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Introduction Methods Results Discussion and Conclusions Although integrated alcohol policies, characterised by being consistent, structurally connected and interdependent, are considered to be best practices, very few evaluations of such policies exist. We evaluated the impact of two phases of integrated alcohol policies implemented in Lithuania in 2008/2009 and 2017/2018 on adult (15+ years of age) alcohol per capita consumption.Alcohol per capita consumption was the main outcome, based on national data from Statistics Lithuania. Time‐series analyses using generalised additive mixed models were used, and unrecorded consumption trends were examined. A sensitivity analysis was conducted with data from the World Health Organization.The two phases of integrated alcohol policies were associated with average reductions in adult alcohol per capita consumption of almost 1 litre (−0.88 L; 95% confidence interval −1.43; −0.34). Sensitivity analyses with comparable international data on Lithuania yielded similar results.Integrated alcohol policies had a substantial effect on the average level of consumption. However, the effect of major single policies for Lithuania and other Baltic countries has been estimated to be of about the same magnitude. We conclude that in order to be successful, integrated alcohol policies should include at least one major effective population‐based policy. [ABSTRACT FROM AUTHOR]

Background Consumption of alcohol is a risk factor for non-communicable and infectious diseases, mental health problems, and can lead injuries and violence. The aim of this study was to evaluate the prevalence of alcohol-involved deaths among decedents who died of external causes and underwent autopsy in Lithuania. Methods Study includes age persons of any age (from 0 to 110 years) who died and were autopsied in Lithuania from 1 January 2017 to 31 December 2020. Data were obtained from the Lithuanian State Register of Deaths and Their Causes. Results Among external causes of death, the presence of alcohol was detected in 55.0% of cases. Male decedents had a significantly higher number of positive BAC level recorded, at 46.6%, compared with female decedents (32.1%; P  < 0.001). The highest incidence of deaths where the alcohol was detected in the deceased's blood was found when the decedent was listed as being in the victims of assault group (71.5%, 95% CI 65.4–77.2). However, the highest median BAC score was found for those in the accidents group (59.7%, 95% CI: 58.2–61.2, BAC 2.42 ‰, IQR 1.86). Conclusions The findings of this study suggest that alcohol use may be a contributing factor in a wide range of fatal incidents, including accidents, injuries, and cases of violent intent. Inequalities between males and females were identified, with a higher proportion of males with alcohol detected in blood at the time of death. [ABSTRACT FROM AUTHOR]

Background: The national lockdowns that occurred all over the world in response to the Coronavirus Disease 2019 (COVID‐19) pandemic have been found to have impacted alcohol use. The aim was to evaluate the impact of COVID‐19‐related national lockdowns on alcohol‐related traffic collisions, injuries, and fatalities in Lithuania. Methods: Using monthly data from the Lithuanian Road Police Service for January 2004 to December 2022, we performed interrupted time‐series analyses using a generalized additive model to evaluate the impact of COVID‐19‐related national lockdowns on alcohol‐related traffic collisions, injuries, and fatalities. In Lithuania, the COVID‐19‐related lockdowns occurred from March 2020 to June 2020 and from November 2020 to June 2021. Results: Although overall rates for traffic collisions and injuries decreased during the COVID‐19‐related lockdowns in Lithuania, these lockdowns were associated with a 3.21% (95% CI: 1.19%, 5.23%) increase in the relative proportion of alcohol‐related traffic collisions and a 2.46% (95% CI: 0.12%, 4.80%) increase in the relative proportion of alcohol‐related traffic injuries. The association between the lockdowns and alcohol‐related traffic fatalities was not statistically significant. Conclusion: The COVID‐19‐related national lockdowns in Lithuania were associated with a decrease in the overall rate of traffic collisions and injuries, but an increase in the relative proportion of alcohol‐related traffic collisions and injuries. [ABSTRACT FROM AUTHOR]

Aims: From 1 January 2018, the number of retail hours for the sale of alcohol was reduced from 14 to 5 hours on Sundays and from 14 to 10 hours on the other days of the week in Lithuania. The significant reduction of hours for the sale of alcohol on Sundays may have affected the distribution of alcohol-attributable deaths during the week. This study aimed to examine the change in the weekly pattern of alcohol-attributable male mortality before and after imposing limits on the hours when alcohol can be sold. Methods: Age-standardised male death rates by days of the week were calculated for four groups according to cause of death: alcohol poisoning (X45), all external causes of death (V01–Y98), diseases of the circulatory system (I00–I99) and all other causes of death. We compared age-standardised death rates for two periods: before (2015–2017) and after (2018–2019) the intervention. Mortality and population data were obtained from the Lithuanian Institute of Hygiene and Human Mortality Database. Results: We found that during 2018–2019, earlier observed peak in age-standardised death rates for external causes of death on Sunday diminished, and this day no longer differed from the weekly average. The same tendency was also observed for the Monday excess mortality due to circulatory diseases. Conclusions: The reduction of the hours when alcohol can be sold from the beginning of 2018 was associated with a change in a weekly pattern of alcohol-attributable male mortality. However, more studies are needed to examine the causes of the change in mortality pattern. [ABSTRACT FROM AUTHOR]

