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European Journal of Public Health, Vol. 24, No. 4, 572–577
ßThe Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
doi:10.1093/eurpub/ckt213 Advance Access published on 27 January 2014
.........................................................................................................
Using multi-level data to estimate the effect of
social capital on hazardous alcohol consumption in the
former Soviet Union
Adrianna Murphy
1
, Bayard Roberts
1
, Michael G. Kenward
2
, Bianca L. De Stavola
2
,
Andrew Stickley
3
, Martin McKee
1
1 Department of Health Services Research and Policy, European Centre on Health of Societies in Transition (ECOHOST),
London School of Hygiene and Tropical Medicine, London, UK
2 Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
3 Stockholm Centre on Health of Societies in Transition (SCOHOST), So
¨derto
¨rn University, Huddinge, Sweden
Correspondence: Adrianna Murphy, 15-17 Tavistock Place, WC1H 2SH, London, UK, Tel: +44 (0) 20 7636 8636, Fax: +44 (0)
20 7436 5389, e-mail: adrianna.murphy@lshtm.ac.uk
Background: Hazardous alcohol consumption is a leading cause of mortality in the former Soviet Union (fSU), but
little is known about the social factors associated with this behaviour. We set out to estimate the association
between individual- and community-level social capital and hazardous alcohol consumption in the fSU. Methods:
Data were obtained from Health in Times of Transition 2010, a household survey of nine fSU countries (n= 18 000
within 2027 communities). Individual-level indicators of social isolation, civic participation, help in a crisis and
interpersonal trust were aggregated to the community level. Adjusting for demographic factors, the association of
individual- and community-level indicators with problem drinking (CAGE) and episodic heavy drinking was
estimated using a population average model for the analysis of multi-level data. Results: Among men,
individual social isolation [odds ratio (OR) = 1.20], community social isolation (OR = 1.18) and community civic par-
ticipation (OR = 4.08) were associated with increased odds of CAGE. Community civic participation (OR = 2.91)
increased the odds of episodic heavy drinking, while community interpersonal trust (OR = 0.89) decreased these
odds. Among women, individual social isolation (OR =1.30) and community civic participation (OR=2.94) increased
odds of CAGE. Conclusion: Our results provide evidence of the role of some elements of social capital in problem
drinking in the fSU, and highlight the importance of community effects. The nature of civic organizations in the
fSU, and the communities in which civic participation is high, should be further investigated to inform alcohol
policy in the region.
.........................................................................................................
Introduction
The former Soviet Union (fSU) region experienced a sharp decline
in life expectancy in the 1990s, from which it has yet to fully
recover.
1
Although there is now compelling evidence that alcohol
has played a major proximal role in this mortality crisis,
2
driven by
rapid social change,
3
the factors determining individual vulnerabil-
ity, or conversely, resilience, are still being worked out in detail. A
recent systematic review of research from the fSU on social factors
and alcohol consumption found little on the role of commonly
studied factors such as education and income, with what exists
providing mixed results, and no published research examining the
role of the social environment on consumption.
4
One social factor that has recently gained attention in public
health research from other regions is ‘social capital’, defined as
‘those features of social organization—such as density of civic as-
sociations, levels of interpersonal trust and norms of reciprocity—
that act as resources for individuals, and facilitate collective
action’.
5
Specific mechanisms via which social capital may affect
health, such as by reducing the negative impacts of stress,
6
or
facilitating the dissemination of health-related information,
7
have
been hypothesized.
8
With regard to health behaviours specifically,
the hypothesis that communities with higher levels of social capital
are better able to exercise social control over health behaviours
7
has found some empirical support in evidence linking elements
of social capital (namely, civic engagement, trust and social
support) to individual health behaviours,
8
including alcohol
consumption.
9,10
Further research showed that the association
between social capital and mortality was attenuated when differ-
ences in health behaviours were accounted for, suggesting that
health behaviours may mediate the effect of social capital on
overall health.
11
While consensus regarding the importance of social capital in
health behaviour research has grown, there is persisting disagree-
ment in the literature as to whether social capital should be treated
as an individual attribute or a collective one (e.g. at the level of the
community or state).
12
In their summary of the various conceptu-
alizations of social capital in public health research, Kawachi et
al.
12
argue that the most theoretically appropriate level for
analysis of its association with health is both the individual and
collective level, within a multi-level framework. They provide
evidence for the legitimacy of aggregating individual survey
responses to obtain collective measures of social capital,
12
an
approach now commonly used.
