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Background: Traditionally, men have been heavier drinkers of alcohol and at greater risk of health problems than women. As men are often reluctant to recognize or seek help for risky drinking, the workplace provides an ideal opportunity to implement and target interventions around risky alcohol use. Methods: A systematic literature review was undertaken to identify studies that examined interventions for risky alcohol consumption among workers within male-dominated industries. Searches were undertaken of major electronic databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Informit, PsycINFO, PubMed, and Scopus), the gray literature, and reference lists of retrieved articles for English-language studies published between January 1990 and June 2012 were also included. Articles were systematically assessed for quality and outcomes. Results: Eight studies met the inclusion criteria. Although the number of studies was small and the nature of implementation research tends to produce less clear outcomes than highly controlled studies, results did show some positive outcomes, including alcohol screening, alcohol testing, brief interventions, peer care or peerbased support interventions, and enhanced employee well-being interventions. Workplace alcohol and drug testing did not appear to be useful. Conclusion: Although the evidence on specific interventions for alcohol use problems in male-dominated industries was limited, the review showed that interventions are feasible in the workplace, even within a culture that is typically ambivalent about addressing risky drinking. Alcohol screening, secondary prevention, and lowintensity intervention activities may be effective for those identified as risky drinkers. Health and well-being promotion activities and alcohol testing, which were examined in a number of studies, did not appear to have an impact on drinking rates. Further research to identify specific and effective interventions to address alcohol use in the workplace, both at the individual and at the workplace level, is needed.
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Review
A Systematic Review of Alcohol Interventions
Among Workers in Male-Dominated Industries
Nicole K. Lee, PhD,
1,2
Ann M. Roche, PhD,
1
Vinita Duraisingam, MOrgPsych,
1
Jane Fischer, MSPD,
1
Jacqui Cameron, MPhil,
1,3
and Ken Pidd, PhD
1
Abstract
Background: Traditionally, men have been heavier drinkers of alcohol and at greater risk of health problems
than women. As men are often reluctant to recognize or seek help for risky drinking, the workplace provides an
ideal opportunity to implement and target interventions around risky alcohol use.
Methods: A systematic literature review was undertaken to identify studies that examined interventions for
risky alcohol consumption among workers within male-dominated industries. Searches were undertaken of
major electronic databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library,
Informit, PsycINFO, PubMed, and Scopus), the gray literature, and reference lists of retrieved articles for
English-language studies published between January 1990 and June 2012 were also included. Articles were
systematically assessed for quality and outcomes.
Results: Eight studies met the inclusion criteria. Although the number of studies was small and the nature of
implementation research tends to produce less clear outcomes than highly controlled studies, results did show
some positive outcomes, including alcohol screening, alcohol testing, brief interventions, peer care or peer-
based support interventions, and enhanced employee well-being interventions. Workplace alcohol and drug
testing did not appear to be useful.
Conclusion: Although the evidence on specific interventions for alcohol use problems in male-dominated
industries was limited, the review showed that interventions are feasible in the workplace, even within a culture
that is typically ambivalent about addressing risky drinking. Alcohol screening, secondary prevention, and low-
intensity intervention activities may be effective for those identified as risky drinkers. Health and well-being
promotion activities and alcohol testing, which were examined in a number of studies, did not appear to have an
impact on drinking rates. Further research to identify specific and effective interventions to address alcohol use
in the workplace, both at the individual and at the workplace level, is needed.
Key words: alcohol; drug; interventions; male-dominated industry; systematic review
Introduction
Throughout life, men experience higher rates of ill-
ness, accidents, and premature death than women; are less
likely than women to report their health as excellent or very
good; and more likely to report their health as only good or fair.
1
Men are more likely to be involved in a workplace injury
than women, and 7% report a long-term condition as a result
of an injury sustained in the workplace, compared with less
than 3% of women. Sixty-eight percent of work compensa-
tion claims come from men, and the top 4 out of 5 compen-
sation claims come from industries that are traditionally
male-dominated workplaces.
2
Excessive alcohol consumption is a major risk factor for a
variety of health and social problems, including accidents,
unsafe sexual practices, violent offending, and a range of
chronic diseases.
1
Alcohol is implicated in all of the top 10
conditions that account for the total burden of disease for
men.
3
Around 10% of men drink at levels that would put them
at risk or high risk of problems in the long-term (i.e., more
than 29 standard drinks a week).
1
In addition, more than half
of men have inadequate health literacy.
1
1
National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia, Australia.
2
National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
3
Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
JOURNAL OF MEN’S HEALTH
Volume 11, Number 2, 2014
ªMary Ann Liebert, Inc.
DOI: 10.1089/jomh.2014.0008
1
There is a clear body of evidence linking the workplace
with employee risky alcohol consumption and alcohol use
problems
4–7
resulting in social and economic costs for the
workers and workplace.
8
In the United States, an estimated
15% of the workforce is affected by workplace alcohol use.
9
Between 5% and 9% of Australian workers use alcohol at or
just before work, potentially affecting work performance.
2,10
There is a significant financial cost to employers through
alcohol’s association with accidents, mortality, and injury,
11–15
and employee alcohol consumption has been associated with
absenteeism and lower than optimum functioning at work
(‘‘presenteeism’’) and reduced productivity and workplace turn-
over.
