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`` 

 

 

 

 
 

 

Public Health and Social 

Desirability in Kazakhstan: 
Methodological Considerations  

 

Brett J. Craig & Martha C. 

Engstrom 

 

Department of Communication, Nazarbayev University, 

Kazakhstan 

 

Vol. 4, No. 2 (2015)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2015.191 |   http://cajgh.pitt.edu 

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Central Asian Journal of Global Health 

Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.191|http://cajgh.pitt.edu 

 

 

Abstract 

Background: As the Republic of Kazakhstan undertakes new public health efforts to promote healthy lifestyles among its citizens, 

the local perceptions of health and health behaviors need to be examined and understood from the sociocultural and historical 

perspectives. The primary aim of this study is to examine the association between perception of control on one’s health and 

engagement in good and bad health behaviors. 

Methods: Students enrolled in a health communication course surveyed 310 citizens of Kazakhstan on their perceptions of control 

over their own health and multiple health behaviors (i.e. smoking status, physical activity, etc.). Twenty-seven students were 

divided into groups and approached every third passerby as a potential participant during common shopping hours in nine popular 

marketplaces in Astana, Kazakhstan. Perception of control on one’s health was measured using a validated measure of health 

control: the multidimensional health locus of control scale (MHLC), developed by Wallston and colleagues. The MHLC measures 

three separate loci of control: internal, chance, and powerful others. 

Results: Participants perceived themselves as having highest control over their health (MHLC subscale internal: 29.70±0.64), 

powerful others had second highest control (MHLC subscale power others: 23.72±0.77), and chance had the lowest but still some 

control on their health (MHLC subscale chance: 20.82±0.85). Most participants rated their current health as very good (18.1%), 

good (45.0%), or moderate (32.3%). Approximately 23.4% of participants were smokers, and 22.2% consumed alcohol. Physical 

activity averaged 3.63 days in the past week, and fruit and vegetable consumption averaged 2 servings of each per day.  Tobacco 

and the powerful others subscale were significantly negatively correlated (r=-0.17, p<0.05).   

Conclusions: Participant reports regarding personal health behaviors and lifestyle did not reflect the national reports regarding 

lifestyle behaviors. The relationship between powerful others subscale and tobacco smoking indicate that using healthcare providers 

may open up avenues to lowering tobacco use through patient education; however, social desirability is a notable concern for public 

health interventions. More importantly, the surveys uncovered future questions for conducting public health research with the 

general public, including issues of trust in the healthcare system and social desirability bias. Additional factors such as distrust in 

healthcare and government also may play a role in the public’s participation in social scientific research. The students who 

conducted the surveys reported a general skepticism from the public ranging from unfamiliarity with survey research to explicit 

distrust in the intentions and purpose of the research itself. 

Keywords: public health, social desirability, control of health, Kazakhstan 

 

Public Health and Social Desirability 

in Kazakhstan: 
Methodological Considerations  

 

Brett J. Craig & Martha C. Engstrom 

 

Department of Communication, Nazarbayev University, 

Kazakhstan 

Research 

Health behaviors and public perception of 

health is an important area of investigation in the 

Republic of Kazakhstan. A previous study examining 

public perceptions of control over health and health 

behaviors faced methodological issues of survey 

research.1 Cultural and historical factors in Kazakhstan’s 

health services delivery likely influence the public’s 

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reports on their individual health behaviors due to a focus 

on disease-centric healthcare rather than wellness-

centric.2 The purpose of this study was to examine the 

relationship between the general public’s perceptions of 

control of one’s health with health behaviors. This 

information can then be used to inform early efforts 

undertaken by the Kazakhstan government to promote 

healthy lifestyles. 

