Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-2020.

Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.

A mystery-shopping study to test enforcement of minimum legal purchasing age in Lithuania in 2022.

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.

Estimating the Size of Illicit Tobacco Market in Lithuania: Results from the Discarded Pack Collection Method.

INTRODUCTION: For decades in Lithuania, the threat of illicit trade has been used to weaken evidence-based tobacco-control policies and to undermine efforts to reduce smoking prevalence and its attributable burden, while also depriving the government of much-needed tax revenue. The aim of this study is to estimate the size of the illicit cigarette market in Lithuania using data from a nationally representative discarded pack collection. AIMS AND METHODS: The study employed a two-stage cluster design by first randomly selecting 65 well-defined population settlements (30 cities and 35 townships), representing both urban and rural areas, in all 10 counties in Lithuania. Next, we randomly selected 358 polling districts within these settlements. Each polling district had one route along which discarded packs were collected between September 2019 and 2020. RESULTS: In total, 28.9% (95% CIs = 27.7 to 30.1) of discarded cigarette packs were classified as illicit. The vast majority (90.1%) of illicit packs originated from Belarus with most (86.9%) packs produced in the Grodno Tobacco Factory Neman. Tax stamps were present on 93.6% of legal packs and also on 76% of illegal packs. CONCLUSIONS: Data from this study suggest that the illicit cigarette trade in Lithuania is more widespread than indicated by other methods and primarily supplied by the neighboring Belarus state-owned tobacco factory in Grodno. This signals the need to adopt Belarus-specific border control and security measures. IMPLICATIONS: This study presents data from the first national industry-independent study on illicit tobacco trade in Lithuania using discarded cigarette pack collection method. As customs seizure data show, our results also indicate that the illicit cigarette market is primarily supplied by Belarus state-owned Grodno Tobacco Factory Neman known for filling Europe with cheap cigarettes. An estimate derived from this study is higher than both the industry-independent estimate obtained by the survey method and the estimates offered by the tobacco industry. This adds to the evidence that the difference in estimates obtained by different methods reflects the strengths and weaknesses of each. The study also demonstrates the impact of a rogue neighbor on the illicit market in an adjacent country and offers suggestions on how to address it.

The Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media.

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.

Illicit Tobacco in Lithuania: A Cross-Sectional Survey.

Taxation policies are the most cost-effective measure to reduce overall tobacco consumption. However, cigarettes in Lithuania are among the cheapest in the European Union. The threat of the illicit trade is often used to compromise evidence-based policies, pricing policies particularly. The aim of this study was to determine the extent of illicit cigarette consumption in Lithuania and identify the main characteristics of illicit cigarette smokers. The national cross-sectional survey with direct observation of the latest purchased pack of cigarettes was conducted between August and September 2019. In total, 1050 smokers aged ≥18 were interviewed face-to-face. The illicit share of the total consumption of cigarettes per year was 10.7% with 9.7% of smokers showing or describing illicit cigarette packs compared to 17% reported by industry-funded studies. Older smokers, smokers with lower education and heavy smokers were more likely to regularly purchase illicit cigarettes. The average price of an illicit pack was almost two times lower than licit. Although the illicit trade of tobacco products is a serious policy challenge, the threat of an increase in illicit trade should not delay tobacco taxation improvements.

Review of the Lithuanian Alcohol Control Legislation in 1990-2020.

Since the early 1990s, Lithuania has experienced an increasing level of alcohol consumption and a heavy burden of alcohol-related harm, which is associated with the development of alcohol policies. The aim of this analysis was to provide a chronology of change of Lithuanian alcohol control legislation and to present several other detailed examples of the political processes. The data were collected using document reviews. During the last three decades, the Lithuanian alcohol control policies have undergone several cycles of stricter control and liberalizations. Some of the limitations of the study are the exceptional focus on the public health perspective and the inclusion of policies targeting the population as a whole. The strength of the study is in providing a detailed background for future policy effectiveness studies. Some of the recent periods when a series of 'best buy' interventions were implemented during a short period are of particular importance, constituting a natural experiment, whose effects need to be studied in more detail in the future.

Alcohol-related male mortality in the context of changing alcohol control policy in Lithuania 2000-2017.

INTRODUCTION AND AIMS: Over the recent decades, Lithuania has reported very high alcohol-related harm and mortality indicators when compared to other countries. This, among other reasons, led to an adoption of comprehensive evidence-based alcohol control policy measures back in 2007 and 2016. The aim of this study is to examine alcohol-related male mortality in the context of changing alcohol control policies over the period 2000-2017. DESIGN AND METHODS: The life table decomposition method was applied to estimate to what extent the age groups and causes of death are responsible for changes in male life expectancy in the period 2000-2017. Furthermore, a time series intervention model was used to study the impact of alcohol control measures on alcohol-related mortality. A seasonal autoregressive integrated moving average model was fitted. RESULTS: Male life expectancy increased by 6.23 years in the period 2007-2017, mainly due to a decrease in mortality from external causes of death (2.12 years), cardiovascular diseases (1.84 years) and alcohol-related disorders (0.86 years). Reduced male mortality in the 30-64 years age group also contributed to a large increase in male life expectancy during the same period. DISCUSSION AND CONCLUSIONS: The greatest positive effect of reduced alcohol-related mortality to male life expectancy was observed during the period 2007-2009. It overlaps with the start of implementation of the comprehensive alcohol control measures. However, further research on the impact of different alcohol policy interventions on various outcomes is needed.

Holding policy makers to account: Monitoring voting patterns on alcohol and tobacco policy in the Lithuanian Parliament.

INTRODUCTION AND AIMS: Systematic monitoring of the parliamentary legislative processes, including voting of members of the Parliament (MPs) and factions, allows better understanding of the mechanisms for adoption of public health policies. The aim of this paper is to present a tool for monitoring voting on tobacco and alcohol control policies in the Lithuanian Parliament and consequent rating of MPs based on their voting. DESIGN AND METHODS: MP rating included the collection of voting data, qualitative assessment of the proposed amendments based on their potentially positive or negative impact on public health, and finally quantitative analysis of voting by applying certain weight coefficients. RESULTS: Analysis included 159 voting episodes. More than half (60%) of the MPs received low scores in the 2012-2016 Parliament's term, and only a small proportion (3%) consistently supported evidence-based alcohol and tobacco control policies. In contrast, only 26.5% MPs received low scores in the 2016-2018 half-term. Significantly higher scores in the 2016-2018 half-term reflect increased political support towards evidence-based public health policies among the new political majority in Lithuania. DISCUSSION AND CONCLUSIONS: MP rating has a potential to become a valuable tool used by various stakeholders for more objective assessment of specific public health commitments of political parties and individual politicians.