Effects of low-dose alcohol exposure on simulated merchant ship piloting by maritime cadets.

The US Department of Transportation (DOT) regulates on-the-job alcohol use by operators of certain categories of commercial transport. For aircraft, trains, and commercial vessels, operators are subject to sanctions for having > or = 0.04 g% blood alcohol concentration (BAC). This study examines the effects of alcohol (between 0.04 and 0.05 g% BAC) on simulated merchant ship handling. A two-group randomized factorial design was used to compare beverage alcohol to placebo while controlling for baseline performance on a previous day. The study was conducted in the Maritime Simulation Center at Maine Maritime Academy, Castine, ME. Participants were 38 volunteer deck officer cadets in their junior or senior year, at least 21 years of age, with previous experience on a bridge simulator. Following a baseline trial on Day 1, on Day 2 participants were randomized to receive alcohol (0.6 g/kg for males and 0.5 g/kg for females) or placebo. After allowing time for absorption, participants completed a bridge simulator task. For baseline and performance trials, participants were randomized to one of four bridge simulator scenarios, each representing passage of a fully loaded container vessel through a channel with commercial traffic. The aggregate scenario score given by blinded maritime educators measured performance. A main effect for alcohol was found indicating that performance was significantly impaired by this low dose of alcohol relative to performance in the placebo condition. These findings are consistent with current federal regulations that limit low-dose alcohol exposure for the operators of commercial transport vehicles. Further research is required to determine effects at lower BACs.

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need.

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Effects of low-dose alcohol exposure on simulated merchant ship handling power plant operation by maritime cadets.

AIMS: Under current US Department of Transportation (DOT) regulations, some commercial vehicle operators are subject to sanctions for having > or = 00.04 g% blood alcohol concentrations (BACs) on the job. This study investigated the effects of alcohol (between 0.04 and 0.05 g% BAC) on the simulated operation of a commercial ship's power plant. DESIGN: A balanced placebo design was used in which alcohol administration was fully crossed with expectancy that alcohol was administrated. SETTING: The study was conducted at the Massachusetts Maritime Academy, Buzzards Bay, MA, USA. PARTICIPANTS: Participants were 18 volunteer engineering students in their senior year, at least 21 years of age, with previous experience on the diesel simulator. INTERVENTION: Following a baseline trial on day 1, on day 2 participants were randomized to expectancy (told alcohol or placebo) and beverage (receive alcohol or placebo). The dosage was 0.6 g/kg for males and 0.5 g/kg for females. In both baseline and performance days, participants were randomized to one of four diesel simulator scenarios, each replicating a system failure in a power plant subsystem (e.g. main propulsion, electrical generating). MEASUREMENT: Performance was measured by time required for problem identification and remediation. FINDINGS: A main effect for alcohol administration was found. In the alcohol condition, simulator performance time was almost twice as long (351 sec) as on the placebo condition (186 sec). The expectancy effect was not significant. CONCLUSION: These findings support the current federal policy on the hazards of this low alcohol level within the context of commercial shipping.

High injury rates among female army trainees: a function of gender?

BACKGROUND: Studies suggest that women are at greater risk than men for sports and training injuries. This study investigated the association between gender and risk of exercise-related injuries among Army basic trainees while controlling for physical fitness and demographics. METHODS: Eight hundred and sixty-one trainees were followed during their 8-week basic training course. Demographic characteristics, body composition, and physical fitness were measured at the beginning of training. Physical fitness measures were taken again at the end of training. Multivariate logistic regression analysis was used to evaluate the association between gender and risk of injury while controlling for potential confounders. RESULTS: Women experienced twice as many injuries as men (relative risk [RR] = 2.1, 1.78-2.5) and experienced serious time-loss injuries almost 2.5 times more often than men (RR = 2.4, 1. 92-3.05). Women entered training at significantly lower levels of physical fitness than men, but made much greater improvements in fitness over the training period.In multivariate analyses, where demographics, body composition, and initial physical fitness were controlled, female gender was no longer a significant predictor of injuries (RR = 1.14, 0.48-2.72). Physical fitness, particularly aerobic fitness, remained significant. CONCLUSIONS: The key risk factor for training injuries appears to be physical fitness, particularly cardiovascular fitness. The significant improvement in endurance attained by women suggests that women enter training less physically fit relative to their own fitness potential, as well as to men. Remedial training for less fit soldiers is likely to reduce injuries and decrease the gender differential in risk of injuries.

Boater training, drinking and boating, and other unsafe boating practices.

