describe the benefits of changing to a healthier lifestyle ... · pdf file... you should be...

After reading this chapter, you should be able to:■ Describe the benefits of changing to a healthier

lifestyle.■ Describe the Stages of Change model used in

changing to a healthy lifestyle.■ Design a personal contract for changing a health-

related behavior.

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Focus on Lifestyle

It is important to take a healthy look at your lifestyle. More than half of the leadingcauses of death in this country are preventable.

Actual causes of death reflect lifestyle and behavioral factors, such as smoking andphysical inactivity, that contribute to this nation’s leading killers, including heart disease,cancer, and stroke . By changing these unhealthy behaviors, people canimprove their health and reduce their risk of disease.

Many individuals do not worry about their health until they lose it. Many haveunsuccessfully tried various diets and a succession of exercise programs. This chapteroffers methods, if used, that will enable you to develop a healthier lifestyle by changing ahealth-related behavior.

Figure 1.1

38%

35%

7%

6%

5%

4%

2%2% 1%

Tobacco (38%)

Poor Diet/PhysicalInactivity (35%)

Alcohol Consumption (7%)

Microbial Agents (6%)

Toxic Agents (5%)

Motor Vehicles (4%)

Firearms (2%)

Sexual Behavior (2%)

Illicit Drug Use (1%)

Actual Causes of Death in the United States

Figure 1.1

Physical inactivity and poor diet are catching up to tobacco as actual causes of death in the United States.(Source: Modified from http://www.cdc.gov/nccdphp/factsheets/death_causes2000_access.htm.)

Changing Behavior

It is never very easy to change, and for some individuals, it is extremely difficult. Whydo some people find it so difficult to adhere to a healthy lifestyle while others find iteasier? One answer involves the short-term pleasure of inappropriate behavior and thedelayed nature of its negative health consequences. Some prefer dealing with life byplaying the odds that they will not contract a problem like heart disease or cancer.

Research reveals that good educational programs can increase knowledge and fosterpositive attitudes. However, these factors have not been found to reliably influence long-term behavior change toward healthier lifestyles. While mastery of accurate informationis necessary, it may not sufficiently empower most people to allow them to control theirbehavior. Conversely, the ability to use self-management techniques often helps individu-als make lifestyle changes.

Changing to a Healthy Lifestyle 1

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Prochaska and colleagues developed the Transtheoretical Model of Change, betterknown as the Stages of Change model, which can help us to change a problem behavior(Prochaska, Norcross, and DiClemente, 1994). This model says that people move through aseries of stages of change (some call it a readiness to change). Its authors describe behaviorchange as a process, not an event. Change does not happen overnight—it could take weeks,months, or even years.

In adopting healthy behaviors (e.g., regular physical activity) or eliminatingunhealthy ones (e.g., eating saturated fat), people progress through five stages related totheir readiness for change. At each stage, different intervention strategies help themprogress to the next stage. The five distinct stages are:

1. Precontemplation2. Contemplation3. Preparation4. Action5. Maintenance

Progression through the stages of change is cyclical rather than linear. Rarely does aperson successfully go through the stages sequentially without encountering setbacks.Most people will recycle through the stages several times before being successful (Pro-chaska, Norcross, and DiClemente, 1994). represents the stages of change ina graphical cyclic manner.

After identifying the stage of change you are in (Lab 1-1), the next step is todetermine the appropriate processes of change to be used for the particular stage.These processes have also been referred to as techniques or strategies.

Refer to for the major processes of change. These are activities andexperiences that individuals engage in when they attempt to change a behavior.

matches the processes of changes and the stages of change. The key to successful change is to determine what stage you are in,

and then to decide what processes (strategies) to use. There is no set time frame for each stage; you may spend more time in one stage than another.Change is a process that is uniqueto the individual and situation.

Figure 1.3

Table 1.1

Figure 1.2

2 1

Figure 1.2

Stages of change. (Source: Centers for Disease Control and Pre-vention, National Center for Chronic Disease Prevention andHealth Promotion. (2005). Physical activity for everyone: Gettingstarted. Online: http://www.cdc.gov/nccdpho/dnpa/physical/starting/index.htm.)

Relapsesor slidingbackwardoccasionallyis not unusual

Notready

yet

Maintaining a good thing for life

!

