The 130th Annual Meeting of APHA

Abstract #48062

Rebecca Spicer, MPH, PhD, Pacific Institute for Research and Evaluation, Trinity Complex 23-S, 425 Silom Soi 5, Bangkok, 10500, Thailand, Ted R. Miller, PhD, Public Services Research Institute, Pacific Institute for Research and Evaluation, Calverton Office Park, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, 307-755-2727, spicer@pire.org, and Gordon S Smith, MBChB, MPH, Liberty Center for Safety Research, 71 Frankland Rd, Boston, MA 01748.

Introduction: This study examined worker substance abuse as an independent risk factor for occupational injury. In a step further, the role of a worker’s problem behaviors in the substance abuse-occupational injury relationship was explored. Methods: This matched case control was nested in a cohort of 26,586 hourly workers. Cases (n=3,994) were workers suffering a work-related injury. Five controls were selected per case from the cohort of workers active at the time of the case’s injury and matched on job type. A worker was labeled a substance abuser if any of the following occurred during the comparison period: alcohol/drug-related Employee Assistance Program (EAP) visit, an excused alcohol/drug-related absence, or an alcohol/drug-relaetd disciplinary action. Three variables identified workplace problems: discipline for absenteeism, incompetence, and dishonesty/unprofessionalism. Conditional logistic regression modeled the association of substance use with occupational injury, controlling for worker characteristics and problem behaviors. Results: The odds of injury among workers with an indicator of substance abuse was 1.40 times greater than the odds among workers without. This odds ratio declined to 1.26 (p=0.061) when workplace problems were controlled for. Notably, absenteeism and dishonesty/unprofessionalism disciplinary actions were still significantly associated with occupational injury, even after controlling for demographic factors and substance abuse; OR=1.66 (p<0.001) and OR=2.14 (p<0.001), respectively. Conclusions: Worker alcohol and drug use significantly predicted occupational injury. However, this relationship weakened once worker behavioral problems were controlled for. Worker behavioral problems, on the other hand, continued to strongly predict occupational injury. These findings suggest that the substance use-occupational injury relationship can be explained, in part, by a worker’s tendency for problem behaviors: the “problem worker syndrome.”

Learning Objectives:

• Describe how substance abuse increases the risk of occupational injury.
• Describe a second pathway that explains how workers with a tendency for problem behaviors are at increased risk of occupational injury.
• Discuss the implications of the findings for either of the explanations in 1 and 2.

Keywords: Occupational Safety, Behavioral Research

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.