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.

Sodium, Potassium and Iodine Intake in an Adult Population of Lithuania.

Hypertension is a leading risk factor for cardiovascular events and death. A reduction in salt intake is among the most cost-effective strategies to reduce blood pressure and the risk of cardiovascular diseases. Increasing potassium lowers blood pressure and is associated with lower cardiovascular risk. Adequate iodine intake is important to prevent iodine deficiency disorders. Salt iodization is a key strategy to prevent such deficiency. In Lithuania, no surveys have been performed to directly assess sodium, potassium and iodine consumption. The aim of the present study was to measure sodium, potassium and iodine intake in a randomly selected adult Lithuanian adult population using 24 h urine collections, and to assess knowledge, attitudes and behavior towards salt consumption. Salt and potassium intakes were estimated in 888 randomly selected participants by 24 h urine sodium and potassium excretion and 679 individuals provided suitable 24 h urine samples for the analysis of iodine excretion. Average salt intake was 10.0 (SD 5.3) g/24 h and average potassium intake was 3.3 (SD 1.3) g/24 h. Only 12.5% of participants consumed less than 5 g/24 h of salt. The median value of urinary iodine concentration (UIC) was 95.5 µg/L. Our study showed that average salt intake is twice as high as the maximum level recommended by the World Health Organization while potassium and iodine intakes in Lithuania are below the recommended levels.

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

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 policy and changes in alcohol-related traffic harm.

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.

Development of an urban green space indicator and the public health rationale.

AIMS: In this study, the aim was to develop and test an urban green space indicator for public health, as proposed by the World Health Organisation (WHO) Regional Office for Europe, in order to support health and environmental policies. METHODS: We defined the indicator of green space accessibility as a proportion of an urban population living within a certain distance from a green space boundary. We developed a Geographic Information System (GIS)-based method and tested it in three case studies in Malmö, Sweden; Kaunas, Lithuania; and Utrecht, The Netherlands. Land use data in GIS from the Urban Atlas were combined with population data. Various population data formats, maximum distances to green spaces, minimum sizes of green spaces, and different definitions of green spaces were studied or discussed. RESULTS: Our results demonstrated that with increasing size of green space and decreased distance to green space, the indicator value decreased. As compared to Malmö and Utrecht, a relatively bigger proportion of the Kaunas population had access to large green spaces, at both shorter and longer distances. Our results also showed that applying the method of spatially aggregated population data was an acceptable alternative to using individual data. CONCLUSIONS: Based on reviewing the literature and the case studies, a 300 m maximum linear distance to the boundary of urban green spaces of a minimum size of 1 hectare are recommended as the default options for the indicator. The indicator can serve as a proxy measure for assessing public accessibility to urban green spaces, to provide comparable data across Europe and stimulate policy actions that recognise the importance of green spaces for sustainable public health.

Particulate air pollution and its impact on health in Vilnius and Kaunas.

UNLABELLED: Particulate matter in outdoor air has a significant impact on health. Small particles, composed of a variety of organic and inorganic compounds, are inhaled deep into the respiratory tract. The mechanisms and outcomes are manifold, resulting mainly in cardiopulmonary diseases. The current study aimed to quantify the health effects of particulate pollutants in Vilnius and Kaunas. MATERIAL AND METHODS: For risk estimation, the methodology of health impact assessment was employed. The exposure was defined as annual PM(2.5) levels for long-term exposure effects and daily PM(10) averages for short-term exposure effects. The baseline mortality/morbidity data were retrieved from health registers and exposure-response relationships from previous epidemiological studies. For health impact calculations, the WHO-developed tool AirQ was also applied. RESULTS: The annual average concentration of PM(2.5) was 11 µg/m(3) in Vilnius and 17.5 µg/m(3) in Kaunas. The exposure above the natural background corresponded annually to 263 (95% CI, 68-464) and 338 (95% CI, 86-605) premature deaths in Vilnius and Kaunas. This resulted in 3438 (95% CI, 905-5952) and 3693 (95% CI, 983-6322) years of life lost and in an average decrease in life expectancy of 0.43 (95% CI, 0.11-0.74) and 0.69 (95% CI, 0.18-1.19) years, respectively. In addition, 143 (95% CI, 86-200) and 129 (95% CI, 78-179) respiratory and 297 (95% CI, 188-377) and 267 (95% CI, 169-338) cardiovascular hospitalizations per year could be expected in Vilnius and Kaunas, respectively. CONCLUSIONS: There is substantial exposure to particulate matter in the main Lithuanian cities, which causes considerable adverse health effects. Traffic and domestic heating are considered locally the most important contributing factors to the degradation of air quality.