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Article Excerpt
Although public sentiments concerning alcohol issues have long been a subject of historical and social research, public opinion in relation to specific alcohol policies has only recently emerged as a research area in its own right. In the late 1970s, Goodstadt et al. stated, "[a]pparently, no sophisticated studies of public attitudes towards [policies regarding] the pricing of alcoholic beverages have been completed" (1978: p. 1630). Approximately ten years later, while Crawford (1987) reviewed 266 studies of a variety of attitudes towards alcohol use and misuse, another review turned up "no published studies of public opinion on alcohol policy in the scientific literature" (Wagenaar & Streff, 1990: p. 190). (Wagenaar has subsequently added to the literature, as discussed later.) Leedham (1987: p. 935) observed that "public opinion data on alcohol and tobacco policy are rarely collected on a regular basis by policymakers. Only where the data feed into decision making in other policy areas, such as taxation policy, is the information collected as part of a data base." Leedham adds that tobacco policy has received more attention than alcohol policy. Thus it would appear that attention given to policy opinions per se has lagged behind that given to generic attitudes towards alcohol. Although the body of literature in this area has been growing, especially subsequent to the U.S. policy development project discussed in this special issue (Greenfield et al., 2004), the literature remains fragmented. Our intention here is to critically review major analyses of public opinion on alcohol policies in an effort to set a benchmark for the field and make suggestions for future research.
The emergence of a coherent agenda for alcohol policy opinion research has the potential to improve both theoretical understanding of the role played by public opinion in public policymaking (Greenfield, 1994) and the evaluation of which public health policy strategies hold the greatest promise of support (Room et al., 1995). While public opinion in and of itself is seldom the central determinant in policy agenda setting, it is in principle an important part of the policymaking mix. A considerable literature in political science addresses the role of public opinion in policymaking (Arnold, 1990; Gozenbach, 1996; Kingdon, 1995, p. 1994; Stimson et al., 1994). Leedham's succinct description is that public opinion "forms part of the context within which strategy is determined and provides an aspect of legitimacy for a chosen course of action," playing a validating role in the policymaking process (Leedham, 1987, p. 935). From a public health perspective, policy opinion research also has the potential to reveal gaps in public understanding of health issues and opportunities for enhanced educational efforts aimed at helping the public understand the rationales for particular policies.
To some extent, the growth of interest in alcohol policy opinion research reflects the shift, begun in the 1970s and established by the mid-1980s, from an alcoholism focus in research literature to an alcohol problems focus generative of a diverse array of public policy proposals directed toward strengthening environmental controls (Edwards et al., 1994; Moore & Gerstein, 1981). Several sources of policy opinion data exist from the earlier period, including federally sponsored research (Harris, 1972, 1973a, 1973b, 1974) and studies of alcohol abuse in a social-problems context (Cahalan et al., 1974; Cameron, 1981; Goodstadt et al., 1978; McKenzie & Giesbrecht, 1981). Starting in 1989 as part of an emerging trend of systematic attempts to address policy opinion in a social epidemiological context, Canadian and American national alcohol surveys added items on specific alcohol control policies. Work reviewed comes from five major data sources on alcohol-related public attitudes and policy opinions: (a) the inclusion of 11 policy opinion questions (see Table 1) on the Canadian National Alcohol and Other Drugs Survey (NADS) in 1989 (Eliany et al., 1992), subsequently used extensively in U.S. national and Canadian provincial and national surveys; (b) the Impact of Alcoholic Beverage Warning Labels Survey conducted by the Alcohol Research Group (ARG) in Berkeley, California, providing both a U.S national cross-sectional data series from 1989 to 1994 and an Ontario, Canada, no-intervention reference series covering the NADS 11 policy opinion item set (Greenfield, 1997a; Hilton & Kaskutas, 1991; Kaskutas, 1993a); (c) ARG's quinquennial U.S. National Alcohol Survey (NAS) cross-sectional series with data collection on policy opinions in 1995/96, 2000/01, and 2004/05 (now being fielded); (d) the annual Ontario Alcohol and Other Drug Opinion Surveys (OADOS; now called CAMH Monitor), sponsored by the Addiction Research Foundation (ARF) from 1992 onward (Anglin, 1995; Bondy, 1994; Ferris et al., 1994; Paglia, 1995), and (e) a 1997 telephone survey of 7,021 "mainland" U.S. adults introduced as a study of "views on teenage drinking problems," funded by a University of Minnesota grant from the Robert Wood Johnson Foundation (A. C. Wagenaar, P.I.) (Wagenaar et al., 2000; Latimer et al., 2001, 2003). Private opinion polling companies have, in addition, periodically included questions about alcohol issues in national surveys (Gallup, 1972, 1985, 1987, 1989; Harris, 1983). The extent of this latter data resource is not assessed here, but private polling data are acknowledged to have utility if used carefully in policy opinion research (Gozenbach, 1996; Hilton & Kaskutas, 1991; Leedham, 1987; Wagenaar & Streff, 1990).
