Full alcohol marketing ban and adolescent drinking patterns: a repeated cross-sectional analysis comparing Lithuania with other EU countries.

Introduction: Alcohol consumption is a leading cause of premature mortality in Europe, with adolescents particularly vulnerable to marketing influences. While alcohol marketing bans are considered a WHO 'best buy', evidence of their effectiveness remains limited. Lithuania's 2018 full national ban on alcohol marketing offers a unique opportunity to assess its impact on adolescent drinking. This study evaluated whether adolescents in Lithuania reported greater declines in alcohol use compared with peers in European Union countries without a full ban. Methods: We conducted a difference-in-difference analysis using generalised linear regression models to assess alcohol use among adolescents. We used data from the European School Survey Project on Alcohol and Other Drugs for 15-16 year-olds in Lithuania and five comparator countries (Estonia, France, Italy, Latvia and Poland) across four waves (2007, 2011, 2015 and 2019; n=84 189). The study follows a prespecified and published protocol. The primary outcome was self-reported frequency of intoxication in the past 12 months, assessed by negative binomial regression models adjusted for individual and country-level covariates. Results: Compared with statutory control for some alcoholic beverages, a full marketing ban was associated with a 35% reduction in frequency of intoxication (incidence rate ratios (IRR) 0.65 (95% CI 0.56 to 0.77)). Sensitivity analyses confirmed this association. Without the ban, predicted intoxication frequency in 2019 would have been nearly twice as high (1.28 vs 0.73 occasions). Additional analyses showed significant reductions in the odds of any intoxication (OR 0.68 (95% CI 0.60 to 0.78)). Protective associations were also observed for alcohol use (IRR 0.88 (95% CI 0.79 to 0.99)) and binge drinking (IRR 0.82 (95% CI 0.72 to 0.92)). Conclusions: The implementation of full alcohol marketing bans was associated with reduced risky drinking behaviours among adolescents in Lithuania. Our findings support full bans as a central component of alcohol control, especially in the digital age, where partial restrictions are easily circumvented.