Taking action

Preparing for action

Thinking about it

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Table 1.1 Processes That Promote Change Processes of Change Stages of Change Examples of Techniques

Source: Adapted from Prochaska J. O., Redding C. A., and Evers K. The Transtheoretical Model and Stages of Change, in Health Behavior

and Health Education: Theory, Research, and Practice, Glanz K., Lewis F. M., and Rimer B. K. (eds.), San Francisco: Jossey-Bass, 1996.

Avoid dessert parties; leave encouragingmessages on a calendar or stuck to themirror or refrigerator

ActionMaintenance

Environmental control: avoiding trig-gers or using cues

Take a walk instead of watching TVActionMaintenance

Countering: substituting healthybehavior for an unhealthy behavior

Reward the behavior change (e.g., buyingnew clothes, movie ticket)

ActionMaintenance

Reward: increasing the rewards forpositive behavioral change anddecreasing the rewards for unhealthybehavior

Make a New Year’s resolution; tell othersabout your intentions

PreparationActionMaintenance

Commitment: making a firm commit-ment to change and believing that itcan be done

See yourself as fit ContemplationPreparation

Self-reevaluation: understanding thatyour behavior is how you are known

Personal testimony of someone who hassolved a similar behavioral problem; see-ing someone suffering the harmful conse-quences of his or her unhealthy behavior

ContemplationPreparation

Emotional arousal: emotional experi-ence related to the unhealthy behavior

Discuss your plans with others; join withanother who is working on the behavior

All five stagesHelping relationships: support systemof family, friends, and co-workers

Availability of a health club; restaurantsoffering low-fat/low-carb foods

PrecontemplationContemplationPreparationAction

Social liberation: societal support forthe healthy behavior change

Read news stories or a book; watch a TVprogram; talk with a friend or doctor

PrecontemplationContemplation

Consciousness-raising: increased awareness

Precontemplation Contemplation Preparation Action Maintenance

Consciousness-Raising

Social Liberation

Helping Relationships

Emotional Arousal

Self-Reevaluation

Commitment

Reward

Countering

Environmental ControlFigure 1.3

Select appropriate processes to promote change. (Source: Adapted from Prochaska J. O.,Norcross J. C., and DiClemente C. O. Changing for Good. New York: Quill, 2002. www.changecompanies.net/change_model.htm.)


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In addition to the stages and processes, the Stages of Change model features severalother unique insights.

Weighing Pros and Cons At each stage, a person weighs the pros and cons of adopting a new behavior. To helppeople move toward change, it is necessary to make the pros outweigh the cons. This isespecially true in the precontemplation and contemplation stages.

TemptationChange is difficult and a combination of cravings, emotional stress, and social situations canlead a person back to old habits. Not only is this possible, but it should also be expected.Should you slip or have a setback, do not think of this as a failure, but learn from it. Whatcaused this setback? Now that you have learned this, avoid it next time! Remember: Changeis a cycle that can move both forward and backward. Either way, the process continues!

Stage 1: Precontemplation

Precontemplation is the stage in which you are considering making a change in your life inthe foreseeable future. Others in this stage have tried to change the past, failed, and simplygiven up. Many of us know that it is important to make healthy choices, but in a world fullof temptations and unhealthy alternatives it is often difficult to find the strength to makethose changes in our lives.

Difficulty Living a Healthy LifestylePeople often find it difficult to adhere to a healthy lifestyle of self-control because of:

■ Firmly established habits■ Immediate gratification—people often want instant results or pleasure■ Delayed negative health consequences of an unhealthy lifestyle—it may take years

or even decades before the effects are seen■ Invincibility—“it won’t happen to me” belief in which it is assumed that poor

health happens to others but not me; prefer dealing with life by taking risks orplaying the odds that they will not contract a disease or get injured

■ Too much scientific information, which sometimes overwhelms or confuses■ Fear of failure—often based on past failed attempts■ Feeling a loss of control over one’s life■ Too many choices from which to pick for type of exercise, food, and weight control

Stage 2: Contemplation

The contemplation stage occurs when you are aware that a problem exists and are seri-ously thinking about overcoming it, but have not yet made a commitment to take action.This is a time of reflection. Finding the reasons to change, the motivation to reach a goal,and the strength to make a plan work requires a lot of soul-searching. This stage can takea good amount of time and should not be rushed. As important as it is to make a healthychange in your life, take the time to find what truly motivates you and your behavior.This stage is the key to a successful course of action.