Health and the perception of control 

Efforts in health promotion are generally 

structured around the general public’s assumptions 

regarding their current and future health status as related 

to or as a result of their health choices and behaviors.3 

However, the strategies of health promotion using 

information dissemination or even social appeal are 

theoretical constructs that assume particular beliefs and 

perceptions about individual responsibility and control 

regarding outcomes.2 Research shows that different 

cultural groups demonstrate variance in health beliefs, 

health behaviors,4-6 and causes of illness.7 Furthermore, 

political backgrounds of healthcare systems contribute to 

the cultural perceptions of roles and responsibilities 

regarding healthcare professionals and the public.8  

Health behaviors and beliefs have been studied 

extensively in the West, but in post-Soviet countries, this 

phenomenon is in need of further investigation.1,9 The 

post-Soviet Republic of Kazakhstan, in addition to 

undergoing significant changes in its healthcare model,10 

is also beginning to develop efforts in public health 

promotion, which present healthy outcomes as a result of 

an individual’s health behaviors.11 Current public health 

intitiatives aim to address the increasing prevalence of 

lifestyle-related non-communicable diseases, 

specifically cardiovascular disease, in Kazakhstan. 

Health behaviors, such as smoking, are of particular 

interest. However, if the public does not see health 

outcomes as within their locus of control, current efforts 

in health promotion will not produce changes in behavior 

towards healthier lifestyles. 

One established measure of perceived health 

locus of control is the multidimensional health locus of 

control scales (MHLC).12,13 The MHLC were developed 

by Wallston and colleagues to assess participants’ reports 

of how much control they perceive they have over their 

health. The MHLC contains three subscales: internal 

(whether you feel that you have control over your own 

health), chance (whether you feel your health is due to 

luck, fate, or chance), and powerful others (whether you 

feel that powerful individuals, such as physicians or other 

health professionals, control your health). Sample 

questions from these subscales are “If I take care of 

myself properly I can prevent diseases” (internal), “Most 

of the things that affect my health happened to me 

accidentally” (chance), and “The best way for me to 

avoid different sicknesses is to visit a doctor on a regular 

basis” (powerful others).  There are 18 questions in the 

MHLC, six for each subscale, and participants are asked 

to respond on a six-item Likert scale from 1 (strongly 

disagree) to 6 (strongly agree). Scores range from 6 to 

36.5,12,13 Each subscale score indicates the degree of 

control the participant attributes to that source. These 

three subscales are not mutually exclusive and can be 

reported as high in all, low in all, or at various levels.  The 

higher the score, the more the participant is placing 

control in that source. Scores can vary across populations 

and groups, but in general participants who score above 

the median on any score can be considered "high" on that 

subscale, and those who score below could be called 

"low." 

Cultural influences in survey research 

The culture and social system of Kazakhstan is 

different than the context in which these measurement 

scales were derived, and the use of surveys among the 

general public is also a relatively new practice in 

Kazakhstan. Previous research has examined the 

influence of culture on survey research in areas such as 

social desirability, issues in translation and meaning, and 

the use of the Likert scale format. 

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Social desirability, using the definition of 

Johnson and Van de Vijver, is “the tendency of 

individuals to ‘manage’ social interactions by projecting 

favorable images of themselves, thereby maximizing 

conformity to others and minimizing the danger of 

receiving negative evaluations from them.”14 Though 

social desirability is likely to be a universal concept, a 

participant’s perception of which answer to a question 

would help him or her appear to be more socially 

desirable varies across cultures. Previous research has 

indicated that there are cultural influences on social 

desirability, particularly in collectivistic cultures, where 

survey respondents tend to answer questions in a manner 

that would be viewed favorably by others.14-16 Honesty 

with strangers in an interaction is valued more in 

individualist cultures, whereas a concern for social 

desirability can bias results to over-report good behavior 

or under-report bad behavior in collectivist cultures.17  

Therefore, social desirability may be more of an 

influence in collectivist cultures than in individualist 

cultures.18,19   

Effectively translating survey instruments from 

their source language is an important part of cross-

cultural research. If meaning is not preserved across 

languages, the original intent of the instrument can be lost 

or distorted, in addition to compromising its validity and 

reliability.20 Embedded in language are the experiences 

and norms for word usage that can be different across 

cultures.21 In order to preserve meaning and intent, 

Brislin’s22 model of translation focuses primarily around 

the notion of back translation. An instrument should be 

translated to the operative language and then translated 

back to the source language by someone unfamiliar with 

the instrument in its source language.  This way the back 

translation can be compared to the original instrument to 

check for consistent meanings. 

