Saturday, March 13, 1999
12:45 - 2:00 p.m.
An Intervention for Reducing Stressors in Pediatric Care Settings
Stacey Kohler Moran, Ph.D., St. Paul Fire and Marine Insurance Company
Stressors confronting employees in medical care today are numerous and the consequences of this stress can be tragic. Performance consequences include errors that may result in death, impairment, chronic pain and suffering, and personal consequences that impact one's health and level of job satisfaction. The St. Paul Fire and Marine Insurance Company (St. Paul) developed a case study intervention to proactively address the stressors confronting our insured pediatric facilities and health care providers in an effort to limit such tragic outcomes.
Following a thorough review of literature and St. Paul's pediatric claims, we conducted focused groups with four pediatric hospitals and with members of the National Association of Pediatric Hospitals and Related Institutes' Human Resources Board. Through these avenues we developed a list of stressors and exposures for performance and well-being among pediatric providers. Subject matter experts clustered the stressors into twelve dimensions.
One pediatric hospital volunteered to assist in the development of the training intervention. Five subject matter experts from this facility created a realistic case scenario encompassing the two stressor dimensions of adversarial interactions and managed care. Built into the case were additional stressors; for example, long-term relationship with patient, boundary-role issues, dysfunctional patient family, and exposure to society's ills (e.g., abused or neglected children).
The training intervention includes a review of pediatric stressors, discussion of the case and case questions, and supporting materials. The case study is easily adapted to fit a one-hour focused intervention workshop (e.g., select one stressor/problem to resolve), one-half day program (focus on two stressor/problem areas and provide "expert" speaker), or a one day program (focus on three or four stressor/problem areas with three "expert" speakers). The program may be offered to a local pediatric facility or on a regional or national basis.
The purpose of creating a case study intervention was to actively involve participants in a problem solving situation. The program, therefore, allows ample time for participants to "vent" their own experiences as well as to focus on problem solving the case scenario. Success is determined by participant's ability to actively manage these types of stressors confronting them in their work environment.
CORRESPONDING AUTHOR: Stacey K. Moran, Ph.D., St. Paul Fire and Marine Insurance Company, 253 Lovers Lane, Ocean Springs, MS 39564, USA
Controlled Worksite Health Promotion with Blue-collar Minority Workers
John G. Carlson, Ph.D., and Kathleen Kim Peters, Ph.D., University of Hawaii
More than a third of all workforce entrants by the year 2000 will be immigrants and minority group members who will benefit from effective worksite health promotion programs. The purpose of the present study was to evaluate the effectiveness of a worksite health promotion program with a primarily minority, blue-collar employee population--a group of maintenance workers on a college campus. Biopsychosocial variables were integrated into both treatment and assessment in efforts to provide a comprehensive focus for the program. A standardized health risk appraisal, stress management, educational workshops/counseling, and self-directed behavior change were incorporated.
A pretreatment/treatment/posttreatment design was used. Maintenance work groups were randomly assigned to two conditions, a treatment group (n=24) and a waitlist control group (n=26). The treatment (TRT) group completed a psychometric and physical assessment and participated in 16 educational workshops over a period of 10 weeks. Follow-up was conducted at 3 months. Upon completion of the TRT group intervention, the wait-list group (CON) participated in treatment. "Treatment finishers" were defined as all those in both groups who completed treatment by follow-up (n=33).
Initial cholesterol levels and height, weight, and blood pressure were determined. Participants then were engaged in a one-hour Health Risk Appraisal (HRA) administration/feedback session, eight large-group educational session--including stress management, cessation of smoking, effects of alcohol, and exercise--eight small-group counseling/stress management-relaxation sessions, a one-hour post-assessment session, and a one-hour follow-up assessment session.
The p level set at .05. In terms of physical factors, a significant percentage of participants in the TRT group showed a decrease in weight at posttreatment. Systolic blood pressure was also significantly reduced from pretreatment for all treatment finishers at both posttreatment and follow-up. Total blood cholesterol levels were significantly lower at posttreatment but showed a return to pretreatment levels at follow-up. Included in the behavioral factors, participants in the TRT group increased their amount of reported exercise significantly when compared with the CON group at posttreatment. Also, treatment finishers' risk age as measured by the HRA was significantly lower at both posttreatment and follow-up. Reported number of healthy behavior changes made from the start of the program were also significantly greater among TRT than CON participants. Among perceived self-control measures, participants in the TRT group dramatically increased their total health self-efficacy scores at posttreatment relative to the CON group. Among various health attitudes and behaviors, social support, and positive (supportive) environment measures yielded significant treatment effects between groups.
CORRESPONDING AUTHOR: John G. Carlson, Ph.D., Department of Psychology, University of Hawaii, 2430 Campus Road, Honolulu, HI 96822, USA.
