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A recipe for good mental health: A pilot randomised controlled trial of a psychological wellbeing and substance use intervention targeting young chefs

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Aims: Workforce entry is a key transition period. It offers an ideal, but under-utilised opportunity to implement intervention strategies to prevent mental health and substance use problems among young people. A brief psychological wellbeing and substance use intervention targeting a high-risk group – apprentice chefs – was undertaken to explore this opportunity. Method: A RCT design (N = 71) was used. The intervention group received two face-to-face sessions, and controls received five related information sheets during the first 2 weeks of training, with 4-month follow-up. Results: These apprentices were a high-risk group for alcohol and other drug harm and poor psychological wellbeing. At T1, 70% of the participants had AUDIT scores indicating problem drinking; 28% had used cannabis and 18% had used amphetamines in the last 12 months; and 24% had high K10 scores. At T2, the intervention group had significantly reduced risky alcohol use (p = 0.008), improved psychological distress (p = 0.045) and ability to talk with supervisors about work issues (p = 0.001) and cope with work stress (p = 0.001) and verbal abuse (p = 0.005), compared to the control group. Conclusions: Brief tailored interventions, delivered in an occupational training environment, have potential to reduce substance use risk and enhance young workers’ psychological wellbeing.
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ISSN: 0968-7637 (print), 1465-3370 (electronic)
Drugs Educ Prev Pol, Early Online: 1–10
!2015 Informa UK Ltd. DOI: 10.3109/09687637.2015.1016400
A recipe for good mental health: A pilot randomised controlled trial of
a psychological wellbeing and substance use intervention targeting
young chefs
Ken Pidd, Ann Roche, and Jane Fischer
National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
Abstract
Aims: Workforce entry is a key transition period. It offers an ideal, but under-utilised opportunity
to implement intervention strategies to prevent mental health and substance use problems
among young people. A brief psychological wellbeing and substance use intervention
targeting a high-risk group – apprentice chefs – was undertaken to explore this opportunity.
Method: A RCT design (N¼71) was used. The intervention group received two face-to-face
sessions, and controls received five related information sheets during the first 2 weeks of
training, with 4-month follow-up. Results: These apprentices were a high-risk group for alcohol
and other drug harm and poor psychological wellbeing. At T1, 70% of the participants had
AUDIT scores indicating problem drinking; 28% had used cannabis and 18% had used
amphetamines in the last 12 months; and 24% had high K10 scores. At T2, the intervention
group had significantly reduced risky alcohol use (p¼0.008), improved psychological distress
(p¼0.045) and ability to talk with supervisors about work issues (p¼0.001) and cope with work
stress (p¼0.001) and verbal abuse (p¼0.005), compared to the control group. Conclusions:
Brief tailored interventions, delivered in an occupational training environment, have potential
to reduce substance use risk and enhance young workers’ psychological wellbeing.
Keywords
Alcohol and other drug use, cannabis,
intervention, randomised controlled trial,
workplace, young people
History
Received 26 October 2014
Revised 2 February 2015
Accepted 3 February 2015
Published online 16 March 2015
Introduction
Background
There is growing interest in the workplace as a setting to
improve mental health (MH) and prevent harmful alcohol and
other drug (AOD) use (Ames & Bennett, 2011; ANPHA,
2013; Harvey et al., 2014; OECD, 2012). In part this is due
to recognition of the economic costs associated with lost
productivity. Annual lost productivity costs are estimated
at $AU5.9 billion (Hilton, Scuffham, Vecchio, & Whiteford,
2010) and $US193.2 billion (Insel, 2008) due to poor MH,
and $AU3.6 billion (Collins & Lapsley, 2008) and $US161.3
billion due to alcohol use (Bouchery, Harwood, Sacks, Simon,
& Brewer, 2011) in Australia and the US, respectively.
Productivity concerns aside, the workplace is an important
setting in which to address MH and AOD issues for a range of
other reasons. Employment can promote MH by providing
regular activity, time structure, social contact, a sense of
collective effort and social identity (Warr, 1987). However,
the workplace can also be a source of psychological stress that
can negatively affect employee MH (Bonde, 2008).
Psychosocial features of the workplace such as decision
latitude, psychological demands, social support, bullying and
harassment are important determinants of employee MH
(Niedhammer, Chastang, Sultan-Taieb, Vermeylen, & Parent-
Thirion, 2013; Stansfeld & Candy, 2006).
The workplace environment can also influence employee
AOD consumption patterns (Frone, 2013; Pidd & Roche,
2008). Factors such as work stress, physical availability of
AOD and co-worker AOD norms all play a role in shaping
employees’ behaviours and beliefs concerning AOD use
(Frone, 2013; Pidd & Roche, 2008). Modifying workplace
factors that contribute to poor MH or harmful AOD use or
providing employees with the skills to deal with these
factors may substantially reduce associated economic and
social costs.
The workplace offers potential as an intervention and
prevention setting. It provides ready access to large numbers
of individuals and contains existing infrastructure and
frameworks that could support strategies to enhance MH
and prevent AOD related harm. Such strategies are likely to
receive substantial employer support given the economic
impost borne by the workplace. Moreover, the workplace
offers the opportunity to develop tailored strategies to target
specific high-risk workforce groups.
High-risk workforce groups
One workforce group at risk of poor MH- and AOD-related harm
is the commercial cookery sector of the hospitality industry.
