Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000–2019
, Mindaugas Štelemėkas 9,10, Carina Ferreira-Borges 11, Huan Jiang 1,2, Shannon Lange 1,2, Maria Neufeld 1,2,3,11, Robin Room 12,13, Sally Casswell 14, Alexander Tran 1,2 and Jakob Manthey 3,4,15,*Round 1
Reviewer 1 Report
ijerph-1094763-review
This manuscript describes a method of classification of policies that potentially my reduce reducing alcohol use in Lithuania. The authors methodically explain their rationale and decision process for evaluating policies that have been implemented in Lithuania and classify theme into Tiered interventions. The authors succeed in describing a system of classification.
The reader may be keen on understanding how the policies related to level of alcohol consumption over time, but in the authors defense that was not the central question of this manuscript. The value of the proposed classification scheme would be validated in future studies that do address drinking outcome. The current is a necessary precursor step toward such analyses. Future validation in this analysis will be challenged, as the authors point out the Lithuania example is challenged by multiple simultaneous or overlapping timings of policies being implemented. Disentangling these in an interrupted time-series analyses will be difficult.
Suggest adding date range to title.
Author Response
This manuscript describes a method of classification of policies that potentially may reduce reducing alcohol use in Lithuania. The authors methodically explain their rationale and decision process for evaluating policies that have been implemented in Lithuania and classify theme into Tiered interventions. The authors succeed in describing a system of classification.
Response: Thank you!
The reader may be keen on understanding how the policies related to level of alcohol consumption over time, but in the authors defense that was not the central question of this manuscript. The value of the proposed classification scheme would be validated in future studies that do address drinking outcome. The current is a necessary precursor step toward such analyses. Future validation in this analysis will be challenged, as the authors point out the Lithuania example is challenged by multiple simultaneous or overlapping timings of policies being implemented. Disentangling these in an interrupted time-series analyses will be difficult.
Response: We provide level of alcohol consumption in Appendix Table A1.
Suggest adding date range to title.
Response: We have added a date range to the title.
Reviewer 2 Report
I have some few specific comments:
Line 79: Information is repeated in line 80, and should be deleted on line 79.
Line 270: One would like to know the BAC allowed before and after change, plus age of "young drivers".
Line 284/5: What is the meaning and implication of the statement that ".. amendments had a flaw..". (This is explained later, in Table 2, but should also appeat in the text).
Box 2, intervention April 1, 2014: "...increase in excise tax by 10-47%; 1 for ethyl alcohol!. Is "...beer and wine" lacking after 47%?
Line 310-11: Scoring of interventions. How was this done, based on what?
Author Response
Response: Based on the comment on English language and style, the whole manuscript was again copy-edited by a professional editor.
I have some few specific comments:
Line 79: Information is repeated in line 80, and should be deleted on line 79.
Response: Comment: line 79 has been deleted.
Line 270: One would like to know the BAC allowed before and after change, plus age of "young drivers".
Response: Clarification has been inserted as: “…and a reduction in the blood alcohol concentration (BAC) threshold for young drivers (those having had a driving license for less than two years) from 0.4 to 0.2 per mille.”
Line 284/5: What is the meaning and implication of the statement that ".. amendments had a flaw..". (This is explained later, in Table 2, but should also appear in the text).
Response: Clarification has been inserted as: “…However, the initial version of the amendment contained a significant flaw (a refusal to undergo BAC testing when suspected of driving under the influence was not an offence under Lithuanian law and therefore police could not force someone to comply) “.
Box 2, intervention April 1, 2014: "...increase in excise tax by 10-47%; 1 for ethyl alcohol!. Is "...beer and wine" lacking after 47%?
Response: We changed the text accordingly.
Line 310-11: Scoring of interventions. How was this done, based on what?
Response: This is explained in the Methods section, which we have now expanded. It now reads:
For the sensitivity analysis, interventions were independently established by a panel of alcohol policy experts using a modified nominal group technique [36], whereby experts gave individual judgments without an interactive group meeting. All alcohol control policy measures during the time period 2000-2019 (see Table 2) were rated. Five alcohol control policy experts were selected to provide the ratings, none of whom at the time of their rating were familiar with the specific data for Lithuania on the level of alcohol consumption, the mortality and other disease burden data, or the data on affordability in Lithuania: Sally Casswell, Carina Ferreira-Borges, Shannon Lange, Maria Neufeld, and Robin Room. The ratings were conducted in May of 2020.
Using this procedure, the experts could not be biased by knowledge of the actual Lithuanian history of associations between policies and mortality. The rating scale applied for each policy ranged from 0 to 10, and ratings were based on the perceived immediate impact of alcohol use on health, based on the following instructions: “Please rank the alcohol policy measures in their predicted immediate impact on alcohol consumption and health (think about all-cause mortality as the main health outcome) from 0 to 10 (0=no impact to 10=highest impact).”
