1000 words and three scholarly references
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The Use and Abuse of Tobacco
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Identify the most widely used forms of tobacco and the contents of tobacco products that contribute to negative health outcomes.
▶ Describe the negative health and economic costs of cigarette and cigar smoking and smokeless tobacco use.
▶ Describe secondhand smoke and identify the negative health consequences of secondhand smoke exposure.
▶ Understand trends in the prevalence of tobacco use. ▶ Identify important factors contributing to recent reductions in tobacco use in the United States.
▶ Describe efforts by the tobacco industry to maintain higher rates of smoking. ▶ Identify effective prevention and intervention approaches designed to reduce rates of tobacco use.
C o
n c
e p
t 1 8
Avoiding Destructive Behaviors ▶ Section VII
Tobacco use is the number one
cause of preventable disease and is
associated with the leading causes of
death in our culture.
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Smokeless chewing tobacco is as addictive (and
maybe more so) as smoking and produces the
same kind of withdrawal symptoms. Chewing tobacco comes in a variety of forms, including loose leaf, twist, and plug forms. Rather than being smoked, the dip, chew, or chaw stays in the mouth for several hours, where it mixes well with saliva and is absorbed into the bloodstream. Smokeless tobacco contains about seven times more nicotine than cigarettes, and more of it is absorbed because of the length of time the tobacco is in the mouth. It also contains a higher level of carcinogens than cigarettes.
Snuff, a form of smokeless tobacco, comes in either dry or moist form. Dry snuff is powdered tobacco and is typically mixed with flavoring. It is designed to be sniffed, pinched, or dipped. Moist snuff is used the same way, but it is moist, finely cut tobacco in a loose form and is sold in tea-bag-like packets.
The Health and Economic Costs of Tobacco Tobacco use is the most preventable cause of
death in our society. The 1964 landmark Surgeon General’s report first called attention to the negative health consequences of smoking. It is now well estab- lished that tobacco use is the leading cause of death in the United States (accounting for nearly one in five of all deaths), contributing to 7 of the 10 leading causes of death. It is estimated that between 80 and 90 percent of all deaths related to lung cancer and obstructive lung disease are caused by smoking, and risk for coronary disease and stroke is two to four times higher among smokers. Further, new information about health risks continues to emerge. For example, a recent study found that risk for Alzheimer’s disease was 157 percent higher among heavy smokers relative to nonsmokers. Another recent study provides the strongest evidence to date that smoking increases risk for breast cancer, particularly for women who begin smoking earlier in life. Thus, the number of diseases resulting from tobacco use is much more extensive than previously thought (see Figure 1 ).
One way to highlight the health risks associated with smoking is to examine the health benefits associated with smoking cessation. Estimates suggest that reducing serum cholesterol to recommended levels can increase life expectancy by about 1 week to 6 months. In contrast, smoking cessation may increase life expectancy by 2½ to 4½ years. The earlier people quit, the more years of life they save, with roughly 3 years saved for those who quit at 60 years of age, 6 years for those who quit at 50, and 9 years for those who quit at 40. The most effective way to reduce health risks associated with smoking is clearly
T obacco is the number 1 cause of preventable mor- tality in the United States. It is linked to most of
the leading causes of death, and it leads to various other chronic conditions. Although rates of smoking in the United States have decreased in recent decades due to better awareness and a changed social norm concerning smoking and tobacco use, smoking is still a major public health problem. Today, 45 million adults in the United States smoke (approximately 22 percent of men and 17 percent of women). Worldwide, 6 million people die annually from smoking, with an estimated 8 million by the year 2030. According to a recent Gallup poll, most smokers (75 percent) would like to quit but find the grip of nicotine difficult to escape. This concept reviews the health risks of tobacco use and provides practical guidelines for quitting.
Tobacco and Nicotine Tobacco and its smoke contain over 400 noxious
chemicals, including 200 known poisons and 50
carcinogens. Tobacco smoke contains both gases and particulates. The gaseous phase includes a variety of harmful gases, but the most dangerous is carbon mon- oxide. This gas binds onto hemoglobin in the blood- stream and thereby limits how much oxygen can be carried in the bloodstream. As a result, less oxygen is supplied to the vital organs of the body. While not likely from smoking, overexposure to carbon monoxide can be fatal. The particulate phase of burning tobacco includes a variety of carbon-based compounds referred to as tar. Many of these compounds found in tobacco are known to be carcinogens. Nicotine is also inhaled during the particulate phase of smoking. Nicotine is a highly addic- tive and poisonous chemical. It has a particularly broad range of influence and is a potent psychoactive drug that affects the brain and alters mood and behavior.
Nicotine is the addictive component of tobacco.
When smoke is inhaled, the nicotine reaches the brain in 7 seconds, where it acts on highly sensitive receptors and provides a sensation that brings about a wide variety of responses throughout the body. At first, heart and breath- ing rates increase. Blood vessels constrict, peripheral cir- culation slows down, and blood pressure increases. New users may experience dizziness, nausea, and headache. Then feelings of tension and tiredness are relieved.
After a few minutes, the feeling wears off and a rebound, or withdrawal, effect occurs. The smoker may feel depressed and irritable and have the urge to smoke again. Physical dependence occurs with continued use. Nicotine is one of the most addictive drugs known, even more addictive than heroin or alcohol.
VIDEO 1
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Concept 18 ▶ The Use and Abuse of Tobacco 407
to quit; however, reducing how much one smokes also makes a difference. In one study, rates of lung cancer dropped by 27 percent among those who reduced their smoking from 20 or more to less than 10 cigarettes a day.
Smoking has tremendous economic costs. In addi- tion to the cost of human life, smoking in the United States causes more than $193 billion in annual health- related economic losses ($97 billion in productivity losses and $96 billion in health-care expenditures). Over and above the costs at the societal level, there are signifi- cant financial costs for the individual, particularly with increased taxes on tobacco products. In an effort to help smokers appreciate the financial burden of smoking, the American Cancer Society has a tool on its website that allows users to see how much they spend on cigarettes. For someone who smokes a pack a day for 10 years, the total would be more than $20,000 based on current aver- age cigarette prices.
The health risks from tobacco are directly related
to overall exposure. In past years, tobacco companies denied there was conclusive proof of the harmful effects of tobacco products. Now, in the face of overwhelming
medical evidence, tobacco officials have finally conceded that tobacco is harmful to health. It is now clear that the more you use the product (the more doses), the greater the health risk. Several factors determine the dosage: (1) the number of cigarettes smoked; (2) the length of time one has been smoking; (3) the strength (amount of tar, nicotine, etc.) of the cigarette; (4) the depth of the inhalation; and (5) the amount of exposure to other lung- damaging substances (e.g., asbestos). The greater the exposure to smoke, the greater the risk.
While risks clearly increase with the amount of expo- sure, recent studies suggest that even low levels of smok- ing have negative consequences. Unfortunately, while overall rates of smoking have decreased in recent years, rates of nondaily smoking have increased. These “chip- pers” or “social smokers” have lower risk relative to regu- lar smokers, but there are negative health consequences of even low levels of smoking. For example, one study found that smoking one to four cigarettes per day nearly triples the risk of death from heart disease. Short-term physical consequences of smoking include increased rates of respiratory infections and asthma, impairment of ath- letic performance, and reduced benefits and enjoyment associated with recreational exercise.
Cigar and pipe smokers have lower death rates
than cigarette smokers but are still at great risk. Cigar and pipe smokers usually inhale less and, therefore, have less risk for heart and lung disease, but cigarette smokers who switch to cigars and pipes tend to continue inhaling the same way. As the number of cigars smoked and the depth of smoke inhalation increase, the risk for death from cigar smoking approaches that of cigarette smoking. Cigar and pipe smoke contains most of the same harmful ingredients as cigarette smoke, sometimes in higher amounts. It may also have high nicotine content, leading to no appreciable difference between cigarette and pipe/cigar smoking with respect to the development of nicotine dependence. Cigar and pipe smokers also have higher risks for cancer of the mouth, throat, and larynx relative to cigarette smokers. Pipe smokers are especially at risk for lip cancer.
Figure 1 ▶ Unhealthy effects of smoking.
Brain: Increases risk of stroke
Blood: Increases risk of leukemia and decreases HDL
Eyes: Increases risk of cataracts two to three times
Lungs: Increases risk of lung cancer, bronchitis, emphysema, pneumonia, and asthma
Kidneys, Bladder, Pancreas: Increases risk of cancer for all and increases diabetes risk
Stomach/ Abdomen: Increases risk of stomach cancer, peptic ulcers, and abdominal aortic aneurysm
Mouth/Throat: Increases risk of cancers
of the mouth, throat, larynx, and esophagus
and causes gum disease
Heart: Increases
risk of coronary
artery disease and
atherosclerosis
Reproductive System: Increases risk of
breast and cervical cancer, birth complications,
unhealthy babies, and sudden death syndrome
in babies of smokers
Carcinogens Substances that promote or facilitate the growth of cancerous cells. Drug Any biologically active substance that is foreign to the body and is deliberately introduced to affect its functioning. Withdrawal A temporary illness precipitated by the lack of a drug in the body of an addicted person. Physical Dependence A drug-induced condition in which a person requires frequent administration of a drug in order to avoid withdrawal.
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Secondhand smoke poses a significant health risk.
When smokers light up they expose those around them to secondhand smoke. Secondhand smoke is a combi- nation of mainstream smoke (inhaled and then exhaled by the smoker) and sidestream smoke (from the burn- ing end of the cigarette). Because sidestream smoke is not filtered through the smoker’s lungs, it has higher levels of carcinogens and is therefore more dangerous. Although the negative consequences of secondhand smoke have been known for some time, a 2006 Surgeon General’s report established in detail the health dangers of second- hand smoke. The following are the six major conclusions from the report (see Surgeon General’s website):
• Millions in the United States are exposed to second- hand smoke despite progress in tobacco control.
• Secondhand smoke exposure leads to disease and early death.
• Infants and children are especially at risk of illnesses related to secondhand smoke.
• Adult secondhand smoke exposure contributes strongly to heart disease and lung cancer risk.
• Even brief secondhand exposure is harmful. • Eliminating secondhand smoke indoors protects
against harm, while separation of smoking and nonsmoking spaces does not.
Women and children are especially susceptible
to the negative effects of secondhand smoke.
