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CORK Bibliography: The Workplace

41 citations. October 2006 to present

Prepared: September 2007

Ahola K; Honkonen T; Pirkola S; Isometsa E; Kalimo R; Nykyri E et al. Alcohol dependence in relation to burnout among the Finnish working population. Addiction 101(10): 1438-1443, 2006. (59 refs.)

Aims: To investigate the relationship of burnout to alcohol dependence and high alcohol consumption. Design: A cross-sectional population-based multi-disciplinary 'Health 2000 Study'. The analyses were performed separately for the women and the men and adjusted for socio-demographic factors. Setting and participants: In Finland, 3276 active employees (1637 women and 1639 men), aged 30-64 years, from a representative population sample. Measurements: The diagnosis of Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) alcohol dependence was based on the standardized Munich Composite International Diagnostic Interview (M-CIDI). The assessment of high alcohol consumption was based on self-reported alcohol use. Burnout was assessed with the Maslach Burnout Inventory-General Survey (MBI-GS). Findings: The 12-month prevalence of alcohol dependence was associated with burnout among both men and women. Each one-point increase in burnout score was associated with an 80% increase in the incidence for alcohol dependence among women and a 51% increase among men. These associations persisted when socio-demographic factors were adjusted. The associations between burnout and high alcohol consumption were not statistically significant. Conclusions: There is an association between burnout and alcohol dependence among both genders. Among both women and men, attention to alcohol-related behaviour is warranted in the clinical context when burnout and other problems related to work are encountered. Interventions which include assessment of work conditions and management of work-related stress should be targeted at employees with alcohol dependence in addition to traditional treatment.

Albertsen K; Borg V; Oldenburg B. A systematic review of the impact of work environment on smoking cessation, relapse and amount smoked. (review). Preventive Medicine 43(4): 291-305, 2006. (50 refs.)

Background. Smoking is an important issue for the majority of the world's working population. it is important to explore in which ways the workplace might contribute to changes in smoking status and smoking behavior. The present article provides a systematic review and quality assessment of studies that have addressed the impact of factors in the work environment on smoking behavior. Methods. An evaluation of the methodological quality of 22 prospective studies was based on 14 explicit criteria, which included features of study design, statistical analysis, sampling issues and measurement. The level of scientific evidence was evaluated for each study. Results. There was strong evidence for an effect of the work environment on the amount smoked, but insufficient or mixed evidence regarding cessation and relapse. Summarizing the results, high job demands were associated with higher amount smoked and with increased likelihood of cessation. Resources at work and social support were positively associated with cessation and negatively associated with relapse and the amount smoked. Conclusions. The results supported the overall hypothesis that the work environment influences aspects of smoking behavior. Recommendations are made for more intervention studies where changes in work environment are carried out in combination with health promotion interventions.

Araki I; Hashimoto H; Kono K; Matsuki H; Yano E. Controlled trial of worksite health education through face-to-face counseling vs. e-mail on drinking behavior modification. Journal of Occupational Health 48(4): 239-245, 2006. (20 refs.)

This study examined the effectiveness of a traditional face-to-face health education and e-mail health education on alcohol usage among male workers in comparison with a control group. Male workers at a manufacturing plant (N=36) who had abnormal serum gamma-GTP were stratified by age and job types, then randomized into three groups: face-to-face education, e-mail education, and the control. The subjects were assessed on their knowledge about and attitude towards drinking, reported alcohol consumption, and serum gamma-GTP before the start of education and 2 months later after comparison of the education. Paired t-test and repeated ANOVA were conducted to test the significance of changes pre and post the intervention and across groups. In the face-to-face group, knowledge (p=0.001), attitude (p=0.026), alcohol consumption (p=0.003) and serum gamma-GTP showed significant improvement. In the e-mail group, only alcohol consumption showed marginal improvement (p=0.077). In the control group, no variables remarkably changed. These results indicate that the face-to-face health education was more effective than the e-mail program. We discuss why the face-to-face approach was superior to the e-mail approach in this study by referring to self-monitoring, goal setting processes and timely feedback. We concluded that further studies are warranted to identify the effect of health education using e-mails and other network tools in consideration of the above three factors.

Bamberger P; Biron M. The prevalence and distribution of employee substance-related problems and programs in the Israeli workplace. Journal of Drug Issues 36(4): 755-786, 2006. (67 refs.)

We used a national sample of 100 Israeli enterprises to examine the prevalence and distribution of employee substance-related workplace problems, as well as the prevalence and distribution of alternative programs/policies aimed at addressing such problems among Israeli workplaces. Although 29% of the responding firms reported having handled one or more cases involving employee workplace substance use or impairment, across these firms, only 53 actual cases were reported. Given an average enterprise size of 325 employees, this suggests a workforce prevalence rate for such problems of 0.16%. Only 10% of the enterprises studied offered any type of substance-related employee assistance, and only 12% included a specific reference to substance use in their discipline policy. The social policy and workplace implications of these findings are discussed.

Ben-Ari E. Sake and "space time": Cultural, organization and drinking in Japanese firms. IN: Umesao T; Yoshida S; Schalow P, eds. Japanese Civilization in the Modern World. XVIII, Alcoholic Beverages. Senri Ethnological Studies no. 64. Osaka Japan: National Museum of Ethnology (Japan), 2003. pp. 89-100. (37 refs.)

This paper provides an analysis of drinking occasions that occur in large Japanese firms. In Japanese society the social life of workers incorporates a variety of leisure-related activities. However, drinking parties are the most common, taking place typically from as often as several times a week, or several times a month. Participation may be workers along with their foremen, or white-collar workers and their section chiefs. These are analyzed from the sociological perspective as "cultural performances" -- special social situations, with are central to maintaining the social order of the organization and providing a forum for expression of tensions and managing conflict. The usual work-related drinking occasion is described -- taking place in 'non-working' hours, but with the workplace hierarchy clearly operative, despite the external appearance of a leveling of status differences. The place of drinking occasions in creating and maintainng the social order of the firm is also outlined.

Bennett JB; Patterson CR; Wiitala WL; Woo A. Social risks for at-risk drinking in young workers: Application of work-life border theory. Journal of Drug Issues 36(3): 485-513, 2006. (54 refs.)