4 1

Ask Yourself• Do I have

health behav-iors I’d like to change?

• Do I participate inactivities that do notpromote health?

• Do I practice behav-iors passed downthrough my family?

The Inside TrackFailure and Change

American society doesnot accept failure. Infact, those who fail areseen as “bad” or “inad-equate.” You mustchange your outlookon failure when itcomes to behavior.There’s an old saying:“without failure, there isno learning.” It maytake many tries, andmany failures, beforeyou find an approachthat works. You mustsimply keep trying!

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What Helps Change a Lifestyle?Factors that influence an individual to change may include:

■ Increasing knowledge—this can influence one’s behavior, but often may not be enoughto influence people to change. The maxim “Why do we do what we do, when we knowwhat we know?” illustrates that knowledge often is insufficient to affect behavior.

■ Motivation, having a reason—a person may want to change to avoid sickness, to lookand feel better, to live longer, or because of pressure from a spouse, child, or friend.

■ Readiness—motivation is required, but may involve physical capabilities as well.Another maxim—“You can lead a horse to water, but you can’t make it drink”—may reflect a lack of motivation or perhaps the physical inability to act for a varietyreasons.

■ Landmark events—resolutions to change often occur at thestart of a new year, during a personal health crisis, on abirthday, upon the birth of a child, or the death of someoneclose to you.

■ Self-management techniques—the ability to employ themhelps individuals to make lifestyle changes.

MotivationMotivation is what drives us to make changes. No matter how big orhow small the change may be, we must be inspired to makechoices. Finding what inspires or motivates you is an essential stepin making a successful adjustment in your lifestyle.

Motivations for change could include:■ Improving self-image and/or self-esteem■ Being a role model for someone else■ Improving relationships with family and peers■ Reducing stress■ Reducing risk of disease

Locus of ControlLife involves many struggles for control. Sometimes external factors can control aspectsof your life for a moment. At other times the power is in your hands. The key to changeis locating what controls a certain behavior. A locus of control is the figurative placewhere a person locates the source of responsibility in his or her life. It can be externalor internal.

An external locus of control could be:■ Believing others’ actions determine your actions■ Environmental factors—weather, location, and so on■ Another person or social group■ Blaming outside influences for your behaviorAn internal locus of control might be:■ Self-expectations■ Internal thoughts (“I can do this”)■ How open one is to change

To create a successful change in your life, you must be the one who takes the responsibil-ity for your actions while developing methods for overcoming external barriers. Individu-als with an internal locus of control are more likely to see their behavior as somethingthey can adapt or change. If you believe it is within your abilities, you may experiencegreater success!

What’s the word. . .What’s the word. . .motivation Theunderlying drive behindmaking changes.

locus of control Thefigurative place wherea person locates thesource of responsibilityfor the events in his orher life.

Ask Yourself• If I were

going tochange a behavior,which ones would Ineed to learn moreabout before I couldchange?

• Where would I findthis information?


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Stage 3: Preparation

The preparation phase combines intention and behavior. Here you will monitor your cur-rent behavior, analyze and identify patterns in your activity, and then set a goal. The mostimportant concept in this stage is honesty. It is easy to try to make your behavior fit a cer-tain pattern or profile. Sometimes the truth isn’t what we want to see, but it is imperativeto set realistic goals and to achieve real changes. When in the preparation stage, individu-als are intending to take action within the next 30 days.

Self-MonitoringSelf-monitoring means observing and recording one’s own behavior. This process is neces-sary to:

■ Make you aware of the size and seriousness of a problem■ Provide a benchmark to compare your original behavior (the point at which you

began to try to change) with your later behaviorBehaviors need recording as they occur, not days later. Self-monitoring devices to

measure the frequency of a behavior include:■ A health notebook, journal, or diary to record the occurrence of a behavior■ Counters to collect data (e.g., pedometers, golf counters)■ Graph paper (horizontal axis represents time—usually days—and vertical axis rep-

resents the amount of the behavior to be changed—body weight, exercise, numberof hours of sleep) Table 1.2

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Table 1.2 Self-Managed Behavior Change Graph

121/212

111/211

101/210

91/29

81/28

71/27

61/26

51/25

41/24

31/23

21/22

11/21

S M T W Th F Sa S M T WTh F Sa S M T W Th F Sa S M T W Th F Sa S M T W Th

Am

ount

: Num

ber

of h

ours

sle

epin

g

Time: Days of the week

Baseline Self-Management

Ask Yourself• Why do I

want to makethis change?

