Impact of the WHO “best buys” for alcohol policy on consumption and health in the Baltic countries and Poland 2000–2020

Funding Information: Funding: Research reported in this publication was in part supported by the (U.S.) National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), grant number 1R01AA028224 . This research was conducted as part of the project ‘Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states’ and we would like to thank the whole team for their input to wider discussions in generating the research reported in this paper. Content is the responsibility of the authors and does not reflect official positions of the NIAAA or the NIH. Publisher Copyright: © 2023Alcohol 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.Peer reviewe

Smoking-attributable social and economic harm assessment in Lithuania

Despite plenty of scientific evidence and global efforts to reduce the prevalence of smoking, it remains one of the leading causes of non-communicable diseases and premature death worldwide. Often only the health effects of smoking are discussed, and socio-economic costs attributable to smoking are completely ignored. Though this aspect becomes even more relevant due to the limited financial resources of the health care systems and the pace of population ageing. Previously smoking-attributable socio-economic harm in Lithuania was almost exclusively assessed within framework of regional or global studies and national efforts were scarce and fragmented. This was partly due to the lack of relevant methodology. To address this problem, country-specific methodology to asses smoking-attributable harm was developed and is based on the recommendations and guidelines prepared by the World Health Organization and international experts. Based on the methodology developed, active and passive smoking-attributable mortality, morbidity, cases of disability and incapability to work were assessed. The socio-economic costs of smoking, including direct (healthcare and social security system) and indirect (morbidity and premature mortality, the loss of productivity from smoking breaks, the loss of productivity due to presenteeism) costs were estimated. Analysis showed that smoking remains an important cause of death in Lithuania, carrying over 6 thousand deaths a year. Smoking causes high socio-economic harm, which, according to conservative estimates, amounted to nearly €953 million in Lithuania in 2013, representing 2.7% of GDP. Estimated costs averaged to €322 per capita or €1,534 per smoker. Overall, smoking-attributable costs represented 3.5% of total healthcare expenditures, meanwhile social security system costs (including sickness benefits and disability and work capacity pensions) represented around 1% of the total budget of the Compulsory Health Insurance Fund. The socio-economic harm caused by smoking in Lithuania could be avoided by curbing the consumption of tobacco products. Therefore, despite significant progress in tobacco control, implementation of evidence-based tobacco control policies should be further strengthened. The aim of the study was to assess SA socio-economic harm in Lithuania in accordance with developed methodology. Objectives: 1) To assess active and passive SA mortality in 2003–2013. 2) To assess active and passive SA morbidity in 2003–2013. 3) To assess active and passive SA cases of disability and incapability to work in 2006–2013. 4) To estimate SA socio-economic costs in Lithuania in 2013 in accor-dance with developed methodology

Smoking-attributable direct healthcare expenditure in Lithuania: A Prevalence-based annual cost approach

Introduction: The estimates of the economic burden of smoking provide the basis for a comprehensive assessment of the overall economic impact and evidence for potential public health policy intervention by the government. The aim of this paper is to estimate the smoking-attributable direct healthcare expenditure covered by the Compulsory Health Insurance Fund (CHIF) in Lithuania in 2013. Methods: A prevalence-based and disease-specific annual cost approach was applied to 25 smoking-related diseases or disease categories. Our analysis included only direct government healthcare expenditure (reimbursed by CHIF), including: smoking-attributable outpatient and inpatient care services, medical rehabilitation, reimbursable and publicly procured pharmaceuticals and medical aids, the emergency medical aid (ambulance) service, nursing, and expensive tests and procedures. The smoking-attributable expenditure on the above-mentioned healthcare services was calculated by multiplying the total annual expenditure by the corresponding smoking attributable fractions (SAFs). Results: The total smoking-attributable government expenditure amounted to €37.4 million in 2013. This represented 3% of the total CHIF budget in 2013. Smoking-attributable expenditure on inpatient care and medical rehabilitation services was two times higher for male smokers, than for female smokers. Conclusions: Smoking imposes a significant preventable financial cost within the budget of the Lithuanian healthcare system. A quantitative estimation of smoking related healthcare costs could provide an incentive for the development of smoking cessation services, with additional attention towards male smokers, as well as an important focus on smoking prevention among children and youths