Correspondence: Dr Ken Pidd, National Centre for Education and
Training on Addiction, Flinders University, Level 3b Mark Oliphant
Building, Laffer drive, Bedford Park, Adelaide, Australia. E-mail:
ken.pidd@flinders.edu.au
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Commercial cookery involves working in kitchens located
within restaurants, hotels, clubs, cafes and catering organ-
isations. Commercial cookery can be particularly challen-
ging, involving long working hours, hot, and hard work,
often for low pay (Pratten, 2003). Moreover, poor physical
conditions, strict kitchen rules and high-pressure work
environments (Pratten & O’Leary, 2007) are associated
with commercial cookery. Occupational stress levels of chefs
have been found to be markedly higher than for most other
professions (Murray-Gibbons & Gibbons, 2007), while
workplace harassment and bullying are relatively common
in commercial kitchens (Alexander, MacLaren, O’Gorman,
& Taheri, 2012; Bloisi & Hoel, 2008; Mathisen, Einarsen, &
Mykletun, 2008; Roche, Pidd, & Kostadinov, 2014).
High prevalence of AOD use is also associated with
commercial cookery (Belhassen & Shani, 2012; Moore,
Ames, Duke, & Cunradi, 2012; Moore, Cunradi, Duke, &
Ames, 2009; Norstrom, Sundin, Muller, & Leifman, 2012;
Pidd, Roche, Fischer, & McCarthy, 2014; Zhu, Tews,
Stafford, & George, 2011). Commercial cookery employees’
AOD use can be a work stress coping strategy (Murray-
Gibbons & Gibbons, 2007), or can be influenced by
co-worker norms (Duke, Ames, Moore, & Cunradi, 2013;
Kjaerheim, Mykletun, Aasland, Haldorsen, & Andersen,
1995) and AOD availability (Zhu et al., 2011).
Young commercial cookery employees may be especially
susceptible to psychological and AOD-related harm. Young
commercial cookery workers have particularly high-
prevalence levels of AOD use (Moore et al., 2009; Pidd,
Roche, Fischer, et al., 2014). Adolescents and young adults in
general are an identified risk group for AOD-related harm with
increased vulnerability evident during the school-to-work
transition period (McMorris & Uggen, 2000; White et al.,
2006). Risky AOD use is more prevalent among workers under
25 years of age compared to older workers (Berry, Pidd, Roche,
& Harrison, 2007; Caban-Martinez et al., 2011; Laberge &
Ledoux, 2011; Pidd, Roche, & Buisman-Pijlman, 2011; Roche,
Pidd, Bywood, & Freeman, 2008).
Work stress, bullying and harassment can also have severe
negative consequences for young workers’ physical and
psychological wellbeing (Hoel & Einarsen, 2003; Melchior
et al., 2007). Within commercial kitchens, younger workers
are more likely than older workers to be subjected to
workplace bullying (Alexander et al., 2012), and commercial
kitchen work stressors may be important predictors of AOD
use among younger employees. Young workers appear to be
more susceptible to work stress (Reicherts & Pihet, 2000), and
work stress is associated with young workers’ AOD use
(Wiesner, Windle, & Freeman, 2005), with bullying identified
as an independent predictor of young people’s alcohol use
(Rospenda, Richman, Wolff, & Burke, 2013). Risky AOD
use, combined with workplace stress and bullying, can have
severe negative consequences for a young worker’s physical
and psychological health and wellbeing (Bartlett & Bartlett,
2011; Pienaar & Willemse, 2008).
Strategies to improve the health and wellbeing of young
workers undergoing occupational training in commercial
cookery may have important organisational and industry
implications. Many new entrants to this occupation are
unaware of, and unprepared for, the challenges involved in
professional cookery and large proportions do not complete
their studies (Pratten, 2003). Approximately 30% of
Australian commercial cookery trainees dropout during or
just after their first year of training, representing one of the
lowest apprenticeship completion rates of any occupational
group (NCVER, 2012). Health and wellbeing strategies may
improve training and subsequent industry retention rates.
The potential risk of AOD and psychological harm to
young commercial cookery workers make harm prevention
strategies a priority. However, few strategies have specifically
targeted this high-risk group. To-date it appears that only one
targeted intervention, Team Resilience, has been developed.
This is a commercially available 7-h U.S. program that aims
to build the resilience of young restaurant workers to deal
with workplace risks concerning alcohol use and stress
(Bennett, Aden, Broome, Mitchell, & Rigdon, 2010). While
this program has been shown to reduce heavy drinking
(Broome & Bennett, 2011) and stress levels (Petree, Broome,
& Bennett, 2012), it involves substantial time and financial
commitments potentially beyond the resources of Australian
Technical and Further Education (TAFE) colleges and private
training organisations. In order to address this issue, a pilot
study of a brief harm prevention strategy tailored to meet the
needs of young Australian workers undergoing occupational
training was undertaken.
Method
Intervention development
The intervention was informed by a preliminary qualitative
study comprising focus groups with second year apprentice
chefs (N¼69) and key informant (trainers and employers)
interviews (N¼7) (Pidd & Roche, 2013). This study
confirmed high levels of AOD use, workplace stress, verbal
abuse and bullying (Pidd, Roche, & Kostadinov, 2014; Roche
et al., 2014). Drinking and cannabis use after work were
common stress reduction strategies, with a minority of
workers using amphetamines to deal with workplace pressure
and fatigue (Pidd, Roche, & Kostadinov, 2014). Workplace
social networks appeared influential in determining AOD
consumption patterns at, and away from, the workplace (Pidd,
Roche, & Kostadinov, 2014). High levels of work stress were
largely accepted as a normal part of working in a commercial
kitchen, while verbal abuse and bullying were normalised as a
legitimate part of on-the-job training (Roche et al., 2014).
