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Adult health in the Russian Federation: more than just a health problem.

https://arctichealth.org/en/permalink/ahliterature162459
Source
Health Aff (Millwood). 2007 Jul-Aug;26(4):1040-51
Publication Type
Article
Author
Patricio Marquez
Marc Suhrcke
Martin McKee
Lorenzo Rocco
Author Affiliation
World Bank. Washington, DC, USA. pmarquez@worldbank.org
Source
Health Aff (Millwood). 2007 Jul-Aug;26(4):1040-51
Language
English
Publication Type
Article
Keywords
Absenteeism
Adult
Birth Rate - trends
Chronic Disease - economics - epidemiology
Cost of Illness
Delivery of Health Care - economics - standards - trends
Female
Health Care Costs - trends
Health status
Humans
Life Expectancy - trends
Male
Middle Aged
Mortality - trends
Risk-Taking
Russia - epidemiology
Sex Factors
Social Conditions
Wounds and Injuries - mortality
Abstract
In this paper we discuss the Russian adult health crisis and its implications. Although some hope that economic growth will trigger improvements in health, we argue that a scenario is more likely in which the unfavorable health status would become a barrier to economic growth. We also show that ill health is negatively affecting the economic well-being of individuals and households. We provide suggestions on interventions to improve health conditions in the Russian Federation, and we show that if health improvements are achieved, this will result in substantial economic gains in the future.
PubMed ID
17630447 View in PubMed
Less detail

Alcohol and Russian mortality: a continuing crisis.

https://arctichealth.org/en/permalink/ahliterature149112
Source
Addiction. 2009 Oct;104(10):1630-6
Publication Type
Article
Date
Oct-2009
Author
David A Leon
Vladimir M Shkolnikov
Martin McKee
Author Affiliation
London School of Hygiene & Tropical Medicine, London, UK and Max Planck Institute for Demographic Research, Rostock, Germany.
Source
Addiction. 2009 Oct;104(10):1630-6
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alcohol Drinking - adverse effects - mortality
Alcohol-Related Disorders - mortality
Alcoholic Beverages - statistics & numerical data
Bias (epidemiology)
Cardiovascular Diseases - etiology - mortality
Cause of Death
Child
Data Collection - methods
Ethanol - poisoning
Female
Humans
Infant
Life Expectancy - trends
Male
Middle Aged
Public Health
Russia - epidemiology
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007, male life expectancy at birth was 61 years, while for females it was 74 years. Alcohol is implicated particularly in deaths among working-age men.
To review the current state of knowledge about the contribution of alcohol to the continuing very high mortality seen among Russian adults
Conservative estimates attribute 31-43% of deaths among working-age men to alcohol. This latter estimate would imply a minimum of 170 000 excess deaths due to hazardous alcohol consumption in Russia per year. Men drink appreciably more than women in Russia. Hazardous drinking is most prevalent among people with low levels of education and those who are economically disadvantaged, partly because some of the available sources of ethanol are very cheap and easy to obtain. The best estimates available suggest that per capita consumption among adults is 15-18 litres of pure ethanol per year. However, reliable estimation of the total volume of alcohol consumed per capita in Russia is very difficult because of the diversity of sources of ethanol that are available, for many of which data do not exist. These include both illegal spirits, as well as legal non-beverage alcohols (such as medicinal tinctures). In 2006 regulations were introduced aimed at reducing the production and sale of non-beverage alcohols that are commonly drunk. These appear to have been only partially successful.
There is convincing evidence that alcohol plays an important role in explaining high mortality in Russia, in particular among working age men. However, there remain important uncertainties about the precise scale of the problem and about the health effects of the distinctive pattern of alcohol consumption that is prevalent in Russia today. While there is a need for further research, enough is known to justify the development of a comprehensive inter-sectoral alcohol control strategy. The recent fall in life expectancy in Russia should give a renewed urgency to attempts to move the policy agenda forward.
PubMed ID
19681805 View in PubMed
Less detail

Alcohol consumption and public health in Russia.