14,16–18
High-risk drinkers are up to 22 times more likely to
be absent from work because of their alcohol use compared with
low-risk drinkers
18
; costs arising from presenteeism are esti-
mated to be four times higher than that of absenteeism.
8
Other factors that have been associated with alcohol and the
workplace include the type and quality of work being per-
formed, isolation, low levels of supervision, the availability of
alcohol at or after work, norms surrounding drinking, and peer
approval of drinking at work.
19–21
There is also an association
between workplace psychosocial factors (e.g., job satisfaction,
bullying) and alcohol use.
7,19
Alcohol use is higher among workers in male-dominated
industries (MDIs)
22
; internationally, there is a higher than av-
erage prevalence of alcohol-related problems among workers
in construction, utilities, manufacturing, agricultural, and
transportation.
23
A number of factors have been cited that provide barriers
for men seeking treatment for health problems, include lim-
ited out of work hour’s appointments, a shortage of male
health professionals, discomfort in waiting rooms, and social
norms relating to masculinity and self-reliance.
1
When help
is sought from a general practitioner, men’s consultations are
often shorter than those for women with a greater focus on
physical health over mental health issues such as concerns
about alcohol consumption.
24,25
Men may be more likely to
seek nonprofessional advice for their health problems before
deciding to seek professional help.
26
With a high proportion of men in the workforce, higher
alcohol use within MDIs, and the low rate of treatment
seeking, the workplace provides an excellent opportunity to
offer men important health information and referrals for in-
tervention where necessary, especially around sensitive and
personal topics such as alcohol consumption.
Therefore, guidance in effective interventions to address
alcohol use in MDIs is crucial for workplaces to develop
appropriate responses to this issue. This study was a sys-
tematic review to examine the efficacy of interventions for
risky alcohol use among workers in MDIs to assist work-
places in making decisions about effective responses.
Methods
A systematic literature review was undertaken to identify
and review studies examining interventions for alcohol
problems among workers within MDIs.
Inclusion and exclusion criteria
The definition of MDI was developed based on Australian
Bureau of Statistics figures indicating the industries with the
highest percentage of male workers (Table 1).
27
An MDI is
defined using the Australian and New Zealand Standard In-
dustrial Classification (ANZSIC).
28
We defined an MDI as
one in which there are greater than 70% male workers. This
definition was chosen to examine industries that are more
than marginally male dominated, which may have a different
dynamic within the workplace in relation to alcohol con-
sumption. In Australia, these industries are agriculture, con-
struction, mining, manufacturing, transport, and utilities.
Although some other industries have a higher proportion of
men than women, including public administration and safety,
which includes fire, police, and ambulance services, these
industries had less than 70% men in the ANZSIC classifica-
tion system.
29
Military is not considered an industry per se,
rather a workplace, and within the ANZSIC classification,
personnel are categorized by their industry type within this
workplace.
Studies were included if they examined primarily alcohol
interventions conducted in the workplace in agriculture,
building and construction, mining, manufacturing, trans-
port, and/or utilities industries, and were published between
January 1990 and June 2012 in the English language, with a
sample of male or female participants in paid formal work
and measured focus on clinically significant alcohol use
issues.
Table 1. B43 Industry of Employment by Sex
Total Males
Industry (Australian Bureau
of Statistics, 2011
27
) Number Number %
Construction 828,910 719,206 86.8
Mining 176,563 145,765 82.6
Transport, postal, and
warehousing
479,181 368,050 76.8
Electricity, gas, water, and
waste services
115,611 87,954 76.1
Manufacturing 902,829 668,017 74.0
Agriculture, forestry, and
fishing
249,828 174,774 70.0
Wholesale trade 403,801 264,640 65.5
Information media and
telecommunications
178,190 103,637 58.2
Professional, scientific, and
technical services
730,062 404,357 55.4
Public administration and
safety
689,931 372,301 54.0
Arts and recreation services 151,574 79,358 52.4
Rental, hiring, and real
estate services
158,853 78,003 49.1
Administrative and support
services
323,779 156,926 48.5
Financial and insurance
services
377,352 176,626 46.8
Accommodation and food
services
650,397 284,815 43.8
Retail trade 1,057,310 446,002 42.2
Education and training 804,418 240,824 29.9
Healthcare and social
assistance
1,167,634 245,316 21.0
Other services 378,217 211,298 55.9
Inadequately described/not
stated
233,885 138,800 59.4
Total 10,058,325 5,366,669 53.4
2 LEE ET AL.
Search strategy
Searches were undertaken using electronic databases
(Cumulative Index to Nursing and Allied Health Literature,
The Cochrane Library, PubMed, PsycINFO, Informit, and
Scopus) and hand searching. A total of 45 articles were as-
sessed as eligible and 8 included in the final review (Fig. 1).
Screening, data extraction, and quality assessment
Studies underwent a two-stage screening process. First,
two reviewers screened each article title and abstract for
relevance to the inclusion criteria. At the second screen, one
reviewer reviewed the full article and checked that the study
met the specified inclusion criteria. This was subsequently
checked by a second reviewer.
A data extraction codebook was developed to ensure
consistency between reviewers. The methodological ade-
quacy of each study was assessed against six criteria (subject
selection, assessment, confounders, statistical analysis, con-
flict of interest, and bias) to determine overall study quality.
Results
The literature in this area is sparse with few good-quality
well-controlled studies. Eight studies
30–37
(Table 2) met the
inclusion criteria, with two being rated of good quality.
