mental health survey conducted in 2002. Separate analyses were conducted for men and women.

RESULTS

The prevalence of lifetime regular smoking was 80.5% in men and 18.7% in women, with median ages at initiation among smokers of 17 and 18, respectively. Furthermore, 61.2% of men and 11.9% of women were current smokers; among the subgroup of lifetime smokers, 75.9% of men and 63.1% of women currently smoked. The youngest female cohort (born 1965-1984) was 26 times more likely to start smoking than the oldest. Smoking initiation was also linked to childhood externalizing behaviors and antecedent use of alcohol in both genders, as well as marital status and personal alcohol abuse in men, and childhood urbanicity and birth cohort in women. Dependence symptoms developed in 61.7% of male and 47.1% of female smokers. The rate increased sharply in the first four years after smoking initiation. Dependence symptoms were related to birth cohort and alcohol abuse in both genders, as well as growing up in a suburb or town and childhood externalizing behaviors in men, and parental antisocial behavior in women.

CONCLUSIONS

Increased smoking in young women heralds a rising epidemic in Ukraine and underscores the need for primary prevention programs, especially in urban areas. Our findings support the importance of childhood and alcohol-related risk factors, especially in women, while pre-existing depression and anxiety disorders were only weakly associated with starting to smoke or developing dependence symptoms.

Influence of household demographic and socio-economic factors on household expenditure on tobacco in six New Independent States

Background

To identify demographic and socio-economic factors that are associated with household expenditure on tobacco in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, and Tajikistan.

Methods

Secondary analysis of the data available through the World Bank Living Standards Monitoring Survey conducted in aforementioned countries in 1995–2000. The role of different variables (e.g. mean age of household members, household area of residence, household size, share of adult males, share of members with high education) in determining household expenditure on tobacco (defined as tobacco expenditure share out of total monthly HH consumption) was assessed by using multiple regression analysis.

Results

Significant differences were found between mean expenditure on tobacco between rich and poor – in absolute terms the rich spend significantly more compared with the poor. Poor households devote significantly higher shares of their monthly HH consumption for tobacco products. Shares of adult males were significantly associated with the share of household consumption devoted for tobacco. There was a significant negative association between shares of persons with tertiary education within the HH and shares of monthly household consumption devoted for tobacco products. The correlation between household expenditures on tobacco and alcohol was found to be positive, rather weak, but statistically significant.

Conclusion

Given the high levels of poverty and high rates of smoking in the New Independent States, these findings have important policy implications. They indicate that the impact and opportunity costs of smoking on household finances are more significant for the poor than for the rich. Any reductions in smoking prevalence within poor households could have a positive economic impact.

Parental smoking behaviour and effects of tobacco smoke on children's health in Finland and Russia

BACKGROUND

There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children.

METHODS

We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%).

RESULTS

Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44).

CONCLUSIONS

Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words).

Social determinants of ever initiating smoking differ from those of quitting: a cross-sectional study in Estonia

BACKGROUND

To study the association of socioeconomic and demographic indicators with ever initiating regular smoking and quitting smoking among ever regular smokers in Estonia in order to identify target groups for equity-oriented tobacco control policies.

METHODS

Data for 4277 individuals in the 25-64 age group come from three cross-sectional studies conducted in 2000, 2002 and 2004. Age-standardized prevalence rates and odds ratios with 95% confidence intervals were calculated.

RESULTS

High rates of ever initiation were observed for lower educated men and women after controlling for other socioeconomic indicators. This association was not observed for women above age 50. Independent, although weaker associations were found among men who were unemployed or with a low occupational status. Low cessation rates were observed among men who were unemployed, who had a lower occupational position or who had a low income. These associations remained after controlling for other socioeconomic variables. The effect of income became stronger in the older age groups among men. Rates of ever initiation and cessation also varied strongly in relationship to some demographic variables. The highest initiation rates were found among divorced women and among women living in the capital city. The lowest cessation rates were found among divorced women, and among Russian men.

CONCLUSIONS

While educational level was the strongest predictor of ever initiating regular smoking, smoking cessation was related more directly to aspects of social disadvantage originating in adult life. To be effective, tobacco control interventions should not only target lower educated, but also those in material disadvantage.

Changes in smoking prevalence in Russia, 1996-2004

OBJECTIVES

In Russia, smoking prevalence has historically been high in men and relatively low in women. Female smoking prevalence is predicted to rise but assessment of changes has been limited by the lack of comparable data. Changes in the prevalence of smoking in Russia between 1996 and 2004, and whether theses changes differed by sociodemographic groups, were investigated.

DESIGN

Repeated national interview surveys in 1996 (731 men and 868 women) and 2004 (727 men and 864 women) aged 18 years or more.

MAIN OUTCOME MEASURE

Prevalence of current smoking.

