Sociodemographic characteristics associated with alcohol consumption and alcohol-related consequences, a latent class analysis of The Norwegian WIRUS screening study

Alcohol Consumption in the Specific Socio-Professional Context of the French Public Service: Qualitative Study Protocol

Alcohol, a psychoactive substance with addictive potential, has major consequences on the population and public health. In France, alcohol use disorder affects approximately 3.5 million people, and 41,000 persons died in 2015. Alcohol consumption is significantly correlated to the workplace. Thus, the workplace is an area of opportunity to change risky behaviors and must play a key role in the prevention of alcohol misuse. To do this, it is essential to understand the consumption framework and to identify specific environmental risk factors. This qualitative study aims to describe the framework of alcohol consumption in the French public service. A focus group will be organized in France from November to January 2023. The participants will be: (i) representatives of the Local Health Insurance; (ii) over 18 years old; (iii) active or retired civil servants; (iv) mutualist activists; and (v) representatives of the Union of Health Prevention for the Obligatory System of the Public Service. The exclusion criteria for the study will be: (i) lack of consent form; (ii) inability to participate in the focus group, and (iii) early departure during the focus group. The focus groups will be supervised by two researchers following an interview guide. The data will be analyzed using the methodological framework, which consists in carrying out a thematic analysis. This will allow for an understanding of the sources of usage behaviors, and the identification of the most appropriate intervention functions for suitable prevention actions in order to reduce the risk of a transition to alcohol use disorder.

Are workplace factors associated with employee alcohol use? The WIRUS cross-sectional study

OBJECTIVES

Sociodemographic predictors of employee alcohol use are well established in the literature, but knowledge about associations between workplace factors and alcohol use is less explored. The aim of this study was to explore whether workplace factors were associated with employee alcohol use (consumption and alcohol-related problems).

DESIGN

Cross-sectional study. Linear and binary logistic regression analyses.

SETTING

Heterogeneous sample of employees (workers and supervisors) from 22 companies across geographical locations and work divisions in Norway.

PARTICIPANTS

Employees (N=5388) responded on survey items measuring workplace factors and alcohol use.

OUTCOMES

Data on alcohol use were collected with the Alcohol Use Disorders Identification Test (AUDIT). Consumption was measured with the AUDIT-C (the first three items), and alcohol-related problems were operationalised as a sum score of 8 or higher on the full 10-item AUDIT.

RESULTS

Higher levels of alcohol consumption were associated with more liberal workplace drinking social norms (b=1.37, p<0.001), working full-time (b=0.18, p<0.001), working from holiday home (b=0.40, p<0.01), being a supervisor (b=0.25, p<0.001), having supervisors with less desired leadership qualities (b=-0.10, p<0.01), shorter working hours (b=-0.03, p<0.05), higher workplace social support (b=0.13, p<0.05) and higher income (b=0.02, p<0.001). Alcohol-related problems were associated with more liberal workplace drinking social norms (OR=3.52, p<0.001) and shorter working hours (OR=0.94, p<0.05).

CONCLUSIONS

Workplace drinking social norms were the supremely most dominant predictor of both consumption and alcohol-related problems. Results suggest that some workplace factors may play a role in explaining employee alcohol consumption, although the predictive ability of these factors was limited. This study points to the importance of drinking social norms, workplace drinking culture and leadership for understanding employee alcohol use.

Alcohol, Tobacco and Psychotropic Drugs Use Among a Population with Chronic Pain in Southern Spain. A Cross-Sectional Study

BACKGROUND

Substance use seems to be higher among populations with chronic pain.

AIM

The aim of this study is to examine the relationship between the quantity of alcohol, tobacco, and psychotropic drugs consumed and chronic pain among women and men.

METHOD

Linear and logistic regression analyses were carried out using data from the 2015-2016 adults' version of the Andalusian Health Survey which is a representative cross-sectional population-based study (n = 6,569 adults aged >16 years; 50.8% women; 49.2% men).

