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An Invitation
to Health
The Power of Now,
Brief Edition
Dianne Hales
10th Edition
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An Invitation to Health: The Power of Now, © 2018, 2016 Cengage Learning
Brief Edition, Tenth Edition
Dianne Hales ALL RIGHTS RESERVED. No part of this work covered by the copyright herein
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Print Number: 01 Print Year: 2016
Brief Contents
CHAPTER 1 The Power of Now 3
CHAPTER 2 Your Psychological and Spiritual Well-Being 23
CHAPTER 3 Stress Management 55
CHAPTER 4 Social Health 81
CHAPTER 5 Personal Nutrition 109
CHAPTER 6 Weight Management 147
CHAPTER 7 Physical Activity and Fitness 169

CHAPTER 8 Sexual Health 205
CHAPTER 9 Reproductive Options 251
CHAPTER 10 Major Diseases 289
CHAPTER 11 Addictive Behaviors and Drugs 341
CHAPTER 12 Alcohol and Tobacco 381
CHAPTER 13 Consumer Health 423
CHAPTER 14 Protecting Yourself and Your Environment 453
CHAPTER 15 A Lifetime of Health 485
Answers for Making This Chapter Work for You 503

Glossary 504
References 510
Index 523
iii
Contents
CHAPTER 1 Gender and Depression 39
Major Depressive Disorder 40
The Power of Now 3 Treating Depression 40
Health and Wellness 4 Bipolar Disorder 41
The Dimensions of Health 4
Anxiety Disorders 42
Health in America 5 Specific Phobia 42
Healthy People 2020 6 Panic Attacks and
Health Disparities 7 Panic Disorder 43
Sex, Gender, and Health 8 Generalized Anxiety Disorder 43
Health on Campus 10 Obsessive–Compulsive Disorder 43
College and Health 10 Attention-Deficit/Hyperactivity Disorder 44
How Healthy Are Today’s Students? 11 Autism Spectrum Disorder 45
Why “Now” Matters 12 Schizophrenia 45
Student Health Norms 12 Nonsuicidal Self-Injury 46
The Promise
Suicide 46
of Prevention 13
Suicide on Campus 47
Protecting Yourself 13 Factors That Lead to Suicide 47
Understanding Risky Behaviors 13
Overcoming Problems of the Mind 48
Making Healthy Changes 14 Where to Turn for Help 49
Understanding Health Behavior 14 Types of Therapy 49
How and Why People Change 15 Other Treatment Options 50
Health Belief Model 16
Self-Determination Theory 16 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
Motivational Interviewing 16 CHAPTER 3
Self-Affirmation Theory 16
Transtheoretical Model 17 Stress Management 55
5IF1PXFSPG/PX t.BLJOH5IJT$IBQUFS8PSLGPS:PV
What Is Stress? 56
Eustress, Distress, and Neustress 56
CHAPTER 2 Stress and the Dimensions of Health 57
Types of Stressors 58
Your Psychological and Spiritual Stress in America 58
Well-Being 23 Stress on Campus 59
Emotional and Mental Health 24 Stress and Student Health 59
The Lessons of Positive Psychology 24 Other Stressors 62
Develop Self-Compassion 25 Financial Stress 62
Boost Emotional Intelligence 25 Occupational Stress 63
Meet Your Needs 26 Burnout 63
Boost Self-Esteem 26 Illness and Disability 64
Pursue Happiness 27 Traumatic Life Events 64
Become Optimistic 28 Acute Stress Disorder 64
Manage Your Moods 29 Posttraumatic Stress Disorder 65
Spiritual Health 29 Inside Stress 66
Spirituality and General Adaptation Syndrome (GAS) 66
Physical Health 29 Coping with Stress 67
Deepen Your Spiritual Intelligence 30 Fight or Flight 67
Clarify Your Values 30 Freezing 67
Enrich Your Spiritual Life 30 Submission 67
Consider the Power of Prayer 31 Challenge Response Model 67
Cultivate Gratitude 32 Tend-and-Befriend Model 68
Forgive 32 Transactional or Cognitive-Relational Model 68
Sleep and Health 32 Yerkes-Dodson Law 69
Student Night Life 33 The Impact of Stress 69
Sleep’s Impact on Health 34 Stress and the Heart 69
How Much Sleep Do You Need? 34 Stress and Immunity 70
Treating Sleep Disorders 35 Stress and the Gastrointestinal System 71
Understanding Mental Health 35 Stress and Cancer 71
What Is a Mental Disorder? 36 Other Stress Symptoms 71
Mental Health on Campus 36 Managing Stress 72
Depressive Disorders 37 Journaling 72
Depression in Students 38 Exercise 72
iv
Routes to Relaxation 72 The USDA Food Patterns 127
Meditation and Mindfulness 73 The DASH Eating Plan 127
Yoga 74 The Mediterranean Diet 128
Resilience 74 Vegetarian Diets 128
Stress Prevention: Taking Control Ethnic Cuisines 129
of Your Time 75 The Way We Eat 130
Time Management 75 Campus Cuisine: How College Students Eat 130
Overcoming Procrastination 76 Money and Time Issues 130
5IF1PXFSPG/PX t.BLJOH5IJT$IBQUFS8PSLGPS:PV Nutrition Knowledge 131
Fast Food: Eating on the Run 132
CHAPTER 4 His Plate, Her Plate: Gender and Nutrition 132
You Are What You Drink 134
Social Health 81 Choosing Healthful Snacks 135
The Social Dimension of Health 82
Dietary Supplements 136
Communicating 83
Learning to Listen 83 Taking Charge of What You Eat 136
Being Agreeable but Assertive 83 Portions and Servings 136
How Men and Women Communicate 84 Nutrition Labels 137
Nonverbal Communication 84 What Is an “Organic” Food? 137
Genetically Engineered Foods 138
Forming Relationships 84
Friendship 85 Food Safety 139
Loneliness 85 Fight BAC! 139
Shyness and Social Anxiety Disorder 86 Avoiding E. Coli Infection 139
Building a Healthy Community 86 Food Poisoning 140
Doing Good 87 Pesticides 140
Living in a Wired World 87 Food Allergies 140
Social Networking on Campus 87 Nutritional Quackery 141
Self-Disclosure and Privacy in a Digital Age 88 5IF1PXFSPG/PX t.BLJOH5IJT$IBQUFS8PSLGPS:PV
Problematic Cell Phone and Internet Use 89
Dating on Campus 90 CHAPTER 6
Hooking Up 90 Weight Management 147
Friends with Benefits 92
Weighing In 148
Loving and Being Loved 92
Intimate Relationships 92 Weight on Campus 149
What Attracts Two People to Each Other? 92 What Is a Healthy Weight? 150
Infatuation 92 Body Mass Index 150
The Science of Romantic Love 93 Waist Circumference 151
Mature Love 94 Waist-to-Hip Ratio (WHR) 152
Dysfunctional Relationships 94 Body Fat 152
Intimate Partner Violence 94 Understanding Weight Problems 152
Emotional Abuse 94 How Did So Many Get So Fat? 153
Codependency 95 Health Dangers of Excess Weight 153
When Love Ends 96 The Impact on the Body 153
Partnering across the Lifespan 97 The Emotional and Social Toll 155
The New Transition to Adulthood 97 If You’re Too Thin: How to Gain Weight 155
Cohabitation 97 A Practical Guide to a Healthy Weight 155
Long-Term Relationships 98 Preventing Weight Gain 156
Marriage 98 Weight-Loss Diets 156
Issues Couples Confront 100 Do Weight-Loss Programs Work? 157
Divorce 101 Physical Activity and Exercise 158
Family Ties 102 Complementary and Alternative Medicine (CAM)
Diversity within Families 102 for Obesity 158
Unmarried Parents 103 Common Diet Traps 158
5IF1PXFSPG/PX t.BLJOH5IJT$IBQUFS8PSLGPS:PV Maintaining Weight Loss 159
Treating Severe Obesity 159
CHAPTER 5 Obesity Medications 160
Personal Nutrition 109 Obesity Surgery 160
The 2015–2020 Dietary Guidelines for Americans 110 Unhealthy Eating on Campus 161
The Building Blocks of Good Nutrition 110 Body Image 161
Calories 110 Disordered Eating 162
Essential Nutrients 116 Extreme Dieting 162
Vitamins 122 Compulsive Overeating 162
Minerals 124 Binge Eating 163
Healthy Eating Patterns 127 Eating Disorders 163
MyPlate 127 5IF1PXFSPG/PX t.BLJOH5IJT$IBQUFS8PSLGPS:PV
Contents v
CHAPTER 7 Sex on Campus 215
Hooking Up 215
Physical Activity and Fitness 169 Friends with Benefits 217
Physical Activity and Fitness 170 Choosing Sexual Partners 217
Fitness and the Dimensions of Health 171 Romantic Relationships 217
Working Out on Campus 171 Ethnic Variations 217
Physical Activity and Exercise 172 Sex in America 218
Exercise Is Medicine 172 Sexual Diversity 218
The Benefits of Exercise 172 Heterosexuality 219
Exercise Risks 176 Bisexuality 219
Physical Activity Guidelines for Americans 176 Homosexuality 219
How Much Exercise Is Enough? 177 The Gender Spectrum 220
Your Exercise Prescription 177
Sexual Activity 221
The Principles of Exercise 178 Celibacy 221
Overload Principle 178 Abstinence 221
FITT 178 Fantasy 221
Reversibility Principle 179 Pornography 222
Improving Cardiorespiratory Fitness 179 Masturbation 222
Monitoring Exercise Intensity 180 Nonpenetrative Sexual Activity (Outercourse) 223
High-Tech Gadgets 180 Intercourse 223
Nontech Methods 180 Oral Sex 223
Designing an Aerobic Workout 182 Anal Stimulation
Your Long-Term Fitness Plan 182 and Intercourse 224
Aerobic Options 183 Sexual Response 224
Building Muscular Fitness 185 Sexually Transmitted Infections and Diseases 226
Muscles at Work 186 Zika Virus 227
Designing a Muscle Workout 187 Risk Factors for Sexually Transmitted
Recovery 189 Infections 227
Core Strength Conditioning 189 The ABCs of Safer Sex 228
Muscle Dysmorphia 189 STIs and Gender 230
Drugs Used to Boost Athletic Performance 190 STIs on Campus 231
Becoming More Flexible 191 What College Students Don’t Know about STIs 231
The Benefits of Flexibility 191 Common STIs and STDs 231
Stretching 191 Human Papillomavirus (HPV) 231
Mind–Body Approaches 193 Genital Herpes 234
Yoga 194 Chlamydia 235
Pilates 194 Pelvic Inflammatory Disease (PID) 236
T’ai Chi 194 Gonorrhea 237
Keeping Your Back Healthy 195 Nongonococcal Urethritis (NGU) 238
Sports Nutrition 196 Syphilis 238
Water 196 Chancroid 239
Sports Drinks 196 Pubic Lice and Scabies 239
Dietary Supplements 197 Trichomoniasis 239
Energy Bars 197 Bacterial Vaginosis 240
Safe and Healthy Workouts 197 HIV and AIDS 240
Temperature 198 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
Exercise Injuries 199
5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
CHAPTER 9
Reproductive Options 251
CHAPTER 8 Reproductive Responsibility 252
Sexual Health 205 Conception 252
Sexual Health 206 Abstinence and Nonpenetrative Sexual Activity 253
Sexuality and the Dimensions of Health 206 Contraception 254
Women’s Sexual Health 207 The Benefits and Risks
Female Sexual Anatomy 207 of Contraceptives 257
The Menstrual Cycle 208 Birth Control on Campus 259
Men’s Sexual Health 211 Contraception Choices 259
Male Sexual Anatomy 211 Oral Contraceptives 259
Responsible Sexuality 212 Other Contraceptive Options 262
Creating a Sexually Healthy Relationship 213 Barrier Contraceptives 265
Making Sexual Decisions 213 Fertility Awareness Methods (FAMs) 272
Saying No to Sex 214 Emergency Contraception 273
Sexual Behavior 214 Sterilization 274
Sexual Initiation: “Having Sex” for the First Time 215 Unwanted Pregnancy 275
vi Contents
Abortion 276 Immunity and Stress 328
The Psychological Impact of Abortion 277 Immunization for Adults 328
The Politics of Abortion 277 Upper Respiratory Infections 328
Pregnancy 278 Common Cold 328
Preconception Care 278 Influenza 330
Home Pregnancy Tests 278 Meningitis 331
Prenatal Care 279 Hepatitis 332
How a Woman’s Body Changes during Pregnancy 279 Insect- and Animal-Borne Infections 334
How a Baby Grows 279 Lyme Disease 334
Complications of Pregnancy 280 West Nile Virus 334
Childbirth 282 Zika Virus 335
Infertility 283 Avian Influenza 335
Adoption 283 The “Superbug” Threat: MRSA 336
5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
CHAPTER 10 CHAPTER 11
Major Diseases 289 Addictive Behaviors and Drugs 341
Your Cardiometabolic Health 290 Understanding Addiction 342
Cardiometabolic Risk Factors 291 Addiction and the Dimensions of Health 342
Metabolic Syndrome 295 Preventing Addictions 342
Who Is at Risk? 295 Gambling and Behavioral Addictions 343
What Are the Signs? 295 Problem Gambling 343
Diabetes 295 Gambling Disorder 344
Insulin Resistance 296 Gambling on Campus 344
Prediabetes 296 Risk Factors for Problem Gambling 345
Diabetes Mellitus 296 Drug Use on Campus 345
Who Is at Risk? 297 Why Students Don’t Use Drugs 345
Types of Diabetes 297 Why Students Use Drugs 345
Diabetes Signs and Symptoms 298
Understanding Drugs and Their Effects 347
Diabetes Management 298
Routes of Administration 348
Treatment 299
Dosage and Toxicity 348
Hypertension 299 Individual Differences 348
Hypertension in the Young 299 Gender and Drugs 348
Who Is at Risk? 299 Setting 349
What Your Blood Pressure Reading Types of Action 349
Means 301 Interaction with Other Drugs or Alcohol 349
Lowering High Blood Pressure 301 Caffeine and Its Effects 349
Your Lipoprotein Profile 302 Caffeine Intoxication 350
What Is a Healthy Cholesterol Reading? 302 Caffeine-Containing Energy Drinks 351
Lowering Cholesterol 302 Medications 351
Lifestyle Changes 303 Over-the-Counter Drugs 352
Cardiovascular (Heart) Disease 304 Prescription Drugs 352
How the Heart Works 304 Drugs and Alcohol 353
Heart Risks on Campus 305
Psychosocial Risk Factors 306 Substance Use Disorders 354
The Heart of a Woman 307 Dependence 354
Abuse 355
Crises of the Heart 308 Intoxication and Withdrawal 355
Coronary Artery Disease 308 Polyabuse 355
Atherosclerosis 308 Coexisting Conditions 355
Heart Attack (Myocardial Infarction) 308 Causes of Substance Use Disorders 355
Is It a Heart Attack? 308 Prescription Drug Abuse 356
Stroke 309 Prescription Drugs on Campus 356
Risk Factors 310 Prescription Stimulants 357
Causes of Stroke 311 Prescription Painkillers 357
Why Quick Treatment Matters 311 Commonly Abused Drugs 358
Cancer 311 Cannabinoids 358
Understanding Cancer 312 Herbal Drugs 361
Who Is at Risk? 312 Synthetic Designer Drugs 361
Common Types of Cancer 314 Club Drugs 363
Infectious Diseases 322 Stimulants 364
Agents of Infection 322 Depressants 369
How Infections Spread 324 Opioids 370
The Process of Infection 325 Hallucinogens 371
Who Develops Infections? 325 Dissociative Drugs 372
Immune Response 327 Inhalants 373
Contents vii
Treatment of Substance Dependence and Abuse 374 Clove Cigarettes (Kreteks) 413
Principles of Drug Addiction Treatment 374 Smokeless Tobacco 413
12-Step Programs 375 Quitting Tobacco Use 414
Relapse Prevention 375 Physical Benefits of Quitting 414
5IF1PXFSPG/PX t.BLJOH5IJT$IBQUFS8PSLGPS:PV Psychological Benefits of Quitting 414
Quitting 414
CHAPTER 12 Nicotine Replacement Therapy 415
Alcohol and Tobacco 381 Electronic Cigarettes 416
Drinking in America 382 Environmental Tobacco Smoke 416
Why People Don’t Drink 382 Health Effects of Secondhand Smoke 416
Why People Drink 383 Thirdhand Smoke 417
Drinking on Campus 383 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
Why Students Don’t Drink 385
Why Students Drink 385 CHAPTER 13
High-Risk Drinking on Campus 386 Consumer Health 423
Why Students Stop Drinking 390 The Affordable Care Act (ACA) 424
Alcohol-Related Problems
What You Need to Know 424
on Campus 390
Consequences of Drinking 390 Consumer-Driven Health Care 425
Understanding Alcohol 392 Improving Your Health Literacy 426
Blood-Alcohol Concentration 393 Finding Good Advice Online 426
Moderate Alcohol Use 395 Getting Medical Facts Straight 427
Alcohol Intoxication 396 Evidence-Based Medicine 428
Alcohol Poisoning 396 Outcomes Research 428
The Impact of Alcohol on the Body 397 Personalizing Your Health Care 428
Digestive System 397 Your Family Health History 429
Weight and Waists 398 Gender Differences 429
Cardiorespiratory System 398 Mobile Health (mHealth) Apps and Monitors 429
Cancer 398 Self-Care 430
Brain and Behavior 398 Oral Health 430
Interaction with Other Drugs 399 Becoming a Savvy Health-Care Consumer 431
Immune System 399 Making the Most of a Medical Visit 432
Increased Risk of Dying 399 Talking with Your Health-Care Provider 433
Alcohol, Gender, and Race 399 After Your Visit 434
Gender 399 Preventing Medical Errors 436
Race 400 Avoiding Medication Mistakes 436
Alcohol-Related Disorders 401 Your Medical Rights 437
Alcohol Use Disorder 401 Your Right to Be Treated with Respect and Dignity 437
Medical Complications 402 Your Right to Information 437
Treatment for Alcoholism 403 Your Right to Privacy and Access to Medical
Records 437
Recovery 404
Your Right to Quality Health Care 438
Tobacco in America 404
Elective Treatments 438
Why People Smoke 404
Vision Surgery 438
Tobacco Use Disorder 405
Cosmetic Surgery 439
Tobacco Use on Campus 406 Body Art Perils 439
Social Smoking 406
College Tobacco-Control Policies 407 Health Hoaxes and Medical Quackery 439
Smoking, Gender, and Race 407 Nontraditional Health Care 440
Tobacco’s Immediate Effects 408 Types of CAM 441
How Nicotine Works 408 The Health-Care System 444
Tar and Carbon Monoxide 408 Health-Care Practitioners 444
