workplace responsibility, stress, alcohol availability and norms as predictors of alcohol...
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Substance Use & Misuse, 44:2062–2079Copyright © 2009 Informa Healthcare USA, Inc.ISSN: 1082-6084 (print); 1532-2491 (online)DOI: 10.3109/10826080902855173
Original Article
Workplace Responsibility, Stress, AlcoholAvailability and Norms as Predictors of Alcohol
Consumption-Related Problems AmongEmployed Workers
DAVID C. HODGINS,1 ROBERT WILLIAMS,2
AND GORDON MUNRO3
1Department of Psychology, University of Calgary, Calgary, Alberta, Canada2University of Lethbridge, Lethbridge, Alberta, Canada3Alberta Alcohol and Drug Abuse Commission, Research Services, Edmonton,Alberta, Canada
The objectives of this study were to determine the prevalence of alcohol use and prob-lems among employed individuals in Alberta, Canada (N = 1,890), and to conduct amultivariate examination of predictors of alcohol consumption-related problems. Gen-eral alcohol problems were identified by 10%, although very few workers described anyspecific work-related alcohol problems (1%). Structural equation modeling revealedthat, as hypothesized, workplace alcohol availability predicted general alcohol prob-lems. Job responsibility and workplace norms also predicted alcohol problems but onlyfor men. Perceived work stress did not predict alcohol problems. Results support thedevelopment of interventions that focus on re-shaping alcohol use norms.
Keywords Worker alcohol problems; workplace drinking norms; work stress;employee alcohol use
Introduction
Alcohol misuse has numerous potential direct and indirect negative effects on the workplace(Harwood and Reichman, 2000). Direct effects include impaired on-the-job performancedue to intoxication or withdrawal symptoms. The indirect consequences, which are likelyeven more widespread, include increased absenteeism because of drinking and impairedperformance due to the psychological and social sequelae of substance abuse. A clearunderstanding of the correlates and causes of alcohol consumption-related problems among
We wish to acknowledge the support of the Alberta Alcohol and Drug Abuse Commission whofunded and directed the survey.
Address correspondence to David Hodgins, PhD, Department of Psychology, University of Cal-gary, 2500 University Drive NW, Calgary, Alberta, Canada, T2N 1N4. E-mail: [email protected].
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Predictors of Alcohol Consumption-Related Problems Among Employed Workers 2063
workers has the potential to afford targeted and effective intervention programs. The currentstudy had two goals. The first was to determine the prevalence of alcohol use and alcoholconsumption-related problems among employed individuals in different occupations andindustries in Alberta, Canada. The second goal was to conduct a multivariate examination ofjob-related and individual characteristics predicting alcohol consumption-related problems,with a particular focus on understanding the role of job responsibility, perceived stress, andworkplace alcohol use norms and availability.
There are limited data about the specifics of alcohol consumption-related problemsand their correlates among workers. The United States 1997 National Household Surveyon Drug Abuse (NHSDA) revealed that 7.6% of full-time workers were “heavy users” ofalcohol (Zhang, Huang, and Brittingham, 1999). These individuals were more likely tobe males, of younger age, Caucasian or Hispanic, and to have less education and lowerincomes. They were also more likely to be employed in medium-sized work establishmentsand to be overrepresented in certain occupations: food preparation workers and servers,handlers, helpers, and labourers and construction workers. Further analysis of the 1997NHSDA (Harwood and Reichman, 2000) showed that compared to other workers, heavydrinkers were more likely to have missed work due to illness, a workplace accident, skippingwork, or leaving jobs voluntarily.
Other studies support these findings. For example, Jenkins (1986) showed a strongrelationship between drinking and absence from work in young British civil servants. Bloseand Holder (1991) reported that problem drinkers required medical treatment for injuries1.6 times more often than other employees and incurred much higher medical costs. Ames,Grube, and Moore (1997) documented a deleterious effect of alcohol hangovers on jobperformance.
More recently, Frone (2006) focused on alcohol use and impairment in the work-place itself. A U.S. national survey revealed that over the past year, 1.8% of workersreported having drunk within 2 hr of starting work, 7.1% had drunk during the workday, 1.7% had worked while under the influence of alcohol, and 9.2% had worked with ahangover. Overall, 15.3% of workers reported at least one indicator of workplace use orimpairment with greater likelihood for older, male, Caucasian and unmarried shiftworkers.The likelihood of workplace use and impairment was higher in management occupations,arts/entertainment/sports/media occupations, food preparation workers and servers, main-tenance workers, and sales occupations.
Alcohol misuse at the workplace as well as general misuse among workers are thoughtto be due to a combination of biological, psychological, and social factors that contribute toalcohol misuse generally, in addition to specific workplace factors. Research on workplacefactors has focused on aspects of work stress using a work-stress (Frone, 1999) or job-strainparadigm (Cooper, Russell, and Frone, 1990). The research findings have been mixed withsome studies reporting a significant association of alcohol misuse with some aspects of jobstress (e.g., Hemmingsson and Lundberg, 1998; Ragland, Greiner, Yen, and Fisher, 2000)and other studies not finding any relationship (e.g., Lehman and Bennett, 2002; Wiesner,Windle, and Freeman, 2005). One possible reason for these inconsistent results is a lackof consensus regarding the conceptualization and measurement of job stress. The constructis a multidimensional one that includes both psychological dimensions (e.g., perceivedstress) and job features that may be the cause of stress (e.g., job control, boredom, security,task complexity, responsibility, time demands, and shiftwork) (Greenberg and Grunberg,1995; Smith, Folkard, and Fuller, 2003). Another possible reason for inconsistent resultsis that these studies also differ in terms of age of workers (Wiesner et al., 2005), occupa-tion (Delaney, Grube, Greiner, Fisher, and Ragland, 2002; Tucker, Sinclair, and Thomas,
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2064 Hodgins et al.
2005), and gender ratio (the majority of studies have included only males) (Kouvonenet al., 2005).