Analysis of problematic alcohol use among 15-74 years old Lithuanian population: results of audit test

gam alkoholio vartojimui nustatyti. Tyrimuose žalingas alkoholio vartojimas nustatomas apsibrėžiant saikingo alkoholio vartojimo ribą ir įvardijamas kaip probleminis alkoholio vartojimas ar tiesiog piktnaudžiavimas alkoholiu. Apibendrinant AUDIT testo rezultatus, šiame tyrime analizuojamas probleminio alkoholio vartojimo paplitimo Lietuvoje reiškinys 2007 m. Metodai. Reprezentatyvus 15–74 m. amžiaus Lietuvos gyventojų tyrimas buvo atliktas 2007 m. spalio- gruodžio mėnesiais. Anketą iš viso užpildė 3302 asmenys. Žalingo alkoholio vartojimo paplitimui įvertinti buvo panaudotas AUDIT klausimynas. Respondentų buvo papildomai paprašyta nurodyti demografinius duomenis bei išlaidas alkoholiniams gėrimams. Rezultatai. Penktadalis 15–74 m. amžiaus Lietuvos gyventojų alkoholį vartoja žalingai. Didžiausias žalingo alkoholio vartojimo paplitimas nustatytas 35–44 m. amžiaus vyrų ir 25–34 m. amžiaus moterų grupėse. Vyrams pavojingas alkoholio vartojimas nustatytas beveik 3 kartus dažniau nei moterims. Taip pat didesnis probleminio alkoholio vartojimo paplitimas nustatytas žemesnį išsilavinimą turinčių, kaimiškose vietovėse gyvenančių, bedarbių bei vienišų asmenų grupėse, o probleminiu alkoholinių gėrimų vartojimu pasižymintys asmenys per mėnesį išleisdavo vidutiniškai 4 kartus didesnę sumą alkoholinių gėrimų įsigijimui. Šis tyrimas parodė, kad alkoholio vartojimo problemos yra aktualios pakankamai didelei daliai Lietuvos gyventojų, o ypatingą susirūpinimą turėtų kelti tai, kad jau pačiose jauniausiose tiriamųjų amžiaus grupėse nustatytas didelis alkoholio vartojimo rizikos lygis.AUDIT test is a traditional methodology to diagnose harmful use of alcohol. The study summarizes the AUDIT test results from the public survey data which was performed in 2007. Methods. The representative sample of Lithuanian adult (15-74 years old) population has been surveyed in October-December 2007. In total 3302 respondents filled in the questionnaire. The level of harmful use of alcohol was estimated with the AUDIT test. The respondents were also asked to provide additional demographic information as well as information about their expenditure on alcoholic beverages. Results. The harmful use of alcohol was observed in 1/5 of 15-74 years old Lithuanians. The highest prevalence of harmful use of alcohol was among 35-44 years old males, and 25-34 years old females. It was around three times more common among males then among females. The lower education, unemployment, living in rural areas, and living alone were the factors more closely associated with the higher prevalence of problematic alcohol use. Problematic alcohol users spend in average 4 times more money to purchase alcoholic beverages. According to the study results alcohol related problems are associated with significant proportion of Lithuanian population. Special concern must be attributed to a fact that the problematic use of alcohol is high among the people in youngest age groups

The Analysis of Problematic Alcohol Use Among 15-74 Years Old Lithuanian Population: Results of Audit

