in motor vehicles and improved fireproofing modification to alcoholic beverages them- • Legislative and regulatory measures include: regulating the conditions of availability of enforcing minimum drinking age laws and enforcing laws prohibiting driving while in- controlling advertising of alcoholic bever- enforcing laws related to production, distri- regulation of conditions under which these periodic re-examination of sanctions to en- patient labeling for certain prescription drugs - drug information for patients in nursing • Economic measures include: excise taxes on alcoholic beverages and other means of affecting the price of alcohol; -tax incentives or disincentives to control levels of advertising expenditures for alcoholic beverages. b. Relative strength of the measures • Systematic evaluation of the effects of education and yearly intervention programs targeted at children and youth and populations at special risk is at an early stage. • Regulatory measures have been the Nation's primary tool of drug abuse prevention during most of the 20th century. There is much debate about the overall cost-benefit assessment of the • Mass media campaigns that have focused public • Alcoholic beverage regulation has not traditionally been focused on public health considerations, but data concerning the impact of regulatory initiatives on tobacco smoking may be transferable to the alcohol area. Research here and in other countries suggests that the availability of alcohol may affect the level and type of alcohol problems, particularly physical health problems consequent to long-term excessive drinking. Consumption, in turn, has been linked fairly conclusively to the relative price of alcohol, and less conclusively to such factors as the legal purchase age, number and dispersion of retail on-premise and off-premise outlets, and hours of sale. Also "Dram Shop" laws can offer powerful incentives for alcoholic beverage licensees to try to reduce the likelihood of intoxication among their patrons. • In general, alcohol and drug education programs 3. Specific Objectives for 1990 a. By 1990, fatalities from motor vehicle accidents involving drivers with blood alcohol levels of .10 percent or more should be reduced to less than 9.5 per 100,000 population per year. (In 1977, there were 11.5 per 100,000 population.) b. By 1990, fatalities from other (non-motor vehicle) accidents, indirectly attributable to alcohol use, e.g., falls, fires, drownings, ski mobile, aircraft) should be reduced to 5 per 100,000 population per year. (In 1975, there were 7 per 100,000 population.) c. By 1990, the cirrhosis mortality rate should be reduced to 12 per 100,000 per year. (In 1978, the rate was 13.8 per 100,000 per year.) d. By 1990, the incidence of infants born with the Fetal Alcohol Syndrome should be reduced by 25 percent. (In 1977, the rate was 1 per 2,000 births, or approximately 1,650 cases.) *NOTE: Same objective as for Pregnancy and Infant Health. e. By 1990, other drug-related mortality should be reduced to 2 per 100,000 per year. (In 1978, the rate was about 2.8 per 100,000.) f. By 1990, adverse reactions from medical drug use that are sufficiently severe to require hospital admission should be reduced to 25 percent fewer such admissions per year. (In 1979, estimates range from approximately 105,000 to 350,000 admissions per year.) • Reduced risk factors g. By 1990, per capita consumption of alcohol should not exceed current levels. (In 1978, about 2.82 gallons of absolute alcohol were consumed per year per person age 14 years and over.) h. 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. (In 1977, the proportion of abstainers was: 46 percent for alcohol; for other drugs, ranging from 89 percent for marijuana to 99.9 percent for heroin.") *NOTE: A person is defined as not using alcohol or other drugs if he or she has never used the substance or if the last use of the substance was more than one month earlier. i. By 1990, the proportion of adolescents 14 to 17 years old who report acute drinking-related problems during the past year should be reduced to below 17 percent. (In 1978, it was estimated to be 19 percent based on 1974 survey data.) *NOTE: Acute drinking-related problems have been defined as problems such as episodes of drunkenness, driving while intoxicated, or drinking-related problems with school authori ties. j. By 1990, the proportion of problem drinkers among all adults aged 18 and over should be reduced to 8 percent. (In 1979, it was about 10 percent.) k. By 1990, the proportion of young adults 18 to 25 years old reporting frequent use of other drugs should not exceed 1977 levels. (In 1977, it was less than one percent for drugs other than marijuana and 19 percent for marijuana.*) *NOTE: "Frequent use of other drugs" means the non-medical use of any specific drug on 5 or more days during the previous month. 1. By 1990, the proportion of adolescents 12 to 17 years old reporting frequent use of other drugs should not exceed 1977 levels. (In 1977, it was less than 1 percent for drugs other than marijuana and 9 percent for marijuana.) • Increased public/professional awareness m. 