RESULTS

Disabling chronic pain was statistically associated with higher tobacco consumption among men (β = -30.0, 95% confidenct interval [CI] -59.5 to -0.60; t = -2.0; p < .05). Regarding alcohol, non-disabling chronic pain and a higher quantity of alcohol consumed are statistically associated for both sexes (women: β = 30.4, 95% CI 2.3-58.6; t = 2.12; p < .05 vs. men: β = 164.2, 95% CI 24.3-340.1); t = 2.30; p < .05). For women and men, both disabling chronic pain (women: odds ratio [OR] = 8.7, 95% CI 6.0-12.7); p < .05 vs. men: OR = 3.5, 95% CI 1.5-8.2); p < .05) and non-disabling chronic pain (women: OR = 3.7, 95% CI 2.0-7.0); p <.05 vs. men: OR = 4.7, 95% CI 95% CI 1.5-14.9); p < .05) were statistically significantly associated with a higher consumption of psychotropic drugs.

CONCLUSIONS

Chronic pain may be related to the quantity of alcohol, tobacco, and psychotropic drugs consumed, and disability appears to be one of the factors that modulates this relationship.

The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis

The emergency department (ED) is a critical setting for the treatment of patients with opioid misuse. Detecting relevant clinical profiles allows for tailored treatment approaches. We sought to identify and characterize subphenotypes of ED patients with opioid-related encounters. A latent class analysis was conducted using 14,057,302 opioid-related encounters from 2016 through 2017 using the National Emergency Department Sample (NEDS), the largest all-payer ED database in the United States. The optimal model was determined by face validity and information criteria-based metrics. A three-step approach assessed class structure, assigned individuals to classes, and examined characteristics between classes. Class associations were determined for hospitalization, in-hospital death, and ED charges. The final five-class model consisted of the following subphenotypes: Chronic pain (class 1); Alcohol use (class 2); Depression and pain (class 3); Psychosis, liver disease, and polysubstance use (class 4); and Pregnancy (class 5). Using class 1 as the reference, the greatest odds for hospitalization occurred in classes 3 and 4 (Ors 5.24 and 5.33, p < 0.001) and for in-hospital death in class 4 (OR 3.44, p < 0.001). Median ED charges ranged from USD 2177 (class 1) to USD 2881 (class 4). These subphenotypes provide a basis for examining patient-tailored approaches for this patient population.

Do Differences in Drinking Attitudes and Alcohol-Related Problems Explain Differences in Sick Leave? A Multilevel Analysis of 95 Work Units Within 14 Companies From the WIRUS Study

Background

Systematic reviews have shown a strong relationship between alcohol consumption and sick leave. The effect of alcohol consumption on sick leave may, however, vary according to the work environment. While attitudes toward drinking may impact sick leave, there is little research on the contribution of drinking attitudes to sick leave. Moreover, alcohol-related problems and drinking attitudes may be influenced by the broader sociocultural contexts of the organizational units where people work.

Objectives

This study aimed to explore the relationship of alcohol-related problems and drinking attitudes with sick leave while considering the nesting of employees within working units within companies.

Method

Data from the WIRUS (Workplace Interventions preventing Risky alcohol Use and Sick leave) study were linked to company-registered sick leave data for 2,560 employees from 95 different work units in public (n = 9) and private companies (n = 5) in Norway. Three-level (employee, work unit, and company) negative binomial regression models were estimated to explore the 12-month prospective association of alcohol-related problems and drinking attitudes with four measures of sick leave (one-day, short-term, long-term, and overall sick leave days). Models were adjusted for gender, age, cohabitation status, educational attainment, work position, and employment sector.

Results

We observed higher variation of one-day, short-term, and overall sick leave days between companies than between work units within companies (15, 12, and 30% vs. 0, 5, and 8%, respectively). However, neither alcohol-related problems nor drinking attitudes were associated with sick leave and, thus, those variations in sick leave were not explained by alcohol-related problems or drinking attitudes.

Conclusion

Our findings suggest company-level differences are more important than within company differences when explaining differences in sick leave. While alcohol-related problems or drinking attitudes were not associated with sick leave, future studies may need to explore the role of company policies, practices, or social norms in variations in sick leave rates.

Causal mechanisms proposed for the alcohol harm paradox-a systematic review

BACKGROUND AND AIMS

The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another.

METHODS

This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations.

RESULTS

Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21).

CONCLUSIONS

While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.

