Nadine Harker Burnhams

A total ban on alcohol advertising: presenting the public health case

Evidence from burden of disease and economic costing studies amply indicate that the public health burden from hazardous and harmful use of alcohol in South Africa warrants drastic action. Evidence that banning alcohol advertising is likely to be an effective intervention is reflected in WHO strategy documents on non-communicable diseases and harmful use of alcohol. Studies on young people furthermore support arguments refuting the claim that advertising only influences brand choice. Given the weakness of relying on industry self-regulation, the government is considering legislation to ban alcohol advertising, resulting in heated debate. Tobacco control and studies investigating the effect of alcohol advertising bans on consumption and alcohol-related deaths point to the effectiveness of such action - ideally supplemented by other policy interventions. Arguments against an advertising ban include possible communication sector job losses, but these are likely to have been exaggerated. Banning alcohol advertising will necessitate greater scrutiny of digital media, satellite television and merchandising to reduce the likelihood of subverting the ban.

Social service offices as a point of entry into substance abuse treatment for poor South Africans

BackgroundIn South Africa, district social service offices are often the first point of entry into the substance abuse treatment system. Despite this, little is known about the profile of people presenting with substance-related problems at these service points. This has a negative impact on treatment service planning. This paper begins to redress this gap through describing patterns of substance use and service needs among people using general social services in the Western Cape and comparing findings against the profile of persons attending specialist substance abuse treatment facilities in the region.MethodsAs part of a standard client information system, an electronic questionnaire was completed for each person seeking social assistance. Data on socio-demographic characteristics, the range of presenting problems, patterns of substance use, perceived consequences of substance use, as well as types of services provided were analysed for the 691 social welfare clients who reported substance use between 2007 and 2009. These data were compared against clients attending substance abuse treatment centres during the same time period.ResultsFindings indicate that social services offices are used as a way of accessing specialist services but are also used as a service point, especially by groups under-represented in the specialist treatment sector. Women, people from rural communities and people with alcohol-related problems are more likely to seek assistance at social service offices providing low threshold intervention services than from the specialist treatment sector.ConclusionsThe study provides evidence that social services are a point of entry and intervention for people from underserved communities in the Western Cape. If these low-threshold services can be supported to provide good quality services, they may be an effective and efficient way of improving access to treatment in a context of limited service availability.

Prevalence and predictors of problematic alcohol use, risky sexual practices and other negative consequences associated with alcohol use among safety and security employees in the Western Cape, South Africa

IntroductionHarmful alcohol use can compromise worker health and productivity. Persons employed in safety-sensitive occupations are particularly vulnerable to hazardous alcohol use and its associated risks. This study describes the patterns of harmful alcohol use, related HIV risks and risk factors for the harmful use of alcohol among a sample of employees in South Africa working in the safety and security sector.MethodsA cross-sectional study that formed the baseline for a clustered randomized control trial was undertaken in 2011. A random sample of 325 employees employed within a safety and security sector of a local municipality in the Western Cape Province of South Africa participated in the study. Data were collected by means of an 18-page self-administered structured questionnaire and analyzed using SAS/STAT software version 9.2. For all significance testing, the F-statistic and p-values are reported.ResultsThree hundred and twenty-five employees were surveyed. Findings suggest that more than half (76.1%) of the 78.9% of participants who consumed alcohol engaged in binge drinking, with close to a quarter reporting a CAGE score greater than the cut-off of 2, indicating potentially hazardous drinking patterns. The study further found that employees who use alcohol are more likely to engage in risky sexual practices when under the influence. A favorable drinking climate (p < 0.001) and poor levels of group cohesion (p = 0.009) were significantly correlated to binge drinking.ConclusionThis study identifies alcohol-related behaviors and associated risks in the context of safety-sensitive occupations at the workplace. It suggests that persons employed within such positions are at high risk for developing alcohol-related disorders and for contracting HIV. This study highlights the need for testing a comprehensive package of services designed to prevent hazardous alcohol use among safety and security employees.

The extent of problematic alcohol and other drug use within selected South African workplaces.

BACKGROUND The use of alcohol and other drugs (AODs) in the workplace has a major impact on the health and productivity of the workforce globally. Yet information on this issue is limited in South Africa (SA). OBJECTIVE To describe the nature and extent of AOD problems in selected workplace settings in SA. METHODS Secondary data analysis was conducted on a large dataset compiled by an Employee Assistance Programme (EAP) service provider in SA. As part of an EAP risk audit, assessments for AOD-related problems were completed for each employee accessing EAP services (n=10 428) between 2005 and 2011. Data on the socio-demographic profiles, AOD use and impact of AOD use on the work performance of employees were analysed. RESULTS Findings indicate that employed men are more likely to experience alcohol-related problems than women, the latter demonstrating a higher percentage of drug-related problems. The majority of referrals to the EAPs emanate from the public, industrial and financial sectors. AOD-related problems were also found to significantly impact on employee work performance. CONCLUSIONS The study begins to address the knowledge gap on the extent of AOD use in SA workplaces and points to the need for further investigations into the exact nature of AOD use. In addition, the study highlights the need for intervention programmes and policies suited to the workplace.

