APPENDIXES


         APPENDIX I
MEASURES FOR BETTER HEALTH--A SUMMARY

  Throughout this report a number of specific
measures have been identified as important to im-
proving the health of individuals.   Summarized in
this Appendix are the principal recommendations for
healthier infants, children, adolescents and young
adults, adults and older adults.

  In most cases,  issues which span several age
groups are discussed for the age group at greatest
risk for the problem addressed.  However, for those
issues in which the nature of the problem varies by
life stage (e.g., nutrition), the recommendation is
repeated with a different emphasis for each age
group.

HEALTHY INFANTS

  Education for parenthood.  People who are well
informed about the care reauired by infants can bet-
ter plan and prepare for' parenthood.  Prospective
parents can seek education for parenthood classes
through physicians, hospitals, and community organi-
zations.  Schools can offer preparation for parent-
hood to children and teenagers.

  Genetic counseling.   Prospective parents who
havewily disorders such as Down
syndrome,  Tay-Sachs disease,  sickle cell anemia,
hemophilia,  muscular dystrophy, or serious mental
disorders should seek special counseling.   Health
professionals can provide this information to their
patients and make appropriate referrals for genetic
services.

  Prenatal care.  Good prenatal care is essential
for a healthy pregnancy.   Medical care, dietary
assistance  and counseling is  important for all
expectant mothers.  Mothers with social and economic

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barriers to such care can be targeted by outreach
and follow-up programs.

  Prenatal nutrition.  Pregnant women have extra
needs for iron, protein, calcium, and calories and
may need to be -provided with dietary suggestions
and/or supplements.  Nutritional guidance and ser-
vices are available from health professionals and
service agencies.

  Prenatal maternal habits.  To reduce the poten-
tial for adverse effects on the developing fetus,
women should avoid tobacco and alcohol during preg-
nancy.  Counseling and appropriate services can help
expectant mothers who wish to avoid these risks.
Similarly,  physicians should avoid prescribing use
of medications and exposure to radiation by pregnant
women, unless warranted by special circumstances.

  Amniocentesis.  A test (amniocentesis) sampling
the intrauterine fluid at about the 16th week of
pregnancy can determine whether certain serious
birth defects exist in the fetus. Expectant mothers
at higher risk include those who:  are 35 and over;
have a history of multiple spontaneous abortions; or
have a family history of Dam syndrome, neural tube
defects,  inherited metabolic disorders, multiple
birth defects,  or sex linked inherited disorders.
Detection of an abnormality may require a personal
decision about an abortion.

plet~refa..;m f$edinc#.   Breast milk is the most com-
           in ant nutrition and is recommended
for full-term newborn babies, unless there are
specific problems or breast feeding is unsuccessful.
If a nursing mother is healthy and well nourished,
fluoride and possibly Vitamin D may be the only
supplements needed by the baby.   After about four
months iron may also have to be added.  Solid foods
should not be introduced hastily into the baby's
diet--rather they should be phased in gradually.

  Pediatric care.   Regular,  comprehensive pedi-
atric care can help assure the early detection of
preventable   problems,   and  provide   preventive

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services such as immunizations (see below).   In ad-
dition to a detailed examination after birth, every
baby should be examined before leaving the hospital
or within 10 days of birth, and again at approxi-
mately two, four, six, and nine months of age.

   Immunizations.   Childhood diseases that can be
prevented by vaccinations continue to be a threat to
infant health.  Babies should be immunized for diph-
theria,  pertussis, tetanus,  and polio at ages two
months, four months, and six months (polio immuni-
zation is optional at six months). They should also
receive  the recormiended  childhood  immunizations
thereafter.

  Social services.  Some families require special
support services to enhance the healthy growth and
development of their children.   Such services in-
clude high quality day care, improved foster care
and adoption programs,  as well as services to assist
families in which a parent may suffer from chronic
disabling disease, mental illness, alcoholism, or
drug abuse.

HEALTHY CHILDREN

  Early childhood development. A stimulating and
healthy environment during the early part of life
can  enhance a  child's growth  and development.
Programs such as Head Start, which provide compre-
hensive services for children, including day care,
health care, nutrition,  education and counseling,
have produced important gains in child development,
particularly for families with low incomes.

  Special support services.  Special sources of
support should be available through community agen-
cies and health care providers to assist children
and families under particular stress.   Foster care
programs and practices should be designed to in-
crease the opportunities for children to grow up in
a stable and healthy environment.

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  Injury reduction.   Accidents  are the single
greatest threat to children's health.  People can
reduce children's risk of injury and death by:

0   having the child secured in an approved
  child carrier, safety harness or seat belt
  when riding in an automobile;

0   storing toxic agents out of reach, away
  from food,  and in special containers with
  fastened safety caps;

@   ensuring against access to knives and guns;

0   carefully  supervising young  children at
  play, particularly when they are near water
  or streets;

e   instructing the child what to do in situa-
   tions of  special  risk (e.g., stoves,
  matches, electrical sockets, traffic).

  Pediatric care.  Some childhood problems can be
prevented or ameliorated through the provision of
certain medical sevices.  Examples of such services
include:  identification and treatment of vision and
hearing problems; assessment of developmental skills
important to learning;  immunizations (see below);
and early diagnosis  and treatment of childhood
infections.   Children should, therefore, receive
routine pediatric evaluations at least every two to
three years.

  Immunizations.  Children should be immunized for
diphtheria, pertussis, tetanus, and polio at ages
two months, four months, six months, 18 months, and
four to six years (polio immunization is optional at
six months),  and for measles, mumps, and rubella at
age 15 months.

