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Work experience and drinking behavior
Public Health (2001) 115, 265–271 ß R.I.P.H.H. 2001 www.nature.com/ph
Work experience and drinking behavior: alienation, occupational status, workplace drinking subculture and problem drinking MJ Yang1,2*, MS Yang3 and I Kawachi4 1 Department of Psychiatry, Chang Gung Memorial Hospital Kaohsiung, Taiwan; 2Chang Gung University, Taiwan; 3School of Nursing, Kaohsiung Medical College, Taiwan; and 4Department of Health and Social Behavior, Harvard School of Public Health, Boston, USA
This study explored the association between alienating job conditions and problem drinking within the context of occupational status and workplace drinking subculture. From December 1994 to March 1995, a questionnaire survey was implemented in the manufactory sector in southern Taiwan. Within the questionnaire, any perceived self-estrangement, powerlessness and social isolation that the individual experienced in his work were measured as the alienating job conditions, and any negative physical, psychological and social consequences the individual experienced during the previous month were considered as affecting problem drinking. Of the 1117 subjects, 668 (61.8%) reported imbibing one or more drinks during the preceding month; the average daily alcohol consumption being 0.2 0.9 drinks. In addition, 188 (16.8%) subjects reported having experienced drinking-related problems in the preceding month. Workers with low occupational status were more likely to become problem drinkers when they felt comparatively self-estranged in their work. Further, those with a family history including any habitual drinker or those under more encouraging workplace drinking subculture were more likely to have drinking-related problems. For the prevention of problem-related drinking behavior, the workplace should be considered as the focus of our future intervention and management program. Public Health (2001) 115, 265–271. Keywords: work experience; drinking behavior; alienation
Introduction During the past forty years, alcohol consumption in Taiwan has steadily soared. Along with the increase in consumption, the incidence of alcoholism with its attendant severe impairment of social functioning has risen from 0.01%1 to 1%2 between 1951 and 1992. Nevertheless, evidence shows not only that alcohol problems are distributed unevenly among different occupations, but also that within the working class, drinking is more of a problem in certain job categories than in others.2,3 With regard to these phenomena, Seeman et al maintain that when alienation resulting from the work experience impacts the individual, who is then unable to cope psychologically with the impact in terms of behavior, cognitive function and so on, the resultant collapse leads to problem drinking.4 – 6 When the worker is engaged in simple, repetitive work that requires no creativity, and has lost decision-making power or control over his work, the work experience then not only fails to supply the individual’s
*Correspondence: MJ Yang, Department of Psychiatry, Chang Gung Memorial Hospital Kaohsiung, No. 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung County 833, Taiwan. E-mail: [email protected] Accepted 29 January 2001
psychological need for satisfaction and success but also may induce a feeling of alienation and, ultimately, will create problems in the behavior and the psychological and cognitive functions of the worker.5,7 – 11 Similarly, Yang et al12 suggested that, in Taiwan, occupation is one of several determining factors in an individual’s sense of alienation; in general, the lower one’s occupational status, the greater the sense of alienation. Thus, it is speculated that the transformation of the Taiwanese economic structure from an agricultural to an industrial society brought more workers into alienating work conditions. This alienation, in turn, led to an increased prevalence of alcohol problems, unevenly distributed across occupations and social class. The concept of alienation from the sociological tradition was adopted to explore the purported association between job conditions and problem drinking among factory workers in Taiwan. From December 1994 to March 1995, proceeding under the assumption that, despite an existence of genetic or biological-constitution predisposition, the structure of work would also play a determinant role in affecting drinking behavior, a questionnaire survey of workers was implemented in the manufactory sector in southern Taiwan. This survey focused on workers between the ages of 17 and 65 at three steel factories (henceforth referred to as factories A, B, and C). The construct of alienation by Seeman13 was applied to explore the influence of work conditions on an individual’s
Work experience and drinking behavior MJ Yang et al
266
drinking behavior. Specifically, the effect of alienation was examined within the context of occupational status and workplace drinking subculture.
Methods Subjects By purposive sampling a complete census was taken of factories A and B. Factory C employed a large number of workers (9374), therefore stratified sampling of departmental units according to job types, which were then further divided and sampled randomly and respectively into on-site and off-site workers within departmental units, was utilized. In total 1117 subjects were recruited: 163 from factory A; 348 from factory B; and 606 from factory C. The response rate was 93.7%. Of the subjects, 1034 were male (93.3%); their average age was 37 8 (range: 19 – 61; about 70% of population were within this age range in Taiwan in 1995), 76.6% were over 30 years old; and 77.3% were married. Most had been working at their present factory for more than a year, 62.0% for more than seven years. Seventy-three percent had already completed their high school or vocational education, and 23.2% had furthered their education beyond the college level. 57 of the subjects had an average monthly income of between 1000 and 3000 US dollars (with a reference to the national average monthly income 900 to 970 US dollars per capita in Taiwan in 1994 – 95). About 20 indicated that at least one close relative was a frequent drinker who drinks two or more drinks per week (Table 1).
