Together, we can ensure that the conditions of work promote the

health and well-being of workers and communities.

February 2023 Newsletter

Registration for our Spring Community Conference is now open!

Health and employment are inextricably linked. In late 2022, the American Public Health Association (APHA) released a new policy health statement declaring access to “decent work,” or work that is productive, fairly paid, secure, and offers development and empowerment opportunities, to be a major public health concern. Such a statement may feel new to us in 2023 but would have been familiar to the early public health practitioners who allied with labor movements to advocate for improved work and investigated the working conditions of high-risk occupations. Today, the ongoing COVID-19 pandemic’s disproportionate effects on essential and frontline workers have reminded us of the inextricable link between health and work.

So why does so much research focus on our lives outside of work, and so little on what we do for so many hours of the day? And why are many people barred from safe, healthy, and well-compensated jobs? Improving work and working conditions in the U.S. offers us a new pathway to solving many health inequities.

Join the movement to improve the future of work at a Spring Community Conference on April 13th! We hope you’ll join us to share your experiences with work in Utah, how to advocate for better employment conditions, and resources aimed at changing the future of work. Attendance is free including a light breakfast and box lunch from a local bakery and café.

Register here today!

Want your organization represented at U-POWER's Spring Conference?

Help us keep registration free and accessible to our community organizations and members by providing a financial donation of $200-$500. Donated funds will be earmarked for the venue and other logistical costs. 

BENEFITS:

• Opportunity to create a table display at the Spring 2022 U-POWER Conference
• Logo recognition on Spring Conference website
• Listed as a Sustaining Partner Sponsor in the Program 

Get a sneak peek at early research results!

Approximately 10% of US workers (14.4 million) are thought to be exposed to infectious diseases at least once per week, and 18.5% (26.7 million) at least once per month. Workers deemed essential to sustaining the well-being of others have had to continue working during the COVID-19 pandemic, often at great risk of infection. This burden has disproportionately affected racialized groups, foreign-born workers, and other vulnerable groups. While COVID-19 continues to disrupt businesses and cause psychosocial stress, illness, and mortality among workers, we must also anticipate future pandemics of respiratory infectious diseases. Our first research project, Incorporating Worksite Interventions in Safety and Health (IWISH): Building Capacity for Total Worker Health, worked with manufacturers in Utah to assess their pandemic response and determine how worker engagement helped increase or diminish satisfaction.

At the 2023 Spring Conference, IWISH Research Assistants (RAs) will be on-site to share findings through research posters and answer questions!

We’re also looking forward to reviewing applications for our community-initiated mini grants and our Research Pilot Project Program—don’t forget to check out the details on our website!

American children in the late twentieth century heard it again and again, in school, within their communities, and in their media. Just say no. We’re fighting a war on drugs. Sign your DARE pledge. This is your brain on drugs. Stringent anti-substance laws and programs became commonplace and rates of incarceration for drug possession rose dramatically in the late 1980s, all in hopes of reducing the use of alcohol, cannabis, tobacco, opioids, psychedelics, and other mind-altering substances.

In 2023, society and governments are critically examining how we think and talk about substance use. The ongoing drug overdose epidemic continues to be a leading cause of injury-related death in the United States. The “war on drugs” has been widely recognized as a way to criminalize people of color, particularly Black people, who have been disproportionately incarcerated for drug possession. Many professional and educational organizations now call for substance use to be considered a health, not a criminal, problem and advocate for harm reduction programs, medication-assisted treatment, and widespread use of naloxone to reduce opioid overdoses.

But what about work? If we acknowledge substance use as a health issue that impacts individual health as well as the health of others around us, then what role does work play in ensuring health? Should employers be permitted to monitor and regulate the substance use of their employees, and if so, how? How can we ensure that workers in safety-sensitive industries like transit don’t put others at risk? And what’s the difference between workforce use and workplace use of substances? In this month’s U-POWER Deep Dive, we’ll take a closer look at alcohol and substance use at work. 

Substances Use At and After Work – A Major Issue? 



60% of Americans drink alcohol. Social norms in the United States frame moderate consumption of alcohol as a way to relax in social situations and unwind after a long day’s work. People grab a cocktail with friends, order wine with dinner, and celebrate sports games with beer and pizza. However, when it comes to the estimated 15% of Americans who drink on the job, that general acceptance can rapidly swing in the other direction. Some work cultures encourage drinking socially at lunch or after shifts, but in other organizations, drinking at or after work is seen as a worrying problem, if not an outright risk to health and safety. The influence of these differing cultures means that certain industry groups, like mining, construction, and accommodation and food service, see heavy alcohol use rates, while health care, educational services, and public administration organizations see lower rates (see figures below). 

