Social Science & Medicine 68 (2009) 12541262

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Social Science & Medicine

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The specter of post-communism: Women and alcohol in eight post-Soviet states

Brian Philip Hinote a, *, William C. Cockerham b, Pamela Abbott c
a
Department of Sociology & Anthropology, Middle Tennessee State University, 1301 East Main Street, MTSU Box 10, TODD 325, Murfreesboro, TN 37132-0001, USA
b
University of Alabama at Birmingham, Birmingham, AL, USA
c
Glasgow Caledonian University, UK

a r t i c l e i n f o a b s t r a c t

Article history: Because men have borne the heaviest burden of premature mortality in the former Soviet Union, women
Available online 21 February 2009 have for the most part been overlooked in studies of the health crisis in this part of the world. A
considerable body of research points to alcohol consumption among males as a primary lifestyle cause of
Keywords: premature mortality. However, the extent to which alcohol use has penetrated the female population
Russia following the collapse of communism and how this consumption is associated with other social factors is
Former Soviet Union
less well-understood. Accordingly, this paper investigates alcohol consumption in eight republics of the
Health lifestyles
Alcohol consumption
former USSR Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine using
Women data collected in 2001. More specically, discussion of gender role transformations and the historical
Gender experiences of women during the Soviet era emphasize two potentially important social inuences
examined in this analysis: psychological distress and Soviet political ideology. Findings suggest that
distress is only weakly statistically associated with frequent drinking behavior among women, but results
for political ideology show that this factor is statistically and signicantly associated with drinking
behaviors. Alcohol consumption was not particularly common among women under communism, but
trends have been changing. Our discussion suggests that, after the collapse of the Soviet state, women are
more able to embrace behavioral practices related to alcohol, and many may do so as an overt rejection of
traditional Soviet norms and values. Findings are also discussed within the context of current epide-
miological trends and future research directions in these eight republics.
2009 Elsevier Ltd. All rights reserved.

Introduction continued under post-communism (Nemtsov, 2005; Shkolnikov,

Women have been overlooked in the majority of studies of the
health crisis in the former Soviet Union. This is because Russian
men have borne the heaviest burden of premature mortality, losing
on average some 5.8 years of life expectancy between 1965 and
2005. In contrast, life expectancy for Russian women stagnated,
advancing only 0.2 years for the average woman over the same 40-
year period (Goskomstat, 2007). Most studies, however, primarily
use females as a comparison group to demonstrate the more severe
health outcomes for males the obviously greater casualties of the
health crisis. While they have not been impacted to the same
degree as men, the health of females has clearly suffered in that
they have not experienced the rise in longevity common to women
in other developed countries around the world.
A considerable body of research shows that alcohol use,
particularly the excessive consumption of vodka, is a major feature
of male health lifestyles in the former Soviet Union that has
* Corresponding author. Tel.: 1 615 494 7914; fax: 1 615 898 5427.
E-mail address: bhinote@mtsu.edu (B.P. Hinote).
Field, & Andreev, 2001; Transchel, 2006; Van Gundy, Schieman,
Kelley, & Rebellonn, 2005). This drinking practice, in turn, is iden-
tied as the primary lifestyle cause of premature male mortality via
heart disease, accidents, poisonings, homicide, and suicide (Cock-
erham, 2000, 2007; Pridemore, 2002, 2006; Shkolnikov et al.,
2004; Van Gundy et al., 2005). However, the specic extent to
which alcohol use has penetrated the female population following
the collapse of communism, and how this consumption is corre-
lated with other important social factors identied in previous
research like psychological distress and political ideology (Cock-
erham, Hinote, & Abbott, 2006a; Cockerham, Snead, & DeWaal,
2002), has not been thoroughly studied. It is the purpose of this
paper, accordingly, to investigate female alcohol consumption in
eight republics of the former USSR, a geographic area correspond-
ing to about 80% of the population of the former Soviet state.
The discussion that follows will consider the negative health
situations in these parts of the world and provide an abbreviated
history of female experiences with alcohol in order to emphasize
the signicant concepts of psychological distress and political
ideology concepts integral to this analysis. As a response to
stressful social conditions, distress is essentially a negative