Background: Lithuania, a Baltic country in the European Union, can be characterized by high alcohol consumption and attributable burden. The aim of this contribution is to estimate the mortality burden due to alcohol use for the past two decades based on different relative risk functions, identify trends, and analyse the associations of alcohol-attributable burden with alcohol control policies and life expectancy. Methods: The standard methodology used by the World Health Organization for estimating alcohol-attributable mortality was employed to generate mortality rates for alcohol-attributable mortality, standardized for Lithuania's 2021 population distribution. Joinpoint analysis, T-tests, correlations, and regression analyses including meta-regressions were used to describe trends and associations. Results: Age-standardized alcohol-attributable mortality was high in Lithuania during the two decades between 2001 and 2021, irrespective of which relative risks were used for the estimates. Overall, there was a downward trend, mainly in males, which was associated with four years of intensive implementation of alcohol control policies in 2008, 2009, 2017, and 2018. For the remaining years, the rates of alcohol-attributable mortality were stagnant. Among males, the correlations between alcohol-attributable mortality and life expectancy were 0.90 and 0.76 for Russian and global relative risks respectively, and regression analyses indicated a significant association between changes in alcohol-attributable mortality and life expectancy, after controlling for gross domestic product. Conclusions: Male mortality and life expectancy in Lithuania were closely linked to alcohol-attributable mortality and markedly associated with strong alcohol control policies. Further implementation of such policies is predicted to lead to further improvements in life expectancy. [ABSTRACT FROM AUTHOR]

Introduction: Major alcohol control policy measures in the Baltic countries and Poland have been shown to reduce alcohol per capita consumption (APC), 100% alcohol-attributable and all-cause mortality. This publication aims to estimate the effects of taxation increases and availability restrictions separately. Material and methods: Data were obtained from the statistical offices of the countries included except for alcohol consumption data, which were taken from the WHO for comparability reasons. Various types of regression analyses were conducted on time-series data using generalized additive mixed models. Results: On average, taxation increases were associated with decreases in APC (-0.89 litres (l); 95% CI: -1.35 l, -0.43 l) and all-cause mortality (-1.3%; 95% CI: -2.4%, -0.17%) among males. Given the average number of deaths in the four countries, the 1.3% reduction in the male mortality rate corresponds to 93 deaths postponed in Estonia, 166 in Latvia, 239 in Lithuania, and 2,606 in Poland, using the 2019 populations of the respective countries as the reference points. For 100% alcohol-attributable mortality, there were significant associations with availability restrictions for males (-12.1%; 95% CI: -17.8%, -6.4%) and females (-8.5%; 95% CI: -16.3%, -0.7%), as well as with taxation for females (-9.06%; 95% CI: -14.02%, -3.83%). All other associations were in the hypothesized direction but did not reach statistical significance. Conclusions: Different effects were found for taxation increases and availability restrictions. The former works via reducing the level of consumption, and thereby reduces all-cause mortality, while the latter seems to work more specifically on reducing heavy drinking occasions and consequently in particular on decreasing 100% alcohol-attributable mortality. Both alcohol control policies important to reduce consumption and alcohol-attributable mortality. However, they produce partly different outcomes, and thus should be implemented depending on the epidemiological profile and the desired effects. [ABSTRACT FROM AUTHOR]

The aim of the study was to estimate unrecorded alcohol consumption in Lithuania for the period 2000–2021 using an indirect method for modelling consumption based on official consumption data and indicators of alcohol-related harm. Methodology employed for estimating the unrecorded alcohol consumption was proposed by Norström and was based on the country's 2019 European Health Interview Survey and indicators of fully alcohol-attributable mortality. The proportion of unrecorded alcohol consumption was estimated as 8.30% (95% CI 7.7–8.9%) for 2019 in Lithuania. The estimated total (recorded and unrecorded) alcohol per capita consumption among individuals 15 years of age and older in 2019 was 12.2 L of pure alcohol, 1.01 (95% CI 0.94–1.09%) L of which is likely unrecorded. The lowest unrecorded alcohol level was estimated for 2009 and 2014, while 2018 had the highest level (i.e. 9.33% of total alcohol per capita consumption). Unrecorded alcohol consumption in Lithuania is likely to be modest when compared to recorded alcohol consumption, the latter of which still remains a major challenge to public health. [ABSTRACT FROM AUTHOR]

It is reasonable to believe that the alcohol policy environment can impact the suicide mortality rates in a given country, considering the well-known link between alcohol use and death by suicide. The current literature, albeit limited, suggests that an increase in alcohol taxation may result in a decrease in deaths by suicide and that the effect is sex-specific. Therefore, the objective of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on suicide mortality among adults 25–74 years of age in Lithuania, by sex. To estimate the unique impact of three alcohol control policies, we conducted interrupted time-series analyses by employing a generalized additive mixed model on monthly sex-specific age-standardized suicide mortality rates from January 2001 to December 2018. Analyses showed a significant impact of the 2017 (p = 0.016) alcohol control policy on suicide mortality for men only. Specifically, we estimated that in the year following the 2017 policy enactment, approximately 57 (95% CI: 9–107) deaths by suicide were prevented among men, 25–74 years of age. The three policy enactments tested were not found to significantly impact the suicide mortality rate among women. Alcohol control policies involving pricing, which result in a notable decrease in alcohol affordability, could be a cost-effective indirect suicide prevention mechanism in not only countries of the former Soviet Union, but in other high-income countries with a comparable health care system to that in Lithuania. Increasing excise tax on alcohol was found to have a sex-specific impact on suicide mortality The 2017 alcohol policy prevented 57 deaths by suicide among men, 25–74 years of age, in the following year Alcohol pricing policies may be a cost-effective indirect suicide prevention mechanism [ABSTRACT FROM AUTHOR]

