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 advertising exposure is a risk factor for earlier alcohol initiation and higher alcohol consumption. Furthermore, engagement in digital alcohol marketing, such as liking or sharing an ad on social media, is associated with increased alcohol consumption and binge or hazardous drinking behavior. In light of these challenges, Lithuania has enacted a total prohibition on alcohol advertising, including social media. This study monitored the two most popular social media networks, Facebook and Instagram, to determine compliance with current legislation. In total, 64 Facebook and 51 Instagram profiles were examined. During the 60-day study period, 1442 and 749 posts on the selected Facebook and Instagram profiles, respectively, were published. There were a total of 163 distinct social media alcohol-related posts. Alcohol-related posts accounted for 5.9 percent of total Instagram posts and 8.3 percent of total Facebook posts. Alcohol advertisements accounted for 1.4 percent of all posts (infringement of the Alcohol Control Law). Influencers were responsible for nearly half (45.5 percent) of all observed alcohol-related Instagram posts. The study demonstrates high compliance with Lithuania’s total alcohol advertising ban on social media and emphasizes the importance of adequately monitoring the growing prominence of influencers on social media.

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.

Aims: To conduct a return on investment analysis of Lithuania's 2017 increase in alcohol excise taxation of 112% for beer, 111% for wine, and 23% for ethyl alcohol (spirits), resulting in a marked decrease in alcohol affordability.Methods: Economic analyses based on costs of the increased taxation and economic benefits derived from a societal perspective. Costs were measured according to World Health Organization standards, based on Lithuanian public data. Benefits were derived from the difference of direct (healthcare, childcare, legal) and indirect costs between 12 months pre‐ and post‐enactment of the policy. All costs and benefits were expressed in 2023 Euros (€).Results: Overall, there were net benefits from reductions in productivity losses and increases in tax revenue. Tax revenue increased by 20%, or more than €100 million, in the first‐year post enactment, and productivity losses decreased over the same time period by about €35.3 million (95% confidence interval [CI]: −51.9 to −17.1; proportionally −7%; 95% CI: −11.0% to −4.0%), the latter based on marked reductions in premature mortality in all alcohol‐attributable causes of death. In addition, healthcare costs decreased by about €3.8 million (95% CI: −8.4 to +0.1; proportionally −5%; 95% CI: −11.0% to +0.1%). On the other hand, childcare and legal costs increased compared with the year before, by €5.3 million (no 95% CI possible; proportionally: +7%) and €4.6 million (95% CI: +0.2 to +8.0; proportionally +5%; 95% CI: +0.3 to +8.7%), respectively. The final return on investment was 420 to 1, i.e. for each Euro invested, the return was €420. In the sensitivity analyses, the return on investment varied between 292 to 1 and 530 to 1, meaning that all assumptions resulted in a very positive return.Conclusions: The increase in excise taxation for alcohol on March 1, 2017 in Lithuania created a large return on investment and reduced alcohol‐attributable mortality and hospitalizations.