The effect of a smoking cessation program for patients in cancer treatment: a quasi-experimental intervention study.

BACKGROUND: Compared to non-smokers, smokers have reduced effects of cancer treatment, and increased risk of treatment-related toxicity. Quitting smoking can improve treatment effects and reduce side effects. This study reports on the potential impact of a smoking cessation program on smoking cessation rates among patients in cancer treatment. MATERIAL AND METHODS: Cancer patients 18 years and older who smoked, with survival prognosis ≥12 months, not suffering dementia or other mental illness, and who were referred to cancer treatment at six Norwegian hospitals were invited to participate. The study took place from 2017 to 2020 and used a pre-test-posttest non-equivalent control group design. The intervention group received structured smoking cessation guidance based on Motivational Interviewing combined with cost-free nicotine replacement products, while the control group received standard smoking cessation treatment. Self-reported smoking status were registered at baseline and at 6 months' follow up. RESULTS: 76% of patients smoked at baseline and 44% at follow-up in the intervention group, correspondingly 72% and 49% in the control group. In an analysis of differences in within-person change, the reduction in the intervention group was 13 percentage points larger (95% CI = (0.25, -0.005), p = 0.041). Adjusting for gender, age, education, labour market participation and partnership status did not attenuate the estimated effect (18 percentage point difference, 95% CI = (-0.346, -0.016), p = 0.032). Demographic factors and dropout rate differed somewhat between the groups with a higher dropout rate in the intervention group, 54% vs. 51%, respectively). CONCLUSION: Offering a structured smoking cessation program based on Motivational Interviewing and cost-free nicotine replacement products to cancer patients can increase cessation rates in comparison to standard smoking cessation care.

The Short-term Impact of Standardised Packaging on Smoking and Snus Use in Norway.

INTRODUCTION: Standardised packaging on tobacco products was required in Norway July 1, 2018. We report pre-registered analyses of the potential impact on daily smoking and on daily snus use among women and men. METHODS: Interrupted time series (segmented regression) on repeated cross-sectional surveys (2012-2019) from two sources: probability samples (Registry Sample, N = 46,957) and market research samples (Market Research Sample, N = 64,465) of Norwegian adults aged 16-79. Self-reported daily smoking and snus use were regressed on a step change impact variable, controlled for trend and demographics (sex, age, region, and education based on national registers in the Registry Sample, and self-reported in the Market Research Sample). RESULTS: There were tendencies of a decline in smoking (Odds Ratio [OR] = 0.94; 95% confidence interval [CI] = 0.87, 1.02; lower-tail p-value [Plower] = 0.07), and women's snus use (OR = 0.89; CI = 0.77, 1.03; Plower = 0.06), but not men's snus use (OR = 1.01; CI = 0.92, 1.11; Plower = 0.59). Analyses using only the Registry Sample did not detect declines in smoking (OR = 0.99; CI = 0.88, 1.11; Plower = 0.43) or women's snus use (OR = 0.99; CI = 0.80, 1.24]; Plower = 0.48), and indicated no decline in men's snus use (OR = 1.18; CI = 1.03, 1.35; Plower = 0.99). Exploratory analyses suggested potential acceleration of the declining trend in smoking (change in trends, OR = 0.97) and of the increasing trend in men's snus use (OR = 1.03). CONCLUSIONS: The analyses indicate that standardised packaging in Norway did not produce a decline in men's snus use. Results are inconclusive regarding smoking and women's snus use. Exploratory analyses indicated a decrease in smoking and an increase in men's snus use. IMPLICATIONS: We could not confirm or disconfirm whether standardised packaging is an effective tobacco control measure in a Norwegian context. According to our analyses, standardized packaging may have effects on smoking prevalence and women's snus use, but is unlikely to reduce men's snus use. The present results may reflect higher effectiveness of standardised packaging for products with stronger health warnings. As the results varied according to samples and outcomes, the study underlines the importance of pre-registering future analyses on this topic. Future confirmatory research should test models of gradual impact of standardised packaging.

Sports participation and alcohol use revisited: A longitudinal study of Norwegian postmillennial adolescents.

