Alcohol Excessive Consumption: Maintaining Limits on Hours of Sale

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends maintaining limits on hours of alcohol sale in on-premises settings, based on sufficient evidence of effectiveness for reducing excessive alcohol consumption and related harms.

Two separate analyses were conducted to determine if an increase in hours of sale in on-premises outlets was associated with an increase in alcohol-related harms:

  • Sufficient evidence was found for increasing hours of sale by two or more hours
  • Insufficient evidence was found for increasing hours of sale by less than two hours

All evidence was from studies of events in high income nations; no studies were conducted in the United States. No studies assessed the effects of increasing hours of alcohol sales in off-premises settings.

Intervention

One strategy to prevent excessive alcohol consumption and related harms is to limit access by regulating the hours during which alcohol can legally be sold. Approaches may include:
  • Maintaining existing limits in response to efforts to expand hours of sale
  • Expanding current limits on hours of sale

Policies limiting hours of sale may apply to outlets that sell alcohol for consumption 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

CDC Newsroom Formatted Article

Community Guide News

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 16 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.

Increasing hours of sale by two or more hours in on-premises settings (e.g., bars and restaurants)

Ten studies qualified for the review. These studies reported on six events that changed the hours of alcohol sales by two or more hours.

  • Extending hours of sale by 2 to 4 hours was associated with:
    • An increase in alcohol consumption (1 study, Australia)
    • A relative increase in motor vehicle crash injuries ranging from 4% to 11% (2 studies, Australia)
    • A shift in timing of motor vehicle crashes corresponding to the change in closing time of the outlet (1 study, Australia)
  • Removing restrictions on hours of sale, i.e., allowing sales of alcohol 24 hours a day or allowing outlets to stay open to any hour, was associated with:
    • An increase in motor vehicle crash injuries (1 study, Australia)
    • An increase in emergency room admissions, injuries, fighting, and suspected driving while intoxicated (1 study, Iceland)
    • An increase in alcohol-related assault and injury (1 study, England)
    • A decrease in violent crime offenses (1 study, England)
    • A decrease in maxillofacial trauma (1 study, England)

Increasing hours of sale by less than two hours in on-premises settings (e.g., bars and restaurants)

Six studies qualified for the review. These studies reported on five events that changed the hours of alcohol sales by less than two hours.

  • Effect estimates from these studies were inconsistent, suggesting no substantial effect on alcohol-related outcomes of changes in hours of alcohol sales that are less than two hours.

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.

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 fill remaining gaps in the evidence base. What are evidence gaps?
  • All existing research on hours of sale to date has been conducted in nations other than the United States. It would be useful to have studies of changes in hours of sale in U.S. settings to confirm results from other settings.
  • All research thus far has assessed the effects of increasing hours of sale. While it may be a less frequent event, evaluating the effects of reducing hours of sale for preventing excessive alcohol consumption and related harms would be useful.
  • Evidence on changes in hours of sale of <2 hours is currently insufficient because of inconsistent findings. Thus, when such changes occur, it may be worthwhile to assess the effects of smaller changes in hours of sale on excessive alcohol consumption and related harms to improve our understanding of the “dose-response” and “threshold” relationships between changes in hours of sale and public health outcomes.
  • Additional research is needed to more fully assess the costs and benefits of restricting the number of hours when alcohol is sold. From a societal perspective, economic elements should include:
    • Intervention costs
    • Loss in sales, 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
  • Finally, we found no studies that assessed the effects of changes in hours of sale in off-premises settings. While consumers at off-premises settings are less likely to be directly affected by the effects of excessive consumption at the place of purchase, it is nevertheless possible that changes in availability in these settings may also affect alcohol-related harms. This issue merits investigation.

Study Characteristics

Increasing hours of sale by two or more hours in on-premises settings (e.g., bars and restaurants)
  • Studies were conducted in Australia (6 studies of 4 events), England (3 studies of 1 event), and Iceland (1 study of 1 event).

