States and municipalities can limit increases in the number and concentration of alcohol outlets by area or by population through licensing or local zoning processes1. Such restrictions can apply to on-premise settings (e.g., bars and restaurants), off-premise outlets (e.g., liquor stores, grocery and convenience stores), or both. Approaches to regulate alcohol outlets vary by state preemption statute: some regulate alcohol retail licensing exclusively, some grant local licensing authorities and issue state minimum standards (e.g., minimum distances between alcohol outlets or distances from schools, or maximum number of licenses per area), others grant local zoning authorities2, 3.
Expected Beneficial Outcomes (Rated)
Reduced excessive drinking
Other Potential Beneficial Outcomes
Reduced underage drinking
Reduced intimate partner violence
Reduced child maltreatment
Reduced gun violence
Evidence of Effectiveness
There is strong evidence that alcohol outlet density restrictions reduce rates of alcohol consumption and violent crime1, 4, 5, 6, 7. Restrictions can also reduce individuals’ alcohol consumption4, 5 and underage drinking1, 8, 9, 10. Limiting the location of alcohol outlets near colleges, universities, and primary and secondary schools is a suggested strategy to reduce underage drinking11.
Rates of alcohol consumption and violent crimes such as assault and robbery increase as alcohol outlet density increases1, 5, 6, 7. Youth living in areas with a high density of on-premise alcohol outlets are more likely to report alcohol use and heavy drinking than peers living in low density areas8, 12, 13.
Greater alcohol outlet density is associated with higher rates of intimate partner violence5, 8, 14, 15, 16 and child abuse and neglect1, 5, 17, 18. Effects appear to vary by alcohol outlet type14, 15, 16, 17, 18.
Lower alcohol outlet density appears to be associated with lower rates of suicide and gun violence5.
Impact on Disparities
As of January 2012, 18 states have exclusive local or joint state-local alcohol retail licensing to regulate alcohol outlet density; 24 states have exclusive state licensing but grant local governments zoning authority or have other mixed policies for density regulation2.
As of January 2016, 12 states have some restrictions on alcohol outlet location near colleges and universities; 11 of these states apply restrictions to both on- and off-premise outlets. Thirty-one states restrict outlet locations near primary and secondary schools; 23 of these states apply such restrictions to both on- and off-premises outlets11.
California and Nebraska are examples of states that have undertaken efforts to reduce alcohol outlet density3.
CAMY-Alcohol outlet density - Sparks M, Jernigan DH, Mosher JF. Strategizer 55 - Regulating alcohol outlet density: An action guide. Alexandria: Community for Anti-Drug Coalitions of America (CADCA); Center on Alcohol Marketing and Youth (CAMY), Johns Hopkins Bloomberg School of Public Health; 2011.
US DHHS-Underage drinking 2018 - US Department of Health and Human Services (US DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA). 2018 State performance and best practices for the prevention and reduction of underage drinking; 2018.
Jernigan 2013 - Jernigan D, Sparks M, Yang E, Schwartz R. Using public health and community partnerships to reduce density of alcohol outlets. Preventing Chronic Disease. 2013;10.
* Journal subscription may be required for access.
1 CG-Alcohol - The Guide to Community Preventive Services (The Community Guide). Excessive alcohol consumption.
2 CDC-Alcohol PSR 2013 - Centers for Disease Control and Prevention (CDC). Prevention Status Reports (PSR) 2013: Excessive alcohol use.
3 CAMY-Alcohol outlet density - Sparks M, Jernigan DH, Mosher JF. Strategizer 55 - Regulating alcohol outlet density: An action guide. Alexandria: Community for Anti-Drug Coalitions of America (CADCA); Center on Alcohol Marketing and Youth (CAMY), Johns Hopkins Bloomberg School of Public Health; 2011.
4 Sherk 2018* - Sherk A, Stockwell T, Chikritzhs T, et al. Alcohol consumption and the physical availability of take-away alcohol: Systematic reviews and meta-analyses of the days and hours of sale and outlet density. Journal of Studies on Alcohol and Drugs. 2018;79(1):58-67.
5 Gmel 2016* - Gmel G, Holmes J, Studer J. Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence. Drug and Alcohol Review. 2016;35(1):40-54.
6 Jernigan 2013 - Jernigan D, Sparks M, Yang E, Schwartz R. Using public health and community partnerships to reduce density of alcohol outlets. Preventing Chronic Disease. 2013;10.
7 Fitterer 2015* - Fitterer JL, Nelson TA, Stockwell T. A review of existing studies reporting the negative effects of alcohol access and positive effects of alcohol control policies on interpersonal violence. Frontiers in Public Health. 2015;3:1-11.
8 Siegfried 2019 - Siegfried N, Parry C. Do alcohol control policies work? An umbrella review and quality assessment of systematic reviews of alcohol control interventions (2006 – 2017). Public Library of Science (PLoS) ONE. 2019;14(4):e0214865.
9 NIAAA-Environmental strategies - National Institute on Alcohol Abuse and Alcoholism (NIAAA). CollegeAIM: Environmental-level strategies.
10 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.
11 US DHHS-Underage drinking 2018 - US Department of Health and Human Services (US DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA). 2018 State performance and best practices for the prevention and reduction of underage drinking; 2018.
12 Shih 2015 - Shih RA, Mullins L, Ewing BA, et al. Associations between neighborhood alcohol availability and young adolescent alcohol use. Psychology of Addictive Behaviors. 2015;29(4):950-959.
13 Paschall 2014a* - Paschall MJ, Lipperman-Kreda S, Grube JW. Effects of the local alcohol environment on adolescents’ drinking behaviors and beliefs. Addiction. 2014;109(3):407-416.
14 Kearns 2015* - Kearns MC, Reidy DE, Valle LA. The role of alcohol policies in preventing intimate partner violence: A review of the literature. Journal of Studies on Alcohol and Drugs. 2015;76(1):21-30.
15 Wilson 2014a* - Wilson IM, Graham K, Taft A. Alcohol interventions, alcohol policy and intimate partner violence: A systematic review. BioMed Central (BMC) Public Health. 2014;14:1-11.
16 Snowden 2016* - Snowden AJ. Alcohol outlet density and intimate partner violence in a nonmetropolitan college town: Accounting for neighborhood characteristics and alcohol outlet types. Violence and Victims. 2016;31(1):111-123.
17 Freisthler 2014* - Freisthler B, Johnson-Motoyama M, Kepple NJ. Inadequate child supervision: The role of alcohol outlet density, parent drinking behaviors, and social support. Children and Youth Services Review. 2014;43:75-84.
18 Morton 2014* - Morton CM, Simmel C, Peterson NA. Neighborhood alcohol outlet density and rates of child abuse and neglect: Moderating effects of access to substance abuse services. Child Abuse and Neglect. 2014;38(5):952-961.
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