6
Disability and Secondary Conditions
6-1	Standard definition of people with disabilities in data sets
6-2	Feelings and depression among children with disabilities 
6-3	Feelings and depression interfering with activities among adults with disabilities
6-4	Social participation among adults with disabilities
6-5	Sufficient emotional support among adults with disabilities
6-6	Satisfaction with life among adults with disabilities
6-7	Congregate care of children and adults with disabilities
6-7a		Adults aged 22 years and older
6-7b		Persons aged 21 years and under
6-8	Employment parity
6-9	Inclusion of children and youth with disabilities in regular education programs
6-10	Accessibility of health and wellness programs
6-11	Assistive devices and technology
6-12	Environmental barriers affecting participation in activities
6-13	Surveillance and health promotion programs
6-13a		States and the District of Columbia
6-13b		Tribes

6-1.	Include in the core of all relevant Healthy People 2010 surveillance instruments a standardized set of questions that identify “people with disabilities.”	
National Data Source	CDC, NCEH, Office on Disability and Health.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent.	
Baseline	0 (1999).	
Numerator	Number of relevant surveillance instruments used to measure Healthy People 2010 objectives that include in their core standardized questions that identify people with disabilities.	
Denominator	Number of relevant instruments used to measure Healthy People 2010 objectives.	
Questions Used To Obtain the National Data	Not applicable.	
Expected Periodicity	Annual.	
Comments	The number of instruments to be included in this measure was under review at the time of publication.	
	No standardized set of questions that identify people with disabilities currently exists.	
	CDC has proposed that a standardized set of questions on disability status be developed. As standard questions are adopted by the data systems, the data produced from them will be incorporated into the Healthy People 2010 objectives that specifically identify people with disabilities. This presents the opportunity in the future to have a standard definition of people with disabilities that can be used across data systems and geographic levels.	
	See Appendix A for focus area contact information.	
    
6-2.	Reduce the proportion of children and adolescents with disabilities who are reported to be sad, unhappy, or depressed.	
National Data Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent.	
Baseline	31 (1997).	
Numerator	Number of children and adolescents aged 4 to 11 years with disabilities who are reported to be unhappy, sad, or depressed.	
Denominator	Number of children and adolescents aged 4 to 11 years with disabilities.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1997 National Health Interview Survey:	
	[NUMERATOR:]
•	During the past 6 months has (Person) been unhappy, sad, or depressed?	
	[DENOMINATOR:]
•	I am now going to ask you about (your/the) general health (of family members) and the effects of any physical, mental, or emotional health problems.	
	[For children under 5:]
•	(Are/Is) (Person) limited in the kind or amount of play activities he/she/they can do because of a physical, mental or emotional problem?	
	[For children 3 to 17:]
•	Because of a physical, mental or emotional problem (do/does) (you/anyone) in the family need the help of other persons with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home?	
	[For children 5 to 17:]
•	Because of a physical, mental or emotional problem (do/does) (you/anyone) in the family need the help of other persons in handling ROUTINE NEEDS, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?	
	[For children under 18:]
•	Do any of the children under 18 in this family receive Special Education or Early Intervention Services?	
	•	Because of a health problem, (do/does) (you/anyone) in the family have difficulty walking without using any special equipment?	
	•	(Are/Is) (you/anyone) in the family LIMITED IN ANY WAY in any activities because of difficulty remembering or because {you/they} experience periods of confusion?	
	•	(Are/Is) (you/anyone) in the family LIMITED IN ANY WAY in any activities because of physical, mental or emotional problems?	
	•	Does (Person) have an impairment or health problem that requires {him/her} to use special equipment, such as a brace, a wheelchair, or a hearing aid (excluding ordinary eyeglasses or corrective shoes)?	
Expected Periodicity	Annual.	
Comments	Children and adolescents aged 4 to 11 are defined as having a disability if the proxy adult respondent responds “yes” to any of the limitation, special services, or special equipment questions listed above in the DENOMINATOR section.	
	A child/adolescent is considered sad, unhappy or depressed if any of these feelings have been observed by the proxy adult respondent during the past 6 months.	
	Baseline percents are based on data obtained in the last two quarters of the 1997 NHIS collection period.	
	This objective was intended to target all children and adolescents aged 2 to 18 years. However with the 1997 NHIS, it was not possible to combine data for the entire age range into one measure. Instead, proxy data for children and adolescents aged 4 to 11 years have been provided.	
	See Part C for a description of NHIS and Appendix A for focus area contact information.	
6-3.	Reduce the proportion of adults with disabilities who report feelings such as sadness, unhappiness, or depression that prevent them from being active.	
National Data Source	National Health Interview Survey (NHIS), CDC, NCHS	
State Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent (age adjusted—see Comments).	
Baseline	28 (1997).	
Numerator	Number of adults aged 18 years and older with disabilities who report negative feelings that prevented them from being active in the last 30 days.	
Denominator	Number of adults aged 18 years and older with disabilities.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1997 National Health Interview Survey:	
	[NUMERATOR:]
•	During the PAST 30 DAYS, how often did you feel
... so sad that nothing could cheer you up?
... nervous?
... restless or fidgety?
... hopeless?
... that everything was an effort?
... worthless?
ALL of the time
MOST of the time 
SOME of the time
A LITTLE of the time 
NONE of the time
Refused/Not ascertained/Don’t know
	
