Alcohol Excessive Consumption: Maintaining Limits on Days of Sale

Summary of CPSTF Finding

On the basis of strong evidence, the Community Preventive Services Task Force (CPSTF) recommends maintaining existing limits on the days on which alcoholic beverages are sold, as one strategy for the prevention of excessive alcohol consumption and related harms. Evidence for this recommendation is based on studies assessing the effects of repealing limits on sales of alcoholic beverages on weekend days. Only two studies evaluated the imposition of new limits on days of sale, limiting the ability to determine the effects of such new limits.

Intervention

Limiting the days when alcohol can be sold is intended to prevent excessive alcohol consumption and related harms by regulating access to alcohol. Most policies limiting days of sale target weekend days (usually Sundays). They may apply to alcohol outlets in which alcohol may be legally sold for the buyer to drink at the place of purchase (on-premises outlets, such as bars or restaurants) or elsewhere (off-premises outlets, such as liquor stores). In the United States, policies may be made at the state level and, where not prohibited by state pre-emption laws, at local levels.

CPSTF Finding and Rationale Statement

Read the CPSTF finding.

Promotional Materials

CDC Media Advisory About Maintaining Limits on Days and Hours of Sale:

CDC Newsroom Formatted Article About Maintaining Limits on Days and Hours of Sale:

Community Guide News:

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 14 studies (search period through February 2008). 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.

Summary of Results

Detailed results from the systematic review are available in the CPSTF finding.

All of the studies that considered the effects of changing days of sale on excessive alcohol consumption looked at limits on weekend days.

Removing limits on days of sale in off-premises settings (e.g., grocery, convenience or liquor stores)

Five studies qualified for the review.

  • A two-phase repeal of a Saturday ban was associated with a small increase in consumption, limited effects on injuries, and an increase in alcohol-impaired driving, some of which may have been due to increased surveillance (Sweden).
  • The closing of state liquor stores on Saturdays (Norway) had mixed results, with declines in consumption and in domestic violence, but increases in overall violence.
  • A 1995 repeal of a ban on Sunday sales was associated with a 30% increase in motor vehicle fatalities on Sundays compared with other days of the week (New Mexico).
  • A study of the effects of increased days of sale in multiple United States states indicated increases in the per capita consumption of spirits and beer.

Removing limits on days of sale in on-premises settings (e.g., restaurants, bars, ballparks)

Six studies qualified for the review.

  • One study found small increases in individual levels of consumption associated with new Sunday sales (Scotland).
  • Five studies found substantial increases in motor vehicle-related harms (fatal and non fatal crashes and alcohol-impaired driving arrests) associated with policies allowing new days of sale in several settings (Australia and the United States).

Imposing limits on days of sale for off-premises settings (e.g., grocery, convenience or liquor stores)

Two studies qualified for the review.

  • An experimental Saturday ban in 1981 was associated with declines in alcohol-related violence and other disturbances (Sweden).
  • Local repeal of a state-wide allowance of Sunday sales was associated with relative declines in motor vehicle fatalities (New Mexico).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF finding.

Two studies qualified for the review.

  • One study modeled the cost effectiveness of restricting alcohol sales in 12 global health regions for a 24-hour period over a weekend.
    • For the region composed of the U.S., Canada, and Cuba, the model estimated an average cost-effectiveness ratio of approximately $700 (in 2007 U.S. dollars) per disability-adjusted life year (DALY) averted by the reduction in heavy or harmful drinking. This is much less than the average annual per capita income in these three countries, making it very cost effective.
  • A study in New Mexico found that lifting a Sunday ban on packaged alcohol led to an estimated increase of 41.6 alcohol-related fatalities on Sundays for the 5-year period from 1995 to 2000. This would result in an estimated additional cost of more than $6 million (in 2007 U.S. dollars) for medical care and lost productivity per year for the state.

Applicability

Results of this review are likely applicable to a variety of settings and geographic locations in the U.S. and other high-income countries.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. What are evidence gaps?
  • The research on days of sale conducted in the U.S. was primarily at the state level. However, additional research is needed to assess the effectiveness of local restrictions on days of sale in preventing excessive alcohol consumption and related harms.
  • It would be useful to better understand the effect of differential policies regarding days of sale across neighboring jurisdictions. Does more ready access in a neighboring region lead to increased travel to this region, allowing the possibility of motor vehicle crashes, especially with intoxicated drivers?
  • Additional research is also needed to more fully assess the costs and benefits of restricting the number of days of sale. From a societal perspective, these should include:
    • Intervention costs
    • Loss in sales and tax revenues and employment
    • Reductions in fatal and nonfatal injuries, crime, and violence
    • Gains in safety and public order
    • Averted loss of household and workplace productivity

Study Characteristics

  • Included studies were conducted in cities, states, and countries or large regions in the U.S., Australia, Norway, Sweden, and Scotland.
  • The policy changes that were assessed took place between 1967 and 2004.
  • Studies used a variety of methods for estimating intervention effects, including chi-square statistics, percentage change, relative risks, and auto-regressive integrated moving average (ARIMA) time series. All but one study had comparison populations or conditions.
  • To be included in the review, studies had to report on outcomes related to excessive alcohol consumption or related harms. Outcome measures included binge drinking, heavy drinking, liver cirrhosis mortality, alcohol-related medical admissions, alcohol-related motor vehicle crashes, including single-vehicle night-time crashes (which are widely used to indicate motor vehicle crashes due to drinking and driving), per capita alcohol consumption (a recognized proxy for estimating the number of heavy drinkers in a population), unintentional injuries, suicide, and crime, such as homicide and aggravated assault.