Stress Reduction in Law Enforcement Agencies
Edward T. Ferguson, Ph.D., Collier County (FL) Sheriff’s Office
As law enforcement moves into the 21st century, effects of stress and stress-related disorders may well become the major cause of officer disillusion and discontentment, resulting in burnout, substance abuse, suicide, and early retirement from the profession. The paper will provide a comprehensive treatment of education/ training programs currently underway at the Collier County (Florida) Sheriff’s Office, which focus on reducing stress in law enforcement officers and their families. The research and development efforts have been made possible by matching funds from the Collier County (Florida) Sheriff’s Office and the National Institute of Justice.
The paper will discuss the results of findings related to several stress-reduction efforts. Research and development has centered about: (1) the formation of peer support groups for the wives/significant others and the adolescent children of deputies; (2) spouse academies, which provide detailed information about agency operations, policies and benefits; (3) supervisory training aimed at recognition of stressors and instruction in basic counseling techniques; and (4) a four-hour block of in-service education/training for all law enforcement and correctional officers on stress awareness and recognition. All efforts are focused on reducing personal and organizational related stress.
The research design utilized pre- and post-testing and a control group from a neighboring law enforcement agency. Findings will be used to evaluate the effectiveness of the programs, isolate critical stressors, and provide a vehicle for contact through the agency’s Employee Assistance Program for those who may be close to a crisis situation. The paper will discuss findings obtained from law enforcement officers and their family members from data derived from several normed instruments. Deputy health and fitness data are also factored into the study, as well as absenteeism rates, job-related accidents, discipline reports, citizen complaints, and performance evaluations.
To ensure confidentiality, all testing is done by an out-of-agency police psychologist under contract to the agency’s Employee Assistance Program. Selected health and fitness data are also obtained from a Personal Wellness profile administered by Naples Community Hospital as part of the agency’s Wellness program. All test results and wellness data are analyzed by two faculty members under contract from the School of Social and Professional Studies at Florida Gulf Coast University.
Current programs related to family stress education and in-service training for deputies will continue for a minimum of twelve months. The paper will also discuss the effects of stress on two sub-groups of law enforcement officers and their families. Twenty deputies assigned to a Community Oriented Policing Unit and their wives/significant others will receive a battery of tests which assess levels of stress found in the unit and in the families of unit members. Although law enforcement has always dealt with a multitude of problems within a community, these deputies are now expected to cope with a wider range of new issues and responsibilities within the specific areas they serve. This role change for these deputies has increased levels of stress within the unit and has resulted in a high rate of burnout and turnover.
A second sub-group, all new recruits who are attending law enforcement and corrections academies, are also being studied in relation to recruit and family stress. Like the COP’s unit, each new recruit is provided a four-hour block of instruction in stress recognition and awareness prior to entering the academy. The Hilson Relationship Inventory for Public Safety Personnel and a battery of several additional data-gathering instruments are administered to each agency member and, as part of the program of the Spouse Academy, the Hilson Spouse/Mate Inventory is given to the wives/significant others. Results from data obtained from the instruments will be reported in the paper.
CORRESPONDING AUTHOR: Edward T. Ferguson, Ph.D., Collier County, Sheriff’s Office, 3301 Tamiami Trail E., Naples, Florida 34112, USA
Outcomes of a Leadership Intervention for a Metropolitan Fire Department
Randal D. Beaton, Ph.D., Fred Fiedler, Ph.D., University of Washington; Susan Infield, Ph.D., Human Engineering research Associates; and Terry Ollis, Fire Chief, City of Everett Fire Department
Effective leadership is important in any hierarchical organization in the public or private sector but crucial in the fire service which is potentially dangerous and relies heavily upon team work.
Intervention. A one-day, 8-hour leadership training intervention designed specifically for fire service officers was tested for its efficacy with a mid-sized metropolitan fire department in a Northwest state. The intervention/workshop consisted of three separate interactive modules including: (1) Leader match training (Fiedler & Infield, 1997); (2) A two-hour psycho-educational cognitive-behavioral stress management component; and (3) A one-hour video tape and discussion of examples of humane approaches to management in the fire service (FEMA, 1980). The above training was provided by the first author for all officers with a rank of Captain or above in a metropolitan fire department. A total of forty (n=40), or approximately 90% of the department's officers, participated in the training.
Outcomes. Short term outcomes at three months post-intervention in a sample of the fire fighter respondents (n=61) who completed both baseline and post-intervention surveys documented statistically significant improvements in their ratings of their ratings of their immediate supervisors' leadership behavior (t=2.57; one tail p< .01), improvements in their subjective appraisal of the ability to attain their career goals (t=-2.02; one tail p< .05) as well as significant decreases in their appraisals of "co-worker conflict" (t=3.63; one tail p< .001). Neither stress symptomatology outcomes nor any other self-reported sources of occupational stress showed statistically significant pre/post intervention decreases. There were also no significant changes in work days lost due to injuries/illness for any of the fire officer ranks or fire fighter line personnel (all t-test p values> .05).
