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Background: This paper examines changes in substance use, and compares the resulting attributable burden of disease in the WHO European Region between 2010 and 2016., Methods: Data for 2010 and 2016 on the number of deaths, years of life lost (YLL) and disability-adjusted life years (DALYs) lost were obtained by sex and country from the 2016 Global Burden of Disease (GBD) study. Exposure data for all substances except alcohol were obtained from the same study, while alcohol data were obtained from the WHO. Proportional changes were calculated for the WHO European Region as a whole to identify trends and for sub-regions to identify which regions contributed most to trends., Results: In the WHO European Region in 2016, substance use caused 2.1 million deaths, 48.6 million YLL and 57.9 million DALYs lost, representing 22.4, 29.0 and 20.4% of all deaths, YLL and DALYs, respectively. The substance-attributable burden of disease was higher among men than women and highest in the eastern parts of the WHO European Region. Changes in the number of deaths, YLL and DALYs lost between 2010 and 2016 were almost uniformly downward, with the largest proportional changes observed for men. Exposure to tobacco, alcohol and illicit drugs also decreased uniformly., Conclusions: Substance use and its attributable mortality and burden of disease have decreased in the WHO European Region since 2010. However, overall levels of substance use and the resulting burden of disease in the Region remain high compared with other regions of the world., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background and aims: Previously identified national drinking patterns in Europe lack comparability and might be no longer be valid due to changes in economic conditions and policy frameworks. We aimed to identify the most recent alcohol drinking patterns in Europe based on comparable alcohol exposure indicators using a data‐driven approach, as well as identifying temporal changes and establishing empirical links between these patterns and indicators of alcohol‐related harm. Design: Data from the World Health Organization's monitoring system on alcohol exposure indicators were used. Repeated cross‐sectional hierarchical cluster analyses were applied. Differences in alcohol‐attributable harm between clusters of countries were analyzed via linear regression. Setting: European Union countries, plus Iceland, Norway and Ukraine, for 2000, 2010, 2015 and 2019. Participants/Cases: Observations consisted of annual country data, at four different time points for alcohol exposure. Harm indicators were only included for 2019. Measurements Alcohol exposure indicators included alcohol per capita consumption (APC), beverage‐specific consumption and prevalence of drinking status indicators (lifetime abstainers, current drinkers, former drinkers and heavy episodic drinking). Alcohol‐attributable harm was measured using age‐standardized alcohol‐attributable Disability‐Adjusted Life Years (DALYs) lost and deaths per 100 000 people. Findings The same six clusters were identified in 2019, 2015 and 2010, mainly characterized by type of alcoholic beverage and prevalence drinking status indicators, with geographical interpretation. Two‐thirds of the countries remained in the same cluster over time, with one additional cluster identified in 2000, characterized by low APC. The most recent drinking patterns were shown to be significantly associated with alcohol‐attributable deaths and DALY rates. Compared with wine‐drinking countries, the mortality rate per 100 000 people was significantly higher in Eastern Europe with high spirits and 'other' beverage consumption [ β^ = 90, 95% confidence interval (CI) = 55–126], and in Eastern Europe with high lifetime abstainers and high spirits consumption (β^ = 42, 95% CI = 4–78). Conclusions: European drinking patterns appear to be clustered by level of beverage‐specific consumption, with heavy episodic drinkers, current drinkers and lifetime abstainers being distinguishing factors between clusters. Despite the overall stability of the clusters over time, some countries shifted between drinking patterns from 2000 to 2019. Overall, patterns of drinking in the European Union seem to be stable and partly determined by geographical proximity. [ABSTRACT FROM AUTHOR]

Aims: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020. Methods: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all‐cause mortality and alcohol‐attributable hospitalizations was discussed. Results: All Baltic countries implemented stringent availability restrictions on off‐premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans. Conclusions: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

OBJECTIVES To determine the impact of alcohol consumption on deaths and disability in Africa. METHODS We estimated alcohol exposure for 2012, and its impact on deaths and disability in Africa using estimates from the WHO Global Health Estimates for outcome data, and the WHO Global Status Report on Alcohol and Health 2014 for risk relations. We provide a scenario that includes the impact of alcohol on HIV/AIDS incidence, and qualitative predictions on future exposure and harm. results Overall, alcohol consumption has a large impact on burden of disease and mortality in African countries. Alcohol-attributable disease burden is more important when the impact of alcohol consumption on the incidence and course of HIV/AIDS is taken into account, with alcohol being responsible, in 2012, for 6.4% of all deaths and 4.7% of all DALYs lost in the African region. Alcohol exposure is expected to increase in the next years, and thus alcohol-attributable fractions. conclusions The weight of new evidence, especially of alcohol's role in the incidence and course of HIV/AIDS, is particularly relevant to African countries and points to the need for a strong policy response to reduce the alcohol-related burden of disease on the continent. [ABSTRACT FROM AUTHOR]

Alcohol use has been determined to be one of the main risk factors of, and contributors to, premature mortality in Russia, but no formal analysis of the impact of alcohol control policies has been undertaken so far. The present contribution is a commentary on a policy impact study undertaken by the World Health Organization on the effects of alcohol control measures on mortality and life expectancy in the Russian Federation. As part of the case study, all alcohol control policies in Russia from 1990 to 2018 were examined, and periods with differing policy intensity were distinguished based on the known effectiveness of different measures. Trends in all-cause mortality during these periods, and the shifts in trends between periods, were analysed using interrupted-time series methodology. As predicted, the intensity of alcohol control policies strongly impacted all-cause mortality. The experience of the Russian Federation in reducing the burden of disease caused by alcohol is a strong argument that effective alcohol policies are essential for improving the prospects for long and healthy lives. [ABSTRACT FROM AUTHOR]