- What are the Prevention Status Reports?
- Why was local authority to regulate alcohol outlet density included in the 2013 PSRs?
- What is the basis for the 2013 PSRs’ green/yellow/red ratings?
- Do the 2013 PSR ratings include local government authority to regulate both new and existing alcohol outlets?
- If local governments can regulate alcohol outlet density using either local zoning authority or licensing authority, why did the 2013 PSRs give a higher (green) rating to states that give local governments licensing authority?
- When rating each state, why do the 2013 PSRs consider local authority to regulate alcohol outlet density instead of actually measuring alcohol outlet density in each state?
- Does a 2013 PSR green rating mean that a state government and/or the local governments in that state have adopted policies that limit alcohol outlet density?
- Can a state with a red or yellow rating in the 2013 PSRs have fewer public health problems associated with alcohol outlet density than a state with a green rating?
As described by the CDC, “the Prevention Status Reports (PSRs) highlight – for all 50 states and the District of Columbia – the status of public health policies and practices designed to address  important public health problems and concerns.”34 The public health problems covered by the PSRs are: alcohol-related harms; food safety; healthcare-associated infections; heart disease and stroke; HIV; motor vehicle injuries; nutrition, physical activity, and obesity; prescription drug overdose; teen pregnancy; and tobacco use.34 For alcohol-related harms, the two evidence-based policies on which the 2015 PSRs report are commercial host liability and state excise taxes.35 The 2013 PSRs also reported on local authority to regulate alcohol outlet density.36
To be included in the PSRs, a public health policy must meet at least one of three criteria. It must be:
- Supported by systematic review(s) of scientific evidence of effectiveness;
- Explicitly cited in a national strategy or national action plan; and/or
- Recommended by a recognized expert body, panel, organization, study, or report with an evidence-based focus.
Local authority to regulate alcohol outlet density is an evidence-based strategy for reducing excessive alcohol use, recognized in the following ways:
Supported by systematic reviews of the literature: The Community Preventive Services Task Force (Task Force) is an independent, nonfederal body of research experts. The Guide to Community Preventive Services (The Community Guide) is based on a scientific systematic review process that examines the effectiveness of various public health strategies. Based on these reviews, the Task Force issues recommendations to help inform the decision-making of federal, state, and local health departments as well as other stakeholders and partners. The Community Guide systematic review process was used to assess 88 research studies on the impact of alcohol outlet density, which resulted in the following recommendation:
“…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.”37
The review found that laws limiting density were consistently related to reductions in diverse adverse public health outcomes, including excessive alcohol consumption measures, alcohol-related violence, and alcohol-related diseases.
Over the past few decades, under the auspices of the World Health Organization, expert panels have conducted systematic reviews of the research literature, assessed the impact of various alcohol policies on public health outcomes, and issued reports detailing their findings. The product of the most recent of these collaborative efforts was released in book form in 2010. Echoing conclusions in previous reports, a chapter in the 2010 book found that reducing alcohol outlet density is associated with reductions in excessive alcohol consumption and related problems, including suicide, violent crime, and interpersonal violence. It also pointed to the potential value of using planning and zoning regulatory tools at the local level to regulate alcohol outlet density.5
Cited in a national strategy or national action plan: In 1989, the Surgeon General’s Workshop on Drunk Driving proposed a national action plan for preventing alcohol-related motor vehicle crashes. It recommended that states strengthen laws that restrict alcohol outlet density and allow local governments to enact regulations that are more restrictive than state Alcohol Beverage Control (ABC) laws.38 In addition, the Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking, released in 2007, urged local communities to control or reduce the number of bars and other alcohol outlets near college campuses as a strategy for reducing alcohol problems among underage college students, including interpersonal violence.24
Recommended by an expert body, panel, organization, study, or report with an evidence-based focus: The Community Preventive Services Task Force provides expert, evidence-based recommendations based on the scientific reviews of The Community Guide. The Task Force explicitly recommended adopting or strengthening laws restricting alcohol outlet density based on a review of the research literature.37
As noted on the CDC’s PSRs website, a “green” rating indicates that the policy or practice is established in accordance with supporting evidence and/or expert recommendations. A “yellow” rating indicates that the policy or practice is established in partial accordance with supporting evidence and/or expert recommendations. Finally, a “red” rating indicates that the policy or practice is either absent or not established in accordance with supporting evidence and/or expert recommendations.3
For the local authority to regulate alcohol outlet density policy, the rating classifications were based on published legal research of state statutes and regulations addressing local licensing and zoning authority, as well as case law interpreting legal provisions and local ordinances. This research identified the distinct categories that are used in the PSR classifications. The ratings in the PSRs were based actual state statutes and case law; this information is readily accessible for all states (because this is a state-level strategy, the District of Columbia is not included in the ratings for this policy).
