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Article Excerpt
Alcohol policy has frequently been the focus of research, community action, and political debate. An extensive literature over the past several decades has concerned the impact of various policy measures on rates of consumption and/or drinking-related chronic and acute effects (Bruun et al., 1975; Edwards et al., 1994; Holder & Edwards, 1995; Farrell, 1985; Holder, 1987, 1994; Makela et al., 1981; Moore & Gerstein, 1981; Moser, 1979; Mosher & Jernigan, 1989; Single et al., 1981). Two lines of evidence may have had an impact on the wide-scale consideration of aggregate-level alcohol policies as viable preventive measures in many Western countries (see Edwards et al., 1994). One indication is the impact of drinking patterns on a wide range of social and health problems, and the other is the effect of system and environmental factors on consumption and the cogent presentation of these findings over a quarter of a century. In the U.S., interest in alcohol control policies is increasingly evident in numerous developments at all three jurisdictional levels--local, state, and national. In contrast to the mid-1970s, by the early 1990s, preceding the project's start in 1996, it appeared that many more groups and organizations (Cahalan, 1991) were focusing on one or more of the following types of legislation: regulations aimed at managing promotion of alcoholic beverages, particularly to youths and ethnic minorities, at special events such as Halloween or cultural festivals, and on college campuses; taxation and pricing measures; ordinances related to physical availability of alcoholic beverages, e.g., density and related issues; and laws designed to reduce service to minors and intoxicated customers.
In a time of declining alcohol sales between approximately 1981 and the late 1990s (Greenfield et al., 2000; Midanik & Clark, 1994; Williams et al., 1992), various sectors of the alcohol industry have not remained passive but, on the contrary, have resisted the passage of such control regulations in whatever political or judicial forum seemed viable, as well as occasionally working to have "friendly" legislation introduced that might counteract the zeal of public health advocates if not the drying trend itself. Examples are the efforts by national beer organizations to reduce the excise tax on beer introduced several years ago, and sporadic efforts to rescind the 21-years-old minimum drinking age (MDA) legislation, which worked by withholding federal highway funds from states that retained or enacted younger MDAs. Their efforts can be readily explained as "reasonable" corporate actions, designed to offset or thwart policy gains that might be achieved by temperance-oriented coalitions. However, the alcohol industry groups also engage in legislative campaigns with apparent preventive objectives, so long as these are not incompatible with their commercial objectives. Mostly these are focused on individual responsibility, such as cracking down on underage purchasers or promoting zero-tolerance laws for underage drivers (e.g., Giesbrecht, 2000; see also Kaskutas, 2004, this issue). Similarly, advocacy groups ally with various religious and other groups to counter such industry-sponsored initiatives. Thus there is a dynamic policy community with contenders engaged in various skirmishes on a range of policy agendas, each seeking access and political opportunity. Policy entrepreneurs and players of all stripes appeal to the policymakers to appreciate the merit of their own approaches and see the inadequacy of their opponents'. In relation to health and transportation, these dynamic processes were well described in Kingdon's (1995 [1984]) seminal work, which formed a conceptual basis for the present research on alcohol-specific policy formation (summarized below).
Previous research on policy formation
Despite much ongoing research on the scientific basis of alcohol policy interventions (Edwards & Holder, 1995), few investigations have focused on the policy formation process itself (Greenfield, 1994). Alcohol researchers have examined the impact of science on policy formulation, reviewed by Room (1991), with some considering the reverse--i.e., the impact of science policy on alcohol research agendas (Babor, 1992).
National political debates often attend major initiatives in alcohol policy, and preventive measures sometimes culminate from such political activity (Room, 1990; Room et a1.,1995). Several case studies of political events behind policy enactment exist--e.g., the alcohol warning label (Greenfield, 1997b; Kaskutas, 1995) and Tony Kingdon's (1993) analysis of the Australian alcohol content labeling experience (Stockwell & Single, 1997). Beauchamp (1981) detailed the political circumstances surrounding the 1969 Alcohol Act in Finland, which liberalized alcohol availability. He is among the few to have assessed political forces for and against an alcohol policy and how these played out. He emphasized the images major players held regarding likely outcomes, the prevailing Zeitgeist, and the cultural and socio-economic history framing the policy debate. Beauchamp posed the question of how much policy formation is driven by deep cultural changes underlying such factors as public opinion and drinking norms versus the actions of government commissions, temperance movements, industry organizations, etc. However, the polarity Beauchamp described may be more heuristic than practical, because positions taken by various actors operationalize and bring to light otherwise unobservable constructs such as cultural forces (Greenfield, 1994).