Background According to the Lithuanian law to prevent the sale of alcohol to customers below the legal minimum purchasing age of 20 years, young adults below 25 years must be asked to show an age-verification document when purchasing alcohol. The aim of this study was to assess whether off-premise outlets comply with the law. Methods In 2022, mystery-shopping study was carried out in three consecutive phases: (i) in a representative sample (n  = 239) of off-premise alcohol outlets covering all Lithuanian district centres, (ii) after lifting the requirement to wear a mask and (iii) after warning the outlets that a mystery-shopping study was ongoing. Phases 2 and 3 were held in two cities. The mystery shopping involved attempts by young, but legally eligible customers to purchase alcohol. Across the three study phases, we compared compliance with the law by measuring overall success of purchase attempts and included situational characteristics (working day or weekend), time of day and number of customers in line as an additional predictor. Results Out of 239 attempts to purchase alcohol from off-premise outlets in the main phase of the study, 107 (or 44.8%) were considered to be successful (visits in which staff were willing to sell alcohol). There was a significantly higher chance of success to purchase alcohol with no ID request if a mystery shopper was the only customer in a queue and on weekends. Conclusions The results indicate an insufficient level of age-verification control in Lithuania, and that additional action is needed to increase compliance. [ABSTRACT FROM AUTHOR]

Introduction: Comparative risk assessments (CRAs) for alcohol use are based on indirect estimates of attributable harm, and usually combine country-specific exposure estimates and global risk relations derived from meta-analyses. CRAs for Eastern European countries, such as Lithuania, base their risk relations not on global risk relations, but on a large Russian cohort study. The availability of a direct estimate of alcohol-attributable mortality following the 2017 implementation of a large increase in alcohol excise taxes in Lithuania has allowed a comparison of these indirect estimates with a country-specific gold standard. Methods: A statistical modelling study compared direct (predictions based on a time-series methodology) and indirect (predictions based on an attributable-fraction methodology) estimates of alcohol-attributable mortality before and after a large increase in alcohol excise taxes in Lithuania. Specifically, Russia-specific versus global relative risks were compared against the gold standard of time-series based predictions. Results: Compared to direct estimates, indirect estimates markedly underestimated the reduction of alcohol-attributable mortality 12 months post intervention by at least 63%. While both of the indirect estimates differed markedly from the direct estimates, the Russia-specific estimates were closer to the direct estimates, primarily due to higher estimates for alcohol-attributable cardiovascular mortality. Discussion: As all indirect estimates were markedly lower than direct estimates, current overall relative risks and price elasticities should be re-evaluated. In particular, global estimates should be replaced by new regional estimates based on cohort studies. [ABSTRACT FROM AUTHOR]

Introduction: On 1 January 2018, an amendment to the alcohol control law was introduced in Lithuania which, among other changes, reduced trading hours for alcoholic beverages by 4 h for weekdays and Saturdays, and by 9 h for Sundays. The objective of the current study was to quantify the potential association of this law with the numbers and types of emergency room (ER) visits in Lithuania, in general and specifically for Sundays, for all ER visits, for injury‐related ER visits and specifically for alcohol poisoning as a 100% alcohol‐attributable cause. Methods: Sex‐stratified time‐series analysis‐based models for the period 2016–2019 were used to test for associations and for potential alternative explanations (e.g., the increase in minimum legal drinking age, which occurred at the same time). Results: Overall, while the reduction in sales hours for both sexes was associated with slight increases in all types and in injury‐related ER visits on a weekly basis, the association with ER visits for alcohol poisoning was in the opposite direction for men in all models. Specifically, among men, it was associated with an approximate decrease of 20% of alcohol poisoning‐related ER visits on Sundays and an approximate decrease of 12% of alcohol poisoning‐related ER visits for all seven weekdays. Discussion and Conclusions: As predicted, restrictions on availability were associated with marked reductions in ER visits for alcohol poisoning in men. However, contrary to expectations, there were no overall reductions in overall ER visits, nor reductions in injury‐related ER visits. [ABSTRACT FROM AUTHOR]

Background : Taxation increases which reduce the affordability of alcohol are expected to reduce mortality inequalities. A recent taxation increase in Lithuania offers the unique possibility to test this hypothesis. Methods: Census-linked mortality data between 2011 and 2019 were used to calculate monthly sex- and education-stratified age-standardized mortality rates for the population aged 40 to 70 years. As primary outcome, we analysed the difference in age-standardized all-cause mortality rates between the population of lowest versus highest educational achievement. The impact of the 2017 taxation increase was evaluated using interrupted time series analyses. To identify whether changes in alcohol use can explain the observed effects on all-cause mortality, the education-based mortality differences were then decomposed into n = 16 cause-of-death groupings. Results: Between 2012 and 2019, education-based all-cause mortality inequalities in Lithuania declined by 18% among men and by 14% among women. Following the alcohol taxation increase, we found a pronounced yet temporary reduction of mortality inequalities among Lithuanian men (− 13%). Subsequent decomposition analyses suggest that the reduction in mortality inequalities between lower and higher educated men was mainly driven by narrowing mortality differences in injuries and infectious diseases. Conclusions: A marked increase in alcohol excise taxation was associated with a decrease in mortality inequalities among Lithuanian men. More pronounced reductions in deaths from injuries and infectious diseases among lower as compared to higher educated groups could be the result of differential changes in alcohol use in these populations. [ABSTRACT FROM AUTHOR]

