Tobacco and alcohol consumption in post-Soviet Ukraine: qualitative findings from community consultations
Keywords:tobacco, alcohol, drinking, smoking, Ukraine, social determinants of health, intersectionality, community consultations
BACKGROUND: This study focuses on a variety of social determinants of alcohol and tobacco consumption, which have been reported as an alarming epidemic in the post-Soviet Ukraine. Authors look at the intersections of social determinants of tobacco and alcohol use in Ukraine as perceived by the study participants, and their perception of structural effects of economic and cultural transition on the prevalence of these harmful lifestyles.
METHODS: This study is part of a mixed-methods research, informed by an intersectional framework, focusing on complex health and health care experiences of Ukrainians. This study uses findings from 21 community consultations in 11 regions, corresponding to Ukraine’s diverse demographics, culture, and geography. At these consultations, participants discussed their health, experiences in seeking healthcare and provided recommendations for healthcare reforms.
RESULTS: The study identifies the important demographic factors like age, gender, SES, and place of residence, and how their intersections influence tobacco and alcohol consumption in Ukraine. People of lower SES have reportedly higher rates of consuming alcohol and tobacco, but younger individuals of low SES are most affected by these unhealthy lifestyles. The study also points to broader structural factors, such as stress, unemployment, poor law enforcement, poor social support, lack of health promotion, features of the built environment, and tobacco and alcohol availability, which affect the uptake of unhealthy behaviors.
CONCLUSIONS: The community consultations revealed people’s perceptions about the complex nature of tobacco and alcohol consumption in the post-Soviet setting. People shared their concern about the vulnerability of certain social groups to using alcohol and tobacco, and their understanding of the detrimental effects these substances have on the health of these groups. This intersectionality-based study concludes that there is a need to look beyond individual demographics and consider how social factors intersecting between themselves, as well as individual demographic factors, affect outcomes.
Abbott, P., & Wallace, C. (2007). Talking about health and well-being in post-Soviet Ukraine and Russia. Journal of Communist Studies and Transition Politics, 23(2), 181-202.
Andreeva, T., & Krasovsky, K.S. (2007). Changes in smoking prevalence in Ukraine in 2001–5, Tobacco Control, 16(3), 202–206.
Andreeva, T. (2012). Differences by gender and education in responding to tobacco control measures implemented in Ukraine since 2005. Tobacco Control and Public Health in Eastern Europe, 2(2), 111-121. doi: 10.6084/m9.figshare.105433.
Bakirov, V., Danilenko, I., Kizilova, K., & Kuzina, I. (2013). General condition and social seterminants of health of the population of Ukraine. In: P. Brigadin, M. MacKee, D. Rothman, A. Khvorostov & C. Haerpfer, eds. Health of Populations and Social Transformations in the Post-Soviet States. Minsk, 325-351.
Bilge, S. (2009). Smuggling intersectionality into the study of masculinity: some methodological challenges. Paper Presented at Feminist Research Methods International Conference at Stockholm University, February 4-6, 2009.
Bowleg, L. (2008). When black + lesbian + woman does not equal black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research, Sex Roles, 59, 312-325. doi: 10.1007/s11199-008-9400-z.
Bowleg, L. (2012). ‘The problem with the phrase women and minorities: intersectionality - an important theoretical framework for public health’. American Journal of Public Health, 102(7), 1267-1273. doi: 10.2105/AJPH.2012.300750.
Brolan C. E., Hussain S., Friedman E. A., Ruano A. L., Mulumba M., Rusike I., Beiersmann C., & Hill P. S. (2014). Community participation in formulating the post-2015 health and development goal agenda: reflections of a multi-country research collaboration. International Journal of Equity in Health, 13(66). doi: 10.1186/s12939-014-0066-6.
Cho, S., Crenshaw, K.W., & McCall, L. (2013). ‘Toward a field of intersectionality studies: theory, applications, and praxis’. Signs 38 (4): 785-810.
Cockerham, W.C. (1999). Health and social change in Russia and Eastern Europe. London: Routledge.
Collins, P. H. (1990). Black feminist thought: knowledge, consciousness, and the politics of empowerment (New York: Routledge).
