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Must be at least 1000 words, and be in apa format with in-text citations. Please number the answers.

1.

1. Complete Lab18A pg. 415

2. Identify and describe the negative health consequences of secondhand smoke exposure. I have attached the reading, also need 3 sources as well.

3. Describe the negative health and economic consequences associated with personal use of tobacco products.

4. Describe 4 ways that you can take advantage of the healthcare system to help you get the most out of your health.


2. Think about how your lifestyle impacts the environment and describe 3 strategies that you can use to improve the environment.

3. Prepare a plan for changing a lifestyle behavior. Following the 6 steps in the presentation, the report should include the following components:

1. Clarify Reasons

2. Identify Needs

3. Set Goals 4.Select Activities

5. Plan for Taking Action

6. Plan for Evaluation

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Avoiding Destructive Behaviors ▶ Section VII Concept 18 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. S ▶ Describe secondhand smoke and identify the negative T health consequences of secondhand smoke exposure. O ▶ Understand trends in the prevalence of tobacco use. V ▶ Identify important factors contributing to recent reductions in tobacco use in the E R higher rates of smoking. ▶ Describe efforts by the tobacco industry to maintain , ▶ Identify effective prevention and intervention approaches designed to reduce rates United States. of tobacco use. C Tobacco use is the number one A R cause of preventable disease and is O associated with the leading causes of L death in our culture. 2 3 1 3 T S 405 406 Section 7 ▶ Avoiding Destructive Behaviors obacco is the number 1 cause of preventable mortality 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 VIDEO 1 guidelines for quitting. T 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 monoxide. This gas binds onto hemoglobin in the bloodstream 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 addictive 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 breathing rates increase. Blood vessels constrict, peripheral circulation 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. 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, S pinched, or dipped. Moist snuff is used the same way, but itT is moist, finely cut tobacco in a loose form and is sold in tea-bag-like packets. O V The Health and Economic E Costs of Tobacco R 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 estabC lished that tobacco use is the leading cause of death in A United States (accounting for nearly one in five of the allRdeaths), contributing to 7 of the 10 leading causes of death. It is estimated that between 80 and 90 percent of allOdeaths related to lung cancer and obstructive lung disease L 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 2 found that risk for Alzheimer’s disease was 157 percent 3 among heavy smokers relative to nonsmokers. higher Another recent study provides the strongest evidence 1 to date that smoking increases risk for breast cancer, 3 particularly for women who begin smoking earlier inTlife. Thus, the number of diseases resulting from tobacco use is much more extensive than previously S 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 Concept 18 ▶ The Use and Abuse of Tobacco Brain: Increases risk of stroke 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 Mouth/Throat: Increases risk of cancers of the mouth, throat, larynx, and esophagus and causes gum disease Heart: Increases risk of coronary S artery disease and T atherosclerosis O V Reproductive System: E Increases risk of breast and cervical R cancer, birth complications, unhealthy babies, , and sudden death syndrome Stomach/ Abdomen: Increases risk of stomach cancer, peptic ulcers, and abdominal aortic in babies of smokers aneurysm Blood: Increases risk of leukemia C and decreases HDL A R O to quit; however, reducing how much one smokes also makes a difference. In one study, rates of lung cancer L Figure 1 ▶ Unhealthy effects of smoking. dropped by 27 percent among those who reduced their smoking from 20 or more to less than 10 cigarettes a day. 2 Smoking has tremendous economic costs. In addi3 tion to the cost of human life, smoking in the United States causes more than $193 billion in annual health1 related economic losses ($97 billion in productivity losses 3 and $96 billion in health-care expenditures). Over and T above the costs at the societal level, there are significant financial costs for the individual, particularly with S 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 average 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 407 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 lungdamaging substances (e.g., asbestos). The greater the exposure to smoke, the greater the risk. While risks clearly increase with the amount of exposure, recent studies suggest that even low levels of smoking have negative consequences. Unfortunately, while overall rates of smoking have decreased in recent years, rates of nondaily smoking have increased. These “chippers” or “social smokers” have lower risk relative to regular 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 athletic 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. 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. 