Measures Occupational status. Index of ‘occupational status’ comprised level of seniority, length of job tenure, type and structure of work, and hierarchical position. Those with the lowest income of less than 1000 US dollar per month, on-site workers performing manual labor, and workers who needed to do shift work were grouped into a construct that was termed ‘low occupational status workers’. Among the subjects, 14.4% were identified as low occupational status workers and the rest were termed ‘high occupational status workers’. Workplace drinking subculture. The workplace drinking subculture was referred to as the unofficial rule that prevails in the workplace for the drinking behavior of company personnel.14 – 16 Enquiries regarded the frequency of company-sponsored receptions that included alcoholic beverages during the preceding month, drinking among colleagues when dining together, drinking when personnel were entertaining customers at dinner and drinking with customers at lunch. Other questions dealt with the number of same-aged colleagues within a work Public Health
Table 1 Percentage distribution of variables among respondents to the survey of work experience and drinking behavior (n ¼ 1117*) Background Sex Male Female Age (y) 15 – 30 31 – 40 > 41 Educational level (y) <9 9 – 12 > 12 Marital status Single Married Widow=Widower Personal income ($US=month) < 1000 1000 – 1999 2000 – 2999 > 3000 Family history of frequent drinkers Yes No Workplace drinking subculture Encouraging Less encouraging Occupational status Low High Self-estrangement Low High Powerlessness Low High Social isolation Low High
n
Percentage (%)
1034 74
93.3 6.7
243 408 389
23.4 39.2 37.4
43 809 257
3.9 73.0 23.1
247 859 5
22.2 77.3 0.5
378 325 310 93
34.2 29.4 28.0 8.4
230 887
20.6 79.4
616 432
58.8 41.2
280 837
25.1 74.9
594 498
54.4 45.6
714 382
65.2 34.9
633 357
63.9 36.1
a
Missing data were omitted. The sum total of n might not equal 1117.
unit, the number of males, and the proportion of people within the workplace who drank frequently. A Likert scale (Cronbach a0.8) was assigned to these measurements. After the scores were summed, the total was used to evaluate the workplace drinking subculture. The higher the score, the more the workplace drinking subculture tended to encourage drinking. A lower score indicated that the subculture offered relatively less encouragement to drink. Further, the median was used to differentiate the workplace drinking subculture into a dichotomous variable – high and low workplace drinking subculture. Alienation. Modeling after Seeman’s concept,13 alienation was treated as a phenomenon of the multifaceted work experience, including: (1) self-estrangement:
Work experience and drinking behavior MJ Yang et al
267
the inability to learn new information on the job or to exercise one’s own ability; (2) powerlessness: the inability to control one’s work; and (3) social isolation: the inability to receive the support of or help from one’s colleagues or superiors. Henceforth, low-technology work that never varies and in which the worker is not supported or helped refers to ‘alienated work’. The measure of self-estrangement comprised six items: the possibility of acquiring new knowledge or skills on the job; whether the work procedures were repetitive and monotonous; the degree to which the job required continual innovation from the worker; the amount of technical skill required by the work; the degree to which the work continually brought the worker into contact with new situations; and the ability of the worker to develop his particular skills. The Cronbach a coefficient for internal consistency was 0.8. Powerlessness was measured by three items — whether the work: permitted ample autonomy; allowed the worker to express his own opinions and views; and allowed the worker to control and exercise decision-making power over his work. The Cronbach a coefficient for internal consistency was 0.7. The workplace social isolation scale comprised seven items: superiors’ advice; colleagues’ advice; psychological support from superiors when difficulties were encountered; psychological support from colleagues; practical help from superiors; practical help from colleagues; and the number of close friendships that it was possible to form while in the workplace. The Cronbach a coefficient for internal consistency was 0.9. Measurement of drinking behavior. The average amount of self-reported alcohol consumed each day during the previous month was measured to estimate daily alcohol consumption. Measure of drink was defined by ‘standard drink’. Generally, a standard drink consists of 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (American system). Each of these drinks contains approximately the same amount of absolute alcohol — about 0.5 ounces (12 grams). The drinking-related problems were assessed by self-reporting the occurrence of lateness to work, absenteeism, lower quality of work, traffic violations, difficulties or quarrels at home and illnesses and accidents. Workers who had any of the drinking-related problems were rated as having problemrelated drinking. Those who reported having family members who drink two or more drinks per week were defined as having a family history of frequent drinkers.
Statistical analysis Frequency distributions and percentages were used for variable description. Univariate analysis was conducted to explore the relationship of drinking behavior to each of the variables regarding the respondent’s background,