The 2013 Prevention Status Reports (PSRs) rated alcohol outlet density based on whether a state allows local control of outlet density, rather than an on actual measure of outlet density in the state.
The green rating was given to states that authorize local licensing, which means local governments can regulate alcohol outlet density through issuing, monitoring, and revoking alcohol licenses. Local governments may have exclusive licensing authority (i.e., the state does not issue licenses) or the state may have a joint state/local licensing system (i.e., an alcohol retailer must obtain both a state and a local license).
The yellow rating was given to states that have exclusive state licensing but allow local zoning restrictions regarding the number, location, and type of new alcohol outlets. In these states, local governments have some authority to regulate alcohol outlet density. However, the state’s licensing provisions will likely limit that authority, and, as discussed below, local zoning authority is not as effective as local licensing in regulating outlet density.
The red rating was given to states that preempt most or all local authority to regulate alcohol outlet density. In many of these states, local governments can provide advice or make recommendations to the relevant state agency, but the final decisions take place at the state level. Note that states coded red may still have state-level density restrictions.3
The PSR ratings were based only on the extent to which local governments can regulate new alcohol outlets. Local authority to regulate existing outlets (those already in existence when a local ordinance restricting new outlets is enacted) was not part of the PSR analysis.
If local governments can regulate alcohol outlet density using either local zoning authority or licensing authority, why did the 2013 PSRs give a higher (green) rating to states that give local governments licensing authority?
In general, local licensing authority is a more efficient strategy for regulating outlet density than local zoning authority.2 Licensing involves the direct regulation of alcohol sales, and is not embedded in complex zoning procedures and land use legal constraints. Thus, the 2013 PSRs apply the green rating for states that have local licensing authority.
Local governments can have concurrent licensing authority (i.e., the state also requires a license) or exclusive licensing authority (no state license is required). Because localities can use licensing to regulate density in both instances, both licensing systems are given green ratings. States with local licensing authority may or may not also permit local governments to use their zoning powers to regulate alcohol outlet density. The PSR ratings do not take into account zoning powers for states that receive a green rating.
Local authority is an important aspect of a state’s alcohol outlet density regulatory landscape. As discussed below, local governments have both the mechanisms and knowledge to address alcohol outlet density within a framework of overall economic and community development planning. Problems associated with overconcentration of alcohol outlets are more likely to come to the attention of local policymakers, who are more likely to respond to community pressure to address them. States that limit or do not allow local authority are therefore making effective density regulation less likely.2,11
However, local authority to regulate alcohol outlet density is an incomplete measure for assessing a state’s density policy; when using the data in the PSRs it is also important to consider state-level laws or policies that limit alcohol outlet density, such as state laws that restrict the number of alcohol outlets, the distance between alcohol outlets, or the distance between alcohol outlets and sensitive locations, such as schools and parks.
Unfortunately, direct measures of density across all states are not readily available. Density regulations are highly complex, often containing numerous exceptions or special applications. This makes it difficult to develop, research, and apply standardized measures of alcohol outlet density across the 50 states and the District of Columbia. The CDC is developing resources to help states and communities to measure alcohol outlet density.
Not necessarily. As discussed above, the 2013 PSR green rating is based on the extent to which the state authorizes local governments to regulate alcohol outlet density. The fact that local governments have this authority does not necessarily mean that they use it, or that any adopted policies have in fact limited alcohol outlet density.
Yes, this is possible. A state with a green rating may have serious alcohol outlet density problems because its local governments have not adopted policies to regulate alcohol outlet density, even though they have the authority to do so. A state with a red rating, on the other hand, may have more effective state-level outlet density regulations, even if it doesn’t grant local governments the authority to regulate density.