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Although the problem of cardiovascular disease (CVD) in Russia has been the subject of attention for decades, a definitive and comprehensive explanation of why the CVD burden there is so high and generally greater than in many other countries has still not been found. In this thesis, I have attempted to advance research on these issues by examining the role of blood lipids, heart damage biomarkers (high sensitivity cardiac Troponin T and NT-proBNP), alcohol use, and diabetes. The methodological approach that I have chosen for Paper 1 and Paper 3 was to compare the biomarker levels in two population-based studies: Know Your Heart (Russia) and Tromsø 7 (Norway). There were no substantial differences in lipid profiles between Know Your Heart and Tromsø 7, however, higher mean high sensitivity C-reactive protein reflected higher pro-inflammatory status in Russian sample. Moreover there was evidence of higher levels of cardiac wall stretch (NT-proBNP) and heart damage (high sensitivity cardiac Troponin T) biomarkers in Know Your Heart compared to Tromsø 7. This work is the first time that levels of these heart damage biomarkers in two population-based studies in Russia and elsewhere have been undertaken. In Paper 3, I compared diabetes prevalence defined as self-reported diabetes and/or medication use for diabetes and/or glycated haemoglobin (HbA1c) ≥ 6.5 % between Know Your Heart and Tromsø 7. Obesity (measured as BMI and waist circumference) explained a substantial proportion of differences in diabetes prevalence between KYH and Tromsø 7 in women but not in men. The analysis in Paper 2 was based on data from Know Your Heart study only and was a comparison of biomarker levels in extremely heavy drinkers in Russian addiction treatment centers to those in the general population of Arkhangelsk (Russia). The levels of NT-proBNP, high sensitivity cardiac Troponin T, and high sensitivity C-reactive protein were much higher in extremely heavy drinkers compared to non-problem drinkers. This thesis implicates non-atherosclerotic pathways as a possible explanation for high cardiovascular disease burden in Russia. This conclusion is supported by higher levels of NT-proBNP and high sensitivity cardiac Troponin T in Know Your Heart compared to Tromsø 7, while atherogenic lipoproteins are at similar levels in both studies. The biomarker profile of extremely heavy drinkers in Russian addiction treatment centers supports the non-ischemic damage as an aetiological pathway leading to heart disease as a consequence of heavy alcohol use. High prevalence of diabetes mellitus in Russia, including a higher proportion of undiagnosed and untreated cases, contributes to cardiovascular disease burden of both atherosclerotic and non-atherosclerotic origin. Strategies to reduce the burden of high cardiovascular disease in Russia should include steps to reduce the prevalence of heavy drinking as well as tackling the high burden of diabetes.

Background Alcohol drinking is an increasingly recognized risk factor for cardiovascular disease. However, there are few studies of the impact of harmful and hazardous drinking on biomarkers of myocardial health. We conducted a study in Russia to investigate the impact of heavy drinking on biomarkers of cardiac damage and inflammation. Methods and Results The Know Your Heart study recruited a random sample of 2479 participants from the population of northwest Russia (general population) plus 278 patients (narcology clinic subsample) with alcohol problems. The general population sample was categorized into harmful drinkers, hazardous drinkers, nonproblem drinkers, and nondrinkers, according to self-reported level of alcohol consumption, whereas the narcology clinic sample was treated as the separate group in the analysis. Measurements were made of the following: (1) high-sensitivity cardiac troponin T, (2) NT-proBNP (N-terminal pro-B-type natriuretic peptide), and (3) hsCRP (high-sensitivity C-reactive protein). The narcology clinic subsample had the most extreme drinking pattern and the highest levels of all 3 biomarkers relative to nonproblem drinkers in the general population: high-sensitivity cardiac troponin T was elevated by 10.3% (95% CI, 3.7%-17.4%), NT-proBNP by 46.7% (95% CI, 26.8%-69.8%), and hsCRP by 69.2% (95% CI, 43%-100%). In the general population sample, NT-proBNP was 31.5% (95% CI, 3.4%-67.2%) higher among harmful drinkers compared with nonproblem drinkers. Overall, NT-proBNP and hsCRP increased with increasing intensity of alcohol exposure (test of trend P

