Index

A

Abortion, 333, 334-335, 336, 338

see also Family planning, Prenatal services

Academic research, 144, 145, 146, 259, 331

Access issues, 10, 27, 68, 94, 280-284, 329

aged persons, 208, 210

assistive technologies, 226, 271

blind, 257

delivery strategies, 4, 27-28, 196, 210-211, 224-225, 272, 282-283

developmental disability and, 130-131, 139, 141, 145

education, children with disabilities, 130-131

historical trends, 54, 56

medical/preventive services, 15, 24-26, 27, 31, 101, 139, 141, 252-258, 268

national agenda, 15, 31, 268

prenatal care, 25, 280-281

public facilities, 33, 87, 88, 94, 233, 330

transportation facilities, 33, 131, 225, 251, 330

vocational services, 27-28, 284

see also Discrimination

Activities of daily living, 1, 42, 44, 45-56, 77, 121, 312, 317

aging and, 44-45, 187, 192-193, 194

causes of limitation, 56-61, 75, 104

gender factors, 46, 74

life tables, 61-67, 74

Acute care, 164-168, 176-179, 209

emergency services, 165, 168, 174-176

spinal cord injuries, steroids, 33-34, 177

Administration for Developmental Disabilities, 141

Adolescents, 26, 154, 191

Advisory committees, 18-19, 268, 271

Advocacy and advocates, 29-30, 132, 225, 243, 244, 252, 331

Age factors, 49, 54, 55, 58-59, 245-246

adolescents, 26, 154, 191

assistive technologies, 192

caregivers of aged persons, 209

chronic conditions, general, 191

cost of care, 71, 72

within elderly population, 195

life tables, 61-67, 74

mental adjustment to disability, 221, 222

personal assistance services, 192-193

young adults, 2, 74-75, 153, 154

see also Adolescents;

Children;

Young adults

Agency for Health Care Policy, 234

Aging and aged persons, 13, 54, 190, 209, 210

access issues, 208, 210

activity limitations, 44-45, 187, 192-194

attitudes about, 194-196, 198, 211-212

attitudes of, 206

chronic diseases, 2, 13, 32-33, 56, 59, 60, 100-101, 106, 184-213

cognitive impairments, 194, 210

cost of care, 67-68, 210

drugs, 201, 202, 213

education of elderly, 195

epidemiology, 12, 44-46, 48, 50-53, 56, 59, 67-68, 100-101, 186-193, 195, 199-200, 208, 261

evaluation of services, 196, 198, 213

family caregivers, 209-210, 256

gender differences, 192, 195

health promotion for, 185, 189, 199

injuries, 201, 206



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Disability in America: Toward a National Agenda for Prevention Index A Abortion, 333, 334-335, 336, 338 see also Family planning, Prenatal services Academic research, 144, 145, 146, 259, 331 Access issues, 10, 27, 68, 94, 280-284, 329 aged persons, 208, 210 assistive technologies, 226, 271 blind, 257 delivery strategies, 4, 27-28, 196, 210-211, 224-225, 272, 282-283 developmental disability and, 130-131, 139, 141, 145 education, children with disabilities, 130-131 historical trends, 54, 56 medical/preventive services, 15, 24-26, 27, 31, 101, 139, 141, 252-258, 268 national agenda, 15, 31, 268 prenatal care, 25, 280-281 public facilities, 33, 87, 88, 94, 233, 330 transportation facilities, 33, 131, 225, 251, 330 vocational services, 27-28, 284 see also Discrimination Activities of daily living, 1, 42, 44, 45-56, 77, 121, 312, 317 aging and, 44-45, 187, 192-193, 194 causes of limitation, 56-61, 75, 104 gender factors, 46, 74 life tables, 61-67, 74 Acute care, 164-168, 176-179, 209 emergency services, 165, 168, 174-176 spinal cord injuries, steroids, 33-34, 177 Administration for Developmental Disabilities, 141 Adolescents, 26, 154, 191 Advisory committees, 18-19, 268, 271 Advocacy and advocates, 29-30, 132, 225, 243, 244, 252, 331 Age factors, 49, 54, 55, 58-59, 245-246 adolescents, 26, 154, 191 assistive technologies, 192 caregivers of aged persons, 209 chronic conditions, general, 191 cost of care, 71, 72 within elderly population, 195 life tables, 61-67, 74 mental adjustment to disability, 221, 222 personal assistance services, 192-193 young adults, 2, 74-75, 153, 154 see also Adolescents; Children; Young adults Agency for Health Care Policy, 234 Aging and aged persons, 13, 54, 190, 209, 210 access issues, 208, 210 activity limitations, 44-45, 187, 192-194 attitudes about, 194-196, 198, 211-212 attitudes of, 206 chronic diseases, 2, 13, 32-33, 56, 59, 60, 100-101, 106, 184-213 cognitive impairments, 194, 210 cost of care, 67-68, 210 drugs, 201, 202, 213 education of elderly, 195 epidemiology, 12, 44-46, 48, 50-53, 56, 59, 67-68, 100-101, 186-193, 195, 199-200, 208, 261 evaluation of services, 196, 198, 213 family caregivers, 209-210, 256 gender differences, 192, 195 health promotion for, 185, 189, 199 injuries, 201, 206