Most apprentices also believed that commercial cookery
provides many positive benefits and opportunities, and
indicates strong commitment to a career as a chef (Pidd &
Roche, 2013).
This initial qualitative research indicated that psychosocial
skills training to improve stress management, workplace
communication and work-related AOD problem solving skills
were most needed (Pidd & Roche, 2013). Psychosocial
interventions typically cover problem solving, goal setting,
social skills training and coping strategies that target
individual beliefs, behaviours and relevant social contexts.
Workplace psychosocial skills training has been shown to be
effective in reducing risky alcohol use in government
(Bennett, Patterson, Reynolds, Wiitala, & Lehman, 2004)
and administration (Snow, Swan, & Wilton, 2003), work
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settings and work-related stress in a variety of work settings
including administration, education, policing and health
(Czabala, Charzynska, & Mroziak, 2011; van der Klink,
Blonk, Schene, & van Dijk, 2001). Evidence also indicates
that even relatively brief psychosocial interventions targeting
alcohol (Cook, Hersch, Back, & McPherson, 2004) and work
stress (Shimazu, Umanodan, & Schaufeli, 2006) are effective
in workplace settings.
The intervention comprised two training modules deliv-
ered in two sessions (1 2 h and 1 1 h) over a 2-week
period. The first focused on enhancing coping and commu-
nication skills, and the second focused on understanding and
reducing risk of AOD-related harm (Table 1). Our initial
qualitative research indicated that work stress and bullying
were commonplace and that many workers had adopted
coping strategies that involved AOD use. To address this, the
intervention included practical exercises to assess individual
stress levels and practice alternative stress reduction tech-
niques. Talking to family, friends, co-workers and supervisors
about work-related issues were also identified by our research
as important coping strategies adopted by the more resilient
apprentices who participated in the focus groups. Thus, the
intervention also included practical exercises to improve
communication skills.
The initial research also found that trainees were largely
unaware of the relationship between working conditions and
AOD use. Thus, the intervention addressed workplace factors
that contribute to harmful AOD use and implications for
workplace safety and career progression. An AOD decision
making exercise was also included as decisions to engage in
risky behaviours can be influenced by affective motivators
such as anticipatory regret (Caffray & Schneider, 2000;
Schneider & Caffray, 2012). Given that the focus group
findings indicated only a small minority used amphetamines,
the decision making exercises focused on alcohol and
cannabis use.
The intervention was designed to be implemented within
the training classroom during normal training times.
Occupational training environments have unique potential as
harm prevention settings. They provide access to large
numbers of young workers employed across a range of
different workplaces, industries and occupations, and the
intervention may have more acceptances if delivered as part
of the occupational training curricula. Psychosocial skills
training that is relevant to the workplace environment and
delivered as part of occupational training is more likely to
transfer to the workplace, especially for those trainees who
strongly identify, or are committed to, their job (Burke &
Hutchins, 2007; Pidd, 2004). Moreover, psychosocial skills
training delivered in the occupational training setting may
produce results that are sustained over the long term. For
many young people, the beginning of an occupational career
is an important and distinct period of identity formation and
involves the establishment of long-term attitudes and behav-
iours, including those related to AOD use and MH (Arnett,
2000). Hence, it represents a key ‘‘teachable moment.’’
Participants and study design
The study involved a randomised control trial with a 4-month
follow up. Participants were commercial cookery trainees and
were enrolled at TAFE colleges located in a large Australian
city. All were undertaking a 3-year training course and
participated in the study at the beginning of their first year of
training. These trainees attended training 1 day per week at
TAFE college premises and worked full time as apprentice
chefs 4 days per week. To minimise the risk of contamination,
two TAFE colleges located 15 km apart were selected for the
study. These two TAFE colleges were invited to participate as
they were the largest providers of commercial cookery
training in the state. Trainees located at one TAFE were
allocated to the intervention group, and trainees located at the
other TAFE were allocated to the control group. Trainees
were informed of the study by TAFE lecturers and researchers
in TAFE classrooms during normal training times in the first
week of semester one. Researchers explained the project to
the trainees and provided all potential participants with an
information sheet about the study. Participants were blinded
to the study purpose and allocation, with the study being
presented as a survey concerning worker wellbeing.
Participation was voluntary, and non-participants were
assigned to another classroom. Written consent was obtained
from participants. Ethical approval for the study was provided
by the Social and Behavioural Research Ethics Committee,
Flinders University.
Procedure
Prior to the intervention, all participants completed an
anonymous survey (T1) to collect pre-intervention baseline
data. Control group participants received AOD and workplace
bullying information sheets, but no other input. Intervention
group participants received the same information sheets,
Table 1. Intervention topics and content.
Module Topic Topic content
1 Stress management Recognising and dealing with workplace abuse and bullying
Recognising the signs of stress
Assessing your stress level and coping style
Understanding and practicing stress management techniques
Workplace communication Understanding submissive, aggressive and assertive behaviour
Verbal and non-verbal aspects of submissive, aggressive and assertive behaviour
Understanding and practising ‘I’ statements
2 Alcohol and drug related harm Levels of AOD use in commercial cookery
Recognising and dealing with workplace conditions associated with AOD use
Recognising potential health, safety and career implications of risky AOD use
Making decisions about cannabis and alcohol use
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plus the face-to-face intervention. All participants were
administered a second anonymous survey (T2) to collect
post-intervention data 4 months following intervention
delivery.
Measures
The pre-intervention survey included measures of age, gender,
living arrangements, previous work experience, previous
work experience in commercial cookery, past academic
performance, alcohol and drug use, and a number of health
and wellbeing measures.