gam alkoholio vartojimui nustatyti. Tyrimuose žalingas alkoholio vartojimas nustatomas apsibrėžiant saikingo alkoholio vartojimo ribą ir įvardijamas kaip probleminis alkoholio vartojimas ar tiesiog piktnaudžiavimas alkoholiu. Apibendrinant AUDIT testo rezultatus, šiame tyrime analizuojamas probleminio alkoholio vartojimo paplitimo Lietuvoje reiškinys 2007 m. Metodai. Reprezentatyvus 15–74 m. amžiaus Lietuvos gyventojų tyrimas buvo atliktas 2007 m. spalio- gruodžio mėnesiais. Anketą iš viso užpildė 3302 asmenys. Žalingo alkoholio vartojimo paplitimui įvertinti buvo panaudotas AUDIT klausimynas. Respondentų buvo papildomai paprašyta nurodyti demografinius duomenis bei išlaidas alkoholiniams gėrimams. Rezultatai. Penktadalis 15–74 m. amžiaus Lietuvos gyventojų alkoholį vartoja žalingai. Didžiausias žalingo alkoholio vartojimo paplitimas nustatytas 35–44 m. amžiaus vyrų ir 25–34 m. amžiaus moterų grupėse. Vyrams pavojingas alkoholio vartojimas nustatytas beveik 3 kartus dažniau nei moterims. Taip pat didesnis probleminio alkoholio vartojimo paplitimas nustatytas žemesnį išsilavinimą turinčių, kaimiškose vietovėse gyvenančių, bedarbių bei vienišų asmenų grupėse, o probleminiu alkoholinių gėrimų vartojimu pasižymintys asmenys per mėnesį išleisdavo vidutiniškai 4 kartus didesnę sumą alkoholinių gėrimų įsigijimui. Šis tyrimas parodė, kad alkoholio vartojimo problemos yra aktualios pakankamai didelei daliai Lietuvos gyventojų, o ypatingą susirūpinimą turėtų kelti tai, kad jau pačiose jauniausiose tiriamųjų amžiaus grupėse nustatytas didelis alkoholio vartojimo rizikos lygis.AUDIT test is a traditional methodology to diagnose harmful use of alcohol. The study summarizes the AUDIT test results from the public survey data which was performed in 2007. Methods. The representative sample of Lithuanian adult (15-74 years old) population has been surveyed in October-December 2007. In total 3302 respondents filled in the questionnaire. The level of harmful use of alcohol was estimated with the AUDIT test. The respondents were also asked to provide additional demographic information as well as information about their expenditure on alcoholic beverages. Results. The harmful use of alcohol was observed in 1/5 of 15-74 years old Lithuanians. The highest prevalence of harmful use of alcohol was among 35-44 years old males, and 25-34 years old females. It was around three times more common among males then among females. The lower education, unemployment, living in rural areas, and living alone were the factors more closely associated with the higher prevalence of problematic alcohol use. Problematic alcohol users spend in average 4 times more money to purchase alcoholic beverages. According to the study results alcohol related problems are associated with significant proportion of Lithuanian population. Special concern must be attributed to a fact that the problematic use of alcohol is high among the people in youngest age groups

Assessing formation of evidence based tobacco and alcohol control policy in Lithuania: the retrospective analysis of voting of the members of parliament