workplace drinking subculture, occupational status and alienation. After controlling for age, educational level and marital status, a separate multivariate regression analysis stratified by occupational status was carried out to enquire into the association of family drinking history, workplace drinking subculture and three different forms of alienation with drinking behavior. Results Individual drinking behavior (Table 2) The average daily alcohol consumption among all the respondents was 0.2 0.9 drinks (range: 0 – 12). Six hundred and sixty-eight respondents (61.8%) had consumed some alcohol and 186 respondents (16.8%) had had a drinking-related problem in the preceding month. The most frequently occurring problems were physical illnesses, difficulties or quarrels at home, and uncontrolled drinking (8.0%, 2.6% and 1.6%, respectively). Less frequently occurring problems included the shivers, nervousness, fidgeting or other withdrawal symptoms; traffic violations; and effects on personal relationships (0.5%, 0.4% and 0.4%, respectively). Social drinking was the most important reason cited by those who had drunk during the previous month. The relationship between background variables and drinking behavior revealed that males drank comparatively more than females (t ¼ 19.8, P < 0.05) and had comparatively more drinking-related problems. There was also no significant difference among age, educational level, or marital status on the daily consumption amount. Even so, lower educational level, younger age, and an unmarried status were associated with comparatively more drinkingrelated problems, though this was not statistically significant. Individuals having a close family member who was a frequent drinker showed an exceptionally significant association with drinking amount (t ¼ 6.54, P < 0.01) and tended to have more drinking-related problems (w2 ¼ 21.79, P < 0.01). Those with low occupational status drank noticeably more on average and also experienced more drinking-related problems than those with high occupational status. There was a significant association between workplace drinking subculture and workers’ drinking behavior. Workers exposed to a workplace that encouraged drinking would be more likely to consume a greater quantity of alcohol (t ¼ 3.60, P < 0.01) and have experienced drinking-related problems (w2 ¼ 6.70, P < 0.05). Exploration of the relationship between alienation and drinking behavior revealed that workers with a higher sense of self-estrangement and powerlessness tended to have higher average alcohol consumption and experience more incidents of drinking-related problems. However, those who reported being more socially isolated would drink more and have more problem-related drinking behavior. Public Health
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Table 2
Background characteristics, sense of alienation and individual’s drinking behavior
Background and alienation Sex Male Female
Drinking amount mean s.d. (median)
Drinking related, problems n (%)
0.21 0.03 (0.02)a 0.01 0.00 (0.00)
184 (29.2%) 2 (11.8%) total is 186
Age (y) 17 – 30 31 – 40 41
0.23 0.96 (0.03) 0.17 0.61 (0.02) 0.20 0.99 (0.02)
50 (34.0%) 67 (27.3%) 56 (25.8%) total is 173
Educational level (y) <9 9 – 12 > 12
0.29 1.27 (0.02) 0.21 0.86 (0.02) 0.19 1.01 (0.02)
7 (30.4%) 142 (30.7%) 38 (23.5%) total is 187
Marital status Others Married
0.18 0.05 (0.02) 0.23 0.03 (0.02)
48 (35.0%) 140 (27.2%) total is 188
Family history of frequent, drinkers Yes No
0.59 1.70 (0.03)a 0.13 0.58 (0.02)
67 (43.8%)a 121 (24.2%) total is 188
Occupational status Low High
0.26 0.06 (0.03) 0.20 0.03 (0.02)
56 (33.1%) 132 (27.3%) total is 188
Self-estrangement Low High
0.19 0.04 (0.02) 0.25 0.04 (0.02)
94 (27.9%) 92 (30.0%) total is 186
Powerlessness Low High
0.19 0.03 (0.02) 0.22 0.04 (0.02)
57 (25.2%) 128 (30.6%) total is 185
Social isolation Low High
0.14 0.03 (0.02) 0.23 0.04 (0.02)
58 (28.3%) 99 (26.6%) total is 157
Workplace drinking subculture Encouraging Less encouraging
0.29 0.96 (0.02)a 0.12 0.61 (0.02)
95 (38.7%)a 82 (24.3%) total is 177
P < 0.05.
a
Multivariate analysis of occupational status, alienation and drinking behavior (Table 3) The results showed that both ‘family history of frequent drinkers’ and ‘workplace drinking subculture’ were positively associated with the occurrence of drinking-related problems, ie if the workplace tended to encourage drinking or if there was a frequent drinker in the family history, the individual not only tended to drink more than the average person but also was more prone to develop drinking-related problems. Notably, this relationship was statistically sigPublic Health
nificant among the high occupational status workers, yet not so among the low occupational status workers. Regarding work alienation and drinking-related problems analyses revealed that the pattern of association was different between low and high occupational status workers. Among the low occupational status workers, those who reported more self-estrangement or powerlessness were more likely to be problem drinkers. Be that as it may, only self-estrangement, among all the variables used to measure alienation, had a statistically significant effect on the development of drinking-related problems (OR ¼ 2.24,
Work experience and drinking behavior MJ Yang et al
269
Table 3 Association between family history, workplace drinking subculture and alienation (self-estrangement, powerlessness and social isolation) with drinking-related problems among low and high occupational status workersa Low occupational status
Family history of frequent drinkers Yes No Workplace drinking subculture Encouraging Less encouraging Alienation Self-estrangement Powerlessness Social isolation
High occupational status
OR
95% CI
OR
95% CI
1.52 1
(0.64 – 3.56) Reference
3.24b 1
(1.87 – 5.63) Reference
1.62 1
(0.56 – 2.77) Reference
1.74b 1
(1.05 – 2.90) Reference
2.24b 1 1.37 1 0.85 1
(1.07 – 4.69) Reference (0.59 – 3.19) Reference (0.37 – 1.96) Reference
0.97 1 0.75 1 1.25 1
(0.61 – 1.54) Reference (0.46 – 1.23) Reference (0.76 – 2.07) Reference
a
Several separate multiple logistic analyses with the control of age, education level and marital status were performed to assess the relationship between the variables of work experience and problem-related drinking among low and high occupational status workers. b P < 0.05.
95% CI 1.07 – 4.69). In other words, the higher the degree of self-estrangement, ie the more it was felt that the work was monotonous, repetitive and without variation, the more likely it was that drinking-related problems would develop. Drinking behavior of workers with high occupational status was, on the contrary, only associated with social isolation in the work experience, though it was not statistically significant. Among the high occupational status workers, the individual who was more socially isolated was more likely to become a problem drinker. Whether it was self-estrangement or powerlessness no significant relationship to individual drinking behavior was found.
