Increasing cocaine use amongst employed Australians: who is most at-risk?

Australian's cocaine use is at record levels. Large increases occurred between 2016-2019, with significant increases predominately found among employed Australians. Patterns, and prevalence of workers' cocaine use were examined using the 2016 and 2019 National Drug Strategy Household Survey data via frequency analyses. Logistic regression modelling identified predictors of employed Australian's: cocaine use (2019); and increased use over time (2016-2019). Workers' cocaine use increased 63% between 2016-2019 (3.8%-6.2%). Predictors of use, and increased use, were age, marital status, state, remoteness, smoking status, alcohol use, and cocaine approval level. Income and psychological distress predicted cocaine use in 2019 only. Highest prevalence in 2019 occurred among workers who approved of regular cocaine use (47.9%), currently smoked (14.9%), were very highly distressed (14.0%), risky alcohol consumers (13.7%), and aged 18-24 years (13.9%). Numerous individual-level characteristics influence workers' cocaine use. Workplace cultural norms and substance use climates may facilitate increased cocaine use. The workplace is a powerful setting for cocaine prevention and intervention efforts. Potential strategies include targeting social norms, shifting positive drug use workplace cultures, and providing health and safety training focussing on the risk of use to self and co-workers whilst also examining demographic subgroups' motivations for use.

Patterns and Prevalence of Daily Tobacco Smoking in Australia by Industry and Occupation: 2007-2016.

INTRODUCTION: Australian workers' daily tobacco smoking over time was examined by industry and occupation, to identify factors associated with high and/or low prevalence. AIMS AND METHODS: Secondary analyses of 2007, 2010, 2013, and 2016 National Drug Strategy Household Surveys were undertaken (pooled n = 49 395). Frequency analyses informed subsequent modeling of select industries and occupations. Four logistic regression models estimated adjusted effects of demographics on daily smoking in industries with high (≥20%) and low (≤15%) daily smoking prevalence and occupations with high (≥20%) and low-moderate (<20%) daily smoking prevalence. RESULTS: The sample comprised 55.7% men, 34.1% 25-39-year-olds, 31.4% New South Wales residents, 70.1% metropolitan residents, 66.9% high socioeconomic status workers, and 70.6% with low psychological distress. Daily smoking prevalence differed by industry and occupation in 2007, generally decreasing between 2007 and 2016. In high prevalence industries, daily smoking was associated with male gender and age (25-39-year-olds) and in low prevalence industries with males and nonmetropolitan workers. In high prevalence occupations, daily smoking was associated with males, female nonmetropolitan workers, and age 25-39 years and in low-moderate prevalence occupations with nonmetropolitan workers and negatively associated with females aged 14-24 years. In all models, increased odds of daily smoking were associated with low socioeconomic status and very high psychological distress. CONCLUSIONS: Low socioeconomic status and very high psychological distress were risk factors for daily smoking regardless of industry, occupation, or high preexisting smoking prevalence. Targeted, as well as universal, interventions are required for workplaces and workers with greatest smoking vulnerability and least smoking cessation progress. IMPLICATIONS: Specific strategies are warranted for identified industries, occupations, and subgroups with increased odds of daily tobacco smoking. Industries and occupations with low-moderate smoking prevalence may confer workers some protection but are not without risk; some subgroups in these settings (eg, nonmetropolitan areas) had elevated daily smoking risk. Hence, the following are supported: (1) universal interventions directed at low socioeconomic workers and workers with very high psychological distress regardless of workplace; (2) interventions targeted at high prevalence industries; (3) cessation efforts targeted for young workers in high prevalence industries and occupations; and (4) focused interventions addressing specific needs of nonmetropolitan at-risk workers in low prevalence industries.

Changing patterns and prevalence of daily tobacco smoking among Australian workers: 2007-2016.

