Collecting substance use data with an anonymous mailed survey

Drug and alcohol problems among Norwegian inmates

Aim & Data

Drug and alcohol problems among Norwegian inmates were explored in this study. Estimates of the portion of drug users among inmates were assessed on the most solid basis to date. The analysis was based on a survey of all Norwegian prisons. During the same week in December 2002 all Norwegian inmates received a questionnaire to survey demographic features, use of alcohol and illicit drugs.

Results

The findings suggest that nearly half of the prison population has regularly used hard drugs before the imprisonment, and a fourth were regular intravenous drug users. Polydrug use is highly prevalent. Almost one-third of the inmates used illicit drugs during the present stay in prison. The proportion of highly frequent drinkers appears to be three to four times that found in the general population.

A Path Analytic Model of Ethical Conflict in Practice and Autonomy in a Sample of Nurse Practitioners

The purpose of this study was to test a causal model of ethical conflict in practice and autonomy in a sample of 254 nurse practitioners working in the primary care areas of family health, pediatrics, adult health and obstetrics/gynecology in the state of Maryland. A test of the model was conducted using a path analytic approach with LISREL 8.30 hypothesizing individual, organizational and societal/market factors influencing ethical conflict in practice and autonomy. Maximum likelihood estimation was used to estimate the parameters most likely to have generated the data. Forty-five percent of the total variance in ethical conflict was explained by the variables of ethical environment and ethical concern. Ethical concern, idealistic philosophy, ethics education in continuing education, percentage of client population enrolled in managed care, and market penetration explained 15% of the total variance in autonomy. The findings of this study indicate that the causal model of ethical conflict in practice and autonomy is consistent with the data and contributed to a fuller understanding of clinical decision making associated with practicing in a managed care environment. The final model supported a conceptual framework that is inclusive of three domains: individual, organizational and societal/market variables.

Assessment of alcohol use in health professionals during the economic crisis

The aim of this study was to investigate the use of alcohol in health professionals during the economic crisis in Greece. The sample included 579 health professionals. Despite the fact that alcohol consumption was low and women held more negative views on the effectiveness of its use compared to men, they consumed more than men both in quantity (mean 1.57 vs 1.46, p=0.291) and in frequency (mean 1.98 vs 1.73, p=0.132). Employees with a higher level of education expressed more opposition to the use of alcohol than those with a basic level of education (93.5% vs 66.7%, p=0.004). There was a significant positive correlation between the amount of alcohol consumed after a stressful event and the frequency with which this amount of alcohol consumption occurred in workers.

Lifetime and 12 Months Prevalence of Alcohol Use and Alcohol Use Disorders Among Soldiers Residing in a Military Community in Ibadan

OBJECTIVE

Aims of the study were to determine lifetime and 12 months prevalence of alcohol use and alcohol use disorders and the profile of problems associated with the diagnoses of alcohol use disorders among a military population in Nigeria.

METHOD

In this descriptive cross-sectional study, 223 military officers were interviewed by multistage stratified systematic sampling method. The Composite International Diagnostic Interview (CIDI) version 7.0 was used to generate data on prevalence of lifetime and current alcohol use, alcohol use disorders, and associated profile of problems. Chi square statistics, Wilcoxon-signed rank test, and binary regression analysis were used to explore the correlates of alcohol use and alcohol use disorder. All analyses were carried using SPSS Version 17.0.

RESULTS

Prevalence of lifetime alcohol use was 76.0%, 12 months prevalence was 53.9%, and frequent binge drinking was reported in 6.7% of respondents. Predictors of lifetime alcohol use were: Hausa/Fulani ethnicity OR = 1.51, 95% CI (1.11-8.71), Igbo ethnicity OR = 1.46, 95% CI (1.09-7.01), involvement in combat OR = 1.41, 95% CI (1.01-6.16). Predictors of 12 months alcohol use were: Hausa/Fulani ethnicity OR = 1.98, 95% CI (1.25-8.71), involvement in combat OR = 1.39 95% CI (1.01-5.28) and junior rank soldier OR = 2.08, 95% CI (1.47-8.99) while predictors of lifetime alcohol use disorders were: Hausa/Fulani ethnicity OR = 2.22, 95% CI (1.03-6.99) and involvement in combat OR = 2.04 95% CI (1.12-6.81).

CONCLUSION

Alcohol misuse is highly prevalent in the Nigerian military and its associated factors exemplify the common "military drinking culture."

Cannabis Use and Associated Harms among Schizophrenia Patients in a Nigerian Clinical Setting: A Case-Control Study

AIM

The overall aim of this study was to determine the prevalence of cannabis use among patients with schizophrenia with associated levels of harm in a Nigerian clinical setting.

