Background: The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers’ skills Training (hereafter, ‘APMaT’), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.

Methods: Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.

Results: No statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness.

Conclusions: The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions.

Background: Alcohol interventions targeting the adult population are often conducted in healthcare settings, while preventive interventions often target adolescents or young adults. The general working population is often overlooked. A workplace-based intervention, consisting of development and implementation of an organizational alcohol policy, and skills development training for managers (APMaT) was carried out in order to prevent and reduce alcohol-related harms by identifying hazardous consumers at an early stage. 

Objective: This study aims to evaluate APMaT by focusing on managers’ inclination to initiate early alcohol intervention.

Methods: In a cluster randomized design, data were obtained from 187 managers (control: n = 70; intervention: n = 117). Inclination to initiate early alcohol intervention was measured using three items on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Changes in managers’ inclination to intervene were analyzed by applying multilevel ordered logistic regression. Predictors included in the model were group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time).

Results: Significant increase in inclination to intervene against hazardous alcohol consumption among managers in the intervention group compared to managers in the control group was observed. Specifically, a 50% increase of confidence to initiate an intervention was observed among managers in the intervention group.

Conclusions: APMaT seems effective to increase managers’ inclination to intervene early against hazardous consumption in the workplace. The effectiveness of APMaT at the employee level should be explored in prospective studies.

A sizeable portion of hazardous alcohol consumers are found in the workforce, suggesting that the workplace could provide opportunities for preventing and reducing hazardous alcohol use at an early stage. One such intervention is the multi-component alcohol prevention programme, ‘APMaT’ (Alcohol Policy and Managers’ skills Training), designed and delivered by Alna, an organisation that provides services to prevent harmful behaviours in Swedish workplaces. This thesis is a programme evaluation of APMaT, assessing its effectiveness through survey data at the managerial and employee levels.

Study I described the sociodemographic, work-, and health-related characteristics of managers relative to their inclination to intervene and organisational alcohol policy knowledge. Moreover, the association between managers’ inclination to intervene and knowledge about organisational alcohol policy was examined. The number of supervised employees was strongly associated with both the inclination to intervene and alcohol policy knowledge, and a graded positive association was found between managers’ inclination to intervene and alcohol policy knowledge. The findings implied that managerial characteristics may play a role in potential actions to initiate early alcohol interventions.

Study II evaluated the effectiveness of APMaT, focusing on changes in the inclination to intervene at an early stage among managers at one-year follow-up. The findings suggested that APMaT is somewhat effective in increasing managers’ inclination to initiate an intervention by increasing their confidence in initiating a dialogue with employees, which may increase the likelihood of initiating an intervention at an early stage.

Study III further assessed the effectiveness of APMaT by examining changes in the risk of hazardous alcohol use among employees at one-year follow-up. The study did not provide strong empirical evidence in support of the effectiveness of APMaT regarding the reduction of hazardous alcohol use within the given follow-up time.

Given the mixed support for the effectiveness provided by Studies II and III, Study IV described managers’ perceived barriers in the dissemination of their organisational alcohol policy. This dissemination was an important component of APMaT because all managers were expected to facilitate its implementation throughout the workplace. Uncertainties and a variety of perceived organisational obstacles were reported by the managers to have hindered the dissemination of the organisational alcohol policy.

This thesis highlights the complexity of delivering and implementing an intervention in a complex and dynamic setting, such as the workplace. The findings suggested that the investigated intervention, APMaT, might be effective in changing attitudes among managers, whereas no concrete effects on employees’ hazardous alcohol use could be demonstrated. Nevertheless, the studies contributed with knowledge to the development of prospective workplace prevention programmes.

En betydande andel av riskkonsumenter av alkohol finns i arbetskraften vilket tyder på att arbetsplatsen kan ge möjligheter att förebygga och minska riskkonsumtion av alkohol i ett tidigt skede. Ett alkoholförebyggande program med flera komponenter, s.k. ‘APMaT’ (engelsk förkortning för alkoholpolicy och utbildningstillfällen för chefer), designades och levererades av Alna, en organisation som tillhandahåller förebyggande insatser kring riskbeteende. Denna avhandling är en utvärdering av APMaT kring dess effektivitet genom att använda enkätdata både på chefs- och medarbetarnivåer.

Studie I beskrev de sociodemografiska, arbets- och hälsorelaterade faktorerna bland chefer avseende deras benägenhet att genomföra insatser och deras kunskaper kring alkoholpolicy. Dessutom undersöktes sambandet mellan benägenhet att genomföra tidiga insatser och kunskaperna kring alkoholpolicy. Antalet underanställda hade ett starkt samband med både chefers benägenhet att genomföra insatser och kunskaperna kring alkoholpolicy, och att ett positivt graderat samband konstaterats mellan chefers benägenhet att genomföra tidiga insatser och deras alkoholpolicykunskap. Resultaten tyder på att chefers individuella faktorer kan ha betydelse för potentiella handlingar att genomföra tidiga insatser.

