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Article Excerpt
The so-called transition in the former Soviet Union and Eastern Europe at large is usually associated with profound changes in three main areas: politics, economy, and social conditions. Although not equally highlighted in the public debate, this transition was also marked by an immense deterioration of public health in some of the former East Bloc countries. An extraordinary upsurge in mortality, commonly referred to as the "public health" or "mortality" crisis, was above all observed in Russia, the Baltic republics, Byelorussia, and the Ukraine. These countries belong to a cluster of former communist republics in which the transition was marked by an extremely high adult mortality, particularly among men (Kaasik et al., 1998). Between 1992 and 1994, life expectancy in Russia fell by 6.1 years for men and by 3.3 years for women (Shkolnikov et al., 1998). Interestingly, most of the former Soviet republics hit their low point in the same year, 1994 (Reamy & Oreskovic, 1999). This was the case in both Russia and the Baltic republics, where average life expectancy at birth in 1994 varied from 64 years (58 years for men) in Russia to 69 years (63 years for men) in Lithuania. For Poland, a former communist country--but not a Soviet republic--the situation was somewhat different. The Polish transition to post-communism was, in public health terms, not nearly as dramatic as in the former Soviet republics. Poland did see a slight decrease in average life expectancy between 1988 and 1991, but it has risen steadily since 1992. (1)
The driving forces behind the public health crisis are many, and opinions differ about how to explain these trends (Shapiro, 1995; Watson, 1995; Chen et al., 1996). Because this sharp rise in mortality during the early 1990s was preceded by a notable increase in life expectancy during the late 1980s, many analysts relate these fluctuations to corresponding changes in alcohol availability and alcohol consumption. During the late 1980s alcohol availability was severely restricted during an anti-alcohol campaign initiated by Mikhail Gorbachev, the Soviet general secretary. When the Soviet Union collapsed, the campaign was in effect already over, but there were now no longer any effective political institutions able or willing to regulate the alcohol market adequately. The latter part of the 1990s was therefore spent trying to re-regulate the alcohol market (Reitan, 2000). Given this variability in alcohol policies and fluctuations in life expectancy, in addition to the composition of the mortality increase during the early 1990s, there is growing acceptance that harmful lifestyles such as detrimental alcohol consumption are indeed associated with public health developments in the region during the past 10-15 years--at least in the former Soviet Union (McKee & Chenet, 1995; Cockerham, 1997; Leon et al., 1997). The Baltic countries are generally perceived as particularly burdened by high levels of recorded as well as unrecorded alcohol consumption, particularly in Latvia and Lithuania (Lehto, 1997; Harkin et al., 1997; Simpura et al., 1999).
In Poland, alcohol had become a heated political issue a few years earlier, in connection with the emergence of the Solidarity movement in the early 1980s. In contrast to the Gorbachev reform, alcohol restrictions in Poland were to a large extent initiated and promoted by the new political and social movements themselves, as a form of opposition toward what was seen as an overly lax alcohol policy on the part of the authorities (Simpura, 1995; Swiatkiewicz, 1997; Moskalewicz & Simpura, 2000). From the mid-1980s alcohol regulations were again liberalized and gradually disintegrated at the beginning of the 1990s, upon which alcohol consumption grew rapidly (Moskalewicz, 1993).
Apart from aggregate studies of alcohol-related mortality and life expectancy, there are few recent survey studies of alcohol consumption and drinking patterns in the Baltic region. One exception is a 1997 study of the three Baltic republics carried out by McKee et al. (2000). In addition, the Fafo Institute for Applied Social Research in Oslo did surveys on living conditions in the three Baltic republics (NORBALT) in 1994 and 1999 that included questions on alcohol consumption (Brunovskis & Ugland, 2003). Leifman and Edgren-Henrichson (2000) have described the availability of statistics on alcohol consumption in the region.