0277-9536/$ see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2009.01.019
 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262
physiological and psychological state characterized by feelings of
depression and anxiety, which generally exert a negative impact on
health (Mirowsky & Ross, 2003). On the other hand, ideology may
be dened as shared frameworks of normative political ideas and
values maintained by a social group that advocates particular
behaviors, social arrangements, and ways of looking at the social
world (Cockerham, Hinote, Abbott, & Cockerham, 2006b). Yet this
paper is more precisely interested in the ideology of Soviet
communism, with its emphasis on the collective and consequent
devaluation of the individual. The structures of the Soviet social
system created conditions of considerable distress for many
members of society, and these conditions exhibit observable
statistical associations with health lifestyle patterns and choices
regarding alcohol use. These effects on males have been investi-
gated in earlier research (Abbott, Turmov, & Wallace, 2006; Cock-
erham et al., 2006b; Shkolnikov et al., 2004), but potential effects
on females arguably deserve further attention. We therefore focus
our analysis on the phenomenon of female alcohol consumption as
an increasingly important health lifestyle practice in these repub-
lics. Some sources point to notable increases in drinking among
women in the former USSR, and this paper seeks to identify specic
correlations involving these important social factors and the
frequency of alcohol consumption within this particular demo-
graphic group. Unlike previous analyses, this paper also considers
the concepts of distress and ideology in the same statistical model
in order to control for the potentially confounding inuence of
each, although we specically investigate the independent effects
of these important predictors, as outlined below.
Mortality, women, and alcohol
From historical, sociological, demographic, and epidemiological
perspectives, the health crisis that developed in this part of the
world from the mid-twentieth century onward is well-documented
(e.g., Blum & Monnier, 1989; Cockerham, 1999). However, when the
Soviet Union collapsed in 1991, the health situation further dete-
riorated and negative health dynamics continue to affect large
segments of many post-socialist republics (Abbott, Turmov, &
Wallace, 2006; Cockerham, Hinote, Abbott, & Haerpfer, 2004,
2006b; Shkolnikov et al., 2004). Recent 2005 gures published by
the WHO (2007) indicate a life expectancy of only 59 years for
Russian males and 72 years for females, while the State Committee
of the Russian Federation on Statistics (Goskomstat, 2007) lists
Russian male longevity at 58.9 years and female longevity at 72.4
years for 2005. To illustrate some differences across these regions,
life expectancy statistics from 2005 show that Russia exhibits the
greatest disadvantages in longevity among both males and females,
with the Central Asian states, Belarus, and Ukraine faring only
marginally better. Data from the Caucasus region, on the other
hand, indicate that residents of Armenia and Georgia may antici-
pate the greatest longevity among the republics in this analysis.
However, even the greatest life expectancy statistics for both sexes
in these eight republics are nearly a full decade behind Western
nations like the U.S., Canada, and the UK (WHO, 2007). As
a particularly harmful lifestyle practice, alcohol consumption
patterns have played a large role in the negative health trajectories
of men, but what is known about alcohols impact on females
during and after communism? Indeed, this is an important ques-
tion worth exploring.
Despite the legacy of alcohol use in Russian history and culture,
statistics on drinking behavior among women during Soviet times
are often hard to come by or do not exist. This is probably not
because females did not drink; rather, it is more likely that drinking
among women did not constitute a particularly signicant or
noteworthy social problem (Shkolnikov et al., 2001; Transchel,
1255
2006). Some sources identify sharp increases in female drinking
and related behaviors as late as the 1980s (e.g., White, 1996), but
historically, alcohol consumption, the male workers only avail-
able source of entertainment and oblivion from the conditions of
his life, was not part of the female world. Women workers
consumed no tobacco and little alcohol (Glickman, 1984:131).
Drinking alcohol and smoking tobacco were typically male
activities, especially outside of the factory gates. Herlihy (2002:93)
writes that by the twentieth century, alcohol was perceived as
a symbol of masculinity and sobriety a symbol of femininity. Society
expected women to conform to its ideal of accepted behavior, with
womens drinking becoming unfeminine and mens sobriety
becoming unmasculine. So, while the female worker may have
been better off not drinking, she was also deprived of an important
social arena for the alleviation of stress and escape from the toils of
everyday life (Glickman, 1984). So distress-related factors likely
affected both males and females alike under communism, but
societal proscriptions prevented many females from engaging in
this traditionally male behavior, for a number of reasons.
However, to say that women rarely imbibed is not to say that
they were unaffected by drunkenness, as alcohol clearly touched
womens lives through interactions with many male counterparts.
From early on, the Bolshevik blueprints for revolutionizing
communist gender relations aimed to undermine the institution of
the family by transforming the traditional roles of men and women
in the home (Issoupova, 2000; Kukhterin, 2000). Yet, because
existing patterns of malefemale interaction were not challenged,
traditional power relationships persisted between them (Ashwin,
2000). These dynamics are notable for two reasons. First, while
men were intentionally stripped of many of their social roles of
power and authority, they were able to re-establish these positions
in the public sphere by serving the state as party functionaries,
soldiers, or workers (Kukhterin, 2000). Second, despite increasing
levels of labor participation, females were still tasked with main-
taining the home and managing domestic life (Kiblitskaya, 2000a).
As a result, mens estrangement from domestic and caring work
meant that they were only weakly integrated into the Soviet
family (Ashwin & Lytkina, 2004:193), and many women were
more and more facing distressful situations of managing the
domestic sphere and the nancial affairs of the family, as well as the
often pervasive negative effects of alcohol consumption among
men.
Kiblitskaya (2000a) traces the evolution of female roles over the
course of Soviet history and also emphasizes the female domestic
role and responsibility to the family throughout the twentieth
century. Men typically assumed the role of breadwinner in Soviet
times, but in many families, mens wages were, for one reason or
another, unreliable to the extent that their wives became the
nancial heads of the household and effectively assumed all of the
central roles of the family. One often cited problem in this research
is the alcohol issue among men a problem often considered
a major contributor to nancial shortcomings within the Soviet
family. These problems worsened during the transition years, as
males consistently lost status in the realm of employment, creating
conditions contributing to the negative health situations for many
men, often through the escapist dimensions of vodka consumption
(Kiblitskaya, 2000b).
Traditionally, then, males were considered the weak link in
many Soviet families, in that there was always a question mark
over their behavior, particularly in relation to drink (Kukhterin,
2000:83). There can be little doubt that the social conditions
surrounding alcohol consumption also affected women, and while
evidence does not implicate direct female consumption as a major
determinant of the stagnation in life expectancy, some sources
show considerable increases in female alcohol consumption in the
1256 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262
1980s (White, 1996). Abbott et al. (2006) report that drinking
among women has become increasingly common, further high-
lighting shifting patterns of female consumption. But what social
factors have potentially played a role in drinking among women in
the republics of the former Soviet Union? In briey describing
gender role transformations and the broader historical experiences
of women during the Soviet era, the trends and accounts cited
above help emphasize two potentially important social inuences
further examined in the analysis that follows: (1) psychological
distress among females as a result of these social conditions and (2)
the legacy of Soviet political ideology in helping to construct these
realities.
Distress and health
The concept of psychological distress may be dened as an
adverse mental state involving marked depression and anxiety that
falls short of clinical mental illness and is characterized by negative
mood and malaise. It is described as a state of misery that is
a common response to a stressful situation, rather than simply
a symptom of disease (Mirowsky & Ross, 2003). Existing research
emphasizes the importance of such factors with regard to health
matters (e.g., Brunner & Marmot, 2001; Marmot, Siegrist, Theorell,
& Feeney, 2001; Stansfeld, 2001), as many ndings suggest that
distress and stress-related symptoms play important roles in
health-related outcomes (e.g., Mechanic & Hansell, 1987; Ross &
Bird, 1994) and lifestyle choices (e.g., Boardman, Finch, Ellison,
Williams, & Jackson, 2001; Umberson, Williams, & Anderson,
2002). Psychological distress not only threatens an individuals
sense of well-being, but may promote negative health behaviors
like drinking and smoking or help bring about negative physio-
logical responses to stressful conditions over time (Mirowsky &
Ross, 2003).
Several existing studies examine the effects of stress and
distress within the broader development of negative trends in
health and longevity in the former Soviet Union (Cockerham
et al., 2006a; Leon & Shkolnikov, 1998; Pietila & Rytkonen, 2008).
Yet, with the available empirical studies that have been con-
ducted, evidence supporting the role of stress and distress as
direct causal factors in the current mortality crisis is limited and