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Disability in America: Toward a National Agenda for Prevention life course perspective, 38-39, 193-195 mental health and illness, 206, 207-208 multidisciplinary approach, 195, 209, 261 preventive measures, 32-33, 185, 189, 195-213 professional education on, 201, 212-213 projections, 56, 193, 209-211 psychological factors, 195, 210 public education, 185, 201, 211-212 quality of life, 189, 190, 196, 198, 199, 208, 209, 210-211, 212 risk factors, 86, 185, 193, 198, 200, 202-205 social factors, 195, 199, 206, 210-211 see also Medicare AIDS, see Human immunodeficiency virus Alcohol abuse, 88, 101, 160, 161, 164, 284 driving while intoxicated, 159-161, 330 fetal alcohol syndrome, 11, 114-115, 138 Allied health professionals, 28, 29-30, 231-232, 286, 331 see also Personal assistance services American Academy of Pediatrics, 25, 145, 280 American Foundation for the Blind, 257 American Medical Association, 312, 313 Americans with Disabilities Act, 14, 33, 88, 91, 182, 267, 271, 329 Assistive technologies, 10, 14, 17, 107, 177, 271 access to, 226, 271 age factors, 192 cost factors, 226-227, 237, 283 definitional issues, 226 developmental disabilities, 131, 132 fall prevention, 226, 227, 228 insurance coverage, 14, 27, 227, 228, 233, 257 secondary conditions, prevention, 215, 224-229, 232-234, 237, 239, 240 transportation, 251 Association for the Care of Children's Health, 129 Attitudes, 87 about aged persons, 194, 195, 196, 198, 211-212 of aged persons, 206 about people with disabilities, 30, 70, 230, 233, 245, 264 self-perceptions, 48, 90, 194, 206, 219-220, 236-237 Automobiles, see Motor vehicles B Beneficiary Rehabilitation Program, 249-250 Blindness, 257 Bipartisan Commission on Comprehensive Health Care, 25, 280 Birth defects, 65, 134-135 gestational, 113, 114-116, 125-126, 138 hereditary, 86, 112, 113, 115, 125, 330 Birth Defects Monitoring Program, 134-135 Birthweight, 26, 130, 263, 281 Black Americans, 46, 64-65, 114 Brain, 136, 153 cerebral palsy, 117 fetal, 89 fetal alcohol syndrome, 11, 114-115, 138 trauma, 12, 116, 151-153, 155, 156-183 Bureau of Maternal and Child Health and Resources Development, 136-137 C Canada, 184, 275 Census Bureau, 43, 102, 276, 327 see also Survey of Income and Program Participation Census Disability Survey, 276 Centers for Disease Control, 16-17, 18, 34, 102, 241, 269-270, 271, 332-333 developmental disabilities, 122, 134-136, 146 Disabilities Prevention Program, 16, 34, 260-261, 269, 338 injury programs, 156, 183, 260-261 study sponsorship, 332-333, 336-338 Central nervous system, see Brain; Spinal cord injuries Cerebral palsy, 117, 122 Children, 70, 121, 281 American Academy of Pediatrics, 25, 145, 280 assistance requirements, 192 chronic conditions, general, 191, 284 comprehensive services, 26, 129-131 day care, 129-131 developmental disabilities, acquired, 116, 126-127 educational interventions, 129-131 elementary/secondary education, 121-122, 129-131, 211 epidemiology, 48, 50, 54, 116-117 multidisciplinary approaches, 129, 284 insurance, 25, 280 special education, 121-122, 248, 330 state programs, 284 well-child care, 124, 128 see also Adolescents; Birth defects; Birthweight; Developmental disabilities Chronic diseases, 6, 12-13, 65, 74, 253 adolescents, 191 aging process and elderly, 2, 13, 32-33, 56, 59, 60, 100-101, 106, 184-213 children, 191, 284 epidemiology, 12, 44-46, 48, 50-53, 56, 59, 67-68, 100-101, 186-193, 195, 199-200, 208, 261 multiple, 60, 191-192

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Disability in America: Toward a National Agenda for Prevention prevention measures, persons with, 39, 106, 196-199 protocols, 208, 213 public education, 185, 201, 211-212 quality of life, 189, 190, 196, 198, 199, 208, 209, 210-211, 212 see also Developmental disabilities Classification, 255, 273-274, 321-327 injuries, 157-158, 159 severity of disability, 179 WHO international system, 5-6, 20-21, 76-78, 97, 158, 273, 319-320, 325, 327 see also Definitional issues; Models Cognitive impairments, 178-179 aged persons, 194, 210 learning disorders, 117, 330 mental retardation, 112, 114-115, 118, 119, 133 Commission on Chronic Illness, 311-312 Committee on Employment of People with Disabilities, 78 Communication limitations, 118, 119, 121, 178, 179, 223, 226, 229 Community-based programs access issues, 27 aged persons, 210 databases, 137-138 demonstration projects, 283-284 developmental disabilities, 130, 143 educational programs, 130 federal coordination, 16, 34, 262, 263 injury rehabilitation, 181, 183 independent living centers, 30, 94, 180, 225, 232 local activities and governments, 262, 282, 283 mental health services, 208 private sector cooperation, 263-264 secondary condition prevention, 238 state regulation of, 263 Comprehensive approaches, 4-14, 242-266 age-related disabilities, 199, 211 injuries, 164-183 prenatal and child care, 26, 129-131 research, 22-23 secondary conditions, prevention, 223-233 vocational, 28, 248, 249-251, 263, 284 see also Multidisciplinary approach Computers and computer science case management, 212-213, 225 injury surveillance, 157-158 Conceptual issues, see Definitional issues; Models Coordination, see Organization and coordination Cost and cost analysis, 281 affordable care, 14, 25-26, 182, 253, 280-283 age factors, 71, 72 aged persons, care, 67-68, 210 assistive technologies, 226-227, 237, 283 child care, 70, 139 developmental disabilities, 11, 110 disability-related, general, 1, 24, 67-73, 75, 242, 248, 310, 337 gender factors, 68 health care, general, 25-26, 252, 256 historical perspective, 67-73 injury-related, 11, 12, 147, 148-150, 153, 160, 163, 164, 174, 183 insurance, 27 long-term care, 282 medical services, 69-73, 139 prenatal care, 26, 280-281 secondary conditions, 220 transfer payments, 69, 70, 310 vocational rehabilitation, 250 Cost of Injury in the United States, 163, 183 D Day care, 129-131 Definitional issues, 76-83, 97, 268, 273-274 assistive technologies, 226 brain injury, 159 disability, 1, 35-37, 78, 81-83, 118, 121-122, 230, 235, 273-274, 309-327 developmental disability, 109, 118 disabling process, 91-92 evaluation, 35 functional limitation, 5, 7, 35-36, 74, 76, 77, 79, 80, 118, 119-121, 312, 313, 314-315, 321, 325 handicap, 6, 77-78, 118, 320, 324, 325 impairment, 7, 35-36, 79, 80, 118, 121, 312, 314, 319-320, 321 international classification system, 5-6, 76-78 pathology, 7, 35-36, 79-80, 313-314, 319 prevention, 35, 36-37, 97 quality of life, 89-90 rehabilitation, 214 risk factors, 37-38, 84-89, 99 secondary condition, 13, 35, 214, 235 social limitations, 6, 42, 74, 77 Demography, 70, 98, 100, 193 educational attainment, 92-94, 195, 222 projections, 56, 193, 209-210 urban/rural, 11, 12, 131, 153, 233 see also Epidemiology; Gender factors; Racial/ethnic factors ; Socioeconomic status Demonstration projects, 262-263, 283-284 preventive, elderly, 199, 211 Dental health, 203, 206 Department of Education, 137, 248, 250, 263 Department of Health and Human Services, see specific constituent agencies

