ORIGINAL HEALTH EDUCATION AND A VALUE SYSTEM BY C, EVERETT KOOP, IAD SURGEON GENERAL AND DEPUTY ASSISTANT SECRETARY FOR HEALTH KEYNOTE ADDRESS TO THE CONFERENCE ON ADOLESCENT HEALTH SPONSORED BY THE FJATIONAL CATHOLIC EDUCATION ASSOCIATION AND THE MARCH OF DIMES BIRTH DEFECTS FOUNDATION SOUTH BEND, INDIANA JUNE 19, 1983 -l- '(GREETINGS TO HOSTS, GUESTS) THIS IS INDEED A GREAT PRIVILEGE FOR ME TO COME HERE THIS EVENING, BEARING THE BEST WISHES OF YOUR CONSTANT FRIEND OF MANY YEARS OF PUBLIC SERVICE, THE HONORABLE MARGARET M, HECKLER, SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. YOU HAVE KNOWN HER OVER THE YEARS SHE SERVED IN THE UNITED STATES CONGRESS. NOW WE ALL KNOW HER AS A MEMBER OF THE EXECUTIVE BRANCH, GUIDING THE AFFAIRS OF ONE OF THE MOST IMPORTANT AGENCIES OF OUR GOVERNMENT, I ALSO BRING YOU THE GOOD WISHES OF A PRESIDENT AND AN ADMINISTRA- TION THAT SHARE WITH YOU THE DEEP AND ABIDING CONCERN THAT WE RAISE EVERY GENERATION OF AMERICANS SO THAT THEY CAN USE TO THE FULLEST THEIR POWERS TO THINKmTHEIR POWERS TO FEELmAND THEIR POWERS TO BELIEVE. I ADMIRE YOUR COMMITMENT -- AS INDIVIDUALS AND AS AN ORGANIZATION -- TO THIS TRIPLE, OR "TRINITARIAN," CONCERN FOR THE MIND, THE EMOTIONS, AND THE SPIRIT, AND I WILL ADMIT THAT I DO NOT ENVY YOUR DAY-TO-DAY EFFORTS TO SHOW YOUR CONCERN WITH THE YOUNG PEOPLE IN YOUR CHARGE, BY COMPARISON, THE CONTROLLED, PRECISE ROUTINES IN SURGERY ARE EASIER TO ACCOMPLISH, -2- ALSO, MY PATIENTS WERE ALWAYS ANESTHETIZED, I'M SURE THAT, NOW AND THEN, SOME OF YOU PROBABLY WISH YOU COULD USE A DROP OR TWO OF ANESTHESIA IN THE CLASSROOM, TOO, SELECTIVELY, OF COURSE, BUT YOU CAN'T...AND YOU DON'T,.,AND SO I BOW TO YOUR LEADERSHIP, THIS EVENING, HOWEVER, I THINK WE NEED TO DO SOME HARD THINKING -- TOGETHER -- ON WHY WE MAY NOT HAVE SHOUN THE LEADERSHIP THAT YOUNG PEOPLE EXPECTED OF US AND WHAT WE SHOULD DO ABOUT IT. AND WHEN I SAY "US, II I MEAN THOSE OF US IN MEDICINE AND HEALTH CARE AND THOSE OF YOU IN EDUCATION. FOR MUCH TOO LONG A TIME, I BELIEVE WE'VE BEEN LEADING OURSELVES AND OUR CHILDREN DOWN TWO BEWILDERING AND POTENTIALLY HARMFUL TRACKS: THE FIRST TRACK IS THAT OF INTRODUCING YOUNG PEOPLE TOO QUICKLY, TOO EARLY, AND TOO CASUALLY INTO THE COMPLEX WORLD OF ADULT LIFE,. . AND THE SECOND TRACK HAS BEEN TO DEAL WITH THE PROBLEMS THAT HAVE ARISEN BY TRYING TO CATCH UP WITH THEM, RATHER THAN ANTICIPATE AND PREPARE FOR THEM. -3- 1 SUPPOSE YOU COULD APPLY THAT CRITICISM TO MANY ASPECTS OF CHILD- RAISING, BUT I THINK THEY ARE ESPECIALLY TRUE FOR THOSE OF US WHO CARE A30UT THE HEALTH AND THE EDUCATION OF OUR YOUNG PEOPLE, NOT TOO MANY YEARS AGO, THIS COUNTRY PULLED OUT ALL THE STOPS AND TRIED TO STRENGTHEN THE TEACHING OF SCIENCE IN OUR PUBLIC SCHOOLS. THE IMMEDIATE REASON, YOU MAY RECALL, WAS THE RUSSIAN LAUNCHING ON OCTO3ER 4, 1957, OF "SPUTNIK," THE FIRST MAN-MADE OBJECT SENT INTO SPACE, FOR THE NEXT TWO DECADES AT LEAST, WE GENERATED WITHIN THE MINDS OF A GENERATION OF YOUNG PEOPLE THE IDEA THAT SCIENCE -- BY ITSELF -- COULD COME WITH THE ANSWERS FOR VIRTUALLY ANY OF MANKIND'S PROBLEMS. TO /dE, IT IS NO COINCIDEXE THAT THE GROWTH OF AMERICAN SCIENCE WAS ACCOMPANIED BY A PARALLEL DEVELOPMENT IN THE PUBLIC CONSCIOUSNESS, ONE THAT 3ECAME KNOWN BY THE SIMPLE AND REPUGNANT SENTENCE, "GOD IS DEAD." IN EFFECT, WE HAD PROMOTED KNOWLEDGE AND NEGLECTED BELIEF, THE RESULT WAS A TERRIBLE PERIOD OF CONFUSION AND DESPAIR FOR MANY OF OUR PEOPLE, ALL OUR IMPORTANT PUBLIC AND PRIVATE INSTITUTIONS -- INCLUDING OUR SCHOOLS -- HAD MOVED QUICKLY FORWARD WITH WHAT THEY CONSIDERED TO BE THE PATRIOTIC MESSAGE OF THE 60s: "GO FORTH AND LEARN MORE , " -4- AND IT lJAS PATRIOTIC ,, ,IT DID STRENGTHEN THE ROLE 0F SCIENCE IN THIS COUNTRY . , 'AND THAT CJAS AN