AOD use
Alcohol use was assessed using the three-item Alcohol Use
Disorder Identification Test (AUDIT-C) (Bush, Kivlahan,
McDonell, Fihn, & Bradley, 1998). A score of four or more is
considered positive for at risk drinking or active alcohol abuse
or dependence. AUDIT-C items also allowed for a measure of
drinking quantity (usually drink less than 4 or less standard
drinks; usually drink more than 4 standard drinks) and
drinking frequency (weekly or more often; less than weekly).
Cannabis and amphetamine use in the last 12 months and the
last month were each assessed using single item frequency
measures.
AOD attitude
Attitudes toward alcohol use at work, cannabis use at work
and amphetamine use at work were each assessed with a
single item measure of approval or disapproval using a five-
item response scale (strongly approve, approve, neither
approve nor disapprove, disapprove and strongly disapprove).
Social support
Two subscales of the MOSS Social Support Scale, emotional/
informational support (8 items) and positive social interaction
(3 items) measured perceived general functional social support
(Sherbourne & Stewart, 1991). Response categories on a five-
point scale were: always; most of the time; some of the time; a
little of the time; and never. Subscale scores were derived by
determining the mean of the sum of items 1 to 8 and 9 to 11,
respectively. A total social support score was determined by
calculating the mean of the sum of the two subscale scores.
High scores indicate high levels of social support.
Psychological distress
The Kessler Psychological Distress Scale (K10) is a 10-item
measure of psychological distress that can detect clinical
symptoms during the most recent 4-week period (Kessler
et al., 2002). Response categories were scored on a five-point
scale scored from one to five and added together to give a
total score. Scores of 22 or more indicate high (22–29) and
very high (429) levels of psychological distress (Australian
Bureau of Statistics, 2012).
Life satisfaction
The Satisfaction With Life Scale (SWLS) is a 5-item measure
of satisfaction with life as a whole (Pavot & Diener, 1993) that
uses a seven-point response scale (strongly agree; agree;
slightly agree; neither agree nor disagree; slightly disagree;
disagree; and strongly disagree). The five items provided a
life satisfaction score ranging from 5 to 35. Higher scores
indicated higher levels of satisfaction.
The pre-intervention survey also contained a single item
self-assessed health rating (poor, fair, good, very good and
excellent) and a single item self-assessed quality of life rating
(very poor, poor, neither poor nor good, good and very good).
Single item measures of self-assessed health have been shown
to significantly correlate with objective measures of health
(Wu et al., 2013) and single item measures of quality of life
significantly correlate with multi-item measures (Cunny &
Perri, 1991). High scores for each measure indicate good
health and good quality of life, respectively.
The post-intervention survey (T2) also contained six single
item self-assessed measures of participants’ perceptions of the
extent to which their ability to: (1) talk with their supervisor/
boss, co-workers, and family or friends about issues/problems
at work and (2) cope or deal with work stress, yelling or
verbal abuse at work, and bullying or harassment at work had
improved over the last 4 months (none, a bit, a lot).
Data analysis
Data were analysed using SPSS Statistics Version 19.
Independent sample ttests were conducted to compare
between group (control and intervention) differences in
continuous variables at T1 and T2, while paired sample t
tests were conducted to examine within group differences in
continuous variables from T1 to T2. ANCOVAs were then
conducted to examine intervention effects on T2 continuous
variables while controlling for observed differences between
groups at T1. Statistically significant between group differ-
ences in categorical variables were determined using
Pearson’s Chi-square and Fisher’s exact test (in the cases of
cell sizes 55). Statistically significant within group differ-
ences in categorical variables were determined using uncor-
rected McNemar’s test and Wilcoxon signed rank test
(Camilli & Hopkins, 1978, 1979; Thompson, 1988). Where
appropriate, Bonferroni corrections for multiple comparisons
were made.
Results
Sample size calculations indicated that a sample of 64 control
and 64 intervention group participants would be required to
provide statistical power greater than 0.8 to detect an effect
size of 0.10. Due to circumstances beyond the researchers’
control, only 71 trainees completed the T1 survey (interven-
tion group n¼44; control group n¼27) and 50 (intervention
group n¼30; control group n¼20) completed the T2 survey
(an attrition rate of 30%). There were no significant T1
differences in demographic, wellbeing, or alcohol and drug
variables between those who dropped out and those who
remained in the study. Data analyses were restricted to
participants who completed both T1 and T2 surveys.
At T1, the majority of participants (53%) were male, aged
24 years or less (72%). The majority (52%) lived at home with
their family, while the remainder lived with their partner
(28%) or with flat/house mates (20%). Most (90%) had
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previous work experience and 50% had previous work
experience in commercial cookery. Less than half (40%)
rated their past academic performance as above average.
There were no significant T1 differences between the control
and intervention groups for these variables (Table 2).
Alcohol and drug use
At T1, total sample AUDIT-C scores ranged from 0 to 11
(M¼5.2, SD ¼3.21), 70% had AUDIT-C scores of 4 or more
and 32% approved of, or were ambivalent about, drinking at
work. More than a third (38%) usually drank more than four
drinks when they drank, 52% drank weekly or more often and
14% did not drink (Table 3). One in four (28%) had used
cannabis and 18% amphetamines at least once in the past 12
months, while 22% had used cannabis and 8.3% amphet-
amines at least once in the past month. Approximately, a third
(36%) believed that cannabis was a harmless drug, 26% either
approved of or were ambivalent about cannabis use at work
and 24% either approved of or were ambivalent about
amphetamine use at work.
