Ebook PDF An Invitation To Health Taking Charge of Your Health 19th Edition

(eBook PDF) An Invitation to Health:
Taking Charge of Your Health 19th

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Copyright 2021 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Autism Spectrum Disorder 58 Transactional or Cognitive-Relational Model 82
ASD on Campus 58 Yerkes-Dodson Law 82
Schizophrenia 58 The Impact of Stress 83
Self-Injury and Suicide 59 Stress and the Heart 83
Suicide on Campus 59 Stress and Immunity 84
Risk Factors 60 Stress and the Gastrointestinal System 84
Overcoming Problems of the Mind 61 Stress and Cancer 84
Self-Care Strategies 61 Other Stress Symptoms 84
Eating Right 61 Managing Stress 85
Exercise 62 Journaling 85
Books and Websites 62
Exercise 85
Routes to Relaxation 85
Virtual Support 62
Meditation and Mindfulness 86
Peer Support 62 Yoga 87
Where to Turn for Help 62 Resilience 87
Types of Therapists 63
Choosing a Therapist 64 Stress Prevention: Taking Control of Your Time 88
Types of Therapy 64 Time Management 88
Overcoming Procrastination 89
Psychodynamic Psychotherapy 64
Interpersonal Therapy 64
Managing Your Money 89
Other Treatment Options 64 Financial Homeostasis 90
Organizing Basics 90
Psychiatric Drugs 64
Making a Budget 91
Alternative Mind—Mood Products 65
Personal Finances 101 92
Taking Charge of Your Health 65 • Self-Survey 66 • Review Your Credit Score 92
Questions 66 Banking Basics 92
Avoid Debit and Credit Card Stress 93
Chapter 4 Digital Financial Management 94
Stress Management 69 Protect Your Private Information 94
What Is Stress? 69 Taking Charge of Your Health 95 • Self-Survey 96 • Review
Eustress, Distress, and Neustress 70 Questions 96
Stress and the Dimensions of Health 71
Physical 71 Chapter 5
Psychological 71 Personal Nutrition 99
Spiritual 71
Dietary Guidelines for Americans 100
Social 71
The Building Blocks of Good Nutrition 100
Intellectual 71
Water 101
Occupational 71 Protein 102
Environmental 71 Protein Sources 103
Types of Stressors 71 Carbohydrates 103
Stress in America 72 Fiber 104
Stress on Campus 73 Gluten 104
Stress and Student Health 73 Glycemic Index and Glycemic Load 104
Gender Differences 73 Low-Carb Foods 105
Students under Age 25 74 Refined Grains 105
Students over Age 25 74 Fats 105
Minority Students 75 Vitamins 106
Entering Freshmen 75 Folic Acid 107
Test Stress 76 Vitamin D 107
Other Stressors 76 Minerals 107
Financial Stress 76 Calcium 108
Occupational Stress 77 Sodium 108
Burnout 77 Calories 108
Illness and Disability 77 Alcohol 109
Traumatic Life Events 78 Healthy Eating Patterns 109
Acute Stress Disorder 78 MyPlate 109
Posttraumatic Stress Disorder 79 The USDA Food Patterns 110
Inside Stress 79 The DASH Eating Plan 110
General Adaptation Syndrome 79 The Mediterranean Diet 110
Fight or Flight 80 Vegetables and Fruits 111
Freezing 80 Vegetarian Diets 112
Submission 81 Ethnic Cuisines 113
Challenge Response Model 81 Campus Cuisine: How College Students Eat 114
Tend-and-Befriend Model 81 Nutrition Knowledge 114
vi Contents
Copyright 2021 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Fast Food: Eating on the Run 114 Compulsive Overeating 143
You Are What You Drink 114 Binge Eating 144
Soft Drinks 115 Eating Disorders 144
Energy Drinks 115 Anorexia Nervosa 145
Choosing Healthful Snacks 116 What Causes Anorexia Nervosa? 145
Taking Charge of What You Eat 117 Health Dangers and Treatment 145
Portions and Servings 117 Bulimia Nervosa 146
Nutrition Labels 117 What Causes Bulimia Nervosa? 146
What Is an “Organic” Food? 117 Health Dangers and Treatment 147
Genetically Engineered Foods 118
Dietary Supplements 119 Taking Charge of Your Health 147 • Self-Survey 148 • Review
Questions 148
Food Safety 119
Fight BAC! 120 Chapter 7
Avoiding E. Coli Infection 120
Food Poisoning 120 Physical Activity and Fitness 151
Pesticides 121 The Dangers of Inactivity 152
Food Allergies 121 Physical Activity and Fitness 152
Nutritional Quackery 121 Fitness and the Dimensions
of Health 153
Taking Charge of Your Health 122 • Self-Survey 122 • Review
Working Out on Campus 153
Questions 124
Physical Activity and Exercise 154
Chapter 6 The Benefits of Exercise 154
Longer and Healthier Life 154
Weight Management and the Obesity Healthier Heart and Blood Vessels 155
Epidemic 127 Healthier Lungs 156
Obesity in America 127 Protection against Cancer 157
Weight on Campus 128 Better Bones 157
Body Composition 130 Lower Weight 157
Body Mass Index 130 Better Mental Health and Functioning 157
Waist Circumference 131 Benefits for Students 157
Waist-to-Hip Ratio 131 Brighter Mood and Less Stress 158
Measuring Body Fat 132 A More Active and Healthy Old Age 158
Skinfold Measurement 132 Enhanced Sexuality 158
Home Body Fat Analyzers 132 Exercise Risks 158
Laboratory Methods 132 Physical A
ctivity Guidelines for Americans 159
Understanding Weight Problems 133 How Much Exercise Is Enough? 160
How Did So Many Get So Fat? 133 Your Exercise Prescription 161
Health Dangers of Excess Weight 133 The Principles of Exercise 161
The Impact on the Body 134 Overload Principle 161
Other Health Problems 135 FITT 162
Premature Death 135 Frequency 162
The Emotional and Social Toll 135 Intensity 162
If You’re Too Thin: How to Gain Weight 135
Time (Duration) 162
A Practical Guide to a Healthy Weight 136 Type (Specificity) 162
Understanding Why We Overeat 136 Reversibility Principle 162
Preventing Weight Gain 136
Weight Loss Diets 136 Improving Cardiorespiratory Fitness 163
High-Protein Diets 137 Monitoring Exercise Intensity 163
Low-Carbohydrate, Low-Fat Diets 137
High-Tech Gadgets 163
Nontech Methods 164
Low-Carbohydrate, High-Fat Diets 137
Target Heart Rate 164
The Bottom Line 137
The Karvonen Formula 164
Do Weight Loss Programs Work? 138
Physical Activity and Exercise 138 Rating of Perceived Exertion 165
Complementary and Alternative Medicine for Obesity 139 Designing an Aerobic Workout 165
Common Diet Traps 139 Warm-up 165
Maintaining Weight Loss 140 Aerobic Activity 165
Treating Severe Obesity 140 Cooldown 165
Obesity Medications 140 Your Long-Term Fitness Plan 165
Obesity Surgery 141 Aerobic Options 166
Unhealthy Eating on Campus 141 Stepping Out: Walk the Walk 166
Body Image 142 America on the Move 166
“Fat Talk” 142 Jogging and Running 167
Disordered Eating 143 High-Intensity Interval Training 167
Extreme Dieting 143 Other Aerobic Activities 168
Contents vii
Building Muscular Fitness 169 Loving and Being Loved 201
Muscles at Work 169 Intimate Relationships 201
Designing a Muscle Workout 171 What Attracts Two People to Each Other? 202
Free Weights versus Machines 171 Infatuation 202
Recovery 171 The Science of Romantic Love 202
Core Strength Conditioning 172 A Psychological View 202
Muscle Dysmorphia 173 An Anthropological View 203
Drugs Used to Boost Athletic Performance 173 A Biochemical View 203
Becoming More Flexible 174 Mature Love 203
The Benefits of Flexibility 174 Dysfunctional Relationships 203
Stretching 176 Intimate Partner Violence 203
Stretching and Warming Up 176 Emotional Abuse 204
Stretching and Athletic Performance 176 Codependency 205
Mind-Body Approaches 177 Signs of Codependency 205
Yoga 177 Enabling 205
Pilates 177 When Love Ends 205
T’ai Chi 178 Partnering across the Lifespan 206
Keeping Your Back Healthy 178 The New Transition to Adulthood 206
Evaluating Fitness Products and Programs 178 Cohabitation 207
Exercise Equipment 178 Long-Term Relationships 207
Athletic Shoes 179 Marriage 208
Barefoot Running and A
lternative Running Shoes 179 Preparing for Marriage 208
Fitness Centers 180 The Benefits of Marriage 208
Sports Nutrition 181 Same-Sex Marriage 209
Water 181 Issues Couples Confront 209
Sports Drinks 181 Money 209
Dietary Supplements 182 Sex 210
Energy Bars 182 Extramarital Affairs 210
Safe and Healthy Workouts 182 Two-Career Couples 210
Temperature 183 Conflict in Marriage 211
Heat Cramps 183 Saving Marriages 211
Heat Syndromes 183 Divorce 211
Heat Exhaustion 183 Family Ties 212
Heat Stroke 183 Diversity within Families 212
Protecting Yourself from Cold 183 Unmarried Parents 213
Exercise Injuries 184 Taking Charge of Your Health 214 • Self-Survey 214 • Review
PRICE 184 Questions 216
Overtraining 184
Exercise Addiction 185 Chapter 9
Taking Charge of Your Health 186 • Self-Survey 186 • Review Sexual Health 219
Questions 187 Sexual Health 220
Sexuality and the Dimensions of Health 220
Chapter 8 Biological Sex 220
Communicating and Connecting 191 How Hormones Work 221
The Social Dimension of Health 191 Women’s Sexual Health 222
Communicating 192 Female Sexual Anatomy 222
Learning to Listen 193 The Menstrual Cycle 223
Being Agreeable but Assertive 193 Premenstrual Syndrome 225
How Men and Women Communicate 193 Premenstrual Dysphoric Disorder 226
Men 194 Menstrual Cramps 226
Women 194 Amenorrhea 226
Nonverbal Communication 194 Toxic Shock Syndrome 226
Forming Relationships 194 Men’s Sexual Health 226
Friendship 195 Male Sexual Anatomy 226
Loneliness 195 Circumcision 227
Shyness and Social Anxiety Disorder 195 The Gender Spectrum 228
Building a Healthy Community 196
Responsible Sexuality 229
Doing Good 197
Creating a Sexually Healthy Relationship 229
Living in a Wired World 197 Making Sexual Decisions 229
Social Networking on Campus 197 Saying No to Sex 231
Self-Disclosure and Privacy in a Digital Age 199
Sexual Behavior 231
Digital Dating 199
Sexual Initiation: “Having Sex” for the First Time 232
Problematic Smartphone and Internet Use 200
Sex on Campus 233
viii Contents
Hooking Up 233 Contraceptive Vaginal Ring 266
Friends with Benefits 234 Long-Acting Reversible Contraceptives 267
Choosing Sexual Partners 234 Intrauterine Device 267
Romantic Relationships 234 Contraceptive Injection 268
Ethnic Variations 234 Contraceptive Implant 268
Sex in America 235 Barrier Contraceptives 269
Sexual Diversity 235 Condoms 270
Heterosexuality 236 Male Condom 270
Bisexuality 236 Female Condom 271
Homosexuality 236 Contraceptive Sponge 272
Roots of Homosexuality 237 Vaginal Spermicides and Film 273
Coming Out 237 Diaphragm 273
Sexual Activity 237 Cervical Cap 274
Celibacy 237 FemCap 274
Abstinence 238 Fertility Awareness and Digital Birth
Fantasy 238 Control 275
Pornography 239 Digital Birth Control 276
Masturbation 239 Emergency Contraception 276
Nonpenetrative Sexual Activity (Outercourse) 240 Sterilization 277
Intercourse 240 Male Sterilization 277
Oral Sex 240 Female Sterilization 278
Anal Stimulation and Intercourse 241 When Pregnancy Occurs 279
Sexual Response 241 Unwanted Pregnancy 279
Excitement 242 Abortion 279
Plateau 242 The Psychological Impact of Abortion 280
Orgasm 242 The Politics of Abortion 280
Resolution 242 Pregnancy 281
Other Models of Sexual Response 242 Preconception Care 281
Sexual Concerns 243 Home Pregnancy Tests 282
Sexual Difficulties and Dysfunctions 243 Prenatal Care 282
Erectile Dysfunction 244 A Healthy Diet 282
Orgasm Problems in Men 245 Exercise 282
Female Sexual Dysfunction 245 Avoid Smoking and Smoke 282
Sex Therapy 246 Don’t Use Alcohol or Drugs 282
Drugs and Sex 246 A Woman’s Bodily Changes During
Atypical Behavior 246 Pregnancy 282
Sexual Addiction 246 Neonatal Development 283
Sexual Deviations 247 Complications of Pregnancy 283
The Business of Sex 247 Ectopic Pregnancy 284
Miscarriage 284
Infections 284
Questions 249
Zika Virus 284
Chapter 10 Genetic Disorders 284
Reproductive Options 253 Preterm Labor 285
Childbirth 285
Reproductive Responsibility 253
Preparing for Childbirth 285
Conception 254
Labor and Delivery 285
Abstinence and Nonpenetrative Sexual Activity 255 Cesarean Birth 286
Contraception 256 Infertility 286
The Benefits and Risks of Contraceptives 256 Options for Infertile Couples 287
Birth Control in America 260
Artificial Insemination 287
Reproductive Coercion 261
Assisted Reproductive Technology 287
Contraception Choices 261 Transgender Individuals 287
Birth Control on Campus 261
Adoption 287
Hormonal Contraceptives 263
Oral Contraceptives 263 Taking Charge Of Your Health 288 • Self-Survey 288 • Review
Combination Oral Contraceptives 263 Questions 289
Progestin-Only Pills 264
Chapter 11
Before Using Oral Contraceptives 264
A Special Caution 264 Sexually Transmitted Infections 291
Long-Acting Oral Contraceptives 265 Sexually Transmitted Infections and Diseases 292
Seasonale and Seasonique 265 Zika Virus 292
Lybrel, the “No-Period” Pill 265 Risk Factors for Sexually Transmitted Infections 293
Contraceptive Patch 266 Screening for Sexually Transmitted Infections 295
Contents ix
The ABCs of Safer Sex 295 Waist Circumference 317
A Is for Abstain 295 Physical Inactivity 318
B Is for Be Faithful 295 Prolonged Sitting 318
C Is for Condoms 296 Healthy Diet 318
STIs and Gender 296 Tobacco Use 318
If You Are a Woman 296 High Blood Glucose 318
If You Are a Man 297 High Blood Pressure (Hypertension) 318
STIs on Campus 297 Lipoprotein Levels 319
What College Students Don’t Know about STIs 298 Risk Factors You Can’t Control 319
Common STIs and STDs 298 Family History 319
Human Papillomavirus 298 Race and Ethnicity 319
Incidence 299 Socioeconomic Status 320
HPV Vaccination 299 Age 320
HPV Vaccination on Campus 300 Height 320
