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Adolescence represents a unique period in the life cycle. No longer children and not yet adults, adolescents make significant choices about their health and develop attitudes and health practices that impact their current safety and well-being. Those choices also often influence their risk for future serious chronic disease. Adolescence also presents an opportunity for encouraging healthy choices and pro social behaviors that will continue into adulthood. By investing in adolescent health today, America invests in the workforce, parents, and leaders of tomorrow. The national "Healthy People 2010" initiative presents a special opportunity to promote the health and well-being of adolescents. It is also an important element of the new prevention initiative--"Steps to a Healthier US"--from the US Department of Health and Human Services. Serving as a blueprint for improving the health of all Americans, "Healthy People 2010" has two overarching goals: (1) to increase quality and years of healthy life; and (2) to eliminate health disparities. This guide is a companion to "Healthy People 2010" and introduces objectives that are vital to the health of adolescents and young adults. It addresses issues such as unintentional injury, violence, substance use and mental health, reproductive health, prevention of chronic disease into adulthood, and mortality. A variety of strategies, tools, and guiding questions are introduced. Additional resources to help interested agencies develop programs and interventions that can prevent adolescent health problems are provided. Examples of various communities that have brought together different sectors of society to prioritize community action and that have developed mechanisms for implementing workable solutions are highlighted. A framework which agencies can utilize in assessing needs, establishing priorities, taking collective action, and measuring progress towards common goals is also presented. [For the companion publication, "Healthy People 2010," see ED443794.]

Federal Medicaid long-term care regulations do not require states to offer home and community-based service (HCBS) alternatives; rather, they are offered at the discretion of each state. The two most significant Medicaid HCBS programs are the Medicaid 1915(c) HCBS waiver programs and the Medicaid Title XIX personal care services (PCS) optional state plan benefit. This report summarizes the most current data on HCBS, combining data from Health Care Financing Administration sources with data collected by the University of California, San Francisco. This report presents estimates of program participants and expenditures, including breakdowns by specific populations and types of service. Findings from the data include: (1) the total number of participants in the 1915(c) HCBS Medicaid waiver program more than doubled between 1992 through 1997 to 561,510 people; (2) expenditures have grown more than $5.7 billion since 1992 for the waivers; (3) expenditures per Medicaid waiver participant grew 52 percent from 1992 to 1997; (4) on average, waiver participants nationwide were allotted approximately $14,016 each in 1997; (5) waivers primarily assist those with mental retardation and adults with disabilities who have aged; and (6) in 1997, the most used category of service remained respite/home health or personal care. (Contains 17 references.) (CR)

This report uses data from the Health and Retirement Survey (HRS) to analyze transitions in disabilities and employment from 1992 to 1994, the first two waves of the HRS survey. The survey included people ages 51 to 61 years of age in 1992, resulting in 8,737 participants. The report estimates the incidence of disabilities from 1992 to 1994 and explores the effect that developing a disability has on maintaining employment. Results of the survey indicate: (1) the prevalence of disability increased from 28.6 percent in 1992 to 30.4 percent in 1994; (2) disability was associated with lower employment rates and persistent disability was associated with the lowest employment rates; (3) among all respondents, employment rates declined from 69.9 percent in 1992 to 63.6 percent in 1994, and people who developed disability experienced a substantial decline in employment rates at 25.2 percent; (4) people with disability in both 1992 and 1994 who were not employed in 1992 reported low rates (61 percent) of job entrance; and (5) the effect of disability on employment was greater for men than for women and for racial/ethnic minorities than for whites. (Contains 10 references.) (CR)

This report provides data on the use of mobility devices in the United States by providing a detailed profile of the population using these devices. It covers their demographic characteristics; health and disability status, including diagnoses and impairments, physical functioning, and activities of daily living; and health insurance status. The report also addresses the accessibility of mobility device users' homes and larger environments. Introductory material includes highlights of the report and analysis of data sources and accuracy. The first major section focuses on population estimates and sociodemographic comparisons, including age and gender, race and ethnicity, educational attainment, employment and labor force participation, family income, and location and setting of residence. The following section addresses the health and disability status of mobility device users, including self-reported health status, hospitalization history, perceived disability status, activity limitation, functional limitation, activities of daily living, and instrumental activities of daily living. The third section considers health conditions and impairments associated with use of mobility devices by age group and by leading conditions. The next section considers accessibility features and problems, including those within and around the home, those outside the home, and public transportation. A brief section on health and insurance and a section on conclusions complete the report. Twenty-six tables are included. (DB)