The use of Likert scales, where participants 

respond by indicating on a scale the degree to which they 

agree or disagree with a statement, is very popular among 

instruments used in survey research. Research has shown 

people from different cultural groups tend to respond 

differently in surveys using Likert scales. Hui and 

Triandis23 found that some groups are more prone to 

report extremes on the scales than others, while Lee, 

Jones, Mineyama, and Zhang24 found that some groups 

favor the midpoint response when cultural beliefs would 

encourage it. Likert scales can include different 

quantities of items, but most common are 4-point, 5-

point, 6-point, and 7-point. The MHLC scales used in this 

study are typically used with a 6-point scale response 

scale.  

The objective of this paper is to establish the 

usability of the MHLC scale as well as explore the issues 

of survey research through street contacts with the 

general public in Kazakhstan.  Researchers using these 

scales, as well as other similar public health 

measurements, may benefit from learning from the 

results of this study. 

 

Methods 

To begin investigating how culture influences 

the perception of control and responsibility in health in 

Kazakhstan, surveys were distributed in nine 

marketplaces in Astana, Kazakhstan after receiving 

approval from Nazarbayev University’s research and 

ethics committee. Surveys included questions about basic 

demographic information and health behaviors, such as 

alcohol and tobacco use, exercise, and diet. We included 

the MHLC scales as the primary measure to determine 

levels of perceived control. Surveys were translated from 

their original language (English) into both Russian and 

Kazakh by a professional translator. A different 

professional translator who had not seen the original 

English version then back translated both translated 

versions into English. Modifications in the translated 

versions were then made to preserve the meaning and 

clarity of the original survey. 

Students from the communication course 

Science, Health and Social Influence, a third-year course, 

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participated in the collection of survey data for this study. 

After learning about the scales as a part of coursework, 

students were trained on how to approach participants 

and handle the distribution and collection of survey data. 

Their training took place as part of the course work and 

focused on the ethics of research, confidentiality, 

interaction with research participants, and techniques of 

answering questions about the research without biasing 

the responses. Twenty-seven students were divided into 

groups of three to create nine groups.  Each group was 

assigned a popular marketplace within the city limits of 

Astana. The marketplaces and their corresponding 

locations within the districts are given in Table 1. 

 

Table 1:  Marketplaces in Astana by district 

 

The marketplaces were chosen on the basis of 

improving regional diversity, while using marketplaces 

that represent common places of general public 

gathering. On a weekend during common shopping 

times, students approached every third passerby as a 

potential participant. This pattern of approaching 

participants did not create a truly random sample, but it 

helped prevent bias on the part of the students in whom 

they chose to approach. Though the marketplaces are 

commonly attended areas by many different groups of 

people, one limitation is that not all groups would be 

equally represented at the marketplaces, especially if 

their health conditions do not permit such activity. 

Records of completed surveys and the numbers of 

potential participants approached were carefully 

monitored. Students were asked to record their 

experiences and impressions afterwards to provide 

further data on this pilot study. 

Data analysis 

First, we conducted descriptive statistics on 

participant characteristics. Second, we examined the 

association of participant characteristics (e.g. age, sex, 

etc.) on MHLC sub-scales using independent-samples t-

tests. Finally, we used bivariate correlation to test the 

association between participant characteristics and each 

of the MHLC sub-scales. All analyses were conducted 

using SPSS, using p<0.05 as the cut-off for significance. 

 

Results  

Participants 

Students collectively approached 824 people, 

310 of which agreed to participate, yielding a 38% survey 

response rate. Of those who responded, 57.7% were 

female with a mean age of 32.53 (SD=13.65).  Details 

regarding the participant language, ethnicity, and marital 

status can be found in Table 2. 

 

Table 2:  Demographic descriptive characteristics of 

participants 

 

Descriptives of participant health 

Participants were asked to rate their overall 

health status.  Nearly all participants rated their current 

health as moderate (32.3%), good (45.8%), or very good 

(18.1%). With regards to health behaviors, 23.4% of 

participants were smokers and 22.3% consumed alcohol. 

Physical activity averaged around 3.63 days in the past 

week, and fruit and vegetable consumption averaged 2 

servings of each per day. Further information on 

participant health ratings and reported behaviors can be 

found in Table 3. 