Studie II utvärderade effektiviteten av APMaT genom att fokusera på förändringar i benägenhet att genomföra tidiga insatser bland chefer vid ettårsuppföljningstid. Resultaten tyder på att APMaT är effektiv till en viss del för att öka benägenhet att genomföra insatser genom ökat självförtroende att påbörja ett samtal med sina medarbetare, vilket kan öka sannolikheten att genomföra tidiga insatser i ett tidigt skede.

Studie III utvärderade effektiviteten av APMaT ytterligare genom att undersöka förändringar i riskkonsumtionen av alkohol bland medarbetare vid ettårsuppföljningstid. Denna studie gav inte en stark empirisk evidens för att stödja effektiviteten av APMaT gällande riskkonsumtion av alkohol med den innevarande uppföljningstiden.

Med tanke på det blandade stödet av effektiviteten som tillhandahölls av Studier II och III, beskrev Studie IV chefers uppfattningar kring potentiella hinder i utspridningen av arbetsplatsens alkoholpolicy som är en viktig del av APMaT då chefer förväntades att underlätta dess implementering igenom hela arbetsplatsen. Osäkerheter och en mångfald av organisationshinder uppfattades som förhinder i utspridningen av arbetsplatsens alkoholpolicy.

Denna avhandling belyser komplexiteten i leveransen och implementeringen av en insats i en komplex och dynamisk miljö, såsom arbetsplatsen. Resultaten föreslog att den alkoholförebyggandeinsatsen, APMaT, kan vara effektiv om att förändra chefers attityd dock kunde inga konkreta effekter bland medarbetares riskkonsumtion av alkohol påvisades. Studierna har dock bidragit med kunskaper för utvecklingen av framtida arbetsplatsrelaterade förebyggande program.

Purpose - An alcohol prevention programme, consisting of the implementation of an organisational alcohol policy and skills development training for managers, was delivered in Swedish workplaces. Previous findings revealed challenges in policy implementation because of the lack of dissemination amongst managers. This study aims to describe perceived dissemination barriers of the organisational alcohol policy by managers. Design/methodology/approach - A cross-sectional survey (n = 193 managers) was performed to identify common dissemination barriers in the workplace and complementary case illustrations derived from semi-structured interviews (n = 18 managers) were used to understand the dissemination barriers of the organisational alcohol policy. Frequency distributions were presented to describe common perceived barriers. Findings - Sixty-five per cent of managers reported that their workplace had not changed their approach to addressing alcohol-related issues compared to their usual practice before programme delivery. Various organisational factors, such as deprioritisation of programme dissemination, lack of communication and inadequate strategies were some of the common barriers perceived by managers. Moreover, managers reported uncertainties regarding any changes concerning the workplace's approach for addressing alcohol-related issues. Increased efforts in disseminating the organisational alcohol policy can reduce uncertainties among managers. Practical implications - A thorough process evaluation to understand processes in programme delivery and implementation is necessary to ensure the uptake of the intervention. Originality/value - This study highlighted the complexity of disseminating an alcohol policy in a dynamic setting, such as the workplace, and provided the importance of addressing organisational obstacles.

Background: Globally, women constitute 30% of researchers. Despite an increasing proportion of women in research, they are still less likely to have international collaborations. Literature on barriers to knowledge transfer and exchange (KTE) between men and women remains limited. This study aimed to assess perceived gender barriers to KTE activities in vaccination-related research in low-, middle- and high-income countries.

Methods: This was a cross-sectional data assessment from a self-administered questionnaire distributed to researchers in the field of vaccination research. The administered questionnaire was developed and validated by WHO and McMaster University. Descriptive statistics were carried out. Structural factors of KTE were assessed using 12 statements measured with a five-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). An index ranging from 12 to 60 points was created to assess structural factors of KTE, with higher score indicating fewer perceived barriers. Multivariable linear regression modelling was applied to examine the association between KTE barriers and gender.

Results: A total of 158 researchers were included in the analysis. Regardless of gender and country of affiliation, researchers experienced challenges with respect to KTE activities; particularly factors related to the availability of human and financial resources and level of technical expertise among their target audience. We were also able to identify perceived facilitators among men and women, such as the presence of structures that link researchers and target audiences, the investment of target audiences in KTE efforts and the presence of stable contacts among target audiences. Our linear regression analysis showed that women perceived more barriers than men (R-2 = 0.014; B = -1.069; 95% CI -4.035; 1.897).

Conclusions: Men and women shared common perspectives on barriers to KTE. KTE activities could be strengthened by improving structural efforts to reduce gender differences and increase collaborations between researchers and their target audience.

Background: High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions.

Objective: This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention.

Methods: Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program.

Results: This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected.

Conclusions: This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace.

