of retail alcohol outlets and the communities in which they
are located: (1) outlet size (i.e., the physical size of the
retail premises or the volume of its sales); (2) clustering
(i.e., the level of aggregation of outlets within a given
area); (3) location (i.e., the proximity of alcohol retail sites
to places of concern, such as schools or places of worship);
(4) neighboring environmental factors (e.g., demographics
of the community and the degree of isolation of a
community); (5) the size of the community (which may affect
access to other retail sites); (6) the type and number of
alcohol outlets (e.g., bar, restaurant, liquor store, grocery
store) in a community may also influence whether and how
outlet density affects drinking behavior21; and (7) alcohol
outlets may be associated with illegal activities, such as drug
abuse, which may also contribute to public health harms. As
with other policies and regulations, the effects of regulations
affecting outlet density may depend on the degree to which
the policies are implemented and enforced.
There are several challenges to directly evaluating the
effectiveness of local policies in changing outlet density on
alcohol consumption and related harms. Direct studies of the
effects of policies changing density on alcohol-related public
health outcomes have not been conducted. Policy changes
may occur in small communities in which documentation and