Western University Scholarship@Western Electronic Thesis and Dissertation Repository 10-28-2016 12:00 AM The Development and Implementation of the Off-Premise Outlet Density Expansion Initiative within Ontario's New Beer Framework: A Case Study Stephanie A. Simpson The University of Western Ontario Supervisor Dr. Sandra Regan The University of Western Ontario Graduate Program in Health Information Science A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Health Information Science © Stephanie A. Simpson 2016 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Health Policy Commons Recommended Citation Simpson, Stephanie A., "The Development and Implementation of the Off-Premise Outlet Density Expansion Initiative within Ontario's New Beer Framework: A Case Study" (2016). Electronic Thesis and Dissertation Repository. 4201. https://ir.lib.uwo.ca/etd/4201 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. ABSTRACT Background: In April 2015, the Ontario government announced the expansion of beer sales in up to 450 grocery stores, thereby substantially increasing access to alcohol. This policy was introduced despite a robust body of research demonstrating a positive relationship between increased outlet density, alcohol consumption, and consequent harm. Methods: This qualitative case study explored the role of health information, and the contexts and factors which shaped its use, in the development and implementation of Ontario’s policy to expand alcohol outlet density. Kingdon’s Streams Model (2011) guided a directed content analysis of policy-related documents (n=69) and transcripts from semi-structured interviews with a range of policy actors (n=11), including government policymakers, alcohol researchers, knowledge translation actors, and media personnel. Results: The grocery outlet expansion initiative was framed as an economic and consumer convenience initiative within policy-related documents. Moreover, many interview participants perceived that the decision to implement the expansion preceded stakeholder consultations. Thus, despite efforts to highlight concern regarding increases to outlet density, knowledge translation strategies by public health actors remained reactive and unpersuasive. Accordingly, the policy appears largely incongruent with pre-existing public health frameworks, including a Health in All Policies approach more broadly. Conclusion: Health information pertaining to outlet density appears to have had a minimal role in informing the development and implementation of Ontario’s expansion policy. The Ontario government is encouraged to prioritize health considerations in future policy development to prevent potential unintended consequences to population health. Keywords: Alcohol Policy; Outlet Density; Public Health; Health Information i ACKNOWLEDGEMENTS To begin, I would like to thank my thesis supervisor, Dr. Sandra Regan, for her guidance throughout this process. I have learned so much from you over the two years we have worked together; I am truly grateful for your patience and approachability, and so inspired by your commitment and work ethic. To my committee member, Dr. Anita Kothari, thank you for your time and feedback to improve my work. I would also like to acknowledge Dr. Robert Mann and Dr. Norman Giesbrecht for their undeniable roles in getting me to where I am today. You were both so willing to extend yourselves to provide me with invaluable experience, and for this I am extremely thankful. To my peers in the Health Information Science program, thanks for every minute of laughing, venting, and time spent in the Grad Club. Finally, I would like to thank my family for their support. Mom, thank you for listening, for being my personal chauffeur, and for always making sure my freezer is full of food. Dad, thank you for your encouragement and willingness to talk beer over a beer. Annie, thank you for always making me laugh! ii DEDICATION This work is dedicated to my dad, who has taught me to think critically and keep fighting. iii Table of Contents ABSTRACT ..................................................................................................................................... i ACKNOWLEDGEMENTS ............................................................................................................ ii DEDICATION ............................................................................................................................... iii LIST OF TABLES ........................................................................................................................ vii LIST OF APPENDICES .............................................................................................................. viii GLOSSARY .................................................................................................................................. ix CHAPTER ONE ............................................................................................................................. 1 Introduction ................................................................................................................................. 1 Background ................................................................................................................................. 2 Strategies to Reduce Alcohol-Related Harm .......................................................................... 2 Health in All Policies .............................................................................................................. 4 Industry Role in Alcohol Policy Development ....................................................................... 5 Alcohol Policy Development: Knowledge Translation in Political Contexts ........................ 7 Problem and Research Objective ................................................................................................ 8 Relevance to Health Information Science ................................................................................... 9 Study Overview ........................................................................................................................ 10 References ..................................................................................................................................... 11 CHAPTER TWO .......................................................................................................................... 16 Introduction ............................................................................................................................... 16 Research Questions ................................................................................................................... 18 Literature Review...................................................................................................................... 18 Systematic Reviews .............................................................................................................. 20 Alcohol Control Policies: Restricting Outlet Density ........................................................... 23 Theoretical Lens: Kingdon’s Streams Model ........................................................................... 24 Problem Stream ..................................................................................................................... 25 Policy Stream ........................................................................................................................ 26 Political Stream ..................................................................................................................... 27 Coupling and Policy Windows ............................................................................................. 29 Methodology ............................................................................................................................. 29 Sampling and Recruitment ........................................................................................................ 31 iv Sample....................................................................................................................................... 32 Stakeholder Group ........................................................................................................................ 33 Data Collection ......................................................................................................................... 33 Semi-Structured Interviews .................................................................................................. 33 Policy Documents ................................................................................................................. 34 Data Management and Analysis ............................................................................................... 35 Establishing Trustworthiness .................................................................................................... 37 Ethics......................................................................................................................................... 39 Findings....................................................................................................................................