Wellbeing
At T1, most participants (90%) rated their health as good,
very good or excellent, and 92% rated their quality of life as
good or very good. Social support scores ranged from 2 to 5
(M¼4.17, SD ¼0.74) indicating high levels of social support
(emotional support M¼3.99, SD ¼0.83; social interaction
M¼4.36, SD ¼0.80). Life satisfaction scores ranged from
13 to 35 (M¼23.88, SD ¼5.84) indicating high levels
of satisfaction. K10 scores ranged from 10 to 38
(M¼18.18, SD ¼6.45) indicating moderate levels of psy-
chological distress. However, 20% of participants
reported K10 scores ranging from 22 to 29, indicating high
levels of distress, and 4% reported scores of 429 indicating
very high levels of distress (Australian Bureau of Statistics,
2012). There were no significant differences in AOD or
wellbeing measures between the control or intervention
groups at T1.
Communication and coping skills (between group
differences)
At T2, there were significant between group differences in
communication and coping skills. Compared to the control
group, a significantly larger (p¼0.001) proportion of inter-
vention group participants reported that in the past 4 months
their ability to talk with their supervisor had improved
(Table 3). Compared to control group participants, a signifi-
cantly larger proportion of intervention group participants
reported their ability to deal with stress and cope with verbal
abuse had improved (p¼0.001 and p¼0.005, respectively)
Table 2. Total T1 sample (N¼50) demographics with intervention and control group differences.
Total sample Intervention Control Treatment versus control
%(n)%(n)%(n) Test statistic, pvalue
Gender
Male 36 (72.0) 76.7 (23) 65.0 (13) w
2
(1) ¼0.81, p¼0.368
Female 14 (28.0) 23.3 (7) 35.0 (7)
Age
18–24 years 29 (58.0) 63.3 (19) 50.0 (10) w
2
(1) ¼0.88, p¼0.349
424yrs 21 (42.0) 36.7 (11) 50.0 (10)
Living arrangements
Live with partner 14 (28.0) 26.7 (8) 30.0 (6) w
2
(2) ¼2.13, p¼0.346
Live with flat/house mates 10 (20) 26.7 (8) 10.0 (2)
Live at home 26 (52.0) 46.7 (14) 60.0 (12)
Previous work experience
Yes 45 (90.0) 86.7 (26) 95.0 (19) p¼0.636
a
No 5 (10.0) 13.3 (4) 5.0 (1)
Previously worked in commercial cookery
Yes 25 (50.0) 50.0 (15) 50.0 (10) w
2
(1) ¼0.00, p¼1.00
No 25 (50.0) 50.0 (15) 50.0 (10)
Past academic performance
Above average 20 (40.0) 33.3 (10) 50.0 (10) w
2
(2) ¼1.52, p¼0.467
Average 26 (52.0) 56.7 (17) 45.0 (9)
Below average 4 (8.0) 10.0 (3) 5.0 (1)
a
Fisher’s exact test (cell size55).
Table 3. Intervention and control group T2 differences in perceptions of improved communication and coping ability.
Intervention Control Treatment versus control
%(n)%(n) Test statistic, pvalue
Improved ability to talk with supervisor 82.8 (24) 35.0 (7) x
2
(1) ¼11.62, p¼0.001
Improved ability to talk with co-worker 58.6 (17) 36.8 (7) w
2
(1) ¼2.18, p¼0.140
Improved ability to talk with family/friends 30.0 (9) 10.5 (2) p¼0.165
a
Improved ability to deal with stress 70.0 (21) 21.1 (4) x
2
(1) ¼11.15, p¼0.001
Improved ability to cope with verbal abuse 56.7 (17) 15.8 (3) x
2
(1) ¼8.05, p¼0.005
Improved ability to cope with bullying 27.6 (8) 15.8 (3) p¼0.488
a
Bold is significant at 50.05 level.
a
Fishers’s exact test (cell size55).
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(Table 3). Bonferroni correction for multiple comparisons
(6 communication measures) adjusted the 0.05 significance
level to 0.0083, indicating that ability to talk with their
supervisor and ability to deal with stress and cope with verbal
abuse had significantly improved.
Wellbeing and AOD measures (between group
differences)
Controlling for between group differences in K10 at T1, an
ANCOVA indicated a significant intervention effect, F¼4.38
(49, 1), p¼0.042, accounting for 8.5% of the variance in T2
levels of psychological distress. At T2, a significantly larger
(p¼0.008) proportion of control group participants (61.1%)
usually drank more than four drinks compared to intervention
participants (20.8%). Bonferroni correction for multiple
comparisons (3 alcohol behaviour measures) adjusted the
0.05 significance level to 0.01, indicating group differences in
usually drinking more than four drinks remained significant.
There were no other significant differences for AOD or
wellbeing measures between the intervention and control
groups at T1 or T2 (Tables 4 and 5).
Wellbeing and AOD measures (within group
differences)
Significant within group differences from T1 to T2 were
observed. For both the control and intervention group, there
was a significant decline in mean social support scores
(t¼2.28 p¼0.03 and t¼2.72 p¼0.013, respectively). For
the control group, there was a significant (w
2
(1) ¼5.00
p¼0.025) increase in the proportion of participants who
had used cannabis in the past month from T1 (10%) to T2
(35%). For the intervention group, there was a significant
decline (t¼2.07 p¼0.048) in mean K10 scores from T1 to
T2, and a significant (w
2
(1) ¼4.00 p¼0.045) decline in the
proportion of participants who usually drank more than four
drinks from T1 (36%) to T2 (20.8%). A significant
(w
2
(1) ¼5.45 p¼0.019) increase in the proportion of inter-
vention participants who disapproved of cannabis use at work
from T1 (66.7%) to T2 (90%) was also observed. Bonferroni
correction for multiple comparisons adjusted the 0.05
significance level to 0.01, indicating this result may be
subject to type 1 error. There were no other significant within
group differences for AOD or wellbeing measures from T1 to
T2 (Tables 4 and 5).