Discussion Findings, with respect to this cross-sectional questionnaire survey, showed that alienation resulting from work indeed had a significant effect on drinking-related problems and it would be varied with workers’ occupational status. For workers with low occupational status, when feeling comparatively self-estranged in their work, ie when it did not require continuous learning and creativity, they were more likely to become problem drinkers. Though not statistically significant, powerlessness and self-estrangement also show influence on the drinking behavior of individuals with low and high occupational status, respectively. Upon considering the subject from a cross-cultural perspective, it is believed that the findings of this study may reflect differences among cultures. Individuals’ perceptions of their work may be shaped by the prevailing cultural practices of their respective society. Workers in an ethnic Chinese society who tend to be collectively oriented
may not be greatly concerned about their power to control their work. Moreover, in an ethnic Chinese society where interpersonal relations normally prevail, there may already be a high level of social support. Therefore in this particular study, with regard to the two variables used to measure powerlessness and social isolation, there may have been insufficient variation to estimate their effects on drinking behavior. Although neither family history nor the workplace drinking subculture showed a relationship to an individual’s occupational status, they may both affect individual drinking behavior. Drinking per se is a social behavior that is influenced by many factors. Among these, social norms constitute unusually decisive variables but ones that are difficult to control for errors in measurement. A contrasting paradigm is cardiovascular disease, with relatively direct and consistent psychophysiological functions. In an ethnic Chinese society, where social drinking has always been the most predominant drinking behavior, drinking alone has often been labelled abnormal, and drinking to relieve the burden of alienation resulting from work is generally considered less common than it actually is. The boundaries between cultural standards for drinking behavior on the one hand and problem drinking on the other are varied and inconsistent. The cultural definition of problem drinking differs from society to society, and any simple consensus on its meaning is unlikely. In future cross-cultural studies on work experience and drinking behavior, the task of overcoming the obstacles arising from the differences in cultures and setting up an acceptable and valid measure will be an important one. Nonetheless, having examined drinking behavior from the perspective of the influence of work and the workplace, Public Health
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the investigators of the present study found that workplace culture is one of the factors that has a strong relationship with individual drinking behavior. If the workplace culture tended to encourage drinking, not only did the workers drink comparatively more, but it was also comparatively more likely that problems related to drinking would arise. In his studies in Taiwan, Harrell17 discovered that drinking is a major factor in Taiwanese social relations, and that it is subject to cultural standards. Moreover, drinking is based on the principle of reciprocity. When one party politely offers a drink, the other must do so in return — to do otherwise would be impolite and disrespectful. Therefore in their drinking behavior, given these kinds of conventions, people will do what they must to maintain personal relationships. Moreover, such behavior is socially sanctioned, and even encouraged. Refusing the other party’s offer of a drink, or drinking alone, may be labelled as deviant or inappropriate behavior. Such observations concerning Taiwanese society provide some substantiation for the finding of this study which is: the workplace subculture is one of the important factors in how work experience is related to individual drinking behavior. The researchers concur with Sorensen et al18 when they maintain that each workplace may be regarded as a separate community with its unique cultural and social standards and that, by determining the norms for individual behavior, this community has an important influence on the behavior of each individual in the workplace. In light of this, it is recommended that considering ways to change the workplace drinking subculture should be an important priority when formulating any plan for treating or preventing problem drinking. While it is true that culture per se is neither good nor bad, problem drinking in Taiwan has progressed concurrently with increasing industrialization. In a society such as Taiwan, where economics dominates, social activities are an unavoidable part of life, giving rise to relatively more opportunities to drink. From a public health standpoint, this will lead not only to increased alcohol use by individuals, but may also lead to many different types of drinking problems. Despite limitations on the inferences that can be drawn, the findings remain significant as an exploratory effort to understand what work-related factors, for example alienation, workplace drinking subculture, and personal attributes, are associated with drinking behavior in the low and high occupational sub-samples of industrial workers. Perhaps the most important conclusion that can be drawn from this study is that rather than continuing to point almost exclusively to genetic background and family history, ie the individual himself, as the cause of problem drinking, work conditions and experiences should be the main focal points. Therefore, from a cross-cultural and more broadly-considered perspective, further studies utilizing extended designs and methodologies should be considered because it is always difficult to interpret data from a cross-sectional survey. Moreover, it seems fallacious to Public Health
refer the rarity of alcoholism to biological differences, without considering the macro socioeconomic factors and their interactions with the norms, values and attitudes of a local cultural system in shaping drinking behavior. For centuries, the sanction of drinking and alcohol beverage production was evidently due to economic considerations and was far more important than other factors in determining Chinese drinking behavior. Nevertheless and also needless to say, a holistic approach to a cross-cultural study should provide information for an in-depth comparison and unbiased interpretation. Even so, the nature of the work experience and the reform of the workplace drinking subculture should be the focal points of intervention and management directed toward the prevention of problem drinking.
References 1 Lin TY. A study of the incidence of mental disorder in Chinese and other cultures. Psychiat 1953; 16: 313 – 336. 2 Yeh EK, Hwu HG. Alcoholism in Taiwan Chinese communities. In: Helzer JE, Canino GJ (eds). Alcoholism in North America, Europe, and Asia. Oxford University Press: New York, 1992, pp 214 – 246. 3 Rin H et al. In: Yang KS, Chiu HY (eds). Taiwanese Society in Transition (II). NanKang, Institute of Ethnology, Academic Sinica: Taipei, 1988, pp 553 – 594. 4 Seeman M, Anderson CS. Alienation and alcohol: the role of work, mastery, and community in drinking behavior. Am Sociol Rev 1983; 48: 60 – 77. 5 Seeman M, Seeman AZ, Budros A. Powerlessness, work, and community: a longitudinal study of alienation and alcohol use. J Health Soc Behav 1988; 29: 185 – 198. 6 Seeman M, Seeman AZ. Life strains, alienation, and drinking behavior. Alcohol Clin Exp Res 1992; 16: 199 – 205. 7 Kohn ML. Occupational structure and alienation. Am J Sociol 1976; 82: 111 – 130. 8 Kohn ML, Schooler C. Job conditions and personality: a longitudinal assessment of their reciprocal effects. Am J Sociol 1982; 87: 1257 – 1286. 9 Kohn ML, Naoi A, Schoenbach C, Schooler C, Slomczynski KM. Position in the class structure and psychological functioning in the United States, Japan, and Poland. Am J Sociol 1990; 95: 964 – 1008. 10 Marx K. The Economic and Philosophical Manuscripts of 1844. International Publishers: New York, 1964. 11 Yang MJ, Ho CK, Fan LR, Yang MS. Job strain and drinking behavior. Kaohsiung J Med Sci 1996; 12: 670 – 684. 12 Yang KS et al. In: Yang KS, Chiu HY, editors. Taiwanese Society in Transition (II). NanKang, Institute of Ethnology, Academia Sinica: Taipei, 1988, pp 473 – 506. 13 Seeman M. On the meaning of alienation. Am Sociol Rev 1959; 24: 783 – 791. 14 Ames GM, Janes CR. A cultural approach to conceptualizing alcohol and the workplace. Alcohol Health Res World 1992; 16: 112 – 119. 15 Yang MJ, Chung CY, Kuo CC, Ho CK, Ichiro Kawachi. The influence of job characteristics and workplace subculture on individuals’ drinking behavior – an exploratory pilot study. Kaohsiung J Med Sci 1996; 12: 339 – 347.
