Evidence of the association of outlet density and alcohol
consumption and related harms derives from studies
conducted primarily in North American and in
Scandinavian countries. One study27 indicated that the
impact of changes in outlet density may be affected by
demographic characteristics (e.g., gender distribution)
of the population; in this case, the association of outlet
density with assaults requiring hospitalization was stronger
where there was a greater proportion of boys/men
in the population. Most of the studies reviewed assessed
the effects of increased outlet density, which is a
consequence of the general trend toward liberalization
of alcohol policies associated with outlet density. Few
data were found from which to draw inferences about
regulations that control or reduce outlet density.
Studies of bans on alcohol sales, conducted primarily
among American Indian and Alaska Native populations,
consistently report a reduction in excessive consumption
and related harms following the implementation
of a ban on alcohol sales, possession, or both,
provided the area affected by the ban was not surrounded
by other sources of alcoholic beverages.
Barriers
Reductions in outlet density, with resultant reductions
in consumption, are likely to have substantial commercial
and fiscal consequences, and thus may be opposed
by commercial interests in the manufacture, distribution,
and sale of alcoholic beverages. In keeping with its
commercial interests, the alcoholic beverage industry
has tended to support policies that facilitate outlet
expansion.115
State pre-emption laws (i.e., laws that prevent implementation
and enforcement of local restrictions) can
also undermine efforts by local governments to regulate
alcohol outlet density.7 Indeed, the elimination of
pre-emption laws related to the sale of tobacco products
is one of the health promotion objectives in Healthy
People 2010.13 However, there is no similar objective in
Healthy People 2010 related to the sale of alcoholic
beverages