Background: Despite being two Baltic countries with similar histories, Estonia and Lithuania have diverged in life expectancy trends in recent years. We investigated this divergence by comparing cause-specific mortality trends.Methods: We obtained yearly mortality data for individuals 20 + years of age from 2001-2019 (19 years worth of data) through Statistics Lithuania, the Lithuanian Institute for Hygiene, and the National Institute for Health Development (Estonia). Using ICD-10 codes, we analyzed all-cause mortality rates and created eight major disease categories: ischemic heart disease, cerebrovascular disease, all other cardiovascular disease, cancers (neoplasms), digestive diseases, self-harm and interpersonal violence, unintentional injuries and related conditions, and other mortality (deaths per 100,000 population). We used joinpoint regression analysis, and analyzed the proportional contribution of each category to all-cause mortality.Results: There was a steeper decline in all-cause mortality in Estonia (average annual percent change, AAPC = -2.55%, 95% CI: [-2.91%, -2.20%], P < .001) as compared to Lithuania (AAPC = -1.26%, 95% CI: [-2.18%, -0.57%], P = .001). For ischemic heart disease mortality Estonia exhibited a relatively larger decline over the 19-year period (AAPC = -6.61%, 95% CI: [-7.02%, -6.21%], P < .001) as compared to Lithuania (AAPC = -2.23%, 95% CI: [-3.40%, -1.04%], P < .001).Conclusion: Estonia and Lithuania showed distinct mortality trends and distributions of major disease categories. Our findings highlight the role of ischemic heart disease mortality. Differences in public health care, management and prevention of ischemic heart disease, alcohol control policies may explain these differences. [ABSTRACT FROM AUTHOR]

Aims To examine how standard analytical approaches to model mortality outcomes of alcohol use compare to the true results using the impact of the March 2017 alcohol taxation increase in Lithuania on all-cause mortality as an example. Methods Four methodologies were used: two direct methodologies: (a) interrupted time-series on mortality and (b) comparing predictions based on time-series modeling with the real number of deaths for the year following the implementation of the tax increase; and two indirect methodologies: (c) combining a regression-based estimate for the impact of taxation on alcohol consumption with attributable-fraction methodology and (d) using price elasticities from meta-analyses to estimate the impact on alcohol consumption before applying attributable-fraction methodology. Results and Conclusions While all methodologies estimated reductions in all-cause mortality, especially for men, there was substantial variability in the level of mortality reductions predicted. The indirect methodologies had lower predictions as the meta-analyses on elasticities and risk relations seem to underestimate the true values for Lithuania. Directly estimated effects of taxation based on the actual mortalities seem to best represent the true reductions in alcohol-attributable mortality. A significant increase in alcohol excise taxation had a marked impact on all-cause mortality in Lithuania. [ABSTRACT FROM AUTHOR]

Aims To determine the effect of an alcohol policy change, which increased the minimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-cause mortality rates in young adults (18–19 years old) in Lithuania. Methods An interrupted time series analysis was conducted on a dataset from 2001 to 2019 (n  = 228 months). The model tested the effects of the MLDA on all-cause mortality rates (deaths per 100,000 individuals) in three age categories (15–17 years old, 18–19 years old, 20–22 years old) in order to control for general mortality trends in young adults, and to isolate the effects of the MLDA from other alcohol control policies. Additional models that included GDP as a covariate and a taxation policy were tested as well. Results There was a significant effect of the MLDA on all-cause mortality rates in those 18–19 years old, when modelled alone. Additional analyses controlling for the mortality rate of other age groups showed similar findings. Inclusion of confounding factors (policies on alcohol taxation, GDP) eliminated the effects of MLDA. Conclusions Although there was a notable decline in all-cause mortality rates among young adults in Lithuania, a direct causal impact of MLDA on all-cause mortality rates in young adults was not definitively found. [ABSTRACT FROM AUTHOR]

Background and Aims: The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population‐level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population‐level alcohol control policies on cirrhosis mortality rates in Lithuania – a high‐income European Union country with high levels of alcohol consumption. Methods: Age‐standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time‐series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted. Results: There was a significant effect of the 2008 (P <.0001) and 2017 (P =.0003) alcohol control policies but a null effect of the 2018 policy (P =.40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02‐3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50‐2.52) deaths per 100,000 adults, corresponding to 245 deaths averted. Conclusions: Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost‐effective and aid in reducing the burden of liver disease. [ABSTRACT FROM AUTHOR]

Introduction: The increase in the suicide mortality rate among middle-aged adults in the United States (US) has been well documented. Aside from a few studies from the United Kingdom, it is unclear whether the suicide mortality rate trend in the US is also occurring in other developed countries. Accordingly, we aimed to compare the suicide mortality rate trends over the past 30 years in the US to a country in the European Union–Lithuania. Methods: Joinpoint regression analyses were performed to identify secular trends in the gender-specific age-standardized suicide mortality rate among individuals 15 + years of age, as well as middle-aged adults (45–54 years of age), and suicide mortality rate ratio for men-to-women. Results: Age-standardized suicide mortality rates among middle-aged adults in the US increased annually, on average, by 0.89% (95% CI: 0.66%, 1.12%) among men and 1.21% (95% CI: 0.75%, 1.66%) among women between 1990 and 2019. In contrast to the US, there was an overall downward trend in the suicide mortality rates among middle-aged adults in Lithuania across the study period. The average annual percent change in the suicide mortality rate ratio for men-to-women were not statistically significant for either country. Conclusion: The suicide mortality rate trend in the US does not appear to be an indicator of an upcoming global trend, but rather should be regarded as a cautionary example of what other countries should strive to avoid. [ABSTRACT FROM AUTHOR]

