Feasibility of brief intermention in the workplace for the detection and treatment of excessive alcohol consumption

The aim of this study was to see whether brief intervention, a method used in the health care services, can be useful in the workplace. At routine health check-ups carried out by the occupational health service (OHS), employees were offered the opportunity to check their alcohol-use habits. Of the 333 employees who were offered alcohol-use screening, only six (2%) failed to participate. Of the remaining 327, 21% (n=68) screened positive for excessive alcohol consumption and were contacted by the OHS. The majority of these, 43 (62%), accepted a further check-up of their alcohol consumption. A much higher percentage of those who were contacted by telephone (80%) than those who were contacted by letter (17%) subsequently came to the OHS. One probable spin-off effect of the project was that 23 persons outside the screened group contacted the OHS about their alcohol abuse problems. The results indicate that it is feasible to use screening and secondary preventive methods at the workplace to discover alcohol abuse.     

Screening for high-risk and elevated alcohol consumption in day and shift workers by use of the AUDIT and CDT

BACKGROUND: Alcohol consumption levels and drinking patterns have been reported to vary between day and shift workers, although the results have been conflicting. Previous results indicate that questions about alcohol habits may be asked in the workplace. However, no studies have evaluated the Alcohol Use Disorders Identification Test (AUDIT) or the alcohol biomarker carbohydrate-deficient transferrin (CDT) in serum for this purpose. AIM: To investigate, in conjunction with routine health examinations, whether there is any difference between permanent day and shift workers in high-risk alcohol consumption, according to the AUDIT and CDT. Gamma-glutamyl transferase (GGT) in serum was included mainly as a comparison test. METHODS: The employees who attended for a regular health examination during the study period were offered voluntary alcohol screening with the AUDIT and CDT. RESULTS: Altogether, 990 employees (day, two-shift, and three-shift workers) participated in the study, 194 (20%) of whom screened positive with the AUDIT and/or CDT. There were no significant differences in the screening results between day and shift workers, whereas significantly fewer of the two-shift workers (odds ratio=0.5, 95% confidence interval=0.3-0.9) screened positive with CDT. CONCLUSIONS: The present findings on employees who attended for regular health examinations suggest that shift workers did not show a higher level of risky alcohol consumption than day workers, according to the results with the AUDIT, CDT and GGT. On the contrary, the two-shift workers appeared to drink significantly less.     

Evaluation of a workplace brief intervention for excessive alcohol consumption: the workscreen project

BACKGROUND: The workplace provides a useful setting for early identification and intervention with individuals who have unhealthy lifestyles. The objective was to evaluate the effects of a workplace-based lifestyle intervention (Workscreen) to reduce excessive drinking. METHOD: There were eight Australia Post networks randomly allocated to experimental and control conditions, comprising 67 worksites and 1206 employees. The experimental condition involved a broad spectrum lifestyle campaign, incorporating support from management, employee awareness of health, and brief interventions for high-risk behaviors, including excessive alcohol use. Focus groups identified relevant cultural factors. Changes in workplace culture and employee behavior were assessed 10 months after baseline. Males and females were analyzed separately. RESULTS: Over half of APOST employees participated at each screening point. In the experimental condition 61% of employees overall and 58% of those identified as excessive drinkers in Phase 1 responded to the lifestyle campaign by attending health assessments. Analyses focusing on the organization as a whole did not reveal significant reductions in excessive alcohol consumption among men or women. However, a significant reduction in number of drinks was observed in the experimental condition among women for whom completion of baseline and follow-up could be confirmed (P < 0.001). CONCLUSIONS: The present study indicates that a workplace-based lifestyle campaign can assist self-selected employees in reducing their alcohol consumption. There was a moderately high level of participation among those identified as drinking excessively, which supports our approach of embedding a low-intensity alcohol program within the context of a broader health promotion campaign.     

Who tells and what happens: disclosure and health service responses to screening for intimate partner violence

Routine screening of women for intimate partner violence (IPV) has been introduced in many health settings to improve identification and responsiveness to hidden abuse. This cross‐sectional study aimed to understand more about how women use screening programmes to disclose and access information and services. It follows women screened in ten Australian health care settings, covering antenatal, drug and alcohol and mental health services. Two samples of women were surveyed between March 2007 and July 2008; those who reported abuse during screening 6 months previously (122) and those who did not report abuse at that time (241). Twenty‐three per cent (27/120) of women who reported abuse on screening were revealing this for the first time to any other person. Of those who screened negative, 14% (34/240) had experienced recent or current abuse, but chose not to disclose this when screened. The main reasons for not telling were: not considering the abuse serious enough, fear of the offender finding out and not feeling comfortable with the health worker. Just over half of both the positive and negative screened groups received written information about IPV and 35% of the positive group accessed further services. The findings highlight the fact that much abuse remains hidden and that active efforts are required to make it possible for women to talk about their experiences and seek help. Screening programmes, particularly those with established protocols for asking and referral, offer opportunities for women to disclose abuse and receive further intervention.     

