Time allocation between work and recreation and the associated injury risks among young people.

PROBLEM: The purpose of this study was to examine the relationship between overall risk of injury and time use patterns between work and active recreation among adolescents and young adults. METHODS: Using a representative sample of 9,795 Canadians aged 15-24 years, a multivariate logistic regression on the likelihood of any medically attended injury was conducted, including sociodemographic, individual, and time factors. RESULTS: Young people who engaged in a combination of high work and high activity hours were twice as likely to sustain a medically attended injury compared to those who worked low hours, but did not participate in any recreational activity. Those respondents who were not in school had a 43% increase in injury risk compared to full-time students. SUMMARY: Our findings suggest that injury risk was not a simple function of fatigue and cumulative exposure time. Our findings suggest the importance of considering time use and the associated injury risk tradeoffs. IMPACT ON INDUSTRY: Relevant to state and federal work safety policy makers, our findings suggest the importance of understanding where youth might otherwise spend their time if constraint were placed on their employment opportunities, and the associated injury risk tradeoffs must be taken into consideration.

Young people and work injuries: an examination of jurisdictional variation within Canada.

OBJECTIVE: The purpose of this study was to identify risk factors of work injuries among Canadian adolescents and young adults and to examine provincial differences in work injury rates. METHODS: Information on work and injuries were obtained from a representative sample of 14 541 Canadians aged 15-24 years. Respondents reported medically attended, work related injuries in the past 12 months, work hours, and type of occupation. A multivariate logistic regression on likelihood of work injury included demographic and work variables, as well as province of residence. RESULTS: Even when factors expected to vary by province such as occupation were statistically controlled, Saskatchewan youth were about twice as likely to be injured at work compared to Ontario youth. Type of job was a major correlate of injury risk, with all jobs showing higher risk than administrative clerical jobs. Even with type of job controlled, visible minorities, students, and 15-17 year olds had a reduced likelihood of work injury than their counterparts. CONCLUSIONS: Many young Canadians sustain work injuries that have clear medical costs and potential long term health consequences. Individual level explanations for youth's increased risk for workplace injuries (for example, inexperience or developmental factors) need to be supplemented with a better understanding of the broader social, economic, and political factors across jurisdictions.

Trial by fire: a multivariate examination of the relation between job tenure and work injuries.

AIMS: This study examined the relation between months on the job and lost-time claim rates, with a particular focus on age related differences. METHODS: Workers' compensation records and labour force survey data were used to compute claim rates per 1000 full time equivalents. To adjust for potential confounding, multivariate analyses included age, sex, occupation, and industry, as well job tenure as predictors of claim rates. RESULTS: At any age, the claim rates decline as time on the job increases. For example, workers in the first month on the job were over four times more likely to have a lost-time claim than workers with over one year in their current job. The job tenure injury associations were stronger among males, the goods industry, manual occupations, and older adult workers. CONCLUSIONS: The present results suggest that all worker subgroups examined show increased risk when new on the job. Recommendations for improving this situation include earlier training, starting workers in low hazard conditions, reducing job turnover rates in firms, and improved monitoring of hazard exposures that new workers encounter.

Opportunities and challenges for collaboration in research and practice in injury prevention across work and other settings.

Even though injuries at work and in other settings (homes, roads, etc) commonly involve similar mechanisms, research and prevention are usually specific to each setting. The potential benefits of addressing common features of injury prevention are noted across setting, while some unique features of the work environment are acknowledged. Further integration is recommended using the following approaches: (i) organization of research questions by injury mechanisms and (ii) support of comparative research across settings by funding agencies.

Using self-help materials to motivate change at assessment for alcohol treatment.

The utility of a brief self-help booklet provided at assessment for alcohol treatment was evaluated using a quasi-experimental design (booklet provided to all clients for one month at a time, interspersed by one month of no booklets, for a 6-month period). While the booklet did not result in any significant reduction in client attrition, clients who received the booklet at their assessment were drinking less by the 6-month follow-up than those who did not receive the booklet. Limitations of this study, including the quasi-experimental design and the impact of the low baseline attrition rates, are discussed.