Adolescents exposed to secondhand smoke may have five times the risk of developing metabolic syndrome, which increases risk for heart disease, stroke, and dia- betes, and they are also at increased risk of becoming smokers themselves. Secondhand smoke can have a negative impact even when smokers try to protect chil- dren from exposure. A recent study found that babies of parents who only smoked outdoors had levels of cotinine (a nicotine by-product) seven times higher than babies of nonsmokers. This has been attributed to “thirdhand” smoke that may cling to clothing and hair. These findings have led to public health efforts to involve pediatricians in smoking cessation efforts, as parents generally see their child’s pediatrician more often than their own doctor. Parents may also be more responsive to the message if they learn that smoking can hurt their children.
While not technically considered secondhand expo- sure, smoking during pregnancy harms a developing fetus. Children of smoking mothers typically have lower birth weight and are more likely to be prema- ture, placing them at risk for a host of health complica- tions. There is also a well-established relation between maternal smoking and risk for sudden infant death syndrome (SIDS). Finally, children of mothers who smoke are at increased risk for later physical problems (respiratory infections and asthma) and behavioral problems (attention deficit disorder). The best way to reduce risk for pregnant mothers and their children is for women to quit smoking altogether. However, there is some evidence that reductions in smoking also have benefits.
Secondhand smoke exposure may also negatively
impact mental health. A recent study using a national survey found a significant relation between cotinine levels, an indicator of secondhand smoke exposure, and depression. Among those who never smoked, risk for depression was substantially increased for those exposed to cigarette smoke in their home or at work. Other recent studies show that secondhand smoke increases the risk of memory problems among the elderly.
The health risks of smokeless tobacco are similar
to those of other forms of tobacco. Some smokers switch to smokeless tobacco, thinking it is a safe sub- stitute for cigarette, cigar, and pipe smoking. While smokeless tobacco does not lead to the same respira- tory problems as smoking, the other health risks may be even greater because smokeless tobacco has more nicotine and higher levels of carcinogens. Because it comes in direct contact with body tissues, the health consequences are far more immediate than those from
Awareness about the risks of secondhand smoke has contributed to changed social norms.
VIDEO 2
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Concept 18 ▶ The Use and Abuse of Tobacco 409
smoking cigarettes. One-third of teenage users have receding gums, and about half have precancerous lesions, 20 percent of which can become oral cancer within 5 years. Some of the health risks of smokeless tobacco are listed in Table 1 .
The Facts about Tobacco Usage At one time, smoking was an accepted part of
our culture, but the social norm has changed. While smoking has always been a part of our culture, the industrialization and marketing in the middle of the 20th century led to tremendous social acceptance of smoking. As odd as it may sound, cigarettes were once provided free to airline passengers when they boarded planes. The release of the Surgeon General’s report on smoking in 1964, aggressive and well-funded antismoking campaigns, and increases in cigarette prices have contributed to reductions in smoking in the United States.
Since the 1950s, the prevalence of smoking has steadily declined from a high of 50 percent. Based on data from the National Health Interview Survey, rates of smoking in the United States dropped from 25 percent in the late 1990s to 19 percent in 2010. Rates among young people (high school students) have dropped even more dramatically, from 36 percent to 20 percent. Unfortunately, decreases in smoking rates have slowed
considerably. Based on slow rates of decline in recent years (see Figure 2 ), it will take renewed efforts to meet the Health People 2020 goals of 16 percent for youth and 12 percent for adults. Although there is still much work to be done in the United States, the current situ- ation is much more positive than for many other coun- tries. While rates have been decreasing in the United States, they have been increasing in many others, par- ticularly developing countries. Prevalence rates in China and many European countries greatly exceed those in the United States.
The use of smokeless tobacco is not as prevalent as smoking, but the National Institute on Drug Abuse estimates that nearly 9 million Americans (mostly males) have used smokeless tobacco in the past month. Young people are among the most frequent users, with 13.4 percent of high school boys reporting smoke- less tobacco use. Unfortunately, decreases in smoke- less tobacco use since the 1990s have been smaller than the decreases in smoking, and recently there have been increases in smokeless tobacco use. Between 2002 and 2008, the number of new smokeless tobacco users increased by 47 percent.
Most tobacco users begin “using” during
adolescence and find it hard to quit. The initiation of smoking is viewed as a pediatric problem by most public health experts. Data from the National Survey on Drug Use and Health indicate that roughly 3,800 ado- lescents initiate cigarette use each day, with over 1,000
Table 1 ▶ Health Risks of Smokeless Tobacco
Smokeless tobacco increases the risk for the following:
• Oral cavity cancer (cheek, gum, lip, palate); it increases the risk by 4 to 50 times, depending on length of time used
• Cancer of the throat, larynx, and esophagus
• Precancerous skin changes
• High blood pressure
• Rotting teeth, exposed roots, premature tooth loss, and worn-down teeth
• Ulcerated, inflamed, infected gums
• Slow healing of mouth wounds
• Decreased resistance to infections
• Arteriosclerosis, myocardial infarction, and coronary occlusion
• Widespread hormonal effects, including increased lipids, higher blood sugar, and more blood clots
• Increased heart rate
Figure 2 ▶ Trends in cigarette smoking. Source: Centers for Disease Control and Prevention.
0 5
10 15 20 25 30 35 40
P er
ce n t (%
)
Year 19
97 19
98 19
99 20
00 20
01 20
02 20
03 20
04 20
05 20
06 20
07 20
08 20
09 20
10
Students Adults
HP 2020 goals
Youth 16%
Adults 12%
Secondhand Smoke A combination of main- stream and sidestream smoke. Mainstream Smoke Smoke that is exhaled after being filtered by the smoker’s lungs. Sidestream Smoke Smoke that comes directly off the burning end of a cigarette/cigar/pipe.
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410 Section 7 ▶ Avoiding Destructive Behaviors
effect. Bans on indoor smoking have also been important for reducing access and exposure. A total of 35 states now ban smoking in all restaurants, 30 ban smoking in bars, and 31 ban smoking in the workplace. A total of 25 states plus the District of Columbia are now smoke-free in all three settings. Including local bans by cities and counties, there are now over 21,000 indoor smoking laws in the United States. For additional information on smoking bans and policies, see A Closer Look.
Fortunately, recent efforts to limit exposure to sec- ondhand smoke seem to be paying off. A recent review confirms that public smoking bans decrease rates of heart attacks. Researchers reviewed studies conducted in the United States, Canada, and Europe, and found that heart attack rates fell 17 percent within a year after implementing smoking bans. Although workplace smok- ing bans have focused on keeping smokers from smoking at work, employers have begun to encourage employ- ees who smoke to quit altogether. Smokers suffer from more physical and mental health problems at a cost to
becoming daily smokers by age 18. Most adult smokers began smoking before age 21, and this group finds it particularly difficult to break the habit later in life.
Although most regular smokers begin in adolescence, a significant number start later in life, particularly dur- ing early adulthood (18–25). Unfortunately, the number of new smokers over age 18 increased from 600,000 in 2002 to 1 million in 2010. Smoking rates among col- lege students are slightly lower than rates among high school seniors (16 versus 19 percent reported that they smoked in the past 30 days), and the rate is dramatically lower than the overall rate among young adults (about 22 percent). Smokeless tobacco use also begins early in life. Almost 50 percent of users report that they started before the age of 13, and initiation of smokeless tobacco use has nearly doubled between 2002 and 2008. The media play a role in promoting and preventing tobacco use ( Figure 3 ). Much of the blame for tobacco use among youth is attributed to media campaigns of tobacco com- panies that target this age group. Lawsuits filed against tobacco companies have played an important role in decreased smoking rates in the United States. Money from state settlements have helped to fund smoking pre- vention programs and public education campaigns. The lawsuits also prevented companies from direct market- ing to anyone under the age of 18. These lawsuits have also had an impact on public opinions of tobacco com- panies. Documents uncovered from the files of tobacco companies, during litigation against the companies, have contained incriminating evidence that has undermined the reputation of tobacco companies and contributed to unfavorable public attitudes.
Public policy can affect tobacco use. A number of states have passed special tax laws to fund anti-tobacco efforts. In addition to efforts at the state level, in 2009 federal taxes were raised from $.39 to $1.01 a pack. These tax increases have contributed to the dramatic decreases in smoking in recent years. There is, however, wide vari- ability in state taxes resulting in prices of more than $10 a pack in areas of New York, compared to prices of about $5 a pack in many other states. Higher state tax rates have been shown to help reduce smoking rates.
Public health campaigns and policies influencing access have also been very effective in reducing smoking. Four states that have aggressive anti-tobacco campaigns reported a 43 percent decrease in tobacco use—double that reported by other states. According to the Sub- stance Abuse and Mental Health Services Administration (SAMHSA), recent efforts to cut down on tobacco sales to minors have also been extremely effective. Rates of selling to minors decreased dramatically between 1997 and 2008, falling from 40.1 to 9.9 percent. Unfortunately, rates of sales to minors increased for the first time in 2009 (by 1 percent). The overall reductions in access have been cor- related to usage so the policies have clearly had a positive
Figure 3 ▶ Warning label images. Source: U.S. Food and Drug Administration.
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Concept 18 ▶ The Use and Abuse of Tobacco 411
employers via higher health-care premiums. The CDC estimates the cost for smoking at over $3,000 per smoker per year, including lost productivity and medical bills. Many employers, including the World Health Organiza- tion, now refuse to hire smokers, and many companies include smoking cessation in employee assistance pro- grams to encourage smokers to quit. Recent evidence suggests that such programs can pay off for employers in as little as 2 years.
Tobacco companies are finding new ways to
recruit tobacco users. As expected, the tobacco indus- try has fought back after the many legal settlements. Since that time, the industry has nearly doubled its budget for advertising and promotions, with spending on advertising estimated at over $10 billion per year. Tobacco compa- nies have also provided discounts to offset increased taxes and are introducing new products and packaging to entice young smokers. For example, companies have released a form of dissolvable tobacco that comes in a candy-like pill form (e.g., Camel Orbs or Marlboro Snus). The pill dissolves and the user swallows the dissolved tobacco. Several companies have introduced “e-cigarettes,” elec- tronic cigarettes that produce a puff of vapor contain- ing nicotine and other additives. Critics have argued that e-cigarettes contain known carcinogens and should have the similar warning labels and regu- lations. Policies banning the sale and use of e-cigarettes have already been
A CLOSER LOOK
Cigarette Taxes and Indoor Smoking Bans Increased taxes and public smoking bans have contrib- uted to overall decreases in smoking in the United States, but not all states have effectively used these approaches. In particular, states referred to as the “tobacco states” have shown considerably smaller decreases in smok- ing relative to most other states. The economy of these states is strongly tied to tobacco crops, creating com- peting interests between economic success and public health. An examination of tobacco taxes and smoking bans by state demonstrates that these states have made less of an effort to curb smoking rates.
