Cannabis use motives and associations with personal and work characteristics among Canadian workers: a cross-sectional study

BACKGROUND

Research on cannabis use motives has focused on youth. Little is known about motives among working adults, including how work may play a role. This study aimed to describe cannabis use motives and their connection to work, and identify the personal and work correlates of work-related motives among a sample of workers.

METHODS

A national, cross-sectional sample of Canadian workers were queried about their cannabis use. Workers reporting past-year cannabis use (n = 589) were asked their motives for using cannabis and whether each motive was related to work or helped them manage at work (i.e., work-related). Multinomial logistic regression analyses were conducted to estimate the associations of personal and work characteristics with work-related cannabis use motives (no work-related motives, < 50% of motives work-related, ≥ 50% of motives work-related).

RESULTS

Use for relaxation (59.3%), enjoyment (47.2%), social reasons (35.3%), coping (35.1%), medical reasons (30.9%), and sleep (29.9%) were the most common motives. Almost 40% of respondents reported one or more of their cannabis use motives were work-related, with coping (19.9%) and relaxation (16.3%) most commonly reported as work-related. Younger age, poorer general health, greater job stress, having a supervisory role, and hazardous work were associated with increased odds of reporting at least some cannabis use motives to be work-related, while work schedule and greater frequency of alcohol use were associated with reduced odds of motives being primarily work-related.

CONCLUSIONS

Cannabis use motives among workers are diverse and frequently associated with work. Greater attention to the role of work in motivating cannabis use is warranted.

Burnout Mediates the Association Between Workaholism and Substance Use: Findings from a French National Company

To examine the mediation effect of burnout on the association between workaholism and tobacco and alcohol use. A total of 2199 workers from the French national electricity company fulfilled an online questionnaire. Smoking status, alcohol use disorder based on the Alcohol Use Disorders Identification Test-Consumption and workaholism based on the Work Addiction Risk Test were used as binary variables. Burnout was assessed as a continuous variable with the Copenhagen Burn-Out Inventory. Mediation analyses tested the direct effect of the associations between workaholism and each substance use, as well as the indirect effect passing through burnout, while adjusting for sociodemographic factors (gender, age, occupational grade and marital life), work stress using the effort-reward imbalance and overcommitment. When testing the mediation effect of burnout on the relation between workaholism and smoking, there was a significant direct effect of workaholism on smoking (Estimated effect of 0.27 [95% CI 0.01; 0.54]) and a significant indirect effect passing through burnout (Estimated effect of 0.09 [95% CI 0.02; 0.15]). When testing the mediation effect of burnout on the relation between workaholism and alcohol use, the direct effect of workaholism on alcohol use was not significant (Estimated effect of 0.21 [95% CI - 0.01; 0.44]) while the indirect effect passing through burnout was significant (Estimated effect of 0.10 [95% CI 0.04; 0.17]). Information and prevention regarding substance use should be reinforced among workers exposed to workaholism, especially if their workaholism led to a high level of burnout. Preventing the emergence of burnout among workaholics might have some benefits on their tobacco and alcohol use.

Workplace and non-workplace cannabis use and the risk of workplace injury: Findings from a longitudinal study of Canadian workers

OBJECTIVES

Findings of previous studies examining the relationship between cannabis use and workplace injury have been conflicting, likely due to methodological shortcomings, including cross-sectional designs and exposure measures that lack consideration for timing of use. The objective was to estimate the association between workplace cannabis use (before and/or at work) and non-workplace use and the risk of workplace injury.

METHODS

Canadian workers participating in a yearly longitudinal study (from 2018 to 2020) with at least two adjacent years of survey data comprised the analytic sample (n = 2745). The exposure was past-year workplace cannabis use (no past-year use, non-workplace use, workplace use). The outcome was past-year workplace injury (yes/no). Absolute risks and relative risks (RR) with 95% confidence intervals (CIs) were estimated between workplace and non-workplace cannabis use at one time point and workplace injury at the following time point. Models were adjusted for personal and work variables and were also stratified by whether respondents' jobs were safety-sensitive.

RESULTS

Compared to no past-year cannabis use, there was no difference in workplace injury risk for non-workplace cannabis use (RR 1.09, 95%CI 0.83-1.44). However, workplace use was associated with an almost two-fold increased risk of experiencing a workplace injury (RR 1.97, 95%CI 1.32-2.93). Findings were similar for workers in safety-sensitive and non-safety-sensitive work.

CONCLUSION

It is important to distinguish between non-workplace and workplace use when considering workplace safety impacts of cannabis use. Findings have implications for workplace cannabis use policies and substantiate the need for worker education on the risks of workplace cannabis use.

