Alcohol-related Problems and Sick Leave: Do Attitudes towards Drinking matter?

Background: Drinking alcohol is integrated into people’s social- and work lives. Drinking attitudes and norms stand out as significant predictors of drinking alcohol but few studies have been focused on working populations. Existing norms and attitudes toward alcohol, nature of work, sociocultural context, and workplace culture can form different drinking patterns and subsequently lead to a range of consequences for the individual who drinks, surroundings people, and society as a whole. Earlier studies have revealed that drinking alcohol increases the risk of sick leave among employees. However, there is a lack in exploring subgroups including measurement groupings and type of data. Moreover, the majority of prior studies focused on individual determinants and had less attention on group-level determinants. To better understand the relationship between alcohol behavior and sick leave, there is a need to explore the determinants at both the individual and group levels while considering employees within their work units and organizations. Aims: The overall aim of this thesis was to obtain new knowledge and a deeper understanding of the relationships between alcohol consumption and sick leave (Papers I and III), and how drinking attitudes might have a role in this relationship (Papers II and III). Materials and methods: In this thesis, data from the national WIRUS project (Workplace Interventions preventing Risky alcohol Use and Sick leave) was used. The relationship between alcohol consumption and sickness absence was explored by reviewing previously published literature and was analyzed descriptively (based on type of design, direction of associations, and type of measurement) and using meta- analysis (Paper I). Six databases were searched, and observational and experimental studies from 1980 to 2020 that reported the results of the association between alcohol consumption and sickness absence in the working population were included. Newcastle-Ottawa Scale was applied to assess the quality of each association test. The status of drinking attitudes, as well as the association between drinking attitudes and alcohol-related problems, were examined in a cross-sectional study of 4,094 employees in 19 Norwegian companies (Paper II). Drinking attitudes were assessed using the Drinking Norms Scale, and the Alcohol Use Disorders Identification Test scale was used to assess any alcohol-related problems. The data were analyzed using multiple logistic regression. Paper III, by considering the organizational structure of the working units, explored whether alcohol-related individual differences (drinking attitudes and alcohol-related problems) can predict one-day, short-term, long-term, and overall company-registered sick leave days. The data from the WIRUS-screening study were linked to company-registered sick leave data for 2,560 employees from 95 different work units. Three- level (employee, work unit, and company) negative binomial regression models were used to examine the association between alcohol-related individual differences and sick leave. Results: In Paper I, fifty-nine studies (58% longitudinal) were included in the systematic review. The systematic review supported the association between alcohol consumption and sickness absence, revealing that sickness absence was more than two times higher among risky drinking employees than among low-risk drinking employees. The increased risk for sickness absence was more likely to be found in cross- sectional studies, studies using self-reported absence data, and those reporting short-term sickness absence (Paper I). In Paper II, a higher proportion of employees reported positive (i.e., liberal) drinking attitudes. When compared with employees with negative drinking attitudes, employees with positive drinking attitudes were three times more likely to report alcohol-related problems (Paper II). Moreover, positive drinking attitudes were found to be more frequent in men than in women. However, the association between drinking attitudes and alcohol-related problems was noticeably stronger for women than for men (Paper II). A high variation in sick leave across work units and companies was found in the sample of Norwegian employees (Paper III). However, alcohol-related problems and drinking attitudes showed no association with higher levels of sick leave in work units within companies (Paper III). Conclusions: This thesis supports earlier evidence on the association between alcohol and sick leave in general and suggests that some specific types of measurement groupings and types of data may produce large effects in different ways. Although there was a lack of association between alcohol-related individual differences and sick leave among a sample of Norwegian employees, this thesis suggests the importance of between company-level differences on sick leave over within company differences. Therefore, further research is warranted to explore whether other unmeasured factors and/or specific company policies and practices can explain these differences. Moreover, the thesis suggests that drinking attitudes are associated with alcohol-related problems. To facilitate early health promotion programs that target alcohol problems, employees’ drinking attitudes may be assessed alongside actual alcohol consumption. These assessments might need to be gender-specific.

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