1.3 Take Charge of Your Health
Learning Objectives
Assess your current level of wellness.
Examine and apply theories about how people make behavioral changes.
Learn ways to improve your health behaviors.
Source: © Shutterstock, Inc.
You’ve learned that genetics, heredity, socioeconomic factors, and environmental factors all contribute to health. It’s time to address the personal habits—the elements you can control. Once you recognize the importance of lifestyle habits, you can exert a healthy measure of personal responsibility for your health.
Consider yourself the architect of your health and well-being. We’re all works in process. Your lifestyle habits promote either construction or demolition. Take a hard look. Like the architect on any remodeling project, you first assess the raw materials, looking for strengths and weaknesses in the design. You do your homework, design a step-by-step plan, and, provided with the necessary tools, build on your assets to create a firm foundation for vitality now and for healthy aging.
If you want to live a long and robust life, follow the pillars of good health:
Engage in physical activity every day. Try to get thirty minutes of aerobic exercise (the kind that’s intense enough to let you talk but not sing) five days a week. Do strength training twice a week. To maintain flexibility, move your joints through their full range of motion.
Make time for friends and family. Nurture those relationships that make you feel secure and happy. Let go of those that only hurt you. Choose friends whose attitudes, values, and habits you admire.
Stay away from all forms of tobacco and other toxic substances.
Get enough sleep. Most people need about eight hours of sleep a night. You know you’re sleeping enough if you awaken refreshed and feel alert throughout the day.
Learn to control stress. Stress is unavoidable and, in limited amounts, good for you. Excessive stress undermines health.
Assess Your Wellness
Earlier, you learned that wellness has at least six components. You’ll feel at your best if you’re satisfying needs in all domains. Many of these areas overlap. For instance, if you have a drinking problem, your health in all areas will decline.
Rather than focus on risk assessment, it can be more motivating to consider your score for preventing illness and promoting your overall well-being. Notice what you’re already doing well.
Examine the following lists, placing a check next to each item that applies to you.
Physical
At each meal, half of my plate is fruits and vegetables.
I avoid highly processed foods (those high in refined grains and added sugar).
I engage in 30 minutes of moderate aerobic exercise (the kind that elevates your heart and breathing rate) most days of the week (for a weekly minimum of 150 minutes).
I do muscle-strengthening exercises two days a week (e.g., lift weights, work with resistance bands or against the resistance of my body weight, yoga, pilates, heavy gardening).
I routinely get enough sleep (I awake feeling refreshed in the morning and feel alert throughout the day).
I rarely feel stressed out.
I don’t smoke or use other tobacco products.
I drink no more than one (if you’re female) or two (if you’re male) alcoholic beverages a day.
I never binge drink (consume five or more drinks at a time if you’re a male, four if you’re a female).
I wear a seatbelt when I’m in a car and a helmet when cycling, skiing, and skating.
I never operate a car or motorcycle under the influence of alcohol or drugs.
I am not sexually active or practice safe sex (consistently use condoms to reduce exposure to sexually transmitted infections and use contraceptives).
I examine my breasts or testicles each month.
I am up to date on immunizations.
I get recommended screening tests (e.g., blood pressure, Papanicolaou [“Pap”] tests).
Emotional
I enjoy my life.
I recognize and accept my emotions.
I can express my emotions to other people in appropriate ways.
I usually feel optimistic.
I appreciate the good things in my life.
I am self-confident.
I have a healthy self-esteem (feel good about myself and believe in my value and worth).
I am able to trust myself and other people.
I take time to relax.
I (would) seek professional help for signs or symptoms of physical or mental illness.
Social
I make friends easily.
I generally get along with people.
I make time to socialize.
I feel supported by friends and family.
I am capable of establishing close bonds with people.
I enjoy giving as much as getting in my social relationships.
I am honest and trustworthy in my relationships.
I am able to ask for help.
Intellectual
I enjoy learning and mastering new skills.
I’m interested in what other people do and think.
I keep up on current affairs through credible news media.
I make decisions calmly.
I solve problems by examining my options and acting accordingly.
I view challenges as learning opportunities.
I learn from my mistakes.
I have a creative pursuit.
I can ask questions when I don’t understand something.
I have a sense of humor.
Spiritual
I have a sense of purpose.
I believe my life has meaning.
I have a strong set of values that help me do right.
I am able to feel compassion for people different from me.
I am able to forgive.
I engage in community service projects or otherwise help others.
I have found an expression of my spirituality (e.g., attending religious services, meditating regularly, spending time in nature, playing music, and creating art).
I feel a part of something greater than myself.
Occupational/Financial
I have a career goal.
