data may be unavailable and where the number of retail
alcohol outlets, alcohol-related outcomes, or both may be
small; thereby it may be difficult to assess the relationship
between outlet density and excessive alcohol consumption
and related harms. Further, the effects of policy decisions on
outlet density may be gradual. Other changes in alcohol
control policies (e.g., enhanced enforcement of the minimum
legal drinking age) may occur simultaneously, making it
difficult to isolate the effect of changes in outlet density on
drinking behavior.
The team used both primary and secondary scientific
evidence to help address these challenges and to comprehensively
assess the impact of changes in alcohol outlet density on
excessive alcohol consumption. Primary evidence included
studies comparing alcohol-related outcomes before and after
a density-related change. In this category were (1) studies
assessing the impact of privatizing alcohol sales—commonly
associated with increases in density; (2) studies assessing the
impact of bans on alcohol sales—associated with decreases in
density; and (3) studies of other alcohol licensing policies
that directly affect outlet density (e.g., the sale of liquor by the
drink). Time–series studies (i.e., studies in which the association
between changes in outlet density and alcohol-related outcomes
is assessed over time) were also used to provide primary evidence