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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 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.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 2.02 MB] External Web Site Icon.

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.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.


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

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • 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?

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.