Health Effects of Cigarette Smoking 409 Health-Care Facilities 445
Health Effects on Students 409 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
Premature Death 410
Heart Disease and Stroke 410 CHAPTER 14
Cancer 410 Protecting Yourself
Respiratory Diseases 410
Other Harmful Effects 411 and Your Environment 453
Emerging Tobacco Products 411 Unintentional Injury 454
Electronic Cigarettes 411 Safety on the Road 454
Water Pipes (Hookahs) 412 Avoid Distracted Driving 455
Other Forms of Tobacco 412 Don’t Text or Talk 456
Cigars 413 Stay Sober and Alert 456
Pipes 413 Buckle Up 457
Bidis 413 Check for Air Bags 457
viii Contents
Rein in Road Rage 457 Ionizing Radiation 478
Cycle Safely 458 Your Hearing Health 479
Violence in America 458 How Loud Is That Noise? 479
Gun Violence 459 Effects of Noise 479
Mass Shootings 459 Are Earbuds Hazardous
A Public Health Approach 460 to Hearing? 480
Violence and Crime on Campus 460 Hearing Loss 481
Hazing 461 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
Hate or Bias Crimes 461
Microaggressions 461 CHAPTER 15
Shootings, Murders, and Assaults 462 A Lifetime of Health 485
Consequences of Campus Violence 462
An Aging Nation 486
Sexual Victimization and Violence 463
Will You Live to 50? 486
Cyberbullying and Sexting 463
Sexual Harassment 463 Successful Aging 487
Stalking 464 Physical Activity: It’s Never Too Late 487
Intimate Partner (Dating) Violence 464 Nutrition and Obesity 488
Sexual Assault on Campus 465 The Aging Brain 489
Changing the Campus Culture 465 Women at Midlife 489
Types of Sexual Victimization and Violence 466 Men at Midlife 491
Nonvolitional Sex and Sexual Coercion 466 Sexuality and Aging 492
Incapacitated Sexual Assault and Date-Rape Drugs 467 The Challenges of Age 492
Rape 467 Mild Cognitive Impairment (MCI) 492
What to Do in Case of Sexual Assault and Rape 470 Alzheimer’s Disease 492
From Personal to Planetary Threats: The Environment Osteoporosis 494
and Your Health 470 Preparing for Medical Crises and the End of Life 494
Climate Change 471 Advance Directives 495
Global Warming 471 The Gift of Life 496
The Health Risks 472 Death and Dying 496
The Impact of Pollution 472 Death Literacy and Education 496
The Air You Breathe 473 Defining Death 497
The Water You Drink 474 Emotional Responses to Dying 497
Is Bottled Better? 474 Suicide 498
Portable Water Bottles 474 Grief 499
Indoor Pollutants: The Inside Story 475 Grief’s Effects on Health 499
Environmental Tobacco Smoke 476 5IF1PXFSPG/PXt.BLJOH5IJT$IBQUFS8PSLGPS:PV
Radon 476
Molds and Other Biological Contaminants 476
Household Products 476
Formaldehyde 477 Answers for Making This Chapter
Pesticides 477
Asbestos 477 Work for You 503
Lead 477
Carbon Monoxide and Nitrogen Dioxide 477 Glossary 504
Chemical Risks 477
Electromagnetic Fields 478 References 510
Cell Phones 478
Microwaves 478 Index 523
Contents ix
Key Features
CON S U M E R A L E RT Stressed-Out Students 59
All the Lonely Students 86
Sleeping Pill Precautions 41 Are You Eating Your Veggies? 131
Online Flirting and Dating 89 The Weight of Student Bodies 150
Dubious Diets 157 Student Bodies in Motion 172
Fitness Monitors 187 The Sex Lives of College Students 216
Should You Get the HPV Vaccine? 233 Students and STIs 231
Are You Addicted to Tanning? 315 Birth Control Choices of College Students 266
Protecting yourself from the Perils of Piercing 333 Cancer Preventive Strategies 313
E-Cigarettes 411 Vaccinations 328
Too Good to Be True? 428 Student Drug Use 346
Bicycle Helmet Heads-up 458 Student Drinking 384
Student Smoking 406
H E A LT H NOW! What’s Trending in Who Uses Complementary and Alternative
Medicine 441
First Steps 11 How Safe Do Students Feel? 460
Accentuate the Positive 26 Dying Young: Leading Causes of Death 496
Count Your Blessings 37
Write It Out! 72 YOU R S T R AT EGI E S FOR C H A NGE
Assessing a Relationship 97
More Healthful Fast-Food Choices 134 How to Forgive 32
Thinking Thinner 159 How to Cope with Distress after a Trauma 65
Excise Exercise Excuses 173 How to Become More Resilient 75
Telling a Partner You Have an STI 232 How to Assert Yourself 83
Choosing a Contraceptive 258 How to Cope with an Unhealthy Relationship 96
Infection Protection 325 Creating a Healthy Eating Pattern 127
Recognizing Substance Abuse 354 Make Smart Choices 131
Kicking the Habit 414 The Right Way to Walk and Run 185
Is a CAM Therapy Right for You? 442 If You Have an STI 230
How to Avoid Date Rape 469 How to Lower Your Blood Pressure 301
Preparing for a Medical Crisis in an Aging Relative 496 Learning about Death 497
How to Cope with Grief 499
H E A LT H ON A BU D GE T
YOUR STRATEGIES FOR PREVENTION
Invest in Yourself 14
Happiness for Free! 28 If You Are at Risk 7
How to Handle Economic Stress 63 How to Help Someone Who Is Depressed 40
Money Can’t Buy Love 95 Steps to Prevent Suicide 48
Frugal Food Choices 132 How to Handle Test Stress 62
Hold the Line! 149 How to Protect Yourself from Food Poisoning 141
Buying Athletic Shoes 195 Keeping the Pounds Off 161
Reducing Your Risk of STIs 214 How to Avoid Stretching Injuries 193
Lowering Your Cardiometabolic Risks 291 How to Avoid Stretching Injuries 194
Caring for Your Cold 330 How to Stay Safe in the “Hookup Era” 218
Develop a Positive Addiction 343 Safe Sex in Cyberspace 222
Drink Less, Save More 385 How to Recognize a Stroke 310
Getting Your Money’s Worth from the Health-Care System 434 Save Your Skin 317
No- and Low-Cost Ways to “Green” Your Space 475 How to Protect Yourself and Others from Influenza 331
Reduce Your Future Health-Care Costs 488 How to Say No to Drugs 356
How to Recognize the Warning Signs of Alcoholism 403
S NA P S HO T: ON CA M P U S NOW How to Boost Health Understanding 426
How to Take Care of Your Mouth 432
Student Health 12 What to Do in an Emergency 454
Sleepy Students 33 How to Protect Your Ears 479
Student Mental Health 38 Keep Your Bones Healthy 495
Preface
To the Student: Starting Now t One in four college students may have at least one risk factor for
cardiovascular disease.
College prepares you for the future. But when it comes to health, t Nine in 10 college students report feeling stressed.
your future starts now! Every day you make choices and take actions t One in three college students reports binge drinking at least once
that may or may not have long-term consequences in the future. Yet in the previous 2 weeks.
they do have immediate effects on how you feel now. Here are some
examples: Such risky behaviors take a toll. According to an international
study, young Americans are less likely to survive until age 55 than
t You stay up late and get less than 5 hours’ sleep. The next day their peers in other developed nations. Those who do live to middle
you feel groggy, your reflexes are off, and you find it harder to age and beyond are more likely to suffer serious chronic diseases
concentrate. and disabilities.
t You scarf down a double cheeseburger with bacon, a supersized You do not have to be among them. An Invitation to Health: The
side of fries, and a milkshake. By the time you’re done with your Power of Now shows you how to start living a healthier, happier,
meal, harmful fats are coursing through your bloodstream. and fuller life now and in the years to come.
t You chug a combo of Red Bull and vodka and keep partying for
hours. Even before you finish your first drink, your heart is rac-
ing and your blood pressure is rising. If you keep drinking, you’ll
reach dangerous levels of intoxication—probably without realizing
To the Instructor
how inebriated you are. You talk to your students about their future because it matters. But in
t Too tired to head to the gym, you binge-watch streaming vid- the whirl of undergraduates’ busy lives, today matters more.
eos for hours. Your metabolism slows; your unexercised muscles As recent research has documented, payoffs in the present are
weaken. more powerful motivators for healthful behaviors than future
t Just this once, you have sex without a condom. You wake up the rewards. Individuals exercise more, choose healthier foods, quit
next morning worrying about a sexually transmitted infection (STI) smoking, and make positive changes when immediate actions
or a possible pregnancy. yield short-term as well as long-term benefits.
t You don’t have time to get to the student health center for a flu An Invitation to Health: The Power of Now incorporates this under-
shot. Then your roommate comes down with the flu. lying philosophy throughout its chapters. As you can see in the
Preface for students, we consistently point out the impact that
t You text while driving—and don’t notice that the traffic light is everyday choices have on their health now and in the future. Each
changing. chapter highlights specific, practical steps that make a difference in
There are countless other little things that can have very big conse- how students feel and function. The “Health Now!” feature gives
quences on your life today as well as through all the years to come. students step-by-step guidance on how to apply what they’re
But they don’t have to be negative. Consider these alternatives: learning in their daily lives. “The Power of Now!” checklist at each
chapter’s end reinforces key behavioral changes that can enhance
t Get a solid night’s sleep after studying, and you’ll remember more and safeguard health.
course material and probably score higher on a test.
Each chapter’s “check-in” feature engages students as they read
t Eat a meal of a low-fat protein, vegetables, and grains, and you’ll by posing questions that relate directly to their lives, experiences,
feel energized. and perspectives. After the definitions of wellness in Chapter 1, for
t Limit your alcohol intake, and you’ll enjoy the evening and feel instance, a “check-in” asks “What does wellness mean to you?” In
better the morning after. the section on healthy habits, another “check-in” instructs students
to rate their own health habits. As they learn about behavioral
t Go for a 10-minute walk or bike ride, and you’ll feel less stressed changes, this feature prompts them to identify a health-related
and weary. change they want to make and their stage of readiness for change.
t Consistently practice safe sex, and you won’t have to wonder if As an instructor, you can utilize the “check-in” features in different
you’ve jeopardized your sexual health. ways. For instance, you might suggest that students use them to
t Keep up with your vaccinations, and you lower your odds of seri- test their comprehension of the material in the chapter. You might
ous illnesses. assign them to write a brief reflection on one or more “check-ins.”
Or you might draw on the “check-ins” to spark classroom discus-
t Pay attention to the road when you drive, and you can avoid
sion and increase student engagement.
accidents.
This textbook is an invitation to you as an instructor. I invite you to
In addition to their immediate effects, the impact of health behav-
share your passion for education and to enter into a partnership with
iors continues for years and decades to come. Consider these the editorial team at Cengage Learning. We welcome your feedback
facts: and suggestions. Please let us hear from you at www.cengage
t More than 40 percent of college students are already overweight .com/health. I personally look forward to working with you toward
or obese. our shared goal of preparing a new generation for a healthful future.
xi
What’s New in An Invitation encephalomyelitis/chronic fatigue syndrome (ME/CFS), Zika
virus, and the latest recommendations for prevention and treat-
to Health, Brief: The Power ment of infectious illnesses.
All the chapters have been updated with the most current research,
of Now including many citations published in 2016, and incorporating the
latest available statistics. The majority come from primary sources,
Some things don’t change: as always, this Invitation presents up- including professional books; medical, health, and mental health
to-date, concise, research-based coverage of all the dimensions of journals; health education periodicals; scientific meetings, federal
health. It also continues to define health in the broadest sense of agencies, and consensus panels; publications from research labo-
the word—not as an entity in itself, but as an integrated process for ratories and universities; and personal interviews with specialists in
discovering, using, and protecting all possible resources within the a number of fields. In addition, “What’s Online” presents reliable
individual, family, community, and environment. Internet addresses where students can turn for additional
What is new is the theme that threads through every chapter: pro- information.
viding students with practical knowledge and tools they can apply As I tell students, An Invitation to Health, Brief: The Power of Now
immediately to improve their health and their lives. One of the keys can serve as an owner’s manual to their bodies and minds. By
to doing so is behavioral change, which has always been funda- using this book and taking their course, they can acquire a special
mental to An Invitation to Health. The one feature that has appeared type of power—the power to make good decisions, to assume
in every edition—and that remains the most popular—is “Your responsibility, and to create and follow a healthy lifestyle. This text-
Strategies for Change.” book is our invitation to them to live what they learn and make the
Each chapter begins with a new feature, “What Do You Think?” most of their health—now and in the future.
questions to have the reader think about his or her personal experi-
ence and knowledge in regard to concepts in the chapter, At the
end of the chapter the “What Did You Decide?” questions ask the
reader to reflect on how his or her answers to these questions may
An Overview of Changes
have changed after reading the chapter. and Updates
Every chapter concludes with “The Power of Now!”, a checklist that
students can use to assess their current status and work toward Following is a chapter-by-chapter listing of some of the key topics
specific goals, whether by creating better relationships (Chapter 4), that have been added, expanded, or revised for this edition.
getting in better shape (Chapter 7), or taking charge of their alcohol
and tobacco intake (Chapter 12). Chapter 5, Personal Nutrition, is Chapter 1: The Power of Now
updated with information on the Dietary Guidelines for Americans College and health; occupational and financial health; health in
2015–2020. Chapter 13, Consumer Health, contains updated infor- America; the dimensions of health; student health norms; self-affir-
mation on the Affordable Care Act as well as ways to evaluate mation theory; and health belief model (HBM)
health information, prepare for a medical exam, get quality tradi-
tional and alternative health care, and navigate the health-care Chapter 2: Your Psychological and Spiritual
system.
Well-Being
Throughout this edition, the focus is on students, with real-life Positive psychology and positive psychiatry; most effective positive
examples, the latest statistics on undergraduate behaviors and psychology interventions; sleep and health; treating sleep disorders;
attitudes, and coverage of new campus health risks, including the toll on students; and major depressive disorder
alcohol mixed with energy drinks (AmEDs), electronic cigarettes
and vaping, hookah (water pipe) smoking, the combination of binge Chapter 3: Stress Management
drinking and disordered drinking, polysubstance abuse, “bath Neustress; stress in America; stress on campus; discrimination
salts,” and cyberbullying. stress; acculturative stress; financial and occupational stress; and
An interactive feature, “On Campus Now,” showcases the latest stress-management apps
research on student behavior, including their sleep habits (Chapter 2),
stress levels (Chapter 3), weight (Chapter 6), and sexual experi- Chapter 4: Social Health
ences (Chapter 8). “Health Now!” presents practical, ready-to-use Loneliness; cyberbullying; Facebook; college students’ cell phone