IMPORTANT THING TO DO. BUT IT WAS ONLY PART OF THE JOB, THOSE OTHER TWO ELEMENTS WERE NEGLECTED, "LEARN MORE" , ..ALL RIGHT, I ACCEPT THAT, BUT WHAT ABOUT 'CARE MORE" AND 'BELIEVE MORE'? SOMEHOW, THEY WERE PUSHED ASIDE, AND IN-THE HEARTS OF MANY YOUNG PEOPLE WHO GREW up IN THE 6oS AND EARLY 70~ m AFRAID THAT 'GOD WAS PRESUMED TO 3E DEAD,' WE ARE NOCJ IN THE PROCESS OF CONTROLLING AND REPAIRING THAT DAMAGE. WE ARE NOW TELLING OUR Your~G PEOPLE THAT SCIENCE CAN ONLY GO so FAR -- AND No FURTHER, TO GO THAT EXTRA DISTANCE' THE DISTANCE THAT IS UPLIFTING AND LIBERATING AND THAT MARKS TRUE PERSONAL EXCELLENCE, YOU HAVE TO CALL UPON A VALUE SYSTEM -- ONE THAT RECOGNIZES RIGHT FROM WRONG -- ONE THAT EVEN SMACKS OF ABSOLUTES' AS UNPOPULAR AS THAT TERM MAY BE TO SOME PEOPLE TODAY, FOR INSTANCE.. , 0 WE HAVE A GOOD IDEA OF A SMOKER'S CHANCES OF CONTRACTING ONE OF SEVERAL KINDS OF SMOKING-RELATED CANCERS. YOUNG PEOPLE NEED TO KNOW THE TERRIBLE ODDS THEY ARE UP AGAINST, IF THEY START TO SMOKE OR IF THEY CONTINUE TO SMOKE. AT THE SAME TIME' THEY NEED TO HOLD ALL LIFE -- INCLUDING THEIR OWN -- IN A\dE AND REVERENCE. WE DON'T WANT -5- THEM TO GAMBLE ON THE OUTCOMES' TO "PLAY THE PERCENTAGES": WE WANT YOUfiG PEOPLE TO DECIDE UNEQUIVOCALLY TO LIVE A HEALTHY LIFE AND PRIMARILY FOR THAT REASON NOT TO SMOKE. BUT YOU NEVER KPIOW, JUST LAST \JEEK I WAS IN ALBUQUERkJE AND A YOUfiG PlAN CAflE UP TO ME AfdD SAID, "OH SURE, I SflOKE. BUT BY THE TI/`.lE I GET CANCER FROM SMOKING, THEY'LL FIND A CURE FOR IT," HE WORE A BIG SMILE, BUT WHAT A SAD REMARK THAT WAS! FOR THAT YOUNG MAN, MODERN SCIENCE OFFERED LITTLE MORE THAfJ A WAY OF HEDGIfiG A BET IN A DEADLY GAflBLE' WITH HIS OWN LIFE. 0 MY MEXT EXAMPLE INVOLVES Af4OTHER SET OF VALUES. AS YOU KNOW, THIS COUNTRY HAS BEEN CARRYING ON A VERY SUCCESSFUL CAMPAIGN TO IflMUf1IZE 95 PERCENT OF ALL SCHOOL-AGE CHILDREN AGAINST THE 7 LEADING INFECTIOUS DISEASES OF CHILDHOOD, IT'S AN AMAZING ACHIEVEMENT: THERE WERE ONLY 7 CASES OF POLIO REPORTED LAST YEAR, WE'RE NOW DEALING 1JITH MEASLES PRIMARILY AS ISOLATED OUTBREAKS, IT'S NOT THE MAJOR NATIONAL THREAT IT ONCE WAS, MUMPS IS WAY DOWf4...SO IS GERMAN MEASLES. AS A RESULT, WE'VE CONVINCED AMERICAN PAREftTS AND CHILDREN THAT VACCINES CAN PREVENT DISEASE. Af4D THERE'S PROBABLY A VACCINE TO CURE JUST ABOUT EVERYTHING, -6- SO IT IS NO WONDER THAT THE NEWS OUT OF EMGLAND THIS PAST WEEK CAUSED SUCH A STIR, SOME RESEARCHERS THERE SAY THEY'VE COPlE UP W1TH.A VACCINE AGAINST GENITAL HERPES. I HAVE SERIOUS DOUBTS ABOUT THEIR WORK, BUT THAT'S REALLY BESIDE THE POIFIT. THE FACT IS THAT OUR YOUNG PEOPLE HAVE BEEN FLOODING TELEPHONE SWITCHBOARDS TO FIND OUT IF THE NEWS IS TRUE, BUT YOU AND I KNOW THAT NO VACCINE WILL EVER PROTECT A PERSOft FROM THE CONSEQUENCES OF FREQUENT, CASUAL, UN-CARING SEX, SCIENCE CAN ONLY PROVIDE A PART OF THE ANSWER, THE OTHER PART IS IfiSIDE THE HEART OF THE INDIVIDUAL, IN THAT SYSTEM OF VALUES THAT DICTATES ONE'S OWN BEHAV- IOR AND PROVIDES ITS owr~ REWARD. 0 Af1D ONE LAST EXAFIPLE, WE HAVE MADE EXCEPTIONAL PROGRESS IN THE PAST 20 YEARS DEVELOPING NEW flEDICINES AND NEW KIfiDS OF PSYCHO- THERAPY TO HELP PAREfjTS AND CHILDREN COPE WITH THE MANIFOLD PRESSURES BEARING IN UPON THE AMERICAN FAMILY, WE HAVE SAID, IN EFFECT, THAT THE BREAKDOWN OF FAMILY LIFE IS UNDERSTANDABLE, MANAGEABLE, SOf.lETIf~lES EVEN REPARABLE OR "CURABLE," FOR MANY YOUNG PEOPLE, THEREFORE, FA?lILY HEALTH IS TREATABLE JUST LIKE ANY OTHER ILLNESS. SO, AS THE KIDS THEMSELVES SAY, "WHAT'S THE BIG DEAL?" -7- "FAWILY HEALTH" MAY BE MY THIRD EXAMPLE, BUT, IN ANY LIST OF PRIORITIES WHETHER FOR EDUCATION OR FOR MEDICINE, IT MUST RANK AS FIRST. OUR NATION CAN ONLY BE AS STRONG AS THE PHYSICAL, INTELLECTUAL, EflOTIOf1AL, AND SPIRITUAL HEALTH