Publications | MEP MIS

Evaluation of a modified contingency management intervention for consistent attendance in therapeutic workplace participants

Giuseppe Masanotti — Wed, 10 Aug 2011 09:05:11 GMT

In a therapeutic workplace business, drug abuse patients are hired as data entry operators and paid to perform data entry work contingent upon documented drug abstinence. Reliable attendance has been difficult to maintain despite the opportunity for operators to earn a living wage, 6 h per day, 5 days per week. A within-subject reversal design experiment evaluated a contingency management intervention that allowed for flexibility regarding when operators could arrive to work, yet maintained a contingency for reliable workplace attendance. Results from a within-subject reversal design experiment demonstrated the contingency management intervention to be effective in increasing the frequency of completed work shifts in four of five operators. Repeated measures ANOVA and Tukey’s post-hoc tests of grouped data showed that the contingency management intervention significantly (P < 0.05) increased the mean percent of days that operators completed work shifts (5% baseline; 63% contingency management; 7% baseline). This study demonstrates an effective procedure for maintaining attendance in therapeutic workplace participants.

Treatment of substance use disorders

Giuseppe Masanotti — Sun, 07 Aug 2011 07:57:20 GMT

National Report - Drugs in Poland 2009

Georgia Magouli — Tue, 08 Mar 2011 10:50:38 GMT

The report desrcibed Polish status quo of drugs usage and addiction as well as ways of coping with that problem. The report was prepared by National Bureau for Drug Prevention.

Workplace social capital and co-occurrence of lifestyle risk factors: the Finnish Public Sector Study.

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

OBJECTIVE: The aim of this prospective study was to examine the link between individual and ecological workplace social capital and the co-occurrence of adverse lifestyle risk factors such as smoking, heavy drinking, physical inactivity and overweight. METHODS: Data on 25 897 female and 5476 male public sector employees were analysed. Questionnaire surveys conducted in 2000-2002 (baseline) and 2004-2005 (follow-up) were used to assess workplace social capital, lifestyle risk factors and other characteristics. Multilevel multinomial logistic regression analysis was used to examine associations between individual and ecological social capital and the co-occurrence of lifestyle risk factors. RESULTS: In the cross-sectional analysis adjusted for age, sex, marital status and employer, low social capital at work at both the individual and ecological level was associated with at least a 1.3 times higher odds of having more than two lifestyle risk factors versus having no risk factors. Similar associations were found in the prospective setting. However, additional adjustment for the co-occurrence of risk factors and socioeconomic status at baseline attenuated the result to non-significant. CONCLUSION: Social capital at work seems to be associated with a lowered risk of co-occurrence of multiple lifestyle risk factors but does not clearly predict the future risk of this co-occurrence.

Alcohol drinking as an issue in the workplace [chapter in:] Workplace Health Promotion. Selected programmes.

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Alcohol is an area where intervention is needed in a workplace. A short explanation of general problems associated with alcohol is provided along with the concept of AA together with Employee Assistance Programmes. Rules and procedures of the WHO, the ILO and the UN model for alcohol and drugs’ control programmes are described. The chapter focuses on models and experiences of western countries. However, this resource covers more general guidelines.

A snapshot of workplace drug testing in the UK

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

BACKGROUND: There is a growing trend towards workplace drug testing in the UK, but there is little published data associated with this work. AIM: This survey reviews our findings from workplace drug testing in comparison with the results obtained from routine illicit drug monitoring. METHODS: The results of the analysis of 1617 specimens from 82 workplace drug testing sources and 12,281 submitted from drug dependency units were collated and compared. RESULTS: Workplace specimens were found to be positive for amphetamines, benzodiazepines, cannabis, cocaine and heroin. CONCLUSIONS: The data presented here suggest that a regular monitoring is required to discern the true extent of drug use in the workplace, especially in safety critical areas.