The current study evaluated work-life risks uniquely associated with at-risk drinking for younger (aged 18 to 30) versus two samples of older workers (31 to 40, and 41 or older). Measures were selected according to theories of alcohol culture (e.g., drinking norms at work) and work-life conflict. Following "work-life border" theory (Clark, 2000), an exploratory model examined relationships of these measures with at-risk drinking (ARD) and job-related hangovers (JRH) across the three age groups within a large municipality (n = 587) and a sample of small businesses (n = 736). Survey results showed life-to-work conflict uniquely predicted ARD for younger workers. In small businesses, younger workers reporting JRH perceived the most permissive drinking norms. Findings suggest risks differ between the small business and municipal samples, and the importance of distinguishing ARD and JRH when assessing outcomes. Results are interpreted with border theory, and discussion focuses on suggestions for prevention programming for young workers.

Carpenter CS. Workplace drug testing and worker drug use. Health Services Research 42(2): 795-810, 2007. (9 refs.)

Objective. To examine the nature and extent of the association between workplace drug testing and worker drug use. Data Sources. Repeated cross-sections from the 2000 to 2001 National Household Surveys on Drug Abuse (NHSDA) and the 2002 National Survey on Drug Use and Health (NSDUH). Study Design. Multivariate logistic regression models of the likelihood of marijuana use are estimated as a function of several different workplace drug policies, including drug testing. Specific questions about penalty severity and the likelihood of detection are used to further evaluate the nature of the association. Principal Findings. Individuals whose employers perform drug tests are significantly less likely to report past month marijuana use, even after controlling for a wide array of worker and job characteristics. However, large negative associations are also found for variables indicating whether a firm has drug education, an employee assistance program, or a simple written policy about substance use. Accounting for these other workplace characteristics reduces-but does not eliminate-the testing differential. Frequent testing and severe penalties reduce the likelihood that workers use marijuana. Conclusions. Previous studies have interpreted the large negative correlation between workplace drug testing and employee substance use as representing a causal deterrent effect of drug testing. Our results using more comprehensive data suggest that these estimates have been slightly overstated due to omitted variables bias. The overall pattern of results remains largely consistent with the hypothesis that workplace drug testing deters worker drug use.

Collins C. Addiction and the law: How dependency issues continue to affect the legal profession. The Oregon State Bar Bulletin 66(August/September): 9-15, 2006. (0 refs.)

Fifteen years ago, addiction referred primarily to dependence on substances: alcohol and other drugs. When the Bulletin last visited the subject, in a special August-September 1991 issue, "Drugs, Alcohol & Lawyers," recovery programs commonly saw the pure alcoholic. This article addresses the nature of addiction problems now encountered. Data is provided (although not referenced) on the disproportionate cases of drug dependence within the law professions.

Commission of the European Communities. An EU Strategy to Support Member States in Reducing Alcohol Related Harm. Communication for the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Brussels: Commission of the European Communitites, 2006. (0 refs.)

In 2001, the Council requested a comprehensive strategy to reduce alcohol-related harm in Europe. This report represents a response to that request. Following an introduction the report sets forth a mandate for action, followed by a case for action. The process of consultation and assessment used in creating these recommendations is then described. This is followed by a description of the five priority themes and the relevant good practices to underpin the implementation. The first of these is Protection of young people, children and the unborn child. The specific aims for accomplishing this are Aim 1: To curb under-age drinking, reduce hazardous and harmful drinking among young people. Aim 2: To reduce the harm suffered by children in families with alcohol problems. Aim 3: To reduce exposure to alcohol during pregnancy, thereby reducing the number of children born with Foetal Alcohol Disorders. The rationale for action is that young people are often unfairly depicted as the perpetrators of alcohol problems rather than the victims. Alcohol is estimated to be a causal factor in 16% of cases of child abuse and neglect. Harmful alcohol consumption among young people has been shown to have a negative impact not only on health and social wellbeing, but also on educational attainment. . There is an increasing trend of �binge-drinking� by young people in many parts of the EU. This is exacerbated by the continued availability of alcoholic beverages to under-age consumers. The Second Theme is to reduce injuries and deaths from alcohol-related road traffic accidents. Aim 4: To contribute to reducing alcohol-related road fatalities and injuries. In setting forth the rationale it is noted that approximately one accident in four can be linked to alcohol consumption, and at least 10,000 people are killed in alcohol-related road accidents in the EU each year. Young people aged 18 to 24 are particularly in danger of having an accident. 35% to 45% of fatalities of this age group are due to traffic accidents. For young people, traffic accidents are the most common cause of death (47% ). For drink-driving accidents, two thirds of the people involved were between 15 and 34 years, and 96% were male. The Third Theme is the prevention of alcohol-related harm among adults and reduce the negative impact on. the workplace. The related aims are Aim 5: To decrease alcohol-related chronic physical and mental disorders; Aim 6: To decrease the number of alcohol related deaths.; Aim 7: To provide information to consumers to make informed choices; Aim 8: To contribute to the reduction of alcohol-related harm at the workplace, and promote workplace related actions. The rationale is that while 85% of adult individuals consume alcohol in a moderate and responsible manner, most of the time, harmful and hazardous alcohol consumption is one of the main causes of premature death and avoidable disease and furthermore has a negative impact on working capacity. While 266 million adults drink alcohol up to 20g (women) or 40g (men) per day, over 58 million adults (15%) consume above this level, with 20 million of these (6%) drinking at over 40g (women) or 60g per day (men). Looking at addiction rather than drinking levels, it is also estimated that 23 million Europeans (5% of men, 1% of women) are dependent on alcohol in any one year. The Fourth Theme is to inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patterns, incorporated in Aim 9. The Fifth Theme is to develop, support and maintain a common evidence base. Aim 10: To obtain comparable information on alcohol consumption, especially on young people; definitions on harmful and hazardous consumption, on drinking patterns, on the social and health effects of alcohol; and information on the impact of alcohol policy measures and of alcohol consumption on productivity and economic development. Aim 11: To evaluate the impact of initiatives taken on the basis of this Communication.

Elliott K; Shelley K. Effects of drugs and alcohol on behavior, job performance, and workplace safety. Journal of Employment Counseling 43(3): 130-134, 2006. (25 refs.)

A study of records for 1 large U.S. company revealed that employees with positive drug screens were fired, whereas workers who self-disclosed drug/alcohol problems remained employed. Both groups were offered substance abuse intervention, and some previously fired workers were rehired after they received treatment. Accident results showed that drug-test positive employees, as compared with self-referred workers, had a significantly higher accident rate in all categories. Treatment data revealed that drug-test positive workers had significantly higher accident rates before and after treatment than self-referred employees. Posttreatment results showed that drug-test positive employees had a significant decrease in accidents after services, whereas the self-referred group showed no change.