BACKGROUND: The objective of this study was to investigate the association between alcohol use by adolescents and relationships with parents and parenting practices in Ukraine. For this analysis, the nested case-control study design was used with pooled data from 1999, 2003, and 2007 surveys of repeated cross-sectional study “European School Survey Project on Alcohol and other Drugs”.METHODS: A nationally representative sample of classes in Ukrainian secondary schools was used. The target population consisted of all 15-16-year-old students in Ukraine. Complete data were available for 10,494 participants. Main exposures were perceptions of the relationships with one’s mother and father, rule-setting, control, and support provided by parents. Outcome measures were: regular use of alcohol, drinking to the point of intoxication, and age when students start consuming alcohol. Associations between the determinants and outcome measures were analyzed using multivariate binary logistic regression analysis.RESULTS: Adolescents who were not so satisfied with the relationships with their mothers were nearly twice as likely (OR=1.7; 95%CI=1.2-2.5) to have used alcohol 10 or more times during the last 30 days. Adolescents who were not at all satisfied with their relationships with father were at risk of drinking to the point of intoxication at least once during last year (OR=1.4, 95%CI=1.2-1.8).Adolescents whose parents never know whom he/she spends evenings with were nearly twice as likely (OR=1.8, 95%CI =1.3-2.4) to have used alcohol 10 or more times during the last 30 days. However, the relationships between rule-setting by parents, perceived support and alcohol use were not consistent.CONCLUSION(s): This study supports the hypothesis that the dissatisfaction with the relationships with one’s mother, unlike the dissatisfaction with the relations with one’s father, may be a risk factor for regular alcohol use among adolescents. Besides, our results denote the negative association of parental support and control with adolescent alcohol use. KEYWORDS: adolescents, alcohol use, risk factors, parenting style. АКТУАЛЬНОСТЬ: Целью этого исследования было изучение связи между употреблением алкоголя подростками и отношениями с родителями/ стилем воспитания в Украине. Для этого анализа были использованы сведенные данные регулярного Европейского опроса учащейся молодежи об употреблении алкоголя и наркотических веществ, проведенного в 1999, 2003 и 2007 годах.МЕТОДЫ: Опрос был проведен на национально-репрезентативной выборке классов в средних, средних специальных учебных заведениях и вузах І-ІІ уровней аккредитации в Украине. Целевая группа состояла из 15-16-летних учеников. Полные данные были доступны для 10494 участников. Основными детерминантами были удовлетворенность отношениями с отцом/ матерью, установление правил, контроль поведения и поддержка, которую получали ученики от родителей. Связь между детерминантами и результирующими переменными анализировалась с помощью многофакторной бинарной логистической регрессии. РЕЗУЛЬТАТЫ: Исследование выявило связь между неудовлетворенностью отношениями с матерью и употреблением алкоголя подростками (соотношение шансов OR=1.7; 95% доверительный интервал CI=1.2-2.5). Но связь с неудовлетворенностью отношениями с отцом наблюдалась только для приема алкоголя до состояния опьянения (OR=1.4, 95%CI=1.2-1.8) и раннего возраста начала употребления алкоголя подростками. Подростки, чьи родители никогда не знали, с кем они проводят время, с вероятностью почти в два раза выше (OR=1.8, 95%CI =1.3-2.4) употребляли спиртное 10 раз и более на протяжении последних 30 дней по сравнению с теми, чьи родители всегда знали, с кем те проводят время. Но связь между установлением правил, поддержкой родителями и употреблением алкоголя подростками наблюдалась только в некоторых регрессионных моделях.ВЫВОДЫ: Это исследование поддерживает гипотезу о том, что неудовлетворенность отношениями с матерью, но не с отцом, может быть фактором риска регулярного употребления алкоголя подростками. Кроме того, наши результаты указывают на присутствие обратной зависимости между контролем и поддержкой со стороны родителей и употреблением алкоголя подростками.КЛЮЧЕВЫЕ СЛОВА: подростки, употребление алкоголя, факторы риска, стиль воспитания. АКТУАЛЬНІСТЬ: Метою цього дослідження є вивчення співвідношення між вживанням алкоголю підлітками та стосунками з батьками і стилем батьківства в Україні. Для цього аналізу були використані зведені дані регулярного Європейського опитування учнівської молоді щодо вживання алкоголю та наркотичних речовин, проведеного у 1999, 2003 та 2007 роках.МЕТОДИ: Опитування було проведене на національно-репрезентативній вибірці класів у середніх, середніх спеціальних навчальних закладах та ВНЗ І-ІІ рівнів акредитації в Україні. Цільова група складалася з 15-16 річних учнів. Повні дані були доступні для 10494 учасників. Основними детермінантами були задоволеність стосунками з батьком/матір’ю, встановлення правил, контроль за поведінкою та підтримка, що отримували учні. Залежними змінними були регулярне вживання алкоголю, пиття до стану сп’яніння та вік початку вживання алкоголю. Зв’язок між детермінантами та залежними змінними аналізували за допомогою багатофакторної бінарної логістичної регресії.РЕЗУЛЬТАТИ: Дослідження показало зв’язок між незадоволеністю стосунками з матір’ю та вживанням алкоголю підлітками (співвідношення шансів OR=1.7; 95% довірчий інтервал CI=1.2-2.5). Однак, незадоволеність стосунками з батьком була пов’язана тільки з питтям до стану сп’яніння (OR=1.4, 95%CI=1.2-1.8) та раннім віком початку вживання алкоголю підлітками.Підлітки, чиї батьки ніколи не знають, з ким вони проводять час, майже вдвічі більш ймовірно (OR=1.8, 95%CI =1.3-2.4) вживали алкоголь 10 разів і більше протягом останніх 30-ти днів, порівняно з тими, чиї батьки завжди знали про їх місцеперебування. Але зв’язок між встановленням правил та підтримкою батьками і вживанням алкоголю спостерігався лише в окремих регресійних моделях.ВИСНОВКИ: Це дослідження підтримує гіпотезу, що незадоволеність стосунками з матір’ю, але не з батьком, може бути фактором ризику щодо регулярного вживання алкоголю підлітками. Крім того, наші результати вказують на наявність зворотної залежності між контролем та підтримкою батьками і вживанням алкоголю підлітками.КЛЮЧОВІ СЛОВА: підлітки, вживання алкоголю, фактори ризику, стиль батьківства.