  Nutrition   and   exercise.   Acquiring  healthy
eatinq and exercise habits in childhood may have
lifelong benefits.  An appropriate balance of food
intake and physical activity promotes normal weight.
Excessive intake of salt, sugar, and fats should be

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avoided.  Parents and schools can emphasize these
points  through  instruction,  meal  planning,   and
physical  education programs emphasizing lifelong
exercise activities.  Nutrition supplements can be
provided to children in high risk families.

habits.
  Healthy       Preparing young children for
peer group pressures with regard to smoking, alcohol
use, drug use, and sexual activity can enhance their
ability to   deal   with   those   pressures   later.
Parents, schools,  and health professionals are all
important to the provision of comprehensive health
education which can help children to acquire skills
to   cope  with  problems  they will   confront as
teenagers.

  Fluoridation.   The most effective and efficient
way to prevent tooth decay is through fluoridation
of- community water supplies.  If the water supply is
not fluoridated, alternative fluoride sources can be
provided through school-based fluoride mouth rinse
or tablet programs,  fluoride rinsing services from
dentists, fluoride tablets for home use.

  Dental care.  Children should be taught proper
tooth brushing and flossing techniques at early
ages,  and should begin regular visits to a dentist
by age three.  Sweets in the diet should be limited
to prevent tooth decay.

HEALTHY ADOLESCENTS AND YOUNG ADULTS

  Roadway safety.   Autombile accidents are the
leading cause of death among young people. A
substantial number of injuries and deaths could be
avoided through careful,  defensive driving habits.
Especially important are avoiding driving after
drinking (or riding  with a driver who has been
drinking) or use of mood-altering drugs; obeying
traffic laws; and using seat belts or, for cyclists,
helmets.   These  efforts   can  be reinforced by
Federal, State,  and local measures to set and
enforce safety regulations and lower speed limits,
and to improve roadway and vehicular design.

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  Smoking, alcohol, and drug use.  Experimental
behavior by young people can lead to dependence or
misuse of certain substances.   Collective measures
can be taken by parents, teachers, health profes-
sionals,  and community organizations  to provide
adolescents and young adults with information and
skills  necessary to help  them avoid cigarette
smoking or harmful use of alcohol or drugs.

  Nutrition and exercise.  Changes in values and
social pressures may encourage adolescents to eat
snack foods that do not contain adequate supplies of
essential nutrients.  Yet,  good eating habits and
regular,  vigorous exercise are important to still
growing  adolescents.  During their growth spurt,
teenagers need more calories, and particularly more
protein, calcium, and iron.

  Family planning.   Unwanted  pregnancy is a
distressing problem for adolescent and young adult
women in this country.  Families, schools, health
professionals,  and social organizations can ensure
that information about birth control measures is
provided to young people of both sexes, and that
family planning services  are easily accessible to
those who are sexually active.  Services (including
continued schooling) can also be made available in
the community for young women who become pregnant
and are in need of care and advice.

  Sexually   transmissible   diseases.   Sexually
transmissible diseases that affect large numbers of
young people are preventable.  Families, schools,
health professionals  and social organizations can
help provide information, confidential counseling,
and   treatment  to prevent   the  transmission of
venereal diseases.  Periodic screening for disease
which may not be symptomatic can be obtained from
private  physicians   and  community  clinics,   and
encouraged for sexually active young people.  Clinic
personnel,   sex  educators,   and  family planning
services counselors can stress the value of condoms
in reducing the spread of disease and can emphasize
the importance of informing partners immediately if
disease is discovered.

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  Wnunization.  Young people should receive a
booster immunization for diphtheria and tetanus at
age 15.

  Mental health.  Young people frequently experi-
ence  periods of  frustration,  uncertainty,   and
confusion,  and should be encouraged to talk over
problems with people with whom they can be open.
Alert and sensitive friends, family members, clergy,
or counselors at school or work can be helpful
during periods of stress, anxiety, depression or
uncertainty.  Hotlines may also be helpful. Mental
health professionals may be needed if conditions
persist.

   Firearms.  Handguns are involved in a substan-
tial number of homicides, suicides and accidental
deaths in this country.  Actions at the individual,
community,  and governmental   levels  can provide
measures to reduce the availability of handguns.

HEALTHY ADULTS

=I?-  Cigarette smoking is the principal
preventa e cause of chronic disease and death in
this country.   Public education efforts at the
Federal, State, and local levels, as well as health
professionals, can provide information about the
health hazards of smoking and suggestions on how to
stop.  Those who cannot quit on their own may
benefit from one of the organized smoking cessation
clinics.  Those who are unable or unwilling to stop
ought to smoke brands low in tar and nicotine, to
inhale less,  to smoke their cigarettes only half
way,  and to reduce gradually the number of ciga-
rettes smoked.

  Alcohol.  Misuse of alcohol leads to accidental
injumily disruption, and chronic disease for
millions of Americans.  It is important that people
realize   the  dangers--particularly   for  pregnant
women--when alcohol is used excessively.   Indivi-
duals  (or their families)  with  alcohol-related
problems may find effective assistance from health
professionals, the clergy, community groups such as

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Alcoholics Anonymous, or programs run by various
businesses to   assist  employees   with  drinking
problems.

  Nutrition.   Good nutrition is an essential
component of good health.   People  should adopt
prudent dietary habits, consuming:

o   only sufficient calories to meet body needs
  (f ewer  calories  if the person is   over-
  weight);

0   less saturated fat and cholesterol;

0   less salt;

o   less sugar;


0   relatively more complex carbohydrates, such
    as  whole  grains,  cereals,   fruits   and
  vegetables; and
0   relatively   more  fish,  poultry,  legumes
         beans, peanuts), and less red

Employers,  food advertisers, grocery stores, and
health and social service agencies can add to the
promotion of healthy nutritional habits by providing
the information and access to foods necessary to a
good diet.