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. (In 1979, it was 73 percent.) n. By 1990, the proportion of adults who are aware of the added risk of head and neck cancers for people with excessive alcohol consumption should exceed 75 percent. (Baseline data unavailable.) o. 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. (In 1979, 63 percent of high school seniors perceived “great risk” to be associated with 1 or 2 packs of cigarettes smoked daily, 42 percent with regular marijuana use, 72 percent with regular barbiturate use, and only 35 percent with having 5 or more drinks per occasion once or twice each weekend.) p. By 1990, pharmacists filling prescriptions should routinely counsel patients on the proper use of drugs designated as high priority by the FDA, with particular attention to prescriptions for pediatric and geriatric patients and to the problems of drinking alcoholic beverages while taking certain prescription drugs. (Baseline data unavailable.) Improved services/protection q. By 1990, the proportion of workers in major firms whose employers provide a substance abuse prevention and referral program (employee assistance) should be greater than 70 percent. (In 1976, 50 percent of a sample of the Fortune 500 firms offered some type of employee assistance program.) r. By 1990, standard medical and pharmaceutical practice should include drug profiles on 90 percent of adults covered under the Medicare program, and on 75 percent of other patients with acute and chronic illnesses being cared for in all private and organized medical settings. (Baseline data unavailable.) • Improved surveillance/evaluation systems s. By 1990, a comprehensive data capability should be established to monitor and evaluate the status and impact of misuse of alcohol and drugs on: health status; motor vehicle accidents; accidental injuries in addition to those from motor vehicles; interpersonal aggression and violence; sexual assault; vandalism and property damage; pregnancy outcomes; and emotional and physical development of infants and children. 4. Principal Assumptions • The Federal emphasis on research and technical assistance will continue, with primary reliance on State and local governments and the voluntary sector for delivery of alcohol and drug abuse prevention services. • Resources and services devoted by State and local governments, and voluntary groups, for drug and alcohol prevention programs and services will expand. • Federal funding for research and evaluation in drug and alcohol prevention will modestly increase, with special attention to the priority areas reflected in the proposed objectives. • Federal information initiatives will continue to sensitize the public to the adverse social and health consequences of heavy or frequent use of alcohol and other drugs. • Strong and varied initiatives both public and private, will seek to minimize use of tobacco, alcohol and other drugs by children and adolescents-including coordinated efforts with alcohol producers, distributors, retailers and State alcohol control commissions. • The allocation of resources by alcohol producers, distributors and retailers to the marketing, promotion and distribution of alcoholic beverages will probably increase. No dramatic shift in tax or regulatory policies toward availability and consumption of alcoholic beverages will occur, unless consumption trends require reconsideration. • There will be no dramatic or permanent shift in the availability of controlled substances outside legitimate medical and scientific channels. • The trend will continue toward modification of the criminal law and its less punitive administration in cases involving arrests for personal possession of marijuana and other drugs. 5. Data Sources a. To National level only Health Interview Survey (HIS). Accidental injuries, disability, use of hospital, medical and other services, and other health-related topics. DHHS-National Center for Health Statistics (NCHS). NCHS Vital and Health Statistics, Series 10, selected reports. and Advance Data, selected reports. Continuing household interview survey; National probability samples. • Health Examination Survey (HES) and the Health and Nutrition Examination Survey (HANES). Alcohol and drug related conditions. DHHS-NCHS. Vital and Health Statistics, Series 11, selected reports. Periodic surveys; National probability samples; data obtained from physician's examinations. National Hospital Discharge Survey (HDS). Utilization of hospital services related to misuse of alcohol and drugs. DHHS-NCHS Vital and Health Statistics, Series 13. Continuing; National probability sample, short stay hospitals. National Ambulatory Medical Care Survey (NAMCS). Alcohol and drug related patientphysician encounters. DHHS-NCHS. NCHS Vital and Health Statistics, Series 13. Continuing survey; National probability sample, office based physicians. • The lifestyle and values of youth. Non-medical use of substances in 12 categories including marijuana, barbiturates, cocaine, prescription drugs, alcohol, cigarettes. DHHS-NIDA. Drugs in the Class of (survey year