Sex, drugs and drinking: health risks in the social lives of young workers. (Peer Reviewed).

A study of almost 400 young people (aged 15-25) in the manufacturing, building, hairdressing, fast food and retail industries in Melbourne found that excessive alcohol consumption and smoking are major health issues facing these young workers. In general, young men engaged in more alcohol and drug risk-taking behaviour than young women; and those in building, manufacturing and hairdressing consumed alcohol and other drugs at higher levels than those in other industries. Young workers at higher risk are identified and possibilities for health promotion are suggested.

WE KNOW that excessive drug, alcohol and tobacco consumption are major health risks for young people, and that this group is also at high risk of contracting sexually transmissible diseases (Moore, Rosenthal & Mitchell 1996; AIHW 1999; National Centre in HIV Epidemiology & Clinical Research 2000). Most research and health promotion efforts aimed at reducing young people's risk-taking behaviours have focused on secondary school and university students -- so-called "captive" samples. Relatively little is known about the risk-taking practices of young people in the work force, especially those who may have left school early.

A national survey of HIV risk in apprentices undertaking TAFE courses in hairdressing, motor mechanics and commercial cookery found that rates of condom use were reasonably high -- almost half the subjects had used condoms at last intercourse. However, areas of concern included gender differences in expectations of monogamy and sexual practice. Some of the young men did not expect to be monogamous and the young women were less likely than the young men to insist on the use of condoms, regardless of type of partner. This research provides useful information but did not examine sexual practices alongside drug and alcohol risk-taking or compare different industry groups (Grunseit 1999).

Australian research on health risks and young people has neglected the issue of social class. It is now well established in the US, UK and Europe that there is a relationship between social inequality and health (otherwise known as the social gradient in health) in which the lower the socioeconomic status of a person, the worse their health is likely to be (Wilkinson & Marmot 1998; Power 1994). Preventable causes of ill health, such as tobacco and alcohol consumption, have been shown to play a role in this relationship. British research has established a clear link between socioeconomic status, tobacco consumption and mortality -- in general terms, poverty is linked to alcohol abuse, illegal drug use and smoking (Jarvis & Wardle 1999). Within the work force, those in lower occupational grades smoke at higher levels than their counterparts in higher occupational grades. There is also a link between socioeconomic status and alcohol consumption but it is not a strictly linear relationship. Those in higher occupational grades have higher levels of moderate drinking than those in lower occupation grades (Marmot 1997). The participants in the present research were drawn from the lower levels of the occupational hierarchy, as it is defined by Lasch and Urry (1994). The majority could be considered members of the "working class" or the developing "lower class" of people with marginal attachment to the work force (Lasch & Urry 1994). The experiences of these young people should contribute to an understanding of the social gradient of health in Australia.

The current social environment is difficult for young people to negotiate. This is particularly the case for young adults who are establishing independent identities, creating independent households and entering the labour force concurrently. According to David Cheal, they are especially likely to experience unstable relationships, as well as unstable employment patterns (Cheal 1999). It is well established that job security increases health and wellbeing (Wilkinson & Marmot 1998). However, at present, young people are at risk of poverty, unemployment and stress. The impact of the restructure of labour markets has fallen most heavily on young people, and it is estimated that one in five young people are now continually disadvantaged in the labour market (Dusseldorp Skills Forum 1999). We could expect these difficult conditions in the wider social context to be reflected in health risk-taking practices. This paper provides an insight into this phenomenon by documenting patterns of alcohol and drug consumption and sexual health practices among an important but neglected sample: young people under the age of 25 who have entered the work force in traditional industries such as manufacturing, building and hairdressing, and high growth industries such as hospitality, fast food and retail.

The study and participants

The 393 participants in this study were aged between 15 and 25 (mean age 21), 51% were male and 49% were female. They were part of the non-professional work force in Melbourne and included tradespeople and labourers, clerical and administrative workers and sales assistants. They were drawn from following industries: manufacturing (19%) building and construction (17%), hospitality (21%), fast food (5%), retail (21%) and hairdressing (17%). The sample used in this study was a non-random purposive sample. The specific industries were chosen to enable comparisons between old and new modes of work and to ensure a gender balance in the study.

