# 2 {#section .Chapter-# .unnumbered}

# Arthritis, Osteoporosis, and Chronic Back Conditions

#### Arthritis and Other Rheumatic Conditions

2-1 Mean number of days without severe pain

2-2 Activity limitations due to arthritis

2-3 Personal care limitations

2-4 Help in coping

2-5 Employment rate

2-6 Racial differences in total knee replacement

2-7 Seeing a health care provider

2-8 Arthritis education

#### Osteoporosis

2-9 Cases of osteoporosis

2-10 Hospitalization for vertebral fractures

#### Chronic Back Conditions

2-11 Activity limitations due to chronic back conditions

### Arthritis and Other Rheumatic Conditions

  -----------------------------------------------------------------------
  2-1. (Developmental)   
  Increase the mean      
  number of days without 
  severe pain among      
  adults who have        
  chronic joint          
  symptoms.              
  ---------------------- ------------------------------------------------
  **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. A
                         proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         See Part C for a description of NHIS and BFRSS
                         and Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

+---------------------+------------------------------------------------+
| 2-2. Reduce the     |                                                |
| proportion of       |                                                |
| adults with chronic |                                                |
| joint symptoms who  |                                                |
| experience a        |                                                |
| limitation in       |                                                |
| activity due to     |                                                |
| arthritis.          |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 27 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 years and older with  |
|                     | chronic joint symptoms who report difficulty   |
|                     | with activities due to arthritis/rheumatism.   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older with  |
|                     | chronic joint symptoms.                        |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| ###### Questi       | From the 1997 National Health Interview        |
| ons Used To Obtain  | Survey:                                        |
| the National Data { |                                                |
| #questions-used-to- |                                                |
| obtain-the-national |                                                |
| -data .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
|                     | -   By yourself, and without using any special |
|                     |     equipment, how difficult is it for you     |
|                     |     to\...                                     |
|                     |                                                |
|                     |     Walk 1/4 of a mile---about 3 city blocks?\ |
|                     |     Walk up 10 steps without resting?\         |
|                     |     Stand or be on your feet for about 2       |
|                     |     hours?\                                    |
|                     |     Sit for about 2 hours?\                    |
|                     |     Stoop, bend, or kneel?\                    |
|                     |     Reach up over your head?\                  |
|                     |     Use your fingers to grasp or handle small  |
|                     |     objects?\                                  |
|                     |     Lift or carry something as heavy as 10     |
|                     |     pounds such as a full bag of groceries?\   |
|                     |     Push or pull large objects like a living   |
|                     |     room chair?\                               |
|                     |     Go out to things like shopping, movies, or |
|                     |     sporting events?\                          |
|                     |     Participate in social activities such as   |
|                     |     visiting friends, attending clubs and      |
|                     |     meetings, going to parties?\               |
|                     |     Do things to relax at home or for leisure  |
|                     |     (reading, watching TV, sewing, listening   |
|                     |     to music)?                                 |
|                     |                                                |
|                     |     \[Response categories:\]\                  |
|                     |     0 Not at all difficult\                    |
|                     |     1 Only a little difficult\                 |
|                     |     2 Somewhat difficult\                      |
|                     |     3 Very difficult\                          |
|                     |     4 Can't do at all                          |
+---------------------+------------------------------------------------+
|                     | \[If response categories are 1-4 to any of the |
|                     | above statements:\]                            |
|                     |                                                |
|                     | -   What condition or health problem causes    |
|                     |     you to have difficulty with {names of up   |
|                     |     to 3 specified activities/these            |
|                     |     activities}?\                              |
|                     |     \[Response categories include:\]\          |
|                     |     Arthritis/rheumatism                       |
+---------------------+------------------------------------------------+
|                     | -   During the PAST 12 MONTHS, have you had    |
|                     |     pain, aching, stiffness or swelling in or  |
|                     |     around a joint?                            |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Were these symptoms present on MOST DAYS   |
|                     |     FOR AT LEAST ONE MONTH?                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have chronic joint   |
|                     | symptoms (arthritis) if they report having had |
|                     | pain, aching, stiffness, or swelling in or     |
|                     | around a joint for most days for at least 1    |
|                     | month in the past 12 months. Persons were      |
|                     | considered to be limited in activity if they   |
|                     | reported that it was only a little difficult,  |
|                     | somewhat difficult, very difficult, or they    |