Signs and Symptoms 300 Metabolic Syndrome 320
Diagnosis and Treatment 300 Who Is at Risk? 320
Genital Herpes 300 What Are the Signs? 321
Incidence 301 Diabetes 321
Signs and Symptoms 301 Insulin Resistance 321
Diagnosis and Treatment 301 Prediabetes 322
Chlamydia 302 Diabetes Mellitus 322
Incidence 302 Who Is at Risk? 322
Signs and Symptoms 302 Types of Diabetes 323
Diagnosis and Treatment 303 Type 1 Diabetes 323
Pelvic Inflammatory Disease 303 Type 2 Diabetes 323
Incidence 303 Gestational Diabetes 324
Signs and Symptoms 303 Detecting Diabetes 324
Diagnosis and Treatment 303 Diabetes Signs and Symptoms 324
Gonorrhea 303 Diabetes Management 324
Incidence 303 Treatment 325
Signs and Symptoms 303 Hypertension 325
Diagnosis and Treatment 304 Hypertension in the Young 326
Nongonococcal Urethritis 304 Who Is at Risk? 327
Syphilis 304 What Your Blood Pressure Reading
Incidence 305 Means 327
Signs and Symptoms 305 Monitoring Your Blood Pressure 328
Diagnosis and Treatment 305 Lowering High Blood Pressure 328
Chancroid 305 Reducing Sodium 328
Pubic Lice and Scabies 306 The DASH Eating Pattern 328
Trichomoniasis 306 Exercise 328
Bacterial Vaginosis 306 Medications 328
HIV and AIDS 306 Your Lipoprotein Profile 328
Incidence 307 What Is a Healthy Cholesterol Reading? 329
Who Is at Risk? 307 Lowering Cholesterol 329
Reducing the Risk of HIV Transmission 308 Lifestyle Changes 329
Sexual Transmission 308 Medications 330
Nonsexual Transmission 309 Cardiovascular (Heart) Disease 331
Preventing HIV Infection 309 How the Heart Works 331
Recognizing and Treating HIV/AIDS 309 Heart Risks on Campus 332
HIV Testing 310 Psychosocial Risk Factors 333
Diagnosing AIDS 310 Stress 333
Prevention and Protection 310 Depression 333
Treatment 310 Anger and Hostility 334
Taking Charge of Your Health 311 • Self-Survey 311 • Review Personality Types 334
Questions 313 The Power of Positive Emotions 334
Other Risk Factors 334
Chapter 12 Inflammation and C-Reactive Protein 334
Major Diseases 315 Homocysteine 335
Your Cardiometabolic Health 316 Illegal Drugs 335
Cardiometabolic Risk Factors 316 Bacterial Infection 335
Risk Factors You Can Control 317 The Heart of a Woman 335
Overweight/Obesity 317 Coronary Artery Disease 336
Body Fat 317 Atherosclerosis 336
x Contents
Heart Attack (Myocardial Infarction) 336 Influenza 370
Is It a Heart Attack? 337 H1N1 Influenza (Swine Flu) 371
Cardiac Arrest 337 The Threat of a Pandemic 371
Saving Hearts 337 Meningitis 371
Stroke 338 Preventing Meningitis 372
Who Is at Risk? 338 Recognizing Meningitis 372
Types of Stroke 339 When to Seek Medical Care 373
Silent Strokes 339 Hepatitis 373
Transient Ischemic Attacks 339 Hepatitis A 373
The Effects of Stroke on the Brain 339 Hepatitis B 373
Why Quick Treatment Matters 339 Who Develops Hepatitis B? 374
Cancer 341 Hepatitis C 374
Understanding Cancer 341 Other Infectious Illnesses 375
Who Is at Risk? 342 Epstein-Barr Virus and Infectious
Heredity 342 Mononucleosis 375
Racial and Ethnic Groups 342 Myalgic Encephalomyelitis/Chronic Fatigue
Obesity 343 Syndrome (ME/CFS) 375
Carcinogens 344 Herpes Gladiatorum (Mat Herpes, Wrestler’s Herpes, Mat
Common Types of Cancer 344 Pox) 375
Skin Cancer 344
Tuberculosis 376
The “Superbug” Threat: MRSA 376
Breast Cancer 346
Preventing MRSA 376
Cervical Cancer 349
Who Is at Highest Risk? 376
Ovarian Cancer 350
Testicular Cancer 350 Insect- and Animal-Borne Infections 377
Lyme Disease 377
Colon and Rectal Cancer 351
West Nile Virus 377
Prostate Cancer 351 Zika Virus 377
Other Major Illnesses 352 Transmission 378
Epilepsy and Seizure Disorders 352 Symptoms 378
Asthma 352
Diagnosis and Treatment 378
Ulcers 353
Prevention 378
Taking Charge of Your Health 354 • Self-Survey 355 • Review Avian Influenza 378
Questions 356 Emerging Infectious Diseases 378
SARS 378
Chapter 13 Ebola 379
Infectious Diseases 359 Smallpox 379
Understanding Infection 360 Reproductive and Urinary Tract Infections 379
Agents of Infection 360 Vaginal Infections 379
Viruses 360 Urinary Tract Infections 380
Bacteria 361 Taking Charge of Your Health 381 • Self-Survey 381 • Review
Fungi 361 Questions 382
Protozoa 361
Helminths (Parasitic Worms) 361 Chapter 14
How Infections Spread 362 Consumer Health 385
Animals and Insects 362 Health Insurance 386
People 362 The Affordable Care Act 386
Food 362 How Health Insurance Works 386
Water 362 What You Need to Know 387
The Process of Infection 362 Consumer-Driven Health Care 388
Who Develops Infections? 362 Evidence-Based Medicine 388
How Your Body Protects Itself 363 Outcomes Research 388
Immune Response 364 Personalizing Your Health Care 388
Immunity and Stress 365 Your Family Health History 389
Immunity and Gender 365 Gender Differences 389
Immune Disorders 366 Mobile Health (mHealth) Apps and Monitors 389
Allergic Rhinitis 366 Self-Care 390
Autoimmune Disorders 366 Oral Health 391
Immunization 367 Becoming a Savvy Health-Care Consumer 392
Childhood Vaccinations 367 Making the Most of a Medical Visit 392
Adult Vaccinations 367 Scheduling the Appointment 392
Upper Respiratory Infections 368 Before Your Appointment 392
Common Cold 368 At Your Appointment 393
Preventing Colds 369 The Physical Examination 393
Antibiotics 370
Contents xi
Talking with Your Health-Care Provider 393 Medications 422
After Your Visit 394 Over-the-Counter Drugs 422
Diagnostic Tests 395 Prescription Drugs 423
Screening Tests 395 Physical Side Effects 423
Preventing Medical Errors 396 Psychological Side Effects 423
Your Medical Rights 397 Drug Interactions 424
Your Right to Be Treated with Respect and Dignity 397 Drugs and Alcohol 424
Your Right to Information 397 Generic Drugs 424
Your Right to Privacy and Access to Medical Buying Drugs Online 424
Records 397 Substance Use Disorders 425
Your Right to Quality Health Care 398 Dependence 425
Elective Treatments 398 Misuse 425
Vision Surgery 398 Intoxication and Withdrawal 425
When Is Vision Surgery Not for You? 398 Polyabuse 425
Cosmetic Surgery 399 Coexisting Conditions 426
Body Art Perils 399 Causes of Substance Use Disorders 426
Health Hoaxes and Medical Quackery 400 The Neurobiology of Dependence 426
Nontraditional Health Care 400 The Psychology of Vulnerability 426
Types of CAM 401 The Opioid Epidemic 427
Alternative Medical Systems 401 How the Epidemic Started 427
Mind–Body Medicine 402 The Impact of the Epidemic 427
Biologically Based Therapies 403 Who Is at Risk? 428
Manipulative and Body-Based Methods 403 Recovery 428
The Health-Care System 404 Prescription Drug Abuse 428
Health-Care Practitioners 404 Prescription Drugs on Campus 429
Physicians 404
Prescription Stimulants 429
Prescription Painkillers 430
The Health-Care Team 405
Dentists 405
Commonly Abused Drugs 430
Cannabinoids 430
Chiropractors 405
CBD 431
Health-Care Facilities 405
Risks and Potential Health Consequences 431
College Health Centers 405
Medical Marijuana 433
Outpatient Treatment Centers 405
Legalized Marijuana 433
Hospitals and Medical Centers 406
Dependence 433
Emergency Services 406
Withdrawal 433
Inpatient Care 406
Herbal Drugs 433
Home Health Care 406
Salvia 433
Taking Charge of Your Health 407 • Self-Survey 407 • Review Khat 434
Questions 408 Synthetic Designer Drugs 434
Synthetic Marijuana 434
Chapter 15 Synthetic Cathinone 434
Addictive Behaviors and Drugs 411 Club Drugs 435
Understanding Addiction 412 Ecstasy 436
Addiction and the Dimensions of Health 412 Herbal Ecstasy 437
Preventing Addictions 413 GHB and GBL 437
Gambling and Behavioral Addictions 413 Nitrites 437
Problem Gambling 414 Stimulants 437
Gambling Disorder 414 Amphetamines 437
Gambling on Campus 415 Methamphetamine 438
Risk Factors for Problem Gambling 415 Cocaine 440
Drug Use on Campus 415 Depressants 442
Why Students Don’t Use Drugs 416 Benzodiazepines and Barbiturates 442
Why Students Use Drugs 416 Opioids 443
Understanding Drugs and Their Effects 417 Fentanyl 444
Routes of Administration 418 Hallucinogens 444
Dosage and Toxicity 418 Dissociative Drugs 445
Individual Differences 418 Ketamine 445
Gender and Drugs 419
PCP 445
Setting 419
Inhalants 446
Types of Action 419
Interaction with Other Drugs or Alcohol 419 Treatment of Substance Dependence and Misuse 447
Principles of Drug Addiction Treatment 447
Caffeine and Its Effects 419
12-Step Programs 447
Caffeine Intoxication 421
Relapse Prevention 448
Caffeine-Containing Energy Drinks 421
xii Contents
Taking Charge of Your Health 449 • Self-Survey 449 • Review Alcoholism’s Impact on Relationships 478
Questions 450 Growing Up with an Alcoholic Parent 478
Adult Children of Alcoholics 478
Chapter 16
Alcohol 453 Questions 480
Drinking in America 454
Why People Don’t Drink 454 Chapter 17
Why People Drink 454 Tobacco 483
Drinking on Campus 455 Tobacco Use in America 484
Why Students Don’t Drink 456 Why People Smoke 484
Why Students Drink 456 Limited Education 485
High-Risk Drinking on Campus 458
Underestimation of Risks 485
Binge Drinking 458
Adolescent Experimentation and Rebellion 485
Who Binge-Drinks in College? 458
Stress 485
Why Students Binge-Drink 458
Parent Role Models 485
Binge Drinking and Disordered E ating 459
Addiction 485
Predrinking/Pregaming 459
Genetics 485
Why Is Predrinking Popular? 460
Weight Control 485
The Perils of Predrinking 460
Mental Disorders 486
Underage Drinking on Campus 460
Substance Abuse 486
Alcohol Mixed with Energy Drinks 460
Why Students Stop Drinking 461 Tobacco Use Disorder 486
Alcohol-Related Problems on Campus 461 Tobacco Use on Campus 486
Consequences of Drinking 461 Social Smoking 487
Drinking and Driving 462 College Tobacco-Control Policies 488
“Secondhand” Drinking Problems 463 Smoking, Gender, and Race 488
Understanding Alcohol 463 Tobacco’s Immediate Effects 489
Blood-Alcohol Concentration 464 How Nicotine Works 489
Moderate Alcohol Use 467 Tar and Carbon Monoxide 490
Alcohol Intoxication 467 Health Effects of Cigarette Smoking 490
Alcohol Poisoning 467 Health Effects on Students 490
The Impact of Alcohol on the Body 468 Premature Death 490
Digestive System 469 Heart Disease and Stroke 491
Weight and Waists 469 Cancer 492
Cardiorespiratory System 469 Respiratory Diseases 492
Cancer 469 Other Smoking-Related Problems 493
Brain and Behavior 469 E-Cigarettes and Vaping 493
Interaction with Other Drugs 470 Other Forms of Tobacco 494
Immune System 471 Water Pipes (Hookahs) 494
Health Problems Later in Life 471 Hookah Use on Campus 494
Increased Risk of Dying 471 Cigars and Pipes 495
Alcohol, Gender, and Race 471 Bidis 496
Gender 471 Clove Cigarettes (Kreteks) 496
Race 472 Smokeless Tobacco 496
African American Community 472 Snus 496
Latino Community 472 Quitting Tobacco Use 497
Native American Community 473 Physical Benefits of Quitting 497
Asian American Community 473 Psychological Benefits of Quitting 497
Alcohol-Related Disorders 473 Quitting on Your Own 498
Alcohol Use Disorder 473 Virtual Support 498
Causes 474 Stop-Smoking Groups 498
Medical Complications 474 Nicotine Replacement Therapy (NRT) 498
Alcoholism Treatments 475 Nicotine Gum 498
Detoxification 475
Nicotine Patches 499
Nicotine Inhaler 499
Medications 475
Electronic Cigarettes 499
Inpatient or Residential Treatment 476 Medications and Other Treatments 499
Outpatient Treatment 476 Combined Treatments 500
Behavioral Therapies 476 Quitting and the Risks Associated with Smoking 500
Moderation Training 476 Environmental Tobacco Smoke 500
12-Step Self-Help Programs 476 Health Effects of Secondhand Smoke 501
Harm Reduction Therapy 477 Thirdhand Smoke 502
Alternatives to AA 477 The Fight for Clean Air 502
Recovery 477 Taking Charge Of Your Health 503 • Self-Survey 504 • Review
Questions 505
Contents xiii
Chapter 18 The Impact of Pollution 538
Personal Safety 509 The Air You Breathe 539
Ozone 539
Unintentional Injury 509
Particle Pollution 540
Why Accidents Happen 510
Green Space 540
Safety on the Road 511
Working toward Sustainability 540
Avoid Distracted Driving 511
Don’t Text or Talk 512 The Water You Drink 541
Stay Alert 512 Is Bottled Water Better? 543
Buckle Up 512 Portable Water Bottles 543
Check for Air Bags 512 Indoor Pollutants: The Inside Story 543
Rein in Road Rage 513 Environmental Tobacco Smoke 543
Cycle Safely 513 Secondhand Smoke 544
Safety at Work and at Home 514 Thirdhand Smoke 544
Computers and Your Health 514 Radon 544
Repetitive Motion Injuries (RMIs) 514 Molds and Other Biological Contaminants 544
Vision Problems and Neck Pain 514 Household Products 545
At Home 515 Formaldehyde 545
Pesticides 546
Which Gender Is at Greater Risk? 515
Asbestos 546
Violence in America 516 Lead 546
Gun Violence 516 Carbon Monoxide and N itrogen Dioxide 547
Mass Shootings 517
Chemical Risks 547
A Public Health Approach 518
Agricultural Pesticides 548
Violence and Crime on Campus 518 Chemical Weapons 548
Hazing 519 Multiple Chemical Sensitivity 548
Hate or Bias Crimes 519
Invisible Threats 549
Microaggressions 520
Electromagnetic Fields 549
Campus Shootings 520
Cell Phones 549
Consequences of Campus Violence 521
Microwaves 550
Sexual Victimization and Violence 521 Ionizing Radiation 550
Sexual Violence against Women 521 Diagnostic X-Rays 550
Sexual Violence against Men 522 Your Hearing Health 550
