Team awareness for workplace substance abuse prevention: the empirical and conceptual development of a training program

The Role of Wellness Climate in Small Business Health Promotion and Employee Wellbeing

Wellness involves physical, emotional, behavioral, social, and spiritual dimensions. A climate for wellness exists at both the psychological and organizational levels, consisting of individual and shared perceptions of policies, structures, and managerial behavior that support or promote employee wellbeing. This study explored the associations between psychological and organizational wellness climate and the effectiveness of a team health promotion training on employees' perceived physical and mental wellbeing and substance use. Employees from 45 small businesses completed self-report measures of wellness climate, wellbeing, positive unwinding behavior, work-family conflict, job stress, drug use, and alcohol use, assessed before, and one and six months after, attending either of two types of onsite health promotion training. Team Awareness training targeted improvements in the social climate at work. Healthy Choices training targeted individual health behavior. A control group did not receive training until after the study. Businesses were randomly assigned to conditions and data were analyzed using multi-level modeling. Models that included wellness climate as a mediator fit the data significantly better than models without climate as a mediator. Team Awareness participants showed greater improvements in wellness climate and wellbeing compared to the control group. Healthy Choices participants showed no changes in climate and no mediation effects of climate. Health promotion efforts may be enhanced by including wellness climate as a target in program design at multiple levels.

Supervisor Undermining, Social Isolation and Subordinates' Problematic Drinking: The Role of Depression and Perceived Drinking Norms

Findings regarding the mechanism underlying the impact of supervisor incivility on subordinate alcohol misuse remain equivocal. Specifically, some studies indicate that stress mediates the impact of supervisor incivility on subordinate alcohol misuse, while others, find no evidence for such an effect, suggesting the need to investigate other mechanisms. Extending Conservation of Resource (COR) theory and employing a longitudinal study design, this study examines two alternative mechanisms grounded on social isolation. The first suggests drinking as a resource-mobilizing response, with social isolation eliciting the perception of more permissive injunctive drinking norms, thus facilitating problematic drinking. The second suggests problematic drinking as a mode of coping with a negative emotional state elicited by social isolation, namely depression. Findings indicate that supervisor undermining's association with subsequent subordinate problematic drinking is serially mediated by social isolation and depression, with no support found for the first mechanism. Implications for research, practice and policy are discussed.

A Brief Measure of Organizational Wellness Climate: Initial Validation and Focus on Small Businesses and Substance Misuse

OBJECTIVE

Organizations with fewer than 100 employees comprise most businesses in the United States. Since small businesses lack comparable resources, they may benefit from a simple valid tool for broadly assessing positive wellness climate, especially because climate contributes to employee wellbeing.

METHODS

Using an ethnically and occupationally diverse sample of 45 businesses (n = 1512), the current study developed and tested a brief self-report measure of organizational wellness climate.

RESULTS

Confirmatory factor analysis shows that a 9-item measure has good model fit (RMSEA = 0.06, CFI = 0.91), inter-item consistency of 0.74, and mean Rwg(j) of 0.87. The new measure is significantly positively correlated with physical health and wellbeing, and negatively correlated with substance use behavior.

CONCLUSIONS

Findings indicate that a 9-item measure has good reliability, construct, and criterion validity. Implications for practical use of the measure are discussed.

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.

Results of a cluster randomised controlled trial to reduce risky use of alcohol, alcohol-related HIV risks and improve help-seeking behaviour among safety and security employees in the Western Cape, South Africa

Objective

To test the effectiveness of a programme aimed at reducing the risky use of alcohol and alcohol-related HIV risk and increase help-seeking behaviour among a sample of municipal employees in the Western Cape Province, South Africa.

Methods

A clustered randomised controlled trial was conducted in 2011–2012 among 325 employees. The eight hour intervention, Team Awareness (TA), addressing behavioural risk among employees was administered to 168 employees in the intervention arm and the 157 employees in the control arm who received a one-hour wellness talk.

Results

The results show that TA had the greatest impact on risky drinking practices and hangover effects. There was a significant group × time interaction (F (1, 117) = 25.16, p < 0.0001) with participants in the intervention condition reducing number of days on which they engaged in binge drinking. There was also a significant time effect with participants in the intervention condition reducing the likelihood of going to work with a hangover (F (1,117) = 4.10, p = 0.045). No reduction in HIV-related risk behaviours were found.