tips related to real-life issues such as recognizing substance abuse use; the brain in love; trends in sexual relationships; hookup culture;
(Chapter 11) and how to avoid date rape (Chapter 14). intimate partner violence; same-sex marriage; and divorce
Other popular features that have been retained and updated
include “Health on a Budget” and “Consumer Alert.” A “Self Sur- Chapter 5: Personal Nutrition
vey” for each chapter can be found within MindTap. End-of-chapter Dietary Guidelines for Americans 2015–2020; protein; vitamin D;
resources include “Review Questions,” “Critical Thinking Ques- sodium; eating patterns in the United States and worldwide; student
tions,” and “Key Terms.” At the end of the book is a full Glossary as use of dietary supplements; food allergies; Mediterranean diet; nutri-
well as complete chapter references. tion labels; choosing healthful snacks; and dietary supplements
Because health is an ever-evolving field, this edition includes
many new topics, including the latest reports on dietary guide- Chapter 6: Weight Management
lines for Americans, students’ mental health, emerging tobacco Weighing in; weight on campus; body mass index (BMI); evaluating
products, the impact of stress, campus hookups, same-sex weight-loss programs; obesity surgery; and emotional eating
marriage, self-injury, suicide prevention, vitamin supplements,
exercise guidelines, sexually transmitted infections, gun vio- Chapter 7: Physical Activity and Fitness
lence, attention-deficit/hyperactivity disorder (ADHD), autism Exercise Is Medicine; countering dangers of sedentary living, your
spectrum disorder, caffeinated alcoholic beverages, binge exercise prescription; exercise apps, trackers, and monitors; and
drinking, weight management, metabolic syndromes, myalgic buying athletic shoes
xii Preface
Chapter 8: Sexual Health Diet & Wellness Plus
Premenstrual syndrome treatments; sexual behavior; sex on Diet & Wellness Plus helps you understand how nutrition relates to
campus; hooking up; choosing sexual partners; ethnic variations your personal health goals. Track your diet and activity, generate
affect sexual behaviors; sexual diversity; LGBT health disparities; reports, and analyze the nutritional value of the food you eat. Diet &
pornography; female ejaculation; Zika virus; and HIV testing and Wellness Plus includes over 75,000 foods as well as custom food
college students and recipe features. The Behavior Change Planner helps you identify
risks in your life and guides you through the key steps to make posi-
Chapter 9: Reproductive Options tive changes. Diet & Wellness Plus is also available as an app that
Reproductive responsibility; prolonged sitting; healthy diet; Contra- can be accessed from the app dock in MindTap.
ceptive information sources for young adults; Zika virus; long-acting
reversible contraceptives (LARCs); male condoms; and abortion Instructor Companion Site
Everything you need for your course in one place! This collection
Chapter 10: Major Diseases of book-specific lecture and class tools is available online via www
Physical inactivity; prolonged sitting; healthy diet; risk of metabolic .cengage.com/login. Access and download PowerPoint presenta-
syndrome; risk of diabetes mellitus; hypertension in the young; tions, images, instructor’s manual, videos, and more.
reducing sodium; cardiovascular (heart) disease; psychological
risk factors for heart disease; impact of stress; cancer in America; Global Health Watch
screening for breast cancer; Zika virus; and Bourbon virus Bring currency to the classroom with Global Health Watch from
Cengage Learning. This user-friendly website provides convenient
Chapter 11: Addictions access to thousands of trusted sources—including academic jour-
Changing drug scene across America; understanding addiction; nals, newspapers, videos, and podcasts—for you to use for research
preventing addictions; caffeine-containing energy drinks (CCEDs); projects or classroom discussion. Global Health Watch is updated
drugs and alcohol; prescription drug abuse; prescription stimulants; daily to offer the most current news about topics related to nutrition.
marijuana’s effects on health; legalized marijuana; artificial reproduc-
tive technology; GHB and GBL; and Fentanyl Cengage Learning Testing Powered by Cognero
This flexible online system allows the instructor to author, edit, and
Chapter 12: Alcohol and Tobacco manage test bank content from multiple Cengage Learning solu-
Drinking in America; drinking on campus; toll of alcohol; sex- tions; create multiple test versions in an instant; and deliver tests
ual orientation and drinking; alcohol mixed with energy drinks from an LMS, a classroom, or wherever the instructor wants.
(AmEDs); fetal alcohol spectrum disorder; alcoholism treatments;
tobacco use on campus; emerging tobacco products; electronic
cigarettes; and vaping
Acknowledgments
Chapter 13: Consumer Health One of the joys of writing each edition of An Invitation to Health is the
Update on the Affordable Care Act (Obamacare); consumer-driven opportunity to work with a team I consider the best of the best in textbook
health care; mobile health apps and monitors; privacy of personal publishing. I thank Krista Mastroianni, product manager, for her enthusi-
health information; trends in plastic surgery; and complementary asm and support; Miriam Myers, senior content developer, for her work on
and alternative medicine use in America and on college campuses the textbook and MindTap; and Michael Cook, senior designer, provided
the evocative cover and eye-catching design.
Chapter 14: Protecting Yourself and Your I thank Marina Starkey, our product assistant, for her invaluable aid; Carol
Environment Samet, senior content project manager, for expertly shepherding this edi-
Safety on the road; microagresssions; sexting; social or intimate vio- tion from conception to production; Liz Harasymczuk for the vibrant new
lence; sexual assault on campus; “It’s On Us” campaign; pollution’s design; and Michael McGranaghan of SPi Global for his supervision of the
health impact; lead-contaminated water; and cell phone dangers production process. Mathangi Anantharaman, our photo researcher, pro-
vided images that capture the diversity and energy of today’s college stu-
Chapter 15: A Lifetime of Health dents. Kanchana Vijayarangan coordinated text permissions, and Christine
Health problems of seniors; impact of feeling younger than actual Myaskovsky managed the overall permissions process.
age; Mediterranean diet and longevity; Alzheimer’s disease and pre- My thanks to Ana Albinson, marketing manager; and to Kellie Petruzzelli,
scription drugs; disabilities in older Americans; and death literacy who guided the ancillaries.
and education
Finally, I would like to thank the reviewers whose input has been so valu-
able through these many editions. I thank the following for their comments
and helpful assistance on the current edition:
Supplemental Resources Joseph Bails, Parkland College
Christina L. Benjamin, Montgomery College
Dr. Rachelle D. Duncan, Oklahoma State University
Health MindTap for An Invitation to Health, William E. Dunscombe, Union County College
Brief: The Power of Now Alicia M. Eppley, Theil College
A new approach to highly personalized online learning. Beyond Michelle Lomonaco, The Citadel
an eBook, homework solution, digital supplement, or premium Jeannie M Neiman, Edmonds Community College
Jennifer Pridemore, Parkland College
website, MindTap is a digital learning platform that works along-
Stephen P. Sowulewski, Reynolds Community College
side your campus LMS to deliver course curriculum across the
range of electronic devices in your life. MindTap is built on an For their help with earlier editions, I offer my gratitude to:
“app” model allowing enhanced digital collaboration and delivery Ghulam Aasef, Kaskaskia College
of engaging content across a spectrum of Cengage and non- Andrea Abercrombie, Clemson University
Cengage resources. Daniel Adame, Emory University
Preface xiii
Lisa Alastuey, University of Houston Anthony F. Kiszewski, Bentley University
Carol Allen, Lone Community College Mark J. Kittleson, Southern Illinois University
Lana Arabas, Truman State University Darlene Kluka, University of Central Oklahoma
Judy Baker, East Carolina University John Kowalczyk, University of Minnesota, Duluth
Marcia Ball, James Madison University Debra A. Krummel, West Virginia University
Jeremy Barnes, Southeast Missouri State University Roland Lamarine, California State University, Chico
Rick Barnes, East Carolina University David Langford, University of Maryland, Baltimore County
Lois Beach, SUNY-Plattsburg Terri Langford, University of Central Florida
Liz Belyea, Cosumnes River College Beth Lanning, Baylor University
Betsy Bergen, Kansas State University Norbert Lindskog, Harold Washington College
Nancy Bessette, Saddleback College Loretta Liptak, Youngstown State University
Carol Biddington, California University of Pennsylvania Raymond A. Lomax, Kean University
David Black, Purdue University David G. Lorenzi, West Liberty State College
Jill M. Black, Cleveland State University S. Jack Loughton, Weber State University
Cynthia Pike Blocksom, Cincinnati Health Department Rick Madson, Palm Beach Community College
Laura Bounds, Northern Arizona University Ashok Malik, College of San Mateo
James Brik, Willamette University Michele P. Mannion, Temple University
Mitchell Brodsky, York College Jerry Mayo, Hendrix College
Jodi Broodkins-Fisher, University of Utah Wajeeha Mazhar, California Polytechnic State University–Pomona
Elaine D. Bryan, Georgia Perimeter College Jessica Middlebrooks, University of Georgia
James G. Bryant, Jr., Western Carolina University Claudia Mihovk, Georgia Perimeter College
Conswella Byrd, California State University East Bay Kim H. Miller, University of Kentucky
Marsha Campos, Modesto Junior College Susan Milstein, Montgomery College
Richard Capriccioso, University of Phoenix Esther Moe, Oregon Health Sciences University
James Lester Carter, Montana State University Kris Moline, Lourdes College
Jewel Carter-McCummings, Montclair State University Richard Morris, Rollins College
Peggy L. Chin, University of Connecticut Rosemary Moulahan, High Point University
Olga Comissiong, Kean University Sophia Munro, Palm Beach Community College
Patti Cost, Weber State University John W. Munson, University of Wisconsin–Stevens Point
Maxine Davis, Eastern Washington University Ray Nolan, Colby Community College
Maria Decker, Marian Court College Shannon Norman, University of South Dakota
Laura Demeri, Clark College Anne O’Donnell, Santa Rosa Junior College
Lori Dewald, Shippensburg University of Pennsylvania Terry Oehrtman, Ohio University
Julie Dietz, Eastern Illinois University Shanyn Olpin, Weber State University
Peter DiLorenzo, Camden County College David Oster, Jefferson College
Robert Dollinger, Florida International University College of Medicine Randy M. Page, University of Idaho
Rachelle D. Duncan, Oklahoma State University Carolyn P. Parks, University of North Carolina
Sarah Catherine Dunsmore, Idaho State University Anthony V. Parrillo, East Carolina University
Gary English, Ithaca College Lorraine Peniston, Hartford Community College
Victoria L. Evans, Hendrix College Miguel Perez, University of North Texas
Melinda K. Everman, Ohio State University Pamela Pinahs-Schultz, Carroll College
Michael Felts, East Carolina University Dena Pistor, Rollins College
Lynne Fitzgerald, Morehead State University Rosanne Poole, Tallahassee Community College
Matthew Flint, Utah Valley University Thomas Roberge, Norwich University
Kathie C. Garbe, Kennesaw State College Keisha Tyler Robinson, Youngstown State University
Gail Gates, Oklahoma State University Joel Rogers, West Hills Community College District
Dawn Graff-Haight, Portland State University Linda J. Romaine, Raritan Valley Community College
Carolyn Gray, New Mexico State University Pamela Rost, Buffalo State College
Mary Gress, Lorain County Community College Karla Rues, Ozarks Technical Community College
Janet Grochowski, University of St. Thomas Veena Sallan, Owensboro Community and Technical College
Jack Gutierrez, Central Community College Sadie Sanders, University of Florida
Autumn R. Hamilton, Minnesota State University Steven Sansone, Chemeketa Community College
Christy D. Hawkins, Thomas Nelson Community College Debra Secord, Coastline College
Stephen Haynie, College of William and Mary Behjat Sharif, California State University–Los Angeles
Amy Hedman, Mankato State University Andrew Shim, Southwestern College
Ron Heinrichs, Central Missouri State University Agneta Sibrava, Arkansas State University
Candace H. Hendershot, University of Findlay Steve Singleton, Wayne State University
Michael Hoadley, University of South Dakota Larry Smith, Scottsdale Community College
Debbie Hogan, Tri County Community College Teresa Snow, Georgia Institute of Technology
Margaret Hollinger, Reading Area Community College Sherm Sowby, Brigham Young University
Harold Horne, University of Illinois at Springfield Carl A. Stockton, Radford University
Linda L. Howard, Idaho State University Linda Stonecipher, Western Oregon State College
Mary Hunt, Madonna University Ronda Sturgill, Marshall University
Kim Hyatt, Weber State University Jacob W. Surratt, Gaston College
Bill Hyman, Sam Houston State University Rosemarie Tarara, High Point University
Dee Jacobsen, Southeastern Louisiana University Laurie Tucker, American University
John Janowiak, Appalachian State University Julia VanderMolen, Davenport University
Peggy Jarnigan, Rollins College Emogene Johnson Vaughn, Norfolk State University
Jim Johnson, Northwest Missouri State University Jennifer Vickery, Winthrop College
Chester S. Jones, University of Arkansas Andrew M. Walker, Georgia Perimeter College
Herb Jones, Ball State University David M. White, East Carolina University
Jane Jones, University of Wisconsin, Stevens Point Sabina White, University of California–Santa Barbara
Lorraine J. Jones, Muncie, Indiana Robert Wilson, University of Minnesota
Walter Justice, Southwestern College Roy Wohl, Washburn University
Becky Kennedy-Koch, The Ohio State University Martin L. Wood, Ball State University
Margaret Kenrick, Los Medanos College Sharon Zackus, City College of San Francisco
xiv Preface
About the Author
Dianne Hales is a widely published and honored author and journalist. She is the author
of 15 trade books, including the New York Times bestseller La Bella Lingua; Mona Lisa:
A Life Discovered; Just Like a Woman; Think Thin, Be Thin; and Caring for the Mind,
with translations into Chinese, Japanese, Italian, French, Spanish, Portuguese, German,
Dutch, Swedish, Danish, Polish, and Korean.
Hales has received the highest honor the government of Italy can bestow on a foreigner,
an honorary knighthood, with the title Cavaliere dell’ Ordine della Stella della Solidarietà
Italiana (Knight of the Order of the Star of Italian Solidarity) in recognition of her book La
Bella Lingua: My Love Affair with Italian, the World’s Most Enchanting Language, as “an
invaluable tool for promoting the Italian language.”
Hales is a former contributing editor for Parade, Ladies’ Home Journal, Working Mother,
and American Health and has written more than 1,000 articles for publications includ-
ing Family Circle, Glamour, Good Housekeeping, Health, the New York Times, Reader’s
Digest, the Washington Post, Woman’s Day, and World Book Encyclopedia.
Hales has received writing awards from the American Psychiatric Association and the
American Psychological Association, an EMMA (Exceptional Media Merit Award) for
health reporting from the National Women’s Political Caucus and Radcliffe College, three EDI (Equality, Dignity, Independence) awards for
print journalism from the National Easter Seal Society, the National Mature Media Award, and awards from the Arthritis Foundation, California
Psychiatric Society, CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), Council for the Advancement of Scientific
Education, and New York City Public Library.
xv
WHAT DO YOU THINK?
What does “health” mean to you?