This report uses data on 10,480 households from the Current Population Survey to investigate computer ownership and Internet use by disability status, racial and ethnic group, and age group. Analysis indicates: (1) people with disabilities are less than half as likely as their non-disabled counterparts to have access to a computer at home; (2) almost three times as many people without disabilities have the ability to connect to the Internet at home as those with disabilities; (3) people with disabilities are far less likely than those without disabilities to make use of the Internet; (4) only one-third of non-elderly persons with work disabilities have computers in their homes, compared to more than half of those without disabilities; (5) 24.9 percent of men with disabilities own computers compared to 53.2 percent without; (6) 23 percent of women with disabilities own computers versus 50.3 percent without; (7) among employed people with work disabilities, 42.6 percent have computers and 26.4 percent use the Internet, compared to 56.9 and 44 percent of their non-disabled counterparts; and (8) within each racial and ethnic group, the rate of computer ownership is much lower when there is a disability present in the household. (CR)

This monograph summarizes what is known about youth and violence, identifying 10 myths that confound people's understanding of the real causes of youth violence. It focuses on: what contributes to youth violence (e.g., children exposed to domestic violence are at risk of using violence, children and adolescents use guns when they are easily accessible, and exposure to violence on television affects child and adolescent behavior); statistics on violence (e.g., violence in the community and community deterioration contribute to youth violence, using substances increases the risk of violent youth behavior, and society's acceptance of guns); what protects children and youth from violence (e.g., children need connections with families, schools, and friends; children need to learn how to resolve conflict nonviolently through example, children need a safe, supportive place to go after school, and children need a healthy home environment); descriptions of school and community violence prevention programs; influences on responses to violence (e.g., boys often exhibit more overt behavioral problems after exposure to violence than girls, children are more affected if the perpetrator or victim is known to them, and chronic exposure is psychologically more harmful than a single exposure). A list of related resources and their contact information is provided. (Contains 61 references.) (SM)

This report uses data from the National Health Interview Survey (n=1,792 million) to describe trends in labor force participation among persons with disabilities for the period 1983 through 1994. It examines labor force participation among persons with disabilities compared to participation among persons without disabilities, how people with disabilities associated with major categories of chronic conditions fare in the labor market, and how age and gender affect employment of persons with disabilities. Results found that during this period, men without disabilities experienced a relative decline in labor force participation by a rate of 0.6 percent, while those with disabilities experienced a 4.1 percent decline. While women without disabilities experienced a 9.7 percent increase in labor force participation, women with disabilities experienced a 21.7 percent increase, although from a lower base. By 1994, the labor force participation rates of younger men and women with disabilities (ages 18-44) were more than 20 percentage points lower than those of typical peers. The labor force participation rates of persons with disabilities differed dramatically across condition. Persons with disabilities caused by impairments and respiratory conditions had high labor force participation rates, while those with disabilities caused by mental, endocrine, and circulatory conditions had low rates. (CR)

This report uses data from the 1990 and 1991 samples of the Survey of Income and Program Participation to construct a profile of the U.S. noninstitutionalized adult population needing assistance with activities of daily living (ADL) and to estimate the size of the population eligible for federal personal assistance services (PAS) under different ADL, income, and age criteria. It also describes current sources of ADL assistance by recipient type. Research results indicate that an estimated 7.3 million noninstitutionalized adults are limited in their capacity to perform one or more of five basic ADLs (bathing, transferring, dressing, eating, toileting), and some 3.7 million require the assistance of another person in performing ADLs. The report concludes that: (1) roughly 1.4 to 2.2 million adults would be eligible for a federal personal assistance benefit under basic ADL criteria; (2) means-testing has a very large effect on total program eligibility counts; (3) younger adults with disabilities constitute over one-third of the adult population needing ADL assistance; (4) a significant proportion of ADL limitations appear to be short-term; (5) most people with ADL assistance needs get help from family members; and (6) ADL assistance requirements are useful in delimiting categories of need. (Contains 75 references.) (CR)