Alcohol-Tolerant Workplace Environments Are a Risk Factor for Young Adult Alcohol Misuse on and off the Job in Australia and the United States

The workplace has been understudied as a setting for the prevention of young adult alcohol misuse. This study examined if alcohol-tolerant workplace environments are associated with greater risk for alcohol use and misuse on and off the job among young adults. Data were collected in 2014 from state-representative, sex-balanced samples (51% female) of 25-year-olds in Washington, U.S. (n = 751) and Victoria, Australia (n = 777). Logistic regressions indicated that availability of alcohol at work, absence of a written alcohol policy, and alcohol-tolerant workplace norms and attitudes were independently associated with a 1.5 to 3 times greater odds of on-the-job alcohol use or impairment. Alcohol-tolerant workplace norms were associated also with greater odds of high-risk drinking generally, independent of on-the-job alcohol use or impairment. Associations were mostly similar in Washington and Victoria, although young adults in Victoria perceived their workplaces to be more alcohol-tolerant and were more likely to use alcohol or be impaired at work and to misuse alcohol generally than young adults in Washington. Cross-nationally, workplace interventions that restrict the availability of alcohol, ban alcohol at work, and reduce alcohol-tolerant norms have the potential to prevent and reduce young adults' alcohol use and misuse on and off the job.

Fatalities Involving Substance Use Among US Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014-2019)

OBJECTIVE

Characteristics of oil and gas extraction (OGE) work, including long hours, shiftwork, fatigue, physically demanding work, and job insecurity are risk factors for substance use among workers. Limited information exists examining worker fatalities involving substance use among OGE workers.

METHODS

The National Institute for Occupational Safety and Health's Fatalities in Oil and Gas Extraction database was screened for fatalities involving substance use from 2014 through 2019.

RESULTS

Twenty-six worker deaths were identified as involving substance use. Methamphetamine or amphetamine was the most common substances (61.5%) identified. Other contributing factors were lack of seatbelt use (85.7%), working in high temperatures (19.2%), and workers' first day with the company (11.5%).

CONCLUSIONS

Employer recommendations to mitigate substance use-related risks in OGE workers include training, medical screening, drug testing, and workplace supported recovery programs.

Structural sexism moderates work and occupational risks for alcohol consumption and binge drinking among US women, 1989-2016

BACKGROUND

People in the labor force and in high-status careers consume alcohol at high rates. State-level structural sexism (sex inequality in political/economic status) is inversely related to alcohol use among women. We examine whether structural sexism modifies women's labor force characteristics and alcohol consumption.

METHODS

We surveyed frequency of alcohol consumption in the past month and any binge drinking in the past two weeks among women ages 19-45 in Monitoring the Future from 1989 to 2016 (N = 16,571) in relation to occupational characteristics (including employment status, high-status career, and occupational gender composition) and structural sexism (measured using state-level indicators of gender inequality) with multilevel interaction models controlled for state-level and individual confounders.

FINDINGS

Working women and women in high-status occupations had higher risks of alcohol consumption than non-working women; differences were most pronounced in lower-sexism states. At the lowest sexism levels, employed women consumed alcohol more frequently (2.61 occasions of use in past 30 days, 95% CI 2.57, 2.64) than unemployed women (2.32, 95% CI 2.27, 2.37). Patterns were more pronounced for frequency of alcohol consumption than binge drinking. Occupational gender composition did not influence alcohol consumption.

INTERPRETATION

In lower sexism states, working and having a high-status career are associated with increased alcohol consumption for women. Labor force engagement extends positive health benefits to women, but it also confers specific risks, which are sensitive to the broader social context; these findings contribute to a growing literature suggesting that alcohol risks are changing in relation to shifting social landscapes.

Workplace Context to Prevent Substance Misuse in the United States: Associations Between workplace Policies and Employee Substance Use Disorders

Workplace policies are important because employee rates of alcohol and drug misuse can be associated with work-related risk factors in the United States. To explore the associations, this study analyzed the 2010–2014 National Survey on Drug Use and Health datasets. The overall sample size was 130,726, and the SUD outcome variables included alcohol, marijuana, pain reliever, and illicit drug use disorders. 20% of participants reported no substance use policies in their workplace. Significant associations were identified between all four measured SUD outcome variables, the presence of specific substance use workplace policies, and individual employment sectors. Specifically, comprehensive policies out of six policies were significantly associated with decreased SUDs in nearly every employment sector. The results of this study suggest that workplace substance use policies are important to prevent the development of employee SUDs and comprehensive policies in place can be most effective.

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.

Workplace Supported Recovery from Substance Use Disorders: Defining the Construct, Developing a Model, and Proposing an Agenda for Future Research

Substance use disorders (SUDs) represent a critical public and occupational health issue. Therefore, understanding the process of SUD recovery has become an issue of growing importance among substance use and recovery professionals. Nonetheless, despite the acknowledged importance of employment for SUD recovery, little conceptual or empirical work exists on how the workplace might support or undermine SUD recovery. In this article, we address this limitation in several ways. First, to promote a better understanding of SUD recovery for occupational health researchers, we provide a brief overview of the nature of a SUD, prior definitions of SUD recovery, and general themes associated with the recovery process. Second, we develop a working definition of workplace supported recovery. Third, we present a heuristic conceptual model showing how the workplace might impact the SUD recovery process. Fourth, using this model and research from the substance use and occupational health literatures, we develop a series of general research propositions. These propositions highlight broad directions requiring more detailed conceptualization and empirical research to understand better how work conditions may support or undermine the process of employee SUD recovery. Our overarching goal is to motivate innovative conceptualization and research on workplace supported recovery from SUDs. Such research may inform the development and evaluation of workplace interventions and policies supporting SUD recovery and highlight the benefits of workplace supported SUD recovery for employees, employers, and communities. Research on this issue may allow occupational health researchers to impact a significant societal and occupational health issue.

