Since then, the government has insinuated itself into other behavioral arenas, launching a war on drugs in 1971 and declaring "a smoke-free society" an achievable goal in the 1980s. Our sex lives are not immune to governmental scrutiny: In 1995 Surgeon General Joycelyn Elders caused an uproar when she said: "I think that [masturbation] is something that is a part of human sexuality and it's a part of something that perhaps should be taught." In 2001 Surgeon General David Satcher told us: "Overweight and obesity may soon cause as much preventable disease and death as cigarette smoking."
Our mental health is now also the government's concern. In her introduction to the 1999 Surgeon General's report on mental health (marking the end of the Congressionally mandated Decade of the Brain), Health and Human Services Director Donna Shalala declared: "We are poised to take what we know and to advance the state of mental health in the Nation." The report went on to assure us that the government "will continue to attend to needs that occur across the lifespan, from the youngest child to the oldest among us."
In this chapter we look at some of the "new epidemics": trends in diet and obesity, and smoking, drug, and alcohol abuse. The government collects statistics on all of them.1
Diet: Our first panels explore the risky way we eat. We have so many obligations and so little time. We must eat, so we eat out. But that is not a healthy way to eat and is blamed for current rates of obesity.
Drug and alcohol abuse: We continue with a look at drug and alcohol abuse. One theory has it that we are all looking for nirvana; some approach it through exercise, others through alcohol or drugs. Attempts to regulate drinking and drugs are not new and such attempts have always met with resistance. Our latest "war on drugs" is criticized as endless, excessive, costly, and ineffectual. In the following panels, we will see why the war on drugs has been called a war on African Americans and a war on children.
We cannot agree on whether risky behaviors are diseases to be treated, character flaws to be condemned, or criminal problems worthy of the harshest punishment. Attitudes change with accumulated knowledge. Yesterday's vilified drug becomes today's socially accepted drug, with the result, for example, that in 2001 the American Medical Association called for more studies of the benefits and risks of using marijuana as a medicine. Several states now allow marijuana to be used for medical purposes, and polls show strong support for this initiative.
Times and attitudes change. Before 9/11, there was talk of alternative approaches to the war on drugs. In 2002 terrorism replaced drug enforcement as the FBI's top priority and President George W. Bush linked drugs to patriotism, announcing that "if you're buying illegal drugs in America, it is likely that money is going to end up in the hands of terrorist organizations."
Smoking: We've known for a long time that smoking is bad for us. Commenting on an 1893 court decision, The New York Times opined: "The smoking of cigarettes may be objectionable, as are many other foolish practices, and it may be more injurious than other modes of smoking tobacco, but it is an evil which cannot be remedied by law… cigarettes are not a legitimate subject for legislative action."2 That is no longer true. By 1992, the 50 state and DC had laws governing tobacco sales and distribution to youths. On June 6, 1996, prevalence of cigarette smoking was added to the list of conditions designated as reportable by states to the CDC, marking the first time a behavior, rather than a disease or illness, was considered nationally reportable. In this chapter, we will examine smoking trends.
Stress: Our chapter continues with a look at stress. Hans Seyle, Viennese physician and pioneer in the study of stress, wrote that "without stress, there would be no life." We will chart a course through a typical working-person's day and enumerate some of the events that can cause stress. We conclude the chapter by looking at two more risky behaviors that have experienced a surge in popularity lately: tanning and tattooing.
Alcohol use trend 1985-1999
:(table): The youngest adult age group showed the greatest decline in alcohol use (a 14% decline compared to 12% and 7%).
Cigarette and marijuana/hashish trends 1985-1999: The 26-34 age group showed the greatest decline in both cigarette smoking (25% compared to 13% and 20%) and use of marijuana and hashish (registering an impressive 122% drop compared to 24% for the youngest group and 4% for the oldest group). As was true with 12-17-year-olds, marijuana use rates rose in the 1990s among the 18-25 group. While the teens then showed a decline, this is not so for the 18-25 group. Marijuana has a reputation for being a relatively harmless illicit substance.
Cocaine use trend: Cocaine use by the youngest adult age group fell 76% and use by the middle group fell 84%. Cocaine use by the oldest age group actually rose 20%, but only a small percentage of that age group ever reported using cocaine (a low of 0.2% in 1990 to a high of 0.6% in 1999).22
The table includes the phenomenon of binge alcohol use among 18-25-year-olds. No doubt this behavior is ages-old, but statistics have only been collected since the 1980s. Media headlines would lead us to believe that binging is rampant on college campuses, and indeed, a rate of 31% of 18-25-year-olds admitting to binging in 1999 might justify alarm. Not shown here is NHSDA data indicating that in 1999, 15% of all people aged 12 and over admitted to being bingers (some 32 million people). Secondhand effects of binging include noise, vandalism, and public disturbances.