This report uses data from the 1990 Survey of Income and Program Participation (n=143.5 million) to examine the relationship between work disability, Social Security program participation, and economic well-being. The report estimates the proportion of people with disabilities who receive benefits, how this proportion depends on their disability status, and how they fare economically. Results indicate that men ages 60-64 who are unable to work enjoy greater economic well-being than their female counterparts or their younger counterparts. Over 94 percent of men aged 60-64 who are unable to work draw on non-means-tested sources, enabling the majority to avoid the poverty that is more commonplace for women in this age group. Younger people of working age (ages 18-59) fare much worse, 27 percent of men and 40 percent of women unable to work are poor. It is estimated that for 1990, 4.3 million working-age people are unable to work and are not receiving Social Security Disability Insurance or Supplemental Security Income. Of these, 3.2 million people are aged 18-59. Texts and charts provide information on the employment status of the work-restricted population, sociodemographic characteristics of the unable-to-work population, income and poverty, age factors, and Social Security disability recipients. (CR)

This statistical digest presents data on the prevalence of disabling conditions among the civilian noninstitutionalized population of the United States. Data were obtained from the National Health Interview Survey, consisting of 49,401 household interviews with 128,412 people in 1992. Disability is defined as a limitation in social or other activity that is caused by a chronic mental or physical disorder, injury, or impairment. The digest concludes that approximately 38 million Americans report a total of 61 million disabling conditions. It notes that heart disease and back problems are the two most common causes of disability and that injuries cause 13.4 percent of all disabling conditions. The text reports on the classification method used, which distinguishes among impairments, disorders, and injuries. Table 1 lists conditions causing disability by the broad categories of the International Classification of Diseases. Table 2 lists the most common health conditions and impairments that cause activity limitation. (DB)

Based on the 1990 Core Questionnaire and Family Resources Supplement of the National Health Interview Survey, involving 108,815 individuals, this report presents estimates of the prevalence of disability in families, selected demographic and socioeconomic characteristics, and utilization of health services by families with and without members with disabilities. Specifically, the data focus on living arrangements of individuals with and without disabilities, family type, probabilities of couples with disabilities living together, probabilities of householders with disability having children with disabilities, family size and disability, race and Hispanic ethnicity, age, educational attainment, income levels, health insurance, physician contacts, and hospitalization. Findings of the report indicate: (1) an estimated 20.3 million families have at least one member with a disability; (2) the family disability rate is 28.5 percent among partnered families and 32.1 percent among single-householder families; (3) when a family has a member with a disability, that member is most likely to be a householder; (4) some 3.8 million families contain one or more children with disabilities; (5) the rate of disability is 29.1 percent for white families, 31.9 percent for black families, and 21.7 percent for other races; (6) the highest observed poverty rates by disability status are among single-householder families with two or more children with disabilities; and (7) families with members with disabilities have significantly higher than average numbers of hospital days. Detailed tables of the statistical data are included and an appendix contains standard errors for the detailed tables. (Contains 15 references.) (CR)

This report presents, in text and 13 tables, data obtained from 128,412 paricipants in the 1992 National Health Interview Survey concerning the prevalence of disability, as measured by limitation in activity caused by chronic health disorders, injuries, and impairments. Prevalence estimates are presented in tables for various population subgroups, characterized by gender, age, race and Hispanic ethnicity, education level, family income level, poverty status, marital status, region, metropolitan status, presence of telephone in household, and chronic health condition. The prevalence of limitations in activity, work, self-care, and school is examined, followed by analysis of the conditions causing the limitations, such as visual impairments, paralysis, infectious diseases, congenital anomalies, injury, etc. Some highlights of the data presented in this report include: (1) Of the total U.S. non-institutionalized population, in 1992, 15 percent, or 37.7 million people report some activity limitation due to chronic health conditions; (2) Of the total population aged 5 and older, 4 percent, or about 9.2 million people, report some need for help in Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL); (3) Of all children and adolescents aged 5-17, 3.2 percent, or 1.5 million persons, attend special schools or classes; (4) Females report a higher number of activity limiting conditions than males; and (5) Of all conditions reported to cause activity limitation, heart disease ranks first, followed by back disorders, arthritis, orthopedic impairments of the lower extremity, and asthma. (Contains 20 references.) (CR)