• For whom am Ichanging? If wechoose to change forour own well-beinginstead of trying togarner the attentionof others, we aremore likely to main-tain the progress.

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AnalysisOnce you have gathered your data, sit back and review yourrecord. You are looking for patterns or clues about why andhow you engage in the unhealthy behavior you wish tochange. You should look at the following:

■ Time. When during the day or week do you find your-self resorting to the activity? Is it linked with anotheractivity (e.g., smoking after a meal or with a beer)?

■ Place. Is there a specific place that you tend to beduring the activity (e.g., making unhealthy dietchoices on the way to class)?

■ Reason. Can you link the behavior with a mood or anevent that might trigger it (e.g., indulging in comfortfood before an exam)?

Sometimes these aspects may not be immediately clear. Take a few days to look over yourlog. Remember that you are analyzing your behavior, not you as an individual. Keep apositive outlook—this behavior may be less than perfect, but you are making strides tochange it, and that is more than the majority can say!

Goal SettingAt this point, you have determined the where, when, and why for your behavior in ques-tion. The next step is to set a goal. Don’t rush through this step. You may think that thegoal is obvious, but certain factors must be taken into consideration for this goal to beeffective. It must be:

■ Realistic. While it is good to aim high, watch out for making your goal a bit tooambitious. If you set an unrealistic goal, you will become frustrated along the wayand lose your motivation quickly. Aim for a moderate expectation—one that willchallenge you but is within your ability. Remember that you can always set ahigher goal once you reach this one.

■ Quantitative. Many times people set goals that are very abstract (i.e., wanting tolose weight). That is a fine ambition, but it is not an effective goal. You want yourgoal to be quantitative so that you can track your progress. A more effective goalwould be to lose 10 pounds, or to stretch for 30 minutes three times a week. Try to define your goal in some type of measurable unit: minutes, pounds, number ofservings, percentages, quantities, and so on.

■ Broken down in steps. If you start out thinking that you are aiming toward this onebig goal from the beginning, you will find that it is easy to get discouraged duringthe first few weeks. You need to choose a goal that can be broken down into smallerintermediate steps—mini goals—along the way. For example, if the goal is to stopdrinking soda, perhaps the mini goals could be to cut back to three sodas per day,then two, then one, and so on. Make sure your mini goals are quantitative.

■ Tracked on a timeline. Having the ambition to live a healthy lifestyle is differentthan trying to achieve your goal. The ambition can be carried with you for as longas you want. The goal, however, must have an end date. By using a timeline it iseasier to keep your progress on track. The end date is not the end of the healthybehavior. After you have completed your goal within the time frame you chose, besure to continue practicing the healthy habits until they stick!

■ Important to you. If you do not feel that this goal is important or worthwhile, itwill not be a success. It does not matter how many people tell you that your goal isgreat, you have to believe in it yourself. If you don’t, go back and revise the goaluntil it fits with your expectations and your motivation.

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8 1

PERSONAL CONTRACT

Start Date:

The Goal:

Motivation (benefits):

Identify your current stage of change:

Match your current stage of change and other stages you anticipate progressingthrough with the appropriate processes of change (see Figure 1.3):

Finish Date:

What specific techniques will you use for each of the processes identified above(see Table 1.1)?

Processes Specific techniques

Stage of change on the finish date:

I, , agree to work toward a healthier lifestyle and in doing so shallcomply with the terms and dates of this contract.

Signature:

Witness:

Mini goals Date Reward

Date:

Date:

Figure 1.4

A personal contract to bind yourself to your chosen course of action.

Having a plan and a contract will help further your success as you begin to reachtoward your goal. See a personal contract in .

The PlanThe plan is where you break your goal down into manageable steps. Your plan shouldinclude:

■ What you will need. Do you need a newly stocked cabinet with healthier food? Doyou need a gym membership? What equipment will you need for each of your steps?

■ What is your timeline? When will you start this plan? When is your ending datefor your goal?