How can states with a financial interest in tobacco become
more engaged in public health efforts to reduce smoking
rates? Should the federal government require taxes or allow
states to decide?
Cigarett
A
es ate Taxerette Taxe
ACTIVITY
Health is available to Everyone for a
Lifetime, and it’s Personal
In the United States, most states have passed laws that ban smoking in workplaces, restaurants, and bars. Some states such as California have pushed for even more legislation that bans smoking in parks, beaches, and other outdoor spaces.
Do you support legislation to prevent smoking in most public
places, including outdoor spaces?
ACTIVITY
Battle over Cigarette Labels In 2009, the Family Smoking Prevention and Tobacco Control Act was passed, giving the
Food and Drug Administration (FDA) the authority to regulate tobacco products. One of the first major regulations was to ban the use of the terms light, low tar, or mild on cigarette labels. The tobacco companies have tried to work around the new regulation by using different colored packages for their light cigarettes and informing consumers about how to iden- tify them. The second major regulation proposed by the FDA was to require graphic images accompanied by new warn- ings about the dangers of smoking on all cigarette packs. In June 2010, the FDA approved nine new labels (see Figure 3
for examples) that would cover half of each cigarette pack. The new labels were scheduled to take effect by October 2012. However, the tobacco industry fought back with a law- suit and a U.S. district judge issued an injunction to block the implementation of the labels, stating that the FDA decision violated the First Amendment rights of tobacco companies. The FDA has since appealed this decision but the appeals process is likely to take years and may ultimately reach the Supreme Court.
Should the FDA be allowed to require these graphic labels on
cigarette packs?
I T
ACTIVITY
In the News
VIDEO 3
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412 Section 7 ▶ Avoiding Destructive Behaviors
initiated. With a ban on obvious marketing to adolescents, tobacco companies’ best legal target for promoting their products is now college students and other young adults. One approach they use to reach this audience is industry- sponsored parties at bars and nightclubs. In a national study of college students, nearly 1 in 10 reported attending industry-sponsored events. Students who had not smoked in high school but attended industry- sponsored events where free ciga- rettes were provided were nearly twice as likely to begin smoking.
Various factors influence a person’s decision to
begin smoking. The reasons for starting smoking are varied, but are strikingly similar to reasons given for using alcohol and other drugs (see Table 2 ). Many young women begin smoking because they believe it will help them con- trol their weight and negative mood states. Some current smokers fear they will gain weight if they quit. Also, those who smoke report higher levels of stress, and stress has been shown to be a maintaining factor among current smokers and a barrier to quitting among those who want to stop smoking. The stress-management approaches introduced in the previous concept may help with manag- ing stress more effectively during attempts to quit.
People who smoke cigarettes also tend to use
alcohol, marijuana, and hard drugs. Alcohol has often been considered a gateway to other drug use, and marijuana is often thought of as a gateway to other drugs, such as cocaine and heroine. Although tobacco use has been studied less extensively as a gateway drug, there is strong evidence that smoking is associated with increased risk for the use of both alcohol and illicit drugs. The combination of smoking and drinking is particu- larly common in college students. Results of a nation- ally representative study of college students indicated that 97 percent of college smokers drink, while other national data report that 80 percent of all college stu- dents drink. Those who drink also report higher levels of smoking. Rates of smoking among college drinkers range from 44 to 59 percent (compared with a national
average rate of under 30 percent). The combination of alcohol use and smoking poses an even greater risk to physical health.
The addictive nature of nicotine makes it difficult
to quit using tobacco. Salient examples of the power of nicotine addiction are high rates of continued use among those with serious smoking-related health con- sequences and low rates of success for quit attempts. In a study in 15 European countries, over half of adults who suffered from serious medical problems known to be associated with smoking (e.g., heart attack, bypass surgery) continued to smoke 1 year later. Data from the CDC found that more than half of the 45 million smok- ers in the United States in 2010 had tried to quit in the past year. Unfortunately, most of these attempts were unsuccessful. Most people make many attempts before they succeed. Withdrawal symptoms and cravings for nicotine are often cited reasons for failed quit attempts. Many former smokers report nicotine craving months and even years after quitting. The good news is that when you quit you may feel better right away and your body will heal. You will feel more energetic, the cough- ing will stop, you will suddenly begin to taste food again, and your sense of smell will return. Your lungs will eventually heal and look like the lungs of a nonsmoker.
Table 2 ▶ Why Young People Start Using Tobacco
• Peer influence
• Social acceptance
• Desire to be “mature”
• Desire to be “independent”
• Desire to be like their role models
• Appealing advertisements
VIDEO 4
VIDEO 5
T E C H N O L O G Y U P D A T E
Social Media Applications for Smoking Cessation The American Cancer Society introduced a new quitting program designed specifically for teens. The program includes a dedicated website (teen.smokefree.gov), texting support, and a smartphone application. Teens can connect with a counselor using instant messaging or their cell phones, and the website provides links to support groups through social networking sites, includ- ing Facebook and Twitter. To reduce defensiveness that is common in young people, the content of the webpage is designed to promote autonomy rather than lecturing to teens. For example, one of the slogans on the site is “We’re not going to tell you what to do.” The hope is that a program tailored to the unique developmental needs of teens will encourage more young people to quit early, before they become lifelong smokers.
Do you think that this type of Web-based program will be more
attractive to young people?
ACTIVITY
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Concept 18 ▶ The Use and Abuse of Tobacco 413
Your risk for lung cancer will return to that of the non- smoker in about 15 to 20 years. If you aren’t successful at first, keep trying, as most people eventually succeed (about 50 million adults in the United States are former smokers).
Exercise and medication can also help you quit.
Recent studies suggest that regular physical activity can reduce the health risks of smoking in two important ways. First, among smokers, those who regularly exercise may be at decreased risk for the development of cardiovascular disease due to improved peripheral blood flow. Perhaps more importantly, physical activity reduces the likelihood of relapse among those who quit. Nicotine replacement products (patches, gum, nasal sprays) and medications such as Zyban, have helped some smokers quit, but oth- ers fail to benefit from their use. Luckily, new options are becoming available. The drug Chantix, recently approved by the FDA, works differently than other products on the market by partially activating nicotinic receptors in the brain, which helps reduce the rewarding properties of smoking and decreases craving for nicotine. In one clini- cal trial, relative to a placebo, participants who received Chantix were roughly 2.5 times more likely to sustain abstinence for 6 months. Table 3 provides additional strategies that can increase your chances of quitting.
Table 3 ▶ Strategies for Quitting Smoking
• You must want to quit. The reasons can be for health, family, money, and so on.
• Remind yourself of the reasons. Each day, repeat to yourself the reasons for not using tobacco.
• Decide how to stop. Methods to stop include counseling, attending formal programs, quitting with a friend, going “cold turkey” (abruptly), and quitting gradually. More suc- ceed with “cold turkey” than with the gradual approach.
• Remove reminders and temptations (ashtrays, tobacco, etc.).
• Use substitutes and distractions. Substitute low-calorie snacks or chewing gum, change your routine, try new activities, and sit in nonsmoking areas.
• Do not worry about gaining weight. If you gain a few pounds, it is not as detrimental to your health as continu- ing to smoke.
• Get support. Try a formal “quit smoking” program for pro- fessional help and seek support from friends and relatives.
• Consider a product that requires a prescription, such as a nicotine transdermal patch (Zyban) or nicotine chewing gum.
• Develop effective stress-management techniques. The single most frequently cited reason for difficulty in quitting smoking is stress.
Strategies for Action
Although quitting is ultimately
up to you, that does not mean
you have to do it alone. A number of national orga- nizations provide telephone hotlines to help those try- ing to quit smoking. These include the American Cancer Society (1-877-YES-QUIT), the National Cancer Institute (1-877-44U-QUIT), and the CDC (1-800-QUIT-NOW). In addition, an online smoking program sponsored by sev- eral federal agencies is now available at www.smokefree .gov. The U.S. Public Health Service (USPH) has published a consumer’s guide to quitting smoking. It has determined that the following five factors are associated with the likeli- hood of success:
1. Get ready.
2. Get support.
3. Learn new skills and behaviors.
4. Get medication and use it correctly.
5. Be prepared for relapse and difficult situations.
Lab 18A will help you evaluate your potential risks for smoking. If you are a smoker, an honest assessment of your background and exposure to tobacco is an important first step to quitting.
The USPHS consumer guide provides a list of questions you may want to ask yourself as you prepare to quit. This exercise may help you increase your motivation to change and decrease the likelihood of a relapse. You may want to talk about your answers with your health-care provider.
1. Why do you want to quit?
2. When you tried to quit in the past, what helped and what did not?
3. What will be the most difficult situations for you after you quit? How will you plan to handle them?
4. Who can help you through the tough times? Your family? Friends? Your health-care provider?
5. What pleasures do you get from smoking? In what ways can you still get pleasure if you quit?
ACTIVITY
S
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you have to do it a
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414 Section 7 ▶ Avoiding Destructive Behaviors
Web Resources American Cancer Society www.cancer.org American Heart Association www.americanheart.org Americans for Non-smokers’ Rights www.no-smoke.org Campaign for Tobacco Free Kids www.tobaccofreekids.org Dr. Koop—Tackling Tobacco Abuse www.drkoop
.com-search tobacco
National Center for Chronic Disease Prevention and Health Promotion: Tobacco Information and Prevention Source www.cdc.gov/tobacco
Quitnet—a Free Resource to Quit Smoking www.quitnet.com Smoking Cessation Health Center from WebMD
www.webmd.com/smoking-cessation
Tobacco News and Information from Tobacco.org www.tobacco.org
You Can Quit Smoking, Consumer Guide, U.S. Public Health Service www.surgeongeneral.gov/tobacco
You Can Quit Smoking Now www.smokefree.gov
Suggested Readings Bandiera, F. C., et al. 2010. Secondhand smoke exposure and
depressive symptoms. Psychosomatic Medicine 72:68–72. Centers for Disease Control and Prevention. 2011. Trends in
Current Cigarette Smoking among High School Students and Adults, United States, 1965–2010. Centers for Disease Control and Prevention. Available at www.cdc.gov/tobacco/ data_statistics/tables/trends/cig_smoking/index.htm
Johnston, L. D., et al. 2011. Monitoring the Future: National Sur- vey Results on Drug Use, 1975–2010, Volume I: Secondary School
Student s. Ann Arbor, MI: Institute for Social Research.