OBJECTIVE: To map patterns and prevalence of daily smoking among employed Australians over time. METHODS: Data from four waves of the triennial National Drug Strategy Household Survey (2007, 2010, 2013 and 2016) were used to assess daily smoking. Frequency analyses and significance testing examined smoking prevalence by sex, age, state, remoteness, Indigeneity, socioeconomic status (SES) and psychological distress. Logistic regression models estimated adjusted effects of demographics on smoking prevalence. RESULTS: Workers' daily smoking prevalence reduced by 32% between 2007 and 2016. The adjusted model showed the lowest smoking reductions among men and non-metropolitan workers. Other interaction effects showed the highest daily smoking rates for: male workers aged 14-39 years; low SES non-metropolitan workers; and low SES workers aged 40-59 years. CONCLUSIONS: Specific workplace policies, prevention and intervention strategies are warranted for male workers, especially those aged 14-39; non-metropolitan workers, especially low SES rural workers; and low SES workers especially 40-59-year-olds. Implications for public health: In spite of significant smoking reductions among workers over time, reductions were unevenly distributed. Tailored, innovative workplace prevention and intervention strategies that apply principles of proportionate universalism and address individual, workplace settings and cultural factors are warranted to reduce smoking disparities among male, rural and low SES workers.

Flying below the Radar: Psychoactive Drug Use among Young Male Construction Workers in Sydney, Australia.

Background: Globally, there is growing concern regarding workers' illicit drug use and its implications for health and workplace safety. Young workers in male-dominated industries, such as construction, may be more susceptible to illicit drug use, risky drinking and its associated harms.Purpose/objectives: To investigate drug use and perceptions of risk among male construction workers, drawing comparisons between workers under 25 years with older age groups.Methods: Workers in Sydney, Australia (N = 511) completed a survey measuring past year illicit drug and alcohol use, psychological distress and perceptions of drug-related risks to health and safety. Prevalence in the total sample was compared with national estimates, and differences between younger and older survey respondents were examined using logistic regression models.Results: Survey respondents' cocaine, meth/amphetamine and cannabis use was significantly higher than estimates of male employees nationally (OR = 6.60, 3.58, 1.61, respectively). Young workers ≤24 were more likely to frequently use illicit drugs, drink heavily, and report psychological distress than those aged 35+. Workers ≤24 were least likely to perceive that drug use posed high risks to health or safety when compared with 25-34 and 35+ age groups.Conclusions/importance: The findings highlight the high prevalence of illicit drug use amongst young construction workers, representing threats to workplace safety even if used outside work hours. Greater emphasis on potential adverse effects of alcohol and drug use and closer examination of contributory workplace factors are required. These findings have practical implications to inform occupational health and safety programs and interventions in high-risk workplaces.

The non-government alcohol and other drug workforce in Australia: Findings from a national survey.

INTRODUCTION: There is growing interest in the role of the non-government sector in the alcohol and other drug (AOD) service delivery system. This study examined the demographic profile of AOD workers in the non-government (NGO) compared to government sector, to ascertain their professional development needs, job satisfaction, retention and turnover. METHODS: This study utilised cross-sectional data from an Australian AOD workforce online survey that assessed participants' demographics, employment profile, professional development needs and barriers. The sample comprised 888 workers in direct client service roles. RESULTS: Binomial logistic regression analysis indicated that NGO workers were more likely to be younger (<35 years), have AOD lived experience and have an AOD vocational qualification. NGO workers were more likely to earn below the national average salary and report job insecurity; but nonetheless were more likely to feel respected and supported at work, believe their work was meaningful and be satisfied working in the AOD sector. Their top professional development barrier was personal financial cost. NGO workers were more likely to report employer financial costs as a professional development barrier, whereas government workers were more likely to report staff shortages. DISCUSSION AND CONCLUSIONS: AOD services in Australia rely increasingly on the NGO sector. Quality services and care pivot on the size, capability and maturity of the workforce. This study highlights the need for systemic interventions addressing structural issues, and the professional development and ongoing support needs of the NGO AOD workforce. Without such support, Australia's AOD services will be potentially jeopardised.

