PROJECT SUMMARY/ABSTRACT Alcohol use has been identified as a major risk factor for the global burden of death, disease and injury. Given the high levels of overall volume of alcohol use, detrimental drinking patterns, and high levels of alcohol-attributable mortality and burden of disease, Lithuania recently implemented three of the most effective alcohol control policies within a short time span: increase in taxation, reduction of availability of alcoholic beverages, and a ban on advertisement. For the first time ever, the implementation of these three best practices in alcohol control policy allows for an evaluation of their combined effect on total amount of alcohol consumed, as well as alcohol-attributable hospitalizations, deaths and violence in the subpopulations targeted by these policies. It also allows for a comprehensive economic evaluation of the return on investment – that is, a comparison of the cost of implementation and the economic benefits due to a reduction in alcohol-attributable hospitalizations, deaths and violence – which has never been done before. Accordingly, the proposed study intends to measure the effectiveness and economic gains of the interventions implemented in Lithuania, and to compare Lithuania to two other Baltic countries (Estonia and Latvia) to ensure that any changes observed within the country were not part of any regional trends that were independent of the interventions. The proposed study will use a mix of different quantitative and qualitative methods, based on high-quality data. Not only is this the first time that the three most effective alcohol control policies have been implemented almost simultaneously, but, given the characteristics of Lithuania, the effects of such interventions can be generalized to other high-income countries, such as the United States. What we learn from the proposed study will inform and enhance our ability to prevent alcohol-attributable deaths, diseases and injuries in the United States, including but not limited to the so-called deaths of despair (i.e., liver cirrhosis, suicide and poisoning). The proposed proposal involves a number of decision-makers and alcohol policy stakeholders, who will be intricately involved in the interpretation, publishing and publicizing the findings.

PROJECT NARRATIVE For the first time ever, Lithuania has implemented all three of the World Health Organization’s “best buys” for alcohol control policy within a relatively short timeframe, allowing for an evaluation of their combined effect on health, crime, and violence, as well as an evaluation comparing the costs of their implementation to the return on investment via the reduction in hospitalization rates. Lithuania will be compared to surrounding countries in the eastern part of the European Union, to ensure that any changes observed within the country were not part of a regional trend independent of the “best buy” interventions. The proposed study will provide findings, never before possible, that are generalizable to other high-income countries, such as the United States.