Discussion
The aim of the current study was to evaluate the effectiveness
of a brief intervention designed to reduce risky AOD use and
improve the psychological wellbeing of young workers
employed in commercial cookery. Pre-intervention baseline
measures confirmed that these young workers are a high-risk
group for AOD harm and psychological distress. Nearly three-
quarters of those who participated in this study reported pre-
intervention AUDIT-C scores indicative of problem drinking
and nearly a third approved of, or were ambivalent about,
drinking at work. Around one in four had used cannabis in the
last month and approved of, or were ambivalent about,
cannabis use at work, and nearly one in four reported
K10 scores indicative of high or very high levels of
psychological distress. These levels are substantially higher
than age-matched Australian population data (Australian
Institute of Health and Welfare, 2011).
The intervention, which was designed to reduce risky AOD
use and improve the psychological wellbeing of young
workers by (1) increasing their understanding of workplace
influences on AOD use and health, safety and career
implications of use and (2) enhancing their stress-related
coping and workplace communication skills, was found to
have a significant effect on psychological distress levels.
Controlling for pre-intervention differences between groups,
the intervention group reported a significant decline in mean
K10 scores, with no significant change in mean K10 scores
for the control group. Moreover, those exposed to the
intervention were significantly more likely than those not
exposed to report that their ability to talk with their supervisor
about work issues and their ability to deal with stress and cope
with verbal abuse had improved.
Reductions in psychological distress among those exposed
to the intervention occurred despite a significant decline in
levels of social support for both the control and intervention
groups. A decline in social support is not unexpected in this
group given the disruptions to established family and social
networks that occur due to ‘‘unsocial’’ work hours required of
chefs. Social support plays an important role in maintaining
psychological wellbeing (Kawachi & Berkman, 2001) and the
observed decline in levels of social support may explain the
non-significant rise in mean K10 scores for the control group.
By contrast, the significant reduction in K10 scores among
the intervention group may indicate that the intervention not
only compensated for the significant decline in levels of social
support, but had an additional beneficial effect on psycho-
logical distress.
Results also indicated that the intervention had a signifi-
cant effect on some AOD behaviours. Compared to the
control group, a significantly smaller proportion of interven-
tion group participants usually drank more than four drinks
post-intervention, with the proportion of intervention group
participants who usually drank four drinks declining signifi-
cantly from pre- to post-intervention. There was also a
significant pre- and post-intervention increase in the propor-
tion of control group participants who had used cannabis in
the past month, indicating that the intervention may have
prevented increases in cannabis use.
There are several potential explanations as to why the
intervention had no effect for other AOD behaviours and
attitudes. First, the majority of participants had previous
work experience with around half having worked in the
hospitality industry. Research indicates that workplace
norms regarding AOD use have an important influence
on the formation and maintenance of the AOD behaviours
and attitudes of workers in general (Ames, Duke, Moore, &
Cunradi, 2009; Ames, Grube, & Moore, 2000), including
hospitality industry workers (Duke et al., 2013; Moore
et al., 2012). Drug education programs, including those that
focus on social influence, may have limited impact on
individual AOD behaviour or attitude change when pre-
sented in a training setting isolated from the normal
workplace environment and not addressing the AOD
6K. Pidd et al. Drugs Educ Prev Pol, Early Online: 1–10
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For personal use only.
Table 4. Total T1 sample (N¼50) AOD measures with T1 and T2 between and within and group differences.
Intervention Control Treatment versus control T1 versus T2
Total sample T1 T2 T1 T2 T1 T2 Treatment Control
Mean (SD) Test statistic pvalue
AUDIT C score 5.3 (3.2) 4.9 (3.2) 4.4 (3.2) 5.7 (3.2) 5.5 (3.6) t(48) ¼0.81, p¼0.424 t(48) ¼1.09, p¼0.283 t(29) ¼1.45, p¼0.158 t(19) ¼0.32, p¼0.751
%(n)
Problem drinking
AUDIT C score of 4 70.0 (35) 66.7 (20) 63.3 (19) 75.0 (15) 70.0 (14) w
2
(1) ¼0.40, p¼0.793 w
2
(1) ¼0.24, p¼0.626 w
2
(1) ¼0.20, p¼0.655 w
2
(1) ¼0.33, p¼0.564
Frequency of drinking
Weekly or more often 52.0 (26) 53.8 (14) 69.6 (16) 70.6 (12) 52.9 (9) w
2
(1) ¼1.21, p¼0.272 w
2
(1) ¼1.15, p¼0.283 w
2
(1) ¼0.50,p¼0.480 w
2
(1) ¼1.00, p¼0.317
Quantity of drinking
More than 4 drinks 38 (19) 36.0 (9) 20.8 (5) 55.6 (10) 61.1 (11) w
2
(1) ¼1.62, p¼0.203 x
2
(1) ¼7.07, p¼0.008 x
2
(1) ¼4.00,p¼0.045 w
2
(1) ¼1.00, p¼0.317
Attitude toward drinking at work
Disapprove 68.0 (34) 66.7 (20) 86.7 (26) 70.0 (14) 75.0 (15) w
2
(1) ¼0.61, p¼0.804 p¼0.454
a
w
2
(1) ¼1.80, p¼0.179 w
2
(1) ¼0.20, p¼0.645
Cannabis use last month
Yes 22.0 (11) 30.0 (9) 26.7 (8) 10.0 (2) 35.0 (7) p¼0.163
a
w
2
(1) ¼0.40, p¼0.529 w
2
(1) ¼0.33, p¼0.563 x
2
(1) ¼5.00, p¼0.025
Cannabis use at work attitude
Disapprove 74.0 (37) 66.7 (20) 90.0 (27) 85.0 (17) 84.2 (16) w
2
(1) ¼2.10, p¼0.148 p¼0.665
a
x
2
(1) ¼5.45, p¼0.019 w
2
(1) ¼0.33,p¼0.563
Amphetamine use last month
Yes 8 (4) 10.0 (3) 6.7 (2) 5.0 (1) 5.0 (1) p¼0.641
a
p¼0.998
a
w
2
(1) ¼0.33,p¼0.563 w
2
(1) ¼0.01, p¼0.795
Amphetamine use at work attitude
Disapprove 76 (38) 76.7 (23) 93.3 (28) 75.0 (15) 90.0 (18) w
2
(1) ¼0.18, p¼0.892 w
2
(1) ¼0.18, p¼0.670 w
2
(1) ¼2.77,p¼0.096 w
2
(1) ¼3.00, p¼0.089
Bold is significant at 50.05 level.