A systematic review of the efficacy, effectiveness and cost-effectiveness of workplace-based interventions for the prevention and treatment of problematic substance use

Employee alcohol and other drug use can negatively impact the workplace, resulting in absenteeism, reduced productivity, high turnover, and worksite safety issues. As the workplace can influence employee substance use through environmental and cultural factors, it also presents a key opportunity to deliver interventions, particularly to employees who may not otherwise seek help. This is a systematic review of workplace-based interventions for the prevention and treatment of problematic substance use. Five databases were searched for efficacy, effectiveness and/or cost-effectiveness studies and reviews published since 2010 that measured use of psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in employees aged over 18. Thirty-nine articles were identified, 28 describing primary research and 11 reviews, most of which focused solely on alcohol use. Heterogeneity between studies with respect to intervention and evaluation design limited the degree to which findings could be synthesized, however, there is some promising evidence for workplace-based universal health promotion interventions, targeted brief interventions, and universal substance use screening. The few studies that examined implementation in the workplace revealed specific barriers including lack of engagement with e-health interventions, heavy use and reluctance to seek help amongst male employees, and confidentiality concerns. Tailoring interventions to each workplace, and ease of implementation and employee engagement emerged as facilitators. Further high-quality research is needed to examine the effectiveness of workplace substance use testing, Employee Assistance Programs, and strategies targeting the use of substances other than alcohol in the workplace.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227598, PROSPERO [CRD42021227598].

The effect of alcohol consumption on workplace aggression: What's love (and job insecurity) got to do with it?

Purpose

The authors tested whether the effect of alcohol consumption during work hours on workplace aggression was influenced by the combined impact of individuals' job insecurity and love of the job.

Design/methodology/approach

The authors employed a time-lagged design whereby 325 working adults (166 men; 159 women) provided data at two time points. Respondents were asked to report their typical alcohol consumption volume in a workday, the extent to which they loved their job, and how insecure they felt about their job. Approximately one week later, respondents completed a workplace aggression measure.

Findings

A substantial positive relationship was observed between the volume of alcohol consumed during work hours and the likelihood of aggressive acts. Beyond this preliminary finding, the authors found evidence for a three-way interaction. It appears that the fear of losing a beloved job creates a condition under which the drinking-aggression relationship is particularly strong.

Practical implications

Besides formal rules deterring alcohol consumption during work hours, managers may look to implement measures that nurture a sense of job love and job security, which can be beneficial in preventing aggression resulting from drinking in the workplace.

Originality/value

By examining alcohol consumption during a typical workday, the study captures the contextual and proximal effects of drinking, which are often not observed in workplace-focused studies that operationalize alcohol consumption in general terms. The findings also suggest that if employees who drink during work hours are afraid of losing the job they love, a particularly stressful situation is created in which workplace aggression is more likely to happen.

Cannabis use and workplace cannabis availability, perceptions and policies among Canadian workers: a comparison before and after the legalisation of non-medical cannabis

OBJECTIVES

Little data exist examining the impact of non-medical (recreational) cannabis legalisation among a working population. The objective was to compare cannabis use patterns and workplace risk perceptions, cannabis availability and workplace use policies before and almost 1 year after legalisation in Canadian workers.

METHODS

Two overlapping cross-sectional samples of Canadian workers were surveyed 4 months before legalisation (time 1 (T1), n=2011) and 9-11 months after legalisation (time 2 (T2), n=4032), gathering information on cannabis use (overall and workplace use), workers' perceptions regarding risks of workplace use, availability of cannabis at work and awareness of workplace substance use policies. The marginal distributions of these variables at T1 and T2 were compared, adjusting for sociodemographic, work and health and lifestyle factors.

RESULTS

Cannabis use status changed from prelegalisation to postlegalisation (p<0.0001), with fewer respondents reporting former use (ie, more than 1 year ago; 40.4% at T1, 33.0% at T2) and a greater proportion of workers reporting past-year use (30.4% at T1, 39.3% at T2). Never use remained stable (29.2% at T1, 27.6% at T2). Workplace cannabis use also remained stable (9.4% at T1, 9.1% at T2; p=0.4580). At T1, 62.7% of respondents reported being aware of their workplace having a substance use policy, increasing to 79.0% at T2 (p<0.0001). Small magnitude changes occurred in perceptions of risk and workplace availability.

CONCLUSIONS

Results point to a lack of substantive changes in the short-term from prelegalisation to postlegalisation. Longer-term data among workers are needed given the evolving nature of this legislative policy.