The current high retention rates in Australian secondary schools are reflected in the fact that most of the young workers had completed Year 12 (65%). However, a substantial minority (17%) had left school by Year 10. Forty-three per cent had completed a post-school qualification: 20% had completed a technical and further education (TAFE) certificate, 5% had completed an apprenticeship, 7% held a diploma and 6% had a degree.

Most of the young workers had been with their present employer for a relatively short period of time. Thirty-eight per cent had been with their company for less than a year and 64% had been with their company for less than two years. A substantial minority (16%) had experienced unemployment in the previous 12 months. One in five of the participants worked part time (21%).

Procedure

In 1999, young workers from 29 companies and four training institutions participated in the study. Workplace representatives and union officials, including human resource managers and occupational health and safety officers, were approached by telephone and then sent information about the project. In addition, advertisements targeting young workers and containing information about the project were posted.

The participants completed a self-administered questionnaire that took about 30 minutes to answer. The majority of the young workers filled in the survey in their workplaces (39%) or training institutions (34%), while 28% responded to an advertisement at their workplace and returned the questionnaire by mail. In the workplaces and training institutions, procedures were put in place to ensure that the survey was confidential. Further details of the methodology can be found elsewhere (Lindsay 1999).

Measures and analysis

Participants were asked to indicate how many standard drinks they usually have on a day when they drink. The response categories ranged from 1 (never drink alcohol) to 7 (13 or more drinks). In the questionnaire a "standard drink" was described as "a small glass of wine or a pot of beer, a nip of spirits or a mixed drink". This variable was re-coded in line with National Health and Medical Research Council guidelines (1996) as follows: participants who did not drink were coded as "Non drinkers", women who drank one to two drinks and men who drank one to four drinks were coded as "Low risk level of drinking", women who drank three to four drinks and men who drank five to six drinks were coded as "Hazardous levels of drinking" and women who drank five or more drinks and men who drank seven or more drinks were coded as "Harmful levels of drinking".

As discussed later in the paper, two important interrelated factors that have an influence on risk-taking are gender and industry type. These factors have been kept separate in the analysis because some industry groups are dominated by one gender and, within a sample of this size, the comparison groups would be too small for analysis.

Alcohol consumption

Alcohol consumption is a normative part of Australian life -- the majority of adults drink alcohol. Since the beginning of the 1990s, consumption rates have been rising, and regular rather than occasional use has also increased (AIHW 1999). The high consumption rates of Australians are reflected in our health statistics. Alcohol is a major factor in drug-related deaths and hospitalisations with the primary causes of these being cirrhosis of the liver, strokes and motor vehicle accidents (AIHW 1999).

Given that alcohol has such a large place in our society, it is not surprising that young people tend to view alcohol use as a right of passage into adulthood (Farringdon, McBride & Midford 2000). Some research has also found that the majority of young people drink to get drunk quickly (Farringdon, McBride & Midford 2000). Drinking tends to be a social activity and consumption levels vary between different settings. For young people under the legal drinking age, large group settings outside the home with no older adults present are associated with high levels of alcohol consumption (Mayer et al. 1998; Knibbe, van de Goor & Drop 1993; Connolly et al. 1992).

In this study, excessive alcohol consumption was found to be a major health issue. More young workers drank and more drank excessively than their contemporaries in the general population (AIHW 1999). The vast majority of young people in the study consumed alcohol (94%). Although the frequency of drinking varied, 60% were regular drinkers, consuming alcohol at least once a week (see Figure 1).

The quantity of alcohol usually consumed by the young workers on any one occasion is a source of concern. Among those who did drink, almost half the young men (49%) were consuming harmful levels of alcohol every time they drank. The young women were not far behind with 41% consuming harmful levels of alcohol every time they drank (see Figure 2). These levels of consumption by the young men are substantially higher than the national average of people in this age group, while consumption by the young women is similar to the national average (AIHW 1999). Of the young men in this study, one in five were drinking 13 or more drinks every time they drank. This is almost double the amount considered harmful by the NHMRC. Many of the current drinkers were binge drinking regularly. Forty per cent of the young men and 29% of the young women were drinking at harmful levels once a week or more.