Kaczynski, A. T., et al. 2008. Smoking and physical activity: A systematic review. American Journal of Health Behavior 32(1):93–110.
Meyers, D. G., J. S. Neuberger, and J. He. 2009. Cardiovascular effect of bans on smoking in public places: A systematic review and meta-analysis. Journal of the American College of Cardiology 54:1249–1255.
Rusanen, M., et al. 2011. Heavy smoking in midlife and long- term risk of Alzheimer Disease and Vascular Dementia. Archives of Internal Medicine 171:333–339.
Substance Abuse and Mental Health Services Administration. 2011. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings (NSDUH Series H-41, HHS Publication No. (SMA) 11-4658). Rockville, MD: Substance Abuse and Mental Health Services Administration.
Teague, M. L., et al. 2011. Your Health Today: Choices in a Changing Society. 3rd ed. New York: McGraw-Hill Higher Education, Chapter 13.
U.S. Department of Health and Human Services. 2012. Preventing Tobacco Use among Youth and Young Adults: A Report
of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services.
Warner, K.E., et al. 2010. Tobacco control policy in developed countries: Yesterday, today, and tomorrow. Nicotine & Tobacco Research 12(9):876–887.
World Health Organization. 2011. WHO Report on the Global Tobacco Epidemic, 2011: Warning about the
Dangers of Tobacco. Geneva, Switzerland: World Health Organization.
Xue, F., et al. 2011. Cigarette smoking and the incidence of breast cancer. Archives of Internal Medicine 171:125–133.
Healthy People
ACTIVITY
2020 The objectives listed below are societal goals designed to help all Americans improve their health between now and the year 2020. They were selected because they relate to the con- tent of this concept.
• Reduce secondhand-smoke exposure.
• Increase the number of current smokers who try to quit.
• Reduce smoking during pregnancy.
• Increase the percentage of smoke-free homes.
• Reduce initiation of tobacco use among youth.
• Increase state and federal taxes on tobacco products.
• Reduce teen exposure to tobacco advertising.
• Increase tobacco screening in health-care settings.
• Increase indoor smoking bans in public places.
A key national goal is to reduce rates of smoking in young people
as most chronic smokers begin in adolescence. Progress has
been made toward this goal, but declines in youth smoking have
slowed in recent years. What approaches do you think are likely
to be most effective in preventing initiation of tobacco use in
youth?
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Lab 18A Use and Abuse of Tobacco
Name Section Date
Purpose: To understand the risks of diseases (such as heart disease and cancer) associated with the use of tobacco or exposure to tobacco by-products
Procedure
1. Read the Tobacco Use Risk Questionnaire (Chart 1). 2. Answer the questionnaire based on your tobacco use or exposure. 3. Record your score and rating (from Chart 2) in the Results section.
Results
What is your tobacco risk score? (total from Chart 1)
What is your tobacco risk rating? (see Chart 2)
Chart 1 Tobacco Use Risk Questionnaire
Circle one response in each row of the questionnaire. Determine a point value for each response using the point values in the first row of the chart. Sum the numbers of points for the various responses to determine a Tobacco Use Risk score.
Points
Categories 0 1 2 3 4
Cigarette use Never smoked 1–10 cigarettes a day
11–40 cigarettes a day
>40 cigarettes a day
Pipe and cigar use Never smoked Pipe— occasional use
Cigar— infrequent daily use
Cigar or pipe— frequent daily use
Cigar—heavy use
Smoking style Don’t smoke No inhalation Slight to moderate inhalation
Deep inhalation
Smokeless tobacco use
Don’t use Occasional use: not daily
Daily use: one use per day
Daily Use: multiple use per day
Heavy use: repetitious, multiple use daily
Secondhand or sidestream smoke
No smokers at home or in workplace
Smokers at workplace but not at home
Smokers at home but not workplace
Smokers at home and at workplace
Years of tobacco use Never used 1 or less 2–5 6–10 >10
Note: Different forms of tobacco use pose different risks for different diseases. This questionnaire is designed to give you a general idea of risk associated with use and exposure to tobacco by-products.
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Conclusions and Implications
1. In several sentences, discuss your personal risk. If your risk is low, discuss some implications of the behavior of other people that affect your risk, including what can be done to change these risks. If your risk is above average, what changes can be made to reduce your risk?
Chart 2 Tobacco Use Risk Questionnaire Rating Chart
Rating Score
Very high risk 16+
High risk 7–15
Moderate risk 1–6
Low risk 0
2. In several sentences, discuss how you feel about public laws designed to curtail tobacco use. Discuss your point of view, either pro or con.
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Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Assess inherited health risks. ▶ Describe how to access and use the health-care system effectively. ▶ Explain the importance of environmental influences on lifestyle (as well as the impact of our lifestyles on our environment).
▶ List the key healthy lifestyles that influence health and wellness. ▶ Explain how personal actions and interactions influence the adoption of healthy lifestyles.
▶ Apply behavioral skills to plan and follow personal health and fitness programs.
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t 2 4
In addition to healthy lifestyles,
other factors such as heredity, health
care, the environment, cognitions
and emotions, and personal actions
and interactions contribute to good
health, wellness, and fitness.
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500 Section 8 ▶ Making Informed Choices
Understand Inherited Risks and Strengths Learn about your family health history and take
stock of inherited risk. Many health conditions and risks are linked to or influenced by your genetics. If members of your immediate or extended family have had specific diseases or health problems, you may have a greater risk or likelihood of the same condition. Your DNA contains the instructions for building the proteins that control the structure and function of all the cells in your body. Abnor- malities in DNA can provide the wrong set of instructions and lead to faulty cell growth or function. There are clear genetic influences on risks for obesity, cardiovascular dis- ease risk factors, diabetes, and many forms of cancer. At present it is not possible for people to truly know their genetic risk profile, but it may be possible in the future with more comprehensive genetic testing.
Take action to diminish risk factors for which
you have a predisposition. As mentioned, research shows strong familial aggregation of certain chronic
T he broad vision of Healthy People 2020 is to cre- ate “a society in which all people live long, healthy
lives.” Two major missions of the 2020 objectives are “to identify nationwide health improvement priorities and increase public awareness and understanding of the determinants of health, disease, and disability and the opportunity for progress.” The first concept in this book introduced you to a model that explained the many factors influencing health, wellness, and fitness (see Figure 1 ). The focus of this book has been on chang- ing factors over which you have control. For this reason, much of the discussion has centered on changing life- styles, because lifestyles impact health, wellness, and fit- ness more than any of the other factors. As shown in the figure, you have the most control over the lifestyles you lead, reasonable control over your cognitions/emotions, some control over your environment and use of health care, but relatively little control over heredity factors. This final concept provides infor- mation about these other factors and overall strategies for optimiz- ing your health. VIDEO 1
Figure 1 ▶ Determinants of health, fitness, and wellness.
Personal actions and interactions Cognitions and emotions
Health
Wellness
Physical fitness
Heredity Age
Disability
Healthy lifestyles Engaging in regular activity Eating well Managing stress Avoiding destructive habits Practicing safe sex Managing time Being an informed consumer Adopting good health habits Adopting good safety habits Learning first aid
Environmental factors Physical, social, spiritual, work site, other
Health-care system Access Compliance
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Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 501
disease risk factors (e.g., obesity, diabetes, cholesterol, blood pressure) as well as some cancers. While you can- not change your heredity risks, you can take steps to reduce your risks for certain inherited conditions. Spe- cifically, adopting healthy lifestyles may significantly reduce inherited risks for certain diseases. A recent study computed obesity risk scores based on the pres- ence or absence of 32 genes known to increase weight status. The genetic risk score was associated with an individual’s inherited risk for being overweight but risk was influenced by lifestyle behaviors. An active lifestyle (marked by the presence of a brisk daily walk) reduced the genetic influence by 50 percent while a sedentary lifestyle (marked by watching television four hours a day) increased the genetic influence by 50 percent. Eat- ing a healthy diet, managing stress, and not smoking are other key lifestyles that would likely contribute to lowering inherited risks for disease.
Use the Health-Care System Effectively Follow sound medical advice and recommendations. The medical system can provide individuals with support- ive, personalized health care, but people have to seek consultation and follow advice for it to be effective (see Table 1 ). Some basic strategies for accessing the medical system effectively are summarized below:
• Get medical insurance. People who think they save money by avoiding the payment of insurance premi- ums place themselves (and their families) at risk and may not really save money.
• Investigate and then identify a hospital and regular doctor. Check with other physicians you know and trust for referrals. Check with your state medical board and national directories (e.g., Directory of Board Certified Medical Specialists, www.abms.org ) for specialist certifi- cations or fellowships. Choose an accredited emergency center near your home and a hospital that is accredited and grants privileges to your personal doctors.
• Get periodic medical exams. Do not wait until some- thing is wrong before you seek medical advice. A yearly preventive physical exam is recommended for adults over the age of 40. Younger people should have an exam at least every 2 years.
• Follow appropriate screening recommendations. Many illnesses and chronic conditions can be effec- tively treated if they are identified early in the disease process. Following cancer screening guidelines is par- ticularly important (e.g., mammograms for women and prostate tests for men). Breast and testicular self- exams are also important for detection.
• Ask questions. Do not be afraid to speak up. Prepare questions for doctors and other medical personnel. The American College of Surgeons suggests several ques- tions before surgeries: What are the reasons for the sur- gery? Are there alternatives? What will happen if I don’t have the procedure? What are the risks? What are the long-term effects and problems? How will the proce- dure impact my quality of life and future health?
• Understand effects of medications. Seek out informa- tion about medicines and supplements so you under- stand their intended effect. Read the inserts that come with the medicine and ask your doctor and pharma- cist about correct dosage and information concern- ing when to take the medication. The FDA recently simplified drug inserts to help you understand the information that comes with medicine. Track your medicine and supplement use and share it with your physician.