408 Section 7 ▶ Avoiding Destructive Behaviors Secondhand smoke poses a significant health risk. When smokers light up they expose those around them to secondhand smoke. Secondhand smoke is a combination of mainstream smoke (inhaled and then exhaled by the smoker) and sidestream smoke (from the burning 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 secondhand smoke. The following are the six major conclusions from the report (see Surgeon General’s website): • Millions in the United States are exposed to secondhand 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 VIDEO 2 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 diabetes, and they are also at increased risk of becoming smokers themselves. Secondhand smoke can have a negative impact even when smokers try to protect children 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, asSparents generally see their child’s pediatrician more often T than their own doctor. Parents may also be more responsive to the message if they learn that smoking O hurt their children. can VWhile not technically considered secondhand exposure, smoking during pregnancy harms a developing E Children of smoking mothers typically have fetus. lower R birth weight and are more likely to be premature, 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 C smoke are at increased risk for later physical problems A (respiratory infections and asthma) and behavioral problems (attention deficit disorder). The best way to R reduce risk for pregnant mothers and their children isO for women to quit smoking altogether. However, there L is some evidence that reductions in smoking also have benefits. Secondhand smoke exposure may also negatively 2 impact mental health. A recent study using a national 3 found a significant relation between cotinine survey levels, 1 an indicator of secondhand smoke exposure, and depression. Among those who never smoked, risk for 3 depression was substantially increased for those exposed toTcigarette smoke in their home or at work. Other recent studies show that secondhand smoke increases the risk of S memory problems among the elderly. Awareness about the risks of secondhand smoke has contributed to changed social norms. 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 substitute for cigarette, cigar, and pipe smoking. While smokeless tobacco does not lead to the same respiratory 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 Concept 18 ▶ The Use and Abuse of Tobacco 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 S T O V E R , C smoking cigarettes. One-third of teenage users have receding gums, and about half have precancerous lesions, A 20 percent of which can become oral cancer within 5 R years. Some of the health risks of smokeless tobacco are listed in Table 1. O 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 situation is much more positive than for many other countries. While rates have been decreasing in the United States, they have been increasing in many others, particularly 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 smokeless tobacco use. Unfortunately, decreases in smokeless 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 adolescents initiate cigarette use each day, with over 1,000 40 35 30 25 20 15 10 5 0 Students Adults HP 2020 goals Youth 16% Adults 12% 19 9 19 7 9 19 8 9 20 9 0 20 0 01 20 0 20 2 0 20 3 0 20 4 0 20 5 06 20 0 20 7 0 20 8 0 20 9 10 At one time, smoking was an accepted part of 2 our culture, but the social norm has changed. 3 While smoking has always been a part of our culture, the industrialization and marketing in the middle of 1 the 20th century led to tremendous social acceptance 3 of smoking. As odd as it may sound, cigarettes were once provided free to airline passengers when they T boarded planes. The release of the Surgeon General’s 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 Percent (%) L The Facts about Tobacco Usage 409 Year Figure 2 ▶ Trends in cigarette smoking. Source: Centers for Disease Control and Prevention. Secondhand Smoke A combination of mainstream 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. 410 Section 7 ▶ Avoiding Destructive Behaviors 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 during 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 college 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 companies 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 prevention programs and public education campaigns. The lawsuits also prevented companies from direct marketing to anyone under the age of 18. These lawsuits have also had an impact on public opinions of tobacco companies. 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 variability 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 Substance 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 correlated to usage so the policies have clearly had a positive S T O V E R , C A R O L Figure 3 ▶ Warning label images. Source: U.S. Food and Drug Administration. 2 effect. Bans on indoor smoking have also been important 3 reducing access and exposure. A total of 35 states now for ban 1 smoking in all restaurants, 30 ban smoking in bars, and 31 ban smoking in the workplace. A total of 25 states plus 3 the District of Columbia are now smoke-free in all three T settings. Including local bans by cities and counties, there are now over 21,000 indoor smoking laws in the United S States. For additional information on smoking bans and policies, see A Closer Look. Fortunately, recent efforts to limit exposure to secondhand 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 smoking bans have focused on keeping smokers from smoking at work, employers have begun to encourage employees who smoke to quit altogether. Smokers suffer from more physical and mental health problems at a cost to Concept 18 ▶ The Use and Abuse of Tobacco A CLOSER LOOK 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. Cigarett Cigarette rette te Taxe Taxes es a and Indoor Smoking Bans Increased taxes and public smoking bans have contributed 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 smoking relative to most other states. The economy of these states is strongly tied to tobacco crops, creating competing 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? ACTIVITY 411 Do you support legislation to prevent smoking in most public places, including outdoor spaces? ACTIVITY S T O V E R , employers via higher health-care premiums. The CDC estimates the cost for smoking at over $3,000 per smoker C per year, including lost productivity and medical bills. A Many employers, including the World Health Organization, now refuse to hire smokers, and many companies R include smoking cessation in employee assistance proO grams to encourage smokers to quit. Recent evidence suggests that such programs can pay off for employers in L as little as 2 years. 