Organizational Characteristics of Small Metal-Fabricating Businessesin Minnesota

Abstract

Small U.S. businesses are underserved in terms of occupational health and safety (ORS) services. Little is known about organizational factors influencing OHS in these establishments. Machine guarding was quantitatively evaluated in 40 small businesses. Checklists were used to develop safety scores. Organizational information such as number of employees, unionization, and number of machines was obtained. Experience modification rates, annual sales, and credit ratings were also obtained. Safety scores were divided into terciles. Businesses with safety scores in the top third were unionized, had effective safety committees, and had been operational for more than 30 years. Interventions and policies targeted toward development and implementation of safety committees are needed to improve ORS in this cohort. Financial capability had no bearing on ability of a small business to mount an OHS programs. Non-unionized small businesses may be more vulnerable to occupational injuries.     

Screening for unhealthy lifestyle factors in the workplace

Objective: To examine (1) the prevalence of four lifestyle behaviours among Australia Post employees and (2) employees' perceptions of the role of the workplace in promotion of lifestyle change.
Design: A cross-sectional survey using a self-administered questionnaire involved 688 employees working in Australia Post throughout metropolitan Sydney.
Main outcome measures: Prevalence related to age and sex of alcohol consumption, cigarette smoking, inadequate exercise, perception of excessive weight.
Results: 36% of men and 11% of women reported drinking alcohol at levels considered hazardous or harmful; 33% of men and 25% of women reported smoking; 51% of men and 62% of women thought they were overweight; 30% of men and 39% of women did not exercise regularly. Younger respondents were more likely to report drinking hazardously or harmfully, were smokers and had multiple risk factors. A majority of respondents thought that their employer should be interested in employee's lifestyle issues, particularly excessive drinking (63%). However, few considered seeking advice from the workplace regarding smoking (16%), weight (25%) and excessive alcohol consumption (12%).
Conclusions: These results show that many of Australia Post employees have unhealthy lifestyle behaviours. While employees perceive that the workplace has an important role in promoting healthy lifestyles among staff, few are presently willing to seek advice from the workplace regarding these issues. Promotion of healthy lifestyles in Australian workplaces is a potentially important public health advance that could reduce the incidence of diseases associated with high-risk lifestyle behaviours.     

The Employee Stress and Alcohol Project: The development of a computer-based alcohol abuse prevention program for employees

The Employee Stress and Alcohol Project (ESAP) developed an interactive computer-based alcohol abuse prevention and early intervention program accessible to employees over the Internet. Behavioral health research recommends that specialists develop and provide comprehensive yet cost-effective approaches to alcohol abuse prevention, early intervention, and treatment within the context of workplace managed care. ESAP is implementing this web site for a diverse 8,567-employee work site. ESAP's web site enables employees to self-assess their stress levels, coping styles, and risk for alcohol-related problems. It provides personalized feedback, recommendations, mini-workshops, a drinking journal, links to other online resources, and an interactive forum for direct participant-to-participant communication. ESAP's web site provides resources for employees who are concerned about another individual's drinking as well as information about adolescent alcohol use. This article discusses the implications of incorporating the ESAP web site into worksite alcohol abuse prevention and early intervention programming.     

Evaluation of occupational health service in the wood processing industry--determination of employee satisfaction

In order to define priorities for improvement of the occupationalhealth service (OHS) in one primary health care unit, employees'satisfaction was evaluated with a postal questionnaire. Thequestionnaire covered items on service reservation, personalhealth education received, quality of the OHS, and use of theOHS within six months by the employees. This evaluation wasone step of the quality system that was planned in accordancewith the ISO 9004-2 standard for continuous quality improvementof OHS. The study population was all of 1,050 employees workingfor five employers; 546 (52%) employees responded to the inquiry.However, only 377 of them had made use of the OHS within thelast six months before the inquiry. The mean age of the responderswas 42 years (SD=9 years) and 76%of the respondents were men.The percentages of employees with a high degree of satisfactionwith the quality of the OHS and personal health education inthe OHS were 76% and 69%, respectively. However, concerningthe quality of the OHS, the proportion of highly satisfied employeeswas 27% higher (95% Cl=19–35%) among those who had usedOHS within six months compared to the others. Furthermore, whenthe oldest (>48 years) and the youngest (<35 years) agegroups were compared, the difference between the proportionsof highly satisfied employees was 21% (95% Cl=11–31%).In conclusion, the high differences suggest a close linkagebetween the employee's satisfaction with the OHS, the use ofthe OHS and ageing.     

Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records

ABSTRACT: BACKGROUND: Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. METHODS: The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. RESULTS: During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as 'high risk' work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury - there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional. CONCLUSIONS: Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical abuse. The most incidents of workplace violence occurred in adult male prisons. Review of the types of adverse health outcomes experienced by the victims of workplace violence and the assessments of severity assigned to violent incidents suggests that, compared with health care settings in the community, correctional settings are fairly safe places in which to practice.     

Use of workplace health promotion apps: Analysis of employee log data

ObjectiveStudies have shown that mobile applications (apps) can effectively support lifestyle-related health. Hence, apps are started to be used in workplaces with the expectation that they can promote the well-being of employees. However, no technological advance can make a difference if it is not utilised. This study investigated the usage of a health app in a workplace through analysing log data.MethodsThe average frequency of using the app by employees at a German IT company was assessed by analysing three months’ worth of log data together with 197 employees’ responses to a questionnaire. The app offered its users the results of an objective health screening, personalised information and assigned challenges. Correlations between the app usage frequency and various factors were established. The factors were gender, age, previous experience with apps, personal innovativeness towards new information technologies, health status and perceived app credibility.ResultsThe app usage frequency was relatively high due to the inclusion of the health screening results; however, it appeared to be impacted by only some of the considered factors.ConclusionDemographic and personal factors of the target group should be considered when developing health apps. The inclusion of appropriate functionalities and their personalisation can ensure a high uptake of health apps in workplaces.     

Prevalence and incidence of workplace bullying among Spanish employees working with people with intellectual disability

BackgroundAlthough workplace bullying is a severe psychosocial risk with a high prevalence, there is a lack of studies addressing its incidence, particularly among staff working with people with intellectual disability.ObjectivesWe examined the prevalence and incidence of workplace bullying in a sample of Spanish employees working with people with intellectual disability. The socio-demographic characteristics of victims and non-victims of workplace bullying were also analyzed.MethodsMulticenter study with two phases (T1 and T2) carried out in Valencia (Spain). The sample consisted of 696 employees from 66 centers in T1. One year later (T2), 422 employees from 61 centers agreed to participate in the study again. Workplace bullying was assessed by means of the instrument “Mobbing-UNIPSICO”.ResultsThe prevalence of workplace bullying was 18.9% and 20.4% in T1 and T2, respectively. Of the 335 employees who were not victims of workplace bullying at T1 who were followed up at T2, 36 reported that they suffered workplace bullying a year later, that is, the accumulated incidence was 11%. In contrast, 81 workers who had been victims of workplace bullying at T1 and who were followed up at T2, 32 reported that they did not suffered from workplace bullying a year later. The victims had more stable contracts and more seniority in the organization/job than the non-victims in T1, but this result was not replicated in T2.ConclusionsWorkplace bullying is a phenomenon with substantial prevalence, but also with considerable incidence (11%) among staff working with people with an intellectual disability.     

Fitness for work in health care workers: state of the art and possible operational recommendations for its formulation and management in relationship to alcohol and drug addiction

Both chronic and acute alcohol or drug consumption have severe health consequences, alter the subject's cognitive functions and work performance and increase the risk of work-related accidents, for the worker and for third parties (e.g., co-workers and other people subject to negative impact of worker's actions). Limited scientific evidence has suggested that some working conditions present in the health care sector (e.g., high levels of responsibility, competitiveness, burnout, shiftwork, work-related stress) may favour alcohol and drug abuse. The aim of the present report is to describe the problem of alcohol and drug consumption among health care professionals and to evaluate the problem of related fitness for work. The magnitude of this problem remains unclear; recent estimates have reported alcohol abuse and addiction problems in 1-14% and psychotropic, illicit and non-illicit, substance abuse in 6-15% of health care workers. The prevalence of tranquilizer and sedative/hypnotic drug use is high, particularly among physicians. However, it remains unclear whether the incidence of workplace accidents and injuries is higher among drug abusers, and whether the statutory introduction of prevention programmes has led to actual control of this problem in the workplace. Italian legislation identifies the occupational physician as a key figure to prevent psychotropic substance abuse in some work activities, but some difficulties in its application remain. Legislators should issue simple norms that clearly define the responsibilities and skills of each actor involved in safeguarding workplace health and safety, as well as clearly outlining workplace monitoring procedures.     

The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada

Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.     

Workplace Health Understandings and Processes in Small Businesses: A Systematic Review of the Qualitative Literature

Introduction Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS). Methods The review was conducted as part of a larger mixed-method review and in consultation with stakeholders. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative articles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethnographic findings synthesis. Results This review finds that SBs have distinctive social relations of work, apprehensions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader structures, policies and systems shape the practice of workplace health in SBs. The themes contribute to ‘layers of evidence’ that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels. Conclusions This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers’ and employers’ apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.     