https://arctichealth.org/en/permalink/ahliterature161827
Source
Lancet. 2007 Aug 18;370(9587):561
Publication Type
Article
Date
Aug-18-2007
Author
David A Leon
Lyudmila Saburova
Susannah Tomkins
Martin McKee
Vladimir M Shkolnikov
Source
Lancet. 2007 Aug 18;370(9587):561
Date
Aug-18-2007
Language
English
Publication Type
Article
Keywords
Alcohol Drinking - adverse effects - mortality
Humans
Public Health
Russia - epidemiology
Notes
Comment On: Lancet. 2007 Jun 16;369(9578):1975-617574077
PubMed ID
17707739 View in PubMed
Less detail

Alcohol consumption and self-reported (SF12) physical and mental health among working-aged men in a typical Russian city: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature113737
Source
Addiction. 2013 Nov;108(11):1905-14
Publication Type
Article
Date
Nov-2013
Author
Agnete S Dissing
Artyom Gil
Katherine Keenan
Jim McCambridge
Martin McKee
Alexey Oralov
Lyudmila Saburova
David A Leon
Author Affiliation
Department of Public Health, The University of Copenhagen, Copenhagen, Denmark.
Source
Addiction. 2013 Nov;108(11):1905-14
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adult
Alcohol Drinking - adverse effects - epidemiology
Alcoholic Beverages - adverse effects - statistics & numerical data
Cross-Sectional Studies
Health status
Humans
Male
Mental Disorders - epidemiology
Middle Aged
Russia - epidemiology
Self Report
Smoking - epidemiology
Socioeconomic Factors
Abstract
To investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking.
Cross-sectional study of an age-stratified random sample of a population register. SETTING : The city of Izhevsk, The Russian Federation, 2008-09.
A total of 1031 men aged 25-60 years (68% response rate). MEASUREMENTS : Self-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting 2 or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking and socio-demographic factors were obtained. FINDINGS : Compared with abstainers, those drinking 10-19?litres of beverage ethanol per year had a PCS score 2.66 [95% confidence interval (CI)?=?0.76; 4.56] higher. Hazardous beverage drinking was associated with a lower PCS score [mean diff: -2.95 (95% CI?=?-5.28; -0.62)] and even more strongly with a lower MCS score [mean diff: -4.29 (95% CI?=?-6.87; -1.70)] compared to non-hazardous drinkers, with frequent non-beverage alcohol drinking being associated with a particularly low MCS score [-7.23 (95% CI?=?-11.16; -3.29)]. Adjustment for smoking and socio-demographic factors attenuated these associations slightly, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably. CONCLUSION : Among working-aged male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10-19?litres per year.
Notes
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Comment In: Addiction. 2013 Nov;108(11):191524118759
PubMed ID
23692519 View in PubMed
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Alcohol increases circulatory disease mortality in Russia: acute and chronic effects or misattribution of cause?

https://arctichealth.org/en/permalink/ahliterature142500
Source
Int J Epidemiol. 2010 Oct;39(5):1279-90
Publication Type
Article
Date
Oct-2010
Author
David A Leon
Vladimir M Shkolnikov
Martin McKee
Nikolay Kiryanov
Evgueny Andreev
Author Affiliation
London School of Hygiene and Tropical Medicine, London, UK. david.leon@lshtm.ac.uk
Source
Int J Epidemiol. 2010 Oct;39(5):1279-90
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Alcoholism - complications - mortality
Cardiomyopathy, Alcoholic - mortality
Cardiovascular Diseases - etiology - mortality
Case-Control Studies
Causality
Chronic Disease
Humans
Male
Middle Aged
Risk factors
Russia - epidemiology
Abstract
There is a consensus that the large fluctuations in mortality seen in Russia in the past two decades can be attributed to trends in alcohol consumption. However, the precise mechanisms linking alcohol to mortality from circulatory disease remain unclear. It has recently been argued that a substantial number of such deaths currently ascribed to cardiovascular disorders are misclassified cases of acute alcohol poisoning.
Analysis of routine mortality data and of a case-control study of mortality among working-age (25-54 years) men occurring in the Russian city of Izhevsk, west of the Ural mountains, 2003-05. Interviews were carried out with proxy informants for both the dead cases (N?=?1750) and the controls (N?=?1750) selected at random from a population register. Mortality was analysed according to indicators of alcohol problems.
Hazardous drinking was associated with an increased risk of death from circulatory diseases as a whole [odds ratio (OR)?=?4.14, 95% confidence interval (CI) 3.23, 5.31] adjusted for age, smoking and education. The association with alcoholic cardiomyopathy was particularly strong (OR?=?15.7, 95% CI 9.5, 25.9). Although there was no association with deaths from myocardial infarction (MI; OR?=?1.17, 95% CI 0.59, 2.32), there was a strong association with the aggregate of all other ischaemic heart disease (IHD; OR?=?4.04, 95% CI 2.79, 5.84). Stronger associations for each of these causes (other than MI) were seen with whether or not the man had drunk very heavily in the previous week. However, associations also remained when analyses were restricted to subjects with no evidence of recent heavy drinking, suggesting that misclassification of acute alcohol poisonings is unlikely to explain these overall associations.
Taken as a whole, the available evidence suggests that the positive association of alcohol with increased cardiovascular disease mortality may be best explained as being the result of a combination of chronic and acute alcohol consumption resulting in alcohol-related cardiac disorders, especially cardiomyopathy, rather than being due to misclassification of acute alcohol poisoning. Further work is required to understand the mechanisms underlying the link between heavy alcohol consumption and deaths classified as being due to IHD (other than MI).
Notes
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PubMed ID
20591986 View in PubMed
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Alcohol policy in a Russian region: a stakeholder analysis.