BACKGROUND: Early life stress is associated with high risk for both negative psychological and physical health outcomes. However, many of the stressful life events inventories that have been used in epidemiological research have not been validated or checked for reliability or consistency. The aim of our study is to use optimal scaling and correspondence analysis that employ categorical principal components analysis (CATPCA) algorithm to consider the internal structure and the geometry of the space of variables obtained through the questions measuring early life stress. This approach was chosen because it allows quantification of categorical (both nominal and ordinal) scales and reduction of initial number of variables with interval quantification of the resulting dimensions. METHODS: A questionnaire for measuring early life stress was applied to the participants of the Ukrainian component of European Longitudinal Study of Pregnancy and Childhood at the age of three and seven years. CATPCA algorithm was used to elaborate a tool for estimating related integral quantified characteristics.RESULTS: Application of quantification and dimension reduction techniques to the categorical variables measuring stress in three- and seven-year-old children resulted in two dimensions. The first dimension that accounts for a major part of initial variance and is associated with all the collected variables can be interpreted as the overall value of stress. The second dimension accounts for smaller but still considerable part of variance and can be related to child’s attachment to mother and acquiring new experience as the route of development.CONCLUSIONS: Application of optimal scaling to the empirical data of early life stress measurement resulted in construction of two integral indicators – first measuring overall stress and second contrasting security related to child’s attachment to mother and new experiences – consistent across age groups of three and seven-year-old children. АКТУАЛЬНОСТЬ: Стресс в ранний период жизни связан с высоким риском как психологических, так и физиологических проблем. При этом многие инструменты, используемые для регистрации стрессовых событий в жизни в эпидемиологических исследованиях, не прошли проверку на валидность, надежность и согласованность. Целью нашего исследования было использование оптимального шкалирования и анализа соответствий по методу главных компонент для категориальных признаков с целью рассмотрения внутренней структуры и пространственной геометрии переменных, полученных из вопросника по измерению стресса в ранний период жизни. Выбор такого подхода был обусловлен тем, что он делает возможным количественное выражение категориальных (номинальных и порядковых) переменных и уменьшение размерности данных с интервальным выражением выявленных размерностей. МЕТОДЫ: Вопросник по измерению стресса в ранние периоды жизни был предложен участникам украинской компоненты Европейского лонгитюдного исследования беременности и детства, когда их дети достигли 3-х и 7-ми лет. Алгоритм анализа соответствий по методу главных компонент для категориальных величин использовался для оценки соответствующих интегральных характеристик.РЕЗУЛЬТАТЫ: Применение количественного выражения и сокращения размерностей к категориальным переменным, измеряющим стресс у 3-х и 7-ми-летних детей, позволило выделить две размерности.Первая размерность, которая учитывает основную часть дисперсии и связана со всеми переменными в исследовании, может быть интерпретирована как общий уровень стресса. Вторая размерность, которая учитывает меньшую, но все же значительную часть дисперсии, сопоставляет привязанность ребенка к матери и получение нового опыта как важные элементы развития. ВЫВОДЫ: Применение оптимального шкалирования к эмпирическим данным по стрессу в ранний период жизни позволило сконструировать два интегральных индикатора. Первый индикатор служит для измерения общего стресса, а второй – для противопоставления ощущения безопасности, выражаемой в привязанности к матери, и получения нового опыта. Оба индикатора были выявлены как в возрастной группе 3-х-летних, так и 7-ми-летних детей. АКТУАЛЬНІСТЬ: Стрес у ранній період життя пов’язаний з високим ризиком як психологічних, так і фізіологічних проблем. Однак, інструменти, що використовують для реєстрації стресових подій у житті в епідеміологічних дослідженнях, не пройшли перевірку на валідність, надійність та узгодженість. Метою нашого дослідження було використання оптимального градуювання і аналізу відповідностей за методом головних компонент для категоріальних величин з метою виявлення внутрішньої структури і просторової геометрії змінних, отриманих з опитувальника, що вимірює стрес у ранній період життя. Вибір такого підходу був зумовлений його здатністю квантифікації категоріальних (номінальних і порядкових) шкал і зменшення розмірності даних з їх інтервальним визначенням.МЕТОДИ: Опитувальник стресу у ранні періоди життя був запропонований учасникам української компоненти Європейського лонгітюдного дослідження вагітності і дитинства, коли їх діти досягли 3-х і 7-ми років. Алгоритм аналізу відповідностей за методом головних компонент для категоріальних величин використовували для оцінки відповідних інтегральних характеристик.РЕЗУЛЬТАТИ: Використання вирахування і скорочення розмірностей щодо категоріальних змінних, які вимірюють стрес в 3-х і 7-ми-літніх дітей, дозволило виділити дві розмірності.Перша розмірність, яка враховує основну частину дисперсії і пов’язана з усіма змінними у дослідженні, може бути проінтерпретована як загальний рівень стресу. Друга розмірність, яка враховує меншу, але все ж значну частину дисперсії, співставляє прив’язаність дитини до матері й отримання нового досвіду як елементи процесу розвитку. ВИСНОВКИ: Використання оптимального градуювання до емпіричних даних зі стресу у ранній період життя дозволило сконструювати два інтегральні індикатори. Перший індикатор служить для вимірювання загального рівня стресу, а другий – для визначення відчуття безпеки, що проявляється через прив’язаність до матері, і отримання нового досвіду. Обидва індикатора були виявлені як у віковій групі 3-х-річних, так і 7-ми-річних дітей.