Fortenberry PA; Hoffman BE. Illegal muscle: A comparative analysis of proposed steroid legislation and the policies in professional sports' CBAs that led to the steroid controversy. Virginia Sports and Entertainment Law Journal 5(121-147), 2006. (161 refs.)

The purpose of this paper is to compare, contrast, and evaluate the steroid clauses within the collective bargaining agreements (CBA) of the four major sports, to look at the steroid policies in the various CBAs prior to the recent steroids controversy, to examine the current steroids policy of the four major sports due to changes made as a result of public pressure and congressional scrutiny, and to discuss the possible future steroid policy that would be mandated by proposed legislation. The respective CBA language concerning steroids and other league steroid policies will be reviewed, specifically looking at (1) their prohibitions, (2) their testing procedures and (3) their disciplinary remedies for steroid violations. A review of the changes voluntarily agreed to by the subject professional sports organizations and the respective unions will be conducted and an analysis of proposed legislation in the Senate and House will also be undertaken.

Garcia SC; Medina-Mora ME; Velez NM; Garcia FJ; Perez LV. Organizational features, stress, and alcohol use in workers from a Mexican textile enterprise. Salud Mental 29(4): 63-70, 2006. (31 refs.)

There are different factors within work environment that could create both wellbeing and distress in workers. The climate perception employees have, as well as their evaluation of some, could have positive and negative consequences at personal and organizational levels. Work stress is another element that has meaningful repercussions on the health of people and on the quality of their performance; it has been related to alcohol and psychoactive substances abuse, besides of an increase in different social and work problems. The main objective of this paper is to determine the relationship between organizational factors (such as work stress, organization climate, and work satisfaction) and alcohol use, and the occurrence of industrial problems and accidents in Mexican workers in a textile organization. Method: In order to interfere as less as possible with the production process, this study was carried out at the facilities of the organization, during work hours and during weekends. Thus, only employees who attended to work these days were interviewed. The sample included 277 workers who basically performed as operative staff. No more organization characteristics are described on behalf of an agreement, and of the anonymity of the answers given by the subjects. All the interviewees were men, their ages fluctuated between 16 and 65 years, 85% of them had attained junior high school, and 72% were married or living, with a partner. A self rated questionnaire was used, along with the AUDIT (alcohol use disorder identification test) alcohol test, a work stress scale, another scale for organization climate, one more for work satisfaction, and some general questions. All the scales had good internal consistency. The procedure consisted in gathering 20 workers in a well-ventilated and illuminated room. The interviewer, who was previously trained, read the instructions aloud, emphasizing anonymity and confidentiality of any information the workers give, and stating that no one from the company would have access to the data. Analyses were performed with statistical software SPSS 11.5. EQS 6.0 was used to test the structural equation model with the. relationship between organizational factors, alcohol use and negative consequences at work. Results: Organizational climate. Most of the workers (92%) perceived a good level of communication with the work group, 87.2% mentioned to receive help from the boss when they have to do an activity they are not familiar with, 78% said they have enough support to solve the problems related to work. There were: differences between the workers according to education level; the ones with the higher level perceived a more adverse climate. There were differences also between shifts (morning, evening, and mixed); the workers from the first one perceived a less favorable climate. Work satisfaction. Most of the workers think of their job as something useful (95%), 93% said they liked it, and 88.3% mentioned their families are satisfied. There are statistical differences between satisfaction and education levels; subjects who had only basic education were more satisfied than those with a higher level. The stress sources are related to the effort implied in the struggle to move forward (87.6%), to have too much work to do (60.5%), and to the possibility of an accident when subjects are careless (51.6%). The total scale scores indicated that 14.2% of the workers had high levels of work stress. Alcohol use: 61.7% of the workers consumed alcohol during the previous year. According to the AUDIT (using eight or more as a cut-off score) 25.8% were classified as cases for alcohol related problems; 26.5% of the subjects had risk consumption, and 5.3% were consuming in a dangerous way because of the frequency and the amount they drink. Work problems: 24.1% of the subjects mentioned they have invested more time than usual in some activity related to work, 21% have been told off because of their performance, 18% felt they could not achieve quality outcomes. The incidents that workers mentioned were: hand injuries (17.5%), finger injuries (15.7%), being close to suffer an accident (13.5%), and suffering damage or injuries when working (10%). A structural equation model allowed to observe that organizational factors, climate, satisfaction, and work stress are meaningful predictors of work accidents and problems. Of all the variables included in this analysis, work stress also was the one that best predicted alcohol use at the work place. A direct effect of the individual level of alcohol use and of the use at the work place on problems and accidents, was observed. This effect was not initially considered in the model of individual consumption, neither were the frequency, the amount consumed, nor the excessive use; it was necessary to add this direct path to adjust the model so they were observed as important elements. Discussion: Interviewees perceived communication as an important climate issue, mainly when established with the work group. Another element mentioned as important was perceived, that is support from the boss or supervisor to solve problems. Education level has a relevant role in the way workers live their work climate; those with a lower level experience it as more favorable. This could be the consequence of higher work expectations related to a higher education level. There are differences among shifts; workers from the first shift experienced a more favorable climate. The model included climate as a meaningful element for the presence of consequences at work place; this had a direct effect over the existence of problems and the occurrence of accidents, it was opposite to the results observed in other studios were there was not a direct relationship. Work satisfaction has to do with job usefulness, the joy for the task done, and family satisfaction with the position. The education at level affects perception of work climate. This evaluation of the worker climate has been identified as a significant factor for the reduction of negative effects at work. It is necessary to mention that employees with a higher stress level are the married ones, which may be caused by the responsibilities implied in being a family supplier. This concurs with the result of a study on burnout, which found that being married is a risk factor to develop high stress. Work stress was the most predictive component of accidents and problems at the work place, which had a direct relation (0.50). It also directly predicted alcohol use at the work place (0.22), and had a negative statistical difference with climate (-.29). Thus, it is important to consider that when workers perceive a better climate, stress level goes down, and it is necessary to consider this organizational factor to improve work conditions besides employees' physical and mental health. According to the model tested in this study, alcohol use has a direct and meaningful effect on performance and on the frequency of problems and accidents, inside and outside the organization. It is important to consider that prevention in work places must be done globally, taking into account organizational factors such as climate, stress, and worker satisfaction. It also should include educative and practical elements that allow reducing excessive alcohol use and its negative consequences (poor performance, bad interpersonal relationships, and bad outcome quality) at work, besides reducing also industrial accidents. The most frequent work problems were as follows: to invest more time than necessary in an activity, to be told-off because of mistakes, and to have problems with the boss or supervisor. These events have an impact on productivity and represent money loss for the company. The most frequent accidents were as follows: hand injuries, which are related to heavy machinery operation, basic in the production process of this industry. This reflects the need to consider the physical aspects of the place where activities are performed, as well as the psychosocial factors affecting individuals, all of which will result in benefit of any organization.