Alcohol and drug screening of occupational drivers for preventing injury (Review)

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Main results: We included two interrupted time-series studies conducted in the USA. One study was conducted in five large US transportation companies (N = 115,019) that carried passengers and/or cargo. Monthly injury rates were available from 1983 to 1999. In the study company, two interventions of interest were evaluated: mandatory random drug testing and mandatory random and for-cause alcohol testing programmes. The third study focused only on mandatory random drug testing and was conducted on federal injury data that covered all truck drivers of interstate carriers. We recalculated the results from raw data provided by the study authors. Following reanalysis, we found that in one study mandatory random and for-cause alcohol testing was associated with a significant decrease in the level of injuries immediately following the intervention (-1.25 injuries/100 person years, 95% CI -2.29 to -0.21) but did not significantly affect the existing long-term downward trend (-0.28 injuries/100 person years/year, 95% CI -0.78 to 0.21). Mandatory random drug testing was significantly associated with an immediate change in injury level following the intervention (1.26 injuries/100 person years, 95%CI 0.36 to 2.16) in one study, and in the second study there was no significant effect (-1.36/injuries/100 person years, 95% CI -1.69 to 0.41). In the long term, random drug testing was associated with a significant increase in the downward trend (-0.19 injuries/100 person years/year, 95% CI -0.30 to -0.07) in one study, the other study was also associated with a significant improvement in the long-term downward trend (-0.83 fatal accidents/100 million vehicle miles/year, 95% CI -1.08 to -0.58). Authors’ conclusions: There is insufficient evidence to advise for or against the use of drug and alcohol testing of occupational drivers for preventing injuries as a sole, effective, long-term solution in the context of workplace culture, peer interaction and other local factors. Cluster-randomised trials are needed to better address the effects of interventions for injury prevention in this occupational setting.

Alcohol, health and policy: the Italian perspective

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Learning from the past, Italy will go ahead in the next National Health Plan in setting targets on alcohol promoting moderation in alcohol consumption and will monitor the drinking habits of the population taking into account at least the following variables: The aims are that the NHP 2000-2003 (to be implemented starting from autumn 2001) should contain a multidimensional key areas framework supporting specific targets that can: - Promote healthier lifestyles and habits (life skills) - Tackle misleading risk-taking cultures - Improve settings (family, schools, communities) - Strengthen health protection of vulnerable groups - Decrease “gradients” within and between groups (inequities in health) and reduce harm

Integrating Health Promotion Interventions for Hazardous and Harmful Alcohol Consumption into Primary Health Care Professionals’ Daily Work STRATEGY FOR ITALY

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

The aim of this contribution is to develop a country-based strategy for the implementation of a programme to integrate interventions for hazardous and harmful alcohol consumption in primary health care settings. The Italian team included representatives from governmental as well as non – governmental organizations, health professional organizations and groups, scientific organizations. Following a track provided by the PHEPA project, the country team has tried, where possible, to identify a series of priorities to be implemented nationwide by mean a programme of actions particularly focused on prevention and health promotion and including targeted approaches for young people. Among the aims of the strategy is to have the strategy endorsed by a number of key partners and stakeholders at the National, regional and local level and to submit the strategy to the Ministry of Health for a possible development of a formalized integration of specific items into the daily GPs activities.

The association between psychosocial characteristics at work and problem drinking: a cross-sectional study of men in three Eastern European urban populations

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

BACKGROUND: Psychosocial factors at work are thought to influence health partly through health behaviours. AIMS: To examine the association between effort-reward imbalance and job control and several alcohol related measures in three eastern European populations. METHODS: A cross-sectional study was conducted in Novosibirsk (Russia), Krakow (Poland), and Karvina (Czech Republic). The participants completed a questionnaire that included effort-reward at work, job control, and a number of sociodemographic variables. Annual alcohol intake, annual number of drinking sessions, the mean dose of alcohol per drinking session, and binge drinking (> or =80 g of ethanol in one session at least once a week) were based on graduated frequencies in the questionnaire. Data were also available on problem drinking (> or =2 positive answers on CAGE questionnaire) and negative social consequences of drinking. All male participants in full employment (n = 694) were included in the present anal! yses. RESULTS: After controlling for age and centre, all indices of alcohol consumption and problem drinking were associated with the effort-reward ratio. Adjustment for material deprivation did not change the results but adjustment for depressive symptoms reduced the estimated effects. Job control was not associated with any of the alcohol related outcomes. CONCLUSIONS: The imbalance of effort-reward at work is associated with increased alcohol intake and problem drinking. The association appears to be partly mediated by depressive symptoms, which might be either an antecedent or a consequence of men's drinking behaviour.