https://arctichealth.org/en/permalink/ahliterature144596
Source
Eur J Public Health. 2010 Oct;20(5):588-94
Publication Type
Article
Date
Oct-2010
Author
Artyom Gil
Olga Polikina
Natalia Koroleva
David A Leon
Martin McKee
Author Affiliation
I.M. Sechenov Moscow Medical Academy, 8-2 Trubetskaya street, Moscow, Russia. artyom.gil@lshtm.ac.uk
Source
Eur J Public Health. 2010 Oct;20(5):588-94
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Alcohol drinking - legislation & jurisprudence - prevention & control
Alcoholic Beverages
Commerce
Government
Health Policy
Humans
Industry
Interviews as Topic
Russia
Abstract
Male life expectancy in the Russian Federation, at 60 years, is the lowest in Europe. Several factors contribute to this situation, but hazardous consumption of alcohol is especially a key factor.
We undertook a stakeholder analysis in a typical Russian region located on the western side of the Urals. Organizations with a stake in alcohol policy in the region were identified by snowball sampling and information on their position and influence on alcohol policy was elicited from interviews with key informants. Their interests and influence were mapped and their relationships plotted.
Twenty-nine stakeholder organizations were identified and 43 interviews were conducted with their staff. The most influential actors were the Federal and regional governments, large beer producers and manufacturers of strong alcohols. However, the majority of organizations that might be expected to play a role in developing or implementing alcohol control policies were almost entirely disengaged and fragmented. No evidence was found of an existing or emerging multi-sectoral coalition for developing alcohol policy to improve health. Organizations that might be expected to contribute to tackling hazardous drinking had little understanding of what might be effective.
While stakeholders with an interest in maintaining or increasing alcohol consumption are engaged and influential, those who might seek to reduce it either take a very narrow perspective or are disengaged from the policy agenda. There is a need to mobilize actors who might contribute to effective policies while challenging those who can block them.
Notes
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PubMed ID
20350932 View in PubMed
Less detail

Analysis of how the health systems context shapes responses to the control of human immunodeficiency virus: case-studies from the Russian Federation.