Goal. To develop the instrument for monitoring and assessment of the Members of Parliament (MP) voting patterns on tobacco and alcohol control policy and present main results of the changes in voting indicator (rating) during 2012–2015. Methodology. Analysis was conducted using statistical data of MP voting on the issues of the tobacco and alcohol control policy publicly available on the internet page of the Parliament of the Republic of Lithuania. Final analysis included 57 law amendments voted on between 16th of November, 2012 and 30th of June, 2015, after assessment of their potentially positive or negative impact on public health. The instrument is used to assess individual MPs and political parliamentary factions based on their votes on the issues of tobacco and alcohol control policy. The final rating was based on calculating weight coefficient depending of the MP vote having the potentially positive or negative impact on public health. A sum of each MPs positive and negative votes was then converted into 10 point scoring system, with the worst assessment of 0 and best – 10. Overall assessment of each Parliamentary faction was calculated as an average of the scores of individual faction members. Results. The instrument for assessment of the Republic of Lithuania MPs voting patterns has been developed and implemented for the six Parliamentary sessions during 2012– 2016. On average 75 MPs voted per voting round (min. 38; max. 114) through 57 voting rounds included in the final analysis. Out of 146 current and former MPs assessed with this instrument 58 percent received less than 5 points (negative assessment), 27 percent were assessed 5-7 points, 13 percent received 8 points and 2 percent – 9-10 points. The assessment of the Parliamentary factions revealed differences between individual voting pattern and that of a political group to which MP belongs. Highest assessments were received by the Lithuanian Polish Election Action and Lithuanian Homeland Union and Lithuanian Christian Democratic political groups (accordingly 6.3 and 5.9 points). Labour party and Order and Justice political groups received barely positive assessment (accordingly 5.1 and 5.3 point). Negative assessments were received by the Liberal Movement political group (2.3 points), the Lithuanian Socialdemocratic Party political group (4.4 point) and the Mixed parliament political group (4.6 point). Conclusions. Assessment of the MP voting patterns has revealed differences between individual MPs and political factions voting rating, also large differences within factions. Over half of the MPS received negative rating assessments. Non-attendance of the Parliamentary meetings by MPs had a significant impact on their negative rating. Instrument is suitable for monitoring individual MPs and political factions inclination to favour public heath interest.Tikslas. Sukurti LR Seimo narių balsavimo tabako ir alkoholio kontrolės politikos srityje vertinimo instrumentą bei pristatyti pagrindinius balsavimo rodiklio (reitingo) rezultatus, apibendrinančius 2012–2015 m. LR Seimo narių balsavimus. Tyrimo metodika. Remiantis LR Seimo interneto svetainėje pateikiama balsavimų tabako ir alkoholio kontrolės politikos klausimais statistika, analizuoti 57 visuomenės sveikatos požiūriu teigiami ir neigiami balsavimai, vykę nuo 2012 m. lapkričio 16 d. iki 2015 m. birželio 30 d. Tyrime vystomas metodinis instrumentas, kuris padeda įvertinti tabako ir alkoholio kontrolės politikos klausimais balsuojančius LR Seimo narius ir frakcijas. LR Seimo narių įvertinimai skaičiuoti sumuojant kiekvieną balsą, prilygintą atitinkamam svorio koeficientui, atsižvelgiant į tai, ar balsuota teigiamai, neigiamai, susilaikyta arba iš viso nedalyvauta posėdžio balsavime. Susumuota kiekvieno LR Seimo nario teigiamų ir neigiamų balsų (svorio koeficientų) suma buvo paversta į 10 balų vertinimo sistemą, kur blogiausias įvertinimas yra 0 balų, o geriausias – 10. Bendras LR Seimo frakcijų įvertinimas gautas išvedant vidurkį iš tabako ir alkoholio srities įvertinimų. Rezultatai. Sukūrus ir pritaikius LR Seimo narių balsavimų vertinimo instrumentą šešių 2012–2016 m. LR Seimo kadencijos sesijų laikotarpiui, nustatyta, kad viso per 57 balsavimus tabako ir alkoholio kontrolės politikos klausimais vidutiniškai balsavo 75 LR Seimo nariai (mažiausiai – 38; daugiausia – 114). Iš 146 įvertintų buvusių ir esamų LR Seimo narių 58 proc. buvo įvertinti mažiau nei 5 balais (neigiami įvertinimai), 27 proc. įvertinti 5–7 balais, 13 proc. – 8 balais ir 2 proc. – 9–10 balų. LR Seimo frakcijų įvertinimai atspindi įvertinimų sklaidą tarp joms priklausančių LR Seimo narių. Aukščiausi įvertinimai teko Lietuvos lenkų rinkimų akcijos ir Tėvynės sąjungos-Lietuvos krikščionių demokratų frakcijoms (atitinkamai 6,3 ir 5,9 balo). Darbo partijos bei „Tvarka ir teisingumas“ frakcijos vos viršijo teigiamo įverčio ribą (atitinkamai 5,1 ir 5,3 balo). Neigiami įvertinimai skirti Liberalų sąjūdžio frakcijai (2,3 balo), Lietuvos socialdemokratų partijos frakcijai (4,4 balo) bei Mišriai Seimo narių grupei (4,6 balo). Išvados. Įvertinus LR Seimo narių balsavimus, matyti dideli skirtumai tarp individualių LR Seimo narių balsų, priklausančių toms pačioms frakcijoms. Daugiau kaip pusė LR Seimo narių gavo neigiamus įvertinimus, kuriuos lėmė dažnas nedalyvavimas LR Seimo posėdžių balsavimuose

Assessing formation of evidence based tobacco and alcohol control policy in Lithuania: the retrospective analysis of voting of the Members of Parliament