unconvincing at present (Shkolnikov et al., 2004). Findings do,
however, suggest that stress and related processes need to be
considered when analyzing the experiences of many people after
the post-communist transition. Leon and Shkolnikov (1998)
identify high levels of stress during the transition but do not link
that pattern to morbidity or mortality. Other studies examine
stress-related inuences and their effects on self-rated health in
Russia (Bobak, Pikhart, Hertzman, Rose, & Marmot, 1998) and
Ukraine (Gilmore, McKee, & Rose, 2002). Other research has
identied higher levels of alienation among Muscovites than
residents of Helsinki, Finland, where alienation was associated
with more physical symptoms and poorer health (Palosuo, 2000,
2003; Palosuo, Uutele, Zhuravleva, & Lakomova, 1998). Further,
residents of Moscow exhibited less healthy lifestyles, while
researchers noted the possibility that lifestyles mediated the
association between stress and health.
Cockerham (1999:107108) also notes this possibility for males,
claiming that the greatest effect of stress and distress was in
promoting unhealthy male lifestyles through excessive drinking
and smoking, rather than in causing a direct physiological shock.
After all, if stress-related factors were direct causal variables, we
would expect females to represent the demographic group most
adversely affected in this health crisis, as existing evidence shows
that women experience and report signicantly higher stress and
distress levels than men (Abbott, 2002; Cockerham et al., 2006a).
Surely, the plight of females under Soviet communism and its
aftermath may be characterized as situations of particular stress
and/or distress, as reected in the research and social circum-
stances described above. Existing research ndings motivate the
following hypothesis:
H1: Higher levels of psychological distress are positively asso-
ciated with frequent alcohol consumption.
Although alcohol consumption clearly has not affected female
longevity to the extent that it has male life expectancy, levels of
distress among women may feasibly be related to more recent
increases in drinking behavior as reported by other researchers
(e.g., Abbott et al., 2006; White, 1996). Perhaps women in the
aftermath of communism have more recently begun to manifest
their elevated levels of distress in the form of more frequent alcohol
consumption, yet ideological dynamics arguably play a role in these
processes as well.
Ideology and health
Previous studies have also investigated the ways that commu-
nist political ideology has shaped the ways that post-Soviet citizens
view, interpret, and act upon the social world in the form of health
lifestyles (Cockerham et al., 2002, 2006b). Yet perhaps surprisingly,
considerations of ideology are relatively recent in sociological
studies of health, even though this concept has been discussed
since the nineteenth century in the broader discipline of sociology.
Karl Marx and Friedrich Engels (1976) considered ideology
a weapon of the ruling class used to perpetuate their interests and
power, an approach that inuenced later thinkers in considering
the role that ideology plays in molding many forms of social
behavior. As a concept, ideology may be dened as shared sets of
normative ideas and values held in common by individuals, groups,
parties, classes, and nations that advocate particular forms of
conduct, social relationships, and solutions to problems (Cocker-
ham et al., 2006b:17991800).
In illustrating the power of ideological forces, Malia (1994)
points out that the Soviet experiment was rst and foremost an
ideocratic regime. For example, the primary social unit under
Soviet-style communism was the collective, which served to ensure
conformity while discouraging any sense of individualism. The
implementation and provision of state services in economic sectors
like housing and health care also reinforced the paternalistic
character of Soviet leadership and social life. As Shkolnikov et al.
(2004:65) write, Soviet ideology placed the interests of the state
above those of the individual.. People were taught to sacrice
their lives to build communism. [while] the value of individual life
and health was low. Existing research also suggests that such
ideological inuences exert a negative impact on health, as Soviet
communism appears to have hindered the implementation of
health practices geared toward promoting individual health and
well-being (Abbott et al., 2006; Cockerham et al., 2002, 2006b).
That is, research examining males shows that identifying with
Soviet political ideology is associated with negative health lifestyles
(i.e., the political ideology hypothesis), but similar relationships
between ideology and female alcohol consumption have not been
sufciently studied (Cockerham et al., 2006b). Indeed, the tenets of
Soviet-style communism, especially considering the roles and
positions of women within such a system, created unique social
conditions that potentially impact individual health lifestyles.
Along with the effects of psychological distress, the precise role of
ideological dynamics is of particular interest when it comes to
female lifestyle choices regarding frequent alcohol use in this study.
Existing research supporting the political ideology hypothesis in
 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262
post-Soviet populations motivates the following hypothesis for
females in this study:
H2: Soviet communist political ideology is positively associated
with frequent alcohol consumption.
It is clear that lifestyle choices like whether or not to drink alcohol
are not simply isolated, uncoordinated behaviors among discon-
nected individuals. Rather, they are patterned routines that are
arguably associated with specic, observable, and measurable social
factors (Cockerham, 2005) like psychological distress and ideolog-
ical dynamics factors that can be traced back to the historical
experiences of females beneath the banner of Soviet communism
and the structural constraints of the former Soviet Union. Important
research undertaken by Abbott et al. (2006:236) further emphasizes
the applicability of this conceptualization within the post-Soviet
context. They specically note that even when structural changes
led people to question aspects of life formerly taken for granted in
the case of post-Soviet citizens, that they do not need to look after
their health because the state will provide for them their ability to
exercise agency and look after their own health is limited by both
structural factors over which they have no control and unques-
tioned, taken-for-granted daily practices.
Analysis of qualitative data reveals that while post-Soviet citi-
zens were aware of the health consequences of negative lifestyle
choices like smoking and drug use, most male informants drank
alcohol and smoked cigarettes, with some reporting vodka
consumption as a way to deal with stress. The authors go on to
write that smoking and drinking have become habitual, part of the
taken-for-granted everyday life, and are seen as both pleasurable,
in a life that offers few pleasures, and as a way of coping with
stress (2006:236). The connection between alcohol (particularly
vodka) and poor health outcomes (across a wide range of indica-
tors) among men in this part of the world has been well-estab-
lished. However, Abbott et al. (2006) note that drinking was also
commonly reported among females in their qualitative study
samples, yet these behaviors are less well-understood. Alcohol use
has not affected female longevity to the same extent as it has mens,
but Shkolnikov et al. (2004:40) point out that mortality from liver
cirrhosis and homicide has become increasingly common among
females types of mortality closely associated with heavy alcohol
consumption (Pridemore, 2002). Accordingly, the analysis of female
consumption patterns may yield some useful insights into the
nature of female lifestyle choices in the years following the collapse
of the Soviet state.
Data and methods
The data for this project come from the Living Conditions,
Lifestyles, and Health (LLH) project, funded by the Copernicus
Program of the European Union. This comprehensive survey
provides a snapshot of social life, health, and well-being in eight
republics of the former Soviet Union. Data for this project are cross-
sectional and were collected in November 2001. Interviews were
conducted by respected survey research organizations in Armenia
(State Engineering University of Armenia, Yerevan), Belarus (Center
for Sociological and Political Research, Belarusian State University,
Minsk), Georgia (Center for Social Studies, Tbilisi), Kazakhstan
(Center for the Study of Public Opinion, Almaty), Kyrgyzstan
(International Center of Sociological, Political, and Social-Psycho-
logical Research, Bishkek), Moldova (Independent Sociological and
Information Service, Chisina u), Russia (Center for Sociological
Studies, Moscow State University), and Ukraine (East Ukrainian
Foundation for Social Research, Kharkov). The survey consists of
representative national samples of the adult female population age
1257
18 years or over for each republic and was developed in consulta-
tion with country representatives. Surveys were translated into
Russian and other national languages, back-translated to ensure
consistency, and pilot-tested in each republic. See Pomerleau, Gil-
more, McKee, Rose, and Haerpfer (2004) for additional discussion
of methodology and Abbott (2002) for more focused data on each
country.
Samples were selected using a multi-stage random sampling
design, with no over- or under-sampling of subpopulations.
However, certain potential respondents were excluded like pris-
oners, military personnel, institutionalized or hospitalized persons,
and the homeless. Persons residing in the scarcely inhabited and
inaccessible regions of the Russian Far North and areas subject to
military action like the Chechen and Ingush Republics of the
Russian Federation were also excluded. Primary sampling units
were established for each country and within each sampling unit,
households were selected using standardized random route
procedures to avoid bias in the selection of respondents when
random selection from household lists is not feasible or available,
with the exception of Armenia, where household lists were used to
ensure a random sample. Sample sizes were determined for each
republic according to population size. Response rates range from
