Biomedical subjects

Tiina Laatikainen

Publications and source records attributed to Tiina Laatikainen.

17 recordsLinked to original sources

PubMed2007

Trends in lifestyle factors affecting blood pressure in hypertensive and normotensive Finns during 1982-2002.

OBJECTIVE: To assess the trends in blood pressure (BP) affecting lifestyle factors in hypertensive and normotensive Finns from 1982 to 2002. DESIGN AND SETTING: Five independent cross-sectional population surveys conducted in 1982, 1987, 1992, 1997 and 2002 in the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland. PARTICIPANTS: Stratified random samples of men and women aged 25-64 years were drawn from the national population register. The participants (n = 28 235) were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive, and treated hypertensive subjects. MAIN OUTCOME MEASURES: Alcohol intake, body mass index (BMI), 24-h urinary sodium and potassium excretion (a subsample of 5849 subjects) and the proportion of subjects with leisure-time physical activity (LTPA) at least three times a week. RESULTS: Mean BMI increased significantly in all groups except in untreated hypertensive women. Alcohol intake increased in all men but especially in hypertensive women (P < 0.001). The 24-h urinary sodium excretion decreased significantly in all BP groups. The proportion of subjects with a recommended level of LTPA increased significantly and similarly in all BP groups (P < 0.001). CONCLUSIONS: The unfavourable trends observed in mean BMI and alcohol intake in the entire population should be reversed in order to decrease the frequency of hypertension in Finland. The health behaviours of hypertensive subjects should be carefully monitored and modified in a more systematic and efficient way than at present.

Adult↗

PubMed2006

Prevention of type 2 diabetes in a primary health care setting. Interim results from the Greater Green Triangle (GGT) Diabetes Prevention Project.

Although clinical trials have shown that lifestyle modifications reduce the risk of type 2 diabetes, translating lessons from trials to primary care remains a challenge. The aim of the study was to evaluate efficacy and feasibility of primary care-based diabetes prevention model with modest resource requirements in rural Australia. Three hundred and eleven subjects with at least a moderate risk of type 2 diabetes participated in a combined dietary and physical activity intervention. Clinical measurements and fasting blood samples were taken at the baseline and after intervention. After 3 months intervention, total (change -3.5%, p<0.001) and LDL cholesterol (-4.8%, p<0.001) plasma levels as well as body mass index (-2.5%, p<0.001), weight (-2.5%, p<0.001), and waist (-1.6%, p<0.001) and hip (-2.7%, p<0.001) circumferences reduced significantly. A borderline reduction was found in triglyceride levels (-4.8%, p=0.058) while no changes were observed in HDL cholesterol (+0.6%, p=0.525), glucose (+0.06%, p=0.386), or systolic (-0.98%, p=0.095) or diastolic (-1.06%, p=0.134) blood pressure levels. In conclusion, a lifestyle intervention improved health outcomes - especially obesity and blood lipids - in a population at high risk of developing type 2 diabetes. Our results suggest that the present model is effective and feasible to carry out in primary care settings.

Adult↗

PubMed2006

Changes in cardiovascular risk factors among adolescents from 1995 to 2004 in the Republic of Karelia, Russia.

BACKGROUND: In Russia, cardiovascular mortality is among the highest in the world. Behaviours related to the development of cardiovascular disease are usually adopted in childhood and adolescence. Very little information exists on prevalence and trends of risk factors among Russian youth. This study aims to investigate changes in the prevalence of cardiovascular risk factors among adolescents in the Republic of Karelia, Russia, from 1995 to 2004. METHODS: Cross-sectional surveys on chronic disease risk factors were carried out among 15-year-old adolescents in Pitkäranta region, in the Republic of Karelia. The surveys were conducted in all 10 secondary schools in the Pitkäranta region. All ninth-grade students in 1995 (N = 385, response rate 95%) and in 2004 (N = 395, response rate 85%) were included in the survey samples. RESULTS: Systolic blood pressure decreased statistically significantly among boys (from 119 to 116 mmHg). Diastolic blood pressure decreased statistically significantly among both girls (from 64 to 59 mmHg) and boys (from 62 to 59 mmHg). Total cholesterol increased statistically significantly only among girls (from 3.9 to 4.1 mmol/l). Body mass index did not exhibit any significant changes in both genders. Daily smoking rate doubled statistically significantly among girls from 7% to 15%. CONCLUSION: The study results show changes in the prevalence of cardiovascular disease risk factors among adolescents in the Republic of Karelia occurring over the last decade. Active measures need to be taken to prevent the increase in smoking prevalence, especially among girls, and to avert the unfavourable development of other risk factors in the future.