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16 Yang MJ, Ho CK, Shih CH, Kawachi I. Work conditions and drinking behavior. Formosa J Ment Health 1998; 11: 83 – 102. 17 Harrell S. Normal and deviant drinking in rural Taiwan. In: Kleinman A, Lin TY (eds). Normal and Abnormal Behavior in Chinese Culture. Dordrecht, D. Reidel Publishing Company: Holland, 1981, pp 49 – 59.
18 Sorensen G, Pechacek T, Pallonen U. Occupational and worksite norms and attitudes about smoking cessation. Am J Public Health 1986; 76: 544 – 549.
Public Health
Work experience and drinking behavior: alienation, occupational status, workplace drinking subculture and problem drinking MJ Yang1,2*, MS Yang3 and I Kawachi4 1 Department of Psychiatry, Chang Gung Memorial Hospital Kaohsiung, Taiwan; 2Chang Gung University, Taiwan; 3School of Nursing, Kaohsiung Medical College, Taiwan; and 4Department of Health and Social Behavior, Harvard School of Public Health, Boston, USA
This study explored the association between alienating job conditions and problem drinking within the context of occupational status and workplace drinking subculture. From December 1994 to March 1995, a questionnaire survey was implemented in the manufactory sector in southern Taiwan. Within the questionnaire, any perceived self-estrangement, powerlessness and social isolation that the individual experienced in his work were measured as the alienating job conditions, and any negative physical, psychological and social consequences the individual experienced during the previous month were considered as affecting problem drinking. Of the 1117 subjects, 668 (61.8%) reported imbibing one or more drinks during the preceding month; the average daily alcohol consumption being 0.2 0.9 drinks. In addition, 188 (16.8%) subjects reported having experienced drinking-related problems in the preceding month. Workers with low occupational status were more likely to become problem drinkers when they felt comparatively self-estranged in their work. Further, those with a family history including any habitual drinker or those under more encouraging workplace drinking subculture were more likely to have drinking-related problems. For the prevention of problem-related drinking behavior, the workplace should be considered as the focus of our future intervention and management program. Public Health (2001) 115, 265–271. Keywords: work experience; drinking behavior; alienation
Introduction During the past forty years, alcohol consumption in Taiwan has steadily soared. Along with the increase in consumption, the incidence of alcoholism with its attendant severe impairment of social functioning has risen from 0.01%1 to 1%2 between 1951 and 1992. Nevertheless, evidence shows not only that alcohol problems are distributed unevenly among different occupations, but also that within the working class, drinking is more of a problem in certain job categories than in others.2,3 With regard to these phenomena, Seeman et al maintain that when alienation resulting from the work experience impacts the individual, who is then unable to cope psychologically with the impact in terms of behavior, cognitive function and so on, the resultant collapse leads to problem drinking.4 – 6 When the worker is engaged in simple, repetitive work that requires no creativity, and has lost decision-making power or control over his work, the work experience then not only fails to supply the individual’s
*Correspondence: MJ Yang, Department of Psychiatry, Chang Gung Memorial Hospital Kaohsiung, No. 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung County 833, Taiwan. E-mail: [email protected] Accepted 29 January 2001
psychological need for satisfaction and success but also may induce a feeling of alienation and, ultimately, will create problems in the behavior and the psychological and cognitive functions of the worker.5,7 – 11 Similarly, Yang et al12 suggested that, in Taiwan, occupation is one of several determining factors in an individual’s sense of alienation; in general, the lower one’s occupational status, the greater the sense of alienation. Thus, it is speculated that the transformation of the Taiwanese economic structure from an agricultural to an industrial society brought more workers into alienating work conditions. This alienation, in turn, led to an increased prevalence of alcohol problems, unevenly distributed across occupations and social class. The concept of alienation from the sociological tradition was adopted to explore the purported association between job conditions and problem drinking among factory workers in Taiwan. From December 1994 to March 1995, proceeding under the assumption that, despite an existence of genetic or biological-constitution predisposition, the structure of work would also play a determinant role in affecting drinking behavior, a questionnaire survey of workers was implemented in the manufactory sector in southern Taiwan. This survey focused on workers between the ages of 17 and 65 at three steel factories (henceforth referred to as factories A, B, and C). The construct of alienation by Seeman13 was applied to explore the influence of work conditions on an individual’s
Work experience and drinking behavior MJ Yang et al
266
drinking behavior. Specifically, the effect of alienation was examined within the context of occupational status and workplace drinking subculture.
