United States, 1988
There has be much curiosity among researchers and the general public alike in connection with the prevalence of alcohol problems among different occupations. The authors explored this issue using notes from the 1988 National Health Interview Survey and found considerable variation within the prevalence of alcohol problems both across occupations and inwardly occupational groups.
This Epidemiologic Bulletin examines the prevalence of alcohol ill-treat and/or alcohol dependence among specific occupations. The findings presented here are from the 1988 National Health Interview Survey (NHIS), the first U.S. national even survey to implement psychiatric definitions of alcohol knock about and alcohol dependence as articulated in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) (American Psychiatric Association 1987). The DSM-III-R definition are the most current definitions immediately in use for the diagnosis of substance swearing and dependence.
BACKGROUND
The Alcohol Epidemiologic Data System (AEDS) has received oodles inquiries from researchers, journalists, and member of the general public roughly speaking alcohol problems in different groups of the U.S. population. A frequently asked query involves the prevalence of alcohol problems among different occupational groups.
We used the 1988 NHIS to explore the prevalence of alcohol use disorders. The definition of alcohol use disorders used here includes alcohol treat roughly, in increase to alcohol dependence. The occupational classification used surrounded by the 1988 NHIS (U.S. Bureau of the Census 1980) defines more than 500 detailed occupation. A different examination of prevalence estimates of dependence among employment groups using the NHIS data set be conducted by Parker and Harford (see the article by Parker and Harford, pp. 97-105). We will discuss this study in more detail subsequent in this article.
DATA SOURCE
Data used contained by the analyses reported here are from the 1988 NHIS, an ongoing, cross-sectional household interview survey designed by the National Center for Health Statistics (NCHS) and conducted by interviewers from the U.S. Bureau of the Census. The survey collects information on the health and other characteristics of respectively member of the households sample.
The 1988 NHIS included a set of supplementary questions designed and funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). These question were asked of one changeably selected character aged 18 or older within each indication household; a total of 43,809 persons be interviewed, representing a response rate of 87 percent. Among the questions be 34 items that could be used to assess alcohol abuse or alcohol dependence; these items be based on criteria articulated contained by the DSM-III-R.
Although the 1988 NHIS used a very huge sample, the certainty that answers come from a sample of adjectives possible respondents means that statistical procedures must be used surrounded by order to assess the significance of any adjectives differences found in analyses of these notes. This survey did not use a random example, because a truly random indication would not have provided adequate respondents representing certain small population groups of special interest (e.g., in 1988 the NHIS oversampled blacks). In direct to increase the reliability of estimates for these relatively small groups in the U.S. population, the 1988 NHIS used a complex multistage sampling design, described elsewhere (Massey et al. 1989). Because of the complex sampling design, it was vital to use special statistical procedures in calculating variance estimates for assessing statistical significance. This be accomplished through the use of SUDAAN (Research Triangle Institute 1991), a set of statistical computer programs that adjust for preview design characteristics.
ALCOHOL ABUSE/DEPENDENCE
The prevalence estimates reported here for alcohol disorders involve respondents who met DSM-III-R criteria for alcohol abuse and/or alcohol dependence within the 12 months prior to the interview. The assignment of a diagnosis of alcohol abuse or dependence is base on responses to 34 questionnaire items in the 1988 NHIS. A detailed explanation of the items and the criteria for the diagnosis of alcohol disorders are presented elsewhere by Grant and co-workers (1991).
In summary, a diagnosis of alcohol dependence requires self-reports of mixed symptoms that meet at smallest three of the following nine DSM-III-R dependence criteria: tolerance; withdrawal; drinking to relieve or avoid bill symptoms; drinking larger amounts than intended; a great deal of time spent drinking; happenings given up for drinking; continued drinking despite problems; neglected responsibilities or obligations; or impair control. The DSM-III-R also includes a duration requirement (i.e., that some symptoms persisted for at lowest possible 1 month or occurred repeatedly over a longer spell of time). In the 1988 NHIS, the duration requirement was self-righteous if respondents reported two or more symptoms in days gone by year for each of two dependence criteria, beside the following two exceptions. First, because withdrawal is a syndrome, or a cluster of symptoms, a respondent must report at lowest possible two symptoms of withdrawal to join the duration criterion. It should be noted, however, that withdrawal is not a compulsory criterion for alcohol dependence. Second, any symptom of tolerance was deem to meet the duration requirement.
A diagnosis of alcohol invective requires a maladaptive pattern of alcohol use, next to self-reports of symptoms that meet one of the following two DSM-III-R mishandle criteria: continued drinking despite a persistent social, work, psychological, or physical problem caused or exacerbated by drinking; or returning drinking in situations in which alcohol use within physically hazardous. The duration requirement for a diagnosis of alcohol abuse be met only if a respondent reported the fact of at least one symptom of knock about two or more times in the year prior to the interview.