  Exercise.  Regular exercise can bring physical
and  psychological   benefits.   Adults  should be
encouraged to exercise vigorously--if possible, at
least three times a week for about 15 to 30 minutes
each time.  Caution should, however, be taken to
initiate activity gradually, and anyone over 40, or
with a health problem of any kind, should consult a
physician  before beginning a vigorous exercise
program.  The importance of regular and sustained
exercise for adults should be stressed in public
information programs  and by health professionals.
Communities  and employers   can  encourage fitness-
related programs,  including,  where practical, the
provision of  facilities or  pathways to   make

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bicycling, running,  and other exercise safer and
more convenient.

  Environmental health.   Toxic  agents in   our
environment can present health hazards which may not
be detected for years.  Private and public actions
at all levels are important to protect against pos-
sible environmental hazards.  Individuals can sup-
port the monitoring of industrial and agricultural
production processes to reduce exposure to poten-
tially toxic agents.

  Worksite health and safety.  The occupational
setting is important both as a source of potential
health hazards and a site for health promotion
activities.  Health programs  at the worksite can
provide information and protection related to all
potential workplace hazards for employees, including
stress,  as well as offer activities and services to
promote healthier lifestyles.  People should both
encourage these programs and take advantage of them.

millii;nP~r~sion.. High blood pressure affects
       Americans and is a major contributor to
heart disease and stroke.   Adults should have a
screening exam for high blood pressure at least
every five years,  and every two to three years if
over age 40.  If hypertension is discovered, and
medication prescribed,  it is important that people
follow their therapeutic regimens carefully.

to iF-=  The Pap smear is an important tool
  etect cervical cancer at early stages.   Women
should have three Pap smears taken one year apart
beginning at age 20, or at the beginning of sexual
activity.  Thereafter, a Pap smear should be taken
every three years to age 35, then every five years
to age 60, then every three years.  Screening fre-
quency should be increased if any abnormalities are
found, or if a woman is taking oral contraceptives
or estrogen therapy.

  Breast examination.   Self-examination is the
most effective way to detect breast cancer at an
early treatable stage.   Women should examine their

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own breasts monthly, after the menstrual period, for
early signs of cancer (lumps, abnormal discharge,
irregular  size).   Post-menopausal   women   should
select a specific day of the month for such self-
examination.  Health professionals and public health
education programs can provide information and
instruction on breast self-examination, and increase
their efforts to disseminate this important informa-
tion.  Periodic screening by mamnography is not
needed until after age 50, except for women who have
already had cancer in one breast, and after 40 for
women with a family history of breast cancer.

  Cancer signs.  Some cancers present signs at
early stages  in which the chances for successful
treatment are greater.  People should watch for
early signs of cancer and consult a physician if any
are noticed.  In addition to the signs for breast
cancer noted above,  other cancer signs  include:
changes in bowel or bladder habits; a sore that does
not heal; unusual bleeding or discharge; difficulty
swallowing;  change in a wart or mole; or nagging
cough or hoarseness (American Cancer Society's seven
cancer signs).

  Mental health.  Many people suffer from various
forms of emotional disorders or mental illness. It
is quite comnon for people to become, at one time or
another,  uncotnnonly  anxious,  depressed, or have
difficulty coping with a life event.   Professional
assistance may be helpful if particular difficulty
is encountered and may be available through health
professionals, employers, local media, community
organizations,  hospitals, telephone hotlines, and
other outreach organizations.

  Dental care.  People frequently lose their teeth
prematurely because of poor dental and gum care.
Adults should take care of their teeth with daily
brushing   and  flossing   and an   annual   dental
examination.

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HEALTHY OLDER ADULTS

  Work and social activity.  Employment and/or
volunteer  opportunities   are  important for older
people accustomed to working. Maintaining an active
social life is also important to their good health.
Older people should remain active socially, avoid
isolation, and maintain ties with family members and
friends.  Community health and social organizations
can facilitate group activities for older people,
when possible, in corrfnunity centers.

  Exercise.  Regular physical activity for older
adults   can  provide  physical   and  psychological
benefits,  as well as help maintain flexibility and
balance important to preventing falls. Older adults
should therefore engage in exercise, such as daily
walks, regularly.

  Nutrition.  Older people have certain special
dietary  needs.   Regular,   nutritious  meals   are
important and particular care should be taken to
include vegetables, sources of iron, calcium, and
fiber, and use more fish, poultry, and legumes than
red meat as sources of protein in the diet.

  Preventive services.  Some problems associated
with aging can be detected and corrected at early
stages.  Older adults should have health check-ups
at least every two years until age 75, and every
year thereafter.  The following should be performed
each time:  blood pressure check (with follow-up and
treatment,  if warranted),  hearing and vision exam,
breast exam for women, urinalysis, and hematocrit
(measurement of red blood cells).  At less frequent
intervals women should have Pap smears,  and all
should have stool examined for blood.  When pos-
sible, these and other preventive services such as
foot care,  dental care and dietary guidance should
be provided at a single location.

  Medication.  Older people frequently receive too
much medication.  Often, fewer kinds of medications
and lower dosages will suffice.  Patients should ask
their physicians to regularly review the medications

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they are taking.  They should also request that
medication be prescribed by its generic name,
whenever feasible.

   Immunization.  Every year, many older adults die
or are incapacitated unnecessarily due to influenza
or pneumonia.  Older people can consult their physi-
cians about immunization against these diseases.

acci$!%$%$Sy Falls are the leading cause of
           and death among older adults.
People and agencies responsible for housing for the
elderly can provide such home safety measures as
ample lighting, sturdy railings and steps, non-slip
floor surfaces,  and fire protection and detection
measures.

  Services to maintain independence.   For those
whose activity 'IS limited, often relatively minor
services  can help older people maintain their
independence.  People should encourage programs and
services to help avoid unnecessary institutionali-
zation.  Examples include programs for:   safe and
affordable housing; dietary assistance through group
meals and home meals;  communications and transpor-
tation services; recreation and education opportuni-
ties;  in-house services such as homemaker, visiting
nurse and home health aides care; reading aids; and
access  to advice and services from appropriate
health professionals.