INTRODUCTION: Recent developments in health behavior among adolescents may have been accompanied by changes in risk factors for alcohol use. Focusing on postmillennial cohorts of adolescents, we revisit the question of whether sports participation is a risk factor for alcohol use. METHOD: This study analyses data from four waves (2017-2020) of the MyLife longitudinal study. Participants were 3425 (45% boys) Norwegian adolescents attending middle school in 2017 (age range: 12-15 years). Annual questionnaire assessments included questions about frequency of sports practice, frequency of alcohol use/heavy episodic drinking, parental cohabitation, unstructured leisure time, sensation-seeking, and behavioral problems. We employed growth curve models (N = 2682) and fixed effects models (N = 3131). RESULTS: Overall, we did not find systematic differences in initial alcohol use or development over time according to sports practice frequency at the first assessment. However, adolescents with the highest initial sports frequency had slightly lower initial alcohol use and a steeper increase (initial use: b = -0.06, p = .351; linear slope: b = -0.12, p = .218; quadratic curvature: b = 0.09, p = .004). There was no, or only a weak negative, association between change in sports practice and change in alcohol use after adjusting for potential time-varying confounders, b = -0.03, p = .065. CONCLUSION: Contrary to most previous research, we found little evidence for an association between sports participation and alcohol use among Norwegian adolescents born after 2000. Sports activities might not require particular attention in the prevention of alcohol use.

The effects of an abrupt increase in taxes on candy and soda in Norway: an observational study of retail sales.

BACKGROUND: Fiscal policies are used to promote a healthier diet; however, there is still a call for real-world evaluations of taxes on unhealthy foods and beverages. We aimed to evaluate the effect of an abrupt increase, of respectively 80 and 40%, in the excising Norwegian taxes on candy and beverages on volume sales of candy and soda. We expected sales to fall. METHODS: We analyzed electronic point of sale data covering approximately 98% of volume sales of grocery stores in Norway. In two pre-registered models with weekly (log-)sales of taxed candy and soda from 3884 individual stores, we modeled the difference between the jump (discontinuity) in the trend around the time of the increase in taxes and the corresponding jump in the trend in a control season from the previous years (Model 1). In addition, we modeled the difference between the intervention and the control season in their changes in average sales (Model 2). RESULTS: Model 1 showed a 6.1% (one-sided 95% CI: not applicable (NA), 23.4, p-value = 0.26) increase and a - 3.9% (95% CI: NA, 4.9, p-value = 0.23) reduction in the differences in the jump in the trends, for candy and soda, respectively. The second model showed a relative decrease of - 4.9% (95% CI: NA, 1.0, p-value = 0.08) in the average sales of candy and an increase of 1.5% (95% CI: NA, 5.0, p-value = 0.24) in sales of soda. Supplementary analyses suggested that the results were sensitive to clustering on the time dimension. CONCLUSIONS: When using two different quasi-experimental designs to model changes in volume sales of taxed candy and soda, we were not able to detect reductions in sales that coincided with an increase in the taxes. Variation across time makes it difficult to detect potentially small changes in sales even when using an entire country's worth of sales data on the level of individual stores. We speculate that the tax increases were too modest to affect the prices to alter sales sufficiently.

Health warning labels describing snus as less harmful than smoking: effects on perceptions of risk.

