Tobacco Documents Online

Historically, alcohol consumption has been higher and was perhaps double current con- sumption in the late 1700s and early 1800s. It fell during the heyday of the temperance movement in the mid-1800s, but it began to rise again in the latter part of the 19th centu- ry (see Chart 1). The 1919 passage of a con- stitutional amendment that prohibited the manuftcture, transportation and sale of alco- hol--also known as Prohibition--decreased use again, at least legal use, and temporarily. I)uring this time, an underground alcohol industry flourished and drinking continued to some degree. The amendment was repealed in 1933 as concerns about lawlessness rose. 1)uring the past decade, alcohol consump- tion has declined. This coincided with rais- ing the minimum drinking age to 21 in all states to counter the alarmino number of fatal automobile crashes invoh-ing alcohol and teenagers. The decrease also is related to a shift in beverage preference. The consumption of distilled spirits, which has a high ethanol con- tent, decreased substantialhy over the past 1~ years; beer consumption remained relatively stable; and wine consumption increased slightly. Both beer and -,.ine have a lower ethanol content. These overall trends in cur- rent alcohol consumption mask many impor- tant differences in drinking patterns across the life course and among demographic groups. as described in this report. Chart 1. Trends in Alcohol Use Annual Per Capita Consumption in Gallons of Ethanol L 10 3.0 • 1.0 • 0.0 . 1850 1855 1860 1865 1870 1875 1880 1885 1890 1895 1900 1905 1910 191'> 1920 51422 4587 SuaSTencE N9u5E ~ , I

. Illicit drugs...The history of illicit drug use in the United States also is marked by shifts in public attitudes and policies, between tol- erance artd intolerance. During the late 1800s, laissez-frtireapproaches to the problem of drug use began to he supplanted by increasing gov- ernmental regulation as the medical profession and the public became aware of the addictive properties of certain drugs. At that time, cocaine and opiates, which were inexpensive and read- ily available, were used widely in medicines available over the counter. A series of legisla- tive acts and court cases during the first two decades of this century resulted in a decrease in cocaine and opiate use, and the nation's drug probleni diminished during the Depression and World War II. During the 1950s and 1960s, however, hero- in emerged as a problem in our cities, and use of a variety of illicit drugs grew among the general population in the 1970s, peaking in the late 1970s for most drugs. The 1960s arid 1970s also saw the development of modern treatment modalities, including methadone maintenance, therapeutic communities, and outpatient care. Illicit drug use decreased among most segments of the population during the 1980s and 1990s. To illustrate recent trends, selected histor- ical events are charted against recent mari- juana use among 18- to 25-year olds from 19-2 to 1992 and cocaine use among 18- to 25- ~ pp jy _f G L a'~•S Ca ~ ° D-0 «.o c ~ ~ ~ 1925 1930 1935 1940 1945 1950 1955 1960 • Neat 260" 2.01 1965 1970 1975 1980 1985 1990 2000 SUSrA11cE A9ASE Notes: Alcobol consumption is measured in gallons of ethanol (absolute alcohol) per person aged 15 and older prior to 1970 and 14 and older tbereafter. Sottrces.' National Institute on Alcobol Abuse and Alco- holisrn, Division ofBio- metry and Epidemiologv. Surveillance Report # 23, Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977- 1990. December 1992. Table 1. p. 1G-17. 11 ,. ,- .;y

year olds from 1974 to 1992 (sec Chart 2). This age group has high rates of rnarijuana use. By 1979, 35 percent of 18- to 25-year olds report- ed being current marijuana users. This was a peak period not only for marijuana use among 18- to 25-year olds, but also for most drugs and for most age groups. Since then, marijuana use has decreased, and by 1992, about 11 percent of 18- to 25-year olds reported using marijua- na in the past month. There is continued con- cern over the impact of illicit drug use, espe- cially cocaine and its derivative, crack. Reported declines in frequent cocaine use since 1985 are not statistically significant. Federal drug poli- cy has emphasized law enforcement and interdic- tion to reduce the supply of illicit drugs, but Chart 2. Trends in Illicit Drug Use 1 Percent Marijuana and Cocaine Users Aged 18-25 30 20 ~ Percent Marijuana Users Aged 18-25 ~ Percent Cocaine Users Aged 18-25 10 . . 0 x 1972 1973 19"4 19?5 1976 1977 19-8 19-9 19811 SUB5TNIICE flBUSE recent trends show an increasino ia~terest in pre- vention and treatment as control measures. Tobacco...Tobacco is a part of this land's ear- liest history, predating the arrival of Colum- bus. Native Americans had long cultivated tobacco and used it in various forms, includ- ing cigars, cigarettes, che-,ving tobacco, and pipes. During the 17th centun; tobacco began as an important cash crop for North Carolina, and by 1864 it was a significant enough com- modity that a federal tax was imposed on cig- arettes to help finance the Civil '\t'ar. By the 1890s, cigarette machines.vere Ferfected that produced cigarettes in much greater volume than possible by hand. 51422 4589 0 r t f r r I

