The Chairman’s Corner

A recent survey of 7th through 11th graders in the Connecticut gold coast town of Westport, Connecticut, nails the importance of targeting alcohol use among teens for parents, teachers, pediatricians and public health professionals who seek to prevent teen substance abuse and addiction.

The survey by the Governor’s Prevention Initiative for Youth revealed that 25 percent of the town’s 9th graders, 37 percent of 10th graders, and 60 percent of 11th graders had been drinking alcohol in the previous 30 days. Translated from substance abuse statistical jargon to plain English, this means that these high school freshman, sophomores and juniors are current drinkers, likely drinking regularly.

Marijuana use is a distant second as a drug of choice among these teens, but it also deserves some attention. Seven percent of 9th graders, 17 percent of 10th graders and 37 percent of 11th graders use marijuana.

But the contrast with nicotine makes it clear that tobacco is NOT a drug of their choice. Only two, three and 11 percent, respectively, of 9th, 10th and 11th graders smoke cigarettes.

Four percent of 7th graders and eight percent of 8th graders drink alcohol, one percent use marijuana and 0.5 percent smoke cigarettes.

Over the past decade, the changes in alcohol and marijuana use were modest (slightly lower for alcohol, slightly higher for marijuana), but smoking was down sharply. For 7th through 10th graders, the Governor’s survey found that smoking was down 90 percent from what it was a decade ago.

Place these findings against what we know about substance abuse and addiction in America and the message could not be any clearer for prevention buffs and those who want to reduce health care costs.

First, the 800 pound gorilla, the King Kong, of adolescent substance abuse is alcohol—beer, wines, alcopops like Mike’s Hard Lemonade, Seagram’s Sweet Tea Vodka and Bacardi Breezer. Use of drugs like heroin, meth and cocaine command time on the airwaves and space in the tabloids. And parents tremble at the thought that their child might experiment with such horrific substances and get hooked on them. But it’s alcohol that should be the main drug of concern for parents, schools, churches, pediatricians and the public health community, with attention paid to marijuana as well. This is especially true as we learn more and more about the threat alcohol and marijuana pose to the adolescent brain.

Second, our kids are getting the message about smoking—and they’re acting on it. The decline in cigarette smoking among these affluent, well-educated Westport teens is dramatic and signals the success of our antismoking campaigns. Indeed, as the person who started the nation’s first antismoking campaign in 1978 while U.S. Secretary of Health, Education, and Welfare, I am astonished and enthralled by what has happened. That’s not to take credit, for many others from Surgeon General Everett Koop in the Reagan administration, to President Bill Clinton, to scores of state, city and county officials, Congressmen like Henry Waxman and Senators like Frank Lautenberg, and hosts of teachers and private citizens deserve the acclaim.

But the overarching point is critical: when the public health message is trumpeted not just by the conductor, but by everyone in the orchestra, the entire audience starts humming the same tune.

Third, the lesson from the success with smoking is, “Yes we can keep our kids from drinking alcohol.” And it is critically important to do so. We’ve known for some time that 90 percent of adults hooked on cigarettes were hooked when they were teens.

CASA Columbia’s recent report on adolescent substance use finds, for the first time, that 90 percent of those addicted to alcohol and other drugs started using them before they were 18. Moreover, we have learned a lot about the adolescent brain in the past several years. One of the most important things that we have learned is that drinking, particularly binge drinking, can stunt the development of a teen’s brain and in some cases do permanent damage. So in addition to helping individual teens, getting the alcohol message across will reduce health care costs (people with alcohol abuse and addiction problems cost a lot more in medical services) and help more of our kids grow up drug free and become productive citizens, in turn contributing to our country’s economic growth and global competitiveness.

The message about smoking is simple and absolute: It’s NO—No for everyone FOREVER—for boys and girls, men and women of all ages throughout their lives.

The message about drinking alcohol is more complex: It’s no for those under 21, no for adults who have a genetic predisposition or are alcoholics; but yes, in moderation, for others who choose to drink.

This means that teens are likely to see their parents drink, to see other adults drink and to be exposed to all sorts of advertising designed to glamorize and sell beer, wine, sweet drinks and hard liquor. It makes it more difficult to deliver the prevention message to our teens. But not less important.

And there are all sorts of things we can do to deliver this message and begin to change the teen drinking culture. We can start by educating younger children to the dangers of drinking way before they are 21 or even teens—teach them about the potential damage to their brains, their lower level of impulse control, the threat that excessive drinking has in terms of crippling and fatal accidents, risky and criminal sexual activity. We can also, as a society, put some serious restrictions on alcohol advertising, eliminating it during television programs and in publications that attract significant proportions of children and teens. And we can educate our kids about drinking in the same health classes where we teach them about the dangers of smoking and obesity and the benefits of exercise and healthy diets.

Most importantly, we must change the culture of drinking for teens so that it is just as uncool for them to drink as it is for them to smoke. That may seem impossible today. But remember this: When in 1978 as HEW Secretary I declared the HEW building to be smoke free, the following morning the employees demonstrated against my decision and demanded that they have the right to smoke in their offices. And no other cabinet officer or agency head followed my lead. Who would have thought then that 30 years later there are virtually no public buildings or private offices in our nation where you can smoke today!

So, let’s stop accepting teen alcohol use as an inevitable rite of passage, and start down this road of cultural change. Any ideas you have on preventing kids from drinking and making it “cool” for teens not to drink, please send them along in your comments and together we can begin to change the culture.