The impact on a veteran who develops a pressure ulcer can be devastating. To heal a pressure ulcer, it can mean the veteran must spend weeks and even months being confined to the bed, experiencing a possible loss of employment and income, loss of physical conditioning, and loss of social interaction. When a pressure ulcer occurs, the veteran's support system (family, care providers) can experience physical, economic, and emotional distress with the increased burden of care. Pressure ulcers are areas of damaged skin and tissue that develop when blood circulation is cut off by unrelieved pressure to that area. They usually occur over the buttocks, hips, and heels, or any other bony area of the body. Healthy people have natural protective mechanisms (sensors) to alert them when the blood flow to tissue is interrupted by pressure, causing them to make unconscious small movements to relieve that pressure. Because spinal cord-injured people have reduced or absent sensation and limited ability to move, pressure ulcers are a common and serious problem. Despite the very high risk, it appears that some spinal cord-injured people rarely, if ever, develop pressure ulcers. The goal of this research is to find out what is different about those who develop pressure ulcers and those who do not. We know that certain factors, such as smoking, diabetes, depression, etc., increase the risk of pressure ulcers; however, there is no definite proof of cause and effect. We will examine a wide variety of potential factors, broadly divided into psychosocial, psychological, behavioral, medical, and physical attributes. This project will lead to the development of clinical assessment tools intended to assist healthcare providers in identifying patients at risk. We expect this project to take two years, at which time we will apply for further funding to develop customized interventions based on the risk assessment tools. We are particularly interested in identifying factors that have a protective effect. From this research we hope to find ways that will prevent the life-time risk of pressure ulcers in persons with spinal cord injury.