摘要：Objectives. We sought to present new data on smoking prevalence in 8 countries, analyze prevalence changes between 2001 and 2010, and examine trend variance by age, location, education level, and household economic status. Methods. We conducted cross-sectional household surveys in 2010 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. We compared smoking prevalence with a related 2001 study for the different countries and population subgroups, and also calculated the adjusted prevalence rate ratios of smoking. Results. All-age 2010 smoking prevalence among men ranged from 39% (Moldova) to 59% (Armenia), and among women from 2% (Armenia) to 16% (Russia). There was a significantly lower smoking prevalence among men in 2010 compared with 2001 in Belarus, Kazakhstan, Kyrgyzstan, and Russia, but not for women in any country. For all countries combined, there was a significantly lower smoking prevalence in 2010 than in 2001 for men aged 18 to 39 years and men with a good or average economic situation. Conclusions. Smoking prevalence appears to have stabilized and may be declining in younger groups, but remains extremely high among men, especially those in lower socioeconomic groups. Rates of smoking among men in countries of the former Soviet Union have traditionally been high as reflected in the very high premature mortality from smoking-related causes. 1 In the Soviet era, cigarettes were easily available and cheap, and heavy smoking (among men) became the norm in a setting where male leisure-time activities centered around negative health behaviors such as heavy drinking and smoking. 2,3 The cigarette market was transformed in the early 1990s when borders opened to the transnational tobacco companies who soon engaged in aggressive and highly sophisticated marketing campaigns coupled with the creation of a domestic manufacturing presence and enhanced distribution systems. 4 Much of this marketing effort was aimed at women who traditionally had low rates of smoking, as well as young people. 5 The Russia Longitudinal Monitoring Survey, which, among other things, has tracked changes in health behavior among the Russian population during the transition period, reported a small but significant rise in the prevalence of tobacco smoking among men from 57% in 1992 to 63% in 2003, whereas rates among women more than doubled from 7% to 15% in the same period and the age of smoking uptake among both genders fell. 6 These findings were consistent with data from other surveys in Russia and also in Ukraine. 7,8 These data suggest that the tobacco epidemic is following a somewhat different pattern in the former Soviet Union than it took in the West. Smoking rates in men have failed to decline as the Western model would predict and as a result the accumulated burden of tobacco-related disease among men younger than 75 years in the former Soviet Union is the highest in the world, 9 whereas smoking rates in women did not increase significantly until the transition. 6,10 Research indicates that younger women appear more likely to smoke than older ones, whereas among men rates are high at all ages until late middle age when they begin to fall. 7,10 However, research on changing patterns of smoking in this region has been largely concentrated in Russia and Ukraine, with little evidence about what has been happening elsewhere. A key source of comparable data on smoking across the former Soviet Union has been the Living Standards, Lifestyles, and Health (LLH) survey undertaken in 2001 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine ( http://www.llh.at ). 10,11 In March 2010, a new series of follow-up surveys, the Health in Times of Transition (HITT) surveys ( http://www.hitt-cis.net ), were undertaken by the same research teams (the civil disturbance in Kyrgyzstan in 2010 delayed the survey there until April 2011). Both series of surveys sought to compare a wide range of social conditions, lifestyles, and health in the adult populations in the countries of the former Soviet Union. Our objectives were to (1) present new data on smoking prevalence in 8 countries of the former Soviet Union in 2010, (2) analyze changes in smoking prevalence between 2001 and 2010 for each country, and (3) examine how trends in smoking prevalence over this period vary by age group, area of residence, level of education, and household economic status. Determining rates and trends in smoking prevalence plus the factors associated with smoking in these countries are important first steps in efforts to address the public health impacts of tobacco in the countries of this region. We hypothesized that we would observe a leveling-off of the extremely high rates of smoking among men, whereas rates of smoking among women would continue to rise with the previously documented increases in smoking among women now spreading to rural areas. This hypothesis was based on studies such as that by Perlman et al. in Russia, which observed only a small rise in smoking among men over the study period, 6 but a more marked rise in women, particularly those in large cities, a trend attributed to the targeting of women by the transnational tobacco companies.