When it comes to illicit substance use (e.g. cocaine, amphetamines, heroin, and cannabis—although the legal status of some of these is rapidly changing), rates of overall use drop dramatically. Most employees (86% of the workforce) do not use illicit substances and an even larger percentage (97%) do not use illicit drugs at work. Interestingly, the majority (58%) of those who use illicit substances do so three times a month or less. But just as with alcohol use, substance use rates tend to follow industry patterns. Accommodations and food service workers also report high substance use rates (see last month’s Deep Dive for an exploration of why this might happen), but management, information, and arts, entertainment, and recreation employees have also been found to use substances at a rate higher than other occupations.

The overall costs of alcohol and other substance use disorders are striking. U.S. businesses and organizations are estimated to lose $81 billion dollars due to various reasons, some of which are labor costs (loss of productivity, turnover, absenteeism), while others are related to higher healthcare costs, work-related injuries, or employee theft.

But is this due to substance use both on and off the job? Researchers aren’t quite sure. A recent study called for more investigation into how off-the-job substance use affects performance and productivity. One systematic review found that use of cannabis during off-hours does not generally affect worker performance during shifts, but noted that more high-quality research was needed. Much of our conventional wisdom about substance use at work has been called into question in the last 10-20 years. Let’s take a look at what we do know and what we might do to support healthier workplaces. 

Workplace Factors Linked to Substance Use



Writer Wendell Berry described a common belief when he wrote that “people use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure.” A famous study on substance use among rats echoed his findings, discovering that rats who were free to roam in a utopian “rat park” were far more likely to prefer plain water over drug-laced water, even when both were freely available. Following this line of thinking, workers who enjoy their work are less likely to use substances.



Of course, work is far from the only determinant of health, but this belief is borne out in the literature to some extent. One study found that workers who were bored, felt little control over their work duties, and had interpersonal conflict with their supervisors and co-workers were more likely to use alcohol at work, while another study linked at-work substance use to a perceived lack of investment in their safety. Work overload may also play a role in substance use. Physically taxing industries that do not provide paid sick leave (e.g. construction, commercial fishing, food preparation, healthcare support) see higher opioid overdose rates among workers. Employment conditions, especially job insecurity, also seem to affect frequency and quantity of substance use.

As previously mentioned, workplace culture can also play a major role in substance use at work. Permissive work cultures where drinking or substance use is normalized see higher rates of alcohol use. Although food service typically sees higher rates of substance use, one study compared the cultures of “back of house” to “front of house” and found that the back of house culture, which was focused on getting through arduous work shifts and second jobs, was much less likely to encourage substance use than front of house culture that emphasized socializing among co-workers. Another study found that for young (16-19-year-old) workers, social support was a stronger contributing factor in workplace substance use than the actual physical availability of substances. In safety-sensitive occupations like aviation and motor transport, where workplace cultures emphasize the importance of safety and utilize random testing, workers are much less likely to use substances on the job. 

Workplace Injury and Substance Use

Alcohol and other substance use are unquestionably linked to injury-related accidents, particularly involving driving. The National Institute on Drug Abuse estimates that 44% of drivers in fatal car crashes test positive for substance use. Alcohol use has been linked to violence, self-harm, and accidental injuries from drowning, falls, and extreme temperatures. However, most of the research on this connection has focused on alcohol, with the associations between other substance use and non-vehicular injury remaining incompletely understood. This same pattern can be seen in the connections between substance use and workplace injury. There is a need for additional study on workplace injuries that are not transport-related (the associations between substance use and vehicle-related injury have been strongly established through post-mortem toxicology tests). In addition, much of substance use and workplace injury research does not differentiate between alcohol and other substances. In particular, there is a need for additional investigations into how workplace injuries are affected by cannabis use, especially given the changing landscape of legalization and medical use.    

Is Drug Testing the Answer?

Employers in the U.S. might say that they’ve cracked the code on handling substance use through drug testing, be it pre-employment screening or testing in response to “reasonable suspicion” of substance use on the job. However, reviews of scientific literature on testing have revealed that their efficacy is often dubious, with one article describing drug testing as mostly symbolic. The ACLU has called for a dramatic decrease in employer reliance on drug tests, noting that they are both intrusive to worker privacy and have an unacceptably high rate of false positives. Pre-employment drug testing has especially been called into question, as it cannot reflect on-the-job impairment. There have also been systematic findings of racial discrimination in drug testing, both in who is asked to undergo a test and the likelihood of negative repercussions if a positive test is detected.