2 3 1 In the News 3 Battle over Cigarette Labels T IIn 2009, the Family Smoking Prevention and Tobacco Control Act was passed, giving S the T 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 identify them. The second major regulation proposed by the FDA was to require graphic images accompanied by new warnings about the dangers of smoking on all cigarette packs. In June 2010, the FDA approved nine new labels (see Figure 3 Tobacco companies are finding new ways to recruit tobacco users. As expected, the tobacco industry 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 companies 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,” electronic cigarettes that produce a puff of vapor containing nicotine and other additives. Critics have argued that e-cigarettes contain known carcinogens and should have the similar warning labels and regulations. Policies banning the sale and VIDEO 3 use of e-cigarettes have already been 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 lawsuit 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? ACTIVITY 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 industrysponsored 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 industrysponsored events where free cigarettes were provided were nearly VIDEO 4 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 control 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 managing 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 particularly common in college students. Results of a nationally representative study of college students indicated that 97 percent of college smokers drink, while other national data report that 80 percent of all college students 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 Table 2 ▶ Why Young People Start Using Tobacco • Peer influence • Social acceptance 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 consequences 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 smokers in the United States in 2010 had tried to quit in the S year. Unfortunately, most of these attempts were past unsuccessful. Most people make many attempts before T they succeed. Withdrawal symptoms and cravings for O nicotine are often cited reasons for failed quit attempts. Many former smokers report nicotine craving months V and even years after quitting. The good news is that E when you quit you may feel better right away and your body R will heal. You will feel more energetic, the coughing will stop, you will suddenly begin to taste food again, , and your sense of smell will return. Your lungs will eventually heal and VIDEO 5 look C like the lungs of a nonsmoker. A R OT E C H N O L O G Y U P D A T E L Social Media Applications for Smoking Cessation 2The American Cancer Society introduced a new quitting 3program designed specifically for teens. The program includes a dedicated website (teen.smokefree.gov), 1texting support, and a smartphone application. Teens connect with a counselor using instant messaging 3can or their cell phones, and the website provides links to Tsupport groups through social networking sites, includFacebook and Twitter. To reduce defensiveness that Sing 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. • Desire to be “mature” • Desire to be “independent” Do you think that this type of Web-based program will be more attractive to young people? • Desire to be like their role models • Appealing advertisements ACTIVITY Concept 18 ▶ The Use and Abuse of Tobacco Your risk for lung cancer will return to that of the nonsmoker 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). 413 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. 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 S such as Zyban, have helped some smokers quit, but othT ers fail to benefit from their use. Luckily, new options are becoming available. The drug Chantix, recently approved O by the FDA, works differently than other products on the V market by partially activating nicotinic receptors in the brain, which helps reduce the rewarding properties of E smoking and decreases craving for nicotine. In one cliniR 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. • Decide how to stop. Methods to stop include counseling, attending formal programs, quitting with a friend, going “cold turkey” (abruptly), and quitting gradually. More succeed 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 continuing to smoke. • Get support. Try a formal “quit smoking” program for professional 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. C A R O S Strategies for Action L A Although quitting is ultimately up to you, that does not mean u you have to do it a alone. A number of national organizations provide telephone hotlines to help those trying 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 several 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 likelihood of success: 2 3 1 3 T S 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 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 Survey Results on Drug Use, 1975–2010, Volume I: Secondary School Students. 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 longterm 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 SServices Administration. Teague, T M. L., et al. 2011. Your Health Today: Choices in a Changing Society. 3rd ed. New York: McGraw-Hill Higher OEducation, Chapter 13. U.S. V Department of Health and Human Services. 