The increase in mortality since 1988 is more complex because it has coincided with both increased alcohol consumption and important socioeconomic changes in Russian society. We have found that the increase in adult mortality in the period 1988-1992 is symmetrical with the previous decline in the period 1985-1987 (Shkolnikov et al., 1994a). The ageand cause-specific pattern of the decline in death rates during 1985-1987 is rather similar to that of the rise in the period 1988-1992. Moreover, trends in age-adjusted and age-specific death rates for many leading causes of death are closely associated with the trend in real alcohol consumption (Shkolnikov et al., 1994a). This is especially true for external causes of death, which strongly affected life expectancy tendencies in the 1980s and the early 1990s (Meslé et al., 1994). Thus the recent mortality increase in Russia can be explained largely by increases in alcohol consumption. During the anti-alcohol campaign, alcohol consumption was very much reduced, and alcohol-related adult mortality was reduced accordingly. Following the campaign, alcohol consumption started rising (in 1992, it approximated the level of 1984), and mortality rose correspondingly.
Actually, recent changes in Russian mortality are more complex than this simple picture (Shkolnikov et al., 1994b), particularly as regards the dramatic mortality rise in 1993. In that year, life expectancy at birth dropped by 3 years for men and by 1.8 years for women. It is difficult to distinguish the effects of