 

Table 3:  Descriptive characteristics of participant health 

 

Multidimensional health locus of control scores 

Most participants tended to perceive themselves 

as having high control over their health (MHLC subscale 

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internal: 29.70±0.64). Participants perceived others, such 

as medical providers, as having high control over their 

health (MHLC subscale power others: 23.72±0.77). 

Participants perceived chance as a somewhat likely entity 

to have control over their health (MHLC subscale 

chance: 20.82±0.85).   

Analysis of association and correlation of predictors of 

MHLC subscales 

Most health behaviors were not significantly 

correlated with any of the reported MHLC subscales and 

differences in sex, age, language or ethnicity. Tobacco 

smoking was significantly, though weakly, associated 

with the powerful others subscale (r=-0.17, p<0.05). 

 

Discussion  

 In this study, in addition to the results of the MHLC 

survey, we found methodological issues common to 

cross-cultural research, such as translation of 

measurements and social desirability in addition to other 

issues perhaps more unique to the region. 

MHLC results 

Such MHLC scores are different than white 

European cultural groups, but they are similar to South 

Asian cultural groups, especially with the powerful 

others and internal subscales,5 revealing possible cultural 

influences on perceptions of health and health behaviors. 

The subscales, developed in a Western cultural setting, 

often find that those reporting a high level of internal 

control report lower scores in control residing in external 

areas such as chance or powerful others. However, as 

Steptoe and Wardle3 found in their study of Eastern 

Europeans and Wrightson and Wardle6 found in their 

study comparing white Europeans with South Asian and 

Afro-Caribbean, these subscales are not always at odds 

with one another in other cultural groups. 

Our pilot study revealed that this also might be 

the case in Kazakhstan. While these participants reported 

high levels of internal control, they also reported high 

levels of control coming from powerful others 

(influential people in their lives). Some possible 

explanations of this perception include the influence of 

the Soviet model of healthcare that focused on treatment 

of disease rather than on health and prevention.1,25 

Healthcare was (and largely still is) provided by the 

government and, therefore, was seen as the responsibility 

of the government. While healthy lifestyles are now 

being promoted and the public may even be reporting a 

sense of control over their own health through their 

lifestyle, the perception that health still resides in the 

hands of powerful others such as healthcare providers 

may be influencing the powerful others subscale score. 

The significant negative correlation between 

tobacco use and the powerful others subscale also 

deserves further investigation. Those who are using 

tobacco are less likely to perceive healthcare providers as 

influencing their health, while those who perceive 

healthcare providers as having some control over their 

heath are less likely to use tobacco. Possible explanations 

for this phenomenon include anti-tobacco messages from 

healthcare providers as well as those participants who are 

generally more health conscious and avoid tobacco also 

see their healthcare providers regularly. 

Methodological issues 

Though several methodological features of this 

study were consistent with similar studies done 

elsewhere such as the response rate of street contacts and 

the influence of survey fatigue, by using the reported 

experiences of students distributing the surveys we found 

that the issues of translation, Likert scales, and social 

desirability may be significantly influencing the 

effectiveness of using surveys, particularly through street 

contacts. Furthermore, the additional issue of trust was 

made salient in the interactions between participants and 

survey distributors.   

Translation and meaning 

Though we had the survey translated and back 

translated into both Russian and Kazakh languages so 

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that participants could respond in their native language, 

participants struggled with many of the questions and 

some were irritated with the translation. Students 

distributing these surveys reported most frequently that 

participants made comments about the questions in the 

MHLC scales being repetitive and not discernibly 

different from one another. This may be an imperfection 

in accurately translating subtle differences in the 

questions, and it may also reveal differences in 

constructions of concepts and perceptions embedded 

within the languages themselves regarding relationships 

with others and control over situations and outcomes.  

As the government of Kazakhstan has been 

strengthening the use and presence of the Kazakh 

language,26 the need for properly translated instruments 

will continue to grow. As demonstrated, translation is 

extremely important for linguistic comprehension and for 

cultural conceptualization and familiarity.  