Behavior change versus stability during the college-to-work transition: Life course and the "stickiness" of alcohol misuse at career entry

To what extent and under what conditions do college graduates disengage from employment-incompatible behaviors during the college-to-work transition? Drawing from the life course perspective, we proposed a model highlighting considerable stability of employment-incompatible behaviors during initial months of organizational socialization. Our model predicted that maturing out of such behaviors, which is expected by employers and beneficial to career adjustment, would be more likely to occur given a conducive transition context. Using a large dataset tracking graduates from their last semester in college to up to approximately 1.5 years after graduation and with alcohol use as our empirical referent, we demonstrated that a pattern of high-risk drinking behavior may remain even after the transition into full-time employment. We further showed that lower levels of perceived cohort drinking norms and higher levels of mentoring were associated with a higher probability of maturing out, manifesting in a transition from a high-risk drinking profile before graduation to a moderate drinking profile after starting full-time employment. Finally, we found that maturing out was associated with lagged outcomes including lower levels of sleep problems and depression and fewer work days lost to absenteeism, thus underscoring the consequential nature of behavior profile shifts during the college-to-work transition.

Alcohol Consumption on the Heaviest Drinking Occasion and Hangovers during the First Dutch COVID-19 Lockdown

The purpose of this study was to compare alcohol consumption between the heaviest drinking occasion in the period before the coronavirus disease 2019 (COVID-19) lockdown (15 January–14 March 2020) and the first COVID-19 lockdown period (15 March–11 May 2020) in the Netherlands, including the presence and severity of associated hangovers. The analysis included a sub-sample from the “Corona Lockdown: how fit are you?” (CLOFIT) study, comprising N = 761 participants who reported consuming alcohol in 2020. Overall, on the heaviest drinking occasion during the first COVID-19 lockdown period a significant reduction in number of alcoholic drinks consumed on the heaviest drinking occasion, drinking duration, and estimated BAC was observed. A significant reduction was also observed for subjective intoxication and next-day hangover severity. During the lockdown period, a significant reduction in the frequency of alcohol hangovers was reported. Several age and sex differences were observed. Specifically, men consumed significantly more alcohol than women and experienced hangovers significantly more frequently, both before and during the lockdown. With regard to age, young adults (18–35 years old) significantly reduced their alcohol intake on the heaviest drinking occasion during the lockdown and also reported lower ratings of subjective intoxication and hangover severity. No significant changes were seen for individuals above 35 years old. In conclusion, the first COVID-19 lockdown in the Netherlands was associated with reduced alcohol intake on the heaviest drinking occasion and a reduction in the severity of hangovers, particularly among young male adults.

Impacts of heavy smoking and alcohol consumption on workplace presenteeism: A cross-sectional study

Presenteeism refers to the practice of going to work despite poor health, resulting in subpar performance. This study aimed to explore the impacts of smoking and alcohol consumption on workplace presenteeism based on demographic, health-related, and employment variables.The study adopted a cross sectional design with 60,051 wage workers from the database of the second and third Korean Working Conditions Surveys in 2010 and 2011, respectively. A total of 41,404 workers aged 19 years and older, who had worked for at least 1 hour in the previous week, answered the survey questions. Chi-square test as well as univariate and multiple logistic regression analyses were conducted using SPSS, version 18.0, to determine the impacts of smoking and alcohol consumption on workplace presenteeism.Of the 41,404 Korean workers, 8512 (20.6%) had experienced presenteeism in the past 12 months. There were significant differences among gender, age, educational status, income, health problems, absenteeism, shift work, night shift, weekly working hours, exposure to secondhand smoke at work, and satisfaction with the workplace environment. Based on the results of multiple regression analysis, heavy smoking (adjusted odds ratio = 1.38, 95% confidence intervals [1.11, 1.72]) and high-risk drinking (adjusted odds ratio = 1.19, 95% confidence intervals [1.08, 1.31]) were significantly related to presenteeism among workers.The results of our study confirmed that smoking and alcohol drinking were related to presenteeism even after controlling other variables (demographic, health-related, and employment variables) that affect presenteeism. Smoking and alcohol drinking are associated with and potentially influence presenteeism; in particular, heavy smoking and high-risk drinking contributed to presenteeism. Companies that encourage employees to receive treatments for reduction of smoking or alcohol consumption may benefit from greater productivity. Hence, we should consider the impact of smoking and alcohol consumption in the workplace and build appropriate strategies and programs to help reduce these behaviors.

Transition to Online Education during the COVID-19 Pandemic: Impact of Changes in Alcohol Consumption and Experiencing Hangovers on Academic Functioning

In the Netherlands, the 2019 coronavirus (COVID-19) pandemic had a significant impact on daily life, with two extensive lockdowns enforced to combat the spread of the SARS-CoV-2 virus. These measures included the closure of bars and restaurants, and the transition from face-to-face to online education. A survey was conducted among Dutch pharmacy students and PhD-candidates to investigate the impact of COVID-19 lockdown on alcohol consumption, hangovers, and academic functioning. The analysis revealed a significant reduction in both quantity and frequency of alcohol consumption during the COVID-19 lockdown periods. This was accompanied with a significant reduction in hangover frequency and lower hangover severity during COVID-19 lockdown periods. The distribution of scores on academic performance showed great variability between respondents: while some participants reported impairment, others reported improved performance during the COVID-19 pandemic, or no change. Women reported that significantly more time investment was associated with maintaining these performance levels. Consistent among participants was the notion of reduced interactions with teachers and other students. Participants who reported more hangovers and most severe hangovers before COVID-19 benefited from the lockdown periods in terms of improved academic performance. Positive correlations were found between study grades/output and both the frequency and severity of hangovers experienced before COVID-19, suggesting that heavier drinkers, in particular, improved academic performance during the lockdown periods. In conclusion, COVID-19 lockdowns were associated with a significant reduction in both alcohol consumption and experiencing hangovers, which was, among heavier drinkers particularly, associated with significantly improved academic functioning.