Health promotion programs in small worksites: results of a national survey

PURPOSE: This study documents the prevalence of workplace health promotion activities at small worksites with 15 to 99 employees. DESIGN: A random sample of U.S. worksites stratified by size and industry (n = 3628) was drawn using American Business Lists. MEASURES: Each worksite was surveyed using a computer-assisted telephone interview system to document activities related to health promotion and related programs, worksite policies regarding health and safety, health insurance, and philanthropic activities. SUBJECTS: Participation varied by industry and size, with an overall response rate for eligible worksites of 78% for a total sample of 2680 worksites. DATA ANALYSIS: Data were analyzed using SUDAAN statistical software. RESULTS: Approximately 25% of worksites with 15 to 99 employees offered health promotion programs to their employees, compared with 44% of worksites with 100+ employees. As with the larger worksites, the most common programs for worksites with 15 to 99 employees were those related to occupational safety and health, back injury prevention, and CPR. The majority of worksites in both size categories had alcohol, illegal drug, smoking, and occupant protection policies. The majority of both small and large worksites also offered group health insurance to their employees (92% and 98%, respectively), with many of the worksites also extending benefits to family members and dependents (approximately 80% for both business sizes). CONCLUSIONS: The results indicated that small worksites are providing programs to their employees, with a primary focus on job-related hazards. Small worksites also have formal policies regarding alcohol, drug use, smoking, and seatbelt use and offer health insurance to their employees at a rate only slightly lower than that of large worksites.     

Primary care physicians' views on screening and management of alcohol abuse: inconsistencies with national guidelines

BACKGROUND: The effects of patients' abuse of and dependence on alcohol are well known, but screening for problem drinking by primary care physicians has been limited. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends that all patients be screened for alcohol use, all users be screened with the CAGE questionnaire, and all nondependent problem drinkers be counseled. We evaluated primary care physicians' screening methods for alcohol use and their management of problem drinkers to determine if they were following the NIAAA guidelines. METHODS: We mailed a questionnaire to 210 internists and family physicians to assess their alcohol screening and management methods. RESULTS: Only 64.9% of the respondents reported screening 80% to 100% of their patients for alcohol abuse or dependence during the initial visit; even less (34.4%) screened that many patients during an annual visit. Nearly all respondents (95%) reported "frequently" or "always" using quantity-frequency questions to screen for alcohol abuse, but only 35% "frequently" or "always" used the CAGE questionnaire. Only 20% of the respondents rated treatment resources as adequate for early problem drinkers, and 72% preferred not to counsel these patients themselves. A belief that a primary care physician could have a positive impact on an alcohol abuser was less likely to be held by respondents who were older, in a nonurban setting, or had more years in practice (P = .05). CONCLUSIONS: A substantial proportion of the physicians in our survey sample were not following NIAAA recommendations. Most physicians preferred not to do the counseling of nondependent problem drinkers themselves, but to refer those patients to a nurse trained in behavioral interventions.     

A Participatory Workplace Intervention for Employees With Distress and Lost Time: A Feasibility Evaluation Within a Randomized Controlled Trial

Introduction Little is known about feasibility and acceptability of return to work (RTW) interventions for mental health problems. RTW for mental health problems is more complicated than for musculoskeletal problems due to stigmatization at the workplace. A participatory workplace intervention was developed in which an employee and supervisor identify and prioritize obstacles and solutions for RTW guided by a RTW coordinator. This paper is a feasibility study of this innovative intervention for employees with distress. The aims of this study were to describe the reach and extent of implementation of the workplace intervention, the satisfaction and expectations of all stakeholders, and the intention to use the workplace intervention in the future. Methods Eligible for this study were employees who had been on sick leave from regular work for 2–8 weeks with distress. Data were collected from the employees, their supervisors, RTW coordinators, and occupational physicians by means of standardized matrices and questionnaires at baseline and 3 months follow-up. Reach, implementation, satisfaction, expectations, and maintenance regarding the workplace intervention were described. Results Of the 56 employees with distress eligible to receive the workplace intervention, 40 employees, their supervisors and RTW coordinators actually participated in the intervention. They identified 151 obstacles for RTW mostly related to job design, communication, mental workload and person-related stress factors. The 281 consensus-based solutions identified were mostly related to job design, communication and training. Of those solutions, 72% was realized at the evaluation with the employee and supervisor. Overall, employees, supervisors and occupational health professionals were satisfied with the workplace intervention and occupational health professionals rated it with a 7.1. Time-investment was the only barrier for implementation reported by the occupational health professionals. Conclusions The results of this study indicate a high feasibility for a broad implementation of a participatory workplace intervention for employees with distress and lost time, and their supervisors.