How healthy are today’s college students?
Do race and gender affect health?
Can people successfully change their health behaviors?
Fotokostic/Shutterstock.com
1
The Power of Now
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 10), 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 pressure could be at greater risk of heart problems in
the future.1
“Maybe I’m not too young to start thinking about my taking charge and making healthy choices for yourself
health,” Keisha concluded. Neither are you, whether and your future. This book includes material on your
you’re a traditional-age college student or, like an ever- mind and your body, your spirit and your social ties,
increasing number of undergraduates, years older. your needs and your wants, your past and your poten-
An Invitation to Health is both about and for you; tial. It will help you explore options, discover possibili-
it asks you to go beyond thinking about your health to ties, and find new ways to make your life worthwhile.
After reading this chapter, you should be able to:

1.1 Define health and wellness. 1.6 Describe the impact of habits formed in college on
1.2 Outline the dimensions of health. future health.
1.3 Assess the current health status of Americans. 1.7 Explain the influences on behavior that support or
impede healthy change.
1.4 Discuss health disparities based on gender
and race. 1.8 Identify the stages of change.
1.5 Evaluate the health behaviors of undergraduates.
What you learn from this book and in this • Supportive friends and family and a nurtur-
Design Pics Inc/Alamy Stock Photo

course depends on you. You have more con- ing intimate relationship with someone you
trol over your life and well-being than anything love
or anyone else does. Through the decisions
• A personally satisfying job or intellectual
you make and the habits you develop, you can
endeavor
influence how well—and perhaps how long—
you will live. • A clean, healthful environment
The time to start is now. Every day you
make choices that have short- and long-term ✓ check-in How would you define health?
consequences for your health. Eat a high-
Image Source/Jupiterimages
fat meal, and your blood chemistry changes.
Wellness can be defined as purposeful,
Spend a few hours slumped in front of the
enjoyable living or, more specifically, a deliberate
television, and your metabolism slows. Chug
lifestyle choice characterized by personal respon-
a high-caffeine energy drink, and your heart
sibility and optimal enhancement of physical,
races. Have yet another beer, and your reflexes
mental, and spiritual health. In the broadest
slow. Text while driving, and you may weave
sense, wellness is:
into another lane. Don’t bother with a condom,
and your risk of sexually transmitted infection • A decision you make to move toward optimal
Robin Skjoldborg/Cultura/Getty Images
(STI) skyrockets. health

