No abstract

Russia, despite recent legal reforms, still has one of the highest rates of imprisonment in the world. There are many reports of the adverse conditions in Russian prisons, often highlighting the consequences for health, in particular, risks of HIV, tuberculosis, and other infectious diseases. However, there are no reviews of the broader health issues in the Russian penal system. This paper reviews the available information on the health of the imprisoned population in Russia and the factors underlying it. It was undertaken by means of a search of Russian and international literature, including unpublished sources, supplemented by in-depth interviews with 27 key informants from the Ministry of Justice, prison administration, and non-governmental organizations. Published and unpublished data from the ministries of health and justice were used to describe the demographic characteristics of the imprisoned population and compare it with the general population. Although convicts are drawn disproportionately from disadvantaged groups in society and are detained in adverse physical conditions, the standardized mortality ratio from all causes is slightly over one-third of that in the overall Russian male population. This is mainly explained by an eight-fold lower mortality from external causes and a more than two-fold lower mortality from cardiovascular disease. These far outweigh the increased mortality from infectious diseases. The chances of survival of young men in Russia may actually be improved by being in prison, highlighting the need for policies that reduce the overall level of violence and other external risks, such as dangerous driving habits, in Russian society. Yet while conditions are improving in Russian prisons, with death rates falling, there are still many avoidable deaths and high levels of mental illness and infectious disease. There is also much that is not known about the health of Russian convicts, with what is available reflecting what is measured rather than what is important.

Aim To describe levels of knowledge on the harmful effects of tobacco and public support for tobacco control measures in nine countries of the former Soviet Union, and to examine the characteristics associated with this knowledge and support. Methods Standardised cross-sectional, nationally representative surveys conducted in 2010/11 with 18000 men and women aged 18 years and above in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. Respondents were asked a range of questions on their knowledge of the health effects of tobacco and their support for a variety of tobacco control measures. Descriptive analysis was conducted on levels of knowledge and support, along with multivariate logistic regression analysis of characteristics associated with overall knowledge and support scores. Results Large gaps exist in public understanding of the negative health effects of tobacco use, particularly in Azerbaijan, Kazakhstan, Kyrgyzstan, and Moldova. There are also extremely high levels of misunderstanding about the potential effects of ‘light’ cigarettes. However, there is popular support for tobacco control measures. Over three quarters of the respondents felt that their governments could be more effective in pursuing tobacco control. Higher levels of education, social capital (membership of an organisation) and being a former or never smoker were associated with higher knowledge on the health effects of tobacco and/or being more supportive of tobacco control measures. Conclusions Increasing public awareness of tobacco’s health effects is essential for informed decision-making by individuals and for further increasing public support for tobacco control measures.

Background Since the political transition in 1991, Russia has been targeted intensively by the transnational tobacco industry. Already high smoking rates among men have increased further; traditionally low rates among women have more than doubled. The tobacco companies have so far faced little opposition as they shape the discourse on smoking in Russia. This paper asks what ordinary Russians really think about possible actions to reduce smoking. Methods A representative sample of the Russian population (1600 respondents) was interviewed face-to-face in November 2007. Results Only 14% of respondents considered tobacco control in Russia adequate, while 37% felt that nothing was being done at all. There was support for prices keeping pace with or even exceeding inflation. Over 70% of all respondents favoured a ban on sales from street kiosks, while 56% believed that existing health warnings (currently 4% of front and back of packs) were inadequate. The current policy of designating a few tables in bars and restaurants as non-smoking was supported by less than 10% of respondents, while almost a third supported a total ban, with 44% supporting provision of equal space for smokers and non-smokers. Older age, non-smoking status and living a smaller town all emerged as significantly associated with the propensity to support of antismoking measures. The tobacco companies were generally viewed as behaving like most other companies in Russia, with three-quarters believing that they definitely or maybe bribe politicians. Knowledge of impact of smoking on health was limited with significant underestimation of dangers and addictive qualities of tobacco. A third believed that light cigarettes are safer than normal. Conclusion The majority of the Russian population would support considerable strengthening of tobacco control policies but there is also a need for effective public education campaigns.