- What are control or monopoly states, and how does alcohol outlet density differ in those states?
- How does the impact of alcohol outlet density vary based on the particular characteristics of a community?
- Do low-income neighborhoods have greater densities of alcohol outlets, and if so, why?
The term control state or monopoly state refers to a state where at least some portion of the wholesale and/or retail alcohol market is operated and controlled by the state itself. As of June 2016, there were 17 control states.16 Thirteen states operate both wholesale businesses and off-premises retail establishments; four states operate wholesale businesses but do not have retail operations.16 No control state operates on-premises retail outlets. Distilled spirits are by far the most common type of alcohol regulated by control states in their wholesale and retail operations. In some states, there are private, licensed establishments as well as state stores.17 Click here to find out which states have state stores and what products are available (see the section of the linked webpage on “Alcohol Control Systems”).
Research suggests that control states experience fewer problems associated with alcohol outlet density, in part because they generally have fewer off-premises outlets.18 There may be other public health benefits to state-run stores: they may have more limited hours of sale, be more likely to comply with laws regulating sales to minors or intoxicated persons, and be less likely to advertise.18 However, despite these public health benefits, most control states have experienced complete or partial privatization over time – that is, the state has shut down some or all parts of its state-run system and turned it over to private businesses using a license system.18 The Guide to Community Preventive Services systematic review process was used to assess the effects of privatization. Based on the resulting analysis, the Community Preventive Services Task Force recommended “against further privatization of alcohol sales in settings with current government control of retail sales.”18,19
Neighborhood and community environments are critically important in assessing alcohol outlet density.20 For example, a high density of alcohol outlets in college communities, where there are large numbers of young people, is correlated with heavy drinking, frequent drinking, and alcohol-related problems.21 Low-income communities, particularly neighborhoods with high population densities, may also face increased health and safety problems associated with alcohol outlet density.22,23 Research shows that a high concentration of alcohol outlets in these environments significantly increases the risk of violence, crime,23 underage drinking,24 and other problems related to excessive drinking.23
Alcohol outlet density is a clear health equity issue: low-income, Black, and Latino neighborhoods in urban settings are far more likely to have high concentrations of alcohol outlets.22 The origin of this inequity dates back at least several decades. In the late 1960s, the federal Small Business Association changed its policies to allow loans to alcohol businesses, and then loaned funds to thousands of such businesses, which were often minority owned.25 The abundance of liquor stores is also due to the historical lack of investment in low-income neighborhoods of color.26,27 As a result of urban neighborhood decline, supermarkets started to relocate from inner city locations to the suburbs in the 1960s and 1970s.26,27 The remaining small markets are located relatively close together28 and rely heavily on alcohol and tobacco sales.27,29 Residents in low-income areas are generally less able to travel several miles to large grocery stores, making these small neighborhood markets more economically viable for these residents.30,31
Decades later, research suggests that alcohol outlet density problems are particularly pronounced in low-income neighborhoods and communities of color.22,32 Regardless of how much people in the neighborhood drink, assaults and violence are higher when establishments selling alcohol for on-premises consumption, such as bars and restaurants, are more tightly clustered.33