Adolescent↗

PubMed2006

Cardiovascular risk factors in the Federation of Bosnia and Herzegovina.

BACKGROUND: Federation of Bosnia and Herzegovina (FBiH) has high cardiovascular disease mortality as other countries in Eastern Europe and situation has even deteriorated in the post war period. Reliable information on risk factor levels and patterns needed in prevention planning and disease management has been lacking. METHODS: A cross sectional population survey was conducted in the FBiH in autumn 2002. A random sample of population, aged 25-64 years, was taken using a three stage stratified sampling methodology. Altogether, 2750 persons participated in the survey (1121 men and 1629 women). The survey was done according to internationally established standards and protocols. RESULTS: The mean systolic blood pressure was 132 mmHg among men and 135 mmHg among women. The mean diastolic blood pressure was 84 mmHg in both genders. Almost 40% of the participants were recognized as hypertensive (blood pressure level over 140/90 mmHg). The prevalence of hypertension among men was 36% and among women 45%. The mean Body Mass Index (BMI) was 26.5 kg/m(2) among males and 27.0 kg/m(2) among females. About 75% of both men and women were overweight (BMI > 25 kg/m(2)) and 16% of men and 20% of women were obese (BMI > 30 kg/m(2)). About 50% of men and 30% of women reported to be daily smokers. CONCLUSIONS: As a whole the non-communicable disease risk factor levels in the FBiH seems to be relatively high. The data can be utilized in health promotion planning and as a baseline for future monitoring activities with possibility of international comparison of results.

Adult↗

PubMed2006

Infectious burden as a determinant of atopy-- a comparison between adults in Finnish and Russian Karelia.

BACKGROUND: Evidence of the influence of pathogen exposure on the development of atopy and atopic disease is not unequivocal. We investigated the association between markers of infections and occurrence of atopy among adults in eastern Finland and western Russia, two adjacent areas with profound differences in living conditions and lifestyles. METHODS: Randomly selected adults aged 25-54 years from Finland (n = 790) and from Russia (n = 387) participated in the study. Skin prick tests were performed to 11 common airborne allergens, and at least one positive prick reaction was considered to indicate atopy. Antibodies to different pathogens including hepatitis A virus (HAV), Helicobacter pylori, Toxoplasma gondii, herpes simplex virus (HSV), Chlamydia pneumoniae and the periodontal pathogens Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were measured. RESULTS: In Finland 34.3% and in Russia 23.3% of the study population was atopic (p < 0.001). Seroprevalences to all these pathogens were significantly higher among the Russians. In multivariate logistic regression analysis, only H. pylori was inversely associated with atopy in Russia. A further stepwise analysis revealed that H. pylori alone can explain 32% of the difference in atopy between the countries, and T. gondii, A. actinomycetemcomitans, HSV and C. pneumoniae had a slightly additive effect, whereas, unexpectedly, seropositivity to HAV and, to a lesser extent, P. gingivalis had an opposite effect. The net result of the stepwise analysis showed that 44% of the difference in atopy between the countries could be explained by seropositivity to these seven pathogens. CONCLUSIONS: Seropositivity to select pathogens, particularly to H. pylori, could explain a substantial part of the difference in atopy prevalence between Finland and Russia. Exposure to HAV was not associated with protection against atopy in this adult population.

Adult↗

PubMed2006

Heavy drinking occasions and depression.

