Young cohorts of Russians drink less: age-period-cohort modelling of alcohol use prevalence 1994-2016

Understanding alcohol use and alcohol use disorders from a developmental psychopathology perspective: Research advances, challenges, and future directions

As part of the special issue of Development and Psychopathology honoring the remarkable contributions of Dr Dante Cicchetti, the current paper attempts to describe the recent contributions that a developmental psychopathology perspective has made in understanding the development of alcohol use and alcohol-related problems over the lifespan. The paper also identifies some of the future challenges and research directions. Because the scope of this task far exceeds the confines of a journal length article this paper does not attempt a comprehensive review. Rather, it builds on an earlier review and commentary that was published in Development and Psychopathology in 2013, with a similar goal.)Building on that work and updating its conclusions and suggestions for future directions, the current paper emphasizes findings from the research areas that were identified for further study in 2013 and the findings that have been published since that time.

An age-period-cohort approach to studying long-term trends in obesity and overweight in England (1992-2019)

OBJECTIVE

This study aims to understand long-term trends in obesity and overweight in England by estimating life-course transitions as well as historical and birth cohort trends for both children and adults.

METHODS

Data on individuals aged 5 to 85 years old from the Health Survey for England were used, covering the period 1992 to 2019 and birth cohorts born between 1909 and 2013. Individual BMI values were classified as healthy weight, overweight, or obesity. Trends were compared, and an age-period-cohort model was estimated using logistic regression and categorical age, period, and cohort groups.

RESULTS

There was significant variation in age trajectories by birth cohorts for healthy weight and obesity prevalence. The odds of having obesity compared with a healthy weight increased consistently with age, increased throughout the study period (but faster between 1992 and 2001), and were higher for birth cohorts born between 1989 and 2008. The odds of having overweight showed an inverted U-shape among children, increased through adulthood, have been stable since 2012, and were considerably higher for the youngest birth cohort (2009-2013).

CONCLUSIONS

Younger generations with higher overweight prevalence coupled with increasing obesity prevalence with age suggest that obesity should remain a high priority for public health policy makers in England.

Generational shifts in attitudes and beliefs about alcohol: An age-period-cohort approach

INTRODUCTION AND AIMS

Population level alcohol consumption has declined markedly in Australia in the past two decades, with distinct generational patterns. The underlying reason for this shift remains unclear and there has been little work assessing how attitudes and beliefs about alcohol have shifted in population sub-groups.

DESIGN AND METHODS

Using seven waves of survey data spanning 19 years (2001-2019, n = 166,093 respondents aged 14 +), we assess age, time-period and birth cohort effects on trends in four measures of alcohol attitudes (disapproval of regular alcohol use, perceptions of safe drinking levels for men and women and perception that alcohol causes the most deaths of any drug in Australia).

RESULTS

There were steady increases in period effects for perceived safe drinking levels (especially for men) and belief that alcohol causes the most deaths. Disapproval of regular use has been stable at the population level, but there are marked cohort differences, with early and recent cohorts more likely than others to disapprove of regular alcohol use.

DISCUSSIONS AND CONCLUSIONS

These findings point to a broad lowering of perceived safe levels of drinking across the population alongside a sharp increase in disapproval of drinking for recent cohorts, potentially contributing to the reductions in drinking that have been reported in these cohorts.

Investigating the relationship between alcohol consumption and subjective poverty in Russia

The Russian government has long struggled with the problem of excessive alcohol consumption. We examined the relationship between alcohol consumption and subjective poverty in Russia using the special survey of the Levada Analytical Center conducted in 2017. Subjective poverty represents an individual's perception of personal well-being when an individual's income is lower than the required not to feel poor. We found that the status of being subjectively poor was associated with the increased probability of consuming vodka for women and the probability of consuming beer for men. Results inform decision-makers about the importance of subjective poverty issues for understanding alcohol consumption.