There were marked differences in alcohol consumption according to which industry young people worked in (see Table 1). Alarming numbers of young people working in manufacturing, building and hairdressing were consuming harmful levels of alcohol when they drank. By contrast, fewer of those working in retail, fast food and other service industries were drinking at harmful levels. Surprisingly, young people working in hospitality demonstrated the most responsible levels of drinking. Twenty-two per cent drank at harmful levels but over half (56%) consumed low-risk amounts when they drank.

Smoking

Tobacco plays a lesser role in Australian culture than alcohol, but for those who smoke, it remains a serious health issue. Unlike alcohol consumption, there are no safe levels of tobacco consumption and smoking is the most common cause of drug-related deaths and hospitalisations in Australia. Over one-quarter of Australian adults currently smoke (AIHW 1999, p.12). It is a concern that young workers in this study smoked tobacco at much higher levels than the rest of the population. Almost half of the young workers in this study were current smokers and one in five smoked more than 10 cigarettes per day (see Figure 3). Similar proportions of men and women were current smokers. Fifty per cent of the young men and 49% of the young women were current smokers. However, the young men tended to smoke larger amounts than the young women. Almost one quarter (24%) of the young men smoked more than 10 cigarettes per day compared with 16% of the young women. One in three of the young workers had never smoked; this included 37% of the young men and 33% of the young women.

As with alcohol consumption, there were marked differences between the industries. More of the young people working in hairdressing and building (71% and 60% respectively) were smokers in comparison with their counterparts in other industries (see Table 2).

Illicit drug use

In contrast to alcohol and tobacco, illicit drug related morbidity and mortality usually affect young people rather than their older counterparts (AIHW 1999, p.19). In Australia, illicit drug use is increasing, particularly among the young. Forty-six per cent of the population over 14 years of age have used illicit drugs at some stage in their lives and 22% have used illicit drugs recently (AIHW 1999, p.19).

Illicit drug use among the young workers in this study was as common as tobacco smoking -- 48% were current users. However, the rates of illicit drug use among these workers were similar to those of their contemporaries in the general population (AIHW 1999).

The most commonly used drug was marijuana (dope), with 67% having used it at some time in their lives and 44% currently using it. Almost one in five (18%) of the young workers smoked dope weekly or more often.

After marijuana, the most commonly used drugs were ecstasy (15%), amphetamines (13%) and LSD (11%). The drugs used less commonly were cocaine (6%) and tranquillisers (5%). As with the general population of young people, heroin use was relatively uncommon. Five per cent of the young workers had tried heroin at some stage and 2% were current users (see Figure 4).

There were some gender differences with illicit drug use. The young men tended to have higher levels of current drug use, particularly marijuana use. These gendered patterns are similar to those found in the general population of young people (AIHW 1999). Of the young men participating in the survey, 73% had used illicit drugs at some time in their lives compared with 68% of the young women. The gender gap widens with current drug use. Fifty-four per cent of the young men and 43% of the young women were current users of illicit drugs (P=0.05). Half of the male workers were current users of dope in comparison with 38% of the female workers (P<0.05). The pattern of young men using drugs at slightly higher levels than the young women was repeated with the other drugs, including amphetamines and LSD.

There were marked industry differences with rates of drug experimentation. Those working in hairdressing and building were more likely than other young workers to have tried illicit drugs and be currently using illicit drugs (see Table 3). This pattern is repeated with current marijuana use (see Table 4). Fewer young workers in the retail and hospitality industries used drugs than their counterparts in other industries.

Sexual practices

The majority of young workers participating in this survey were sexually active. It is encouraging that half of the young workers reported using condoms during their last sexual encounter. This indicates that condom use is slowly becoming the norm among this population. However, the flip side is that half of the young workers did not use a condom and put themselves at risk of contracting an STD. Moreover, a substantial minority used ineffective or no protection against either STDs or unwanted pregnancies. In general, the young men engaged in more risk-taking behaviour than the young women. The young men reported having more sexual partners in the previous year and more casual partners than the young women.

Sexual experience

Most of the young workers (94%) were sexually active. The definition of sexually active in this study included those who had had "straight intercourse" (penis and vaginal intercourse), those who had given and/or received oral sex and those who had had anal sex. The most common sexual practice was straight intercourse (90% had experienced this) but most had also practised oral sex (88%). Of high relevance to HIV prevention, is the finding that almost one-quarter of the young workers had engaged in anal sex (24% in total, includes 27% of young men and 22% of young women).