OBJECTIVES: Identify associations between lack of formal boater training, drinking and boating, and other unsafe boating practices. METHODS: A telephone survey queried respondents (age 16 or older in continental United States) about boating experience, type of boat used, and training. RESULTS: Of the 3,042 boaters surveyed (70% response), most had no formal training (73%). Boaters with formal training failed to use PFDs about as often as those without formal training and were equally or more likely to use alcohol while boating. CONCLUSIONS: The unexpected association between formal training and unsafe boating practices is probably due to reduced risk perception and inadequacies of boater training programs. Such programs seldom mention the risks of alcohol use while boating. Decisions to mandate formal training should be informed by these results; if mandated, training should address the risks of alcohol use while boating, and should be renewed frequently enough to offset reductions in risk perception.

Employee drinking practices and work performance.

OBJECTIVE: The purpose of this study was to examine the independent effects of a variety of drinking indicators on self-reported work performance. METHOD: Data from a cross-sectional mailed survey (response rate = 71%) of managers, supervisors and workers (N = 6,540) at 16 worksites were analyzed. Average daily volume was computed from frequency and usual quantity reports. Drinking on the job included drinking during any of six workday situations. The CAGE was used to indicate alcohol dependence. Employees were also asked how frequently they drank to get high or drunk. Work performance was measured through a series of questions about work problems during the prior year. The number of times respondents experienced work performance problems was regressed on the four drinking measures, and a variety of demographic characteristics, job characteristics and life circumstances that might also negatively affect work performance. RESULTS: The frequency of self-reported work performance problems increased, generally, with all four drinking measures. In a multivariate model that controlled for a number of demographics, job characteristics and life-situations, average daily volume was no longer significantly associated with work performance but the other three drinking measures were. Interestingly, although moderate-heavy and heavy drinkers reported more work performance problems than very light, light, or moderate drinkers, the lower-level-drinking employees, since they were more plentiful, accounted for a larger proportion of work performance problems than did the heavier drinking groups. CONCLUSIONS: Employers should develop clear policies limiting drinking on the job and, in addition to employee assistance programs for problem drinkers, should develop worksite educational interventions aimed at informing all employees about the relationship between drinking behaviors and work performance.

Sunbathing habits and sunscreen use among white adults: results of a national survey.

OBJECTIVES: This study assessed current levels of sunbathing and sunscreen use in the United States. METHODS: From a general-population telephone survey of aquatic activities among adults in 3042 US households, we examined responses by the 2459 Whites. RESULTS: Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher. CONCLUSIONS: About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.

Worksite barriers to the effective management of alcohol problems.

The purpose of this analysis is to describe barriers to workplace interventions in cases of alcohol abuse. A survey of 7255 supervisors in 114 worksites across seven major corporations was completed (79% responded). Information about barriers to intervention was elicited by 12 questions. Cluster analysis revealed three analytically independent classes of barriers--Organizational, Interpersonal, and Individual. Most managers reported encountering some barriers to intervention: the extent of barriers perceived was related to characteristics of the worksite, job, and/or the environment. Barriers were greatest for female managers, managers in larger worksites, and the first-line supervisors. Barriers were also related to the form (formal vs informal) of intervention a manager was willing to make. Intervention strategies must take into account differences between company worksites and job levels, and not assume that policies are equally effective throughout the corporation.

Employee attitudes toward work-site alcohol testing.

Few studies have been published on how employees feel about work-site alcohol testing. By mail, we surveyed employees (n = 6370) at 16 corporate work sites stratified by type of work force, industrial setting, and managerial tolerance toward drinking. We queried respondents about their drinking on the job and support for work-site alcohol testing under three conditions: pre-employment testing, testing after an accident, and random testing. Sixty-five percent of respondents supported pre-employment testing, 81% supported testing after an accident, and 49% supported random testing. Support was relatively consistent across hierarchy (managers, supervisors, and workers) but different by age, education, occupation, type of work force, and perceived exposure to occupational hazards. Support for work-site alcohol testing was highest among blue-collar workers whose jobs involved manufacturing or exposure to work-site hazards.

Perceptions of risks of drinking and boating among Massachusetts boaters.

OBJECTIVES: Public policy has treated drinking and boating as though it were analogous to drinking and driving. Accordingly, recent Federal and state laws to prevent drinking and boating have focused solely on alcohol use by the boat operator. This study was designed to determine boaters' knowledge about the epidemiology of boating fatalities and how boaters perceive the risks of drinking and boating. METHODS: In the summer of 1995, the authors conducted a survey by mail of a random sample of 600 owners of boats registered in Massachusetts. RESULTS: Survey results indicated that boaters believe passengers can safely drink more than operators. Respondents also thought that people on boats at rest can safely drink more than people on boats underway. CONCLUSIONS: The results of this study could be helpful in designing future boating safety campaigns by identifying gaps in knowledge about about the risks of drinking and boating for both operators and passengers.