The association between beverage-specific alcohol consumption and mortality among road users in Russia, 1965-2019

A vast body of literature suggests a relationship between alcohol consumption and road traffic fatalities. Despite an impressive downward trend in road traffic fatalities in Russia, the death rate is still unacceptably high. Far fewer studies have differentiated the association by road users and types of alcoholic beverages. This population-based study aims to estimate the associations of total and beverage-specific alcohol per capita (15+) consumption (APC) based on official alcohol sales statistics and road traffic mortality using police data on the number of deaths by road users. The study covers the period 1965-2019. We employed a first-order difference linear regression model with robust and autocorrelation consistent standard errors, controlling for a level of motorisation. To examine the possible evolution of the phenomenon, we repeated models separately for three consecutive periods (1965-1984, 1985-2002, 2003-2019). The findings suggest that an annual 1-litre increase in APC (in litres of pure alcohol) associated with a corresponding increase in the death rates (per 100,000 inhabitants) of both unprotected road users and motor vehicle occupants by about 0.3 (p < 0.01) and 0.4 (p < 0.05), respectively. A beverage-specific analysis for 1965-2019 revealed a positive and significant association between mortality of pedestrians and cyclists and the consumption of strong alcoholic beverages (p < 0.05) as well as mortality of drivers and passengers and the consumption of weaker alcoholic beverages, primarily beer (p < 0.01). Various road safety strategies should be applied to prevent road traffic fatalities of road users.

'More options…less time' in the 'hustle culture' of 'generation sensible': Individualization and drinking decline among twenty-first century young adults

There has been a dramatic decline in alcohol consumption among younger people, including an increase of conscious moderation and abstinence. Change has a generational character, with different cohorts' drinking changing over time from the heavy, embedded pattern among post-war 'boomers' to the more selective habits initiated by 'millennials'. This is a surprising development in historical terms and has been cast as indicating the emergence of a moderating 'generation sensible'. It is also coincident with more negative trends, such as young adults worsening mental health. Informed by the perspective of individualization, we consider the decline in youth drinking in the context of generational changes in the lifecourse. We focus upon how recent generations of young people experience greater choice, pressure and a prolonged adolescence, characterized by more limited autonomy. Explored with conscious young moderators through a survey (N = 517) and focus groups (N = 13), these themes resonated with our sample who appear a self-conscious generation with significant and open-ended focus upon maintaining their wellbeing and control. Further, they appear more disembedded from pressure to conform but under greater pressure to perform. The same forces of individualization encouraging moderate drinking may also weigh down upon young people who feel under pressure not only to transform their own lives but feel a burden of responsibility for a damaged, unjust world. The article's originality lies in applying individualization to both generational change and consumption, suggesting this can be usefully done through a focus upon freedom/choice and pressure/performance. It also considers what is regarded as the positive trend of drinking decline alongside, and as related to, negative trends such as greater loneliness and less autonomy among young adults.

Prevalence of self-reported alcohol consumption among pregnant women in Russia between 1994 and 2018

BACKGROUND

Although pregnant women in Russia are thought to have a high level of alcohol consumption, nationwide data have not been available. We compared changes in consumption among pregnant and nonpregnant women of childbearing age from 1994 to 2018 and examined predictors of consumption among the pregnant women.

METHODS

Data were obtained from the annual, nationally representative Russian Longitudinal Monitoring Survey (RLMS-HSE), comprising 1,943 pregnant and 80,237 nonpregnant women of childbearing age. Past 30-day alcohol prevalence and current pregnancy status were self-reported. Logistic regressions using generalized linear mixed models examined two dependent variables: (1) current drinkers (any alcohol in the past 30 days) versus nondrinkers and (2) current drinkers and occasional drinkers (ever drinkers at any level) versus nondrinkers. Analyses included a series of predictors and control variables.

RESULTS

Between 1994 and 2018, a decrease in the 30-day prevalence of alcohol consumption was observed in both pregnant (from 25.6 (95% CI ± 3.3) to 9.4% (95% CI ± 2.2)) and nonpregnant (from 57.3 (95% CI ± 0.7) to 39.0% (95% CI ± 0.6)) women. Between 2006 and 2018, the percentage of pregnant abstainers increased from 46.8% (95% CI ± 4.2) to 54.6% (95% CI ± 3.6) while occasional drinking among pregnant women remained at 35% (95% CI ± 4.0). Time period, preventative check-ups, hospitalization, and frequent doctor's visits were significant predictors of the decrease in the 30-day prevalence of alcohol intake in pregnant women, but these did not predict the prevalence of occasional drinking.

CONCLUSION

Despite significant reductions in consumption among pregnant women in Russia, a substantial proportion reported occasional drinking. Conflicting information on how low alcohol intake affects health risks limited efforts to promote abstinence. Occasional drinking reflects a self-control domain for women that, depending on perceptions of a healthy pregnancy, is framed by social institutions and the environment.

Understanding long-term trends in smoking in England, 1972-2019: an age-period-cohort approach

BACKGROUND AND AIMS

Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age-period-cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour.