AIMS: To assess the risk of depression for subjects with or without heavy drinking occasions after adjusting for the average long-term alcohol consumption, age, gender, marital status, employment status, and chronic diseases. METHODS: In a cross-sectional population survey (N = 3124) carried out in Finland in 1997, long-term average alcohol consumption was assessed by a self-administered quantity-frequency questionnaire. A heavy drinking occasion was defined as six or more drinks for men and four or more drinks for women consumed at one session. The self-administered 21-item Beck Depression Inventory score of > or = 10 was classified as clinically significant depression. RESULTS: Ex-drinkers and subjects with heavy drinking occasions had more often clinically significant depression compared with lifelong abstainers and individuals without heavy drinking occasions. In addition to the drinking habit, the risk for clinically significant depression increased also with age. Men aged 45-64 years with heavy drinking occasions had 2.3 times higher risk for depression compared with young men (aged 25-34 years) without heavy drinking occasions. The respective risk for old women was 2.2 times higher. CONCLUSIONS: Drinking pattern with heavy drinking occasions is independently associated with clinically significant depression irrespective of average long-term alcohol consumption.

Adult↗

PubMed2006

Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study.

BACKGROUND: Several vascular risk factors are associated with dementia. We sought to develop a simple method for the prediction of the risk of late-life dementia in people of middle age on the basis of their risk profiles. METHODS: Data were used from the population-based CAIDE study, which included 1409 individuals who were studied in midlife and re-examined 20 years later for signs of dementia. Several midlife vascular risk factors were studied to create the scoring tool. The score values were estimated on the basis of beta coefficients and the dementia risk score was the sum of these individual scores (range 0-15). FINDINGS: Occurrence of dementia during the 20 years of follow-up was 4%. Future dementia was significantly predicted by high age (> or = 47 years), low education (< 10 years), hypertension, hypercholesterolaemia, and obesity. The dementia risk score predicted dementia well (area under curve 0.77; 95% CI 0.71-0.83). The risk of dementia according to the categories of the dementia risk score was 1.0% for those with a score of 0-5, 1.9% for a score of 6-7, 4.2% for a score of 8-9, 7.4% for a score of 10-11, and 16.4% for a score of 12-15. When the cut-off of 9 points or more was applied the sensitivity was 0.77, the specificity was 0.63, and the negative predictive value was 0.98. INTERPRETATION: The dementia risk score is a novel approach for the prediction of dementia risk, but should be validated and further improved to increase its predictive value. This approach highlights the role of vascular factors in the development of dementia and could help to identify individuals who might benefit from intensive lifestyle consultations and pharmacological interventions.

Area Under Curve↗

PubMed2005

Growing disparities in atopy between the Finns and the Russians: a comparison of 2 generations.

BACKGROUND AND OBJECTIVE: Western lifestyle has consistently been associated with the current asthma and atopy epidemics. We examined the occurrence and risk factors of atopy among schoolchildren and their mothers in 2 geographically adjacent areas with fundamental differences in living conditions and lifestyles. METHODS: A population-based study of 2 generations was carried out in eastern Finland and in western Russia. Randomly selected schoolchildren aged 7 to 16 years (367 in Finland and 446 in Russia) and their mothers (365 and 437, respectively) were enrolled. Data were obtained by using a modified International Study of Asthma and Allergies in Childhood questionnaire and by performing skin prick tests against 14 common airborne and food allergens. RESULTS: In children a 4-fold higher risk for atopy (> or =1 positive prick test result) was found in Finland compared with Russia. Sensitization rates in Finland were generally higher among children compared with those of their mothers, whereas in Russia the opposite trends emerged. Parental farming in early life (<1 year) in Finland (odds ratio [OR], 0.53; 95% CI, 0.28-0.99) and in Russia (OR, 0.47; 95% CI, 0.22-1.03) and currently in Finland (OR, 0.45; 95% CI, 0.22-0.91) conferred protection against atopy. Having pets, dogs in Finland (OR, 0.57; 95% CI, 0.35-0.95) and cats in Russia (OR, 0.43; 95% CI, 0.24-0.80), in early life was also inversely associated with atopy. CONCLUSION: Atopy was several-fold more common in Finland compared with in Russia, and disparities in sensitization rates between the countries have further increased during these generations. The similarity of explanatory variables of atopy in both countries suggests that determinants of atopy are shared, at least in similar geoclimatic conditions.