METHOD

In this case-control study, consecutive 150 patients with schizophrenia were matched by age and gender with an equal number of patients that utilized the general outpatient department of the State Hospital, Ring Road Ibadan. The alcohol, smoking and substance involvement screening test (ASSIST) was used to obtain prevalence of cannabis use and level of health risk as determined by the ASSIST score. The positive and negative syndrome scale was used to determine the severity of psychosis.

RESULTS

Prevalence of cannabis use among the cases and control group was 10.0 and 2.7%, respectively, p = 0.03. Mean ASSIST score was significantly higher among the cases compared with the control, p < 0.001. Respondents of male gender and those who were not married were significantly more likely to be cannabis users among patients with schizophrenia (p < 0.001 and p < 0.02), respectively.

CONCLUSION

Cannabis use was prevalent among patients with schizophrenia and was associated with health risks. Thus, routine screening for cannabis use and brief intervention is suggested to be integrated into care for adolescents and adults with schizophrenia.

Sources of Error in Substance Use Prevalence Surveys

Population-based estimates of substance use patterns have been regularly reported now for several decades. Concerns with the quality of the survey methodologies employed to produce those estimates date back almost as far. Those concerns have led to a considerable body of research specifically focused on understanding the nature and consequences of survey-based errors in substance use epidemiology. This paper reviews and summarizes that empirical research by organizing it within a total survey error model framework that considers multiple types of representation and measurement errors. Gaps in our knowledge of error sources in substance use surveys and areas needing future research are also identified.

Examining non-response bias in substance use research--are late respondents proxies for non-respondents?

BACKGROUND

Non-response is a major concern among substance use epidemiologists. When differences exist between respondents and non-respondents, survey estimates may be biased. Therefore, researchers have developed time-consuming strategies to convert non-respondents to respondents. The present study examines whether late respondents (converted former non-participants) differ from early respondents, non-consenters or silent refusers (consent givers but non-participants) in a cohort study, and whether non-response bias can be reduced by converting former non-respondents.

METHODS

6099 French- and 5720 German-speaking Swiss 20-year-old males (more than 94% of the source population) completed a short questionnaire on substance use outcomes and socio-demographics, independent of any further participation in a cohort study. Early respondents were those participating in the cohort study after standard recruitment procedures. Late respondents were non-respondents that were converted through individual encouraging telephone contact. Early respondents, non-consenters and silent refusers were compared to late respondents using logistic regressions. Relative non-response biases for early respondents only, for respondents only (early and late) and for consenters (respondents and silent refusers) were also computed.

RESULTS

Late respondents showed generally higher patterns of substance use than did early respondents, but lower patterns than did non-consenters and silent refusers. Converting initial non-respondents to respondents reduced the non-response bias, which might be further reduced if silent refusers were converted to respondents.

CONCLUSION

Efforts to convert refusers are effective in reducing non-response bias. However, converted late respondents cannot be seen as proxies of non-respondents, and are at best only indicative of existing response bias due to persistent non-respondents.

Cohort profile: The Stockholm Public Health Cohort

The Stockholm Public Health Cohort was set up within the Stockholm County Council public health surveys to inform on determinants and consequences of significant contributors to the current burden of disease. Participants are 89 268 randomly selected individuals from the adult population of Stockholm County. Baseline surveys took place in 2002, 2006 and 2010 via self-administered questionnaires. So far, participants recruited in 2002 were re-surveyed twice, in 2007 and 2010, and those enrolled in 2006 were re-surveyed once, in 2010. Self-reported data are regularly supplemented by information from national and regional health data and administrative registers, for study participants and their relatives (including their offspring). Available data are extensive and include a wide array of health, lifestyle, perinatal, demographic, socio-economic and familial factors. The cohort is an international resource for epidemiological research, and the data available to the research community for specific studies obtained approval from the Stockholm Public Health Cohort Steering Committee and the Stockholm Regional Ethical Review Board.

Surveying Nurses

While surveys of nurses are an important tool in health services and policy research, they are often characterized by low response rates. The authors conducted a systematic review of 22 published reports of efforts to improve response rates to nurse surveys. Two general strategies were explored in this literature: incentive and design-based approaches. Even small financial incentives were found to be effective in improving nurse survey participation. Token nonmonetary incentives, in contrast, were much less effective. In terms of design strategies, postal and telephone strategies have generally been more successful than have fax or web-based approaches, with evidence also supporting use of mixed-mode surveys in this population. In addition, use of first-class stamps on return envelopes as well as questionnaires personalized and endorsed by legitimizing professional associations were also more likely to be successful. Researchers should continue to implement evidence-based strategies in order to improve the survey response of nurses.

