practice, however. In some countries, alcohol-related deaths are coded to various other causes, such as acute alcohol poisoning; alcohol dependence; and drug-use, subcode alcohol.

We turn now to a more detailed examination of the mortality patterns in North FSE.

Understanding North FSE

The mortality trends and cause-of-death patterns in North FSE are unique. Many hypotheses advanced to explain the rising adult mortality in the former Soviet Union really apply primarily to this region. The same set of factors can also be invoked to explain not only the trend, but also the high level of adult male mortality. Each of these factors is discussed in turn below.

Alcohol. Excessive intake of hard liquor has been the most popular explanation for adult mortality in the Former Socialist Economies (see the chapters by Treml and Shkolnikov and Nemtsov, in this volume). Some of the share of excess years of life lost due to cirrhosis, neuropsychiatric causes, motor vehicle accidents, poisonings, falls, drownings, suicides, and homicides is probably related to alcohol; nevertheless, total alcohol consumption rates are lower than in a number of West European countries (NTC, 1992). Alcohol probably plays a greater role in acute intoxication and the associated risk of injury or poisoning. This profile of alcohol-related mortality is consistent with the short-term reduction in mortality associated with Gorbachev's anti-alcohol campaign (Blum and Monnier, 1989).

Smoking. Smoking rates are high in the Former Socialist Economies. The Monitoring Cardiovascular Disease Study (MONICA) surveillance sites in Warsaw, Budapest, and Moscow show age-standardized rates of regular smoking of 58, 52, and 47 percent, respectively, for males in 1984 (World Health Organization, 1994). Total cigarettes per capita is, however, still lower than in many Western communities (U.S. Department of Agriculture, 1993). The cause-of-death profile shows that lung cancer accounts for nearly 4 percent of total years of life lost. Other smoking-associated causes play a large role as well. Lopez (in this volume) provides estimates of smoking-attributable mortality by republic in the age groups 30-69 and 70+. Because of the high underlying rates of cardiovascular disease in this region, the Peto et al. (1992) method may exaggerate the proportion of these causes attributed to smoking.

Cohort Effect. A popular explanation for the rise in mortality among adult males within the former Soviet Union is the effect of deprivation during World War II on a cohort of adult males. As Eberstadt (1990) notes, there are two main reasons to suggest that this effect may not be very important. First, some areas severely affected by World War II, such as The Netherlands, failed to experience a similar mortality increase. Second, some of the age groups affected by rising adult male mortality in North FSE were born after World War II.



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