Alcohol Excessive Consumption: Maintaining Limits on Hours of Sale
Findings and Recommendations
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.
The full CPSTF Finding and Rationale Statement and supporting documents for Alcohol Excessive Consumption: Maintaining Limits on Hours of Sales are available in The Community Guide Collection on CDC Stacks.
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.
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.
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).
Summary of Results
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
- 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.
Implementation Considerations and Resources
- Restrictions on hours 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.
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.