Adolescent↗

PubMed2005

Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997.

In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular risk factors were measured in random samples of patients in 1982 (n=8,501) and 1997 (n=4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register, social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality reduction, and risk factors explained some 53-72% of the reduction. These findings highlight the value of a comprehensive strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance of maximizing population coverage of effective treatments.

Adult↗

PubMed2005

Associations of leisure time physical activity, self-rated physical fitness, and estimated aerobic fitness with serum C-reactive protein among 3,803 adults.

OBJECTIVE: Serum C-reactive protein (CRP), a marker of systemic inflammation, is a risk factor for cardiovascular disease. Obesity and physical activity are associated with CRP, though population studies are sparse. METHODS AND RESULTS: We assessed the cross-sectional relationship of physical activity, self-rated fitness and estimated aerobic fitness with serum CRP among a population-based random sample of 3,803 Finnish adults aged 25-74 years. Conditioning, commuting and non-conditioning physical activity was measured by a recall and self-rated physical fitness by a questionnaire. A non-exercise test was used to estimate aerobic fitness. The combined association of aerobic fitness and waist-to-hip ratio (WHR) on CRP was also assessed. Self-rated fitness and aerobic fitness had inverse associations with CRP (adjusted for age, WHR, smoking, anti-hypertensive drugs, aspirin, diabetes, hypercholesterolemia, hormone replacement therapy and menopausal status) in both sexes (p < 0.001). An inverse age-adjusted association of conditioning and non-conditioning physical activity with CRP was found in both sexes. After further adjustments, associations remained significant in women for conditioning and non-conditioning activity (p < 0.001 and p = 0.010, respectively) and borderline significant in men (p = 0.074 and p = 0.070, respectively). Commuting physical activity was inversely associated with CRP among women only (p = 0.012). CONCLUSIONS: Physical activity and fitness may have an anti-inflammatory effect, which is independent of obesity.

Adult↗

PubMed2005

Trends in fatal and nonfatal strokes among persons aged 35 to > or =85 years during 1991-2002 in Finland.

BACKGROUND AND PURPOSE: Declining trends in the incidence and mortality of stroke have been observed in Finland since the beginning of the 1980s until 1997. In this study we analyzed the trends in fatal and nonfatal strokes in Finland during 1991-2002. METHODS: The Finnish Hospital Discharge Register was linked to the National Causes of Death Register to produce a Cardiovascular Disease Register, which includes data on 410 760 cerebrovascular events (International Statistical Classification of Diseases, 10th Revision [ICD-10] codes I60-I69) in patients aged > or =35 years in 1991-2002. RESULTS: Age-standardized incidence of first-ever stroke (ICD-10 codes I60-I64, excluding I63.6) per 100 000 persons declined during 1991-2002 annually by 2.2% (95% CI, -2.4% to -1.9%) among men and 2.5% (-2.8% to -2.2%) among women aged 35 to 74 years. In patients aged 75 to 84 years, the change in the incidence of first-ever stroke was -2.6% per year (-3.0% to -2.2%) among men and -3.2% per year (-3.5% to -2.9%) among women. A similar trend was observed also in the oldest age group, in patients aged > or =85 years. Among patients aged 35 to 74 years, the 28-day case fatality of first-ever stroke declined annually by 3.2% (-3.9% to -2.5%) among men and by 3.0% (-3.8% to -2.2%) among women. A significant decrease was found in the 28-day case fatalities of all subtypes of stroke in this age group. CONCLUSIONS: The favorable development in stroke incidence, mortality, and case-fatality has continued in Finland during 1991-2002.

Adult↗

PubMed2005

Associations between estimated aerobic fitness and cardiovascular risk factors in adults with different levels of abdominal obesity.