The 5HTOL/5HIAA Ratio as a Biomarker of Alcohol Hangover

Assessment of the presence and severity of alcohol hangovers relies on the subjective method of self-report. Therefore, there is a need of adequate biomarkers that (1) correlate significantly with hangover severity, and (2) correspond to the level of hangover-related performance impairment objectively. In this naturalistic study, n = 35 social drinkers participated. Urine samples were obtained the morning after alcohol consumption and after an alcohol-free control day. Concentrations of 5-hydroxytryptophol (5-HTOL), 5-hydroxyindoleacetic acid (5-HIAA) and the 5-HTOL/5-HIAA ratio were determined. The results confirm previous findings that 5-HTOL and the 5HTOL/5-HIAA ratio are useful biomarkers of recent alcohol consumption. Significant correlations were found with the amount of alcohol consumed, total drink time, and estimated BAC. However, urine concentrations of 5-HTOL and 5-HIAA (and their ratio 5HTOL/5-HIAA) did not significantly correlate with hangover severity. In conclusion, urine 5-HTOL, 5-HIAA, and the 5HTOL/5-HIAA ratio cannot be considered to be suitable biomarkers of alcohol hangover.

Understanding how family demands impair health behaviors in working sole mothers: The role of perceived control over leisure time

Working sole mothers (i.e., nonpartnered women who work) may experience elevated family demands that impose barriers to pursuing health behaviors during their daily leisure time. We aimed to map the process through which evening family demands influence leisure-time health behaviors in this priority population of employees, in an effort to identify targets for intervention development and health disparity reduction. Conducting a 7-day daily survey study in a sample of 102 working sole mothers, we supported perceptions of control over leisure time as a key mechanism linking evening family demands to leisure-time exercise. Furthermore, we identified the individual difference of present focus (i.e., a tendency to focus on current experiences) as a key factor that alters how evening family demands affect control over leisure time, which ultimately mitigates the detrimental influence of these demands on evening exercise engagement. In contrast, we did not find evidence to support relationships of evening family demands with the health behaviors of leisure time consumption of alcohol or high sugar, high fat foods via control over leisure time. We discuss how our findings advance theory regarding how family demands influence health and inform practical efforts to reduce health disparities that working sole mothers face.

A Qualitative Exploration of Addiction Disclosure and Stigma among Faculty Members in a Canadian University Context

Addiction is one of the most stigmatized public health issues, which serves to silence individuals who need help. Despite emerging global interest in workplace mental health and addiction, scholarship examining addiction among university faculty members (FMs) is lacking, particularly in a Canadian context. Using a Communication Privacy Management (CPM) framework and semi-structured interviews with key informants (deans and campus mental health professionals), this qualitative study aimed to answer the following research questions: (1) What is the experience of key informants who encounter FM addiction? (2) How may addiction stigma affect FM disclosure and help-seeking? and (3) What may help reduce addiction stigma for FMs? Thematic analysis was used to identify three main themes: (1) Disclosure was rare, and most often involved alcohol; (2) Addiction stigma and non-disclosure were reported to be affected by university alcohol and productivity cultures, faculty type, and gender; (3) Reducing addiction stigma may involve peer support, vulnerable leadership (e.g., openly sharing addiction-recovery stories), and non-discriminatory protective policies. This study offers novel insights into how addiction stigma may operate for FMs in relation to university-specific norms (e.g., drinking and productivity culture), and outlines some recommendations for creating more recovery-friendly campuses.

Do the associations between the use of electronic cigarettes and smoking reduction or cessation attempt persist after several years of use? Longitudinal analyses in smokers of the CONSTANCES cohort

INTRODUCTION

We examined whether duration of electronic cigarette (e-cigarette) use could be associated with smoking reduction or cessation attempt.

METHODS

5,409 current smokers at baseline enrolled in the French CONSTANCES cohort in 2015 or 2016 were included. Duration of e-cigarette use was categorized as follows: never; former user for more than one year; former user for less than one year; new user for less than one year; return to use for less than one year; regular use for one to two years; regular use for more than two years. Two outcomes were considered at one-year of follow-up: change in the number of cigarettes per day and cessation attempt.

