Determinants of alcohol preventive actions by managers: a cross-sectional study among Swedish managers

BackgroundUse of alcohol is a major public health issue, representing the 7th largest burden of disease in the world. Workplaces offer a unique arena for health initiatives addressing alcohol use, where occupational health services (OHS) personnel play an important role. However, we do not know if the extent of such initiatives may be influenced by personal drinking attitudes among OHS personnel. Thus, the aim of the study was to explore how drinking attitudes among OHS personnel were associated with their frequency of working with alcohol-related cases and with their views on alcohol prevention activities in the OHS.MethodsThe WIRUS project included a cross-sectional survey of attitudes and practices among OHS personnel (n = 325) employed by Norwegian OHS services (n = 69), who informed about sociodemographic and professional characteristics, drinking attitudes, frequency of cases with alcohol-related issues, and perceptions toward the role of the OHS in primary, secondary, and tertiary alcohol prevention activities. Measures of associations were examined with linear and logistic regression models.ResultsDrinking attitudes were unrelated to the frequency of working with alcohol-related cases. Physicians, psychologists, and nurses had higher frequency of working with alcohol-related cases, compared to those with other professional backgrounds (β = 0.46, p = 0.01). Drinking attitudes were also unrelated to attitudes towards primary/secondary/tertiary alcohol prevention activities in the OHS, while female OHS personnel were more positive towards increased primary alcohol prevention activities in the OHS (OR: 1.82, p < 0.05). Only marginal portions (1%-3%) of the variance in attitudes towards alcohol prevention activities in the OHS were accounted for by the models.ConclusionThis study did not find evidence of associations between OHS personnel’s drinking attitudes and their practices and attitudes towards alcohol prevention activities. The lack of association between OHS personnel’s attitudes towards alcohol use and their attitudes and practices relating to alcohol prevention in the workplace might point towards professionalism, as personal attitudes appear not to interfere with their priorities and professional mission. Given the small amount of outcome variance explained by the tested models, other variables should be used in future studies.

The world of drinking: national alcohol control experiences in 18 countries

Personal attitudes toward alcohol consumption are reliable predictors of alcohol use and related problems, with emerging work suggesting that one’s favorable attitude toward limited drinking (i.e., at levels below the threshold for heavy episodic drinking) is a buffer against alcohol use and binge drinking. However, little work has examined the specific mechanism(s) through which one’s personal attitude toward limited drinking is associated with alcohol use and related problems. One such mechanism may be an individual’s self-efficacy to limit their alcohol use. The current study aimed to evaluate whether self-efficacy to limit one’s alcohol use mediates the association between one’s personal attitude toward limited drinking and actual alcohol use and related problems over time. Participants were mandated students (n = 568; 28% female) who violated campus alcohol policy and received a brief motivational intervention. Mediation models were used to test (a) self-efficacy to limit one’s alcohol use as a traditional mediator of the attitudes—drinking quantity association and (b) self-efficacy and drinking quantity as serial mediators of the attitudes—alcohol-problems link. Favorable attitudes toward limiting drinking at baseline were positively associated with self-efficacy to limit drinking at 1 month, which was associated with a reduction in drinking quantity at 3 months; this, in turn, was associated with a reduction in alcohol-related problems at 5 months. These findings provide a rationale for incorporating attitudes and self-efficacy in the development and refinement of intervention strategies.

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil

Conversation with <scp>C</scp>onnie <scp>W</scp>eisner

Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields

Positive heavy drinking attitude mediates the association between college alcohol beliefs and alcohol-related outcomes

Little research has considered the importance of a person's attitude toward heavy drinking when evaluated against other well-known predictors of alcohol use and related harm including drinking motives and drinker identity. The current study aimed to evaluate whether one's favorable attitude toward heavy drinking is a unique predictor of prospectively assessed drinking-related outcomes when considered against descriptive and injunctive norms, drinking intentions, drinking motives, and drinker identity. Participants in the current study comprised mandated students (n=374; 54% male) who violated a campus alcohol policy and received a brief intervention (eCHECKUP TO GO). Analyses included the use of negative binomial regression to examine baseline predictors- attitude toward heavy drinking, perceived descriptive and injunctive norms, drinking intentions, drinking motives, and drinker identity-of prospective alcohol use outcomes and alcohol-related problems 1month later. We found that one's attitude toward heavy drinking remains a significant predictor of binge frequency, peak drinking, and alcohol-related problems when accounting for norms, intentions, motives, and identity. This study has important theoretical and intervention implications. Indeed, the finding that one's attitude toward heavy drinking remains a significant predictor of alcohol-related outcomes when intentions are included in the model has implications within the theory of planned behavior. Furthermore, attitude toward heavy drinking has predictive utility when considered against descriptive and injunctive norms, drinking motives, and drinker identity. These findings contribute to a growing literature suggesting that attitudes could be an important intervention target when the goal is to change drinking behavior.