Cigarette consumption increased dramati- cally between 1900 and the mid-1960s, with small peaks and valleys paralleling historical events: It wa.s slightly higher during World War I and World War II, and lower during the I)epression years (see Chart 3). Consumption peaked in 1963, at 4,345 cigarettes per person aged 18 and older per year. (Smoking a pack of cigarettes a day amounts to about 7,500 cig- aretres a year.) The precipitating event in the decline since then was the 1964 Surgeon General's Report that definitively linked ciga- rette smoking to health problems. The tobacco industry has tried to reverse the downward trend in tobacco consumption. For example, filter cigarettes were heavily i 1982 1983 1984 1985 1986 1987 promoted during the 1950s, and low-tar cig- arettes were introduced in the 1960s. Smoke- less and perfumed cigarettes were introduced in the 1980s to attract new smokers and keep current smokers from quitting. The tobacco industry also has targeted minorities and women in their advertising. In spite of these efforts, consumption con- tinues to decline. The decreases, however, have not been uniform across all groups. The poor, the less-educated and minority groups have had smaller reductions in rates, and so have women in comparison to men. While the 1992 per capita consumption was the lowest since 1963-2,629 cigarettes a person a year-it is roughly the same as in the early 1940s. 0 ~ r ~ aa 1988 1989 1990 Year 2000 0 7.896 1991 1992 ~ 5UB5TAUCE ABU5E y Noter: Data for 1992 are prelintinary. Sources: Substance Abuse and Mental Health Services Administration, Office ofApplied Studies. National Household Sun,ey on Drug Abuse: Highlights 1991. Rockville, i1D: DIIHS Pub. No. (SmA) 9-3-19 9, 1993. Table A. 10. p. 78. Substance Abuse and Metual Health Services Administration, Office of Applied Studies. Preliminary Estimates from the 1992 National Household Survec on Drug Abuse. Advance Report No. 3. Rockville, MD: fune, 1993. 7able 7A, p. 44.

1 Al.l, SEGSIFNI'S OF SOCIETYAFFECTLD... No polr ulation group is immune to substance abuse and its effects. Men and wotnen and people of all ages, racial and ethnic groups and levels of education smoke, drink and use illicit drugs. In 1991, some 103 million Americans used alcohol in the past month, 46 million smoked, and almost 13 million used illicit drugs. There are, however, significant differences in sub- stance use among groups. Young adults, for example, are the group most likely to use alcohol, illicit drugs and tobacco, and many adolescents have already started. In terms of gender, men are more likely than women to use most substances, but they are particularly more likely to be heavy users of alcohol and to Chart 3. Trends in Cigarette Use Annual Per Capita Consumption of Cigarettes 5UBSTBUCE ABUSE be problem drinkers. Whites are more likely than blacks or Hispanics to drink, but they are no more like- ly to drink heavily. Native Americans, mean- while, are more apt to have problems with alco- hol. Illicit drug use disproportionately affects minority groups, with minority groups at an additional risk for a range of adverse conse- quences, because they are more likely to use these drugs intravenously. Level of education is increasingly recog- nized as an important correlate of substance use, with heavier use among those who are less well-educated. People with higher edu- cation levels are more likely to drink, but those with less education are more likely to 51422 4591 i f 0 I

&0`41arl 0 1945 Is drink heavily. Among less-educated people, smoking is more common and smoking ces- sation less likely. The impact of substance abuse is felt from earliest infancy through old age. Some infants are born already compromised through expo- sure to substances consumed by their moth- ers during pregnancy. Throughout childhood, boys and girls are affected in many ways by their parents' substance use, from neglect and abuse associated with alcohol and illicit drug abuse to chronic respiratory problems from environmental tobacco smoke. Adolescence is a period of experinientation with substance use, and teenagers are partic- ularly at risk for being involved in alcohol- and 1950 1955 1960 1965 1970 drug-related vehicle injuries. Because substance use is higher in young adulthood, men and women in this age group are more likely to experience problems associated with it. For example, workplace problems and family dis- ruption can develop during this time. But it is later in life that the long-term health effects from alcohol use and cigarettes are most appar- ent. A lifetime of drinking and smoking exacts a heavy toll in chronic health problems and premature death. SOC1E7'A1., COSTS OF SUBSTANCE ABUSE... The total economic cost of substance abuse on the U.S. economy each year is staggering, and at least one estimate is in excess of $238 1975 1980 1985 19901992 5UBSTBBCE BBUSE Notes: Data for 1992 are prelirrtinary. Sources: For 1900-1974: Tobacco Yearbook 1981. Col. Clem Cockrel. Bowling Green, h'Y. p.5 ,. For 1975-1981: US Department of Agriculture. Tobacco Situation and Outlook Report. Cotnmodity Economics Division, Economics Research Service. Rockville, .t1U: April 1985. T able ? p. 6. F'or 1982-1991: US Department of Agriculture. Tobacco Situation and Outlook Report. Commodity Economics Division, Economics Research Service. Rockville, .111): Apri11992. Table 2, p.4. For 1992: US Department of Agriculture. Tobacco Situation and Outlook Report. Commodity Economics Division. Economics Researcb Service. Rockuille. .11D: Apri1199_3. Table? p.v. ©