Help-seeking timeline followback for problem drinkers: preliminary comparison with agency records of treatment contacts.

OBJECTIVE: A pilot study assessed the utility of the Timeline Followback (TLFB) method to collect information on help seeking. METHOD: Using the TLFB method, 34 clients (26 men) who had attended at least one session of an outpatient alcohol treatment program reported on treatment contacts, including any supplemental services (e.g., psychiatric care). TLFB reports of help seeking at that agency were compared with agency records of treatment contacts. RESULTS: Clients reported on their help-seeking behavior for a period of approximately 8 months after they had completed an initial assessment for the outpatient treatment. With regard to the number of outpatient sessions they attended, intraclass correlations and equivalence testing showed that the TLFB data were comparable to the agency records of treatment contacts. Analysis of week-to-week correspondence of the presence or absence of help-seeking episodes showed good agreement between TLFB and the agency records for most participants, although there was substantial variation. Degree of correspondence was not associated with the length of the recall period or individual differences (e.g., drinking pattern). Older participants, however, tended to have lower week-to-week concordance than did younger participants. CONCLUSIONS: These data provide preliminary support for the utility of a help-seeking TLFB instrument to assess addiction- and mental health-related contacts. This instrument may be especially useful in research in which collecting temporal patterns of help seeking is of interest (e.g., in studies examining factors influencing the delay in help seeking after relapse).

A comparison of a brief and long version of the Situational Confidence Questionnaire.

Assessing confidence to resist drinking in high risk situations is an important part of behavioral treatments for alcohol problems. The present study assessed the reliability and validity of the original 100-item Situational Confidence Questionnaire (SCQ) and of an 8-item brief version (BSCQ). Using a visual analog scale, the BSCQ asked respondents to report their confidence to resist urges to drink heavily using the original eight SCQ subscales (e.g., pleasant times with others, social pressure). Data were collected from 120 adult problem drinkers who voluntarily entered an outpatient alcohol treatment program. The comparability of the BSCQ and the SCQ-100 was evaluated through intraclass correlations between the eight subscales and comparison of both instruments' underlying factor structures. Correlation coefficients for the subscales ranged from 0.56 to 0.80. Both instruments showed similar, but not identical factor structures. The present results indicate that the BSCQ provides comparable information to the SCQ-100. Limitations, as well as the clinical advantages, of using the BSCQ over longer versions are discussed.

Alcohol administration methodology 1994-1995: what researchers do and do not report about subjects and dosing procedures.

This article reviews which parts of the alcohol administration methodology were reported in 90 alcohol studies on humans published from 1994 to 1995. although several subject characteristics such as gender were regularly reported, other variables that can influence pharmacokinetics and responses to alcohol were not consistently reported. It is suggested that guidelines for reporting human alcohol administration studies be created and that journal editors and funding agencies require submissions to meet minimum standards for describing the study methodology. Potential guidelines are presented.

Problem drinkers: evaluation of a stepped-care approach.

The present study evaluated a stepped-care model for the treatment of problem drinkers; those not severely dependent on alcohol. The initial treatment consisted of a motivationally based, four-session outpatient treatment. Based on previous research, treatment nonresponders were defined as having consumed more than 12 drinks per week between the assessment and third session. Six-month follow-up interviews were conducted on three groups of problem drinkers: (1) those who responded to the initial intervention (n = 67); (2) those who did not respond to the initial treatment (n = 36); and (3) those who did not respond to the initial treatment and received a supplemental intervention (n = 33). The last two groups were used to evaluate whether providing treatment nonresponders with an additional "step" would improve treatment outcomes. The primary dependent measures were posttreatment percent days abstinent and posttreatment drinks per drinking day. Results suggested that (1) within treatment drinking can help identify treatment nonresponse in stepped-care models; (2) the supplemental intervention did not influence posttreatment drinking; (3) treatment responders and nonresponders sought additional help at the same rate. The present study is the first study on stepped-care for alcohol treatment and provides a methodology for evaluating stepped interventions. Recommendations for future research in this area include more attention to assessing the needs of treatment nonresponders and help seeking behavior of both responders and nonresponders after an initial intervention.

Gender and alcohol dosing: a procedure for producing comparable breath alcohol curves for men and women.

