Absenteeism and business costs: Does substance abuse matter?

Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States

IMPORTANCE

Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender.

OBJECTIVES

To identify and synthesize evidence on the humanistic and economic consequences of SOGICE among LGBTQ youths in the US.

DESIGN, SETTING, AND PARTICIPANTS

This study, conducted from December 1, 2020, to February 15, 2021, included a systematic literature review and economic evaluation. The literature review analyzed published evidence on SOGICE among LGBTQ individuals of any age. The economic model evaluated the use of SOGICE vs no intervention, affirmative therapy vs no intervention, and affirmative therapy vs SOGICE to estimate the costs and adverse outcomes for each scenario and to assess the overall US economic burden of SOGICE. Published literature and public sources were used to estimate the number of LGBTQ youths exposed to SOGICE, the types of therapy received, and the associated adverse events (anxiety, severe psychological distress, depression, alcohol or substance abuse, suicide attempts, and fatalities).

EXPOSURES

SOGICE (licensed or religion-based practitioners) or affirmative therapy (licensed practitioners).

MAIN OUTCOMES AND MEASURES

Total incremental costs and quality-adjusted life-years (QALYs) vs no intervention and total economic burden of SOGICE.

RESULTS

Among 28 published studies, which included 190 695 LGBTQ individuals, 12% (range, 7%-23%) of youths experienced SOGICE, initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months. At least 2 types of SOGICE were administered to 43% of recipients. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%). In the economic analysis, over a lifetime horizon with a 3% annual discount rate, the base-case model estimated additional $97 985 lifetime costs per individual, with SOGICE associated with 1.61 QALYs lost vs no intervention; affirmative therapy yielded cost savings of $40 329 with 0.93 QALYs gained vs no intervention. With an estimated 508 892 youths at risk for SOGICE in 2021, the total annual cost of SOGICE is estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion.

CONCLUSIONS AND RELEVANCE

This economic evaluation study suggests that there is a high economic burden and high societal costs associated with SOGICE and identifies additional research questions regarding the roles of private and public funding in supporting this harmful practice.

Effect of water-soluble propolis administration on the ethanol-induced hangover in rats

Water soluble propolis was prepared using β-cyclodextrin, and its effect on an ethanol-induced hangover was examined in Sprague-Dawley (SD) rats fed with ethanol. When SD rats were administrated with propolis 30 min after ethanol feeding, ethanol content in the rat serum decreased 2.1 times 1 h after ethanol feeding. Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) activity in rat liver increased 3.0 and 4.4 times, respectively, 1 h after ethanol feeding and administration of propolis 30 min after ethanol feeding. There were no differences in the expression of ADH and ALDH genes regardless of propolis administration. These results indicated that a decrease in ethanol content in the serum was not due to an increase in the expression of ADH or ALDH genes but rather, an increase in activities of ADH and ALDH.

Binge Drinking by Occupation Groups among Currently Employed U.S. Adults in 32 States, 2013-2016

BACKGROUND

Excessive alcohol use, including binge drinking (i.e., ≥5 drinks (males); ≥4 drinks (females), per occasion during the past 30 days), is associated with work-related injuries, absenteeism, and lost productivity. Binge drinking varies by sociodemographic characteristics (e.g., age, sex, income). However, information on binge drinking by occupation is limited. Purpose: This study examined binge drinking prevalence, frequency, intensity, and total binge drinks per binge drinker by sociodemographic characteristics and occupation. Methods: Data were analyzed from 358,355 currently employed U.S. adults who resided in the 32 states that administered the Behavioral Risk Factor Surveillance System industry and occupation questions during 2013-2016. Binge drinking was evaluated using weighted and adjusted prevalence models. Results: Among currently employed adults in the 32 states, 20.8% reported binge drinking, with an average of nearly 49 times per year and an average intensity of 7.4 drinks per binge episode, resulting in 478 total binge drinks per binge drinker. The adjusted binge drinking prevalence ranged from 15.9% among community and social services workers to 26.3% among construction and extraction workers. The total annual binge drinks per binge drinker ranged from 207 drinks among community and social services workers to 749 drinks among construction and extraction workers. Conclusions: One in five employed adults binge drink, and binge drinking varied across occupation groups. Widespread use of effective community-based strategies for preventing excessive alcohol use (e.g., regulating alcohol outlet density), as well as interventions tailored to specific occupation groups, and could reduce binge drinking and improve occupational safety and health.