'Very demanding. Extremely rewarding': Exploring the co-occurrence of burnout and engagement in alcohol and other drug workers.

INTRODUCTION: Alcohol and other drug (AOD) work can be highly meaningful and satisfying, but also intense and highly demanding. This combination often creates significant strain for workers. Mirroring this complexity, this study considered the predictors and outcomes of the concurrent experience of burnout and engagement in AOD workers. The Job Demands-Resources model informed the study. METHODS: This study utilised data from a recent Australian AOD workforce survey. The sample comprised 886 workers in direct client service roles. K-means cluster analysis on burnout and engagement measures identified four discrete groups: burnt out (15.6%) (high burnout/low engagement), engaged (36.7%) (low burnout/high engagement), overextended (26.5%) (high burnout/high engagement) and indifferent (21.2%) (low burnout/low engagement). RESULTS: Multinomial logistic regression analysis indicated that workers were more likely to be burnt out or overextended, rather than engaged, if they reported high work intensity, low organisational openness to change and low support. Multivariate analysis of variance showed burnt-out workers had the least favourable and engaged respondents the most favourable outcomes on job satisfaction, turnover intention, health and life quality. Overextended workers were comparable to indifferent workers on these outcomes. DISCUSSION AND CONCLUSION: This study offers a unique and nuanced view of AOD worker wellbeing. For the one-quarter of workers reporting simultaneous burnout and engagement, their enthusiasm and commitment did not protect them from poor personal and organisational outcomes typically linked with burnout. The need for systemic and structural interventions is clearly indicated, including open and supportive organisational cultures, leadership development and adequate staffing.

Older workers in the alcohol and other drug sector: Predictors of workforce retention.

OBJECTIVE: Older workers are increasingly prevalent in health and human services, including the alcohol and other drug (AOD) sector. Their turnover intentions have important implications for service system stability and retention. METHODS: Descriptive and regression analyses of survey data examined age-related differences (<50, ≥50 years old) in non-government workers' demographic, health and professional profiles and predictors of turnover intention. RESULTS: Older workers (≥50 years, n = 86) comprised one-third of this workforce. Compared to younger workers (n = 164), they experienced greater discrimination but higher work-life balance and work engagement. Turnover intention was predicted by job satisfaction, discrimination and work engagement. CONCLUSION: Older workers' well-being and workforce retention are essential for effective leadership, succession planning and service continuity. Their needs and retention motivations are identified. Age-specific support mechanisms, proactive retention and anti-discrimination strategies are identified priorities.

Why are you asking about gender? Negotiating survey research methods within an industry collaboration.

Objectives: This brief report describes a survey design process undertaken in collaboration with industry stakeholders from government, non-government and other applied fields. This account highlights fundamental and contested issues of knowledge creation in research, situated within the broader contemporary context of social change addressing inequality and inclusion for historically marginalised and vulnerable groups. Study design: The study comprised a non-probability survey of the Australian Alcohol and Other Drugs Workforce. Methods: A reflective account is provided. Results: Significant and unanticipated differences in conceptual frames and perceptions of research ethics between the research team and industry representatives emerged during the collaboration, with major implications for the validity of the research process. Conclusions: The traditional, and largely unquestioned, understanding of quantitative survey research methodology is encountering increasing challenges in light of contemporary considerations of identity, privacy and wellbeing of survey participants. Some of these differences seriously challenged conventional approaches to research methodology, quality and rigour. There is a pressing need for further exploration, discussion and debate regarding the process of knowledge creation, ownership and stewardship. Strategies to better equip the research community and their industry stakeholders to navigate issues of research veracity, integrity and rigour are urgently needed, including training and guidance on negotiate differences in values, priorities and perspectives for upcoming and established researchers.

Have decreases in young workers' risky drinking resulted in an increase in illicit drug use?