Gender differences in peak breath alcohol concentrations (BrACs) reached in alcohol administration studies can make the interpretation of study findings difficult. This study evaluated the CBAC computer program as a way of minimizing gender differences in the BrAC curve. After consuming a predrink meal that was adjusted by body mass, 31 female and 27 male subjects consumed an alcoholic beverage targeted for either 0.04% or 0.08%. Mean peak BrACs for women and men were not significantly different. Similarly, the four BrAC readings obtained over the first 2 hr postdrink showed no gender differences. A dose x gender interaction was observed on time to peak BrAC, with women reaching peak BrAC faster than men only in the high dose groups. By decreasing gender differences in BrAC curves, this dosing procedure can aid in reducing the potential confound of dose and gender.

Alcohol treatment outcome methodology: state of the art 1989-1993.

This article reviews the 61 alcohol treatment outcome studies published from 1989-1993 with respect to methodology. Although better assessment of subjects' pretreatment characteristics was noted, a minority of studies met even the basic requirements of experimental studies. Further, some reversals of methodological progress were observed in several areas, particularly in collecting outcome data from multiple sources. It is suggested that funding agencies and journal editors require that submissions meet minimum standards for adequate outcome evaluation.

Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings.

AIMS: Cost containment, a central issue in current health planning, encourages the use of brief interventions. Although brief interventions for problem drinkers have proved successful, a portion of such individuals do not change their alcohol use during treatment. DESIGN: Repeated measures design (pre-treatment, within-treatment and 6 months post-treatment). SETTING AND PARTICIPANTS: To identify individuals at risk for continued problem drinking, predictors of post-treatment drinking were examined for 212 problem drinkers who presented for treatment in an outpatient treatment clinic. INTERVENTION: All participants completed a brief cognitive behavioral motivational intervention. MEASUREMENTS: At the pre-treatment assessment demographic, drinking pattern, severity of dependence and other cognitive variables (e.g. self-efficacy, goal choice) were collected. Within-treatment, drinking pattern and cognitive variables such as self-efficacy and goal choice were again measured. FINDINGS: Regression analyses showed that therapist prognosis ratings contributed significantly to the prediction of outcome even when pre-treatment variables were controlled. However, when within-treatment variables were included in the prediction, variables such as within treatment drinking eliminated the predictive utility of therapist prognosis ratings. This pattern held for both percentage of days abstinent and drinks per drinking day at a 6-month follow-up. CONCLUSIONS: It is suggested that a stepped care approach based on prediction models that include clients' within-treatment response can be applied to the treatment of problem drinkers who show little initial response to treatment.

Relationship between posttreatment drinking and alternative responses to high-risk situations proposed during treatment by problem drinkers.

Problem drinkers' alternatives to high-risk situations were evaluated and related to treatment outcome. participants were 80 problem drinkers (64% males, 36% females) who completed a brief outpatient Guided Self-Change treatment. Treatment included a homework exercise where clients identified two to three high-risk situations and generated alternative responses for each situation. Based on a coding scheme developed by Moser and Annis (1996), responses were coded as (a) cognitive or behavioral, and (b) active or avoidant. Results indicated that the proportion of cognitive coping responses (e.g., thinking through the consequences) was positively related to posttreatment improvement. This prospective study suggests that intention to use active cognitive coping responses influences the relapse process.

Stress and alcohol: the moderating effect of chronic stress on the acute stress--intoxication relationship.

OBJECTIVE: The present study evaluated whether chronic stress levels moderated the impact of laboratory stressors on subjective and behavioral responses to alcohol. METHOD: Healthy volunteers (N = 60; 30 male) completed measures of background stress levels (e.g., major life events). In addition, subjects were exposed to two laboratory stressors (i.e., cold pressor or film stressor task) or a control condition after consuming a 0.7 g/kg dose of alcohol. RESULTS: Regression analyses showed that the combination of high background stress levels and exposure to a lab stressor reduced two measures of perceived intoxication (i.e., Sensation Scale, Visual Analog Intoxication Scale). CONCLUSIONS: These data are consistent with a biobehavioral model of alcohol use where acute and chronic stressors are associated with a diminished response to alcohol. The possible mechanisms that may underlie this sobering effect include stress-related cognitive deficits and situation specific tolerance associated with high chronic stress levels.

