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


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.


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Summary of Results

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


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.