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  • 1.
    Baburin, Aleksei
    et al.
    National Institute for Health Development, Tallinn, Estonia / University of Tampere, Tampere, Finland.
    Lai, Taavi
    University of Tartu, Tartu, Estonia.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition). Centre for Health Equity Studies, Stockholm University/Karolinska Institutet.
    Avoidable mortality in Estonia: Exploring the differences in life expectancy between Estonians and non-Estonians in 2005-2007.2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 11, p. 754-762Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: A considerable increase in social inequalities in mortality was observed in Eastern Europe during the post-communist transition. This study evaluated the contribution of avoidable causes of death to the difference in life expectancy between Estonians and non-Estonians in Estonia.

    STUDY DESIGN: Descriptive study.

    METHODS: Temporary life expectancy (TLE) was calculated for Estonian and non-Estonian men and women aged 0-74 years in 2005-2007. The ethnic TLE gap was decomposed by age and cause of death (classified as preventable or treatable).

    RESULTS: The TLE of non-Estonian men was 3.53 years less than that of Estonian men, and the TLE of non-Estonian women was 1.36 years less than that of Estonian women. Preventable causes of death contributed 2.19 years to the gap for men and 0.78 years to the gap for women, while treatable causes contributed 0.67 and 0.33 years, respectively. Cardiorespiratory conditions were the major treatable causes of death, with ischaemic heart disease alone contributing 0.29 and 0.08 years to the gap for men and women, respectively. Conditions related to alcohol and substance use represented the largest proportion of preventable causes of death.

    CONCLUSIONS: Inequalities in health behaviours underlie the ethnic TLE gap in Estonia, rather than inequalities in access to health care or the quality of health care. Public health interventions should prioritize primary prevention aimed at alcohol and substance use, and should be implemented in conjunction with wider social policy measures.

  • 2. McKee, M
    et al.
    Balabanova, D
    Akingbade, K
    Pomerleau, J
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Rose, R
    Haerpfer, C
    Access to water in the countries of the former Soviet Union2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 4, p. 364-372Article in journal (Refereed)
    Abstract [en]

    Background: During the Soviet period, authorities in the USSR invested heavily in collective farming and modernization of living conditions in rural areas. However, many problems remained, including poor access to many basic amenities such as water. Since then, the situation is likely to have changed; economic decline has coincided with migration and widening social inequalities, potentially increasing disparities within and between countries. Aim: To examine access to water and sanitation and its determinants in urban and rural areas of eight former Soviet countries. Methods: A series of nationally representative surveys in Armenia, Belarus, Georgia, Moldova, Kazakhstan, Kyrgyzstan, Russia and Ukraine was undertaken in 2001, covering 18,428 individuals (aged 18+ years). Results: The percentage of respondents Living in rural areas varied between 27 and 59% among countries. There are wide urban-rural differences in access to amenities. Even in urban areas, only about 90% of respondents had access to cold running water in their home (60% in Kyrgyzstan). In rural areas, less than one-third had cold running water in their homes (44% in Russia, under 10% in Kyrgyzstan and Moldova). Between one-third and one-half of rural respondents in some countries (such as Belarus, Kazakhstan and Moldova) obtained their water from welts and similar sources. Access to hot running water inside the homes was an exception in rural households, reflecting the tack of modern heating methods in villages. Similarly, indoor access to toilets is common in urban areas but rare in rural areas. Access to all amenities was better in Russia compared with elsewhere in the region. Indoor access to cold water was significantly more common among rural residents Living in apartments, and in settlements served by asphalt roads rather than dirt roads. People with more assets or income and living with other people were significantly more likely to have water on tap. In addition, people who had moved in more recently were more likely to have an indoor water supply. Conclusions: This was the largest single study of its kind undertaken in this region, and demonstrates that a significant number of people living in rural parts of the former Soviet Union do not have indoor access to running water and sanitation. There are significant variations among countries, with the worse situation in central Asia and the Caucasus, and the best situation in Russia. Access to water strongly correlates with socio-economic characteristics. These findings suggest a need for sustained investment in rebuilding basic infrastructure in the region, and monitoring the impact of living conditions on health.

  • 3. Razvodovsky, Y
    et al.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Suicide in urban and rural regions of Belarus, 1990-20052009In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the occurrence of suicide in urban and rural regions of Belarus in the post-Soviet Period. Study design: Unlinked cross-sectional study using data drawn from four time points. Methods: Age- and gender-specific suicide data for urban and rural regions of Belarus were obtained from the Belarus Ministry of Statistics for the years 1990, 1995, 2000 and 2005. The data were recalculated into seven age categories and then directly standardized. Poisson regression models were used to assess changes ill urban-rural suicide rate ratios across the four time points. Results: Between 1990 and 2000, the suicide rate rose sharply in Belarus. It started to reduce after 2000, but in 2005 it was still much higher than its initial level. The same was true for urban and rural suicide rates and for male Suicide rates in all regions combined. However, after 1995, there was a divergence between gender-specific rates in urban and rural areas. A small reduction in urban suicide rates for both genders contrasted with a sharp increase in suicide rates among trien and women in rural areas. By 2005, although suicide rates had fallen from their 2000 level for both genders in urban and rural locations, the decrease was much smaller in rural areas. These changes resulted in a deteriorating rural-urban suicide ratio across the period 1990-2005, with suicide rates among nearly every rural male age group remaining extreme after 1995. Although it is probable that a deteriorating social and economic situation has underpinned increasing suicide rates in all regions, there may be factors that are specific to rural locations, such as increasing social isolation and poor provision of medical services, that account for the extreme suicide rates now being recorded there. Conclusion: By 2005, Belarus had one of the highest suicide rates in the world. This now requires urgent intervention by the necessary authorities to ameliorate this situation in urban and, especially, rural locations.