Likert scales and time 

The use of Likert scales was not reported by 

participants as a point of confusion; however, the 

unfamiliarity with the concept as well as using the 6-

point scales may have contributed to time and even 

survey fatigue. Many students noted that it took much 

longer than typical to fill out a two-page questionnaire. 

Other research suggests simplifying a 6-point to a 4-point 

scale for different populations without a loss in reliability 

or validity.20 The confusion created by the fact so many 

questions seemed to be the same according to the 

participants might have been compounded by the choice 

in six responses for each question. Using 4-point scales 

or more simplified versions of responses may improve 

the accuracy of responses and decrease survey fatigue. 

Social desirability and culture 

The participants’ reports on tobacco and alcohol 

use are much lower than expected considering the World 

Health Organization’s (WHO) nationwide statistics on 

usage.27 Additionally, their reports on diet and exercise 

indicate a much healthier sample than the greater 

population where the prevalence of behaviorally related 

diseases creates a significant burden and is projected to 

increase.28 Though our sample of participants is not truly 

random and cannot be expected to closely match 

generalized figures, the relatively healthy behaviors 

reported on average indicate the possibility of social 

desirability influencing responses. As Kazakhstan is a 

more collectivistic than individualistic society, it is likely 

that many survey responses may be influenced by a 

strong desire to save face, especially when answers to 

questions can reflect a negative image. Some students 

reported experiences where participants either ignored or 

did not understand anonymity and privacy and felt they 

had to explain and justify each of their answers to the 

students. A few students rather indignantly reported that 

they knew participants were not being honest about their 

behaviors such as tobacco use because students could see 

packages of cigarettes in participants’ hands or pockets. 

However, the age of the students needs to be considered 

in the collection of data because Kazakhstan is a 

hierarchical culture which values age as well as position. 

Thus, their responses to these students may be influenced 

by these norms and values. 

If social desirability significantly influenced 

these participants’ responses, this may further add to the 

knowledge gained from this pilot study. In order for 

social desirability to influence participants’ answers 

regarding health behaviors, the participants must possess 

a basic knowledge of what a healthy lifestyle is. 

Therefore, though their health behaviors may not actually 

be as healthy as they reported, participants may have 

more knowledge of what healthy behaviors are and why 

they are socially desirable than was expected. If health 

promotion is to be effective it needs to be informed by 

research that has examined influences on health 

behaviors beyond knowledge and information. Research 

in Kazakhstan needs to explore social and economic 

factors that are shaping the population’s health behaviors. 

More research is needed regarding the public’s 

perspectives on why they do what they do rather than 

simply what they know. 

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Trust   

One unanticipated issue students encountered in 

administering questionnaires was lack of trust in the 

healthcare system. Participants frequently asked about 

the purpose of the survey. When students told them it was 

to help better promote health in Kazakhstan, they 

generally expressed disbelief. Some participants laughed 

and mocked the students for being naïve. Others refused 

to participate because it would be a “waste of time.” 

Some participants shared stories of negative experiences 

with healthcare system, while others went so far as to 

name doctors who they felt were responsible for bad care. 

Additionally, participants expressed distrust in the 

research process itself, claiming such work will not help 

improve anything. However, some participants were 

interested in knowing the results of the survey and even 

expressed appreciation, saying more research like this 

needed to be done. 

Trust is a common issue in many post-Soviet 

healthcare systems because of Soviet-era characteristics, 

such as paternalism, that current governments are 

struggling to change. Health care during the Soviet era 

was largely underfunded and included non-evidence 

based practices and beliefs,8 where corruption has been a 

problem in the form of informal payments.29 These 

characteristics, coupled with lack of knowledge on 

preventive practices, results in the general public not 

seeking timely medical care.30 The perception that 

utilizing healthcare services will not yield desired results 

needs to be addressed in future research. The issue of 

trust may have higher relevance when considering the 

high MHLC subscale score of powerful others. If the 

public perceives control over their health to be in the 

hands of powerful others such as doctors but does not 

trust doctors, this may influence health behaviors and 

choices leading to negative outcomes. It may also 

dissuade the public from using medical services in 

appropriate and necessary ways.  

