Author: Jessica Thomas
Thomas, Jessica, 2023 Translating knowledge into meaningful action: Advancing alcohol related breast cancer prevention, Flinders University, College of Medicine and Public Health
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Alcohol is a Group-1 carcinogen and a modifiable breast cancer risk factor. Women drinking heavily have a 60% excess risk for breast cancer relative to non-drinkers. Even consumption at low levels previously considered ‘safe’, are now known to significantly elevate cancer risk. Therefore, finding ways to reduce alcohol intake, on a population scale, could reduce breast cancer incidence.
Whilst women during midlife are drinking more, there is limited research on this population. The existing literature on alcohol interventions has focused on men, young people or pregnant women. Significant motivations, gender and life stage differences exist. In midlife, women experience significant identify, family and gender-role changes. Indicating that an important knowledge gap exists where effective and tailored strategies around risk minimisation are needed for women (Livingston, 2015).
There is low public awareness and/or acceptance of alcohol as a risk factor for cancer. Public awareness is low with under half (47%) of Australians identifying alcohol as a risk factor for cancer; concerningly lower awareness exists amongst those most at risk, heavier drinkers. Whilst there is strong evidence of breast cancer cases attributed to alcohol, there is limited knowledge on why women are drinking more and how to effect change. This PhD study will make an original contribution to knowledge, by addressing this gap.
The research questions include:
1). What are the individual and structural drivers of alcohol consumption for women?
2). What strategies are effective in reducing alcohol related breast cancer risk in women?
An innovative methodology was utilised to ensure that drinking - as a behaviour - was understood within the gendered, social context of women’s lives through a focus on the commercial determinant of alcohol advertising. Members of the public collaborated with academic researchers to investigate the phenomena of online alcohol advertising.
Qualitative research with the use of theories from Simone de Beauvoir’s revealed that women predominately drink for the reasons of pleasure or relief from oppression. The application of Jean-Paul Sartre’s theory of bad faith explained the psychological motivation for drinking and why women can act in ways that can appear against their best interests. Drinking alcohol has benefits for women, and the public health discourse embraces a harm-based narrative. The two are incompatible. The theory of bad faith is used to provide a bridge for meaningful discourse on alcohol related breast cancer prevention between public health and everyday Australian women.
The application of Louis Althusser’s theories revealed how the alcohol industry embeds cultural values of drinking as essential to the practice of women’s social roles. This research found that alcohol marketing creates positive expectancies of alcohol which may actively inhibit breast cancer messaging.
The translation of the research into policy and practice change is discussed, alongside the barriers to increasing alcohol regulation. The challenges of meaningful engagement with women about drinking are explored and opportunities for positive action are provided. Alcohol literacy interventions have proven effective with other populations and present an opportunity to inoculate women against some of the influence of Big Alcohol marketing.
Future research which ‘works with’ women utilising alcohol literacy, presents a promising meaningful way to engage with diverse groups of women to reduce alcohol related breast cancer risk. By understanding the individual and environmental drivers behind why women drinking, and the commercial determinants which seek to embed cultural values of femininity with drinking, this research discusses the drivers of women’s alcohol consumption and interventions levers for future breast cancer prevention.
Keywords: breast cancer, alcohol, women, drinking, prevention, citizen science, participatory research
Subject: Medicine thesis
Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Medicine and Public Health
Supervisor: Professor Tara Brabazon