Miščikienė, Laura

Alcohol consumption remains a serious public health challenge worldwide, contributing to thousands of deaths each year and imposing a substantial burden on individuals, communities, and health systems. Its impact is particularly high in Lithuania, where alcohol consumption levels and alcohol-related harm have been among the highest in Europe for many years. This dissertation evaluates the implementation of alcohol control policies in Lithuania and their impact on alcohol-related mortality and violence. Adopting a multidisciplinary approach, it explores policy enforcement, analyzes post-intervention trends, and investigates associations between alcohol consumption, mortality from external causes, and violence. A field study revealed significant enforcement gaps in age verification, with nearly half of test purchases completed without ID checks, while social media monitoring indicated high compliance with the advertising ban. Interrupted time-series analyses demonstrated that policy interventions were associated with reductions in all-cause mortality among men and a notable decline in sexual assaults. Forensic autopsy data showed that 55% of deaths from external causes involved alcohol, with high intoxication numbers in assaults and accidents. Although homicide rates have decreased, the proportion of intoxicated perpetrators remains persistently high. A review of alcohol-related homicide cases showed that most of them occurred during binge drinking episodes in domestic settings.

Since the beginning of the conflict in Ukraine, close to 4.3 million non-EU citizens have been granted temporary protection in the European Union (EU). Beneficiaries gain access to health care in their host countries. All EU countries must ensure coverage for and access to a minimum set of health care services, but they can arrange delivery and extend the services covered as they deem feasible, necessary, and appropriate.

A strong association between alcohol and violence and homicide has been well established. Much less is known about the relationship between alcohol policies and the perpetration of alcohol-involved homicides, especially in the Central and Eastern European region. Despite recent progress, Lithuania still has one of the highest alcohol per capita consumption and homicide rates in the European region. Using quarterly data on homicide perpetrators in Lithuania for 2004-19, interrupted time-series were performed to evaluate whether the 2017 and 2018 alcohol control policies had an impact on the rate of perpetrators of homicide and the proportion of perpetrators under the influence of alcohol using a generalized additive model and generalized linear model, respectively. Although a rapid decline was observed in both the absolute numbers of homicides and rates of homicide perpetrators between 2004 and 2019, the proportion of homicide perpetrators under the influence of alcohol remained high. The analyses revealed that there was no significant effect of either of the two alcohol control policies on the rate of homicide perpetrators or the proportion of perpetrators under the influence of alcohol. The problem of persistently high occurrence of alcohol-involvement in homicides cannot be addressed by implementing alcohol control policies alone and thus, requires more inter-sectorial policy actions. More research is needed to understand homicide contexts and factors from both the victim and perpetrator perspectives.

Alcohol per capita consumption in Lithuania among the population 15 years of age and older has been among the highest globally in recent decades. Long-term alcohol consumption trends and drinking patterns signal a significant public health problem, as well as social and economic losses. This study aimed to estimate the economic burden associated with alcohol consumption in Lithuania from 2015 to 2020. We used a cost-of-illness methodology with the human capital approach to estimate the economic burden and applied a prevalence-based approach. Using multiyear data, we estimated both, direct and indirect costs. Direct costs included healthcare and childcare, law enforcement, and justice system costs. Indirect costs included costs of productivity loss due to premature mortality. The total economic cost of alcohol consumption in Lithuania between 2015 and 2020 was estimated at an annual average of €542.958 million (in 2020 Euros) or about 1.18% of the Lithuanian total Gross Domestic Product. The highest proportion (65%) of the estimated costs was associated with productivity losses due to premature mortality. Alcohol use places a considerable burden on Lithuanian society in terms of illness, injury, death, and economic costs. Alcohol control policies, in particular excise taxation increases and availability restrictions have been shown to decrease this burden.

Background and Objectives: Alcohol consumption has been a longstanding public health concern and known link to violence. The aims of this study were to analyze alcohol-related homicide cases in Lithuania, focusing on the prevalence of binge drinking among perpetrators and victims, the situational and behavioral patterns leading to violence, and the legal outcomes of these cases. Materials and Methods: This study employed a retrospective analysis of court case law of criminal cases of the year 2019. The analysis was conducted by combining qualitative and quantitative analytical approaches. Results: The findings revealed that 84.6% of homicides occurred during binge drinking events. Alcohol intoxication was prevalent among both perpetrators (92.3%) and victims (86.5%), emphasizing the dual role of alcohol in homicide cases. Interpersonal violence was the primary pattern of homicide (78.8%), while planned homicides accounted for 21.2%. Thematic content analysis of the cases revealed that Lithuanian courts consistently regard alcohol consumption as an aggravating factor that contributes to the commission of violent crimes and influences the severity of criminal punishment. This reflects a judicial position that voluntary intoxication does not lessen legal responsibility, despite its effects on impairing judgment, heightening aggression and impulsivity, and escalating conflicts into deadly violence. Conclusions: Our findings revealed that the majority of alcohol-involved homicides occurred during binge drinking events, in a domestic environment, and because of unplanned acts of interpersonal violence. Targeted public health interventions should focus on strengthening alcohol control policies and enforcing stricter regulations to discourage binge drinking environments.

The aim of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on assaults and sexual assaults in Lithuania. The hypothesis tested was that alcohol control policy implementation is associated with a reduction in the occurrence of both assaults and sexual assaults.

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.

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.

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.