BACKGROUND: Using snus (Swedish moist snuff) is less harmful than smoking, but health warning labels (HWLs) on snus products do not reflect this relation. There are few studies on the effects of comparative risk information in snus warning labels. The purpose of this experiment is to examine whether risk perceptions differ after exposure to non-comparative vs. comparative risk information in snus warning labels. METHODS: A total of 254 Norwegians aged 19-69 were exposed to pictures of snus packages in one of four HWL conditions: non-comparative EU-based ("Snus is damaging to your health"), control (the text "Snus" only), general comparative risk ("Snus is less damaging to your health than smoking"), or percentage comparative risk ("Snus is 90% less damaging to your health than smoking"). Perceptions of risk from snus use and smoking were measured before (pre) and during (post) exposure to the HWL. Changes from pre to post in (1) perceptions of risk from snus use and (2) perceptions of risk differences from snus use versus smoking were tested in repeated measures ANOVAs with current snus and cigarette use as covariates. RESULTS: Both the perceived risks from snus use and its perceived risk difference to smoking decreased more in the control and the percentage HWL conditions than in the EU-based HWL condition. When comparing the general comparative risk and the EU-based HWL, a similar difference was found for the perceived risk difference, but not for the separate measure of snus risk. Both the snus risk and risk difference perception decreased more for the percentage than for the general relative risk HWL. CONCLUSIONS: The non-comparative EU-based HWL claiming that "Snus is health damaging" maintains a high level of perceived risk from snus use, while no HWL and the suggested comparative HWLs adjust perceptions of risk in the direction of lower harm from snus use. An HWL describing snus as 90% less harmful than smoking was more effective than a general claim.

Work-Related Alcohol Use and Harm to Others.

BACKGROUND: Drinking alcohol with coworkers is a common practice in many occupational cultures. This practice may produce negative consequences for some employees. Objectives: We estimate the prevalence of a set of negative consequences of work-related alcohol use and identify risk factors associated with experience of harm from coworkers' drinking. Methods: In an online survey, Norwegian employees (n = 3596) aged 20-69 reported whether they had experienced the following due to coworkers' drinking the past 12 months: (a) felt excluded, (b) experienced unwanted sexual attention, (c) been physically harmed, and (d) been verbally abused. Each outcome was regressed on socio-demographics (age, gender, education, and income), job characteristics (flexibility and autonomy), respondents' alcohol use, and perceived intoxication frequency in work contexts for a typical coworker (perceived coworker intoxication frequency). Results: The 12-month prevalence of experiencing any of the negative consequences was 18%. Having felt excluded (10.7%) and experienced unwanted sexual attention (7.0%) were more common than being verbally abused (4.8%) or physically harmed (1.9%). Perceived coworker intoxication frequency was strongly associated with all outcomes. Respondents' own drinking frequency predicted being verbally abused, being physically harmed, and experiencing unwanted sexual attention. Women experienced less physical harm and more unwanted sexual attention than men. Prevalence also varied by age, education, income, and job characteristics. Conclusions: Each year, approximately one-sixth of Norwegian employees experience harm from their coworkers' drinking. The frequency of intoxication in work contexts is strongly associated with harm to others.

Standardised snus packaging reduces brand differentiation: a web-based between-subject experiment.

BACKGROUND: Perceptions of tobacco packaging may be consequential for consumption and initiation. We explored the potential effect of standardised packaging on young adults' ratings of the appeal of brands of snus (Swedish moist snuff) and on their perceptions of typical users of these brands. We were interested in both the effects on average levels of ratings and on the within-subject variability of the ratings. The latter was used as a measure of the extent to which individuals can differentiate between brands. METHODS: A sample of 625 Norwegians aged 16-30 were randomly allocated to one of three between-subject conditions: Branded Packaging, Standardised Packaging, or Standardised Packaging with Health Warnings. The participants rated 10 snus brands on measures of general appeal and on their perceptions of the typical brand user (e.g., "… is sporty and active"). RESULTS: The standardised packages (without health warnings) were not rated more negatively than the branded packages, while the standardised packages with health warnings were rated slightly more negatively than the branded packages. However, in terms of within-subject standard deviations, the variability of the brand ratings across the packages was substantially lower for standardised packaging types in comparison to branded packages. CONCLUSIONS: Even in cases where standardised tobacco packaging appears to have little overall effect on the valence of the average ratings, it can have a strong effect on the variability of the ratings. This suggests that standardised packaging can reduce the potential for brand differentiation.

Contrasting smokers' and snus users' perceptions of personal tobacco behavior in norway.