Non-response bias in alcohol and drug population surveys

INTRODUCTION AND AIMS

This proposed study was to assess non-response bias in the 2004 Canadian Addictions Survey (CAS).

DESIGN AND METHODS

Two approaches were used to assess non-response bias in the CAS which had a response rate of only 47%. First, the CAS sample characteristics were compared with the 2002 Canadian Community Health Survey (CCHS, response rate 77%) and the 2001 Canada Census data. Second, characteristics of early and late respondents were compared.

RESULTS

People with lowest income and less than high-school education and those who never married were under-represented in the CAS compared with the Census, but similar to the CCHS. Substance use was more prevalent in the CAS than the CCHS sample, but most of the CAS and CCHS estimates did not exceed +/-3% points. Late respondents were also significantly more likely to be male, young adult, highly educated, used, have high income, live in different provinces and report substance use. Multivariate logistic regression found significant non-response bias for lifetime, past 12 months, chronic risky, acute risky and heavy monthly alcohol use, lifetime and past year cannabis use, lifetime hallucinogen use, any illicit drug uses of lifetime and past year. Adjustment for non-response bias substantially increased prevalence estimates. For example, the estimates for lifetime and past 12 month illicit drug use increased by 5.22% and 10.34%.

DISCUSSION AND CONCLUSIONS

It is concluded that non-response bias is a significant problem in substance use surveys with low response rates but that some adjustments can be made to compensate.

Professional impairment: a history and one state's response

Professionals who provide care to clients may have an impaired practice because of alcohol or drug abuse problems. Health care professionals can harm clients when their practice is impaired. Evidence suggests that doctors, nurses, pharmacists, psychologists, and social workers are vulnerable to substance misuse. A professional with an impaired practice can recover with help. This article reviews the literature on impaired practice of health professionals and highlights prevalence rates of drug and alcohol problems. South Carolina's recovering professional program is one response that protects the public and helps the professional get better.

Risk factors for alcohol and other drug use by healthcare professionals

BACKGROUND

Given the increasingly stressful environment due to manpower shortages in the healthcare system in general, substance induced impairment among some healthcare professions is anticipated to grow. Though recent studies suggest that the prevalence of substance abuse is no higher in healthcare professionals (HPs) than the general population, given the responsibility to the public, any impairment could place the public at increased risk for errors. Few studies have ever reported predictors or risk factors for alcohol and other drug use (AOD) across a sample of HPs.

METHODS

The study used a cross-sectional, descriptive self-report survey in a small northeastern state. A 7-page survey was mailed to a stratified random sample of 697 dentists, nurses, pharmacists and physicians registered in a northeastern state. The main outcome measures were demographic characteristics, lifetime, past year and past month prevalence of AOD use, the frequency of use, drug related dysfunctions, drug misuse and abuse potential. Six contacts during the summer of 2002 resulted in a 68.7% response rate (479/697).

RESULTS

Risk factors contributing to any reported past year AOD use, as well as significant (defined as the amount of AOD use by the top 25% of respondents) past year AOD use by HPs were examined using logistic regression. Risk factors of any self-reported past year AOD use included moderate or more frequency of alcohol use, being in situations when offered AODs, feeling immune to the addictive effects of drugs (pharmaceutical invincibility) and socializing with substance abusers. Risk factors of significant past year AOD use were HPs with younger licensees, a moderate pattern of alcohol use and not socializing with substance abusers.

CONCLUSION

National and state organizations need to develop policies that focus on prevention, treatment, and rehabilitation of alcohol and other drug-using healthcare professionals. The results of this study may help to delineate the characteristics of HPs abusing drugs, leading to the development of more effective policies designed to protect the public, and move toward more tailored and effective intervention strategies for HPs.

Demographic and occupational predictors of early response to a mailed invitation to enroll in a longitudinal health study

Background

Often in survey research, subsets of the population invited to complete the survey do not respond in a timely manner and valuable resources are expended in recontact efforts. Various methods of improving response have been offered, such as reducing questionnaire length, offering incentives, and utilizing reminders; however, these methods can be costly. Utilizing characteristics of early responders (refusal or consent) in enrollment and recontact efforts may be a unique and cost-effective approach for improving the quality of epidemiologic research.

Methods

To better understand early responders of any kind, we compared the characteristics of individuals who explicitly refused, consented, or did not respond within 2 months from the start of enrollment into a large cohort study of US military personnel. A multivariate polychotomous logistic regression model was used to estimate the effect of each covariate on the odds of early refusal and on the odds of early consent versus late/non-response, while simultaneously adjusting for all other variables in the model.