Sometimes making the best choices demands
• A way of life you design to achieve your high-
making healthy changes in your life. This chap-
est potential
ter shows you how—and how to live more fully,
more happily, and more healthfully. This is an • A process of developing awareness that health
offer that you literally cannot afford to refuse. and happiness are possible in the present
Your life may depend on it—starting now. • The integration of body, mind, and spirit
• The belief that everything you do, think, and
Health is the process of
feel has an impact on your state of health and
discovering, using, and the health of the world
protecting all the resources
Health and
within our bodies, minds, Wellness ✓ check-in What does wellness mean to you?
spirits, families, communities,
and environment.
The Dimensions of Health
By simplest definition, health means being Scientists are discovering that various dimen-
sound in body, mind, and spirit. The World sions and the interplay among them can affect
Health Organization defines health as “not
us at a molecular level. For instance, a lack
merely the absence of disease or infirmity” but
of education—an indicator of poor intellectual
“a state of complete physical, mental, and social
health—has long been linked with poor physi-
well-being.” Health involves discovering, using,
cal health and relatively early death. However,
and protecting all the resources within our bod-
other factors—such as having meaningful rela-
ies, minds, spirits, families, communities, and
tionships with others (part of social health)
environment.
and a sense of meaning and purpose in life (an
Health has many dimensions: physical, psy-
indicator of spiritual health)—can overcome
chological, spiritual, social, intellectual, environ-
the disadvantages associated with poverty or
mental, occupational, and financial. This book
minimal schooling.
integrates these aspects into a holistic approach
By learning more about the dimensions of
that looks at health and the individual as a whole
health, you gain insight into the complex inter-
rather than part by part.
health A state of complete
play of factors that determine your level of well-
Your own definition of health may include dif-
well-being, including physical, ness. The following are the most commonly
ferent elements, but chances are you and your
psychological, spiritual, social, recognized dimensions of health and wellness,
classmates would include at least some of the
intellectual, and environmental following: but some models treat emotional, cultural, or
dimensions. financial health as separate categories rather than
• A positive, optimistic outlook aspects of psychological, social, or occupational
wellness A deliberate lifestyle health.
• A sense of control over stress and worries,
choice characterized by per-
time to relax
sonal responsibility and optimal ✓ check-in What do you consider the most
enhancement of physical, mental, • Energy and vitality, freedom from pain or seri-
and spiritual health. important or relevant dimensions of health?
ous illness
4 CHAPTER 1 The Power of Now
Physical Health The 1913 Webster’s Dic- the impact your world has on your well-being.
tionary defined health as “the state of being hale, It involves protecting yourself from dangers in
sound, or whole, in body, mind, or soul, espe- the air, water, and soil, as well as in products you
cially the state of being free from physical disease use—and working to preserve the environment
or pain.” More recent definitions conceive physi- itself. (See Chapter 14.)
cal health as an optimal state of well-being, not
merely the absence of disease or infirmity. Health Occupational and Financial Health In the
is not a static state but a process that depends coming decades, you will devote much of your time
on the decisions we make and the behaviors we and energy to your career. Ideally, you will contrib-
practice every day. To ensure optimal physical ute your unique talents and skills to work that is
health, we must feed our bodies nutritiously, rewarding in many ways—intellectually, emotion-
exercise them regularly, avoid harmful behaviors ally, creatively, and financially. College provides
and substances, watch for early signs of sickness, the opportunity for you to choose and prepare for
and protect ourselves from accidents. a career that is consistent with your personal val-
ues and beliefs and to learn how to manage your
Psychological Health Like physical well- money and safeguard your financial well-being.
being, psychological health, discussed in Chap- Health educators have expanded the traditional
ter 2, encompasses our emotional and mental individualistic concept of health to include the
states—that is, our feelings and our thoughts. It complex interrelationships between one person’s
involves awareness and acceptance of a wide health and the health of the community and envi-
range of feelings in oneself and others, as well as ronment. This change in perspective has given rise
the ability to express emotions, to function inde- to a new emphasis on health promotion, which
pendently, and to cope with the challenges of educators define as “any planned combination of
daily stressors. educational, political, regulatory, and organiza-
tional supports for actions and conditions of living
Spiritual Health Spiritually healthy individuals conducive to the health of individuals, groups, or
identify their own basic purpose in life; learn how communities.” Examples on campus include estab-
to experience love, joy, peace, and fulfillment; and lishing smoke-free policies for all college build-
help themselves and others achieve their full poten- ings, residences, and dining areas; prohibiting
tial. As they devote themselves to others’ needs tobacco advertising and sponsorship of campus
more than their own, their spiritual development social events; ensuring safety at parties; and
produces a sense of greater meaning in their lives. enforcing alcohol laws and policies.
Social Health Social health refers to the

ability to interact effectively with other people
and the social environment, to develop satisfying
interpersonal relationships, and to fulfill social
Health in America
roles. It involves participating in and contribut-
ing to your community, living in harmony with
fellow human beings, developing positive inter-
✓ check-in Do you exercise regularly?
dependent relationships, and practicing healthy
sexual behaviors. (See Chapter 4.) Eat nutritious meals? Maintain a healthy
weight? Avoid smoking? If you answer yes
Intellectual Health Every day you use to all four questions, you’re among the
your mind to gather, process, and act on infor-
2.7 percent of Americans who do so.
mation; to think through your values; to make
decisions, set goals, and figure out how to handle According to a recent national survey of more
a problem or challenge. Intellectual health refers than 4,700 people, 97.3 percent get a failing
to your ability to think and learn from life expe- grade in healthy lifestyle habits. For the minority
rience, your openness to new ideas, and your who do adapt these health guidelines, the payoff
capacity to question and evaluate information. includes a lower risk of many health problems,
Throughout your life, you’ll use your critical including type 2 diabetes, heart disease, and health promotion A
thinking skills, including your ability to evaluate cancer. A higher percentage report at least one combination of educational,
health information, to safeguard your well-being. healthy habit: political, regulatory, and
organizational supports
Environmental Health You live in a phys- • 71 percent do not smoke
to improve the well-being
ical and social setting that can affect every aspect • 46 percent get sufficient amounts of physical of individuals, groups, or
of your health. Environmental health refers to activity communities.
Health in America 5
vehicle accidents, firearm-related injuries, and drug
poisonings and overdoses.4
Rather than focus solely on life expectancy,
experts are calculating healthy life expectancy
(HALE), based on years lived without disease
or disability. On average, life expectancy at
birth for Americans averages about age 79,
but the average HALE is considerably shorter:
about 68 years.5
✓ check-in How do you think your life

expectancy and your healthy life expectancy
(HALE) compare?
Healthy People 2020

Every decade since 1980, the U.S. Department of
Health and Human Services (HHS) has published
a comprehensive set of national public health
objectives as part of the Healthy People Initiative.
The government’s vision is to create a society in
which all people can live long, healthy lives. Its
mission includes identifying nationwide health
improvement priorities, increasing public aware-
ness of health issues, and providing measurable
Zoonar GmbH/Alamy Stock Photo

objectives and goals.6
The overarching goals for Healthy People 2020
are as follows:
• Eliminate preventable disease, disability,
injury, and premature death.
• Achieve health equity, eliminate disparities,
Your choices and and improve the health of all groups.
behaviors during your • Create social and physical environments that
• 38 percent eat a healthy diet
college years can promote good health for all.
• 10 percent have a normal body fat percentage
influence how healthy • Promote healthy development and healthy
(see Chapter 6)
behaviors across every stage of life.
you will be in the
Women are more likely than men to not
future. Here are examples of specific new recom-
smoke and to eat a healthy diet but less likely to
mendations that have been added to the national
have adequate physical activity levels. Mexican
health agenda for 2020:
Americans are more likely to eat a healthy diet
than blacks or whites.2 • Nutrition and weight status: Prevent inap-
Life expectancy at birth in the United States propriate weight gain in youths and adults.
has increased to an all-time high of 76.4 years
• Tobacco use: Increase smoking-cessation
for men and 81.2 years for women, but citizens
success by adult smokers.
of other affluent nations, such as Japan and
Switzerland, live significantly longer.3 If you are • Sexually transmitted infections: Increase
under age 50, you may think this doesn’t apply the proportion of adolescents who abstain
to you. Think again. The Americans experienc- from sexual intercourse or use condoms if
ing the greatest health deficits and losing the sexually active.
most years to illness, disability, and premature • Substance abuse: Reduce misuse of pre-
death are not the elderly but young adults. As scription drugs.
a young American, your probability of reaching
• Heart disease and stroke: Increase overall
your 50th birthday is lower than in almost every
other high-income nation. The main reasons for cardiovascular health in the U.S. population.
the gap in life discrepancy between the United • Injury and violence prevention: Reduce
States and 12 comparable countries are motor sports and recreation injuries.
✓ check-in If you were setting personal YOUR STRATEGIES FOR PREVENTION
health objectives to attain by 2020, what
would they be?
If You Are at Risk
Certain health risks may be genetic, but behavior influences their impact. Here are
specific steps you can take to protect your health:
Health Disparities
Despite improvements in the overall health of Ask if you are at risk for any medical conditions or disorders based on
the nation, Americans who are members of cer- your family history or racial or ethnic background.
tain racial and ethnic groups—including African Find out if there are tests that could determine your risks. Discuss the
Americans, American Indians, Alaska Natives, advantages and disadvantages of such testing with your doctor.
Asian Americans, Hispanics, Latinos, and Pacific
Islanders—are more likely than whites to suffer If you or a family member requires treatment for a chronic illness, ask
disease and disability, including major depres- your doctor whether any medications have proved particularly effective
sion, poor physical health, functional limitations, for your racial or ethnic background.
and premature death. However, there has been If you are African American, you are significantly more likely to develop
progress in some important areas, including less
high blood pressure, diabetes, and kidney disease. Being overweight or
racial discrepancy in infant death rates, cesarean
obese adds to the danger. The information in Chapters 6–8 can help you lower
birth rates, and smoking among women.7
your risk by keeping in shape, making healthy food choices, and managing
Genetic variations, environmental influences,
your weight.
and specific health behaviors contribute to health
disparities, but poverty may be a more signifi- Hispanics and Latinos have disproportionately high rates of respiratory
cant factor. A much higher percentage of blacks problems, such as asthma, chronic obstructive lung disease, and tuber-
(26 percent) than non-Hispanic whites (10 per- culosis. To protect your lungs, stop smoking and avoid secondary smoke.
cent) live below the federal poverty level and Learn as much as you can about the factors that can trigger or worsen lung
may be unable to get needed medical treatment.8 diseases.
This may be changing for young Americans. The
expected lifespan for those under age 20 is less
affected by whether they are rich or poor now
than in the past.9
If you are a member of a racial or ethnic
minority, you need to educate yourself about
your health risks, take responsibility for those • Caucasians are prone to osteoporosis (pro-
within your control, and become a savvy, asser- gressive weakening of bone tissue); cystic
tive consumer of health-care services. The federal fibrosis; skin cancer; and phenylketonuria
Office of Minority Health and Health Disparities (PKU), a metabolic disorder that can lead to
(www.cdc.gov/omhd), which provides general cognitive impairment.
information and the latest research and recom- • Native Americans, including those indigenous
mendations, is a good place to start. to Alaska, are more likely to die young than
the population as a whole, primarily as a
✓ check-in Are you a member of a racial or result of accidental injuries, cirrhosis of the
ethnic minority? If so, do you think this liver, homicide, pneumonia, and complica-
tions of diabetes.
status affects your health or health care?
• The suicide rate among American Indians
and Alaska Natives is 50 percent higher than
Why Race Matters If, like many other the national rate. The rates of co-occurring
Americans, you come from a racially mixed mental illness and substance abuse (especially
background, your health profile may be com- alcohol abuse) are also higher among Native
plex. Here are just some of the differences race American youth and adults.
makes:10
• Black Americans lose substantially more years
Cancer Overall, black Americans are more
of potential life to homicide (nine times as
likely to develop cancer than persons of any other
many), stroke (three times as many), and dia-
racial or ethnic group. As discussed in Chapter 10,
betes (three times as many) as whites.
medical scientists have debated whether the
• About one in three Hispanics has prediabetes; reason might be that treatments are less effec-
only about half of Hispanics with diabetes tive in blacks or whether many are not diagnosed
have it under control.11 early enough or treated rigorously enough.
Health in America 7
Cardiovascular Disease Heart disease and
stroke are the leading causes of death for all racial
and ethnic groups in the United States, but mortal-
ity rates of death from these diseases are higher
among African American adults than among white
adults. African Americans also have higher rates of
high blood pressure (hypertension), develop this
problem earlier in life, suffer more severe hyper-
tension, and have higher rates of stroke.
Diabetes American Indians and Alaska

