AIM: To systematically review the evidence on the impacts of policies regulating the spatial availability of off-premises alcohol on consumption and harms.

METHODS: Narrative review that examined peer-reviewed studies published from 2016 to 2024 on policy changes affecting the spatial availability of off-premises alcohol. Outcomes of interest were alcohol consumption, alcohol-related harms and mortality.

RESULTS: The review identified 20 observational studies, primarily natural experiments, examining four policy types: malt liquor restrictions, sales expansion to retail outlets, privatization and changes to allowable alcohol content. Across studies, there was a suggestion that allowing alcohol sales in gas station convenience stores was associated with increased consumption and harms, whereas expanding to grocery stores was not. There was no clear evidence that restricting malt liquor reduces crime. Similarly, privatization was not associated with crime or health outcomes, though it was accompanied by price increases. Increases in allowable alcohol content were not associated with higher consumption, but decreases were associated with fewer alcohol-related emergency visits and hospitalizations.

CONCLUSIONS: The impact of policy changes in spatial alcohol availability depends on the policy details and retail outlet types. To mitigate public health impacts, policymakers should consider comprehensive alcohol control measures, such as regulating convenience store sales and accompanying grocery store expansions with minimum unit pricing, taxation and marketing restrictions. High-quality natural experiments with pre-post designs, control groups and confounder adjustments are needed to better understand how these policies impact both the general population and high-risk subgroups.