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Status of the 1990 Objectives on Misuse of Alcohol and Drugs
Nineteen of the 226 health objectives for the nation published in 1980 (1,2) concern alcohol and drug misuse. As part of an ongoing series of Public Health Service progress reviews, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) and representatives of collaborating agencies recently reported on the status of the 13 high-priority objectives in this area.
Progress toward achieving these objectives is encouraging, although results of the 1986 survey of high school seniors (3) revealed some areas of concern. Trends in students' self-reported use of marijuana, amphetamines, heroin, and sedatives have continued downward (Table 1). Despite this generally positive trend, however, special efforts are needed to reduce cocaine use, alcohol consumption, cigarette smoking, and binge drinking among students. In addition, continued attention to alcohol and drug problems among adults is necessary to further reduce the incidence of fetal alcohol syndrome (FAS), prescription drug abuse, and cirrhosis mortality.
ADAMHA reviewers identified three areas that need improvement if the 1990 objectives on alcohol and drug misuse are to be met: 1) the conversion of attitudes and beliefs into behavioral changes, 2) the improvement and expansion of surveillance systems and epidemiologic studies to identify populations at greatest risk, and 3) the ability to identify and monitor the introduction of new substances such as crack and controlled substance analogues and to determine their consequences quickly.
At present, five of the 13 objectives are likely to be achieved by 1990. Three of the remaining eight are progressing, but may not be achieved by 1990. National data are inadequate to predict the outcome for two of the objectives, and three are unlikely to be met. All 13 objectives are presented below, along with a status report:
Reduce annual fatalities from alcohol-related motor vehicle crashes to less than 9.5 per 100,000 U.S. population. In 1977, there were 11.5 such fatalities per 100,000 population. By 1984 and 1985, there were 9.5 per 100,000. This objective has been met. ADAMHA continues to work closely with the National Highway Traffic Safety Administration to increase national awareness of risks associated with driving after drinking. The midcourse review issued by the Office of Disease Prevention and Health Promotion (4) also recommends intervention programs for impaired drivers who could become repeat offenders.
Reduce the annual cirrhosis mortality rate to 12 per 100,000 population. In 1978, the cirrhosis mortality rate was 13.5 per 100,000 population. By 1984, the rate had declined to 11.6 per 100,000. This objective has been met, largely because of the recent decline in per capita consumption of alcoholic beverages. However, cirrhosis rates for races other than white are substantially above those for whites, and it is unlikely that these rates will drop to 12 per 100,000 by 1990.
Per capita alcohol consumption should not exceed current levels. In 1978, absolute alcohol was consumed at 2.71 gallons per person by those 14 years of age or older. By 1984, absolute alcohol was being consumed by this age group at 2.65 gallons per person. This objective is currently being achieved for a variety of reasons, including changing lifestyles and heightened awareness of the health- and safety-related risks of alcohol consumption.
More than 90% of women of childbearing age should be aware of risks associated with drinking during pregnancy, in particular, the fetal alcohol syndrome. In 1979, 73.0% of such women were aware of these risks. In 1985, 88.0% were aware. Achievement is likely by 1990. ADAMHA has launched a public and professional education campaign, beginning with FAS Awareness Week.
Proportion of workers in major firms providing an employee assistance program (EAP) for substance abuse should exceed 70%. In 1976, 50.0% of a sample of Fortune 500 firms provided such EAPs. By 1979, the number of firms offering EAPs increased to 57%. According to knowledgeable professionals, most Fortune 500 firms are realizing the benefits of EAPs and worksite wellness programs.
The proportion of 12- to 17-year-olds who abstain from alcohol or other drug use should not fall below 1977 levels. In 1977, 69.0% of persons in this age group reported abstaining from alcohol; 83.9% reported abstaining from marijuana; and 99.9%, from heroin. In 1982, 73.1% reported abstaining from alcohol; 88.5%, from marijuana; and 99.5%, from heroin. In 1985, 69.0% reported abstaining from alcohol. There has been progress in discouraging marijuana use; however, stronger public education and prevention efforts are needed to improve the rates of abstinence from alcohol.