Implications. This relatively brief, one-day leadership training intervention was associated with rather specific improvements in reported supervisory ratings and self-reported decreases in co-worker conflicts at three months post-intervention. It is not yet clear whether these gains are temporary and/or whether they will eventually result in long-term health and safety improvements in this fire department.
CORRESPONDING AUTHOR: Randal D. Beaton, Ph.D., Univ. of Washington, Dept. of Psychosocial & Community Health, Box 357263, Seattle, WA 98195
International Occupational Stress Research Studies
Presenters: Carlla Smith, Ph.D. Bowling Green State University; Norito Kawakami, M.D. Department of Public Health, Gifu School of Medicine; Eila Jarvenpaa, Ph.D., Helsinki University of Technology; and Christian Koranka, Ph.D., Institute of Psychology, University of Vienna.
Within the past decade, organizations are investing outside of the U.S. or forming alliances with organizations in other nations. As business is becoming more global, members from different organizations across the globe are working and collaborating with each other. Many questions arise. For example, how unique are leadership and work practices, and job and work environment characteristics to each nation or culture? Are these aspects of the work environment differentially impacting workers’ stress, health and well-being in each nation; and what would that mean to their company’s bottom line? Does a "set" of organizational and job characteristics exist that are important in predicting workers’ health and safety regardless of nationality? Or does a "set" of characteristics exist for each culture or nation, and why? These questions and others will be addressed in this symposium, where researchers representing Europe, Asia, and North America will convene to share with us their results and experiences in conducting occupational stress research in their countries and cross-nationally.
Each presenter in this symposium will share with us their experience in conducting cross cultural research. The first paper provides a theoretical framework for studying stress cross-culturally. Next is a paper on a large scale, longitudinal occupational health study that is underway in Japan. This is followed by two different papers which compare Finnish and U.S., and Austria and U.S. organizations (both private and public sectors). The audience may learn from these presenters not only from their findings, but also their challenges in conducting cross-cultural and large-scale research studies.
A Theoretical Framework for Examining Organizational Stress Cross-culturally
C. Smith, Ph.D., J. Stanton, Ph.D., and R. House, Ph.D. Bowling Green State University.
The voluminous literature on job-related stress has focused almost exclusively on the impact of stress in western (mostly North American) cultures. Researchers know relatively little about how job-related stress affects people in other cultures, particularly non-western cultures. Unfortunately, the scant existing research is largely descriptive, post hoc, and anecdotal. We therefore offer out preliminary efforts to develop theory-driven hypotheses regarding cross-cultural differences in common work stressors for white collar jobs.
We have developed a conceptual framework in which cultural variables influence the strength of the relationship between job stressors and perceived stress (and strains) and differentiate among job-related coping behaviors. These cultural characteristics include those originally proposed and documented by Hofstede (1980) and extended by House et al. 1977). One example of a cultural characteristics with implication for work stress in individualism/collectivism, or the degree to which individuals are integrated into groups within an organization or society. We hypothesize that people from collectivist cultures will perceive interpersonal conflict at work to be more stressful than those from individualistic cultures. Our rationale is that, because group cohesion is very important in collectivist cultures, interpersonal conflict among group members would especially stressful. In this presentation, the rationale for these hypotheses is explored and the implication of this framework for conducting cross-cultural stress research discussed.
CORRESPONDING AUTHOR: Carlla Smith, Ph.D. Bowling Green State University, Department of Psychology, Bowling Green, OH 43403.
Job Stress in Japan: Empirical Evidence from a Large-scale Study
Norito Kawakami, MD, Department of Public Health, Gifu University School of Medicine; Takashi Haratani, National Institute of Industrial Health, and Japan Work Stress and Health Cohort Study Group*
Japan has been paid much attention because of its collective culture, distinctive management style and a recent social concern on "karoshi" (death from overwork). Recently, the Japan Work Stress and Health Cohort Group completed a baseline survey of 25,000 employees in Japan. This paper reviews empirical findings from this large scale study, and to clarify a possible difference in job stress and its effects between Japan and Western countries (mainly the U.S.).
Study subjects were employees working at ten worksites in Japan. A total of 25,000 employees completed a questionnaire concerning job stressors, psychological distress, past histories and past sick absence. The baseline questionnaire included two sets of job stressor scales: five scales of the Job Content Questionnaire (JCQ) as well as 15 scales from the NIOSH Generic Job Stress Questionnaire.
Results of this study indicated that job demands and job overload were almost similar to those reported from U.S. and Canadian working populations; job control, supervisor support and coworker support were lower in our sample of Japanese workers. Occupational distributions of job demands and job control in our study were almost similar to those reported in the U.S. QES in 1969, 1972, and 1977. There were some exceptions - male machine operators’ job demands were less in our sample than in the QES data. Our study also found that the demands-control model was significantly associated with depression in male employees. The effort/imbalance model, a combination of high job demands and high job insecurity, predicts worker strain, was also significantly associated with depression in male and female workers. Support from supervisor and coworkers significantly and negatively correlated with depression in male and female workers, which is also consistent with previous U.S. data. In addition, we also found that Japanese workers had greater levels of depression and lower levels of satisfaction than U.S. workers.