Cyberbullying and Sexting 522 How Loud Is That Noise? 551
Sexual Harassment 522 Effects of Noise 551
Stalking 523 Are Earbuds Hazardous to Hearing? 551
Intimate Partner (Dating) Violence 523 Hearing Loss 553
Risk Factors for Intimate Partner
Violence 524
Questions 554
Disclosure and Support 524
Rape 524 Chapter 20
Sexual Assault on Campus 525
Changing the Campus Culture 525 A Lifetime of Health 557
#MeToo 526 Quality and Quantity of Life 558
Bystander Training 526 Will You Live to 50? 559
Sexual Coercion 526 Aging Well 559
Incapacitated Sexual Assault and Date-Rape Physical Activity: It’s Never Too Late 559
Drugs 526 Nutrition and Obesity 560
Rape on Campus 527 The Aging Brain 560
Acquaintance or Date Rape 527 Cognitive Aging 561
Stranger Rape 528 Memory 561
Male Nonconsensual Sex and Rape 528 Women at Midlife 561
Impact of Rape 528 Menopause 562
What to Do in Case of Sexual Assault and Rape 529 Hormone Therapy 562
Helping the Victims of Violence 529 Men at Midlife 563
Low Testosterone 563
Prostate Problems 563
Questions 532
Sexuality and Aging 563
The Challenges of Age 564
Chapter 19 Mild Cognitive Impairment 565
A Healthier Environment 535 Alzheimer’s Disease 565
The Environment and Your Health 535 Osteoporosis 566
Climate Change 536 Preparing for M edical Crises and the End of Life 566
Global Warming 536 Advance Directives 567
The Health Risks 537 Health-Care Proxies 567
xiv Contents
Living Wills 567 The Practicalities of Death 574
The Five Wishes 567 Funeral Arrangements 574
DNR Orders 567 Autopsies 574
Holographic Wills 568 Grief 574
Ethical Dilemmas 568 Grief’s Impact on Students 575
The Gift of Life 568 Grief’s Effects on Health 575
Death and Dying 569 Taking Charge of Your Health 576 • Self-Survey 577 • Review
Death Literacy and Education 569 Questions 579
Defining Death 569
Denying Death 570
Emotional Responses to Dying 570
How We Die 571
Answers to Review Questions 581
A “Good” Death 572
Caregiving 572 Glossary 583
Hospice: Caring When Curing Isn’t Possible 572
Near-Death Experiences 572 Index 593
Suicide 573
“Rational” Suicide 573
Euthanasia and Assisted Suicide 573
Right-to-Die Laws 573
Contents xv
Key Features
Consumer Alert Caring for Your Cold 370
Getting Your Money’s Worth from the Health-Care System 394
Sleeping Pill Precautions 38 Develop a Positive Addiction 413
The Pros and Cons of Antidepressants 54 Drink Less, Save More 457
Dubious Diets 137 The Toll of Tobacco 484
Fitness Monitors 163 No- and Low-Cost Ways to Green Your Space 542
Online Flirting and Dating 199 Reduce Your Future Health-Care Costs 561
Safe Sex in Cyberspace 238
Should You Get the HPV Vaccine? 300 snapshot: on campus now
Are You Addicted to Tanning? 345
Protecting Yourself from the Perils of Piercing 374 Student Health 11
Too Good to Be True? 389 Sleepy Students 36
Alcohol and Drug Interactions 470 Student Mental Health 49
E-cigarettes 493 Stressed-Out Students 74
Bicycle Helmet Heads-Up 513 Are You Eating Your Veggies? 119
What Difference Does a Lightbulb Make? 541 The Weight of Student Bodies 129
Student Bodies in Motion 155
Health NOW! All the Lonely Students 196
The Sex Lives of College Students 232
First Steps 12 Birth Control Choices of College Students 262
Count Your Blessings 26 Students and STIs 298
Count Your Blessings 58 Cancer Preventive Strategies 341
Write It Out! 85 Vaccinations 368
More Healthful Fast-Food Choices 114 Complementary and Alternative Medicine on Campus 401
Thinking Thinner 136 Student Marijuana Use 412
Eliminate Exercise Excuses 155 Student Drinking 456
Assessing a Relationship 203 Student Smoking 487
Developing Sexual Responsibility 229 How Safe Do Students Feel? 518
Choosing a Contraceptive 260 Students’ Views on Climate Change 536
Telling a Partner You Have an STI 299 Dying Young: Leading Causes of Death 569
Infection Protection 363
Is a CAM Therapy Right for You? 403 Your Strategies for Change
Recognizing Substance Abuse 425
If Someone Close to You Drinks Too Much 478 How to Forgive 34
Kicking the Habit 497 How to Cope with Distress after a Trauma 88
How to Avoid Date Rape 528 Frugal Living 91
Protecting the Planet 537 Creating a Healthy Eating Pattern 110
Preparing for a Medical Crisis in an Aging Relative 568 The Right Way to Walk and Run 167
How to Assert Yourself 193
Health on a Budget How to Cope with an Unhealthy Relationship 206
If You Have an STI 296
Invest in Yourself 15 How to Lower Your Blood Pressure 328
Happiness for Free! 27 How to Say No to Drugs 429
The Exercise Prescription 62 Learning about Death 570
Frugal Food Choices 115 How to Cope with Grief 575
Hold the Line! 129
Low-Cost Fitness Aids 180 Your Strategies for Prevention
Money Can’t Buy Love 210
Seven Secrets to a Good Sexual Relationship 230 If You Are at Risk 6
Reducing Your Risk of STIs 297 How to Help Someone Who Is Depressed 54
Lowering Your Cardiometabolic Risks 317 Steps to Prevent Suicide 61
xvii
How to Handle Test Stress 76 How to Protect Yourself and Others from Influenza 372
How to Protect Yourself from Food Poisoning 120 How to Avoid MRSA 376
Keeping the Pounds Off 139 How to Boost Health Understanding 388
How to Avoid Stretching Injuries 177 How to Take Care of Your Mouth 392
How to Stay Safe in the “Hookup Era” 233 How to Recognize the Warning Signs of Alcoholism 475
Checking Your Blood Pressure at Home 327 What to Do in an Emergency 510
How to Recognize a Stroke 338 How to Protect Your Ears 551
Save Your Skin 347 Keep Your Bones Healthy 567
xviii Key Features
Preface
Any college course may expand knowledge, broaden perspective, immunizations. An interactive feature, Snapshot: On Campus Now,
and deepen understanding in some way. Personal health and well- showcases the latest research on student behavior, including sleep
ness courses do even more than that: They can change a life and habits, stress levels, and safe sex practices. Health Now! presents
shape a future. practical, ready-to-use tips related to real-life issues such as making
Other courses cover subjects that range from anthropology to math- healthier fast-food choices, protecting yourself from infection, and
ematics to zoology. But health and wellness are not topics that recognizing substance abuse. Consumer Alert explores subjects
instructors simply “teach” and undergraduates merely “study.” They such as dubious diets, fitness monitors, and e-cigarettes.
are essential parts of living every day to the fullest and creating the Each of the 20 chapters, reordered in response to reviewers’ sug-
foundation for a fulfilling future. This is why we chose “Taking Charge gestions, concludes with Taking Charge of Your Health, a checklist
of Your Health” as the theme for this edition of Invitation to Health. that students can use to assess their current status as well as work
Every chapter not only presents the latest medical knowledge and toward specific goals, whether by getting in better shape, taking
health information, but goes beyond the facts to provide step-by- charge of their alcohol intake, or caring for Mother Earth.
step guidance on how students can incorporate what they are Because health is an ever-evolving field, this edition includes many
learning into how they are living. The lessons learned in health and new, expanded, and updated topics, as detailed in the following
wellness courses, as research has confirmed, can influence choices chapter-by-chapter summaries.
and habits that have a lifelong impact.
Today’s students are more diverse than ever before. A growing per- Chapter 1: Taking Charge of Your Health
centage are older than the traditional ages of undergraduates. Many Updated statistics on health in America; updated statistics on college
have a wide range of life experiences, such as full-time employment students’ health; new research on older students and health-care
and military service. Although the specific circumstances of their issues related to age, race, gender, and living arrangements; a new
day-to-day lives may vary greatly, students in health and wellness section, “Informing Yourself,” includes guidance on evaluating online
courses share a commitment to realizing their full potential. health information, evidence-based medicine, outcomes research,
and practice guidelines.
If you are a student, this course is our invitation to live what you
learn and to make the most of your health—now and in the future.
By using An Invitation to Health: Taking Charge of Your Health as an Chapter 2: Psychological and Spiritual
owner’s manual for your body and mind, you can acquire a special Well-Being
type of power—the power to make good decisions, to assume Latest findings from the science of subjective well-being; expanded
responsibility, and to create and follow a healthy lifestyle. If you coverage of student self-care; review of research on the benefits and
are an instructor, I look forward to working with you as you explore components of happiness; impact of growing up in a religious family;
the dimensions of health and how they relate to your students’ daily science linking gratitude and health; insomnia’s effects on quality of
lives. I welcome feedback from any and all of you at www.cengage life; sleep health on college campuses.
.com/health.
Stay well, Chapter 3: Caring for Your Mind
Dianne Hales Latest research and statistics on student mental health; mental
health disparities among college students of color; mental health
issues for LGBTQIA students; mental health issues for athletes and
veterans; impact of depression on health; depression, anxiety, and
What’s New in An Invitation to attention disorders on campus; suicidal thoughts and behaviors
among students; campus counseling after student deaths.
Health: Taking Charge of Your
Chapter 4: Stress Management
Health Updated statistics on student stress from the ACHA-National College
Health Assessment; latest findings from the American Psychological
As in previous editions, this Invitation presents up-to-date, concise,
Association’s Stress in America survey; new section, “Managing
research-based coverage of all the dimensions of health. It also con-
Your Money,” includes behavioral strategies such as organizing
tinues to define health in the broadest sense of the word—not as
financial files, making a budget, frugal living, banking basics, avoid-
a self-contained entity, but as an integrated process for discover-
ing debit and credit card stress, and digital financial management;
ing, using, and protecting all possible resources within the individual,
expanded coverage of stress for specific student groups, including
family, community, and environment.
first-generation students, minority students, student athletes, and
Every chapter begins by engaging students with a What Do You military veterans; updated research on student vulnerability to stress
Think? feature, with four questions that stimulate students to evalu- and coping techniques such as mindfulness.
ate what they already know—or think they know—about a subject.
We ask the same questions under the heading of What Did You Chapter 5: Personal Nutrition
Decide? at the end of each chapter to see whether and how the Recommendations for most recent dietary guidelines; updated
material they’ve studied may have changed students’ perspec- research on college students’ food choices and diets; comprehen-
tive, and we follow those questions with a Reflection that invites sive review of research on the benefits of fiber; new findings on vita-
students to adopt healthier habits based on the reading. min D, fish oil supplements, and calcium; gluten-free diets; latest
Every chapter includes updated statistics, research findings, research on the health benefits of the Mediterranean diet; cover-
and guidelines on topics such as nutrition, physical activity, and age of “food insecurity” on campus; impact of sugar-sweetened
xix
beverages; update on nutrition labels; recent findings on benefits of Chapter 12: Major Diseases
organic food; update on use of dietary supplements. Updated statistics on major diseases; updated statistics on college
students diagnosed with various diseases; importance of physical
Chapter 6: Weight Management and the activity for cardiometabolic health of young people; latest research
Obesity Epidemic on enhancing cardiometabolic health; newly recognized risk fac-
New section and focus on the obesity epidemic; most recent sta- tors for cardiometabolic diseases; new guidelines on high blood
tistics on overweight and obesity in the United States; updated pressure diagnosis and treatment; latest findings on the impact
research on the causes of obesity; updated statistics on college of supplements, blood fats, and active and passive smoking on
students’ weights; new section on body composition; new research cardiovascular health; updated statistics on cancer in America,
on the efficacy of various diets; latest findings on non-sugar sweet- including cancer rates, survival, and deaths; new coverage of male
eners; coverage of ethnic differences in eating disorders among breast cancer; latest findings on skin cancer risks and prevention;
young women. asthma update.
Chapter 7: Physical Activity and Fitness Chapter 13: Infectious Diseases

