Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 26-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Objectives that met or exceeded their targets. Students, grades 9 through 12, riding with a driver who has been drinking (26-6) achieved its target. In addition, a nationwide legal standard of .08 percent BAC maximum levels for driving while intoxicated (DWI)³ enforcement and prosecution (26-25) was achieved. This standard represents an effective tool in the effort to combat drunk driving. Research has found that passage of a 0.08 percent BAC per se law, particularly when accompanied by publicity, results in a 6 percent to 8 percent reduction in alcohol-related fatalities.⁴ The proportion of 8th graders who disapprove of trying marijuana or hashish once or twice (26-16d) increased from 69 percent in 1998 to 76 percent in 2004, exceeding the target of 72 percent.

Objectives that moved toward their targets. Alcohol-related motor vehicle crash deaths (26-1a) showed progress. Between 1998 and 2002, this objective achieved 20 percent of the targeted change. Alcohol-related fatalities decreased during the 1980s and early 1990s due to several factors, including tougher penalties for impaired drivers, raising the legal drinking age to 21 years, enhanced law enforcement, and the proliferation of grassroots organizations.⁵ Since progress began to stall in the mid-1990s, the National Highway Traffic Safety Administration (NHTSA) has pursued a number of key strategies, including:⁶

• High-visibility law enforcement to promote general deterrence.
  
• Support of prosecutors handling DWI³ cases.
  
• Use of DWI/drug courts to closely supervise high-risk offenders.
  
• Routine use of alcohol screening and brief interventions by medical and health care professionals.

In addition, NHTSA is developing strategies to reduce impaired-driving fatalities among persons at greatest risk.⁷ Regarding youths, pursuant to congressional direction, the Substance Abuse and Mental Health Services Administration (SAMHSA) has convened an Interagency Coordinating Committee to Prevent Underage Drinking in which NHTSA is participating.7

The proportion of adults who exceed low-risk drinking guidelines (26-13) decreased between 1992 and 2002. As illustrated in the Progress Quotient (see Figure 26-1), the proportion of females who exceed low-risk drinking guidelines (26-13a) achieved 77 percent of the targeted change. In comparison, the proportion of males who exceed low-risk drinking guidelines (26-13b) achieved 54 percent of the targeted change. Between 1998 and 2004, the number of high school seniors never using alcohol (26-9c) or illicit drugs (26-9d) achieved 40 percent and 30 percent of their respective targeted changes. Overall drug use continued to decline: 600,000 fewer teens used drugs in 2004 than in 2001.⁸

When youth do not try drugs in their teenage years, their likelihood of having substance use problems later in life is reduced.⁹ Adolescents' disapproval of substance abuse is inversely related to their reports of use.⁹ From 1998 to 2004, increasing numbers of young people disapproved of substance use and abuse. Between 1998 and 2004, 8th graders' disapproval of one to two alcoholic drinks per day (26-16a) increased from 77 percent to 79 percent, achieving 33 percent of the targeted change. Disapproval of trying marijuana by 10th graders (26-16e) also increased, achieving 25 percent of the targeted change. Slight increases occurred in 12th graders' disapproval rates for daily alcohol use (26-16c) and trying marijuana (26-16f).

Adolescents' perception of the risk of smoking marijuana once a month (26-17b) achieved 75 percent of its targeted change between 2002 and 2003. In contrast, adolescents' perception of the risk of weekly binge drinking (26-17a) achieved 8 percent of the targeted change.

Between 1997 and 2002, treatment admissions for injection drug use (26-20) achieved 86 percent of the targeted change. Persons seeking help for intravenous or injection opioid abuse experience several barriers to treatment.¹⁰ The most effective form of therapy—opioid agonist medical maintenance¹⁰—is limited to established treatment programs that do not reach patients in certain regions of the United States. New medications (buprenorphine products) and a new treatment modality (office-based opioid agonist medical maintenance) are expanding treatment options for injection drug use and bringing such emerging therapies into mainstream medicine.¹¹ SAMHSA is collaborating with the Food and Drug Administration to ensure that treatment centers for injection drug users are fully accredited and that physicians receive training on the use of buprenorphine in the treatment of persons with opioid addictions.

Several subobjectives experienced progress of less than 5 percent toward their targeted changes: cirrhosis deaths (26-2), adolescent use of marijuana (26-10b), adult use of illicit drugs (26-10c), and binge drinking in the past month by adults and adolescents (26-11c and d).