Notes: Aledi<<rl.• 1)irect e.ipenduures. Ilbress•. Present ra6re of lost productivity due to illness or mjuq,. 1)eatGs: 1'resettt mtlue of frrturc lost productivity due to prerrr,tture tleatA Other Releted (.osts: 1)iret•t--criutr•, ntotor vcl itle rnul es, et,: Ittdirect-c4i tints of frirne, ittrnr rnuion, etc. Special C.'ondiriorts: AI!)S attributable to drug eGuse. k'etal zih'ol,ol Syndrome. Sources: Ciupulilisbed dtat for 199o fio» t Uo,'otl,y P. Rice. Institute for Nealth and.-lgirtg, linirersity of Ctli/i)rnia at San Fran- cisco, CA 9-t1-r.i-061?. 9.4 billion. Although specific cost estimates vary across studies because of differences in under- lying assumptions and definitions, all show substantial economic costs. This is an enor- mous burden that affects all of societv-- people who abttse alcohol, illicit drugs or tobac- co, and those who do not. This cost includes the expense of treating substance abuse, the productivity losses caused by premature death and inability to perform usual activi- ties, and costs related to crime, destruction of property and other losses. Alcohol is the most costly abused substance, with the total bill to the nation estimated to be $99 billion in 1990. Using the same econont- ic model, the cost of drug abuse was $67 bil- lion, and preliminary estimates place the cost of smoking at $72 billion (see Chart 4). Each substance has different impacts on users and on society: The major burden of alcohol abuse relates to productivity losses as_rociated with illness and death; crime plays the major role in drug-relat- ed costs; and for smoking, the most significant losses are associated with premature deaths. The core costs of alcohol and illicit drug abuse (costs of medical expenses, illness and death) fall disproportionately on people ages 15 to 44. "1'his reflects their higher preva- lence of substance abuse problems and larger number of related deaths. The core costs for most other health conditions tend to be con- centrated in older age groups. Chart 4. Economic Costs of Substance Abuse,1990 4.8 Drug Abuse/7otal Cost 566.9 billion - Medical 16 Alcohol Abuse/Total Cost $98.6 billion - Illness - Deaths SIIBSTAl1CC ABU5B Smoking/Total Cost S-2.0 billion (pnliminarv estinwtt) - Other ~ Special Related Conditions 51422 4593 c c 4 c 4 . . t 4 4 d . ...,. . ... .. ..:..~._. __,_.w .._.,~..a __.. ..

TAKING AC:7ION... Substantial governmental and private cfforts are being directed toward combatting the nation's substance abuse prob- lem, and there is a clear mandate to do more. However, the sheer size of the alcohol and tobacco industries and their influence in the economy-national, state and local-impedes progress. With more than 100,000 manufac- turing employees, these industries have a com- bined payroll that is more than 1.5 times the nation's soft drink manufacturing industry. Retail sales for beer, wine and distilled spirits total S92 billion, and tobacco sales total $44 billion. To help promote these sales, alcohol and tobacco are among the most widely adver- tised products in the country. In 1990, $3.9 billion was spent on tobacco advertising and promotions. Moreover, even though per capi- ta consumption is down, profits for tobacco manufacturers increased from 7 cents per pack in 1981 to 35 cents in 1991. These numbers powerfully influence the mix of governmental policies toward substance abuse. Some policies regulate, tax and other- wise limit the distribution of these products, while others create tax write-offs for advertis- ing them. In addition, tobacco and alcohol advertising targets some of the very groups at which the public health community is aiming its health promotion eflorts. ntolrrl)RENG CHANGE... 'I'his report presents indicators that describe the nature and extent of substance use and abuse, associated conse- quences, and efforts to combat the problem. Throughout, descriptive findings are provid- ed as well as measures that document change over time. Observed increases and decreases in these indicators will help determine how suc- cessful efforts have been and where addition- al resources need to be targeted. Meanwhile, the U.S. Public Health Service has set objectives for decreases in the use of alcohol, illicit drugs, and tobacco as part of a major effort to increase the span of healthy life for Americans, reduce health disparities among population groups, and achieve access to pre- ventive services for all. The federal govern- ment's Healthy People 2000: National Health Promotion and Disease Prevention Objectives offers specific measurable targets across the life course and for many population groups. The indicators presented in this report were chosen after careful review of current knowl- edge about substance abuse and its impact. National data were emphasized, although the charts also trace the progress of important pop- ulation subgroups, such as youth. A number of the Healt{ry People 2000 objectives appear with- in the indicators in this report, as noted. Together, the year 2000 objectives and the indicators presented here provide a blueprint for action and a means of charting our nation's progress against substance abuse.