71% in Kyrgyzstan to 88% in Armenia and Georgia.
Dependent variables measured drinking behaviors among
females, including the frequency of alcohol consumption (all types),
as well as the frequency of beer consumption and the frequency of
wine consumption. All three outcome measures are operationalized
as follows: once per week or more frequently (i.e., multiple times
per week or daily) 1, or less frequently than once per week 0.
Vodka is the leading alcoholic beverage in most parts of the former
Soviet Union and is closely identied with male drinking (Herlihy,
2002; Transchel, 2006). However, we examined the frequency of
vodka consumption among females in these data and found its use
to be low. Results were not statistically signicant and, unlike beer
and wine, are therefore not reported as a separate outcome. The
lack of signicant numbers of women vodka drinkers and statistical
outcomes is interesting in itself and identies an important
difference between men and women with respect to alcohol use.
Feelings of psychological distress were measured using a 12-item
distress scale, and this scale was arranged into a series of dummy
variables indicating the presence of (1) 02 symptoms, (2) 36
symptoms, (3) 79 symptoms, and (4) 1012 symptoms. Distress-
related symptoms are not simply discrete outcomes among indi-
viduals; they are not something that are entirely present or
completely absent. Problems related to psychological distress range
on a continuum from quite minor to very severe, so it is important
to use measures that are capable of measuring such a continuum of
distress, in contrast with the traditional diagnostic approach to
mental health (Mirowsky & Ross, 2003). The measurement
instrument used in the current study is consistent with recent
recommendations for studying this phenomenon and exhibits
a high degree of reliability (Cronbachs alpha (a) 0.841). The scale
used here is also supported in the literature by recent research in
Belarus, Russia, Kazakhstan, and Ukraine (Cockerham et al., 2006a)
and offers a quite useful measure of psychological distress.
Communist political ideology was measured by asking respon-
dents if they believed they would be better off under communism
and wanted it restored. Responses included (1) agree, (2) partially
agree, (3) dont know/neutral, (4) partially disagree, and (5)
disagree. We do not intend this variable to capture the structural
effects of political ideology; rather, this item indicates individual-
level afnity or support for communism and its underlying ideol-
ogy, for any reason. It resembles similar measures employed in past
studies (Cockerham et al., 2002, 2006b). As one might suspect, the
distress and ideology predictors employed in this analysis are not
1258 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262
completely unrelated. These variables are correlated in a way
suggesting that those female respondents agreeing with a return to
Soviet communism tend to also report higher levels of psycholog-
ical distress. This would seem to make sense in that respondents
favoring a restoration of previous structural arrangements report
greater feelings of distress in their current situations. After all,
those favoring a return to Soviet-style communism may not be
doing as well as other females in the post-communist period, thus
manifesting higher distress levels, while the opposite is likely true
among females that do not wish to return to communism. These
considerations are important in developing an appropriate
modeling strategy to test derived hypotheses, which are further
specied below.
Six demographic covariates derived from the relevant literature
were also employed in this analysis, measuring nationality, age,
marital status, income, education, and occupation. Age was measured
by asking respondents their age at their last birthday and coded
into three categories: (1) ages 1834 years, (2) ages 3559 years,
and (3) ages 60 years and above. Nationality was measured by
asking what nationality respondents considered themselves.
Nationality responses were coded into a series of dummy variables,
including (1) Russian, (2) Armenian, (3) Belarusian, (4) Georgian,
(5) Kazakh, (6) Kyrgyz, (7), Moldovan/Romanian, (8) Ukrainian, or
(9) other nationality. Previous work by Cockerham (2005) suggests
the need to investigate the relationship between health lifestyles
and different ethnic groups and nationalities, as previous studies
have tended to focus on overall health proles and nations rather
than specic health lifestyle patterns common to particular
national groups.
Marital status is measured in a dichotomous format, whether
respondents are (1) married, or (2) single, divorced, or widowed.
Income is measured as the level of material living conditions of the
respondents family, as reported by the respondent, whether their
income (1) is not enough for nutrition, (2) is just enough for food/
clothes, (3) is enough to purchase major consumer goods (televi-
sion, refrigerator) but not enough to buy a car or a at, or they (4)
can purchase expensive goods (car, at).
Education is measured using the following coding scheme: (1)
primary or without education, (2) unnished secondary education,
(3) secondary vocational education (medical, technical, pedagog-
ical, etc.), (4) unnished higher education, or (5) higher education.
Finally, occupation is categorized as: (1) agricultural/unskilled
worker, (2) skilled worker, (3) ofce clerk without higher educa-
tion, (4) public service employee, (5) manager/professional, (6)
senior ofcial/top manager, or (7) other/none.
To assess the relationships between psychological distress,
political ideology, and alcohol consumption, we employ a series of
multivariate logistic regression analyses to test the following
hypotheses, which have been developed above but are rened
here:
H1: Controlling for the effects of political ideology, higher levels
of psychological distress are positively associated with frequent
alcohol consumption.
H2: Controlling for the effects of psychological distress, favoring
a return to Soviet communism is positively associated with
frequent alcohol consumption.
We hypothesize independent and measurable effects for
distress and ideology on frequent drinking behavior, and we
employ a stepwise logistic regression design in order to ensure that
independent effects are indeed being tested. Distress and ideology
predictors are included in the same statistical model in order to
control for any potentially confounding inuence stemming from
the association between these two variables, which is noted above.
The block of demographic covariates, including nationality, marital
status, and social class variables, was entered into the regression
model initially, followed stepwise by the distress and ideology
predictors at steps two and three, respectively. We utilize such
a design in order to observe statistical correlations while control-
ling for other potentially confounding variables and also to examine
any shifts or uctuations in adjusted odds ratios at each step of
analysis, if they exist. However, no signicant changes in these
coefcients emerged when distress and ideology predictors were
entered, suggesting that distress and ideology effects are indeed
independent, as hypothesized. As a result, only the completed
logistic regression model and coefcients are presented in Table 2.
Table 1 reports descriptive statistics for the females included in this
study, while adjusted odds ratios and 95% condence intervals are
reported and interpreted below.
Results
Descriptive statistics, reported in Table 1, show that the majority
of females in this sample are of Russian, Ukrainian, or Armenian
national background, with other national groups also represented
in various proportions. The largest represented age group is the 35
59-year-old demographic, followed by younger women and then
women over age 60 years, and the majority of these females report
being married. Descriptive income data indicate that most females
report having just enough money for food and clothes, with the
second most frequently reported category reecting not even
having enough money for nutritional needs. Indeed, nancial
resources in the form of income appear to be low among this
sample of women. Most of this sample possesses a secondary
education or higher, and occupying a relatively wide range of
occupational categories, but very few of these females report
employment as senior ofcials or top managers. Symptoms of
psychological distress appear skewed toward the lower end of this
distribution of scores, with most females self-reporting between
zero and six distress symptoms, while females reporting either
agreeing or disagreeing with a restoration of the communist system
appear about equally represented in this sample. Finally, between
9% and 12% of females responding to items regarding alcohol report
consumption of at least once per week or more frequently,
depending on the type of beverage.
The completed analysis shows that Russian females consume
alcohol more frequently than non-Russians in these eight
republics, with the exception of Moldovans (Table 2). Younger
females consume alcohol more frequently than older women, and
the married imbibe less frequently than unmarried, divorced, or
widowed respondents. Results for income indicate a positive
socioeconomic gradient in general alcohol consumption, with
women in the highest two income categories drinking most
frequently. The association between psychological distress and
general alcohol consumption is modest, with females that report
moderate levels of psychological distress (36 symptoms) drinking
more often than females reporting fewer symptoms. Women
reporting distress at the highest levels of measurement do not
appear to drink more frequently than women reporting very few or
no symptoms, indicating very little support for our rst hypothesis
when controlling for demographic covariates and political ideology.
In other words, psychological distress does not appear strongly
associated with the frequent drinking outcomes analyzed here. Yet,
women who do not favor returning to Soviet communism are more
likely to report frequently consuming alcohol in general than those
females that are neutral on this item, seemingly contradicting our
second hypothesis. This is a surprising and interesting nding. In
the years following the collapse of the communist system, younger
 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262 1259