Drug testing may be a strategy best reserved for high-risk groups and occupations. Right now, U.S. law requires that workers applying for safety-sensitive positions like truck drivers, machinery operators, and transportation workers produce a negative test before beginning work. However, concerns remain over whether or not pre-employment and random screening actually makes work safer. Testing for alcohol—which research has established as one of the most dangerous substances for workplace injury—is almost always voluntary. The National Workrights Institute argues that computer-assisted performance tests that measure hand-eye coordination and response time are much more effective in preserving workplace safety, especially since fatigue or physical illness can also impact employee performance.

Employers are starting to reduce dependence on pre-employment drug screening, especially in regard to cannabis. THC, the psychoactive compound in cannabis, is difficult to test for, especially since many tests conflate THC and CBD (a legal, non-psychoactive chemical). In response to labor shortages and growing normalization of cannabis use, employers like Amazon have removed cannabis from drug testing screens. This may spread to other industries, as some states and Washington D.C. have banned employers from discipling or removing workers who use cannabis for medical reasons. There are even those who argue for removing pre-employment cannabis screening among truck drivers and relying instead on articulable signs of impairment. 

What Can (and Should) Employers Do About Substance Use?

Substance use is unquestionably a health problem at work that can affect not only employees but also their dependents and families. Advice to managers warns against hiding or ignoring signs of substance use, since the financial and interpersonal costs of substance misuse (lost time, turnover) can be high. But just as legal systems have begun to shift away from substance possession and use as a crime, workplaces have sought to become “recovery-friendly” organizations that do not automatically dismiss employees for substance use or misuse. By supporting employees who experience substance use issues, employers can help reduce stigma and encourage a healthier workplace culture.

Employers have also seen benefits for all workers by using Employee Assistance Plans (EAPs). EAPs evolved from Occupational Alcoholism Programs to help lower the barriers to accessing preventive services, screening, and other behavioral health interventions. EAPs benefit employers as well, since they can help workers obtain treatment for issues before they begin to affect performance.

These programs and policies are supported by federal law such as the Americans with Disabilities Act, which considers addiction to alcohol (whether it occurred in the past or present) and recovery from illicit substances (in the past only) as disabilities in need of accommodations. Accommodations can include workplace environment improvements like alternative lighting and noise-canceling headsets or work arrangements like flexible scheduling and work-from-home, when available. These policies are also encouraged when using a Total Worker Health® approach, since that can make work better for all workers. 

March Seminar Series: Food Service Workers in New York City

A Presentation from Emilia Vignola

Join U-POWER for our March Seminar Series for a presentation from Emilia Vignola, CUNY Urban Food Policy Institute Fellow and Doctoral Candidate in Community Health and Social Sciences at the CUNY Graduate School of Public Health and Health Policy. Ms. Vignola will discuss her research among low-wage food service workers in New York City.

This event will be held on March 16, 2023 at 4:00 pm MST

Join us at: https://utah.zoom.us/j/94437641630 (Passcode: 272624)

Want a glimpse into Ms. Vignola's work? Check out this article on CUN Urban Food Institute's website that she co-authored, Making food workers essential participants in the food justice movement. An excerpt is below.

"Most low wage food workers are Black, Latinx, or other people of color, recent immigrants and/or women. Their overrepresentation in the lowest paid occupations and industries of the food system imposes a double burden — the low pay, limited benefits and unsafe conditions of their work, and the legacy of policies, hierarchies and business practices that perpetuate racial, gender, and other inequities in the workplace and beyond. The disproportionate burden of the COVID-19 pandemic on communities of color in general and low wage food workers in specific illustrate the cumulative impact of intersecting systems of oppression. Just as the food justice movement fights racial gaps in access to healthy food, we should support efforts to increase minimum wages as a step towards racial equity."



-Making food workers essential participants in the food justice movement by Emma Vignola, Luis Saavedra, Katy Tomaino Fraser, and Nicholas Freudenberg from the CUNY Urban Food Policy Institute at the CUY School of Public Health

Want to receive meeting invites and updates from U-POWER directly? Contact us or become an affiliate member to be added to our event list.

Meet Our Keynote Speaker, Anthony Tenney



Meet our keynote speaker for our upcoming Spring 2023 Conference: Collective Action to Advance Total Worker Health! Anthony Tenney is a second-year law student dedicated to labor law and policy. During his keynote, he will share his experiences with advocacy, including his time supporting the Driver’s Union (Seattle), an association of drivers for various app-based companies such as Lyft and Uber. His keynote will offer concrete strategies and approaches to advocating for a future of safe, healthy, and equitable work.

Read more about Anthony's journey to worker rights.

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Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Participation by the Utah Center for Promotion of Work Equity Research (U-POWER) does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or the National Institute for Occupational Safety and Health.