OF OUR AflERICAN FAMILIES, THAT IS CERTAINLY THE FOUfJDATION UPON WHICH VIRTUALLY ALL OUR PUBLIC HEALTH CONCEPTS ARE BASED. I KNOW IT IS THE SAflE FOR EDUCATION AS WELL. If4 THIS RESPECT, I AGREE WITH THE WORDS 0F POPE JOHN PAUL II, IN HIS flESSAGE "REGARDING THE ROLE OF THE CHRISTIAN FAMILY If4 THE MODERN WORLD." THE POPE SAID, IN HIS flESSAGE OF f1OVEflBER 1381.. , "THE RIGHT AfiD DUTY OF PARENTS TO GIVE EDUCATION IS ESSEfjTIAL, SINCE IT IS CONNECTED WITH THE TRANSMISSION OF HUMAN LIFE: IT IS ORIGINAL AND PRIMARY WITH REGARD TO THE EDUCATIONAL ROLE OF OTHERS, ON ACCOUNT OF THE UNIQUENESS OF THE LOVIfjG RELATIONSHP BETWEEN PAREfJTS AfJD CHILDREN: AND IT IS IRREPLACEABLE AND INALIENABLE, AND THEREFORE INCAPABLE OF BEIfiG ENTIRELY DELEGATED TO OTHERS OR USURPED BY OTHERS," -8- THOSE WORDS ARE JUST AS TRUE TODAY. IN THAT SAME MESSAGE, AS YOU KflOWt POPE JOHN PAUL II ALSO SPOKE OF "EDUCATION IN LOVE AS SELF- GIVING," WHICH HE TERflED "THE IMDISPENSABLE PREMISE FOR PARENTS CALLED TO GIVE THEIR CHILDREN A CLEAR AND DELICATE SEX EDUCATION," TO HELP PARENTS ACCOMPLISH THAT SENSITIVE TASK, 1JE NEED TO WORK CLOSELY AND COMPASSIONATELY WITH THEM. ONE OF OUR MOST IMPORTANT CHALLENGES -- IN HEALTH AND IN EDUCATION -- IS TO TEACH PARENTS TO TEACH. I BELIEVE WE ARE ABLE TO SUCCEED ONLY TO THE EXTENT THAT PARENTS THEMSELVES SUCCEED WITHIN THE CONTEXT OF THEIR OWf1 FAMILIES. AFTER ALL THE PHYSIOLOGY AND BIOLOGY LESSONS HAVE BEEN GIVEN -- HOldEVER EXPERTLY THEY ARE DELIVERED AfdD WITH \lHATEVER NEW IfIFORf~1ATION -- WE ARE NEVERTHELESS FORCED TO ADMIT THAT,., THERE IS STILL NO VACCINE TO PROTECT ONE'S OWN PERSON FROM BEING ABUSED BY ANOTHER.,. THERE IS STILL fJ0 MEDICATIOfi TO PREVENT ONE'S FEELINGS FROM BEING TREATED WITH CONTEMPT BY AfJ0THER.s. Af4D WE HAVE YET TO DISCOVER A THERAPY THAT PROTECTS HUMAN LOVE FROM BEING TRIVIALIZED, -9- WE NEED -- AND WE SHOULD BE ABLE TO DELIVER -- BETTER HEALTH EDUCATION THAN WAS POSSIBLE IN FORMER YEARS. WE KNOW MORE, WE CAN DO MORE, BUT WITHOUT A SYSTEM OF HUMAN VALUES TO GO WITH IT, IT'S LIKE BUILDING HALF A HOUSE: IT DOESN'T WORK AND IT WON'T STAND UP. BY THE WAY, LEST THERE BE ANY MISTAKE ABOUT IT, LET ME SAY RIGHT HERE THAT I AM VERY OPTIMISTIC ABOUT THE SUCCESS OF A HEALTH EDUCATION PROGRAM BASED UPON DECENT HUMAN VALUES. THERE ARE A NUMBER OF POSITIVE SIGNS AfiD SIGNALS COMING FROM YOUNG PEOPLE TODAY AND I THINK WE NEED TO RECOGNIZE THEM AND RESPECT THEM FOR THE GREAT POTENTIAL THEY SEEfl TO OFFER, LET ME FIRST DESCRIBE WHAT WE DETECT IN THE AREA OF DRUG ABUSE. EACH YEAR THE f4ATIOfiAL INSTITUTE ON DRUG ABUSE OF THE PUBLIC HEALTH SERVICE HAS A SURVEY MADE OF THE EXTENT OF DRUG USAGE AMONG YOUNG PEOPLE, AS A RESULT, THE INSTITUTE HAS BUILT UP OVER THE YEARS A CERTAIfJ DEGREE OF SENSITIVITY TO SHIFTS HERE AND THERE. AND LATELY WE'VE BEGUN TO DETECT A CONTIfJUIf~G. STEADY, ALBEIT GRADUAL, DECLINE IN DRUG USAGE AMONG YOUf-IG PEOPLE, THIS IS THE CONCLUSION FROM THE LATEST SURVEY CF HIGH SCHOOL SENIORS DONE FOR US BY THE INSTITUTE FOR SOCIAL RESEARCH AT THE UNIVERSITY OF MICHIGAN, -lO- ACCORDING TO THIS SURVEY, HIGH SCHOOL SENIORS "ARE CONTINUING TO GRADUALLY MODERATE THEIR USE OF ILLICIT DRUGS." THE USE OF MARIJUANA, FOR EXAMPLE, HAS BEEN DECLINING SINCE 1979. THE LATEST SURVEY SHOWS THAT ABOUT 6 PERCENT OF LAST YEAR'S HIGH SCHOOL SENIORS -- OR AROUND 180,000 YOUNGSTERS -- USED MAR1 JUANA EVERY DAY. THIS WAS-DOWN FROM THE 11 PERCENT LEVEL OF 1978, THE NET RESULT, THEN, Is THAT LAST YEAR ABOUT HALF THE NUMBER OF HIGH SCHOOL SENIORS USED MARIJUANA, COMPARED TO THE YEAR 1978, THAT IS A SUBSTANTIAL DROP IN DRUG USAGE. PlARIJUANA IS THE flOST WIDELY USED OF THE ILLICIT DRUGS, BUT Uf4FORTUNATELY IT'S NOT THE ONLY ONE. YOUNG PEOPLE ALSO EXPERIMENT