Methods Subjects By purposive sampling a complete census was taken of factories A and B. Factory C employed a large number of workers (9374), therefore stratified sampling of departmental units according to job types, which were then further divided and sampled randomly and respectively into on-site and off-site workers within departmental units, was utilized. In total 1117 subjects were recruited: 163 from factory A; 348 from factory B; and 606 from factory C. The response rate was 93.7%. Of the subjects, 1034 were male (93.3%); their average age was 37 8 (range: 19 – 61; about 70% of population were within this age range in Taiwan in 1995), 76.6% were over 30 years old; and 77.3% were married. Most had been working at their present factory for more than a year, 62.0% for more than seven years. Seventy-three percent had already completed their high school or vocational education, and 23.2% had furthered their education beyond the college level. 57 of the subjects had an average monthly income of between 1000 and 3000 US dollars (with a reference to the national average monthly income 900 to 970 US dollars per capita in Taiwan in 1994 – 95). About 20 indicated that at least one close relative was a frequent drinker who drinks two or more drinks per week (Table 1).
Measures Occupational status. Index of ‘occupational status’ comprised level of seniority, length of job tenure, type and structure of work, and hierarchical position. Those with the lowest income of less than 1000 US dollar per month, on-site workers performing manual labor, and workers who needed to do shift work were grouped into a construct that was termed ‘low occupational status workers’. Among the subjects, 14.4% were identified as low occupational status workers and the rest were termed ‘high occupational status workers’. Workplace drinking subculture. The workplace drinking subculture was referred to as the unofficial rule that prevails in the workplace for the drinking behavior of company personnel.14 – 16 Enquiries regarded the frequency of company-sponsored receptions that included alcoholic beverages during the preceding month, drinking among colleagues when dining together, drinking when personnel were entertaining customers at dinner and drinking with customers at lunch. Other questions dealt with the number of same-aged colleagues within a work Public Health
Table 1 Percentage distribution of variables among respondents to the survey of work experience and drinking behavior (n ¼ 1117*) Background Sex Male Female Age (y) 15 – 30 31 – 40 > 41 Educational level (y) <9 9 – 12 > 12 Marital status Single Married Widow=Widower Personal income ($US=month) < 1000 1000 – 1999 2000 – 2999 > 3000 Family history of frequent drinkers Yes No Workplace drinking subculture Encouraging Less encouraging Occupational status Low High Self-estrangement Low High Powerlessness Low High Social isolation Low High
n
Percentage (%)
1034 74
93.3 6.7
243 408 389
23.4 39.2 37.4
43 809 257
3.9 73.0 23.1
247 859 5
22.2 77.3 0.5
378 325 310 93
34.2 29.4 28.0 8.4
230 887
20.6 79.4
616 432
58.8 41.2
280 837
25.1 74.9
594 498
54.4 45.6
714 382
65.2 34.9
633 357
63.9 36.1
a
Missing data were omitted. The sum total of n might not equal 1117.
unit, the number of males, and the proportion of people within the workplace who drank frequently. A Likert scale (Cronbach a0.8) was assigned to these measurements. After the scores were summed, the total was used to evaluate the workplace drinking subculture. The higher the score, the more the workplace drinking subculture tended to encourage drinking. A lower score indicated that the subculture offered relatively less encouragement to drink. Further, the median was used to differentiate the workplace drinking subculture into a dichotomous variable – high and low workplace drinking subculture. Alienation. Modeling after Seeman’s concept,13 alienation was treated as a phenomenon of the multifaceted work experience, including: (1) self-estrangement:
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the inability to learn new information on the job or to exercise one’s own ability; (2) powerlessness: the inability to control one’s work; and (3) social isolation: the inability to receive the support of or help from one’s colleagues or superiors. Henceforth, low-technology work that never varies and in which the worker is not supported or helped refers to ‘alienated work’. The measure of self-estrangement comprised six items: the possibility of acquiring new knowledge or skills on the job; whether the work procedures were repetitive and monotonous; the degree to which the job required continual innovation from the worker; the amount of technical skill required by the work; the degree to which the work continually brought the worker into contact with new situations; and the ability of the worker to develop his particular skills. The Cronbach a coefficient for internal consistency was 0.8. Powerlessness was measured by three items — whether the work: permitted ample autonomy; allowed the worker to express his own opinions and views; and allowed the worker to control and exercise decision-making power over his work. The Cronbach a coefficient for internal consistency was 0.7. The workplace social isolation scale comprised seven items: superiors’ advice; colleagues’ advice; psychological support from superiors when difficulties were encountered; psychological support from colleagues; practical help from superiors; practical help from colleagues; and the number of close friendships that it was possible to form while in the workplace. The Cronbach a coefficient for internal consistency was 0.9. Measurement of drinking behavior. The average amount of self-reported alcohol consumed each day during the previous month was measured to estimate daily alcohol consumption. Measure of drink was defined by ‘standard drink’. Generally, a standard drink consists of 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (American system). Each of these drinks contains approximately the same amount of absolute alcohol — about 0.5 ounces (12 grams). The drinking-related problems were assessed by self-reporting the occurrence of lateness to work, absenteeism, lower quality of work, traffic violations, difficulties or quarrels at home and illnesses and accidents. Workers who had any of the drinking-related problems were rated as having problemrelated drinking. Those who reported having family members who drink two or more drinks per week were defined as having a family history of frequent drinkers.