Combahee River Collective. (1995). ‘Combahee River Collective statement’ (original work published 1977). In B. Guy-Sheftall (ed.), Words of fire: an anthology of African American feminist thought (New York: New Press): 232-240.
Commonwealth of Australia (2010). National male health policy: building on the strength of Australian men. Available from http://www.health.gov.au/internet/main/publishing.nsf/Content/7935AC78159969D4CA257BF0001C6B07/$File/MainDocument.pdf
Crenshaw, K. (2011). ‘Postscript’. In H. Lutz, M. T. H. Vivar and L. Supik (eds.), Framing intersectionality: debates on a multi-faceted concept in gender studies. (London: Ashgate).
Currie, C., Zanotti, C., Morgan, A., Currie, D., De Looze, M., Roberts, C., et al. (2012). Social determinants of health and well-being among young people. Health behaviour in school-aged children (HBSC) study: international report from the 2009/2010 survey. Health Policy for Children and Adolescents, No. 6. Copenhagen: WHO Regional Office for Europe.
Donath, C., Gräßel, E., Baier, D. Pfeiffer, C., Karagülle, D., Bleich, S., & Hillemacher, T. (2011). Alcohol consumption and binge drinking in adolescents: comparison of different migration backgrounds and rural vs. urban residence- a representative study. BMC Public Health, 11, 84.
Fishkin, J. S. (2009). When the people speak: deliberative democracy and public consultation. New York: Oxford University Press.
Grace, D. (2014). Intersectionality-informed mixed methods research: A primer. Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University.
Hancock, A.M. (2007). ‘When multiplication doesn't equal quick addition: examining intersectionality as a research paradigm’. Perspectives on Politics 5(1): 63-79.
Hancock, A.M. (2011). Solidarity politics for millennials: a guide to ending the oppression olympics. (New York: Palgrave Macmillan).
Hancock, A.M. (2013). Empirical intersectionality: a tale of two approaches. UC Irvine Law Review 3.
Hankivsky, O. (ed.) (2011). Health inequities in Canada: intersectional frameworks and practices (Vancouver, BC: University of British Columbia Press).
Hankivsky, O. (ed.) (2012). An intersectionality-based policy analysis framework (Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University).
Hankivsky, O., & Grace, D. (2014). “Understanding and emphasizing difference and intersectionality in mixed and multimethods research”. In The Oxford Handbook of Mixed and Multimethods Research. Hesse-Biber, S.N. and Johnson, R.B., Eds. Oxford University Press.
Hankivsky, O., & Cormier, R. (2009). Intersectionality and women's health research: a primer (Vancouver, BC: Women's Health Research Network).
Hankivsky, O., Reid, C., Cormier, R., Varcoe, C., Clark, N., Benoit, C., & Brotman, S. (2010). ‘Exploring the promises of intersectionality for advancing women’s health research’. International Journal for Equity in Health 9(5): 1-15.
Hankivsky, O. (2014). Intersectionality 101. Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University.
Hankivsky, O., & Salnykova, A. (eds.) (2012). Gender, politics, and society in Ukraine. University of Toronto Press.
Hinote B.P., Cockerham W.C., & Abbott, P. (2009). The specter of post-communism: women and alcohol in eight post-Soviet states, 68(7): 1254-62.
hooks, b. (1984). Feminist theory: from margin to center (Boston: South End Press).
Hunting, G. (2014). Qualitative intersectionality-informed research: A primer. Institute for Intersectionality Research and Policy, Simon Fraser University.
Katainen, A. (2010). Social class differences in the accounts of smoking – striving for distinction? Sociology of Health & Illness, 32(7): 1087-1101.
Lekhan, V., Rudiy, V., & Richardson, E. (2010). Ukraine health system review. Health Systems in Transition, 12: 1-183.
Lovan, W. R., Murray, M., & Schaeffer, R. (2004). Participatory governance in a changing world. In W.R. Lovan, M. Murray, and R. Schaeffer (Eds.), Participatory Governance: Planning, Conflict Mediation and Public Decision Making in Civil Society (pp. 1-22). Aldershot: Ashgate.