Results

From regression analyses, we found many similarities between early refusers and early consenters. Factors associated with both early refusal and early consent included older age, higher education, White race/ethnicity, Reserve/Guard affiliation, and certain information technology and support occupations.

Conclusion

These data suggest that early refusers may differ from late/non-responders, and that certain characteristics are associated with both early refusal and early consent to participate. Structured recruitment efforts that utilize these differences may achieve early response, thereby reducing mail costs and the use of valuable resources in subsequent contact efforts.

The use of sleep aids among Emergency Medicine residents: a web based survey

BACKGROUND

Sleepiness is a significant problem among residents due to chronic sleep deprivation. Recent studies have highlighted medical errors due to resident sleep deprivation. We hypothesized residents routinely use pharmacologic sleep aids to manage their sleep deprivation and reduce sleepiness.

METHODS

A web-based survey of US allopathic Emergency Medicine (EM) residents was conducted during September 2004. All EM residency program directors were asked to invite their residents to participate. E-mail with reminders was used to solicit participation. Direct questions about use of alcohol and medications to facilitate sleep, and questions requesting details of sleep aids were included.

RESULTS

Of 3,971 EM residents, 602 (16%) replied to the survey. Respondents were 71% male, 78% white, and mean (SD) age was 30 (4) years, which is similar to the entire EM resident population reported by the ACGME. There were 32% 1st year, 32% 2nd year, 28% 3rd year, and 8% 4th year residents. The Epworth Sleepiness Scale (ESS) showed 38% of residents were excessively sleepy (ESS 11-16) and 7% were severely sleepy (ESS>16). 46% (95 CI 42%-50%) regularly used alcohol, antihistamines, sleep adjuncts, benzodiazepines, or muscle relaxants to help them fall or stay asleep. Study limitations include low response and self-report.

CONCLUSION

Even with a low response rate, sleep aid use among EM residents may be common. How this affects performance, well-being, and health remains unknown.

Prevalence and distribution of illicit drug use in the workforce and in the workplace: findings and implications from a U.S. national survey

This U.S. national study explored the overall prevalence, frequency, and distribution of illicit drug use in the workforce and in the workplace during the preceding 12 months. Illicit drug use in the workforce involved an estimated 14.1% of employed adults (17.7 million workers). Illicit drug use in the workplace involved an estimated 3.1% of employed adults (3.9 million workers). Illicit drug use in the workforce and in the workplace is not distributed uniformly in the employed population. At-risk, though circumscribed, segments of the U.S. workforce were identified with prevalence rates up to 55.8% for any use of illicit drugs and up to 28.0% for illicit drug use in the workplace. The implications of these data for future theoretical research and for management policy and practice are discussed.

How Long and How Much Are Nurses Now Working?

OBJECTIVE

Extended work schedules-those that vary from the standard eight hours per day, 35 to 40 hours per week-are common in nursing and contribute to problems with nursing recruitment and retention, in addition to compromising patient safety and the health and well-being of nurses. This study describes the nature and prevalence of such schedules across nursing settings.

METHODS

Quantitative survey data collected as part of the Nurses Worklife and Health Study were analyzed. The sample consisted of 2,273 RNs. Demographic data, information about respondents' primary jobs (position, workplace, and specialty), and specific work schedule variables were analyzed, including data on off-shifts, breaks, overtime and on-call requirements, time off between shifts, and how often respondents worked more than 13 hours per day and on scheduled days off and vacation days. Respondents were also asked about activities outside of work, commuting time, and other non-nursing activities and chores.

RESULTS

More than a quarter of the sample reported that they typically worked 12 or more hours per day, as did more than half of hospital staff nurses and more than a third of those with more than one job. A third of the total sample worked more than 40 hours per week, and more than a third worked six or more days in a row at least once in the preceding six months. Nearly a quarter rotated shifts. Almost one-quarter of nurses with more than one job worked 50 or more hours per week, and they were more likely to work many days consecutively, without sufficient rest between shifts, and during scheduled time off. Single parents were as likely as those with more than one job to work 13 to 15 hours per day, 50 to 60 hours or more per week, and many days consecutively. Seventeen percent of all nurses worked mandatory overtime, as did almost a quarter of the single parents. Nearly 40% of the total sample and more than 40% of hospital staff nurses had jobs with on-call requirements.

CONCLUSIONS

The proportion of nurses who reported working schedules that exceed the recommendations of the Institute of Medicine should raise industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care.