Illicit drug use and work in a model therapeutic workplace

BACKGROUND

The link between illicit drug use and impaired employee performance in the workplace has been assumed, but the relation has not been demonstrated clearly in research. This study was an evaluation of the relations between cocaine and opiate use, attendance, and performance in a job skills training program in a population with high rates of drug use.

METHODS

Out-of-treatment injection drug users (N = 42) attended a model therapeutic workplace where they could earn a maximum pay of around $10 per hour, 4 h every weekday, for 30 weeks. At the workplace, participants could complete practice trials on computer-based typing and keypad training programs. Participants were asked to provide urine samples thrice weekly, which were tested for opiates and cocaine.

RESULTS

Participants worked for more hours on a program that resulted in a flat hourly wage when their urine was negative for opiates and cocaine than when their urine was opiate and cocaine positive. Attendance was positively associated with opiate-negative samples during the study. When participants attended the workplace, however, their performance was not related to drug use. Participants completed the same number of practice trials, performed at the same accuracy, and typed at the same speed when they were positive and negative for cocaine and opiates.

CONCLUSIONS

Contrary to common expectations, this study failed to show that the use of opiates or cocaine affected in-training performance, even though opiate and cocaine use predicted reduced attendance under some circumstances.

A cluster randomized trial of alcohol prevention in small businesses: a cascade model of help seeking and risk reduction

PURPOSE

The current study adapted two workplace substance abuse prevention programs and tested a conceptual model of workplace training effects on help seeking and alcohol consumption.

DESIGN

Questionnaires were collected 1 month before, 1 month after, and 6 months within a cluster randomized field experiment.

SETTING

Texas small businesses in construction, transportation, and service industries.

SUBJECTS

A total of 1510 employees from 45 businesses were randomly assigned to receive no training or one of the interventions.

INTERVENTION

The interventions were 4-hour on-the-job classroom trainings that encouraged healthy lifestyles and seeking professional help (e.g., from the Employee Assistance Program [EAP]). The Team Awareness Program focused on peer referral and team building. The Choices in Health Promotion Program delivered various health topics based on a needs assessment.

MEASURES

Questionnaires measured help-seeking attitudes and behavior, frequency of drinking alcohol, and job-related incidents.

ANALYSIS

Mixed-model repeated-measures analyses of covariance were computed.

RESULTS

Relative to the control group, training was associated with significantly greater reductions in drinking frequency, willingness to seek help, and seeking help from the EAP. After including help-seeking attitudes as a covariate, the correlation between training and help seeking becomes nonsignificant. Help-seeking behavior was not correlated with drinking frequency.

CONCLUSION

Training improved help-seeking attitudes and behaviors and decreased alcohol risks. The reductions in drinking alcohol were directly correlated with training and independent from help seeking.

Prevalence and causes of medical absenteeism among staff (case study at mazandaran university of medical sciences: 2009-2010)

INTRODUCTION

Work absenteeism is a significant issue and can be observed in terms of human resources management. Given the importance of staff practices, which are anticipated in every organization, the role of each employee in this system and the implications of their absence as well as the importance of recovery time rest in fast recovery of staff and anticipated costs for their lost work days, thus this study is aimed to determine the extent and causes of medical absenteeism (sickness absence) of head staff of Mazandaran University of Medical Sciences.