McCall, L. (2005). The Complexity of Intersectionality. Signs 30(3): 1771-1800.
Murphy, A., Roberts, B., Stickley, A., & McKeem M. (2012). Social factors associated with alcohol consumption in the former Soviet Union: a systematic review. Alcohol and Alcoholism, 47:6, 711–718.
O'Mara-Eves A., Brunton G., McDaid D., Oliver S., Kavanagh J., & Jamal F. (2013). Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Research, 1(4).
Palipudi K.M., Gupta P.C., Sinha D.N., Andes L.J., Asma S., et al. (2012) Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from global adult tobacco survey. PLoS ONE, 7(3).
Pomerleau J, Gilmore A, McKee M, Rose R, Haerpfer C.W. et al. (2004). Determinants of smoking in eight countries of the former Soviet Union: results from the living conditions, lifestyles and health study, Addiction, 99 (12): 1577-85.
Roberts, B., Gilmore, A., Stickley, A., Kizilova, K., Prohoda, V., Rotman, D., et al. (2013). Prevalence and psychosocial determinants of nicotine dependence in nine countries of the former Soviet Union. Nicotine & Tobacco Research, 15:1, 271–276.
Rogers, J., & Kelly, U. A. (2011). Feminist intersectionality: bringing social justice to health disparities research. Nursing Ethics 18(3): 397-407.
Rouhani, R. (2014). Intersectionality-informed quantitative research: A primer. Institute for Intersectionality Research and Policy, Simon Fraser University.
Schulz, A. J., & Mullings, L. (2006). Gender, race, class, and health: intersectional approaches (San Francisco, CA: Jossey-Bass).
Skryzhevska, Y., & Karacsonyi, D. (2012). Rural population in Ukraine: assessing reality, looking for revitalization. Hungarian Geographical Bulletin 61: 49-78.
Stickley, A., & Carlson, P. (2009). The social and economic determinants of smoking in Moscow, Russian. Scandinavian Journal of Public Health, 37 (6): 632-9.
Swedish International Development Agency (SIDA). (2003). Gender issues in Ukraine: challenges and opportunities. Kyiv: SIDA.
Venkatesan, C., & Abraham, K. K. (2010). “If we involve, will they contribute?”: involvement of people living with HIV in policy and program decision-making. A qualitative situation assessment of greater involvement of people living with and affected by HIV/AIDS (GIPA) in five indian states. India: Indian Network for People Living with HIV/AIDS.
VERBI – GmbH, MaxQDA (Version 11) (2014). The Art of Qualitative Data Analysis. Available from: www/maxqda/com
Verkhovna Rada of Ukraine, 2012, Bill #4844. “On introducing changes to some laws of Ukraine improving certain articles about limitations of smoking in public places” (Pro vnesennia zmin do dejakyx zakoniv Ukrainy schodo vdoskonalennia okremyx polozhen’ pro obmezhennia misc’ kurinnia tiutiunovykh vyrobiv – in Ukrainian).
Weber, L., & Castellow, J. (2012). ‘Feminist research and activism to promote health equity’. In Sharlene Hesse-Biber, (ed.) Handbook of Feminist Research: Theory and Praxis. 2nd ed. (Thousand Oaks, CA: Sage Publications): 434-454.
World Bank. (2009). An avoidable tragedy: combating Ukraine's health crisis - lessons from Europe. Available from: http://documents.worldbank.org/curated/en/686961468171870399/An-avoidable-tragedy-combating-Ukraines-health-crisis-lessons-from-Europe
World Health Organization. (1978). Declaration of Alma-Ata. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdf
World Health Organization. (1996). Ottawa charter for health promotion. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
World Health Organization. (2003). The framework convention on tobacco control. Available from: http://www.who.int/fctc/text_download/en/
World Health Organization. (2013). WHO report on the global tobacco epidemic, 2013 Enforcing bans on tobacco advertising, promotion and sponsorship. Available from: http://www.who.int/tobacco/global_report/2013/en/
World Health Organization. (2014). Social determinants of health: key concepts. Available from: http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/