	[Asked of persons who at least some of the time, have felt sad, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless in the past 30 days.]
o	We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?	
	[DENOMINATOR:]
•	I am now going to ask you about (your/the) general health (of family members) and the effects of any physical, mental, or emotional health problems.	
	•	Because of a physical, mental or emotional problem (do/does) (you/anyone) in the family need the help of other persons with PERSONAL CARE NEEDS, such as eating, bathing, dressing, or getting around inside this home?	
	•	Because of a physical, mental or emotional problem (do/does) (you/anyone) in the family need the help of other persons in handling ROUTINE NEEDS, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?	
	•	Does a physical, mental or emotional problem NOW keep (you/any family members aged 18 and older) from working at a job or business?	
	•	(Are any family members aged 18 and older) limited in the kind OR amount of work (you/they) can do because of a physical, mental or emotional problem?	
	•	Because of a health problem, (do/does) (you/anyone) in the family have difficulty walking without using any special equipment?	
	•	(Are/Is) (you/anyone) in the family LIMITED IN ANY WAY in any activities because of difficulty remembering or because {you/they} experience periods of confusion?	
	•	(Are/Is) (you/anyone) in the family LIMITED IN ANY WAY in any activities because of physical, mental or emotional problems?	
	•	Do you now have any health problems that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?	
Expected Periodicity	Annual.	
Comments	Adults aged 18 years and older are defined as having a disability if a “yes” response is obtained to any of the limitation or special equipment questions listed above in the DENOMINATOR section.	
	An adult is considered to have feelings that prevent them from being active if he/she answered the feelings interfered “a lot” or “some” with their life or activities.	
	Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion of age adjustment, see Part A, section 5.	
	See Part C for a description of NHIS and BRFSS, and Appendix A for focus area contact information.	
    