BACKGROUND: We investigated the association between estimated aerobic fitness and cardiovascular risk factors, and how the association is affected by abdominal obesity. DESIGN: Cross-sectional population study. METHODS: Participants comprised 3820 adults aged 25 to 64 years from the FINRISK 2002 Study in Finland. Aerobic fitness was estimated using a non-exercise test. Waist-to-hip ratio (WHR), blood pressure, total cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, HDL-C to total cholesterol ratio, and gamma-glutamyl transferase (GGT) levels were measured by standardized methods. RESULTS: After controlling for age, smoking and alcohol consumption, aerobic fitness was inversely associated with systolic (P=0.027) and diastolic (P<0.001) blood pressure, total cholesterol (P=0.009), triglycerides (P=0.001), and GGT (P<0.001), and directly associated with HDL-C (P<0.001) and HDL-C to total cholesterol ratio (P<0.001) in men. In women, inverse associations were found for diastolic blood pressure (P=0.027) and triglycerides (P<0.001), and direct association for HDL-C (P<0.001) and HDL-C to total cholesterol ratio (P<0.001). Waist-to-hip ratio was independently associated with a better risk factor profile in both sexes. Interactions were found between fitness and WHR in relation to total cholesterol (P=0.001), HDL-C to total cholesterol ratio (P=0.005), triglycerides (P=0.001), and systolic (P=0.009) and diastolic (P<0.001) blood pressure among men only. CONCLUSIONS: Our data suggest that good estimated aerobic fitness is associated with a better cardiovascular risk factor profile, regardless of the level of abdominal obesity in Finnish men and women. Men in the highest WHR third seem to have more benefit of aerobic fitness on their cardiovascular risk levels than men with lower WHR.

Adult↗

PubMed2004

The combined use of cholesterol-lowering drugs and cholesterol-lowering bread spreads: health behavior data from Finland.

BACKGROUND: Cholesterol-lowering drugs may metabolically interact with cholesterol-lowering bread spreads. This study analyses the prevalence of use of drugs, bread spreads or the combination of both in people aware of their high/elevated cholesterol level, and compares users of the three therapies on health behavior and demographics. METHODS: Participants (9581, 25-74 years) from The National FINRISK 2002 Study filled out a questionnaire on demographics and health (related) issues. Blood samples, blood pressure, body weight and height were measured. RESULTS: Of those who reported to have a high cholesterol level (31% of the study population), 19% used cholesterol-lowering drugs, 11% used cholesterol-lowering bread spreads and 5% combined both therapies. On a population level, only 1% jointly used a drug and bread spread therapy. The combination was used by especially highly educated people and those having a healthy diet. CONCLUSION: Combining a cholesterol-lowering drug with a bread spread regimen is relatively rare, even among those being aware of their high cholesterol levels. The combined usage was most frequent among 'the better off'. Public health risks of a metabolic interaction between both therapies may not be of major importance yet, but future follow-up is recommended.

Adult↗

PubMed2004

Trends in fatal and non-fatal coronary heart disease events in Finland during 1991-2001.

OBJECTIVE: To analyse the trends in fatal and non-fatal coronary heart disease (CHD) events in Finland during an 11-year period 1991-2001. DESIGN: Data on hospitalizations due to CHD in the Hospital Discharge Register were linked to the National Causes of Death Register in order to produce a Cardiovascular Disease Register including data on 271,771 events in 234,244 individuals. RESULTS: The annual average decline in the age-standardized CHD mortality rate was 5.2% (95% CI, -5.6, -4.8%) among men and 6.1% (-6.6, -5.6%) among women. The incidence of first myocardial infarction declined annually on average by 5.5% (-5.9, -5.1%) from 1991 to 1997 and by 2.4% (-3.0, -1.7%) from 1998 to 2001 among men. The respective changes among women were -5.9% (-6.5, -5.2%) and -1.7% (-2.7, -0.6%). The number of hospitalizations due to unstable angina pectoris increased between 1991 and 1996 (p = 0.0002) and remained stable for the rest of the study period. CONCLUSIONS: The Cardiovascular Disease Register is a powerful tool for epidemiological monitoring of cardiovascular diseases in Finland.

Adult↗

PubMed2003

Periodontitis is associated with a low concentration of vitamin C in plasma.