Natives, African Americans, and Hispanics are
twice as likely to be diagnosed with diabetes as
are non-Hispanic whites.
Infant Mortality African American, Ameri-

can Indian, and Puerto Rican infants have higher
death rates than white infants.
Mental Health American Indians and Alaska

Natives suffer disproportionately from depression
and substance abuse. Minorities have less access
to mental health services and are less likely to
receive needed high-quality mental health ser-
vices. The prevalence of dementia varies signifi-
cantly among Americans of different racial and
ethnic groups, with the highest rates among
John Lund/Marc Romanelli/Getty Images

blacks and American Indians/Alaskan Natives
and the lowest among Asian Americans. Hispan-
ics and whites have intermediate rates.14
Infectious Disease Asian Americans and

Pacific Islanders have much higher rates of hepa-
titis B than other racial groups. Black teenagers
Heredity places this and young adults become infected with hepatitis B
Pima Indian infant three to four times more often than those who
Although blacks continue to have higher can- are white. Black people also have a higher inci-
at higher risk of cer death rates than whites, the disparity has dence of hepatitis C infection than white people.
developing disease, narrowed for all cancers combined in men and Almost 80 percent of reported cases affect racial
women and for lung and prostate cancers in men. and ethnic minorities.
but environmental
However, the racial gap in death rates has wid-
factors also play ened for breast cancer in women and remained HIV and Sexually Transmitted Infec-
a role. level for colorectal cancer in men.12
tions Although African Americans and
• African American women are more than twice Hispanics represent only about one-quarter
as likely to die of cervical cancer as are white of the U.S. population, they account for about
women and are more likely to die of breast two-thirds of adult AIDS cases and more than
cancer than are women of any racial or ethnic 80 percent of pediatric AIDS cases.15
group except Native Hawaiians.
• Native Hawaiian women have the highest Sex, Gender, and Health
rates of breast cancer. Women from many Medical scientists define sex as a classification,
racial minorities, including those of Filipino, generally as male or female, according to the
Pakistani, Mexican, and Puerto Rican descent, reproductive organs and functions that derive
are more likely to be diagnosed with late- from the chromosomal complement. Gender
stage breast cancer than white women. refers to a person’s self-representation as male
• Cancer has surpassed heart disease as the or female or how social institutions respond to
leading cause of death among Hispanics in a person, on the basis of the individual’s gender
the United States, with an overall prevalence presentation. Gender is rooted in biology and
rate of 4 percent.13 shaped by environment and experience.
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 76.2 years • has a life expectancy of 81.1 years
FIGURE 1.1 Some of the Many Ways Men and Women Are Different
The experience of being male or female in a ✓ check-in How do you think your gender
particular culture and society can and does have
affects your health?
an effect on physical and psychological well-
being. In fact, sex and gender may have a greater Among the reasons that may contribute to the
impact than any other variable on how our bod- health and longevity gap between the sexes are
ies function, how long we live, and the symp- the following:
toms, course, and treatment of the diseases that
• Biological factors. For example, women have
strike us. (See Figure 1.1.)
Here are some health differences between two X chromosomes and men only one, and
men and women: men and women have different levels of sex hor-
mones (particularly testosterone and estrogen).
• Boys are more likely to be born prematurely,
• Social factors. These include work stress, hos-
to suffer birth-related injuries, and to die
tility levels, and social networks and supports.
before their first birthdays than girls.
• Behavioral factors. Men and women differ
• Men around the world have shorter lifespans
in risky behavior, aggression, violence, smok-
than women and higher rates of cancer, heart
disease, stroke, lung disease, kidney disease, ing, and substance abuse.
liver disease, and HIV/AIDS.16 They are four • Health habits. The sexes vary in terms of
times more likely to take their own lives or to regular screenings, preventive care, and mini-
be murdered than women. mizing symptoms.
• Cardiovascular disease is the leading cause
Sexual orientation can also affect health.
of death for women in the United States, yet
Lesbian, gay, bisexual, transgender, and queer
only about one-third of clinical trial subjects
(LGBTQ) individuals are more likely to encoun-
in cardiovascular research have been female.17
ter health disparities linked to social stigma, dis-
• Lung cancer is the leading cause of cancer crimination, and denial of their human and civil
death among women, with increased rates rights. Such discrimination has been implicated
particularly among young female nonsmokers. as a cause of high rates of psychiatric disorders,
• Women are 70 percent more likely than men substance abuse, and suicide. The Healthy Peo-
to suffer from depression over the course of ple 2020 initiative has made improvements in
their lifetimes. LGBTQ health one of its new goals.
Health in America 9
• If you’re a drifter, focus on developing
Health on Campus specific strategies to reach your educational
goals.
• If you’re a passenger, find a mentor or
As one of an estimated 21 million college stu-
dents in the United States, you are part of a advisor to help you interpret what you learn.
remarkably diverse group. Today’s undergrad- • If you’re a planner, look for help in
uates come from every age group and social,
applying the information you’ve gathered to
racial, ethnic, economic, political, and religious
background. Some 12 million are female; 9 mil- your unique situation.19
lion, male. You may have served in the mili-
tary, started a family, or emigrated from another College and Health
country. You might be enrolled in a 2-year col-
Although the words “college health” often appear
lege, a 4-year university, or a technical school.
Your classrooms might be in a busy city or a together, they are, in fact, two different things
small town—or they might exist solely as a vir- that profoundly influence each other. Healthier
tual campus. Although the majority of under- students get better grades and are more likely
graduates are “traditional” age (between 18 and to graduate. A college education boosts health
24 years), more of you than ever before—8 mil- status, income, and community engagement later
lion—are over age 25.18 in life.20 Yet the transition from high school to
Today’s college students are both similar to college is considered an at-risk period for health
and different from previous generations in many and healthy behaviors.
ways. Among the unique characteristics of cur- As studies in both the United States and
rent undergraduates are the following: Europe have documented, from their final year
of high school to the second year of college, stu-
• They are the first generation of “digital
dents are likely to:
natives,” who’ve grown up in a wired world.
• They are the most diverse in higher-education • Gain weight. In a recent study, undergradu-
history. About 15 percent are black; an equal ates put on around 6 pounds—9 pounds for
percentage are Hispanic. men and 4 pounds for women.
• They are both more connected and more iso- • Cut back on their participation in sports—
lated than their predecessors, with a “tribe” of perhaps because they move away from
friends, family, and acquaintances in constant hometown teams or they lack free time.
contact through social media but with weak
• Decrease some sedentary behaviors, such as
interpersonal, communications, and problem-
viewing TV/DVDs and playing computers,
solving skills.
but increase others, such as Internet use and
• More students are working, working longer studying.
hours, taking fewer credits, requiring more
• Eat less fruit and fewer vegetables.
time to graduate, and leaving college with
large student loan debts. • Consume more alcohol.21
• They are more coddled and protected by par-
Although healthier than their peers who are
ents, who remain very involved in their daily
not attending college, undergraduates have sig-
lives.
nificant health issues that can affect their overall
• They face a future in which the pace and well-being and ability to perform well in an aca-
scale of change will constantly accelerate. demic environment:
• More than half report common acute illnesses,
✓ check-in A recent analysis of community such as colds and flus, that interfere with their
college students identified four types of studies.
undergraduates: dreamers, drifters, • A significant proportion report symptoms
passengers, and planners. Here is some of depression, anxiety, and other mental
disorders.
specific advice for each type:
• For many, poor sleep has an impact on aca-
• If you’re a dreamer, seek guidance to fill
demic performance.
in the details of your “big picture” goal for
• Undergraduates are more likely to use alcohol
college.
and drugs than nonstudents their age.
• College students experience higher rates of
interpersonal violence.
• About 10 percent reported having smoked a
cigarette at least once in the past month. (See
HEALTH
• On the positive side, college students are less Chapter 12.) NOW!
likely to be overweight or obese, to smoke, to • A higher percentage—15 percent—had used
consume high-fat and low-fiber foods, to have First Steps
marijuana in the previous month. (See Chap-
high cholesterol levels, and to engage in high-
ter 11.) To lower your risk of heart
risk sexual behavior than young adults who
disease, get your blood
are not attending college.22 • Only 10.5 percent of students said they get
pressure and cholesterol
enough sleep to feel rested in the morning checked. Don’t smoke. Stay
College also represents a rite of passage,
6 or more days a week; 13 percent said they at a healthy weight. Exercise
when undergraduates typically engage in “adult”
never feel rested. (See Chapter 2.) regularly.
behaviors, such as drinking, getting involved
in intimate relationships, and taking personal • College athletes have lower health-related To lower your risks of
responsibility for health behaviors (such as major diseases, get regular
quality of life than their same-age peers who
sleep schedules and nutrition) that their par- checkups. Make sure you
did not or no longer play college sports.25 are immunized against infec-
ents may have previously supervised. Students
cramming for a big exam may decide not to tious illnesses.
sleep and accept the short-term consequences ✓ check-in How do you think your current To lower your risks of sub-
on their health. Others, thinking ahead to future stance abuse and related
health behaviors may affect your future? illnesses and injuries, don’t
goals, may consciously choose to avoid behav-
iors, such as unsafe sex or drug use, that may Colleges and universities have tried various drink, or limit how much you
jeopardize their plans.23 drink. Avoid illegal drugs.
interventions to improve students’ health choices
To lower your risk of sexu-
and habits. Do they work? In a meta-analysis of
✓ check-in Do you feel that today’s ally transmitted infections
41 studies, most conducted in the United States, or unwanted pregnancy,
undergraduates face unique pressures that
34 yielded significant improvements in one of abstain from sex. If you
can take a toll on physical and psychological several key outcomes, including the following: engage in sexual activities,
health? protect yourself with con-
• Physical activity: more steps per day, more traceptives, condoms, and
time in vigorous and/or moderate exercise, spermicides.
How Healthy Are Today’s greater maximum oxygen consumption, and To prevent car accidents,
Students? improved muscle strength, endurance, and stay off the road in hazard-
flexibility ous circumstances, such
In the American College Health Association’s
as bad weather. Wear a
National College Health Assessment (ACHA- • Nutrition: lower calorie intake, more fruits
seat belt when you drive
NCHA) survey, more than 8 in 10 undergraduates and vegetables, reduced fat consumption, and use defensive driving
(fewer than in previous years) rated their health more macronutrients, and better overall diet techniques.
as good, very good, or excellent (see Snapshot: quality
On Campus Now). Yet the habits of young Amer- Identify your top preven-
icans often aren’t healthy: • Weight: improved weight, lower body fat, tive health priority—lowering
and healthier waist circumference and waist- your risk of heart disease, for
• About one in four (38.6 percent) of under- instance, or avoiding accidents.
to-hip ratio
graduates had BMIs (body mass indexes) indi- Write down a single action
cating they were overweight or obese. (See The most effective interventions spanned a you can take this week that
Chapter 6 on weight.)24 will reduce your health risks.
semester or less, targeted only nutrition rather than
As soon as you take this step,
• Fewer than half (45.4 percent, less than in multiple behaviors, and were imbedded within write a brief reflection in your
previous years) of undergraduates got the college courses. As the researchers noted, “Univer- online journal.
recommended amounts of physical activity
sities and colleges are an ideal setting for imple-
(discussed in Chapter 7).
mentation of health promotion programs.” Why?
• Sixty percent had drunk alcohol at least once
in the previous months; 30 percent reported • They reach a large student population during
having consumed five or more drinks in a a crucial life transition.
single sitting at least once within the past
• They offer access to world-class facilities,
2 weeks. (See Chapter 12.)
technology, and highly educated staff in
• Of those engaging in vaginal intercourse, only various health disciplines.
about half (47.8 percent) reported having
used a condom mostly or always. (See Chap- • They reach young adults at an age “where
ter 8.) health behaviors that impact on health later in
life can be provided.”26
Health on Campus 11
SNAPSHOT: ON CAMPUS NOW
Student Health
Percentage of students who describe their health as good, very good, or excellent:
Men Women Average
88.4 84.3 85.4
Top Ten Health Problems Percent
1. Allergies 21.3
2. Sinus infection 18.8
3. Back pain 13.7
4. Strep throat 12.1
5. Urinary tract infection 10
6. Migraine headache 9.9
7. Asthma 9.0
8. Ear infection 6.9
9. Broken bone/fracture/sprain 6.8
10. Bronchitis 6.2
Proportion of college students who reported being diagnosed or Source: American College Health Association. American College Health Association–National Col-
lege Health Assessment II: Reference Group Executive Summary, Fall 2015 (Hanover, MD: American
treated for these health problems in the past year. College Health Association, 2016).
Why “Now” Matters a reduced risk of cardiovascular disease later in