DESIGN

APC analysis of repeated cross-sectional smoking prevalence data obtained from three nationally representative surveys.

SETTING

England (1972-2019).

PARTICIPANTS

Individuals aged 18-90 years.

MEASUREMENTS

We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2-year survey periods (1972-73 to 2018-19) and 20 groups of 5-year birth cohorts (1907-11 to 1997-2001). Age and period rates were studied for two groups of birth cohorts: those aged 18-25 years and those aged over 25 years.

FINDINGS

Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41-1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04-0.08). They also decreased almost linearly with period relative to 1972-73 (for 2018-19: OR = 0.30, 95% CI = 0.26-0.34) and with birth cohort relative to 1902-06, with the largest decreased observed for birth cohort 1992-96 (OR = 0.44, 95% CI = 0.35-0.46) and 1997-2001 (OR = 0.35, 95% CI = 0.74-0.88). Smoking declined in the 18-25 age group by an average of 7% over successive 2-year periods and by an average of 5% in those aged over 25.

CONCLUSIONS

Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.

The Alcohol Use Disorders Identification Test (AUDIT) in the Russian language - a systematic review of validation efforts and application challenges

The Alcohol Use Disorders Identification Test (AUDIT) is one of the most frequently used screening instrument for hazardous and harmful use of alcohol and potential alcohol dependence in primary health care (PHC) and other settings worldwide. It has been translated into many languages and adapted and modified for use in some countries, following formal adaptation procedures and validation studies. In the Russian Federation, the AUDIT has been used in different settings and by different health professionals, including addiction specialists (narcologists). In 2017, it was included as a screening instrument in the national guidelines of routine preventive health checks at the population-level (dispanserization). However, various Russian translations of the AUDIT are known to be in use in different settings and, so far, little is known about the empirical basis and validation of the instrument in Russia—a country, which is known for its distinct drinking patterns and their detrimental impact on health. The present contribution is the summary of two systematic reviews that were carried out to inform a planned national validation study of the AUDIT in Russia.

Two systematic searches were carried out to 1) identify all validation efforts of the AUDIT in Russia and to document all reported problems encountered, and 2) identify all globally existing Russian translations of the AUDIT and document their differences and any reported issues in their application. The qualitative narrative synthesis of all studies that met the inclusion criteria of the first search highlighted the absence of any large-scale rigorous validation study of the AUDIT in primary health care in Russia, while a document analysis of all of the 122 Russian translations has revealed 61 unique versions, most of which contained inconsistencies and signaled obvious application challenges of the test.

The results clearly signal the need for a validation study of the Russian AUDIT.

Screening of minor psychiatric disorders and burnout among a sample of medical students in St. Petersburg, Russia: a descriptive study

Background

Despite the general interest of researchers around the world, there are few studies on the psychological wellbeing and burnout among medical students in Russia. The aim of this study was to perform screening for minor psychiatric disorders, burnout, problematic alcohol use, and quantify the psychological issues and stress among a sample of medical students in St. Petersburg, Russia.

Results

According to the GHQ-12, screening for minor mental disorders was positive in 140 students (85%). Screening for burnout using the OLBI showed positive results in 121 (73%) students for disengagement and 132 (80%) students for exhaustion. Screening with the CAGE tool identified a risk of alcohol consumption in 33 students (20%). Most students reported academic studies as the main source of stress in their life (n = 147; 89.1%).

Conclusions

This study identified very high levels of stress, burnout, risk of minor mental disorders, and problematic alcohol use among medical students in St. Petersburg, Russia. These findings suggest more attention is needed to the poor mental wellbeing and health in medical students in Russia.

Age, Period and Cohort Effects On Alcohol Consumption In Estonia, 1996-2018

AIMS

To analyse the independent effects of age, period and cohort on estimated daily alcohol consumption in Estonia.

METHODS

This study used data from nationally representative repeated cross-sectional surveys from 1996 to 2018 and included 11,717 men and 16,513 women aged 16-64 years in total. The dependent variables were consumption of total alcohol and consumption by types of beverages (beer, wine and strong liquor) presented as average daily consumption in grams of absolute alcohol. Mixed-effects negative binomial models stratified by sex were used for age-period-cohort analysis.

RESULTS

Alcohol consumption was highest at ages 20-29 years for both men and women and declined in older ages. Significant period effects were found indicating that total alcohol consumption and consumption of different types of beverages had increased significantly since the 1990s for both men and women. Cohort trends differed for men and women. Men born in the 1990-2000s had significantly lower daily consumption compared to earlier cohorts, whereas the opposite was found for women.