• Consider potential side effects of medicines you take. Most medications are tested for use with certain pop- ulations and they may not be safe or effective for all people. Consider the safety and potential risks. Side effects from preventable adverse reactions to medi- cines account for more than 1.5 million deaths each year. When medicine is prescribed, ask for details. Ask why the medicine was prescribed and the nature of side effects. Ask if the medicine interacts with other medicines or supplements.
• If you have doubts about medical advice, get a second opinion. As many as 30 percent of original diagnoses are incorrect or differ from second opinions. Don’t worry about offending your doctor by getting another opinion. Good doctors encourage this.
• More women than men have a regular physician.
• More than half of young men have no personal doctor.
• Three times more women than men have visited a doctor in the past year.
• Women are more aware of health issues than men.
• Nearly half of men wait a week or more to see a doctor when ill.
• Many men see sickness as “unmanly.”
• Married men see doctors more frequently than single men because their wives prompt them.
• Lack of health insurance results in fewer doctor’s visits, less frequent health screening, and less access to prescribed medicine.
Table 1 ▶ Facts about Personal P hysicians and Health Insurance
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• Make your wishes for health care known. Have a medical power of attorney. This document spells out the treatments you desire in the case of severe illness. Without such a document, your loved ones may not be able to make decisions consistent with your wishes. Be sure your loved ones have a similar document so that you can help them carry out their wishes.
Become a wise health- and medical-care consumer. Medical illiteracy and lack of health-care information are linked to higher than normal death rates. This is why improving medical literacy is such a high priority for public health officials. Some strategies for becoming a better health- and medical-care consumer are below:
• Become familiar with the symptoms of common medical problems. If symptoms persist, seek medical help. Many deaths can be prevented if early warning signs of medical problems are heeded.
• Practice good hygiene. The recent fears about dangerous versions of flu (e.g., H1N1) led to increased awareness about good hygiene. There was debate over whether regular hand washing impacts the spread of H1N1, but it is clearly the best defense against the common cold and other respiratory diseases. Always wash hands before preparing food or eating and after using the toi- let, touching animals, handling garbage, coughing, or blowing your nose. Avoid sharing cups and utensils and use hand sanitizers when you don’t have access to water.
• Stay home when you are sick. Most companies urge sick employees to stay home to prevent spreading ill- ness to others. According to one survey, 40 percent of employees say they have gotten the flu at work. This is possibly because most workers feel guilty staying home or pressure to go to work even when sick. Sick workers are less productive, and working when sick lengthens recovery time.
• Carefully review the credibility and accuracy of new health information. As described in Concept 23, there are many examples of misleading claims and fraud in the health and fitness industry. Even news reports from credible scientific studies can exert too much influence on consumer decisions. It takes years for sci- entific consensus to emerge, so carefully review new health claims. (See In the News.)
Consider Environmental Influences on Your Health Understand how environmental factors shape your
behaviors. As described throughout the book, environmen- tal factors influence your health and well-being. Experts in obesity research have coined the term obesogenic environments to specifically describe how aspects of our environment con- tribute to overeating and lack of physical activity. To live healthy, it is important to understand how environmental
Does Zinc Help with Treatment of the Common Cold? The common cold is one of the top causes of visits to the doctor and absenteeism from
school and work. It is typically caused by the rhinovirus and there are no proven treatments. While colds may not be pre- ventable, evidence has been accumulating on the benefits of taking supplemental zinc to shorten the length and severity of colds. A variety of products are available to provide supplemen- tal zinc (e.g., Zicam), which is thought to work by slowing the replication of the virus. A respected Cochrane Review examined 25 years of research and concluded that zinc treatments are beneficial in reducing the duration and severity of the common
cold in healthy people when taken within 24 hours of onset of symptoms. A meta-analysis in the Canadian Medical Asso- ciation Journal reviewed 17 controlled trials and reported that zinc shortened the duration of cold symptoms in adults by 2 to 3 days. Higher doses of zinc were also associated with better outcomes but surprisingly no effect was observed in children. The results are promising but additional trials are needed.
Would you consider using zinc supplements or do you need more
evidence? Explain your answer and describe how you approach new
health products or supplements that are being promoted.
D T o
ACTIVITY
In the News
Physical activity contributes to fitness, wellness, and quality of life.
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Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 503
settings and factors influence our lifestyles. Figure 2 sum- marizes the broad impact of physical, spiritual, social, intel- lectual, and emotional environments on personal health and wellness. Specific environmental strategies that you can use for each dimension of wellness are listed below:
• Strategies for the physical environment. Living healthy in our modern society can be challenging, but this can
be overcome with good planning. Think ahead about ways to be sitting less during the day and how to add daily physical activity (e.g., commuting and walk breaks). Plan your meals and dining choices to ensure you can make healthier food choices. Avoid smoke-filled establishments, highly polluted environments, and use of toxic products.
Physical
Emotional/ mental
Spiritual
Social Intellectual
A positive spiritual environment helps to support spiritual fulfillment.
Opportunities for spiritual development: Reading spiritual materials, prayer, meditation, and discussions with others provide opportunities to clarify and solidify spiritual beliefs.
Access to spiritual community and leadership: Finding a community for worship provides comfort and a path to fulfillment for many. Consider consultation with those with experience and expertise.
A positive physical environment helps make the healthy choice the easy choice.
Access to physical activity and healthy foods: A healthy environment supports efforts to adopt healthy lifestyles by making it easier to be active and to eat healthy. Parks, trails, green spaces provide opportunities to be active. Farmers’ markets, health sections of grocery stores, and food co-ops make it easier to select healthy food.
Safe and clean communities: A pleasant, clean, and safe environment encourages healthy living and the adoption of healthy lifestyles. Clean water and clean air are critical for good health.
A positive emotional environment can help with adopting healthy lifestyles and managing stress.
Supportive personal relationships: Support by others, especially family members, can help in managing stress and in adopting healthy lifestyles. Unhealthy relationships have the opposite effect.
Stress management skills: Friends, families, and co-workers can provide emotional support to assist in coping and stress management.
A healthy social environment enhances quality of life and supports wellness.
Creating a sense of community: Being a part of the greater community is important to social and mental health. Community-based groups are also important for planning and promoting healthy lifestyles for residents.
Using social support: A strong support network can help in times of need and provide advice, assistance, or support when needed.
A stimulating intellectual environment fosters learning and critical thinking.
Access to accurate information: Whether the source is formal education or self-learning, access to accurate information is essential. Of course, good information is beneficial only if used.
Build and maintain cognitions: A stimulating intellectual environment can promote self-discovery, build cognitive skills, and promote critical thinking.
•
•
•
•
•
•
•
•
•
•
Figure 2 ▶ The influence of environmental factors on dimensions of wellness.
VIDEO 2
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504 Section 8 ▶ Making Informed Choices
• Strategies for the social and emotional environ- ment. Find a social community that accommodates your personal and family needs; get involved in com- munity affairs, including those that affect the envi- ronment; build relationships with family and friends; provide support for others so that their support will be there for you when you need it; use time-manage- ment strategies to help you allocate time for social interactions.
• Strategies for the spiritual environment. Pray, meditate, read spiritual materials, participate in spiritual discussions, find a place to worship, pro- vide spiritual support for others, seek spiritual guid- ance from those with experience and expertise, keep a journal, experience nature, honor relationships, help others.
• Strategies for the intellectual environment. Make decisions based on sound information, question simple solutions to complex problems, seek environments that stimulate critical thinking.
A CLOSER LOOK
City, County, and State Health Ratings Numerous organizations conduct surveys to deter- mine which cities and states are the healthiest. All use indicators such as access to health care, percentage of people insured, health-care costs, resources (e.g., parks, work-site wellness programs), environmental quality, and personal fitness and health (e.g., percent of population that is overweight, access to fitness cen- ters). Results vary depending on the organization doing the polling, the methods used to compile the data, and the indicators used. The rankings vary considerably but some consistent patterns emerge. In general, health status and wellness appear to be worst in the South. In contrast, health rankings tend to be higher in the West (i.e., mountain states), Midwest, and Northeast. A com- prehensive review by the Robert Wood Johnson Foun- dation ranks the health of individual counties across the country based on objective health indicators. The Well-Being Index by Gallup-Healthways uses a detailed polling system to compare health status and well-being in states across the country. The American Fitness Index of the American College of Sports ranks cities based on availability and usability of physical activity resources.
Do you see any potential public health value by posting this
type of information online?
A
City County andounty aCounty a
ACTIVITY
Choose to live and work in places that support
healthy living. Environmental factors are often out of a person’s control. However, you do have some autonomy regarding where you choose to live and work. If physi- cal activity is important to you, find a community with parks and playgrounds and accessible sidewalks, bike paths, jogging trails, swimming facilities, a gym, or health club. Avoid environments that only have fast-food restau- rants. Find a social environment that reinforces healthy lifestyles. If possible, work in businesses or settings that support healthy lifestyles. Ideally, the work environment should have adequate space, lighting, and freedom from pollution (tobacco smoke), as well as a healthy physical, social, spiritual, and intellectual environment. Consider- able attention has been given recently to characteristics that define healthy work sites, communities, cities, and states (see A Closer Look). This is encouraging because the increased demand for healthy resources could lead to increased supply.
Adopt and Maintain Healthy Lifestyles Consider strategies for adopting healthy lifestyles.
Statistics show that more than half of early deaths are caused by unhealthy lifestyles. For this reason, chang- ing lifestyles is the focus of this book. We emphasize priority healthy lifestyles such as being regularly active, eating well, managing stress, avoiding destructive behav- iors, and practicing safe sex because they are factors over which we have some control, and if adopted, they have considerable impact on health, wellness, and fitness. (see Figure 1 ). Being an informed consumer is another healthy lifestyle emphasized in the book since it enables you to understand health information and take appro- priate action. Other healthy lifestyles not emphasized in the book include adopting good health and safety habits and learn- ing first aid. Examples of healthy lifestyles in these domains are high- lighted in Table 2 .
Consider the impact of your lifestyle on the health
of the environment. The environment clearly influ- ences your lifestyle, but your lifestyle can also have a damaging effect on the environment. Consider our use of fossil fuels. Burning fossil fuels has contributed to depletion of the ozone layer and the associated pattern of global warming. The changes in weather along with the pollution of our air and water compromise our agricul- tural systems, which in turn threatens our food and water supply. These are just a few examples of the complex
VIDEO 3
VIDEO 4
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Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 505
Lifestyle Examples
Adopting good personal health habits. Many of these habits, important to optimal health, are considered to be elementary because they are often taught in school or in the home at an early age. In spite of their importance, many adults regularly fail to adopt these behaviors.