Table 1 working class appear to consume beer more frequently than agri-
Sample descriptives for health lifestyles, political ideology, psychological distress, cultural or unskilled workers and managers or professionals. As for
and sociodemographic covariates females (n 10,454)
political ideology, Table 2 shows that female respondents opposing
Variable n Valid % a return to Soviet-style communism are signicantly more likely to
Nationality report frequent consumption of beer. In addition, those reporting
Russian 3072 29.6 a partial agreement to returning to communism prior to the collapse
Armenian 1234 11.9
appear signicantly less likely to consume beer frequently. Conse-
Belarusian 930 9.0
Georgian 978 9.4 quently, it appears that older women are less likely to frequently
Kazakh 385 3.7 consume this beverage, while younger women opposed to commu-
Kyrgyz 705 6.8 nism returning are signicantly more likely to do so.
Moldovan/Romanian 855 8.2 Results for frequent wine consumption are also reported in
Ukrainian 1424 13.7
Other 799 7.7
Table 2. Contrasting with other results reported here, Belarusian,
Georgian, Moldovan, and Ukrainian females are signicantly more
Age (years)
likely than Russian women to report consuming wine once per
1834 3025 28.9
3559 4635 44.3 week or more frequently. Frequent wine consumption also appears
60 2794 26.7 to be more evenly distributed across age groups than general
alcohol or beer consumption, with no statistically discernible
Marital status
Single, divorced, widowed 4353 41.9 differences among age categories. Marital status effects also
Married 6033 58.1 disappear, while the positive gradient association with income
Income
persists. Frequent wine consumption also appears more probable
Not even enough for nutrition 2639 25.2 among females of the unskilled or agricultural working class with
Just enough for food/clothes 6213 59.4 lower levels of education. Finally, the consistent ideology effects
Enough to but TV/fridge but not car/at 1224 11.7 emerge once again for frequent wine consumption, with respon-
Can purchase expensive goods 177 1.7
dents opposing a return to Soviet communism increasingly likely to
Education imbibe more often. In summary, we nd very modest support for
None/primary/unnished secondary 1775 17.0 the hypothesized positive association between psychological
Secondary education 2724 26.1
Secondary vocational 3203 30.6
distress and frequent drinking, while ndings surprisingly contra-
Unnished higher 525 5.0 dict the hypothesized association between favoring a return to
Higher education 2172 20.8 Soviet communism and drinking behavior. Despite the relevant
Occupation studies to support the formulation of hypothesis two and statisti-
Armed force/public service 66 0.6 cally controlling for possible confounding variables, the statistical
Agricultural/unskilled worker 2160 20.7 results for political ideology are consistent across all dependent
Skilled worker 1760 16.8 measures. This latter nding is an unexpected one, but it none-
Ofce clerk w/o higher education 1443 13.8
theless uncovers a very interesting and important dynamic likely
Manager/professional 2457 23.5
Senior ofcial/top manager 177 1.7 operating among the females included in this study.
Other/none 2391 22.9