METHODS AND MATERIALS

This descriptive and cross-sectional study was conducted using medical absenteeism (sickness absence) persons happened in 2010. Research population was included all records of staff working in central departments of Mazandaran University of Medical Sciences. There was no sampling due to the importance of the issue. Studied variables were included age, gender, employment status, employees' education, name of the disease, physician specialty in issuing the medical absence paper, leave issuing reference and department, position of the employee, number of absence days, number of absences, number of annual leave days. Also, data were gathered using a checklist, then were entered into the SPSS software and got analyzed using descriptive statistics. In order to respect the confidentiality, name of the doctors and employees weren't mentioned publicly.

RESULTS

Based on the results, 1200 employees were leaved the organization due to the sickness issue, which 957 (79.7%) of them were studied. The mean age for those employees was 39±7. Also, total average sick leave days and total sick leave days were 2±1 and 2571, respectively. 40.8 % ( 390 employees) were male and the rest were female. Moreover, 18.3% of sick leaves were issued for singles and the remained were for married employees. Regarding the employees' education, 2% under diploma, 11.3% diploma, 7.8% upper diploma, 47.6% B.Sc., 14.6% MS.c and 15.85 had doctorate degree. Considering their position, 65%, 30.3%, 2.5% and 1.8% were experts, others, heads, and mangers, respectively. Furthermore, their employment status indicated that 62.3%, 18.1%, 16.8% and 2.8% of employees were employed in form of formal, short-term contract, long-term contract and other forms, respectively. Among the aspiratory diseases, 115 persons had got cold and 97 were infected to flu. The prevalence of other diseases was as follows: neck and back pain among the skeletal diseases (118 persons), fever and headache among the signs (71 persons) and diarrhea and vomiting among the infectious diseases (88 persons).

CONCLUSION

According to the study results, due to the nature of staff work, physical problems, which are caused by doing mental works as well as low mobility, are rising among the employees. Of course, practicing ergonomic considerations, devoting hours in form of exercise break for staff can be effective in this regard. In order to address other diseases, vaster researches are needed with a concentration on exact reasons of work absenteeism.

Relation of supervisor social control to employee substance use: considering the dimensionality of social control, temporal context of substance use, and substance legality

OBJECTIVE

Research on supervisor social control provided little evidence for a relation to employee alcohol use, and only one study explored illicit drug use. Based on past research, several hypotheses were developed that the relation between supervisor social control and substance use depends on (a) the dimension social control (contact vs. enforcement), (b) the temporal context of substance use (on the job vs. off the job), and (c) substance legality (alcohol vs. illicit drugs).

METHOD

Data came from a national probability sample of U.S. workers. Supervisor social control represented both supervisor contact and supervisor enforcement. Measures of alcohol and illicit drug use each assessed several dimensions of off-the-job use (overall use, overall impairment, and use after work) and on-the-job use (use before work, use during the workday, and impairment during the workday).

RESULTS

As hypothesized, the results did not support a relation of supervisor contact to off-the-job or on-the-job alcohol use and illicit drug use. Supervisor enforcement was unrelated to off-the-job alcohol use but was negatively related to on-the-job alcohol use. Supervisor enforcement was negatively related to both off-the-job and on-the-job illicit drug use.

CONCLUSIONS

These findings help clarify the generally unsupportive findings from past research for a relation between supervisor social control and employee alcohol use, as well as extend this line of research to include illicit drug use. The results suggest that to fully understand the relation of supervisor social control to employee substance use, one must consider the dimension of supervisor social control, temporal context of substance use, and substance legality.

Alcohol consumption and workplace absenteeism: the moderating effect of social support

Although it is commonly assumed that alcohol consumption has a significant impact on employee absenteeism, the nature of the alcohol-absence relationship remains poorly understood. Proposing that alcohol impairment likely serves as a key mechanism linking drinking and work absence, we posit that this relationship is likely governed less by the amount of alcohol consumed and more by the way it is consumed. Using a prospective study design and a random sample of urban transit workers, we found that the frequency of heavy episodic drinking over the previous month is positively associated with the number of days of absence recorded in the subsequent 12-month period, whereas modal consumption (a metric capturing the typical amount of alcohol consumed in a given period of time) is not. In addition, consistent with both volitional treatments of absenteeism and social exchange theory, perceived coworker support was found to attenuate, and supervisory support to amplify, the link between the frequency of heavy episodic drinking and absenteeism.