• Brushing and flossing teeth • Regular bathing and hand washing • Adequate sleep • Care of ears, eyes, and skin • Limit exposure to loud sounds, including live and recorded music. • Limit sun exposure (e.g., wear protective clothing, hats, and sunglasses)
and use sunscreen with high SPF to reduce exposure to ultraviolet rays from the sun.
Adopting good safety habits. Thousands of people die each year and thousands more suffer disabilities or problems that detract from good health and wellness. Not all accidents can be prevented, but we can adopt habits to reduce risk.
• Automobile accidents. Wear seat belts, avoid using the phone while driv- ing, do not drink and drive, and do not drive aggressively.
• Water accidents. Learn to swim, learn CPR, wear life jackets while boating, do not drink while boating.
• Others. Store guns safely, use smoke alarms, use ladders and electrical equipment safely, and maintain cars, bikes, and motorcycles properly.
Learning first aid. Many deaths could be prevented and the severity of injury could be reduced if those at the sites of emergencies were able to administer first aid.
• Learn cardiopulmonary resuscitation (CPR). New research shows that chest compression alone saves lives even without mouth-to-mouth breathing.
• Learn the Heimlich maneuver to assist people who are choking. • Learn basic first aid.
T able 2 ▶ Other Healthy Lifestyles
Make it a priority to find ways to remain active throughout your life.
ecological systems going on in the world. There are a number of promising strategies being implemented to address these problems, including the use of alternative energy sources to reduce our consumption of fossil fuels. While technology can solve some of the problem, we cannot completely heal the environment without major efforts from large segments of the population. Individu- ally we can’t change the world, but if each person makes small changes, we can together have a big impact. For example, individual efforts to use your car less, recycle, and use less paper can add up to larger changes in society. See Technology Update for an example of a novel, fit- ness-related technology that may help to change aware- ness about lifestyles and the environment.
Importance of Personal Actions and Interactions Consider strategies for taking action and benefiting
from personal interactions. The diagram in Figure 1 includes a box labeled “Personal actions and interactions” at the very top of the image. It is at the top for a reason— ultimately, it is what you do that counts. You can learn everything there is to know about fitness, health, and well- ness, but if you do not take action and take advantage of your interactions with people and your environments, you will not benefit. As described in this concept (and through- out the book), your actions and interactions have a major influence on all aspects of wellness.
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Commit to using this information to help plan your approaches for healthy living. (See Table 3.) People who plan are not only more likely to act; they are also more likely to act effectively and more proactively. Many people put off health and wellness, believing they will eventually be able to get control over their lives and their lifestyles. Delaying action will only make it harder to change in the future. As noted in Concept 15, it is
Table 3 ▶ Actions and Interactions That Influence Wellness
Dimension of Wellness Influential Factors
Physical wellness Pursuing behaviors that are conducive to good physical health (being physically active and maintaining a healthy diet)
Social wellness Being supportive of family, friends, and co-workers and practicing good communication skills
Emotional wellness Balancing work and leisure and responding proactively to challenging or stressful situations
Intellectual wellness Challenging yourself to continually learn and improve in your work and personal life
Spiritual wellness Praying, meditating, or reflecting on life
Total wellness Taking responsibility for your own health
much easier to maintain a healthy weight than it is to lose weight after it is gained. This applies to all aspects of healthy living. Do not put off until tomorrow what you can do today. The information in the book can help you create plans for healthy living, but the decision to follow them is up to you.
Consider your cognitions and emotions when
planning strategies for action. Much of the infor- mation in this book is designed to help you make good decisions about health, wellness, and fitness. Using the guidelines presented throughout this book and using self-management skills can help you make good deci- sions. As noted in Concept 1, it is also important to con- sider your emotions when making decisions. Consider these guidelines:
• Collect and evaluate information before you act. Become informed before you make important deci- sions. Get information from reliable sources and con- sult with others you trust.
• Emotions will influence certain decisions but should not detract from sound decision-making processes.
Fear and anger are two emotions that can affect your judgment and influence your ability to make deci- sions. Even love for another person can influence your actions. Get control of your emotions, or seek guid- ance from others you trust, before making important decisions in emotionally charged situations.
• Resist pressure to make quick decisions when there is no need to decide quickly. Salespeople often press for a quick decision to get a sale. Take some time to think before making a quick decision that may be based on emotion rather than critical thinking. Of course, some decisions must be made when emotions are charged (e.g., medical care in an emergency), but, when pos- sible, delaying a decision can be to your advantage.
• Use stress-management techniques to help you gain control when you must make decisions in emotionally
charged situations. Practice stress-management tech- niques (see Concepts 16 and 17) so that you can use them effectively when needed.
• Honor your beliefs and relationships. Actions and interactions that are inconsistent with basic beliefs and that fail to honor important relationships can result in reduced quality of life.
• Seek the help of others and provide support for others who need your help. As already noted, support from friends, family, and significant others can be critical in helping you achieve health, wellness, and fitness. Get help. Do what you can to be there for others who need your help.
• Consider using professional help. Most colleges have health center programs that provide free, confidential assistance or referral. Many businesses have employee
T E C H N O L O G Y U P D A T E
Sustainable Exercise Machines Interest in energy conservation has led to the develop- ment of exercise equipment that harnesses the energy you expend. One leading company (Plug Out Fitness) sells lines of exercise equipment that track energy savings in addition to energy consumption—rather than expending calories you are producing watts! According to estimates from the company, an average exerciser can produce 50 watts of electricity per hour when exercising at a mod- erate pace. The company believes it may be possible to use that energy by transferring it into the electrical grid. The movement is still in its infancy but there are already sustainable gyms and sustainable dance clubs that are powered by the exercisers in the facility.
Can you envision a future in which human energy is captured
and used as part of a more sustainable environment?
ACTIVITY
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Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 507
assistance programs (EAP), providing counselors who will help you or your family members find ways to solve a particular problem. Other programs and support groups help with lifestyle changes. For example, most hospitals and many health organizations have hotlines that pro- vide referral services for establishing healthy lifestyles.
Consider your personal beliefs and philosophy when
making decisions. Though science can help you make good decisions and solve problems, most experts tell you that there is more to it than that. Your personal philosophy and beliefs play a role. The following are factors to consider:
Health is available to Everyone for a
Lifetime, and it’s Personal
Some people rely on personal trainers to help motivate them to stay active. Health coaches and life planners are increasingly common for helping people learn how to live healthy and balanced lifestyles. These support systems can be useful, but the hope is that you now have the background and insights to do these things on your own. Motivation and confidence are important for adopting and maintaining a healthy lifestyle but there are no shortcuts or ways to store up good health in the bank. Healthy lifestyles must be maintained over time to provide continued benefits.
Do you have the skills to take responsibility for your health,
fitness, and wellness?
ACTIVITY
• Clarify your personal philosophy and consider a new way of thinking. Health, wellness, and fitness are often subjective. Making comparisons to other people can result in setting personal standards impossible to achieve. For example, achieving the body fat of a model seen on TV or performing like a professional athlete is not realistic for most of us. For this reason, the standards for health, wellness, and fitness in this book are based on health criteria rather than com- parative criteria. Adhering to the HELP philosophy can help you adopt a new way of thinking. This phi- losophy suggests that each person should use health ( H ) as the basis for making decisions rather than com- parisons with others. This is something that everyone ( E ) can do for a lifetime ( L ). It allows each of us to set personal ( P ) goals that are realistic and possible to attain.
• Allow for spontaneity. The reliance on science empha- sized in this book can help you make good choices. But if you are to live life fully, you sometimes must allow yourself to be spontaneous. In doing so, the key is to be consistent with your personal philosophy so that your spontaneous actions will be enriching rather than a source of future regret.
• Believe that you can make a difference. As noted pre- viously, you make your own choices. Though heredity and several other factors are out of your control, the choices that you make are yours. Believing that your actions make a difference is critical to taking action and making changes when necessary, allowing you to be healthy, well, and fit for a lifetime.
Strategies for Action
Develop and follow a plan for healthy
living. You do not have full control over health and wellness factors, but it is important to take control over those you can. In Concept 2, you learned about the six steps involved in planning for a healthy lifestyle change. The labs at the end of this concept help you to use these six steps. Lab 24A helps you identify areas in which you especially need to pre- pare for lifestyle changes. Lab 24B helps you prepare for making lifestyle change from the list presented in Figure 1 . Lab 24C is designed to help you plan a per- sonal physical activity program. This lab utilizes results compiled from the fitness-related concepts in the book and provides a culminating personal fitness plan.
Formal steps can become less formal with experience. The labs in this concept use a structured approach to self-assessment and planning. It is important to learn this
process but it is likely that you will eventually adopt less for- malized procedures on your own. Few of us will go through life doing formal fitness assessments every month, writing down goals weekly, or self-monitoring activity daily. How- ever, the more a person does self-assessments, the more he or she is aware of personal fitness status. This aware- ness reduces the need for frequent testing. For example, a person who does regular heart-rate monitoring knows when he or she is in the target zone without counting heart rate every minute. The same is true of other self-management skills. With experience, you can use the techniques less formally to manage your lifestyle in the future.
ACTIVITY
VIDEO 5 VIDEO 6
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508 Section 8 ▶ Making Informed Choices
Web Resources Academy of Nutrition and Dietetics www.eatright.org ACSMs American Fitness Index www.americanfitnessindex.org American College Health Association www.acha.org American Heart Association (search CPR)
www.americanheart.org CDC Healthy Places Network www.cdc.gov/healthyplaces/ County Health Rankings-Robert Wood Johnson Foundation
www.countyhealthrankings.org Gallup-Healthyways Well-Being Index www.well-beingindex
.com
Healthfinder www.healthfinder.gov Healthy People 2020 www.healthypeople.gov/hp2020 Mayo Clinic www.mayoclinic.com National Health Interview Survey www.cdc.gov/nchs/nhis.htm Prevention Institute www.preventioninstitute.org/ Research America www.researchamerica.org U.S. Consumer Information Center http://publications.usa
.gov/USAPubs.php
World Health Organization www.who.int
Suggested Readings Boehm, J. K., and L. D. Kubzansky. 2012. The heart’s content:
The association between positive psychological well-being and cardiovascular health. Psychological Bulletin. Published online April 12.
Bray, S. R. 2007. Self-efficacy for coping with barriers helps students stay physically active during transition to their first year at a university. Research Quarterly for Exercise and Sport 78(1):61–70.
