Guide to community preventive service
Effectiveness of Policies Restricting Hours of Alcohol Sales in Preventing Excessive Alcohol Consumption and Related Harms

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Abstract

Local, state, and national policies that limit the hours that alcoholic beverages may be available for sale might be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of such policies. All of the studies included in this review assessed the effects of increasing hours of sale in on-premises settings (in which alcoholic beverages are consumed where purchased) in high-income nations. None of the studies was conducted in the U.S. The review team's initial assessment of this evidence suggested that changes of less than 2 hours were unlikely to significantly affect excessive alcohol consumption and related harms; to explore this hypothesis, studies assessing the effects of changing hours of sale by less than 2 hours and by 2 or more hours were assessed separately.

There was sufficient evidence in ten qualifying studies to conclude that increasing hours of sale by 2 or more hours increases alcohol-related harms. Thus, disallowing extensions of hours of alcohol sales by 2 or more should be expected to prevent alcohol-related harms, while policies decreasing hours of sale by 2 hours or more at on-premises alcohol outlets may be an effective strategy for preventing alcohol-related harms. The evidence from six qualifying studies was insufficient to determine whether increasing hours of sale by less than 2 hours increases excessive alcohol consumption and related harms.

Introduction

Excessive alcohol consumption is responsible for approximately 79,000 deaths per year in the U.S., making it the third-leading cause of preventable death.1 Binge drinking (consuming five or more drinks per occasion for men and four or more drinks per occasion for women) is reported by approximately 15% of U.S. adults aged ≥18 years and by approximately 29% of high school students in the U.S.2, 3 The direct and indirect economic costs of excessive drinking in 1998 were $184.6 billion.4 The reduction of excessive alcohol consumption in general and binge drinking in particular are thus matters of major public health and economic interest. Reducing binge drinking among U.S. adults has been a public health objective in Healthy People 2010.5

In the U.S., local control of the total or specific hours during which alcoholic beverages may be sold (hereafter referred to as “hours of sale”) varies from one state to another. Some states allow cities, counties, and other local jurisdictions to enact their own alcohol control policies, and in these states, restrictions on hours of sale can vary from one location to another. In other states, local control may be pre-empted by state regulations that prohibit local authorities from enacting alcohol control regulations stricter than those that apply to the rest of the state.6, 7 As of 1953, American Indian reservations have the authority to establish their own alcohol-related policies, prior to which alcohol was formally prohibited.8

There is also wide variation among states in the specific restrictions they place on the hours of sale by retail setting (i.e., on- or off-premises) and by the day of the week.9 For on-premises alcohol outlets, states allow facilities to serve alcohol for a median of 19 hours a day on weekdays and Saturdays. Nine states (Alabama, Florida, Georgia, Illinois, Louisiana, Maryland, Nevada, New Jersey, and South Carolina) have no limits on hours of sale for on-premises alcohol outlets.9 On Sundays, alcohol may be served for a median of 17 hours at on-premises facilities, with seven states placing no restrictions on Sunday on-premises sales; four states allow no sales of alcohol at on-premises facilities on Sundays. In off-premises settings, hours of sale are limited to a median of 18 hours on weekdays and Saturdays. Restrictions range from no limits on hours of sale in Alabama, Florida, Georgia, Illinois, Louisiana, Maryland, and Nevada to 8 hours of sale allowed in Idaho. On Sundays, states allow a median of 13 hours of alcohol sales at off-premises facilities, with five states having no restrictions; 18 states with “blue laws” allow no off-premises sales.

This review uses the methods of the Guide to Community Preventive Services (Community Guide)10 to assess the effects of changes in the hours during which alcohol is served on excessive alcohol consumption and related harms. A separate review published in this issue assesses the effects of changing days of sale on excessive alcohol consumption and related harms and concludes that increasing days of sale leads to increased consumption and related harms. The focal question of the present review is how, within allowable days of sale, the number of hours available for acquisition and service of alcohol affects excessive alcohol consumption and related harms.

Several scientific reviews11, 12, 13, 14 have concluded that restricting the hours when alcohol may be sold is an effective strategy for reducing excessive alcohol consumption and related harms. One review,11 funded by the Center for Substance Abuse Prevention (CSAP), found substantial evidence of harms associated with expanding the hours and days of alcohol sales. This conclusion was based on previous empirical research indicating that the expansion of the hours and days of sale increased prevalence of excessive alcohol consumption and alcohol-related problems. Most prior reviews have combined findings on days and hours and none have examined a threshold effect. The CSAP review included studies prior to 1999; a recent review14 includes studies published between 2000 and 2008. The present review covers both periods using the systematic methods of the Community Guide described below.

Several international bodies have also recommended the control of hours or days of sale, or both as means of reducing excessive alcohol consumption and related harms.15 For example, a recent review16 of alcohol control strategies by the WHO found that limiting of hours of sale was an effective method for reducing alcohol-related harms. In Ireland, the Department of Health and Children's Strategic Task Force on Alcohol17 concluded (p. 30) that “restricting any further increases in the physical availability of alcohol (number of outlets and times of sales)” is among the most effective policy measures for influencing alcohol consumption and related harms.

Section snippets

Methods

The methods of the Community Guide were used to systematically review scientific studies that have evaluated the effectiveness of limiting or maintaining existing limits on the hours of sale for preventing excessive alcohol consumption and related harms.10 In brief, the Community Guide process involves forming a systematic review development team (review team), consisting of subject matter and methodology experts from other parts of the CDC, other federal agencies, and academia, and the Task

Studies of Changes of >2 Hours in Hours of Sale

Ten studies22, 23, 24, 25, 26, 27, 28, 29, 30, 31 of six events that resulted in a change of ≥2 hours in the hours of alcohol sales met the inclusion criteria. Only one study22 was of greatest design suitability; however, the principal analysis in this study was presented graphically and did not allow the estimation of a numeric effect size. One study23 was of moderate design suitability and eight24, 25, 26, 27, 28, 29, 30, 31 were of least suitable design. All studies had fair quality of

Discussion

Based on a systematic review of qualifying studies, this review confirms the findings of previous reviews and adds details regarding a possible dose or threshold effect. Evidence of the effects of changes in hours of sale of <2 hours was insufficient to determine effectiveness because of inconsistency among findings in the body of evidence, leaving unanswered the question of the effects of small increases in hours of sale. Data are not sufficient to allow systematic assessment of the relative

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    The names and affiliations of the Task Force members are listed at www.thecommunityguide.org/about/task-force-members.html.

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