We are interested in the long-term health consequences associated with severe starvation and war trauma, and whether certain "age windows" exist when exposure to such events are particularly harmful.The siege of Leningrad (now St. Petersburg) during World War II provided an opportunity to study this. For 872 days, German troops prevented supplies from reaching Leningrad. Simultaneously, there was a food blockade and a steady and merciless bombardment by shells from guns and from the air. The first winter, 1941/42, represents the most severe food shortage, amounting to mass starvation or semi-starvation. Our late colleague, Professor Dimitri Shestov, had suffered the consequences of the Leningrad siege as a boy and believed that it had taken a toll on people beyond its immediate short- and medium-range consequences. He was particularly concerned about its long-term consequences for circulatory disease. A 1973 US-Soviet agreement, the socalled Lipid Research Clinics Collaboration, gave him an opportunity to study this. From 1975 to 1982 men and women living in Leningrad (now St. Petersburg) were randomly sampled and invited to examine their health and cardiovascular functioning. Dimitri Shestov added a simple question to this examination: "Were you in Leningrad during the blockade?" A third of the participants were. They had experienced peak starvation (in January 1942) at ages 1-31 (women) or 6-26 (men).The mortality follow-up began immediately after the first clinical examinations in 1975 and continued for three decades, until the end of 2005. Our analyses show that the siege of Leningrad, particularly when experienced in puberty, has had long-term effects on blood pressure both in men and women.We also found a raised IHD and stroke risk among those men. This was partly mediated via blood pressure but not by any other measured biological, behavioral, or social factors.Girls experiencing the siege around puberty suffered an elevated risk of dying from breast cancer later in life.The fact that the effect of siege exposure is modified by the age at exposure is highly interesting from a scientific point of view. It may suggest that a reprogramming of physiological systems can occur at specific age windows in response to starvation and/or war trauma. The team that worked from 1975-2005 to collect clinical information and death certificates for participants in the study included Svetlana Plavinskaya, born in Leningrad during the siege. Dimitri Shestov and Svetlana Plavinskaya died in 2010 and 2011, respectively. We dedicate this chapter to their memory.

The population of Leningrad suffered from severe starvation, coldand psychological stress during the siege in World War II in1941–1944. We investigated the long-term effects of the siege oncancer mortality in 3,901 men and 1,429 women, born between1910 and 1940. All study subjects were residents of St. Petersburg,formerly Leningrad, between 1975 and 1982. One third of themhad experienced the siege as children, adolescents or young adults(age range, 1–31 years at the peak of starvation in 1941–1942).Associations of siege exposure with risk of death from cancer werestudied using a multivariable Cox regression, stratified by genderand period of birth, adjusted for age, smoking, alcohol and socialcharacteristics, from 1975 to 1977 (men) and 1980 to 1982, respectively(women), until the end of 2005. Women who were 10–18 years old at the peak of starvation were taller as adults (ageadjusteddifference, 1.7 cm; 95% CI, 0.5–3.0) and had a higherrisk of dying from breast cancer compared with unexposedwomen born during the same period (age-adjusted HR, 9.9; 95%CI, 1.1–86.5). Mortality from prostate cancer was nonsignificantlyhigher in exposed men. The experience of severe starvation andstress during childhood and adolescence may have long-termeffects on cancer in surviving men and women.

BACKGROUND:

Post-communist transition has had a huge impact on mortality in Eastern Europe. We examined how educational inequalities in mortality changed between 1990 and 2000 in Estonia, Lithuania, Poland and Hungary.

METHODS:

Cross-sectional data for the years around 1990 and 2000 were used. Age-standardized mortality rates and mortality rate ratios (for total mortality only) were calculated for men and women aged 35-64 in three educational categories, for five broad cause-of-death groups and for five (seven among women) specific causes of death.

RESULTS:

Educational inequalities in mortality increased in all four countries but in two completely different ways. In Poland and Hungary, mortality rates decreased or remained the same in all educational groups. In Estonia and Lithuania, mortality rates decreased among the highly educated, but increased among those of low education. In Estonia and Lithuania, for men and women combined, external causes and circulatory diseases contributed most to the increasing educational gap in total mortality.

CONCLUSIONS:

Different trends were observed between the two former Soviet republics and the two Central Eastern European countries. This divergence can be related to differences in socioeconomic development during the 1990s and in particular, to the spread of poverty, deprivation and marginalization. Alcohol and psychosocial stress may also have been important mediating factors.