INTRODUCTION: In Norway, snus use and cigarette smoking are at different developmental stages as described by the diffusion of innovation model. Concomitant with declining smoking rates, the use of snus is increasing. In light of these differences in use trends, we assumed that snus users and cigarette smokers would have different perceptions of their personal tobacco use. METHODS: A total of 4,852 smokers and snus users were recruited from a large sample of online panelists (n = 62,000) and a postal database (n = 15,000). The responses to 16 evaluative statements assessing perceptions about tobacco use were compared between exclusive snus users and exclusive smokers and within dual users. The statements concerned self-evaluative emotions, moral judgments, social disapproval, and benefits of quitting. RESULTS: The perceptions of personal tobacco use differed greatly between exclusive smokers and exclusive snus users, even after controlling for age and sex. Smoker's perceptions were more negative compared with snus users' perception. The differences between smoking and snus use were particularly large for indices of social disapproval (Cohen's d = 1.56) and benefits from quitting use of the product (Cohen's d = 1.47) between exclusive users. Dual users exhibited a similar pattern. CONCLUSIONS: Smokers have a more negative perception of their own use compared to snus users. Dual users also devaluated smoking in comparison to their snus use. This finding may have important values for prevention strategies targeting smokers, snus users, and dual users.

Concurrent decline in teenage fertility rate and binge drinking? An observational study across 45 nations.

INTRODUCTION: Alcohol consumption is associated with unintended pregnancies among teenagers. Its role as a broader determinant of teenage fertility rates remains unclear. We investigate whether adolescent binge drinking affects the number of teenage births. METHODS: Binge drinking data from 137,898 females aged 15-16 were collected in the HBSC study (2002-2018, 43 countries/regions) and 267,359 in the ESPAD study (1995-2019, 41 countries/regions). Age-specific fertility rates were from the Human Fertility Database and the World Health Organization. We examined changes over time in countries' average levels of binge drinking among female pupils aged 15-16 and population-level fertility rates for the same cohorts when aged 16-19 years. RESULTS: Controlling for differences between countries and survey waves, we found an association between binge drinking and fertility rate, B = 0.019, 95% confidence interval [0.004, 0.034]. When accounting for the countries' time trends, the association was substantially reduced, B = 0.006, 95% confidence interval [-0.0062, 0.0174]. The relationship was not moderated by abortion rates and controlling for contraceptive use had no impact on the findings. DISCUSSION AND CONCLUSIONS: The association between adolescent binge drinking and fertility rates diminishes when accounting for country-specific time trends. Given the lack of clear mechanisms linking binge drinking to trends in fertility rates rather than shorter-term changes, the association likely reflects broader secular trends. Binge drinking may be involved in teen pregnancy and childbirth in individual cases but it does not explain recent developments in teenage fertility rates.

Fear appeals in advanced tobacco control environments: the impact of a national mass media campaign in Norway.

Norway has one of the most comprehensive infrastructures for tobacco control in the world and has launched several media campaigns recent years. Can yet another anti-smoking campaign, using fear appeal messages, have an immediate impact on smoking behavior, motivation to quit and health beliefs? A sample of smokers (N = 2543) completed a survey before and after a 7-week national media campaign. Individual exposure to campaign (unaided recall) was used as predictor of change. We observed no statistically significant effect on smoking status but tendencies were in the expected direction for daily smokers (P = 0.09). There were no effects on number of cigarettes per day, likelihood to quit or reduce smoking. Small but statistically significant effects were found on motivation to quit (P < 0.01, ηp(2) = 0.004) and perceived seriousness of health hazards (P < 0.05, ηp(2) = 0.002). In addition, there was an increase in interpersonal discussions about health and smoking for those exposed to the campaign (P < 0.01, ηp(2) = 0.008). We conclude that there are very small effects of a relatively short and intense mass media campaign on a population of smokers already exposed to one of the most comprehensive tobacco control programs in the world.

The effect of free school fruit on academic performance: a nationwide quasi-experiment.