  • 4.
    Reile, R.
    et al.
    University of Tartu, Tartu, Estonia.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Re: Letter to the Editor of Public Health in response to ‘Large variation in predictors of mortality by levels of self-rated health: results from an 18-year follow-up study’2017In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 147, p. 157-158Article in journal (Refereed)
  • 5.
    Reile, Rainer
    et al.
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tartu, Tartu, Estonia.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Large variation in predictors of mortality by levels of self-rated health: Results from an 18-year follow-up study2017In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 145, p. 59-66Article in journal (Refereed)
    Abstract [en]

    Objectives: To analyze the variation in factors associated with mortality risk at different levels of self-rated health (SRH).

    Study design: Retrospective cohort study.

    Methods: Cox regression analysis was used to examine the association between mortality and demographic, socioeconomic and health-related predictors for respondents with good, average, and poor SRH in a longitudinal data set from Estonia with up to 18 years of follow-up time.

    Results: In respondents with good SRH, male sex, older age, lower income, manual occupation, ever smoking, and heavy alcohol consumption predicted higher mortality. These covariates, together with marital status, illness-related limitations, and underweight predicted mortality in respondents with average SRH. For poor SRH, only being never married and having illness-related limitations predicted mortality risk in addition to older age and male sex.

    Conclusions: The predictors of all-cause mortality are not universal but depend on the level of SRH. The higher mortality of respondents with poor SRH could to a large extent be attributed to health problems, whereas in the case of average or good SRH, factors other than the presence of illness explained outcome mortality.

  • 6.
    Stickley, Andrew
    et al.
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tokyo, Tokyo, Japan.
    Koyanagi, Ai
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Ferlander, Sara
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Sabawoon, W
    University of Tokyo, Tokyo, Japan.
    McKee, M
    London School of Hygiene and Tropical Medicine, London, UK.
    Loneliness and health in Eastern Europe: findings from Moscow, Russia2015In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 29, no 4, p. 403-410Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine which factors are associated with feeling lonely in Moscow, Russia, and to determine whether loneliness is associated with worse health.

    STUDY DESIGN: Cross-sectional study.

    METHODS: Data from 1190 participants were drawn from the Moscow Health Survey. Logistic regression analysis was used to examine which factors were associated with feeling lonely and whether loneliness was linked to poor health.

    RESULTS: Almost 10% of the participants reported that they often felt lonely. Divorced and widowed individuals were significantly more likely to feel lonely, while not living alone and having greater social support reduced the risk of loneliness. Participants who felt lonely were more likely to have poor self-rated health (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.38-3.76), and have suffered from insomnia (OR: 2.43; CI: 1.56-3.77) and mental ill health (OR: 2.93; CI: 1.88-4.56).

    CONCLUSIONS: Feeling lonely is linked to poorer health in Moscow. More research is now needed on loneliness and the way it affects health in Eastern Europe, so that appropriate interventions can be designed and implemented to reduce loneliness and its harmful impact on population well-being in this setting.

  • 7.
    Stickley, Andrew
    et al.
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Razvodovsky, Y
    Mckee, M
    Alcohol mortality in Russia: A historical perspective2009In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    Objective: To examine major changes in the supply of alcohol in Russia and its impact on health in late-tsarist and early-Soviet society. Study design and methods: Statistical data on acute forms of alcohol mortality were drawn from official publications and medical literature published in the period 1860-1930 that covered the 50 provinces of European Russia and some of the major cities in the Russian Empire. These data were examined for across-time changes in alcohol mortality in relation to changes in the availability of alcohol products, both in terms of increased and decreased levels of supply. Results: Rapid changes in the supply of alcoholic products in earlier periods of Russian history resulted in quick and marked changes in the levels of acute alcohol mortality. However, while restrictions on the availability of spirits have sometimes been effective in reducing alcohol mortality, there has often been a rapid recourse to alternative forms of alcohol, i.e. alcohol surrogates. Conclusion: The lesson of history suggests that any attempt to deal with the problem of hazardous drinking in Russia must deal with all sources of alcohol, both legal and illegal, as individuals have demonstrated a high degree of ingenuity in identifying alternative sources of alcohol, both in the past and the present.

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