Gates T; Duffy K; Moore J; Howell W; McDonald W. Alcohol screening instruments and psychiatric evaluation outcomes in military aviation personnel. Aviation, Space, and Environmental Medicine 78(1): 48-51, 2007. (17 refs.)

Introduction: Alcohol-related disorders are the most prevalent psychiatric conditions in the aviation population. Efforts to effectively screen aviators for these disorders are continually sought, as under-diagnosis may negatively impact aviation safety. This study evaluates screening tools that have been validated in non-aviators in terms of their utility for aviator patients. Methods: There were 111 male aviation patients (27 +/- 7 yr) referred for psychiatric evaluation at the Naval Aerospace Medicine Institute who completed the Self-Administered Alcohol Screening Test (SAAST), the Alcohol-Use Disorders Identification Test (AUDIT), and the Common Alcohol Logistical Scale-Revised (CAL-R) prior to evaluation by a staff psychiatrist or psychologist. Results: There were 40 patients who were qualified psychiatrically with no diagnosis and 49 patients who were disqualified for psychiatric reasons due to a non alcohol-related diagnosis. The remaining 22 patients were disqualified for psychiatric reasons with an alcohol-related diagnosis. The optimal aviator cut-off scores were consistent with those of the general population, although the cut-off score used for the SAAST was set at the published sub-threshold level to provide greater sensitivity. The sensitivity/specificity values for the SAAST, AUDIT, and CAL-R were 59%/94%, 46%/96%, and 68%/81%, respectively. Conclusion: The psychometrically sophisticated CAL-R is sensitive, specific, and has good negative predictive value, although its use requires a psychologist and its availability is limited. The SAAST and AUDIT can be administered by a flight surgeon or aviation medical examiner (AME). Given the higher sensitivity of the SAAST it may be the most beneficial if administered first. The AUDIT can be used as a follow-up diagnostic test given its higher specificity.

Graham MD. Addiction, the addict, and career: Considerations for the employment counselor. Journal of Employment Counseling 43(4): 168-178, 2006. (42 refs.)

Employment counselors have been resistant to working with persons in recovery from addiction except under the strictest of criteria. This article examines the relationship between this resistance and the concepts of addiction and addict. Following this is an examination of substance abuse recovery and practical suggestions on incorporating recovery knowledge into career counseling. The goals of the article are twofold: (a) to present a framework that highlights the necessity of employment counseling for the recovery process from substance misuse and (b) to affirm that many employment counselors have the skills needed to assist clients who have been labeled as addicts.

Haagen PH. Symposium: From grand slams to grand juries. Performance-enhanicng drug use in sport. The players have lost that argument: Doping, drug testing, and collective bargaining. New England Law Review 40(831-849), 2006. (95 legal refs.)

This article addresses the use of performance-enhancing drugs in professional sports, and legal efforts to address doping is professional sports which can have an impact for collective bargaining in the US. This article describes several legislative efforts to address the issue. In one hearing it was made clear that Congress now regarded performance-enhancing drugs in sports as a "transcendent issue." In the face of such transcendence, a matter affecting the terms of conditions of work, drug testing, and thus a mandatory subject of collective bargaining, would not be permitted to go through the normal process of collective bargaining. The Union was informed that its obligation to protect all of its members did not extend to "cheaters." Comprehensive drug testing, including out of competition, random, unannounced testing was characterized as "not about privacy." Among the topics considered is the perceived need to control doping, and the response in Olympic and professional sports. The issue of whether drug testing works is also considered as well as the nature of penalties and due process.

Hahn EJ; Rayens MK; York N; Okoli CTC; Zhang M; Dignan M et al. Effects of a smoke-free law on hair nicotine and respiratory symptoms of restaurant and bar workers. Journal of Occupational and Environmental Medicine 48(9): 906-913, 2006. (59 refs.)

Objective: Bar and restaurant workers' exposure to secondhand smoke (SHS) was compared before and 3 and 6 months after implementation of a smoke-free ordinance. Methods: Hair nicotine, self-reported exposure to SHS, and respiratory symptoms were assessed on 105 smoking and nonsmoking workers from randomly selected establishments in Lexington, Kentucky. Thirty-eight percent were current smokers with more than half smoking 10 or fewer cigarettes per day. Workers provided a hair sample at baseline and at the 3-month interview. Results: There was a significant decline in hair nicotine 3 months post law when controlling for cigarettes smoked per day. Bar workers showed a significantly larger decline in hair nicotine compared with restaurant workers. The only significant decline in SHS exposure was in the workplace and other public places. Regardless of smoking status, respiratory symptoms declined significantly postlaw. Conclusions: Hospitality workers demonstrated significant declines in hair nicotine and respiratory symptoms after the law. Comprehensive smoke-free laws can provide the greatest protection to bar workers who are the most vulnerable to SHS exposure at work.

Halpern MT; Dirani R; Schmier JK. Impacts of a smoking cessation benefit among employed populations. Journal of Occupational and Environmental Medicine 49(1): 11-21, 2007. (32 refs.)

Objective: The objective of this study was to project the health and economic impacts of providing a workplace smoking cessation benefit. Methods: The authors conducted an update of a previously published outcomes model using recently published data and clinical trial results. Results: In four example workplace types evaluated, coverage of a cessation benefit resulted in greater numbers of successful cessations and decreased rates of smoking-related diseases. Total savings from benefit coverage (decreased healthcare and workplace costs) exceeded costs of the benefit within 4 years. Total savings per smoker ranged from $350 to $582 at 10 years and $1152 to $1743 at 20 years. Internal rate of return ranged from 39% to 60% at 10 years. Conclusion: Providing a workplace smoking cessation benefit results in substantial health and economic benefits with economic savings exceeding the cost of the benefit within a relatively short period. Clinical Significance: Providing a workplace smoking cessation benefit is projected to increase the rate of smoking cessation as well as decrease the incidence of smoking-related conditions and healthcare costs. In addition, workplace cessation benefits can result in decreased absenteeism, increased productivity, and net cost savings within 4 years.

Howland J; Almeida A; Rohsenow D; Minsky S; Greece J. How safe are federal regulations on occupational alcohol use? Journal of Public Health Policy 27(4): 389-404, 2006. (52 refs.)