Socioeconomic Classes among Oldest-Old Women in South Korea: A Latent Class Analysis

Oldest-old women are known to live at the intersection of multiple socioeconomic disadvantages in South Korean society. This study classified oldest-old Korean women into several socioeconomically homogeneous classes based on various socioeconomic status (SES) risks and compared health characteristics among the identified classes. This cross-sectional study utilized the 2019 Korean Community Health Survey, including data from 11,053 women (≥80 years). Latent class analysis determined the number of underlying socioeconomic classes based on nine selected SES variables. Four distinct socioeconomic classes were identified: “Urban, living alone, recipient of NBLSS, moderate education, leisure activity” (Class 1), “Rural, traditional house, living with others, not financially deprived, low education, employed” (Class 2), “Urban, living with family, financially affluent, not employed, no barriers to healthcare” (Class 3), “Rural, traditional house, living alone, financially deprived, uneducated, employed, barriers to healthcare” (Class 4). Depressive symptoms, subjective stress, and the prevalence of sleep disorder and diabetes were higher in Class 1 compared to other classes. Health-related quality of life, perceived health, and self-rated oral health were the poorest in Class 4. Class 3 reported the best health status. Understanding the intersecting SES risk factors in this group can aid in developing targeted interventions.

Willingness to Participate in Alcohol Prevention Interventions Targeting Risky Drinking Employees. The WIRUS Project

Background: The extent to which eligible individuals in a target population are willing to participate in interventions is important when evaluating the efficacy of public health interventions.

Objectives: As part of a process evaluation of an ongoing randomized controlled trial, this study aimed to identify the proportion of risky drinkers who were willing to participate in an alcohol prevention intervention in an occupational health setting, and correlates for such willingness.

Methods: Risky drinking employees from 22 companies in Norway were identified through an alcohol screening survey. Risky drinkers' (N = 779) willingness to complete a health examination and to be randomized into an alcohol prevention intervention (digital or face-to-face intervention, or control) was recorded by personnel from occupational health services. The proportion of employees who were willing to participate was assessed on 31 potential correlates (sociodemographic, alcohol-related, work-related, and lifestyle/daily activity). Adjusted (multiple logistic regression) analyses were utilized to explore associations between potential correlates and willingness to participate.

Results: Altogether, 38.1% of employees were willing to participate in prevention interventions. In the adjusted analysis, only 5 out of 31 potential correlates were significantly associated with willingness to participate. Managers were more than twice as willing to participate than workers (OR = 2.17, p < 0.01). Willing employees had less workplace decision latitude (perceived control over workplace decisions and less possibility of utilizing personal skills in the job) (OR = 0.62, p < 0.05), and were more overcommitted with exorbitant work ambition and need for approval (OR = 1.49, p < 0.05). Willing employees had to some extent less alcohol-related impaired work performance (presenteeism, OR = 0.78, p < 0.05), and they spent less time on care activities (OR = 0.84, p < 0.05).

Conclusions: Reaching four out of ten with risky drinking habits for prevention interventions strengthens the rationale for targeting this public health problem in occupational health care settings. In particular, this study suggests the importance of ensuring secure commitment among workers, who were less willing til participate than managers. Nevertheless, tailoring recruitment and implementation strategies based on easily identifiable correlates may be onerous.

Are Demanding Job Situations Associated with Alcohol-Related Presenteeism? The WIRUS-Screening Study

Alcohol-related presenteeism (impaired work performance caused by alcohol use) is an important but under-researched topic. The aim of this study was to explore whether psychosocial work environment factors were associated with alcohol-related presenteeism. A cross sectional study of Norwegian employees (n = 6620) was conducted. Logistic regression analyses were used for estimating associations with alcohol-related presenteeism, which was reported among 473 (7.1%) of the employees. Adjusted by age, gender, education level and managerial level, higher levels of overcommitment to work were associated with alcohol-related presenteeism. Higher age, male gender and higher education were also associated with alcohol-related presenteeism. Occupational health services and employers should especially focus on overcommitted employees when designing workplace health promotion programs. Modifying attitudes towards alcohol-related presenteeism among overcommitted employees may be of importance for safety at work.

Associations of alcohol use, mental health and socioeconomic status in England: Findings from a representative population survey

BACKGROUND

Alcohol use and mental health problems often co-occur, however, little is known about how this varies by type of mental health problem and to what extent associations are explained by socioeconomic status (SES). Our study examined the prevalence and associations of non-drinking, hazardous use, and harmful/probable dependence in individuals who do and do not meet criteria for different mental health problems and whether associations remained after adjustment for SES.