https://arctichealth.org/en/permalink/ahliterature171981
Source
Bull World Health Organ. 2005 Oct;83(10):730-8
Publication Type
Article
Date
Oct-2005
Author
Rifat A Atun
Martin McKee
Francis Drobniewski
Richard Coker
Author Affiliation
Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London SW7 2AZ, England, UK. r.atun@imperial.ac.uk
Source
Bull World Health Organ. 2005 Oct;83(10):730-8
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Delivery of Health Care - organization & administration
HIV Infections - prevention & control
Humans
National Health Programs
Organizational Case Studies
Political Systems
Public Health
Russia
Abstract
To develop a methodology and an instrument that allow the simultaneous rapid and systematic examination of the broad public health context, the health care systems, and the features of disease-specific programmes.
Drawing on methodologies used for rapid situational assessments of vertical programmes for tackling communicable disease, we analysed programmes for the control human of immunodeficiency virus (HIV) and their health systems context in three regions in the Russian Federation. The analysis was conducted in three phases: first, analysis of published literature, documents and routine data from the regions; second, interviews with key informants, and third, further data collection and analysis. Synthesis of findings through exploration of emergent themes, with iteration, resulted in the identification of the key systems issues that influenced programme delivery.
We observed a complex political economy within which efforts to control HIV sit, an intricate legal environment, and a high degree of decentralization of financing and operational responsibility. Although each region displays some commonalities arising from the Soviet traditions of public health control, there are considerable variations in the epidemiological trajectories, cultural responses, the political environment, financing, organization and service delivery, and the extent of multisectoral work in response to HIV epidemics.
Within a centralized, post-Soviet health system, centrally directed measures to enhance HIV control may have varying degrees of impact at the regional level. Although the central tenets of effective vertical HIV programmes may be present, local imperatives substantially influence their interpretation, operationalization and effectiveness. Systematic analysis of the context within which vertical programmes are embedded is necessary to enhance understanding of how the relevant policies are prioritized and translated to action.
PubMed ID
16283049 View in PubMed
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An analysis of trends and determinants of health insurance and healthcare utilisation in the Russian population between 2000 and 2004: the 'inverse care law' in action.

https://arctichealth.org/en/permalink/ahliterature151304
Source
BMC Health Serv Res. 2009;9:68
Publication Type
Article
Date
2009
Author
Francesca Perlman
Dina Balabanova
Martin McKee
Author Affiliation
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK. francesca.perlman@lshtm.ac.uk
Source
BMC Health Serv Res. 2009;9:68
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Cross-Sectional Studies
Female
Health Services - utilization
Health Services Research
Humans
Insurance Coverage - statistics & numerical data - trends
Insurance, Health - statistics & numerical data - trends
Logistic Models
Longitudinal Studies
Male
Medically Uninsured - statistics & numerical data
Poverty - economics
Private Sector - economics
Russia
Socioeconomic Factors
Universal Coverage - economics
Abstract
The break-up of the USSR brought considerable disruption to health services in Russia. The uptake of compulsory health insurance rose rapidly after its introduction in 1993. However, by 2000 coverage was still incomplete, especially amongst the disadvantaged. By this time, however, the state health service had become more stable, and the private sector was growing. This paper describes subsequent trends and determinants of healthcare insurance coverage in Russia, and its relationship with health service utilisation, as well as the role of the private sector.
Data were from the Russia Longitudinal Monitoring Survey, an annual household panel survey (2000-4) from 38 centres across the Russian Federation. Annual trends in insurance coverage were measured (2000-4). Cross-sectional multivariate analyses of the determinants of health insurance and its relationship with health care utilisation were performed in working-age people (18-59 years) using 2004 data.
Between 2000 and 2004, coverage by the compulsory insurance scheme increased from 88% to 94% of adults; however 10% of working-age men remained uninsured. Compulsory health insurance coverage was lower amongst the poor, unemployed, unhealthy and people outside the main cities. The uninsured were less likely to seek medical help for new health problems. 3% of respondents had supplementary (private) insurance, and rising utilisation of private healthcare was greatest amongst the more educated and wealthy.
Despite high population insurance coverage, a multiply disadvantaged uninsured minority remains, with low utilisation of health services. Universal insurance could therefore increase access, and potentially contribute to reducing avoidable healthcare-related mortality. Meanwhile, the socioeconomically advantaged are turning increasingly to a growing private sector.
Notes
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PubMed ID
19397799 View in PubMed
Less detail

Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data.

