Faces of Public Health: Lloyd Johnston

Dec 28, 2011, 4:57 PM, Posted by NewPublicHealth

LD_Johnston1_lowres_photo Lloyd Johnston, University of Michigan Institute for Social Research

Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe.

Cigarette and alcohol use by teens are at their lowest point since the Monitoring the Future survey began polling teenagers in 1975, according to this year’s survey results. But good news is tempered by a slowing rate of decline in teen smoking and continued high rates of abuse of hookahs, small cigars and smokeless tobacco, as well as marijuana and prescription drugs. According to the current survey, conducted annually by researchers at the University of Michigan Institute for Social Research and funded by the National Institute on Drug Abuse, more teens continue to abuse marijuana than cigarettes, and alcohol is still the top substance of choice.

Close to 50,000 students from 400 public and private schools participated in this year's survey. NewPublicHealth spoke with the survey’s principal investigator, Lloyd Johnston, PhD.

NewPublicHealth: What were key results in this year’s survey?

Lloyd Johnston: I think the most important stories were related to the most widely used products—tobacco, alcohol and marijuana. The decline in use among teens continued in all three grades we studies. For example, smoking declined from thirteen percent down to 12 percent, and while that’s a small decrease it translates into a lot of lives saved—perhaps 30,000 to 40,000 fewer kids smoking now.

NPH: What makes teens think marijuana is relatively safe?

Lloyd Johnston: That’s a good question. There has been an increase for four years and the perception of risk has declined for five years. Why they think it’s safe is the $64,000 question. It may have to do with the widespread adoption of medical marijuana laws, and California had a vote to legalize marijuana. The effect of that is not just state-specific, because the country as a whole hears about it. If you start to hear about use of a drug as a medicine, then perhaps it can’t be all that bad.

NPH: What's behind the overall trend in teen drug use?

Lloyd Johnston: The trend has to do with many things such as home environment, success in school—kids with lower grades tend to be more likely to use drugs—and the impact of media. Some kids are more susceptible, perhaps through modeling around them. There’s a whole host of factors.

Before the mid-60s, there were very low levels of drug use. The drug epidemic hit during the Vietnam era, and became symbolic against the government and norms changed dramatically. It has taken us a while to kind of move back from that. One thing we see is that if the dangers of a drug came to be seen as quite consequential, use of the drug drops down. With cocaine, for example, there was a 75 percent decline in two years after the peak use in 1986. Hearing that a drug is more dangerous, such as LSD, and later cocaine and, until recently, ecstasy, can have a deterrent value.

NPH: Ecstasy is showing an uptick. Why is that?

Lloyd Johnston: We have a concept called generational forgetting. As a new generation comes of age, they weren’t old enough to have learned from the experiences of teens that preceded them. They don’t know not to use, but have the curiosity to try. It’s a lag and might take eight to ten years. Ecstasy use was high in 2001 and it dropped when kids came to see it as dangerous. We’re seeing the beginning of a relapse. This has happened with heroin, LSD and cocaine, where you get this generational lag and the next generation of kids coming into adolescence simply doesn’t know the lessons.

NPH: What can you do to intersect that generational forgetfulness?

Lloyd Johnston: I wish I had an easy answer for that. Most persuasive is what they see on television, that these events were real and there were real people dying. I think it’s much harder to convey that information convincingly in a classroom setting. Media efforts could include that but they haven’t really and it’s best to have them be drug-specific.

One problem is that Congressional funding for anti-drug campaigns have been cut quite dramatically so there is much less of an effort. The focus of one campaign was marijuana and they were fighting an uphill battle; the evaluation now finds it did make a difference.

NPH: Why does binge drinking continue to be an issue in this age group?

Lloyd Johnston: There are some parents who say “at least it’s not marijuana.” Among secondary school kids, binge drinking has declined, in part because of campaigns starting in the early 80s. There were several campaigns that played a major role including one by Mothers against Drunk Driving. After that there was a campaign to get designated drivers if you’ve been driving, which helped to raise awareness of the seriousness of drunkenness among kids and adults.

Another important effort was [legislation to] withhold some federal highway funds from states that did not move the legal drinking age up to 21.

NPH: Looking ahead, what kinds of things do you hope will happen that might make a difference?

Lloyd Johnston: If young people come to see some of these drugs as more dangerous, that would bode well for their usage levels. There has been a leveling off of an important increase that had been occurring and that has been misuse of prescription drugs. It grew as much as it did because kids didn’t see them as dangerous, since the drugs are prescribed by doctors. The fact is they are still dangerous drugs and all have the potential to cause addiction and death. The word has gotten out and was helped by the Drug Enforcement Administration campaign this year to get people to return their [unwanted, unused prescription] drugs. The use of these drugs has at least leveled and there has been some decline—that’s good news.

This commentary originally appeared on the RWJF New Public Health blog.