This report on HIV/AIDS, disability, and employment analyzes data from the AIDS Cost and Services Utilization Survey of 1991-1992, a longitudinal study of 1,949 HIV-infected men and women. The report examines the diagnostic history of people living with HIV and its relation to function, disability, and labor force participation over time. Study participants were interviewed six times over an 18-month period. Text, graphs, and tables present data on the following areas: demographics of the study population, HIV diagnostic categorization, health insurance coverage, Social Security Disability Insurance (SSDI), functional and activity limitations, measures of depressive symptomatology, labor force participation, and occupational status. Highlights of the study included the following: (1) 33 percent of study participants were covered by private health insurance, 38 percent had Medicare or Medicaid, and 29 percent had neither private nor public health coverage; (2) as diagnostic severity increased, the likelihood of private insurance coverage decreased; (3) men were far more likely to be receiving SSDI than women; (4) women were far more likely to have been denied disability insurance than men; (5) at each stage of HIV disease, women were more likely to report depression; and (6) over half the study population was out of the labor force at the time of the initial interview, with an additional ll percent unemployed but looking for work. Appendices provide technical notes and medical condition and symptom codes. Findings indicate that to encourage greater labor force participation of people with HIV and AIDS, attention must be given not only to reducing funcational disability but also the employer attitudes and access to health insurance and other work-related benefits and workplace accommodations. (DB)

This abstract summarizes recent statistics on the prevalence and causes of traumatic brain injuries (TBI), the populations it affects, and the degree of disability it causes. Estimates are based on 1985-1987 data from the National Health Interview Survey, a household survey of the noninstitutionalized U.S. population. Analysis indicates: the overall incidence rate is 0.8 percent, with young males having the highest incidence rates of any group; an estimated 31 percent of TBI is caused by moving motor vehicles; half of TBI cases are severe enough to cause a disability; firearms are the most common cause of fatality due to TBI; and strategies to reduce TBI should concentrate on youth and younger adults. Three tables provide detailed data on: (1) annual number and incidence rate of TBI cases, by gender and age; (2) annual number and incidence rate of TBI cases, by class of accident and place of accident; and (3) types of injury causing greatest activity limitation. (DB)

This abstract summarizes recent statistics on the prevalence and causes of disability among U.S. children, based on data from the 1992 National Health Interview Survey, a household survey of the noninstitutionalized U.S. population. Analysis indicates that there are difficulties in comparing disability prevalence across age groups; overall, 5.5 percent of children (ages 5-17) have disabilities related to schooling, of whom 58 percent attend special schools or classes; diseases of the respiratory system constitute the most common group of disabling conditions; and children from poor families attend special schools and classes at nearly twice the rate of those who are not poor. Four tables present detailed data on: (1) number and percent of children with disabilities, by degree of limitation and age; (2) number and percent of children with school-related disabilities, by degree of limitation and gender; (3) number and percent of children needing and receiving special education by race, ethnicity, and poverty status; and (4) health conditions and impairments causing disability in children by broad condition category. (DB)

This report presents detailed tables on the medical expenditures of people, from young children to older adults, who are limited in activity or who need assistance in activities of daily living. It uses data from the 1987 National Medical Expenditures Survey and compares these with 1993 estimates. Tables of results are presented on: (1) total and per capita medical expenditures by type of expenditure, activity limitation status, gender, age, sociodemographic characteristics, self-reported health status, and work disability status; and (2) sources of payment for medical expenditures by age group, activity limitation status, and sociodemographic characteristics. Highlights include: 17 percent of the non-institutionalized population are limited in activity and account for 47 percent of total medical care expenditures; 11 percent of these individuals have expenditures of $10,000 or greater; total per capita expenditures are over four times greater for people with activity limitations than for people with no limitations; people limited in activity represent 38 percent of hospitalized persons and 57 percent of expenditures for hospitalization; per capita medical expenditures for white children with activity limitation are nearly twice those for black children; and 4 percent of the non-institutionalized population requires assistance in activities of daily living. An appendix provides standard error data. (DB)

This statistical abstract presents data on the sources of payment for medical care for people with disabilities in different age groups. All estimates come from the National Medical Expenditures Survey, a nationally representative survey of the civilian non-institutionalized population of the U.S. conducted in 1987. Six categories of payment sources are reported here: (1) out of pocket, including payments by the individual or a member of the family; (2) private health insurance; (3) Medicare (not shown for children aged 1-17); (4) Medicaid; (5) other public programs, military coverage, community mental health centers, coverage for dependents of active or retired military personnel, coverage for dependents or survivors of disabled veterans, and Supplemental Security Income; and (6) other sources, including workers' compensation, bad debt, services provided without charge, automobile or non-health insurance, and payments by school, union, company, charity, friend, or foreign government. Results found people with disabilities are much more likely to have public coverage to pay for their health care than those without disabilities. People with disabilities have 50 percent of their health care expenditures paid by public sources: 30 percent Medicare, 10 percent Medicaid, and 10 percent other public sources, for a total public expenditure of $79 billion in 1987. (CR)