Overall, results from this study suggests a possible difference in perception of job stressors and expression of emotions between Japan and U.S. These findings might be explained by Japanese management style and culture.
* The Japan Work Stress and Health Cohort Study Group includes, F. Kobayashi, M. Ishizaki, T. Hayashi, O. Fujita, Y. Aizawa, S. Miyazaki, H. Hiro, S. Hashimoto, S. Araki, M.D., as well as N. Kawakami and T. Haratani.
CORRESPONSDING AUTHOR: Norito Kawakami, MD, Department of Public Health, Gifu University School of Medicine. 40 Tsukasa-machi, Gifu 500-8705, Japan.
Effect of TQM on Psychosocial Work Factors and Stress: A Cross-national Comparison
Christian Korunka, Institute of Psychology, University of Vienna, Austria
Pascale Carayon, Ecole des Mines de Nancy, France
François Sainfort, Department of Industrial Engineering, University of Wisconsin-Madison, USA
This research reports the effects of total quality management (TQM) on psychosocial work factors and stress of employees in two public service organizations in two different countries. Two field studies were designed and carried out: one in Madison, Wisconsin, USA and the second in Vienna, Austria. In both studies, a similar research approach and similar instruments were used. The City of Madison has been involved with TQM since 1983. In this study, 424 employees in four agencies of the City of Madison were surveyed in the Fall of 1995 (58% response rate). A comprehensive questionnaire survey collected information about job and organizational characteristics, organizational culture, quality of working life, and implementation and institutionalization of TQM. Correlation analyses show that TQM institutionalization was correlated with several measures of psychosocial work factors and quality of working life. TQM institutionalization was positively correlated with job content, job control and participation, and high social support. TQM institutionalization was also related to job involvement, organizational identification, and job satisfaction. Hierarchical regression analyses were performed and demonstrated that TQM institutionalization explained a significant additional amount of variance of the quality of working life measures, beyond psychosocial work factors. In the Vienna study, the implementation of TQM and TQM-related changes was studied in a longitudinal single case study. The organization investigated is a municipal service unit, responsible for the area's public housing system. Changes include a comprehensive organizational restructuring process, the development of a new customer-centered orientation, team leadership, an incentive system, and a general quality orientation. Effects of the TQM-implementation on the employees (sample size: n=205) are investigated at three time points during a 12-month observation period. Psychosocial work factors, job satisfaction and strain were measured with questionnaires. A noticeable increase in strain could be observed during the implementation period. The highest increase in strain and decrease in job satisfaction were found in those employees who felt initially little informed about the organizational changes. TQM institutionalization, measured with a German language translation of the Madison questionnaire, was found to be generally low at the first measurement. An increase is expected for measurement t3, which will be taken in June 1998. Preliminary comparison of the Austrian and American studies show that TQM has both positive and negative effects on individuals. Detailed results regarding the cross-national comparison are expected when data collection in the Austrian sample will be completed. All results will be presented and discussed.
Occupational Stressors & Stress Symptomatology of Emergency Workers
Chair: Wayne Corneil, Sc.D., University of Ottawa; Presenters: Randal Beaton, Ph.D., University of Washington; Wayne Corneil, Sc.D., University of Ottawa; and Kathleen Kowalski, Ph.D., National Institute for Occupational Safety & Health
This symposium will address some similarities and differences in emergency workers’ job-related stress and the implications of these similarities and differences for remedial and preventive organizational- and employee-based interventions. This symposium will summarize and synthesize prior and recent investigations on occupational stress with three closely aligned emergency worker groups: namely, fire fighters, rescue workers and emergency dispatchers (Beaton & Murphy, 1995). Each of these worker groups are considered "high strain" occupations within the framework of the demand/control model (Karasek & Theorell, 1990). However, there are a number of relatively unique task demands and cultural, demographic and psychosocial variables which distinguish each of these worker groups from one another. This symposium will endeavor to identify and describe these differences as well as their inherent similarities in terms of their parallel occupational stressors including time urgency, life-and-death responsibilities, shift work demands, leadership characteristics and management styles. Based on available research findings, these worker groups also all apparently co-experience high rates of various stress-related medical conditions, mental disorders and substance abuse and/or psychosocial problems. Finally, this symposium will also examine organizational factors, work design/re-design and psychosocial support factors for each of these worker populations as well as the limitations of our current research findings, suggestions for future study and implications for preventive and remedial interventions.
CORRESPONDING AUTHOR: Randal D. Beaton, Ph.D., Univ. of Washington, Dept. of Psychosocial & Community Health, Box 357263, Seattle, WA 98195-7263, USA
Emergency Dispatchers: An Under-researched and Underserved High Strain Occupation
Randal D. Beaton*, Ph.D., Clark Johnson, Ph.D., Shirley Murphy, Ph.D., University of Washington; and Wayne Corneil, Sc.D., University of Ottawa
Emergency dispatchers (EDs) (or 911 operators) respond to calls from citizens and perform a vital function for fire, law enforcement and other rescue personnel. Although this is clearly a high strain occupation with high psychological demands and low job control, little research has been conducted with this worker group. In addition, EDs are seldom included in critical incident debriefings. Even though EDs are not "on scene," they often "absorb" stress as they perform their duties.
