Mindaugas Štelemėkas

Bio: Mindaugas Štelemėkas is an academic researcher from Lithuanian University of Health Sciences. The author has contributed to research in topics: Medicine & Demography. The author has an hindex of 8, co-authored 24 publications receiving 137 citations.

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

Abstract: 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 control policy and changes in alcohol‐related traffic harm

Abstract: 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 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.

Alcohol control policy measures and all-cause mortality in Lithuania: an interrupted time–series analysis

Abstract: 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.

Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects.

Abstract: 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.

Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000-2019.

Abstract: 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.

Use of alcohol, tobacco, cannabis, and other substances during the first wave of the SARS-CoV-2 pandemic in Europe: a survey on 36,000 European substance users.

Abstract: SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. Data were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances. Across all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use. Our findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.

Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analyses.

Abstract: Summary Background As a policy option to reduce consumption of alcohol and the harm it does, on May 1, 2018, Scotland introduced a minimum price of 50 British pence (p) per unit of alcohol (8 g) sold; Wales followed suit on March 2, 2020, with the same minimum unit price (MUP). We analysed household purchase data based on bar codes to assess the impact of these policy options in the medium term for Scotland and in the immediate term for Wales. Methods For these location-controlled, interrupted time series regression analyses, the data source was Kantar WorldPanel's household shopping panel, which, at the time of our analysis, included 35 242 British households providing detailed information on 1·24 million separate alcohol purchases in 2015–18 and the first half of 2020. With no data exclusions, we analysed the impact of introducing MUP in Scotland, using purchases in northern England as control, and in Wales, using western England as control. The studied changes associated with MUP were price paid per gram of alcohol purchased, grams of alcohol purchased, and amount of money spent on alcohol. Findings In Scotland, price increases and purchase decreases following the introduction of MUP in 2018 were maintained during the first half of 2020. The difference between Scotland and northern England in 2020 was a price increase of 0·741 p per gram (95% CI 0·724–0·759), a 7·6% increase, and a purchase decrease of 7·063 g per adult per household per day that an alcohol purchase was made (6·656–7·470), a 7·7% decrease. In Wales, the introduction of MUP led to similar results. The difference between Wales and western England was a price increase 0·841 of 0·841 p per gram (0·732–0·951), an 8·2% increase, and a purchase decrease of 7·052 g per adult per household per day that an alcohol purchase was made (6·463–7·640), an 8·6% decrease. For both Scotland and Wales, reductions in overall purchases of alcohol were largely restricted to households that bought the most alcohol. The introduction of MUP was not associated with an increased expenditure on alcohol by households that generally bought small amounts of alcohol and, in particular, those with low incomes. The changes were not affected by the introduction of COVID-19 confinement in the UK on March 26, 2020. Interpretation The evidence base supporting the positive, targeted impact of MUP is strengthened by the comparable results for Scotland and Wales. The short-term impact of MUP in Scotland during 2018 is maintained during the first half of 2020. MUP is an effective alcohol policy option to reduce off-trade purchases of alcohol and should be widely considered. Funding None.

Trends in adolescent drinking across 39 high-income countries: exploring the timing and magnitude of decline

Abstract: BACKGROUND Evidence suggests adolescent alcohol consumption has declined since the turn of the millennium in almost all high-income countries. However, differences in the timing and magnitude of the decline have not been explored across countries. METHODS We examined trends in adolescent past month or monthly alcohol consumption prevalence from cross-national or national survey reports for 39 countries and four US territories. For each country, we calculated the magnitude of the decline in youth drinking as the relative change in prevalence from the peak year to the most recent year available. Heat maps were utilized to present the timing and magnitudes of these declines. RESULTS The timing and extent of youth drinking declines have varied markedly across countries. The decline began in the USA before 1999, followed by Northern European countries in the early 2000s; Western Europe and Australasia in the mid-2000s. The steepest declines were found for Northern Europe and the UK, and the shallowest declines were observed in Eastern and Southern European countries. CONCLUSIONS Previous analyses of the decline in adolescent drinking have emphasized the wide reach of the changes and their near-coincidence in time. Our analysis points to the other side of the picture that there were limits to the wide reach, and that there was considerable variation in timing. These findings suggest that as well as broader explanations that stretch across countries, efforts to explain recent trends in adolescent drinking should also consider factors specific to countries and regions.

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

Abstract: 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.