■ The steps you will take. Your goal should be broken down into smaller mini goals,each with its own timeline.

Figure 1.4

The Inside TrackGraduated RegimenImplementationStarting a new behavioror stopping a behaviorall at once is difficult.

Graduated programscan shape desiredbehaviors. Example:slowly start exercising.

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Tipping Point

Contracting with Others• Contracting with another person makes the contract a public commitment.

• This person should have a meaningful relationship with you—a roommate, friend, par-ent, or relative, for example.

• Have this person review your contract and sign it as a witness to your new commitment.

• A commitment to friends and family is less likely to be broken than just a personal commitment.

Tipping Point

Rewards• Self-contracting means you establish and administer your own rewards.

• Rewards are meant as motivation to keep the momentum going until you reach yourgoal.

• Rewards should be given immediately and frequently but in moderate amounts.

• Tailor your rewards to your individual taste—make sure they are desirable enough tomotivate you.

• The reward should not be associated with the negative behavior you are trying tochange. For example, if you are trying to lose weight, don’t make your reward a brownie.

Ask Yourself• Who could

I really counton to support mewhen I’m trying tochange behavior?

• What challenges will Iface when I try tochange?

The ContractWrite a contract binding yourself to the chosen course of action. Your contract shouldinclude:

■ Start date Write the date that you will begin your plan.■ Finish date Write the date when you will have completed your goal.■ The goal Be specific and concise.■ Motivation (benefits) Determine what is in it for you.■ Identify your current stage of change.■ Identify the processes (strategies) of change Use Figure 1.3 for each possible

stage of change.■ For each process of change to be used, identify a specific technique. See Table 1.1.■ Identify the stage of change when you finish.■ Mini goals with rewards What are the intervals along the way that will indicate

you are making progress?■ Your signature Sign your name as a sign of your commitment to your plan.■ Witness signature Have a close friend or family member sign your contract as well.

Stage 4: Action

The action stage is where you begin to move toward a healthier behavior. You have yourmotivation, your internal locus of control, and your goal. You are ready to make thischange! Action involves the most observable behavioral changes and requires the greatestcommitments of time and energy.

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Sometimes your energy during the action phase can dwindle down, leaving the suc-cess of your plan vulnerable to barriers.

The five main barriers to successful change are:■ Social impact■ Stress■ Postponing■ Justification■ Denying responsibility

Social ImpactThere can be both positive and negative social impacts on your plan to change a behavior.

Positive social impacts may be in the form of:■ Structured support groups■ Cheerleading by friends and family■ Role models—people around you to whom you respect and admireNegative social impacts may include:■ Feeling like the odd one out■ Peer pressure■ Attending functions that tempt you to break your contract

Let those around you know that you are trying to change this specific behavior. They maybe able to offer tips and suggestions to help you along. More importantly, if you explainyour goals to them, they are more likely to respect your decision and less likely to pres-sure you into relapsing into old behavior patterns.

StressOne of the biggest barriers to changing lifestyle behaviors is stress. Stress can occur any-where in our daily lives and without the correct management techniques it can lead youaway from your goal. Eating comfort food, drinking, and engaging in other reckless behav-ior are common ways that many people deal with stress—none of which are effective or

10 1

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Tipping Point

Dealing with Negative Social Impact• Realize that this is your individual goal. Not everyone around you will have the same

intentions as you.

• Stay committed to your goal. Review your contract before you go out to remind yourselfhow important this change is to you.

• Try to choose healthy alternatives whenever possible.

• Be a role model to others. By sticking with your plan and committing yourself to ahealthier lifestyle, you may motivate others to do the same!

• Have a friend who wants you to push the limits of your goal? Assign that person as yourpersonal coach or cheerleader. By making him or her feel like a responsible party in yourplan, that individual may very well take on a role of support rather than peer pressure!

healthy. Learning effective coping techniques can make it easier for you to stay on trackwith your plan of action and help you to create a better sense of wellness overall. You willcover stress and its impact on your health more completely in Chapter 8.

When life throws curve balls at you, try these helpful tips to calmdown and get back on track:

■ Close your eyes and count to 10. Take deep breaths between eachnumber.

■ Have a CD on hand with calming music. Put it on and focus on themusic for 5 minutes.

