Alcohol Excessive Consumption: Enhanced Enforcement of Laws Prohibiting Sales to Minors

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption.

The systematic review included eight studies.

• Enhanced enforcement programs reduced retail sales of alcohol to minors.
• All of the studies evaluated the percentage of purchase attempts by underage or youthful-looking decoys that resulted in sales. Some studies also assessed rates of underage drinking.
• Sales to decoys decreased by a median of 42% (8 studies)
• Enhanced enforcement programs were associated with modest decreases in underage alcohol consumption (3 studies), but this effect was directly attributable to enhanced enforcement in only one study.

• What are intervention effects on minors’ alcohol consumption?
• If it becomes more difficult to purchase alcohol, are minors more likely to seek alcohol from alternative sources?
• What are the independent effects of enhanced enforcement when used alone or as part of a multicomponent intervention?
• How does intervention intensity affect outcomes? Intensity refers to the percentage of retailers that receive compliance checks, or the number of repeat compliance checks a given retailer receives.
• How do the amount and reach of associated publicity efforts affect outcomes?

• Studies were randomized controlled trials or other designs with concurrent comparison groups (5 studies), or time series designs conducted within a single community (3 studies).
• Most of the enforcement efforts targeted off-premises establishments; one study targeted both on-premises and off-premises establishments.
• Follow-up periods ranged from 1 month to 24.5 months with a median of 24 months.
• Five studies evaluated multicomponent interventions that included enhanced enforcement of retailer compliance.
  • Interventions typically were spearheaded by community coalitions and frequently included training in responsible beverage service and attempts to change alcohol-related policies.
  • Two of the studies evaluated interventions implemented in multiple communities, and community coalitions had substantial autonomy in deciding which approaches to use. As a result, only some of the communities implemented enhanced enforcement programs.

Elder RW, Lawrence B, Janes G, et al. Enhanced enforcement of laws prohibiting sale of alcohol to minors: systematic review of effectiveness for reducing sales and underage drinking. Transportation Research E-Circular. 2007;(E-C123):181-8. Available at: http://onlinepubs.trb.org/onlinepubs/circulars/ec123.pdf.

Effectiveness Review

Analytic Framework
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

No content is available for this section.

Effectiveness Review

Barry R. Enhanced enforcement of laws to prevent alcohol sales to underage persons: New Hampshire, 1999 2004. MMWR 2004;53:452 4.

Grube JW. Preventing sales of alcohol to minors: results from a community trial. Addiction 1997;92(Suppl 2):S251 60.

Perry CL, Williams CL, Veblen-Mortenson S, Toomey TL, Komro KA, Anstine PS, et al. Project Northland: outcomes of a community-wide alcohol use prevention program during early adolescence. American Journal of Public Health 1996;86:956 65.

Preusser DF, Williams AF, Weinstein HB. Policing underage alcohol sales. Journal of Safety Research 1994;25:127 33.

Scribner R, Cohen D. The effect of enforcement on merchant compliance with minimum legal drinking age laws. Journal of Drug Issues 2001;31:857 66.

Wagenaar A, Gehan JP, Jones-Webb R, Toomey TL, Forster JL. Communities mobilizing for change on alcohol: outcomes from a randomized community trial. Journal of Community Psychology 1999;27:315 26.

Wagenaar AC, Toomey TL, Erickson DJ. Preventing youth access to alcohol: outcomes from a multi-community time-series trial. Addiction 2005;100:335 45.

Wallin E, Andreasson S. Can I have a beer, please? A study of alcohol service to young adults on licensed premises in Stockholm. Prevention Science 2004;5:221 9.

Implementation Resource

Rural Health Information Hub, Prevention and Treatment of Substance Use Disorders Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of programs to prevent and treat substance use disorders in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

• Prevention Policies

The following databases were searched from inception up to October 2007 to identify studies assessing the impact of changes for all interventions included in the Community Guide series of alcohol reviews: Econlit, PsycInfo, Sociology Abstracts, Medline, Embase, and EtOH (not available after 2003). The search yielded 6442 articles, books, and conference abstracts, of which 5645 were unique.

