The present program aims to reduce the consumption of alcohol and other drug by service employees of the FCC S.A. Delegation in the workplace by implementing an integral program based on health promotion and a prevention intervention and, as a secondary aim, to improve healthy habits through the reduction of alcohol and other drug consumption during leisure time.
Design
This intervention, assessed in a nonrandomized single group, study aimed to promote health and prevent alcohol and drug consumption in the workplace and was conducted in 12 work centers. This workplace program was started in 2009, enrolling 240 employees in the pilot intervention in Reus. Afterward, the recruitment was done gradually until it included 12 FCC S.A. workplace delegations located across Tarragona and Lleida provinces of Spain so that the intervention could be implemented in all 12 FCC S.A. delegations by the company responsible. The 12 sites of FCC S.A. received the same intervention and the same monitoring by executive and occupational health service and medical service staff. The 12 sites were introduced gradually to the intervention; for logistical reasons, Reus was first, and Selsa was last (Fig. 1). The analysis considered the first incorporation of each employee in the present health promotion and prevention program as baseline data. The baseline data were generated at the following times: a) after the incorporation of a new worker, or b) at the first time of promotion and prevention program implementation. The workers first received a letter from the executive director of FCC S.A. with the presentation of the program. After the selection based on the inclusion criteria, the baseline assessment and program intervention were performed (Fig. 1).
This program obtained the approval of the security and health committees of all of the company worksites; members of the worksite unions agreed to participate and signed informed consent documents, which are now included in the collective bargaining agreement. The program design was approved by the Catalan public administration (Subdirección General de Drogodependencias de la Agència de Salut Pública de Catalunya del Departamento de Salud, Servicios Territoriales de Tarragona del Departamento de Trabajo). The confidentiality of the participants’ clinical information was strictly maintained according to the organic law 17/1999 ratified on December 13 regarding personal data protection. All reference data from the detection controls were collected from the medical service of the FCC S.A. Delegation.
Inclusion criteria
To be eligible for inclusion, participants had to 1) have been an employee of the FCC S.A. Delegation with at least one year of service, 2) be ≥18 years old, and 3) have had at least one alcohol or other drug consumption registered through the work health surveillance program. Noncompliance with an inclusion criterion was considered grounds for exclusion.
Intervention
After one year of previous work, the application of the prevention and action policies of zero tolerance and the intervention designed to prevent the consumption of alcohol and other drugs, the intervention program was developed and divided into 2 parts. Before its implementation, the intervention was explained as a professional training program that addressed the following:
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Executive and occupational health service training in promoting health [14].
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Medical service staff training in detection, brief intervention and motivational interviews to ensure the reliability among medical staff (the primary medical staff receive the same training from the general vice president for Drug Addiction of the Agència de Salut Pública de Catalunya).
This program was initially designed to be comprehensive (Fig. 2).
A) First process: Health promotion and health monitoring
A.1 Awareness phase: Employees received different actions during the first year of enrollment in the program. These actions included the Occupational Health and Prevention Services of the FCC S.A. Delegation, the general vice president for drug addiction of the Agència de Salut Pública de Catalunya, and authority and security agents.
A.1.a) Information:
Each employer received a personal letter from the Executive of the FCC S.A. Delegation regarding program implementation.
Posters with images and messages of the program were designed and showed alcohol and/or drugs risks during work hours and extra-work hours. This message was positive and not coercive regarding consumption (Additional file 1).
A.1.b) Training:
All employees received 5 h of training in methods designed to change behaviors and reduce alcohol and drug consumption through the active encouragement of participants in discussions of real cases in groups of 25 employers who expressed their doubts and prejudices.
Training topics
○ Surveys of employer opinions regarding alcohol and/or other drug use, as well as the relevance of program implementation.
○ Conflicts related to the consumption of alcohol and/or other drugs.
○ Explanations of the alcohol and drug prevention programs in Catalonia and the conception of the present program.
○ Relevance of the role of each employer in the program.
○ Behavior during conflicts and the procedures associated with consumption during work hours at both relationship and work levels.
○ Program internal regulations: The consequences of tests meant to detect the use of alcohol and/or other drugs at work.