ISSUES ADDRESSED: Recent reductions in young people's risky alcohol use have been widely documented but have not been examined among employed youth. Young workers' risky drinking may have corresponded with increased illicit drug use. This study investigated these issues. METHODS: Secondary analyses were conducted for 15-24 year old Australian workers using nationally representative data from 2007 to 2016. Frequency analyses examined alcohol and illicit drug use, Z scores assessed differences over time, and logistic regression examined predictors of illicit drug use. RESULTS: Risky drinking decreased significantly over time whilst low-risk drinking increased. This pattern was observed for both young workers and young employed illicit drug users. Whilst "any" illicit drug use did not change over time, methamphetamine use decreased, and cannabis and hallucinogen use increased. Drinking alcohol at risky levels (monthly) was associated with illicit drug use in 2016, as were being single and having high/very high levels of psychological distress. CONCLUSIONS: Risky drinking reductions over time have not corresponded with increased illicit drug use. Nonetheless, as risky drinking remains high among young workers, and is strongly associated with illicit drug use, it warrants concerted health promotion efforts that may also help minimise illicit drug use. SO WHAT?: Despite a reduction in young workers' risky alcohol consumption, risky drinking is still high and may impact the health and safety of workers and the wider community. As risky drinking is strongly associated with illicit drug use, workplaces could potentially play a vital role in combating alcohol and illicit drug misuse.

Exploring the relationship between psychological distress and likelihood of help seeking in construction workers: The role of talking to workmates and knowing how to get help.

BACKGROUND: Mental health problems are prevalent in male-dominated industries such as construction, where suicide rates are higher than the population average and help seeking is typically low. OBJECTIVE: To examine psychological distress in Australian construction workers and its relationship with help seeking via two hypothesised mediators: confidence in knowing how to get help and confidence in talking to workmates about mental health issues. METHODS: Workers (N = 511) completed a survey that assessed psychological distress, likelihood of help seeking, and confidence in knowing how to get help and talking to workmates. Bootstrapped multiple mediation analysis was performed using the PROCESS macro for SPSS. RESULTS: Psychological distress was higher than national estimates and most prevalent in men aged 25-44. Controlling for age and ability to recognise personal signs of mental health problems, psychological distress negatively predicted likelihood of help seeking. This relationship was partially mediated by knowing how to get help and confidence in talking to workmates. CONCLUSIONS: Results highlight the need to redress and mitigate mental health problems among high-risk groups of male workers. It provides useful guidance on multilevel workplace strategies to reduce stigma, enhance confidence and comfort in the process of seeking help and support in construction and other male-dominated industries.

Ageing and Alcohol: Drinking Typologies among Older Adults.

Objectives: Alcohol consumption and harms among older people are increasing. We examined different demographic characteristics and drinking patterns among an older population. Methods: Secondary analyses of nationally representative Australian data; subjects aged 50+ years (N = 10,856). Two-step cluster analysis was performed to identify demographic groups and alcohol consumption behaviours. Results: Three groups were identified: Group 1 (older, unmarried, and lived alone): >65 years, moderate drinkers, poorest health, psychological distress, social disadvantage, smokers, illicit drug users, and more frequent previous alcohol treatment. Group 3 (older married): >65 years, good health, low psychological distress, less likely to drink at risky levels, and one in five drank daily. Group 2 (younger married): 50-64 years, mostly employed, highest proportion of risky drinkers and of 5+ standard drinks per session, and liberal drinking attitudes with most concern from others about their drinking. Discussion: These demographic typologies can inform targeted prevention efforts for an estimated 1.3 million adults older than 50 years drinking at risky levels.

Construction workers' alcohol use, knowledge, perceptions of risk and workplace norms.