life.27 Simple steps such as those listed in Health
The choices you make today have an immediate Now! can get you started in the right direction
impact on how you feel as well as long-term con- now!
sequences, including the following:
• Individuals who begin using tobacco or alco- Student Health Norms
hol in their teens and 20s are more likely to
continue to do so as they get older. Psychologists use the term norm, or social
norm, to refer to a behavior or an attitude that
• Obese children often grow into obese ado- a particular group expects, values, and enforces.
lescents and obese adults, with ever-increas- Norms influence a wide variety of human activ-
ing risks of diabetes and cardiovascular ities, including health habits. However, percep-
disease. tions of social norms are often inaccurate. Only
• People in their 20s who have even mildly anonymous responses to a scientifically
elevated blood pressure face an increased designed questionnaire can reveal what indi-
risk of clogged heart arteries by middle age. viduals really do—the actual social norms—as
• Young adults who acquire an STI may jeop- compared to what they may say they do to gain
ardize both their future fertility and their social approval.
health. Undergraduates are particularly likely to mis-
judge what their peers are—and aren’t—doing.
social norm A behavior or an At any age, health risks are not inevitable. As In recent years, colleges have found that publi-
attitude that a particular group recent research has shown, young adults with cizing research data on behaviors such as drink-
expects, values, and enforces. high aerobic fitness (discussed in Chapter 7) have ing, smoking, and drug use helps students get a
more accurate sense of the real health norms on
campus.
The gap between students’ misperceptions
and accurate health norms can be enormous.
For example, undergraduates in the ACHA sur-
vey estimated that only 12.7 percent of students
had never smoked cigarettes. In fact, 77.4 percent
never had. Students guessed that only 5.3 percent
of their peers never drank alcohol. In reality, 25.5
percent never did.28 Providing accurate informa-
tion on drinking norms on campus has proven
effective in changing students’ perceptions and
in reducing alcohol consumption by both men
Dragon Images/Shutterstock.com
and women.
✓ check-in Do you think your peers have

better or worse health habits than you?
The Promise Regular screening
of Prevention of vital signs, such
You may think you are too young to worry about as blood pressure,
serious health conditions. Yet many chronic others see them as a form of protection against can lead to early
problems begin early in life: dangerous diseases. Unfortunately, many adults detection of a poten-
• Two percent of college-age women already are not getting the immunizations they need—
tially serious health
have osteoporosis, a bone-weakening dis- and are putting their health in jeopardy as a
ease; another 15 percent have osteopenia, result. (See Chapter 10 to find out which vaccina- problem.
low bone densities that put them at risk of tions you should receive.)
osteoporosis. You can prevent STIs or unwanted pregnancy
by abstaining from sex. But if you decide to
• Many college students have several risk fac- engage in sexual activities, you can protect your-
tors for heart disease, including high blood self with condoms and spermicides. Similarly,
pressure and high cholesterol. Others increase you can prevent many automobile accidents by
their risk by eating a high-fat diet and not not driving when road conditions are hazardous.
exercising regularly. The time to change is But if you do have to drive, you can protect your-
now. self by wearing a seat belt and using defensive
driving techniques.
No medical treatment, however successful or
sophisticated, can compare with the power of ✓ check-in What steps are you taking to
prevention. Two out of every three deaths and
protect your health?
one in three hospitalizations in the United States
could be prevented by changes in six main risk
factors: tobacco use, alcohol abuse, accidents, Understanding Risky
high blood pressure, obesity, and gaps in screen-
ing and primary health care.
Behaviors
Prevention remains the best weapon against Today’s students face different—and potentially
cancer and heart disease. One of its greatest suc- deadlier—risks than undergraduates did a gener-
cesses has come from the antismoking campaign, ation or two ago. The problem is not that students
which in the past 40 years has prevented 8 mil- who engage in risky behavior feel invulnerable or prevention Information and
do not know the danger. Young people, accord- support offered to help healthy
lion premature deaths in the United States, giving
ing to recent research, actually overestimate the people identify their health
these ex-smokers an average of nearly 20 addi-
risks, reduce stressors, prevent
tional years of life.29 risk of some outcomes. However, they also over-
potential medical problems, and
estimate the benefit of immediate pleasure when,
enhance their well-being.
for instance, engaging in unsafe sex, and they
Protecting Yourself underestimate the negative consequences, such protection Measures that an
There is a great deal of overlap between preven- as an STI. individual can take when partici-
tion and protection. Some people might think College-age men are more likely than women pating in risky behavior to pre-
of immunizations as a way of preventing illness; to engage in risky behaviors—to use drugs and vent injury or unwanted risks.
Health on Campus 13
HEALTH ON A BUDGET
Invest in Yourself
As the economy has declined, visits to doctors have dropped, Don’t go to a specialist without consulting your
and millions of people are not taking prescribed medications. primary care provider, who can help you avoid overtest-
However, trying to save money in the short term by doing with- ing and duplicate treatments.
out needed health care can cost you a great deal—financially
If you need a prescription, ask if a generic form is
and physically—in the long term. Here are some ways to keep
available. Brand names cost more, and most insurers
medical costs down without sacrificing your good health:
charge higher copayments for them.
Stay healthy. Use this book to learn the basics of a healthy Take medications as prescribed. Skipping doses or
lifestyle and then live accordingly. By eating nutritiously, cutting pills in two may seem like easy ways to save money,
exercising, getting enough sleep, not smoking, and getting but you may end up spending more for additional care
regular immunizations, you’ll reduce your risk of conditions because the treatment won’t be as effective.
that require expensive treatments.
Don’t go to an emergency department unless abso-
Build a good relationship with a primary care physi- lutely necessary. Call your doctor for advice or go to the
cian. Although your choices may be limited, try to sched- student health service. Emergency departments are over-
ule appointments with the same doctor. A physician who burdened with caring for the very ill and for injured people,
knows you, your history, and your concerns can give the and their services are expensive.
best advice on staying healthy.
alcohol, to have unprotected sex, and to drive Fortunately, our understanding of change has itself
dangerously. Men are also more likely to be changed. Thanks to decades of research, we now
hospitalized for injuries and to commit suicide. know what sets the stage for change, the way
Three-fourths of the deaths in the 15- to 24-year- change progresses, and the keys to lasting change.
old age range are men. We also know that personal change is neither
Drinking has long been part of college life mysterious nor magical but rather a methodical
and, despite efforts across U.S. college campuses science that anyone can master.
to curb alcohol abuse, two out of five students
engage in binge drinking—consumption of five or ✓ check-in What health-related change
more drinks at a single session for men or four for would you like to make?
women. Heavy drinking increases the likelihood of
other risky behaviors, such as smoking cigarettes, Understanding Health Behavior
using drugs, and having multiple sexual partners.
New trends, such as drinking caffeinated alcoholic Three types of influences shape behavior:
beverages (discussed in Chapter 12), vaping (Chap- predisposing, enabling, and reinforcing factors
ter 12), and using dangerous stimulants called “bath (Figure 1.2).
salts” (Chapter 11), present new risks.
Predisposing Factors Predisposing fac-
✓ check-in What is the greatest health risk tors include knowledge, attitudes, beliefs, val-
you’ve ever taken? ues, and perceptions. Unfortunately, knowledge
isn’t enough to cause most people to change
their behavior; for example, people fully aware of
the grim consequences of smoking often con-
tinue to puff away. Nor is attitude—one’s likes
Making Healthy and dislikes—sufficient; an individual may dislike
the smell and taste of cigarettes but continue to
predisposing factors The
beliefs, values, attitudes, knowl-
Changes smoke anyway.
Beliefs are more powerful than knowledge
edge, and perceptions that influ- and attitudes, and researchers report that people
ence our behavior. are most likely to change health behavior if they
If you would like to improve your health behavior,
hold three beliefs:
you have to realize that change isn’t easy. Between
40 and 80 percent of those who try to kick bad • Susceptibility. They acknowledge that they
health habits lapse back into their unhealthy are at risk for the negative consequences of
ways within 6 weeks. (See Health on a Budget.) their behavior.
• Severity. They believe that they may pay a
Predisposing
very high price if they don’t make a change. Factors
• knowledge
• Benefits. They believe that the proposed • attitude
change will be advantageous to their health. • beliefs
• values
• perceptions
Enabling Factors Enabling factors alth Behav

He io
include skills, resources, accessible facilities, and in
rI
ge
nc
physical and mental capacities. Before you initi-
tive Chan
orpo tes...
ate a change, assess the means available to reach
your goal. No matter how motivated you are,
ra
you’ll become frustrated if you keep encounter- Reinforcing
si
Po
Enabling Factors
ing obstacles. Breaking down a task or goal into • praise from others
Factors
step-by-step strategies is very important in behav- • skills • rewards
ioral change. • resources • encouragement
• accessible facilities • recognition
• physical capabilities • sense of achievement
Reinforcing Factors Reinforcing factors • mental capabilities
may be praise from family members and friends,

rewards from teachers or parents, or encourage-
ment and recognition for meeting a goal.
Although these help a great deal in the short run,
FIGURE 1.2 Factors That Shape Positive Behavior
lasting change depends not on external rewards
but on an internal commitment and sense of
achievement. To make a difference, reinforce-
while failure is seen as a sign of character weak- reinforcing factors Rewards,
ment must come from within.
ness. In the enlightenment model, you submit to encouragement, and recognition
A decision to change a health behavior should that influence our behavior in the
strict discipline to correct a problem; this is the
stem from a permanent, personal goal, not from a short run.
approach used in Alcoholics Anonymous. The
desire to please or impress someone else. If you behavioral model involves rewarding yourself
lose weight for the homecoming dance, you’re when you make positive changes. The medi-
almost sure to regain pounds afterward. But if cal model sees the behavior as caused by forces
you shed extra pounds because you want to feel beyond your control (a genetic predisposition Your stated
better about yourself or get into shape, you’re far to being overweight, for example) and employs
more likely to keep off the weight. knowledge-based
an expert to provide advice or treatment. For
many people, the most effective approach is the belief may be that
✓ check-in What goal would motivate you
unsafe driving can
to change?
cause accidents. Your
actual belief is that it
won’t happen to you.
How and Why
People Change
Change can simply happen. You get older. You
put on or lose weight. You have an accident.
Intentional change is different: A person con-
sciously, deliberately sets out either to change
a negative behavior, such as chronic procrasti-
nation, or to initiate a healthy behavior, such as
daily exercise. For decades psychologists have
SelectStock/Vetta/Getty Images
studied how people intentionally change and

have developed various models that reveal the
anatomy of change.
In the moral model, you take responsibility
for a problem (such as smoking) and its solu-
tion; success depends on adequate motivation,
How and Why People Change 15
compensatory model, which doesn’t assign blame motivated by a desired outcome; for instance, they
but puts responsibility on individuals to acquire might exercise for the sake of better health or lon-
whatever skills or power they need to overcome ger life. Behavior becomes self-determined when
their problems. someone engages in it for its own sake, such as
exercising because it’s fun.
Health Belief Model Numerous studies have evaluated self-
determination as it relates to health behavior.
Psychologists developed the health belief In research on exercise, individuals with greater
model (HBM) about 50 years ago to explain self-determined motivation are less likely to stop
and predict health behaviors by focusing on the exercising; they have stronger intentions to con-
attitudes and beliefs of individuals. (Remember tinue exercise, higher physical self-worth, and
that your attitudes and beliefs are predisposing lower social anxiety related to their physique.
influences on your capacity for change.) Accord-
ing to this model, people will take a health-
related action (e.g., use condoms) if they:
Motivational Interviewing
Health professionals, counselors, and coaches
• Feel susceptible to a possible negative conse-
use motivational interviewing, developed by psy-
quence, such as a sexually transmitted infec-
chologists William Miller and Stephen Rollnick, to
tion (STI)
inspire individuals, regardless of their enthusiasm
• Perceive the consequence as serious or for change, to move toward improvements that
dangerous could make their lives better. The United States
• Think that a particular action (using a condom) Public Health Service, based on its assessment
will reduce or eliminate the threat (of STIs) of current research, recommends motivational
interviewing as an effective way to increase all
• Feel that they can take the necessary action
tobacco users’ willingness to quit.32 Building a
without difficulty or negative consequences
collaborative partnership, the therapist does not
• Believe that they can successfully do what’s persuade directly but uses empathy and respect
necessary—for example, use condoms com- for the patient’s perspective to evoke recognition
fortably and confidently30 of the desirability of change.
Readiness to act on health beliefs, in this model,

