title: Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence.
abstract: OBJECTIVE
  There have been reviews on the association between density of alcohol outlets and harm including studies published up to December 2008. Since then the number of publications has increased dramatically. The study reviews the more recent studies with regard to their utility to inform policy.
  
  
  METHODS
  A systematic review found more than 160 relevant studies (published between January 2009 and October 2014). The review focused on: (i) outlet density and assaultive or intimate partner violence; (ii) studies including individual level data; or (iii) 'natural experiments'.
  
  
  RESULTS
  Despite overall evidence for an association between density and harm, there is little evidence on causal direction (i.e. whether demand leads to more supply or increased availability increases alcohol use and harm). When outlet types (e.g. bars, supermarkets) are analysed separately, studies are too methodologically diverse and partly contradictory to permit firm conclusions besides those pertaining to high outlet densities in areas such as entertainment districts. Outlet density commonly had little effect on individual-level alcohol use, and the few 'natural experiments' on restricting densities showed little or no effects.
  
  
  CONCLUSIONS
  Although outlet densities are likely to be positively related to alcohol use and harm, few policy recommendations can be given as effects vary across study areas, outlet types and outlet cluster size. Future studies should examine in detail outlet types, compare different outcomes associated with different strengths of association with alcohol, analyse non-linear effects and compare different methodologies. Purely aggregate-level studies examining total outlet density only should be abandoned. [Gmel G, Holmes J, Studer J. Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence. Drug Alcohol Rev 2015].
authors.affiliation: Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland.|Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne, Switzerland.|Centre for Addiction and Mental Health, Toronto, Canada.|University of the West of England, Frenchay Campus, Bristol, UK.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gmel
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: John
authors.initials: J
authors.lastname: Holmes
authors.affiliation: Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Studer
keywords: density; off-premise; on-premise; review; violence