6-4.	Increase the proportion of adults with disabilities who participate in social activities.	
National Data Source	National Health Interview Survey (NHIS), CDC, NCHS.	
State Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent (age adjusted—see Comments).	
Baseline	95.4 (1997).	
Numerator	Number of adults aged 18 years and older with disabilities who report participation in social activities.	
Denominator	Number of adults aged 18 years and older with disabilities.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From the 1997 National Health Interview Survey:	
	[NUMERATOR:]
•	By yourself, and WITHOUT using any special equipment, how difficult is it for you to . . . Go out to things like shopping, movies, or sporting events?
Not at all difficult	
Only a little difficult	
Somewhat difficult	
Very difficult 
Can’t do at all
Do not do this activity
Refused/Not ascertained/Don’t know	
	[DENOMINATOR:]
See Questions Used To Obtain the National Data (DENOMINATOR) provided with objective 6-3.	
Expected Periodicity	Annual.	
Comments	Adults aged 18 years and older are defined as having a disability if he/she responds “yes” to any of the limitation questions listed in the DENOMINATOR section for objective 6-3.	
	An adult is considered to participate in social activities if he/she responded “not at all difficult,” “only a little difficult,” “somewhat difficult,” or “very difficult” to the question listed in the NUMERATOR section above.	
	This objective was intended to measure whether persons with disabilities engage in social activity. It is currently possible to measure only how difficult it is for someone to participate in social activities from the NHIS, thus a proxy measure has been used. The 1999 BRFSS piloted another set of participation questions in Colorado. Future periodic NHIS modules or BRFSS surveys may include these or similar questions in the next few years.	
	Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion of age adjustment, see Part A, section 5.	
	See Part C for a description of NHIS and BRFSS, and Appendix A for focus area contact information.	
    
6-5.	Increase the proportion of adults with disabilities reporting sufficient emotional support.	
National Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
State Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent (age adjusted—see Comments).	
Baseline	71 (1998) (10 States and the District of Columbia—see Comments).	
Numerator	Number of adults aged 18 years and older with disabilities who report receiving sufficient emotional support.	
Denominator	Number of adults aged 18 years and older with disabilities.	
Population Targeted	Civilian, noninstitutionalized population of selected States (see Comments).	
Questions Used To Obtain the National Data	From the 1998 Behavioral Risk Factor Surveillance System:	
	[NUMERATOR:]
•	How often do you get the social and emotional support you need?
Always
Usually
Sometimes	
Rarely
Never
Refused/Not ascertained/Don’t know	
	[DENOMINATOR:]
•	Are you limited in any way in any activities because of any impairment or health problem?	
	•	If you use special equipment or help from others to get around, what type do you use?	
Expected Periodicity	Periodic.	
Comments	For this objective, adults with disabilities are defined as persons aged 18 years and older who report being limited in any activity because of impairments or health problems or who require special equipment. An adult is considered to have sufficient social support if he/she reported “always” or “usually” to the question listed in the NUMERATOR section above.	
	1998 baseline data are based on responses from 10 States and the District of Columbia.	
	Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion of age adjustment, see Part A, section 5.	
	See Part C for a description of BRFSS and Appendix A for focus area contact information.	
    
6-6.	Increase the proportion of adults with disabilities reporting satisfaction with life.	
National Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
State Data Source	Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent (age adjusted—see Comments).	
Baseline	87 (1998) (10 States and the District of Columbia—see Comments).	
Numerator	Number of adults aged 18 years and older with disabilities who report satisfaction with life.	
Denominator	Number of adults aged 18 years and older with disabilities.	
Population Targeted	Civilian, noninstitutionalized population of selected States (see Comments).	
Questions Used To Obtain the National Data	From the 1998 Behavioral Risk Factor Surveillance System:	
	[NUMERATOR:]
•	In general, how satisfied are you with your life?
Very satisfied		
Satisfied			
Dissatisfied		
Very dissatisfied
Refused/Not ascertained/Don’t know
	
	[DENOMINATOR:]
•	Are you limited in any way in any activities because of any impairment or health problem?	
	•	If you use special equipment or help from others to get around, what type do you use?	
Expected Periodicity	Periodic.	
Comments	For this objective, adults with disabilities are defined as persons 18 years and older who report being limited in any activity because of impairments or health problems or who require special equipment. An adult is considered to be satisfied with life if he/she reported being “very satisfied” or “satisfied” to the question listed in the NUMERATOR section above.	
	Data are age adjusted to the 2000 standard population. Age-adjusted percents are weighted sums of age-specific percents. For a discussion of age adjustment, see Part A, section 5.	
	1998 baseline data are based on responses from 10 States and the District of Columbia.	
	See Part C for a description of BRFSS and Appendix A for focus area contact information.	
    