Central Intelligence Agency. 2012. The World Fact Book. Washington, DC: CIA.
Duhigg, C. 2012. The Power of Habit. New York: Random House. Eime, R. M. 2010. Does sports club participation contribute to
health-related quality of life? Medicine and Science in Sports and Exercise 42(5):1022–1028.
Nagao, K., et al. 2007. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study. Lancet 369(9565):920–926.
Qi, Q., et al. 2012. Genetic predisposition to dyslipidemia and type 2 diabetes risk in two prospective cohorts. Diabetes 61(3):745–752.
Qi, Q., et al. 2012. Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resis- tance: The Preventing Overweight Using Novel Dietary Strat- egies trial. American Journal of Clinical Nutrition 95(2):506–513.
Steptoe, A., and J. Wardle. 2011. Positive affect measured using ecological momentary assessment and survival in older men and women. Proceedings of the National Academy of Sciences 108(45):18244–18248.
Taylor, S. 2011. Health Psychology. 8th ed. New York: McGraw-Hill. Trust for America’s Health. 2008. Blueprint for a Healthier
America. Washington, DC: Trust for America’s Health. Available at http://healthyamericans.org/report/55/ blueprint-for-healthier-america
World Health Organization. 2009. Global Health Risks. Geneva: WHO. Available at www.who.int/publications/en
Xu, J., and R. E. Roberts. 2010. The power of positive emo- tions: It’s a matter of life or death—Subjective well-being and longevity over 28 years in a general population. Health Psychology 29(1):9–19.
Healthy People
ACTIVITY
2020 The objectives listed below are societal goals designed to help all Americans improve their health between now and the year 2020. They were selected because they relate to the con- tent of this concept.
• Attain high-quality, longer lives free of preventable disease, injury, and premature death.
• Achieve health equity and eliminate disparities.
• Create healthy social and physical environments.
• Promote quality of life across all stages of life.
• Increase public awareness and understanding of the determinants of health, disease, and disability.
• Improve the health literacy of the population.
• Increase percentage of college students receiving information on priority risk-behavior areas.
• Increase percentage of people with health-care providers who involve them in decisions about health care.
• Increase recycling and environmental health efforts.
• Increase proportion of adults who have social support.
Two of the primary national health goals are “attaining high-quality
life (wellness)” and “attaining longer lives free of preventable
disease, injury, and premature death.” In Concept 1, you reflected on
these two goals. Reflect again on these goals. What can you do to
achieve these two goals for you personally and what can people do
in general to accomplish them?
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Lab 24A Assessing Factors That Influence Health, Wellness, and Fitness
Name Section Date
Purpose: To assess the factors that relate to health, wellness, and fi tness
Factor Very True Somewhat True Not True At All Score
Heredity
1. I have checked my family history for medical problems. 3 2 1
2. I have taken steps to overcome hereditary predispositions. 3 2 1
Heredity Score =
Health Care
3. I have health insurance. 3 2 1
4. I get regular medical exams and have my own doctor. 3 2 1
5. I get treatment early, rather than waiting until problems get serious 3 2 1
6. I carefully investigate my health problems before making decisions. 3 2 1
Health-Care Score =
Environment
7. My physical environment is healthy. 3 2 1
8. My social environment is healthy. 3 2 1
9. My spiritual environment is healthy. 3 2 1
10. My intellectual environment is healthy. 3 2 1
11. My work environment is healthy. 3 2 1
12. My environment fosters healthy lifestyles. 3 2 1
Environment Score =
Lifestyles
13. I am physically active on a regular basis. 3 2 1
14. I eat well. 3 2 1
15. I use effective techniques for managing stress. 3 2 1
16. I avoid destructive behaviors. 3 2 1
17. I practice safe sex. 3 2 1
18. I manage my time effectively. 3 2 1
19. I evaluate information carefully and am an informed consumer. 3 2 1
20. My personal health habits are good. 3 2 1
21. My safety habits are good. 3 2 1
22. I know first aid and can use it if needed. 3 2 1
Lifestyles Score =
Personal Actions and Interactions
23. I collect and evaluate information before I act. 3 2 1
24. I plan before I take action. 3 2 1
25. I am good about taking action when I know it is good for me. 3 2 1
26. I honor my beliefs and relationships. 3 2 1
27. I seek help when I need it. 3 2 1
Personal Actions/Interactions Score =
Chart 1 Assessment Questionnaire: Factors That Influence Health, Wellness, and Fitness
A sse
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F a c to
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Procedures
1. Answer each of the questions in Chart 1 on page 509. Consider the information in this concept as you answer each question. The five factors assessed in the questionnaire are from Figure 1, page 500.
2. Calculate the scores for heredity (sum items 1 and 2), health care (sum items 3–6), environment (sum items 7–12), lifestyles (sum items 13–22), and actions/interactions (sum items 23–27).
3. Determine ratings for each of the scores using the Rating Chart. 4. Record your scores and ratings in the Results chart. Record your comments in the Conclusions and Implications
section.
Rating Chart
Factor Healthy Marginal Needs Attention
Heredity 6 4–5 Below 4
Health care 11–12 9–10 Below 9
Environment 16–18 13–15 Below 13
Lifestyles 26–30 20–25 Below 20
Actions/ interactions
13–15 10–12 Below 10
Results
Factor Score Rating
Heredity
Health care
Environment
Lifestyles
Actions/interactions
Conclusions and Implications
1. In the space below, discuss your scores for the five factors (sums of several questions) identified in Chart 1. Use several sentences to identify specific areas that need attention and changes that you could make to improve.
2. For any individual item on Chart 1, a score of 1 is considered low. You might have a high score on a set of questions and still have a low score in one area that indicates a need for attention. In several sentences, discuss actions you could take to make changes related to individual questions.
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Lab 24B Planning for Improved Health, Wellness, and Fitness
Name Section Date
Purpose: To plan to make changes in areas that can most contribute to improved health, wellness, and fi tness
Procedures
1. Experts agree that it is best not to make too many changes all at once. Focusing attention on one or two things at a time will produce better results. Based on your assessments made in Lab 24A, select two areas in which you would like to make changes. Choose one from the list related to health care and environment and one related to lifestyle change. Place a check by those areas in Chart 1 in the Results section. Because Lab 24C is devoted to physical activity, it is not included in the list. You may want to make additional copies of this lab for use in making other changes in the future.
2. Use Chart 2 to determine your Stage of Change for the changes you have identified. Since you have identified these as an area of need, it is unlikely that you would identify the stage of maintenance. If you are at maintenance, you can select a different area of change that would be more useful.
3. In the appropriate locations, record the change you want to make related to your environment or health care. State your reasons, your specific goal(s), your written statement of the plan for change, and a statement about how you will self-monitor and evaluate the effectiveness of the changes made. In Chart 3, record similar information for the lifestyle change you identified.
Results
Chart 1
Check one in each column.
Area of Change ✔ Area of Change ✔
Health insurance Eating well
Medical checkups Managing stress
Selecting a doctor Avoiding destructive habits
Physical environment Practicing safe sex
Social environment Managing time
Spiritual environment Becoming a better consumer
Intellectual environment Improving health habits
Work environment Improving safety habits
Environment for lifestyles Learning first aid
Chart 2
List the two areas of change identified in Chart 1. Make a rating using the diagram at the right.
Identified Area of Change Stage of Change Rating
1.
2.
Maintenance The change has lasted at least 6 months.
Action “I have made some short-term changes.”
Preparation “I am getting ready to change.”
Contemplation “I am thinking about a change.”
Precontemplation “I don’t want to change.”
Note: Some of the areas identifi ed in this lab relate to personal information. It is appropriate not to divulge personal information to others (including your instructor) if you choose not to. For this reason, you may choose not to address certain problems in this lab. You are en- couraged to take steps to make changes independent of this assignment and to consult privately with your instructor to get assistance.
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Describe First Area of Change (from Chart 1) Describe Second Area of Change (from Chart 1)
Step 1: State Reasons for Making Change Step 1: State Reasons for Making Change
Step 2: Self-Assessment of Need for Change List your stage from Chart 2.
Step 2: Self-Assessment of Need for Change
List your stage from Chart 2.
Step 3: State Your Specifi c Goals for Change
State several specifi c and realistic goals. Step 3: State Your Specifi c Goals for Change
State several specifi c and realistic goals.
Step 4: Identify Activities or Actions for Change
List specifi c activities you will do or actions you will take to meet your goals.
Step 4: Identify Activities or Actions for Change
List specifi c activities you will do or actions you will take to meet your goals.
Step 5: Write a Plan; Include a Timetable
Expected start date: Step 5: Write a Plan; Include a Timetable
Expected start date:
Expected fi nish date: Expected fi nish date:
Days of week and times: list times below days. Mon. Tue. Wed. Th. Fri. Sat. Sun.
Days of week and times: list times below days. Mon. Tue. Wed. Th. Fri. Sat. Sun.
Location: Where will you do the plan? Location: Where will you do the plan?
Step 6: Evaluate Your Plan
How will you self-monitor and evaluate to determine if the plan is working?
Step 6: Evaluate Your Plan
How will you self-monitor and evaluate to determine if the plan is working?
Chart 3 Making Changes for Improved Health, Wellness, and Fitness
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Lab 24C Planning Your Personal Physical Activity Program
Name Section Date
Purpose: To establish a comprehensive plan of lifestyle physical activity and to self-monitor progress in your plan (note: you may want to reread the concept on planning for physical activity before completing this lab)
Procedures
Step 1. Establishing Your Reasons
In the spaces provided below, list several of your principal reasons for doing a comprehensive activity plan.
1. 4.
2. 5.
3. 6.
Step 2. Identify Your Needs Using Fitness Self-Assessments
and Ratings of Stage of Change for Various Activities
In Chart 1, rate your fitness by placing an X over the circle by the appropriate rating for each part of fitness. Use your results obtained from previous labs or perform the self-assessments again to determine your ratings. If you took more than one self-assessment for one component of physical fitness, select the rating that you think best describes your true fitness for that fitness component. If you were unable to do a self-assessment for some reason, check the “No Results” circle.