Conclusions

This intervention study was able to demonstrate a modest but significant reduction in risky drinking practices and hangover effects. This provides encouraging evidence for the effectiveness of interventions that address risky use of alcohol among employed persons, further providing a launch pad for strengthening and replicating future RCT studies on workplace prevention, especially in developing country settings.

Clinical Trial Registration Number

Pan-African Control Trial Registry (201301000458308).

Prevalence and predictors of problematic alcohol use, risky sexual practices and other negative consequences associated with alcohol use among safety and security employees in the Western Cape, South Africa

Introduction

Harmful alcohol use can compromise worker health and productivity. Persons employed in safety-sensitive occupations are particularly vulnerable to hazardous alcohol use and its associated risks. This study describes the patterns of harmful alcohol use, related HIV risks and risk factors for the harmful use of alcohol among a sample of employees in South Africa working in the safety and security sector.

Methods

A cross-sectional study that formed the baseline for a clustered randomized control trial was undertaken in 2011. A random sample of 325 employees employed within a safety and security sector of a local municipality in the Western Cape Province of South Africa participated in the study. Data were collected by means of an 18-page self-administered structured questionnaire and analyzed using SAS/STAT software version 9.2. For all significance testing, the F-statistic and p-values are reported.

Results

Three hundred and twenty-five employees were surveyed. Findings suggest that more than half (76.1%) of the 78.9% of participants who consumed alcohol engaged in binge drinking, with close to a quarter reporting a CAGE score greater than the cut-off of 2, indicating potentially hazardous drinking patterns. The study further found that employees who use alcohol are more likely to engage in risky sexual practices when under the influence. A favorable drinking climate (p < 0.001) and poor levels of group cohesion (p = 0.009) were significantly correlated to binge drinking.

Conclusion

This study identifies alcohol-related behaviors and associated risks in the context of safety-sensitive occupations at the workplace. It suggests that persons employed within such positions are at high risk for developing alcohol-related disorders and for contracting HIV. This study highlights the need for testing a comprehensive package of services designed to prevent hazardous alcohol use among safety and security employees.

Employee assistance program services for alcohol and other drug problems: implications for increased identification and engagement in treatment

BACKGROUND

Fourteen million U.S. workers meet the diagnostic criteria for substance dependence, costing millions in lost productivity. Prior research suggests that employees who follow through with their Employee Assistance Program's (EAP) recommendations are more likely to participate and remain engaged in alcohol and other drug (AOD) treatment programs. This study identified rates of lifetime EAP service use for AOD problems and compared adults who reported using EAP services for AOD problems with those who used services other than EAP.

METHODS

Researchers analyzed a subset of participants from the National Epidemiologic Survey of Alcohol and Related Conditions who reported having received help for an AOD problem (NESARC, 2001-2002). Statistical analyses tested for differences in sociodemographic variables, lifetime mental health and substance abuse disorders, and health disability between EAP services users and users of other types of services.

RESULTS

Among adults who sought services for AOD problems (n= 2,272), 7.58% (n= 166) reported using EAP services for these problems at some point during their lives. Major depressive disorder (lifetime), a drug use disorder (lifetime), and Black race/ethnicity were associated with a greater likelihood that someone would seek EAP services for help with their AOD problem.

CONCLUSIONS

Results provide a foundation for researchers to understand who uses EAP services for AOD problems. Health and mental health professionals should increase their knowledge of EAP services to improve continuity of care for employees with AOD problems. EAPs are in a unique position to reach out to vulnerable employees in the workplace and engage them in treatment.

Occupation as an independent risk factor for binge drinking

BACKGROUND

Understanding associations between binge drinking and occupation is important from economic and public health perspectives.

OBJECTIVE

While unadjusted differences in binge drinking by occupation have been reported previously, this study tests these differences after adjusting for important common determinants.

METHODS

To assess the relationship between occupation and binge drinking after adjusting for worker characteristics, a probit model was fit to data from 29,785 working-age respondents to the 2005 California Health Interview Survey. Unadjusted and adjusted marginal effects are reported. Professionals, the largest employed category, were the referent.