Sample. Both paper and pencil survey findings and observational data were collected from a small sample of uniformed fire service dispatchers (n=8). Behavioral observational data, interviews with key informants and a review of the job descriptions were obtained from a larger sample (n=110) of civilian dispatchers. Comparison data were available for the uniformed EDs sample on a number of self-report stress indices from a much larger sample (n=289) of fire fighters employed by the same department.
Results. EDs appeared to meet the high demand/low control criteria for a high strain occupation based upon their sources of occupational stress and their symptomatic complaints. Statistical comparisons between the uniformed sample (n=8) of EDs and the larger sample of field fire personnel (n=289) were limited by the former groups’s small sample size. However, the survey averages reported by the EDs sample on selected occupational stress and health indices--their Symptoms of Stress total score, total Impact of Events Scale score and total Sources of Occupational Stress--were approximately double those reported by "street personnel," i.e. fire fighters/EMTs and paramedics (all t-test p values£ .05).
Summary/Conclusions. Based on survey and observational data, interviews with key informants and other convergent data sources, it seems likely that EDs are a high strain occupation. The comparatively high scores on the self-report occupational stress indices for the ED sample compared to same department’s fire fighters and paramedics were remarkable, although the EDs sample was small. Furthermore, based on a review of available literature, EDs sources and symptoms of occupational stress have not been the foci of much published research. Clearly the stress and occupational health of EDs merits further study so that remedial and preventive stress management interventions can be formulated and evaluated for their effectiveness.
CORRESPONDING AUTHOR: Randal D. Beaton, Ph.D., Univ. of Washington, Dept. of Psychosocial & Community Health, Box 357263, Seattle, WA 98195-7263, USA
Occupational Epidemiology of Stress Related Disorders in Fire Fighters
Wayne Corneil, Sc.D. Occupational Health and Safety Agency, Health Canada
Over the past decade there has been an increased focus on occupationally related mortality risk for fire fighters from exposure-related diseases such as cardiovascular and coronary heart disease as well as certain types of cancer. While the principle research has concentrated on toxic environmental agents, there is a growing understanding about the contribution of psycho-social factors in the etiology of such disorders.
The presentation will review the findings of a number of recent studies which examine psycho-social risk factors from an occupational epidemiologic approach. While there has been a concentration on exposure to traumatic stress, the literature also reveals an increase risk arising from organizational and structural factors.
The examples will illustrate the occupational epidemiologic issues which have to be addressed in studying such populations. The implications for program interventions and evaluation research will also be discussed. The role of such interventions as critical incident stress debriefings will be contrasted with other approaches with a discussion of the needs for research controls.
CORRESPONDING AUTHOR: Wayne Corneil, Sc.D. Occupational Health & Safety Agency, Health Canada, PL1903A1, Jeanne Mance Bldg. Ottawa, ON Canada K1A 0L3
Leadership Characteristics in Escape from Three Underground Mine Fires
Kathleen M. Kowalski, Ph.D., Office for Mine Safety and Health, NIOSH Pittsburgh Research Laboratory
The characteristics of leaders under the duress of an emergency are important in the development of emergency planning, training, and in the management of an actual emergency. Knowledge of human behavior is an important component in the formation of emergency strategies. The U.S. Bureau of Mines, presently the Office for Mine Safety and Health, NIOSH analyzed the leadership behavior in three underground mine fire escapes. The subjects described their escapes during open-ended interviews. Data were coded according to: (1) evidence of leadership behavior, (2) evidence of lack of leadership behavior, and (3) characteristics of the individual in each group who led the subjects out of the mines. This presentation discusses the profile of six individual leadership characteristics which emerged from the data.
Beyond Drug-testing and EAPs: Recent Innovations in Workplace Substance Use Prevention
Chair: Joel B. Bennett, Ph.D., Texas Christian University; Presenters: Wayne E.K. Lehman, Ph.D., Texas Christian University; Martin Shain, S.J.D., Addiction Research Foundation, Toronto, CA; Royer F. Cook, Ph.D., ISA Associates; Discussant: Jacque Normand, Ph.D., National Institutes of Health
For the vast majority of work organizations – from small businesses to large corporations – drug-testing has become the primary method for addressing employee substance use problems. Clearly, the increased surveillance provided through both random and for-cause drug-testing serves as a deterrent to potential abuse. In addition, many businesses use testing in conjunction with employee assistance programs (EAPs) to help employees with alcohol and drug problems get the counseling and treatment services they need. In and of themselves, these initiatives do not serve as workplace prevention programs. That is, they do not help employees avoid problems associated directly or indirectly with substance use. In addition to individual dependence on substance use, such problems include associated health concerns, a drinking climate at work or social norms in support of drinking, and other psychosocial factors that place employees at risk when they have co-workers who abuse alcohol or drugs. As a complement to traditional EAP and drug-testing programs, presenters at this symposium have developed workplace prevention programs that attempt to integrate the goals of reductions in substance use with other goals of physical well-being, psycho-social health, and organizational wellness.