WITH -- AND BECOME ADDICTED TO -- STIMULANTS, SEDATIVES, AND COCAINE. NEVERTHELESS, THERE \JERE DECLINES If1 USAGE AMONG THESE DRUGS AS WELL, THE STORY IN COCAIfiE IS ESPECIALLY INTERESTING. THE DRUG HAS BEEN GIVEN A GREAT DEAL OF PUBLICITY AND HAS BEEN IDENTIFIED WITH SO MANY PEOPLE IN SPORTS AND ENTERTAINMEfjT, MEN AND WOMEN WHO COULD BE CON- SIDERED AS IDOLS OR "ROLE MODELS" FOR YOUNG PEOPLE, AND, INDEED, COCAINE USAGE AMONG HIGH SCHOOL SENIORS DOUBLED BETWEEN 1975 AND 1979, LEVELLED OFF FRCM 1979 TO 1981, AND FINALLY TURNED DOWNWARD IN 1982, ONLY HEROIN AND THE AMYL AND BUTYL NITRITE INHALANTS SEEMED TO SHOW NEITHER A RISE NOR A DECLINE IN USAGE IN 1982, FOLLOWING A STEADY DE- CLINE IN USAGE FOR THE PRECEDING THREE YEARS, SOMETHING IS GOING ON. AND WHATEVER IT IS, IT'S IMPORTANT, I ASKED OUR EXPERTS AT THE NATIONAL INSTITUTE ON DRUG ABUSE AND CAME AWAY WITH THESE CONCLUSIONS: 0 FIRST, AROUND 1978, CIHICH SEEMS TO BE A HIGH POINT IN DRUG USAGE, THIS COUNTRY BACKED AWAY FROM THE NOTION OF DE-CRIMINALIZING ANY ILLICIT DRUG USE. OUR SOCIAL POLICY IS NO\i QUITE CLEAR AND CONSISTENT AT NATIONAL, STATE, AND COMMUNITY LEVELS, SELLING OR USING ILLEGAL DRUGS IS A CRIME -- PERIOD. THERE HAD BEEN SOME AMBIVALENCE DURING THE 60s AND EARLY 70s. BUT THE COUNTRY FINALLY SETTLED ON A CLEAR POLICY OF HOLDING TO CRKlINAL PENALTIES FOR ILLICIT DRUG TRAFFICKING AND DRUG USAGE. 0 SECOND, I BELIEVE THAT THE NATION, THE STATES, OUR LOCAL COMMUNITIES, AND PARENTS HAVE FINALLY PUT TOGETHER A COHERENT ANTI-DRUG MESSAGE THAT TALKS NOT ONLY ABOUT THE REAL, MEASURABLE RISKS OF DRUGS FOR THE BODY AND MIND OF THE DRUG USER, BUT ALSO -12- ABOUT THE IMMEASURABLE PERSONAL RISKS,..THE REAL LOSS OF FRIEND- SHIP, RESPECT, AND LOVE, IN OTHER WORDS, DRUG USAGE MAKES A PERSON SO MUCH LESS HUMAN AND, HENCE, SO MUCH LESS ATTRACTIVE AND WORTHY OF AFFECTION, THAT IS A TRUE RISKmKIDS KNOW IT'S TRUE,,, AND THEY ALSO KNOW THAT, FOR THEM AT THEIR AGE, SUCH A LOSS CAN BE DEVASTATING. 0 AND THIRD, WITH THE FADING OF DE-CRIMINALIZATION AND WITH THE SHARPENED PERCEPTIONS OF THE DANGERS OF DRUG USAGE, PARENTS HAVE GONE ON THE OFFENSIVE. THEY ARE Now ORGANIZED INTO A ~IIDESPREAD, EFFECTIVE, GRASSROOTS MOVEMENT TO FIGHT DRUGS AND THEY HAVE NO HESITATION TO CALL FOR ASSISTANCE FROM ALL AVAILABLE RESOURCES IN THE PRIVATE SECTOR AND FROM EVERY LEVEL OF GOVERNMENT. PAST FEELINGS OF HELPLESSNESS HAVE PRETTY MUCH FADED AWAY, I MIGHT ADD THAT LAST OCTOBER I HAD THE PRIVILEGE OF JOINING THE FIRST LADY, MRS. RONALD REAGAN, AT THE WASHINGTON CONFERENCE SPON- SORED BY THE NATIONAL FEDERATION OF PARENTS FOR DRUG-FREE YOUTH, PARENTS REPRESENTING GROUPS FROM ALL OVER THE COUNTRY WERE THERE. THEY FELT THEY WERE RIGHT AND THEY FELT THEY WERE STRONG, AND I CERTAINLY AGREE THAT THEY WERE -- AND ARE. -13- 1 BELIEVE THIS NEW POSTURE BY PAREfJTS HAS HAD AN IMPORTANT EFFECT UPON CHILDREN, AT LEAST, THAT IS HOW I WOULD EXPLAIN THE ANSWERS GIVEN IN A SEPARATE PART OF THE MIGHIGAN SURVEY. IN THAT PART, LAST YEAR'S SENIORS WERE QUIZZED ON THEIR PARENTS' ATTITUDES ABOUT DRUG-TAKING, THE ANSWERS INDICATED THERE \JAS VERY LITTLE AMBI- VALENCE AT HOME: BETWEEN 92 AND 97 PERCENT OF THE SENIORS SAID THEIR PARENTS WOULD DISAPPROVE OR "STRONGLY DISAPPROVE" OF THE USE OF MARIJUANA, THE ATTITUDE WAS THE SAME FOR MANY OF THE SO-CALLED "HARD DRUGS," TOO, I THINK WE CAN SAFELY SAY THAT OUR SCHOOLS HAVE STRONG, CONSISTENT ALLIES IN MOST AMERICAN HOMES, WHEN THE BATTLE TURNS TO THE USE OF ILLICIT DRUGS. PROBABLY OF MORE SIGNIFICANCE IS THE DATA ON HOW EFFECTIVE THE ATTITUDES OF PEERS CAN BE UPON THE POTENTIAL DRUG USER, WHILE THE PERCENTAGES ARE NOT AS HIGH AS THOSE FOR PARENTS, I WAS STILL VERY HEARTENED TO SEE THAT A SUBSTANTIAL NUMBER OF HIGH SCHOOL SENIORS -- 3 OUT OF EVERY 4 -- SAID THEY THOUGHT THEIR FRIENDS WOULD DISAPPROVE IF THEY SNOKED MARIJUANA EVERY DAY, BETTER THAN HALF THOUGH FRIENDS WOULD DISAPPROVE OF OCCASIONAL MARIJUANA USAGE, AND 5 OUT OF EVERY 10 THOUGHT THEIR FRIENDS WOULD EVEN DISAPPROVE OF EXPERIMENTING WITH MARIJUANA, -14- IN OTHER WORDS, THOSE OF US IN THE PROFESSIONS OF HEALTH AND EDUCATION HAVE ALLIES NOT ONLY AMONG THE PARENTS OF OUR STUDENTS BUT AMONG THE STUDENTS THEMSELVES. I HAVE NOT TRIED TO PUT TOO GOOD A FACE ON ANY OF THE-FACTS I'VE LAID BEFORE YOU THIS EVENING, EVEN THOUGH I BELIEVE WE CAN BE MUCH MORE HOPEFUL TODAY THAN WE WERE A DECADE AGO, BUT THE FACT REMAINS -- AND WE MUST NEVER FORGET IT -- THAT THIS COUNTRY HAS THE HIGHEST RATE OF DRUG USAGE AMONG YOUNG PEOPLE OF ANY COUNTRY OF THE WEST OR, FOR THAT MATTER, OF THE WORLD. SO FAR IN THIS TALK, I'VE BEEN USING FIGURES FROM A SURVEY OF SENIORS, BY THEN, LATE IN HIGH SCHOOL, MOST YOUNG PEOPLE HAVE LEARNED FROM THEIR ELDERS -- USUALLY BY OUR OWN DREADFUL EXAMPLES -- HOW TO EQUIVOCATE, "WAFFLE," CLARIFY, MODERATE, AND QUALIFY, SO I WOULD TEND TO SAY THAT WE MIGHT BE EVEN MORE SUCCESSFUL FINDING ALLIES AMONG YOUNGER STUDENTS.,.THOSE IN THE UPPER ELEMENTARY AND JUNIOR HIGH GRADES. IT'S A MUCH MORE EXPLOSIVELY CANDID TIME OF LIFE, THE SUBTLE DIFFERENCE BETWEEN "DISAPPROVE" AND "STRONGLY DISAPPROVE" Is LOST 0N MOST 8TH GRADERS. AND I SAY, "HURRAY FOR THEM," -15- OUR DRUG ABUSE STAFFS HAVE BEEN WORKING ON PREVENTION PROGRAMS FOR SOME TIME NOW AND NOT TOO LONG AGO THEY PUBLISHED A TEACHING GUIDE WITH A TITLE WORTHY OF THE JUNIOR HIGH STUDENTS IT IS MEANT TO SERVE, THE TITLE IS "SAYING NO," THE IDEA BEHIND THE PUBLICATION IS THAT WE NEED TO SPEND MORE TIME STRENGTHENING THE INHERENT DECENCY AND-COMMON SENSE WE FIND IN OUR PRE-TEENS AND EARLY TEENAGERS. I CJANT TO QUOTE A COUPLE OF SENTENCES FROM THE BEGINNING OF THIS PU3LICATION BECAUSE I THINK THEY BEAR REPETITION: "TEACHERS ~0 NOT NEED TO BECOME 'EXPERTS' 0N DRUGS TO DO EFFECTIVE DRUG ABUSE PREVENTION IN THE CLASSROOM." ALSO.,, "AN EFFECTIVE STRATEGY FOR DRUG ABUSE PREVENTION AT THE JUNIOR HIGH LEVEL IS TO HELP STUDENTS UNDERSTAND AND SAY 'NO' TO PRESSURES FROM THEIR PEERS," THAT FIRST SENTENCE -- THE ONE ABOUT NOT NEEDING TO BE AN EXPERT ON DRUGS -- IS A REFLECTION, I THINK, OF THE LESSONS WE'VE LEARNED ABOUT RELYING TOTALLY AND FOOLISHLY ON THE WEIGHT OF SCIENCE ALONE TO -lG- CARRY AN IMPORTANT HEALTH MESSAGE TO OUR CHILDREN. WE KNOW NOW THAT GOOD SCIENCE -- SOLID INFORMATION -- IS ONLY PART OF OUR MESSAGE,,,~ jlLJ OF IT. THE SECOND SENTENCE TELLS US THAT STUDENTS -- LIKE ADULTS -- REALLY DO LEARN FROM EACH OTHER. SOMETIMES THE LESSON IS POSITIVE, SOMETIMES IT IS NOT, OUR JOB AS EFFECTIVE TEACHERS AND HEALTH EDUCATORS IS TO HELP STIFFEN THE CHILD'S BACKBONE A LITTLE BIT, WHEN HE 0R SHE IS coN- FRONTED BY NEGATIVE PEER PRESSURES. CONVERSELY, WE SHOULD DO \JHAT WE CAN TO HELP CHILDREN DEVELOP POSITIVE PEER PRESSURES AMONG THEMSELVES ,,,TO SET HIGH VALUES ON SHARING THE GOOD STUFF THAT LIFE HAS TO OFFER US AND OUR FRIENDS. DURING THE PAST YEAR AND A HALF, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND THE PUBLIC HEALTH SERVICE ITSELF HAVE BECOME INCREASINGLY CONCERNED ABOUT THE USE BY YOUNG PEOPLE OF T\/O OTHER DRUGS: ALCOHOL AND CIGARETTES, THEY ARE NOT ILLICIT, ALTHOUGH THERE ARE LA\6 AND LOCAL ORDNANCES GOVERNING THEIR SALE TO YOUNG PEOPLE, THE VERY FACT THAT THESE DRUGS ARE LEGALLY AVAILABLE COMPLICATES THE PROBLEM 0F cowINcING YOUNG PEOPLE OF THEIR HARM, -17- FOR THIS REASON, WE BEGAN TO LOOK AT THE POTEFITIAL ROLE THAT YOUNG PEOPLE THEMSELVES COULD PLAY IN THE FIGHT TO REDUCE AND EVEN ELIMINATE SMOKING AND DRINKING AMONG AMERICA'S YOUNG PEOPLE, FIRST OF ALL, LET ME SAY THAT