Current US federal regulations on occupational alcohol use for safety-sensitive jobs do not account for impairment from low doses of alcohol and next day effects of heavy drinking. Research on the effects of low doses of alcohol on neurocognitive and simulated occupational tasks suggests that the current per se level of these regulations is set too high. Research on the effects of heavy drinking on next-day neurocognitive and simulated occupational performance is mixed and suggests that further research is needed to determine the safety of current "bottle-to-throttle" times. Although low-dose and residual drinking effects may pose low relative risk for occupational error, the aggregate contribution of these exposures to workplace problems may be substantial, given the number of people exposed.

Jain NB; Hart JE; Smith TJ; Garshick E; Laden F. Smoking behavior in trucking industry workers. American Journal of Industrial Medicine 49(12): 1013-1020, 2006. (31 refs.)

Background: In retrospective occupational studies, the degree of confounding by smoking depends on variation in smoking among job-related exposure groups. We assessed the relationship between job title and smoking behavior as part of a study on occupational exposures and lung cancer. Methods: A questionnaire on smoking was mailed to a sample of 11,986 trucking industry workers. Company records were used to gather other relevant information. Results: The response rate was 40.5%. Among white males, the age-adjusted prevalence of ever smoking was highest among longhaul truck drivers (67%) and lowest among clerks (44%). Smoking rates among workers with other job titles were similar Conclusions: Our results will be used to adjust for the differences in smoking among job-related exposure groups when assessing the association between particulate matter exposure and lung cancer mortality. Our study also suggests that an assessment of methods to control for smoking should be considered in the design of retrospective occupational health studies.

Kim PT. Collective and individual approaches to protecting employee privacy: The experience with workplace drug testing. Louisiana Law Review 66(Summer): 1008 - 1034, 2006. (78 legal refs.)

The latter half of the twentieth century saw a marked shift in the form of legal regulation of the workplace. At mid-century, unions were at the height of their power in terms of membership and bargaining strength. The dominant legal model for governing workplace relations was the one put into place by the Wagner Act in 1935, a model promoting collective bargaining. Since then, however, union strength has steadily eroded, and with it, collectively bargained agreements as a source of rights for workers. Paralleling this decline has been the growth of government mandates creating rights in the individual worker. This shift-from collective bargaining to individual employee rights as the primary source of legal regulation-has been both applauded and decried by observers and legal scholars. This Comment asks what difference it makes to think about workers' rights under a collective as opposed to an individual rights model in a particular context: that of protecting employee privacy. More specifically, it undertakes an examination of the range of disputes between employers and employees over workplace drug testing in the late 1980's and the 1990's, focusing on the differences between cases brought with union involvement and those brought by individual workers acting alone. In doing so, it asks how collective forms of disputing about drug testing differed from individual approaches, and whether these differences affected the ability of workers to assert and protect their interests in personal privacy. The purpose of this Comment is not to argue for or against the legality of drug testing, but rather to understand how collective approaches to contesting employer policies looked different from individual rights based claims.

Knealing TW; Wong CJ; Diemer KN; Hampton J; Silverman K. A randomized controlled trial of the therapeutic workplace for community methadone patients: A partial failure to engage. Experimental and Clinical Psychopharmacology 14(3): 350-360, 2006. (41 refs.)

The Therapeutic Workplace is an employment-based treatment for drug addiction that uses wages for work to reinforce drug abstinence. The Therapeutic Workplace has promoted abstinence from heroin and cocaine in treatment-resistant mothers in methadone treatment. This study attempted to replicate that effect in crack cocaine users recruited from community-based methadone programs. Participants were randomly assigned to a Therapeutic Workplace (n = 22) or usual care control (n = 25) group. Therapeutic Workplace participants were invited to work in the workplace and earn vouchers every weekday for 9 months contingent on documented opiate and cocaine abstinence. The two groups did not differ significantly on measures of cocaine or opiate use collected during study participation. Daily attendance and urinalysis results of the Therapeutic Workplace group were analyzed, and only 7 of the 22 participants initiated consistent periods of abstinence and workplace attendance. Two individuals gained access to the workplace on a few days, and 9 participants attempted to gain access to the workplace but never provided a drug-negative urine sample. Possible reasons for differences between the current study and the previous Therapeutic Workplace study are considered. Procedures that increase participant contact with the Therapeutic Workplace and its reinforcement contingencies might increase the likelihood of these individuals being successful in the treatment program.

Kouvonen A; Kivimaki M; Vaananen A; Heponiemi T; Elovainio M; Ala-Mursula L et al. Job strain and adverse health behaviors: The Finnish public sector study. Journal of Occupational and Environmental Medicine 49(1): 68-74, 2007. (30 refs.)

Objective: The objective of this study was to explore the association between job strain and the co-occurrence of adverse health behaviors, smoking; heavy drinking; obesity, and physical inactivity. Methods. The authors studied cross-sectional data of 34,058 female and 8154 male public sector employees. Results: Multinomial logistic regression models adjusted for sex, age, basic education, marital status, and type of job contract showed that high job strain and passive jobs were associated with 1.3 to 1.4 times higher odds of having >= 3 (vs 0) adverse health behaviors. Among men, low job control was associated with a 1.3 fold likelihood and amon women active jobs were associated with a 1.2 fold likelihood of having >= 3 (vs 0) adverse behaviors. High demands were associated with a higher likelihood of co-occurrence of one to two (vs 0) adverse behaviors among women. Conclusions. Strain conditions may be associated with the co-occurrence of adverse health behaviors that contribute to preventable chronic diseases. Clinical Significance. Adverse job conditions may increase the likelihood of co-occurring health risk behaviors. Reducing work stress by increasing low control and decreasing psychologic demands might help efforts to promote healthy 1 festyles.

Lee DJ; Fleming LE; Arheart KL; LeBlanc WG; Caban AJ; Chung-Bridges K et al. Smoking rate trends in US occupational groups: The 1987 to 2004 National Health Interview Survey. Journal of Occupational and Environmental Medicine 49(1): 75-81, 2007. (44 refs.)

Objective: It is unknown if the gap in smoking rates observed between United States blue- and white-collar workers over the past four decades has continued into the new millennium. Methods: The National Health Interview Survey is a nationally representative survey of the US civilian population. Smoking and current occupational status were assessed over survey periods 1987 to 1994 and 1997 to 2004 (n = 298,042). Results: There were significant annual reductions in smoking rates for all adult US workers in both survey periods. Several blue-collar groups had greater annual smoking rate reductions in the most recent survey period relative to the earlier survey period. However, the majority of blue-collar worker groups had pooled 1997 to 2004 smoking rates in excess of the 24.5% smoking prevalence noted for a workers. Conclusion: Development of effective smoking prevention strategies specifically targeting blue-collar groups is warranted.