6-7.	Reduce the number of people with disabilities in congregate care facilities, consistent with permanency planning principles.
6-7a.	Persons aged 22 years and older in 16 or more bed congregate facilities.	
National Data Source	Survey of U.S. Residential Facilities, University of Minnesota.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Measure	Number.	
Baseline	93,362 (1997).	
Numerator	Number of adults aged 22 years and older in congregate care facilities with 16 or more beds.	
Denominator	Not applicable.	
Population Targeted	U.S. resident population.	
Questions Used To Obtain the National Data	From the 1997 Survey of U.S. Residential Facilities:	
	•	Facility type, number of beds, age of residents.	
Expected Periodicity	Annual.	
Comments	State residential facilities are asked to complete a form and the information is abstracted, analyzed by investigators at the University of Minnesota, and reported in Residential Services for Persons with Developmental Disabilities: Status and Trends.1	
	See Appendix A for focus area contact information.	
    
6-7b.	Persons aged 21 years and under in congregate care facilities.	
National Data Source	Survey of U.S. Residential Facilities, University of Minnesota.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent.	
Baseline	24,300 (1997).	
Numerator	Number of persons aged 22 years and under in congregate care facilities with 16 or more beds.	
Denominator	Not applicable.	
Population Targeted	U.S. resident population.	
Questions Used To Obtain the National Data	From the 1997 Survey of U.S. Residential Facilities:	
Expected Periodicity	•	Facility type, number of beds, age of residents.	
Comments	Annual.	
	State residential facilities are asked to complete a form and the information is abstracted, analyzed by investigators at the University of Minnesota, and reported in Residential Services for Persons with Developmental Disabilities: Status and Trends.1	
	See Appendix A for focus area contact information.	
    