THESE T'JO DRUGS DO PRESENT VERY SPECIAL, WIDESPREAD, AND STUBBORN PROBLEMS FOR US ALL, ONCE AGAIU, ACCORDING TO THE MICHIGAN SURVEY, IT APPEARS THAT AT LEAST 93 PERCENT OF LAST YEAR'S HIGH SCHOOL SENIORS HAD AT LEAST TRIED ALCOHOL BY THE TIME THEY WERE READY To GRADUATE, No OTHER DRUG HAS THIS HIGH AN EXPERIENCE RATING, BUT THERE ARE TlJO ADDITIONAL POINTS THAT ARE EVEN MORE TROUBLING: 0 THE SAME PERCENTAGE OF HIGH SCHOOL SENIORS -- 5.7 PERCENT -- WERE DRINKING ALCOHOL EVERY DAY IN 19G2 AS WERE DRINKING EVERY DAY IN 1975, THAT'S ROUGHLY ONE IN EVERY 17 HIGH scHo0~ SENIORS, A VERY HIGH PROPORTION AND IT DOESN'T SEEM TO BE COMING DOWN, 5 IN ADDITION, THERE HAS BEEN A RISE IN WHAT'S CALLED "BINGE DRINKING," THAT IS, DRINKING 5 OR MORE GLASSES IN A ROW OF AN ALCOHOLIC BEVERAGE, ACCORDING TO SURVEY RESPONSES, 41 PERCENT OF -13- ALL SENIORS HAD SUCH A "BINGE" WITHIN THE TWO-WEEK PERIOD PRIOR TO THE 1982 SURVEY. THAT WAS UP FROM THE 37 PERCENT WHO SAID THEY'D HAD SUCH A BINGE IN THE TWO WEEKS PRIOR TO THE 1975 SURVEY. IN OTHER WORDS, WHILE OTHER DRUG USAGE IS EITHER STABILIZING OR CON- TINUING TO HEAD DOWN, ALCOHOL ABUSE IS STABILIZING OR EVEN HEADING UP, WE SHOULD ALL BE DEEPLY CONCERNED ABOUT THIS, BECAUSE ALCOHOL CAN CAUSE SUCH IRREVERSIBLE DAMAGE TO THE CARDIOVASCULAR, GASTROINTESTINAL, AND CENTRAL NERVOUS SYSTEMS, IT IS ALSO A MAJOR THREAT TO THE UNBORN CHILD, AS THE CO-SPONSOR OF THIS MEETING, THE MARCH OF DIMES BIRTH DEFECTS FOUNDATION, KNOWS SO WELL. AND RIGHT HERE LET ME PUBLICLY THANK THAT ORGANIZATION FOR ITS EXCELLENT PORK IN TH 1s AREA, IT NOT ONLY CARRIES OUT ITS OWN PROGRAM, BUT IT STIMULATES OTHER NATIONAL GROUPS, SUCH AS THE N.C.E.A., TO GET MORE DEEPLY INVOLVED IN HEALTH MATTERS, AND IT ALSO STAYS ON TOP OF THE GOVERNMENT TO MAKE SURE WE DO WHAT 1JE'RE SUPPOSED TO DO. MUCH OF THAT ACTIVITY IS DERIVED FROM THE PERSONAL COMMITMENT OF DR, MARY HUGHES, VICE PRESIDENT OF THE MARCH OF DIMES, TO WHOM WE OWE A SPECIAL VOTE OF THANKS, -19- JUST WHAT Is THE DANGER THAT ALCOHOL POSES TO PREGNANT WOMEN? WE GET SOME IDEA OF IT FROM THE CENTERS FOR DISEASE CONTROL IN ATLANTA, WHICH HAVE BEEN TRACKING THE INCIDENCE OF SOME 150 BIRTH DEFECTS FOR OVER A DECADE. IT IS THEIR CONSERVATIVE ESTIMATE THAT 1,800 TO 2,400 INFANTS ARE BORN EACH YEAR WITH FETAL ALCOHOL SYNDROME, BUT WE ALSO HAVE EVIDENCE OF "FETAL ALCOHOL EFFECTS": THAT IS, WE ARE SEEING DAMAGE TO THE FETUS THAT SEEMS ALCOHOL-RELATED, BUT IS OF A LESSER MAGNITUDE THAN IS CHARACTERISTIC OF THE FETAL ALCOHOL SYNDROME, ALL TOLD, THEN, OUR INFORMATION HAS INDICATED THERE MAY BE MORE LIKE 36,000 BABIES EACH YEAR AFFECTED IN SOME ADVERSE WAY BY THEIR MOTHERS' DRINKING. BECAUSE THE PROBLEM IS THAT SERIOUS, WE RELEASED A SURGEON GENERAL'S WARNING ON FETAL ALCOHOL SYNDROME IN JULY 1981, AT THAT TIME WE ADVISED THAT EVERY WOMAN "SHOULD BE TOLD ABOUT THE RISK OF ALCOHOL CONSUMPTION DURING PREGNANCY, AND ADVISED NOT TO DRINK ALCOHOLIC BEVER- AGES AND TO BE AWARE OF THE ALCOHOLIC CONTENT OF FOODS AND DRUGS," -2o- IT IS A STRONG WARNING, BUT THE MEDICAL PROFESSION 1s IN GENERAL AGREEMENT, IN THE RECENT MAY 13 ISSUE OF THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, THE COUNCIL ON SCIENTIFIC AFFAIRS OF THE A.M.A. HAS REAFFIRMED OUR WARNING, THE COUNCIL ADVISES THAT "PHYSICIANS SHOULD BE EXPLICIT IN REINFORCING THE CONCEPT THAT, WITH SEVERAL ASPECTS OF THE ISSUE STILL IN DOUBT, THE SAFEST COURSE IS ABSTINENCE," THE RESEARCH IS STILL NEW AND, YES, SOME QUESTIONS ARE STILL UN- ANSWERED. HOWEVER, WE DO KNOW THAT A MOTHER'S HEAVY DRINKING -- "BINGE" DRINKING -- DURING A PREGNANCY CAN CONTRIBUTE TO THE BABY'S SUFFERING MODERATE TO SEVERE MENTAL RETARDATION, LESS THAN NORMAL PRENATAL AND POSTNATAL GROWTH, A VARIETY OF UNPLEASANT