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.

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.

Issues The last Soviet anti‐alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign's policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign's end, the region faces diverse challenges in relation to alcohol. Approach The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments. Key Findings Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol‐control measures. The so‐called three ‘best buys’ put forward by the World Health Organization to reduce alcohol‐attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries. Implications In recent years, evidence‐based alcohol policies have been actively implemented as a response to the enormous alcohol‐attributable burden in many of the countries, although there is big variance across and within different jurisdictions. Conclusion Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.

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.

For the public health community, results of the evaluation of these policy changes will be of critical importance.

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.

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.

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