Guidance on alcohol and drug misuse in the workplace

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

This guidance is intended to give pragmatic support to occupational physicians in addressing problems of alcohol and drug misuse in the workplace. It sets out the actions to be taken, in the face of difficult situations, and aims to help the occupational physician to ensure a fair and consistent approach. Whilst aimed primarily at occupational physicians, this guidance will also be of assistance to other healthcare professionals, managers, employees, human resources staff and trade union representatives. It explains why and how a workplace policy should be implemented, whether to test for alcohol and drugs and how this should be carried out, fitness for work and rehabilitation. In the course of this, the guidance refers to the ethical and legal aspects of dealing with alcohol and drug problems at work, and clarifies roles and procedures.

Team awareness, problem drinking and drinking climate : workplace social health promotion in a policy context

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Purpose. (1) To determine the effectiveness of classroom health promotion/prevention training designed to improve work climate and alcohol outcomes; (2) to assess whether such training contributes to improvements in problem drinking beyond standard workplace alcohol policies. Design. A cross-sectional survey assessed employee problem drinking across three time periods. This was followed by a prevention intervention study; work groups were randomly assigned to an 8-hour training course in workplace sical health promotion (Team Awareness), a 4-hour informational training course, or a control group. surveys were administered 2 to 4 weeks before and after training and 6 months after posttest. Setting and subjects. Employees were surveyed from work departments in a large municipality of 3000 workers at three points in time(year, sample and response rate are shown): (1) 1992, n=1081, 95%; 1995, n=856, 97%; and (3) 1999, n=587, 73%. Employees in the 1999 survey were recruited from safety sensitive departments and were randomly assigned to receive the psychosocial (n=201), informational (n=192), or control (n=194) condition. Intervention. The psychosocial program (Team Awareness) provided skills training in team referral, team building and stress management. Informational training used a didactic review of policy, employee assistance and drug testing. Measures. Self-reports measured alcohol use (frequency, drunkenness, hangovers, and problems) and work drinking climate (enabling, responsiveness, drinking norms, stigma, and drink with co-workers). Results. Employees receiving Team Awareness reduced problem drinking from 20% to 11% and working with or missing work because of a hangover from 16% to 6%. Information-trained workers also reduced problem drinking from 18% to 10%. These rates of change contrast with changes in problem drinking seen from 1992 (24%) to 1999 (17%). Team Awareness improvements differed significantly from control subjects, which showed no change at 13%. Employees receiving Team Awareness also showed significant improvements in drinking climate. For example, scores on the measure of coworker anabling decreased from pretest (mean=2.19) to posttest (mean=2.05) and follow up (mean=1.94). Posttest measures of drinking climate also predicted alcohol outcomes at 6 months. Conclusion. Employers should consider the use od prevention programming as an enhancement to standard drug-free workplace efforts. Team Awareness training targets work group social health, aligns with employee assistance efforts, and contributes to reductions in problem drinking.

