title: Evaluation of work-based screening for early signs of alcohol-related liver disease in hazardous and harmful drinkers: the PrevAIL study.
abstract: BACKGROUND
  The direct cost of excessive alcohol consumption to health services is substantial but dwarfed by the cost borne by the workplace as a result of lost productivity. The workplace is also a promising setting for health interventions. The Preventing Alcohol Harm in Liverpool and Knowsley (PrevAIL) project aimed to evaluate a mechanism for detecting the prevalence of alcohol related liver disease using fibrosis biomarkers. Secondary aims were to identify the additive effect of obesity as a risk factor for early liver disease; to assess other impacts of alcohol on work, using a cross-sectional survey.
  
  
  METHODS
  Participants (aged 36-55 y) from 13 workplaces participated (March 2011-April 2012). BMI, waist circumference, blood pressure and self-reported alcohol consumption in the previous week was recorded. Those consuming more than the accepted UK threshold (men: >21 units; female: >14 units alcohol) provided a 20 ml venous blood sample for a biomarker test (Southampton Traffic Light Test) and completed an alcohol questionnaire (incorporating the Severity of Alcohol Dependence Questionnaire).
  
  
  RESULTS
  The screening mechanism enrolled 363 individuals (52 % women), 39 % of whom drank above the threshold and participated in the liver screen (n = 141, complete data = 124 persons). Workplaces with successful participation were those where employers actively promoted, encouraged and facilitated attendance. Biomarkers detected that 30 % had liver disease (25 %, intermediate; 5 % probable). Liver disease was associated with the frequency of visits to the family physician (P = 0.036) and obesity (P = 0.052).
  
  
  CONCLUSIONS
  The workplace is an important setting for addressing alcohol harm, but there are barriers to voluntary screening that need to be addressed. Early detection and support of cases in the community could avert deaths and save health and social costs. Alcohol and obesity should be addressed simultaneously, because of their known multiplicative effect on liver disease risk, and because employers preferred a general health intervention to one that focused solely on alcohol consumption.
authors.affiliation: School of Health Sciences, University of Salford, Salford, UK. p.a.cook@salford.ac.uk.
authors.forename: Penny A
authors.initials: PA
authors.lastname: Cook
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Liverpool, UK. m.j.morleo@ljmu.ac.uk.
authors.forename: Michela
authors.initials: M
authors.lastname: Morleo
authors.affiliation: School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK. d.billington@ljmu.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Billington
authors.affiliation: Greater Manchester Public Health Network, Manchester, UK. kevinrvs1@gmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sanderson-Shortt
authors.affiliation: Faculty of Health Education and Community, Liverpool John Moores University, Liverpool, UK. C.Jones2@ljmu.ac.uk.
authors.forename: Colin
authors.initials: C
authors.lastname: Jones
authors.affiliation: Health Services Research, University of Liverpool, and Brownlow Health, Liverpool, UK. M.B.Gabbay@liverpool.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Gabbay
authors.affiliation: Clinical Hepatology, University of Southampton, Southampton, UK. nick.sheron@soton.ac.uk.
authors.forename: Nick
authors.initials: N
authors.lastname: Sheron
authors.affiliation: College of Health and Behavioural Sciences, Bangor University, Gwynedd, UK. m.a.bellis@bangor.ac.uk.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Penelope.Phillips-Howard@lstmed.ac.uk.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.affiliation: University of Liverpool, Liverpool, UK. I.Gilmore@liverpool.ac.uk.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Gilmore
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D000437:Alcoholism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D015415:Biomarkers; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016272:Occupational Health; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D017132:Workplace
chemical_list: D015415:Biomarkers