The three approaches presented in this symposium all have a basis in theory and some grounding in empirical research. Each of the presenters will review program evaluation data regarding the effectiveness of the approach. The following summarizes each approach, according to theoretical background and goals of prevention.
The Health Promotion Approach (R. Cook, ISA Associates). Integrates social learning with health promotion. Educates in stress reduction and the avoidance of drugs that are used for stress relief.
The Psychosocial Approach (M. Shain, Addiction Research Foundation). Integrates Diffusion of Innovations theory with work design. Helps workers to adapt new ways of recognizing and dealing with health & safety hazards.
The Team Approach (W. Lehman & J. Bennett, Texas Christian University). Work group climate moderates employee response to policy. Seeks to increase team- orientation and accountability for dealing with substance use.
CORRESPONDING AUTHOR: Joel B. Bennett, Ph.D., Institute of Behavioral Research, Texas Christian University, TCU Box 298740; Fort Worth, Texas, 76129 e-mail; (817) 257-7226
Research on Employees, Work and Substance Use
Joel Bennett, Ph.D. and Wayne E. K Lehman, Ph.D., Institute of Behavioral Research, Texas Christian University, Fort Worth, TX
This presentation summarizes results from a program of research into employee substance use that has lead to the development of prevention programs. The major areas of study include workplace outcomes associated with substance use, workplace culture, social norms and group processes, and attitudes toward policy. Discussion emphasizes implications of results for prevention training in the workplace. All studies reported here are based on surveys of municipal employees from different cities in the southwest U.S.
Substance use outcomes. Substance use (SU) accounted for significant variance in job behavior (psychological withdrawal, physical withdrawal, antagonistic behaviors) after controlling for the influence of personal and job background factors (Study 1). SU was also the strongest predictor of accidents for employees classified as having safety sensitive jobs (Study 2). Employees who report higher levels of background deviance are more likely to report substance use as well as negative job behaviors (Study 3).
Workplace culture. Several studies have examined workplace culture in terms of occupational characteristics, drinking climates, and organizational wellness. Exposure to co-worker SU and drinking climates were associated with higher levels of stress and job withdrawal (Study 4) and increased exposure to job-related violence (Study 5). In contrast, ratings of a healthy work climate (openness and safety) were associated with less SU in the work group and more positive attitudes toward policy (Study 6).
Social norms and group processes. Work group social processes also appear to operate as risks and buffers for employee SU. Tolerant attitudes toward co-worker SU correlated with a variety of risks. Employees with high tolerant attitudes had lower bonding to the organization, more negative job behaviors, more negative attitudes toward policy, and significantly higher levels of SU (Study 7). In contrast, team-work or cohesiveness buffers against the negative effects of co-worker use and was associated with less overall use (Study 4).
Attitudes toward policy. Employees reporting the most dissatisfaction with policy were likely to be exposed to co-worker alcohol and drug use. Those most against policy were those employees most likely to report their own alcohol or drug use (Study 9). Employees were also more likely to favor punishment when exposed to co-worker use in high risk jobs (Study 10).
Implications for prevention training. These studies describe important relationships between employee SU, work group culture, social norms, and policy, and work group SU and its consequences. A variety of work group characteristics have been identified as either risk or protective factors for the presence and the negative consequences of use. Prevention programs that target these group-level factors are needed to effectively reduce the bottom-line costs of substance use to the organization and its employees.
CORRESPONDING AUTHOR: Joel B. Bennett, Ph.D., Institute of Behavioral Research, Texas Christian University, TCU Box 298740; Fort Worth, Texas, 76129 e-mail; (817) 257-7226
Psychosocial Hazards, Substand Abuse and Injuries in the Workplace: Evidence, Action and Lessons Learned
Martin Shain, S.J.D., Centre for Addiction and Mental Health.
An accumulating body of research evidence links psychosocial factors related to the organization of work with substance abuse and injuries. For example, there is evidence that low job visibility, unstructured work, highly stressful work, "alienating" work, conflictful labour relations and work characterised by few social controls or by norms favourable to excessive use are factors implicated in higher rates of employee alcohol and drug consumption. It remains difficult, however, to communicate this evidence convincingly to decision-makers in the workplace. This paper will a) review the evidence and b) describe a project in a leading Canadian forest products company that is directed toward communicating the evidence in ways likely to reduce the incidence of injuries. The communications perspective taken is drawn from Diffusion of Innovations theory. Accordingly, the account emphasizes the ways in which new concepts, ideas and evidence are used, adapted and sometimes rejected by actual and potential consumers.