30,33
In one study, voluntary alcohol screening plus a 15-minute
brief intervention was compared with screening plus com-
prehensive intervention in a transport workplace.
30
All
groups significantly reduced their drinking, suggesting that
alcohol screening in workplaces is a powerful intervention in
itself, an effect that has also been demonstrated in the general
population.
38,39
In another study
32
that targeted multiple industries, in-
cluding construction, bus drivers, and small aircraft pilots,
participants were allocated to one of two 4-hour interven-
tions. The first intervention focused on team awareness, stress
reduction, social use of alcohol, and help-seeking, while the
second intervention was a health promotion program that
focused on healthy alternatives to drinking. Neither inter-
vention had an impact on drinking rates, but there was a
reduction in stress-related behaviors in both groups.
A brief intervention study in a national postal organization
by Richmond et al.
33
compared a three-phased interven-
tion (N=631) across 67 worksites consisting of a lifestyle
health campaign incorporating individual health assessments,
with an assessment-only control (N=575). The interven-
tion comprised three phases: phase 1 was a baseline screen-
ing, phase 2 a 4-week lifestyle campaign, and phase 3 was
a follow-up screening. Results across the organization as a
whole did not reveal significant reductions in excessive
alcohol consumption. However, a significant benefit was
found for women, but not for men, in reducing overall alcohol
consumption.
Spicer and Miller
35
conducted a retrospective records audit
of injury rates over 14 years in a transportation company.
After the introduction of a ‘‘PeerCare’’ intervention (which
included changing workplace behaviors and attitudes to
alcohol and drug use, through peer or union support plus
training for workers) they found that for every worker cov-
ered by the program, injury rates declined by 0.16% per
month, suggesting that peer-based programs may be effective
in reducing injuries at work.
A number of other studies examined the efficacy of peer
support or peer-based interventions. A PeerCare program was
examined retrospectively in a transportation company, which
included changing workplace behaviors and attitudes toward
alcohol (and drug) use through peer and managerial sup-
port, as well as random alcohol testing.
31
The study found a
significant reduction (estimated to be worth $48 million) in
FIG. 1. Flow diagram of
the study selection for sys-
tematic review of published
research on alcohol interven-
tions in male-dominated in-
dustries.
ALCOHOL INTERVENTION IN MALE-DOMINATED INDUSTRIES 3
Table 2. Included Alcohol Intervention Studies
Participant characteristics
Ref., country,
study design Intervention Industry
Study population
and description Intervention Controls
Total sample
number Measures
Analysis and
outcomes
Study
quality
Hermansson
et al. (2010)
30
Sweden
Randomized
control trial
Voluntary alcohol
screening; brief
intervention
(15 min) by
Occupational
Health and Safety
nurse
comprehensive
intervention
comprising a choice
of a brief session or
timeline follow
back interview or
self-monitoring
drinking diary for
1 month
Transport Male-dominated
industry
Workers aged 20–
64 years
(mean =43;
standard
deviation =9.6)
(68% male)
presenting for
routine health
and lifestyle
check-up, who
voluntarily
participated in
an alcohol
screening test
Brief intervention:
N=58
Comprehensive
intervention:
N=66
N=70
Voluntary
screening only
Recruited: 990
Eligible: 194
Follow-up %:
81%
Measures: Self-report:
Alcohol Use Disorders
Identification Test
Blood sample
carbohydrate-deficient
transferrin in serum
Confounders: Age
(p<0.002); lack of
adherence to treatment
protocol; significant
baseline differences in
carbohydrate-deficient
transferrin in serum
values for males
between groups
Analysis: Linear regressions
Outcome 1: All three groups
had significant reduction in
alcohol scores at follow-up
(p<0.0001).
No significant differences in
scores between intervention
groups.
Alcohol screening may be an
effective intervention in
itself.
Good
Miller et al.
(2007)
31
USA
Retrospective
study
PeerCare program
(changing
workplace
behaviors and
attitudes to
substance use
through peer/
managerial
support); Random
drug testing
Transport Male-dominated
industry workers
in a
transportation
company.
Age and % males
not reported.
Not applicable Not applicable Not reported
Follow-up %:
Not applicable
Measures: Company
records and industry
data on injury rates/
costs & no. of workers
trained for PeerCare.
Specific injury rates as a
result of alcohol/drugs
not measured.
Confounders: Decline in
injury rates could be
due to other factors
(e.g., work safe
policies)
Analysis: Poisson and linear
regressions
Outcome 1: Combined effect
of peer-based program,
random drug testing
estimated to have reduced
injury rates by a third and
savings of $48m for
employers in 1999.
Peer-based programs
combined with drug
testing could be cost-
effective and improve
workplace safety.
Fair
Patterson et al.
(2005)
32
USA
Randomized
control trial
Intervention 1: Team
awareness
(addresses stress
reduction, social use
of alcohol, help
seeking strategies +
resources)
Intervention 2:
Choices in Health
Promotion
(encourages healthy
alternatives to
substance
use +links to
resources).
Both interventions
were 4-hour
prevention training
programs.
Multiple industries Workers from
small
businesses,
including
construction
(37%), bus
drivers (19%),
and small
aircraft pilots
(4%). Age range
not reported.