A.1.c) Participation in workshops outside of work:
Different activities/workshops were provided during work hours as expositions and technical workshops concerning the present program, but some activities were conducted outside of the workplace during work hours.
A.2. Evaluation and health surveillance:
At baseline and in the consecutive years after conducting the initial intervention, the Occupational Health Service of the FCC S.A. Delegation assessed the results to identify employees exhibiting risky consumption of alcohol and/or other drugs (during work and leisure time).
A.2.a) Medical examination:
A semistructured interview was conducted by a physician and a nurse with the purpose of evaluating and monitoring the alcohol and drug consumption of each employee (assessed in standard drink units (SDUs), where 1 SDU = 10 g of alcohol) and/or other drugs during or outside of work, in the past week. Physician and nurse staff were previously trained and standardized regarding semistructured interviews to ensure reliability. In addition, signs related to alcohol and/or drug consumption were assessed. This semistructured interview had questions about how many SDUs of alcohol and drug were consumed inside or outside of work hours and on weekdays or weekends to determine the scope of alcohol abuse. The obtained information was treated confidentially by the medical service and was not remitted to responsible FCC S.A. The results of the interview did not influence the relationships of the employees with the company.
Furthermore, detection tests (Alcotests, drug tests and urine tests) were performed among employees under different circumstances (randomly, for suspected acute poisoning, for work accidents and for planned detection).
B) Second process: Secondary prevention
Secondary prevention was conducted by the Occupational Health Service of the FCC S.A. Delegation following their expert’s criteria personalized for each worker according to their risky consumption of alcohol and/or other drugs (during work and leisure time). The secondary interventions were as follows:
B.1 Brief intervention: Risky alcohol and/or drug consumption was detected in employees using a semistructured interview; a brief 10–15 min intervention based on objective negotiation strategies to change the behaviors associated with consumption patterns was implemented [16].
B.2 Personalized advice: Among employees with a positive drug test (i.e., Alcotest, drug test and/or urine test), a motivational interview was performed to explore and solve doubts that would enable the employee to agree to reduce his/her consumption.
B.3 Personalized follow-up assessment: Among employees who received the brief intervention and/or personalized advice, a personalized follow-up assessment was conducted through a planned visit (when necessary), where the risk of consumption was assessed, or detection tests were used to confirm the employee’s capability to work.
B4. Referral to the Center for the Attention and Monitoring of Drug Addictions (CAM): Employees presenting with the signs and symptoms of substance dependence according to the International Statistical Classification of Diseases and Problems Related to Health, 10th review (ICD 10) of the WHO were referred to the CAM for diagnosis and multidisciplinary treatment.
Outcomes
The principal outcomes were a) risky alcohol consumption (more than 28 SDUs/week in men and 17 SDUs/week in women), as assessed by the semistructured interview of consumption habits [17] (taking into account global consumption, during work and leisure time), b) drug consumption (positive detection was considered as risky consumption), and c) total risky consumption (combination of risky alcohol consumption and drug consumption).
An Alcotest (Dräger Alcotest ® 6810 med, Madrid, Spain) greater than 0.0 units was considered a positive test across two measures of the alcohol content in exhaled air separated by a 10 min interval (Instrucción 07/S- 94 Dirección General de Tráfico, 2008). The drug test (Dräger drug test ® 5000, Madrid, Spain) was considered positive if any drugs (e.g., opiates, cocaine, tetrahydrocannabinol, benzodiazepines, amphetamines and methamphetamines) were detected in the saliva (Instrucción 07/S- 94 Dirección General de Tráfico, 2008).
Furthermore, the following outcomes were recorded and compared with the WHO standards: weight (kg) using the Roman scale, height (m) using the Lohman scale [18], body mass index (BMI) (kg/m2; categorized using the WHO thresholds) [19] and systolic and diastolic blood pressure (mmHg) [20].
Statistical analyses
Continues variables are presented as the means ± standard deviations (SD), and categorical variables are presented as percentages. McNemar’s test was used to compare the categorical variables between the baseline measurements and after the intervention.
All data were analyzed using SPSS V.23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The level of statistical significance was set to p < 0.05.