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       APPENDIX II
SOURCES OF ADDITIONAL INFORMATION

  Additional information about various health pro-
motion and disease prevention activities is avail-
able from a number of sources.   This section lists
representative sources of information,  grouped by
the 15 activity areas  introduced in Section III.
Both government  agencies and private,  non-proifit
groups are listed.  These agencies and organizations
comprise  only  a portion  of the total possible
sources.  Many other qualified sourcs of such infor-
mation  exist,  including State and local health
agencies which generally provide a comprehensive
repository of consumer-oriented health information.
Most groups listed offer free or low cost litera-
ture.  The Surgeon General does not necessarily en-
dorse the statements or viewpoints of the organi-
zations listed.

PREVENTIVE HEALTH SERVICES

Family Planning

a   National Clearinghouse for Family Planning
   Information

6110 Executive Blvd., Suite 250
Rockville, Maryland 29852
(301) 881-9400

0   Planned Parenthood Federation of America,
   Inc.

810 Seventh Avenue
New York, New York 10019
(212) 541-7800

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0   National Family Planning and Reproductive
  Health Association, Inc.

Suite 350
425 Thirteenth Street, N.W.
Washington, D.C. 20004
(202) 783-1560

0  American College of Obstetricians and
  Gynecologists

Resource Center
Suite 2700
1 East Wacker Drive
Chicago, Illinois 60601
(312) 222-1600

Pregnancy and Infant Care

0   Office of Maternal and Child Health

     Program Services Branch
     Bureau of Comnunity Health Services
      Health Services Administration
     Room 7A20, Parklawn
      5600 Fishers Lane
     Rockvillc, Maryland 20857
     (301) 443-4273

0   National Foundation -- March of Dimes

     Public Health Education Department
      1275 Mamaroneck Avenue
     White Plains, New York 10605
     (914) 428-7100, ext. 298

0   American College of Obstetricians and
  Gynecologists

Resource Center
Suite 2700
1 East Wacker Drive
Chicago, Illinois 60601
(312) 222-1600

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0   American Academy of Pediatrics

      1801 Hinman Avenue
     Evanston, Illinois 60204
     (312) 869-4255

Immunizations

0   Center for Disease Control

Bureau of State Services
Technical Information Services
Center for Disease Control
Atlanta, Georgia 30333
(404) 452-4021

@   National Institute of Child Health and
  Human Development

Office of Research Reporting
Room 2A34, Building 31
National Institutes of Health
Bethesda, Maryland 20205
(301) 496-5133

Sexually Transmissible Diseases

0   Center for Disease Control

      Bureau of State Services
      Technical Information Services
      Center for Disease Control
     Atlanta, Georgia 30333
     (404) 452-4021

a   American Social Health Association

      260 Sheridan Avenue
     Palo Alto, California 94306
     (415) 321-5134

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o   National Operation Venus

      1213 Clover Street
    Philadelphia, Pennsylvania 19107
     (800) 523-1885

High Blood Pressure and Heart Disease

0   National High Blood Pressure Information
   Center

Suite 1300
7910 Woodmont Avenue
Bethesda, Maryland 20014
(301) 652-7700

0   National Heart, Lung, and Blood Institute

     Public Inquiries Office
     Room 4A21, Building 31
     National Institutes of Health
     Bethesda, Maryland 20205
     (301) 496-4236

0   American Heart Association

      7320 Greenville Avenue
     Dallas, Texas 75231
     (214) 750-5300
     (or local chapters)

0   Consumer Information Center

      Consumer Information Center
     Pueblo, Colorado 81009
     (303) 544-5277, ext. 370

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HEALTH PROTECTION

Toxic Agent Control

0   Center for Disease Control

     Chronic Diseases Division
     Bureau of Epidemiology
     Building 1, Room 5127
      Center for Disease Control
     Atlanta, Georgia 30333
     (404) 329-3165

0   Environmental Protection Agency

      Office of Public Awareness
     Environmental Protection Agency
     401 M Street, S.W.
      Mail Code: A-107
     Washington, D.C. 20460
     (202) 755-0700

0   National Institutes of Health

     National Institute of Environmental
        Health Sciences
      Post Office Box 12233
     Research Triangle Park,
       North Carolina 27709
     (919) 541-3345

0   American Lung Association

     1740 Broadway
     New York, New York 10019
     (212) 245-8000
     (or local chapter)

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Occupational Safety and Health

0   Occupational Safety and Health
  Admlnlstratlon

Office of Public and Consumer Affairs
U.S. Department of Labor (Room N3637)
200 Constitution Avenue, N.W.
Washington, D.C. 20210
(202) 523-8151

o   Clearinghouse for Occupational Safety
   and Health

National Institute for Occupational
Safety and Health
Center for Disease Control
Robert A. Taft Laboratory
4676 Columbia Parkway
Cincinnati, Ohio 45226
(513) 684-8326

a   National Safety Council

     444 North Michigan Avenue
     Chicago, Illinois 60611
     (312) 527-4800

0   American Industrial Hygiene Association

     475 Wolf Ledges Parkway
      Akron, Ohio 44311
     (216) 762-7294

0   American Occupational Medical Association

Suite 2240
150 North Wacker Drive
Chicago, Illinois 60606
(312) 782-2166

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Accidental Injury Control

0   Consumer Product Safety Commission

      Consumer Education and Awareness
        Division
      5401 Westbard Avenue
     Washington, D.C. 20207
     (202) 492-6576
     (or local Poison Control Centers)

0   Department of Transportation

     General Services Division (NAD-42)
     National Highway Traffic Safety
        Administration
     Department of Transportation
     400 Seventh Street, S.W. (Room 4423)
     Washington, D.C. 20590
     (202) 426-0874
       ATTN:  E. Kitts

