Health Objectives for the Nation Progress Toward Achieving the 1990 National Objectives for the Misuse of Alcohol and Drugs

Nineteen of the 1990 Health Objectives for the Nation (1) address the misuse of alcohol and other drugs. This report summarizes progress toward achieving eight of these objectives through November 1989.By 1990, fatalities from all alcohol-related motor vehicle accidents* should be re duced to less than 9.5 per 100,000 population per year.

This objective will be met. In 1988, following a general downward trend, fatalities from alcohol-related motor vehicle crashes were 9.5 per 100,000 population, compared with 11.5 per 100,000 in 1977 (National Institute on Alcohol Abuse and Alcoholism, unpublished data).By 1990, the cirrhosis mortality rate should be reduced to 12 per 100,000 per year.

This objective has been achieved. Deaths from cirrhosis of the liver declined from almost 13.5 per 100,000 in 1978 to less than 10.0 in 1986 (2).By 1990, per capita consumption of alcohol should not exceed current levels.

This objective has been achieved. Annual per capita consumption for persons aged greater than or equal to 14 years decreased from 2.7 gallons in 1978 to less than 2.6 gallons in 1987, the lowest level since 1958 (3).By 1990, the proportion of adolescents 12 to 17 years old who abstain from using alcohol or other drugs should not fall below 1977 levels.  This objective has been partially met. The proportion of alcohol abstainers among persons aged 12-17 years increased from 68.8% in 1977 to 74.8% in 1988. Marijuana abstention also increased, from 83.4% to 93.6%; however, the proportion of cocaine abstainers declined slightly, from 99.2% to 98.9% (4,5). By 1990, the proportion of young adults 18 to 25 years old reporting frequent use of other drugs should not exceed 1977 levels.

This objective has been partially met. The frequent use (i.e., greater than or equal to 5 days per month) of marijuana by young adults aged 18-25 years declined from 18.7% in 1977 to 6.9% in 1988 (6; National Institute on Drug Abuse (NIDA), unpublished data); however, frequent use of other drugs increased from less than 1.0% in 1977 to 1.3% in 1988, primarily due to the increase in the use of cocaine (6; NIDA, unpublished data).By 1990, the proportion of adolescents 12 to 17 years old reporting frequent use of other drugs should not exceed 1977 levels.

This objective has been partially met. In 1977, 8.7% of adolescents 12-17 years of age reported frequent use of marijuana, and less than 1.0% reported frequent use of drugs other than marijuana. In comparison, in 1988, frequent use of marijuana among this age group was 2.0%, and frequent use of drugs other than marijuana was 0.8% (6; NIDA, unpublished data).By 1990, the proportion of women of childbearing age aware of risks associated with pregnancy and drinking, in particular the Fetal Alcohol Syndrome, should be greater than 90 percent.

This objective likely will be achieved. In 1979, 73% of women of childbearing age were aware of risks associated with pregnancy and drinking. In 1985, 88% of women were aware that heavy drinking during pregnancy increased the risk for low birthweight and birth defects, and 86% were aware of increased risk for miscarriages and mental retardation in newborns (7).By 1990, 80 percent of high school seniors should state that they perceive great risk associated with frequent regular cigarette smoking, marijuana use, barbiturate use, or alcohol intoxication.

This objective has been partially met. From 1979 to 1988, the proportion of high school seniors aware of risks associated with regularly smoking cigarettes increased from 63.0% to 68.0%; regularly smoking marijuana, from 42.0% to 77.0%; regularly using cocaine, from 69.5% to 89.2%; and alcohol intoxication (i.e., five or more drinks per occasion), from 34.9% to 42.6%. In contrast, the proportion aware of the risk of habitual barbiturate use decreased from 71.6% in 1979 to 69.6% in 1988 (8). Reported by: EM Johnson, PhD, Alcohol, Drug Abuse and Mental Health Administration, Public Health Service, US Department of Health and Human Services.

Editorial Note

Editorial Note: Since 1980, substantial progress has been made toward increasing public knowledge and awareness of the adverse social and health consequences associated with the misuse of alcohol and drugs. Risk perception has generally increased, and reductions have been achieved in alcohol-related traffic fatalities, per capita alcohol consumption, and casual use of drugs. The involvement of individuals and organizations has contributed to campaigns to eliminate drinking and driving, to raise the minimum purchase age for alcohol to 21 years, to ban "happy hours," and to hold the host responsible for the actions of inebriated guests (9). Heightened health consciousness nationwide also may have reduced the appeal of heavy drinking.  In contrast, the percentage of persons using cocaine at least once a week has increased from 5.3% in 1985 to 10.5% in 1988 (5). At greatest risk are inner-city and Native American reservation populations, women of childbearing age, persons addicted to crack cocaine, and "high-risk youth."** Increased use of cocaine among adolescents is of particular concern because the prevalence of substance abuse among adults increases inversely with the age at which drugs or alcohol were first experienced (10-12).

References

1. Public Health Service. Promoting health/preventing disease:

objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980:67-72.

2. Grant B, Zobeck T. Liver cirrhosis mortality in the United States, 1972-1986. Rockville, Maryland: National Institute on Alcohol Abuse and Alcoholism, 1989. (Surveillance report no. 11).

3. Brooks SD, Williams GD, Stinson FS, Noble J. Apparent per capita alcohol consumption--national, state, and regional trends, 1977-1987. Rockville, Maryland: National Institute on Alcohol Abuse and Alcoholism, 1989. (Surveillance report no. 13).

4. National Institute on Drug Abuse. National Household Survey on Drug Abuse: population projections, 1977. Rockville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, 1978.

5. National Institute on Drug Abuse. National Household Survey on Drug Abuse: population estimates, 1988. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (ADM)89-1636.

6. National Institute on Drug Abuse. National Household Survey on Drug Abuse: main findings 1977. Vol 1. Rockville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, 1978; DHEW publication no. (ADM)78-618.

7. Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

8. National Institute on Drug Abuse. Drug use, drinking, and smoking: national survey results from high school, college and young adult populations, 1975-1988. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (ADM)89-1638.

9. General Accounting Office. Drinking-age laws: an evaluation synthesis of their impact on highway safety--report to the Chairman, Subcommittee on Investigations and Oversight, Committee on Public Works and Transportation, House of Representatives. Washington, DC: US General Accounting Office; no. GAO/PEMD-87-10. 10. Adams EH, Gfroerer JC. Elevated risk of cocaine use in adults. Psychiatr Ann 1988;18:523-7. 11. Kandel DB, Logan JA. Patterns of drug use from adolescence to young adulthood. I. Periods of risk for initiation, continued use, and discontinuation. Am J Public Health 1984;74:660-6. 12. Kandel DB, Murphy D. Cocaine use in young adulthood: patterns of use and psychosocial correlates. In: Kozel NJ, Adams EH, eds. Cocaine use in America: epidemiologic and clinical perspectives. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1985; DHHS publication no. (ADM)85-1414. (NIDA research monograph no. 61). *When a death occurs under "accidental circumstances," the preferred term within the public health community is "unintentional injury." **As defined in Section 509, Title V, of the Public Health Service Act and 42 U.S.C. Section 290aa-8.

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