Preventing Excessive Alcohol Consumption: Regulation of Alcohol Outlet Density

Alcohol outlet density regulation is defined as applying regulatory authority to reduce alcoholic beverage outlet density or to limit the increase of alcoholic beverage outlet density. Regulation is often implemented through licensing or zoning processes. An alcohol outlet is a place where alcohol may be legally sold for the buyer to drink there (on-premises outlets, such as bars or restaurants) or elsewhere (off-premises outlets, such as liquor stores). Density refers to the number of alcohol outlets in a given area.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force  recommends the use of regulatory authority (e.g., through licensing and zoning) to limit alcohol outlet density on the basis of sufficient evidence of a positive association between outlet density and excessive alcohol consumption and related harms. 

Task Force Finding

Results from the Systematic Reviews

No studies were found that directly examined the effects of local interventions to limit alcohol outlet density.

Several types of studies were found that consistently indicated that alcoholic beverage outlet density and policy changes that affect alcohol outlet density were associated with excessive alcohol consumption and related harms.

Findings from the various types of the 30 qualifying studies are described below.

Policy Changes that Increased Alcohol Outlet Density

Four studies qualified for systematic review.

• Policies that increased alcohol outlet density were found to result in increased excessive alcohol consumption and related harms.
• Studies were conducted in Iceland, Finland, New Zealand, and North Carolina.

Alcoholic Beverage Retail Privatization

This occurs when governments relinquish monopoly control over the retail sale of alcoholic beverages. Privatization commonly results in increased alcohol outlet density, among other changes.

Seventeen studies that assessed the effects of privatization in 14 settings and one study of government re-monopolization qualified for the review.

• Privatization of alcohol sales was associated with increases in excessive alcohol consumption of the privatized beverage and minimal effects on beverages not privatized.
• One study of government re-monopolization indicated that re-monopolization may reduce alcohol-related harms.

Bans Against Alcoholic Beverages

Bans against alcoholic beverages reduce the density of alcohol outlets to zero. Repeal of bans allows for expanded density of outlets.

Seven studies qualified for systematic review.

• Bans against alcoholic beverages can reduce excessive alcohol consumption and related harms, particularly in isolated environments without other sources of alcohol.
• Reviewed studies were conducted in non-tribal areas of the United States and Canada and within American Indian and Native settings in Alaska, northern Canada, and the southwestern United States.

Association Between Alcohol Outlet Density Change and Alcohol-related Harms, in Which the Cause of Density Change Was Not Assessed

Nine studies qualified for the review.

• Generally, increased outlet density was associated with increases in alcohol-related harms.
• One possible exception was alcohol-related motor vehicle crashes for which evidence was mixed.
• Studies were conducted in the United States (6 studies), Canada (1), the United Kingdom (1), and Norway (1).

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to excessive alcohol consumption.

Supporting Materials

• Analytic framework [PDF - 108KB]
• Research gaps
• Summary evidence table [PDF - 126KB]
• Included studies
• Search strategy

Publications

Campbell CA, Hahn RA, Elder R, Brewer R, Chattopadhyay S, Fielding J, Naimi TS, Toomey T, Briana Lawrence B, Middleton JC, Task Force on Community Preventive Services. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. [PDF - 445KB] Am J Prev Med 2009;37(6):556-69.

Task Force on Community Preventive Services. Recommendations for reducing excessive alcohol consumption and alcohol-related harms by limiting alcohol outlet density. [PDF - 82KB] Am J Prev Med 2009;37(6):570-1.

More Community Guide publications about Preventing Excessive Alcohol Consumption

Promotional Materials

Community Guide News

• Regulating Alcohol Outlet Density Prevents Excessive Alcohol Use
  Developed by The Community Guide in collaboration with CDC’s Alcohol Program

Action Guides

• Strategizer 55 - Regulating Alcohol Outlet Density: An Action Guide
  Developed by the Community Anti-Drug Coalitions of America in partnership with the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health

More promotional materials for Community Guide reviews about Preventing Excessive Alcohol Consumption.

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing excessive alcohol consumption: regulation of alcohol outlet density. www.thecommunityguide.org/alcohol/outletdensity.html. Last updated: MM/DD/YYYY.

Review completed: February 2007