Aims: The aim of this contribution was to estimate the impact of the last significant alcohol taxation increase in Lithuania in 2017 on alcohol consumption, incident cancer cases, and cancer mortality, as well as the number of cancer outcomes that could have potentially been averted in 2018 had larger increases in alcohol excise taxation been applied. Design: Statistical modelling was used to estimate the change in alcohol per capita consumption following the tax increase, and alcohol-attributable fraction methodology was then used to estimate the associated cancer incidence and mortality. Potential increases of current excise duties were modelled in two steps. First, beverage-specific price elasticities of demand were used to predict the associated decreases in consumption and cancer outcomes, and second, the outcomes arising from the actual numbers and the modelled numbers were compared. Method: Data were taken from the following sources: alcohol consumption data from Statistics Lithuania and the WHO, cancer data from the International Agency of Research on Cancer, and risk relations and elasticities of demand from published meta-analyses. Results: A total of 15,857 new cancer cases (8,031 in women and 7,826 in men) and 8,534 cancer deaths (3,757 in women and 4,777 in men) were recorded in Lithuania in 2018. Using the attributable fraction methodology, we estimate that 4.8% of 761 of these new cancer cases were attributable to alcohol use (284 in women; 477 in men), as well as 5.5% or 466 cancer deaths (115 in women; 351 in men). With the taxation increase of 2017, 45 new cases and 24 deaths will be averted over the next 10 years. Further taxation increases of 100% could double the number of new cancer cases averted or saved. Conclusion: In a high-consumption European country like Lithuania, alcohol use is an important and avoidable risk factor for cancer. Taxation is an important measure to reduce the alcohol-attributable cancer burden. [ABSTRACT FROM AUTHOR]

Background: Lithuania possesses one of the highest alcohol per capita consumption and has previously implemented alcohol control policies to reduce the alcohol-attributable burden. The aim of this study was to investigate Lithuanian cardiovascular disease (CVD) mortality rate trends between 2001 and 2018 and to explore a possible link between CVD mortality rate and alcohol control policy implementation.Methods: Lithuanian population mortality and alcohol consumption data for 2001-2018 were obtained from Statistics Lithuania and The State Register of Death Cases and Their Causes, Institute of Hygiene. Sex-specific CVD mortality rates were directly standardized to the European standard population by five-year age groups and categorized according to the ICD-10 codes for all CVDs (I00-I99), ischemic heart disease (IHD) (I20-I25), cerebrovascular diseases (I60-I69) and alcoholic cardiomyopathy (ACM) (I42.6). Joinpoint regression analyses were performed to identify points of inflection to explore their alignment with five selected alcohol policy enactments.Results: Overall, the 2001-2018 yearly mortality rates for all CVDs significantly decreased on average by - 1.6% (95% CI -2.0, - 1.2%) among men and - 2.1% (95% CI -2.5, - 1.8%) among women. Yearly changes in all CVDs, IHD, cerebrovascular diseases and ACM mortality rates were insignificant prior to their respective critical year points in 2006, 2005, 2008 and 2007, but significantly decreased afterwards by an average of - 2.4% (95% CI -2.7, - 2.0%), - 1.6% (95% CI -2.1, - 1.1%), - 1.2% (95 CI -1.7, - 0.6%) and - 4.5% (95% CI -7.3, - 1.6%) among men, and by - 2.7% (95% CI -3.0, - 2.3%), - 2.0% (95% CI -2.6, - 1.4%), - 1.8% (95% CI 2.4, - 1.3%) and - 6.6% (95% CI -10.7, - 2.2%) among women, respectively. The changes in the mortality rate trends for all CVDs, IHD, cerebrovascular diseases and especially ACM coincided with alcohol policies enacted on the January 1, 2008, January 1, 2009, April 1, 2014 and March 1, 2017.Conclusions: Yearly mortality rates for all CVDs, IHD, cerebrovascular diseases and ACM have declined in Lithuania between 2001 and 2018, and declining trends were more prominent in women than in men. Among the ICD-10 CVD categories investigated, the points of inflection identified for the ACM mortality rate trend coincided best with the selected alcohol policy enactment dates. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all‐cause mortality. Design Interrupted time–series methodology by means of general additive models. Setting: Lithuania. Participants: Adult population of Lithuania, aged 20 years and older. Measurements Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non‐)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex‐stratified and total monthly age‐standardized rates of all‐cause mortality for the adult population. Findings During the period 2001–18, effective alcohol control policy measures were implemented on several occasions, and in those years the all‐cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = −166 to –2739) in the year following the implementation of the policy. Conclusions: Alcohol control policies in Lithuania appear to have reduced the overall adult all‐cause mortality over and above secular trends. [ABSTRACT FROM AUTHOR]