10
Several studies have found a
positive association between aggregate social capital measures and
individual health outcomes;
13
however, as pointed out by
d’Hombres and colleagues,
14
these studies did not simultaneously
include individual-level measures of social capital, thereby failing
to eliminate the possibility that the positive effect of community-
level social capital was due to its positive correlation with
individual-level social capital.
14
Some subsequent studies that
measured both individual- and community-level social capital sim-
ultaneously found no residual association between community-
level social capital and health once individual-level social capital
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was adjusted for, leading d’Hombres and colleagues to conclude
that ‘community social capital does not have an independent effect
on self-reported health’ once individual-level social capital is
accounted for and therefore ‘affects health only indirectly’;
14
however, studies from elsewhere have reported independent asso-
ciations between community-level social capital and self-reported
health,
15
as well as alcohol consumption.
10
That social capital, either at the community or individual level,
might have an effect on alcohol consumption in the fSU is
plausible, given what we know of the region. The Soviet regime
suppressed civil society, leading its citizens to rely on informal
networks, such as friends and family, for financial or other means
of support, leaving socially isolated individuals vulnerable.
5
This
lack of social capital has been linked to worse health outcomes
generally among individuals in Russia,
5
elsewhere in the fSU
14
and
in the wider post-communist world;
16
however, any association
between social capital and alcohol consumption in the region has
not yet been explored. Recognizing the need for research on social
determinants of alcohol consumption in the fSU, and building on
existing evidence of the specific role of social capital in health in
the fSU, and in alcohol consumption elsewhere, we set out to
analyse the association between individual- and community-level
social capital and hazardous alcohol consumption in nine fSU
countries.
Methods
Data
Data were obtained from the Health in Times of Transition 2010
study (HITT). The HITT conducted nationally representative
surveys in nine fSU countries—Armenia, Azerbaijan, Belarus,
Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine—
between March and June 2010 (data collection in Kyrgyzstan was
postponed by one year due to political violence). Multistage random
sampling with stratification by region and rural/urban settlement
type was used; within each primary sampling unit (PSU; local ad-
ministrative unit), households were selected by standardized random
route procedures. Using a standardized survey instrument, trained
fieldworkers interviewed survey participants in their homes. The
response rates for the HITT varied from 47.3% in Kazakhstan to
83% in Moldova. There were 1800 respondents in each country,
except in Russia (3000) and Ukraine (2200) to reflect the larger
and more regionally diverse populations in these two countries,
and in Georgia (2200) where a booster survey of 400 additional
interviews was undertaken in November 2010 to ensure a more
representative sample. The final sample size was N= 18 000.
Measuring social capital
Social capital is still a relatively new concept in public health
research and, as yet, there is no standard approach to its meas-
urement. One model regards social capital as consisting of two
components: a structural component, which includes the ‘extent
and intensity of associational links and activity’, and a cognitive
component, which includes ‘perceptions of support, reciprocity,
sharing and trust’.
17
Using this framework, we operationalized
social capital using the following indicators: social isolation
(structural), active civic participation (structural), having
someone to turn to for help in a crisis (cognitive) and interper-
sonal trust (cognitive). Using self-reported survey responses,
‘social isolation’ (‘How often do you feel lonely?’) and ‘interper-
sonal trust’ (‘To what degree do you feel that people can be
trusted?’) were measured as continuous variables, while ‘help in
a crisis’ (‘Is there anyone who you can really count on to help
you out in a crisis?’) and ‘active civic participation’ (‘Are you an
active member of at least one of these organizations?’) were
measured as binary variables. More detailed information on the
survey questions used and response options can be found in
Appendix table 1.
We used the PSUs in the HITT survey to represent
communities: 2027 PSUs were included with approximately 8–
10 individuals per PSU. To estimate simultaneously the associ-
ation between community-level and individual-level social capital
and our outcomes of interest, we followed standard multilevel
practice
18
and introduced both the individual-level score as well
as the average of all scores in the community into the linear
predictor. Unlike recent studies of social capital and health that
have used ‘self-excluded’ measures of community-level social
capital (i.e. the individual’s score is not included in the average
community-level score),
15
we used a ‘self-included’ measure (i.e.
the individual’s score is included in the average community-level
score). This approach decomposes the collective effect of social
capital into its within- and between-group components, and
allows us to estimate the expected changes in hazardous
drinking of individual iin community jassociated with a unit
change in individual-level social capital, expressed as a deviation
from the community mean, and with a unit change in
community-level social capital, respectively.