FACIAL ABNORMAL- ITIES, OR OTHER EFFECTS SUCH AS RENAL, SKELETAL, OR CARDIAC MALFORMA- TIONS, VIRTUALLY HALF OF ALL BIRTHS IN THIS COUNTRY ARE DELIVERED OF WOMEN AGED 15 THROUGH 24, WITH ABOUT A HALF MILLION WOMEN HAVING THEIR FIRST CHILD BEFORE THEY REACH THEIR 13~~ BIRTHDAY. WHAT COULD BE MORE CATASTROPHIC FOR A YOUNG WOMAN, POSSIBLY A YOUNG GIRL STILL IN HIGH SCHOOL, THAN TO DELIVER HER FIRST CHILD AND DISCOVER IT IS IRREVERSIBLY DISABLED, DISFIGURED -- OR DEAD? -21- ALCOHOL IS ALSO CLOSELY LINKED TO THE NUMBER ONE CAUSE OF DEATH AMONG MEN AND WOMEN AGE 16-24: THE MOTOR VEHICLE, EACH YEAR, SOME 10,000 LIVES IN THIS AGE GROUP ARE LOST IN ALCOHOL-RELATED MOTOR VEHICLE ACCIDENTS, STATISTICALLY THAT'S ONE DEATH EVERY 52 MINUTES, BUT IN PUBLIC HEALTH TERMS, IT IS ONE OF OUR WORST EPIDEMICS, FORMER SECRETARY RICHARD S, SCHWEIKER PUT THIS PROBLEM RIGHT NEAR THE TOP OF HIS ACTION AGENDA. IN OCTOBER OF LAST YEAR, HE SET IN MOTION A "SECRETARY'S INITIATIVE TO COMBAT TEENAGE ALCOHOL ABUSE" AND BEGAN THE PLANNING FOR A SPECIAL "SECRETARY'S CONFERENCE FOR YOUTH ON DRINKING AND DRIVING." SECRETARY SCHWEIKER LEFT THE DEPARTMENT LAST WINTER, BUT THE CONFERENCE WAS HELD or3 SCHEDULE IN LATE MARCH, WITH THE SOLID SUPPORT OF OUR NEW SECRETARY, MARGARET HECKLER, AS A MEASURE OF THE KIND OF SUPPORT THIS PROGRAM IS GETTING INSIDE THE FEDERAL GOVERNMENT, LET ME TELL YOU WHO SHOWED UP FOR THE OPENING CEREMONIES OF THAT CONFERENCE LAST MARCH: THERE WAS, OF COURSE, THE CONFERENCE HOST, SECRETARY HECKLER, -22- SHE wAs JONED 0N THE PLATFORM By ELIZABETH DOLE, THE SECRETARY 0F TRANSPORTATION,, . AND BY TERREL BELL, THE SECRETARY OF EDUCATION,., AND BY AssIsTANT SECRETARY FOR HEALTH, DR. EDWARD N. BRANDT, JR,.,, AND BY FORMER SECRETARY SCHWEIKER... AND CONGRESSMAN MICHAEL BARNES OF MARYLAND, WHO SPONSORED THE FEDERAL LAW THAT HELPS STATES GET DRUNK DRIVERS OFF THEIR HIGHWAYS,,. AND DR. WILLIAM MAYER, THE ADMINISTRATOR OF THE ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION OF THE U.S. PUBLIC HEALTH SERVICE. BUT I HAVE TO TELL YOU THAT, AS ILLUSTRIOUS A GROUP AS THAT WAS, THE !,1OST IMPRESSIVE PEOPLE AT THE CONFERENCE WERE THE 324 TEENAGERS WHO WERE THE REAL PARTICIPANTS, THERE WERE AT LEAST 5 FROM EACH STATE AND TERRITORY, PLUS OTHERS WHO WERE INVITED TO COME AND DESCRIBE THE PROGRAMS THEY HAD STARTED. -23- THE CONFERENCE WAS "BY STUDENTS m STUDENTS' WHO ARE CONCERNED ABOUT THE TERRIBLE LOSS OF LIFE BECAUSE OF DRUNK DRIVING BY YOUNG PEOPLE, PRESENTATIONS IiERE MADE BY STUDENTS FROM SUCH GROUPS AS., . 0 'OPERATION:StlOWBALL' IN ILLINOIS, AN ALCOHOL AND-DRUG PROGRAM STARTED BY 5 TEENAGERS IN i977.,, 0 AN ALCOHOL SAFETY EDUCATION PROGRAM IN MINNESOTA CALLED 'THE CONTROL FACTOR" IN WHICH TRAINED STUDENTS WORK WITH THEIR CLASSMATES,., 5 "PROJECT GRADUATION" IN MAINE' 1IHICH EMPHASIZES "CHEMICAL- FREE' PARTIES FOR GRADUATING HIGH SCHOOL SENIORS,,, 0 AND 'STUDENTS AGAINST DRUNK DRIVING,' OR 'S.A.D.D.,' A NATIONAL PROGRAM LAUNCHED BY STUDENTS AT CJAYLAND HIGH SCHOOL IN MASSACHUSETTS AND NOW NUMBERING HUNDREDS OF CHAPTERS IN 22 STATES ACROSS THE COUNTRY, THIS IS THE KIND OF POSITIVE PEER PRESSURE THAT !4E FEEL MIGHT FINALLY TIP THE BALANCE AGAINST ALCOHOL AND SEND THOSE STATISTICAL CURVES DOWNWARD ONCE AGAIN, -24- BUT MEANWHILE, WE MUST FACE THE FACT THAT MORE SENIOR HIGH SCHOOL STUDENTS USE ALCOHOL THAN ANY OTHER PSYCHOACTIVE DRUG...THAT NEARLY A THIRD OF ALL HIGH SCHOOL STUDENTS BECOME DRUNK AT LEAST 6 TIMES A YEAR ,,.AND THAT THE AVERAGE AGE AT WHICH YOUNG PEOPLE BEGIN TO DRINK IS NOW 13, BUT THAT AVERAGE IS STILL CONTINUING TO GO DOWN, BECAUSE OF ITS TERRIBLE EFFECTS UPON THE HUMAN MIND, BODY, AND SPIRIT A~JD BECAUSE IT 1s SUCH A FACTOR IN HIGHWAY DEATHS AND INJURIES, ALCOHOL ABUSE NEEDS TO BE FOUGHT WITH AS MUCH 1:1TELLIGENCE AND ENERGY AS WE HAVE AVAILABLE. THIS IS O!