New section on the dangers of inactivity and excess sitting; findings Updated statistics on infectious diseases in America; updated data on
on “screen time” and physical activity in college students; updated vaccinations of college students; latest recommendation for immu-
statistics on exercise on campus; updated, expanded coverage nizations of various age groups and for adults in general; updated
of the recently revised federal Physical Activity Guidelines; official discussion of autoimmune disorders; coverage of controversy over
definitions of types of recommended exercises; updates on latest vaccinating children; updated statistics on influenza; latest findings
research on the benefits of various levels of physical activity and and recommendations on meningitis vaccinations; latest findings
exercise; comparison of benefits of aerobic, resistance, and combi- and recommendations for hepatitis A, B and C; updates on the Zika
nation training; new findings on the health benefits of resistance and virus and Lyme disease.
strength training; new coverage of the “extreme exercise hypoth-
esis”; new research on the impact of exercise on the brain, including Chapter 14: Consumer Health
mood, symptoms of depression and anxiety, and cognitive func- The most recent available status of the Affordable Care Act; con-
tioning at different ages; new section on smartwatches as fitness troversial provisions in the ACA; the boom in mHealth apps and
trackers; update on performance-enhancing supplements; update devices; research on benefits of mHealth for consumers and
on nutrition for athletes. patients; increase in cosmetic surgery among young adults
and minorities; growth of interest in and use of CAM; risks and cau-
Chapter 8: Communicating and Connecting tions related to yoga.
New chapter, “Communicating and Connecting”; includes updated
statistics on student loneliness, shyness, and social anxiety; new Chapter 15: Addictive Behaviors and Drugs
research on the digital life of college students; positive and nega- New section, “The Opioid Epidemic”; updated statistics on drug
tive impact of Facebook and social networks; new section, “Digital use on campus; trends in drug use in America; caffeine and health;
Dating”; cyberbullying on college campuses; impact of problematic impact of medical marijuana legalization; new research on gambling
Internet/smartphone use on college students; how falling in love disorders; new section on CBD; update on treatment options for
affects the immune system; intimate partner violence and depres- drug addiction.
sion; impact of parental divorce on college students; need for
financial aid and child care for students with young children. Chapter 16: Alcohol
Updated statistics on alcohol in America; newest data on drinking in
Chapter 9: Sexual Health college; impact of social norms on student drinking; drinking behav-
Updated statistics on the sex lives of college students; new and ior through the college years; social anxiety as a motive for student
expanded section, “The Gender Spectrum,” includes latest on drinking; secondhand dangers of alcohol for students; long-term
LGBTQIA community; new section, “Sex on Campus,” includes lat- impact of college drinking after graduation; alcohol and cardiovas-
est on hooking up (prevalence, pros, cons) and friends with ben- cular health; alcohol’s impact on women.
efits; latest research on treatments for premenstrual syndrome; new
research on benefits of circumcision; new research on prevalence Chapter 17: Tobacco
and treatment of erectile dysfunction in young men. Latest statistics on smoking in America; update on smoking on
campus; new section, “E-Cigarettes and Vaping”; dangers of elec-
Chapter 10: Reproductive Options tronic cigarette smoke; patterns of e-cigarette use; vaping and use
New statistics on contraception on campus; update on Affordable of illicit drugs; college students’ beliefs about e-cigarettes; updates
Care Act coverage of birth control and related state legislations; lat- on hookah use; cigar smoking prevalence; medications for quitting
est CDC report on contraception in the United States; updates on smoking.
risks and benefits of contraceptives; expanded coverage of LARCs;
new section, “Digital Birth Control” (fertility awareness apps); new Chapter 18: Personal Safety
section on fertility issues for transgender individuals; update on state Updates on statistics on motor vehicle accidents and safety; new
restrictions on abortions. data on drowsy driving; effect of texting-while-driving bans on emer-
gency department visits; preventing musculoskeletal disorders in
Chapter 11: Sexually Transmitted Infections the workplace; impact of sit-stand stations on activity and health;
Latest statistics on STI incidence globally and nationally; newest mobile phone use and neck pain; expanded section on gun vio-
recommendations for screening for STIs; updated section, “STIs lence; updated statistics on campus shootings; impact of concealed
on Campus”; updated coverage of HPV, including vaccinations and carry laws on campus crime; updated data on intimate partner and
outcomes; updated coverage of herpes, chlamydia, gonorrhea and sexual violence; updated section on sexual victimization and vio-
syphilis; extensively revised and updated sections on HIV/AIDS, lence; cyberbullying research; revised definition of sexual harass-
including latest statistics, stages of infection, and advances such as ment; sexual violence on campus; revictimization of college student
PrEP and PEP. sexual violence survivors; risk factors for sexual violence in dating
xx Preface
relationships; campus sexual violence statistics; new coverage of Cengage Learning Testing Powered
changing the college sexual culture and #MeToo; college services
for sexual assault survivors. by Cognero
This flexible online system allows the instructor to edit and manage
test bank content from multiple Cengage Learning solutions; create
Chapter 19: A Healthier Environment multiple test versions in an instant; and deliver tests from an LMS, a
New Snapshot: On Campus Now: How Students View Climate classroom, or wherever the instructor wants.
Change; updated sections on climate change and global warm-
ing; updated coverage of health risks of climate change; updated
coverage of air pollution; health risks of outdoor exercise in pol-
luted air; new section, “Green Space”; updated coverage of house-
hold air pollution and its impact on health; environmental tobacco
Acknowledgments
smoke and cardiovascular disease; heavy metal and nanoplastic It takes a team of top-notch professionals to create a success-
contamination; health risks of mobile phone use; updated coverage ful and effective textbook. I appreciate and applaud our product
of hearing loss. manager Courtney Heilman; learning designer Paula Dohnal; con-
tent manager Lianne Ames, who shepherds both the print book
Chapter 20: A Lifetime of Health and MindTap; product assistant Hannah Shin; MPS Limited proj-
Updated statistics on longevity and life expectancy; fatal drug over- ect manager Lori Hazzard; art director Sarah Cole; and marketing
doses as an increasing cause of death in young adults; increase manager Shannon Hawkins.
in suicides among the young; functional impairment and decline in Finally, I would like to thank the reviewers whose input has been so
middle age; impact of healthy behaviors on life expectancy; benefits valuable through these many editions.
of high-intensity exercise for older adults; anxiety and depression in Ghulam Aasef, Kaskaskia College
perimenopause; treatments for menopause symptoms; changes in Andrea Abercrombie, Clemson University
immunity over time; cognitive training for the aging brain; prevent- Daniel Adame, Emory University
ing/treating frailty in the elderly; factors influencing cognitive decline Dr. Lisa Alastuey, University of Houston
and Alzheimer’s disease; calcium supplements for bone health; low- Carol Allen, Lone Community College
dose and transdermal hormone therapy for osteoporosis; where Lana Arabas, Truman State University
people die; new Snapshot data on Dying Young: Leading Causes Joseph Bails, Parkland College
Judy Baker, East Carolina University
of Death.
Marcia Ball, James Madison University
Dr. Jeremy Barnes, Southeast Missouri State University
Rick Barnes, East Carolina University
Lois Beach, SUNY-Plattsburg
Supplemental Resources Liz Belyea, Cosumnes River College
Christina L. Benjamin, Montgomery College
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MindTap for An Invitation to Health: Taking Nancy Bessette, Saddleback College
Carol Biddington, California University of Pennsylvania
Charge of Your Health David Black, Purdue University
MindTap is an outcomes-driven application that propels students Jill M. Black, Cleveland State University
from memorization to mastery. MindTap is the platform that gives Cynthia Pike Blocksom, Cincinnati Health Department
you complete control of your course—to craft unique learning expe- Nikki Bonnani, M.S., CPT, CES, Ithaca College
Laura Bounds, Northern Arizona University
riences that challenge students, build confidence, and elevate per-
James Brik, Willamette University
formance. cengage.com/mindtap
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Cengage Unlimited Elaine D. Bryan, Georgia Perimeter College
James G. Bryant Jr., Western Carolina University
Cengage Unlimited saved students over $60 million in its first year.
Conswella Byrd, California State University, East Bay
One subscription includes access to every Cengage online textbook Marsha Campos, Modesto Junior College
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dents explore careers and gain the skills employers want. cengage James Lester Carter, Montana State University
.com/unlimited/instructor Jewel Carter-McCummings, Montclair State University
Peggy L. Chin, University of Connecticut
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Diet & Wellness Plus Patti Cost, Weber State University
Diet & Wellness Plus helps you understand how nutrition relates to Maxine Davis, Eastern Washington University
your personal health goals. Track your diet and activity, generate Maria Decker, Marian Court College
reports, and analyze the nutritional value of the food you eat. Diet & Laura Demeri, Clark College
Wellness Plus includes over 82,000 foods as well as custom food Lori Dewald, Shippensburg University of Pennsylvania
and recipe features. The Behavior Change Planner helps you identify Julie Dietz, Eastern Illinois University
Peter DiLorenzo, Camden County College
risks in your life and guides you through the key steps to make posi-
Robert Dollinger, Florida International University, Herbert Wertheim College of Medicine
tive changes. Diet & Wellness Plus can also be accessed from the Rachelle D. Duncan, Oklahoma State University
app dock in MindTap. Dr. Rachelle D. Duncan, Oklahoma State University
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Instructor Companion Site Gary English, Ithaca College
Everything you need for your course in one place! This collection Alicia M. Eppley, Theil College
of book-specific lecture and class tools is available online via www Victoria L. Evans, Hendrix College
.cengage.com/login. Access and download PowerPoint presenta- Melinda K. Everman, Ohio State University
tions, images, an instructor’s manual, and more. Michael Felts, East Carolina University
Preface xxi
Lynne Fitzgerald, Morehead State University Esther Moe, Oregon Health Sciences University
Matthew Flint, Utah Valley University Kris Moline, Lourdes College
Dr. Wendy Frappier, Professor, Minnesota State University Moorhead Lisa M. Moran, MSHS, RVT, RDMS, Ph.D. (ABD), Kentucky Community
Kathie C. Garbe, Kennesaw State College and Technical College System
Gail Gates, Oklahoma State University Richard Morris, Rollins College
Dawn Graff-Haight, Portland State University Dr. Jonathan T. Moss, Montclair State University
Carolyn Gray, New Mexico State University Rosemary Moulahan, High Point University
Mary Gress, Lorain County Community College Sophia Munro, Palm Beach Community College
Janet Grochowski, University of St. Thomas John W. Munson, University of Wisconsin-Stevens Point
Jack Gutierrez, Central Community College Jeannie M. Neiman, Edmonds Community College
Autumn R. Hamilton, Minnesota State University Ray Nolan, Colby Community College
Amanda J. Harvey M.S., CHES, Eastern Illinois University Shannon Norman, University of South Dakota
Christy D. Hawkins, Thomas Nelson Community College Anne O’Donnell, Santa Rosa Junior College
Stephen Haynie, College of William and Mary Terry Oehrtman, Ohio University
Amy Hedman, Mankato State University Shanyn Olpin, Weber State University
Ron Heinrichs, Central Missouri State University David Oster, Jefferson College
Candace H. Hendershot, University of Findlay Randy M. Page, University of Idaho
Michael Hoadley, University of South Dakota Carolyn P. Parks, University of North Carolina
Debbie Hogan, Tri County Community College Anthony V. Parrillo, East Carolina University
Margaret Hollinger, Reading Area Community College Lorraine Peniston, Hartford Community College
Harold Horne, University of Illinois at Springfield Miguel Perez, University of North Texas
Linda L. Howard, Idaho State University Pamela Pinahs-Schultz, Carroll College
Mary Hunt, Madonna University Dena Block Pistor, Rollins College
Kim Hyatt, Weber State University Rosanne Poole, Tallahassee Community College
Bill Hyman, Sam Houston State University Jennifer Pridemore, Parkland College
Dee Jacobsen, Southeastern Louisiana University Thomas Roberge, Norwich University
John Janowiak, Ph.D., Appalachian State University Keisha Tyler Robinson, Youngstown State University
Peggy Jarnigan, Rollins College Joel Rogers, West Hills Community College District
Jim Johnson, Northwest Missouri State University Linda J. Romaine, M.S., MBA, B.S., Raritan Valley Community College
Ches Jones, University of Arkansas Pamela Rost, Buffalo State College
Herb Jones, Ball State University Karla Rues, M.S., Ozarks Technical Community College
Jane Jones, University of Wisconsin, Stevens Point Veena Sallan, Owensboro Community and Technical College
Lorraine J. Jones, Muncie, Indiana Sadie Sanders, University of Florida
Walter Justice, Southwestern College Steven Sansone, Chemeketa Community College
Becky Kennedy-Koch, The Ohio State University Debra Secord, Coastline College
Margaret Kenrick, Los Medanos College Behjat Sharif, California State University, Los Angeles
Anthony F. Kiszewski, Bentley University Andrew Shim, Southwestern College
Mark J. Kittleson, Southern Illinois University Agneta Sibrava, Arkansas State University
Darlene Kluka, University of Central Oklahoma Steve Singleton, Wayne State University
John Kowaczyk, University of Minnesota Duluth Larry Smith, Scottsdale Community College
Debra A. Krummel, West Virginia University Teresa Snow, Georgia Institute of Technology
Roland Lamarine, California State University, Chico Sherm Sowby, Brigham Young University
Gina LaMonica, Ed.D., Adjunct Health and Nutrition Instructor, Exercise Physiologist, Stephen P. Sowulewski, Reynolds Community College
Health and Nutrition Consultant, Ventura College Carl A. Stockton, Radford University
David Langford, University of Maryland, Baltimore County Linda Stonecipher, Western Oregon State College
Terri Langford, University of Central Florida Ronda Sturgill, Marshall University
Beth Lanning, Baylor University Jacob W. Surratt, Gaston College
Norbert Lindskog, Harold Washington College Rosemarie Tarara, High Point University
Loretta Liptak, Youngstown State University Dr. Nigel Mark Thomas, CUNY Bronx Community College
Raymond A. Lomax, Kean University Shirley Treanor, Ed.D., RRT-NPS, Foothill College
Michelle Lomonaco, The Citadel Laurie Tucker, American University
David G. Lorenzi, West Liberty State College Julia VanderMolen, Davenport University
S. Jack Loughton, Weber State University Emogene Johnson Vaughn, Norfolk State University
Rick Madson, Palm Beach Community College Jennifer Vickery, Winthrop College
Ashok Malik, College of San Mateo Andrew M. Walker, Georgia Perimeter College
Michele P. Mannion, Temple University David M. White, East Carolina University
Jerry Mayo, Hendrix College Sabina White, University of California, Santa Barbara
Wajeeha Mazhar, California Polytechnic State University, Pomona Robert Wilson, University of Minnesota
Jessica Middlebrooks, University of Georgia Roy Wohl, Washburn University
Claudia Mihovk, Georgia Perimeter College Martin L. Wood, Ball State University
Kim H. Miller, University of Kentucky Sharon Zackus, City College of San Francisco
Susan Milstein, Montgomery College
xxii Preface
About the Author
Dianne Hales is a widely published and esteemed journalist and author. In addition to more
than 30 editions of college textbooks related to health, she is the author of 16 trade books,
including La Passione: How Italy Seduced the World; Mona Lisa: A Life Discovered; La Bella
Lingua; Just Like a Woman; and Caring for the Mind. Her books have been translated into
many languages, including Chinese, Japanese, Italian, French, Spanish, Portuguese, German,
Dutch, Swedish, Danish, and Korean.
Hales is a former contributing editor for Parade, Ladies’ Home Journal, Working Mother, and
American Health, and she has written more than 1,000 articles for national publications. She
has received writing awards from the American Psychiatric Association and the American
Psychological Association; an EMMA (Exceptional Media Merit Award) for health reporting
Julia Hales
from the National Women’s Political Caucus and Radcliffe College; three EDI (Equality, Dignity,
Inclusion) awards for print journalism from the National Easter Seal Society; the National
Mature Media Award; and awards from the Arthritis Foundation, California Psychiatric Asso-
ciation, CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), Council for
the Advancement of Scientific Education, and New York Public Library.
xxiii
An Invitation
to Health
mimagephotography/Shutterstock.com
LEARNING OBJECTIVES
After reading this chapter, you should be able to:
1.1 Define health and wellness. 1.7 Evaluate health information for accuracy and
1.2 Outline the dimensions of health. reliability.
1.3 Assess the current health status of Americans. 1.8 Explain the influences on behavior that support
or impede healthy change.
1.4 Discuss health disparities based on gender
and race. 1.9 Identify the stages of change.
1.5 Evaluate the health behaviors of undergraduates.
1.6 Describe the impact of habits formed in college
on future health.
What Do You Think?