|                     | could not do at all [any]{.underline} of the   |
|                     | activities listed above. The limitation was    |
|                     | considered to be due to arthritis if they      |
|                     | selected "arthritis/rheumatism" from the list  |
|                     | of conditions.                                 |
+---------------------+------------------------------------------------+
|                     | The NHIS, with input from the National         |
|                     | Arthritis Data Workgroup, changed its approach |
|                     | to collecting arthritis data in 1996. Instead  |
|                     | of asking for self reports of arthritis        |
|                     | diagnosis, which is difficult for many         |
|                     | respondents who do not know their type of      |
|                     | arthritis, the NHIS now asks for self-reports  |
|                     | of symptoms.                                   |
+---------------------+------------------------------------------------+
|                     | A proposed State data source is the Behavioral |
|                     | Risk Factor Surveillance System (BRFSS). The   |
|                     | personal interview-based NHIS and the          |
|                     | telephone-based BRFSS optional arthritis       |
|                     | module ask identical questions about pain,     |
|                     | aching, stiffness, or swelling in or around a  |
|                     | joint that was present on most days for at     |
|                     | least 1 month in the past 12 months (the       |
|                     | self-report definition of chronic joint        |
|                     | symptoms).                                     |
+---------------------+------------------------------------------------+
|                     | The new field of arthritis public health is    |
|                     | evolving rapidly and case definitions may      |
|                     | change as understanding improves. Cognitive    |
|                     | testing and validation of self-reports and     |
|                     | other arthritis-related questions over the     |
|                     | next few years may result in the rephrasing of |
|                     | some of the national arthritis objectives.     |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 2-3. Reduce the     |                                                |
| proportion of all   |                                                |
| adults with chronic |                                                |
| joint symptoms who  |                                                |
| have difficulty in  |                                                |
| performing two or   |                                                |
| more personal care  |                                                |
| activities, thereby |                                                |
| preserving          |                                                |
| independence.       |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 2.0 (1997).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 years and older with  |
|                     | chronic joint symptoms who report difficulty   |
|                     | with two or more personal care activities.     |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older with  |
|                     | chronic joint symptoms.                        |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Because of a physical, mental, or          |
|                     |     emotional problem, (do/does)               |
|                     |     ([Person]{.underline}) need the help of    |
|                     |     other persons with PERSONAL CARE NEEDS,    |
|                     |     such as eating, bathing, dressing, or      |
|                     |     getting around inside this home?           |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   (Do/Does) ([Person]{.underline}) need the  |
|                     |     help of other persons with\...\            |
|                     |     bathing or showering?\                     |
|                     |     dressing?\                                 |
|                     |     eating?\                                   |
|                     |     getting in or out of bed or chairs?\       |
|                     |     using the toilet, including getting to the |
|                     |     toilet?\                                   |
|                     |     getting around inside the home?            |
+---------------------+------------------------------------------------+
|                     | -   During the PAST 12 MONTHS, have you had    |
|                     |     pain, aching, stiffness or swelling in or  |
|                     |     around a joint?                            |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Were these symptoms present on MOST DAYS   |
|                     |     FOR AT LEAST ONE MONTH?                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered to have chronic joint   |
|                     | symptoms (arthritis) if they report having had |
|                     | pain, aching, stiffness, or swelling in or     |
|                     | around a joint for most days for at least one  |
|                     | month in the past 12 months. Persons are       |
|                     | considered to have difficulty with personal    |
|                     | care activities if they responded "yes" to     |
|                     | needing help of other persons with two or more |
|                     | of the six personal care activities listed     |
|                     | above.                                         |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Comments provided with objective 2-2 for   |
|                     | more information.                              |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  -----------------------------------------------------------------------
  2-4. (Developmental)   
  Increase the           
  proportion of adults   
  aged 18 years and      
  older with arthritis   
  who seek help in       
  coping if they         
  experience personal    
  and emotional          
  problems.              
  ---------------------- ------------------------------------------------
  **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. A
                         proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         See Part C for a description of NHIS and BFRSS
                         and Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