In past research, higher intake of fruit has been associated with better academic achievement. In Norway, the government required lower secondary schools to provide fruit to their pupils from 2007 to 2014. The present study assessed whether this policy improved academic performance. In addition to secondary schools, the policy covered schools with combined elementary and lower secondary education, but not ordinary elementary schools. This differentiation, in combination with administrative data on test scores before, during, and after the law was enforced, created a nationwide quasi-experiment. Population register data on parents' sociodemographic characteristics allowed for targeted analyses on a subsample of boys with low sociodemographic status. In analyses of 5th grade tests, the free fruit policy coincided with a slight decline in test scores among eligible compared to non-eligible pupils in the subsample (B = - 0.18, 95%CI[- 0.35, - 0.01]) and entire population (B = - 0.14, 95%CI[- 0.24, - 0.05]). Exploratory analyses of exam data in 10th grade yielded similar results, and sensitivity tests either failed to detect any effect or demonstrated a negative tendency. In a Western country with low levels of food insecurity, a policy that required schools to provide free fruit to pupils did not appear to improve academic performance.

Alcohol-related sexual harassment in the workplace: A between and within industry analysis.

INTRODUCTION: Sexual harassment as a political/legal issue was revitalised by the #MeToo movement in 2017. We estimate the prevalence and development of alcohol-related sexual harassment (ASH) across industries over the years 2015 to 2021, including potential changes from 2017, and assess differences in the risk of ASH according to industry- and individual-level characteristics. METHODS: Based on annual surveys (2015-2021) among employees in 21 Norwegian industries (observations N = 11,512, individuals N = 6353). Age range 20-69 years, 48% women. Associations between ASH and industry- and individual-level demographics, work autonomy, work-related drinking and intoxication were estimated in linear probability models RESULTS: ASH prevalence was 6% between 2015 and 2021 and varied between 4% and 13% across industries. Men showed a gradual increase in ASH from 2015 to 2021. The was no significant trend among women or a change after #MeToo. Industries with older employees, more women and frequent intoxication at work-related occasions had more ASH, while those with more highly educated employees had less. At the individual level, frequent work-related drinking occasions, tendency to get intoxicated at these occasions, being a woman and younger age were associated with more ASH. We found no individual- or industry-level association between work autonomy and ASH. DISCUSSION AND CONCLUSIONS: Annually, 6% of Norwegian employees experience alcohol-related sexual harassment in work-related settings. The risk of ASH is higher among employees who are young, female, frequently drink and drink to intoxication at work-related events, and that work in industries with older employees, more women, less formal education and frequent intoxication.

Desire for control and optimistic time predictions.

Few studies have investigated individual differences in time predictions. We report two experiments that show an interaction between the personality trait Desirability of Control and reward conditions on predictions of performance time. When motivated to perform a task quickly, participants with a strong desire for control produced more optimistic predictions than those with a weaker desire for control. This effect could also be observed for a completely uncontrollable task. The results are discussed in relation to the finding that power produces more optimistic predictions, and extend this work by ruling out some previously suggested explanations.

The use of disaggregate data in evaluations of public health interventions: cross-sectional dependence can bias inference.

Higher availability of administrative data and better infrastructure for electronic surveys allow for large sample sizes in evaluations of national and other large scale policies. Although larger datasets have many advantages, the use of big disaggregate data (e.g., on individuals, households, stores, municipalities) can be challenging in terms of statistical inference. Measurements made at the same point in time may be jointly influenced by contemporaneous factors and produce more variation across time than suggested by the model. This excess variation, or co-movement over time, produce observations that are not truly independent (i.e., cross-sectional dependence). If this dependency is not accounted for, statistical uncertainty will be underestimated, and studies may indicate reform effects where there is none. In the context of interrupted time series (segmented regression), we illustrate the potential for bias in inference when using large disaggregate data, and we describe two simple solutions that are available in standard statistical software.

Smoking, hazardous drinking and individual differences in cost and gain discounting.