The effects of stress and coping on daily alcohol use in women.

To evaluate the notion that perceived stress and drinking covary over time, daily logs were periodically collected over a 6-month period from 32 middle-aged women. Results indicated that significantly less alcohol was consumed on high-stress weeks than low-stress weeks. Problem-focused (P-F) coping preference moderated this relationship, with low P-F copers consuming more alcohol per occasion than did high P-F copers but only during low-stress weeks. These findings support a model of stress and alcohol use that includes coping preference as an important moderator of women's drinking. In addition, our data are consistent with the notion that stress can influence alcohol consumption but that low P-F women regulate their use, preferring to delay their drinking until after the termination of the stressor.

Effect of stress on perceived intoxication and the blood alcohol curve in men and women.

To determine the influence of stress on intoxication and blood alcohol concentration (BAC) 60 healthy male and female volunteers were exposed to a cold pressor test, distressing film, or control condition after consuming a moderate dose of alcohol. Two measures of perceived intoxication suggested a sobering effect of acute stressors. In addition, Ss viewing the distressing film showed longer latency to peak BAC than Ss in the control condition. As BAC began to fall, the cold pressor test initially increased rate of alcohol elimination. These stress-induced changes in intoxication and the BAC curve support a biobehavioral model in which stress may increase alcohol use partly because it attenuates alcohol's psychopharmacological impact.

An evaluation of the balanced placebo design in alcohol administration research.

Results from a study using the balanced placebo design to assess alcohol's effects on anxiety raise serious doubts about the utility of the design even at moderate blood alcohol concentrations. Despite being informed that they were not drinking alcohol, 44% of the subjects who were administered alcohol reported consuming at least some alcohol. Moreover, subjects' scores on the Marlowe-Crowne Social Desirability Index (MCSD) were associated with deception success, suggesting that individual differences in reporting bias influence the manipulation. In contrast, only 6% of subjects who were told that they had consumed alcohol but were given tonic water were not deceived. Among subjects in this placebo condition, scores on the MCSD were not associated with success of the deception. These data suggest that at a moderate dose of alcohol, drink deception in the antiplacebo condition is much more difficult to execute than in the placebo condition, and that deception in the former condition may be confounded with experimenter demand.

Parental history of alcohol abuse and the effects of alcohol and expectations of intoxication on social stress.

Male and female social drinkers, half of whom had a biological father who abused alcohol, were exposed to a social stressor (anticipation and delivery of a public speech) after consuming either a moderate dose of alcohol or tonic water. Half of each group were led to believe that they had consumed alcohol, the other half tonic water, yielding a 2 x 2 x 2 x 2 factorial design. Intoxication, but not beliefs about having consumed alcohol, significantly reduced subjective anxiety and negative self-evaluation in response to the stressor in both men and women. Parental history of alcohol abuse differentially affected alcohol's influence on mood, but not measures of subjective intoxication, subjective physiological responses to alcohol, beliefs about alcohol's effects on behavior, or reactivity to the stressor.

Alcohol and anxiety: postdrink-performance feedback alters affective and self-evaluative responses to a subsequent social stressor.

Several models of alcohol use and abuse implicate self-evaluation as a variable that mediates alcohol's anxiolytic effects. Self-evaluation when drinking, in turn, is affected by people's causal attributions for their behavior and alcohol expectancies. Accordingly, postdrink performance feedback was manipulated by having 20 subjects engage in a set of tasks before and after a moderate dose of alcohol. Half of the subjects received feedback that alcohol impaired their task performance whereas the other half received feedback that alcohol did not impair their performance. All subjects then participated in a stressful social interaction. As expected, subjects in the high behavioral impairment condition made more external performance attributions during the social stressor and reported less negative self-evaluation and subjective anxiety than subjects in the low behavioral impairment condition. Alcohol expectancies appeared to account partially for the data. The results indicate that information concerning alcohol-induced behavioral impairment moderates alcohol's effects on self-evaluation and subjective anxiety.