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Disability in America: Toward a National Agenda for Prevention Department of Labor, 102 Department of Veterans Affairs, 259-260 Dependence/independence, 4, 33, 90-91, 107, 249, 265, 266 advocacy and, 243, 244 aged persons, 206 case study, 219-220 gender differences, 67 independent living centers, 30, 94, 180, 225, 232 institutionalized persons, 47, 206, 210 see also Activities of daily living; Assistive technologies; Functional limitations; Mobility limitations Depression, 33, 40, 205, 206, 215, 219, 221, 222, 238, 240 Developmental disabilities, 10-11, 109-146 access issues, 130-131, 139, 141, 145 acquired, 116, 126-127 assistive technologies, 131, 132 CDC, 122, 134-136, 146 coordination of services, 34, 132-133, 139, 141, 143, 144-145 costs of, 11, 110 definitional issues, 109, 118 epidemiology, 11, 21, 109-122, 131, 134-139 federal programs, general, 141, 142, 145 functional limitations, 118, 119-121 historical perspective, 122-123 local community activities, 130, 143 mental retardation, 112, 114-115, 118, 119, 133 models, 118-122 multidisciplinary approach, 129 poverty and, 141-142, 145 preventive measures, 11, 34, 118, 122-146 private sector, 143-144 professional education on, 132, 146 research, 138-139 risk factors, 122, 123, 125-127 screening, 122-123, 128-129 secondary conditions, 122, 123 state government action, 34, 131, 133, 137-138, 141, 143, 144-145 toxicology of, 11, 114-115, 124, 131, 134 Developmental Disabilities Act, 109 Diabetes, 196, 197 Disabilities Prevention Program (CDC), 16, 34, 260-261, 269, 338 Disability conceptualization, 320-327 Disabling process, 91-92 Discrimination, 33, 87, 182, 223, 263-264, 329 Down syndrome, 115 Drug abuse, 88-89, 164, 207, 284 see also Alcohol abuse Drug labeling, 201 Drugs, prescribed, 86 aged persons, 201, 202, 213 secondary conditions, 228, 229, 236 spinal cord injuries, 33-34, 177 E Economic factors, see Cost and cost analysis; Employment and unemployment; Income maintenance; Productivity, losses; Socioeconomic status Educational attainment, 92, 93-94, 195, 222 Education and training childhood, 121-122, 129-131, 211 families of people with disabilities, 29-30, 87 family planning, 26-27, 128-129, 338 learning disorders, general, 117, 330 mental retardation, 112, 114-115, 118, 119, 133 of people with disabilities, 117, 177-178, 213-233, 248, 287 preventive, 105, 129-131 special, for children with disabilities, 121-122, 248, 330 see also Professional education; Public education; Vocational rehabilitation Education for All Handicapped Children Act, 330 Elderly, see Aging and aged persons; Medicare Emergency medical services, 165, 168, 174-176 Employee Retirement and Income Security Act, 254 Employment and unemployment, 17, 78, 87, 94, 102, 251 brain damage and, 152-153 discrimination, 33, 87, 182, 223, 263-264, 329 insurance provide by employer, 24, 253, 254 occupational risk factors, 84, 157, 330 quality of life and, 33, 172-173 productivity losses, 68, 69, 148, 163 spinal cord injuries, 154, 220 SSDI, 52, 248, 249-252, 257, 310, 313 vocational services, 27-28, 93-94, 165, 172, 179-183, 244, 248, 249-251, 263, 284, 311 women, 64 work limitations, 43, 50, 51, 54, 56, 64, 74, 154, 220, 221-223, 233, 253-254, 257-258, 316 Environmental factors, 86-88, 224, 233, 237 preventive measures, 105, 131-132, 233 public facilities, access, 33, 88, 87, 94, 233, 330 secondary conditions, 224, 233, 235, 237 toxic agents, 98, 131

