CAMPAIGNING against drug abuse and the sale of tobacco to minors, US Secretary of Health and Human Services Louis Sullivan recently spoke with Monitor editors and writers on these issues. Responding to questions, Dr. Sullivan explained his goals and strategies.
On why HHS is supporting state statutes against selling tobacco to minors rather than a national statute:
We have 44 states that have laws that are poorly enforced.... In the effort to get something done as quickly as possible and build on the momentum we've developed this far, we have focused on better state enforcement, [including] changing some of the laws that exist.
On why state laws aren't being enforced:
Among the reasons we have found is that many states [make selling to minors a] criminal rather than civil offense. The police, involved in robberies and crimes, have not seen tobacco as an issue sufficient to command their time.... And judges have been reticent to have someone with a criminal offense on [their record]; it's seen in many instances that the punishment would be worse that the crime. So we're recommending that it be a civil offense. Also that states consider having another agency as the enforcement agency, like the public health department.
On minors' use of vending machines:
Three to 16 percent [of the cigarettes that minors get] ... are from vending machines. It's difficult to monitor them. We've proposed that the sale of tobacco by retailers be licensed the same as alcohol sales, and that sale of tobacco out of vending machines be eliminated.... An interim measure could be restrict vending machines to places where only adults gather, like bars and nightclubs.
On market testing of a cigarette for women:
That is the one group where smoking is increasing ... white women who are high school dropouts. The tobacco companies knew precisely what they were doing; they were targeting what they saw as a growth market. They're marketing a product that is dangerous for the nation's health and doing it solely for the profits, which I find unconscionable.
On a new report indicating that life expectancy of young black males has actually declined in recent years:
There are several factors: AIDS - blacks and Hispanics are disproportionately affected. The drug abuse epidemic. And even such things as violence. Violence is the No. 1 cause of death for black men and the death rate is 7 to 8 times that for white males.
On what HHS can do to help prevent violence among black males:
Violence in our community is not only a criminal justice problem but a public health one as well. We need to find ways to have our young people learn how to resolve conflicts other than resorting to violence.
Part of this is related to the crack [cocaine] epidemic and illegal activities in our communities, but it's more than that, it's domestic violence. We're already supporting a number of demonstration projects around the country. And on May 31, we announced in the Federal Register a new grant program, starting small, of $1.5 million, for which we're inviting applications from community organizations for grants to address the problems of black males: health issues, issues of violence. We see it as a serious problem, because if the black male is in trouble, it means the black family is in trouble.
On efforts to control substance abuse by pregnant women:
That's a very difficult issue.... We haven't sorted it out yet. The position I've taken is this: We do have a growing problem with crack babies exposed to drugs in utero, whose lives have now been compromised and whose potential to become productive adults has been compromised. I think we not only need to develop programs for drug treatment and education, but we also need to ... develop a climate of less tolerance for drug use.
On instances of prosecuting women who have used alcohol or cocaine:
As to the issue of criminal prosecution, that's a difficult one. [There's] a lot of activity in the states now, where some are pushing for that and some are not. We want to do everything we can to get mothers into treatment. But the question is how do we balance that?
We are also paying for this as a society, in the lost potential of those individuals and in [the cost of] their care. I saw a crack baby in Broward, Fla., whose mother had walked out, and the hospital and the county were left with the bill. For eight months, it was $648,000 and the meter was still ticking. We need to have a climate that says this is not acceptable, not normal - this is bad. I think that does influence people.