BACKGROUND: Early life stress is associated with high risk for both negative psychological and physical health outcomes. However, many of the stressful life events inventories that have been used in epidemiological research have not been validated or checked for reliability or consistency. The aim of our study is to use optimal scaling and correspondence analysis that employ categorical principal components analysis (CATPCA) algorithm to consider the internal structure and the geometry of the space of variables obtained through the questions measuring early life stress. This approach was chosen because it allows quantification of categorical (both nominal and ordinal) scales and reduction of initial number of variables with interval quantification of the resulting dimensions. METHODS: A questionnaire for measuring early life stress was applied to the participants of the Ukrainian component of European Longitudinal Study of Pregnancy and Childhood at the age of three and seven years. CATPCA algorithm was used to elaborate a tool for estimating related integral quantified characteristics.RESULTS: Application of quantification and dimension reduction techniques to the categorical variables measuring stress in three- and seven-year-old children resulted in two dimensions. The first dimension that accounts for a major part of initial variance and is associated with all the collected variables can be interpreted as the overall value of stress. The second dimension accounts for smaller but still considerable part of variance and can be related to child’s attachment to mother and acquiring new experience as the route of development.CONCLUSIONS: Application of optimal scaling to the empirical data of early life stress measurement resulted in construction of two integral indicators – first measuring overall stress and second contrasting security related to child’s attachment to mother and new experiences – consistent across age groups of three and seven-year-old children., АКТУАЛЬНОСТЬ: Стресс в ранний период жизни связан с высоким риском как психологических, так и физиологических проблем. При этом многие инструменты, используемые для регистрации стрессовых событий в жизни в эпидемиологических исследованиях, не прошли проверку на валидность, надежность и согласованность. Целью нашего исследования было использование оптимального шкалирования и анализа соответствий по методу главных компонент для категориальных признаков с целью рассмотрения внутренней структуры и пространственной геометрии переменных, полученных из вопросника по измерению стресса в ранний период жизни. Выбор такого подхода был обусловлен тем, что он делает возможным количественное выражение категориальных (номинальных и порядковых) переменных и уменьшение размерности данных с интервальным выражением выявленных размерностей. МЕТОДЫ: Вопросник по измерению стресса в ранние периоды жизни был предложен участникам украинской компоненты Европейского лонгитюдного исследования беременности и детства, когда их дети достигли 3-х и 7-ми лет. Алгоритм анализа соответствий по методу главных компонент для категориальных величин использовался для оценки соответствующих интегральных характеристик.РЕЗУЛЬТАТЫ: Применение количественного выражения и сокращения размерностей к категориальным переменным, измеряющим стресс у 3-х и 7-ми-летних детей, позволило выделить две размерности.Первая размерность, которая учитывает основную часть дисперсии и связана со всеми переменными в исследовании, может быть интерпретирована как общий уровень стресса. Вторая размерность, которая учитывает меньшую, но все же значительную часть дисперсии, сопоставляет привязанность ребенка к матери и получение нового опыта как важные элементы развития. ВЫВОДЫ: Применение оптимального шкалирования к эмпирическим данным по стрессу в ранний период жизни позволило сконструировать два интегральных индикатора. Первый индикатор служит для измерения общего стресса, а второй – для противопоставления ощущения безопасности, выражаемой в привязанности к матери, и получения нового опыта. Оба индикатора были выявлены как в возрастной группе 3-х-летних, так и 7-ми-летних детей., АКТУАЛЬНІСТЬ: Стрес у ранній період життя пов’язаний з високим ризиком як психологічних, так і фізіологічних проблем. Однак, інструменти, що використовують для реєстрації стресових подій у житті в епідеміологічних дослідженнях, не пройшли перевірку на валідність, надійність та узгодженість. Метою нашого дослідження було використання оптимального градуювання і аналізу відповідностей за методом головних компонент для категоріальних величин з метою виявлення внутрішньої структури і просторової геометрії змінних, отриманих з опитувальника, що вимірює стрес у ранній період життя. Вибір такого підходу був зумовлений його здатністю квантифікації категоріальних (номінальних і порядкових) шкал і зменшення розмірності даних з їх інтервальним визначенням.МЕТОДИ: Опитувальник стресу у ранні періоди життя був запропонований учасникам української компоненти Європейського лонгітюдного дослідження вагітності і дитинства, коли їх діти досягли 3-х і 7-ми років. Алгоритм аналізу відповідностей за методом головних компонент для категоріальних величин використовували для оцінки відповідних інтегральних характеристик.РЕЗУЛЬТАТИ: Використання вирахування і скорочення розмірностей щодо категоріальних змінних, які вимірюють стрес в 3-х і 7-ми-літніх дітей, дозволило виділити дві розмірності.Перша розмірність, яка враховує основну частину дисперсії і пов’язана з усіма змінними у дослідженні, може бути проінтерпретована як загальний рівень стресу. Друга розмірність, яка враховує меншу, але все ж значну частину дисперсії, співставляє прив’язаність дитини до матері й отримання нового досвіду як елементи процесу розвитку. ВИСНОВКИ: Використання оптимального градуювання до емпіричних даних зі стресу у ранній період життя дозволило сконструювати два інтегральні індикатори. Перший індикатор служить для вимірювання загального рівня стресу, а другий – для визначення відчуття безпеки, що проявляється через прив’язаність до матері, і отримання нового досвіду. Обидва індикатора були виявлені як у віковій групі 3-х-річних, так і 7-ми-річних дітей.

