Hazardous alcohol consumption in the former Soviet Union: Do community factors play a role?

Background: There is strong evidence implicating hazardous alcohol consumption in the high rates of mortality and morbidity in countries of the former Soviet Union (fSU). Less is known about the social determinants of this behaviour in the region. The aim of this thesis was to investigate the role of community-level factors in hazardous alcohol consumption in the fSU and to generate a new conceptual framework that could explain the associations observed. Methods: This thesis comprises four studies: i) a systematic review of the literature on social factors associated with alcohol consumption in the fSU; ii) an exploration of the association between community-level physical characteristics, such as alcohol advertising and availability, with hazardous alcohol consumption, using a population average model of multilevel data from nine fSU countries; iii) an analysis of the association between community-level social capital and drinking in these countries using the same data and modelling approach; and iv) a qualitative study using semi-structured interviews and focus group discussions in Ukraine to help interpret the quantitative findings. Results: The systematic review uncovered limited research on the role of community factors in hazardous alcohol consumption in the fSU. The analysis of community-level physical characteristics showed that seven characteristics had one latent factor underlying them, and this factor was associated with an increased risk of hazardous alcohol consumption, suggesting that community-level physical characteristics may work together to create an ‘alcogenic’ environment. In the analysis of social capital, community-level social isolation and membership of civic organisations both increased the odds of hazardous drinking, while community-level interpersonal trust decreased these odds. The association with membership of civic organisations was driven mostly by trade union membership. This finding informed the sampling strategy for the qualitative study of trade union members in Ukraine. The data from that study suggested that co-workers of the same trade union experience a strong sense of ‘social solidarity’ with their co-workers, and that drinking together may act as means of expressing this solidarity. Engagement in sports and family activities may mitigate the role of co-worker solidarity in alcohol consumption. Conclusions: There is evidence that certain physical and social aspects of the community, namely alcohol advertising, alcohol outlet density and some elements of social capital, are associated with hazardous alcohol consumption in the fSU. These factors should be included in future research on alcohol consumption in the region in order to inform policy recommendations.