Matano RA; Koopman C; Wanat SF; Winzelberg AJ; Whitsell SD; Westrup D et al. A pilot study of an interactive web site in the workplace for reducing alcohol consumption. Journal of Substance Abuse Treatment 32(1): 71-80, 2007. (46 refs.)

An interactive web-site-based intervention for reducing alcohol consumption was pilot tested. Participants were 145 employees of a work site in the Silicon Valley region of California, categorized as low or moderate risk for alcohol problems. All participants were given access to a web site that provided feedback on their levels of stress and use of coping strategies. Participants randomized to the full individualized feedback condition also received individualized feedback about their risk for alcohol-related problems. Some evidence was found for greater alcohol reduction among participants who received full individualized feedback, although due to difficulties in recruiting participants, the sample size was inadequate for evaluating treatment effects on drinking. The results provide preliminary support for using an interactive web site to provide individualized feedback for persons at risk for alcohol problems. However, the low participation rate (2.7%) suggests that such an intervention must address the challenges of recruiting employees through their work site.

McNulty TL; Oser CB; Johnson JA; Knudsen HK; Roman PM. Counselor turnover in substance abuse treatment centers: An organizational-level analysis. Sociological Inquiry 77(2): 166-193, 2007. (85 refs.)

This article draws on institutional and ecological perspectives on work and organizations to develop a workplace level model of variation in voluntary counselor turnover rates across privately funded substance abuse treatment centers in the United States. Results show that participatory management structures reduce turnover rates principally by promoting organizational commitment. The analysis also tests hypotheses regarding the effects on turnover rates of other relevant theoretic domains of treatment center structure and organization. We discuss theoretical implications of the findings and suggest directions for future research.

Miller TR; Zaloshnja E; Spicer RS. Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing. Accident Analysis and Prevention 39(3): 565-573, 2007. (34 refs.)

Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective ill the workplace.

Moore RS; Lee JP; Antin TMJ; Martin SE. Tobacco free workplace policies and low socioeconomic status female bartenders in San Francisco. Journal of Epidemiology and Community Health 60(Supplement 2): 51-56, 2006. (24 refs.)

Study objective: Multiple studies have found that, compared with employees in other settings, workers in bars and restaurants have been exposed to high levels of secondhand smoke, putting them at increased risk for health complications. Among these bar employees are many women of low socioeconomic status (SES). Smoke free workplace ordinances have been extended to bars and restaurants in cities and states throughout the USA; some bars, however, continue to be out of compliance with these laws. The objective of this study is to assess the relation between bartender gender and smoke free workplace compliance in bars. Design: This paper reports on analyses of observational data on compliance with smoke free workplace policy in 121 randomly selected bars together with qualitative data from semi-structured interviews with bartenders and patrons in bars. Setting: San Francisco County bars. Main results: Findings from this research showed that smoke free policy non-compliance was associated with bars in which women were bartenders, increasing their tobacco exposure compared with male bartenders. In interviews, although some female bartenders expressed ambivalence toward the smoke free ordinance, many others described experiencing positive health and social consequences when the bars in which they worked could eliminate interior smoking. Conclusions: The analyses presented here shed light on the benefits of improving the workplace environment for low SES female bartenders through the extension of strong smoke free workplace policies to all workplaces, including bars.

Nakata A; Ikeda T; Takahashi M; Haratani T; Hojou M; Fujioka Y et al. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Social Science & Medicine 63(9): 2452-2463, 2006. (47 refs.)

Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged 16-83 years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p = 0.025), 2.27 at work (p = 0.015), and 3.08 at home (p = 0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs (1.11-1.19). In contrast, current and former smoking men had significant increases in adjusted ORs (1.57-2.00). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men.

O'Connell M; Comerford BP; Wall HK; Yanchou-Njike V; Faridi Z; Katz DL. Impediment profiling for smoking cessation: Application in the worksite. American Journal of Health Promotion 21(2): 97-100, 2006. (11 refs.)

Purpose. To replicate results of a pilot smoking cessation study and demonstrate applicability to a worksite setting. Methods. Smokers employed by a community hospital participated in an onsite smoking cessation program. Participants used an "impediment profiling" instrument to rate Personal barriers to cessation and were assigned to between one and seven interventions. Cessation was defined as carbon monoxide concentration in expired air of <= 10 ppm. Results. Fifty-one employees participated. Subjects lost to follow-up were assumed to be smoking, resulting in a 39.2 %-year quit rate,-47.5 % of program completers (n = 40) were smoke-free at I year. Se (reported quit rate at 2.5 years was 25.5 % (17 lost to attrition assumed to be smoking) with 38.2 % of program completers smoke-free. Discussion. This study suggests that impediment profiling holds promise for smoking cessation and demonstrates feasibility in a worksite setting. Further evaluation of this intervention in the context of randomized controlled trials is warranted.

Pidd K; Boeckmann R; Morris M. Adolescents in transition: The role of workplace alcohol and other drug policies as a prevention strategy. Drugs: Education, Prevention and Policy 13(4): 353-365, 2006. (32 refs.)

Aims: To assess ( 1) the alcohol and other drug ( AOD) consumption patterns of adolescent new entrants to the Australian workforce and ( 2) the association between these consumption patterns and workplace factors. Methods: A cross-sectional survey of 300 first-year apprentices ( aged 15 - 22 years) employed in South Australian workplaces was conducted. Findings: More than 40% of apprentices surveyed reported cannabis and alcohol consumption patterns that placed them at risk of potential harm. In addition, 19% reported drinking alcohol and 6.7% reported using cannabis during work-related hours. Workplace alcohol availability and the existence of workplace AOD policies were significantly associated with apprentices' consumption patterns. Apprentices employed in workplaces where alcohol was available used alcohol more often than those reporting no alcohol availability at work. Apprentices reporting an alcohol policy at their workplace reported less alcohol use compared to apprentices reporting no policy. Apprentices reporting a drug policy at their workplace reported lower levels of cannabis and alcohol use compared to those reporting no policy. Conclusions: Workplace factors, in particular workplace AOD policies, were significantly associated with adolescent AOD use both at and away from the workplace. These findings indicate that the workplace has potential as a setting for prevention strategies design to minimize AOD-related harms.