2012. Preventing Tobacco Use among Youth and Young Adults: A Report Eof the Surgeon General. Atlanta, GA: U.S. Department of RHealth 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 CGlobal Tobacco Epidemic, 2011: Warning about the ADangers of Tobacco. Geneva, Switzerland: World Health ROrganization. Xue, F., et al. 2011. Cigarette smoking and the incidence of Obreast cancer. Archives of Internal Medicine 171:125–133. L Healthy People 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 content 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. 2 3 • 1 Reduce teen exposure to tobacco advertising. • Increase tobacco screening in health-care settings. 3 • Increase indoor smoking bans in public places. T S national goal is to reduce rates of smoking in young people A key 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? ACTIVITY Lab 18A Use and Abuse of Tobacco 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 Lab 18A Name Procedure Results What is your tobacco risk score? What is your tobacco risk rating? Chart 1 Tobacco Use Risk Questionnaire Use and Abuse of Tobacco 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. S (total from Chart 1) T O (see Chart 2) V E R , 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. Categories 0 Cigarette use Never smoked Pipe and cigar use Never smoked Smoking style Don’t smoke Smokeless tobacco use Don’t use Secondhand or sidestream smoke No smokers at home or in workplace Years of tobacco use Never used 1 Pipe— occasional use Points C A2 R 1–10 cigarettes a day O L Cigar— infrequent daily use 2 Occasional use: 3 not daily 1 3 Smokers at workplace but not T at home S 1 or less 3 4 11–40 cigarettes a day >40 cigarettes a day Cigar or pipe— frequent daily use Cigar—heavy use No inhalation Slight to moderate inhalation Deep inhalation Daily use: one use per day Daily Use: multiple use per day Heavy use: repetitious, multiple use daily Smokers at home but not workplace Smokers at home and at workplace 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. 415 Use and Abuse of Tobacco Lab 18A 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 Conclusions and Implications S 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 T done to change these risks. If your risk is above average, what changes can be made to reduce your risk? O V E R , C A R O L 2 2. In several sentences, discuss how you feel about public laws 3 designed to curtail tobacco use. Discuss your point of view, either pro or con. 1 3 T S 416 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. S ▶ Explain the importance of environmental influences T on lifestyle (as well as the impact of our lifestyles on our environment). O ▶ List the key healthy lifestyles that influence health and wellness. V ▶ Explain how personal actions and interactions influence the adoption of healthy Concept 24 E ▶ Apply behavioral skills to plan and follow personalRhealth and fitness programs. , lifestyles. In addition to healthy lifestyles, C A such as heredity, health other factors R care, the environment, cognitions O and emotions, and personal actions L and interactions contribute to good 2 health, wellness, and fitness. 3 1 3 T S 499 500 Section 8 ▶ Making Informed Choices he broad vision of Healthy People 2020 is to create “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 changing factors over which you have control. For this reason, much of the discussion has centered on changing lifestyles, because lifestyles impact health, wellness, and fitness 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 information about these other factors and overall strategies for optimizVIDEO 1 ing your health. T 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. Abnormalities 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 disease risk factors, diabetes, and many forms of cancer. At S present it is not possible for people to truly know their T risk profile, but it may be possible in the future genetic with O more comprehensive genetic testing. Take V action to diminish risk factors for which you have a predisposition. As mentioned, research E strong familial aggregation of certain chronic shows R , C Personal actions and A interactions Cognitions and emotions R O L Health 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 2 3 1 3 T S Wellness Environmental factors Physical, social, spiritual, work site, other Physical fitness Health-care system Access Compliance Heredity Age Disability Figure 1 ▶ Determinants of health, fitness, and wellness. Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change disease risk factors (e.g., obesity, diabetes, cholesterol, blood pressure) as well as some cancers. While you cannot change your heredity risks, you can take steps to reduce your risks for certain inherited conditions. Specifically, adopting healthy lifestyles may significantly reduce inherited risks for certain diseases. A recent study computed obesity risk scores based on the presence 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. EatS ing a healthy diet, managing stress, and not smoking are other key lifestyles that would likely contribute to T lowering inherited risks for disease. O V Use the Health-Care System E Effectively R , Follow sound medical advice and recommendations. The medical system can provide individuals with supportive, personalized health care, but people have to seek C consultation and follow advice for it to be effective (see Table 1). Some basic strategies for accessing the medical A system effectively are summarized below: R • Get medical insurance. People who think they save O money by avoiding the payment of insurance premiums place themselves (and their families) at risk and L may not really save money. Table 1 ▶ Facts about Personal Physicians and Health Insurance • 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. 2 3 1 3 T S 501 • 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 certifications 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 something 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 effectively treated if they are identified early in the disease process. Following cancer screening guidelines is particularly important (e.g., mammograms for women and prostate tests for men). Breast and testicular selfexams 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 questions before surgeries: What are the reasons for the surgery? 