Aims: Past research has linked substance use to individual differences in discounting of future rewards. Since behaviours such as smoking and excessive drinking appear to involve a devaluation of future negative consequences, discounting of costs may also be relevant in the understanding of such behaviour. The primary aims were to investigate the association between cost discounting and the behaviours smoking and hazardous drinking. Methods: In four studies, individuals recruited from the crowdsourcing marketplace Amazon Mechanical Turk responded to measures of discounting. Results were combined by meta-analysis of the standardised mean differences (d) between self-reported smokers and non-smokers, and between participants with AUDIT scores of 10+ (hazardous drinking) and those with scores below 10. Results: In comparison with non-smokers, smokers' relative valuations of future gains were lower, d = -0.32, 95% CI [-0.47, -0.18]. There was no association between smoking and cost discounting, d = -0.02, 95% CI [-0.17, 0.13]. Participants with AUDIT scores of 10+ valued future gains somewhat lower than participants with scores below 10, d = -0.17, 95% CI [-0.35, 0.01]. There was no association between hazardous drinking and cost discounting, d = -0.02, 95% CI [-0.21, 0.16]. According to Bayes Factors (BF), the data supported an association between gain discounting and smoking (BF > 100). It was insensitive in the analysis of gain discounting and hazardous drinking (BF = 0.6), but it strongly supported null-effects in both analyses of cost discounting (BFs = 0.1). Conclusion: The results suggest that the robust link between gain discounting and smoking status does not reflect a general devaluation of future outcomes among smokers.

Socio-demographic differences in alcohol-related work impairment.

BACKGROUND AND AIMS: The costs of alcohol-related presenteeism (being at work in an impaired state due to alcohol use) have been estimated as substantially larger than the costs of alcohol-related absenteeism. Past studies indicate that employees with lower socio-economic status experience more alcohol-attributable problems than employees in higher socio-economic strata. We aimed to estimate the prevalence of alcohol-related presenteeism among Norwegian adults and its association with sex, age, income and education. DESIGN AND SETTING: Annual national cross-sectional telephone surveys on alcohol, tobacco and drug use (2016-19) among Norwegian adults. PARTICIPANTS: A total of 5430 full- and part-time employees aged 16-79 years; 53% were men. MEASUREMENTS: The main outcome was self-reported 12-month occurrence of work impairment due to alcohol use the previous day. Main predictors were income and education obtained from national registries, age and gender. A secondary outcome variable was self-reported alcohol-related absenteeism. FINDINGS: The 12-month prevalence of alcohol-related work impairment was 8.7%, 95% confidence interval (CI) = 7.9, 9.4. Adjusted risk ratios (RR) indicated a higher risk for men compared with women (RR = 1.26, 95% CI = 1.06, 1.50) and higher risk for young employees (e.g. less than 26 years compared with 55+, RR = 7.64, 95% CI = 4.88, 11.95). The risk increased as a function of higher education (in order of increasing education, RR = 1.12, 95% CI = 0.87, 1.45; RR = 1.64, 95% CI = 1.26, 2.12; RR = 2.19, 95% CI = 1.63, 2.95). The risk was estimated as lower in the middle-income categories compared with the lowest (RR = 0.76, 95% CI = 0.58, 1.00, RR = 0.89, 95% CI = 0.66, 1.20, RR = 0.94, 95% CI = 0.68, 1.29) and higher for employees with the highest income (RR = 1.04, 95% CI = 0.73, 1.48; RR = 1.47, 95% CI = 1.09, 2.00). CONCLUSIONS: In Norway, the risk of alcohol-related work impairment for employees in the highest education category is approximately twice that of employees with secondary education or less. Except for employees in the lowest income category, who had a higher risk than those in the middle-income categories, higher income is associated with increased risk of work impairment. Being younger and male are also associated with increased risk of alcohol-related work impairment.

Are changes in binge drinking among European adolescents driven by changes in computer gaming?