Analytic Framework

Effectiveness Review

Analytic Framework see Figure 1 on page 577
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.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table [PDF – 103 kB]

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

The Effect of Changing the Number of Days that Alcohol was Sold at On-Premises Outlets

Knight I, Wilson P. Scottish licensing laws. London: Office of Population Censuses and Surveys, Social Survey Division, 1980.

Ligon J, Thyer B. The effects of a Sunday liquor sales ban on DUI arrests. J Alcohol Drug Educ 1993;38(2):33 40.

Ligon J, Thyer BA, Lund R. Drinking, eating, and driving: Evaluating the effects of partially removing a Sunday liquor sales ban. Journal Alcohol Drug Educ 1996;42(1):15-24.

Smith DI. Impact on traffic safety of the introduction of Sunday alcohol sales in Perth, Western Australia. J Stud Alcohol 1978;39(7):1302-4.

Smith DI. Effect on traffic accidents of introducing Sunday hotel sales in New South Wales, Australia. Contemp Drug Probl 1987;279-94.

Smith DI. Effect on Traffic Accidents of Introducing Sunday Alcohol Sales in Brisbane, Australia. Int J Addict 1988;23(10):1091-9.

Smith DI. Effect on casualty traffic accidents of changing Sunday alcohol sales legislation in Victoria, Australia. J Drug Issues 1990;20(3):417-26.

The Effect of Changing the Number of Days that Alcohol was Sold at Off-Premises Outlets

McMillan GP, Hanson TE, Lapham SC. Geographic variability in alcohol-related crashes in response to legalized Sunday packaged alcohol sales in New Mexico. Accid Anal Prev 2007;39(2):252-7.

McMillan GP, Lapham SC. Effectiveness of bans and laws in reducing traffic deaths: Legalized Sunday packaged alcohol sales and alcohol-related traffic crashes and crash fatalities in New Mexico. Am J Public Health 2006;96(11):1944-8.

Nordlund S. Effects of Saturday closing of wine and spirits shops in Norway. Oslo, Norway: Statens institutt for alkoholforskning, 5-1-1985.

Norstrom T, Skog OJ. Saturday opening of alcohol retail shops in Sweden: An impact analysis. J Stud Alcohol 2003;64(3):393-401.

Norstrom T, Skog OJ. Saturday opening of alcohol retail shops in Sweden: an experiment in two phases. Addiction 2005;100(6):767-76.

Olsson O, Wikstrom PH. Effects of the experimental Saturday closing of liquor retail stores in Sweden. Contemp Drug Probl 1982;325-53.

Stehr M. The effect of Sunday sales bans and excise taxes on drinking and cross-border shopping for alcoholic beverages. Natl Tax J 2007;60(1):85-105.

Economic Review

Chisholm D, Rehm J, Ommeren MV, Monteiro M. Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Stud Alcohol 2004;65:782 93.

McMillan GP, Lapham SC. Effectiveness of bans and laws in reducing traff c deaths: legalized Sunday packaged alcohol sales and alcohol-related traff c crashes and crash fatalities in New Mexico. Am J Public Health 2006;96(11):1944 8.

McMillan GP, Hanson TE, Lapham SC. Geographic variability in alcohol-related crashes in response to legalized Sunday packaged alcohol sales in New Mexico. Accid Anal Prev 2007;39(2):252 7.

Search Strategies

The following outlines the search strategy used for these reviews of interventions to prevent excessive alcohol consumption: Dram Shop Liability; Increasing Alcohol Taxes; Maintaining Limits on Days of Sale; Maintaining Limits on Hours of Sale; Overservice Law Enforcement Initiatives; Regulation of Alcohol Outlet Density; Enhanced Enforcement of Laws Prohibiting Sales to Minors.

The following databases were searched from their 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)

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.
  • Restrictions on days of sale may be opposed by firms involved in manufacturing, distributing, or selling alcoholic beverages.
  • State pre-emption laws (i.e., laws that prevent the implementation and enforcement of more restrictive local alcohol sales laws) can also undermine efforts by local governments to regulate days of sale.
  • This review did not address the potential consequence of neighboring areas having differing policies. For example, if a community restricts access to alcohol by not allowing sales on certain days and a neighboring community lacks these restrictions, it is possible that harms (e.g., crashes from driving, drunk or sober, over longer distances) may result when people travel between communities.

Information on the use of evidence for establishing policies at the state or local levels is available from the National Institute on Alcohol Abuse and Alcoholism.