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Study flow diagram.

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Figure 1

Study flow diagram.

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Summary of findings 1. The effects of random alcohol testing (RAT) on workplace safety outcomes and adverse events

Population: Workers in positions with safety‐sensitive functions, other than commercial drivers
Intervention: RAT
Comparison: Comparing two frequencies of RAT, 25% or 10% of the workforce annually

Outcomes

Assumed risk

Corresponding risk

Relative effect

No. of random tests

(studies)

Quality of the evidence

(GRADE)

Comments

Rate of positive results found by RAT among airline employees in the USA

Random tests were conducted by certified technicians using National Highway Traffic Safety Administration approved devices according to the US Department of Transportation Procedures for Transportation Workplace Drug Testing Programs (Department of Transportation (US) 2019). A positive result was defined as a test result where a blood alcohol concentration was ≥ 0.04%, or when a worker refused to be tested.

Testing data were retroactively provided by the US Federal Aviation Administration (FAA) to the study authors some time after 2002, the final year of the study's data.

Rate of positive results found in FAA‐regulated aviation personnel performing safety‐sensitive functions from 1995 to 1997 (25% of workplace required to be tested) was 0.07%.

Rate of positive results found in FAA‐regulated aviation personnel performing safety‐sensitive functions from 1998 to 2002 (10% of workplace required to be tested) was 0.11%.

59.7%

511,745 random tests

(1 study)

Very lowa

When the review authors re‐analysed the results, they found a statistically significant increase (estimated change in level: 0.040, 95% CI 0.005 to 0.07; P = 0.031)

Fatal injuries — not measured

‐

‐

‐

‐

‐

No data reported for this outcome in the included study

Non‐fatal injuries — not measured

‐

‐

‐

‐

‐

No data reported for this outcome in the included study

Non‐injury accidents — not measured

‐

‐

‐

‐

‐

No data reported for this outcome in the included study

Absenteeism — not measured

‐

‐

‐

‐

‐

No data reported for this outcome in the included study

Adverse events associated with RAT — not measured

‐

‐

‐

‐

‐

No data reported for this outcome in the included study

Summary of findings table created with guidance from Chapter 14, Section 14.1 of the Cochrane Handbook of Systematic Review of Interventions (Higgins 2020) and Ryan 2016b.

Abbreviations

FAA: United States Federal Aviation Administration

RAT: random alcohol testing

Grade assessment: the evidence quality began at a 'low' rating, as the included study was non‐randomised. The evidence was further downgraded because of a rating of 'serious' for indirectness. This judgement of 'serious' was given because: only two random testing regimes (10% and 25%) were investigated; only one industry was investigated; only random alcohol testing was evaluated; and the comparison of one random testing regime against another is not as high quality as comparing a random testing regime against no random testing regime.

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Summary of findings 1. The effects of random alcohol testing (RAT) on workplace safety outcomes and adverse events
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Table 1. Logic model

Context

  1. Company characteristics:

    1. size

    2. location

    3. industry

    4. organisational climate

  2. Job characteristics:

    1. types of positions

    2. work content

  3. Employee characteristics:

    1. socioeconomic status

    2. age

    3. sex or gender

    4. tobacco smoking

    5. previous history of addiction or substance use disorder(s)

Inputs

Intervention

Intermediate outcomes

Longer‐term outcomes

  1. Identification of need for RDAT:

    1. safety‐sensitive work

    2. demonstrated drug and/or alcohol problem in the workplace

    3. desire to reduce workplace injuries and accidents

  2. Resources (supplies, personnel, monetary)

  1. Testing:

    1. number of tests completed

    2. number of positive test results

    3. number and percentage of employees tested

    4. schedule of testing

  2. Service provision:

    1. employee assistance program

    2. drug and alcohol education

    3. drug and alcohol treatment

  3. Data collection:

    1. fatal injury rate

    2. non‐fatal injury rate

    3. non‐injury accident rate

    4. absenteeism

    5. adverse events associated with RDAT

  1. Deterrence of use or nonuse related to:

    1. punitive action (discipline, sanction, or discharge penalties);

    2. rehabilitative action (receiving treatment for an addiction or substance use disorder);

    3. receiving accommodations for substance use as a disability

  1. Injuries:

    1. changes in fatal injury rate

    2. changes in non‐fatal injury rate

    3. changes in non‐injury accident rate

  2. Changes in rate of absenteeism

  3. Adverse events associated with RDAT

Abbreviation

RDAT: random drug and alcohol testing
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Table 1. Logic model
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Table 2. Reasons for exclusion

Reason for exclusion

Excluded studies

Ineligible study design

Buchanan 1988; Carpenter 2007; Crouch 1989; DuPont 1995; Elliott 2006; Fitzsimons 2008; Fox 2014; French 2004; Li 2010; Li 2011; Maretha 2016; Marques 2014; McFadden 1997; Miller 2007; Ozminkowski 2003; Price 2012; Price 2014a; Price 2014b; Price 2015; Price 2016; Schofield 2011; Schofield 2013; Vignali 2013

Primary research not reported

Carlton 2004; Grabowski 1989

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Table 2. Reasons for exclusion
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Table 3. National occupational classifications of employees in Li 2007

Occupation

Broad occupational category (BOC)

BOC code

Unit group title

Unit group code

Flight crew

Natural and applied sciences and related occupations

2

Air pilots, flight engineers and flying instructors

2271

Flight attendants

Sales and service occupations

6

Pursers and flight attendants

6522

Flight instructors

Natural and applied sciences and related occupations

2

Air pilots, flight engineers and flying instructors

2271

Aircraft dispatchers

Natural and applied sciences and related occupations

2

Air traffic controllers and related occupations

2272

Maintenance personnel

Natural and applied sciences and related occupations

2

Aircraft instrument, electrical and avionics mechanics, technicians and inspectors

2244

Aviation screeners

Trades, transport and equipment operators and related occupations

7

Aircraft mechanics and aircraft inspectors

7315

Ground security co‐ordinators

Sales and service occupations

6

Security guards and related security service occupations

6541

Air traffic controllers

Natural and applied sciences and related occupations

2

Air traffic controllers and related occupations

2272

The occupations listed have been classified according to Canada’s National Occupational Classification (Statistics Canada and ESDC 2018).

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Table 3. National occupational classifications of employees in Li 2007
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Table 4. Results from re‐analysis of Li 2007

Pre‐int level (SE)

Change level (SE)

Estimated change in level

95% Confidence interval

P value

Pre‐intervention slope (SE)

Change slope (SE)

Estimated change in slope

95% Confidence interval

P value

0.067 (0.011)

0.040 (0.013)

0.040

0.005 to 0.075

0.031

0.051 (0.019)

‐0.0057 (0.0063)

‐0.006

‐0.022 to 0.010

0.41
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Table 4. Results from re‐analysis of Li 2007
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