In this project the "general knowledge" from the scientific evidence relating psychosocial hazards, substance abuse and injuries had to be grounded and validated in "local theory" before it could be used. This exercise was accomplished by utilizing the joint forces of the company’s Occupational Health and Safety and the Employee Family Assistance Program Committees. These committees struck a time-limited task force whose job was to find ways of acquiring, adapting and using both general and local knowledge to understand and deal with the "psychosocial hazard/substance abuse/injury connection". Part of this process involved task force members in conducting studies of employees and their families to generate "local theory" about this connection. Both general and local theory were found to include individual and organizational factors in their accounts of the connection. However, the task force did not feel comfortable in dealing with organizational factors in its recommendations to management. Consequently, the action component of this project devolved into the provision of individually-oriented programs on "enabling" and conflict resolution. An analysis of why this happened and of how this outcome can be avoided in the future is given in the context of Diffusion of Innovations theory.
CORRESPONDING AUTHOR: Martin Shain, S.J.D., Senior Scientist, Centre for Addiction and Mental Health, and Head, Workplace Program Centre for Health Promotion, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
Substance Abuse Prevention in the Workplace: The Role of Stress Management
Royer F. Cook, Ph.D., ISA Associates
Substance abuse (SA) is increasingly recognized as a problem that erodes the health and productivity of working adults. The most common means of addressing SA among workers is through the establishment of employee assistance programs and drug testing programs. Although there is evidence that these approaches are effective in identifying workers with SA problems and (at least with respect to EAPs) providing them with beneficial treatment, neither EAPs nor drug testing offer effective primary or secondary prevention services aimed at helping the mainstream of workers avoid SA problems.
For the past decade, the author and his associates have been developing substance abuse prevention programs for the workplace, and have recently used Stress Management programs as a vehicle for reducing substance abuse in the workforce. This paper will present a brief description of the SA prevention approach, then present findings from two studies, one recently completed and the other in progress.
Study #1: At the Integon Insurance Corporation, 426 employees participated in either Stress Management or Healthy Eating sessions. Participants were randomly assigned to either the SA prevention condition (receiving specially developed prevention messages and materials along with the stress management or diet information) or a control group from which the SA prevention materials were withheld. Self-report assessments on health and SA were gathered before and at two points after the sessions. In general, participants in the Stress Management program showed substantial improvements in stress levels and substance use attitudes and behavior, regardless of whether they were in the experimental or control group. While participants in the Healthy Eating program showed improvements on all measures of eating practices, only subjects in the experimental group showed significant improvement on SA measures.
These findings indicate that when SA prevention materials are inserted into health promotion offerings, improvements in substance use attitudes and behavior can be achieved with out diluting the impact of the health promotion program. In addition, stress management programs appear to effectively reduce substance abuse among workers even when explicit SA prevention materials are not present.
Study # 2: At three sites (two union apprenticeship programs and one large construction company), a sample of 324 construction workers have been assessed in individual interviews on several SA indices, using both self-report measures and bio-assays (urinalysis and hair analysis), then given a stress management program called "Power Tools: Healthy Choices for Life", tailored specifically toward blue-collar working men. All workers were randomly assigned to a Power Tools program that included substance abuse prevention or a program that did not. This paper will present preliminary findings from this study.
CORRESPONDING AUTHOR: Royer F. Cook, Ph.D., ISA Associates, Inc., 201 N. Union St., Suite 330, Alexandria, VA, 22314, USA
A Team-based Approach to Substance Abuse Prevention Training in the Workplace
Wayne E.K. Lehman, Ph.D. and Joel Bennett, Ph.D., Institute of Behavioral Research, Texas Christian University Fort Worth, TX
This presentation will describe a new substance abuse prevention program that incorporates team principles and is sensitive to work group cultures. It differs from more traditional approaches because it treats the work group and environment rather than the individual as the focus. Thus, substance abuse is made relevant for all group members, users and non-users, because all may be affected by use of any member.
The need for new approaches to workplace substance abuse prevention is based in part on two recent trends in American business. The first represents the trend toward corporate downsizing and the development of team-based and job re-engineering (e.g. JIT, Total Quality) programs. The second represents increased surveillance requirements for substance use in many industries. These trends suggest the need for a program that incorporates new workplace practices and is based on participatory principles.
Traditional workplace-based substance use prevention training has typically focused on signs and symptoms of use, and identification and referral of the problem employee, treatment, or disciplinary action. The traditional program is generally a stand-alone program that is not well integrated with other organizational programs and agendas.
The enhanced training views substance use from a work group or team perspective. Emphasis is placed on how use by one member effects other members. The training addresses work culture and employee behavior and attitudes that enable, support, encourage, or ignore use. Training is integrated with overall organizational objectives such as performance improvement, teamwork, and customer service. It consists of highly involving exercises that should assist transfer of training into everyday work practices.