Measuring hazardous alcohol consumption
Two measures of hazardous drinking were used. The first used a
validated standard measure of problem drinking—the CAGE 4-item
questionnaire for assessing alcohol dependence.
19
Cronbach’s alpha
for the CAGE questionnaire in the HITT data was 0.75.
The second measure- episodic heavy drinking (EHD)- is more
specific to the post-Soviet context where this pattern of drinking
is widespread and a major driver of mortality, being linked to
increased risk of sudden cardiac death
20
as well as injury and
violence.
21
It is particularly common among working-age men in
the fSU.
22
As noted by Pomerleau et al.,
22
researchers in countries of
the fSU have used different definitions of EHD; for consistency we
use Pomerleau et al.’s definition (i.e. >2 L of beer, 750 g of wine or
200 g of strong spirits on one occasion).
Statistical analysis
Our dataset consists of 18 000 individuals nested in 2027
communities, thus calling for a modelling approach that
accounts for the non-independence of individuals within the
same community. Though much of the recent research on
community-level social capital and health has favoured ‘random
effects’ multilevel modelling,
12,13,15
which uses maximum
likelihood estimation, we have opted for a ‘population average
model’, which uses a generalized estimating equation approach.
Applied to our research question, a random-effects approach
would provide us with an estimate of the average odds ratio
(OR) of CAGE problem drinking or EHD associated with a
unit change in social capital, within a given community (i.e.
comparing two individuals from the same community, or from
two communities with all relevant characteristics equal), whereas
the population-average approach provides an estimate of the ORs
of these outcomes associated with a unit change in social capital
across all communities (i.e. comparing two individuals taken from
the whole population, irrespective of community). The latter
provides estimates that represent average effects over the whole
population, and so reflects population-level changes in social
capital. Such models require fewer assumptions than the corres-
ponding random-effects models in terms of the distribution of
unobservable community random effects. Hubbard et al.
23
have
provided a more detailed discussion of the use of population
average models vs. random effects models to study community-
level effects on health.
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We began with the following model, which has been used in
previous research on community-level social capital
15
:
logit pr Aij ¼1
¼0þ1ðSij SjÞþ2Sjþ3Xij,
where A
ij
is the dependent variable (CAGE or EHD) for
individual iin community j,S
ij
is the social capital indicators
measured for individual iin community j,S
j
is the average of
social capital indicators in community jand X
ij
is the set of
socio-demographic potential confounders for individual iand
community j.
We then re-parameterized this model in the following way:
logitfpr ðAij ¼1Þg ¼ 0þ1Sij þð21ÞSjþ3Xij ,
where (
2
1
)represents the effect of community-level social
capital over and above any individual level effect (i.e. if
2
=
1
,
there is no effect of social capital at the level of the community).
Both models give the same individual-level coefficient, but while
the community-level coefficient in the first model represents the
combined effect of individual- and community-level social capital
on drinking, in our model it represents the contribution of
community-level social capital variables over and above
individual-level variables. Men and women were analysed
separately given the large differences in consumption patterns
between them,
22
and the following variables were controlled for in
the analysis: age, marital status, religion, education, occupation,
household economic status, place of residence (urban vs. rural),
country of residence and smoking status.
Results
Table 1 shows the characteristics of the study sample and the distri-
bution of social capital indicators. Roughly 44% of the sample was
male; most were married (62%), employed (88%) and living in
urban areas (60%). Almost 10% of the sample reported being
lonely ‘often’; roughly 6% reported being active in a civic organiza-
tion; 92% had someone to go to in a crisis, and about 5% reported
low trust in others. Social capital indicators were not highly
correlated with each other.
The prevalence of CAGE problem drinking and EHD in our
sample, by age category and gender, are shown in table 2. As
expected, men were much more likely to report CAGE-defined
problem drinking and EHD than women, and our estimates are
similar to the earlier study by Pomerleau, et al.
22
that examined
the prevalence of EHD in this population.