■ Keep a journal. Record how you feel; sometimes just getting yourthoughts on paper can help release tension.

■ Go for a short brisk walk. The change of scenery and fresh air canrenew your mood.

■ Stop, stretch your muscles, and breathe deeply.

PostponementAfter that initial surge of motivation in the beginning of the action phase, it can get diffi-cult to muster the energy to continue to make the healthy choices. Many times the stepsto reaching your goal get pushed aside or postponed until a later point in time. It is bestto stop the procrastination as soon as you feel yourself slipping into that mindset.

When you realize that you are postponing a step in your plan:■ Stop and identify out loud that you are procrastinating.■ Try to pin down why you are avoiding that particular step. For example, is cold

weather causing you to avoid going to the gym? Or is that healthy dish too time-consuming to make?

■ Once you have identified why you are postponing a particular step, try to revisethat step to fit better with your life. For example, buy a few exercise DVDs forworking out at home when the weather is bad. Or, find simpler recipes that stilloffer the same nutritional value.

JustificationMany times when we procrastinate we justify or rationalize our actions. We make excusesfor why we have not completed the task. It is important to catch yourself if you find thatyou are justifying not meeting your goal or one of your steps. Your plan may quickly

What’s the word. . .What’s the word. . .stress The physicaland emotional tensionthat comes from situa-tions the body per-ceives as threatening.

procrastinationPushing a task to alater point in time.

rationalizationMaking excuses for notcarrying out a task.

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12 1

Tipping Point

Avoiding Procrastination• Mark your calendar, daily planner, or appointment book.

• Leave messages on the refrigerator, bulletin board, or wall calendar; next to the bed; oron the bathroom mirror.

• Set your alarm, enter your goal in your computer, or have a friend call you.

What’s the word. . .What’s the word. . .blaming Placing theresponsibility of anunmet goal on someone else.

become a slippery slope where nothing is accomplished, but everything is rationalized.When you feel yourself making excuses:

■ Say your excuse out loud and listen—is it credible?■ Write down those times when you push your task off and explain why you did so.

If you find yourself falling off course with your goal, these logs will provide a goodresource describing when and why you aren’t meeting each step.

■ Understand that there will be times when you can’t complete a step that second.Make sure that you are justifying the valid procrastinations, not the ones made outof low motivation.

Denying ResponsibilityAlong with justification can come blaming. Blaming occurs when you displace the respon-sibility for missing a step or not completing a goal onto someone else (external locus ofcontrol). Because of him/her/them or what they did, the goal was not met. This is an easytrap to fall into because it is convenient and gives the appearance that you are not atfault. No matter how good blaming looks on paper, it will not help you reach your goal.You will still be left with an unfinished plan. It is important to accept responsibility foryour own actions.

Stage 5: Maintenance

After at least 6 months in the action stage, the person may move into the fifth stage:maintenance. This phase is when you keep up the new healthier habits that have replacedthe old habits without much worry of returning to the old behavior. Change is main-tained more easily now. There may be an initial excitement associated with making a

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change in which your motivation and commitment will both be high and the outlooktoward your goal is positive.

Many of the activities used in the maintenance phase are the same as you’ll use if youare in the action phase, just with small adaptations. For instance:

■ Rewards You still need to set reward dates; however, they are more distant and therewards should become smaller as the behavior becomes more natural.

■ Environmental control Once the first set of influences is overcome, new challengescan be established.

Issues to Face in MaintenanceRelapseRelapse can occur at any stage of the change process. It can be triggered by many things:an extra stressful day or week, an unexpected event, low levels of motivation. If you findyourself relapsing along the way, try to identify a reason. Are you losing motivation? Isyour plan unrealistic? Do you not have the right equipment or facilities?

This is a process; nothing is set in stone. You have the freedom to go back and reviseyour goal at any time. Don’t be afraid to reevaluate your plan. If something is not work-ing for you, find alternatives that will still help you change the behavior. Most impor-tantly: Do not give up! A relapse is normal—it doesn’t mean that you will never completeyour goals. It is a minor setback that can be overcome.

AcceptanceAcceptance is the finish line. The old unhealthy behavior has been fully replaced at thispoint. Not only have you completed your goal, but you have also integrated healthyhabits into your daily routine. Be aware that this stage may not come quickly. Achievingyour goal and dealing with relapses may take a long while, but your healthy new lifestyleis definitely worth it.

