Alcohol Excessive Consumption: Enhanced Enforcement of Laws Prohibiting Sales to Minors
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends enhanced enforcement of laws prohibiting sale of alcohol to minors to limit underage alcohol purchases. More research is needed to determine how changes in retailer behavior affect underage drinking.
The full CPSTF Finding and Rationale Statement and supporting documents for Alcohol Excessive Consumption: Enhanced Enforcement of Laws Prohibiting Sales to Minors are available in The Community Guide Collection on CDC Stacks.
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 used as part of multicomponent, community-based efforts to reduce underage drinking. Many programs aim to increase perceived risk of detection by publicizing enforcement activities and warning retailers not to sell alcohol to minors. Messages may be delivered through mass media or letters may be mailed to local retailers.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of eight 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.
Study Characteristics
- 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.
Summary of Results
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.
Detailed results from the systematic review are available in the published evidence review.
Summary of Economic Evidence
A systematic review of economic evidence has not been conducted.
Applicability
Based on results from this review, the finding is applicable to on-premises (e.g., bars) and off-premises (e.g., liquor stores) establishments in rural and urban environments in the United States. The finding applies to populations across ethnic and socioeconomic groups, regardless of baseline rates of retail alcohol sales to minors.
Evidence Gaps
- 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?
Implementation Considerations and Resources
- 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 includes the following objectives related to this CPSTF recommendation.