Results of a cluster randomised controlled trial to reduce risky use of alcohol, alcohol-related HIV risks and improve help-seeking behaviour among safety and security employees in the Western Cape, South Africa

ObjectiveTo test the effectiveness of a programme aimed at reducing the risky use of alcohol and alcohol-related HIV risk and increase help-seeking behaviour among a sample of municipal employees in the Western Cape Province, South Africa.MethodsA clustered randomised controlled trial was conducted in 2011–2012 among 325 employees. The eight hour intervention, Team Awareness (TA), addressing behavioural risk among employees was administered to 168 employees in the intervention arm and the 157 employees in the control arm who received a one-hour wellness talk.ResultsThe results show that TA had the greatest impact on risky drinking practices and hangover effects. There was a significant group × time interaction (F (1, 117) = 25.16, p < 0.0001) with participants in the intervention condition reducing number of days on which they engaged in binge drinking. There was also a significant time effect with participants in the intervention condition reducing the likelihood of going to work with a hangover (F (1,117) = 4.10, p = 0.045). No reduction in HIV-related risk behaviours were found.ConclusionsThis intervention study was able to demonstrate a modest but significant reduction in risky drinking practices and hangover effects. This provides encouraging evidence for the effectiveness of interventions that address risky use of alcohol among employed persons, further providing a launch pad for strengthening and replicating future RCT studies on workplace prevention, especially in developing country settings.Clinical Trial Registration NumberPan-African Control Trial Registry (201301000458308).

Establishing a computerized substance abuse surveillance system for district social workers in the Western Cape Province, South Africa: Methods, successes and challenges

The provision of accurate, in-depth data on substance abuse trends and service needs has become increasingly important in light of the growing wave of substance abuse in South Africa and particularly in the Western Cape Province. This article describes the design and implementation of an electronic substance abuse surveillance system (SASS) between 2007 and 2009. The function of this system is to gather data on substance use, associated problems, service needs and services received on all clients presenting for generic social welfare services at the 16 district social service offices in the Western Cape. This article describes key features of SASS, examines the strengths of this system, reviews the process of implementing SASS and describes major challenges to the effective implementation and use of the system. Major challenges include limited infrastructure, inadequacies in staff capacity and lack of organizational support for the system. Recommendations for addressing these challenges and improving the use of this surveillance system are provided.

Data collection challenges experienced while conducting the international alcohol control study (IAC) in Tshwane, South Africa

Abstract Aims: There is limited literature on the challenges encountered during household surveys on alcohol consumption in low- and middle-income countries. This paper aims to describe the problems encountered during data collection for the IAC study in South Africa and put forward recommendations for addressing identified challenges. Methods: Data on methodological and other challenges emerged from feedback sessions held with fieldworkers, supervisors, observations made of and follow up meetings with project investigators, based on the pilot and main study of 2844 adults and adolescents in Tshwane (South Africa). Results: Challenges identified included the following: delays in software development which resulted in postponement of data collection with subsequent budgetary implications; difficulties in identifying the full range of alcohol beverages during the adaptation of the questionnaire as manufacturers sometimes changed quantities and packaging to enhance sales; a resultant lengthy questionnaire which negatively impacted on participation; potential participants sometime being afraid to allow fieldworkers onto premises due to high crime rates in many participating areas and religious beliefs concerning alcohol consumption that prevented some parents from consenting to their adolescent children’s participation. Conclusion: When planning community surveys on alcohol use, it is important to anticipate and prepare for these and other challenging conditions that arise in the preparation for, and execution of fieldwork.

Using respondent-driven sampling (RDS) to recruit illegal poly-substance users in Cape Town, South Africa: implications and future directions

BackgroundSouth Africa continues to witness an increase in illicit poly-substance use, although a precise measurement continues to be compounded by difficulties in accessing users. In a pilot attempt to use respondent-driven sampling (RDS)—a chain referral sampling method used to access populations of individuals who are ‘hard-to-reach’—this article documents the feasibility of the method as recorded in a simultaneously run, multisite, poly-substance study in Cape Town. Here we aim to a) document the piloting of RDS among poly-substance users in the three socio-economic disparate communities targeted; b) briefly document the results; and c) review the utility of RDS as a research tool.MethodsThree cross-sectional surveys using standard RDS procedures were used to recruit active poly-substance users and were concurrently deployed in three sites. Formative research was initially conducted to assess the feasibility of the survey. To determine whether RDS could be used to successfully recruit poly-substance users, social network characteristics, such as network size was determined.ResultsA 42.5 % coupon return rate was recorded in total from 12 initial seeds. There were vast differences in the recruitment chains of individual seeds—two generated more than 90 recruits, and 2 of the 10 recruitment chains showing a length of more than 10 waves. Findings include evidence of the use of 3 or more substances in all three sites, high levels of unemployment among users, with more than a third of participants in two sites reporting arrest for drug use in the past 12 months.ConclusionsOur results indicate that RDS was a feasible and acceptable sampling method for recruiting participants who may not otherwise be accessible. Future studies can use RDS to recruit such cohorts, and the method could form part of broader efforts to document vulnerable populations.

The state of interventions to address substance-related disorders in South African workplaces : implications for research, policy, and practice

Substance abuse in South Africa is highly prevalent and continues to be a major cause of mortality and a risk factor for both communicable and non-communicable diseases. The employer costs associated with substance abuse remain high owing to rising health costs, accidents, absenteeism, and workers’ compensation claims placing the organisation and its employees at risk for harm. This article describes the status of current policy, prevention, and treatment interventions to address substance abuse in the South African workplace. Key issues highlighted are the need for research into the extent and impact of substance abuse in the South African workforce, the promotion of substance abuse policies that are comprehensive in nature, and the need to upscale prevention and treatment initiatives through a move away from a traditional labour approach to addressing substance-related disorders in the workplace to the adoption of a more public health approach. Cost-effectiveness of substance abuse interventions is explored alongside the importance of ensuring that employers, practitioners, and other role players engage with the evidence of what works using international standards as the basis.