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 procedure impact my quality of life and future health? • Understand effects of medications. Seek out information about medicines and supplements so you understand their intended effect. Read the inserts that come with the medicine and ask your doctor and pharmacist about correct dosage and information concerning 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 populations and they may not be safe or effective for all people. Consider the safety and potential risks. Side effects from preventable adverse reactions to medicines 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. 502 Section 8 ▶ Making Informed Choices In the News Does Zinc Help with Treatment of the Common Cold? D T The common cold is one of the top causes of visits to the doctor and absenteeism from o school and work. It is typically caused by the rhinovirus and there are no proven treatments. While colds may not be preventable, 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 supplemental 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 • 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 toilet, 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 illness 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. cold in healthy people when taken within 24 hours of onset of symptoms. A meta-analysis in the Canadian Medical Association 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. S T O V E R , ACTIVITY C A R O L activity contributes to fitness, wellness, and quality of life. Physical • 2Carefully review the credibility and accuracy of new health information. As described in Concept 23, there 3are many examples of misleading claims and fraud 1in the health and fitness industry. Even news reports from credible scientific studies can exert too much 3influence on consumer decisions. It takes years for sciTentific consensus to emerge, so carefully review new health claims. (See In the News.) S Consider Environmental Influences on Your Health Understand how environmental factors shape your behaviors. As described throughout the book, environmental 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 contribute to overeating and lack of physical activity. To live healthy, it is important to understand how environmental Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 503 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 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. Spiritual S T Physical O V E R , Social C A R A healthy social environment enhancesO quality of life and supports wellness. L • Creating a sense of community: Being a part of the greater community is important to social and mental health. 2 Community-based groups are also important for planning and promoting 3 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. 1 3 T S A positive emotional environment can help with adopting healthy lifestyles and managing stress. Emotional/ mental Intellectual • 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 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. settings and factors influence our lifestyles. Figure 2 summarizes the broad impact of physical, spiritual, social, intellectual, 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 VIDEO 2 use of toxic products. 504 Section 8 ▶ Making Informed Choices A CLOSER LOOK City, County City County, ounty a and State Health Ratings Numerous organizations conduct surveys to determine 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 centers). 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 comprehensive review by the Robert Wood Johnson Foundation 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? ACTIVITY • Strategies for the social and emotional environment. Find a social community that accommodates your personal and family needs; get involved in community affairs, including those that affect the environment; 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-management 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, provide spiritual support for others, seek spiritual guidance 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. 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 physical 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 restaurants. 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. Considerable attention has been given recently to characteristics S define healthy work sites, communities, cities, and that states T (see A Closer Look). This is encouraging because the increased O demand for healthy resources could VIDEO 3 lead V to increased supply. E R Adopt and Maintain Healthy , Lifestyles Consider strategies for adopting healthy lifestyles. Statistics show that more than half of early deaths are C caused by unhealthy lifestyles. For this reason, changA lifestyles is the focus of this book. We emphasize ing priority R healthy lifestyles such as being regularly active, eating well, managing stress, avoiding destructive behavO iors, and practicing safe sex because they are factors over L we have some control, and if adopted, they have which considerable impact on health, wellness, and fitness. (see Figure 1). Being an informed consumer is another 2 lifestyle emphasized in the book since it enables healthy you 3 to understand health information and take appropriate action. Other healthy lifestyles not emphasized in1the book include adopting good health 3 and safety habits and learning first aid. Examples of healthy VIDEO 4 T lifestyles in these domains are highlighted S in Table 2. Consider the impact of your lifestyle on the health of the environment. The environment clearly influences 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 agricultural systems, which in turn threatens our food and water supply. These are just a few examples of the complex Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 505 Table 2 ▶ Other Healthy Lifestyles 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. • • • • • • 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 driving, 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. 