Psychological distress
Discussion
02 symptoms 2488 31.3
36 symptoms 2969 37.4 From the historical and sociological contexts discussed above,
79 symptoms 1537 19.3 we formulate and carry out this analysis in order to identify
1012 symptoms 952 12.0
statistically signicant correlations between psychological distress
Communist political ideology and ideology on one hand, and frequent drinking outcomes on the
Disagree 2670 25.5 other. Our ndings suggest that distress is only weakly associated
Partially disagree 1516 14.5
Dont know/neutral 2073 19.8
with frequent drinking behavior among females in these eight
Partially agree 1586 15.2 republics. However, ndings for ideology indicate that this factor is
Agree 2609 25.0 associated with frequent drinking behaviors among the females in
Drinking frequency general this study. Consistently throughout this analysis, females reporting
Less than once per week 9222 88.2 that they do not favor a return to Soviet-style communism exhibit
Once per week or more frequently 1228 11.8 an increased likelihood of frequently drinking alcohol, regardless of
Drinking frequency beer type. These data offer some interesting insights into the nature and
Less than once per week 5470 88.9 patterns of female consumption following the Soviet collapse.
Once per week or more frequently 683 11.1 Drinking was not a particularly common behavior for females
Drinking frequency wine under Soviet communism, as previously cited evidence indicates,
Less than once per week 5574 90.6 but existing research also suggests that consumption trends among
Once per week or more frequently 580 9.4 women have been changing over the past two decades or more.
In summarizing their own qualitative data from the former
women may feel there is a more permissive environment in which USSR, Abbott et al. (2006:236) note that the majority of our male
to consume alcohol. informants smoked and drank, and while few of the women
Results for beer consumption point to Russian females as more smoked, they did drink alcohol. While types of alcohol involved
frequent drinkers, compared with other nationalities in this study. are not mentioned, these ndings are noteworthy because they
Again, younger respondents appear to drink more frequently than suggest that women are drinking more alcohol in the republics of
those in middle and upper age groups, while married respondents the former Soviet Union. That is, while drinking did not constitute
report less frequent consumption when it comes to beer. Females in appropriately feminine behavior under the ideology of Soviet
the highest income groups report more frequent beer consumption communism, females are now apparently more able to embrace
than those in the lowest income category, while females of the skilled these behavioral practices, if they wish to do so. With the collapse,
1260 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262

