Enhanced enforcement of laws prohibiting alcohol sales to minors
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Health factors shape the health of individuals and communities. Everything from our education to our environments impacts our health. Modifying these clinical, behavioral, social, economic, and environmental factors can influence how long and how well people live, now and in the future.
Enhanced enforcement programs for laws prohibiting the sale of alcohol to minors initiate or increase the frequency of retailer compliance checks, shoulder tap operations, or parking lot observation outside alcohol establishments1, 2. These enforcement programs are generally conducted by local law enforcement or alcohol beverage control agencies. For retailer compliance checks, a trained underage operative (i.e., a decoy) enters an alcohol retail store or a bar and attempts to purchase alcohol1. In shoulder tap operations, a decoy approaches an adult going into an alcohol establishment and asks the adult to purchase alcohol for them3. Violators receive legal or administrative sanctions4.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced underage alcohol purchases
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced underage drinking
Reduced alcohol-related crashes
What does the research say about effectiveness?
There is strong evidence that enhanced enforcement of laws that prohibit alcohol sales to minors, especially conducting underage compliance checks, reduces retail sales to minors4, 5, 6. Such enforcement also appears to reduce underage alcohol consumption4, 7, 8 and alcohol-related crashes among drivers under age 219. However, additional evidence is needed to confirm effects.
Underage compliance checks have been shown to reduce alcohol sales to minors of various racial and ethnic groups in both bars and liquor stores in rural and urban communities4. Compliance checks may also reduce alcohol sales to underage youth, in the short-term, at establishments in neighboring communities that do not conduct such enforcement5. Adopting rigorous enforcement strategies such as compliance checks, shoulder tap operations, and enforcement of laws against providing alcohol to minors is associated with reduced underage drinking8. An increase in the number of compliance checks is associated with decreases in alcohol-related crashes for drivers under age 21, but not with crashes for drivers aged 21 or older9.
Alcohol enforcement agencies in urban areas are more likely to conduct underage compliance checks than suburban, small town, and rural agencies. Agencies in urban areas are also more likely to enforce penalties around alcohol provision to minors and consumption by minors than agencies in suburban areas10. Enforcement agencies are more likely to enforce laws that target adults providing alcohol to underage youth, including underage alcohol compliance checks, if they have a full-time officer specific to alcohol enforcement, a division specific to alcohol enforcement, perceive underage drinking as very common, and/or are in larger communities2, 11.
Research suggests that compliance checks are most effective when checks are frequent, well-publicized, well-designed, solicit community support, and involve penalties to the licensed establishment, instead of just the server6. Compliance checks are labor-intensive and expensive to implement frequently and should be paired with other efforts to reduce underage drinking12. Publicizing monitoring and enforcement activities and building public awareness are components for effective alcohol control policy implementation13.
How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples
As of 2017, 36 states have formal compliance check protocols or guidelines: the maximum age of the decoy ranges from 19 to 21, and decoy training is mandatory in 15 states. Most states permit law enforcement agencies to conduct compliance checks on a random basis1. Many states and local governments use community-based strategies to prevent underage drinking that include enhanced enforcement of laws prohibiting sales to minors. For example, South Carolina’s Alcohol Enforcement Teams and their enforcement and education partners implement various efforts to reduce youth access to alcohol, including compliance checks, public education, and media advocacy14.
Implementation Resources
PSEDC-Compliance checks - Prevention Solutions@EDC. Compliance checks.
Prevention First-Enforcement - Prevention First. Law enforcement strategies.
US DHHS-Underage drinking 2018 - U.S. Department of Health and Human Services (U.S. DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA). 2018 State performance and best practices for the prevention and reduction of underage drinking; 2018.
Footnotes
* Journal subscription may be required for access.
1 US DHHS-Underage drinking 2018 - U.S. Department of Health and Human Services (U.S. DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA). 2018 State performance and best practices for the prevention and reduction of underage drinking; 2018.
2 Jones-Webb 2015 - Jones-Webb R, Toomey TL, Lenk KM, Nelson TF, Erickson DJ. Targeting adults who provide alcohol to underage youth: Results from a national survey of local law enforcement agencies. Journal of Community Health. 2015;40(3):569-575.
3 Prevention First-Enforcement - Prevention First. Law enforcement strategies.
4 CG-Alcohol - The Guide to Community Preventive Services (The Community Guide). Excessive alcohol consumption.
5 Erickson 2013 - Erickson DJ, Smolenski DJ, Toomey TL, Carlin BP, Wagenaar AC. Do alcohol compliance checks decrease underage sales at neighboring establishments? Journal of Studies on Alcohol and Drugs. 2013;74(6):852-858.
6 RAND-Imm 2007 - Imm P, Chinman M, Wandersman A, et al. Preventing underage drinking: Using Getting To Outcomes™ with the SAMHSA strategic prevention framework to achieve results. Santa Monica: RAND Corporation; 2007: Technical Report 403.
7 IOM-Underage drinking 2004 - Institute of Medicine (IOM), National Research Council (NRC), Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Board on Children, Youth, and Families (BCYF). Reducing underage drinking: A collective responsibility. (Bonnie RJ, O’Connell ME, eds.). Washington, D.C.: National Academies Press; 2004.
8 Wolfson 2017 - Wolfson M, Reboussin B, Wagoner K, et al. Identifying the effects of local policies and enforcement strategies to prevent alcohol use by older adolescents. Winston-Salem, NC: Wake Forest School of Medicine; 2017.
9 George 2021 - George MD, Holder R, Shamblen S, Nienhius MM, Holder HD. Alcohol compliance checks and underage alcohol-involved crashes: Evaluation of a statewide enforcement program in South Carolina from 2006 to 2016. Alcoholism: Clinical and Experimental Research. 2021;45(1):242-250.
10 Calvert 2020 - Calvert C, Toomey T, Lenk K, et al. Variation in alcohol policy enforcement across urban and nonurban communities. Journal of Rural Health. 2020;36(2):240-246.
11 Erickson 2014 - Erickson DJ, Lenk KM, Sanem JR, et al. Current use of underage alcohol compliance checks by enforcement agencies in the United States. Alcoholism: Clinical and Experimental Research. 2014;38(6):1712-1719.
12 OJJDP-Krevor 2017 - Krevor BS, Grube J, DeJong W. Mystery shop programs to reduce underage alcohol sales. Office of Juvenile Justice and Delinquency Prevention (OJJDP); 2017.
13 Jones-Webb 2014 - Jones-Webb R, Nelson T, Mckee P, Toomey T. An implementation model to increase the effectiveness of alcohol control policies. American Journal of Health Promotion. 2014;28(5):328-335.
14 SC-AETs - South Carolina Department of Alcohol and Other Drug Abuse Services. Underage drinking: Alcohol Enforcement Teams (AETs).
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/enhanced-enforcement-of-laws-prohibiting-alcohol-sales-to-minors
To see all strategies:
countyhealthrankings.org/whatworks