• Alcohol;
  • deterrence;
  • drinking age;
  • enforcement;
  • RBS;
  • youth


Aims/intervention  The Complying with the Minimum Drinking Age project (CMDA) is a community trial designed to test effects of two interventions designed to reduce alcohol sales to minors: (1) training for management of retail alcohol establishments and (2) enforcement checks of alcohol establishments.

Design  CMDA is a multi-community time-series quasi-experimental trial with a nested cohort design.

Setting/participants  CMDA was implemented in 20 cities in four geographic areas in the US Midwest.

Measurements  The core outcome, propensity for alcohol sales to minors, was directly tested with research staff who attempted to purchase alcohol without showing age identification using a standardized protocol in 602 on-premise and 340 off-premise alcohol establishments. Data were collected every other week in all communities over 4 years. Mixed-model regression and Box–Jenkins time-series analyses were used to assess short- and long-term establishment-specific and general community-level effects of the two interventions.

Findings  Effects of the training intervention were mixed. Specific deterrent effects were observed for enforcement checks, with an immediate 17% reduction in likelihood of sales to minors. These effects decayed entirely within 3 months in off-premise establishments and to an 8.2% reduction in on-premise establishments.

Conclusions  Enforcement checks prevent alcohol sales to minors. At the intensity levels tested, enforcement primarily affected specific establishments checked, with limited diffusion to the whole community. Finally, most of the enforcement effect decayed within 3 months, suggesting that a regular schedule of enforcement is necessary to maintain deterrence.