Intervention 1:
N=194 (51%
male)
Intervention 2:
N=124 (61%
male)
N=212 (46%
male)
N=539
Follow-up rate:
27%
Intervention
1=37%;
Intervention
2=19%
Control
group =47%
Measures: Self-report:
CAGE, workplace
drinking norms,
unwinding behaviors,
drinking incidents,
emotional confidence,
group cohesion, sense
of coherence-
manageability,
perceived wellness
Confounders: Age,
turnover, and drinking
incidents were
predictors of attrition.
Analysis: Analysis of
variance and multivariate
analysis of variance
Outcome 1: While the
training helped promote
greater positive unwinding
behaviors; neither training
interventions resulted in
significant changes of
substance use unwinding
behaviors.
Prevention training may be
useful in promoting
positive unwinding
behaviors in workers who
are stressed.
Fair
(continued)
4
Table 2. (Continued)
Participant characteristics
Ref., country,
study design Intervention Industry
Study population
and description Intervention Controls
Total sample
number Measures
Analysis and
outcomes
Study
quality
Richmond et al.
(2000)
33
Australia
Randomized
control trial
Lifestyle health
campaign,
individual health
assessment, brief
intervention, and
motivational
interview
Postal Male-dominated
workers from a
national postal
corporation
aged between 18
and 65 (62%
male)
N=631; n=333
(53%)
completed
baseline
questionnaire;
n=382 (61%)
attended brief
intervention;
Follow-up =149
N=575; n=355
(62%)
completed
baseline
questionnaire;
Follow-up =171
N=1,206
Follow-up %:
27%
Measures: Self-report:
quantity/frequency
index of average weekly
alcohol consumption
and binge drinking in
previous 3 months;
Short Alcohol
Dependence Data
Questionnaire for
regular excessive
drinkers.
Confounders:
Organizational
restructuring
Analysis: ANOVAs
Outcome 1: Compared to
control group, no significant
differences in alcohol
intake for males at follow-
up. Significant reduction in
alcohol consumption for
females at follow-up
(p<0.01).
Workplace lifestyle
campaign that
incorporates a low-key
alcohol intervention may
be effective in reducing
alcohol consumption for
certain subgroups of
workers.
Good
Sieck and
Heirich
(2010)
34
USA
Three workplace
intervention
studies
Intervention 1:
Random drug
testing +2-day drug
education & health
fair; Intervention
2: Proactive wellness
counseling on
moderating alcohol
consumption)
within the context
of general health
counseling;
Intervention
3: Enhanced employee
assistance program–
health promotion
(stress management,
healthy eating),
substance abuse
prevention/
intervention
program +standard
employee assistance
program services
Multiple industries:
Manufacturing
(Random drug
testing); University
(Proactive wellness
counseling);
Insurance org
(enhanced
employee assistance
program)
Workers from
manufacturing
companies (74%
male),
universities
(43% male), and
insurance
companies (16%
male), with a
mean age
between 37 and
44 years
Random drug
testing: n=571
(32% at risk
drinkers);
Proactive
wellness
counseling:
n=456 (16% at
risk drinkers);
enhanced
employee
assistance
program:
n=383 (8% at-
risk drinkers)
Control group
sample sizes not
reported
N=1,410
Follow-up %: not
reported
Measures: Self-report:
quantity/frequency
index of average weekly
alcohol consumption;
alcohol risk perception;
alcohol consumption
status; alcohol risk
status
Confounders: The
worksite composition
for the manufacturing
company may have
changed as a result of
random drug testing
(e.g., workers could
have been fired as a
result of positive drug
tests).
Analysis: ANOVAs
Outcome 1: No significant
changes in alcohol
consumption for random
drug testing study
Outcome 2: For the proactive
wellness study, males in the
intervention group showed
improvements in levels of
alcohol consumption. At-
risk drinkers in both
intervention group and
control group decreased
consumption. A higher
proportion of at-risk
drinkers in the intervention
group lowered their
drinking risk.
Outcome 3: For the enhanced
employee assistance study,
a higher proportion of at-
risk drinkers in the
intervention group reduced
their drinking risk although
differences were not
significant.
Interventions that are based
on health promotion may
be more effective in
reducing drinking risks
compared to those that
are punitive based.
Fair
(continued)
5
Table 2. (Continued)
Participant characteristics
Ref., country,
study design Intervention Industry
Study population
and description Intervention Controls
Total sample
number Measures
Analysis and
outcomes
Study
quality
Spicer and Miller
(2005)
35
USA
Retrospective
study
PeerCare intervention
program (changing
workplace behavior
and attitudes to
substance use
through peer/union
support) +training
workers to
recognize and refer
colleagues with
alcohol problems
Transport Male-dominated
industry
Workers in a
transportation
company.
Age and % males
not reported
N=26,000
workers
The comparison
companies had
between 20,000
and 30,000
workers.
Not reported
Follow-up %: not
reported
Measures: Company
records and industry
data on injury rates &
no. of workers trained
for PeerCare. Specific
injury rates as a result
of alcohol/drugs not
clear.
Confounders: Other
safety programs could
have been implemented
and had an impact on
injury rates, e.g.,
improvements in
operational processes,
advances in technology,
and changes in
awareness of substance
abuse.
Analysis: Regressions
Outcome 1: For every 1% of
the workforce covered by
PeerCare, monthly injury
rates declined by 0.16%
(relative risk 0.9984; 95%
confidence interval 0.9975–
0.9994). When 86% of the
workforce was covered by
PeerCare, monthly injury
rates declined by 14% on
average.