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. S T • Learn cardiopulmonary resuscitation (CPR). New research shows that chest O compression alone saves lives even without mouth-to-mouth breathing. • Learn the Heimlich maneuver to assist people who are choking. V • Learn basic first aid. E R , C A R O L 2 3 1 3 T S 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. Individually 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, fitness-related technology that may help to change awareness 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 wellness, 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 throughout the book), your actions and interactions have a major influence on all aspects of wellness. 506 Section 8 ▶ Making Informed Choices TECHNOLOGY UPDATE Sustainable Exercise Machines Interest in energy conservation has led to the development 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 moderate 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 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 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 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 information 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 decisions. As noted in Concept 1, it is also important to consider your emotions when making decisions. Consider S guidelines: these • TCollect and evaluate information before you act. OBecome informed before you make important decisions. Get information from reliable sources and conVsult with others you trust. • EEmotions will influence certain decisions but should Rnot detract from sound decision-making processes. Fear and anger are two emotions that can affect your , judgment and influence your ability to make decisions. Even love for another person can influence your actions. Get control of your emotions, or seek guidCance from others you trust, before making important Adecisions in emotionally charged situations. • RResist pressure to make quick decisions when there is no need to decide quickly. Salespeople often press for Oa quick decision to get a sale. Take some time to think Lbefore 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 2(e.g., medical care in an emergency), but, when possible, delaying a decision can be to your advantage. 3 • Use stress-management techniques to help you gain 1control when you must make decisions in emotionally 3charged situations. Practice stress-management techniques (see Concepts 16 and 17) so that you can use Tthem effectively when needed. • SHonor 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 Concept 24 ▶ Toward Optimal Health and Wellness: Planning for Healthy Lifestyle Change 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? S T ACTIVITY O V assistance programs (EAP), providing counselors who will help you or your family members find ways to solve E a particular problem. Other programs and support groups R help with lifestyle changes. For example, most hospitals , and many health organizations have hotlines that provide referral services for establishing healthy lifestyles. C Consider your personal beliefs and philosophy when making decisions. Though science can help you make A good decisions and solve problems, most experts tell you R that there is more to it than that. Your personal philosophy and beliefs play a role. The following are factors to consider: O 507 • 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 comparative criteria. Adhering to the HELP philosophy can help you adopt a new way of thinking. This philosophy suggests that each person should use health (H) as the basis for making decisions rather than comparisons 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 emphasized 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 previously, 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. L Strategies for Action 2 3 Develop and follow a plan for healthy living. You do not have full control over 1 health and wellness factors, but it is important to take control over those you can. In Concept 2, you learned about the 3 six steps involved in planning for a healthy lifestyle change. The labs T 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 preS pare for lifestyle changes. Lab 24B helps you prepare for making lifestyle change from the list presented in Figure 1. Lab VIDEO 5 24C is designed to help you plan a personal physical activity program. This lab utilizes results compiled from the fitness-related concepts in the book and provides a culminating personal fitness plan. process but it is likely that you will eventually adopt less formalized 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. However, the more a person does self-assessments, the more he or she is aware of personal fitness status. This awareness 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 VIDEO 6 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. 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 ACTIVITY 508 Section 8 ▶ Making Informed Choices Web Resources 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 resisStance: The Preventing Overweight Using Novel Dietary StratTegies trial. American Journal of Clinical Nutrition 95(2):506–513. Steptoe, A., and J. Wardle. 2011. Positive affect measured using Oecological momentary assessment and survival in older men Vand women. Proceedings of the National Academy of Sciences 108(45):18244–18248. E S. 2011. Health Psychology. 8th ed. New York: McGraw-Hill. Taylor, Trust R for America’s Health. 