Sexual attraction and sexual identification

More than eight in 10 of the young workers were sexually attracted only to people of the opposite sex, but a significant minority (17%) were not exclusively heterosexual in terms of their feelings of sexual attraction. Nine per cent were attracted to people of their own sex, 5% were attracted to both males and females and 3% were unsure about their feelings of sexual attraction. In comparison to younger samples of high school students, more of the young workers were not exclusively heterosexual in terms of sexual attraction (17% of young workers in comparison to 9% of secondary students) (Lindsay, Smith & Rosenthal 1997, p.27).

When asked about sexual identity, a larger majority of the young workers defined themselves as heterosexual (93%), while 3% identified as bisexual, 2% identified as homosexual and 2% were unsure. When it came to actual sexual practices, the sexually active young men were more likely to report same-sex sexual contact than the young women. In the previous year, 6% of the men had sex with men only and 2% had sex with both men and women, whereas only 2% of the women had sex with women only and 3% had sex with both women and men.

Sexual partners, condom use and contraceptive use

Half of the sexually active young workers had one sexual partner in the previous year but a substantial minority (32%) had three or more sexual partners in the previous year (see Fig. 5). The young women reported having fewer sexual partners than the young men. Forty-two per cent of the young men compared with 21% of the young women had three or more sexual partners in the previous year (P<0.01).

There were some industry differences in reported numbers of sexual partners in the previous year. Those working in manufacturing and building had more sexual partners in the previous year than those working in hospitality and retail (see Table 5). However, there were no significant industry differences in other sexual practices such as condom use.

In terms of STD prevention and contraception, the findings are encouraging. From a list of possible forms of contraception and STD prevention, almost 60% indicated that they usually used condoms and almost 60% indicated they usually used the pill. However, it is unclear what proportion usually used both methods simultaneously and what proportion is indicating they usually used either one method or the other. Alternative methods of contraception such as the diaphragm, the morning-after pill and the rhythm method were rarely used (2%). A substantial minority of the young workers put themselves at risk of sexually transmitted disease and/or unwanted pregnancy by usually practising withdrawal (18%) or no form of protection at all (6%).

The most recent sexual encounter

Specific questions about the most recent sexual encounter offer more detailed and more reliable data on sexual practices than general questions on usual practices.

Many of the young workers had sex with casual partners. In their most recent sexual encounter, almost 15% of the young workers had sex with someone they had just met, 25% had sex with someone they had known for a while and over 60% had sex with a steady or regular partner. The young men were more likely to report having sex the last time with someone they had just met than the young women (20% compared with 6% respectively P<0.01). Furthermore, the men were more likely than the women to report being drunk the last time they had sex (33 % compared with 21% respectively P<0.05). However, perhaps in response to these risks, the young men were more likely than the young women to report using a condom on their last sexual occasion (56% compared with 41% P<0.01).

Here too, in terms of STD prevention, the results are reasonably encouraging. Almost 50% of the young workers used condoms or both condoms and the pill the last time they had sex. The condom and the pill were equally popular as forms of protection against STDs and/or unwanted pregnancy. Almost one in three used condoms and almost one in three used the pill the last time they had sex. Interestingly, 17% of the young workers were cautious and simultaneously used the condom and the pill during their last sexual encounter. At the other end of the scale, a substantial minority (16%) used withdrawal or no protection at all, putting themselves at high risk of both STDs and unwanted pregnancy (see Table 6).

Implications

Limitations of the study

This was a relatively small-scale project using a purposive (non-representative) sample from the Melbourne area. While the results are highly suggestive, they cannot be used to generalise about other workers in these industries or in other geographic locations. A large-scale survey with a random and representative sample from a broader range of industries would provide useful public health information for practitioners, employers and unions. A larger scale survey would also provide the opportunity to do more complex analysis on causal pathways. Nevertheless, the results of this survey do provide useful information.