Studies have also differed in terms of whether they are investigating alcohol use, “heavyalcohol use,” or alcohol consumption-related problems, either generally or in the workplacespecifically (Frone, 2006; Wiesner et al., 2005). Each of these potential areas of focus hasdifferent implications for prevention and treatment. For example, focus on workplace useand misuse is particularly relevant in terms of productivity and prevention of workplaceaccidents (Frone, 2004, 2006). A focus on general alcohol consumption-related problemsmay have relevance for productivity as well as overall worker health and well-being.
The workplace is an ideal setting for prevention and intervention programs as mostadults are employed, they spend considerable time at work, and employers are well posi-tioned to provide external motivators for employees to participate (Roman and Blum, 2002).There is evidence that secondary and tertiary alcohol misuse prevention interventions amongemployees are effective, although “gold standard” randomized controlled trials in whichworkers are randomly assigned to an intervention or a comparison condition are rare. Forexample, a number of uncontrolled outcome evaluations of Employee Assistance Programsthat provide services for employees misusing alcohol show them to be successful at makingmany employees return to work (Blum and Roman, 1995). As well, correlational data in-dicate that employees in workplaces that offer a greater amount of education about alcoholand drugs and/or have alcohol and drug use policies report less substance use (Zhang et al.,1999). Several uncontrolled evaluations of specific workplace alcohol consumption-relatededucation programs also show positive effects on attitude and behavior (Roman and Blum,1996). Moreover, in one of the few controlled trials, Cook, Black, and Trudeau (1996) foundpositive effects of a three session alcohol consumption-related education program com-pared with a control group. Similarly, Snow, Swan, and Wilton (2003) reported two studiesin which participants assigned to a stress-coping skills training intervention showed largerreductions in drinking than control participants who were assigned to a less intensive educa-tional program. On the other hand, Kishchuk et al. (1994) found that participants randomlyassigned to a nutrition education group had equivalent reduction in their drinking comparedto those assigned to an alcohol misuse prevention education group of equal intensity.
General health promotion programs that include alcohol along with other health be-haviors have also generally found them to be helpful at reducing drinking in uncontrolledevaluations (Shain, Suurvali, and Boutilier, 1986). Interestingly, a controlled trial of amonth-long general lifestyle campaign provided to employees of four randomly selectedpostal networks found that women, but not men, showed reduced rates of drinking at a 10-month follow-up compared to workers in comparison postal networks (Richmond, Kehoe,Heather, and Wodak, 2000).
In terms of targeted secondary prevention programs, Anderson and Larimer (2002)provided an individualized brief motivational and feedback intervention to workers at amedium-sized company in the United States. Those randomly assigned to the interventioncondition reduced their alcohol and heavy alcohol consumption compared with the controlparticipants. Among problem drinkers, effects were found for women but not men, similarto the study by Richmond et al. (2000) above. The authors of both these studies speculatedthat workplace alcohol use norms are an important consideration in planning effective inter-vention programs. Workplace norms are individual beliefs about the availability, approval,and use of alcohol in the workplace. Similarly, Bennett, Patterson, Reynolds, Wiitala, andLehman (2004) evaluated a group intervention focused on workplace climate among mu-nicipal workers and demonstrated that change in norms was related to reduced alcoholproblems over the following 6 months.
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Predictors of Alcohol Consumption-Related Problems Among Employed Workers 2065
Workplace norms, which can support or discourage alcohol use, may evolve throughoutan organization or be limited to specific work groups. In previous research, norms haveproven to be some of the most consistent and strongest predictors of worker drinking andproblem drinking (Ames, Grube, and Moore, 2000; Bennett et al., 2004; Macdonald, Wells,and Wild, 1999; Rice, Longabaugh, and Stout, 1997). For example, Bacharach, Bamberger,and Sonnenstuhl (2002) studied 3,000 union workers in a variety of worksites and found thatcoworker norms (e.g., perceptions of coworker drinking) predicted problem drinking morestrongly than other risk factors such as stress and alienation. Furthermore, coworker normshad both a direct effect on problem drinking and a mediational role between stress andalcohol problems. These findings, if replicated, support the value of focusing on modifyingnorms through workplace interventions.
In summary, a variety of factors have been shown to be associated with worker al-cohol problems in some, but not all, studies. The current study provides a multivariateexamination of job-related and individual characteristics predicting alcohol consumption-related problems in a large and diverse sample of workers. The focus is on general alcoholproblems versus workplace use and misuse. As shown in Figure 1, workplace perceivedstress and job features reflecting responsibility were conceptualized as separate but relatedfactors. Similarly, workplace alcohol availability and workplace alcohol use norms, indi-cated by coworkers drinking together after work, were hypothesized as being independentwith availability predicting norms. As shown in Figure 1, occupational responsibility wasconceptualized as a latent variable, with three indicators: the seriousness of consequencesof not doing job properly, amount of work-related travel, and amount of overtime and longhours required. Two indicators of workplace alcohol availability included availability onwork premises or near work premises. In addition, it was predicted that age and maritalstatus of the employee would be associated with workplace norms and alcohol problems(e.g., younger and single individuals seeking job environments with norms supportingheavier drinking) so these two variables were included as moderators. Gender was includedas an additional moderator as it was also predicted that gender would be associated withworkplace norms, work stress, and alcohol problems.
Alcohol on premises
Alcohol problems
Age
Marital status
Job
responsibility
Long hours Travel Risk of harmAlcohol near work
Workplace
availability
StressAlcohol norms
Gender
Figure 1. Hypothesized structural model: Influence of workplace norms, job responsibility, workstress, and alcohol availability on alcohol consumption-related problems.
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2066 Hodgins et al.
Materials and Method
Sample
The sample consisted of a stratified sample of 2,836 Albertans. Households were randomlyselected by means of random digit dialing conducted between November 26, 2002, andJanuary 21, 2003, and the interviewer spoke with the adult (18+) having the last birthdayamong the people in the household. This person was subsequently deemed eligible ifhe/she had engaged in paid employment sometime in the past 12 months. If ineligible,then the household was excluded. The sample was stratified according to age, region ofthe province (north or south), and occupation. Response rate of eligible households was39.9%. The demographics of the obtained sample were closely representative of the AlbertaLabour Force population in 2001 (Statistics Canada, 2001), and, therefore, no samplingweighting was used.