A systematic review of work-place interventions for alcohol-related problems

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Aims: The aims of this study were to (1) gauge any improvement in methodological quality of work-place interventions addressing alcohol problems; and (2) to determine which interventions most effectively reduce work-place-related alcohol problems. Methods: A literature search was undertaken of the data bases, Ovid Medline, PsychINFO, Web of Science, Scopus, HSELINE, OSHLINE and NIOSHTIC-2 for papers published between January 1995 and September 2007 (inclusive). Search terms varied, depending on the database. Papers were included for analysis if they reported on interventions conducted at work-places with the aim of reducing alcohol problems. Methodological adequacy of the studies was assessed using a method derived from the Cochrane Collaboration guidelines. Results: Ten papers reporting on work-place alcohol interventions were located. Only four studies employed randomized controlled trials (RCT), but all these had methodological problems. Weaknesses in all studies related to representativeness of samples, consent and participation rates, blinding, post-test time-frames, contamination and reliability, and validity of measures used. All except one study reported statistically significant differences in measures such as reduced alcohol consumption, binge drinking and alcohol problems. Conclusions: The literature review revealed few methodologically adequate studies of work-place alcohol interventions. Study designs, types of interventions, measures employed and types of work-places varied considerably, making comparison of results difficult. However, it appears from the evidence that brief interventions, interventions contained within health and life-style checks, psychosocial skills training and peer referral have potential to produce beneficial results.

Social support has both positive and negative effects on the relationship of work stress and alcohol consumption

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Previous studies imply that certain combinations of work stressors, social support (SS), and other conditions could lead to both increased and decreased alcohol consumption. Thus, we evaluated both positive and negative influences of social support on the work stress-alcohol consumption relationship in a general population. The study design was a cross-sectional survey. Of a probability sample of persons 25 years of age or older and living in the United States (n = 3617), subjects who drank and who were without missing values with respect to study variables were analysed (n = 967 or 94). Since previous studies have suggested the necessity of adopting the sensitivity hypothesis (i.e. different stressors require different social supports), hierarchical regression analyses were carried out to test the effects of interactions between two types of social support (e.g. family social support or out-of-family social support) and two types of work stressors (e.g. job psychological demand, job decision latitude) on alcohol consumption. Our analysis verified that (1) social support had both positive and negative effects on the work stress-alcohol relationship. Specifically, (2) interactions between physical activity and decision latitude, and between child support and psychological job demand were related to decreased alcohol consumption. However, (3) interactions between spouse support and decision latitude, and between informal social integration and psychological job demand, were related to increased alcohol consumption. It has been suggested that social support is not of universal benefit in reducing excessive drinking and may sometimes be a reinforcing factor. Since the external validity of these findings might be limited because of the small sample size in some analyses, further study is necessary.

Positive and negative effects of social support on the relationship between work stress and alcohol consumption

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

OBJECTIVE: This study was performed to evaluate both positive and negative influences of social support on the relationship between work stress and alcohol consumption in male white-collar workers. METHOD: This study was performed in a population of male white-collar workers in Osaka, Japan. The subjects (N = 661) were categorized into nine subgroups based on the moderated mediation model of Frone and on the results of signal detection analysis using chi-square parameters calculated from work stressors and depression (mediators). Hierarchical linear regression analyses were performed among the nine subgroups to test the effects of interactions between four types of social support (i.e., two types of belonging support and two types of appraisal support) and work stress on alcohol consumption. RESULTS: Our results verified that social support has both positive and negative effects on the relationship between work stress and alcohol consumption: (1) interactions between "belonging support (1)" and depressive symptoms were related to decreased alcohol consumption in two subgroups (p < .01 in Group 1 and p < .05 in Group 6), whereas the interaction was related to increased alcohol consumption in one subgroup (p < .01 in Group 7); (2) interaction between "belonging support (2)" and depressive symptoms was related to decreased alcohol consumption in two groups (p < .05 in Group 5 andp < .01 in Group 7), whereas the interaction was related to increased alcohol consumption in one group (p < .01 in Group 1). CONCLUSIONS: Social support was suggested to have various types of influences (i.e., positive, negative or no effect) on the relationship between work stress and alcohol consumption, depending on the type of social support and environmental factors defining the groups.