Statistical analysis Frequency distributions and percentages were used for variable description. Univariate analysis was conducted to explore the relationship of drinking behavior to each of the variables regarding the respondent’s background,
workplace drinking subculture, occupational status and alienation. After controlling for age, educational level and marital status, a separate multivariate regression analysis stratified by occupational status was carried out to enquire into the association of family drinking history, workplace drinking subculture and three different forms of alienation with drinking behavior. Results Individual drinking behavior (Table 2) The average daily alcohol consumption among all the respondents was 0.2 0.9 drinks (range: 0 – 12). Six hundred and sixty-eight respondents (61.8%) had consumed some alcohol and 186 respondents (16.8%) had had a drinking-related problem in the preceding month. The most frequently occurring problems were physical illnesses, difficulties or quarrels at home, and uncontrolled drinking (8.0%, 2.6% and 1.6%, respectively). Less frequently occurring problems included the shivers, nervousness, fidgeting or other withdrawal symptoms; traffic violations; and effects on personal relationships (0.5%, 0.4% and 0.4%, respectively). Social drinking was the most important reason cited by those who had drunk during the previous month. The relationship between background variables and drinking behavior revealed that males drank comparatively more than females (t ¼ 19.8, P < 0.05) and had comparatively more drinking-related problems. There was also no significant difference among age, educational level, or marital status on the daily consumption amount. Even so, lower educational level, younger age, and an unmarried status were associated with comparatively more drinkingrelated problems, though this was not statistically significant. Individuals having a close family member who was a frequent drinker showed an exceptionally significant association with drinking amount (t ¼ 6.54, P < 0.01) and tended to have more drinking-related problems (w2 ¼ 21.79, P < 0.01). Those with low occupational status drank noticeably more on average and also experienced more drinking-related problems than those with high occupational status. There was a significant association between workplace drinking subculture and workers’ drinking behavior. Workers exposed to a workplace that encouraged drinking would be more likely to consume a greater quantity of alcohol (t ¼ 3.60, P < 0.01) and have experienced drinking-related problems (w2 ¼ 6.70, P < 0.05). Exploration of the relationship between alienation and drinking behavior revealed that workers with a higher sense of self-estrangement and powerlessness tended to have higher average alcohol consumption and experience more incidents of drinking-related problems. However, those who reported being more socially isolated would drink more and have more problem-related drinking behavior. Public Health
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Table 2
Background characteristics, sense of alienation and individual’s drinking behavior
Background and alienation Sex Male Female
Drinking amount mean s.d. (median)
Drinking related, problems n (%)
0.21 0.03 (0.02)a 0.01 0.00 (0.00)
184 (29.2%) 2 (11.8%) total is 186
Age (y) 17 – 30 31 – 40 41
0.23 0.96 (0.03) 0.17 0.61 (0.02) 0.20 0.99 (0.02)
50 (34.0%) 67 (27.3%) 56 (25.8%) total is 173
Educational level (y) <9 9 – 12 > 12
0.29 1.27 (0.02) 0.21 0.86 (0.02) 0.19 1.01 (0.02)
7 (30.4%) 142 (30.7%) 38 (23.5%) total is 187
Marital status Others Married
0.18 0.05 (0.02) 0.23 0.03 (0.02)
48 (35.0%) 140 (27.2%) total is 188
Family history of frequent, drinkers Yes No
0.59 1.70 (0.03)a 0.13 0.58 (0.02)
67 (43.8%)a 121 (24.2%) total is 188
Occupational status Low High
0.26 0.06 (0.03) 0.20 0.03 (0.02)
56 (33.1%) 132 (27.3%) total is 188
Self-estrangement Low High
0.19 0.04 (0.02) 0.25 0.04 (0.02)
94 (27.9%) 92 (30.0%) total is 186
Powerlessness Low High
0.19 0.03 (0.02) 0.22 0.04 (0.02)
57 (25.2%) 128 (30.6%) total is 185
Social isolation Low High
0.14 0.03 (0.02) 0.23 0.04 (0.02)
58 (28.3%) 99 (26.6%) total is 157
Workplace drinking subculture Encouraging Less encouraging
0.29 0.96 (0.02)a 0.12 0.61 (0.02)
95 (38.7%)a 82 (24.3%) total is 177
P < 0.05.
a
Multivariate analysis of occupational status, alienation and drinking behavior (Table 3) The results showed that both ‘family history of frequent drinkers’ and ‘workplace drinking subculture’ were positively associated with the occurrence of drinking-related problems, ie if the workplace tended to encourage drinking or if there was a frequent drinker in the family history, the individual not only tended to drink more than the average person but also was more prone to develop drinking-related problems. Notably, this relationship was statistically sigPublic Health
nificant among the high occupational status workers, yet not so among the low occupational status workers. Regarding work alienation and drinking-related problems analyses revealed that the pattern of association was different between low and high occupational status workers. Among the low occupational status workers, those who reported more self-estrangement or powerlessness were more likely to be problem drinkers. Be that as it may, only self-estrangement, among all the variables used to measure alienation, had a statistically significant effect on the development of drinking-related problems (OR ¼ 2.24,
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Table 3 Association between family history, workplace drinking subculture and alienation (self-estrangement, powerlessness and social isolation) with drinking-related problems among low and high occupational status workersa Low occupational status
Family history of frequent drinkers Yes No Workplace drinking subculture Encouraging Less encouraging Alienation Self-estrangement Powerlessness Social isolation
High occupational status
OR
95% CI
OR
95% CI
1.52 1
(0.64 – 3.56) Reference
3.24b 1
(1.87 – 5.63) Reference
1.62 1
(0.56 – 2.77) Reference
1.74b 1
(1.05 – 2.90) Reference
2.24b 1 1.37 1 0.85 1
(1.07 – 4.69) Reference (0.59 – 3.19) Reference (0.37 – 1.96) Reference
0.97 1 0.75 1 1.25 1
(0.61 – 1.54) Reference (0.46 – 1.23) Reference (0.76 – 2.07) Reference
a
Several separate multiple logistic analyses with the control of age, education level and marital status were performed to assess the relationship between the variables of work experience and problem-related drinking among low and high occupational status workers. b P < 0.05.