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Disability in America: Toward a National Agenda for Prevention transportation facilities, access to, 33, 131, 225, 251, 330 urban/rural, 11, 12, 131, 153, 233 weather, 94, 233 see also Assistive technologies; Safety equipment; Social factors Epidemiology, 1, 4, 32, 34, 41-75, 95-104, 337 children, 48, 50, 54, 116-117 chronic diseases and aging, 12, 44-46, 48, 50-53, 56, 59, 67-68, 100-101, 186-193, 195, 199-200, 208, 261 data sources, 34, 41-45, 97-104, 134-138, 274-276 developmental disabilities, 11, 21, 109-122, 131, 134-139 disability indexes, general, 103-104, 179, 276-277, 315 functional limitations, 21, 40, 42-44, 45, 49-50, 51 injuries, 12, 22, 32, 39, 147-159, 176, 179 life expectancy, 1, 56, 61, 64-65, 67, 184, 185, 208 life tables, 61-67, 74 longitudinal, 22-23, 99, 102, 193-194, 200, 261, 277-279 national program, 15, 20, 21-22, 31, 268, 243, 245-246, 268, 274-277 prevalence data, general, 1, 4, 32, 41, 45-56, 101-102, 309 secondary conditions, 22, 137, 218, 220, 240 see also Risk factors Ethical issues, 252 Europe, 251-252 Evaluation, 39, 68, 159, 337 advocacy, 331 age-related disease prevention, 196, 198, 213 community-based, 283-284 definitional issues, 35 disability conceptualization, 320-327 government assistance programs, 68, 182 injury prevention, 160 injury rehabilitation, 181, 182-183 national program, 273, 283 preventive measures, general, 247, 278-279, 284 public assistance programs, 68, 102 rehabilitation programs, 245, 279 secondary conditions, prevention, 223, 234-335 Exercise as primary prevention, 86, 200, 205, 229-230, 248 for people with disabilities, 177-178, 229-230, 235 F Fall injuries, 149, 150, 155, 157, 160, 164, 201, 206 assistive/safety devices, 226, 227, 228 Families/informal caregivers, 222, 223, 232, 256, 271 aged people with disabilities, 209-210, 256 developmental disabilities, poverty, 141, 145 education of, 29-30, 287 Family planning, 26-27, 128-129, 281-282, 338 abortion, 333, 334-335, 336, 338 Federal government, 14-31, 248-258 age-related disabilities, 185 developmental disabilities, 141, 142, 145 disability-related expenditures, general, 24 home care programs, 255-256 injury prevention, 260-261 interagency coordination, 19-20, 24, 102, 133, 241, 243, 258-259, 263, 267, 271-274 local coordination by, 16, 34, 262, 263 national objectives, 15, 31, 245-247, 249, 268 rehabilitation research, 259-260 state cooperation with, 16, 34, 131, 133, 141, 145, 248, 250, 261, 262, 311 see also Laws, specific federal; National Disability Prevention Program; specific departments, agencies, and programs Fetal alcohol syndrome, 11, 114-115, 138 Firearms, 150, 154, 157, 330, 338 Follow-up, 179-183, 225 Foreign countries, 65, 76, 184, 251-252, 275, 279, 310 Fragile X syndrome, 112 Framingham Study, 102 Functional electrical stimulation (FES), 177, 179 Functional Limitations, 32, 90, 196 defined, 5, 7, 35-36, 74, 76, 77, 79, 80, 118-121, 312, 313, 314-315, 321, 325 developmental disabilities, 118, 119-121 epidemiology, 21, 40, 42-44, 45, 49-51 injury-related, 171-172 spinal cord injuries, drugs, 33-34, 177 see also Activities of daily living G Gender factors, 54, 62-63, 64, 67, 256 activity limitations, 46, 74 aged persons, 192, 195 disability costs, 68 injuries, 12, 153 Genetics, 86, 112, 113, 115, 125, 330 preventive interventions, 123-124, 128-129, 330

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Disability in America: Toward a National Agenda for Prevention screening, 330, 333, 334 Glasgow Coma Scale, 151-152 Government role developmental disabilities, 11, 110 private sector coordination, 17-18, 261-264, 270-271, 331 see also Community-based programs; Federal government; Public assistance; State governments Guide to Clinical Preventive Services, 247-248 H Handicap, 6, 77-78, 118, 320, 324, 325 Head injuries, see Brain Head Start programs, 129-130, 145, 284 Health Care Financing Administration, 44, 102, 138, 145, 199, 263 Health care professionals allied, 28, 29-30, 231-232, 286, 331 associations, 25, 145, 280, 312 attitudes of, 245 physicians, 27, 29, 222, 231, 232, 245, 285-286, 331 see also Personal assistance services; Professional education Health promotion, 38-39, 105, 245-247, 283 aged persons, 185, 189, 199 models, 38-39, 227, 283 secondary conditions and, 215, 224, 227-230 Health services delivery, 4, 27-28, 196, 210-211, 224-225, 272, 282-283 secondary conditions, 224-225 Healthy People 2000, 185, 246-247 Hearing, see Communication limitations Hispanics, 136 Historical perspectives, 2 access issues, 54, 56 conceptualization of disability, 311-327 costs of disability, 67-73 developmental disabilities, 122-123 employer-provided insurance, 254 injuries, 32, 155-156 prevalence of disabilities, 53-56 Home care, 210, 233, 255-256 see also Families/informal caregivers; Personal assistance services Homelessness, 207, 262 Housing, 220, 225 Human immunodeficiency virus, 88, 96, 107 perinatally acquired, 115-116 I Impairment defined, 7, 35-36, 79, 80, 118, 121, 314, 319-320, 321 injury-related, 171-172 see also Multiple impairments; specific impairments Income maintenance, 310 Social Security Disability Insurance, 52, 248, 249-252, 310, 313 Supplemental Security Income, 52, 141, 248, 310 Independence, see Dependence/independence Independent living centers, 30, 94, 180, 225, 232 Indexes of disabilities, general, 103-104, 179, 276-277, 315 Informal caregivers, see Families/informal caregivers Injury, 11-12, 147-183 aged persons, 201, 206 brain damage, 12, 116, 168-183 CDC, 156, 183, 260-261 classification, 157-158, 159 computer surveillance, 157-158 coordination of services, 157-158, 164, 183 cost of, 11, 12, 147, 148-150, 153, 160, 163, 164, 174, 183 education on, 164, 182 epidemiology, 12, 22, 32, 39, 147-159, 176, 179 evaluation of interventions, 159, 160, 181, 182-183 firearms, 150, 154, 157, 330, 338 functional limitations/impairments, 171-172 gender factors, 12, 153 historical perspectives, 32, 155-156 local efforts, 181, 183 medical services, 147, 155, 165, 168, 174-176 mobility limitations, 176-177, 178, 179 multidisciplinary approach, 182 prevention, 37-38, 39, 159-164, 183, 201, 226, 227, 228, 260-261, 330 productivity losses, 148, 163 psychological factors, 151, 152, 165, 173, 179-183 quality of life, 172-173, 182 risk factors, 84, 157, 330 secondary conditions, 164, 168, 174-176 social factors, 151, 152, 163, 173-174, 179-183 traumatic brain injury, see Brain urban areas, 12, 153 young adults, 74-75, 153 work-related, 84, 157, 330 see also Brain; Fall injuries; Motor vehicles; Spinal cord injuries Injury Control and Disabilities Prevention Programs, 260 Institute of Medicine, 26, 39, 200, 281, 332, 333, 335 Institutionalized persons, 47, 206, 210