Survey
The telephone survey was divided into nine sections and averaged 15–20 min in length. Allemployees were asked sections pertaining to employment status, work environment, jobfactors, workplace issues, and demographics. In addition, employees were asked two of thethree following modules: tobacco and alcohol; illicit drugs and medications; and gambling.The present study utilizes the two subsamples who completed the alcohol module (n =1,890).
Participants’ open-ended descriptions of their employment were subsequently codedinto occupational and industry codes using the National Occupation Classification (Hu-man Resources Development Canada, 2003) and North American Industry ClassificationSystem/Standard Industrial Classification (Statistics Canada, 2003b) respectively. Age wasrecorded in the following categories: 18–24, 25–34, 35–44, 45–64, 65 and older. Mari-tal status was recorded as married/common-law, divorced, separated, widowed, or nevermarried and was recoded dichotomously, as currently married/common-law or not.
The Alcohol Use Disorders Identification Test (AUDIT) (Saunders, Aasland, Babor,del al Fuente, and Grant, 1993) was used to assess at-risk or harmful alcohol consumption.The scale has been shown to be a reliable and valid indicator of alcohol consumption-relatedproblems in numerous populations including general population surveys (Reinert and Allen,2002). The AUDIT items cover three content areas: consumption, related problems, andimpaired control. The standard cutoff of 8 or greater was used to identify a hazardous levelof alcohol problems.
Participants were asked a series of questions about alcohol in the work context over thepast year, including the frequency of drinking in the workplace and drinking within 4 hr ofstarting work. They were also asked whether they experienced any work-related problemswith alcohol use (yes, no) and, if yes, to provide a brief description of the problem orproblems. Questions related to tobacco included frequency of use in the past month, bothgenerally and at work.
For the structural equation modeling, three job responsibility factors were measuredwith three indicators: The risk of harm scale (α = .84) was composed of six items, eachrated on a 4-point Likert scale indicating the likelihood (no chance, very slight chance,moderate chance, quite a good chance) that if the individual failed to do their job well,the following would occur: physical injury to the worker or a coworker, physical injuryto someone outside the organization, damage of the environment, damage of company
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Predictors of Alcohol Consumption-Related Problems Among Employed Workers 2067
equipment or property, hurting the organization’s reputation, or loss of a lot of money forthe organization. The travel scale (α = .62) was composed of three dichotomous items:traveling on the job, worksite remote from home, and entertaining or being entertainedfor business reasons. The final indicator was an item measuring the need to work longhours: Does your job involve working long hours, including overtime? (no = 0, yes =1). Perceived stress was measured by one item: How stressful do you consider your job?(not at all = 0, somewhat = 1, extremely = 2). Workplace availability was measured withtwo indicators: Is alcohol permitted on the premises at work? Is alcohol available near theworkplace? Each question had a 4-point scale (0 = never, 1 = sometimes, 2 = most of thetime, 3 = almost always). Finally, workplace alcohol use norms were measured using thesame 4-point scale with the following item: Do people who work here frequently go fordrinks after work together?
Results
Descriptive Statistics
Frequency of alcohol use in the past year (AUDIT question 1) was rated as never by 19%,monthly or less by 29%, two to four times per month by 30%, two to four times per week by15%, and four or more times per week by 6%. Of the 1,517 workers who drank in the pastyear, the modal number of standard drinks consumed on a typical drinking day (AUDITquestion 2) was 1–2 (66%). Three or four drinks per typical drinking day was reported by23%, whereas 7% reported 5–6 drinks, 3% reported 7–9 drinks, and 2% reported 10 ormore drinks per typical day. The mean AUDIT score was 3.3 (SD = 3.6, mode = 0, median=2) and 10% of the workers scored above the cutoff for hazardous drinking (8+). Very fewworkers described any work-related problems with alcohol use (n = 18, 1%). Among thoseworkers who reported work-related problems, the most commonly reported problems weremissing a day of work (39%), arriving late for work (23%), working less than their normalcapacity (23%), or producing work of lower quality (15%). Drinking while at work in thepast year was reported by 11% of the sample and another 4% reported drinking within 4hr of starting work. Nineteen percent of the sample indicated that alcohol was permitted atwork at least sometimes. Sixty-one percent indicated that alcohol was available near theirworkplace. Sixty-two percent reported that coworkers frequently go for drinks after workat least sometimes and 12% indicated that they did this most of the time or almost always.
Table 1 displays these descriptive statistics by industry and occupation and showsthat for most variables the rates varied significantly. The industries with the highestproportion of hazardous drinkers were construction and forestry/mining. Those withthe lowest proportion were social services, education, telecommunications, hospitals, fi-nance, insurance, and real estate. In terms of occupation, the highest proportion of haz-ardous drinking was in construction and the lowest proportion was in clerical/office andmanager/professional.
In terms of tobacco, 30% of the workers reported smoking or using tobacco in the past4 weeks and 27% reported daily use. Almost one quarter (22%) reported smoking or usingtobacco while at work in the past month. Table 1 displays smoking by occupation, whichranged from 19% in primary occupations to 52% in material handling jobs, and industry,which ranged from 15% in education to 46% in construction. Smoking was significantlyrelated to hazardous alcohol use (χ2(1) = 81.1, p < .0001). Over 20% of current smokerswere hazardous drinkers compared with 6% of nonsmokers.