2008. Blueprint for a Healthier Washington, DC: Trust for America’s Health. , America. Available at http://healthyamericans.org/report/55/ 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. blueprint-for-healthier-america World Health Organization. 2009. Global Health Risks. CGeneva: WHO. Available at www.who.int/publications/en AJ., and R. E. Roberts. 2010. The power of positive emoXu, Rtions: It’s a matter of life or death—Subjective well-being and longevity over 28 years in a general population. Health OPsychology 29(1):9–19. L Healthy People 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 content 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. • • • 2 3 1 Increase percentage of college students receiving information on priority risk-behavior areas. 3 Increase percentage of people with health-care providers T who involve them in decisions about health care. S 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? ACTIVITY Lab 24A Assessing Factors That Influence Health, Wellness, and Fitness Name Section Date Chart 1 Assessment Questionnaire: Factors That Influence Health, Wellness, and Fitness Factor Very True Somewhat True Not True At All Score Lab 24A Purpose: To assess the factors that relate to health, wellness, and fitness Heredity 3 2 1 2. I have taken steps to overcome hereditary predispositions. 3 2 1 Assessing Factors That Influence Health, Wellness, and Fitness 1. I have checked my family history for medical problems. Heredity Score = Health Care S 4. I get regular medical exams and have my own doctor. T 5. I get treatment early, rather than waiting until problems get serious O 6. I carefully investigate my health problems before making decisions. V E Environment R 7. My physical environment is healthy. , 8. My social environment is healthy. 3. I have health insurance. 9. My spiritual environment is healthy. 10. My intellectual environment is healthy. 11. My work environment is healthy. 12. My environment fosters healthy lifestyles. Lifestyles C A R O L 3 2 1 3 2 1 3 2 1 3 2 1 Health-Care Score = 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 Environment Score = 13. I am physically active on a regular basis. 3 2 1 14. I eat well. 2 15. I use effective techniques for managing stress. 3 16. I avoid destructive behaviors. 1 17. I practice safe sex. 3 18. I manage my time effectively. T 19. I evaluate information carefully and am an informed consumer. S 20. My personal health habits are good. 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 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 = 509 Lab 24A 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. Results Assessing Factors That Influence Health, Wellness, and Fitness Factor Rating Chart Score Rating Factor Heredity Heredity Health care Health care Healthy Marginal Needs Attention 6 4–5 Below 4 11–12 9–10 Below 9 13–15 Below 13 S Environment 16–18 26–30 20–25 Below 20 Lifestyles T Lifestyles 13–15 10–12 Below 10 O Actions/ Actions/interactions interactions V Conclusions and Implications E 1. In the space below, discuss your scores for the five factors R (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. , Environment C A R O L 2. 510 2 3 1 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 3 for attention. In several sentences, discuss actions you and still have a low score in one area that indicates a need could take to make changes related to individual questions. T S Lab 24B Planning for Improved Health, Wellness, and Fitness Section Date Purpose: To plan to make changes in areas that can most contribute to improved health, wellness, and fitness Procedures E R , Results Chart 1 Check one in each column. Physical environment C A Eating well Managing stress R Avoiding destructiveO habits Practicing safe sex L Social environment Managing time Area of Change Health insurance Medical checkups Selecting a doctor Spiritual environment Intellectual environment Work environment Environment for lifestyles Chart 2 ✔ Area of Change 2 3 Improving health habits 1 Improving safety habits Learning first aid 3 T S ✔ Becoming a better consumer Maintenance 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 Action Preparation The change has lasted at least 6 months. “I have made some short-term changes.” “I am getting ready to change.” 1. Contemplation 2. Precontemplation “I am thinking about a change.” “I don’t want to change.” Note: Some of the areas identified 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 encouraged to take steps to make changes independent of this assignment and to consult privately with your instructor to get assistance. 511 Planning for Improved Health, Wellness, and Fitness 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 identifyS the stage of maintenance. If you are at maintenance, you can select a different area of change that would be more useful. T to make related to your environment or health care. State 3. In the appropriate locations, record the change you want your reasons, your specific goal(s), your written statement O 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 V lifestyle change you identified. Lab 24B Name Planning for Improved Health, Wellness, and Fitness Lab 24B Chart 3 Making Changes for Improved Health, Wellness, and Fitness 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. S T OStep 3: State Your Specific Goals for Change State several specific and realistic goals. V E R , Step 3: State Your Specific Goals for Change State several specific and realistic goals. Step 4: Identify Activities or Actions for Change List specific activities you will do or actions you will take to meet your goals. Step 5: Write a Plan; Include a Timetable Expected start date: C A R O LStep 5: Write a Plan; Include a Timetable Expected start date: Expected finish date: Days of week and times: list times below days. Mon. Tue. Wed. Th. Fri. Sat. Step 4: Identify Activities or Actions for Change List specific activities you will do or actions you will take to meet your goals. Sun. 2 3 Expected finish date: 1 3 TDays of week and times: list times below days. Fri. Sat. S Mon. Tue. Wed. Th. 