RESULTS

The age standardised prevalence of smoking in 1996 and 2004 was 61% and 63%, respectively in men and 15% and 16%, respectively in women (both p values > 0.4). In men, the prevalence of smoking seemed to decline in those with university education (from 51% to 40%, p = 0.085). Among women, smoking appeared to increase in those with university education (from 10% to 17%, p = 0.071) and low levels of self-reported material deprivation (from 11% to 18%, p = 0.053). There was a pronounced increase in prevalence among women living in villages (from 8% to 14%, p = 0.049); the strong urban/rural gradient seen in 1996 became considerably weaker by 2004.

CONCLUSIONS

Overall smoking prevalence in both men and women in Russia remained stable between 1996 and 2004 but, given the sample size, a moderate increase in female smoking cannot be ruled out. In men, smoking increased among the least educated and declined in the most educated. In women the opposite appeared to occur, in addition to an increase in smoking in rural areas. More long term monitoring of smoking patterns in Russia, especially among women, using sufficiently large surveys, is required.

Marital status, social support and survival after curative resection in non-small-cell lung cancer

It has been suggested that marital status and social support are associated with survival in cases of lung cancer, and that such an association may be mediated by several factors. In this prospective cohort study, we investigated the effect of marital status and social support on survival after curative resection for non-small cell lung carcinoma (NSCLC) in Japan. From June 1996 to April 1999, a total of 238 patients with resectable NSCLC were enrolled. Marital status and social support were assessed. The presence and absence of confidants and the satisfaction level with the confidants were used as factors reflecting social support. During the follow-up period, 57 deaths from all causes were identified through January 2004. For the statistical analysis, Cox proportional hazards regression analyses were used. With regard to marital status, the multivariable adjusted hazard ratio (HR) of unmarried patients versus married patients was 0.8 (95% confidence interval, 0.3-1.8) (P-value=0.53) after controlling for potential confounding factors, including age, sex, occasion of cancer diagnosis, pathological stage, smoking status, smoking status after surgery and serum albumin level. Similarly, the multivariable adjusted HR of patients without confidants versus those with confidants was 1.0 (0.5-2.2) (P-value=0.90), whereas the multivariable adjusted HR of the dissatisfied-with-confidants group versus the satisfied-with-confidants group was 0.7 (0.4-1.3) (P-value=0.28). The present data do not support the hypothesis that marital status and social support are associated with survival in NSCLC.

Pushing up smoking incidence: plans for a privatised tobacco industry in Moldova

Moldova, one of the former Soviet republics and Europe's poorest country, has so far resisted pressure to privatise its tobacco industry. This paper examines the policies pursued by the transnational tobacco companies in Moldova in order to inform the ongoing debate about tobacco industry privatisation. We analysed relevant internal industry documents made public through litigation. The documents suggest that although a competitive tender for the state owned monopoly was later announced, British American Tobacco (BAT) and the German manufacturer Reemtsma each initially sought to secure a closed deal, with BAT accusing Reemtsma of underhand tactics. Imperial Tobacco, which now owns Reemstma, was unable to comment on these allegations as it only acquired Reemstma after the events in question. BAT sought to acquire a monopoly position, bolstered by excise rules developed by the company that would uniquely favour its products. Despite hoping to establish a monopoly, it planned intensive marketing, as if in a competitive market, aiming to target young urban dwellers, particularly opinion leaders. In so doing it predicted that smoking uptake would increase, especially among women. The documents also suggest that BAT was aware of the sensitive nature of its plans to cull the processing workforce and aimed to present "sanitised" information on future employment levels to the Moldovans. The potential for tobacco industry privatisation to undermine tobacco control and promote cigarette consumption is highlighted and is consistent with economic theory. Countries planning tobacco industry privatisation should ensure a transparent and competitive privatisation process, seek to prevent the predicted increase in consumption by implementing effective tobacco control policies and consider the impacts on employment. Multilateral financial organisations promoting tobacco industry privatisation could ensure their loan conditions protect public health by making the implementation of tobacco control policies a pre-requisite for privatisation.

Prevalence of smoking in 8 countries of the former Soviet Union: results from the living conditions, lifestyles and health study

OBJECTIVES

We sought to provide comparative data on smoking habits in countries of the former Soviet Union.

METHODS

We conducted cross-sectional surveys in 8 former Soviet countries with representative national samples of the population 18 years or older.

RESULTS

Smoking rates varied among men, from 43.3% to 65.3% among the countries examined. Results showed that smoking among women remains uncommon in Armenia, Georgia, Kyrgyzstan, and Moldova (rates of 2.4%-6.3%). In Belarus, Ukraine, Kazakhstan, and Russia, rates were higher (9.3%-15.5%). Men start smoking at significantly younger ages than women, smoke more cigarettes per day, and are more likely to be nicotine dependent.

CONCLUSIONS

Smoking rates among men in these countries have been high for some time and remain among the highest in the world. Smoking rates among women have increased from previous years and appear to reflect transnational tobacco company activity.