RESULTS

Compared to never users, former users had an increase in the number of cigarettes per day at follow-up (B = 0.95[95%CI:0.57-1.33] and B = 1.03[95%CI:0.47-1.59] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had a decrease in the number of cigarettes per day (B = -3.31[95%CI:-4.07;-2.54] and B = -4.18[95%CI:-5.06;-3.29] for new users of less than one year and users of more than two years, respectively). Compared to never users, former users had a decreased likelihood of cessation attempt (OR = 0.80[95%CI:0.67-0.95] and OR = 0.77[95%CI:0.60-0.99] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had an increased likelihood of cessation attempt (OR = 3.12[95%CI:2.32;4.19] and OR = 3.36[95%CI:2.39;4.72] for new users of less than one year and users of more than two years, respectively).

CONCLUSIONS

E-cigarette use was associated with smoking reduction and cessation attempt for individuals who have used it for less than one year and additional benefits are expected to occur with a longer duration of use. Former users of e-cigarettes had poorer outcomes than those who have never used them.

Work Conditions are Associated with Alcohol Use after Taking into Account Life Conditions Outside of Work: Findings from a French Occupational Health Service

Background: Our aim was to examine whether work conditions could be associated with alcohol use even after taking into account life conditions outside of work. Methods: In 2019, 591 consecutive French workers were screened for alcohol use with the Fast Alcohol Consumption Evaluation (FACE). Ten different work conditions and four life conditions outside of work were assessed with 5-item Likert scales. Sociodemographic factors, smoking status and the Copenhaguen Burn-out Inventory were also collected. The associations between each work condition and FACE total score were examined with generalized linear models. Results: After adjusting for sociodemographic factors, the following work conditions were associated with a decreased FACE total score: "positive and/or grateful feedback on your work" (B = -0.22 (95%CI: -0.37; -0.07), p = 0.004), "time to do your job well" (B = -0.19 (95%CI: -0.35; -0.03), p = 0.019) and "freedom to organize your work" (B = -0.25(95%CI: -0.43; -0.08), p = 0.004). After further adjusting for life conditions outside of work, "positive and/or grateful feedback on your work" (B = -0.18 (95%CI: -0.33; -0.03), p = 0.021) and "freedom to organize your work" (B = -0.20(95%CI: -0.38; -0.02), p = 0.027) remained significantly associated with FACE total score. Additional adjustments for smoking status and burnout did not alter these results. Conclusions: Life conditions outside of work should not interfere with how improvements work conditions can help reduce alcohol use.

Patterns and correlates of workplace and non-workplace cannabis use among Canadian workers before the legalization of non-medical cannabis

BACKGROUND

Little information exists about cannabis use and its correlates among workers, particularly use before or at work, which may impact occupational safety. This study explores overall and workplace cannabis use patterns before legalization among Canadian workers and estimates the associations of personal and work-related characteristics with workplace and non-workplace cannabis use.

METHODS

Cross-sectional data were collected from 1651 Canadian workers in June 2018. The primary outcome was past-year cannabis use pattern: use, including before/at work (past-year workplace use); use, but not before/at work (past-year non-workplace use); no past-year use (non-past-year use). The associations of personal (sociodemographic, health) and work-related factors with workplace and non-workplace cannabis use were estimated using multinomial logistic regression.

RESULTS

A quarter of respondents reporting past-year cannabis use used cannabis before and/or at work. Respondents reporting workplace use were more likely to report more frequent cannabis use, use for medical or mixed purposes, and high THC cannabis use than workers reporting non-workplace use. Several personal factors were positively associated with workplace and non-workplace use (e.g., younger age, lower education). A safety-sensitive job, drug testing, supervisor role, less job visibility, lower perceived ability of supervisors to identify use/impairment, and less restrictive workplace smoking policies were positively associated with workplace use only.

CONCLUSIONS

A non-trivial proportion of workers reported workplace use, but the nature of this use is complex. Work-related factors addressing the likelihood of detection and being in a safety-sensitive job were associated with workplace use. Worker education on lower risk use appears warranted.

Effects of Rapid Recovery on Alcohol Hangover Severity: A Double-Blind, Placebo-Controlled, Randomized, Balanced Crossover Trial

The aim of this study was to evaluate the efficacy of putative hangover treatment, Rapid Recovery, in mitigating alcohol hangover (AH) symptom severity. Using a double-blind, randomized, placebo-controlled, balanced crossover design, 20 participants attended the laboratory for two evenings of alcohol consumption, each followed by morning assessments of AH severity. Participants were administered Rapid Recovery and placebo on separate visits. In the first testing visit, participants self-administered alcoholic beverages of their choice, to a maximum of 1.3 g/kg alcohol. Drinking patterns were recorded and replicated in the second evening testing visit. In the morning visits, AH severity was assessed using questionnaires measuring AH symptom severity and sleep quality, computerized assessments of cognitive functioning as well as levels of blood biomarkers of liver function (gamma-glutamyl transferase (GGT)) and inflammation (high-sensitive C-reactive protein (hs-CRP)). There were no differences in the blood alcohol concentrations (BAC) obtained in the Rapid Recovery (mean = 0.096%) and placebo (mean = 0.097%) conditions. Participants reported significantly greater sleep problems in the Rapid Recovery compared to placebo condition, although this difference was no longer significant following Bonferroni's correction. There were no other significant differences between Rapid Recovery and placebo. These data suggest that Rapid Recovery has no significant effect on alcohol hangover nor on associated biomarkers.