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Tabl
e1
Dri
nkin
gan
dsm
okin
gin
dica
tors
byin
dust
ryan
doc
cupa
tion
Con
sum
edA
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olis
perm
itted
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ohol
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azar
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arth
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nker
sdr
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rsat
wor
kat
wor
kaw
orkp
lace
aSm
oker
s
Indu
stry
Util
ities
2689
%8%
11%
4%69
%19
%Fo
rest
ry/m
inin
g42
88%
17%
10%
10%
49%
29%
Publ
icad
min
istr
atio
n10
187
%8%
7%25
%75
%25
%Fi
nanc
e,in
sura
nce,
real
esta
te98
85%
4%22
%35
%72
%27
%H
ospi
tals
179
85%
4%2%
7%58
%26
%U
pstr
eam
oila
ndga
s39
85%
15%
15%
11%
35%
36%
Tele
com
mun
icat
ions
3683
%3%
17%
24%
69%
31%
Con
stru
ctio
n13
483
%18
%9%
10%
46%
46%
Edu
catio
n17
681
%3%
12%
18%
50%
15%
Man
ufac
turi
ngan
dpr
oces
sing
113
81%
10%
10%
12%
43%
32%
Oth
erse
rvic
es41
580
%15
%18
%33
%76
%33
%T
rans
port
atio
n81
79%
12%
4%12
%49
%39
%W
hole
sale
and
reta
iltr
ade
288
79%
15%
7%13
%60
%39
%So
cial
serv
ices
5673
%2%
2%6%
60%
18%
Agr
icul
ture
9461
%9%
11%
36%
39%
16%
Tota
l1,
878b
81%
11%
11%
19%
60%
30%
Chi
-squ
are
(df=
14)
34.9
∗∗53
.8∗∗
66.5
∗∗11
6.2∗∗
105.
0∗∗68
.8∗∗
(Con
tinu
edon
next
page
)
2068
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Dri
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cupa
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(Con
tinu
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Con
sum
edA
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olis
perm
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ohol
avai
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azar
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alco
hol
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arth
eN
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wor
kat
wor
kaw
orkp
lace
aSm
oker
s
Occ
upat
ion
Man
ager
/pro
fess
iona
l72
184
%6%
14%
19%
65%
23%
Tra
nspo
rtat
ion
equi
pmen
tope
ratin
g48
83%
13%
2%6%
42%
48%
Cle
rica
l/offi
ce16
881
%5%
11%
23%
61%
27%
Sale
s15
981
%14
%9%
18%
66%
40%
Serv
ices
375
80%
14%
8%21
%65
%35
%C
onst
ruct
ion
9480
%27
%7%
12%
43%
50%
Oth
er13
978
%15
%9%
19%
51%
32%
Mat
eria
lsha
ndlin
g21
76%
19%
0%15
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%52
%Pr
oces
sing
4374
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%7%
9%39
%42
%Pr
imar
yoc
cupa
tions
122
68%
9%12
%21
%36
%19
%To
tal
1890
81%
11%
11%
19%
61%
30%
Chi
-squ
are
(df=
9)19
.6∗
62.0
∗∗20
.9∗
12.9
54.2
∗∗71
.1∗∗
aT
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5;**
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.
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2070 Hodgins et al.
Structural Equation Model
We conducted all analyses using AMOS V7 (Arbuckle, 2007) with maximum-likelihoodestimation procedures that allow for a small amount of incomplete data. Comparative fitindex (CFI) scores greater than .95 (Hu and Bentler, 1999) and root-mean-square errorof approximation (RMSEA) value of .06 or less (Browne and Cudeck, 1994) were usedto indicate acceptable fit. The assumptions of univariate and multivariate normality wereassessed for the observed variables in the hypothesized model (see Figure 1). Univariateindices were all adequate. Eight multivariate outliers were identified using Mahalanobisdistances due to extreme scores on the AUDIT measure. These extreme scores were recodedas 12. Three additional multivariate outliers were identified and were eliminated from thesample, yielding a final sample of n = 1,887. The means, standard deviations, and zero-order correlations of the model variables are included in Table 2.
Initial analyses indicated that the hypothesized model provided an inadequate fit forthe data, χ2(36) = 262.7, CFI = .90, RMSEA = .06. Examination of the regression weightsindicated that although the effect of job responsibility on perceived stress was significant(standardized regression coefficient = .29), the effect of stress on alcohol problems wasestimated to be zero. The stress variable was, therefore, eliminated from the model. Ex-amination of the modification indices suggested the addition of a direct path from age toworkplace availability, which made intuitive sense. Together these changes produced animproved and good fitting model, χ2(27) = 69.4, CFI = .98, RMSEA = .03, RMSEA 90thCI (confidence interval) = .021–.037, which accounted for 26% of the variance in alcoholproblems. The final model with standardized coefficients is displayed in Figure 2. Becausepost hoc modifications were performed, a correlation was calculated between the modelparameters estimates from the hypothesized model and those from the final model, r(16) =.996. This strong correlation indicates that the estimated effects changed very little despitemodifying the model (Tabachnick and Fidell, 2007).
As hypothesized, workplace alcohol availability, job responsibility, and workplacenorms had significant direct effects on alcohol problems. Contrary to our hypothesis, per-ceived work stress did not predict alcohol problems. Job responsibility and, to a less extent,workplace availability, had significant effects on workplace norms as did age and maritalstatus (those younger and single were more likely to drink together after work). Youngerworkers were more likely to be employed in workplaces with greater alcohol availability. Inaddition, gender, age, and marital status had direct effects on alcohol problems, as expectedwith younger, single males reporting greater alcohol problems.
The influence of gender was further examined by fitting the model simultaneously formen and women. The model fit the data for both genders well, χ2(40) = 74.8, CFI =.98, RMSEA = .02, RMSEA 90th CI = .01–.03. A chi-square difference test indicatedthat a comparison of a model constraining the regression weights to be identical for menand women differed significantly from this unconstrained model, χ2(7) = 15.5, p < .02,which indicates that some regression weights differed by gender. Table 3 displays thenonstandardized and standardized regression weights and by gender. Pairwise comparisonsrevealed that the magnitude of the regression weights differed for three paths at p < .05(see Table 3). For two of these paths the regression weights differed in magnitude withlarger weights for males while still being significant for both genders. For one path, theeffect of job responsibility on alcohol problems, the path was significant for men but notwomen. The effect of workplace norms on alcohol problems was also significant for menbut not women, although the regression coefficients did not differ statistically. Finally, theeffect of marital status on workplace norms was significant only for females, although
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Tabl
e2
Cor
rela
tions
,mea
ns,a
ndst
anda
rdde
viat
ions
for
the
hypo
thes
ized
mod
el(N
=1,
887)
12
34
56
78
910
11
1.G
ende
r–
––
––
––
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––
2.A
ge.0
5∗–
––
––
––
––
–3.