Alcohol hangover: a critical review of explanatory factors

OBJECTIVE

To describe the hangover phenomenon and briefly review its main explanatory factors.

DESIGN

Bibliographic research on main databases (Medline and Psychinfo).

RESULTS

Alcohol hangover is characterized by adverse physical and mental effects that occur the next morning after the intake of toxic doses of alcohol. This phenomenon is a very frequent experience among alcohol-consuming people and it has been associated to high socio-economic costs, mainly due to absenteeism and poor performance in academic and work settings. Multiple theories exist to explain the appearance and severity of hangover, such as direct or indirect effects of alcohol, alcohol withdrawal, and toxic effects of alcoholic beverage congeners or of alcohol metabolites. In addition, a number of intervening factors have been identified, such as vulnerability to alcohol dependence or psychological factors.

CONCLUSIONS

Although several studies analyze and describe hangover, it is still poorly understood. Further well-designed studies with a unitary methodology and clear operational criteria to define hangover are necessary in order to clarify such a phenomenon. We suggest some future working ideas that should be pursued in order to address the current shortcomings.

Economic benefit of chemical dependency treatment to employers

Using assessment data from the Substance Abuse Treatment Support System, we estimated the economic benefit of chemical dependency treatment to employers. A cohort of individuals (N = 498) treated at Kaiser Permanente's Addiction Medicine programs in Southern California completed assessments before and at least 30 days after treatment began. Compared to intake, subsequent assessments indicated substantial reduction in the number of patients who missed work, were late for work, were less productive than usual at work, and/or had conflict with coworkers or management. The net economic value of these improvements to their employers depended upon the utilization rate of the benefit and the salary level of the employees receiving treatment. For a utilization rate of 0.9% and a mean annual salary of US$45,000, the net benefit of treatment was US$1,538 for > or = 61 days of treatment. Based solely upon these employment-related measures, without factoring in the medical cost offset or indirect benefits of treatment that may help employees to maintain higher levels of productivity, employers break even on an investment of US$30 per member per year for a chemical dependency treatment benefit if the mean annual salary of the employees participating in treatment is US$36,565.

Estimating the cost of alcohol-related absenteeism in the Australian workforce: The importance of consumption patterns

OBJECTIVE

To estimate the extent and cost of alcohol-related absenteeism in the Australian workforce.

DESIGN

A secondary analysis of select data obtained from 13 582 Australian workers (aged > or = 14 years) collected as part of the 2001 National Drug Strategy Household Survey.

MAIN OUTCOME MEASURES

Self-reported measures of alcohol-related absenteeism, illness or injury absenteeism and alcohol consumption categorised according to National Health and Medical Research Council (NHMRC) guidelines for short- and long-term risk.

RESULTS

The use of self-reported measures of alcohol-related absenteeism resulted in an estimate of 2,682,865 work days lost due to alcohol use in 2001, at a cost of 437 million dollars. The use of self-reported measures of illness or injury absenteeism to determine the extent of absenteeism attributable to alcohol use resulted in an estimate of 7,402,341 work days lost, at a cost of 1 .2 billion dollars. These estimates are about 12 to 34 times greater than previous estimates based on national data. Low-risk drinkers and infrequent or occasional risky and high-risk drinkers accounted for 49%-66% of alcohol-related absenteeism.

CONCLUSIONS

The extent and cost of alcohol-related absenteeism is far greater than previously reported, and more than half the burden of alcohol-related absenteeism is incurred by low-risk drinkers and those who infrequently drink heavily.