Objectives that demonstrated no change. Average age at first use of alcohol and marijuana among adolescents aged 12 to 17 years (26-9a and b) showed no change from 2002 to 2003. Also demonstrating no change were the proportion of adolescents who remained drug and alcohol free in the past 30 days (26-10a), binge drinking in the past 2 weeks by college students (26-11b), the proportion of 10th graders who disapprove of one to two drinks per day (26-16b), and the proportion of adolescents who perceive that using cocaine once per month poses a great risk (26-17c). In 2004, SAMHSA's Center for Substance Abuse Prevention implemented the Strategic Prevention Framework State Incentive Grant (SPF SIG) program, one of many efforts to improve and disseminate prevention strategies throughout the Nation.¹² The program's goals are as follows:

• Prevent the onset and reduce the progression of substance abuse, including childhood and underage drinking.
• Reduce substance abuse-related problems in the community.
• Build prevention capacity and infrastructure at the State and community levels.

Every SPF SIG grantee is expected to conduct a needs assessment; mobilize and build capacity; develop a comprehensive strategic plan; implement evidence-based programs, practices, and policies, along with the community-level infrastructure to support them; and monitor and evaluate effectiveness and sustainability. Through the SPF SIG program, SAMHSA is working with its State and community partners to improve prevention and move these objectives toward their targets.

One initiative being implemented by SAMHSA's Center for Substance Abuse Treatment is the Targeted Capacity Expansion Campus Screening and Brief Intervention grants, which are promoting screening, brief interventions, and referrals to treatment among college and university students with a high risk of substance abuse disorders.^{13, 14} These grants are intended to expand existing campus-based medical services by integrating student health programs with screening and interventions for substance abuse and to motivate students to take appropriate action. In addition to the SPF SIG program, examples of effective programs to prevent drug abuse are reviewed in the National Institute on Drug Abuse (NIDA) publication, Preventing Drug Abuse Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders.¹⁵ The SPG SIG and the NIDA publication are efforts of HHS to address substance abuse among youth and other populations.

The number of States that have administrative license revocation laws for DWI (26-24) also showed no change. NHTSA continues to encourage States to require prompt, mandatory administrative revocation or suspension of driver's licenses for alcohol and other drug test failure or refusal. As of December 2003, 41 States and the District of Columbia had adopted some form of administrative license revocation.¹⁶

Objectives that moved away from their targets. Drug-induced deaths (26-3) and drug-related emergency department visits (26-4) moved away from their targets. Drug-induced deaths are a broad measure of the overall impact of all drugs, making interpretation of the lack of progress difficult. SAMHSA's Drug Abuse Warning Network survey, which provides data on drug-related emergency department visits (26-4), has undergone significant revisions. The revisions have affected interpretation of trends. This change and other factors complicate analysis of progress toward the target.

Annual per capita alcohol consumption (26-12) moved away from its target. Again, interpretation is difficult, because drinking patterns vary significantly within the Nation's population.¹⁷ More research is necessary to better understand changing patterns of heavy, moderate, light, and low-risk drinkers and to combine aggregate data, surveys, and longitudinal or panel studies to ask more specific questions about the Nation's drinking patterns.

Subobjectives 26-14b and c—steroid use among 10th and 12th graders—moved away from their targets. Inhalant use in the past year among adolescents aged 12 to 17 years (26-15) also exhibited a 5 percent movement away from the targeted change.

The treatment gaps for alcohol or illicit drugs (26-18) and treatment for alcohol abuse (26-21) remain substantial and have moved away from their targets. These gaps suggest that treatment capacity should be expanded.¹⁸ Dissemination of evidence-based treatment modalities and expanded services can contribute to reducing treatment gaps.

Objectives that could not be assessed. Although data sources were identified, no data were available for assessing five objectives: alcohol-related hospital emergency department visits (26-5), intentional injuries from alcohol- and drug-related violence (26-7), substance abuse treatment in correctional facilities (26-19), hospital emergency department referrals for alcohol or drug problems and suicide attempts (26-22), and community partnerships and coalitions to prevent substance abuse (26-23). Data beyond the baseline were not available for lost productivity in the workplace due to alcohol and drug use (26-8).

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