Rating
Health-Related Fitness Tests
High-
Performance
Zone
Good
Fitness
Zone
Marginal
Zone
Low
Zone
No
Results
1. Cardiovascular: 12-minute run (Chart 6, page 133)
2. Cardiovascular: step test (Chart 2, page 131)
3. Cardiovascular: bicycle test (Chart 5, page 133)
4. Cardiovascular: walking test (Chart 1, page 131)
5. Cardiovascular: swim test (Chart 7, page 134)
6. Flexibility: sit-and-reach test (Chart 1, page 220)
7. Flexibility: shoulder flexibility (Chart 1, page 220)
8. Flexibility: hamstring/hip flexibility (Chart 1, page 220)
9. Flexibility: trunk rotation (Chart 1, page 220 )
10. Strength: isometric grip (Chart 3, page 190)
11. Strength: 1 RM upper body (Chart 2, page 188)
Chart 1 Rating for Self-Assessments
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Chart 1 Rating for Self-Assessments, continued
Rating
Health-Related Fitness Tests
High-
Performance
Good
Fitness Marginal Low
No
Results
12. Strength: 1 RM lower body (Chart 2, page 188)
13. Muscular endurance: curl-up (Chart 4, page 190)
14. Muscular endurance: 90-degree push-up (Chart 4, page 190)
15. Muscular endurance: flexed arm support (Chart 5, page 190)
16. Fitness rating: skinfold (Chart 1, page 306)
17. Body mass index (Chart 7, page 311)
Rating
Excellent
Very
Good or
Good Fair Poor
No
Results
Skill-Related Fitness and Other Self-Assessments
1. Agility (Chart 1, page 281)
2. Balance (Chart 2, page 282)
3. Coordination (Chart 3, page 282)
4. Power (Chart 4, page 283)
5. Reaction time (Chart 5, page 283)
6. Speed (Chart 6, page 284)
7. Fitness of the back (Chart 2, page 258)
8. Posture (Chart 2, page 261)
Rating
Summarize Your Fitness Ratings Using the Results Above
High-
Performance
Good
Fitness Marginal Low
No
Results
Cardiovascular
Flexibility
Strength
Muscular Endurance
Body fatness
Excellent
Very
Good or
Good Fair Poor
No
Results
Skill-related fitness
Posture and fitness of the back
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Rate your stage of change for each of the different types of activities from the physical activity pyramid. Make an X over the circle beside the stage that best represents your behavior for each of the five types of activity in the lower three levels of the pyramid. A description of the various stages is provided below to help you make your ratings.
I n Step 1, you wrote down some general reasons for developing your physical activity plan. Setting goals requires more specific statements of goals that are realistic and achievable. For people who are at the contemplation or preparation stage for a specific type of activity, it is recommended that you write only short-term physical activity goals (no more than 4 weeks). Those at the action or maintenance level may choose short-term goals to start with, or if you have a good history of adherence, choose long-term goals (longer than 4 weeks). Precontemplators are not considered because they would not be doing this activity.
“I don't want to change.”
“Thinking about doing this but have not done it yet”
“Some participation but not on a regular basis”
“Regular participation but less than six months”
“Regular participation for at least six months”
Precontemplation
Contemplation
Preparation
Action
Maintenance
Energy Balance
Energy Out (Activity)
Energy In (Diet)
Vigorous Sports and Recreation
Moderate Physical Activity
Flexibility Exercises
Muscle Fitness Exercises
Vigorous Aerobics
Maintenance Action Preparation Contemplation Precontemplation
Maintenance Action Preparation Contemplation Precontemplation
Maintenance Action Preparation Contemplation Precontemplation
Maintenance Action Preparation Contemplation Precontemplation
Maintenance Action Preparation Contemplation PrecontemplationX
o n
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X o
n e c
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X o
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ir c le
X o
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X o
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Avoid Inactivity
*150 minutes of moderate or 75 minutes of vigorous activity per week is recommended; moderate and vigorous activity can be combined to meet guidelines.
Source: C. B. Corbin
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Step 4. Selecting Activities
In Chart 3, indicate the specific activities you plan to perform from each area of the physical activity pyramid. If the activity you expect to perform is listed, note the number of minutes or reps/sets you plan to perform. If the activity you want to perform is not listed, write the name of the activity or exercise in the space designated as “Other.” For lifestyle activities, active aerobics, and active sports and recreation, indicate the length of time the activity will be performed each day. For flexibility, muscle fitness exercises, and exercises for back and neck, indicate the number of repetitions for each exercise.
Chart 2 Setting Goals
Physical Activity Goals. Place an X over the appropriate circle for the number of days and weeks for each type of activity. Write the number of exercises or minutes of activities you plan in each of the five areas.
Phy sical Fitness Goals (for People at Action or Maintenance Only). Write specific physical fitness goals in the spaces provided below. Indicate when you expect to accomplish the goal (in weeks). Examples include improving the 12-minute run to a specific score, being able to perform a specific number of push-ups, attaining a specific BMI, and being able to achieve a specific score on a flexibility test.
Part of Fitness Description of Specific Performance Weeks to Goal
Vigorous Sports and Recreation
Moderate Physical Activity
Flexibility Exercises
Muscle Fitness Exercises
Vigorous Aerobics
Flexibility exercises
21 3 4 5 6 7
21 3 4 5
Days per week: Weeks: Number of exercises:
21 3 4 5 6 7
21 3 4 5
Days per week: Weeks: Number of exercises:
21 3 4 5 6 7
21 3 4 5
Days per week: Weeks: Minutes per day:
21 3 4 5 6 7
21 3 4 5
Days per week: Weeks: Minutes per day:
21 3 4 5 6 7
21 3 4 5
Days per week: Weeks: Minutes per day:
Moderate physical activity
Vigorous aerobics
Vigorous sports and recreation
Muscle fitness exercises
Energy Balance
Energy Out (Activity)
Energy In (Diet)
Avoid Inactivity *150 minutes of moderate or 75 minutes of vigorous activity per week is recommended; moderate and vigorous activity can be combined to meet guidelines.
Step 3. Set Specific Goals
Source: C. B. Corbin
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✔ Lifestyle Activities Min./Day ✔ Active Aerobics Min./Day ✔ Active Sports
and Recreation Min./Day
Walking Aerobic exercise machines
Basketball
Yard work Bicycling Bowling
Active housework Circuit training or calisthenics
Golf
Gardening Dance or step aerobics Karate/judo
Social dancing Hiking or backpacking Mountain climbing
Occupational activity Jogging or running (or walking)
Racquetball
Wheeling in wheelchair
Skating/cross-country skiing
Skating
Bicycling to work or store
Swimming Softball
Other: Water activity Skiing
Other: Other: Soccer
Other: Other: Volleyball
Other: Other: Other:
Other: Other: Other:
Other: Other: Other:
Other: Other: Other:
✔ Flexibility
Exercises
Reps/
Sets ✔ Muscle Fitness
Exercises
Reps/
Sets ✔ Exercises
for Back and Neck
Reps/
Sets
Calf stretch Bench or seated press Back saver stretch
Hip and thigh stretch Biceps curl Single knee to chest
Sitting stretch Triceps curl Low back stretch
Hamstring stretch Lat pull down Hip/thigh stretch
Back stretch (leg hug) Seated rowing Pelvic tilt
Trunk twist Wrist curl Bridging
Pectoral stretch Knee extension Wall slide
Arm stretch Heel raise Pelvic stabilizer
Other: Half-squat skiing Neck rotation
Other: Lunge Isometric neck exercise
Other: Toe press Chin tuck
Other: Crunch or reverse curl Trapezius stretch
Other: Other: Other:
Other: Other: Other:
Other: Other: Other:
Chart 3 Lifetime Physical Activity Selections
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Step 5. Preparing a Written Plan
In Chart 4, place a check in the shaded boxes for each activity you will perform for each day you will do it. Indicate the time of day you expect to perform the activity or exercise (Example: 7:30 to 8 A.M. or 6 to 6:30 P.M.). In the spaces labeled “Warm-Up Exercises” and “Cool-Down Exercises,” check the warm-up and cool-down exercises you expect to perform. Indicate the number of reps you will use for each exercise.
✔ Monday Time ✔ Tuesday Time ✔ Wednesday Time
Lifestyle activity Lifestyle activity Lifestyle activity
Active aerobics Active aerobics Active aerobics
Active sports/rec. Active sports/rec. Active sports/rec.
Flexibility exercises* Flexibility exercises* Flexibility exercises*
Muscle fitness exercises* Muscle fitness exercises* Muscle fitness exercises*
Back/neck exercises* Back/neck exercises* Back/neck exercises*
Warm-up exercises Warm-up exercises Warm-up exercises
Other: Other: Other:
✔ Thursday Time ✔ Friday Time ✔ Saturday Time
Lifestyle activity Lifestyle activity Lifestyle activity
Active aerobics Active aerobics Active aerobics
Active sports/rec. Active sports/rec. Active sports/rec.
Flexibility exercises* Flexibility exercises* Flexibility exercises*
Muscle fitness exercises* Muscle fitness exercises* Muscle fitness exercises*
Back/neck exercises* Back/neck exercises* Back/neck exercises*
Warm-up exercises Warm-up exercises Warm-up exercises
Other: Other: Other:
✔ Sunday Time ✔ Warm-Up Exercises Reps ✔ Cool-Down Exercises Reps
Lifestyle activity Walk or jog 1–2 min. Walk or jog 1–2 min.
Active aerobics Calf stretch Calf stretch
Active sports/rec. Hamstring stretch Hamstring stretch
Flexibility exercises* Leg hug Leg hug
Muscle fitness exercises* Sitting side stretch Sitting side stretch
Back/neck exercises* Zipper Zipper
Warm-up exercises Other: Other:
Other: Other: Other:
*Perform the specific exercises you checked in Chart 3.
Chart 4 My Physical Activity Plan
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Step 6. Keeping Records of Progress and Evaluating Your Plan
Make copies of Chart 4 (one for each week that you plan to keep records). Each day, make a check by the activities you actually performed. Include the times when you actually did the activities in your plan. Periodically check your goals to see if they have been accomplished. At some point, it will be necessary to reestablish your goals and create a revised activity plan.
Results
After performing your plan for a specific period of time, answer the question in the space provided.
How long have you been performing the plan?
Conclusions and Implications
1. In several sentences, discuss your adherence to the plan. Have you been able to stick with the plan? If so, do you think it is a plan you can do for a lifetime? If not, why do you think you are unable to do your plan?
2. In several sentences, discuss how you might modify your plan in the future.
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3. In several sentences, discuss your goals for your program. Do you think you will meet your goals? Why or why not?
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