1) Alcohol Keywords

• (Alcoholic drink$ OR alcoholic beverage* OR alcohol OR liquor OR beer OR wine OR spirits OR drunk OR intoxicat$ OR alcoholic binge* OR binge drinking)

2) Keywords for interventions of interest (assume ORs between bullets) {Target intervention}

• ((day$ or hour$ or sale$) and (limit$ or sale$ or extend$ or restrict$ or trading)) {Restrictions on days and hours of sale}
  • (day OR hour OR “time of day” OR time) AND (sale* OR trading OR commerce) AND (limit OR restrict OR regulate)
• (tax or taxes or taxation or cost or costs$ or prices or price) {Increased alcohol taxes}
  • (tax*) AND (increase OR raise)
• (social and (host$ or liability or provider$ or provision)) {Social host liability}
  • (“social host” OR provider* OR provision) AND (liability OR responsibility)
• ((underage or minor or youth or young or teenage$) and licens$ and (enforcement or fee$ or driver$)) {License suspension/revocation for non-MV alcohol violations among underage drinkers}
  • (underage OR minor OR youth OR adolescent OR teen*) AND (“drivers license” OR) AND (suspension OR revocation OR revoke) AND (“non-mv alcohol violation” OR (“alcohol violation” NOT (driving OR “motor vehicle”))
• (privatiz$ or monopol$ or ((sale$ or distribut$ or industry) and (ban$ or strike$ or prohibition))) {Government monopolies on off-premise outlets}
  • (“off-premise”) AND (“government monopoly” OR government OR privatiz* OR monopoly) AND (sale* OR distribut* OR industry)
• (minimum age or drinking age or purchase age or legal age or MDA or MLDA or ((teen$ or adolescen$ or young or college$ or youth$ or student$ or underage$ or minor$) and (enforce$ or deterrence$ or avail$ or access$ or crackdown or ID or identification or compliance))) {Enhanced enforcement of laws prohibiting possession or consumption of alcohol by minors}
  • (underage OR minor OR youth OR adolescent OR teen*) AND (possess* OR consum* OR access*) AND (law* OR regulat* OR enforce* OR deter* OR crackdown OR complia*) AND (“minimum age” OR “drinking age” OR “purchase age” OR “legal age” OR “MDA” OR “MLDA”)
• (advertis$ or marketing or promotion$ or internet or product placement or billboard$ or sponsorship) {Limiting advertising exposure}
  • (advertis* OR market* OR promotion* OR internet OR www OR World Wide Web OR “product placement” OR billboard* OR sponsor* OR target*) AND (underage OR minor OR youth OR adolescent OR teen*) AND (limit OR reduc* OR restrict* OR regulat*)
• (compliance check$ or sting$ or decoy$ or purchase attempt or dram shop) {Enhanced enforcement of laws prohibiting provision of alcohol to minors}
  • (“dram shop” OR “on-premise” OR provider) AND (“compliance check*” OR “purchase attempt*” OR enforce*) AND (law* OR regulat* OR prohibit*) AND (underage OR minor OR youth OR adolescent OR teen*)
• (((manager$ or management or serv$ or clerk$ or seller$) and (liabilit$ or practice$ or training or beverage$)) or liquor liability) {Responsible beverage server programs/Dram shop liability}
  • (provider OR manage* OR serv* OR “dram shop” OR “on-premise” OR sale*) AND ((liabil* OR responsib*) OR (“responsible beverage server program*” OR training OR program*)
• (gas station or self service or ((outlet$ or store$ or bar or bars or establishment) and (density or densities or on-sale or off-sale or type or types or number$ or location$ or concentration or zoning))) {Outlet density and zoning restrictions}
  • (“gas station” OR store OR bar* OR establishment* OR sale*) AND (zon* OR restriction* OR regulat* OR law*) AND (dens*)
• (happy hour$ or liquor by the drink or ladies night or (drink$ and (special$ or discount$ or pric$)) { Decreasing promotional pricing}
  • (promot* OR special OR discount OR “happy hour” OR “ladies night”) AND (pric*) AND (decrease OR restrict* OR regulat* OR limit OR reduc*)

3) Exclusionary keywords

• (air and quality) or pollution
• methanol or methyl
• solvent$

Search for (1) AND (2), NOT (3)

• Interventions implemented as part of a more comprehensive approach to reducing underage drinking may be more likely to maximize intervention effects.
  • If enhanced enforcement limits minors’ access to alcohol through retail outlets, it is possible minors will increasingly turn toward social providers, such as friends, family, or strangers.
  • A comprehensive approach could involve efforts to reduce access to alcohol from social providers and aim to reduce drinking opportunities and demand for alcohol among young people.
• While interventions reduce the likelihood that retailers will provide alcohol to minors during the period of time in which enforcement efforts are maintained, effects diminish rapidly when enforcement ceases.
• An important barrier to implementation is the perception that communities do not support the interventions. Without community support, there may be little incentive for regulatory and law enforcement agencies to increase enforcement activities, particularly in the face of resistance from retailers.
  • Incentives to implement and maintain enforcement programs could be increased by making receipt of federal block grant funds conditional on achieving target rates of retailer compliance.
  • Concerned organizations could conduct their own decoy operations and publicize results to highlight the problem in their community.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of adolescents who drank alcohol in the past month — SU-04
• Reduce the proportion of people under 21 years who engaged in binge drinking in the past month — SU-09