Objectives: The aim of this review was to explore the notion of alcohol-related presenteeism; that is, whether evidence in the research literature supports an association between employee alcohol consumption and impaired work performance. Design: Systematic review of observational studies. Data sources: MEDLINE, Web of Science, PsycINFO, CINAHL, AMED, Embase and Swemed+ were searched through October 2018. Reference lists in included studies were hand searched for potential relevant studies. Eligibility criteria: We included observational studies, published 1990 or later as full-text empirical articles in peer-reviewed journals in English or a Scandinavian language, containing one or more statistical tests regarding a relationship between a measure of alcohol consumption and a measure of work performance. Data extraction and synthesis: Two independent reviewers extracted data. Tested associations between alcohol consumption and work performance within the included studies were quality assessed and analysed with frequency tables, cross-tabulations and χ ² tests of independence. Results: Twenty-six studies were included, containing 132 tested associations. The vast majority of associations (77%) indicated that higher levels of alcohol consumption were associated with higher levels of impaired work performance, and these positive associations were considerably more likely than negative associations to be statistically significant (OR=14.00, phi= 0.37, p<0.001). Alcohol exposure measured by hangover episodes and composite instruments were over-represented among significant positive associations of moderate and high quality (15 of 17 associations). Overall, 61% of the associations were characterised by low quality. Conclusions: Evidence does provide some support for the notion of alcohol-related presenteeism. However, due to low research quality and lack of longitudinal designs, evidence should be characterised as somewhat inconclusive. More robust and less heterogeneous research is warranted. This review, however, does provide support for targeting alcohol consumption within the frame of workplace interventions aimed at improving employee health and productivity. PROSPERO registration number: CRD42017059620.

Background: The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings. Objective: We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions. Methods: A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Results: In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%). Conclusions: This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges. Trial Registration: PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777

Aim: Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term).Method: Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078.Results: Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33–10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16–8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73–8.60).Conclusion: This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

Background: Alcohol consumption is deeply integrated in people’s social- and work lives and, thus, constitutes a serious public health challenge. Attitudes toward drinking stand out as important predictors of drinking, but have to date been sparsely studied in employee populations. This study explores the association of employees’ attitudes toward drinking with their alcohol-related problems, and whether this association is moderated by gender and employment sector. Methods: Cross-sectional data were collected from a heterogeneous sample of employees (N = 4094) at 19 Norwegian companies. Drinking attitudes were assessed using the Drinking Norms Scale. The AUDIT (Alcohol Use Disorders Identification Test) scale was then used to assess any alcohol-related problems. Data were analyzed using chi-square tests, analysis of covariance (ANCOVA), and multiple logistic regression. Results: Employees with predominantly positive drinking attitudes were almost three times as likely to report alcohol-related problems compared to employees with more negative drinking attitudes (OR = 2.75; 95% CI: 2.00–3.76). Gender moderated the association between positive drinking attitudes and alcohol-related problems (OR = 3.30; 95% CI: 2.10–5.21). The association was stronger in women (OR = 5.21; 95% CI: 3.34–8.15) than in men (OR = 3.10; 95% CI: 2.11–4.55). Employment sector did not moderate the association between drinking attitudes and alcohol-related problems. Conclusions: Employee attitudes toward alcohol should be monitored to better enable early workplace health promotion interventions targeting alcohol problems. These interventions might need to be gender-specific.

Background: Systematic reviews have shown a strong relationship between alcohol consumption and sick leave. The effect of alcohol consumption on sick leave may, however, vary according to the work environment. While attitudes toward drinking may impact sick leave, there is little research on the contribution of drinking attitudes to sick leave. Moreover, alcohol-related problems and drinking attitudes may be influenced by the broader sociocultural contexts of the organizational units where people work.Objectives: This study aimed to explore the relationship of alcohol-related problems and drinking attitudes with sick leave while considering the nesting of employees within working units within companies.Method: Data from the WIRUS (Workplace Interventions preventing Risky alcohol Use and Sick leave) study were linked to company-registered sick leave data for 2,560 employees from 95 different work units in public (n = 9) and private companies (n = 5) in Norway. Three-level (employee, work unit, and company) negative binomial regression models were estimated to explore the 12-month prospective association of alcohol-related problems and drinking attitudes with four measures of sick leave (one-day, short-term, long-term, and overall sick leave days). Models were adjusted for gender, age, cohabitation status, educational attainment, work position, and employment sector.Results: We observed higher variation of one-day, short-term, and overall sick leave days between companies than between work units within companies (15, 12, and 30% vs. 0, 5, and 8%, respectively). However, neither alcohol-related problems nor drinking attitudes were associated with sick leave and, thus, those variations in sick leave were not explained by alcohol-related problems or drinking attitudes.Conclusion: Our findings suggest company-level differences are more important than within company differences when explaining differences in sick leave. While alcohol-related problems or drinking attitudes were not associated with sick leave, future studies may need to explore the role of company policies, practices, or social norms in variations in sick leave rates.

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.