Wiener (1981) reviewed the sociological theory on policy formation, especially the construction of the social-problems approach, using this to account for how, in the United States, alcoholism changed from an "invisible problem" in 1970 to an "arena" with an "institutionalized civilian army," funded in 1978 by a $161 million federal budget appropriation. She identified the process constructs of "animating the problem (establishing turf rights, developing constituencies, funneling advice, imparting skills and information); legitimating the problem (borrowing expertise and prestige, redefining its scope, building respectability, maintaining a separate identity); and demonstrating the problem (competing for attention, combining for strength, selecting supportive data, convincing opposing ideologists, enlarging the bounds of responsibility" (p. 6). These "sub-processes" occur not in "steps or stages but, rather, as a continually ricocheting interaction" (p. 7). The primary value of these sociological conceptualizations is with problem definition and agenda setting, which are only small parts of the policy development process.
From an advocacy perspective, in a U.S. appraisal focused on alcohol control rather than on treatment policy, Mosher and Jernigan (1989) enumerated barriers to change, looking at dynamics that must be addressed if policies are to be enacted. According to these public health activists, the alcohol industry actively erects and maintains impediments to needed alcohol control policies. They explored a number of mechanisms and tactics actively exploited by the industry and, based on these dynamics, suggested counter-strategies applicable to citizen actions and movements. Indeed, public health activists and practitioner-researchers have for some time been descriptively addressing ways of mobilizing communities to press for policy change, as can be seen from collections of case studies (Giesbrecht et al., 1990; Greenfield & Zimmerman, 1993). The sphere of application is generally a local community or neighborhood, perhaps a city, or at most some area of a state or province. Still, some useful insights can be gleaned. For example, in considering the dynamics involved in passing the 1990 Liquor License Act in Ontario, Canada, McKenzie noted that "[t]hroughout the process, policy makers sought the middle ground on contentious issues in order to satisfy the interests of all the relevant actors in the policy debate" (1993, p. 47). Where present, such a tendency toward compromise by legislators might make it possible to predict certain features of a resultant policy (like the sharpness of its "teeth") by assessing decision-makers' (or more readily, Congressional staffs') estimations of (a) perceived political resources or power and (b) strength/direction of position of each stakeholder group. Constituent opinion might be taken as one such actor. Other political processes, such as deal making, may make it difficult to test such a simple model in practice.
Project focus and goals
For reasons of expediency and scale, our focus was the policy process at the U.S. national level. Although we were cognizant of the interplay of local and regional developments and policy issues and how they emerge to influence and in turn be shaped by developments on the national front, limited resources precluded a complete multilevel analysis. The project built upon two developments: the literature on the relevance of policy measures for managing drinking-related problems, and the concrete efforts by diverse groups that help determine the outcomes of alcohol policy questions. A primary purpose of the research was to contribute empirically to a hitherto inadequate knowledge base with regard to the alcohol policymaking process in the U.S. (Greenfield, 1994) and the political roles and activities of different interests in this process. Secondly, we are interested in whether research findings and trends in research contribute to policy discussions and related deliberations on alcohol questions, and if so, how. As suggested by previous work on this second topic (Bruun, 1973; Gordis, 1991, 1993; Rist, 1994; Room, 1993), possibilities ranged from minimal influence, to setting agenda and boundaries on policy options, to playing a key role in framing policy proposals and pieces of legislation. A third consideration was the relative impact of various influences on policy outcomes; therefore we explore the impact of different actors be they individuals (such as policy entrepreneurs), federal agencies or other institutions, segments of the industry, or organized groups. As noted above, our work has been informed throughout by the conceptualizations of political scientist John Kingdon (1995), who regards research as playing a distinct role in certain stages of the policy process, particularly in agenda setting and development of policy proposals.
Study objectives
To identify factors that influence alcohol policy formation in the U.S. at the federal level:
* Adapt, refine, and operationalize political science and sociological theory to...
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