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SPP 299

Author: Bobak, Chenet, Hertzman, Leon, McKee, Marmot, Pikhart, Rose and Shkolnikov
Bobak, Hertzman, Marmot, Pikhart and Rose

Russia has the lowest life expectancy among industrialised countries, but little is known about determinants of health in the Russian population. Here we report a cross-sectional study of a national sample of the Russian population of social and psychosocial determinants of two self-reported health indicators: self-rated health (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). Overall, 25 per cent of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly related to both outcomes; adjustment for a battery of other factors reduced these estimates only slightly. Associations between control over one’s health and both outcomes were also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Education was inversely related to self-rated health, and unmarried men reported poor physical functioning substantially more often. Subjects not approving the economic changes reported poorer health but this association was removed by adjustment for socioeconomic factors and control. Subjects who could not rely on informal social structures when in problems reported worse health; this effect largely persisted in multivariate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social structures, socioeconomic deprivation, and lack of perceived control. The absence of informal social networks, vital for maintaining general welfare, seems to affect adversely self-rated health. Deprivation and low perceived control may provide a useful framework for many biological and behavioural factors.

Bobak, Chenet, Leon, McKee, Rose and Shkolnikov

Tobacco is a leading cause of avoidable death in Russia but there is relatively little information in the public domain about who is smoking. This paper seeks to determine the prevalence of smoking in Russia and its association with socio-demographic factors with data collected in the New Russia Barometer. Smoking is common among males of all ages and in all areas. 65% of those aged 18-24 smoke, rising to 73% in those aged 25-34 and then falling steadily to 41% in those aged 65 and over. Among women it is much more common among the young (27% age 18-34) than the middle aged and 5% in those over 55 and among those living in urban areas. Smoking is also more common among those suffering material deprivation. There is no independent association with education. Among men, but not women, church attendance is inversely associated with smoking. Among both sexes, heavy drinking and smoking are associated. Tobacco thus poses a major threat to the health of future generations in Russia, especially among women.

The Authors: Martin Bobak, Michael Marmot and Hynek Pikhart are at the International Centre for Health and Society, Department of Epidemiology and Public Health, University College, London. Laurent Chenet, David Leon and Martin McKee are at the European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine. Clyde Hertzman is at the Department of Health Care and Epidemiology, University of British Columbia, Canada. Richard Rose is Director of the Centre for the Study of Public Policy, University of Aberdeen. Vladimir Shkolnikov is at the Center of Demography and Human Ecology, Institute for Economic Forecasting, Moscow.

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