FINDINGS
Table 1 shows percent prevalence estimates for alcohol disorders (either dependence or abuse) for specific occupation and groups of occupations for the United States for 1988. Not adjectives of the more than 500 occupations defined by the U.S. Bureau of the Census (1980) appear here table. To increase the reliability of the prevalence estimates, occupations not represented surrounded by the sample or for which in attendance were a smaller amount than 30 NHIS respondents are not shown. For occupations beside at least 30 manly or 30 female respondents, sex-specific prevalence estimates are also shown. In almost adjectives instances in which estimates be available for males and females separately, the male prevalence was larger.
Using standard errors derived from SUDAAN, statistical test of proportional differences between the prevalence of alcohol disorders within respectively specific occupation and occupational group and the prevalence of alcohol disorders within the overall labor force were conducted. For both sexes combined, 15 detailed occupation had prevalence significantly high and 41 had prevalences significantly lower than 10.59 percent, the prevalence of alcohol disorders for the common population (z > 1.96; p < .05). [TABULAR DATA OMITTED]
There is considerable variation within the prevalence of alcohol disorders across different occupations. The great prevalence observed for males and females combined was see for bartenders (42.19 percent), with the prevalence for masculine bartenders exceeding 50 percent. Radiologic technicians and three other occupations showed an estimated 0.0 percent prevalence for alcohol use disorders.
In add-on, there is a large amount of variation surrounded by prevalence within employment groups. For example, the prevalence of alcohol use disorders for the category of writers, artists, entertainers, and athletes (9.82 percent) is not significantly different from the prevalence for the overall work force. However, inwardly this category the prevalence for designers (5.22 percent) is significantly lower and the prevalence for editors and reporters (20.15 percent) is significantly higher than for the average worker. The category of construction and extractive trades (20.83 percent) have a significantly elevated prevalence, yet it includes electricians, who enjoy an estimated prevalence of 12.07 percent, which is not statistically different from the general labor force.
DISCUSSION
The prevalence estimates for alcohol disorders presented here represent the most detailed exploration of alcohol problems among a substantial number of different occupations to appear surrounded by any one source that the authors could discover. They are particularly adjectives because they come from a single, nationally representative survey. This funds that the assessment methods and the sampling procedures did not differ from one occupation to another. In addition, as stated previously, the prevalence estimates are base on DSM-III-R criteria, the diagnostic system in current use within the United States.
As mentioned previously, Parker and Harford (see the article by Parker and Harford, pp. 97-105) determined age-standardized prevalence estimates of alcohol dependence for 42 occupational groups using one and the same data set (the 1988 NHIS). There are two crucial differences between our findings and those reported by Parker and Harford. First, the prevalence estimates presented by Parker and Harford are age standardized. Age standardizing controls for the fact that different occupation have different age distributions. Some of the professional differences in prevalence estimates can be explained by these different age distributions. Because alcohol use disorders are more prevalent among younger individuals (Grant et al. 1991), prevalence rates will be greater for occupations near a younger group of workers. In the findings presented here, we did not standardize prevalence estimates for age because we wanted to present the actual observed prevalence. In the luggage of occupational prevalence for alcohol use disorders, it is essential to know what occupations enjoy higher prevalence, even if the highly developed prevalence is due to a relatively younger group of workers in the occupation. Our purpose contained by producing these prevalence estimates was to provide a description of the actual distribution of alcohol disorders among different occupation. We have made no attempt to hope explanations for occupational differences contained by the prevalence of alcohol disorders.
Second, the definition of alcohol use disorders we used includes alcohol abuse, surrounded by addition to alcohol dependence. Parker and Harford focused on alcohol dependence, a specific alcohol use disorder. According to Grant and colleagues (1991), 11.1 million Americans aged 18 and elder were alcohol dependent within 1988. In addition, however, another 4.2 million met criteria for alcohol invective without dependence. We examined both misuse and dependence in this study, because we be interested in the prevalence of alcohol abuse disorders regardless of the specific outlook of the disorder.
Estimates of the cost to society of alcohol abuse indicate that costs associated near lost employment and reduced productivity resulting from alcohol-related death and weakness range from 61 percent (U.S. Department of Health and Human Services 1990) to 72 percent of the total cost (Rice et al. 1990). Employee assistance programs (EAPs) enjoy been established by copious employers to assist workers within overcoming problems associated with alcohol rough up. The data presented contained by this article should assist in identify the magnitude of the population within need within specific occupations.
The findings from this study provide NIAAA next to a scientific justification for answering questions in the region of occupationally based alcohol problems. An informal survey in connection with the perceptions of occupation with substantial alcohol problems revealed that stereotypes be not supported by the findings reported here. For example, physicians and lawyers regularly were identified as occupation having substantial alcohol problems. The findings presented here indicate that physicians enjoy a significantly lower prevalence of alcohol problems than is seen surrounded by the general labor force; the prevalence of alcohol disorders for lawyer is not significantly different from that for the average worker. Popular fiction suggests that police and detectives also have an excessive rate of alcohol problems, but the findings reported here indicate that the prevalence for this occupation is roughly speaking the same as for the standard labor force.
The prevalence estimates presented here should help correct some erroneous beliefs and focus attention on occupation in which at hand seem to be serious alcohol problems.
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