What does “health” mean to you? Is online health information generally accurate?
How healthy are today’s college students? Can people successfully change their health
behaviors?
1
Taking Charge of Your Health
K
eisha always thought of health as something you worry about when you get
older. Then her twin brother developed a health problem she’d never heard of:
prediabetes (discussed in Chapter 12), which increased his risk of diabetes and
heart disease. At a health fair on campus, she found out that her blood pressure
was higher than normal. She also learned that young adults with high blood pres-
sure could be at greater risk of heart problems in the future.1
“Maybe I’m not too young to start thinking Simple changes in your lifestyle can add more
about my health,” Keisha concluded. Neither than a decade to your life expectancy—and
are you, whether you’re a traditional-age col- enhance your well-being through all the years
lege student or, like an ever-increasing number of your life.2
of undergraduates, years older. The time to start is now. Every day, you make
An Invitation to Health is both about and for choices that have short- and long-term conse-
you; it asks you to go beyond thinking about quences for your health. Eat a high-fat meal,
your health to taking charge and making and your blood chemistry changes. Spend a
healthy choices for yourself and your future. few hours slumped in front of the television, and
This book includes material on your mind and your metabolism slows. Chug a high-caffeine
your body, your spirit and your social ties, your energy drink, and your heart races. Have yet
needs and your wants, your past and your another beer, and your reflexes slow. Text while
potential. It will help you explore options, dis- driving, and you may weave into another lane.
cover possibilities, and find new ways to make Don’t bother with a condom, and your risk of
your life worthwhile. sexually transmitted infection (STI) skyrockets.
What you learn from this book and in this Sometimes making the best choices de
course depends on you. You have more con- mands making healthy changes in your life.
trol over your life and well-being than anything This chapter shows you how—and how to live
or anyone else does. Through the decisions more fully, more happily, and more health-
you make and the habits you develop, you fully. This is an offer that you literally cannot
can take charge of your health and influ- afford to refuse. Your life may depend on it—
ence how well—and how long—you will live. starting now. <
The Dimensions of Health
Health and Wellness By learning more about the dimensions of health,
YanLev/Shutterstock.com
you gain insight into the complex interplay of
factors that determine your level of wellness. The
By simplest definition, health means being sound following are the most commonly recognized
in body, mind, and spirit. The World Health Orga- dimensions of health and wellness, but some
nization defines health as “not merely the absence models treat emotional, cultural, or financial
of disease or infirmity” but “a state of complete health as separate categories rather than aspects
physical, mental, and social well-being.” Health of psychological, social, or occupational health.
Image Source/Getty Images

