Survey1.pdf

Name Section Date

(over)

Inse

l/Ins

el/R

oth,

Con

nect

Cor

e Co

ncep

ts in

Hea

lth. C

opyr

ight

© 2

020

McG

raw

-Hill

Educ

atio

n.

W E L L N E S S W O R K S H E E T

Evaluate Your Lifestyle

All of us want optimal health, but many of us do not know how to achieve it. Taking this quiz, adapted from one created by the U.S. Public Health Service, is a good place to start. The behaviors covered in the quiz are recommended for most Americans. (Some of them may not apply to people with certain diseases or disabilities or to pregnant women, who may require special advice from their physician.) After you take the quiz, add up your score for each section.

Alm

ost

alw

ays

Som

etim

es

Nev

er

Tobacco Use

If you never use tobacco, enter a score of 10 for this section and go to the next section.

1. I avoid smoking cigarettes. 4 1 0

2. I avoid using pipes, cigars, bidis, hookahs, and other forms of smoked or inhaledtobacco.

2 1 0

3. I avoid spit tobacco. 2 1 0

4. I limit my exposure to environmental tobacco smoke. 2 1 0

Tobacco Score:Alcohol and Other Drugs

1. I avoid alcohol or I drink no more than one drink (women) or two drinks (men) a day. 4 1 0

2. I avoid using alcohol or other drugs as a way of handling stressful situations or problems in my life.

2 1 0

3. I am careful not to drink alcohol when taking medications, such as for colds or allergies, or when pregnant.

2 1 0

4. I read and follow the label directions when using prescribed and over-the-counter drugs.

2 1 0

Alcohol and Other Drugs Score:

Nutrition

1. I eat a variety of foods each day, including seven or more servings of fruits andvegetables.

3 1 0

2. I limit the amount of saturated and trans fat in my diet. 3 1 0

3. I avoid skipping meals. 2 1 0

4. I limit the amount of salt and added sugar I eat. 2 1 0

Nutrition Score:

Evaluate Your Lifestyle — continued

(over)

Alm

ost

alw

ays

Som

etim

es

Nev

er

Exercise/Fitness

1. I engage in moderate-intensity exercise for 150 minutes or more per week. 4 1 0

2. I maintain a healthy weight, avoiding overweight or underweight. 2 1 0

3. I do exercises to develop muscular strength and endurance at least twice a week. 2 1 0

4. I spend some of my leisure time participating in physical activities such as gardening,bowling, golf, or baseball.

2 1 0

Exercise/Fitness Score:

Emotional Health

1. I enjoy being a student, and I have a job or do other work that I like. 2 1 0

2. I find it easy to relax and express my feelings freely. 2 1 0

3. I manage stress well. 2 1 0

4. I get along well with other people. 2 1 0

5. I participate in group activities (such as church and community organizations) orhobbies that I enjoy.

2 1 0

Emotional Health Score:

Support

1. I volunteer one or more times each year. 2 1 0

2. I enjoy helping other people. 2 1 0

3. I feel free to ask others for help. 2 1 0

4. I have close friends with whom I can talk about personal matters. 2 1 0

5. I acknowledge the success and achievements of others. 2 1 0

Support Score:

Safety

1. I wear a seat belt while riding in a car. 2 1 0

2. I avoid driving while under the influence of alcohol or other drugs. 2 1 0

3. I obey traffic rules and speed limits when driving. 2 1 0

4. I read and follow instructions on the labels of potentially harmful products orsubstances, such as household cleaners, poisons, and electrical appliances.

2 1 0

5. I avoid using a cell phone while driving. 2 1 0

Safety Score:

Evaluate Your Lifestyle — continued

Alm

ost

alw

ays

Som

etim

es

Nev

er

Disease Prevention

1. I know the warning signs of cancer, diabetes, heart attack, and stroke. 2 1 0

2. I avoid overexposure to the sun and use sunscreen. 2 1 0

3. I get recommended medical screening tests (such as blood pressure checks and Paptests), immunizations, and booster shots.

2 1 0

4. I do not share needles to inject drugs. 2 1 0

5. I am not sexually active, or I have sex with only one mutually faithful, uninfectedpartner, or I always engage in safer sex (using condoms).

2 1 0

Disease Prevention Score:

What Your Scores Mean

Scores of 9 and 10–Excellent! Your answers show that you are aware of the importance of this area to your health. More important, you are putting your knowledge to work for you by practicing good health habits. As long as you continue to do so, this area should not pose a serious health risk.Scores of 6–8–Your health practices in this area are good, but there is room for improvement.Scores of 3–5–Your health risks are showing.Scores of 0–2–You may be taking serious and unnecessary risks with your health.

Using Your Results

How did you score? Are you satisfied with your scores in each area? Why or why not? In which areas would you most like to improve your scores?

To improve your scores, look closely at any item to which you answered “sometimes” or “never.” Below, identify and list at least three possible targets for a health behavior change program. (If you are aware of other risky health behaviors you currently engage in, but that were not covered by this assessment, you may include those on your list.) For each item, identify at least one strategy you could adopt to move forward. Possible strategies might be obtaining information about the behavior, completing an analysis of the pros and cons of change, or starting to track your target behavior.

SOURCE: Adapted from Healthstyle: A Self-Test, developed by the U.S. Public Health Service.

Our customer support team is here to answer your questions. Ask us anything!