Pidd KJ; Berry JG; Roche AM; Harrison JE. Estimating the cost of alcohol-related absenteeism in the Australian workforce: The importance of consumption patterns. Medical Journal of Australia 185(11/12): 637-641, 2006. (22 refs.)

Objective: To estimate the extent and cost of alcohol-related absenteeism in the Australian workforce. Design: A secondary analysis of select data obtained from 13,582 Australian workers (aged >= 14 years) collected as part of the 2001 National Drug Strategy Household Survey. Main outcome measures: Self-reported measures of alcohol-related absenteeism, illness or injury absenteeism and alcohol consumption categorised according to National Health and Medical Research Council (NHMRC), guidelines for short- and long-term risk. Results: The use of self-reported measures of alcohol-related absenteeism resulted in an estimate of 2,682,865 work days lost due to alcohol use in 2001, at a cost of $437 million. The use of self-reported measures of illness or injury absenteeism to determine the extent of absenteeism attributable to alcohol use resulted in an estimate of 7,402,341 work days lost, at a cost of $1.2 billion. these estimates are about 12 to 34 times greater than previous estimates based on national data. Low-risk drinkers and infrequent or occasional risky and high-risk drinkers accounted for 49%-66% of alcohol-related absenteeism. Conclusions: The extent and cost of alcohol-related absenteeism is far greater than previously reported, and more than half the burden of alcohol-related absenteeism is incurred by low-risk drinkers and those who infrequently drink heavily.

Roesler U; Jacobi F; Rau R. Work and mental disorders in a German national representative sample. Work and Stress 20(3): 234-244, 2006. (34 refs.)

Most previous studies concerning the associations between work and mental ill-health have used dimensional self-report questionnaires for mental health problems (e.g., depressive symptoms). This study contributes to occupational health research by providing standardized clinical diagnoses based on DSM-IV criteria. A total of 2329 employees (age 18-65 years) took part in a structured, computer-assisted clinical interview (DIA-X/M-CIDI). Further, they specified whether their job was characterized by physical workload, overtime, or stress, and evaluated whether they feel impaired by each job characteristic. Results show that substance abuse/dependence (including nicotine dependence) was the highest prevalent mental disorder in German employees (12 month prevalence: 14.4%; only alcohol and illicit substance abuse/dependence: 4.9%) followed by anxiety (12.0%) somatoform (9.7%), and affective (9.3%) disorders. Sequential logistic regression analyses showed significant associations between the presence of stress at work and affective and somatoform disorders. Furthermore, feeling impaired by stress at work was strongly associated with anxiety, affective, somatoform disorders, and substance abuse/dependence. Beside work, personal characteristics, primarily gender, were associated with mental disorders in employees. However, except for affective disorders, gender did not modify the association between job characteristics and mental disorders. Taken together, results corroborate the necessity of considering mental disorders at work. Further studies to define the relation between work and mental disorders in employees are strongly recommended and should include objective analyses of job characteristics.

Rohsenow DJ; Howland J; Minsky SJ; Arnedt JT. Effects of heavy drinking by maritime academy cadets on hangover, perceived sleep, and next-day ship power plant operation. Journal of Studies on Alcohol 67(3): 406-415, 2006. (43 refs.)

Objective: The effects of an evening of heavy drinking on next-day occupational performance are mixed across studies and have not been investigated for ship-handling performance. Furthermore, it is not known whether the residual effects of alcohol on next-day performance are due to its effects on sleep. Method: Merchant marine cadets (N = 61) who had been trained on a diesel power plant simulator and who drank heavily at least episodically were given placebo beer one evening and were randomized on a second evening to placebo or real beer that resulted in a mean breath alcohol concentration (BrAC) of .115 g%. After an 8-hour sleep period, a meal, and a return to <=.02 g% BrAC, cadets were assessed with self-report measures and the power plant simulator. Results: No effects of beverage condition were seen on actual performance, although cadets who consumed alcohol rated their performance as impaired compared with the placebo conditions. Alcohol consumption also increased the Acute Hangover Scale score, improved perceived sleep quality, and decreased perceived latency to sleep onset while not affecting perceived sleep duration. Conclusions: While residual alcohol effects are found on some complex performance tasks, residual effects of .11 to .12 g% BrAC were not seen on ship engine simulator performance despite increased hangover symptoms and perceived impairment from the hangover. Therefore, this level of heavy drinking might not be deleterious to next-day routine occupational performance by young ship engineers despite the Subjective ill effects. The perception that alcohol improves sleep onset might be a motivation for some to drink heavily. The effects on older engineers, at higher alcohol levels, and on other ship-handling tasks still need to be studied.

Sansoy P; Ambroselli C; Padieu R; Ives R; Masar O; Anokhina IP, eds. Ethical Eye: Drug Addiction. Strasbourg France: Council of Europe Publishing, 2005

This edited volume with twelve chapters and sixteen contributors deals with ethical issues related to substance abuse, drawing upon the experiences in a variety of European countries and the Russian Federation. Following an introduction and opening chapter which outline ethical issues in respect to durg and use and the societal concerns drug use presents, the following chapters focus upon specific issues. Chapters consider information processing and data confidentiality; drug prevention and education; intensive treatment in countries with weak economics; compulsory treatment from three perspectives, the approach in the Russian Federation, the Swedish approach, and the treatment as an alternative to imprisonment. Other areas addressed are drug testing in the workplace, care for pregnant women or mothers, and treatment access for young people. The concluding chapter deals with the role of the Council of Europe in addressing drug addiction.

Scarinci IC; Silveira AF; Dos Santos DF; Beech BM. Sociocultural factors associated with cigarette smoking among women in Brazilian worksites: A qualitative study. Health Promotion International 22(2): 146-154, 2007. (33 refs.)

This study examined the contextual factors associated with smoking initiation and cessation among women in Brazilian worksites (Curitiba., Parand, Brazil). A total of 22 focus groups were conducted among 108 women in private and public worksites. The most frequently endorsed negative factors that contributed to smoking initiation included exposure to smoking-prompting behaviors through family members, peer pressure, media and easy access/low cost of cigarettes. Positive factors that served as protective mechanisms against initiation included smoking-related health effects and strong influence from parents and family members. The most salient negative factors associated with smoking cessation included stressl anxiety-relieving benefits, weight control, access1low cost of cigarettes, being around smokers and risk-exempting beliefs. Positive factors included smoking restrictions at home and workplace and concerns about appearance. Current and former smokers reported that they had never received any assistance from their physicians to quit smoking, nor did they rely on smoking cessation programs or aids or believe in their effectiveness. There are specific contextual factors that contribute to smoking initiationlcessation among women in Brazilian worksites which have important clinical, research and policy implications.

