PROJECT SUMMARY
During the coronavirus disease 2019 (COVID-19) pandemic, countries all over the world implemented various
public health measures (e.g., complete lockdowns, occupancy limitations, and travel restrictions) in an effort to
limit the spread of the virus. Such measures inherently impacted alcohol use, and, as such, likely had an
impact on alcohol-attributable harms. The proposed Supplement will evaluate the effects of COVID-19 public
health measures on alcohol consumption and on select alcohol-attributable disease and mortality outcomes in
Lithuania, a high-income member state of the European Union. We postulate that the pandemic and its
associated public health measures impacted alcohol consumption and alcohol-attributable harms in the
following ways: consumption is hypothesized to polarize – i.e., people who had been drinking heavily before
the pandemic (heavy drinking will be defined a 40+ grams of pure alcohol per day for women, and 60+ g of
pure alcohol per day for men) will have, on average, increased their alcohol consumption, whereas the rest of
the population will have, on average, decreased their consumption. We will also test mediating mechanisms of
availability and affordability for decreases, and stress for increases. In terms of alcohol-attributable harm, we
selected the following key consequences of alcohol consumption and theoretically derived several hypotheses
impacted by confinement, social distancing and other public health measures taken during the pandemic to
reduce infection risk: suicide attempts and deaths by suicide, domestic violence, non-domestic violence, traffic
collisions and injuries, and liver cirrhosis. In short, we postulate that suicide attempts and suicide, domestic
violence and liver cirrhosis hospitalizations and mortality increased during lockdowns, in part fueled by the
polarization of drinking, while traffic collisions and injury as well as non-domestic violence decreased; the latter
two because of less traffic and fewer situations where such violence would typically occur, overall. However,
we also postulate that the proportion of alcohol-attributable traffic collisions and injury to all such collisions and
injury will increase. If our hypotheses are supported, we will be able to improve future calculations of alcohol-
attributable burden and disease and mortality, further moving away from simple attributable-fraction models
based on level of exposure and outcome (as currently practiced by the World Health Organization and the
Global Burden of Disease study) towards more complex models which specify country-specific boundary
conditions. But as indicated above, the analyses planned for this Supplement will not only improve the
theoretical knowledge in alcohol epidemiology, but also specify necessary boundary conditions for alcohol
control policy implementation, not only during times of future pandemics, but economic and other crises as
well. Lithuania offers a unique opportunity to test these hypotheses due to the richness of its data (e.g., five
large-scale national general population surveys from 2019-21).