Aims: To study the impact of alcohol control policy measures (i.e. increases in taxation, restrictions on availability, including minimum purchasing age regulations, legislation on drink driving and advertisement bans) on alcohol‐related traffic harm in Lithuania between January 2004 and February 2019. Design Analyses of trend data on the proportion of alcohol‐related collisions and crashes, injury and mortality, adjusting for secular trends, seasonality, periods of alcohol control measure implementation and economic development. Generalized additive mixed models were used. Multiple sensitivity analyses were conducted. Setting: Lithuania. Cases Monthly number of alcohol‐related cases of traffic collisions and crashes, injuries and deaths. Interventions and comparators: Periods of time during which new alcohol control measures were implemented and/or augmented compared to periods when they were not. Measurements Monthly data for 2004 to 2019 from routine statistics of the Lithuanian Road Police Service. Findings All indicators decreased consistently and significantly after the implementation of alcohol control measures, including increased taxation, reduction of availability and a ban on advertisement, starting in 2014. On average, each implemented policy measure permanently reduced the proportion of alcohol‐attributable crashes by 0.55% [95% confidence interval (CI) = 0.21–0.90%; P = 0.002], the proportion of alcohol‐attributable injuries by 0.60% (95% CI = 0.24–0.97%; P = 0.001) and the proportion of alcohol‐attributable deaths by 0.13% (95% CI = 0.10–0.15%; P < 0.001). Conclusions: Alcohol control policy measures, including measures to reduce overall level of alcohol consumption, were associated with a marked decrease in alcohol‐related traffic harm. [ABSTRACT FROM AUTHOR]

Aim: To collate prevalence estimates of fetal alcohol spectrum disorder (FASD) among special subpopulations (defined by service use). Design Systematic literature review and meta‐analysis of original, quantitative studies published between 1 November 1973 and 1 December 2018. The PRISMAGATHER were adhered to. The review protocol [includes FASD prevalence in (a) general and (b) special populations] is available on PROSPERO (registration number: CRD42016033837). Prevalence estimates were collated for all included studies with country‐, disorder‐ [FASD and fetal alcohol syndrome (FAS)] and population‐specific random‐effects meta‐analyses conducted. Setting and Participants: A number of service‐defined subpopulations globally (see Findings). Measurements The main outcome was the prevalence of FASD among special subpopulations. The critical appraisal of each study was conducted using the Joanna Briggs Institute tool. Findings We identified 69 studies, comprising 6177 individuals diagnosed with FASD from 17 countries: Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), eastern Europe (Moldova, Romania and Ukraine; n = 1), Germany (n = 1), Israel (n = 1), Lithuania (n = 1), the Netherlands (n = 1), Poland (n = 1), Russia (n = 9), South Korea (n = 1), Spain (n = 1), Sweden (n = 1) and United States (n = 25). FAS and FASD prevalence rates were collated for the following five subpopulations: children in care, correctional, special education, specialized clinical and Aboriginal populations. The estimated prevalence of FASD in these special subpopulations was 10–40 times higher compared with the 7.7 per 1000 (95% confidence interval = 4.9–11.7) global FASD prevalence in the general population. Conclusions: Global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations have a significantly higher prevalence of fetal alcohol spectrum disorder compared with the general population, which poses a substantial global health problem. [ABSTRACT FROM AUTHOR]

Abstract Aims: The rates of alcohol-attributable mortality in Lithuania and Hungary have been shown to be higher than those in most other European countries. Quality of alcohol products is investigated as a possible explanation. Methods: In a descriptive pilot study, a convenience sample of alcohol products was collected from local city markets in both countries,(Lithuania n = 10, Hungary n = 15) and chemical analyses, including some that have not been done in prior studies, were conducted. The parameters studied were alcoholic strength, volatiles (methanol, acetaldehyde, higher alcohols), ethyl carbamate, anions (including nitrate) and inorganic elements (including lead). Additionally, a multi-target screening analysis for toxicologically relevant substances was conducted. Results: The majority of samples (64%) had an alcohol content between 35% voL and 40% vol., being in accordance with the typical strength of legal spirits in Europe. Three samples containing significantly higher concentrations of alcohol above 60% vol. were found to be unrecorded alcohol products, defined as any alcohol that is outside of legal and taxed production. Screening analysis showed that those samples contained various flavourings, including the hepatotoxic substance coumarmn, at concentrations above the legal limit for foods. All other substance classes under study were found to be at levels of no toxicological concern. Conclusions: Although some problems with the quality of the alcohol samples were found, there is insufficient evidence from this pilot study to conclude that alcohol quality has an influence on health as reflected in alcohol-attributable mortality rates. Given the extent of alcohol-attributable disease burden in central and eastern European countries, future research should focus on collection of large, representative samples, particularly of unrecorded sources, which was the most problematic product group in our study. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020., Method: We used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status-i.e., gross domestic product (GDP) per capita., Results: Our findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models., Conclusions: The relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts., (© 2024. The Author(s).)