Table 2
Odds ratios (OR) and 95% condence intervals (CI) for alcohol consumption among females

Drinking frequency general Drinking frequency beer Drinking frequency wine

OR 95% CI OR 95% CI OR 95% CI

Nationality
Russian Ref. Ref. Ref.
Armenian 0.337 0.2410.472*** 0.275 0.1620.467*** 1.339 0.8332.150
Belarusian 1.093 0.8601.387 0.992 0.7381.334 2.070 1.4372.981***
Georgian 0.218 0.1380.345*** 0.831 0.4931.402 2.790 1.6284.782***
Kazakh 0.525 0.3520.784** 0.242 0.1200.485*** 0.954 0.4831.883
Kyrgyz 0.144 0.0840.246*** 0.243 0.1240.475*** 0.170 0.0410.700*
Moldovan/Romanian 1.638 1.2802.095*** 0.339 0.2060.557*** 7.692 5.57010.622***
Ukrainian 0.997 0.8021.240 0.938 0.7111.236 1.804 1.2752.552***
Other 0.561 0.4170.755*** 0.755 0.5141.107 1.570 0.9922.486

Age (years)
1834 Ref. Ref. Ref.
3559 0.612 0.5190.722*** 0.394 0.3180.487*** 1.081 0.8381.394
60 0.208 0.1560.278*** 0.099 0.0560.176*** 0.802 0.5441.183

Marital status
Unmarried, divorced, widowed Ref. Ref. Ref.
Married 0.836 0.7180.975* 0.805 0.6580.984* 0.905 0.7201.137

Income
Not enough for nutrition Ref. Ref. Ref.
Just enough for food/clothes 1.216 0.9841.502 1.154 0.8421.580 1.133 0.8381.532
Enough to buy TV/fridge but not car/at 2.347 1.8123.040*** 2.029 1.4222.897*** 2.159 1.4783.154***
Can purchase expensive goods 2.630 1.6694.145*** 1.871 1.0393.370* 2.589 1.3554.947**

Education
None/primary/unnished second. 1.116 0.8241.511 0.762 0.4401.320 1.597 1.0492.430*
Secondary education Ref. Ref. Ref.
Secondary vocational education 0.934 0.7621.146 1.109 0.8581.434 1.074 0.7871.466
Unnished higher education 1.330 0.9761.812 1.067 0.7321.454 1.353 0.8622.125
Higher education 1.164 0.9311.454 0.983 0.7321.319 0.940 0.6751.309

Occupation
Public service 1.004 0.4272.361 1.714 0.7174.097 0.478 0.0633.622
Agricultural/unskilled worker 1.045 0.8101.349 0.571 0.3910.834** 1.821 1.2442.666**
Skilled worker Ref. Ref. Ref.
Ofce clerk w/o higher education 1.115 0.8691.430 0.879 0.6491.191 1.360 0.9002.057
Manager/professional 0.926 0.7181.193 0.669 0.4820.930* 1.454 0.9852.147
Senior ofcial/top manager 1.197 0.7211.987 0.774 0.3901.535 1.680 0.7703.668
Other/none 0.768 0.5900.998* 0.781 0.5671.077 1.296 0.8541.967

Psychological distress
02 symptoms Ref. Ref. Ref.
36 symptoms 1.226 1.0321.456* 1.019 0.8181.270 1.049 0.8181.345
79 symptoms 1.186 0.9511.479 1.140 0.8541.522 0.907 0.6521.262
1012 symptoms 1.157 0.8661.547 0.700 0.4391.116 0.826 0.5341.276

Communism
Disagree 1.406 1.1381.738** 1.327 1.0091.744* 1.642 1.1922.262**
Partially disagree 0.947 0.7371.216 0.889 0.6431.230 1.094 0.7421.612
Neutral Ref. Ref. Ref.
Partially agree 0.783 0.5961.028 0.602 0.4080.888* 0.914 0.6101.371
Agree 0.913 0.7061.180 0.881 0.6121.270 1.352 0.9291.967

Pseudo-R2 0.160 0.182 0.139

*p  0.05; **p  0.01; ***p  0.001.