Iakunchykova, O., Andreeva, T. I., Shkiryak-Nizhnyk, Z., Antipkin, Y., Hryhorczuk, D., Zvinchuk, A., & Chislovska, N. (2013). Optimal scaling for early life stress measurement. Tobacco Control and Public Health in Eastern Europe, 3(1), 17-27. BACKGROUND: Early life stress is associated with high risk for both negative psychological and physical health outcomes. However, many of the stressful life events inventories that have been used in epidemiological research have not been validated or checked for reliability or consistency. The aim of our study is to use optimal scaling and correspondence analysis that employ categorical principal components analysis (CATPCA) algorithm to consider the internal structure and the geometry of the space of variables obtained through the questions measuring early life stress. This approach was chosen because it allows quantification of categorical (both nominal and ordinal) scales and reduction of initial number of variables with interval quantification of the resulting dimensions.METHODS: A questionnaire for measuring early life stress was applied to the participants of the Ukrainian component of European Longitudinal Study of Pregnancy and Childhood at the age of three and seven years. CATPCA algorithm was used to elaborate a tool for estimating related integral quantified characteristics.RESULTS: Application of quantification and dimension reduction techniques to the categorical variables measuring stress in three- and seven-year-old children resulted in two dimensions.The first dimension that accounts for a major part of initial variance and is associated with all the collected variables can be interpreted as the overall measure of stress. The second dimension accounts for smaller but still considerable part of variance and can be related to child’s attachment to mother and acquiring new experience as the route of development.CONCLUSIONS: Application of optimal scaling to the empirical data of early life stress measurement resulted in construction of two integral indicators – first measuring overall stress and second contrasting security related to child’s attachment to mother and new experiences – consistent across age groups of three and seven-year-old children. KEYWORDS: psychological stress; questionnaires; mathematical models; algorithms; scaling; statistics; computation; optimal scaling; correspondence analysis.

BACKGROUND: Early life stress is known to be associated with increased propensity to substance abuse. The present study seeks to confirm the association between early life stress and tobacco smoking initiation by adolescents. METHODS: This study is based on the data of the Family and Children of Ukraine Study, which is a part of the cohort study in Europe for pregnancy and childhood “ELSPAC”. Main exposures were stressful life event scores at 3 and 7 years that were calculated by summing the perceived impact score reported by mothers for each life event. Smoking status of the adolescent and age of smoking initiation, reported at the 16-years-old follow-up, were outcome measures. Data were analyzed using multivariate binary logistic regression models separately for boys and girls controlling for socio-demographic characteristics and mother’s smoking. RESULTS: Stressful life events score was available for 898 participants at age 3 years and for 840 participants at age 7 years and varied from 0 to 48 points, with mean equal 4.69 and 5.96 respectively. In the gender-stratified analysis, current smoking by boys or girls was not associated with early life stress measured at 3 years old. Association between smoking and early life stress at age 7 years was not observed for boys. However, girls who experienced much stress at 7 years (more than 12 points) had 3 times higher odds of smoking (OR=2.94, 95% CI=1.26-6.83). Girls who had scored more than 12 points for stressful life events at 3 or 7 years old were respectively three times (OR=3.34, 95% CI=1.50-7.42) or two times (OR=2.19, 95% CI=1.01-4.74) more likely to start smoking at 13 years old or younger. CONCLUSIONS: Early life stress may have effect on vulnerability to tobacco smoking by adolescents. However, this effect was significant only for girls at high incidence of stressful life events. KEYWORDS: early life stress, smoking, adolescents.

OBJECTIVE(S): To investigate associations between alcohol drinking by parents at different time of their life and alcohol use by adolescents. DESIGN: The longitudinal epidemiological study design was used to answer the proposed research questions. This study is based on the data of the Family and Children of Ukraine Study, which is a prospective cohort study of women and children. PARTICIPANTS: Recruited subjects were pregnant women with last menstrual period between 25 December 1992 and 23 July 1994. Self-completed questionnaires and the medical record data were collected at the first antenatal clinic visit and at the delivery. The sample in the city of Dniprodzerzhynsk consists of 2148 women, their children and partners (if any), but at 15-17-years-old follow-up only data about 1020 participants were available. MAIN EXPOSURES: Use of alcohol by mother/father before pregnancy, during pregnancy, and at 15-17 years of child’s age. OUTCOME MEASURE: Use of alcohol by 15-17-year-old adolescent. RESULTS: Use of alcohol more than once a week by mother before pregnancy was associated with alcohol abuse by adolescents, unlike father’s use of alcohol before and during pregnancy. Use of alcohol both by mother and father during adolescence of their offspring was strongly associated with alcohol abuse by the child. In the multivariate analysis, only alcohol use by mother during adolescence of the child was significantly associated with alcohol use by the adolescent. CONCLUSIONS: This study supports the hypothesis that concurrent social factors influence regular alcohol use among adolescents more intensively than early life factors. KEYWORDS: alcohol, parents, adolescents.