involves discovering, using, and protecting all the
resources within your body, mind, spirit, family, ✓ check-in What do you consider the most
community, and environment. important or relevant dimensions of health?
Health has many dimensions: physical, psycho-
logical, spiritual, social, intellectual, environmental,
occupational, and financial. This book integrates Physical Health The 1913 Webster’s Dic-
these aspects into a holistic approach that looks at tionary defined health as “the state of being
Robin Skjoldborg/Cultura/Getty Images
health and the individual as a whole rather than hale, sound, or whole, in body, mind, or soul,
part by part. especially the state of being free from physical
Your own definition of health may include dif- disease or pain.” More recent texts define physi-
ferent elements, but chances are you and your cal health as an optimal state of well-being, not
classmates would include at least some of the merely the absence of disease or infirmity. Health
following: is not a static state but a process that depends
on the decisions we make and the behaviors we
●● A positive, optimistic outlook. practice every day. To ensure optimal physical
Health is the process of dis- ●● A sense of control over stress and worries, health, we must feed our bodies nutritiously,
covering, using, and protect- time to relax. exercise them regularly, avoid harmful behaviors
Energy and vitality, freedom from pain or seri- and substances, watch for early signs of sickness,
ing all the resources within ●●
ous illness. and protect ourselves from accidents.