Work-site variation in managerial drinking.

To assess cross-work-site variation in the general drinking behaviors (on and off the job) of employees, we conducted a cross-sectional survey of managers (n = 7255) at 114 places of work located throughout the continental United States. The work-site mean for the total number of drinks consumed on a typical drinking day ranged from 1.4 to 3.17, a two-fold differential. Regression analysis showed an independent work-site effect, controlling for respondents demographics and type of work. This finding suggests that modifiable work-site characteristics could influence what employees drink on and off the job.

Medical surveillance for ethylene oxide exposure: practices and clinical findings in Massachusetts hospitals.

The medical surveillance requirements of the Occupational Safety and Health Administration's (OSHA) ethylene oxide (EtO) standard became effective in 1985. However, little is known about the nature of the response of EtO users to this regulatory requirement. In an effort to begin to understand this, we conducted a survey of EtO health and safety in Massachusetts hospitals (n = 92). We determined the cumulative incidence of provision of EtO medical surveillance, the characteristics of the surveillance interventions provided, and the clinical findings of EtO medical surveillance efforts in Massachusetts hospitals. From 1985 to 1993, medical surveillance for EtO exposure was provided one or more times in 62% of EtO-using hospitals. Sixty-five percent of EtO medical surveillance providers reported performance of all five medical surveillance procedures required by OSHA's EtO standard. Medical surveillance provider certification in occupational medicine or nursing, and a greater extent of coverage of written medical surveillance policies, were related to higher likelihoods of fulfillment of OSHA-required procedures. Twenty-seven percent of medical surveillance providers reported detection of EtO-related symptoms or conditions, ranging from mucous membrane irritation to peripheral neuropathy. These findings reveal wide-spread implementation of OSHA-mandated EtO medical surveillance, with concomitant incomplete fulfillment of OSHA-specified procedures. From the provider-based survey, we estimate that one or more workers at 19% of EtO-using Massachusetts hospitals have experienced EtO-related health effects.

Determinants of the provision of ethylene oxide medical surveillance in Massachusetts hospitals.

An in-depth survey of ethylene oxide (EtO) health and safety was conducted in Massachusetts hospitals (n = 92) to investigate the determinants of the provision of medical surveillance for EtO exposure. We have evaluated the relationships between provision of EtO medical surveillance and (1) activating OSHA-specified triggers for providing EtO medical surveillance, (2) worker training on EtO health and safety, and (3) various public policy, organizational, group, and individual characteristics. Among the Occupational Safety and Health Administration's (OSHA) five specified triggers for provision of EtO medical surveillance, only accidental worker exposures were related to provision of surveillance (RR = 2.56, P < 0.001). Exceeding the Action Level for 30 or more days, one of OSHA's EtO triggers that is also used in a number of other standards, was not related to provision of surveillance (RR = 0.84, P = 0.714). Reports of coverage of EtO medical surveillance issues in worker training were also correlated with the provision of EtO medical surveillance (RR = 3.68, P < 0.001), supporting OSHA's premise that worker training plays an important role in medical surveillance implementation. The presence of detailed written EtO medical surveillance policies was positively related to the provision of EtO medical surveillance (RR = 1.81, P < 0.001). The relationships between these potential determinants and provision of medical surveillance were also validated in multivariate analyses. Implications for improvement of OSHA medical surveillance implementation through revised trigger schemes, improved worker training efforts, and other measures are discussed. Findings are relevant to the future development of medical surveillance and exposure monitoring policies and practices in both substance-specific and generic contexts.

Why are most drowning victims men? Sex differences in aquatic skills and behaviors.

Men have higher drowning rates than women for most age groups. Data from a 1991 national household survey (n = 3042) on aquatic activities were used to examine hypotheses about differential drowning rates by sex. Men and women were compared by (1) exposure to aquatic environments; (2) frequency of aquatic activities involving or potentially involving, submersion; (3) swimming training and ability; (4) aquatic risk-taking behaviors; and (5) alcohol use on or near the water. Men had elevated risks for exposure, risk taking, and alcohol use. It was concluded that several factors contribute to their relatively high drowning rates, including a possible interaction between overestimation of abilities and heavy alcohol use.

Interventionalists' guide to the patient's experience of lower extremity arterial occlusive disease.