FURTHER READInG 18 USE, ABUSE AND DEPF.NDENCE U.S. National Institute on Drug Abuse. Drug Abuse and IDrrrgAbrtse Research. The Third "Ihennial Report to C,ongress from the Secretary, Department of Health and Human Services. Rockville, MD: D11HS Pub. No. (ADM) 91- 1704,1991. HISTORICAI. TRENI)S IN CONSUMPTION ANI) POLICY l.evine, I 1G. "'1'he Alcohol Problem in America: From 7cmperance to Alcoholism," British Journal ofAddiction, -9:109-119, 1984. Musto, DF. 7he Anaerican Disease: Origins of Narcotic Control New York: Otiford University Press, 1987. Musto, DF. "Opium, Cocaine and Marijuana in American History," Scierrri6cAraerican, July, 40-47, 1991. Slade, J. "The Tobacco Epidemic: Lessons From History," Jotn-nal of P.•,,z-hoactiue Drugs, 21 (3): 281-291, 1989. A1.L SI'.GMENTS OF SOCIE'Il' AFFECTED Clark, WD, Hilton, MF. (eds.). Alcohol in Anterica: Drinking Practices and Problems. Albany: State University of New York Press, 1991. 5BBSTAIICE BBUSE Substance Abuse and Mental Health Services Administration. Ot-tice of Applied Studies. National Household Srnz ey on DnegAbuse: Main Findings 1991. Rockville, MD: DIIHS Pub. No. (ADM) 93-1979, 1993. SOCIETAI. COSTS OF SUBSTANCE ABUSE Rice, DI', Kelman, S, Miller, LS, Dunmeyer, S. The Economic Costs ofAlcohol, and Drug Abuse and Mental Illness 1985. San Francisco: DHHS Pub. No. (ADM) 90-1694, 1990. TAKING ACTION Kleiman, MAR Against Excess: Drug Poliry for Results. New York: Basic Books, 1992. MONITORING CHANGE U.S. Department of Health and Human Services, Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Full Report, with Commentary. Washington, DC: DHHS Pub. No. (I'HS) 91-50212, 1991. Ir

C PERCEPTIOIIOF RISK 0 R h(FRICANS INCRFASINGLYrecognireY that the use of alcohol, illicit drugs, and tobacco carries substantial health risks. And, as a result, substance use among many segments of the popu- lation has declined. Several factors contribute to this change in the perception ofpotential harm (Indicator la). C)ne is the success of intensive communitv- based and public information campaigns on the health haiards ofsubstance abuse. Another is a grcater societal commitment to healthy lifcstyles in t;eneral and increased disapproval of substance use. Itesearch suggests that at least two of these factors --- increased awareness of risks and disapproval of use - have led to a drop in marijuana use among youth. I)espite increases in the percent of youth perceiving great risk, the percent still }alls far below the objectives targeted by IIe<tlt{iy Peofile 2000. Not all substances are perceived as equally risky. Illicit drug use is viewed by people of all a,;es as much riskier than smoking or drink- ing, and regular or heavier use of drugs or alco- hol is seen as riskier than occasional or exper- imental use. '1'herc also are differences in S7B5TAtlCE ABUSE perception of risk by age (Indicator 1b). In general, older people are more likely than young people to think that substance use is risk:,: One exception is that most teenagers as well as peo- ple ages 35 and older think usin~ ma-ijuana regularly is risky. Cigarettes are the only substance that is per- ceived as increasingly risky with each succes- sive age group. Forty-eight percent of vouth think it is risky to smoke one or mor: packs a day, whereas 68 percent of people 15 and older believe it risky. The fact that so manv young people do not think smoking i~ risky, is especially important because youth is a period of experimentation. More information about the risks of smoking should be targeted specif- ically to teenagers. Americans also are worried about envi- ronmental tobacco smoke -- the exposure of nonsmokers to cigarette smoke in Feople's homes, at work and in public places. Accord- ing to a nationwide poll, three offoLr non- smokers at some point in their lives have lived with smokers, and nearly half are concerned that environmental smoke miaht cause seri- ous health problems for them. cn ~ ~ N tJ 4P U'I lD J . 4 .