our bodies, minds, spirits,
families, communities, and
●● Supportive friends and family, and a nurturing
intimate relationship with someone you love. Psychological Health Like physical well-
environment. being, psychological health, discussed in Chapter 2,
●● A personally satisfying job or intellectual
encompasses our emotional and mental states—
endeavor.
that is, our feelings and our thoughts. It involves
●● A clean, healthful environment. awareness and acceptance of a wide range of
feelings in oneself and others, as well as the
✓ check-in How would you define health? ability to express emotions, to function indepen-
dently, and to cope with the challenges of daily
Wellness can be defined as purposeful, enjoy- stressors.
able living or, more specifically, a deliberate lifestyle
choice characterized by personal responsibility and Spiritual Health Spiritually healthy individu-
optimal enhancement of physical, mental, and spir- als identify their own basic purpose in life; learn
itual health. In the broadest sense, wellness is: how to experience love, joy, peace, and fulfill-
●● A decision you make to move toward optimal ment; and help themselves and others achieve
health. their full potential. As they devote themselves to
others’ needs more than their own, their spiritual
●● A way of life you design to achieve your high-
development produces a sense of greater mean-
est potential.
ing in their lives.
health A state of complete
●● A process of developing awareness that health
well-being, including physical, and happiness are possible in the present.
Social Health Social health refers to the
psychological, spiritual, social, ●● The integration of body, mind, and spirit. ability to interact effectively with other people
intellectual, and environmental ●● The belief that everything you do, think, and and the social environment, to develop satisfying
dimensions.
feel has an impact on your state of health and interpersonal relationships, and to fulfill social
wellness A deliberate lifestyle the health of the world. roles. It involves participating in and contribut-
choice characterized by per- ing to your community, living in harmony with
sonal responsibility and optimal ✓ check-in What does wellness mean fellow human beings, developing positive inter-
enhancement of physical, mental, dependent relationships, and practicing healthy
to you?
and spiritual health. sexual behaviors. (See Chapter 8.)
4 chapter 1 Taking Charge of Your Health
Intellectual Health Every day, you use
your mind to gather, process, and act on infor-
mation; to think through your values; to make
decisions; set goals; and figure out how to han-
dle a problem or challenge. Intellectual health
refers to your ability to think and learn from life
experience, your openness to new ideas, and
your capacity to question and evaluate infor-
mation. Throughout your life, you’ll use your
critical thinking skills, including your ability to
evaluate health information, to safeguard your
well-being.
Environmental Health You live in a physi-

cal and social setting that can affect every aspect
of your health. Environmental health refers to
the impact your world has on your well-being.
It involves protecting yourself from dangers in
the air, water, and soil, as well as in products you
Merla/Shutterstock.com
use—and working to preserve the environment Your choices and behaviors
itself. (See Chapter 19.)
during your college years can
influence how healthy you
Occupational and Financial Health
Even a part-time job can have an impact on will be in the future.
your health. Freshmen who worked more than
10 hours a week are more likely to smoke and
drink than those who aren’t employed.3 How-
ever, they may be gaining valuable experience in
managing their time, setting priorities, and find-
Health in America
ing a healthy balance in their lives.
After graduation, you will devote much of
your time and energy to your career. Ideally, you ✓ check-in Do you exercise regularly?
will contribute your unique talents and skills to Eat nutritious meals? Maintain a healthy
work that is rewarding in many ways—intellectu-
weight? Avoid smoking? If you answer
ally, emotionally, creatively, and financially. Col-
lege provides the opportunity for you to choose yes to all four questions, you’re among the
and prepare for a career that is consistent with 2.7 percent of Americans who do so.
your personal values and beliefs and to learn
how to manage your money and safeguard your
financial well-being. According to a national survey of more than 4,700
people, 97.3 percent get a failing grade in healthy
lifestyle habits. For the minority who do adapt
Community Health Educators have ex
these health guidelines, the payoff includes a lower
panded the traditional individualistic concept of
risk of many health problems, including type 2
health to include the complex interrelationships
diabetes, heart disease, and cancer. Although few
between one person’s health and the health of
Americans get a perfect health-habit score, a sig-
the community and environment. This change in
nificant number report at least one healthy habit:
perspective has given rise to a new emphasis on
health promotion, which educators define as ●● 71 percent do not smoke.
“any planned combination of educational, politi- ●● 46 percent get sufficient amounts of physical
cal, regulatory, and organizational supports for
activity.
actions and conditions of living conducive to the
health of individuals, groups, or communities.”4 ●● 38 percent eat a healthy diet. health promotion Any planned
Examples on campus include establishing smoke- combination of educational,
●● 10 percent have a normal body fat percentage
free policies for all college buildings, residences, political, regulatory, and organi-
(see Chapter 6).
and dining areas; prohibiting tobacco advertising zational supports for actions and
and sponsorship of campus social events; ensur- Women are more likely than men to not conditions of living conducive to
ing safety at parties; and enforcing alcohol laws smoke and to eat a healthy diet but less likely to the health of individuals, groups,
and policies. have adequate physical activity levels. Mexican or communities.
Health in America 5
Americans are more likely to eat a healthy diet Healthy People 2020
than blacks or whites.5
Life expectancy at birth in the United States Every decade since 1980, the U.S. Department
has declined recently to 76.1 years in men and of Health and Human Services (HHS) has pub-
81.1 years in women. The major factors contrib- lished a comprehensive set of national public
uting to the decline in life expectancy among health objectives as part of the Healthy People
younger Americans are unintentional injury, Initiative. The government’s vision is to create
including fatal drug overdoses, and suicide.6 a society in which all people can live long,
In fact, the Americans experiencing the greatest healthy lives. Its mission includes identify-
health deficits and losing the most years to illness, ing nationwide health improvement priorities,
disability, and premature death are not the elderly increasing public awareness of health issues,
but young adults. As a young American, your prob- and providing measurable objectives and goals.9
ability of reaching your 50th birthday is lower than These include:
in almost every other high-income nation. The main ●● Eliminate preventable disease, disability,
reasons for the gap in life expectancy between the injury, and premature death.
United States and 12 comparable countries are
●● Achieve health equity, eliminate disparities,
motor vehicle accidents, firearm-related injuries,
and improve the health of all groups.
and drug poisonings and overdoses.7
Quality of life matters as much as quantity. ●● Create social and physical environments that
Rather than focus solely on life expectancy, experts promote good health for all.
are calculating healthy life expectancy (HALE), ●● Promote healthy development and healthy
based on years lived without disease or disability. behaviors across every stage of life.
The average HALE for Americans is considerably
shorter than their life expectancy: about 68 years.8
✓ check-in What are your personal health
✓ check-in How do you think your life objectives?
expectancy and your healthy life expectancy
(HALE) compare?
Health Disparities
Americans who are members of certain racial
and ethnic groups—including African Americans,
Your Strategies For Prevention American Indians, Alaska Natives, Asian Americans,
Hispanics, Latinos, and Pacific Islanders—are
If You Are at Risk more likely than whites to suffer disease and dis-
ability, including major depression, poor physi-
Certain health risks may be genetic, but behavior influences their impact. Here are
cal health, functional limitations, and premature
specific steps you can take to protect your health:
death. However, there has been progress in some
Ask if you are at risk for any medical conditions or disorders based on important areas, including less racial discrepancy
your family history or racial or ethnic background. in infant death rates, cesarean birth rates, and
smoking among women.10
Find out if there are tests that could determine your risks. Discuss the Genetic variations, environmental influences,
advantages and disadvantages of such testing with your doctor. and specific health behaviors contribute to health
If you or a family member requires treatment for a chronic illness, ask disparities, but poverty may be a more signifi-
your doctor whether any medications have proved particularly effective cant factor. A much higher percentage of blacks
for your racial or ethnic background. (26 percent) than non-Hispanic whites (10 per-
cent) live below the federal poverty level and
If you are African American, you are significantly more likely to develop may be unable to get needed medical treatment.11
high blood pressure, diabetes, and kidney disease. Being overweight or This may be changing for young Americans. The
obese adds to the danger. The information in Chapters 6 through 8 can help you expected lifespan for those under age 20 is less
lower your risk by keeping in shape, making healthy food choices, and managing affected by whether they are rich or poor now
your weight. than in the past.12
If you are a member of a racial or ethnic
Hispanics and Latinos have disproportionately high rates of respira- minority, you need to educate yourself about
tory problems, such as asthma, chronic obstructive lung disease, and your health risks, take responsibility for those
tuberculosis. To protect your lungs, stop smoking and avoid secondary within your control, and become a savvy, asser-
smoke. Learn as much as you can about the factors that can trigger or worsen tive consumer of health-care services. The federal
lung diseases. Office of Minority Health and Health Disparities
(www.cdc.gov/omhd), which provides general
information and the latest research and recom-
mendations, is a good place to start.
✓ check-in Are you a member of a racial

or ethnic minority? If so, do you think this
status affects your health or health care?
Why Race Matters If, like many other