https://arctichealth.org/en/permalink/ahliterature269757
Source
Lancet. 2016 Jan 2;387(10013):61-9
Publication Type
Article
Date
Jan-2-2016
Author
Rasha Khatib
Martin McKee
Harry Shannon
Clara Chow
Sumathy Rangarajan
Koon Teo
Li Wei
Prem Mony
Viswanathan Mohan
Rajeev Gupta
Rajesh Kumar
Krishnapillai Vijayakumar
Scott A Lear
Rafael Diaz
Alvaro Avezum
Patricio Lopez-Jaramillo
Fernando Lanas
Khalid Yusoff
Noorhassim Ismail
Khawar Kazmi
Omar Rahman
Annika Rosengren
Nahed Monsef
Roya Kelishadi
Annamarie Kruger
Thandi Puoane
Andrzej Szuba
Jephat Chifamba
Ahmet Temizhan
Gilles Dagenais
Amiram Gafni
Salim Yusuf
Source
Lancet. 2016 Jan 2;387(10013):61-9
Date
Jan-2-2016
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - economics - supply & distribution - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - economics - supply & distribution - therapeutic use
Argentina
Aspirin - economics - supply & distribution - therapeutic use
Bangladesh
Brazil
Canada
Cardiovascular Agents - economics - supply & distribution - therapeutic use
Cardiovascular Diseases - drug therapy
Chile
China
Colombia
Developed Countries
Developing Countries
Drug Costs
Family Characteristics
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics - supply & distribution - therapeutic use
Income
India
Iran
Malaysia
Pakistan
Pharmacies
Platelet Aggregation Inhibitors - economics - supply & distribution - therapeutic use
Poland
Rural Population
Secondary Prevention
South Africa
Sweden
Turkey
United Arab Emirates
Urban Population
Zimbabwe
Abstract
WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability.
We analysed information about availability and costs of cardiovascular disease medicines (aspirin, ß blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry.
Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24,776), 33% of lower middle-income countries (13,253 of 40,023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16,874). In low-income and middle-income countries, patients with previous cardiovascular disease were less likely to use all four medicines if fewer than four were available (odds ratio [OR] 0·16, 95% CI 0·04-0·57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (0·16, 0·04-0·55).
Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines. Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO's targets of 50% use of key medicines by 2025.
Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.
Notes
Comment In: Lancet. 2016 Jan 2;387(10013):9-1126498705
PubMed ID
26498706 View in PubMed
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Availability and characteristics of nonbeverage alcohols sold in 17 Russian cities in 2007.

https://arctichealth.org/en/permalink/ahliterature154144
Source
Alcohol Clin Exp Res. 2009 Jan;33(1):79-85
Publication Type
Article
Date
Jan-2009
Author
Artyom Gil
Olga Polikina
Natalia Koroleva
Martin McKee
Susannah Tomkins
David A Leon
Author Affiliation
London School of Hygiene & Tropical Medicine, London, UK.
Source
Alcohol Clin Exp Res. 2009 Jan;33(1):79-85
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adult
Alcohol Drinking - economics - epidemiology - legislation & jurisprudence
Alcoholic Beverages - economics
Case-Control Studies
Cities - economics - epidemiology
Ethanol - administration & dosage - economics
Humans
Male
Middle Aged
Russia - epidemiology
Urban Health - trends
Abstract
It is known that a range of nonbeverage alcohols including eau-de-colognes and medicinal tinctures are consumed by sections of the Russian population. Research conducted in a city in the Urals (2003 to 2005) showed that consumption of such products is associated with very high mortality from a wide range of causes. However, there have been no systematic attempts to investigate the extent to which such products are available in other cities of the Russian Federation. There is particular interest in establishing this following the introduction of new federal regulations in January 2006 aimed at restricting the availability of these products.
In the first half of 2007, we conducted a survey in 17 cities that spanned the full range of city types in the Russian Federation excluding those in the Far East. In each city, fieldworkers visited pharmacies and other types of retail outlets and purchased samples of nonbeverage alcohols. These were defined as being typically 10 to 15 roubles per bottle, with an ethanol concentration of at least 60% by volume.
We were able to purchase samples of nonbeverage alcohols in each of the 17 cities we investigated. The majority of the 271 products included were a cheaper and more affordable source of ethanol than standard Russian vodka. Medicinal tinctures, sold almost exclusively in pharmacies, were particularly common with an average concentration of 78% ethanol by volume. Most importantly, the majority of the products were of a sort that our previous research in 2004 to 2005 had established were drunk by working-age men.
While the 2006 federal regulations introduced in part to reduce the availability and consumption of nonbeverage alcohols may have had some effect on certain classes of nonmedicinal products, up until June 2007 at least, medicinal tinctures as well as some other nonbeverage alcohols that are consumed appear to have been readily available.
Notes
Comment In: Alcohol Clin Exp Res. 2009 May;33(5):759-6019320624
PubMed ID
19018753 View in PubMed
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