date), Behaviors, Attitudes and Recent National Trends, series Number 20. Annual surveys since 1975 of high school seniors in a National sample of public and private schools. • The National Survey on Drug Abuse. Estimates of the levels of illicit and legal drug use in the United States: marijuana-hashish, cocaine, hallucinogens, heroin and other opiates; summary of data on use of inhalants, alcohol, cigarettes and the non-medical use of psychotherapeutic drugs legally prescribed. DHHS-NIDA. Highlights from the National Survey on Drug Abuse, 1977. Continuing survey since 1971; National sample. Drug Abuse Warning Network (DAWN). Drug abuse encountered in emergency rooms and medical examination offices. DHHS-NIDA and the Drug Enforcement Administration. Quarterly reports of provisional data Series G, NIDA. Continuing survey in 26 standard metropalitan statistical areas. •National Prescription Audit (NPA). Drug sales, including barbiturates, tranquilizers; source of prescription; payment status, provider type. IMS America, Ltd., Ambler, Pennsylvania. IMS reports. Continuing audit of pharmacies on IMS panel. • Third Special Report to the US Congress on Alcohol and Health, June 1978. Subsequent reports will be available approximately every three years. b. To State and/or local level • National Vital Registration System Mortality. Deaths by cause (including alcohol and drug related), by age, sex and race, DHHS-NCHS. NCHS Vital Statistics of the United States, Vol II, and NCHS Monthly Vital Statistics Reports. Continuing reporting from States; National full count. (Many States issue earlier reports.) • Hospitalized illness discharge abstract systems. Professional Activities Study (PAS). Patients in short stay hospitals; patient characteristics, alcohol and drug related diagnoses, procedures performed, length of stays. Commission on Professional and Hospital Activities, Ann Arbor, Michigan. Annual reports and tapes. Continuous reporting from 1900 CPHA member hospitals; not a probability sample, extent of hospital participation varies by State. Medicare hospital patient reporting system (MEDPAR). Characteristics of Medicare patients, diagnosis, procedures. DHHS Health Care Financing Administration, Office of Research, Demonstration and Statistics (ORDS). Periodic reports. Continuing reporting from hospital claim data; 20 percent sample. Other hospital discharge systems as locally available. • Area Resource File (ARF). Demographic, health facility and manpower data at State and county level from various sources. DHHSHealth Resources Administration Area Resource File: A Manpower Planning and Research Tool, DHHS-HRA-80-4, Oct. 79. One time compilation. • Annual Census of State and County Mental Hospitals. Resident patients and new admissions to mental institutions; costs, diagnoses of alcohol psychoses. DHHS-ADAMHA, National Institute of Mental Health (NIMH). Mental Health Statistical Notes, selected issues; special reports and tabulations furnished to the Center for Disease Control. Continuing reporting; National full count of patients in State and county mental hospitals. WASHINGTON OFFICE COLLEGE OF AMERICAN PATHOLOGISTS / ALFRED S. ERCOLANO, Director 1101 VERMONT AVE, N W/ SUITE 401 WASHINGTON, DC 20005 PHONE 202-466-4112 January 19, 1984 Dear Congressman: We enclose for your information a recent news release that addresses a major health and safety concern -- that of alcohol related traffic deaths. The College of American Pathologists recently developed a news feature detailing studies in four states showing that alcohol-related accidents resulting in death are much higher than generally reported. Stimulated by the reaction of a Minnesota pathologist who heard a national television newscast give a much lower figure than his own experience, the studies demonstrate the first-hand, daily awareness of the magnitude of the problem as seen by pathologists performing autopsies as medical examiners or as hospital-based community pathologists. The response to our article has been phenomenal, generating hundreds of newspaper articles, coverage on Cable News Network and CBS and Mutual Radio Network, as well as calls from James Fell of the National Traffic Safety Administration, the Insurance Institute of Highway Safety, anti-drunk driving groups, state legislators and legislative staff, television stations, universities, libraries, and private citizens. Recognizing the importance of the subject and knowing that you share the College's concern about alcohol-related traffic deaths in this country, we would like to encourage distribution of this information and are happy to provide access to our member pathologists' expertise in this important issue. The CAP is currently developing a survey of its 9,500 members to collect statistics for individual counties or states on alcohol-related traffic deaths. The survey will compile information on how and what information is collected and also ask whether the local area requires blood alcohol content tests (BACS). For additional information, please contact Barbara Chapman, CAP, 7400 N. Skokie Blvd., Skokie, IL 60077, 312-677-3500, Ext. 457. |