台灣體力勞工飲用含咖啡因酒精性飲料之健康影響與社會脈絡

Health Effects and Social Context of Caffeinated Alcoholic Beverage Drinking in Manual Workers of Taiwan

鄭婉汝(Wan-Ju Cheng)

指導教授 ： 鄭雅文

國立臺灣大學/公共衛生學院/健康政策與管理研究所/博士(2015年)

https://doi.org/10.6342/NTU.2015.00549

摘要

臺灣勞工朋友飲用含咖啡因酒精性飲料的歷史已超過40年，儘管政府採取廣告內容管制、加註警語、及限制販售地點等管理政策，此類飲用行為卻仍盛行於勞力工作者間。在歐美國家，含咖啡因的提神飲料銷售快速增加，且大學生在娛樂場合中混合酒精及提神飲料以增加飲酒量及酒精作用的行為，引起了是否對健康不利的疑慮。美國食品藥物管理局在2010年認定4款含咖啡因酒精性飲料不符安全規範故不可販售。在臺灣，規律飲用含咖啡因的酒精性飲料的勞工朋友中，有六成於工作前或工作中飲用，其飲用之情境與歐美國家的飲用者有所不同，而帶來的健康風險也未曾被探討。
本研究利用實驗方法檢驗臺灣含咖啡因酒精性飲料對主觀感受、認知及運動功能的影響，並利用深度訪談分析臺灣勞工朋友在職場飲用含咖啡因酒精性飲料的脈絡因素。
在實驗研究中，共收集了29位沒有飲酒習慣的30到38歲男性，每一位以隨機的順序接受4次實驗，每次飲用1種飲料:含咖啡因酒精性飲料、酒、含咖啡因提神飲料、及安慰劑。飲用後受試者接受主觀感受評量、認知測驗及運動功能測驗。利用混合設計變異數分析，檢驗4種飲料飲用後的差異。在質性研究中，共訪談了28位受訪者，其中包含三位小雇主及三位工地主任。
研究結果發現酒精引起顯著的運動功能缺損，且無法被咖啡因抵消。咖啡因使得認知反應變快，酒精則沒有影響。在深度訪談中發現慢性肝病及酒精成癮是習慣性飲用含咖啡因之酒精性飲料的勞工朋友們最主要的顧慮。勞工朋友在上班中飲用含咖啡因之酒精性飲料的行為非常普遍，每人每天飲用的純酒精量在24至96毫克間；多半是共同飲用，飲用的動機是提神、增加體力、社交、及強身。飲用含咖啡因之酒精性飲料的脈絡因素包含酷熱、登高、長工時等的工作環境；職場酒精管理不良而導致工作者在工作時飲用的因素則包括不利的雇用條件如臨時雇用、按日或按件計酬、雇主本身對酒精之危害相關知識不足、及工作發包者的規模較小及屬於私部門。最後，勞力職場人力不足、酒駕政策、及職場文化也會影響職場含咖啡因酒精性飲料的飲用行為。就目前含咖啡因酒精性飲料政策而言，勞工朋友認為對其飲用行為影響不大，但職場飲酒管理措施就會影響其飲用行為。
總而言之，飲用含咖啡因酒精性飲料對台灣勞工的可能健康影響，在於初期飲用者的受傷風險，與長期飲用後的慢性肝病及酒精成癮。由於職場飲酒管理是影響台灣受雇勞工飲用含咖啡因酒精性飲料的重要因素，因此應採取針對職場脈絡因子來介入的管理措施，以維護勞工職業安全與健康。

關鍵字

含咖啡因之酒精性飲料 ； 職場 ； 脈絡 ； 健康

並列摘要

Background: Caffeinated alcoholic beverages (CABs) have been popular among Taiwanese manual workers for more than 40 years. CABs are often consumed in the workplace even after the government intervened by labeling alcohol strength and warning signs on the products, banning advertisements using workplace as the background and restricting their sales only in pharmacies. In European and northern American countries, the sale of caffeinated energy drinks has increased rapidly. The practice of mixing alcohol with energy drinks, mostly by college students in recreational occasions, has raised health concerns. The Food and Drug Administration of the United States announced in 2010 that four brands of CABs were considered unsafe and were therefore prohibited for sale. In contrast, a survey of employees in Taiwan showed that 60% of regular CAB drinkers drank CABs before or at work. While the drinking pattern is quite different from that in western societies, the context of CAB drinking behaviors has not been studied. Furthermore, health effects of CAB among manual workers have never been explored.
Study objectives: The first part of this study utilized experimental study design to examine the effects of CABs on workers’ subjective perceptions as well as cognitive and motor functions. In the second part of this study, in-depth interviews were conducted to examine contextual factors for CAB drinking behaviors among manual workers.
Methods: A total of 29 male non-regular alcohol drinkers aged between 30 and 38 participated in the experimental study. Study subjects were assigned to experimental trials in which the following four beverages were provided in a random order: CAB, alcohol, caffeinated energy drink and placebo. Subjective perception ratings, cognitive tasks and motor functions were evaluated after beverage consumption. Mixed-method ANOVA was used to examine the difference of tests between the 4 beverage trials. In the qualitative study, a total of 28 participants were interviewed including 3 employers, 3 worksite mangers and 22 employees.
Results: From the experimental study, it was found that alcohol caused significant motor function impairment which couldn’t be antagonized by caffeine. Furthermore, caffeine shortened study subjects’ response time in cognitive tests while alcohol had no effect. From the interviews, it was found that interviewees were most concerned of chronic liver diseases and alcohol addiction. Drinking CABs during work was common among manual workers. The drinking amount was between 24 to 96 mg of pure alcohol per day. They drank mostly collectively and drank for the purposes of energy-boosting, socializing and health restoration. Harsh working conditions including heat, high, and long work hour, and poor workplace alcohol management due to precarious employment conditions such as temporary employment and day/piece-rated pay, small-scale or private outsourcers as well as poor knowledge concerning alcohol-related hazards were found to be contextual factors for CAB drinking. In addition, a shortage of manual workforce, workplace cultures and police enforcement of drunk driving policy also influenced workplace CAB drinking behaviors. Interviewees perceived little effects from current CAB management policies but they considered workplace alcohol management more effective in changing their drinking behaviors.
Conclusion: The short-term effects to be concerned of CAB consumption are increased injury risks among beginner drinkers, and long-term effects include the risk of chronic liver diseases and alcohol dependence. Since workplace alcohol management is an important factor of CAB consumption among employed manual workers in Taiwan, interventions focused on workplace contextual factors are mandatory to promote health and safety.

並列關鍵字

caffeinated alcoholic beverage ； workplace ； context ； health

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