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Disability in America: Toward a National Agenda for Prevention Instrumental activities of daily living, see Activities of daily living Insurance, 17, 24-25, 211, 252-257, 271, 280, 282 assistive devices, 14, 27, 227, 228, 233, 257 eligibility criteria, 14, 26-27, 139, 182, 227, 228, 233, 254-257, 280, 313 employer-provided, 24, 253, 254 family planning/prenatal services, 25, 26-27, 139, 280 injuries, rehabilitation, 182 Medicaid, 24, 248, 255, 257 Medicare, 24, 44, 199, 209, 229, 255-257 Injury in America, 39, 163, 183 Injury Prevention, 183 Interagency Committee on Disability Research, 258, 259 Interagency Council on Disability Prevention, 19, 272 Interagency Forum on Aging-Related Statistics, 53 International Center for the Disabled, 43, 48, 244, 250 International perspectives, 65, 76, 184, 251-252, 275, 279, 310 see also World Health Organization International Classification of Impairments, Disabilities, and Handicaps, 5-6, 20-21, 76-78, 97, 158, 273, 319-320, 325, 327 L Laws, specific federal, 242, 243 Americans with Disabilities Act, 14, 33, 88, 91, 182, 267, 271, 329 Developmental Disabilities Act, 109 Education for All Handicapped Children Act, 330 Employee Retirement and Income Security Act, 254 Medicare Catastrophic Coverage Act, 256 Occupational Health and Safety Act, 330 Rehabilitation Act, 313 Social Security Act, 249 Vocational Rehabilitation Act, 311 Lead toxicity, 11, 116-117, 131 Learning disabilities, 117, 330 mental retardation, 112, 114-115, 118, 119, 133 special education, 121-122, 248, 330 Legal issues discrimination, 33, 87, 182, 223, 263-264, 329 driving while intoxicated, 161 injury reporting, mandatory, 159 see also Laws, specific federal Life course perspective, 38-39, 193-195, 235 aged persons, 185 Life expectancy, 1, 56, 61, 64-65, 67, 184, 185, 208 Lifestyle risk factors, 88-89, 228, 248 Life tables, 61-67, 74 Local activities and governments, 262, 282, 283 see also Community-based programs Longitudinal studies, 22-23, 99, 102, 275-276, 277-279 aging and chronic diseases, 193-194, 200, 261 Longitudinal Study of Aging, 44-45, 67 Long-term care, 4, 194, 243, 244, 265, 282, 285 insurance, 27, 255-257 national survey, 44, 53, 194, 200, 209 nursing homes, 46, 149, 206, 210, 219, 256 Louis Harris and Associates, 43 International Center for the Disabled, 43, 48, 244, 250 M Maternal and Child Health Bureau, 129 Maternity Outreach Services, 262-263 Medicaid, 24, 248, 255, 257 Medical services, 4, 14 access issues, 15, 24-26, 27, 31, 101, 139, 141, 252-258, 268 acute care, 164-168, 176-179, 209 costs, 69-73, 139 emergency services, 165, 168, 174-176 injury-related, 147, 155, 165, 168, 174-176 model of disability, traditional, 27, 36-37, 104, 244-245, 339 secondary conditions, 224-225 see also Health care professionals Medicare, 24, 44, 199, 209, 229, 255, 256, 257 Medicare Catastrophic Coverage Act, 256 Mental health and illness, 207, 208 adjustment to disability, age factors, 206, 207-208, 221, 222 aged persons, 206, 207-208 chronic, 5, 40, 207-208 coordination of services, 263 depression, 33, 40, 205, 206, 215, 219, 221, 222, 238, 240 secondary conditions, 5, 33, 216, 219, 221-223 work limitations, 51, 251-253 see also Alcohol abuse; Cognitive impairments; Drug abuse; Psychological factors Mental retardation, 112, 114-115, 118, 119, 133 special education, 121-122, 248, 330