In this review we focus on public opinion on alcohol control policies, drawing on published and some unpublished analyses of the data sets outlined above and other research on public support for specific policy preferences. Consideration is given to county- or state-level data (Fischer, 1989; Jones & Greenfield, 1991; Jones-Webb et al., 1993; Moloney & Emanuels, 1995; Wagenaar & Streff, 1990; Wagenaar et al., 1988; Schmid et al., 1990) as well as national-level data. While a sizeable body of non-U.S, data and research reports exists (e.g., Ahlstrom & Osterberg, 1992; Anglin, 1995; Anglin et al., 2001; Bondy, 1994; Cameron, 1981; Casswell et al., 1989; Eliany et al., 1992; Ferris et al., 1994; Giesbrecht & Greenfield, 1991, 1999; Giesbrecht & Kavanaugh, 1999; Giesbrecht et al., 2001; Goodstadt et al., 1978; Paglia, 1995; Room et al., 1995), we restrict our attention to public opinion research in the United States (Giesbrecht & Greenfield, 1999; Latimer et al., 2001, 2003; Room et al., 1995). In addition, this review focuses on analytic rather than purely descriptive reporting on policy opinion. We begin by reviewing norms around alcohol use and then consider dimensions of public support for specific policy alternatives and critical issues in refining and improving policy opinion research.
Norms, attitudes, and drinking behaviors
Attitudes toward drinking and drunkenness, while known to predict behavior only imperfectly, reflect stances regarding the social location (status and function) and context of alcohol use that underlie the formulation of specific policy preferences. A 1964-to-1984 trend study examined such attitudes by inquiring about acceptable consumption levels in four social contexts: drinking with people from work, with neighbors, with close friends, or among people from church (Hilton, 1991a). In this 20-year period (during most of which time per capita consumption was increasing), three of these four settings became "wetter" (more permissive); only "among people from church," originally a very dry setting, showed no change. These results were interpreted to suggest that norms about drinking were becoming more liberal. In a study of situational drinking norms (defined as subjective levels of acceptable consumption in various situations), Greenfield and Room (1997) used NAS U.S. adult data from 1979, 1984, and 1990 to examine trends in acceptance of "drinking at all" and of "drunkenness." The authors found considerable stability in the normative structure of American drinking during the 1980s, but they noted some changes as well, finding "a diminished acceptability of any drinking in dryer but not in wetter situations, and of heavier drinking in public situations or in situations which will require travel afterwards" (p. 45). These reductions were seen as paralleling the downturn of alcohol consumption in the U.S. from the beginning of the 1980s through to 1990 (Midanik & Clark, 1994), which has not continued beyond 1995 (Greenfield et al., 2000a) and in fact has begun to trend upward (Kerr et al., 2004). Thus, based on studies in the 1980s and early 1990s (the period from 1995 to 2000 has not yet been studied), norms around alcohol use seem to be associated with levels of consumption in the population, as do sociocultural variables.
Attitudes toward drinking and drunkenness have also been looked at in terms of reasons for drinking (or abstaining from drinking) and by regional and gender differences. Using NAS data, Greenfield (1993) found between 1984 and 1990 some weakening over time among abstainers in "goes against religion" as a reason for not drinking, while moderate drinkers' reasons for limiting their intake saw...
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