BACKGROUND: Many authors discuss factors which influence involving adolescence into alcohol use. This study was aimed to assess contribution of factors related to alcohol use in the family, getting into situations of alcohol use as well as preventive work in teenage establishments. MATERIAL AND METHODS: Survey of 373 adolescents attending teenage clubs was conducted in Kazan, Russia, with questions related to alcohol use in the family and among peers, age and circumstances of first alcohol use. The outcome measure was whether respondents were current alcohol users. Associations were explored through logistic regression models. RESULTS: Alcohol use by teenagers did not differ by gender. Odds of using alcohol increased with age (OR=1.46 95%CI 1.19-1.80 per year). Risk of alcohol use was lower if no family members used alcohol (OR=0.3 95%CI 0.2-0.5) compared to those teenagers who have any family members who used alcohol. After adding to the model variables related to the first alcohol use, most significant was association with the response that no one has ever proposed to drink alcohol (OR=0.014 95%CI 0.005-0.041) compared to any situations of alcohol use, while the association with familial factors was attenuated. This shows that impact of familial factors could be mediated through the occasions of alcohol use. Teenagers whose parents do not use alcohol less likely get into situations where they are proposed to drink in a peer group (12% vs. 24%) or at a party (18% vs. 25%). Adolescents who expressed negative attitude to alcohol-related work in youth clubs more likely were alcohol users themselves (OR=21.1 95%CI 2.6-170.3), which is better applicable for diagnostics than for program evaluation. CONCLUSION: Absence of alcohol in the family predetermines alcohol use by adolescents. Teenagers whose parents do not use alcohol less likely get into situations where they are suggested to drink alcohol. KEY WORDS: alcohol, alcohol initiation, adolescents, family, parents, youth peer groups, youth clubs, АКТУАЛЬНОСТЬ: Многочисленные работы обсуждают факторы, касающиеся приобщения подростков к употреблению алкоголя. Цель работы - оценить вклад факторов, связанных с потреблением алкоголя в семье, попадания в ситуации, где принято употреблять алкоголь, профилактической работы в подростковых учреждениях. МАТЕРИАЛ и МЕТОДЫ: Опрошено 373 человека, посещавших подростковые клубы города Казани, Россия. Анкета включала вопросы, касающиеся потребления алкоголя, правил, принятых в семье и в компаниях сверстников, возраста первой пробы и ситуаций, в которых она произошла. Результирующая переменная – употребляет ли респондент алкоголь. Построены логистические регрессионные модели, учитывающие перечисленные выше факторы. РЕЗУЛЬТАТЫ: Потребление алкоголя подростками не различалось в зависимости от пола. С возрастом вероятность того, что подросток потребляет алкоголь, увеличивалась (OR=1.46 95%CI 1.19-1.80 на год). Добавление в модель переменных, касающихся потребления алкоголя членами семьи, показало, что вероятность его потребления подростком ниже, если никто в семье его не потребляет, (OR=0.3 95%CI 0.2-0.5) чем в случае потребления алкоголя любыми членами семьи. После добавления в модель переменных, касающихся ситуации первого употребления алкоголя, наиболее статистически значимой оказалась связь с ответом, что никто и никогда прежде не предлагал алкоголь (OR=0.014 95%CI 0.005-0.041) по сравнению с любыми ситуациями предложения алкоголя, значимость же связи с употреблением алкоголя членами семьи при этом снизилась, что указывает на медиацию влияния потребления алкоголя в семье через ситуации потребления алкоголя. Подростки, чьи родители не употребляют алкоголь, с меньшей вероятностью оказываются в ситуациях, когда им могут предложить алкоголь в компании сверстников (12% против 24%) или на вечеринке (18% против 25%). Добавление в модель переменных, касающихся профилактической работы в клубах, не изменило результатов, однако если подростки негативно оценивали такую работу, то они с большей вероятностью были потребителями алкоголя (OR=21.1 95%CI 2.6-170.3), что скорее может служить диагностическим целям, чем оценке эффективности проведенных мероприятий. ВЫВОДЫ: Отсутствие алкоголя в семье является фактором, определяющим употребление алкоголя подростками. Подростки, чьи родители не употребляют алкоголь, с меньшей вероятностью попадают в ситуации, где им могут предложить алкоголь.

Conference abstract Familial and social factors of involving teenagers into alcohol use Kulagina, Radana; Ananjeva, Galina; Iakunchykova, Olena; Andreeva, Tatiana BACKGROUND: Many authors discuss factors which influence involving adolescence into alcohol use. This study was aimed to assess contribution of factors related to alcohol use in the family, getting into situations of alcohol use as well as preventive work in teenage establishments. MATERIAL AND METHODS: Survey of 373 adolescents attending teenage clubs was conducted in Kazan, Russia, with questions related to alcohol use in the family and among peers, age and circumstances of first alcohol use. The outcome measure was whether respondents were current alcohol users. Associations were explored through logistic regression models. RESULTS: Alcohol use by teenagers did not differ by gender. Odds of using alcohol increased with age (OR=1.46 95%CI 1.19-1.80 per year). Risk of alcohol use was lower if no family members used alcohol (OR=0.3 95%CI 0.2-0.5) compared to those teenagers who have any family members who used alcohol. After adding to the model variables related to the first alcohol use, most significant was association with the response that no one has ever proposed to drink alcohol (OR=0.014 95%CI 0.005-0.041) compared to any situations of alcohol use, while the association with familial factors was attenuated. This shows that impact of familial factors could be mediated through the occasions of alcohol use. Teenagers whose parents do not use alcohol less likely get into situations where they are proposed to drink in a peer group (12% vs. 24%) or at a party (18% vs. 25%). Adolescents who expressed negative attitude to alcohol-related work in youth clubs more likely were alcohol users themselves (OR=21.1 95%CI 2.6-170.3), which is better applicable for diagnostics than for program evaluation. CONCLUSION: Absence of alcohol in the family predetermines alcohol use by adolescents. Teenagers whose parents do not use alcohol less likely get into situations where they are suggested to drink alcohol. KEY WORDS: alcohol, alcohol initiation, adolescents, family, parents, youth peer groups, youth clubs Abstract (pdf) in English and Russian