CONCLUSION

While age-related patterns of alcohol consumption are aligned with life course stages, alcohol use has increased over the study period. Although the total daily consumption among men is nearly four times higher than among women, the cohort trends suggest convergence of alcohol consumption patterns for men and women.

The effect of alcohol sales restrictions on alcohol poisoning mortality: Evidence from Russia

This paper examines the tough anti-alcohol legislation recently introduced in Russia, which due to regional variation allows it to be used as a natural experiment. The effect of the restricted trading hours on alcoholic poisoning mortality is estimated. To establish a causal link, difference-in-differences and synthetic controls are used. The main conclusion is that the sales restrictions lead to higher alcohol poisoning mortality, which implies that more toxic alcohol surrogates serve as substitutes for commercially available alcohol.

Decline in alcohol consumption in Russia: Collectivity or polarisation?

INTRODUCTION

Sales and survey data have shown a decline in alcohol consumption in Russia since 2007. This study examines whether this decline is consistent across lighter and heavier drinkers in line with the theory of the collectivity of drinking cultures.

METHODS

Data were collected through annual nationally representative surveys conducted between 2006 and 2018 of 33 109 individuals aged 18-85 years. We estimated generalised linear regression with Gamma distribution and used log alcohol volume consumed during the previous 30 days as the dependent variable for five percentile groups: heavy drinkers (95th), near heavy drinkers (90th), moderate drinkers (80th), light drinkers (60th for men and 70th for women) and non-drinkers. Dummy variables for years, percentile groups and their interactions were used as independent variables. The controls were age, education, income, body weight, marital status, household demographic structure, residence, ethnicity and regional climate.

RESULTS

Reductions in alcohol consumption were observed in all percentiles, but the scale of change was proportionally smaller among heavier drinkers than among lighter drinkers. However, consumption fell by a smaller amount among lighter drinkers than among heavier drinkers. Results of the regression analysis fit with the descriptive statistics. Interactions between the time period and the percentile groups were significant after 2010. Trends were similar for both sexes.

DISCUSSION AND CONCLUSIONS

Downward trends across percentiles were in the same direction but the magnitude of change varied. Obtained evidence fails to support a polarisation and points towards soft collectivity hypothesis in the reduction in drinking in Russia.

Russia's National Concept to Reduce Alcohol Abuse and Alcohol-Dependence in the Population 2010-2020: Which Policy Targets Have Been Achieved?

In the 2000s, Russia was globally one of the top 5 countries with the highest levels of alcohol per capita consumption and prevailing risky patterns of drinking, i.e., high intake per occasion, high proportion of people drinking to intoxication, and high frequency of situations where alcohol is consumed and tolerated. In 2009, in response to these challenges, the Russian government formed the Federal Service for Alcohol Market Regulation and published a national strategy concept to reduce alcohol abuse and alcohol-dependence at the population level for the period 2010-2020. The objectives of the present contribution are to analyze the evidence base of the core components of the concept and to provide a comprehensive evaluation framework of measures implemented (process evaluation) and the achievement of the formulated targets (effect evaluation). Most of the concept's measures were found to be evidence-based and aligned with eight out of 10 areas of the World Health Organization (WHO) policy portfolio. Out of the 14 tasks, 7 were rated as achieved, and 7 as partly achieved. Ten years after the concept's adoption, alcohol consumption seems to have declined by about a third and alcohol is conceptualized as a broad risk factor for the population's health in Russia.

Changes over time in young adults' harmful alcohol consumption: A cross-temporal meta-analysis using the AUDIT

BACKGROUND

Recent studies suggest that young adult participation in, and volume of, alcohol consumption has decreased. However, the evidence on trends in harmful alcohol consumption in this age group is limited. The current paper aims to examine changes over time in harmful alcohol consumption using a robust, widely employed measure.

METHODS

The literature was systematically searched for articles reporting on Alcohol Use Disorders Identification Test (AUDIT) scores in young adults aged 18-24 years. The key data extracted were year of measurement and mean AUDIT score (proportion above clinical cut-off was not relevant for these analyses). Cross-temporal meta-analysis was applied to the extracted data.