RESULTS

Professionals had a binge drinking risk of 16.6%. Before adjustment, workers in several occupational groups had higher risk compared to professionals, including those in installation (15.2 percentage points higher; 95% CI: 9.2, 21.1), construction (14.8 percentage points higher; 95% CI: 10.4, 19.2), and sales (6.9 percentage points higher; 95% CI: 4.0, 9.9), while those without employment had a 6.6 point lower risk (95% CI: -8.4, -4.9). After adjustment, workers employed in installation were 6.7 points (95% CI: 1.8, 11.7), construction 4.8 points (95% CI: 1.0, 8.6), and salespersons 5.3 points (95% CI: 2.8, 7.7) more likely to binge drink relative to professionals. No significant adjusted differences in risk between professionals and those without a job were found.

CONCLUSIONS

This study demonstrates binge drinking varies significantly across occupations. Adjusting for worker characteristics accounted for much of the unadjusted relationship between employment in physically demanding occupations (e.g., installation, construction) and binge drinking. Distinguishing between occupation- and employee-level determinants of alcohol misuse may improve employee assistance programs and preventive services.

Exploring and Reducing Stress in Young Restaurant Workers: Results of a Randomized Field Trial

Purpose.

Young adult restaurant workers face the dual stressors of work adjustment and managing personal responsibilities. We assessed a new psychosocial/health promotion training designed to reduce these stressors in the context of restaurant work.

Design.

A cluster-randomized trial of a training program, with surveys administered approximately 2 weeks before training and both 6 and 12 months after training.

Setting.

A national restaurant chain.

Subjects.

A total of 947 restaurant workers in 28 restaurants.

Measures.

Personal stress, exposure to problem coworkers, and personal and job characteristics.

Intervention.

Team Resilience (TR) is an interactive program for stress management, teamwork, and work-life balance. TR focuses on “five Cs” of resilience: compassion, commitment, centering community, and confidence.

Analysis.

Mixed-model (multilevel) analysis of covariances.

Results.

Compared with workers in control stores, workers in TR-trained stores showed significant reductions over time in exposure to problem coworkers (F[2, 80.60] = 4.48; p = .01) and in personal stress (F[2, 75.28] = 6.12; p = .003).

Conclusion.

The TR program may help young workers who face the challenges of emerging adulthood and work-life balance.

Substance abuse among nurses--defining the issue

The prevalence of substance abuse in the nurse population is believed to parallel that in the general population (i.e. approximately 10%). Nurses with substance abuse problems need help. They are in danger of harming patients, the facility's reputation, the nursing profession, and themselves. The consequences of not reporting concerns can be far worse than those of reporting the issue. Part one of this two-part series discusses how society views addiction and the nursing profession, signs and symptoms of substance abuse, reasons nurses should report an impaired colleague, the code of silence that exists among nurses, and board of nursing jurisdiction.

Substance abuse among nurses--intercession and intervention

IT IS NOT EASY to report a coworker who may have a substance abuse problem, so many nurses choose to remain silent about this issue. THIS ARTICLE PROVIDES suggestions for staff nurses about how to confront a peer, document inappropriate nursing behaviors related to substance abuse, and report these issues to a manager. The manager's role in counseling and intercession with a substance abusing employee also is detailed. REMEDIATION AND SUPPORT programs are addressed along with return-to-work issues and the need for education about this debilitating disease.

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

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 social 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 rates are shown): (1) 1992, n = 1081, 95%; (2) 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 peer 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 enabling 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 of 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.

Job risk and employee substance use: the influence of personal background and work environment factors

Previous studies have noted that employees who work in jobs with physical risk report more substance use than employees working in nonrisky jobs. This study examined the extent to which this relationship could be explained by personal background, specifically general deviance or psychosocial functioning, or work characteristics, including job stressors, organizational bonding, or work group drinking climate. Results from two worksites (ns = 943, 923) indicated that the relationship of job risk and alcohol problems could be fully explained by personal characteristics, particularly deviant behavior styles. Interaction effects were also found. Employees with more deviance indicators were particularly susceptible to recent drug use and problem drinking when they worked in drinking climates or exposed to co-worker drinking. These results suggest the joint influence of personal and job factors and support prevention programs that target the workplace social environment.