CDC COMMUNITY GUIDE: 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.

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.

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).