Gender and risk-taking

The results suggest that many of the young men in this study subscribe to a toxic, risk-taking version of masculinity. Half of the young men drank harmfully, half smoked more than 10 cigarettes a day and more than half were current users of illicit drugs. The young men were more likely than the young women to have multiple sexual partners, have sex with casual partners and be drunk the last time they had sex. However, mitigating these risks was the young men's higher reported rates of condom use. These results suggest health promotion programs that address the connections between masculinity and risk-taking would be worthwhile.

However, young women and the ways in which femininity shapes risk-taking should not be neglected. Like their male counterparts, a significant minority of young women were engaging in risk-taking practices. It has been well documented that women are more vulnerable than men to the physical harms of alcohol, and that women who drink excessively are likely to be damaged more quickly (Broom 1995). Moreover, women are likely to suffer as partners of men who are taking risks in their social lives.

In relation to sexual health, it is a concern that fewer young women than young men used condoms. The difficulties that young women face in negotiating safe sex have been well documented. Young women generally have less power than men in heterosexual encounters and are further constrained from insisting on condom use through pressure to appear sexually naive and protect their sexual reputations (Moore, Rosenthal & Mitchell 1996; Hillier, Harrison & Warr 1998; Holland et al. 1992).

Workplaces, socialising and health risks

In this research, work cultures were connected to particular patterns of socialising and drug and alcohol consumption patterns. The positive side of this finding is that work cultures could be used for targeting health promotion and intervention.

More of the workers in building and hairdressing were taking risks in their social lives than their counterparts in other industries. The majority of builders smoked tobacco, consumed alcohol at harmful levels and used illicit drugs, particularly marijuana. Moreover, these young workers were more likely than others to have three or more sexual partners in the previous year. Similar patterns were found in the female-dominated industry of hairdressing -- the majority of hairdressers were smokers, consumers of harmful levels of alcohol and current illicit drug users. However, they were having sex with fewer sexual partners than the builders.

Anecdotally, building and manufacturing are male-dominated industries with heavy drinking cultures. The practice of large groups of young men drinking together and going in "shouts" increases the likelihood of heavy drinking. With "shouts", each drinker is obliged to keep up with the fastest and heaviest drinker in the group (Barbara, Usher & Barnes 1978). A national health survey carried out by the ABS in 1989-90 found that men working in building and construction were among the highest consumers of alcohol (Hagan & Egan 1992). In contrast, hairdressing, with its concern with beauty and body image, is anecdotally associated with a party culture. More research is needed to investigate why workers in these industries are making these choices and whether these patterns hold in a representative national sample of young people.

The finding that hospitality workers were the most responsible drinkers was surprising given their close association with alcohol at work. However, the nature of the work with its long and unsociable hours and exposure to intoxicated people may discourage these young people from consuming to excess. Alternatively, the lower consumption levels of these hospitality workers may be a product of sample selection. Most of the participants in the sample from this industry were drawn from large unionised businesses such as exclusive hotels where, although the young people are paid low wages, they may be an ambitious and career-oriented group. Workers in other sections of the hospitality industry, such as small restaurants and public hotels, may consume alcohol and drugs at different levels. The national health survey carried out in 1989-90 found that men working in restaurants, hotels and clubs were among the highest consumers of alcohol (Hagan & Egan 1992).

Conclusion

The findings from this research clearly demonstrate that young non-professional workers face particular health risks in their social lives. The high levels of alcohol and tobacco consumption among young workers require urgent attention. Moreover, the substantial minority of young workers who use no protection against either STDs or unwanted pregnancies are risking their sexual health. There is a need for further research to explain why these risk-taking practices are so prevalent among young workers. The qualitative stage of this project currently under way will explore the experiences of young people in the hairdressing and building industries in greater depth. The results reported here suggest that targeting public health promotion toward different work cultures and tailoring messages to women and men independently would be useful.

At a broader level, we need to work on making the transition to independent adulthood an easier one for young people. Policies and programs directed at reducing relationship and labour market insecurities would alleviate much of the stress that underlies harmful drug, alcohol and tobacco consumption, and sexual risk-taking.