This article is intended as a guide for all who propose to intervene in patients with symptomatic lower extremity arterial occlusive disease. It reviews the natural history of and therapies for intermittent claudication. The results of a survey of claudicants are summarized; this survey gathered data on claudicants' general health, comorbid conditions, symptoms of claudication, and functional abilities. Respondents predicted a 20% improvement in their ability to perform instrumental activities of daily living (eg, walking several blocks, climbing one flight of stairs, performing household tasks) if lower extremity symptoms were relieved. This level of improvement is consistent with that reported in the literature following revascularization. The conclusion is that patients with claudication have modest goals with respect to improvement following vascular intervention. More data should be collected on the functional outcomes of vascular intervention so that patients can make better informed choices regarding treatment of symptomatic lower extremity arterial occlusive disease.

Researching and preventing alcohol problems at work: toward an integrative model.

PURPOSE OF PROPOSAL. A consolidated framework is proposed to highlight modifiable factors in work organizations that may contribute to alcohol-related problems. This research model serves to organize existing knowledge, highlight pathways for new research initiatives, and offer insights into the design of primary and secondary preventive strategies. CONTRIBUTING INFLUENCES. Current research on problem drinking in the workplace either locates problems in individual drinkers or looks to the social environment to understand how drinking problems unfold. There is a clear need for a more complete theoretical model which incorporates social, cultural, organizational, and personal factors. PROPOSAL SUMMARY. This article elaborates on a model for examining problem drinking at work which integrates policy, normative, and psychosocial influences. It emphasizes the structures within which health-related decisions and actions are contained and constrained. The focus here on the connections between alcohol use and work builds on the premise that health is socially produced.

Health promotion versus health protection? Employees' perceptions and concerns.

The "second public health revolution" targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the "wellness movement" has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more evident than in the workplace, where the new wellness professionals are at odds with specialists in occupational health and industrial hygiene. This paper reports findings from a cross-sectional survey of a sizeable sample of workers at six New England facilities of a very large American manufacturing firm, assessing their perceptions of risk in the two domains: environmental exposures and lifestyle risks. Multiple regression analyses reveal that both job risks and life risks are associated with a variety of potentially costly and disruptive health problems, even after controlling for demographic and occupational factors. This analysis suggests that wellness programs in the workplace will be more effective if they integrate environmental protection with efforts to reduce lifestyle risk.

A pilot survey of aquatic activities and related consumption of alcohol, with implications for drowning.

The investigators considered the relationship between participation in aquatic activities and the consumption of alcohol, with their implications for the risk of drowning. In a telephone survey with random-digit dialing, interviewers asked Massachusetts residents ages 20 years and older how often they engaged in various aquatic activities, in what settings, and how often they drank alcohol in connection with participation in aquatic activities. Of 294 respondents, 79 percent of the men and 72 percent of the women reported participating in aquatic activities during August 1988, the month prior to the interview. Respondents were asked to identify their most recent aquatic activity. The mean number of days of participation in the month was 13. The most frequently reported aquatic activities were swimming (76 percent), followed by sunbathing (74 percent), power boating (25 percent), and fishing from shore (15 percent). Among those persons reporting participation in aquatic activities, 55 percent had been at the ocean on the most recent occasion, 26 percent at lakes or ponds, 17 percent at pools, and 2 percent at rivers. Among those persons reporting aquatic activities, 36 percent of the men and 11 percent of the women reported having drunk alcohol on the most recent occasion. Those who reported drinking in aquatic settings were more likely to report driving after drinking than those who did not drive. Implementation of new Federal regulations and State laws concerning drinking and boating should be accompanied by public education on the risks of drowning if aquatic activities and alcohol consumption are combined.

AIDS education practices among Massachusetts physicians.

Physicians have a major role to play in the prevention of AIDS transmission. Promotion of health behaviors needs to be expanded beyond the traditional AIDS high risk populations; however, little information is available on the AIDS education practices of physicians. A survey of Massachusetts physicians in four specialty groups, Family Medicine Practitioners, Internists, Obstetricians/Gynecologists and Pediatricians, was conducted to determine the extent of their AIDS education practices. Three hundred and ninety one physicians returned the questionnaire for an overall response rate of 66%. Sixty three percent (63%) of the physicians surveyed educate patients they believe to be at least at moderate risk for AIDS transmission or exposure. However, neither physicians screening for patients' AIDS risk status nor the content of the AIDS education was uniform. Also, very few physicians have received specific training in AIDS education. A number of practice, patient, and physician characteristics were found to be related to educational practices. This study suggests that a more comprehensive screening of patients' participation in AIDS risk behaviors be conducted as part of medical history taking, and that more comprehensive education be provided to those patients determined to be at least at moderate risk for AIDS transmission or exposure.