+---------------------+------------------------------------------------+
| 2-5. Increase the   |                                                |
| employment rate     |                                                |
| among adults with   |                                                |
| arthritis in the    |                                                |
| working-aged        |                                                |
| population.         |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 67 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 to 64 years with      |
|                     | chronic joint symptoms who report being        |
|                     | employed.                                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 to 64 years who       |
|                     | report having chronic joint symptoms.          |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized population |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Which of the following {were/was} {person} |
|                     |     doing last week?\                          |
|                     |     Working at a job or business\              |
|                     |     With a job or business but not at work\    |
|                     |     Looking for work\                          |
|                     |     Not working at a job or business           |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   During the PAST 12 MONTHS, have you had    |
|                     |     pain, aching, stiffness or swelling in or  |
|                     |     around a joint?                            |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Were these symptoms present on MOST DAYS   |
|                     |     FOR AT LEAST ONE MONTH?                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Persons are considered employed if they        |
|                     | answered "yes" to "working at a job or         |
|                     | business" or "with a job or business but not   |
|                     | at work." Persons are considered to have       |
|                     | chronic joint symptoms (arthritis) if they     |
|                     | report having had pain, aching, stiffness, or  |
|                     | swelling in or around a joint for most days    |
|                     | for at least 1 month in the past 12 months.    |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Comments provided with objective 2-2 for   |
|                     | more information.                              |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  -----------------------------------------------------------------------
  2-6. (Developmental)   
  Eliminate racial       
  disparities in the     
  rate of total knee     
  replacements.          
  ---------------------- ------------------------------------------------
  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources are Medicare records,
                         HCFA, National Hospital Discharge Survey (NHDS),
                         CDC, NCHS; and Hospital Cost and Utilization
                         Project (HCUP), AHQR.

                         See Appendix A for focus area contact
                         information.

  2-7. (Developmental)   
  Increase the           
  proportion of adults   
  who have seen a health 
  care provider for      
  their chronic joint    
  symptoms.              

  **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. A
                         proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  ---------------------- ------------------------------------------------
  2-8. (Developmental)   
  Increase the           
  proportion of persons  
  with arthritis who     
  have had effective,    
  evidence-based         
  arthritis education as 
  an integral part of    
  the management of      
  their condition.       

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Effective, evidence-based arthritis education
                         includes information about community and
                         self-help resources.

                         A proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS. A
                         proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Osteoporosis

  -----------------------------------------------------------------------
  2-9. Reduce the        
  proportion of adults   
  with osteoporosis.     
  ---------------------- ------------------------------------------------
  **National Data        National Health and Nutrition Examination Survey
  Source**               (NHANES), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           10 (1988--94).

  **Numerator**          Number of adults aged 50 years and older with a
                         femoral bone mineral density (BMD) value less
                         than 0.64.

  **Denominator**        Number of adults aged 50 years and older.

  **Population           U.S. civilian, non-institutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual, beginning with 1999.
  Periodicity**          

  **Comments**           Bone mineral densities are determined from
                         measurements made as part of the NHANES battery
                         of examinations. The choice of a femoral BMD of
                         less than 0.64 is the measure 2.5 or more
                         standard deviations below the reference mean for
                         young adults aged 20 to 29 years.**^1,\ 2^**

                         Data are age adjusted to the 2000 standard
                         population. Age-adjusted percents are weighted
                         sums of age-specific percents. For a discussion
                         on age adjustment, see Part A, section 5.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

+---------------------+------------------------------------------------+
| 2-10. Reduce the    |                                                |
| proportion of       |                                                |
| adults who are      |                                                |
| hospitalized for    |                                                |
| vertebral fractures |                                                |
| associated with     |                                                |
| osteoporosis.       |                                                |
+=====================+================================================+
| **National Data     | National Hospital Discharge Survey (NHDS),     |
| Source**            | CDC, NCHS.                                     |
+---------------------+------------------------------------------------+
| **State Data        | State hospital discharge data systems.         |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 10,000 population (age adjusted---see |
|                     | Comments).                                     |
+---------------------+------------------------------------------------+
| **Baseline**        | 17.5 (1998).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of discharges from short-stay hospitals |
|                     | among persons aged 65 years and older for      |
|                     | vertebral fractures (ICD-9-CM codes 805.0,     |
|                     | 805.2, 805.4, or 805.8 in any listed           |
|                     | diagnostic field).                             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 65 years and older.     |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Hospital Discharge      |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Final diagnoses:                           |
|                     |                                                |
|                     |     -   Principal:                             |
|                     |                                                |
|                     |     -   Other/additional:                      |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Discharges with an ICD code indicating         |
|                     | vertebral fracture due to osteoporosis         |
|                     | included any person with a diagnosis of closed |
|                     | cervical, thoracic, or lumbar spine fracture   |
|                     | without spinal cord involvement (ICD-9-CM      |
|                     | codes 805.0, 805.2, or 805.4) in any of the    |
|                     | seven diagnostic fields. Closed spinal         |
|                     | injuries elusive of cord involvement without   |
|                     | reference to a specific site (ICD-9-CM code    |
|                     | 805.8) were also included. These criteria      |
|                     | selected the vertebral fractures most likely   |
|                     | to be due to osteoporosis by excluding open    |
|                     | vertebral fractures and those with spinal cord |
|                     | involvement, which are usually due to severe   |
|                     | trauma.**^3^**                                 |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted rates are weighted    |
|                     | sums of age-specific rates. For a discussion   |
|                     | on age adjustment, see Part A, section 5.      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHDS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