Mar
itals
tatu
s−.
05−.
30–
––
––
––
––
4.A
lcoh
olus
eon
prem
ises
.00∗
−.06
.05
––
––
––
––
5.A
lcoh
olne
arw
ork
.01∗
−.04
∗.0
2∗.2
1–
––
––
––
6.C
owor
kers
drin
kaf
ter
wor
k−.
13−.
19.0
9.1
3.1
3–
––
––
–7.
Perc
eive
dst
ress
.04∗
.06
−.08
.06
.12
.11
––
––
–8.
Lon
gho
urs
−.22
.00∗
.00∗
.05
.04∗
.12
.27
––
––
9.W
ork
trav
el−.
27.0
4∗−.
05.0
5.0
8.1
0.1
4.3
0–
––
10.R
isk
ofha
rm−.
27−.
03∗
−.01
∗−.
03∗
−.00
∗.1
2.1
4.2
3.2
1–
–11
.AU
DIT
−.27
−.34
.28
.16
.11
.21
.01∗
.08
.11
.14
–M
1.5
3.0
1.4
1.2
1.6
1.6
2.0
0.6
0.9
11.5
3.2
SD0.
51.
10.
50.
40.
50.
50.
60.
51.
05.
03.
1
Not
e.A
UD
IT=
Alc
ohol
Use
Dis
orde
rsId
entifi
catio
nTe
st;G
ende
r1
=fe
mal
e,2
=m
ale,
mar
itals
tatu
s1
=m
arri
ed,2
=no
tmar
ried
.∗ N
otsi
gnifi
cant
.
2071
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2072 Hodgins et al.
Alcohol on premises
Alcohol problems
Age
Marital status
Job
responsibility
.17
−.30
Long hours Travel Risk of harmAlcohol near work
.50 .52 .48
Workplace
availability
.60.52
Alcohol norms
Gender
−.19
−.18
.09
−.22
−.21
e7
d1
e6
d2
e2e1 e3 e4 e5
.08
.12
.17
.43.19
−.51
Figure 2. Final structural model with standardized coefficients.
the coefficients did not differ statistically. The SEM accounted for 27% of the variance inalcohol problems for men and 16% for women.
Discussion
About the same proportion of this employed sample reported drinking in the past yearcompared with recent national statistics for Canadians aged 18–74 years (81% vs. 79%)(Adlaf, Begin, and Sawka, 2005). The proportion of workers scoring in the hazardousrange of the AUDIT was slightly lower in this sample (10% vs. 12.8%). By comparison, theproportion of workers who were current (30%) and daily smokers (27%) appeared higherthan the provincial estimates for individuals aged 15 and older (23% and 18%) (StatisticsCanada, 2003a). Smoking rates and alcohol problem rates varied more by occupation thandid alcohol use rates with workers in the construction industries most likely to smoke andhave alcohol consumption-related problems. However, this association is also confoundedby the different gender ratios in these industries (i.e., higher rates of problems in industrieswith higher proportions of males). Although a fair proportion of workers acknowledgeddrinking at work at least occasionally, less than 1% described alcohol consumption-relatedwork problems (e.g., missing work, arriving late, working at less than normal capacity).This finding suggests that workplace interventions targeted at individuals who have any typeof alcohol problem will reach many more individuals than programs targeted at individualswho have experienced work problems related to drinking specifically. Because of the highassociation between cigarette smoking and alcohol consumption-related problems, it mayalso be feasible and efficient to address alcohol concerns in the context of interventions forsmoking, or vice versa.
The modified structural model was a good fit for the data which illustrates the com-plexity of the relationship between workplace factors and alcohol consumption-relatedproblems. Norms supportive of drinking such as going for drinks after work and avail-ability of alcohol at or near the workplace and degree of job responsibility were all pre-dictors of general alcohol consumption-related problems. Although job responsibility was
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Tabl
e3
Reg
ress
ion
wei
ghts
byge
nder
Fem
ales
(n=
1,01
1)M
ales
(n=
876)
Reg
ress
ion
Stan
dard
ized
Reg
ress
ion
Stan
dard
ized
Reg
ress
ion
path
ses
timat
eSE
estim
ate
estim
ate
SEes
timat
e
Mar
itals
tatu
s→
Wor
kpla
ceno
rms
.17
.04
.12
.10n
s.0
5.0
6A
ge→
Wor
kpla
ceno
rms
−.10
.02
−.15
−.17
.03
−.23
Age
→W
orkp
lace
avai
labl
e−.
08.0
2−.
18−.
11.0
2−.
25Jo
bre
spon
sibi
lity
→W
orkp
lace
norm
s.2
0.1
1.0
8.7
9.2
1.2
2W
orkp
lace
avai
labl
e→
Wor
kpla
ceno
rms
.81
.10
.52
.56
.10
.34
Mar
itals
tatu
s→
Alc
ohol
prob
lem
s∗.7
0.1
6.1
41.
48.2
3.2
1A
ge→
Alc
ohol
prob
lem
s∗−.
48.0
8−.
21−.
80.1
1−.
24W
orkp
lace
norm
s→
Alc
ohol
prob
lem
s.0
7ns
.16
.02
.48
.18
.11
Wor
kpla
ceav
aila
ble
→A
lcoh
olpr
oble
ms
1.28
.34
.24
1.24
.39
.17
Job
resp
onsi
bilit
y→
Alc
ohol
prob
lem
s∗.4
6ns
.39
.05
2.20
.87
.14
SE=
Stan
dard
erro
rof
the
estim
ate.
*Gen
der
diff
eren
ce,p
<.0
5.N
ote:
All
regr
essi
onw
eigh
tsar
esi
gnifi
cant
exce
ptth
ose
mar
ked
ns(n
s=
non-
sign
ifica
nt).