INTRODUCTION AND AIMS: Globally, there is growing concern regarding workers' alcohol use and its implications for health, wellbeing and workplace safety. Male-dominated industries are more susceptible to risky alcohol consumption and its associated harms. This paper investigated the patterns, prevalence and predictors of risky drinking among construction workers. DESIGN AND METHODS: Male construction workers (n = 511) completed a survey measuring alcohol-related measures including Alcohol Use Disorders Identification Test - Concise (AUDIT-C), which was compared with population data. Hierarchical multiple regression examined alcohol-related knowledge, perception of risk to workplace safety, psychological distress, job stress, general health, quality of life and workplace alcohol culture variables as predictors of risky drinking. RESULTS: Prevalence of risky drinking was higher than the national average, particularly for younger (<25 years) and mid-aged (45-54 years) workers. One in six construction workers reported workmates being visibly affected by alcohol in the workplace. Key predictors of risky drinking were perception of alcohol-related risks to workplace safety, general health, alcohol knowledge and descriptive norms regarding workmates' alcohol use. DISCUSSION AND CONCLUSIONS: These findings provide useful insights into the patterns and predictors of risky drinking in construction and can inform future preventive programs and interventions in high-risk workplaces. In addition to tailoring programs to both young and mid-aged workers, this work highlights the importance of implementing strategies to increase awareness of risks to workplace safety; and the adoption of norms that inhibit the social acceptability of risky drinking behaviour in the wider workplace.

Predictors of work engagement among Australian non-government drug and alcohol employees: Implications for policy and practice.

BACKGROUND: The alcohol and other drugs (AOD) workforce faces multiple challenges including stigma, limited resources, ideological conflicts and complex demands. An engaged, supported and stable workforce is essential for optimal service provision, quality care, effective harm reduction implementation and cost efficiency. However little research has examined factors that impact worker engagement in the AOD sector. To inform policy and practice on cost efficient service provision and effective workforce development, this study examined a range of potential predictors of work engagement among Australian AOD non-government workers. METHODS: An online, cross-sectional survey of 294 non-government AOD workers measuring demographic, work-related psychosocial, and health and wellbeing variables was conducted in New South Wales, Australia. Multiple hierarchical linear regressions were conducted to identify significant predictors of worker engagement. RESULTS: Most AOD workers demonstrated high work engagement levels. Significant predictors of engagement included role clarity, leadership quality, growth opportunities, resilience and social support, and older age. These workers were likely to be more energised, enthusiastic and dedicated in their jobs. CONCLUSIONS: This study is an important initial step in understanding work engagement among AOD workers. It offers valuable insights into ways to foster engagement, which in turn may ensure a more sustainable workforce that can deliver high quality care. Workers with high levels of engagement are more likely remain in their AOD roles over longer periods of time, acquire more skills and experience, and be better equipped to address complex demands. Workforce policies and programs specifically designed to enhance leadership skills and role clarity, while enhancing professional growth, resilience, and social supports, particularly for younger workers, are highlighted as essential strategies to promote engagement among AOD workers.

Tobacco Cost of Illness Studies: A Systematic Review.

INTRODUCTION: To identify studies reporting costs arising from tobacco use and detail their (1) economic approaches, (2) health outcomes, and (3) other cost areas included. METHODS: We searched PubMed, Scopus, Cochrane Library, EconLit, and Google Scholar for studies published between 2008 and April 2018 in English. Eligible articles reported tobacco-related costs and included all tobacco-using populations (multinational, national, subpopulations, and involuntary smokers). All economic approaches that resulted in monetary outcomes were included. We reported USD or converted local currencies to USD. Two health economists extracted and two researchers independently reviewed the data. RESULTS: From 4083 articles, we reviewed 361 abstracts and examined 79 full-texts, with 63 (1.6%) deemed eligible. There were three multinational, thirty-four national, twenty-one subpopulation or condition(s)-specific analyses, and five evaluating involuntary smoking. The diverse approaches and outcomes precluded integrating costs, but these were substantial in all studies. For instance, about USD 1436 billion in global health expenditures and productivity losses in 2012 and USD 9 billion in lost productivity in China, Brazil, and South Africa in 2012. At the national level, costs ranged from USD 4665 in annual per respondent health expenses (Germany 2006-2008) to USD 289-332.5 billion in medical expenses (United States 1964-2014). CONCLUSIONS: Despite wide variations in the methods used, the identified costs of tobacco are substantial. Studies on tobacco cost-of-illness use diverse methods and hence produce data that are not readily comparable across populations, time, and studies, precluding a consistent evidence-base for action and measurement of progress. Recommendations are made to improve comparability. IMPLICATIONS: In addition to the health and financial costs to individual smokers, smoking imposes costs on the broader community. Production of comparable estimates of the societal cost of tobacco use is impaired by a plethora of economic models and inconsistently included costs and conditions. These inconsistencies also cause difficulties in comparing relative impacts caused by differing factors. The review systematically documents the post-2007 literature on tobacco cost-of-illness estimations and details conditions and costs included. We hope this will encourage replication of models across settings to provide more consistent data, able to be integrated across populations, over time, and across risk factors.