Peer-based programs may
be effective in reducing
injuries in the workplace.
Fair
Stoltzfus and
Benson
36
(1994)
USA
Randomized
control trial
Comprehensive drug
& alcohol
prevention program
comprising
supervisor training,
2.5-hour workshop
for employees
(discussion of
alcohol and other
drug policies,
personal alcohol
consumption
guidelines,
appropriate
responses to alcohol
and other drug-
related issues in and
outside the
workplace), and a
peer support
program designed to
promote listening,
communication, and
friendship skills
Manufacturing Male-dominated
industry,
workers from a
manufacturing
company aged
<24 to 55 +
(45% male)
across two sites
of the same
organization
Site 1: N=445 Site 2: N=215 N=659
Follow-up %:
91%
Measures: Self-report:
Questions on alcohol and
drug use based on
National Household
Survey of Drug Use,
worker at-risk behavior,
work effects of alcohol
and drug use, worker
and supervisor skill
development,
empowerment, and
morale
Analysis: Comparison of
changes in pre- and
postsurveys (percentage)
Outcome 1: There was a 5–
7% reduction in alcohol
consumption at posttest and
follow-up. There was a
reduction in the proportion
of heavy and binge drinkers
at posttest and follow-up.
Outcome 2: No changes in
substance use for the
intervention or control
group.
Outcome 3: A larger
proportion of workers from
the experimental group
reported no at-risk
behaviors at posttest. No
changes in the control
group.
A comprehensive, multilevel
alcohol and other drug
prevention program may
help reduce alcohol
consumption and increase
awareness of workers
regarding the negative
impact of alcohol and
other drug in the
workplace.
Fair
(continued)
6
Table 2. (Continued)
Participant characteristics
Ref., country,
study design Intervention Industry
Study population
and description Intervention Controls
Total sample
number Measures
Analysis and
outcomes
Study
quality
Wickizer et al.
(2004)
37
USA
Pre-post study
design
Drug-free workplace
intervention
program (alcohol
and or drug
workplace policy
and employee
assistance services)
Multiple industries:
Agriculture, forestry
and fishing, mining,
construction,
manufacturing,
transportation and
public utilities,
wholesale and retail
trade, finance,
insurance and real
estate and services
Companies from
various
industries. Age
and percentage
of males not
reported
Number =261
companies
(manufacturing
28%,
construction
25%,
transportation
16%); 14,500
workers
Number =20,500
companies,
650,000 workers
Around 664,500
workers
Follow-up%: not
applicable
Measures: Workers’
compensation claims
and work hours data.
Specific injury rates as a
result of alcohol/drugs
not clear.
Confounders: The
intervention may not
have been carried out
uniformly across
different companies
Analysis: Stratified analysis,
autoregressive, integrated
moving-average (ARMIA)
model
Outcome 1: There was a
significant net reduction of
3.33 injuries per 100
person-years observed in all
three industries during the
intervention period
(p<0.05). The magnitude
of reduction was largest for
the services industry (7.11),
followed by construction
(4.78), and manufacturing
(3.41). The comparison
companies also had a
reduction in injury rates but
the proportion of change
was relatively smaller.
Outcome 2: The rate of more
serious injuries (involving
time loss) significantly
reduced for the intervention
companies for the
construction and services
industries ( p<0.05).
Drug-free workplace
interventions may help
minimize work-related
injury rates in certain
occupational groups.
Fair
7
injury rates. The authors suggest that the combination of
these interventions produced the change. Other studies
34
showed no benefit from random alcohol testing alone, and the
literature overall shows alcohol testing in the workplace to
have little or no impact on drug use or injury levels.
40
Therefore, it is likely that the peer-based intervention was the
main catalyst for change in the Miller et al.’s study.
31
Another study by Sieck and Heirich
34
examined aspects
of adult work life that influence alcohol risk perception and
consumption in three different worksite interventions. The
first included random alcohol and drug testing plus educa-
tion, the second included proactive wellness counseling
within the context of general health counseling, and the
third was an enhanced employee assistance program for
high-risk drinkers that included stress management, healthy
eating, substance abuse prevention, plus standard employee
assistance program. The three employee groups targeted
included manufacturing workers (n=571), university em-
ployees (n=456), and insurance workers (n=383). Among
the risky drinkers, there were decreases in alcohol con-
sumption in the intervention groups, although the numbers
in each group were small. There were no changes to al-
cohol risk perception. The results suggested that worksite
characteristics influence drinking norms and behavior.
Risk appeared to be a factor only when the interventions
helped focus attention on the personal significance of risky
behaviors.
A comprehensive intervention program
36
in the manu-
facturing sector (N=660) compared (1) a peer-based inter-
vention, (2) policy changes, and (3) alcohol and other drug
education among workers at a large manufacturing company
in the United States. The three components of the program
included a 10-hour supervisory training program; a session
for all employees designed to discuss policies, clarify per-
sonal alcohol use guidelines, and promote discussion about
appropriate responses to and responsibility for a range of
alcohol both inside and outside the work environment; and a
peer support program. This study found a reduction in alcohol
consumption (5–7% at follow-up after 16 months) and fewer
risk behaviors at the intervention site compared with the
control site as well as improvements such as prevention of
incidents and a reduction in alcohol- and drug-related work
performance issues.