The proportion of 18- to 25-year-olds reporting frequent use of nonalcoholic drugs should not exceed the 1977 level. In 1977, 18.7% of persons in this age group used marijuana frequently; less than 1.0% used other drugs frequently. In 1985, 10.5% reported using marijuana frequently, and 1.8% reported frequent use of other drugs. The increase in the proportion of those using other drugs probably reflects the concentration of cocaine users in this age group. The National Institute on Drug Abuse has initiated a program designed to prevent the progression from early drug use to cocaine use.
The proportion of 12- to 17-year-olds reporting frequent use of nonalcoholic drugs should not exceed the 1977 level. In 1977, 9.0% of persons in this age group reported using marijuana frequently; less than 1.0% reported using other drugs frequently. In 1985, 4.4% reported using marijuana frequently, and 1.2% reported frequent use of other drugs. Although progress has been made in reducing marijuana use, introduction of other substances such as crack and controlled substance analogues makes it difficult to assure achievement of this objective. Federal initiatives and campaigns are under way to improve public awareness of the dangers of any illicit drug use.
More than 75% of adults should be aware of the added risk of head and neck cancers associated with excessive alcohol use. Baseline data were not available; however, in 1985, 48.0% of adults were aware of the added risk of cancers associated with excessive alcohol use. To date, few public health campaigns have included explicit messages related to alcohol consumption and cancer risk. Achievement of this objective by 1990 is unlikely.
Reduce the incidence of fetal alcohol syndrome (FAS) by 25%. In 1977, the estimated incidence of FAS was 1 per 2,000 births. Currently, no national surveillance system tracks this objective. With an International Classification of Diseases Code now available for FAS and with the increasing awareness of physicians, the apparent incidence of FAS may increase, even though the actual number of cases may decrease. Awareness efforts noted in the midcourse review include the "Healthy Mothers, Healthy Babies Coalition."
Reduce drug-related mortality to 2 per 100,000 per year. In 1978, there were 2.7 such deaths per 100,000. By 1984, drugs other than alcohol were responsible for 3.3 deaths per 100,000. Current data are too inclusive to meaningfully reflect the results of education and intervention efforts. However, data from the Drug Abuse Warning Network, which is based on hospital emergency room and medical examiner reports from 26 major U.S. cities, suggest that prevention efforts should focus on cocaine use and on the use of alcohol in combination with other drugs.
The proportion of 14- to 17-year-olds reporting acute drinking-related problems in the past year should be reduced to below 17%. In 1978, an estimated 19.0% of adolescents reported such problems. In 1985 and 1986, 37.0% of high school seniors reported consuming five or more drinks at a time at least once in the 2 weeks before the survey. Widespread acceptance of alcohol use and related availability restricts substantial progress on this objective, and achievement is unlikely.
Eighty percent of high school seniors should say they perceive great risk associated with frequent, regular cigarette smoking; marijuana use; barbiturate use; or alcohol intoxication. In 1979, 63.0% of high school seniors perceived great risk in smoking one to two packs of cigarettes daily; 42.0% perceived great risk in daily use of marijuana; 71.6%, in daily barbiturate use; and 35.0%, in alcohol intoxication. In 1986, 66.0% of high school seniors perceived great risk in smoking one or two packs of cigarettes daily; 71.3% perceived great risk in daily use of marijuana; 67.2%, in daily barbiturate use; and 39.1%, in alcohol intoxication. Achievement of this objective by 1990 is unlikely. To increase awareness of the risks associated with alcohol intoxication, ADAMHA has initiated the "Be Smart, Don't Start--Just Say No" campaign aimed at 8- to 12-year-olds. Reported by: MM Silverman, MD, R Denniston, Alcohol, Drug Abuse, and Mental Health Administration. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Public Health Svc, DHHS. Div of Environmental Hazards and Health Effects, Center for Environmental Health and Injury Control, CDC.
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