Conclusion

Lifestyle change is a process that involves many steps and a lot of persistence. Althoughnot recommended, it is possible to have multiple changes taking place at once. Thechapters in this text provide a wealth of information on many different aspects ofhealthy living. By incorporating each topic into your daily life, you will be workingtoward a more rounded sense of wellness.


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14 1

Reflect Reinvigorate Reinforce Knowledge CheckAnswers in Appendix D

1. What is the first stage of change? A. PreparationB. Precontemplation C. Action

2. An effective plan for changing a behavior should have:A. The steps to be takenB. How long it will lastC. List of items neededD. All of the above

3. Which factors influence a person to change?A. Obtaining more knowledgeB. The ability to use self-management skillsC. Having a reasonD. All of the above

For each of the following, identify which stage of change the person is in, two strategiesthat may move the person to the next stage, one significant barrier the person may face,and a method to overcome that barrier.

4. Experiencing an episode or time frame when current behavior goes back to previ-ously discontinued behavior is called:A. MaintenanceB. RelapseC. ActionD. Acceptance

5. When an individual makes excuses for not taking action on an issue, he or she is saidto be:A. In denialB. PreparingC. ProcrastinatingD. In action

6. Lateisha has researched the benefits of becoming active. She has developed a schemeto move forward and is scheduled to begin taking steps in 2 weeks. What stage isLateisha in?A. ContemplationB. PreparationC. ActionD. Maintenance

7. The individual behavior responsible for more deaths than any other behavior is:A. Alcohol consumptionB. Use of illegal drugsC. Irresponsible sexual behaviorD. Tobacco use

8. The strategy that substitutes a healthy behavior for an unhealthy one is called:A. ReinforcementB. Self-evaluationC. CounteringD. Emotional arousal

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Modern ModificationsThe chapters in this text illustrate a wide variety of the important aspects of a healthylifestyle. In each chapter there will be a section in which you will be given a chance to:

■ Take a moment to look at your lifestyle in the terms of the topic discussed. Whatwould you like to change in that area of your life?

■ Go through and pick one of the suggestions provided. These suggestions are meantto be easily absorbed into your daily routine and offer immediate opportunities forchange.

■ Congratulate yourself. You are one step closer to a happier healthier lifestyle. Evensmall changes can make a big difference!

Critical ThinkingTake a moment to analyze these situations:

1. Angela had been involved in ballet for many years, and she now wants to begin danc-ing again. She knows she lacks the flexibility to do so, but is willing to work on it—she just isn’t sure how.

2. Max has been smoking since he was 12 (he is now 22). He looks forward to that firstdrag in the morning and is unconcerned with all the “hype” about cancer. Everyonein his family smokes and no one has ever gotten cancer!

Going Above and BeyondWebsitesMedlinePlus: Exercise and Physical Fitnesshttp://www.nlm.nih.gov/medlineplus/exercisephysicalfitness.htmlPhysician and Sports Medicinehttp://www.physsportsmed.comMorbidity and Mortality Weekly Reporthttp://www.cdc.mmwr.govTranstheoretical Model www.uri.edu/research/cprc/transtheoretical.htm

References and Suggested ReadingsMarcus B., et al. Assessing motivational readiness and decision-making for exercise.

Health Psychology 1992; 22:257–261.Prochaska J. O. Strong and weak principles for progressing from precontemplation to

action on the basis of twelve problem behaviors. Health Psychology 1994; 13:47–51.Prochaska J. O. and Markus B. H. The Transtheoretical Model: Applications to Exercise,

in Advances in Exercise Adherence, Dishman R. K. (ed.), Champaign, IL: Human Kinetics, 1994.

Prochaska J. O., Norcross J. C., and DiClemente C. O. Changing for Good. New York:HarperCollins Publishers, 1994. Reprinted by Quill, 2002.

Prochaska J. O. and Velicer W. F. The transtheoretical model of health behavior change.American Journal of Health Promotion 1997; 12:38–48.

U.S. DHHS. Healthy People 2010. Washington, DC: DHHS, 2000.———. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: DHHS,

1996.Zimmerman G. L., et al. A “Stages of Change” approach to helping patients change behavior.

American Family Physician, March 1, 2000: American Academy of Family Physicians.

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