36
Wickizer et al.
37
reviewed an intervention suite that in-
cluded the development and implementation of regulations
and policy, the introduction of an employee assistance
program, supervisor training, employee education to rec-
ognize colleagues with problems, and drug testing. Two
hundred sixty-one intervention companies representing a
range of industries, including construction, transportation,
retail and wholesale trade, agriculture, forestry and fishing,
mining, finance, insurance, and real estate companies, that
enrolled in the program were compared with 20,500 non-
intervention companies. The intervention suite was associ-
ated with significantly reduced injury rates (3.33 injuries per
100 persons) and significantly reduced serious injury, es-
pecially in the construction industry.
Overall, it appears that the introduction of screening for
risky drinking, but not conducting brief interventions, may
have a positive impact on workers in MDIs who are risky
drinkers, as well as members of the general workforce.
Secondary prevention and low-intensity intervention activi-
ties may also be effective for those identified as risky
drinkers. Health promotion activities or alcohol testing did
not appear to have an impact on drinking rates and do not
appear to be viable interventions for this workplace.
Discussion
Men experience greater health problems than women,
including alcohol-related issues, but are less likely to seek
treatment. Barriers include discomfort in waiting rooms and
social norms relating to masculinity and self-reliance.
However, a large proportion of men are active workforce
participants, and workplace norms also have a strong in-
fluence on health-related behaviors for men. So male-
dominated workplaces, where collective stigma attached to
help-seeking may be higher, are therefore an ideal context to
provide primary, secondary, and tertiary interventions and
referrals for men, who may not otherwise present to primary
care or specialist services for assistance with alcohol-related
issues.
This systematic review identified interventions to address
alcohol problems among workers in heavily male-dominated
industries. Eight studies met the inclusion criteria.
30–37
Overall results showed that some simple interventions can
help reduce drinking rates, harms, and absenteeism in male-
dominated workplaces. Screening and low-intensity interven-
tions may have some impact on risky alcohol consumption if
targeted at risky drinkers. Low-intensity multimodal work-
place interventions may be effective in reducing absenteeism
in male-dominated workplaces. Workplace interventions that
address attitudes toward drinking may be effective in reducing
injury rates.
Interventions that appeared to be effective for alcohol in-
cluded the following:
Screening for risky alcohol use, which can reduce al-
cohol consumption if targeted at risky drinkers
Peer-based workplace interventions aimed at changing
attitudes to drinking by staff and management, which
can reduce injury rates in workplaces
Brief-alcohol education counseling for identified
risky drinkers provided in conjunction with initial
screening
Workplace policies on alcohol and drug use in the
workplace
Employee assistance program services, which can reduce
rates of injury
The limited research so far is consistent with other work
looking at alcohol risk reduction practices in the workplace,
which suggests that a combination of strategies that address
workplace culture is most effective; these include, for exam-
ple, preventative health promotion programs that target the
workforce through education, employee assistance, alcohol
testing, and web-based interventions.
41,42
The introduction of a
policy for alcohol that is collaborative and inclusive with wide
dissemination can also reduce risk.
41
Such a policy should be
considered in conjunction with other workplace policies, such
as risk assessment, occupational health and safety, and ab-
senteeism, and should involve training for frontline workers
and managers.
43
Further research to identify specific and effective inter-
ventions to address alcohol and drug use in the workplace,
8 LEE ET AL.
both at the individual and at the workplace level, is needed.
Research using well-controlled study designs that foster an
understanding of the effective components of multimodal
interventions is required.
Overall, the results of this review suggest that there is a
potential benefit in providing intervention and secondary
prevention activities for alcohol disorders within the work-
place setting, including the development and implementation
of policies that address workplace risks related to alcohol,
beyond routine workplace alcohol and drug testing, which
does not have a clear benefit in reducing harms in the
workplace.
40
The type of research that is possible within a real-world
workplace setting is necessarily broad, often tailored to the
workplace and not well controlled, making generalizations to
other work settings difficult. However, overall, the results
show some consistency in the types of interventions that
might be successful within male-dominated workplaces, and
although the research is weak, the little that does exist pro-
vides guidance for employers.
Male-dominated workplaces should develop workplace
policies to address alcohol use that include a multilevel
approach.
44
Policies need to target both behaviors and at-
titudes of individual workers, and also organizational fac-
tors and working conditions that contribute to harmful
alcohol use.
45
Workplaces should consider implementing
evidence-based brief interventions that address workplace
alcohol risks as a routine health and safety measure and
address managers’ and workers’ attitudes to alcohol in the
workplace.
Strengths and limitations
This study is the first to look at this important area of men’s
health in a systematic review and shows that men’s health
interventions in the workplace are feasible, even with a
sensitive topic like alcohol consumption.
There were, however, very few well-controlled studies of
high quality upon which to base firm conclusions. This is
consistent with similar reviews such as Webb et al.’s
46
with
narrow search criteria and limited results. The studies found
were variable in their design and the interventions im-
plemented were of variable quality.
It is not clear why this area is so under-researched,
47,48
but
complexities within male-dominated workplaces, such as
subcultural norms
49
that enable a heavy drinking culture, may
be part of the explanation.