Efforts to lower cholesterol levels can be made using traditional medicine. The better a person's knowledge and attitude towards traditional medicine will influence his actions in choosing medicine. This study aims to determine the relationship between knowledge and attitudes regarding traditional medicine on the behavior/actions of choosing celery to treat hypercholesterolemia in the community around the Gandus Health Center, Palembang. Analytical observational research with a cross-sectional design has been carried out at the Gandus Palembang Health Center from 13 to 20 September 2023. 30 respondents met the inclusion criteria. There are still many (43.3%) respondents who have poor knowledge about the use of herbs as anti-hypercholesterolemia, especially celery, while 30% of respondents with a negative attitude towards choosing traditional medicine were found. Based on statistical analysis, the results showed that there was an insignificant relationship between knowledge and behavior (PR = 1.500 (IK95% 0.325 – 6.918); p = 0.896). However, there is a significant relationship between attitudes and behavior (PR = 21.00 (95% CI 2.868 – 153.754); p = 0.002). A person's attitude towards traditional medicine is related to their behavior/actions in choosing celery for the treatment of hypercholesterolemia.

ObjectiveThe objective of this study was to explore Swedish managers’ and HR-officers’ experiences and perceptions of skills training including a development and implementation of an alcohol policy.MethodsSemi-structured interviews were conducted with Swedish managers (n = 44) and HR-officers (n = 9) from nine different organizations whom had received skills training and an organizational policy implementation. The interviews were analyzed using thematic analyses.ResultsIn total, nine themes were identified as: The prevalence of alcohol problems: a wake-up call; a reminder to intervene immediately; an altered view of the responsibility of the employer; initiating conversations about alcohol: a useful toolbox; an imprecise, yet positive, memory; increased awareness of issues related to alcohol culture; I have not heard a word about a new alcohol policy; the alcohol policy: a mere piece of paper; and alcohol problem prevention: hardly a low-hanging fruit. Participants’ experiences of the skills training were positive overall.ConclusionVarious aspects of the skills training were appreciated by managers and HR-officers, including insight of prevalence statistics and employer responsibilities. Participants emphasized the value of repeated skills training occasions for retaining knowledge. Future research may investigate further in what way skills training may affect managers’ willingness to engage in workplace alcohol prevention. Since the implementation of any policy had gone unnoticed to participants, a reason for which could be related to the notion of the existing policy as “good enough” in its current condition, implementation and organizational issues, or a reluctance to address alcohol-related matters unless necessary; future research may focus on investigating in what manner alcohol policies are in fact utilized within organizations.

General medical practitioners are essential for the prevention, diagnosis, and management of alcohol use disorders. Studies to examine medical practice in this field, however, are very rare. A cross-sectional study involving 2010 patients seen by a sample of 145 general practitioners in the Auvergne region of central France was conducted on a given day in May 1998. The purpose of the study was to evaluate the prevalence of alcohol use disorders (using the DSM-IV diagnostic criteria for alcohol abuse or dependence and the CAGE questionnaire) and so to estimate the proportion of nonsomatic alcohol-related care dispensed. Sixteen percent of patients consulting their general practitioner had an alcohol problem, 27% of men and 5% of women. On average, a quarter of these patients had not been previously identified by the physician. Diagnosis seemed particularly difficult in women: 11% of women aged between 36 and 45 had an alcohol-related problem that went unidentified in 60% of cases. Care for alcohol-related health problems was therefore seriously inadequate. In one third of cases, patients with a diagnosed alcohol-related problem were not followed up by the physician for that problem. Two thirds received no medication, and in more than 80% of cases the physician did not refer to a specialist or prescribe admission to a specialized hospital ward. These results underline the diagnostic and therapeutic difficulties experienced by general practitioners. This study has led to the establishment of a pilot health care network for patients suffering from alcohol use disorders. This network involves voluntary doctors who have been trained and are better paid for their services. Care protocols have been established to which these practitioners have to adhere.

Alcohol policy research: putting together a global evidence base

This article presents results from a survey aimed at identifying the extent of alcohol prevention efforts in Swedish workplaces focusing on the dissemination of a model for secondary prevention — the ‘Risk Drinking model’. From a random sample of 929 human resource managers at Swedish workplaces, 374 answered a web-based questionnaire (response rate = 40%). Results showed that about 70% had an alcohol policy at their workplace, 51% were engaged in alcohol prevention efforts and about 19% used the Risk Drinking model. Regression analyses showed that large workplaces, workplaces where employees received training on alcohol, public sector and female-dominated workplaces were significantly associated with alcohol prevention activities. We conclude that training is important for the implementation of alcohol prevention at Swedish workplaces, and is of particular importance in small enterprises.