Americans, you come from a racially mixed
background, your health profile may be com-
plex. Here are just some of the differences race
makes:13
●● Black Americans lose substantially more years

of potential life to homicide (nine times as
many), stroke (three times as many), and dia-
betes (three times as many) as whites.
●● About 1 to 3 Hispanics has prediabetes; only
John Lund/Marc Romanelli/Getty Images
about half of Hispanics with diabetes have it
under control.14
●● Caucasians are prone to osteoporosis (pro- Heredity places this Pima
gressive weakening of bone tissue), cystic Indian infant at higher risk
fibrosis, skin cancer, and phenylketonuria
of developing diabetes,
(PKU, a metabolic disorder that can lead to
cognitive impairment). but environmental factors
also play a role.
●● Native Americans, including those indigenous
to Alaska, are more likely to die young than
the population as a whole, primarily as a
result of accidental injuries, cirrhosis of the cancer than are women of any racial or eth-
liver, homicide, pneumonia, and complica- nic group except Native Hawaiians.
tions of diabetes. ●● Native Hawaiian women have the highest
●● The suicide rate among American Indians rates of breast cancer. Women from many
and Alaska Natives is 50 percent higher than racial minorities, including those of Filipino,
the national rate. The rates of co-occurring Pakistani, Mexican, and Puerto Rican descent,
mental illness and substance abuse (especially are more likely to be diagnosed with late-
alcohol abuse) are also higher among Native stage breast cancer than white women.
American youth and adults. ●● Cancer has surpassed heart disease as the
leading cause of death among Hispanics in
Cancer Overall, black Americans are more the United States.
likely to develop cancer than persons of any other
racial or ethnic group.15 As discussed in Chapter 12, Cardiovascular Disease Heart disease
medical scientists have debated whether the rea- and stroke are the leading causes of death
son might be that treatments are less effective in for all racial and ethnic groups in the United
blacks or whether many are not diagnosed early States, but mortality rates from these diseases
enough or treated rigorously enough. are higher among African American adults than
Although blacks continue to have higher among white adults. African Americans also have
cancer death rates than whites, the disparity higher rates of high blood pressure (hyperten-
has narrowed for all cancers combined in men sion), develop this problem earlier in life, suffer
and women, and for lung and prostate cancers more severe hypertension, and have higher rates
in men. However, the racial gap in death rates of stroke.
has widened for breast cancer in women and
remained level for colorectal cancer in men.16
Diabetes American Indians and Alaska
●● African American women are more than twice Natives, African Americans, and Hispanics are
as likely to die of cervical cancer as are white twice as likely to be diagnosed with diabetes
women, and are more likely to die of breast than non-Hispanic whites.
Health in America 7
Infant Mortality African American, American Sex, Gender, and Health
Indian, and Puerto Rican infants have higher
Medical scientists define sex as a classification,
death rates than white infants.
generally as male or female, according to the
reproductive organs and functions that derive
Mental Health American Indians and Alaska from the chromosomal complement. Gender
Natives suffer disproportionately from depres- refers to a person’s self-representation as male
sion and substance abuse. Minorities have less or female or how social institutions respond to
access to mental health services and are less a person on the basis of the individual’s gender
likely to receive needed high-quality mental presentation. Gender is rooted in biology and
health services.17 The prevalence of dementia shaped by environment and experience.
varies significantly among Americans of dif- The experience of being male or female in a
ferent racial and ethnic groups, with the high- particular culture and society can and does have
est rates among blacks and American Indians/ an effect on physical and psychological well-
Alaskan Natives and the lowest among Asian being. In fact, sex and gender may have a greater
Americans. Hispanics and whites have interme- impact than any other variable on how our bod-
diate rates.18 ies function, how long we live, and the symp-
toms, course, and treatment of the diseases that
Infectious Disease Asian Americans and strike us (see Figure 1.1).
Pacific Islanders have much higher rates of hepa- Here are some health differences between
titis B than other racial groups. Black teenagers men and women:
and young adults become infected with hepatitis B
three to four times more often than those who ●● Boys are more likely to be born prematurely,
are white. Black people also have a higher inci- to suffer birth-related injuries, and to die
dence of hepatitis C infection than white people. before their first birthdays than girls.
Almost 80 percent of reported cases affect racial ●● Men around the world have shorter lifespans
and ethnic minorities. than women and higher rates of cancer, heart
disease, stroke, lung disease, kidney disease,
HIV/AIDS Although African Americans and liver disease, and HIV/AIDS.20 They are four
Hispanics represent only about one-quarter of times more likely to take their own lives or to
the U.S. population, they account for about two- be murdered than women.
thirds of adult AIDS cases and more than 80 per- ●● Cardiovascular disease is the leading cause
cent of pediatric AIDS cases.19 of death for women in the United States, yet
He: She:
• averages 12 breaths a minute • averages 9 breaths a minute
• has lower core body temperature • has higher core body temperature
• has a slower heart rate • has a faster heart rate
• has more oxygen-rich hemoglobin • has higher levels of protective
in his blood immunoglobulin in her blood
• is more sensitive to sound • is more sensitive to light
• produces twice as much saliva • takes twice as long to process food
• has a 10 percent larger brain • has more neurons in certain brain regions
• is 10 times more likely to have • is twice as likely to have an
attention deﬁcit disorder eating disorder
• as a teen, has an attention span • as a teen, has an attention span
of 5 minutes of 20 minutes
• is more likely to be physically active • is more likely to be overweight
• is more prone to lethal diseases, • is more vulnerable to chronic diseases,
including heart attacks, cancer, like arthritis and autoimmune disorders,
and liver failure and age-related conditions like
• is ﬁve times more likely to become osteoporosis
an alcoholic • is twice as likely to develop depression
• has a life expectancy of 76 years • has a life expectancy of 81 years
Figure 1.1 Some of the Many Ways Men and Women Are Different
only about one-third of clinical trial subjects economic, political, and religious background.
in cardiovascular research have been female. Some 12 million are female; 9 million, male. You
●● Lung cancer is the leading cause of can- may have served in the military, started a family,
cer death among women, with increased or emigrated from another country. You might
rates particularly among young female be enrolled in a two-year college, a four-year
nonsmokers. university, or a technical school. Your class-
rooms might be in a busy city or a small town—
●● Women are 70 percent more likely than men
or they might exist solely as a virtual campus.
to suffer from depression over the course of
Although the majority of undergraduates are
their lifetimes.
“traditional” age (between 18 and 24 years), more
of you than ever before—8 million—are over
✓ check-in How do you think your gender age 25.23
affects your health? Today’s college students are both similar
to and different from previous generations in
Among the reasons that may contribute to the many ways. Among the unique characteristics
health and longevity gap between the sexes are of current traditional-age undergraduates are the
the following: following:
●● Biological factors. For example, women ●● They are the first generation of “digital
have two X chromosomes and men only one, natives,” who’ve grown up in a wired world.
and men and women have different levels of
●● They are the most diverse in higher education
sex hormones (particularly testosterone and
history. About 15 percent are black; an equal
estrogen).
percentage are Hispanic.
●● Social factors. These include work stress,
hostility levels, and social networks and
●● They are both more connected and more iso-
supports. lated than their predecessors, with a “tribe” of
friends, family, and acquaintances in constant
●● Behavioral factors. Men and women differ contact through social media but with weak
in risky behavior, aggression, violence, smok- interpersonal, communications, and problem-
ing, and substance abuse. solving skills.
●● Health habits. The sexes vary in terms of ●● More students are working, working longer
regular screenings, preventive care, and mini-
hours, taking fewer credits, requiring more
mizing symptoms.
time to graduate, and leaving college with
large student loan debts.
Sexual orientation can also affect health.
LGBTQIA (lesbian, gay, bisexual, transgender, ● They face a future in which the pace and
queer or questioning, intersex, and asexual) scale of change will constantly accelerate.
individuals are more likely to encounter health
disparities linked to social stigma, discrimina-
tion, and denial of their human and civil rights.21 ✓ check-in A recent analysis of community
Gender-based discrimination increases the risk college students identified four types of
of psychiatric disorders, substance abuse, and
undergraduates: dreamers, drifters,
suicide. On campus, transgender students may
face similar issues, as well as particular stigma passengers, and planners. Here is some
over so-called “bathroom bills” that require them specific advice for each type:
to use public facilities corresponding with the ■ If you’re a dreamer, seek guidance to fill
sex designated on their birth certificates.22 The
in the details of your “big picture” goal for
Healthy People 2020 initiative has made improve-
ments in LGBTQIA health one of its new goals. college.
■ If you’re a drifter, focus on developing
specific strategies to reach your educational
Health on Campus ■
goals.
If you’re a passenger, find a mentor or
advisor to help you interpret what you learn.
As one of an estimated 19.9 million college stu- ■ If you’re a planner, look for help in
dents in the United States, you are part of a remark- applying the information you’ve gathered
ably diverse group. Today’s undergraduates come
to your unique situation.24
from every age group and social, racial, ethnic,
Health on Campus 9
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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(eBook PDF) An Invitation to Health:

Taking Charge of Your Health 19th

xviii Key Features

Chapter 7: Physical Activity and Fitness Chapter 13: Infectious Diseases

What Do You Think?

Image Source/Getty Images

ous illness. and protect ourselves from accidents.

4 chapter 1 Taking Charge of Your Health

Environmental Health You live in a physi-

6 chapter 1 Taking Charge of Your Health

✓ check-in Are you a member of a racial

Why Race Matters If, like many other

●● Black Americans lose substantially more years

8 chapter 1 Taking Charge of Your Health

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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