Given the causal impact of alcohol use on stroke, alcohol control policies should presumably reduce stroke mortality rates. This study aimed to test the impact of three major Lithuanian alcohol control policies implemented in 2008, 2017 and 2018 on sex- and stroke subtype-specific mortality rates, among individuals 15+ years-old. Joinpoint regression analyses were performed for each sex- and stroke subtype-specific group to identify timepoints corresponding with significant changes in mortality rate trends. To estimate the impact of each policy, interrupted time series analyses using a generalized additive mixed model were performed on monthly sex- and stroke subtype-specific age-standardized mortality rates from January 2001-December 2018. Significant average annual percent decreases were found for all sex- and stroke subtype-specific mortality rate trends. The alcohol control policies were most impactful on ischemic stroke mortality rates among women. The 2008 policy was followed by a positive level change of 4,498 ischemic stroke deaths per 100,000 women and a negative monthly slope change of -0.048 ischemic stroke deaths per 100,000 women. Both the 2017 and 2018 policy enactment timepoints coincided with a significant negative level change for ischemic stroke mortality rates among women, at -0.901 deaths and -1.431 deaths per 100,000 population, respectively. Hemorrhagic stroke mortality among men was not affected by any of the policies, and hemorrhagic stroke mortality among women and ischemic stroke mortality among men were only associated with the 2008 policy. Our study findings suggest that the impact of alcohol control policies on stroke mortality may vary by sex and subtype.

Background: The Baltic countries-Lithuania, Latvia and Estonia-are characterized by a high rate of fully alcohol-attributable mortality, compared with Poland. Alcohol control policy measures implemented since 2001 in the Baltic countries included a restriction on availability and an increase in excise taxation, among others. The aim of the current study was to evaluate the relationship between alcohol control policy implementation and alcohol-attributable mortality in the Baltic countries and Poland., Methods: Alcohol-attributable mortality data for 2001-2020 was defined by codes 100% alcohol-attributable for persons aged 15 years and older in the Baltic countries and Poland. Alcohol control policies implemented between 2001 and 2020 were identified, and their impact on alcohol-attributable mortality was evaluated using an interrupted time-series methodology by employing a generalized additive model., Results: Alcohol-attributable mortality was significantly higher in the Baltic countries, compared with Poland, for both males and females. In the final reduced model, alcohol control policy significantly reduced male alcohol-attributable mortality by 7.60% in the 12 months post-policy implementation. For females, the alcohol control policy mean-shift effect was higher, resulting in a significant reduction of alcohol-attributable mortality by 10.77% in the 12 months post-policy implementation. The interaction effects of countries and policy tested in the full model were not statistically significant, which indicated that the impact of alcohol control policy on alcohol-attributable mortality did not differ across countries for both males and females., Conclusions: Based on the findings of the current study, alcohol control policy in the form of reduced availability and increased taxation was associated with a reduction in alcohol-attributable mortality among both males and females., (© 2023. The Author(s).)

Alcohol advertising exposure is a risk factor for earlier alcohol initiation and higher alcohol consumption. Furthermore, engagement in digital alcohol marketing, such as liking or sharing an ad on social media, is associated with increased alcohol consumption and binge or hazardous drinking behavior. In light of these challenges, Lithuania has enacted a total prohibition on alcohol advertising, including social media. This study monitored the two most popular social media networks, Facebook and Instagram, to determine compliance with current legislation. In total, 64 Facebook and 51 Instagram profiles were examined. During the 60-day study period, 1442 and 749 posts on the selected Facebook and Instagram profiles, respectively, were published. There were a total of 163 distinct social media alcohol-related posts. Alcohol-related posts accounted for 5.9 percent of total Instagram posts and 8.3 percent of total Facebook posts. Alcohol advertisements accounted for 1.4 percent of all posts (infringement of the Alcohol Control Law). Influencers were responsible for nearly half (45.5 percent) of all observed alcohol-related Instagram posts. The study demonstrates high compliance with Lithuania's total alcohol advertising ban on social media and emphasizes the importance of adequately monitoring the growing prominence of influencers on social media.

Aims: To determine the effect of an alcohol policy change, which increased the minimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-cause mortality rates in young adults (18-19 years old) in Lithuania., Methods: An interrupted time series analysis was conducted on a dataset from 2001 to 2019 (n = 228 months). The model tested the effects of the MLDA on all-cause mortality rates (deaths per 100,000 individuals) in three age categories (15-17 years old, 18-19 years old, 20-22 years old) in order to control for general mortality trends in young adults, and to isolate the effects of the MLDA from other alcohol control policies. Additional models that included GDP as a covariate and a taxation policy were tested as well., Results: There was a significant effect of the MLDA on all-cause mortality rates in those 18-19 years old, when modelled alone. Additional analyses controlling for the mortality rate of other age groups showed similar findings. Inclusion of confounding factors (policies on alcohol taxation, GDP) eliminated the effects of MLDA., Conclusions: Although there was a notable decline in all-cause mortality rates among young adults in Lithuania, a direct causal impact of MLDA on all-cause mortality rates in young adults was not definitively found., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Introduction: Alcohol use is a major risk factor for mortality. Previous studies suggest that the alcohol-attributable mortality burden is higher in lower socioeconomic strata. This project will test the hypothesis that the 2017 increase of alcohol excise taxes linked to lower all-cause mortality rates in previous analyses will reduce socioeconomic mortality inequalities., Methods and Analysis: Data on all causes of deaths will be obtained from Statistics Lithuania. Record linkage will be implemented using personal identifiers combining data from (1) the 2011 whole-population census, (2) death records between 1 March 2011 (census date) and 31 December 2019, and (3) emigration records, for individuals aged 40-70 years. The analyses will be performed separately for all-cause and for alcohol-attributable deaths. Monthly age-standardised mortality rates will be calculated by sex, education and three measures of socioeconomic status (SES). Inequalities in mortality will be assessed using absolute and relative indicators between low and high SES groups. We will perform interrupted time series analyses, and test the impact of the 2017 rise in alcohol excise taxation using generalised additive mixed models. In these models, we will control for secular trends for economic development., Ethics and Dissemination: This work is part of project grant 1R01AA028224-01 by the National Institute on Alcohol Abuse and Alcoholism. It has been granted research ethics approval 050/2020 by Centre for Addiction and Mental Health Research Ethics Board on 17 April 2020, renewed on 30 March 2021. The time series of mortality inequalities as well as the statistical code will be made publicly available, allowing other researchers to adapt the proposed method to other jurisdictions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This contribution provides insights into the methodology of a pan-European population-based online survey, performed without external funding during the COVID-19 pandemic. We present the impact of different dissemination strategies to collect data from a non-probabilistic convenience sample and outline post-stratification weighting schemes, to provide guidance for future multi-country survey studies., Methods: Description and comparison of dissemination strategies for five exemplary countries (Czechia, Germany, Lithuania, Norway, Spain) participating in the Alcohol Use and COVID-19 Survey. Comparison of the sample distribution with the country's actual population distribution according to sociodemographics, and development of weighting schemes., Results: The dissemination of online surveys through national newspapers, paid social media adverts and dissemination with the support of national health ministries turned out to be the most effective strategies. Monitoring the responses and adapting dissemination strategies to reach under-represented groups, and the application of sample weights were helpful to achieve an analytic sample matching the respective general population profiles., Conclusion: Reaching a large pan-European convenience sample, including most European countries, in a short time was feasible, with the support of a broad scientific network., (© 2021 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.)