2073
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2074 Hodgins et al.
associated with perceived job stress, stress was not associated with alcohol consumption-related problems.
The finding that norms and problems are linked is consistent with the bulk of previousresearch on workplace norms (Bacharach et al., 2002; Bennett et al., 2004) and supports thefurther development of interventions focused on re-shaping alcohol use norms. However,important gender differences, not previously reported, emerged in this sample. Whereasnorms significantly predicted alcohol consumption-related problems for men, the effectwas not significant for women. This finding is consistent with Anderson and Larimer(2002) who found greater reductions for women than men in a brief workplace interventionand speculated that the workplace norms for men are more supportive of drinking whichweakens the impact of a brief intervention model for men. The results of the present studywould suggest, in addition to men, that young single workers might have poorer outcomeswith such an intervention unless it focused on changing their norms.
Frone (1999) has suggested previously that some job characteristics might be moreclosely related to alcohol consumption-related problems among men than women. Whereasworkplace availability predicted alcohol consumption-related problems for both men andwomen, job responsibility predicted alcohol consumption-related problems for men only.Men not only reported higher levels of job responsibility, but responsibility was linkedto greater general alcohol consumption-related problems. Level of work responsibility inwomen was unrelated to alcohol consumption-related problems.
Perceived work stress was not a significant predictor of alcohol consumption-relatedproblems. In previous research, measures of work stress are often composites that includeboth source of stress indicators (e.g., low skill variety, job responsibility, and other en-vironmental features) and impact indicators (e.g., alienation and perceived stress). Theseresults suggest that it may be helpful, in future research, to continue to separate job struc-tural characteristics from psychological stress in order to model these relationships moreaccurately. In the current study our single item measure of perceived stress may have beenlimited in terms of reliability although we found the hypothesized relationship between jobresponsibility and perceived stress, which supports its validity.
Wiesner et al. (2005) also argue for the importance of examining different aspects ofwork stress separately. They investigated five different indicators of work stressors in youngadult workers and found that different indicators were associated with different alcohol,drug, and depression outcomes. Generally few alcohol effects were uncovered but theyfound that job stress, as indicated by low skill variety, was linked to heavy alcohol usefor men only. They speculated that this gender difference reflected gender differences inalcohol use norms although they did not include a measure of norms in their study. It isimportant to include measures of multiple constructs to understand the relationship fully.
The construct of workplace norms or climate is not well defined in the literature.We used one indicator of the construct and measured it at the individual level. However,norms reflect a group level influence, although the boundaries of the work group are hardto define. For example, it may be that men and women working in the same industryoccupation or setting may experience different norms. More research on the constructvalidity and measurement of this important factor is required.
Although availability of alcohol has been conceptualized as an indicator of workplacenorms (e.g., (Ames and Grube, 1999), we measured it as a separate latent construct. Theavailability paradigm links availability with alcohol and illicit drug use in the workplaceand its effects on job performance (Frone, 2004).
The current investigation has a number of strengths as well as weaknesses. The samplesize was large and representative of workers in the general population. The age range was
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Predictors of Alcohol Consumption-Related Problems Among Employed Workers 2075
wide and both men and women were well represented. The sampling was done at the level ofthe individual and not limited to individuals employed in certain companies or industries,or to one gender. In addition, a well-validated measure of alcohol consumption-relatedproblems was used. On the other hand, the reliance on self-report via telephone survey isa possible limitation of the study as is the cross-sectional nature of the design. Prospectivedata would allow stronger causal inferences. In contrast to the measurement of alcoholconsumption-related problems, the measurement of workplace norms and work stress wasless sophisticated. Other researchers have suggested that better measures of job-relatedconstructs need to be developed (Hurrell, Nelson, and Simmons, 1998). We also did notinclude measures of intrinsic job motivation (Wiesner et al., 2005), work-family conflict(Snow et al., 2003), and drinking for negative affect management (Frone, 1999) and ourdata did not allow investigation of the effort–reward imbalance model, which suggeststhat alcohol consumption-related problems are greater when workers expend a large jobeffort for little reward (Bobak et al., 2006; Head, Stansfeld, and Siegrist, 2004). Inclusionof a wider range of variables might also have allowed prediction of a greater amount ofvariance in alcohol consumption-related problems. The current model accounted for aboutone-quarter of the variance, which is a reasonable amount given that many extra-workplacefactors contribute to alcohol consumption-related problems.
RESUME
Responsabilite de lieu de travail, effort, disponibilite d’alcool et normes commeprediseurs des problemes d’alcool parmi les ouvriers employes
Les objectifs de cette etude etaient de determiner la predominance de l’utilisation d’alcool etles problemes parmi un groupe representatif des individus employes dans Alberta, Canada(N = 1890) et pour conduire un examen multivariable des prediseurs de l’alcool ont reliedes problemes. Des problemes generaux d’alcool ont ete identifies de 10% bien que trespeu d’ouvriers aient decrit tous les problemes travailler-connexes specifiques d’alcool (1%).Modeler structural d’equation a indique que, comme presume, la disponibilite d’alcool delieu de travail a prevu des problemes generaux d’alcool. Les normes de responsabiliteet de lieu de travail du travail ont egalement prevu des problemes d’alcool mais seule-ment pour les hommes. Les contraintes du travail percues n’ont pas prevu des problemesd’alcool. Les resultats soutiennent le developpement des interventions qui se concen-trent sur des normes de remodelage d’utilisation d’alcool. Les limitations de l’etude sontnotees.
RESUMEN
La responsabilidad en el lugar de trabajo, el stress las reglas y disponibilidad dealcohol como predictores de problemas por consumo de alcohol entre los
trabajadores
Los objetivos de este estudio era determinar el predominio de los problemas causados porel consumo de alcohol, en una muestra de individuos empleados en Alberta, Canada (N =
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2076 Hodgins et al.