The Association between Ethanol Elimination Rate and Hangover Severity

Assessments in blood and saliva suggests that the amount of ethanol present in the first hours after alcohol consumption and into the following morning is associated with hangover severity. The current analysis determines how ethanol elimination rate is related to hangover severity reported throughout the day. n = 8 subjects participated in two studies. The first was a naturalistic study comprising an evening of alcohol consumption. Hangover severity was assessed hourly from 10 a.m. to 4 p.m., using a 1-item hangover severity scale ranging from 0 (absent) to 10 (extreme). The second study comprised a highly controlled alcohol challenge to reach a breath alcohol concentration (BrAC) of 0.05%. Breathalyzer tests were conducted every 5 min until BrAC reached zero. The ethanol elimination rate, expressed in BrAC%/hour, was computed by dividing the peak BrAC (%) by the time to BrAC of zero (h). At 11:00, 13:00, and 14:00, there were significant negative partial correlations, controlling for estimated BrAC, between ethanol elimination rate and hangover severity. The findings suggest that drinkers with a faster ethanol elimination rate experience less severe hangovers. The observations should be confirmed in a larger sample of subjects who participate in a single study that assesses both hangover severity and ethanol elimination rate.

Perceived Immune Fitness, Individual Strength and Hangover Severity

Various factors may contribute to alcohol hangover severity. The purpose of the current investigation was to evaluate the possible impact of alcohol consumption patterns, perceived immune status, and baseline fatigue on hangover severity. A survey was completed by a convenience sample of N = 199 Dutch students who reported on their latest past month's heavy drinking occasion, including subjective intoxication (perceived drunkenness) and next-day hangover severity, which were rated on single-item scales ranging from 0 (absent) to 10 (extreme). In addition, perceived (momentary) immune fitness was assessed, and the Checklist Individual Strength (CIS) was completed to assess baseline fatigue. The analysis revealed that instead of the amount of alcohol consumed or estimated blood alcohol concentration, it appeared that subjective intoxication (i.e., level of drunkenness) was the most important determinant of alcohol hangover severity. Especially in men, albeit modest, it was perceived that immune fitness also significantly contributed to the level of hangover severity experienced.

The Impact of Alcohol Hangover on Simulated Driving Performance During a 'Commute to Work'-Zero and Residual Alcohol Effects Compared

Driving is increasing across the world and road traffic accidents are a major cause of serious injuries and fatalities. The link between alcohol consumption and impaired driving has long been established and has led to legislation in many countries, with enforcement of legal limits based on blood alcohol concentration levels. Alcohol hangover research is an emerging field with a range of laboratory and naturalistic studies now clearly demonstrating the significant impairments that can result from hangover, even when alcohol levels are measured at or close to zero the day following a social drinking occasion. Driving is a commonplace activity but requires competency with a range of complex and potentially demanding tasks. Driving impaired can have serious consequences, including death and serious injury. There have been only limited alcohol hangover driving studies. The studies presented examined the consequences of alcohol hangover with a driving simulator contrasting a group with zero residual alcohol (N = 26) next day and another with residual alcohol (N = 26) assessed with breathalyzer in the morning before undertaking a 20 min commute to work. All participants completed a morning drive after a night without alcohol consumption and another after a night of social drinking. The driving scenarios were relatively demanding including traffic and pedestrians, traffic lights and other potential hazards in a mixed rural and urban journey. Subjective hangover and workload were assessed in addition to a range of driving performance variables, including divided attention, steering control and driving violations. Analyses contrasted driving in the no alcohol condition with the residual alcohol condition. The combined groups data (N = 52) was contrasted with the zero and residual alcohol groups. Significant contrasts were found for a range of driving measures, including divided attention, vehicle control, and driving violations as well as perceived workload. The pattern of impairment was broadly similar across both groups, indicating that whether or not residual alcohol was present, consistent driving impairment was seen. The relatively high number of significant variables may reflect the increased cognitive demand of the 20 min commute drive including busy and complex urban environments. This was also reflected in the significant increase in perceived workload recorded across the 6 dimensions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Associations between subjective measures and driving performance with hangover suggested a potential lack of awareness of impairment, though were limited in number. The overall findings indicate that the levels of impairment seen reflect those seen with alcohol impaired driving, even when breath alcohol is zero.