95% CI 1.07 – 4.69). In other words, the higher the degree of self-estrangement, ie the more it was felt that the work was monotonous, repetitive and without variation, the more likely it was that drinking-related problems would develop. Drinking behavior of workers with high occupational status was, on the contrary, only associated with social isolation in the work experience, though it was not statistically significant. Among the high occupational status workers, the individual who was more socially isolated was more likely to become a problem drinker. Whether it was self-estrangement or powerlessness no significant relationship to individual drinking behavior was found.
Discussion Findings, with respect to this cross-sectional questionnaire survey, showed that alienation resulting from work indeed had a significant effect on drinking-related problems and it would be varied with workers’ occupational status. For workers with low occupational status, when feeling comparatively self-estranged in their work, ie when it did not require continuous learning and creativity, they were more likely to become problem drinkers. Though not statistically significant, powerlessness and self-estrangement also show influence on the drinking behavior of individuals with low and high occupational status, respectively. Upon considering the subject from a cross-cultural perspective, it is believed that the findings of this study may reflect differences among cultures. Individuals’ perceptions of their work may be shaped by the prevailing cultural practices of their respective society. Workers in an ethnic Chinese society who tend to be collectively oriented
may not be greatly concerned about their power to control their work. Moreover, in an ethnic Chinese society where interpersonal relations normally prevail, there may already be a high level of social support. Therefore in this particular study, with regard to the two variables used to measure powerlessness and social isolation, there may have been insufficient variation to estimate their effects on drinking behavior. Although neither family history nor the workplace drinking subculture showed a relationship to an individual’s occupational status, they may both affect individual drinking behavior. Drinking per se is a social behavior that is influenced by many factors. Among these, social norms constitute unusually decisive variables but ones that are difficult to control for errors in measurement. A contrasting paradigm is cardiovascular disease, with relatively direct and consistent psychophysiological functions. In an ethnic Chinese society, where social drinking has always been the most predominant drinking behavior, drinking alone has often been labelled abnormal, and drinking to relieve the burden of alienation resulting from work is generally considered less common than it actually is. The boundaries between cultural standards for drinking behavior on the one hand and problem drinking on the other are varied and inconsistent. The cultural definition of problem drinking differs from society to society, and any simple consensus on its meaning is unlikely. In future cross-cultural studies on work experience and drinking behavior, the task of overcoming the obstacles arising from the differences in cultures and setting up an acceptable and valid measure will be an important one. Nonetheless, having examined drinking behavior from the perspective of the influence of work and the workplace, Public Health
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the investigators of the present study found that workplace culture is one of the factors that has a strong relationship with individual drinking behavior. If the workplace culture tended to encourage drinking, not only did the workers drink comparatively more, but it was also comparatively more likely that problems related to drinking would arise. In his studies in Taiwan, Harrell17 discovered that drinking is a major factor in Taiwanese social relations, and that it is subject to cultural standards. Moreover, drinking is based on the principle of reciprocity. When one party politely offers a drink, the other must do so in return — to do otherwise would be impolite and disrespectful. Therefore in their drinking behavior, given these kinds of conventions, people will do what they must to maintain personal relationships. Moreover, such behavior is socially sanctioned, and even encouraged. Refusing the other party’s offer of a drink, or drinking alone, may be labelled as deviant or inappropriate behavior. Such observations concerning Taiwanese society provide some substantiation for the finding of this study which is: the workplace subculture is one of the important factors in how work experience is related to individual drinking behavior. The researchers concur with Sorensen et al18 when they maintain that each workplace may be regarded as a separate community with its unique cultural and social standards and that, by determining the norms for individual behavior, this community has an important influence on the behavior of each individual in the workplace. In light of this, it is recommended that considering ways to change the workplace drinking subculture should be an important priority when formulating any plan for treating or preventing problem drinking. While it is true that culture per se is neither good nor bad, problem drinking in Taiwan has progressed concurrently with increasing industrialization. In a society such as Taiwan, where economics dominates, social activities are an unavoidable part of life, giving rise to relatively more opportunities to drink. From a public health standpoint, this will lead not only to increased alcohol use by individuals, but may also lead to many different types of drinking problems. Despite limitations on the inferences that can be drawn, the findings remain significant as an exploratory effort to understand what work-related factors, for example alienation, workplace drinking subculture, and personal attributes, are associated with drinking behavior in the low and high occupational sub-samples of industrial workers. Perhaps the most important conclusion that can be drawn from this study is that rather than continuing to point almost exclusively to genetic background and family history, ie the individual himself, as the cause of problem drinking, work conditions and experiences should be the main focal points. Therefore, from a cross-cultural and more broadly-considered perspective, further studies utilizing extended designs and methodologies should be considered because it is always difficult to interpret data from a cross-sectional survey. Moreover, it seems fallacious to Public Health
refer the rarity of alcoholism to biological differences, without considering the macro socioeconomic factors and their interactions with the norms, values and attitudes of a local cultural system in shaping drinking behavior. For centuries, the sanction of drinking and alcohol beverage production was evidently due to economic considerations and was far more important than other factors in determining Chinese drinking behavior. Nevertheless and also needless to say, a holistic approach to a cross-cultural study should provide information for an in-depth comparison and unbiased interpretation. Even so, the nature of the work experience and the reform of the workplace drinking subculture should be the focal points of intervention and management directed toward the prevention of problem drinking.
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