1980) y conducir una evaluacion multivariada predictiva de los problemas relacionadosal alcohol. En general, los problemas creados por el consumo de alcohol fueron identifi-cados en un 10% aunque muy pocos trabajadores describieron los problemas de trabajoespecıficamente relacionados al alcohol (el 1%). El modelo estructural de la ecuacion rev-elo que, como hipotesis, la disponibilidad de alcohol en el lugar de trabajo, es predictivode problemas relacionados al consumo del mismo. Las responsabilidades y las reglas deaceptacion en el lugar de trabajo tambien predijeron problemas por el consumo de alcoholpero solo en los hombres. El stress laboral percibido, no predijo problemas de consumo.Los resultados, apoyan el desarrollo de normas centradas en el consumo de alcohol. Debetenerse en cuenta las limitaciones de este estudio.
THE AUTHORS
David C. Hodgins, Ph.D., is currently a professor in theDepartment of Psychology, University of Calgary, withan adjunct appointment with the Faculty of Medicine. Dr.Hodgins is also a practicing clinical psychologist. Hisresearch publications and clinical work are in the areaof recovery from addictions. A brief treatment approachfor problem gamblers involving self-help and telephonesupport that his team had developed has been recognizedas a promising treatment by the United States SubstanceAbuse and Mental Health Administration. In 2006, he re-ceived the Annual Research Award from the U.S. NationalCouncil on Problem Gambling.
Robert Williams, Ph.D., is a professor in the School ofHealth Sciences, University of Lethbridge, and also theLethbridge Coordinator for the Alberta Gaming ResearchInstitute. Dr. Williams is a clinical psychologist by train-ing and spent the first part of his career as a clinician innorthern Manitoba (1985–1996) and then Calgary (1996–2001). In 2001 Dr. Williams accepted a faculty position atthe University of Lethbridge, funded by the Alberta Gam-ing Research Institute. Dr. Williams has published in theareas of addictive behavior, psychophysiology, seasonalaffective disorder, evolutionary theory, fetal alcohol syn-drome, health care practice, public policy, and gambling.In the past couple of years most of his work has focused
on gambling, where he is an internationally recognized expert.
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Predictors of Alcohol Consumption-Related Problems Among Employed Workers 2077
Gordon Munro, Ph.D., has a broad background in addic-tions. He has worked in policy development, counseling,program management, and research for 25 years. He hastaught about addictions and sociology at several univer-sities and is presently involved in working in the area ofhomeless youth and addictions.
References
Adlaf, E. M., Begin, P., Sawka, E. (2005). Canadian Addiction Survey (CAS): a national survey ofCanadians’ use of alcohol and other drugs. Ottawa: Canadian Centre on Substance Abuse.
Ames, G. M., Grube, J. W. (1999). Alcohol availability and workplace drinking: mixed methodanalyses. Journal of Studies on Alcohol, 60:383–393.
Ames, G. M., Grube, J. W., Moore, R. S. (1997). Relationship of drinking and hangovers to workplaceproblems: an empirical study. Journal of Studies on Alcohol, 58:37–47.
Ames, G. M., Grube, J. W., Moore, R. S. (2000). Social control and workplace drinking norms: acomparison of two organizational cultures. Journal of Studies on Alcohol, 61:203–219.
Anderson, B. K. Larimer, M. E. (2002). Problem drinking and the workplace: an individualizedapproach to prevention. Psychology of Addictive Behaviors, 16:243–251.
Arbuckle, J. L. (2007). AMOS (Version 7) [Computer software]. Chicago, IL: Smallwaters Corpora-tion.
Bacharach, S. B., Bamberger, P. A., Sonnenstuhl, W. J. (2002). Driven to drink: managerial control,work-related risk factors, and employee problem drinking. Academy of Management Journal,43:637–658.
Bennett, J. B., Patterson, C. R., Reynolds, S., Wiitala, W., Lehman, W. E. K. (2004). Team awareness,problem drinking, and drinking climate: workplace social health promotion in a policy context.American Journal of Health Promotion, 19:103–113.
Blose, J. O., Holder, H. D. (1991). Injury-related medical care utilization on a problem drinkingpopulation. American Journal of Public Health, 81:1571–1574.
Blum, T. C., Roman, P. M. (1995). Cost-effectiveness and preventive implications of employee assis-tance programs. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Bobak, M., Pikhart, H., Kubinova, R., Malyutina, S., Pajak, A., Sebakova, H., et al. (2006). Theassociation between psychosocial characteristics at work and problem drinking: a cross sectionalstudy of men in three Eastern European urban populations. Occupational and EnvironmentalMedicine, 62:546–550.
Browne, M. W., Cudeck, R. (1994). Alternative ways of assessing model fit. In K. A. Bollen & J. S.Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.
Cook, R. F., Black, A. S., Trudeau, J. (1996). Preventing alcohol use problems among blue collarworkers: a field test of the Working People program. Substance Use and Misuse, 31:255–275.
Cooper, M. L., Russell, M., Frone, M. R. (1990). Work stress and alcohol effects: a test of stress-induced drinking. Journal of Health and Social Behavior, 31:260–276.
Delaney, W. P., Grube, J. W., Greiner, B., Fisher, J. M., Ragland, D. R. (2002). Job stress, unwindingand drinking in transit operators. Journal of Studies on Alcohol, 63:420–429.
Frone, M. R. (1999). Work stress and alcohol use. Alcohol Research and Health, 23:284–291.
Subs
t Use
Mis
use
Dow
nloa
ded
from
info
rmah
ealth
care
.com
by
Uni
vers
ity o
f W
ater
loo
on 1
0/31
/14
For
pers
onal
use
onl
y.
2078 Hodgins et al.
Frone, M. R. (2004). Alcohol, drugs, and workplace safety outcomes: a view from a general modelof employee substance use and productivity. In J. Barling & M. R. Frone (Eds.), The psychologyof workplace safety (pp. 127–156). Washington, DC: American Psychological Association.
Frone, M. R. (2006). Prevalence and distribution of alcohol use and impairment in the workplace: aUS national survey. Journal of Studies on Alcohol, 67:147–156.