a
Fisher’s exact test (cell size 55).
Table 5. Total T1 sample (N¼50) wellbeing measures with T1 and T2 between and within and group differences.
Intervention Control Treatment versus control T1 versus T2
Total sample T1 T2 T1 T2 T1 T2 Treatment Control
Mean (SD) Test statistic pvalue
Social support 4.17 (0.74) 4.1 (0.8) 3.8 (0.9) 4.26 (0.7) 3.8 (0.8) t(47) ¼0.69, p¼0.50 t(48) ¼0.11, p¼0.91 t(28) ¼2.28, p¼0.030 t(19) ¼2.72, p¼0.013
Life satisfaction 23.9 (5.8) 24.1 (5.4) 23.1 (6.5) 23.6 (6.6) 26.5 (6.4) t(48) ¼0.27, p¼0.785 t(48) ¼1.79, p¼0.079 t(29) ¼0.88, p¼0.385 t(19) ¼2.17, p¼0.043
Psychological distress K10 score 18.2 (6.5) 18.5 (6.5) 16.9 (4.8) 17.7 (6.5) 19.6 (9.0) t(48) ¼0.47, p¼0.64 t(48) ¼1.35, p¼0.18 t(29) ¼2.07, p¼0.048 t(19) ¼1.15, p¼0.264
%(n)
Psychological distress K10 score 4
22 24.0 (12) 26.7 (8) 13.3 (4) 22.0 (4) 15.0 (3) w
2
(2) ¼0.29, p¼0.589 w
2
(2) ¼0.03, p¼0.868 x
2
(2) ¼4.00, p¼0.045 w
2
(2) ¼0.33, p¼0.564
Health rating
Excellent/very good 50.0 (25) 50.0 (15) 50.0 (15) 50.0 (10) 60.0 (12) w
2
(2) ¼0.91, p¼0.341 w
2
(2) ¼0.88, p¼0.350 Z¼0.98, p¼0.329
a
Z¼1.32, p¼0.180
a
Good 40.0 (20) 43.3 (13) 30.0 (9) 35.0 (7) 30.0 (9)
Poor/very poor 10.0 (10) 6.7 (2) 20.0 (6) 15.0 (3) 10.0 (2)
Quality of life
Good/very good 36.0 (18) 36.7 (11) 83.3 (25) 35.0 (7) 90.0 (18) w
2
(2) ¼0.18, p¼0.673 w
2
(1) ¼0.43, p¼0.510 Z¼1.67, p¼0.096
a
Z¼0.71, p¼0.480
a
Neither good nor poor 56.0 (28) 56.7 (17) 16.7 (5) 55.0 (11) 10.0 (2)
Poor/very poor 8.0 (4) 6.7 (2) 0.0 (0) 10.0 (3) 0.0 (0)
Bold is significant at 50.05 level.
a
Wilcoxon signed rank test.
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For personal use only.
behaviours and attitudes of other workers within that
environment. On the other hand, potential effects of the
intervention on AOD behaviours and attitudes may be
delayed. Previous research indicates that work stress also
plays an important role in the AOD use of workers (Frone,
2008; Marchand, 2008) including chefs (Murray-Gibbons &
Gibbons, 2007), and commercial kitchens are stressful
working environments (Hoel & Einarsen, 2003). The
current intervention focused on building the capacity of
young workers to deal with stress by enhancing their
coping, communication and stress management skills, the
latter as an alternative to AOD. While these components of
the intervention appeared to have an immediate effect on
reducing stress levels in the 4 months following interven-
tion exposure, any effect on AOD use may be delayed until
these newly adopted strategies and skills become well-
practiced normative behaviours.
Another possible explanation is that the study sample size
was insufficient to detect any intervention effect. Original
sample size calculations indicated that a sample of 64 control
and 64 intervention group participants would be required to
provide adequate statistical power. However, substantially
fewer participants were recruited to the study and an attrition
rate of approximately 30%, while consistent with TAFE
training attrition rates (NCVER, 2012), further compounded
sample size issues. Given that an intervention effect was
observed for the number of drinks usually consumed, a larger
sample size may have found intervention effects for other
AOD variables.