The results from our population average model in table 3 show
the additional effect of community-level social capital variables on
CAGE problem drinking and EHD among men, over and above the
individual effect. Adjusting for possible socio-demographic
Table 1 Sample characteristics HITT 2010
Characteristic
a
Frequency (%)
b
Gender
Male 7828 (43.5)
Age category
18-29 5042 (28.0)
30-39 3411 (19.0)
40-49 3380 (18.8)
50-59 2755 (15.3)
60+ 3410 (19.0)
Marital status
Married 11129 (62.1)
Single 3691 (20.6)
Divorced 1152 (6.4)
Widowed 1962 (10.9)
Religion
Muslim (vs. Non-Muslim) 4436 (24.7)
Education
Incomplete secondary or lower 2345 (13.1)
Incomplete higher or lower 11543 (64.3)
Complete higher 4066 (22.65)
Occupation
Employed 15766 (88.2)
Unemployed (not seeking work) 608 (3.4)
Unemployed (seeking work) 1499 (8.4)
Household economic status
Very bad/bad 3616 (20.3)
Average 10195 (57.3)
Very good/good 3984 (22.4)
Place of residence
Urban (vs. Rural) 10864 (60.4)
Smoking status
Smoker (vs. Non-smoker) 4642 (25.8)
Social isolation
Never 8454 (47.6)
Rarely 3723 (21.0)
Sometimes 3892 (21.9)
Often 1702 (9.6)
Active civic participation
Yes (vs. No) 1,149 (6.4)
Help in a crisis
Yes (vs. No) 16233 (91.5)
Interpersonal trust
1 (Low) 954 (5.4)
2 781 (4.4)
3 1638 (9.2)
4 2079 (11.7)
5 3674 (20.7)
6 2912 (16.4)
7 2650 (14.9)
8 1950 (11.0)
9 680 (3.8)
10 (High) 487 (2.7)
a: All characteristics were self-reported.
b: Proportions may not sum to exactly 100 due to rounding.
Table 2 Prevalence of CAGE problem drinking and EHD by age category and gender, HITT 2010
Age category CAGE problem drinking Episodic heavy drinking Both
Men N (%) Women N (%) Men N (%) Women N (%) Men N (%) Women N (%)
18–29 421 (18.7) 160 (7.2) 488 (19.8) 102 (4.0) 182 (8.1) 29 (1.3)
30–39 383 (27.7) 120 (7.0) 403 (27.6) 107 (5.5) 191 (14.0) 39 (2.3)
40–49 408 (30.7) 104 (6.30) 387 (27.0) 78 (4.0) 179 (13.5) 21 (1.3)
50–59 353 (33.1) 77 (5.5) 299 (26.1) 42 (2.6) 160 (15.0) 18 (1.3)
60+ 278 (22.8) 50 (2.7) 183 (13.9) 20 (1.0) 85 (7.0) 4 (0.2)
Total 1843 (25.4) 511 (5.8) 1760 (22.5) 349 (3.4) 797 (11.0) 111 (1.3)
Source: Health in Times of Transition Study 2010, http://www.hitt-cis.net/
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confounders, we found that in addition to the increased odds of
individual CAGE problem drinking associated with individual-
level social isolation, community-level social isolation also
increased the odds of this behaviour, as did community-level civic
participation. The odds of EHD also increased with community-
level civic participation but were not significantly associated with
individual-level social isolation, while the odds of engaging in EHD
among men decreased with higher levels of community interper-
sonal trust.
The results of the same analysis for women are found in table 4.
A similar pattern was observed among women as among men for
CAGE problem drinking. Higher odds were observed for individual-
level social isolation and community-level civic participation,
although, unlike men, civic participation was also associated with
increased risk of CAGE problem drinking at the individual level.
Also unlike men, social isolation at the community level was
associated with increased risk of EHD among women.
Discussion
To the best of our knowledge, this is the first analysis of both
individual- and community-level social capital and their relation
with hazardous alcohol consumption in countries of the fSU. We
used two measures of hazardous consumption, both relevant
to health but addressing different constructs. Responses to the
CAGE instrument capture the role of alcohol in aspects of the indi-
vidual’s daily life, in particular the extent to which they are
dependent on it. EHD captures a particular behaviour that may be
seen in those who are not necessarily dependent but which, none-
theless, has profound health consequences. The associations with the
two measures differ.
Individual-level social isolation is associated with CAGE prob-
lem drinking among both men and women. One possible explan-
ation is that socially isolated individuals are less well equipped to
cope, particularly given the shock of the social and economic
transition that occurred in the fSU, leading them to turn to
problem drinking as a coping mechanism. This hypothesis is
supported by previous research linking social isolation to poor
self-reported health
14
and to psychological stress,
24
which may in
turn lead to hazardous alcohol consumption,
25
and is consistent
with the excess mortality observed among single men in post-
communist societies compared with married men,
16
and among
the socially marginalized.