One of the most important methodological 

approaches utilized in this study was the involvement of 

students in data collection. We believe that this 

experience exposed students to the nature of research and 

data collection and helped them to think more critically 

about data collection and statistical approaches to use for 

survey research. It also helped students to see the value 

in seeking out and measuring the public’s perception 

because through their experiences these students learned 

how diverse in opinion and experience their fellow 

citizens actually are.  While we attempted to obtain a 

diverse sample of participants in this study by going to 

marketplaces belonging to different socioeconomic 

classes, we also acknowledge the limitations in the 

generalizability of this study.  Astana itself as the capital 

city of Kazakhstan is drawing people from different 

regions within the country to live there, and as such may 

not be representative of the entire country.   

 

Conclusions 

This pilot study has revealed significant 

challenges to conducting face-to-face survey research 

with the general population of Kazakhstan. Due to 

cultural influences on social interactions with research 

staff, participants’ answers to survey questions could be 

significantly influenced by social desirability. 

Additionally, a history of distrust with authority figures 

may also influence participants to alter their answers or 

influence decision to participate in research. These are 

issues that need to be considered and accounted for in 

designing and carrying out social scientific research in 

Kazakhstan, and Central Asia in general. 

 

 

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2. Sharman A. A new paradigm of primary health care in 

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CRAIG 

 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.191|http://cajgh.pitt.edu 

 

 

Table 1: Marketplaces in Astana by district 

Market District 

Tsum Saryarka West 

Alem Saryarka North 

Khan Shatyr Yesil West 

Near railway station Saryarka outer region 

New Central Market Almaty North 

Anvar Food Fair Yesil South 

Arteom Saryarka Center 

Gulzhan Saryarka Center 

Shapagat Saryarka East 

 

  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.191|http://cajgh.pitt.edu 

 

 

Table 2: Demographic descriptive characteristics of participants 

Variables 

m±SD  

or  

N(%) 

Age 32.53 ± 13.65 

  

Sex  

   Male 130 (41.9) 

   Female 179 (57.8) 

   Unknown 1 (0.3) 

Language  

   Russian 231 (74.5) 

   Kazakh 79 (25.5) 

Ethnicity  

   Kazakh 230 (74.2) 

   Russian 51 (16.5) 

   Other/Unknown 29 (9.3) 

Marital status  

   Currently married 131 (42.3) 

   Never married 108 (34.8) 

   Divorced 19 (6.1) 

   Widowed 13 (4.2) 

   Cohabitating 10 (3.2) 

   Separated 5 (1.6) 

   Cohabitating 2 (0.6) 

   Unknown 22 (7.2) 

 

  

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http://www.pitt.edu/
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CRAIG 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 2 (2015) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.191|http://cajgh.pitt.edu 

 

 

Table 3. Descriptive characteristics of participant health 

Variables 

Total 

m±SD 

or 

N (%) 

Female 

m±SD 

or 

N (%) 

Male 

m±SD 

or 

N (%) 

Physical activity 3.63 ± 0.23 3.08 ± 2.85 3.83 ± 2.63 

Fruit servings 2.03 ± 0.23 2.08 ± 1.86 1.96 ± 2.02 

    

Health status rating    

   Very good 56 (18.1) 22 (12.2) 34 (26.2) 

   Good 142 (45.8) 84 (46.9) 58 (44.6) 

   Moderate 100 (32.3) 66 (36.9) 34 (26.2) 

   Bad 3 (1.0) 3 (1.7) 0 (0.0) 

   Very bad 1 (0.3) 1 (0.6) 0 (0.0) 

   Unknown 8 (2.5) 3 (1.7) 4 (3.0) 

Tobacco smoking    

   Daily 37 (12.0) 6 (3.4) 31 (23.8) 

   Non-daily 32 (10.3) 13 (7.3) 19 (14.6) 

   Did not smoke 224 (72.3) 151 (84.3) 73 (56.2) 

   Unknown 17 (5.4) 9 (5.0)  7 (5.4) 

Alcohol consumption (past week)    

   None 215 (69.3) 118 (65.9) 97 (74.6) 

   Yes (average of 2.28 drinks) 69 (22.3) 36 (20.1) 33 (25.4) 

    Unknown 26 (8.4) 25 (14.0) 0 (0.0) 

 

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