Recommendations for reducing excessive alcohol consumption and alcohol-related harms by limiting alcohol outlet density.

The Task Force on Community Preventive Services T he serious toll that alcohol imposes on the population of the U.S. led the Task Force on Community Preventive Services (Task Force) to include the reduction of excessive alcohol consumption and related harms as a priority topic in its earliest planning sessions. 1 As the third-leading cause of preventable death in the nation, 2 excessive use of alcohol is a public health challenge that can be approached from many directions. The Task Force first studied and made recommendations on several ways to reduce alcohol-impaired driving. 3–7 It next assessed ways to reduce excessive alcohol consumption , 8 exploring the effectiveness of interventions to maintain limits on the days on which alcohol can be sold (recommended); increase taxes on alcoholic beverages (recommended); limit privatization of alcohol sales (insufficient evidence to determine effectiveness); enhance enforcement of laws prohibiting sales to minors (recommended); and regulate alcohol outlet density, reviewed in the accompanying article. On the basis of the reviewed evidence, the Task Force found sufficient evidence of a positive association between outlet density and excessive alcohol consumption and related harms to recommend limiting alcohol outlet density through the use of regulatory authority (e.g., licensing and zoning) as a means of reducing or controlling excessive alcohol consumption and related harms. A diverse group of studies of the association of outlet density with alcohol consumption and related harms indicates that when the density of on-or off-premises alcohol outlets is high or increases, the level of alcohol consumption is correspondingly high or increases, and excessive consumption and its diverse related harms occur. A smaller number of studies indicates the converse association. The validity of the causal link between outlet density and excessive alcohol consumption and its related harms is further supported by evidence from evaluations of related interventions that affect outlet density (e.g., bans or privatization of alcohol sales). On the basis of this evidence, the Task Force concludes that limiting on-and off-premises alcoholic beverage outlet density— either by reducing current density levels or limiting density growth— can be an effective means of reducing the harms associated with excessive alcohol consumption. It may also provide additional benefits for quality of life by reducing community problems such as loitering, public disturbances, and vandalism. The intervention reviewed here may be useful in reaching objectives specified in Healthy People 2010, 10 the disease prevention and health promotion agenda for the U.S. …