How does relevant theory inform a public alcohol policy model?

380 Pages·2013·1.46 MB·English

How does relevant theory inform a public alcohol
policy model?

by
Cecile Ann McKeown B.Soc.Sci. (Hons) Health Science
School of Government

Submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy
University of Tasmania January 2013
Declaration
I, Cecile Ann McKeown, am the author of the thesis titled “How does relevant theory
inform a public alcohol policy model?” I declare that the thesis contains no material which
has been accepted for a degree or diploma by the University of Tasmania or any other
institution, except by way of background information and duly acknowledged in the thesis,
and to the best of my knowledge and belief no material previously published or written by
another person except where due acknowledgement is made in the text of the thesis, nor
does the thesis contain any material that infringes copyright.

Cecile Ann McKeown Date …/…/…

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Statement of authority of access
This thesis is not to be made available for loan or copying for two years following the date
this statement was signed. Following that time the thesis may be made available for loan
and limited copying and communication in accordance with the Copyright Act 1968.

Cecile Ann McKeown Date …/…/…

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Acknowledgements
Thank you to my husband and family for their emotional and practical support. Thanks
also go to my Supervisors, Professor Jenny Fleming and Dr Kelly Shaw, for their
guidance. Appreciation is also due to Professor Robin Room and Associate Professor
Roberta Julian who are always available as valued mentors.

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Abstract
This thesis investigates the problems associated with alcohol and solutions to these
concerns through a theory based alcohol policy model. Public alcohol policy is
challenging to frame in Australia in the context of the policy environment, unclear
government agendas, shifting governance structures, and the influence of the alcohol
industry on policy direction. To add to these complexities, the current National Alcohol
Strategy has done little to reduce the extent and severity of alcohol related harms. A
sociocultural focus dominates the Strategy within, predominantly, a harm reduction
approach. This emphasis has resulted in issues such as alcohol availability, aggregate
consumption and drinker control being inconsistently addressed in strategic actions. In the
wake of these omissions, policy advancement is a pressing concern. The thesis determines
a way forward for alcohol policy in Australia by analysing research related to alcohol
availability and drinker behaviour. Gaps are apparent in the literature. Evidence of an
ordered approach to policy development is lacking and relevant theory is not referred to
for an alcohol policy model.
To inform a model for public alcohol policy, an appeal to theory is made. Analysis of
population theory and behavioural theory is conducted against key indicators of alcohol
associated risk. An integrated approach to alcohol problems and their policy solutions is
sought. Availability Theory and the Theory of Planned Behaviour emerge as theories of
relevance to alcohol outcomes and alcohol policy. The thesis demonstrates that limiting
actual availability and modifying perceived availability are effective ways to lessen
population consumption and harms. The importance of strengthening actual behavioural
control and modifying perceived behavioural control is likewise confirmed. The thesis
establishes the benefits of analysing and applying relevant theory to alcohol policy
development. Results of the investigation are presented in a public alcohol policy model.
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The ‘PRACTISE’ Model is the definitive contribution of this thesis to the alcohol research
and public policy fields.
Figure 1: The ‘PRACTISE’ Model

Limit Strengthen
Alcohol Behavioural
Availability Control
Modify
Perceptions of
Availability &
Control

The Policy ‘Risk appraisal’ of Availability and Control to Increase Strategic Effectiveness
(PRACTISE) Model is comprised of a number of components. The Model incorporates the
policy aims of limited alcohol availability and stronger behavioural control. Also
acknowledged in the Model are the contributions of perceived alcohol availability and
perceived behavioural control to the prevention of risk from consumption. The
‘PRACTISE’ Model is a theory based framework and practical way for governments and
communities to confront alcohol related harms. A number of Principles are central to the
Model, as is a Policy Risk Index. The ‘PRACTISE’ Model, as a scaffold for
conceptualising alcohol related risk, informs interventions associated with alcohol. A suite
of aims, objectives, goals and strategies support the Model. The Model is a strategic
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planning tool for policy makers as well as a guide for field practitioners, and is suitable for
implementation at national, jurisdictional and community levels. The Model does not
contain all the answers; that would be difficult with alcohol. What is provided is a
systematic way to achieve more acceptable levels of risk, in order to prevent alcohol
associated harms.
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List of Figures
Figure 1: The ‘PRACTISE’ Model ....................................................................................... v
Figure 1: The ‘PRACTISE’ Model ................................................................................... 271
Figure 1: The ‘PRACTISE’ Model ................................................................................... 316

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List of Tables
Table 1: Population Theory and the Environmental Context of Use ................................ 134
Table 2: Behavioural Theory and the Attributes of Consumption .................................... 141
Table 3: Relationships between Aggregate Population Consumption and Alcohol Related
Harms ................................................................................................................................ 153
Table 4: Significance of Perceived Availability/Subjective Availability in Alcohol Related
Outcomes ........................................................................................................................... 169
Table 5: Relevance of the Theory of Planned Behaviour to Predicting Behaviours and
Behavioural Change Interventions .................................................................................... 195
Table 6: Relative Contribution of the Theory of Planned Behaviour Variables to Alcohol
Related Behaviours ............................................................................................................ 212
Table 7: Theoretical Perspectives on Alcohol Risk and Harms ........................................ 263
Table 8: Public Alcohol Policy Development ................................................................... 274
Table 9: Goals and Strategies for Implementation ............................................................ 284

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Table of Contents
Abstract ............................................................................................................................... iv
List of Figures .................................................................................................................... vii
List of Tables .................................................................................................................... viii
Table of Contents ................................................................................................................ ix
Chapter 1: Introduction ...................................................................................................... 1
1.1 Thesis Rationale ..................................................................................................... 1
1.2 Thesis Aims ............................................................................................................ 4
1.3 Scope and Assumptions ......................................................................................... 4
1.4 Thesis Questions .................................................................................................... 6
1.5 Thesis Methodology ............................................................................................... 7
1.6 Research Significance .......................................................................................... 10
1.7 Thesis Outline ...................................................................................................... 11
Chapter 2: Australia’s Alcohol Policy Context ............................................................... 12
2.1 Introduction ....................................................................................................... 12
2.2 Public Alcohol Policy Challenges ..................................................................... 13
2.2.1 Political and Policy Processes ................................................................ 13
2.2.2 National Alcohol Policy Governance .................................................... 19
2.2.3 Industry Involvement in Public Policy Making ..................................... 22
2.2.4 Ethics in Public Alcohol Policy ............................................................. 25
2.3 The Global Environment ................................................................................... 26
2.3.1 Consumption Estimates and Social Value ............................................. 26
2.3.2 Global Action and Global Policy ........................................................... 27
2.4 The Local Use Environment ............................................................................. 30
2.4.1 A Short History of Alcohol .................................................................... 30
2.4.2 Country Comparison .............................................................................. 32
2.4.3 Australia’s Consumption Estimates ....................................................... 34
2.4.4 The Place of Alcohol in the Australian Context .................................... 36
2.4.5 Alcohol Related Legislative Ruling ....................................................... 40
2.5 Australia’s National Alcohol Strategy .............................................................. 41
2.5.1 National Alcohol Strategy Overview ..................................................... 41
2.5.2 Alcohol Strategy Comparison ................................................................ 45
2.5.3 Supporting Consultation Processes ........................................................ 47
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