Older Australians' perceptions of alcohol-related harms and low-risk alcohol guidelines.

INTRODUCTION AND AIMS: Australia has an ageing population. Given the concomitant increase in the numbers and proportion of risky drinkers among older adults, research examining contributory factors is a priority. The current study examined older adults' estimates of the NHMRC low-risk drinking guidelines, consumption patterns and associated harms and self-identification of drinking type. DESIGN AND METHODS: Data from respondents aged 50+ years (N = 11 886) in the 2016 National Drug Strategy Household Survey were subjected to secondary analyses. Estimates of low-risk drinking levels, perceived level of harm from current drinking, self-identification of drinking type and awareness of standard drinks and labelling were included. Data were examined for those aged 50-59 years and 60+. RESULTS: Seventeen percent of older Australians drank at both long-term and short-term risk levels. Approximately 39% of males and 11% of females overestimated the long-term low-risk levels and 54% of males and 20% of females overestimated the short-term low-risk levels. Overestimation was highest among risky drinkers. Most older risky drinkers were aware of standard drinks and labelling; however, less than half perceived their drinking as harmful, instead identifying as social drinkers. DISCUSSION AND CONCLUSIONS: Although substantial gaps are evident in older respondents' estimates of low-risk drinking, additional public awareness campaigns are likely to be of limited use. Older peoples' engagement with the public health system presents 'windows of opportunity' to provide targeted, age-appropriate harm reduction strategies. Appropriate intervention and policy responses are required to direct resources to this emerging area of concern.

Operationalising the quality of life construct in studies of alcohol and drug residential rehabilitation programme clients: A systematic review.

INTRODUCTION AND AIMS: Quality of life (QOL) is increasingly recognised as an important treatment indicator in the alcohol and other drug (AOD) sector, particularly in treatment modalities providing 'whole of life programmes', such as residential rehabilitation. However, it is currently unclear how studies conducted in AOD residential rehabilitation settings have operationally defined and measured QOL. This study therefore aimed to determine current practices in defining and measuring the QOL of residential rehabilitation clients. DESIGN AND METHODS: A systematic review of studies examining the QOL of AOD residential rehabilitation clients was conducted. Potential studies published in English between 1990 and 2018 were identified through a search of electronic databases (e.g. PsycINFO and PubMed), search engines (Google Scholar) and article reference lists. RESULTS: The search identified a total of 1267 records, of which 16 met the inclusion criteria. Less than half of the included studies provided an operational definition of QOL. QOL was generally understood to be a subjective, multidimensional, client assessment construct. Twelve different instruments were used to assess QOL, of which two enabled clients to identify QOL dimensions important to themselves. DISCUSSION AND CONCLUSIONS: QOL has been inconsistently measured in studies of AOD residential rehabilitation clients. As a result, the comparability and validity of research in this field may be weakened. There is a need to develop a consensual operational definition of QOL, including a core set of domains relevant to and endorsed by residential rehabilitation clients. Appropriate tools to measure client QOL need to be identified and disseminated.