50–52
A few studies have explored
drinking cultures in male-dominated workplaces and found
that drinking was considered to be a normal part of working
life, and acceptance, and indeed any management intervention
would be actively challenged by workers.
45,47–49
Likewise,
managers may be ambivalent to respond to these issues.
Most studies used a whole of workplace approach and
implemented a menu of interventions. This made it difficult
to determine whether individual components or the suite of
intervention activities were required to achieve positive
outcomes.
Conclusions
A considerably improved evidence base is required to in-
form the judicious selection of effective and appropriate in-
terventions that may be applied in the workplace. Given the
high prevalence of alcohol problems in MDIs, further re-
search in these areas is crucial. However, the limited evi-
dence from this review suggests that if employers implement
policies addressing risking alcohol use in the workplace, and
develop screening interventions that directly address atti-
tudes toward drinking, as well as offering avenues for
counseling, such as employee assistance programs, they can
improve health and safety in the workplace.
Acknowledgments
This project was undertaken with funding from be-
yondblue and from the Australian Government Depart-
ment of Health.
Author Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Nicole K. Lee, PhD
National Centre for Education and Training on Addiction
Flinders University
GPO Box 2100
Adelaide
South Australia 5001
Australia
E-mail: nicole.lee@flinders.edu.au
ALCOHOL INTERVENTION IN MALE-DOMINATED INDUSTRIES 11
... Of the 13 systematic reviews focused on mental health, six were rated high quality 13,15,16,[19][20][21] and five were rated moderate quality reviews. 12,14,18,22,23 For substance use Webb et al. 25 was rated high quality, and Lee et al. 24 moderate quality. There were an additional 11 systematic reviews that included mental health components. ...
... Only two systematic reviews addressed substance abuse disorders, Webb et al. 25 and Lee et al. 24 . Webb et al. 25 completed a systematic review that included two primary articles that measure our work outcomes of interest. ...
... The second study found that interventions addressing workplace attitudes and substance use recognition training resulted in positive impacts for workrelated productivity outcomes. The second review addressing substance abuse was completed by Lee et al. 24 . Three primary studies were included that paid specific attention to workplace costs, including injury and compensation rates/costs and work hours. ...
Technical Report
Full-text available
Despite growing interest, and regulation to address mental health in the workplace, stakeholders report that they feel unsure about how, when, and what types of occupational mental health interventions are necessary. Furthermore, employers and organizations face ever increasing financial pressure that often requires clear financial benefit in order to justify expenditure on occupational mental health interventions. This is the third in a series of stakeholder-centred best evidence syntheses. The first synthesis was to better understand risk factors that contribute prolonged work absence across diseases and working populations. The second synthesis was to identify interventions that address these risk factors. The focus of this third synthesis is to identify and evaluate workplace-based interventions that prevent or mitigate work-related psychosocial hazards that contribute to mental health disorders and prolonged work absence. Based on findings and trend analysis, the academic-stakeholder team proposed a framework for planning, implementing and evaluating interventions to mitigate psychosocial hazards in the workplace. Due to low quality evidence and experimental pre and post design of many studies recommendations should be considered with some caution noting the need for more rigorous monitoring of their implementation.
... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
... Existing systematic reviews focus on the health and wellbeing of employees. However, the extant published literature has not been necessarily based on workplace interventions or in male-dominated industries [25,[36][37][38][39][40][41][42][43][44][45]. To our knowledge, there is no published systematic review that examines the effectiveness of workplace interventions designed to address the health and wellbeing of employees in male-dominated industries. ...
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... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
... research explores the feasiblility and effectiveness of interventions in relation to alcohol use in workplaces, particularly in male-dominated industries, where alcohol screening, secondary prevention and low-intensity intervention programs have had some benefit for heavy drinkers(Lee et al. 2014). However, further research is needed to identify and assess interventions that may remedy harms experienced in the workplace due to co-workers' alcoholconsumption. ...