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Disability in America: Toward a National Agenda for Prevention Metropolitan Atlanta Congenital Defects Program, 134 Metropolitan Atlanta Developmental Disabilities Study, 135 Minority groups, 1, 12, 45, 46, 64-65, 114, 136, 153 Mobility limitations, 2, 65 developmental disabilities, 118, 119 injury-related, 176-177, 178, 179 public facilities, 33, 87, 88, 94, 233, 330 transportation facilities, 33, 131, 225, 251, 330 weather-related, 94, 233 young persons, 74-75 see also Paralysis Models, 97 acute care and rehabilitation, 164-183 demonstration projects, 199, 211, 262-263, 283-284 developmental disability, 118-122 disability, general, 4, 5-10, 76, 83-108, 193-195, 196, 309-327 health promotion, 38-39, 227, 283 injuries, response, 164-183 medical, traditional, 27, 36-37, 104, 211, 244-245, 339 protocols, 13, 208, 213, 234-241, 259 secondary conditions, 215-223 spinal cord injuries, 154 Motor vehicles, 38-39, 149-150, 153, 157, 161-162 driving while intoxicated, 159-161, 330 safety equipment, 38, 157, 161-163, 339 spinal cord injuries, 11, 154, 155 Multidisciplinary approach, 259, 265, 266, 285, 321 aged persons and aging, 195, 209, 261 child-focused programs, 129, 284 developmental disabilities, 129 injury-related disabilities, 182 secondary conditions, 234 Multiple impairments, 94-95, 121, 218 drugs, multiple, 201 chronic, 60, 191-192 injury-related, 174 risk factors, 234 see also Secondary conditions N Nagi, Saad, 4, 7, 76, 77, 81-82, 83, 95, 309-327 National Accident Sampling System, 156 National Center for Health Services Research, 136, 138 National Center for Health Statistics, 102, 135-136, 156-157 National Center for Medical Rehabilitation Research, 261 National Coalition for the Prevention of Mental Retardation, 133 National Committee for Injury Prevention and Control, 160 National Council on Disability, 16, 34, 43, 78, 133, 243, 269, 331 National Council on the Handicapped, see National Council on Disability National Crime Survey, 156 National Disability Prevention Program, 4-31 (passim), 34, 267-287, 332, 337 aged persons, 190-191 agenda, 15, 31, 268 education, 15, 31, 268 epidemiology, 15, 20, 21-22, 31, 268, 243, 245-246, 268, 274-277 evaluation, 273, 283 objectives, 15, 31, 245-247, 249, 268 preventive measures, 4-14, 17, 18, 32-33, 245-247, 267-273, 284 research, 15, 31, 268, 272, 277 National Electronic Injury Surveillance System, 156 National Handicapped Sports and Recreation Association, 229-230 National Health and Nutrition Examination Surveys, 136 National Health Interview Survey, 42-43, 44, 45-48, 50-51, 53, 60, 61, 64, 66, 73, 74, 75, 95, 102, 276 aging and chronic diseases, 186, 189, 191-192 developmental disabilities, 118, 135 injuries, 156-158 secondary conditions, 218 Supplement on Aging, 44-45, 60, 67, 192 National Hospital Discharge Survey, 156-158 National Institute of Child Health and Human Development, 261 National Institute on Aging, 102, 261 National Institute on Disability and Rehabilitation Research, 78, 102, 137, 146, 166, 241, 258-259 National Institute of Mental Health, 263 National Institutes of Health, 136, 146, 259 National Long-Term Care Survey, 44, 53, 194, 200, 209 National Maternal and Infant Health Survey, 136 National Medical Care Expenditures Survey, 136 National Medical Care Utilization and Expenditure Survey (1980), 110, 135-136 National Research Council, 39, 103, 220 National Spinal Cord Injury Data Base, 155 Native Americans, 114

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Disability in America: Toward a National Agenda for Prevention New Jersey, 262-263 Nursing homes, 46, 149, 206, 210, 219, 256 Nutrition, 86, 136, 138, 200, 201, 204, 229, 235, 248 O Occupational Health and Safety Act, 330 Occupational disabilities risk factors, 84, 157, 330 work limitations, 43, 50, 51, 54, 56, 64, 74, 154, 220, 221-223, 233, 253-254, 257-258, 316 Office of Disease Prevention and Health Promotion, 133 Office of Human Development Services, 145 Organization and coordination, 14-19, 31, 258-266, 267-273 acute care, 165 advisory committees, 18-19, 268, 271 aging and chronic disease, 195, 208-211 developmental disabilities, 34, 132-133, 139, 141, 143, 144-145 injury-related disabilities, 157-158, 164, 183 interagency, 19-20, 102, 133, 241, 243, 258-259, 263, 267, 268, 271-274 local, 282 local-federal, 16, 34, 262, 263 national agenda, 15, 31, 268 private sector, 17-18, 261-264, 270-271, 331 research, 19, 22-23, 277 secondary conditions, 224-225, 241 state-federal, 16, 34, 131, 133, 141, 145, 248, 250, 261, 262, 311 see also Comprehensive approaches; Multidisciplinary approach P Paralysis, 2, 95, 154, 176-177 paraplegia/quadraplegia, 35, 154, 155, 177, 215, 219-220 Pathology, 7, 35-36, 79-80, 234, 313-314, 319 Personal assistance services, 271 age factors, 192-193 attendants, education, 29-30, 232, 287 federal insurance for, 254-255 see also Assistive technologies; Families/informal caregivers Physicians, 222 access to, 27 education, 29, 231, 232, 285-286, 331 Peer influence, 132, 173, 225 Political factors, 163, 328 advocacy and advocates, 29-30, 132, 225, 243, 244, 252, 331 see also Public opinion Poverty, 1, 24-25, 47, 48, 92, 253, 280 developmental disabilities, 141-142, 145 Head Start programs, 129-130, 145, 284 homelessness, 207, 262 Medicaid, 24, 248, 255, 257 prenatal care, 26, 262-263, 281-282 see also Public assistance Pregnancy termination, see Abortion; Family planning; Prenatal services Prenatal services, 26-27, 37, 101, 124, 128-129, 281-282, 333, 337-338 abortion, 333, 334-335, 336, 338 access to, 25, 280-281 comprehensive, 26, 262-263 cost factors, 26, 280-281 drug abuse, 88-89 family planning, 26-27, 128-129, 281-282, 338 fetal alcohol syndrome, 11, 114-115, 138 insurance coverage, 25, 26-27, 139, 280 poor women, 26, 262-263, 281-282 state program, 262-263 Preventing Low Birthweight, 26, 281 Preventive measures, 1, 40, 104-108, 242-266, 330-331, 337 access to, 24-26, 139, 141, 252-258, 268 age-related chronic disabilities, 32-33, 185, 189, 195-213 chronic disabilities, persons with, 39, 106, 196-199 comprehensive, 4-14 definitional issues, 35, 36-37, 97 developmental disabilities, 11, 34, 118, 122-146 educational, 129-131, 286-287 environmental factors, 105, 131-132, 233 evaluation, general, 247, 278-279, 284 genetic, general, 123-124, 128-129, 330 injury, 37-38, 39, 159-164, 183, 226, 227, 228, 260-261, 330 insurance coverage, 25, 26-27, 139, 211, 227, 228, 233 life course perspective, 38-39, 193-195 model of, 102-103, 104-108 national, 4-14, 17, 18, 32-33, 245-247, 267-273, 284 private sector, 40 research, 24, 278-279 secondary conditions, 3, 7, 14, 27, 164, 214, 215, 223-241 social factors, 4, 23-24, 237-238 standards, 103 see also Health promotion; Prenatal services; Risk factors; Safety equipment; Screening; Well-child care Private sector, 331 advocacy, 29-30, 132, 225, 243, 244, 252, 331 developmental disabilities, 143-144 employment programs, 251