RESULTS

A decrease was found in young adults' AUDIT scores measured between 1989 and 2015 (b=-0.13, β=-0.38, p = 0.015, 95 % CI=-0.24, -0.03), representing a 0.63 standard deviation change over this period. Variance did not change over this time, suggesting scores decreased equally over the distribution.

CONCLUSIONS

Results indicate that harmful alcohol consumption in young adults may have declined between 1989 and 2015. Despite the continued problems posed by dependence and short and long-term harms, these promising findings offer hope that the considerable alcohol-related disease burden in this age group may be reduced. Ongoing data collection is required to evaluate whether these declines in young adulthood persist into later life, and future research should explore the reasons for declining harmful alcohol consumption in young adults.

Exploring the relationship between drinking preferences and recorded and unrecorded alcohol consumption in Russian regions in 2010-2016

BACKGROUND

In recent years, Russia has seen a decline in alcohol consumption per capita (APC) accompanied by a significant reduction in the share of spirits in total APC. Our aim was to investigate regional variation in alcohol consumption and the association between the share of spirits in APC, and recorded and unrecorded APC.

METHODS

Data on recorded APC were taken from Rosstat. Our estimates on unrecorded APC were based on the guidelines of the Ministry of Health of the Russian Federation and data on alcoholic psychoses and mortality from external causes (546 observations for 78 regions from 2010 to 2016). We estimated fixed effects models with the dependent variables of recorded and unrecorded APC of the population 15+. Independent variables included share of spirits in recorded APC, vodka prices, average income, duration of alcohol sales hours, and others.

RESULTS

During the 2010-2016 period, recorded APC varied by regions from 1.1 to 17.8 litres; unrecorded - from almost zero to 21 litres; the share of spirits in recorded APC - from 20.6% to 89.3%. A 1% increase in the share of spirits was attributed to a 0.2% increase in recorded APC and to a 2.1% increase in unrecorded APC. Various factors were related to regional APC: vodka prices (with elasticity coefficient -0.46 for recorded and 1.67 for unrecorded APC); income (0.23 for recorded and -2.23 for unrecorded APC); duration of sales hours (-0.9 for unrecorded APC); and shares of working age and of urban population.

CONCLUSION

Taking into account a strong correlation between the share of spirits in the recorded APC and consumption of recorded and unrecorded APC, the price of spirits should be increased. In the regions with pronounced preference for spirits, stricter availability restrictions on the alcohol sales are needed, along with strict control of shadow markets.

The Decline in Alcohol Consumption in Russia from 2006 to 2017: Do Birth Cohorts Matter?

AIM

Previous studies on youth drinking showed opposite trends for high-income and low-income countries. In Russia, a recent decline was observed in the prevalence of alcohol use, particularly among younger cohorts. This study aims at disentangling age and birth cohort effects to better understand the dynamics of abstinence and the volume of alcohol consumption.

METHODS

Data were collected from annual nationally representative panel surveys from 2006 to 2017. Data included 34,514 individuals aged 14-80. We estimated mixed-effects binary-choice models for percentage of abstainers and mixed-effects linear models with Heckman correction for alcohol volume. Integer variables of age and age-squared were used. Period was defined with a dummy variable using 2012 as the dividing line associated with a new Russian alcohol policy. Birth cohorts were defined as 13 groups from 1930-1939 to 2000-2003. Controls were per capita income, education, marital status, composition of households, body weight, ethnicity, residence type, regional per capita income and regional climate.

RESULTS

In both genders, percentage of abstainers increased and drinking volumes declined. Age for both genders showed u-shaped trend for abstinence and inverse u-shaped trend for alcohol volume. Controlling for age effects, cohorts born after 1990 demonstrated the strongest increase in abstinence for both genders and the strongest decrease in alcohol volume for males. The period of 2012-2017 had the effect of increasing the abstinence and decreasing the alcohol volume.

CONCLUSION

Downward trend in alcohol consumption in Russia is partially attributable to increased abstinence and reduced alcohol volume among younger cohorts.

The changing relation between alcohol and life expectancy in Russia in 1965–2017

Introduction and Aims

Design and Methods

Results

Discussion and Conclusions

Patterns in the relationship between life expectancy and gross domestic product in Russia in 2005-15: a cross-sectional analysis

BACKGROUND

Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth.

METHODS

We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014-15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components.

FINDINGS

Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow.

INTERPRETATION

Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health.

FUNDING

This work was partly funded through the International Project on Cardiovascular Disease in Russia supported by a Wellcome Trust Strategic Award (100217) and was supported by the Russian Academic Excellence Project 5-100.