-IE BATTLE WE DARE NOT LOSE, THE LAST DRUG I WILL DISCUSS THIS EVENING IS ONE THAT SOME OF YOU INDULGE IN AT GRAVE RISK TO YOURSELVES, TO YOUR FRIENDS AND COLLEAGUES, A!lD TO YOUR FAMILIES,. . IT IS A PROVEN KILLER: WE'VE GOT MORE THAN ENOUGH GOOD SCIENCE TO SHOW THAT... THIS YEAR IT WILL CAUSE AN ESTIMATED 340,000 AMERICANS TO DIE PREMATURELY BY 1iATJY YEARS.. . -25- IT IS A MAJOR FACTOR IN DEATHS FROM CANCER, HEART ATTACKS, AND STROKE. I'M TALKING ABOUT CIGARETTES. HERE AGAIN, WE ARE VERY TROUBLED BY A FLATTENING OUT OF THE CURVE OF USE, FOR A WHILE THERE WAS A STEADY DROP IN THE NUMBERS OF HIGH SCHOOL SENIORS SMOKING CIGARETTES, ACCORDING TO THE MICHIGAN DATA.,, FROM 29 PERCENT OF THE CLASS OF 1377 TO 20 PERCENT OF THE CLASS OF 1381, BUT IN 1982 THE DECLINE STOPPED AND MAY EVEN HAVE TURNED AROUND, WHICH IS VERY WORRISOME. IF THAT 1s REALLY THE CASE, THEN WE HAD BETTER PREPARE Now FOR THE EXTRAORDINARY BURDEN OF CHRONIC ILLNESS OUR SOCIETY WILL HAVE TO BEAR, WHEN TODAY'S YOUNGSTERS REACH MIDDLE AGE, I SAID EARLIER THAT I WAS OPTIMISTIC ABOUT OUR ABILITY TO WAGE A SUCCESSFUL FIGHT AGAIKT THE ABUSE OF ALCOHOL AND DRUGS, I BASED MY OPTIMISM ON THE STRONG FEELINGS EXPRESSED BY PARENTS TO THEIR TEEFAAGE CHILDREN AND EXPRESSED BY THE CHILDREN THEMSELVES, -2G- PARENTS WERE DESCRIBED BY THEIR CHILDREN -- LAST YEAR'S SENIOR HIGH SCHOOL CLASS -- AS DISAPPROVItlG OF PACK-A-DAY SklOKING AND DAILY DRINK- ING. AGAIN, THE FIGURE WAS 92 PERCENT OR BETTER OF THE RESPONDING STUDENTS REPORTED THIS. BUT WE NEED TO HANDLE THIS STATISTIC WITH SOME CARE, A THIRD OF OUR ADULTS SMOKE CIGARETTES, OBVIOUSLY, MANY PARENTS WHO TELL THEIR CHILDREN NOT TO SMOKE ARE, THEMSELVES, CIGARETTE SMOKERS. MANY PARENTS WHO SAY, "DON`T DRINK," ARE, THEMSELVES, HEAVY DRINKERS, AND WE KNOW FROM OTHER SOCIAL SCIENCE DATA THAT THE CHILDREN OF SMOKERS TEND TO SMOKE AND THE CHILDREN OF DRINKERS TEND TO DRINK, THE MICHIGAN RESULTS ARE GOOD. BUT WE MUST NOT BE SATISFIED UNTIL WE CAN REPORT WITH SOME ASSURANCE THAT "92 PERCENT OR BETTER OF RESPONDING HIGH SCHOOL SENIORS SAID THEIR PARENTS DISAPPROVED OF SMOKING AND DRINKING BY SAYING SO AND ALSO BY ABSTAINING FROM BOTH TO SHOW THEY MEAN IT." POSITIVE PEER PRESSURE IS NOT AS STRONG AS PARENTAL FEELINGS, AS PERCEIVED BY STUDENTS. BUT IT'S NEVERTHELESS AS STRONG AGAINST THESE TWO LEGALLY SOLD DRUGS -- CIGARETTES AND ALCOHOL -- AS IT IS WITH THE -27- ILLICIT DRUGS, ABOUT 3 OF EVERY 4 HIGH SCHOOL SENIORS THINK THEIR FRIENDS WOULD DISAPPROVE IF THEY SMOKED A PACK OF CIGARETTES OR HAD ONE OR MORE ALCOHOLIC DRINKS EACH DAY, I WOULD HAVE PREFERRED TO HAVE SEEN SOMETHING CLOSER TO 9 OUT OF lo,,, BUT FOR NOW I AM WILLING TO WORK FROM A REASONABLY STRONG BASE OF 3 OUT OF EVERY 4, AND I URGE EVERY ONE OF YOU TO JOIN ME, I HAD WANTED TO CLOSE MY PRESENTATION THIS EVENING ON A HOPEFUL NOTE AND I REALLY BELIEVE I CAN. THE EVIDENCE WE'RE BEGINNING TO GET -- FROM SURVEYS, FROM PARENT ACTION GROUPS, AND FROM ORGANIZATIONS SUCH AS THE MARCH OF DIMES AND THE NATIONAL CATHOLIC EDUCATION ASSOCIATION -- IS EVIDENCE THAT CAN JUSTIFY OUR BEING OPTIMISTIC. MOST OF OUR INFORMATION DOES POINT US IN A HOPEFUL DIRECTION: IT SUMMONS US TO CONTINUE WORKING HARD FOR PROGRESS IN CHILD HEALTH. ,a -25- IT STRENGTHENS OUR IkSTIKTS TO HELP OUR NEIGHBORS AND TO CARE DEEPLY ABOUT ALL OF AMERICA'S CHILDREN,.. AND IT REMINDS US THAT THERE IS STILL MUCH ROOM AND MUCH TIME FOR GROWTH, AND, LEST WE FORGET, "GROWTH," AS CARDINAL NEWMAN WROTE OVER A CENTURY AGO, "IS THE ONLY EVIDENCE OF LIFE." ONCE AGAIN, THANK YOU FOR YOUR GRACIOUS INVITATION TO SHARE THIS EVENING WITH YOU, AND BEST WISHES FOR THIS VERY IMPORTANT CONFERENCE. #####?#