This study aimed to clarify how concentrations of vitamin C in plasma relate to the serology of periodontitis. The random sample used comprised 431 men, 194 from Finland and 237 from Russia. The plasma vitamin C concentration was determined by o-phtaldialdehyde-fluorometry, and serum immunoglobulin G antibodies to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were determined by a multiserotype enzyme-linked immunosorbent assay (ELISA). The mean plasma vitamin C concentration was higher (P < 0.001) in Finnish subjects (mean +/- standard deviation, 4.5 +/- 2.8 mg/liter) than in Russian subjects (1.4 +/- 1.8 mg/liter). Mean antibody levels to both A. actinomycetemcomitans (4.7 +/- 3.6 versus 5.2 +/- 3.1 ELISA units [P = 0.05]) and P. gingivalis (5.7 +/- 2.5 versus 7.6 +/- 2.9 ELISA units [P < 0.001]) were lower in Finnish men than in Russian men. In the combined Finnish and Russian population, the antibody levels to P. gingivalis were negatively correlated with vitamin C concentrations (r = -0.22; P < 0.001); this association remained statistically significant (P = 0.010) in a linear regression model after adjustment for confounding factors. The proportion of P. gingivalis-seropositive subjects decreased with increasing vitamin C concentrations (P for trend, <0.01), but no trend was seen among A. actinomycetemcomitans-seropositive subjects. In conclusion, P. gingivalis infection is associated with low concentrations of vitamin C in plasma, which may increase colonization of P. gingivalis or disturb the healing of the infected periodontium.

Adult↗

PubMed2002

Changes in cardiovascular risk factors and health behaviours from 1992 to 1997 in the Republic of Karelia, Russia.

BACKGROUND: In Russia rapid changes have taken place both in total and chronic disease mortality during recent years. Little reliable information is available on the trends in conventional risk factors in Russia. METHODS: Chronic disease risk factors and health behaviours were studied in the Republic of Karelia, Russia in 1992 and 1997, in population surveys connected with the National FINRISK Study in Finland. Independent random population samples (n = 1000) of people aged between 25 and 64 years were drawn in both survey years. Surveys included a self-administered questionnaire, physical measurements and laboratory analyses. RESULTS: The levels of systolic blood pressure, total serum cholesterol, and high-density lipoprotein cholesterol decreased among both genders from 1992 to 1997, but the difference between the survey years was statistically significant only among women. Both self-reported alcohol consumption and serum gamma-glutamyl transferase levels increased significantly in both men and women. There was a significant shift in the type of fat used on bread and in cooking, from butter use to use of margarine and vegetable oil, among both genders. CONCLUSIONS: As a whole the risk factor levels in the Republic of Karelia are high. However, some slight improvement in risk profile was seen. Positive changes in dietary habits, such as change in the quality of fat and associated reduction in serum cholesterol levels may have contributed to the decline in cardiovascular disease mortality seen in Russia since 1995. However, since smoking and elevated blood pressure levels as well as alcohol consumption are still highly prevalent, there is a great need for effective interventions.

Adult↗

PubMedDate not supplied

Self-reported alcohol consumption and association to carbohydrate-deficient transferrin and gamma-glutamyltransferase in a random sample of the general population in the Republic of Karelia, Russia and in North Karelia, Finland.

In the present study, alcohol consumption was estimated in a population survey in Pitkäranta in the Republic of Karelia, Russia (RUS) and in the neighbouring province of North Karelia in Finland (FIN) in the spring of 1997 in connection with the National FINRISK Study. Alcohol consumption was evaluated by self-report and by the biological markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT). In RUS, elevated CDT values were observed in 36.6% of the men and 17.6% of the women. In FIN, the respective rates were 9.6% and 9.4%, which are similar to average European rates. The prevalence of elevated CDT values seen in RUS is the highest prevalence ever reported in general population surveys. However, the self-reported alcohol consumption was similar in the two regions. These results suggest that alcohol consumption especially in Russia may not be reliably estimated by self-reporting, and that alcohol consumption is relatively high, especially among men, in RUS.

Adult↗