many, often younger, females may be adopting these behaviors
either as a personal statement against a formerly masculine-
dominated social system or against the traditionalist Soviet order,
or as a way of exercising agency or individual choice in an
increasingly uncertain time.
This interpretation is consistent with research conducted by
Gilmore and McKee (2005), noting that smoking American ciga-
rettes has been viewed as a symbol of status, used to display a sense
of individuality and personal freedom that directly contradicts the
tenets of Soviet communism. This type of dynamic appears
particularly relevant to females, where women may be engaging in
traditionally un-feminine behaviors like drinking and smoking as
a way to assert a sense of individuality in the post-Soviet period.
Contemporary social theorists like Bauman (2000), Beck (1992),
and Giddens (1991) describe the emergence of new forms of
modernity, where consumption patterns increasingly become
salient markers related to social identity. As one form of
consumption, lifestyle choices, including whether or not to drink
alcohol, are one way that females may participate in the ongoing
construction and maintenance of self-identity in these republics.
Our ndings are perhaps further elucidated by other existing
research as well. Karen Van Gundy et al. (2005) examine gender
role orientations and alcohol use among Toronto and Moscow men
and women. They highlight sex differences in consumption
patterns and also discuss the various ways that masculine and
feminine gender roles inuence drinking behaviors in these pop-
ulations. Van Gundy et al. (2005:2326) go on to note that increases
in alcohol use among women in the Moscow sample may be related
to a tendency to reject Soviet ideals and/or embrace increasingly
individualist values. Discussion of their ndings also emphasizes
 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262
the fact that such a distinct break from tradition is particularly
meaningful for women and very different from such a break among
men. Further, because behavioral proscriptions and forces related
to gender socialization have encouraged abstention from alcohol,
the adoption of these individualist values may free them to
consume alcohol in rejection of conventional drinking norms.
These interpretations support our ndings, despite the fact that we
are testing quite different ideas than the earlier study.
More generally speaking, lifestyle choices are also ways that
individuals can exercise some semblance of agency when many
events and forces seem beyond their control. This may be partic-
ularly true in the years following the collapse of the Soviet Union.
Further supporting these conclusions are statistical results showing
that drinking practices are associated with increasing levels of
disposable income among females. Evidence appears to support the
connections between material consumption and lifestyle practices
when it comes to drinking among women. In other words, drinking
itself may be conceptualized as one form of consumption that
serves as a social marker signifying individuality or as an assertion
of self-identity as part of a younger, post-communist cohort of
citizens. It is also important to remember that consumption effects
related to income persist even while accounting for the potential
inuence of other related or intervening variables.
Still, it is somewhat misleading to claim that all elements of the
Soviet order have been either rejected outright or completely
eradicated when it comes to females and lifestyle choices, as
ndings for age and marital status seem to suggest that some
vestiges of Soviet society likely remain intact. These data show that
married women of middle or older age groups are signicantly less
likely to report consuming alcohol (and specically, beer) on a more
or less regular basis. These data may be interpreted in a way that
continues to reect the positions, identities, and roles of many
women in post-Soviet societies. As noted above, females have
historically been the center of the domestic sphere, responsible for
keeping the household running, while males have traditionally
occupied the dominant breadwinner roles, despite the fact that
both males and females have historically represented important
and equally sizable parts of the Soviet workforce (Ashwin, 2000;
Ashwin & Lytkina, 2004). Accordingly, it may be the case that older,
married females are still somewhat bound to the operations of the
household through their identities as wives and/or mothers
(identities lauded by the Soviet state), so that less time is available
for extra-household activities time perhaps spent socializing or
having a drink with friends or relatives. Again, these processes may
deprive females, both now and historically, of one socially accept-
able way to alleviate stress or to escape from the repetition of
everyday life, thus contributing to the higher distress levels that
may be discerned among post-Soviet females generally.
Finally, ndings for nationality show that this concept is an
important way to differentiate lifestyle choices, supporting Cock-
erhams (2005) assertion that nationality and ethnicity are impor-
tant elements of lifestyle formulation and reproduction. This is an
integral element of this analysis and as far as we are aware, this is
the only lifestyle study conducted thus far to consider nationality so
extensively. Russian females appear to favor beer and other sources
of alcohol other than wine when they choose to drink more or less
frequently. The frequent consumption of wine, on the other hand, is
most common among Belarusian and Ukrainian, and perhaps not
unexpectedly, Georgian and Moldovan women (Georgia is a wine-
producing region). It is also important to remember that these
differences refer to national and ethnic groups as a whole,
regardless of country of residence, although we acknowledge
signicant, yet far from perfect, overlap between these variables.
So, this analysis attempts to grasp ethnic and cultural differences
independent of current country of residence.
1261
Limitations
The current analysis is not without limitations, however.
First, alcohol consumption is one behavior that may often go
underreported among many survey respondents, so self-reported
data such as these may represent conservative estimates of
drinking patterns among women included in this sample. Heavy
alcohol use may sometimes serve to conceal levels of self-reported
distress as well. In addition, factors relating to political ideology are
often difcult to accurately measure and interpret, but considering
that our instrument is supported in the existing research literature
(Cockerham et al., 2002, 2006b), we are condent that our
measures are valid, especially when controlling for potentially
confounding variables such as age and socioeconomic standing as
well as psychological distress. It should also be noted that these
data are cross-sectional, so it is therefore impossible to make any
distinct attributions of causality, which we have been cautious to
avoid. While more a methodological decision than a limitation, our
choice to analyze pooled data from these eight republics may serve
to mask within-country correlations, but with our ndings we
nonetheless highlight and discuss some important statistical
associations across these regions, thus making a contribution to the
existing body of literature. Finally, this study involves only indi-
vidual-level data, which effectively precludes any direct observa-
tion of the effects of any structural or contextual inuences on
drinking behavior. Predictors of this type are arguably important to
consider, and future studies should strive to incorporate hierar-
chical, nested data to examine associations at multiple levels of
analysis.
Conclusion
Our results indicate that political ideology is associated with
female drinking behaviors in the eight republics included in this
study. These conclusions are interesting contributions to the liter-
ature on post-Soviet health lifestyles but also to the study of female
drinking behavior in these republics. Incidentally, our discussion
may have something to say about future trends as well. Recent data
(WHO, 2007) and the implications of our results point to the fact
that alcohol consumption among younger females may signal
coming increases in alcohol-related morbidity and mortality
among these demographic groups. However, women in this region
have escaped the high mortality levels of men thus far, so perhaps
they will continue to do so. Female drinking is characterized
primarily by beer and wine consumption, rather than the harmful
binge consumption of vodka that often characterizes male drinking.
Yet, the overall stagnation in female life expectancy statistics may
indicate a delicate balance of factors that increasingly unhealthy
lifestyle patterns may disturb. Dynamics related to such factors
need to be investigated in future research.
There are also broader implications for this research as well. As
other authors (Van Gundy et al., 2005) have noted previously, the
continued development of Western values and ideals in the former
USSR may affect the health of both men and women in distinct
ways. Practitioners and researchers alike must address these effects
in the coming years and decades. Alcohol consumption is deeply
embedded in history and society across many parts of the former
Soviet Union, and lifestyle decisions involving alcohol are not likely
to disappear among populations in these regions, especially those
groups and areas with traditionally high rates and harmful
consumption patterns. Although the quantities and patterns of
consumption are very different among males and females in many
republics, recent increases in drinking, along with the implications
of the relationships identied here and elsewhere, may put some
female populations at especially high risk of developing future
1262 B.P. Hinote et al. / Social Science & Medicine 68 (2009) 12541262
health problems. Potential interventions targeting harmful
drinking patterns and their deleterious effects should arguably
consider the social inuences discussed in this study and others.
Social, political, and ideological inuences are indeed important
factors to consider in examining alcohol-related outcomes in these
regions factors that help construct a more complete theoretical
picture of lifestyles and the health crisis in the former Soviet Union.
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