26
It is important to note the possibility of
reverse causality, as individuals who engage in problem drinking
may in fact be more likely to experience family conflicts,
27
withdraw from society
28
and become psychologically distressed.
29
Qualitative research in Russia, using narratives provided by
widows of men who died of alcohol-related causes, indicates a bi-
directional relationship, with hazardous drinking and psychological
distress mutually reinforcing each other, although either can start
the process off.
30
We found that higher interpersonal trust was associated with
lower odds of EHD among men at the community level. This is
consistent with previous reports of a strong association between
community-level trust and self-rated health,
15
(although there is
only limited support thus far for the hypothesis that the relationship
between social capital and health is mediated by health behaviours
such as alcohol consumption).
8
The relationship between
community-level trust and EHD in the fSU might be explained, in
part, by fear of crime. There was a sharp rise in crime in many fSU
countries in the immediate post-Soviet period,
31
and crime has been
associated with worse health outcomes,
3
including increased psycho-
logical distress.
32
This is important because, as mentioned above,
psychological distress may in turn have increased the risk of
hazardous alcohol consumption.
25
It is possible that communities
with higher levels of mistrust are those in which crime, and resulting
psychological distress, is more prevalent. Research from the United
States provides evidence of increased community-level social
mistrust in communities with higher rates of firearm homicides.
33
A simple regression of community-level interpersonal trust on
community-level fear of crime in our data showed that the former
was strongly negatively associated with the latter (=6.822);
however, a more in-depth analysis of these factors is required
before drawing conclusions on their relationship.
Perhaps our most surprising finding is that of a positive associ-
ation between community-level civic participation and CAGE
problem drinking among men and women, and EHD among men.
This finding challenges the theory that membership in groups may
encourage the dissemination of health information and curtail
deviant and hazardous health behaviours,
7
including alcohol con-
sumption among college students in the United States.
10
However,
our study differs from the college study in terms of study popula-
tion and context. Another key difference is the nature of
the organizations to which study participants belong, which
likely differs significantly between the fSU and American college
campuses.
Further analysis of our data (not shown) indicated that the most
commonly reported organization in which individuals were
members was a ‘trade union’, and community-level trade union
Table 3 Association between community- and individual-level
social capital and hazardous alcohol consumption among males
a
,
HITT 2010
Social capital indicators CAGE EHD
OR 95% C.I. OR 95% C.I.
Community-level variables
Social isolation 1.18 1.00–1.38 1.02 0.87–1.19
Active civic participation 4.08 2.23–7.47 2.91 1.51–5.59
Help in a crisis 1.36 0.72–2.54 1.17 0.66–2.10
Interpersonal trust 0.97 0.92–1.03 0.89 0.83–0.95
Individual-level variables
Social isolation 1.20 1.11–1.29 1.06 0.97–1.15
Active civic participation 0.94 0.72–1.22 0.91 0.69–1.19
Help in a crisis 0.99 0.78–1.26 1.05 0.81–1.36
Interpersonal trust 0.98 0.94–1.02 1.02 0.98–1.05
a: Adjusted for age, education, occupation, marital status, religion,
household economic status, country of residence, place of residence
(urban v. rural) and smoking status. Source: Health in Times of
Transition Study 2010, http://www.hitt-cis.net/
Table 4 Association between community- and individual-level
social capital and hazardous alcohol consumption among females
a
,
HITT 2010
Social capital indicators CAGE EHD
OR 95% C.I. OR 95% C.I.
Community-level variables
Social isolation 1.09 0.86–1.37 1.34 1.01–1.79
Active civic participation 2.94 1.20–7.21 1.01 0.35–2.89
Help in a crisis 0.34 0.11–1.03 1.24 0.30–5.17
Interpersonal trust 1.06 0.96–1.17 0.98 0.87–1.10
Individual-level variables
Social isolation 1.30 1.16–1.46 0.99 0.86–1.14
Active civic participation 1.47 1.02–2.11 0.72 0.44–1.20
Help in a crisis 0.96 0.68–1.37 1.28 0.70–2.35
Interpersonal trust 0.96 0.90–102 0.95 0.86–1.02
a: Adjusted for age, education, occupation, marital status, religion,
household economic status, country of residence, place of residence
(urban v. rural) and smoking status. Source: Health in Times of
Transition Study 2010, http://www.hitt-cis.net/
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membership was significantly associated with an increased risk of
both CAGE problem drinking and EHD. What is it about trade
union membership that results in increased hazardous drinking in
the fSU? One possible explanation is that trade unions are an
example of ‘single issue organizations’ that entail a narrow ‘radius
of trust’ and are not likely to improve generalized trust in others.