This report presents results of analysis of data from 5,215 noninstitutionalized persons with disabilities as reported in the 1979 and 1980 National Health Interview Survey, Home Care Supplement. Results are reported for the following assistance categories: assistance in basic physical activities; frequency of help in basic physical activities; assistance in selected instrumental activities of daily living; and correlates of assistance needs. A discussion notes that about 43 percent of persons living in the community who need assistance in basic life activities are nonelderly, that women outnumber men in needing assistance, that nonelderly adults are the most likely to use special equipment, and that nonelderly adults needing assistance make the greatest use of physician services. Implications of these findings for life-span planning of services are considered. About 30 tables present detailed data by type of activity or nature of assistance, age groups, sex, chronic health conditions, and how often someone must be present at home. An appendix documents the statistical methodology involved. (DB)

This workbook for teachers is intended as a guide for developing a curriculum in Family Life Education for physically disabled high school students, although information on specific disabilities and sex related issues is not included except in the bibliographies. Each group of materials is followed by questions teachers can ask themselves to determine the usefulness of the information to them. Topics include: (1) needs assessment; (2) approaching parents and administrators; (3) developing objectives; (4) course content; (5) community resources; (6) aspects of sexuality, birth control, pregnancy and social skills in relation to disability; (7) group process; and (8) suggestions for evaluating course effectiveness. The guide also includes a sample letter to parents, suggested activities, a sexual knowledge test for students, acceptable behaviors test, and resources test. Also included is a list of disability consumer organizations, independent living projects in California, and an extensive annotated bibliography of print, film and other media resources for teaching family life education to the physically disabled. (JAC)

This series in diagnostic radiological physics has been designed to provide the physics background requisite for the proper conduct of medical diagnostic x-ray examinations. The basic goal of the series is to bridge physics theory and radiological practice, achieved by combining pertinent lecture material with laboratory exercises that illustrate the clinical applications under simulated clinical conditions. Nine chapters contain background physics information and laboratory exercises on the following topics: (1) x-ray production and machine output; (2) radiographic contrast; (3) subject contrast; (4) the control of scattered radiation; (5) intensifying screens; (6) radiographic film; (7) contrast and processing; (8) quality assurance of automatic film processing; (9) geometric factors in radiography; (10) x-ray quality assurance; and (11) reduction of unnecessary patient exposure. (CS)

This manual describes the Job Seekers' Workshop and its component activities. It is intended as a guide to workshop leaders and discusses technical considerations such as materials, equipment, and recruitment of clients. The introduction states that the workshop is designed to improve job-seeking skills, especially behavior in a job interview, and has as its ultimate goal the increased employment of drug treatment clients. Three studies, two with methadone maintenance clients and one with former heroin addicts on probation or parole, which suggest the effectiveness of the workshop, are briefly reviewed. The philosophy of the workshop is explained and the need to build the client's self-confidence is stressed. A section on preparation for the workshop covers the topics of: (1) facilities, equipment, and materials; (2) videotape equipment; (3) location of the workshop; (4) recruitment of workshop participants; (5) criteria for screening and selection of participants; (6) size of the workshop; (7) adapting the workshop to one person; (8) preparing the clinic staff; and (9) selecting workshop staff. A section on workshop components presents the workshop activities for the eight workshop components ("Introduction and Purpose,""Initial Videotape Experience,""Initial Job Interview,""Job Applications,""Later Job Interviews,""Developing Job Leads,""Final Interviews," and "Closing Summary"). An estimated time allotment, comments to the leader, and suggested remarks are given for each component. Suggestions for follow-up are made. Relevant materials and forms are appended. (NB)

Curriculum development in women's health has undergone a transformation over the past 15 years based on the availability of teaching resources. Today, the range of resources for curriculum development in women's health is more intimidating than elusive. While there has been a virtual explosion of both popular and scholarly research and writing in the many areas of women's health, there has been a dearth of materials on developing curricula in these areas. This volume is designed for use by faculty in undergraduate, graduate, and health professions and educational institutions who wish to initiate or expand their curriculum in women's health. The materials in this volume are largely edited versions of papers originally presented at three Summer Institutes on Women, Health, and Healing organized by the Women, Health and Healing Program of the University of California, San Francisco. The primary focus of these working papers on curriculum development in women's health studies is on the development and enhancement of curricula through the integration of social science perspectives on women's health, through the integration of minority women's health issues, and through addressing issues at the intersection of social science and clinical concerns. (BZ)