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? 512 Lab 24C Planning Your Personal Physical Activity Program Section Lab 24C Name 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 1. 4. S 5. T 3. 6. O Step 2. Identify Your Needs Using V Fitness Self-Assessments and Ratings of Stage of Change for Various Activities E In Chart 1, rate your fitness by placing an X over the circle by the appropriate rating for each part of fitness. Use your R 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 2. for that fitness component. If you were unable to do a self-assessment for some reason, check the “No Results” circle. Chart 1 Rating for Self-Assessments Health-Related Fitness Tests C A R O L Rating HighPerformance 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) 2 3 1 3 T S 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) 513 Planning Your Personal Physical Activity Program In the spaces provided below, list several of your principal reasons for doing a comprehensive activity plan. Chart 1 Rating for Self-Assessments, continued Rating Lab 24C Health-Related Fitness Tests HighPerformance Good Fitness Marginal Low No Results Poor 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) Planning Your Personal Physical Activity Program 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) Skill-Related Fitness and Other Self-Assessments 1. Agility (Chart 1, page 281) 2. Balance (Chart 2, page 282) S T O Excellent V E R , Rating Very Good or Good Fair 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) Summarize Your Fitness Ratings Using the Results Above Cardiovascular Flexibility C A R O L 2 3 1 HighPerformance 3 T S Rating Good Fitness Marginal Low No Results Very Good or Good Fair Poor No Results Strength Muscular Endurance Body fatness Excellent Skill-related fitness Posture and fitness of the back 514 Maintenance Action “Regular participation for at least six months” “Regular participation but less than six months” Lab 24C 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. “Some participation but not on a Preparation regular basis” Planning Your Personal Physical Activity Program Contemplation “Thinking about doing this but have not done it yet” Precontemplation “I don't want to change.” S Energy Balance T O V E R t:PHB ,Flexibility Exercises X one circle X one circle X one circle X one circle X one circle Energy Out (Activity) t Maintenance t Action t Preparation t Contemplation t Precontemplation t Maintenance t Action t Preparation t Contemplation t Precontemplation t Maintenance t Action t Preparation t Contemplation t Precontemplation t Maintenance t Action t Preparation t Contemplation t Precontemplation t Maintenance t Action t Preparation t Contemplation t Precontemplation Energy In (Diet) t4USFUDI C A R O Vigorous SportsL Muscle Fitness Exercises t$BMJTUIFOJDT t3FTJTUBODF FYFSDJTF and Recreation Vigorous Aerobics Moderate Physical Activity 2 3 1 3 T S t5FOOJT t)JLF t+PH t#JLF t"FSPCJDEBODF t8BML t:BSEXPSL t(PMG *150 minutes of moderate or 75 minutes of vigorous activity per week is recommended; moderate and vigorous activity can be combined to meet guidelines. Avoid Inactivity Source: C. B. Corbin In 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. 515 Step 3. Set Specific Goals Lab 24C 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. Energy Balance Energy Out (Activity) Energy In (Diet) Planning Your Personal Physical Activity Program Flexibility exercises Days per week: 1 2 Weeks: 1 2 3 4 5 Number of exercises: 3 4 5 Muscle fitness exercises Days per week: 1 2 Weeks: 1 2 3 4 5 Number of exercises: 3 4 5 6 7 6 Flexibility Exercises 7 Muscle Fitness Exercises S T Vigorous Sports and Recreation O V Vigorous Aerobics E R Moderate , Physical Activity t:PHB t4USFUDI t$BMJTUIFOJDT t3FTJTUBODF FYFSDJTF Vigorous sports and recreation Days per week: 1 Weeks: 1 2 3 4 Minutes per day: 2 3 4 5 Vigorous aerobics Days per week: 1 Weeks: 1 2 3 4 Minutes per day: 2 3 4 5 Moderate physical activity Days per week: 1 Weeks: 1 2 3 4 Minutes per day: 2 3 4 5 6 7 5 6 7 5 6 7 5 t5FOOJT t)JLF t+PH t#JLF t"FSPCJDEBODF t8BML t:BSEXPSL t(PMG C A Source: C. B. Corbin R Physical 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 theOgoal (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 L *150 minutes of moderate or 75 minutes of vigorous activity per week is recommended; moderate and vigorous activity can be combined to meet guidelines. Avoid Inactivity being able to achieve a specific score on a flexibility test. Part of Fitness Description of Specific Performance 2 3 1 3 T S Weeks to Goal 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. 516 Chart 3 Lifetime Physical Activity Selections ✔ Lifestyle Activities Min./Day ✔ Min./Day ✔ Active Sports and Recreation 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 S Swimming T O Water activity V Other: E Other: R Other: , Other: Other: Other: Other: Softball Skiing Soccer Volleyball Other: Other: Other: Other: Other: Other: Other: Hip and thigh stretch C Other: A Muscle Fitness R Exercises O Bench or seated press L Biceps curl Sitting stretch Triceps curl Other: Flexibility Exercises Calf stretch Reps/ Sets ✔ Other: Reps/ Sets ✔ Exercises for Back and Neck Single knee to chest Low back stretch Bridging 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: Back stretch (leg hug) Trunk twist Pectoral stretch Arm stretch Reps/ Sets Back saver stretch 2 Lat pull down 3 Seated rowing 1 Wrist curl 3 Knee extension T Heel raise S Hamstring stretch Planning Your Personal Physical Activity Program Aerobic exercise machines Min./Day Lab 24C Walking Bicycling to work or store ✔ Active Aerobics Hip/thigh stretch Pelvic tilt Wall slide Pelvic stabilizer 517 Lab 24C 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. Chart 4 My Physical Activity Plan Planning Your Personal Physical Activity Program ✔ Monday Time ✔ Wed...
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