Greenberg, E. S. Grunberg, L. (1995). Work alienation and problem alcohol behavior. Journal ofHealth and Social Behavior, 36:83–102.
Harwood, H. J., Reichman, M. B. (2000). The cost to employers of employee alcohol abuse: a reviewof the literature in the United States of America. Bulletin on Narcotics, LII:39–51.
Head, J., Stansfeld, S. A., Siegrist, J. (2004). The psychosocial work environment and alcoholdependence. Occupational and Environmental Medicine, 61:219–244.
Hemmingsson, T., Lundberg, I. (1998). Work control, work demands, and work social support inrelation to alcoholism among young men. Alcoholism: Clinical and Experimental Research,22:921–927.
Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the RoyalSociety of Medicine, 58:295–300.
Hu, L., Bentler, P. M. (1999). Cut-score criteria for fit indices in covariance structure analysis:conventional criteria versus new alternatives. Structural Equation Modeling, 6:1–55.
Human Resources Development Canada. (2003). Career handbook Canada. Human Resources De-velopment Canada.
Hurrell, J. J., Nelson, D. L., Simmons, B. L. (1998). Measuring job stressors and strains: where havewe been, where are we, and where we need to go. Journal of Occupational Health Psychology,3:368–389.
Jenkins, R. (1986). Sex differences in alcohol consumption and its associated morbidity in youngcivil servants. British Journal of Addiction, 81:525–535.
Kishchuk, N., Peters, C., Towers, A. M., Sylvestre, M., Bourgault, C., Richard, L. (1994). Formativeand effectiveness evaluation of a worksite program promoting healthy alcohol consumption.American Journal of Health Promotion, 8:353–362.
Kouvonen, A., Kivimaki, M., Cox, S. J., Poilolainen, K., Cox, T., Vahtera, J. (2005). Job strain, effort-reward imbalance and heavy drinking: a study in 40,851 employees. Journal of Occupationaland Environmental Medicine, 47:503–513.
Lehman, W. E. K., Bennett, J. B. (2002). Job risk and employee substance use: the influence ofpersonal background and work environment factors. American Journal of Drug and AlcoholAbuse, 28:263–286.
Macdonald, S., Wells, S., Wild, T. C. (1999). Occupational risk factors associated with alcohol anddrug use. American Journal of Alcohol Abuse, 25:351–369.
Ragland, D. R., Greiner, B. A., Yen, I. H., Fisher, J. M. (2000). Occupational stress factors and alcohol-related behavior in urban transit operators. Alcoholism: Clinical and Experimental Research,24:1011–1019.
Reinert, D. F., Allen, J. P. (2002). The Alcohol Use Disorders Identification Test (AUDIT): a reviewof recent research. Alcoholism: Clinical and Experimental Research, 26:272–279.
Rice, C., Longabaugh, R., Stout, R. L. (1997). Comparison sample validation of “Your workplace”: aninstrument to measure perceived alcohol support and consequences from the work environment.Addictive Behaviors, 22:711–722.
Richmond, R., Kehoe, L., Heather, N., Wodak, A. (2000). Evaluation of a workplace brief interventionfor excessive alcohol consumption: the workscreen project. Preventive Medicine, 30:51–63.
Roman, P. M., Blum, T. C. (1996). Alcohol: a review of the impact of worksite interventions on healthand behavioral outcomes. American Journal of Health Promotion, 11:136–149.
Roman, P. M., Blum, T. C. (2002). The workplace and alcohol problem prevention. Alcohol Researchand Health, 26:49–57.
Saunders, J. B., Aasland, O. G., Babor, T. F., del al Fuente, J. R., Grant, M. (1993). Developmentof the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on earlydetection of persons with harmful alcohol consumption—II. Addiction, 88:791–804.
Subs
t Use
Mis
use
Dow
nloa
ded
from
info
rmah
ealth
care
.com
by
Uni
vers
ity o
f W
ater
loo
on 1
0/31
/14
For
pers
onal
use
onl
y.
Predictors of Alcohol Consumption-Related Problems Among Employed Workers 2079
Shain, M., Suurvali, H., Boutilier, M. (1986). Health promotion and employee assistance programs.Lexington, MA: Lexington Books.
Smith, C. S., Folkard, S., Fuller, J. A. (2003). Shiftwork and working hours. In J. Campbell & L. E.Tetrick (Eds.), Handbook of occupational health psychology (pp. 163–183). Washington, DC:American Psychological Association.
Snow, D. L., Swan, S. C., Wilton, L. (2003). A workplace coping-skills intervention to preventalcohol abuse. In J. B. Bennett & W. E. K. Lehman (Eds.), Preventing workplace substanceabuse: beyond drug testing to wellness (pp. 57–96). Washington, DC: American PsychologicalAssociation.
Statistics Canada. (2001). Statistics Canada provincial profile—Alberta [On-line]. www12.statcan.ca/english/census01/products/standard/prprofile.
Statistics Canada. (2003a). Canadian Tobacco Use Monitoring Survey (CTUMS), February–December 2002. Ottawa: Statistics Canada.
Statistics Canada. (2003b). North American Industry Classification System, Canada 2002. StatisticsCanada, Standards Division.
Tabachnick, B. G., Fidell, L. S. (2007). Using multivariate statistics. (5 ed.). Boston: Allyn & Bacon.Tucker, J. S., Sinclair, R. R., Thomas, J. L. (2005). The multilevel effects of occupational stressors on
soldiers’ well-being, organizational attachment, and readiness. Journal of Occupational HealthPsychology, 10:276–299.
Wiesner, M., Windle, M., Freeman, A. (2005). Work stress, substance use and depression amongyoung adult workers: an examination of main and moderator effect models. Journal of Occupa-tional Health Psychology, 10:83–86.
Zhang, Z., Huang, L. X., Brittingham, A. (1999). Worker drug use and workplace policies andprograms: results from the 1994 and 1997 National Survey on Drug Abuse [Computer software].Rockville, MD: SAMHSA, Office of Applied Statistics.
Subs
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Mis
use
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For
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onal
use
onl
y.