0   National Safety Council

     444 North Michigan Avenue
     Chicago, Illinois 60611
     (312) 527-4800

0   American Red Cross

     National Headquarters
      18th and E Streets, N.W.
     Washington, D.C. 20006
     (202) 857-3555

Community Water Supply Fluoridation

a   Center for Disease Control

     Dental Disease Prevention Activity
      (E107)
      Center for Disease Control
     Atlanta, Georgia 30333
     (404) 262-6631

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0   National Institute of Dental Research

     Public Inquiries Office
     Room 2C34, Building 31
      National Institutes of Health
     Bethesda, Maryland 20205
     (301) 496-4261

0   American Dental Association

       Bureau of Health Education
        and Audiovisual Services
      American Dental Association
     211 East Chicago Avenue
     Chicago, Illinois 60611
     (312) 440-2593

Infectious Agent Control

0   Center for Disease Control

Public Inquiries
Management Analysis and Service Office
Building 4, Room B2
Center for Disease Control
Atlanta, Georgia 30333
(404) 329-3534

0   National Institute of Allergy and
   Infectious Diseases

Office of Research Reporting
and Public Response
Room 7A32, Building 31
National Institutes of Health
Bethesda, Maryland 20205
(301) 496-5717

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HEALTH PROMOTION

Smoking Cessation

o  Technical Information Center for Smoking
   and Health

Office on Smoking and Health
Department of Health, Education, and

Welfare (Room 1-16, Park Building)
5600 Fishers Lane
Rockville, Maryland 20857
(301) 443-1690

0  Office of Cancer Communications

      National Cancer Institute
     Room lOA18, Building 31
      National Institutes of Health
     Bethesda, Maryland 20205
     (301) 496-5583

0   American Cancer Society

     Public Information Department
      777 Third Avenue
     New York, New York 10017
     (212) 371-2900, ext. 254
     (or local chapter)

0   American Lung Association

     1740 Broadway
     New York, New York 10019
     (212) 245-8000
     (or local chapter)

0   American Heart Association

7320 Greenville Avenue
Dallas, Texas 75231
(214) 750-5300
(or local chapter)

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Reducing Misuse of Alcohol and Drugs

0   National Clearinghouse on Alcohol
   Information

Post Office Box 2345
Rockville, Maryland 20852
(301) 468-2600

0   National Clearinghouse on Drug Abuse
   Information

Room lOA53, Parklawn Building
5600 Fishers Lane
Rockville, Maryland 20857
(301) 443-6500

m   National Council on Alcoholism

       733 Third Avenue
     New York, New York 10017
     (212) 986-4433

m   Alcoholics Anonymous

     General Services Office (6th Floor)
      468 Park Avenue South
     New York, New York 10016
     (212) 686-1100
       ATTN:  Public Information Department

Improved Nutrition

m   Food and Drug Administration

Office of Consumer Communications
(HFG-10)
Food and Drug Administration
Room 15832, Parklawn Building
5600 Fishers Lane
Rockville, Maryland 20857
(301) 443-3170

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U.S. Department of Agriculture

Human Nutrition Center - SEA
Room 421A
U.S. Department of Agriculture
Washington, D.C. 20250
(202) 447-7854

Consumer Information Center

Consumer Information Center
Pueblo, Colorado 81009
(303) 544-5277, ext. 370

Nutrition Foundation

Suite 300
888 Seventeenth Street, N.W.
Washington, D.C. 20006
(202) 872-0778

National Nutrition Education Clearinghouse

Suite 1110
2140 Shattuck Avenue
Berkeley, California 94704
(415) 548-1363

Exercise and Fitness

0   President's Council on Physical Fitness and
  Sports

Department of Health, Education
and Welfare (Room 3030 Donohoe)
400 Sixth Street, S.W.
Washington, D.C. 20201
(202) 755-7947

0   American Alliance for Health, Physical
  Education, Recreation, and Dance

Promotions Unit
1201 Sixteenth Street, N.W.
Washington, D.C. 20036
(202) 833-5534

AII-11


a   American College of Sports Medicine

      1440 Monroe Street
     Madison, Wisconsin 53706
     (608) 262-3632

Stress Control

0  National Clearinghouse for Mental Health
   Information

National Institute of Mental Health
Room llA21, Parklawn Building
5600 Fishers Lane
Rockville, Maryland 20857
(301) 443-4515

0   Mental Health Association

      1800 North Kent Street
    Arlington, Virginia 22209
     (or local chapters)
     (703) 528-6405

0   Public Affairs Committee, Inc.

Room 1101

381 Park Avenue South
New York, New York 10016
(212) 683-4331

0   Blue Cross and Blue Shield Associations

      Public Relations Office
      840 North Lake Shore Drive
    Chicago, Illinois 60611
     (312) 440-5955

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GENERAL INFORMATION SOURCES

Public Health Service

0   Bureau of Health Education

     Building 14
      Center for Disease Control
     Atlanta, Georgia 30333
     (404) 329-3111

0   Office of Health Information and Health
  Promotion

Office of the Surgeon General
Department of Health, Education,

and Welfare (Room 7218 HHH)
200 Independence Avenue, S.W.
Washington, D.C.
(202) 472-5370

National Organizations

0   National Association of Community
  Health Centers, Inc.

Suite 420
1625 Eye Street, N.W.
Washington, D.C. 20006
(202) 833-9280

0   National Center for Health Education

     211 Sutter Street (4th Floor)
     San Francisco, California 94108
     (415) 781-6144

State and Local Levels


   o   Contact your family physician


   0   Contact your local health department

0   Contact your county's cooperative
   extension service

AII-13


ACKNOWLEDGEMENTS

Preparation of this report was coordinated by the
U.S. Public Health Service's Office of Disease Pre-
vention and Health Promotion, directed by J. Michael
McGinnis, M.D.,  Deputy Assistant Secretary for
Health.  Contributions were made by a wide variety
of agencies and individuals, listed below.  Special
acknowledgement should be given to the Institute of
Medicine of the National Academy of Sciences, which
developed a series of scientific background papers
for the report,  as well as to the Center for Disease
Control   and   the   National   Center   for   Health
Statistics,  which contributed substantially to the
development of the data and tables contained in the
report.