Alcohol consumption is a major risk factor for premature mortality. Although alcohol control policies are known to impact all-cause mortality rates, the effect that policies have on specific age groups is an important area of research. This study investigates the effect of alcohol control policies implemented in 2009 and 2017 in Lithuania on all-cause mortality rates. All-cause mortality rates (deaths per 100,000 people) were obtained for 2001-2018 by 10-year age groups (20-29, 30-39, 40-49 years, etc.). All-cause mortality rates, independent of macro-level secular trends (e.g., economic trends) were examined. Following a joinpoint analysis to control for secular trends, an interrupted time series analysis showed that alcohol control policies had a significant effect on all-cause mortality rates (p = .018), with the most significant impact occurring among young adults (20-29 and 30-39 years of age). For these age groups, their mortality rate decreased during the 12 months following policy implementation (following the policy in 2009 for those 20-29 years of age, p = .0026, and following the policy in 2017 for those 30-39 years of age, p = .011). The results indicate that alcohol control policy can impact all-cause mortality rates, above and beyond secular trends, and that the impact is significant among young adults., (© 2021. The Author(s).)

Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1-highly effective general population interventions with an anticipated immediate impact; Tier 2-other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.

Alcohol is a major risk factor for burden of disease. However, there are known effective and cost-effective alcohol control policies that could reduce this burden. Based on reviews, international documents, and contributions to this special issue of International Journal of Environmental Research and Public Health (IJERPH), this article gives an overview of the implementation of such policies in the World Health Organization (WHO) European Region, and of best practices. Overall, there is a great deal of variability in the policies implemented between countries, but two countries, the Russian Federation and Lithuania, have both recently implemented significant increases in alcohol taxation, imposed restrictions on alcohol availability, and imposed bans on the marketing and advertising of alcohol within short time spans. Both countries subsequently saw significant decreases in consumption and all-cause mortality. Adopting the alcohol control policies of these best-practice countries should be considered by other countries. Current challenges for all countries include cross-border shopping, the impact from recent internet-based marketing practices, and international treaties.

Background: Phthalates are synthetic compounds with a widespread field of applications. For example, they are used as plasticizers in PVC plastics and food packaging, or are added to personal care products. Diethyl phthalate (DEP) may be used to denature alcohol, e.g., for cosmetic purposes. Public health concerns of phthalates include carcinogenic, teratogenic, hepatotoxic and endocrine effects. The aim of this study was to develop and validate a method for determining phthalates in alcohol samples and to provide a risk assessment for consumers of such products., Methodology/principal Findings: A liquid-liquid extraction procedure was optimized by varying the following parameters: type of extraction solvent (cyclohexane, n-hexane, 1,1,2-trichlorotrifluoroethane), the ratio extraction solvent/sample volume (1 ratio 1 to 50 ratio 1) and the number of extraction repetitions (1-10). The best extraction yield (99.9%) was achieved with the solvent 1,1,2-trichlorotrifluoroethane, an extraction solvent volume/sample volume ratio of 10 ratio 1 and a double extraction. For quantification, gas chromatography/mass spectrometry with deuterated internal standards was used. The investigated samples were alcoholic beverages and unrecorded alcohol products from different countries (n = 257). Two unrecorded alcohol samples from Lithuania contained diethyl phthalate in concentrations of 608 mg/L and 210 mg/L., Conclusions/significance: The consumption of the phthalate-positive unrecorded alcohols would exceed tolerable daily intakes as derived from animal experiments. Both positive samples were labelled as cosmetic alcohol, but had clearly been offered for human consumption. DEP seems to be unsuitable as a denaturing agent as it has no effect on the organoleptic properties of ethanol. In light of our results that DEP might be consumed by humans in unrecorded alcohols, the prohibition of its use as a denaturing agent should be considered.