Ethical conflict associated with managed care: views of nurse practitioners

BACKGROUND

Ethical conflict of nurse practitioners (NPs) practicing within a managed care environment has not been systematically examined, yet like physician practitioners, NPs are confronted with daily ethical conflicts.

OBJECTIVE

To determine perceptions toward ethical conflict in practice espoused by NPs affiliated with managed care systems and to identify the relationship between selected individual, organizational, and societal/market contextual factors and ethical conflict in practice.

METHOD

Descriptive, cross-sectional, correlational survey of a stratified random sample of 700 NPs licensed and certified to practice in the state of Maryland, conducted from November 2000 to January 2001.

RESULTS

A majority of respondents reported being moderately to extremely concerned with managed care. Eighty percent of the sample perceived that it was sometimes necessary to bend managed care guidelines with 61% agreeing that the practitioner must weigh the patient's interest against managed care organizations' interests. The NPs in a staff/group model health maintenance organization (a) were less ethically concerned (p <.001); (b) perceived the ethical environment more positively (p <.001); and (c) had lower ethical conflict scores (p <.001) than NPs in other types of practice settings.

DISCUSSION

Results from this study indicate that NPs are experiencing ethical conflict associated with practicing within a managed care environment; however, NPs in a staff/group model health maintenance organization report these concerns less. Ethical support through intervening strategies (i.e., ethics education and interdisciplinary ethics support systems) may help mitigate the conflict associated with this system of care.

Workplace access, negative proscriptions, job strain, and substance use in registered nurses

BACKGROUND

Both occupational conditions and individual factors have been shown as contributors to the likelihood of substance use among health professionals.

OBJECTIVES

To assess the use of Winick's (1974) model for explaining nurses' substance use, which asserts that groups with access to substances, freedom from negative proscriptions, and role strain have an increased likelihood of drug dependence.

METHODS

Data were analyzed from the 3,600 working nurses participating in the Nurses Worklife and Health Study, a nationally representative survey of registered nurses in the United States. A structural equation model was tested fitting workplace access to substances (availability, frequency of administration, and knowledge), freedom from negative proscriptions (internal: religiosity; external: social network), and role strain (job demands and depressive symptoms) to the frequency of past year alcohol, marijuana/cocaine, and prescription-type drug use.

RESULTS

Nurses were more likely to use substances when workplace access to substances increased (p < 0.001), with social networks containing more drug users, and when religiosity decreased (p < 0.001). Role strain (measured through job demands and depressive symptoms) also was related to substance use. Depressive symptoms were related directly and negatively to substance use (p < 0.01), whereas job demands were related indirectly to substance use through depressive symptoms.

CONCLUSIONS

Winick's model has use in explaining nurses' substance use. Research and preventive initiatives should consider the multidimensional aspects of substance use in nurses.

Job strain and non-medical drug use

In this study, the Karasek demand/control formulation of job strain, initially used in research on cardiovascular health, has been extended to drug use. Full-time nurses (n = 2375), all participants in a national anonymous mailed survey, were an estimated 1.5 times more likely to be a recent non-medical drug user if they had a high strain job as compared to nurses in low strain jobs. The psychosocial work environment might influence whether nurses become and remain non-medical drug users, over and above the risk-modifying functions related to nurses' individual vulnerabilities and their greater access to controlled substances.

Estimation of the Prevalence of Substance Use Problems among Nurses Using Capture-Recapture Methods

This study estimated the lifetime prevalence of substance use problems among registered nurses using capture-recapture methods with two separate items indicating a history of substance use problems from the same questionnaire. Capture-recapture methods yielded an estimate of 6.4 percent of nurses with a history of substance use problems, a 22 percent increase in the estimate from the data as collected. Among respondents indicating no history of problems, a substantial number reported substance use behavior that was as high as those in the reported problem group, suggesting that the estimate of additional unreported cases (from capture-recapture) is plausible. This estimate should be valuable for planning preventive initiatives for nurses, and the methodology should invite further consideration of multiple measures of a variable as sources to estimate prevalence using capture-recapture methods.

Substance use among nurses: differences between specialties

OBJECTIVES

Valid data on factors that increase a health care worker's likelihood of substance use are integral in ensuring professional standards and quality health care for consumers. This study explored the association between nursing specialty and past-year substance use.

METHODS

In an anonymous mailed survey, a balanced stratified sample of registered nurses (n = 4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking.

RESULTS

Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.5, 8.2); oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR = 2.4; 95% CI = 1.6, 3.8). No specialty differences appeared for prescription-type drug use.

CONCLUSIONS

Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by specialty, preventive initiatives should consider inter-disciplinary approaches to substance use education.