Schweitzer PK; Randazzo AC; Stone K; Erman M; Walsh JK. Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. Sleep 29(1): 39-50, 2006. (85 refs.)

Objectives: To evaluate the effects of napping, caffeine, and napping plus caffeine on performance and alertness in both laboratory and field settings. Design: (1) Laboratory Study: parallel-groups design with random assignment to 1 of 4 experimental conditions. (2) Field Study: crossover design. Setting: Sleep laboratory and field settings. Participants: (1) Laboratory Study: 68 healthy individuals; (2) Field Study: 53 shiftworkers who worked nights or rotating shifts. Interventions: (1) Laboratory Study: an evening nap opportunity before the first 2 of 4 consecutive simulated night shifts plus placebo taken all 4 nights, caffeine taken nightly, the combination of the nap and caffeine conditions, or placebo. (2) Field Study: an evening nap on the first 2 of 4 consecutive night shifts plus caffeine taken nightly versus placebo taken nightly without naps. Measurements and Results: (1) Laboratory Study: Napping, caffeine, and their combination all improved alertness and performance as measured by Maintenance of Wakefulness Test and Psychomotor Vigilance Task, but the combination of napping and caffeine was best in improving alertness. (2) Field Study: Napping plus caffeine improved performance as measured by Psychomotor Vigilance Test and decreased subjective sleepiness in individuals working the night shift. Conclusions: Napping plus caffeine helps improve performance and alertness of night-shift workers.

Shelley D; Yerneni R; Hung D; Das D; Fahs M. The relative effect of household and workplace smoking restriction on health status among Chinese Americans living in New York City. Journal of Urban Health 84(3): 360-371, 2007. (38 refs.)

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18-74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Smokers who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure.

Siegrist J; Rodel A. Work stress and health risk behavior. Scandinavian Journal of Work, Environment and Health 32(6): 473-481, 2006. (77 refs.)

This contribution discusses current knowledge of associations between psychosocial stress at work and health risk behavior, in particular cigarette smoking, alcohol consumption and overweight, by reviewing findings from major studies in the field published between 1989 and 2006. Psychosocial stress at work is measured by the demand-control model and the effort-reward imbalance model. Health risk behavior was analyzed in the broader context of a health-related Western lifestyle with socially and economically patterned practices of consumption. Overall, the review, based on 46 studies, only modestly supports the hypothesis of a consistent association between work stress and health risk behavior. The relatively strongest relationships have been found with regard to heavy alcohol consumption among men, overweight, and the co-manifestation of several risks. Suggestions for further research are given, and the need to reduce stressful experience in the framework of worksite health promotion programs is emphasized.

Slaymaker VJ; Owen PL. Employed men and women substance abusers: Job troubles and treatment outcomes. Journal of Substance Abuse Treatment 31(4): 347-354, 2006. (33 refs.)

The majority of U.S. adults with substance abuse or dependence are gainfully employed. However, little is known about outcomes among stably employed people in treatment for substance dependence. Participants (N = 212) entering a residential treatment program completed the Addiction Severity Index (ASI) at intake and 6 and 12 months follow-up. Significant improvements were seen in absenteeism, number of employment problem days, and whether their job was in jeopardy 12 months later. Overall, 65% were retained by their original employer. ASI composite alcohol, drug, legal, family, and psychiatric scores also improved significantly. Continuous abstinence was achieved by 65% and 51% at 6 and 12 months, respectively. Although less likely to be referred to treatment by their employer, women responded to treatment as well as men, reporting similar abstinence rates and overall quality of life during the year following discharge from treatment.

Stout PR; Horn CK; Klette KL; Given J. Occupational exposure to methamphetamine in workers preparing training aids for drug detection dogs. Journal of Analytical Toxicology 30(8): 551-553, 2006. (8 refs.)

Cocaine is rapidly metabolized to major metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME), and minor metabolites, norcocaine, p-hydroxycocaine, m-hydroxycocaine, p-hydroxybenzoylecgonine (pOHBE), and m-hydroxybenzoylecgonine. This IRB-approved study examined cocaine and metabolite plasma concentrations in 18 healthy humans who provided written informed consent to receive low (75 mg/70 kg) and high (150 mg/70 kg) subcutaneous cocaine hydrochloride doses. Plasma specimens, collected prior to and up to 48 h after dosing, were analyzed by gas chromatography-mass spectrometry (2.5 ng/mL limits of quantification). Cocaine was detected within 5 min, with mean+/-SE peak concentrations of 300.4+/-24.6 ng/mL (low) and 639.1+/-56.8 ng/mL (high) 30-40 min after dosing. BE and EME generally were first detected in plasma 5-15 min post-dose; 2-4 h after dosing, BE and EME reached mean maximum concentrations of 321.3+/-18.4 (low) and 614.7+/-46.0 ng/mL (high) and 47.4+/-3.0 (low) and 124.4+/-18.2 ng/mL (high), respectively. Times of last detection were BE>EME>cocaine. Minor metabolites were detected much less frequently for up to 32 h, with peak concentrations of 18 ng/mL for all analytes except pOHBE (up to 57.7 ng/mL). These data improve our knowledge of the pharmacokinetics of cocaine and its major and minor metabolites in plasma following controlled subcutaneous cocaine administration.

Vervaeke HKE; Korf DJ. Long-term ecstasy use and the management of work and relationships. International Journal of Drug Policy 17(6): 484-493, 2006. (52 refs.)

This study is a supplement to the Netherlands XTC Toxicity Study (NeXT), a multidisciplinary study on the neurotoxicity of ecstasy. We focus here on behavioural aspects of long-term, heavy ecstasy use, with particularly emphasis on occupational careers and intimate relationships. We interviewed a targeted sample of 29 ecstasy users in Amsterdam (11 females, 18 males, aged 38-55) with a lifetime consumption of �250 pills. They varied widely in terms of work careers and current employment. Career interruptions due to illness or unemployment were rather common. Most of these heavy ecstasy users were not particularly career-minded, but gave priority to their social life instead. Nonetheless, two-third of the respondents (19/29) were currently employed, and hence did not differ in this respect from their age-group peers in the Amsterdam general population. Respondents employed various strategies to keep their ecstasy use from adversely affecting their functioning, such as working flexible hours and tempering their ecstasy use in busy periods. More than half of respondents (16/29) had an intimate relationship (�1 year) at the time of the interview, almost all with a partner who also took ecstasy.