Participating Agencies.   The  following   Federal
agencies contributed to preparation and review of
the report:

Public Health Service (HEW)

Alcohol, Drug Abuse, and Mental Health
Administration

Gerald Klerman, M.D., Administrator

Center for Disease Control
William H. Foege, M.D., Director

Food and Drug Administration
Donald Kennedy, Ph.D., Commissioner

Health Resources Administration
Henry A. Foley, Ph.D., Administrator

Health Services Administration
George I. Lythcott, M.D., Administrator

AIII-1


National Center for Health Statistics
Dorothy P. Rice, Director

National Institutes of Health
Donald S. Fredrickson, M.D., Director

Office of Health Planning and Evaluation
James Mongan, M.D., Deputy Assistant
Secretary for Health

Office of Population Affairs
Irvin M. Cushner, M.D., Deputy Assistant
Secretary for Health

Office of Public Affairs
Michael F. White, Director

Office of Research, Statistics and Technology
Ruth S. Hanft, Deputy Assistant Secretary
for Health

Office on Smoking and Health
John M. Pinney, Director

Department of Agriculture

M. Rupert Cutler, Ph.D.
Assistant Secretary for Conservation,
Research and Education

Carol Tucker Foreman
Assistant Secretary for Food and Consumer
Services

Department of Labor

Eula Bingham, Ph.D.
Assistant Secretary for Occupational Safety
and Health

Department of Transportation

Joan Claybrook, Administrator
National Highway Traffic Safety
Administration

AIII-2


Department of the Treasury

Richard J. Davis
Assistant Secretary for Enforcement and
Operations

Consumer Product Safety Commission

Susan B. King, Chairman

Environmental Protection Agency

Douglas M. Costle, Administrator

Contributors.  The following individuals contributed
materials to the development of the manuscript:

Irwin L. Auerbach, Program Analyst,
Environmental Protection Agency

Norman W. Axnick, Director, Office of Program
Planning and Evaluation, Center for Disease
Control, U.S. Public Health Service

Clement Barbaza, Printing and Reproduction
Management Branch Chief, Office of Management,
Office of the Assistant Secretary for Health,
U.S. Public Health Service (production
assistance)

Katharine Bauer, Senior Advisor, Office of
Health Information, Health Promotion and
Physical Fitness and Sports Medicine, U.S.
Public Health Service

Alexander Cohen, Ph.D., Chief, Behavioral and
Motivational Factors Branch, Division of
Biomedical and Behavioral Science, National
Institute for Occupational Safety and Health,
Center for Disease Control, U.S. Public Health
Service

AIII-3


Ralph Cosham, Editorial Consultant, Office of
Health Information, Health Promotion and
Physical Fitness and Sports Medicine, U.S.
Public Health Service

Audrey T. Cross, Nutrition Policy Coordinator,
Office of the Secretary, U.S. Department of
Agriculture

Paul Danaceau, Editorial Consultant, Office of
Disease Prevention and Health Promotion, U.S.
Public Health Service

Winthrop N. Davey, M.D., Director, Bureau of
Training, Center for Disease Control, U.S.
Public Health Service

Ervin E. Duggan, Special Assistant to the
Secretary, Department of Health, Education, and
Welfare

Lawrence Farer, M.D., Director, Tuberculosis
Division, Bureau of State Services, Center for
Disease Control, U.S. Public Health Service

Barry Felrice, Acting Associate Administrator
for Plans and Programs, National Highway Traffic
Safety Administration, Department of
Transportation

Allen Forbes, M.D., Director, Nutrition and
Consumer Sciences, Food and Drug Administration,
U.S. Public Health Service

David Fraser, M.D., Chief, Special Pathogens
Branch, Bacterial Diseases Division, Bureau of
Epidemiology, Center for Disease Control, U.S.
Public Health Services

Frank Frodyma, Operations Research Analyst,
Occupational Safety and Health Administration,
Department of Labor

AIII-4


Lawrence Galton, Editorial Consultant, Office of
Disease Prevention and Health Promotion, U.S.
Public Health Service

John C. Greene, D.M.D., Deputy Surgeon General,
U.S. Public Health Service

Michael B. Gregg, M.D., Deputy Director, Bureau
of Epidemiology, Center for Disease Control,
U.S. Public Health Service

Stephen W. Havas, M.D., Medical Advisor, Office
of Health Information, Health Promotion and
Physical Fitness and Sports Medicine, U.S.
Public Health Service

John W. Horm, Statistician, Demographic Analysis
Section, Biometry Branch, National Cancer
Institute, National Institutes of Health, U.S.
Public Health Service

Juel Janis, Ph.D., Special Assistant to the
Assistant Secretary for Health and Surgeon
General, U.S. Public Health Service

Vicki Kalmar, Professional Associate, Division
of Health Promotion and Disease Prevention, The
Institute of Medicine, National Academy of
Sciences

Martha Katz, Special Assistant to the Acting
Deputy Assistant Secretary for Health, Office of
Disease Prevention and Health Promotion, U.S.
Public Health Service

Samuel S. Kessel, M.D., Robert Wood Johnson
Foundation Fellow, Office of the Assistant
Secretary for Health, U.S. Public Health Service