In recent years, a growing number of studies in the United States have addressed the relationships among the environments in which people live, the alcoholic beverages they consume, and the problems they experience in different community settings. Such research arises from a view of community settings and alcohol problems that takes into account both individual drinking behaviors and the environmental contexts in which these behaviors occur. According to this approach, drinking in different settings (e.g., drinking at restaurants) exposes drinkers to different risks (e.g., driving after drinking), and these risks become greater with the continued use of alcohol (e.g., heavy drinking leading to driving while intoxicated). The availability of alcohol at different places where people may drink affects drinking practices and shapes the incidence, prevalence, and geographic distribution of alcohol-related problems in the community (Stockwell and Gruenewald 2001). The different places where drinkers may use alcohol also change in response to the demand for alcohol and in response to changes in community systems that meet this demand (i.e., changes in alcohol availability policy) (Holder 1998). Regulations and policies related to the availability and use of alcohol provide an opportunity for policymakers to affect the geographic distribution of alcohol problems and create safer communities (Gruenewald et al. in press). Policymakers have had the opportunity to regulate the distribution of alcohol for the benefit of public health for many decades (Edwards et al. 1994). Research to evaluate the effectiveness of these efforts, however, has been limited by inadequate models of the individual-- environmental interactions that support alcohol use and by imprecise views of how these interactions are related to the geographic distribution of alcohol use and related problems. Knowledge of where alcohol problems occur and why they occur in the places that they do is essential to local policymakers. Such knowledge can inform decisions as to what to regulate (e.g., alcohol beverage serving practices vs. restrictions on places that can serve alcohol) and where such regulation is most called for (e.g., bars or restaurants in downtown or outlying areas). This knowledge is also useful for researchers to consider when planning and evaluating community prevention programs. In recent years, studies of the geographic relationships between places where alcohol is sold and local alcohol-- related problems have begun to flourish. These advances have been coupled with the development of computerized systems for storing and mapping data known as geographic information systems (GIS) and geostatistical methods (Wilson and Dufour 2000). Although still at its earliest stages, geographical analysis has begun to reveal very useful spatial associations between features of the alcohol environment and problems related to alcohol, particularly motor vehicle crashes, pedestrian injuries, and violence. Most current ecological studies of the interactions of individual drinking practices with the drinking environment are rooted in the simple observation that alcohol problems occur in environmental settings, and environmental settings may be changed through community action. The question these studies attempt to answer, then, is this: What specific changes in the alcohol environment should be recommended to communities? Some preliminary answers to this question are available, and several of them are discussed in this issue of Alcohol Research & Health. A more complete answer to this question, however, will require considerably more work. The full effects of environmental changes in community settings are not well understood. Current research provides researchers and policymakers with early demonstrations of relationships between environmental settings and drinking practices. This work has not, however, clarified the specific components of these ecological relationships that are most productive of alcohol-related problems. …

Alcohol policies are often based on a combination of political expediency, commercial interests, historical tradition, common sense, public health need, crisis intervention, and a scientific understanding of what works. Of all the factors influencing alcohol policy, scientific understanding is perhaps the most important but the least influential route to effective ways to minimize or prevent alcohol-related problems. How can the social, biological, political and population sciences take their proper place in the alcohol policy-making process? Despite the growing strength and professionalism of alcohol science throughout the world, there is no cadre of career scientists who are trained and experienced in the development, implementation and evaluation of alcohol policies. Nor have national and international agencies charged with alcohol research and health policies been effective in mobilizing the kind of political support necessary to sustain an ongoing program of policy initiatives that could be systematically evaluated from a public health perspective. Nevertheless, during the past 25 years a grassroots movement has emerged from the community of alcohol research professionals to bring science and policy into a closer alignment. The articles collected in this issue of Contemporary Drug Problems are part of this movement. Ingeborg Rossow's paper reviews the international epidemiological evidence on the social costs of alcohol, showing that both heavy drinking over time and acute intoxication on specific drinking occasions increase the risk of suicidal and violent behavior. Beyond the identification of important gaps in the knowledge base, she discusses the implications of the findings for prevention strategies aimed at both high-risk groups and at the general population of drinkers. The paper also provides some intriguing insights into the collateral damage resulting from the effects of alcohol problems on third parties such as children, spouses and other family members. Maggie Brady's paper deals with the indigenous minorities living in four developed countries where socioeconomic marginalization has been associated with a distinct drinking pattern (opportunistic binge drinking). The article explores the question of how applicable national alcohol policies are to the alcohol-related problems of indigenous people. Using a combination of social history, social anthropology and epidemiology, the review synthesizes a broad array of evidence in a way that can inform the policy-making process on both the local and national levels. Therese Reitan's paper looks at the public health crisis in the former Soviet Union and its relation to alcohol consumption patterns. The Gorbachev-era restrictions on alcohol and the subsequent economic transition to open markets constitute a monumental natural experiment in alcohol control policies that, according to this analysis, may account for dramatic fluctuations in male mortality rates during that period. Although there is no simple answer to the question of how alcohol affects mortality, the epidemiological detective work described in this paper clearly shows that alcohol policies have strong cultural and historical roots that are only temporarily affected by the broader political and economic environment. Economic transition and its relation to alcohol problems is also the subject of Jacek Moskalewicz's paper on Poland during the 1990s. But unlike the situation in the former Soviet Union, the one in Poland shows a different set of relationships among economic factors, drinking patterns, and alcohol-related problems-a relationship that suggests that alcohol policies need to be integrated with the prevailing social, economic and political forces in order to be effective. Finally, Kate Graham provides a more focused review of the evidence on alcohol policies designed to prevent problems within relatively circumscribed drinking environments. …