I am learning skills that will help me achieve my career goals.
I take academic pursuits seriously.
I am financially secure.
My work gives me a sense of personal satisfaction.
I am able to balance work and play.
I stick to my budget, keeping track of and prioritizing my expenditures.
I’m careful with credit cards, avoiding debt by not overspending and by paying off my monthly charges.
Environmental
I feel safe in my neighborhood.
My personal space makes me feel peaceful and secure.
I can usually sleep without loud noises (or other disturbances) awakening me.
I have ready access to green spaces (city parks, gardens, or natural environments).
My campus provides bins to recycle paper, glass, and plastic—and I use them.
I turn off lights, computers, monitors, and other electrical devices when I leave my room.
I use only as much water as I need.
I never litter.
I believe my efforts to protect the environment matter.
How did you do? No one’s perfect. Most people will have a couple unchecked spaces in each category. Some things aren’t entirely under your control, such as the serenity of your environment and your need to take on financial debt to attend college. In which area do you have the most work to do?
Making Positive Behavioral Changes
We make changes all the time. Many we embrace enthusiastically: learning to drive a car, going to college, adopting a pet, getting married, and becoming a parent. Some habits—those that you do almost reflexively—can be hard to change. That’s especially true if undesirable habits provide immediate gratification or if their absence causes withdrawal symptoms.
Public health experts have long studied what it takes to change health behaviors. During the twentieth century, they tried to understand why people weren’t universally responding to informational campaigns about the risks of smoking, the ruinous effects of alcoholism, and the benefits of vaccinations. Clearly, knowledge alone wasn’t sufficient. If it were, all doctors would be lean, physically fit, and lacking in vices like tobacco use.
Beginning in the 1940s, researchers learned how people made decisions affecting their health and what elements supported successful adoption of positive lifestyle modifications. Since then, scientists have put forth several models to explain how people make behavioral changes. One prominent theory is the Health Belief Model.
Health Belief Model
Developed in the 1950s, the Health Belief Model remains a widely used framework for explaining health behaviors. The model holds that motivation is key to making positive changes. In addition to knowledge, other motivating factors for giving up a bad habit and/or adopting a health behavior include the following:
Perceived susceptibility. You believe you’re vulnerable to diseases or other adverse consequences associated with an undesirable behavior. The following is an example: “All sexually active people are at risk for human papillomavirus. Some strains of the virus cause cancer. A vaccine helps prevent it.”
Perceived severity. You believe the consequences can be dire. Take the following example: “Alcoholism can wreck families and cause cirrhosis of the liver. My uncle was an alcoholic. He lost his job. His wife divorced him. Liver disease turned his skin and the whites of his eyes yellow. He died before he reached sixty.”
Perceived benefits. You believe that positive actions will avert and improve your risks. Here’s an example: “My doctor says that if I eat more vegetables, my blood sugar will be better controlled, and I won’t need as much medication for diabetes.”
Perceived cost-to-benefit ratio. You believe that the benefits of your action will outweigh any costs. For instance, a person might think, “If I quit smoking, I might gain weight. But with the money I’ll save from not buying cigarettes, I could join a gym. If I’m not smoking, it will be easier to exercise. I won’t catch as many colds.”
Four main factors influence the cost-to-benefit analysis:
Perceived barriers to action. These are the things individuals think will make it difficult to adopt and maintain a new behavior. For instance, you want to quit smoking but believe you’re too stressed to take that on right now.
Sense of self-efficacy. Self-efficacy means you believe you have the power to achieve your goals. You also believe that your actions make a difference to your health. Positive self-efficacy furnishes the necessary motivation, confidence, problem-solving skills, determination, and tenacity for long-term lifestyle changes. Past experiences will shade that perception, which is why it helps to remember past successes. Probably years of avoiding sweets, flossing, tooth brushing, and routine dental hygiene have prevented you from having a mouthful of rotted teeth.
Subjective assessment of starting to take action. If you perceive this adventure in a positive light, you’re more likely to persist. Stay alert to encouraging signs. Perhaps you’ve incorporated exercise into your routine. Even before your fitness improves, you might feel more energetic by day, have better mental focus, and fall asleep more easily at night.
Social milieu. Social influences establish norms. If many people around you disdain exercise, eat junk food, smoke, drink heavily, or express negative attitudes, those behaviors start to seem normal. Stepping outside the norm isn’t easy. It helps to hang out with people who have habits that align with your goals, who have already achieved (or are working toward) your goal. Having even one supportive friend can make a big difference.