This study examines attitudes towards violenceagainst women among the populace in Moscow, Russiausing data drawn from the Moscow Health Survey.Information was obtained from 1,190 subjects (510 menand 680 women) about their perceptions of whetherviolence against women was a serious problem in contemporaryRussia, and under what circumstances they thoughtit was justifiable for a husband to hit his wife. Less thanhalf the respondents thought violence was a seriousproblem, while for a small number of interviewees therewere several scenarios where violence was regarded asbeing permissible against a wife. Being young, divorced orwidowed, having financial difficulties, and regularly consumingalcohol were associated with attitudes moresupportive of violence amongst men; having a loweducational level underpinned supportive attitudes amongboth men and women. Results are discussed in terms of the public reemergence of patriarchal attitudes in Russia in thepost-Soviet period.

The harmful effects of alcohol consumption are not necessarily limited to the amounts consumed. Drinking in binges is a specific feature of Russian alcohol consumption that may be of importance even for explaining the current mortality crisis. Based on interviews conducted with a stratified random sample of 1190 Muscovites in 2004, this paper examines binge drinking in relation to the respondents’ economic situation and social relations. Consistent with prior research, this study provides further evidence for a negative relationship between educational level and binge drinking. Our results also indicate a strong but complex link between economic strain and binge drinking. The odds ratios for binge drinking of men experiencing manifold economic problems were almost twice as high compared to those for men with few economic problems. However, the opposite seemed to be true for women. Being married or cohabiting seemed to have a strong protective effect on binge drinking among women compared to being single, while it seemed to have no effect at all among men. Women having regular contact with friends also had more than twice the odds for binge drinking compared to those with little contact with friends, while again no effect was found among men. Gender roles and the behavioural differences embedded in these, may explain the difference. The different effects of economic hardship on binge drinking may also constitute an important factor when explaining the large mortality difference between men and women in Russia.

Objectives: The aim of this paper is to present the Moscow Health Survey 2004, which was designed to examine health inequalities in Moscow. In particular we want to discuss social survey problems, such as non-response, in Moscow and Russia. Methods: Interviews, covering social and economic circumstances, health and social trust, of a stratified random sample of the greater Moscow population, aged 18+. Reasons for nonresponse were noted down with great care. Odds ratios (ORs) for self-rated health by gender and by six social dimensions were estimated separately for districts with low and high response rates. Bias due to non-response is discussed. Results and conclusions: About one in two (53.1 %) of approached individuals could not be interviewed, resulting in 1190 completed interviews. Non-response in most Russian surveys, but perhaps particularly in Moscow, is large, partly due to fear of strangers and distrust of authorities. ORs for poor health vary significantly by gender, occupational class, education and economic hardship. We find no significant differences in these ORs when comparing districts with low and high response rates. Non-response may be a problem when estimating prevalence rates or population means, but much less so when estimating odds ratios in multivariate analyses.

Acute alcohol poisoning has now reached unprecedented rates in parts of the ex-USSR with worrying trends among men as well as among women. Effective action by the governments concerned is now essential.

The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in 1941–1944. We investigated long-term effects of the siege on cardiovascular risk factors and mortality in surviving men and women. 3905 men born 1916–1935 and 1729 women born 1910–1940, resident in St Petersburg (formerly Leningrad) between 1975 and 1982, of whom a third experienced the siege as children, adolescents or young adults,were examined for cardiovascular risk factors in 1975–1977 and 1980–1982 respectively and followed till end 2005. Effects of siege exposure on bloodpressure, lipids, body size, and mortality were studied in multivariate analysis stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics. Women who were 6–8 years old and men who were 9–15 years-old at the peak of starvation had higher systolic blood pressure compared to unexposed subjects born during the same period of birth (fully adjusted difference 8.8, 95% CI:0.1–17.5 mm Hg in women and 2.9, 95% CI: 0.7–5.0 mm Hg in men). Mean height of women who were exposed to siege as children appeared to be greater than that of unexposed women. Higher mortality from ischaemic heart disease and cerebrovascular disease was noted in men exposed at age 6–8 and 9–15, respectively. The experience of severe stress and starvation in childhood and puberty may have long-term effects on systolic blood pressure and circulatory disease in surviving men and women with potential gender differences in the effect of siege experienced at pre-pubertal age.