The Effects of SJP-001 on Alcohol Hangover Severity: A Pilot Study

Background. Despite a clear market need and many hangover products available, currently there is no hangover treatment that is supported by substantial scientific evidence demonstrating its efficacy and safety. A pilot study was conducted to investigate the effects of a potential new hangover treatment, SJP-001, and its constituents (220 mg naproxen and 60 mg fexofenadine) on hangover severity. Methods. N = 13 healthy social drinkers (36.3 ± 8.9 years old) participated in a double-blind, factorial design, cross-over study. On each test day, they consumed their own choice of alcohol up to a self-reported level sufficient to elicit a next-day hangover. Treatments were administered prior to onset of drinking. Next morning, hangover severity was assessed with the Acute Hangover Scale (AHS). Subjects were included in the efficacy analysis only if they reported a hangover after placebo. Results. N = 5 subjects (60% male, 35.2 ± 9.0 years old) were included in the analysis. They consumed a mean (SD) of 4.6 ± 1.1 units of alcohol and had an average peak breath alcohol concentration (BrAC) of 0.065% across conditions. Compared to placebo, SJP-001 significantly improved the AHS overall hangover severity score (0.8 ± 0.3 versus 1.5 ± 0.9, p = 0.042). Compared to placebo, SJP-001 also reduced scores on the individual item ‘hangover’, although the observed improvement (−1.6) did not reach statistical significance (p = 0.102). The differences from placebo after naproxen alone and fexofenadine alone were not statistically significant. SJP-001 also improved scores for the individual hangover symptoms tired, thirsty, headache, dizziness, nausea, and loss of appetite, but these effects did not reach statistical significance. Discussion. Compared to placebo, SJP-001 significantly reduced overall hangover severity. The effects of SJP-001 should be further examined in a double-blind, placebo-controlled trial with a larger sample size and controlled administration of sufficient amounts of alcohol to provoke a more substantial alcohol hangover.

The Assessment of Overall Hangover Severity

The aim of this study was to critically evaluate and compare the different methods to assess overall hangover severity. Currently, there are three multi-item hangover scales that are commonly used for this purpose. All of them comprise a number of hangover symptoms for which an average score is calculated. These scales were compared to a single, 1-item scale assessing overall hangover severity. The results showed that the hangover symptom scales significantly underestimate (subjective) hangover severity, as assessed with a 1-item overall hangover severity scale. A possible reason for this could be that overall hangover severity varies, depending on the frequency of occurrence of individual symptoms included in the respective scale. In contrast, it can be assumed that, when completing a 1-item overall hangover scale, the rating includes all possible hangover symptoms and their impact on cognitive and physical functioning and mood, thus better reflecting the actually experienced hangover severity. On the other hand, solely relying on hangover symptom scales may yield false positives in subjects who report not having a hangover. When the average symptom score is greater than zero, this may lead to non-hungover subjects being categorized as having a hangover, as many of the somatic and psychological hangover symptoms may also be experienced without consuming alcohol (e.g., having a headache). Taken together, the current analyses suggest that a 1-item overall hangover score is superior to hangover symptom scales in accurately assessing overall hangover severity. We therefore recommend using a 1-item overall hangover rating as primary endpoint in future hangover studies that aim to assess overall hangover severity.

Systematic Review of Cannabis Use and Risk of Occupational Injury

Aim: A range of nations, including countries of the European Union, Australia, and the Americas have recently implemented or proposed reforms to how they control cannabis use, thereby departing from traditional approaches of criminal prohibition that have dominated throughout most of the twentieth century. Given these policy developments and the widespread global use of cannabis, it is critically important to understand the possible risks associated with cannabis use in relation to major societal harms. Methods: This systematic review investigates the potential link between cannabis use and occupational injury. Consequently, it appraises all available current literature from five databases, following Cochrane and PRISMA guidelines. Results: Seven of the 16 reviewed studies show evidence supporting a positive association between cannabis use and occupational injury. One study shows evidence supporting a negative association and the remaining eight studies show no evidence of a significant relation. None of the studies assessed cannabis-related impairment. Only three of the reviewed studies show clear evidence that cannabis use preceded the occupational-injury event. Conclusion: The current body of evidence does not provide sufficient evidence to support the position that cannabis users are at increased risk of occupational injury. Further, the study quality assessment suggests significant biases in the extant literature are present due to potential confounding variables, selection of participants, and measurement of exposures and outcomes. Future high-quality evidence will be needed to elucidate the relation between cannabis use and occupational injury.

Relationship between Alcohol Hangover and Physical Endurance Performance: Walking the Samaria Gorge

Alcohol hangover is a potentially debilitating state. Several studies have demonstrated that it does not seem to impair strength or short-term endurance, but its effects on continuous exercise performance/long-term endurance have never been investigated. Therefore, the aim of the current study was to assess hiking performance of participants who walked the 15.8 km Samaria Gorge in Crete, Greece. Participants completed a survey in the morning before walking the Gorge, and in the afternoon after completion of the walk. Demographics, data on previous evening alcohol consumption, sleep, hangover symptoms, and walking performance were assessed. Data from N = 299 participants with a mean (SD) age of 38.9 (11.0) years were analyzed. N = 223 participants (74.6%) consumed alcohol the evening before walking the Samaria Gorge, and N = 176 (78.9%) of those reported a hangover. They consumed a mean (SD) of 3.0 (1.8) alcoholic drinks (10 g alcohol each) with a corresponding next-morning hangover severity of 4.6 (2.4) on a 0–10 scale. Participants with a hangover reported feeling significantly more exhausted after the walk compared to participants with no hangover. The groups did not significantly differ in duration of the walk, and the number and duration of breaks. Overall hangover severity, assessed either before, during, or after walking the Samaria Gorge was not significantly correlated with any walking outcome. In conclusion, hungover participants experienced significantly more exhaustion when performing physical activity at the same level as non-hungover participants.