Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. C. Dennis Simpson

Second Advisor

Dr. Kieran Fogarty

Third Advisor

Dr. Stephen Magura


Moderate alcohol consumption, grounded theory, evaluation, health and disease, primary care providers


The complexity of health benefits of moderate alcohol consumption (MAC) is well documented. From the World Health Organization recent report, impact of harm from alcohol consumption was 3.3 million deaths or 5.9 percent of all global deaths (WHO, 2014).

Yet, the benefits of MAC for better health and longer life expectancy compared with abstinence are advocated in numerous studies (Nova, Baccan, Zapatera and Marcos, 2012). However, the nature of alcohol, its role on human sufferings has generated disagreements in the scientific community. Analysis of the results of early studies advocating better health for moderate drinkers, reveal discrepancies regarding the influence of confounding factors and systematic errors (Chikritzhs, Fillmore, and Stockwell, 2009) that might explain previous findings. Additionally, evaluation of risks/benefits of MAC reveals detrimental effects on health and accidents related injuries (NIAAA, 2003)

There is lack of knowledge in understanding how primary care providers (PCPs) perceive the health risks/benefits of MAC and subsequently what they recommend to patients. Therefore the purpose of this study was to evaluate the phenomenon understudy in order to develop a substantive theory that explains the experiences of PCPs as they interact with patients in a Midwestern city of the United States.

A constructivist grounded theory approach was used to conduct the study. A sample of nine PCPs, mainly Physicians Assistants (PAs) was recruited permitting the formulation of a substantive theory regarding the perspective of these PAs on the issue. This substantive theory contributes knowledge relevant to better understanding of the complexity of MAC, evaluation research of alcohol prevention/treatment program, formulation of better alcohol policies as it relates to definition of MAC in context where alcohol is accepted.

This was achieved through discovering, describing and explaining the phenomenon of “conflict‟ which participants experienced as a result of the interrelationship and interactions of subjectivity, vulnerability, expressing doubt and imparting knowledge. These interactions intersect and describe the influence of culture and context which in turn influence participants’ ability to control patients’ choice of that which can harm them. A cost-effectiveness evaluation is necessary to fully understand risks/benefits of MAC on health to make corrective strategies on existing policies.

Access Setting

Dissertation-Open Access