Percentage of Persons 18-25, 26-34, and 35+ Who Are Current Users
| Age/Drug | 1985 | 1990 | 1995 | 1997 | 1998 | 1999 |
| 18 to 25 Years Old | ||||||
| Marijuana/hashish | 21.7 | 12.7 | 12.0 | 12.8 | 13.8 | 16.4 |
| Cocaine | 8.1 | 2.3 | 1.3 | 1.2 | 2.0 | 1.9 |
| Alcohol | 70.1 | 62.8 | 61.3 | 58.4 | 60.0 | 60.2 |
| Binge alcohol use | 34.4 | (NA) | 29.9 | 28.0 | 31.7 | 31.1 |
| Cigarettes | 47.4 | 40.9 | 35.3 | 40.6 | 41.6 | 41.0 |
| 26 to 34 Years Old | ||||||
| Marijuana/hashish | 19.0 | 9.5 | 6.7 | 6.0 | 5.5 | 6.4 |
| Cocaine | 6.3 | 1.9 | 1.2 | 0.9 | 1.2 | 1.0 |
| Alcohol | 70.6 | 64.4 | 63.0 | 60.2 | 60.9 | 61.9 |
| Cigarettes | 45.7 | 42.4 | 34.7 | 33.7 | 32.5 | 34.4 |
| 35 Years and Over | ||||||
| Marijuana/hashish | 2.6 | 2.4 | 1.8 | 2.6 | 2.5 | 2.5 |
| Cocaine | 0.5 | 0.2 | 0.4 | 0.5 | 0.5 | 0.6 |
| Alcohol | 57.5 | 49.5 | 52.6 | 52.8 | 51.7 | 53.4 |
| Cigarettes | 35.5 | 28.9 | 27.2 | 27.9 | 25.1 | 28.5 |
According to BoozeNews: "For current alcohol use, binge drinking [5 or more drinks] and heavy alcohol use, 21 [the legal drinking age in every state] is the age of peak prevalence" before these behaviors decline. The prevalence of cigarette and marijuana smoking and use of cocaine also tends to decline with age.
This graphic shows the downward trend in the rates of use of all illicit drugs23 and alcohol and cigarettes among people 12 years old and over between 1985 and 1990. Rates of use of these substances held fairly steady through the 1990s.
Current Users Aged 12+, Illicit Drugs, Alcohol, and Cigarettes: 1985-2000
Earlier panels showed substance use trends in younger age groups and this panel covers adults. What about older adults? A government report on substance use among older adults showed that in 2000, some 568,000 people aged 55+ (1%) had used illicit drugs in the month before the survey, and more than 5 million (9%) were "binge" alcohol users, including more than 1 million (<2%) who were heavy users of alcohol. It is predicted that the aging of the baby boom generation will increase the number of older users of illicit drugs.
Interesting survey results about illicit drug use on the job are worth noting. Drug Strategies, a private research group that promotes "more effective approaches to the nation's drug problems," reports that 75% of U.S. drug users are white and working. (Since 80% of the population is white, whites represent less than their share of drug users.) The Substance Abuse and Mental Health Services Administration (SAMHSA) states that the highest rates of illicit drug use on the job are reported by construction and food service workers (17.3% and 16.3%, respectively), the lowest rates by police officers, teachers, and child care workers (1%, 2.3%, and 2.6% respectively). In a poll taken by Minnesota- based Hazelden Foundation, 60% of respondents reported knowing someone who had gone to work under the influence of alcohol or drugs.
Is there a drug crisis? When the media talk about one, they are usually referring to increases in emergency room visits for drug-related problems. We look at those next.
Sources: Chart and Table: Statistical Abstract of the United States: 2001, Table 189; primary sources, U.S. Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse. Harvard School of Public Health, "Secondhand Effects of Student Alcohol Use Reported by Neighbors of Colleges: The Role of Alcohol Outlets," retrieved July 23, 2002, from http://www.hsph.harvard.edu/cas/Documents/secondhand/. "Key Findings on Adolescent Alcohol Use From the National Household Survey on Drug Abuse and the Parents' Resource Institute for Drug Education Survey," BoozeNews, retrieved July 23, 2002, from http://www.cspinet.org/booze/adolescent_statistics2.htm. "Illicit drug use down; varies by job," Public Health Reports, V111 (Sept/Oct 1996), pp. 385-6. "Substance Use Among Older Adults," The NHSDA Report, November 23, 2001, retrieved July 24, 2002, from http://www.samhsa.gov/oas/facts/olderadults.htm.
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