Limitations
Despite indicating the intervention had an effect on improving
psychological wellbeing, limitations to the study restrict
conclusions that can be drawn. First, the small sample size
may impact on the reliability of the results. Also, as the
sample was restricted to commercial cookery trainees, the
results may not be generalisable to vocational trainees
employed in other occupations and industries. Moreover, the
study was undertaken with commercial cookery trainees in
only two locations, and while these locations involved the
largest cookery training provider in the state, findings may not
generalise to trainees in other locations. In addition, post-
intervention outcomes were only measured at one point in
time, 4 months after exposure. Therefore, the results say little
about the longevity of observed intervention effects and
whether the intervention needs to be repeated over time to
maintain these effects. Finally, as changes in behaviour were
assessed by self-report, social desirability bias (Nederhof,
1985) may have played a role, especially for self-reports of
non-validated measures of improved communication and
coping skills.
While these are important limitations, the purpose of the
study was not to reach definitive conclusions regarding the
efficacy of the intervention. Rather, the purpose was to
evaluate the potential of an innovative intervention with the
view to undertaking a more extensive and comprehensive
study if the initial pilot study showed promise. In this regard,
the study achieved its purpose by demonstrating that even a
relatively brief intervention, specifically designed to meet the
needs and circumstances of the target group, can have an
impact on AOD risk and the psychological wellbeing of
young workers when delivered within a training environment
in a classroom setting.
Future research
The encouraging results of the current study indicate a need
for further research to examine and refine the intervention
utilising a larger and more representative sample size, and
follow participants over a longer period of time. Should such
research produce similar results to the current study, applic-
ability of similar brief interventions delivered in occupational
training environments to wider occupational, industry groups
and workplace settings should be examined. The results of
such research may indicate that the intervention not only has
a positive impact on individual psychological wellbeing and
risky AOD use, but also wider organisational and industry
benefits. Any intervention that improves young workers
wellbeing and enhances their resilience in dealing with
adverse working conditions is likely to also improve training
and ultimately occupational and industry retention rates.
Conclusion
The results of the current study indicate that brief intervention
strategies, specifically targeting young workers, can be
effective in improving psychological wellbeing and reducing
risk of AOD harm. The results also confirm that occupational
training environments have potential for the delivery of such
strategies.
Acknowledgements
The authors would like to thank all participants who gave
their time to participate in this research. Thanks are also owed
to Jane Fisher from NSW TAFE who helped to support this
project and Michael White for his assistance with resource
preparation and delivery.
Declaration of interest
This study was undertaken with financial support from the
National Cannabis Prevention and Information Centre and the
Australian Government Department of Health. The authors
have no conflict of interest to declare.
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... Support in the workplace is considered a positive factor for employees, whereas social support helps them to cope with workplace stress (Wadsworth & Owens, 2007). If an individual receives social support from their family, friends or peers and can get professional support from a colleague or a supervisor, their stress level is reduced and their resilience grows (Pidd, Roche & Fischer, 2015;Ariza-Montes et al., 2018). Ichiro Kawachi and Lisa F. Berkman (2001) conclude that social support stimulates the psychological well-being of individuals. ...
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Objectives: To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff. Search methods: We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research. Selection criteria: Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies). Data collection and analysis: Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. 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Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search. Authors' conclusions: Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.
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Trainee chefs beginning work for the first time are vulnerable to risky levels of alcohol and other drug (AOD) use. The present study explores the nature and extent of AOD use among this population, drivers of use, and correspondence with the stress, availability, social norms, and culture theories of employee substance use. Nine focus groups were conducted with trainee chefs from two Technical and Further Education (TAFE) colleges in New South Wales. Trainees' experiences of working in commercial cookery, working conditions, and AOD use were explored, and themes identified. Participants (N = 69) reported high levels of alcohol, illicit drug and tobacco use, but perceived this to be due to personal rather than work-related factors. Despite this, responses indicated that workplace factors did play a substantial role. In particular, work stress, social norms, and AOD accessibility contributed to a workplace culture that facilitated substance use. Results suggest that young chefs are heavily influenced by workplace norms regarding AOD use but seem to be largely unaware of the relationship between working conditions and alcohol and drug use. Interventions are required to raise trainees' awareness of this relationship, and to build their capacity to respond appropriately. Implications for prevention strategies are discussed.
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There is increasing concern about the challenging working conditions experienced by trainee chefs, and their high rates of early stage training attrition. Despite this, little research has examined trainees’ initial workplace experiences or strategies to address their wellbeing. This study explored young chefs’ experiences of work-related stress, working conditions, coping and resilience. Nine focus groups comprising 69 participants in total were conducted with second year trainee chefs from two Technical and Further Education (TAFE) colleges in New South Wales. Results were subjected to thematic analysis. Stressors, including long hours, low pay and bullying, were described as ubiquitous within commercial cookery. Less ambitious trainees and those without prior knowledge of industry working conditions were perceived to be more vulnerable to attrition and/or psychological injury. A typology was identified from emergent themes, and trainees categorised according to their level of resilience. Results provide a framework for early intervention strategies to improve young workers’ wellbeing. Keywords: hospitality, stress, bullying, resilience, training
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The workplace offers advantages as a setting for interventions that result in primary prevention of alcohol abuse. Such programs have the potential to reach broad audiences and populations that would otherwise not receive prevention programs and, thereby, benefit both the employee and employer. Researchers have implemented and evaluated a variety of workplace alcohol problem prevention efforts in recent years, including programs focused on health promotion, social health promotion, brief interventions, and changing the work environment. Although some studies reported significant reductions in alcohol use outcomes, additional research with a stronger and integrated methodological approach is needed. The field of workplace alcohol prevention also might benefit from a guiding framework, such as the one proposed in this article.