The analyses in this article are based on a 2001 survey of representative samples of around 1,000 individuals in Estonia, Latvia, Lithuania, and Poland. The survey focused mainly on political values and participation, trust in societal institutions, views on environmental policy, and views on nationalism and ethnicity. Some alcohol-related questions were, however, included. They basically centered on the respondent's consumption level and pattern and on his/her views on alcohol policy, drinking, and drinking behavior. The questions are largely similar to or identical to those posed in the European Comparative Alcohol Study (ECAS). (2) This article concentrates on a descriptive comparison between the Baltic and the ECAS data in terms of drinking patterns, informal social control, and attitudes toward government responsibility for keeping alcohol consumption down. (3)
In anticipation of EU enlargement
Comparative studies of social phenomena are generally valuable per se, but after the fall of the Soviet Union, comparative studies of the eastern and western parts of Europe have become even more relevant and essential. This certainly applies to alcohol studies, where cross-country comparisons are not always copious and often concentrate on a limited number of Western countries. (4) As many of the former East Bloc countries join the European Union, comparing new and present member states becomes even more pertinent: In addition to the tedious process of incorporating new members into the full body of EU legislation, the acquis communautaire, an enlargement of this magnitude will also inevitably bring about a meeting between different alcohol cultures in terms of drinking habits, policy traditions, social norms related to drinking, attitudes toward alcohol regulation, etc. Comparative studies are crucial in any attempt to identify national drinking cultures and how such cultures may be related to political, economic and social changes. One of the conclusions from the ECAS project, for example, was that the second half of the 20th century saw a period of converging alcohol policies as well as increased homogenization in beverage preferences and consumption levels. There are many plausible explanations for this adjustment, but the research team emphasizes the importance of institutional factors related to EU membership: free movement of capital, goods, services, and labor, the introduction of the single European market, growth of consumerism, and the general pressure toward convergence in many policy areas. The Nordic countries have already been through a process of dismantling their traditional model of alcohol regulation, while other countries have increased their level of alcohol regulation; alcohol policies in this part of the world are more alike now than they used to be (Norstrom, 2002; Osterberg, 2002; Ugland, 2002).
It is, then, of great interest to study the alcohol situation comparatively at a time when the Baltic countries are facing many institutional changes in connection with their EU accession. (5) First, this survey will serve as a baseline for future investigations of developments before and after EU accession in the Baltic countries. Second, if the alcohol cultures of the new member countries are very different from those of the present EU--in terms of volumes, types of beverages, and drinking habits--this is likely to influence policies about alcohol in the EU. If new member countries bring harmful drinking cultures with them into the community, it is more likely that alcohol will be defined as a social and medical problem than as just another traded product. Many of the questions about alcohol in the 2001 survey in Estonia, Latvia, Lithuania, and Poland, on which this article is based, are identical to or similar to those used in the ECAS study--thereby allowing for comparisons between east and west and between current EU members and current applicant countries. (6)
The aim of this article, then, is to compare alcohol consumption data from four Baltic countries with similar data from EU countries, and to briefly compare an attitude issue between the groups of countries. In addition, some attention is paid to gender differences within and between countries.
Data and methods
The 2001 survey in the Baltic republics and Poland (7) was developed in English and thereafter translated to Estonian, Latvian, Lithuanian, Polish, and Russian. Four survey institutes (8) drew samples of approximately 1,100 individuals ages 18 years or more, and basically representative of the national populations in terms of gender, age group, and region. Face-to-face interviews were then conducted in respondents' homes, between May 10 and June 10 in the Baltic republics, and between November 1 and November 16 in Poland. The sampling techniques varied somewhat, but they were all based on multi-stage stratification.
In Estonia, 127 sampling points in every district were first chosen so that all 15 counties and the capital, Tallinn, were represented according to their real share of the entire population. In addition, the proportion of town and rural populations in every county was taken into consideration. In the second stage, procedures varied somewhat between towns and rural areas: In towns, every interviewer got a starting address and followed a specific route in order to choose the next address. At each address, the interviewer first asked for the youngest male household member (at least 18 years old) and secondarily for the youngest female member of the household. In this way young male respondents, who are usually the most difficult to contact at home, are given a greater probability of being selected, thereby providing a more representative gender and age structure in the sample. (9) In rural areas, a probability sample was ordered from an authorized processor of the population registers. Last, quotas were used to ensure the correct proportion of Estonian- and Russian-language interviews.
In Latvia, 113 sampling points, representative of the proportionality of inhabitants, were chosen in the first stage. In the second stage, a random route of starting addresses selected from the population registers was applied. From the starting address, the interviewer approached every fifth apartment or every third private house according to a given pattern of odd and even house numbers. If no one was home or the respondent was unable to participate at the time, the interviewer returned later. As in Estonia, interviewers first asked to speak to the youngest adult male at home, and secondarily to the youngest adult female. (10)
In Lithuania, the population was first divided into 15 strata (ten counties and five cities), based on data from the Lithuanian Department of Statistics. The size of each sample in every stratum was proportional to the composition of the total population. Thereafter, starting addresses were selected randomly from the population register of the Department of Statistics, and from there specific instructions were given about how to select the next address. If no one was home at the time of the first visit, interviewers returned up to two times. In each household, respondents were chosen according to the "next birthday" rule. (11)
In Poland, respondents were selected according to a representative quota. Each interviewer received instructions providing socio-demographic characteristics according to which targets were to be chosen. The selection parameters were based on official statistical documentation--i.e., characteristics related to sex, age, and education. Moreover, respondents were selected according to the regional structure of the population, including distribution between rural...
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