INTRODUCTION: There is currently no good explanation for the decline in adolescent drinking reported for many Western countries in recent years. As modern computer gaming is highly exciting and socially rewarding, it may function as a substitute for adolescent binge drinking. We hypothesized a negative correlation between country-level changes in computer gaming and binge drinking. METHODS: We analysed within-country changes based on data from 15-16 year-old pupils (n = 517 794) participating in the European School Survey Project on Alcohol and Drugs from 1995 to 2015. Binge drinking in the last 30 days (5+ units on one occasion) was regressed on frequency of computer gaming and three control variables measuring the frequency of engagement in other hobbies, reading books and going out (to a disco, cafe, etc.). RESULTS: Descriptive data showed no general decline in binge drinking across European countries. In contrast to our prediction, the association between binge drinking and computer gaming was not negative [b = 0.26, one-sided 95% confidence interval (-∞, 0.47), P = 0.98, Bayes Factor = 0.21]. We found the same pattern of result in a secondary analysis on six Nordic countries that have experienced declines in adolescent drinking recent years. In analyses with covariates reflecting engagement in other activities, we only observed statistical evidence for an effect of going out. DISCUSSION AND CONCLUSIONS: A substantial decline in adolescent binge drinking during the years 1995-2015 is only evident in some European countries, and it is likely not caused by increased computer gaming.

Conceptualizations of Addiction and Moral Responsibility.

The present study explored the connection between conceptualizations of addiction and lay people's inferences about moral responsibility. In Study 1, we investigated how natural variations in people's views of addiction were related to judgments of responsibility in a nationwide sample of Norwegian adults. In Study 2, respondents recruited from Mechanical Turk were asked to consider different conceptualizations of addiction and report on how these would affect their judgments of moral responsibility. In Study 3, we tested whether manipulating conceptualizations through textual information and through the framing of addiction in terms of states versus behavior could influence participants' judgments of moral responsibility. We found that attributions of moral responsibility were lower when addiction was connected to diseases and disorders, such as dysfunctional processes in the brain, and greater when addiction was associated with agency and addictive behaviors. In conclusion, different conceptualizations of addiction imply different moral judgments, and conceptualizations are malleable.

Alcohol-related absence and presenteeism: Beyond productivity loss.

BACKGROUND: Alcohol use by employees is associated with negative consequences for the workplace in terms of absence and poor work performance. The aims of this study were to map the prevalence of alcohol-related absence and inefficiency using survey data from a broad sample of employees, and to explore how alcohol-related absence and presenteeism are experienced and handled using data from qualitative interviews. METHODS: The prevalence data stems from a web survey completed by 1940 Norwegian employees aged 20-74 years. The qualitative data consists of analyses of 24 interviews with managers, co-workers of heavy drinking employees, and heavy drinking employees, from various lines of businesses. RESULTS: 1-2% reported alcohol-related full day absence in the last 12 months, and 2% reported partial day absence; 11% reported inefficiency due to drinking the previous day. Analyses of interview data revealed that alcohol-related absence and presenteeism may cause a range of economic and practical problems. Managers reported spending a lot of resources and effort on single cases. In addition, the results showed how the presence of a heavy drinking employee may have a negative impact on the broader psychosocial environment, and cause concern for workplace safety. Due to consideration of the drinker's well-being and fear of negative reactions, problem cases can last for years. CONCLUSIONS: Despite the relatively low prevalence of alcohol-related absence and inefficiency, the study suggest that the alcohol-related problems of a few, or only one, employee may still have substantial and far-reaching negative consequences for the workplace.

Overlap in attitudes to policy measures on alcohol, tobacco and illegal drugs.

BACKGROUND: Effective alcohol, tobacco and illegal drug policies reduce the harm to users and third parties. Knowledge about determinants and interrelations between attitudes held by the general public to different types of policy measures can benefit policy-makers who aim to increase acceptance for effective policy. The present study describes the level of support for various policy measures held by the general public, and investigates the association between attitudes to policy measures on alcohol, tobacco and illegal drug. METHODS: A sample of the Norwegian general population aged 16-64 (N=1803) was interviewed by telephone. Respondents reported demographic information, personal substance use and attitudes to various policy measures. Associations between attitudes were assessed with correlation and regression analysis. RESULTS: Associations between attitudes were strongest for similar policy measures across substance groups (e.g. tax increases on alcohol and tobacco). There was a weaker association between attitudes to different policy measures aimed at the same substance (e.g. tax increase on alcohol and campaigns on alcohol). CONCLUSION: The degree to which people approve or disapprove of the use of particular types of policy measures is irrespective of the targeted substance.