6-8.	Eliminate disparities in employment rates between working-aged adults with and without disabilities.	
National Data Source	Survey of Income and Program Participation (SIPP), Department of Commerce, Bureau of Census.	
State Data Source	Not identified.	
Healthy People 2000 Objective	Not applicable.	
Measure	Percent.	
Baseline	52 (1994–95).	
Numerator	Number of adults aged 21 to 64 years with disabilities who are employed.	
Denominator	Number of adults aged 21 to 64 years with disabilities.	
Population Targeted	U.S. civilian, noninstitutionalized population.	
Questions Used To Obtain the National Data	From Wave 6 of the 1993 Survey of Income and Program Participation:	
	[NUMERATOR:]
•	During the 4-month period outlined on this calendar, that is from (4 months ago) through (last month), did (Person) have a job or business, either full time or part time, even for only a few days?  (Mark “yes” for active duty in the Armed Forces, any temporary or part-time work, and work without pay in a family business or farm)	
	•	Even though (Person) did not have a job during this period, did (Person) do any work at all that earned some money?	
	•	Did (Person) have a job or business, either full or part time, during EACH of the weeks in this period?	
	•	During the weeks that (Person) did not have a job, did (Person) do any work at all that earned some money?	
	[DENOMINATOR:]
•	(Mark by observation if apparent.)  Does (Person) use any of the following aids to get around?
a. A cane, crutches, or a walker
b. A wheelchair	
	[If “yes” to a or b above:]
o	Has (Person) used (Aid mentioned in a or b above) for six months or longer?	
	•	Does (Person) have difficulty seeing the words and letters in ordinary newspaper print even when wearing glasses or contact lenses if ... usually wears them?	
	•	Does (Person) have any difficulty hearing what is said in normal conversation with another person (using a hearing aid if (Person) usually wears one)?	
	•	Because of a health condition or problem, does (Person) have any difficulty having his/her speech understood?	
	•	Does (Person) have any difficulty lifting and carrying something as heavy as 10 lbs., such as a full bag of groceries?	
	•	Does (Person) have any difficulty climbing a flight of stairs without resting?	
	•	Does (Person) have any difficulty walking a quarter of a mile - about 3 city blocks?	
	•	Does (Person) have any difficulty using the telephone?	
	•	Because of a physical or mental health condition, does (Person) have difficulty doing any of the following by himself/herself (exclude the effects of temporary conditions)?   (If an aid is used, ask whether the person has difficulty even when using the aid.)
Getting around INSIDE the home?
Going OUTSIDE the home, for example to shop or visit a doctor’s office?
Getting in and out of bed or a chair?
Taking a bath or shower?
Dressing?
Walking?
Eating?
Using the toilet, including getting to the toilet?
Keeping track of money and bills?
Preparing meals?
Doing light housework, such as washing dishes or sweeping a floor?
Taking the right amount of prescribed medicine at the right time?	
	•	Does (Person) have – 
Mental retardation?
A developmental disability such as autism or cerebral palsy?
Alzheimer’s disease, senility, dementia?
Any other mental or emotional conditions?	
	•	We have recorded that (Person)’s health or condition limits the kind or amount of work (Person) can do. Is that correct?	
	•	Does (Person) have a physical, mental, or other health condition which limits the kind or amount of work (Person) can do?	
	•	Does (Person) have a physical, mental, or other health condition which limits the kind or amount of work (Person) can do around the house?	
Expected Periodicity	Periodic.	
Comments	Adults aged 21 to 64 years are defined as having a disability if he/she has used a cane, crutch, walker or wheelchair to get around for 6 months or longer or responds “yes” to any of the limitation questions listed in the DENOMINATOR section above.	
	An adult is considered be employed if he/she answered “yes” to any of the job-related questions listed in the NUMERATOR section above.	
	Additional information on disability data from the SIPP, can be found at the following Web site: www.census.gov/hhes/www/disable/dissipp.html.	
	See Appendix A for focus area contact information.	
    
6-9.	Increase the proportion of children and youth with disabilities who spend at least 80 percent of their time in regular education programs.	
Comments	A complete operational definition was not specified at the time of publication.	
	See Appendix A for focus area contact information.	
    
6-10.	(Developmental) Increase the proportion of health and wellness and treatment programs and facilities that provide full access for people with disabilities.	
Comments	An operational definition could not be specified at the time of publication. A proposed national data source is the National Independent Living Centers Network.	
	See Appendix A for focus area contact information.	
    
6-11.	(Developmental) Reduce the proportion of people with disabilities who report not having the assistive devices and technology needed.	
Comments	An operational definition could not be specified at the time of publication. A proposed national data source is the National Health Interview Survey (NHIS), CDC, NCHS.	
	See Appendix A for focus area contact information.	
    
6-12.	(Developmental) Reduce the proportion of people with disabilities reporting environmental barriers to participation in home, school, work, or community activities.	
Comments	An operational definition could not be specified at the time of publication. A possible data source is the Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP.	
	See Appendix A for focus area contact information.	
    
6-13.	Increase the number of Tribes, States, and the District of Columbia that have public health surveillance and health promotion programs for people with disabilities and caregivers.
6-13a.	States and the District of Columbia	
Comments	A complete operational definition was not specified at the time of publication.	
	See Appendix A for focus area contact information.	
    
6-13b.	(Developmental) Tribes	
Comments	An operational definition could not be specified at the time of publication. A potential data source is the Office on Disability and Health, CDC, NCEH.	
	See Appendix A for focus area contact information.	
    
Reference
1. Prouty, R., and Lakin, K.C., eds. Residential Services for Persons With Developmental Disabilities: Status and Trends Through 1996. Report No. 49. Minneapolis, MN: University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration, 1997.