IntroductionRussia has experienced massive fluctuations in mortality at working ages over the past three decades. Routine data analyses suggest that these are largely driven by fluctuations in heavy alcohol drinking. However, individual-level evidence supporting alcohol having a major role in Russian mortality comes from only two case-control studies, which could be subject to serious biases due to their design.Methods and FindingsA prospective study of mortality (2003–9) of 2000 men aged 25–54 years at recruitment was conducted in the city of Izhevsk, Russia. This cohort was free from key limitations inherent in the design of the two earlier case-control studies. Cox proportional hazards regression was used to estimate hazard ratios of all-cause mortality by alcohol drinking type as reported by a proxy informant. Hazardous drinkers were defined as those who either drank non-beverage alcohols or were reported to regularly have hangovers or other behaviours related to heavy drinking episodes.Over the follow-up period 113 men died. Compared to non-hazardous drinkers and abstainers, men who drank hazardously had appreciably higher mortality (HR = 3.4, 95% CI 2.2, 5.1) adjusted for age, smoking and education. The population attributable risk percent (PAR%) for hazardous drinking was 26% (95% CI 14,37). However, larger effects were seen in the first two years of follow-up, with a HR of 4.6 (2.5, 8.2) and a corresponding PAR% of 37% (17, 51).InterpretationThis prospective cohort study strengthens the evidence that hazardous alcohol consumption has been a major determinant of mortality among working age men in a typical Russian city. As such the similar findings of the previous case-control studies cannot be explained as artefacts of limitations of their design. As Russia struggles to raise life expectancy, which even in 2009 was only 62 years among men, control of hazardous drinking must remain a top public health priority.

AimTo investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking.DesignCross-sectional study of an age-stratified random sample of a population register.SettingThe city of Izhevsk, The Russian Federation, 2008–09.ParticipantsA total of 1031 men aged 25–60 years (68% response rate).MeasurementsSelf-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting 2 or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking and socio-demographic factors were obtained.FindingsCompared with abstainers, those drinking 10–19 litres of beverage ethanol per year had a PCS score 2.66 [95% confidence interval (CI) = 0.76; 4.56] higher. Hazardous beverage drinking was associated with a lower PCS score [mean diff: −2.95 (95% CI = −5.28; −0.62)] and even more strongly with a lower MCS score [mean diff: −4.29 (95% CI = −6.87; −1.70)] compared to non-hazardous drinkers, with frequent non-beverage alcohol drinking being associated with a particularly low MCS score [−7.23 (95% CI = −11.16; −3.29)]. Adjustment for smoking and socio-demographic factors attenuated these associations slightly, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably.ConclusionAmong working-aged male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10–19 litres per year.

BackgroundRussia has particularly low life expectancy for an industrialised country, with mortality at working ages having fluctuated dramatically over the past few decades, particularly among men. Alcohol has been identified as the most likely cause of these temporal variations. One approach to reducing the alcohol problem in Russia is 'brief interventions' which seek to change views of the personal acceptability of excessive drinking and to encourage self-directed behaviour change. Very few studies to evaluate the efficacy of brief interventions in Russia have been conducted. Motivational Interviewing (MI) is a person-centred counselling style which can be adapted to brief interventions in which help is offered in thinking through behaviour in the context of values and goals, to decide whether change is needed, and if so, how it may best be achieved.MethodsThis paper reports on an individually randomised two-armed parallel group exploratory trial. The primary hypothesis is that a brief adaptation of MI will be effective in reducing self-reported hazardous and harmful drinking at 3 months. Participants were drawn from the Izhevsk Family Study II, with eligibility determined based on proxy reports of hazardous and harmful drinking in the past year. All participants underwent a health check, with MI subsequently delivered to those in the intervention arm. Signed consent was obtained from those in the intervention arm only at this point. Both groups were then invited for 3 and 12 month follow ups. The control group did not receive any additional intervention.Results441 men were randomised. Of these 61 did not have a health check leaving 190 in each trial arm. Follow up at 3 months was high (97% of those having a health check), and very similar in the two trial arms (183 in the intervention and 187 in the control).No significant differences were detected between the randomised groups in either the primary or the secondary outcomes at three months in the intention to treat analyses. The unadjusted odds ratio (95% CI) for the effect of MI on hazardous and harmful drinking was 0.77 (0.51, 1.16). An adjusted odds ratio of 0.52 (0.28, 0.94) was obtained in the pre-specified per protocol analysis.ConclusionsThis trial demonstrates that it is possible to engage Russian men who drink hazardously in a brief intervention aimed at reducing alcohol related harm. However the results with respect to the efficacy are equivocal and further, larger-scale trials are warranted.Trial RegistrationISRCTN: ISRCTN82405938

Background: Russia is one of the very few industrialised countries in the world where life expectancy has been declining. Alcohol has been implicated as a major contributor to the rapid fluctuations observed in male life expectancy since 1985 that have been particularly marked among working-age men.

The objective of this study was to examine whether 10-year risk for incident stroke is associated with cognitive decline. Methods Study sample comprised of 4512 men and 1741 women, mean age 55.6 years, from the Whitehall II study, a longitudinal British cohort study. The Framingham Stroke Risk Profile was used to assess 10-year risk of stroke. It incorporates age, systolic blood pressure, diabetes mellitus, smoking status, prior cardiovascular disease, atrial fibrillation, left ventricular hypertrophy, and use of hypertensive medication. Measures of cognitive function consisted of tests of reasoning, memory, phonemic and semantic fluency, and vocabulary, assessed three times over 10 years. Linear mixed models were used to determine longitudinal associations between stroke risk and subsequent cognitive decline over 10 years. Results Higher stroke risk at baseline was associated with faster rate of cognitive in tests of reasoning, verbal fluency, vocabulary and global cognition. For example, compared to persons in the low stroke risk group (<2.5%), those in the moderate stroke risk group (2.5# stroke risk <5%) and the high stroke risk group ($5%) had a 12.5% and 43.8% faster rate of decline in, phonemic fluency respectively. Conclusions Higher 10-year stroke risk in middle age is associated with faster rate of cognitive decline in more than one cognitive domain. These results support early targeting of vascular risk factors to prevent or delay cognitive decline.