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Disability in America: Toward a National Agenda for Prevention government coordination of, 17-18, 261-264, 270-271, 331 insurance, 14, 17, 24-25, 26-27, 139, 182, 211, 227, 228, 233, 253, 252-257, 271, 280, 282 local cooperation, 263-264 preventive measures, 40 Productivity, losses, 68, 69, 148, 163 Professional associations, 25, 145, 280, 312 Professional education, 28-29, 31, 146, 264-265, 268, 284-286 on aged persons, 201, 212-213 developmental disabilities, 132, 146 national agenda, 15, 31, 268 researchers, 279, 331 secondary conditions, 231, 232, 239-240 see also Vocational rehabilitation Projections, aging population, 56, 193, 209-211 Prosthetics, see Assistive technologies Protocols, 13, 208, 213, 234-241, 259 Psychological factors, 23-24, 92-93, 94, 98-99, 278 aged persons, 195, 210 injuries, 151, 152, 165, 173, 179-183 rehabilitation, related to, 206, 207-208, 221, 222, 236-237 see also Mental health and illness Public assistance, 248, 253, 282 developmental disabilities, 141 eligibility criteria, 56, 249-250, 256, 257, 263, 313 evaluation, 68, 182 housing, 220, 225 Medicaid, 24, 248, 255, 257 Medicare, 24, 44, 199, 209, 229, 255, 256, 257 people with mental disabilities, 208 Social Security Disability Insurance, 52, 248, 249-252, 310, 313 Supplemental Security Income, 52, 141, 248, 310 see also Medicaid; Medicare Public education, 15, 17, 28, 31, 230, 264, 268, 283, 286-287 aging process, 185, 211-212 chronic diseases and aging, 185, 201, 211-212 family planning, 26-27, 128-129, 281-282 injury-related disabilities, 164, 182 national agenda, 15, 31, 268 secondary conditions, 224, 230-233 Public facilities, access to, 33, 87, 88, 94, 233, 330 transportation, 33, 131, 225, 233, 330 Public Health Service, 245-246 Public opinion, 4, 94 about aging, 194, 195, 196, 198, 211-212 about people with disabilities, 30, 70, 230, 233, 264 Q Quality of life, 1, 2-3, 4, 8, 20, 32, 34, 74, 105, 245, 265-266 aging and chronic diseases, 189, 190, 196, 198, 199, 208, 209, 210-211, 212 central nervous system injury, 172-173, 182 disability model, factor in, 85, 89-91 employment and, 33, 172-173 handicap, defined, 78 secondary condition prevention, 235 standard of living, 84, 90 WHO, 89-90 see also Activities of daily living; Dependence/independence R Racial/ethnic factors, 1, 12, 45, 46, 64-65, 114, 136, 153 blacks, 46, 64-65, 114 Hispanics, 136 Native Americans, 114 Regulations alcohol and drug abuse, 161, 164 environmental toxins, 131 labeling, 201 see also Standards Rehabilitation, 3, 107, 214 concept of, 311 evaluation of, 245, 279 geriatric, 194-195 independent living centers, 30, 94, 180, 225, 232 injuries, systems approach, 164-183 models, 164-183 professional education on, 231 psychological factors, 206, 207-208, 221, 222, 236-237 research, 24, 258-260, 278-279 secondary conditions, prevention, 214, 215, 236-237 Social Security Disability Insurance, 52, 248, 249-252, 310, 313 vocational, 27-28, 165, 179-183, 244, 248, 249-251, 263, 284, 311 Rehabilitation Act, 313 Rehabilitation Services Administration, 263 Research, 22-24, 75, 100, 268, 277-279 aging and disease, 189, 193-194, 208 brain, 136 coordination, 19, 22-23, 277 developmental disabilities, 138-139 injuries, 163, 164, 176, 179 national program, 15, 31, 268, 272, 277 preventive measures, 24, 278-279 rehabilitation, 24, 258-260, 279 risk factors, 4, 33, 86, 98-99, 164, 277-278