Ronald J. Kostraba, Technical Services
Specialist, Administrative Services Center,
Office of Management, Office of the Assistant
Secretary for Health, U.S. Public Health Service
(cover design)

AIII-5


J. Michael Lane, M.D., Director, Bureau of
Smallpox Eradication, Center for Disease
Control, U.S. Public Health Service

Seth N. Leibler, Ed.D., Deputy Director, Bureau
of Training, Center for Disease Control, U.S.
Public Health Service

Frank S. Lisella, Ph.D., Program Development
Branch, Environmental Health Services Division,
Bureau of State Services, Center for Disease
Control, U.S. Public Health Service

Brian J. McCarthy, M.D., Family Planning
Evaluation Division, Bureau of Epidemiology,
Center for Disease Control, U.S. Public Health
Service

J. Donald Millar, M.D., Director, Bureau of
State Services, Center for Disease Control, U.S.
Public Health Services

Sanford Miller, Ph.D., Director, Bureau of
Foods, Food and Drug Administration, U.S. Public
Health Service

Catherine Milton, Special Assistant to the
Assistant Secretary for Enforcement and
Operations, Department of the Treasury

John E. Mounts, Publications Branch Chief,
National Center for Health Satistics, U.S.
Public Health Service

Elena 0. Nightingale, M.D., Ph.D., Director,
Division of Health Promotion and Disease
Prevention, The Institute of Medicine, National
Academy of Sciences

Godfrey P. Oakley, Jr., M.D., Chief, Birth
Defects Branch, Chronic Diseases Division,
Bureau of Epidemiology, Center for Disease
Control, U.S. Public Health Service

AIII-6


Horace G. Ogden, Director, Bureau of Health
Education, Center for Disease Control, U.S.
Public Health Service

Jennifer Peck, Social Science Analyst, Bureau of
the Census, Department of Comnerce

Earl S. Pollock, Sc.D., Chief, Biometry Branch,
National Cancer Institute, National Institutes
of Health, U.S. Public Health Service

Thomas W. Poore, Chief, Text Preparation
Section, Publications Branch, National Center
for Health Statistics, U.S. Public Health Service

Kate Prager, Sc.D., Statistician, Mortality
Statistics Branch, Division of Vital Statistics,
National Center for Health Statistics, U.S.
Public Health Service

Robert Proctor, Public Affairs Officer, Office
of Public Affairs, U.S. Public Health Service

Robert L. Ringler, Ph.D., Deputy Director,
National Institute on Aging, National Institutes
of Health, U.S. Public Health Service

Don Robinson, Printing Specialist, Printing and
Reproduction Management Branch, Office of
Management, Office of the Assistant Secretary
for Health, U.S. Public Health Service
(production assistance)

Harry Rosenberg, Ph.D., Chief, Mortality
Statistics Branch, Division of Vital Statistics,
National Center for Health Statistics, U.S.
Public Health Service

Lisbeth Bamberger Schorr, Chairperson, Select
Panel for the Promotion of Child Health

Roger Sherwin, M.D. Associate Professor,
Department of Epidemiology and Preventive
Medicine, University of Maryland

AIII-7


James W. Stratton, M.D., Medical
Officer/Prevention Planning, Office of Program
Planning and Evaluation, Center for Disease
Control, U.S. Public Health Service

Susan B. Toal, M.P.H., Instructional Systems
Specialist, Bureau of Training, Center for
Disease Control, U.S. Public Health Service

Dennis D. Tolsma, M.P.H., Program Analysis
Officer. Office of Prooram Planninq and

Evaluation
Public Hea

     Center for"Disease Cot&-o
    !th Service            1


     ler, M.D., Director, Family
     Division, Bureau of Epidem i
      Disease Control, U.S. Pub1 i


William Walton, III, Acting Director,

Carl W. Ty
Evaluation
Center for
Service

, U.S.

Planning
OlWY,
c Health

Office of

Strategic Planning, Consumer Product Safety
Commission

Basil Whiting, Deputy Assistant Secretary,
Occupational Safety and Health Administration,
Department of Labor

Ronald W. Wilson, Chief, Health Status and
Demographic Analysis Branch, Division of
Analysis, National Center for Health Statistics,
U.S. Public Health Service

David Wu, Program Analyst, Office of Health
Information, Health Promotion and Physical
Fitness and Sports Medicine, U.S. Public Health
Service

Reviewers.  The following individuals provided
review and comments for the development of the
manuscript:

Herbert K. Abrams, M.D., M.P.H., Director of the
Arizona Center for Occupational Safety and
Health, Arizona Health Sciences Center,
University of Arizona

AI1 I-8


Duane Alexander, M.D., Assistant to the
Director, National Institute of Child Health and
Human Development, National Institutes of
Health, U.S. Public Health Service

John R. Ball, M.D., J.D., Senior Policy Analyst,
Office of Science and Technology Policy,
Executive Office of the President

Robert Benedict, Commissioner, Administration on
Aging, Office of Human Development Services

George A. Bray, M.D., Nutrition Coordinator,
U.S. Public Health Service

Lester Breslow, M.D., M.P.H., Dean, School of
Public Health, Center for the Health Sciences,
University of California at Los Angeles

John H. Bryant, M.D., Deputy Assistant Secretary
for International Health, U.S. Public Health
Service

Benjamin T. Burton, Ph.D., Associate Director,
National Institutes of Arthritis, Metabolism,
and Digestive Diseases, National Institutes of
Health, U.S. Public Health Service

Kathy Buto, Policy Coordinator, Executive
Secretariat, Office of the Secretary, Department
of Health, Education, and Welfare

C. Carson Conrad, Executive Director,
President's Council on Physical Fitness and
Sports, U.S. Public Health Service

Richard Cotton, Executive Secretary, Department
of Health, Education, and Welfare

Charles L. Cox, Assistant to the Director of the
Bureau of Radiological Health, Food and Drug
Administration, U.S. Public Health Service