Transtheoretical Model: Stages for Behavior Change
Precontemplation. At this stage, an individual has no intention of changing. They may be ignorant of or in denial of a problem. Or past failures to change have led to a resigned hopelessness. They may react with resistance or defensiveness to others’ attempts to help. If the individual is conscious of a health threat, they may feel changing isn’t worth the effort or may feel that change may be offset by a disadvantage (“If I quit taking my roommate’s Ritalin, I might not get the grades I need to go to law school.”)
Contemplation. The individual gains awareness, believes they ought to make a change, and intends to take action within six months. They may gather information and weigh the pros and cons of the new behavior—without necessarily doing anything. The Southern expression, “I’m fixin’ to do it,” sums up that stage. Many people become stuck in this stage.
Preparation. The individual makes plans and intends to take action within a month. They have now decided that the pros of making a positive change (e.g., using a condom every time you have sex) outweigh any inconvenience (going to a store and buying the condoms). In addition, the negatives of not modifying the behavior (becoming infected with HIV) outweigh any reluctance to change. The person takes initial steps in the right direction. For instance, someone vowing to begin an exercise program may investigate gym memberships, shop for athletic shoes, or read a book about running.
Action. Behavior shifts. Positive actions continue for six months. The individual goes from smoking a pack to half a pack a day, eats an apple instead of a donut, drinks seltzer water rather than beer, or laces up their sneakers and heads out the door. The individual also overcomes barriers and accesses resources. Maybe the person moves to a substance-free dorm, gets a prescription for a nicotine patch, meets with a nutritionist, works with an athletic trainer, or joins a support group.
Maintenance. At this stage, the behavioral change has lasted over six months. The person figures out ways to resist temptation and otherwise prevent relapse.
Termination. The person has gained complete confidence in this new lifestyle and feels no temptation to relapse. The positive behavior now starts to feel routine and necessary. For instance, someone who has taken up jogging now feels out of sorts when they miss a day, someone who commits to eating more fruits and vegetables loses the desire to eat a bag of pork rinds, and someone who quit smoking now abhors the smell of burning tobacco. You’re probably already at this stage for a number of behaviors—buckling your seatbelt, brushing your teeth, consistently using a condom.
The passage from stage to stage is neither linear nor irreversible. Some stages may be skipped, especially if there’s a sudden sense of urgency. (For instance, a heart attack can belatedly motivate someone to quit cigarettes cold turkey.) And people may relapse, which moves them back a stage or two. Often people cycle back and forth between stages. They take two steps forward, one step back. Sometimes the pros of the positive behavior outweigh cons. Other times, the cons outweigh the pros. For instance, you might decide to give up baked goods for a while. You feel better. But it’s your birthday and a friend has baked you a cake. That doesn’t mean you can’t get back on target the next day.
Changing for the Better: Skills for Success
A number of skills will make you successful in your goals of improving your health and well-being. Here are some specific tips.
Do it for you. You’re more likely to hang in there if you want to change than if you’re trying to please someone else. Tell yourself you’re worth the effort and capable of positive change. After all, these modifications should ultimately make you feel better.
Create precise goals. For instance, wanting to eat better and exercise more is vague. More specific targets include being able to run a half-marathon in three months or having more energy in the afternoons. Review Figure 1.6 for more information on creating precise goals.
Decide where to set the bar. If it’s too high, you’ll become frustrated. If it’s too low, you may not feel inspired. Are you an overachiever or an underachiever? If you tend to be an overachiever, especially if that predisposition typically results in feeling burnout, you may want to start with more modest goals. If you’re a self-identified slacker, why not aim higher? Maybe you’ll surprise yourself.
Post your goals. Put them on your screensaver, write them on bookmarks, or put a note on your refrigerator. Make sure you see them often.
Take it one day at a time. Divide your long-term goal into doable chunks. Go one day without a cigarette. Exercise for thirty minutes today. Eat one breakfast of fruit and yogurt. Wake up each day, ready to recommit to your goal.
Find enjoyable substitutions. Giving something up is harder if something good doesn’t take its place. Find a healthier (more rewarding, more fun) alternative for the behavior you want to quit. If you focus on the new thing (rather than the old habit), you shift from the problem to the solution. For instance, if you want to reduce the time you spend watching videos, you might instead join an intramural sports team, learn to play the harmonica, or help out at a food bank.
Use your strengths and skills. Those assets enable you to scale perceived barriers and resist temptations. Humans too often focus on problems and negative emotions. Instead, make a list of your talents. Perhaps you’re kind, steady, independent, social, and tenacious. All these skills can help you adopt and maintain a new health habit.