Trial Registration: ISRCTN17250048; http://www.isrctn.com/ISRCTN17250048

International Registered Report Identifier (IRRID): DERR1-10.2196/17145

Purpose - Individual factors associated with managers' organisational alcohol policy knowledge and inclination to initiate early alcohol interventions have been understudied. This study aims to examine differences in managers' policy knowledge and inclination across a range of socio-demographic, work-related and health characteristics, and it aims to examine the association between policy knowledge and inclination to intervene, net of these characteristics.

Design/methodology/approach - Questionnaire data were collected from 430 managers. Organisational alcohol policy knowledge and inclination to intervene were measured using a 5-point Likert scale ranging from 1 (very low) to 5 (very high). Socio-demographic, work-related and health characteristics included gender, age, education, managerial responsibility, years in current position, self-rated health and alcohol consumption. Associations were examined using multilevel ordinal regression analysis.

Findings - Managers with a greater number of employees demonstrated the highest level of organisational alcohol policy knowledge and were more inclined to initiate early alcohol interventions. Alcohol policy knowledge was associated with inclination to intervene, net of individual characteristics.

Practical implications - Considering how managers' characteristics might influence efforts to decrease hazardous alcohol consumption is potentially important when designing future workplace alcohol prevention programmes.

Originality/value - Several individual factors related to managers' organisational alcohol policy knowledge and inclination to initiate early alcohol interventions were identified, particularly managerial responsibility. However, the association between policy knowledge and inclination to intervene remained strong after accounting for these individual factors. Future studies should explore alternative explanations at the individual and organisational levels.

Background: Increases in overweight and obesity among youths have resulted in the diagnosis of Type 2 diabetes mellitus (T2DM) at earlier ages. The impact of lifestyle-related factors has been implicated; however, its relation to morbidity and mortality and sex differences remain unclear. We aimed to document the changes in risk factors and sex differences associated with T2DM-related morbidity and mortality during 1995-2015.

Method: We used mortality rates and morbidity estimates from the Global Burden of Diseases Study 2016 using Disability-Adjusted Life Years (DALY). Multiple linear regression analyses were used to determine associations between T2DM-related mortality and related risk factors. DALYs were grouped by country income level, and were stratified by sex.

Results: Increases in mortality were observed for both sexes, and females tended to have higher mortality rates per 100,000 persons. Body mass index (BMI) continued to be the leading risk factor for T2DM-related mortality, and increases in BMI were more common in low- and middle-income countries (LIC and MIC). Low physical activity was strongly associated with mortality rates, followed by dietary risks and smoking (2.4; 1.4; 0.8 per 100,000 persons, respectively). Similar patterns were observed after adjustments for income level, sex, and age. DALYs continued to show increasing trends across all income levels during 1995-2015 (high-income (HIC):16%; MIC: 36%; LIC: 12%). Stratification by sex showed similar results; males had fewer T2DM DALYs than females, though a greater increase was observed among males.

Conclusion: Overall, T2DM related mortality was higher among females. Compared to in HIC, there appeared to be a considerable increase in the burden of T2DM in MIC and LIC, where BMI is the leading risk factor for T2DM-related mortality. Prevention programs should emphasize related risk factors according to the existing standard of care.

Background: The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers’ skills Training (hereafter, ‘APMaT’), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.

Methods: Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs intervention), time (baseline vs 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.

Results: Employees in the intervention group showed a larger decrease in the odds of hazardous alcohol use compared to the control group. However, this difference was not statistically significant, even after adjusting for several factors, including the sociodemographic factors and policy awareness.

Conclusions: The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions. 

Trial registration: ISCRTN: ISRCTN17250048.

Purpose: An alcohol prevention programme, consisting of the implementation of an organisational alcohol policy and skills development training for managers, was delivered in Swedish workplaces. Previous findings revealed challenges in policy implementation due to the lack of dissemination amongst managers. This study aims to describe perceived dissemination barriers of the organisational alcohol policy by managers.

Methodology: A cross-sectional survey (n=193 managers) was performed to identify common dissemination barriers in the workplace and complementary case illustrations derived from semi-structured interviews (n=18 managers) were used to understand the dissemination barriers of the organisational alcohol policy. Frequency distributions were presented to describe common perceived barriers.

Findings: Sixty-five percent of managers reported that their workplace had not changed their approach to addressing alcohol-related issues compared to their usual practice before programme delivery. Various organisational factors, such as deprioritisation of programme dissemination, lack of communication, and inadequate strategies were some of the common barriers perceived by managers. Moreover, managers reported uncertainties regarding any changes concerning the workplace’s approach for addressing alcohol-related issues. Increased efforts in disseminating the organisational alcohol policy can reduce uncertainties among managers. 

Practical implications: A thorough process evaluation to understand processes in programme delivery and implementation is necessary to ensure the uptake of the intervention. 

Originality/value: The study highlighted the complexity of disseminating an alcohol policy in a dynamic setting, such as the workplace, and provided the importance of addressing organisational obstacles.