James F. Dickson, III, M.D., Senior Advisor for
Environmental Affairs, U.S. Public Health Service

AIII-9


Allen Duncan, Assistant for Program Operations,
Office of Health Affairs, Food and Drug
Administration, U.S. Public Health Service

Kenneth Flieger, Special Assistant to the Acting
Associate Cowiissioner for Health Affairs, Food
and Drug Administration, U.S. Public Health
Service

Calvin Frederick, Ph.D., Chief, Disaster
Assistance and Emergency Mental Health Section,
Division of Special Mental Health Programs,
National Institute of Mental Health, Alcohol,
Drug Abuse, and Mental Health Administration,
U.S. Public Health Service

Peter L. Froner, M.D., Deputy Director,
National Heart, Lung, and Blood Institute,
National Institutes of Health, U.S. Public
Health Service

Carol W. Garvey, M.D., Acting Chief Medical
Officer, Office of Primary Care, Bureau of
Community Health Services, Health Services
Administration, U.S. Public Health Service

Stephen E. Goldston, Ed.D., M.S.P.H.,
Coordinator for Primary Prevention Programs,
National Institute of Mental Health, Alcohol,
Drug Abuse, and Mental Health Administration,
U.S. Public Health Service

David A. Hamburg, M.D., President, The Institute
of Medicine, National Academy of Sciences

Stephen P. Hersh, M.D., Assistant Director for
Children and Youth, National Institute of Mental
Health, Alcohol, Drug Abuse, and Mental Health
Administration, U.S. Public Health Services

Richard N. Hill, Acting Director, Health Effects
and Science Policy, Office of Toxic Substances,
Environmental Protection Agency

AIII-10


Mary Jane Jesse, M.D., Director, Division of
Heart and Vascular Diseases, National Heart,
Lung, and Blood Institute, National Institutes
of Health, U.S. Public Health Service

George M. Kirqnan, Director, Office of Program
Planning and Evaluation, National Institute of
Environmental Health Sciences, National
Institutes of Health, U.S. Public Health Service

Charles Krautharrrner, M.D., Special Assistant to
the Administrator, Alcohol, Drug Abuse, and
Mental Health Administration, U.S. Public Health
Service

George A. Lamb, M.D., Associate Professor,
Department of Preventive and Social Medicine,
Harvard Medical School

Mildred K. Lehman, Director, Office of
Communications and Public Affairs, Alcohol, Drug
Abuse, and Mental Health Administration, U.S.
Public Health Service

Mark H. Lepper, M.D., Vice-President of
Evaluation, Rush Medical Center, Chicago,
Illinois

Charles U. Lowe, M.D., Director, Office of Child
Health Affairs, U.S. Public Health Service

Bernard R. McColgan, Chief, Prevention Branch,
National Institute on Drug Abuse, Alcohol, Drug
Abuse, and Mental Health Administration, U.S.
Public Health Service

Carolyn G. McHale, Head, Program Information
Section, National Eye Institute, National
Institutes of Health, U.S. Public Health Service

Laura A. Miller, Special Assistant to the
Secretary, Department of Health, Education, and
Welfare

AIII-11


Lulu Mae Nix, Ed.D., Director, Office of
Adolescent Pregwncy Programs, Office of the
Assistant Secretary for Health, U.S. Public
Health Service

Mark Novitch, M.D., Acting Associate
Commissioner for Health Affairs, Food and Drug
Administration, U.S. Public Health Service

Gilbert S. Omenn, M.D., Ph.D., Associate
Director for Human Resources and Social and
Economic Services, Office of Science and
Technology Policy, Executive Office of the
President

Seymour Perry, M.D., Associate Director for
Medical Applications of Research, National
Institutes of Health, U.S. Public Health Service

Blandina Ramirez, M.D., Commissioner,
Administration for Children, Youth and Families,
Office of Human Development Services

Renie Schapiro, M.P.H., Staff Fellow, Office of
Health Affairs, Food and Drug Administration,
U.S. Public Health Service

Marvin Schneiderman, Ph.D., Associate Director
for Science Policy, National Cancer Institute,
National Institutes of Health, U.S. Public
Health Service

John R. Seal, M.D., Deputy Director, National
Institute of Allergy and Infectious Diseases,
National Institutes of Health, U.S. Public
Health Service

Cliff Sessions, Deputy Assistant Secretary for
Public Affairs, Department of Health, Education,
and Welfare

AIII-12


Zekin Shakhashiri, M.D., Special Assistant to
the Chief, Office of Program Planning and
Evaluation, National Institute of Neurological
and Communicative Disorders and Stroke, U.S.
Public Health Service

Laurel C. Shannon, Special Assistant to the
Associate Administrator for Planning,
Evaluation, and Legislation, Health Resources
Administration, U.S. Public Health Service

L. David Taylor, Deputy Assistant Secretary for
Management Analysis and Systems, Office of the
Secretary, Department of Health, Education, and
Welfare

Howard R. Veit, Director, Office of Health
Maintenance Organizations, Office of the
Assistant Secretary for Health, U.S. Public
Health Service

Graham W. Ward, M.P.H., Chief, Health Education
Branch, Office of Prevention, Education, and
Control, National Heart, Lung, and Blood
Institute, National Institutes of Health, U.S.
Public Health Service

Lois G. Whitley, Deputy Director, Division of
Prevention, National Institute on Alcohol Abuse
and Alcoholism, Alcohol, Drug Abuse, and Mental
Health Administration, U.S. Public Health Service

Sidney C. Wolverton, Acting Associate
Administrator for Program Coordination, Alcohol,
Drug Abuse, and Mental Health Administration,
U.S. Public Health Service

Z U. S. WVEIWMWT PRINTING OFFICE : 1979 297-780

AIII-13