Iakunchykova O, Andreeva T, Hryhorczuk D, Shkiryak-Nizhnyk Z, Zvinchuk A, Chislovska N, Antipkin Y (2012) The impact of early life stress on risk of tobacco smoking initiation by adolescents. Tobacco Control and Public Health in Eastern Europe 2 (Supplement 1, 2nd conference 'Economics, sociology, theory and practice of public health'):s49-s50. BACKGROUND: Early life stress is known to be associated with increased propensity to substance abuse. The present study seeks to confirm the association between early life stress and tobacco smoking initiation by adolescents. METHODS: This study is based on the data of the Family and Children of Ukraine Study (FCOU), which is a part of the cohort study in Europe for pregnancy and childhood “ELSPAC”. Main exposures were stressful life event scores at 3 and 7 years that were calculated by summing the perceived impact score reported by mothers for each life event. Smoking status of the adolescent and age of smoking initiation, reported at the 16-years-old follow-up, were outcome measures. Data were analyzed using multivariate binary logistic regression models separately for boys and girls controlling for socio-demographic characteristics and mother’s smoking. RESULTS: Stressful life events score was available for 898 participants at age 3 years and for 840 participants at age 7 years and varied from 0 to 48 points, with mean equal 4.69 and 5.96 respectively. In the gender-stratified analysis current smoking by boys or girls was not associated with early life stress measured at 3 years old. Association between smoking and early life stress at age 7 years was not observed for boys. However, girls who experienced much stress at 7 years (more than 12 points) had 3 times higher odds of smoking (OR=2.94, 95% CI=1.26-6.83). Girls who had scored more than 12 points for stressful life events at 3 or 7 years old were respectively three times (OR=3.34, 95% CI=1.50-7.42) or 2 times (OR=2.19, 95% CI=1.01-4.74) more likely to start smoking at 13 years old or younger. CONCLUSIONS: Early life stress may have effect on vulnerability to tobacco smoking by adolescents. However, this effect was significant only for girls at high incidence of stressful life events.

Iakunchykova, O. and T. Andreeva (2012). "Suboptimal parenting practices as a risk factor for adolescent alcohol consumption in Ukraine." Tobacco Control and Public Health in Eastern Europe 2(1): 33-42. BACKGROUND: The objective of this study was to investigate the association between alcohol use by adolescents and relationships with parents/ parenting practices in Ukraine. For this analysis, the nested case-control study design was used with pooled data from 1999, 2003, and 2007 surveys of repeated cross-sectional study “European School Survey Project on Alcohol and other Drugs”. METHODS: Nationally representative sample of classes in Ukrainian secondary schools was used. The target population consisted of all 15-16-year-old students in Ukraine. Complete data were available for 10,494 participants. Main exposures were perceptions of the relationships with one’s mother and father; rule-setting, control, and support provided by parents. Outcome measures were: regular use of alcohol, drinking to the point of intoxication, and age when students start consuming alcohol. Associations between the determinants and outcome measures were analyzed using multivariate binary logistic regression analysis. RESULTS: Adolescents who were not so satisfied with the relationships with their mothers were nearly twice as likely (OR=1.7; 95%CI=1.2-2.5) to have used alcohol 10 or more times during the last 30 days. Adolescents who were not at all satisfied with their relationships with father were at risk of drinking to the point of intoxication at least once during last year (OR=1.4, 95%CI=1.2-1.8). Adolescents whose parents never know whom he/she spends evenings with were nearly twice as likely (OR=1.8, 95%CI =1.3-2.4) to have used alcohol 10 or more times during the last 30 days. However, the relationships between rule-setting by parents, perceived support and alcohol use were not consistent. CONCLUSION(s): This study supports the hypothesis that the dissatisfaction with the relationships with one’s mother, unlike the dissatisfaction with the relations with one’s father, may be a risk factor for regular alcohol use among adolescents. Besides, our results denote the negative association of parental support and control with adolescent alcohol use.

BACKGROUND. Increasing number of incomplete families is considered a negative trend in the society because it results in deterioration of the family’s educative function, due to which children in such families are more likely to start and practice antisocial behaviors. Many sociological studies showed that children from single-parent and reconstructed families are at increased risk of early use of alcohol, drugs, and smoking. According to the State Statistics Committee of Ukraine, 27,5% of families with children younger than 18 years in Ukraine are single-parent families, which is a substantial portion. Therefore, we aimed to identify levels of alcohol consumption by adolescents, based on the type of family in which they have been brought up. METHODS. The study group consisted of 28 000 Ukrainian youth aged 14-27 who were participants of the European School Survey Project on Alcohol and Other Drugs conducted in different types of secondary schools in 1995, 1999, 2003, and 2007. The outcome variable was alcohol consumption. Independent variables included accessibility of alcohol, economic status, parental control, smoking status, relationship with parents, and the type of family. RESULTS. The multivariate analysis revealed that higher alcohol consumption was associated with unsatisfactory relationship with a father, with being brought up in a single-parent family, with insufficient control by parents, and with smoking of an adolescent. CONCLUSIONS. The study documents the existence of social phenomenon which is related to families characterized by problematic relationship both between spouses and between generations, and alcohol and tobacco use by adolescents and possibly by their parents. The data do not give grounds to ascribe these families to a particular socio-economic stratum, but they definitely deserve public attention and care.