Increasing hours of sale by less than two hours in on-premises settings (e.g., bars and restaurants)

  • Studies were conducted in Australia (2 studies of 2 events), Scotland (2 studies of 1 event), England and Wales (1 study of 1 event), and Canada (1 study of 1 event).

Analytic Framework

Effectiveness Review

Analytic Framework see Figure 1 on page 592
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 See Table 1 on pages 594-598

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

Studies of Changes of 2 Hours in Hours of Sale

Ten studies of six events that resulted in a change of 2 hours in the hours of alcohol sales qualified for the review.

Babb P. Violent crime, disorder and criminal damage since the introduction of the Licensing Act 2003. Home Office Online Report 16/07 . 2007.

Briscoe S, Donnelly N. Problematic licensed premises for assault in inner Sydney, Newcastle and Wollongong. Australian and New Zealand Journal of Criminology 2003;36(1):18-33.

El-Maaytah M, Smith S, Jerjes W, et al. The effect of the new “24 hour alcohol licensing law” on the incidence of facial trauma in London. British Journal of Oral and Maxillofacial Surgery. 2008.

Newton A, Sarker SJ, Pahal GS, van den Bergh E, Young C. Impact of the new UK licensing law on emergency hospital attendances: a cohort study. Emerg Med J 2007;24:532-34

Ragnarsdottir T, Kjartansdottir A, Davidsdottier S. Effect of extended alcohol serving hours in Reykjavik, Iceland. In: Room R, ed. The effects of Nordic alcohol policies. Helsinki: Nordic Council for Alcohol and Drug Research, 2002:145-54.

Raymond A. Ten o’clock closing – The effect of the change in hotel bar closing time on road accidents in the metropolitan area of Victoria. Australian Road Research 1969;3(10):3-17.

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

Smith DI. Effect on casualty traffic accidents of the introduction of 10 p.m. Monday to Saturday hotel closing in Victoria. Australian Drug and Alcohol Review 1988;7:163-6.

Smith DI. Effect on traffic accidents of introducting flexible hotel trading hours in Tasmania, Australia. Br J Addict 1988;83:219-22.

Williams RA. Changes in trading hours: Ten O’clock closing and consumption of alcohol in Victoria. Economic Record 1972;48:123-7.

Studies of Changes of <2 Hours in Hours of Sale

Six studies of five events (reported in ten papers) that resulted in a change of <2 hours in the hours of alcohol sales qualified for the review.

Bruce D. Changes in Scottish Drinking Habits and Behaviour following the Extension of Permitted Evening Opening Hours. Health Bulletin 1980;38(3):133-7.

Chikritzhs T, Stockwell T, Masters L. Evaluation of the public health and safety impact of extended trading permits for Perth hotels and nightclubs. National Drug Institute, 1997.

Chikritzhs T, Stockwell T. The impact of later trading hours for Australian public houses (hotels) on levels of violence. Journal of Studies on Alcohol 2002;63(5):591-9.

Chikritzhs T, Stockwell T. The impact of later trading hours for hotels on levels of impaired driver road crashes and driver breath alcohol levels. Addiction 2006;101(9):1254-64.

Chikritzhs T, Stockwell T. The impact of later trading hours for hotels (public houses) on breath alcohol levels of apprehended impaired drivers. Addiction 2007;102(10):1609-17.

De Moira ACP, Duffy JC. Changes in licensing law in England and Wales and alcohol-related mortality. Addiction Research 1995;3(2):151-64.

Duffy JC, De Moira ACP. Changes in licensing law in England and Wales and indicators of alcohol-related problems. Addiction Research 1996;4(3):245-71.

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

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

Vingilis E, McLeod AI, Seeley J, Mann RE, Beirness D, Compton CP. Road safety impact of extended drinking hours in Ontario. Accid Anal Prevent 2005;37(3):549-56.

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 hours of sale may be opposed by f rms 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.