9
This form of civic participation has been coined the ‘miniaturization
of community’
34
and has been linked to alcohol consumption.
9
Another, perhaps more likely explanation, given the weakened role
of trade unions in people’s lives since the fall of the Soviet Union, is
that communities with high levels of union membership simply
represent communities where many inhabitants are in industrial
employment where there is mandatory union membership. This
latter hypothesis is consistent with research from Ukraine, which
has shown that alcohol consumption is higher in the industrial
South and East regions of the country compared with the agrarian
West.
35
This might also explain why we found an association
between membership and hazardous alcohol consumption only at
the community level for men and not at the individual level
(although there was an association at the individual level for
women).
One other possible explanation for the association between
community-level civic participation and hazardous alcohol con-
sumption is that communities where there is a high level of
membership in organizations may offer frequent opportunities to
gather at social events where drinking is common and expected. This
explanation was offered by an earlier study in Taiwan that found a
similar association between community social participation and
frequent drinking.
36
The potential for social capital to create
demands for conformity among community members has been
described by Portes
37
and Ferlander,
38
and is plausible in the fSU
context; however, further qualitative research is required to better
understand the nature of civic organization membership (especially
trade union membership) in the fSU and the role that it plays in
alcohol consumption.
There are some limitations to our study. First, the cross-sectional
nature of the data prohibits us from making conclusions about
causality, as discussed above with regards to social isolation and
alcohol use. Second, there is a tendency for respondents, especially
in the fSU, to under-report their own alcohol consumption.
39
As
such, our estimate of the prevalence of EHD may be an underesti-
mate; however, there is no reason to believe that this potential
underestimate would create spurious associations between our
indicators of interest and EHD. The measurement of CAGE
problem drinking may be less vulnerable to bias, as it does not
focus on perceived alcohol consumption.
19
Also, this study will
have probably missed the most severe drinkers (e.g. intoxicated,
homeless), who may also be the most socially isolated, thereby
producing somewhat conservative estimates of the relationship
between social capital and hazardous alcohol consumption across
these countries. Third, as there is almost no existing research on
the relationship between social capital and alcohol consumption
among adults, we were forced to compare and contrast our
findings with those from studies of social capital and general
health, despite inconsistent evidence thus far that alcohol plays a
mediating role between them.
8,11
Fourth, we were not able to dis-
tinguish between different forms of social capital that may be
important in the association between civic engagement and
alcohol consumption, namely, ‘bonding’, ‘bridging’ and ‘linking’,
which have shown to be important to health outcomes in other
contexts.
40
Lastly, because of the resources required for conducting
a multi-country study, the number of individuals in each
community in the HITT survey was small (an average of nine per
community). Although this does not invalidate our findings, it does
highlight the need for further research within individual countries
using larger community samples.
Conclusions
Our results provide evidence of the independent association between
individual-level social isolation, as well as community-level civic
participation and interpersonal trust, and hazardous alcohol con-
sumption in the fSU. The finding that community-level civic par-
ticipation is associated with increased odds of hazardous alcohol
consumption seems to contradict evidence from other regions that
links civic participation to improvements in health and should be
investigated further.
Funding
This work (part of the Health in Times of Transition Project of the
European Centre on Health of Societies in Transition) was
supported by the European Union’s 7
th
Framework Program,
project HEALTH-F2-2009-223344. The European Commission
cannot accept any responsibility for any information provided or
views expressed.
Conflicts of interest: None declared.
Key points
To our knowledge, this is the first study that investigates the
effect of individual- and community-level social capital on
hazardous alcohol consumption in the former Soviet Union,
using multi-level data from nine former Soviet countries.
We show that some elements of social capital—social
isolation, social mistrust and active civic participation—
are positively associated with hazardous consumption in
the region, and we highlight the importance of community
effects.
The strong positive relationship between community-level
civic participation and hazardous alcohol consumption is
particularly surprising, given evidence from other regions
of the world pointing to the protective effect of civic par-
ticipation on drinking.
The nature of civic organizations in the former Soviet Union
and the role they play in alcohol consumption should be
researched further in order to inform public health interven-
tions at the community level.
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