Surmount barriers. Tangible roadblocks (not yet having a pair of running shoes) can be relatively easy to identify and solve. Don’t forget about the intangibles—your own attitudes and beliefs. Is your identity tangled up with the behavior you want to switch? Perhaps you have prided yourself on being a “party animal” but now realize carousing into the wee hours isn’t working out well. In order to change, you will need to convince yourself that this new lifestyle suits you better and makes you feel proud. You’re now the kind of person who gets up at 7 a.m., clear-eyed and ready for a jog.
Dodge temptations. Look for the cues with which you associate undesirable habits (coffee and cigarettes, parties and alcohol, television and overeating). Break those associations. Willpower is a finite resource. Eventually, the part of you that wants immediate gratification or relief from cravings will outmuscle your better self.
Inform close friends of your goal. Solicit their support. It can help you persist and feel proud of your achievements. Also, “coming out” with your goals may act as insurance against backsliding. Finding a buddy with the same objective will elevate your commitment.
Create contingency plans for battling temptations and cravings. Will you write in a journal or play music? Take ten slow, deep breaths? Call your support buddy? Go for a walk?
Identify outside resources. The list depends on the goal. Resources might include friends, family, informal support groups, and professionals. Ask for help. You deserve it.
Pay attention to positive signs and symptoms. Maybe you notice that you feel more cheerful and focused after you get a good night’s sleep, more energetic after moderate exercise, more joyous after doing something nice for a friend, and more confident when you make ample time to study for an exam. These are signs of more vitality and success in your life.
Be flexible. Not every day turns out as planned. Relapses happen. If you judge yourself harshly, you may become too consumed with guilt, shame, and hopelessness to get back on track. Turn those negative feelings into motivations. Forgive yourself, but don’t give up on the prize. It’s perseverance that counts, not perfection.
Remember, you are enough—as you are right now. If anyone has told you otherwise, disregard that erroneous opinion. No one’s perfect. Everyone has room for improvement. Just because someone makes straight As, has a flock of adoring friends, or carries a yoga mat around campus—none of these things makes them better than you.
Figure 1.6 S.M.A.R.T. Goals
Set S.M.A.R.T. goals. These points help you set clear expectations to help you achieve your goal.
Source: FlatWorld
Long Description
Specific: The goal is clear, precise, and well-defined. Measurable: The goal has explicit criteria, is manageable, and is quantifiable. Achievable: The goal is something you can reasonably work towards and is an attainable challenge. Realistic: The goal is relevant and not too difficult or too easy. Time-based: The goal has a deadline, a time frame, or an end point.
Behavioral Change Contract
Review your previous answers to the wellness assessment in “Assess Your Wellness”. Pick one thing you feel ready to change now.
Describe the change you want to make. Be as specific as possible. Vague: “I want to eat healthier meals.” Specific: “I will eat a vegetable or fruit with every meal.” Or, “I will eat raw carrots instead of French fries.”
Write down the date you start to adopt this behavior.
Write down the date by which you hope to achieve that goal.
List three short-term goals. For instance, if you plan to run a half-marathon in three months, map out exercise targets for each week. If you plan to eat more fruits and vegetables, write out a sample menu. (Note: Some goals can’t be “chunked.” Buckle your seatbelt each time you get into a car. Use a condom every time you have sex.)
List perceived barriers to this change. Then list your strategies for surmounting each barrier.
List outside resources that will promote your success (books, websites, recreation centers, health center, family, friends, coaches, doctors, therapists, clergy, etc.).
List possible temptations. Then describe a contingency plan for resisting.
Write down your reward for completing your long-term goal.
Provide the name of a buddy to whom you’ll report your progress and call upon when you feel tempted to revert to old habits.
Sign and date the contract to indicate your commitment to your goals and ask a witness or behavior-change buddy to sign as well.
Key Takeaways
Researchers have generated theories to explain how people make health-related decisions. The most prominent theory in health education is the Health Belief Model.
The Transtheoretical Model describes the stages people pass through as they initiate positive behavioral changes.
A number of skills help individuals successfully change their behaviors for the better.
Discussion Questions
Choose an unhealthy behavior you or your peers commonly engage in. Using the Health Belief Model, analyze this behavior according to possible perceptions of susceptibility, severity, benefits, and barriers to change. Examples include not wearing helmets while cycling, binge drinking, smoking, and not using condoms.
Identify a health behavior you’d like to change. Examine the stages of the Transtheoretical Model. Note which stage you’re in now and explain why. What will it take to push you to the next stage?
Around the world, tobacco is a leading preventable cause of death. It contributes to the top killers: heart disease, chronic lung disease, stroke, and many cancers. Why do you think so many people continue to smoke?