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Disability in America: Toward a National Agenda for Prevention secondary conditions, 234, 240-241 social factors, 278 socioeconomic status, 23-24, 278 training for, 279, 331 university-based, 144, 145, 146, 259, 331 see also Demonstration projects; Epidemiology; Evaluation Retirement History Survey, 102 Risk factors, 4, 8, 12-13, 20, 80, 84-89, 91-92, 94, 96, 101, 228, 248 aged persons, 86, 185, 193, 198, 200, 202-205 assistive technologies and, 226 brain injury, 153 definitions, 37-38, 84-89, 99 developmental disabilities, 122, 123, 125-127 epidemiological research, general, 4, 22, 33, 98-99 injuries, 163, 164, 165 insurance classifications, 255 multiple impairments, 234 occupational, 84, 157, 330 research, 4, 33, 86, 98-99, 164, 277-278 secondary conditions, general, 214, 215, 226, 234, 235 sexual activities, 88, 96, 107, 248 see also Screening; specific factors Robert Wood Johnson Foundation, 263 Rural areas, 131 S Safety equipment, 163-164, 330 fall injuries, prevention, 226, 227, 228 motor vehicles, 38, 157, 161-163, 339 Schizophrenia, 207 Screening, 106, 107, 247-248, 257 developmental disabilities, general, 122-123, 128-129 employer-provided insurance, 254 federal support, 145 genetic, 330, 333, 334 Secondary conditions, 13-14, 94-95, 214-241 assistive technologies and, 215, 224, 225-229, 232, 233, 234, 237, 239, 240 CDC, 241 coordination of services, 224-225, 241 cost, 220 defined, 13, 35, 214, 235 depression, 33, 40, 205, 206, 215, 219, 221, 222, 238, 240 developmental disabilities and, 122, 123 drug treatment, 228, 229, 236 environmental factors, 224, 233, 235, 237 epidemiology, 22, 137, 218, 220, 240 evaluation of interventions, 223, 234-335 health promotion interventions, 215, 224, 227-230 injury-related, 164, 168, 174-176 learning disabilities, 330 local intervention, 238 medical interventions, general, 224-225 mental/emotional, general, 5, 33, 216, 219, 221-223 multidisciplinary approach, 234 prevention, 3, 7, 27, 33, 34, 107, 164, 207, 223-241 professional education on, 231, 232, 239-240 protocols, 13, 234-241 public education, 224, 230-233 rehabilitation and, 214, 215, 236-237 research, 234, 240-241 risk factors, 214, 215, 226, 234, 235 social factors, 223, 235, 237-238 Sensory limitations, 118, 119, 121, 178, 179, 203, 216, 228 Sex differences, see Gender factors Sexual activity family planning, 26-27, 128-129, 281-282 of people with disabilities, 222 as risk factor, 88, 96, 107, 248 Smoking, 88, 101, 200, 205, 248 Social factors, 75, 86-87, 98-99 aged persons, 195, 199, 206, 210-211 disability definitional issues, 6, 42, 74, 77, 315-317, 320, 321, 324, 325 injuries, 151, 152, 163, 173-174, 179-183 international comparisons, 252 limitations, defined, 6, 42, 74, 77 peer influence, 132, 173, 225 preventive interventions, 4, 23-24, 237-238 research, 278 and secondary conditions, 223, 235, 237-238 support networks, 4, 99, 132, 206, 223, 224-225, 237-238 see also Demography; Public opinion Social Security Act, 249 Social Security Administration, 102, 138, 249 Social Security Disability Insurance, 52, 248, 249-252, 257, 310, 313 Socioeconomic status, 47, 101 brain injury epidemiology, 153 in disabling process, 23-24, 84, 92, 93, 94 prenatal care, 281-282 research on, 23-24, 278 see also Poverty Speech, see Communication limitations Special education, 121-122, 248, 330 Spinal cord injuries, 12, 150-151, 153-183, 215 adolescents and young adults, 154 employment issues, 154, 220 motor vehicles, 11, 154, 155

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Disability in America: Toward a National Agenda for Prevention paraplegia/quadraplegia, 35, 154, 155, 177, 215, 219-220 protocols, 236, 259 steroids, 33-34, 177 Sports and athletics, 154, 229-230 Standards accreditation, professional education, 231 chronic disease, protocols, 208, 213 disability indexes, general, 103-104, 179, 276-277, 315 disability measures, 20-21, 179, 273-274 insurance eligibility, 14, 26-27, 139, 182, 227, 228, 233, 254-257, 280, 313 national objectives, 15, 31, 245-247, 260, 268 prevention criteria, general, 103 public assistance, eligibility, 56, 249-250, 256, 257, 263, 313 secondary conditions, protocols, 13, 234-241 spinal cord injuries, protocols, 13, 234-241 spinal cord injuries, protocols, 236, 259 see also Classification; Definitional issues; Quality of life Standards of living, 84, 90 State governments, 262 aged persons, data, 190 blind, services, 257 child-focused programs, 284 databases, 137-138, 190-191 developmental disabilities, 34, 131, 133, 137-138, 141, 143, 144-145 federal cooperation with, 16, 34, 131, 133, 141, 145, 248, 250, 261, 262, 311 home care programs, 255-256 injuries, mandatory reporting, 159 local activities, regulation, 263 prenatal care, 262-263 rehabilitation programs, 311 vocational rehabilitation, 248, 250 Statistical programs and activities, see Cost and cost analysis; Epidemiology Steroids, 33-34, 177 Substance abuse, see Drug abuse Supplemental Security Income, 52, 141, 248, 310 Supplement on Aging (NHIS), 44-45, 60, 67, 192 Surgeon General, 184-185, 333 Surveillance, see Epidemiology Survey of Income and Program Participation, 43-44, 49-53, 74, 75, 102, 253 Survey of Occupational Injuries and Illnesses, 156 T Technical assistance, 34 Technology, see Assistive technologies; Safety equipment Therapy, see Rehabilitation Toward Independence, 243, 260 Toxicity environmental, general, 98, 131 developmental disabilities, 11, 114-115, 124, 131, 134 lead, 11, 116-117, 131 Training, see Education and training Transfer payments, 69, 70, 310 Transportation facilities access to, 33, 131, 225, 233, 330 assistive devices, 251 Traumatic Brain Injury, 180 Traumatic brain injury, see Brain; Injury Traumatic injury, see Injury U Uniform Hospital Discharge Set, 157 University programs, 144-146, 259, 331 Urban areas, 233 brain injuries, 12, 153 lead poisoning, 11 Utilization of services, 27, 68 V Veterans, 52, 259-260, 310 Vocational rehabilitation, 27-28, 93-94, 165, 172, 179-183, 244, 248, 249-251, 263, 284, 311 Vocational Rehabilitation Act, 311 W Weather, 94, 233 Well-child care, 124, 128 Women, 64, 256 see also Gender factors; Prenatal services Work issues, see Employment and unemployment World Health Organization, 4, 7, 76, 83 ICIDH classification system, 5-6, 20-21, 76-78, 97, 273, 319-320, 325, 327 quality of life, 89-90 World Institute on Disability, 256 Y Young adults, 2 injuries, 74-75, 153 spinal cord injuries, 154 see also Adolescents