XTRA

* For more information about the Australian Research Centre in Sex, Health and Society, and its publications, see their web site at: http://www.latrobe.edu.au/arcshs/

* The Dusseldorp Skills Forum produces a range of publications concerned with young people, education and work. A recent publication by Richard Curtain, How Young People are Faring, Key Indcators 2001, provides an update on the learning and work situation of young Australians. Publications can be downloaded from the Dusseldorp web site at: www.dsf.org.au

* The 1998 National Drug Strategy Household Survey: Detailed findings is available online at The Australian Institute of Health and Welfare's web site at: http:// www.aihw.gov.au/publications/health/ ndshs98d/index.html

Other AIHW publications include: Statistics on Drug Use in Australia 1998 at: http:// www.aihw.gov.au/publications/health/sdua9 8/index.html; and Australia's Young People - their health and wellbeing 1999 at: http://www.aihw.gov.au/publications/health/ ayp99/index.html#s02

* The NHMRC publishes a number of resources on drug and substance abuse including the Australian Alcohol Guidelines: Health Risks and Benefits, which is available at: http://www.health.gov.au/nhmrc/ publications/synopses/ds9syn.htm

Table 1: Current drinkers:Alcohol
consumption and risk level by industry

Industry            Low risk   Hazardous   Harmful

Manufacturing         34%         14%        52%
Building              24%         15%        61%
Hospitality           56%         22%        22%
Retail, fast food
  and other           27%         34%        39%
Hairdressing          16%         24%        60%
% total sample        32%         23%        45%

N=363 P<0.01
Table 2: Tobacco use by
industry

Industry            Current smokers

Manufacturing             45%
Building                  59%
Hospitality               43%
Retail, fast food
  and other               38%
Hairdressing              71%
% total sample            50%

N=390 P<0.01
Table 3: Industry and drug use

Industry              Have used         Currently
                    illicit drugs *   using illicit
                                        drugs **

Manufacturing             65%              41%
Building                  76%              68%
Hospitality               62%              43%
Retail, fast food
  and other               68%              40%
Hairdressing              83%              59%
% total sample            70%              48%

N=369 * P<0.05 ** P<0.01
Table 4: Industry and current
use of marijuana

Industry               Current
                    marijuana user

Manufacturing            38%
Building                 62%
Hospitality              38%
Retail, fast food
  and other              37%
Hairdressing             52%
% total sample           44%

N=375 P<0.01
Table 5: Industry and number of
sexual partners in previous year

Industry            One sexual    Three or more
                     partner     sexual partners

Manufacturing           49%            36%
Building                19%            57%
Hospitality             60%            27%
Retail, fast food
  and other             66%            23%
Hairdressing            44%            23%
% total sample          50%            32%

N=326 P<0.01
Table 6: Protection used in
last sexual encounter

Form of protection   Percentage

Condom                  32%
Pill                    31%
Condom and pill         17%
Condom and
  withdrawal             3%
Withdrawal               7%
Other protection         1%
No protection            9%

Total N=314            100%
Figure 1: Frequency of drinking

                    Percentage

Never drink             6
Less than monthly      12
Monthly                 5
2-3 days/month         17
Weekly                 27
2-3 days/week          25
4-6 days/week           5
Daily                   3

Note: Table made from bar graph.
Figure 2: Quantity of alcohol consumed
on any one occasion by category

                 Percentage

         Low risk   Hazardous   Harmful

Male       36%         15%        49%
Female     28%         31%        41%

Note: Table made from bar graph.
Figure 3: Tobacco use

Non-smoker                          51%
Occasional smoker                   13%
Regular smoker (up to 10 per day)   16%
Regular smoker (11-20 per day)      15%
Regular smoker (over 20 per day)     5%

Note: Table made from pie chart.
Figure 4: Current illicit drug use

                 Percentage

Marijuana            44
Ecstacy              15
Amphetamines         13
LSD                  11
Cocaine               6
Tranquillisers        5
Heroin                2

Note: Table made from bar graph.
Figure 5: Number of sexual partners in
previous year

              Percentage

0 partners        3
1 partner        50
2 partners       14
3+ partners      32

Note: Table made from bar graph.

Acknowledgments

I am grateful to Doreen Rosenthal for her comments on a previous draft of this paper. This project is funded by a postdoctoral fellowship from the National Medical Research Council.

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Jo Lindsay is a Research Fellow at the Australian Research Centre in Sex, Health and Society. Her research interests include youth, health and family research.