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

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Snapshot

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends enhanced enforcement of laws prohibiting sale of alcohol to minors, on the basis of sufficient evidence of effectiveness in limiting underage alcohol purchases. Further research will be required to assess the degree to which these changes in retailer behavior affect underage drinking.

Intervention

Enhanced enforcement programs initiate or increase the frequency of retailer compliance checks for laws against the sale of alcohol to minors in a community. Retailer compliance checks, or “sting operations,” are conducted by, or coordinated with local law enforcement or alcohol beverage control (ABC) agencies, and violators receive legal or administrative sanctions.

Enhanced enforcement programs are often conducted as part of multicomponent, community-based efforts to reduce underage drinking. Many also include strategies to increase perceived risk of detection by publicizing the increased enforcement activities and cautioning proprietors against selling alcohol to minors. These messages can be delivered using either mass media or by sending letters to all local alcohol retailers.

CPSTF Finding and Rationale Statement

Read the CPSTF finding pdf icon [PDF - 108 kB].

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 8 studies (search period through July 2005). 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.

Context

There is no information for this section.

Summary of Results

Detailed results from the systematic review are available in the CPSTF finding [PDF - 108 kB].

Eight studies met the criteria for inclusion in the review.

Enhanced enforcement programs were effective in reducing 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: median decrease of 42% (interquartile interval: –57% to –17%; 8 studies)
Three studies found that enhanced enforcement programs were associated with modest decreases in underage alcohol consumption, but this effect was directly attributable to enhanced enforcement in only one study.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results for interventions in different settings and populations, findings are applicable to most communities in the U.S. including those with the following:

On-premises (e.g., bars) and off-premises (e.g., liquor stores) establishments
Rural or urban environments
Different ethnic and socioeconomic groups
Various baseline rates of retail sales of alcohol to minors

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

Additional research could address the following questions:

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 effort affect outcomes?

Study Characteristics

Five of the included studies were randomized controlled trials or other designs with concurrent comparison groups. The remaining three were time series designs conducted within a single community.
Most of the enforcement efforts were targeted at establishments that sell alcohol for consumption off the premises; however, 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 of the studies evaluated intervention programs for which enhanced enforcement of retailer compliance was one of multiple components.
- The multicomponent interventions evaluated in this review were typically spearheaded by community coalitions, and frequently included training in responsible beverage service and attempts to change alcohol related policies.
- Two of the studies were implemented in multiple communities, for which community coalitions had substantial autonomy in deciding on the specific approaches used to address problematic alcohol consumption. As a result, only some of the communities evaluated in these two studies actually implemented enhanced enforcement programs.

Publications

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.

Supporting Materials

Analytic Framework

Analytic Framework pdf icon [PDF - 200 kB]

Summary Evidence Table

No content is available for this section.

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).

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.

Additional Materials

There is no information for this section.

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 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)

Review References

There is no information for this section.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

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. Interventions implemented as part of a more comprehensive approach to reducing underage drinking may be more likely to maximize intervention effects. Such a comprehensive approach could involve efforts to reduce access to alcohol from social providers along with efforts to reduce drinking opportunities and demand for alcohol among young people.
Interventions reduce the likelihood that retailers will provide alcohol to minors during the period of time in which enforcement efforts are maintained, however, effects diminish rapidly when enforcement ceases.

Perhaps the most important barrier to implementation is the perception that the community does not support such interventions. Without community support, there may be little incentive for regulatory and law enforcement agencies to increase their enforcement activities, particularly in the face of resistance from retailers.
- The Institute of Medicine has proposed that incentives for implementing and maintaining enforcement programs could be increased by making receipt of federal block grant funds conditional on achieving target rates of retailer compliance nationally.
- Concerned organizations could highlight the extent of the problem of alcohol sales to minors in their communities by conducting their own decoy operations and publicizing the results.

Crosswalks

Healthy People 2020

Healthy People 2020 includes the following objectives related to this CPSTF recommendation.

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

Tabs

Summary of CPSTF Finding

Intervention

CPSTF Finding and Rationale Statement

Users who viewed this also viewed

About The Systematic Review

Context

Summary of Results

Summary of Economic Evidence

Applicability

Evidence Gaps

Study Characteristics

Publications

Analytic Framework

Summary Evidence Table

Included Studies

Additional Materials

Search Strategies

Review References

Considerations for Implementation

Crosswalks

Healthy People 2020

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