### Chronic Back Conditions

+---------------------+------------------------------------------------+
| 2-11. Reduce        |                                                |
| activity limitation |                                                |
| due to chronic back |                                                |
| conditions.         |                                                |
+=====================+================================================+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 population (age adjusted---see  |
|                     | Comments).                                     |
+---------------------+------------------------------------------------+
| **Baseline**        | 32 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 18 years and older with  |
|                     | limitation in activity due to chronic back or  |
|                     | neck problems.                                 |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 18 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Because of a physical, mental, or          |
|                     |     emotional problem, (do/does)               |
|                     |     ([Person]{.underline}) need the help of    |
|                     |     other persons with PERSONAL CARE NEEDS,    |
|                     |     such as eating, bathing, dressing, or      |
|                     |     getting around inside this home?           |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   (Do/Does) (Person) need the help of other  |
|                     |     persons with\...                           |
|                     |                                                |
|                     |     bathing or showering?\                     |
|                     |     dressing?\                                 |
|                     |     eating?\                                   |
|                     |     getting in or out of bed or chairs?\       |
|                     |     using the toilet, including getting to the |
|                     |     toilet?\                                   |
|                     |     getting around inside the home?            |
+---------------------+------------------------------------------------+
|                     | -   Because of a physical, mental, or          |
|                     |     emotional problem, (do/does)               |
|                     |     ([Person]{.underline}) 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 keep ([Person 18+]{.underline})    |
|                     |     from working at a job or business?         |
+---------------------+------------------------------------------------+
|                     | -   (Are/(Other than the persons mentioned     |
|                     |     are) any of these family members) ([Person |
|                     |     18+]{.underline}) 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 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?                                 |
+---------------------+------------------------------------------------+
|                     | -   What conditions or health problems cause   |
|                     |     ([Person]{.underline}) limitations?        |
|                     |                                                |
|                     |     \[Response categories include:\]\          |
|                     |     Back or neck problem causes limitation     |
+---------------------+------------------------------------------------+
|                     | -   How long (have/has) ([Person]{.underline}) |
|                     |     had this back or neck problem?             |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The estimate for chronic back conditions       |
|                     | includes neck problems because of the way the  |
|                     | questionnaire was worded. The condition is     |
|                     | considered "chronic" if it has lasted 3 months |
|                     | or more. Persons are considered limited in     |
|                     | activity if they respond "yes" to any of the   |
|                     | activity limitation questions listed above:    |
|                     | personal care needs; routine needs; or         |
|                     | physical, mental, or emotional problems that   |
|                     | preclude working or limit the kind or amount   |
|                     | of work that can be done.                      |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted rates are weighted    |
|                     | sums of age-specific rates. For a discussion   |
|                     | on age adjustment, see Part A, section 5.      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
|                     |                                                |
|                     |                                             |
+---------------------+------------------------------------------------+

##  References

1\. World Health Organization (WHO). *Assessment of Fracture Risk and
Its Application to Screening for Postmenopausal Osteoporosis.* Technical
Report Series No. 843. Geneva, Switzerland: WHO, 1994.

2\. Looker, A.C.; Orwoll, E.S.; Johnston; C.C.; et al. Prevalence and
low femoral bone density in older U.S. adults from NHANES III. *Journal
of Bone and Mineral Research* 12:1761-8, 1997.

3\. Jacobsen, S.J.; Cooper, C.; Gottlieb, M.S.; et al. Hospitalization
with vertebral fracture among the aged: A national population-based
study, 1986--1989. *Epidemiology* 3(6):515-518, 1992.