Impact of an alcohol misuse intevention for health care workers -2: employee assistance programme utilization, on-the-job injuries, job loss and health services utilization

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Aims: This study evaluated the effects of an enhanced substance misuse (SM) prevention/early intervention programme on referrals to an employee assistance programme, health care utilization rates, on-the-job injury rates and job termination rates among health care professionals employed in a managed care organization. Methods: The intervention was implemented at one site, with the remaining sites serving as the comparison group. Existing data from hospital databases were used to compare events occurring in the periods before and after initiation of the intervention. To account for baseline differences in age, gender and job class, logistic regression models produced adjusted means for events per employee month-at-risk. Results: We found that employee assistance referrals and non-SM-related in-patient hospitalizations increased significantly post-intervention, while rates of total out-patient SM-related visits decreased at both the intervention and comparison sites post-intervention. There was a small, statistically significant decrease in the monthly rate (OR = 0.92) of non-SM out-patient utilization at the intervention site, once the intervention was in place. No differences potentially attributable to the intervention were detected in job turnover or injury rates. Conclusions: We conclude that, while the intervention did not appear to affect health care utilization for SM-related problems, it was associated with increased referrals for employee assistance

Employees' reactions to an interactive website assessing alcohol use and risk for alcohol dependence, stress level and coping

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Objective: We assessed employee's reactions to using a website-based intervention designed to identify moderate and high-risk drinkers and to reduce their problematic drinking. Methods: One hundred and eighty-seven participants completed a prewebsite-intervention survey, website intervention, and a follow-up survey assessing participants' reactions to the website. The website provided feedback regarding participants' alcohol use, risk of lifetime or current alcohol dependence, stress level, and coping style. Participants identified as at 'low' or 'moderate' risk for alcohol-related problems were randomly assigned to receive either 'limited individualized feedback' or 'full individualized feedback'. High-risk participants were given the full individualized feedback intervention. Results: Twenty-three per cent were identified to be at high risk of having alcohol-related problems, and 17% were at moderate risk. Most participants viewed the site information as interesting and easy to use. High-risk participants were more interested in alcohol-related information than were other participants. Eight per cent of the respondents reported a change in their drinking with this brief intervention. Conclusion: These findings demonstrate the potential of the Internet to attract and engage persons who are high- or moderate-risk for alcohol-related problems in learning more about their risk as well as about their stress and their strategies for coping.

Assessment of binge drinking of alcohol in highly educated employees

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session

Achieving professional change : from training to workforce development

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

Issues: The traditional approach to increasing the capacity of health and human service professionals to deliver alcohol, tobacco and other drug interventions has been to build relevant knowledge, skills and attitudes through the provision of education and training. However, as a stand alone strategy, education and training is likely to have limited impact. Approach: This paper examines not only the features and characteristics of successful training programs and approaches, but also the wider array of systems and structural factors that might act as impediments to the implementation of new knowledge, skills and clinical behaviours. Key Findings: There is a constellation of factors that extend beyond traditional notions of 'training' that fall under the rubric of 'workforce development'. Implications and Conclusions: A workforce development approach requires three levels of action-system-wide, capacity building and professional development to ensure effective responses

Collective agreements (CAO's)

Isabelle Jeffares — Tue, 07 Sep 2010 14:33:08 GMT

In some collective agreements (CAO's) provisions are included on drinking during working hours. Mostly reflecting specific laws on: Road Traffic [WegenVerkeerswet]: It is forbidden to drive with a blood alcohol content (BAC) greater than 0.5 Air Cargo [Luchtvaartwet]: Airport Staff must not drink alcohol in the ten hours of work. It is also forbidden to perform work at a BAC greater than 0.2 Navigation Acts [Scheepvaartwet]: It is forbidden to sail a ship or a sea route; to drive as a pilot on board these ships as the master / operator or to advise on the movement to implement navigation, with a BAC greater than 0.8 Beverage and Catering[Drank- en Horecawet]: When alcohol is available in a workplace which employees people aged under 16 years, employers can face criminal proceedings. The Beverage and Catering Act prohibits serving or selling alcohol to people under sixteen years. This law is based on a fine for the provider, not the drinker.