Table 1. Feasible adult-oriented policies and programmes implementable at city level dependent on jurisdictional responsibilities, with evidence of impact and opportunity for city implementation.

Policy measure	Evidence of impact	Opportunity for city implementation
Pricing policies
Alcohol taxes	Effective Systematic reviews and meta-analyses find that increases in the price and taxation of alcohol reduce consumption and alcohol-related harm for all groups of drinkers, and in high, middle and low-income countries ( Anderson et al., 2009; Dhalwani, 2011; Elder et al., 2010; Fogarty, 2008; Gallet, 2007; Sornpaisarn et al., 2013; Wagenaar et al., 2009; Wagenaar et al., 2010; Xu & Chaloupka, 2011).	Many cities have opportunity to set alcohol beverage sales taxes, which can bring in municipal revenues ( KPMG LLP, 2016).
Access policies
Outlet density	Effective Systematic reviews ( Bryden et al., 2012; Campbell et al., 2009; Gmel et al., 2016; Holmes et al., 2014; Livingston et al., 2007; Popova et al., 2009) and individual studies ( Fone et al., 2016; Morrison et al., 2016; Richardson et al., 2015) find that greater alcohol outlet density is associated with increased alcohol consumption and harms, including injuries, violence and crime.	Licensing of alcohol sales outlets allows local governments to control where alcohol is sold to the public, with restrictions on density related to less crime ( de Vocht et al., 2016).
Days and hours of sale	Effective Systematic reviews find that days and hours of sale are related to alcohol consumption and harms ( Hahn et al., 2010; Middleton et al., 2010; Wilkinson et al., 2016). Individual studies find that restrictions on hours of sale reduce harm ( Duailibi et al., 2007; Kypri et al., 2014; Rossow & Norström, 2011).	Licensing of alcohol sales outlets allows local governments to control when alcohol is sold to the public, with restrictions on hours of sale related to less harm ( de Vocht et al., 2016; Wittman, 2016a; Wittman, 2016b).
Bar policies
Training of bar staff, responsible serving practices, security staff in bars and safety- oriented design of the premise	Mixed effectiveness A systematic review found limited impact unless backed-up by police enforcement and licence inspectors ( Ker & Chinnock, 2008).	Drinking environments can be foci of alcohol- related harms ( Hughes & Bellis, 2012). Ongoing enforcement is the required ingredient to reduce harm in drinking environments ( Brännström et al., 2016; Florence et al., 2011; Månsdotter et al., 2007; Wallin et al., 2001; Warpenius et al., 2010; Trolldal et al., 2013).
Advertising policies
Volume of advertising	Effective Systematic reviews find associations between volume of advertising exposure and alcohol-related consumption and harm ( Bryden et al., 2012; Booth et al., 2008; Gallet, 2007; Stautz et al., 2016).	Cities have the opportunity of restricting advertising, including billboards, in the public places that they own or through the public services, such as transportation, that they provide ( Fullwood et al., 2016; Swensen, 2016).
Drink-drive restrictions
Sobriety checkpoints and unrestrictive (random) breath testing	Effective Systematic reviews and meta-analyses find that both introducing and expanding sobriety checkpoints and random breath testing result in reduced alcohol-related injuries and fatalities ( Bergen et al., 2014; Erke et al., 2009; Shults et al., 2001), enhanced with mass-media campaigns ( Elder et al., 2004; Yadav & Kobayashi, 2015).	Cities have the opportunity to step-up sobriety checkpoints and random breath testing ( Voas, 2008).
Designated driver campaigns	Ineffective A systematic review did not find evidence for designated driver programmes in reducing the prevalence of people drink driving or being a passenger with a drink driver ( Ditter et al., 2005)	Whist a seemingly attractive approach, there is insufficient evidence to warrant widespread investment in designated driver campaigns.
Screening, advice and treatment
Digital interventions	Effective A systematic review found that digital interventions were just as effective as face-to-face interventions in reducing alcohol consumption and related harm ( Beyer et al., 2015; Kaner et al., 2015).	Off-the-shelf applications can be deployed at city level ( Crane et al., 2015; Garnett et al., 2015), enhanced with context awareness and use of ecological momentary assessments ( Freisthler et al., 2014; Morgenstern et al., 2014; Wray et al., 2014).
Primary health care	Effective Systematic reviews and meta-analyses find a positive impact of screening and brief advice programmes on alcohol consumption, mortality, morbidity, alcohol-related injuries, alcohol-related social consequences, healthcare resource use and laboratory indicators of harmful alcohol use ( O’Donnell et al., 2014). There is stronger evidence of effectiveness for primary health care-based screening and brief advice programmes than for emergency care ( Nilsen et al., 2008), general hospital settings ( McQueen et al., 2011), obstetric or antenatal care ( Doggett et al., 2005), and pharmacy settings ( Brown et al., 2016). Systematic reviews and meta-analyses find that implementation strategies are effective in increasing the volume of primary health care screening and brief advice activity ( Anderson et al., 2004; Keurhorst et al., 2015).	Tailored screening and brief advice programmes embedded within community and municipal action are more likely to be scaled-up ( Anderson et al., 2017; Heather 2006).
Workplace	Largely ineffective Systematic reviews of workplace-based programmes ( Webb et al., 2009) and workplace-based screening and brief advice programmes find little evidence for reducing consumption and harm ( Schulte et al., 2014).	Although business cases are made for workplace-based programmes ( Martinic, 2015), the evidence appears insufficient to justify a city- based investment.
Secondary health care	Effective Systematic reviews find that psycho-social ( Magill & Ray, 2009; Smedslund et al., 2011; The British Psychological Society & The Royal College of Psychiatrists, 2011) and pharmacological therapies ( Rösner et al., 2010a; Rösner et al., 2010b; The British Psychological Society & The Royal College of Psychiatrists, 2011) are effective in treating heavy drinking.	Treatment services can be embedded within comprehensive care pathways ( NICE, 2016) at the city level.
Education and information
School-based programmes	Ineffective Systematic reviews find that reported benefits are seen only in the short term and are often not replicated ( Foxcroft & Tsertsvadze, 2011a; Strom et al., 2014)	Whilst a popular intervention, and a necessary part of school education, investment in school- based education programmes should be proportionate, given the evidence for lack of effectiveness.
Public information campaigns	Ineffective Systematic reviews find evidence of little or no sustained impact of public education campaigns in changing drinking behaviour ( Martineau et al., 2013), with the exception of drink driving ( Elder et al., 2004).	Media campaigns should focus on changing behaviour in relation to existing programmes, such as drink driving ( Yadav & Kobayashi, 2015), rather than acting in isolation, where there is evidence of ineffectiveness.
Changing social norms	Limited evidence Overviews suggest that alcohol-related social norms can be changed by campaigns, particularly when related to behaviour changes ( Miller & Prentice, 2016; Anderson et al., 2018).	Social norms campaigns should focus on topics that are the subject of behaviour change programmes, such as drink driving ( Perkins et al., 2010).
Product reformulation
Alcohol content and packaging	Limited evidence A systematic review indicates the theoretical likelihood that reductions in the average alcohol content of beverages would reduce alcohol-related harm ( Rehm et al., 2016).	Cities could set limits on beverage container sizes ( Jones-Webb et al., 2011; McKee et al., 2012).