METHODS

A secondary analysis of an English dataset, 2014 Adult Psychiatric Morbidity Survey (N = 7,218), was conducted. The Alcohol Use Disorder Identification Test was used to categorise participants as non-drinking, low risk, hazardous use and harmful/probable dependence. Mental health problems were screened using a range of validated tools. Multinomial logistic regression analyses were used to address study aims.

RESULTS

The prevalence of non-drinking, hazardous and harmful/probable dependence was higher among those meeting criteria for a mental health problem. After adjustment for SES, non-drinking was most common in those meeting criteria for probable psychotic disorder (MOR = 3.42, 95 %CI = 1.74-6.70), hazardous use in those meeting criteria for anti-social personality disorder (MOR = 2.66, 95 %CI = 1.69-4.20) and harmful/probable dependence in those meeting criteria for borderline personality disorder (MOR = 9.77, 95 % CI = 4.81-19.84).

CONCLUSIONS

There were marked increases in the odds of reporting both non-drinking and harmful drinking among those meeting criteria for a mental health problem, particularly more severe problems. Our findings indicate that the relationship between alcohol and mental health is more complex and comorbid alcohol and mental health problems should be treated in parallel with access to both services.

Satisfaction With Life, Mental Health Problems and Potential Alcohol-Related Problems Among Norwegian University Students

Objective: Recent studies have shown that today's college students more than ever are struggling with mental health and alcohol problems. While poor satisfaction with life and mental health problems have been linked to higher alcohol consumption, there is still a lack of studies examining in detail the shape and nature of the relationship between mental health and alcohol consumption. Aim: To investigate the associations between satisfaction with life, mental health problems and potential alcohol-related problems among Norwegian university students. The shape of the associations was also examined. Methods: Data were drawn from a 2018 national survey of students in higher education in Norway (the SHoT-study). Associations between satisfaction with life, mental health problems and potential alcohol-related problems (AUDIT; risky and harmful alcohol use) were investigated using logistic regression. Both crude models and models adjusted for age, gender and marital status were conducted. To investigate the shape of the associations, logistic regression with quadric and cubic terms was tested. Results: Decreased satisfaction with life and increased mental health problems were associated with potential alcohol-related problems. For satisfaction with life, a curvilinear association with risky alcohol use and a linear association with harmful alcohol use was identified. For mental health problems, curvilinear associations were found for both risky and harmful alcohol use. Conclusion: Many students report potential alcohol-related problems. Students with harmful alcohol use seem to be more at risk of reduced satisfaction with life and increased mental health problems than students with risky alcohol use. Educational institutions may be an ideal setting for raising awareness of mental health issues and responsible alcohol consumption among students. The present study contributes with important information about the shape of the associations between satisfaction with life, mental health problems and potential alcohol-related problems in the student population.

Insomnia, Alcohol Consumption and ADHD Symptoms in Adults

Introduction

Substance use disorders and insomnia are common in the general population, and particularly among adults with attention-deficit/hyperactivity disorder (ADHD). Here we investigated the relationship between insomnia, alcohol consumption and ADHD symptoms.

Methods

Adults with an ADHD diagnosis (n = 235, 41.3% males) and controls (n = 184, 38% males) completed a questionnaire assessing insomnia (Bergen Insomnia Scale), alcohol consumption (Alcohol Use Disorders Identification Test), and current ADHD symptoms (Adult ADHD Self-report Scale). The majority of the sample (95%) gave additional information about childhood ADHD symptoms (Wender Utah Rating Scale), and information about lifetime occurrence of an internalizing disorder was included as part of background information.

Results

Compared to controls, the ADHD group reported a higher frequency of insomnia, a higher quantity of consumed alcohol and a higher frequency of internalizing disorders. Current and childhood ADHD symptoms were more severe in those with than without insomnia. Scores on ADHD symptom scales were explained by the presence of insomnia and internalizing disorders, while the contribution from alcohol consumption was restricted to the control group.

Discussion

The high functional impact of insomnia, alcohol misuse and internalizing disorders is well known. The present study contributed by focusing on their relations to ADHD symptoms, and by showing that strong relations were not restricted to adults with a clinical ADHD diagnosis. By this, the results put a critical light on a categorical delineation between adults with an ADHD diagnosis and population selected controls, and call for further studies including dimensional metrics of ADHD symptoms and co-occurring problems.