BACKGROUND. Literature about risk factors of alcohol use points at the association between alcohol use and parenting style. This study investigates the relationship between family structure of adolescents in Ukraine and their initiation of alcohol use with parenting style as a mediating variable. METHODS: Pooled data from the repeated cross-sectional nationally representative survey of classes in Ukrainian secondary schools with target group of all 15-16 year old students, held in 1999, 2003, and 2007, were used for this analysis. Complete data were available for 11019 participants. Main exposures were family structure (full, single parent and reconstructed) and perceptions of the relationships with mother and father, rule-setting, control, and support provided by parents. Outcome measure was age when students started consuming alcohol. RESULTS: In bivariate analysis, children in reconstructed families had higher risk for initiating alcohol use at age of 13 or younger (odds ratio 1.37, confidence interval 1,15-1,63) compared to full families. In reconstructed families, adolescents were more likely to be dissatisfied with their relationships with mother compared to intact family structure (8.7% vs. 4.7%) and dissatisfied with their relationships with father compared to intact family structure (19,8% vs. 9,1%). Parental support was lacking in higher proportion of reconstructed families, compared to intact family structure (20.7% vs. 15.1%). In the multivariate analysis, controlling for relationship with mother and father, support received from parents, and socio-demographic characteristics, the association between family structure and alcohol drinking initiation was attenuated. CONCLUSIONS: Children in reconstructed families have higher risk of early drinking initiation. This study also supports the hypothesis that dissatisfaction with relationships with parents and lack of support received from parents may mediate the association between family structure and early drinking initiation. Hence, reconstructed families may require additional attention of public health professionals in their prevention programs.

BACKGROUND: Early life stress is known to be associated with increased propensity to substance abuse. The present study seeks to confirm the association between early life stress and tobacco smoking initiation by adolescents.METHODS: This study is based on the data of the Family and Children of Ukraine Study (FCOU), which is a part of the cohort study in Europe for pregnancy and childhood “ELSPAC”. Main exposures were stressful life event scores at 3 and 7 years that were calculated by summing the perceived impact score reported by mothers for each life event. Smoking status of the adolescent and age of smoking initiation, reported at the 16-years-old follow-up, were outcome measures. Data were analyzed using multivariate binary logistic regression models separately for boys and girls controlling for socio-demographic characteristics and mother’s smoking.RESULTS: Stressful life events score was available for 898 participants at age 3 years and for 840 participants at age 7 years and varied from 0 to 48 points, with mean equal 4.69 and 5.96 respectively. In the gender-stratified analysis current smoking by boys or girls was not associated with early life stress measured at 3 years old. Association between smoking and early life stress at age 7 years was not observed for boys. However, girls who experienced much stress at 7 years (more than 12 points) had 3 times higher odds of smoking (OR=2.94, 95% CI=1.26-6.83).Girls who had scored more than 12 points for stressful life events at 3 or 7 years old were respectively three times (OR=3.34, 95% CI=1.50-7.42) or 2 times (OR=2.19, 95% CI=1.01-4.74) more likely to start smoking at 13 years old or younger. CONCLUSIONS: Early life stress may have effect on vulnerability to tobacco smoking by adolescents. However, this effect was significant only for girls at high incidence of stressful life events.

BACKGROUND: Many authors discuss factors which influence involving adolescence into alcohol use. This study was aimed to assess contribution of factors related to alcohol use in the family, getting into situations of alcohol use as well as preventive work in teenage establishments.MATERIAL AND METHODS: Survey of 373 adolescents attending teenage clubs was conducted in Kazan, Russia, with questions related to alcohol use in the family and among peers, age and circumstances of first alcohol use. The outcome measure was whether respondents were current alcohol users. Associations were explored through logistic regression models.RESULTS: Alcohol use by teenagers did not differ by gender. Odds of using alcohol increased with age (OR=1.46 95%CI 1.19-1.80 per year). Risk of alcohol use was lower if no family members used alcohol (OR=0.3 95%CI 0.2-0.5) compared to those teenagers who have any family members who used alcohol. After adding to the model variables related to the first alcohol use, most significant was association with the response that no one has ever proposed to drink alcohol (OR=0.014 95%CI 0.005-0.041) compared to any situations of alcohol use, while the association with familial factors was attenuated. This shows that impact of familial factors could be mediated through the occasions of alcohol use. Teenagers whose parents do not use alcohol less likely get into situations where they are proposed to drink in a peer group (12% vs. 24%) or at a party (18% vs. 25%).Adolescents who expressed negative attitude to alcohol-related work in youth clubs more likely were alcohol users themselves (OR=21.1 95%CI 2.6-170.3), which is better applicable for diagnostics than for program evaluation.CONCLUSION: Absence of alcohol in the family predetermines alcohol use by adolescents. Teenagers whose parents do not use alcohol less likely get into situations where they are suggested to drink alcohol.