title: Alcohol and other drug related deaths among young people in CIS countries: proximal and distal causes and implications for policy.
abstract: BACKGROUND
  Although the mortality crisis that followed the break-up of the Soviet Union in 1992 has been well researched, most attention has been paid to mortality among middle-aged men. There has been relatively little analysis of death rates among young people, many of which appear related to alcohol and other drug (AOD) use. Death rates ranged from exceedingly high in some countries (e.g. Russia) to very low in others (e.g. Armenia). This divergence among Commonwealth of Independent States (CIS) countries increased considerably over the 1990s. What caused this divergence in youth deaths and what policy response is needed?
  
  
  METHODS
  An ecological study of country-level data was used to explore the relationships between risk factors, AOD use and youth deaths across time and between countries. Qualitative research literature was used to supplement the statistical data.
  
  
  RESULTS
  AOD abuse risk factors were divided into 'proximal causes' (e.g. AOD availability) and 'distal causes' (e.g. social cohesion, welfare, culture). Proximal risk factors appeared to explain some of the AOD use and death data, but they did not explain all of the country differences. Analysis of distal risk factors suggested that family and community strength are important factors in the trends in AOD abuse and youth mortality.
  
  
  CONCLUSIONS
  The policy response to AOD abuse and mortality among young people needs to attend to both proximal and distal factors. An exclusive focus on proximal risk factors is unlikely to provide a satisfactory solution. Rather, the social determinants of child and youth development need to be considered. More research is needed on the relationship between AOD abuse and youth mortality, and on the influence of family and community strength on both these outcomes in the region. Useful lessons may be learned from countries such as Armenia, where both AOD abuse and youth mortality have remained low.
authors.affiliation: Social Policy Research Centre, University of New South Wales, Australia. g.redmond@unsw.edu.au
authors.forename: Gerry
authors.initials: G
authors.lastname: Redmond
authors.forename: Catherine
authors.initials: C
authors.lastname: Spooner
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000208:ethnology / Q000331:legislation & jurisprudence / Q000401:mortality* / Q000523:psychology; D017517:Commonwealth of Independent States / Q000453:epidemiology; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D005195:Family Relations; D033161:Government Regulation; D006291:Health Policy; D006801:Humans; D011203:Poverty; D012111:Residence Characteristics; D012307:Risk Factors; D012309:Risk-Taking; D012922:Social Change; D019966:Substance-Related Disorders / Q000208:ethnology / Q000401:mortality* / Q000523:psychology; D013997:Time Factors; D055815:Young Adult