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Introduction The aim of this report was to review national and international published and ‘grey’ literature to identify and describe evidence that informs the development of best practice interventions in the workplace that can prevent and reduce alcohol-related harm within and outside the workplace. The review process included a search and critical analysis of published and unpublished Australian and international literature. Scope and nature of the issue Interest has been increasing in identifying and responding to alcohol-related harm in a range of settings, including in the workplace. It has been suggested that hazardous and harmful alcohol use can result in a loss of workplace productivity due to absenteeism, poor decision-making and increased morbidity and mortality. Benefits to the workplace Despite a limited evidence base, it is increasingly apparent that alcohol can contribute to significant costs in the workplace. The range of impacts suggests that economic, safety and health gains can be achieved by preventing and reducing alcohol-related harm in the workplace. Some commentators have suggested that the workplace is a potential site to implement interventions that have relevance for the broad community – the majority of the population works, at least part-time, and so work settings may be a good location to ‘capture’ a large proportion of the population in health promotion activities. It is argued that such approaches will assist employers and employees to comply with occupational safety and health, and related, legislation. Best practice workplace interventions A. Prevalence Papers The prevalence literature shows that alcohol use is widespread in many countries, in particular across Australia, and that consumption and related harm vary by age and sex and among occupations and industries. Some Australian and overseas evidence indicates that workplace factors and structures contribute to high-risk alcohol consumption. B. Policy papers WorkSafe Western Australia identified alcohol policy (accompanied by supporting procedures) as an integral part of workplace ‘risk management’, suggesting that such policies substantiate employers’ ‘duty of care’ obligations, prevent procedural uncertainty, demonstrate commitment to safety and education, and facilitate ‘peer support’ that potentially positively informs workplace behaviour and culture. It has been suggested that workplaces should develop policies on a collaborative and consultative basis and they should be clearly communicated to all staff once developed. C. Intervention papers a. Health promotion programs Rather than being specifically, or uniquely, concerned with minimising the impact of harms associated with alcohol consumption, health promotion programs are more broadly concerned with improving or promoting the general ‘health’ and ‘wellbeing’ of the workforce through education aimed at behavioural change, risk or harm prevention, and changes to the workplace environment. Although there is much ‘promising work’ and some clear guidance, quality evidence about effective health promotions to prevent and reduce alcohol-related harm in the workplace is limited. Where supporting evidence is available, one common theme appears to be the use of brief intervention approaches that have been clearly demonstrated to have an impact in other settings. b. Employee assistance programs Employee assistance programs (EAPs) have primarily involved the assessment and identification of employees with alcohol-related problems and their referral to treatment. Although EAPs are among the most commonly used strategies in Australia, and overseas, to reduce alcohol problems in the workplace, these programs are seldom evaluated, and little is known about their effectiveness. Many studies have indicated that a large proportion of EAP attendees are self-referrals, so perhaps the key element should be an approach that gives employees in need greater access to a service in an environment where they spend much of their waking life: at work. c. Alcohol testing Drug and alcohol testing in the workplace is a complex and contentious issue. However, testing for alcohol alone is less contentious, particularly in safety-sensitive jobs – alcohol testing directly assesses breath/alcohol levels and these levels have been associated with given risk of impairment. However, the evidence base remains scant. In recent years, some employers have adopted an approach that incorporates the opportunity to self-test along with random testing and for-cause testing. For example, an employee will have access to hand-held breath-testing machines. If they privately test themselves and record a positive, they simply report sick. Usual procedures for sick leave are employed (e.g. frequent regular sick leave will be investigated and/or require a medical certificate). Although the approach seems to have some merit, no analysis has been reported. d. Web-based interventions Recent research (typically well-conducted, randomised controlled trials) all points to the potential effectiveness of web-based technology for improving health outcomes in the workplace. Interestingly, it is consistent with research in other settings (e.g. university students or as part of a general health intervention) that web-based brief interventions are acceptable, have good penetration into target groups, and have an impact on drinking behaviour. It is important to note that the impact on drinking is small and generalisability across workplaces is unclear. e. Other interventions A review of ‘other interventions’ found that carefully targeted resources, developed in consultation and with support, appear to have impact. ‘New’ systems of intervention delivery (web-based approaches) appear to be acceptable, even attractive, and have reasonable penetration into the workforces where they have been trialled. When they are coupled with evidence-based brief interventions, they appear to have some impact. f. Kits Various kits have been developed to assist employers and employees to develop effective responses. Typically these are not evaluated, although a small evidence base does exist. It appears that various ‘kits’ have been used with varying levels of acceptance and success for promoting and implementing alcohol-related policies in the workplace. Conclusions Effective responses to alcohol-related harm in the workplace are likely to commence with the recognition that there is no single reason for risky alcohol use, no single alcohol problem and no single effective response. Many factors shape alcohol use and alcohol-related problems, and these include the availability of alcohol, the nature of work and the work culture, the pattern and context of alcohol use (in the broad community and at work) and individual characteristics. Individual, community and workplace factors increase and decrease risk. Responses to alcohol problems in the workplace will therefore need to be tailored and multifaceted. For example, approaches to prevent intoxication may be distinct from, but complement, those that aim to reduce absenteeism related to regular heavy use. Responding to problems in a remote area where work is safety-sensitive may have different characteristics to strategies used in a lower risk office environment. Given the consistent evidence about the important influence of alcohol access, it may be important to prioritise initial interventions to high-risk occupations and workplaces where alcohol is more readily available.
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Middling youth were centre stage in research on school-to-work transitions from the early-20th century up to and throughout the 1980s. Since then they have been overshadowed by sociological attention to the young unemployed/NEETs on the one side, and university students and graduates on the other. Simultaneously, economists have been crowding out sociologists in the study of education-to-work transitions, especially in the middle ground. However, this paper argues that this is not just a case of the sociological gaze missing the middle. It is argued that old middling labour market destinations have diminished in number, and the new middle remains elusive because the employment tends to be precarious. Thus today's middling groups of school-leavers must either try to move-up or face career-long threats of descent to the bottom.
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In 1989, 3M developed a comprehensive alcohol and other drug prevention program using multiple and interactive strategies aimed at altering workplace culture and promoting employee "ownership" of the program. The three core components of the program included a ten-hour supervisory training program; a 2-1/2 hour all-employee program designed to discuss 3M policies, clarify personal alcohol-use guidelines, and promote dialogue about appropriate responses to and responsibility for a range of alcohol and other drug issues both inside and outside the work environment; and a peer helper program. The program was piloted in 1990 and 1991 in a manufacturing plant in a small midwestern community. An evaluation study comparing change in experimental and control sites demonstrated reduced alcohol consumption, improvement in employee and supervisor prevention skills, and a decrease in incidents in which substance use negatively affected work performance. Plans are in process to refine and then replicate the program in 70 manufacturing sites over a three-year period.
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