The enhanced training program consists of preparatory focus groups and six modules. These include (1) general discussion about stress and service quality, (2) a board game ("Risks & Strengths"), played by teams, that informs about policy in the context of organizational wellness, (3) the dynamics of tolerance for workplace problems (problem co-workers), (4) Skills in stress-related group problem-solving, (5) communication skills for "nudging" others to get help, and (6) integrative dialogue for transfer back to work.
The program was evaluated in a municipal workforce with a modified Solomon 4-group design, with work groups assigned to one of three conditions (enhanced team-based training, standard didactic training, and a no-training control group).Evaluation data included employee self-report data as well as organizational records. Development and assessment is still in the preliminary stages. Initial training results indicates that participatory exercises help breakdown employee denial regarding their vulnerability to substance abuse problems in their work groups and enhance stress problem-solving.
CORRESPONDING AUTHOR: Wayne E.K. Lehman, Ph.D., Institute of Behavioral Research, Texas Christian University, TCU Box 298740; Fort Worth, Texas, 76129
e-mail; (817) 257-7226
Increasing Inequality in Ischaemic Heart Disease Morbidity among Employed Men in Denmark 1981 - 1993.
Finn Tüchsen and Lars A. Endahl
Background: In the mid 1980's European governments committed themselves to the WHO goal "reduced inequality in health by year 2000" according to which inequality in health should be reduced by 25% by the year 2000. The study aim is to estimate the time trend in relative risk due to ischaemic heart disease morbidity (IHD) in employment status groups in Denmark in the period from 1981 to 1993 and to recommend a strategy to reduce inequality in health. Material and methods: The study dealt with change in relative risk of IHD in main employment status groups as measured in three successive cohorts. The cohorts were defined as all gainfully employed men in Denmark as of 1 January 1981, 1986 and 1991, respectively. Information on employment was retrieved for the three previous years. The cohorts were followed for first admissions with ischaemic heart disease as the principal cause during 5, 5, and 3 years respectively. Results: Managers and white collar workers had an average or low and decreasing relative risk while male blue collar workers had a high and increasing relative risk. Thus the social inequality in IHD is rapidly increasing. Some occupational groups are known to be at high risk. Some of these high risk groups, such as bus drivers, have even an increasing relative risk. Conclusions: The general health education has been successful in the prevention of IHD in the high status groups but has failed to reduce the risk among blue collar workers. Preventive measures against IHD should focus on occupational groups at high, increasing risk and the measures should tailor to their "subculture."
A Conceptual Model for Epidemiologic Research on Fatigue: The Design of the Maastricht Cohort Study on Fatigue at Work
Presenter: IJmert Kant, PhD, Ute Bültmann, M.Sc., Helga J. van den Elzen, PhD, Anna J.H.M. Beurskens, PhD, Gerard M.H. Swaen, PhD Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
Fatigue and psychological distress at work affects the personal performance and may lead to sick leave and work disability. So far, most studies on this subject have been cross-sectional. However, these studies did not reveal the etiology and prognoses of fatigue which is a prerequisite for effective prevention and treatment.
Therefore, at Maastricht University a large-scale prospective cohort study was started in May 1998. By using a longitudinal design causal relationships can be established. The Maastricht Cohort Study includes seven different research projects. The aims of these studies are to investigate the risk factors for the development and the prognoses of fatigue and psychological distress at work. Furthermore, different treatments will be evaluated.
Fatigue and psychological distress has a multifactorial etiology and prognosis. In the Maastricht Cohort Study three groups of potential risk factors are taken into account:
Work-related factors, including job content, working conditions, work relations, conditions of employment or a combination of these factors
Private situation, including household, leisure activities
Individual characteristics, including general health, coping
In addition there may be interactions (additive or multiplicative) between the work-related risk factors and/or non-work-related risk factors, i.e. the work-family interface.
In the cohort study the primary health outcome is fatigue. However, fatigue has different dimensions and different expressions. In the Maastricht Cohort Study we differentiate between fatigue as a complaint and/or a symptom of burnout and the consequences of fatigue (sick leave and work disability).
There are several interactions between the risk factors and the different expressions of fatigue. To deal with these complex relationships a conceptual model for epidemiologic research on fatigue at work was developed. This model takes into account the multifactorial etiology, the different dimensions of fatigue and the interactions. Based on this model the Maastricht Cohort Study was designed.
The Maastricht Cohort Study surveys a heterogeneous study population of 12,000 employees from different companies and follows them for three years. At baseline, participants completed a self-administered questionnaire on work, private situation, personality and fatigue. Follow-up consist of fatigue (perception, complaints and sick-leave) as reported by the participants and record linkage to the company=s sick-leave registry systems.
In the paper the conceptual model for epidemiologic research on fatigue at work and the subsequent design of the Maastricht Cohort Study will be presented and discussed in relation with other concepts of psychosocial exposure assessments (e.g. demand/control/ support model).
CORRESPONDING AUTHOR: IJmert Kant, PhD, Department of Epidemiology, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands. Fax. : +31-43-3618685 ; E-mail