Goal. To develop the instrument for monitoring and assessment of the Members of Parliament (MP) voting patterns on tobacco and alcohol control policy and present main results of the changes in voting indicator (rating) during 2012–2015. Methodology. Analysis was conducted using statistical data of MP voting on the issues of the tobacco and alcohol control policy publicly available on the internet page of the Parliament of the Republic of Lithuania. Final analysis included 57 law amendments voted on between 16th of November, 2012 and 30th of June, 2015, after assessment of their potentially positive or negative impact on public health. The instrument is used to assess individual MPs and political parliamentary factions based on their votes on the issues of tobacco and alcohol control policy. The final rating was based on calculating weight coefficient depending of the MP vote having the potentially positive or negative impact on public health. A sum of each MPs positive and negative votes was then converted into 10 point scoring system, with the worst assessment of 0 and best – 10. Overall assessment of each Parliamentary faction was calculated as an average of the scores of individual faction members. Results. The instrument for assessment of the Republic of Lithuania MPs voting patterns has been developed and implemented for the six Parliamentary sessions during 2012– 2016. On average 75 MPs voted per voting round (min. 38; max. 114) through 57 voting rounds included in the final analysis. Out of 146 current and former MPs assessed with this instrument 58 percent received less than 5 points (negative assessment), 27 percent were assessed 5–7 points, 13 percent received 8 points and 2 percent – 9-10 points. The assessment of the Parliamentary factions revealed differences between individual voting pattern and that of a political group to which MP belongs.Highest assessments were received by the Lithuanian Polish Election Action and Lithuanian Homeland Union and Lithuanian Christian Democratic political groups (accordingly 6.3 and 5.9 points). Labour party and Order and Justice political groups received barely positive assessment (accordingly 5.1 and 5.3 point). Negative assessments were received by the Liberal Movement political group (2.3 points), the Lithuanian Socialdemocratic Party political group (4.4 point) and the Mixed parliament political group (4.6 point). Conclusions. Assessment of the MP voting patterns has revealed differences between individual MPs and political factions voting rating, also large differences within factions. Over half of the MPS received negative rating assessments. Non-attendance of the Parliamentary meetings by MPs had a significant impact on their negative rating. Instrument is suitable for monitoring individual MPs and political factions inclination to favour public heath interest

Alkoholio vartojimo sąlygojamas žalos Lietuvoje skaičiavimo metodikos parengimas ir žalos įvertinimas 2015 m. ir 2016 m. [elektroninis išteklius]

Projektas „Alkoholio vartojimo sąlygojamas žalos Lietuvoje skaičiavimo metodikos parengimas ir žalos įvertinimas 2015 m. ir 2016 m.”, finansavimo sutarties Nr. S-320/PRM17-171Alkoholio vartojimo sąlygota žala – grynoji išteklių, kurių visuomenė neteko dėl ankstesnio ir dabartinio alkoholinių gėrimų vartojimo, vertė ir neapčiuopiama žala, patirta dėl svaiginimosi šia psichoaktyviąja medžiaga. Paprastai socialinė ir ekonominė žala sistemiškai skirstoma į tris pagrindines rūšis – tiesioginę, netiesioginę ir neapčiuopiamą. Alkoholio vartojimo sukeliamą žalą patiria ne tik pats geriantysis, bet ir aplink jį esantys, o kartais ir tiesioginio ryšio neturintys, asmenys ar asmenų grupės ir galiausiai visa visuomenė. Šio metodinio leidinio tikslas – apžvelgti ir apibendrinti alkoholio vartojimo sąlygojamos žalos vertinimo metodus bei, remiantis atlikta metodų analize, sukurti Lietuvai tinkančią alkoholio vartojimo sąlygojamos žalos skaičiavimo metodiką ir pagal šią metodiką bei prieinamus duomenis įvertinti alkoholio vartojimo sąlygojamą žalą Lietuvoje 2015 ir 2016 m. Metodai. Šis tyrimas atliktas taikant ligos kaštų vertinimo metodą, paremtą alkoholio vartojimo paplitimu, ir atskirai vertinant tiesiogines ir netiesiogines su alkoholio vartojimu siejamas išlaidas. Taip pat tyrimas apima alkoholio žalos kitiems nei geriantysis kaštus ir nusikalstamų veikų, padarytų neblaivių asmenų, bei alkoholio vartojimo sąlygotus teisėsaugos sistemos kaštus. Siekiant apskaičiuoti alkoholio vartojimui priskiriamą mirtingumą, ligotumą ir netektą darbingumą bei su tuo susijusius valstybės patiriamus kaštus, vertinti kaštai pagal alkoholio vartojimo sąlygotas ligas ir sveikatos būkles, suskirstytas į 3 stambias grupes: I) būklės, visiškai sąlygojamos tik alkoholio vartojimo; II) iš dalies alkoholio vartojimo sąlygojamos būklės (daugiausiai onkologinės, lėtinės, širdies ir kraujagyslių sistemos ligos); ir III) išorinės sužeidimų ir mirties priežastys...[...]Lietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universitetas. Medicinos akademijaPolitikos mokslų ir diplomatijos fakult.Viešojo administravimo katedraVytauto Didžiojo universiteta

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