depends on how vulnerable individuals feel, how Self-Affirmation Theory
severe they perceive the danger to be, the benefits Affirmations, discussed in Chapter 2, can improve
they expect to gain, and the barriers they think integrity, problem solving, self-worth, and self-
they will encounter. Another key factor is self- regulation. They are also effective in encouraging
efficacy, confidence in their ability to take action. behavioral change. According to self-affirmation
In a study that tested the relationship between theory, thinking about core personal values, impor-
college students’ health beliefs and cancer self- tant personal strengths, or valued relationships
examinations, women were more likely to exam- can provide reassurance and reinforce self-worth.
ine their breasts than men were to perform Repeating an affirmation is one of the fastest ways
testicular exams. However, students of both sexes to restructure thought patterns, develop new
were more likely to do self-exams if they felt sus- pathways in the brain, and make individuals less
ceptible to developing cancer, if they felt com- defensive about changing health behaviors.33
fortable and confident doing so, and if they were Recent neuroimaging studies have revealed
given a cue to action (such as a recommendation how self-affirmations may increase the effec-
by a health professional).31 tiveness of many health interventions. Using
functional magnetic resonance imaging (fMRI),
Self-Determination Theory scientists were able to visualize changes in the
brains of volunteers as they were reciting affir-
This approach, developed several decades ago
mations in their minds. These internal messages
by psychologists Edward Deci and Richard Ryan,
produced more activity in a region of the brain
focuses on whether an individual lacks motivation,
associated with positive responses.34
is externally motivated, or is intrinsically motivated.
Someone who is “amotivated” does not value an ✓ check-in Some common self-affirmations
activity, such as exercise, or does not believe it will
lead to a desired outcome, such as more energy are “I am strong” or “I can handle this
health belief model (HBM) A or lower weight. Individuals who are externally challenge.”
model of behavioral change that motivated may engage in an activity like exercise What would you say to yourself to
focuses on an individual’s atti- to gain a reward or avoid a negative consequence
encourage a behavioral change?
tudes and beliefs. (such as a loved one’s nagging). Some people are
Transtheoretical Model
Psychologist James Prochaska and his colleagues,
by tracking what they considered to be universal ance
Mainten
stages in the successful recovery of drug addicts
and alcoholics, developed a way of thinking
about change that cuts across psychological theo-
ries. Their transtheoretical model focuses on Relapses occasionally Action
universal aspects of an individual’s decision- can happen.
making process rather than on social or biologi-
cal influences on behavior. on
Preparati
The transtheoretical model has become
the foundation of programs for smoking ces-
sation, exercise, healthy food choices, alcohol
cessation, weight control, condom use, drug use tion
Contempla
cessation, mammography screening, and stress
management. Recent studies have demonstrated
that it is more effective in encouraging weight
n
loss than physical activity.35 Precontemplatio
The following sections describe these key
components of the transtheoretical model:
FIGURE 1.3 The Stages of Change
• Stages of change—a sequence of stages to
make a change
• Processes of change—cognitive and behav-
ioral activities that facilitate change
2. Contemplation. In this stage, you still pre-
• Self-efficacy and locus of control—the
fer not to have to change, but you start to
confidence people have in their ability to
realize that you can’t avoid reality. Maybe
cope with challenge
none of your jeans fit anymore, or you feel
sluggish and listless. In this stage, you may
The Stages of Change According to the alternate between wanting to take action
and resisting it.
transtheoretical model of change, individuals
progress through a sequence of stages as they
✓ check-in Are you contemplating change?
make a change (Figure 1.3). No one stage is
more important than another, and people often You may be if you find yourself thinking
move back and forth between them. Most people • “I hate it that I keep…”
“spiral” from stage to stage, slipping from main- • “I should…”
tenance to contemplation or from action to pre-
• “Maybe I’ll do it someday—not tomorrow,
contemplation, before moving forward again.
People usually cycle and recycle through the • but someday.”
stages several times. Smokers, for instance, report
making three or four serious efforts to quit before 3. Preparation. At some point, you stop waf-
they succeed. fling, make a clear decision, and feel a burst
of energy. This decision heralds the prepa-
The six stages of change are as follows: ration stage. You gather information, make
1. Precontemplation. You are at this stage if phone calls, do research online, and look
you, as yet, have no intention of making a into exercise classes at the gym. You begin
change. You are vaguely uncomfortable, but to think and act with change specifically in
this is where your grasp of what is going on mind. If you were to eavesdrop on what
ends. You may never think about exercise, you’re saying to yourself, you would hear
for instance, until you notice that it’s harder statements such as, “I am going to do this.”
to zip up your jeans or that you get winded 4. Action. You are actively modifying your transtheoretical model
walking up stairs. Still, you don’t quite regis- behavior according to your plan. Your A model of behavioral change
ter the need to do anything about it. resolve is strong, and you know you’re on that focuses on an individual’s
During precontemplation, change remains your way to a better you. You may be get- decision making; it states that an
hypothetical, distant, and vague. Yet you may ting up 15 minutes earlier to make time for individual progresses through a
speak of something bugging you and wish a healthy breakfast or to walk to class rather sequence of six stages as he or
that things were somehow different. than take the shuttle. In a relatively short she makes a change in behavior.
time, you acquire a sense of comfort and • Emotional arousal. This process, also
ease with the change in your life. known as dramatic relief, works on a deeper
5. Maintenance. This stabilizing stage, which level than consciousness-raising and is equally
follows the flurry of specific steps taken important in the early stages of change.
in the action stage, is absolutely neces- Emotional arousal means experiencing and
sary to retain what you’ve worked for and expressing feelings about a problem behavior
to make change permanent. In this stage, and its potential solutions.
you strengthen, enhance, and extend the Example: Resolving never to drink and
changes you’ve initiated. drive after the death of a friend in a car
6. Relapse. It’s not unusual for people to slip accident.
backward at any stage. However, a relapse
• Self-reevaluation. This process requires
is simply a pause, an opportunity to regroup
a thoughtful reappraisal of your problem,
and regain your footing so you can keep
including an assessment of the person you
moving forward. After about 2–5 years, a
might be once you have changed the behavior.
behavior becomes so deeply ingrained that
you can’t imagine abandoning it. Example: Recognizing that you have a
gambling problem and imagining yourself
Research on college students has shown that
as a nongambler.
attitudes and feelings are related to stages of
change. Smokers who believe that continuing to • Commitment. In this process, you
smoke would have only a minor or no impact acknowledge—first privately and then
on their health remain in the precontemplation publicly—that you are responsible for your
stage; those with respiratory symptoms move on behavior and the only one who can change it.
to contemplation and preparation.
Example: Joining a self-help or support
✓ check-in Do you want to change a health group.
behavior? If so, what stage of change are • Rewards. In this process, you reinforce posi-
you in? tive behavioral changes with self-praise or
small gifts.
Example: Getting a massage after a month
The Processes of Change Anything you of consistent exercise.
do to modify your thinking, feeling, or behavior
can be called a change process. The processes of • Countering. Countering, or countercondi-
change included in the transtheoretical model are tioning, involves substituting healthy behav-
as follows: iors for unhealthy ones.
• Consciousness-raising. This most widely Example: Chewing gum rather than
used change process involves increasing smoking.
knowledge about yourself or the nature of
• Environmental control. This is an action-
your problem. As you learn more, you gain
oriented process in which you restructure
understanding and feedback about your
your environment so you are less likely to
behavior.
engage in a problem behavior.
Example: Reading Chapter 5 on making
Example: Getting rid of your stash of
healthy food choices.
sweets.
• Social liberation. In this process, you take
• Helping relationships. In this process, you
advantage of alternatives in the external envi-
recruit individuals—family, friends, therapist,
ronment that can help you begin or continue
coach—to provide support, caring,
your efforts to change.
understanding, and acceptance.
Example: Spending as much time as pos-
sible in nonsmoking areas. Example: Finding an exercise buddy.
Self-Efficacy and Locus of Control Do
you see yourself as master of your fate, asserting
control over your destiny? Or do so many things
happen in your life that you just hang on and
hope for the best? The answers to these questions
reveal two important characteristics that affect
your health: your sense of self-efficacy (the
belief in your ability to change and to reach a
goal) and your locus of control (the sense of
being in control of your life).
Your confidence in your ability to cope with
challenge can determine whether you can and
Mimagephotography/Shutterstock.com
will succeed in making a change. In his research
on self-efficacy, psychologist Albert Bandura of
Stanford University found that the individuals
most likely to reach a goal are those who believe
they can. The stronger their faith in themselves,
the more energy and persistence they put into
making a change. The opposite is also true, espe-
cially for health behaviors: Among people who Do you picture yourself
begin an exercise program, those with lower self- as master of your own
efficacy are more likely to drop out. • “Internals,” who believe that their actions destiny? You are more
largely determine what happens to them, act
✓ check-in How “internal” or “external” do likely to achieve your
more independently, enjoy better health, are
you rate your locus of control? more optimistic about their future, and have health goals if you do.
If you believe that your actions will make a lower mortality rates.
self-efficacy Belief in one’s
difference in your health, your locus of control • “Externals,” who perceive that chance or out-
ability to accomplish a goal or
is internal. If you believe that external forces or side forces determine their fate, find it harder
change a behavior.
factors play a greater role, your locus of control to cope with stress and feel increasingly help-
is external. Hundreds of studies have compared less over time. When it comes to weight, for locus of control An individual’s
people who have these different perceptions of instance, they see themselves as destined to belief about the sources of power
control: be fat. and influence over his or her life.
WHAT DID YOU DECIDE?
What does “health” mean to you?

How healthy are today’s college students?
Do race and gender affect health?
Can people successfully change their health behaviors?
THE POWER OF NOW!
Making Healthy Changes
Ultimately, you have more control over your health than anyone ____ Lose a pound. If you’re overweight, you may not think a pound
else. Use this course as an opportunity to zero in on at least one will make a difference, but it’s a step in the right direction.
less-than-healthful behavior and improve it. Here are some sug- ____ If you’re a woman, examine your breasts regularly. Get in
gestions for small steps that can have a big payoff. Check those the habit of performing a breast self-examination every month
that you commit to making today, this week, this month, or this after your period (when breasts are least swollen or tender).
term. Indicate “t,” “w,” “m,” or “term,” and repeat this self-evaluation ____ If you’re a man, examine your testicles regularly. These sim-
throughout the course. ple self-exams can help you spot signs of cancer early, when
it is most likely to be cured.
____ Use seat belts. In the past decade, seat belts have saved more
____ Get physical. Just a little exercise will do some good. A
than 40,000 lives and prevented millions of injuries.
regular workout schedule will be good for your heart, lungs,
____ Eat an extra fruit or vegetable every day. Adding more fruits
muscles, and bones—even your mood.
and vegetables to your diet can improve your digestion and
____ Drink more water. You need eight glasses a day to replenish
lower your risk of several cancers.
lost fluids, prevent constipation, and keep your digestive sys-
____ Get enough sleep. A good night’s rest provides the energy
tem working efficiently.
you need to make it through the following day.
____ Do a good deed. Caring for others is a wonderful way to care
____ Take regular stress breaks. A few quiet minutes spent stretch-
for your own soul and connect with others.
ing, looking out the window, or simply letting yourself unwind
are good for body and soul.
MAKING THIS CHAPTER WORK FOR YOU

Review Questions (LO 1.3) 4. Which of the following statements is true about the
health and habits of Americans, according to the
(LO 1.1) 1. __________ is defined as a state of complete physi- latest findings from the Centers for Disease Control
cal, mental, and social well-being. and Prevention?
a. Volatility c. Health a. More than 50 percent of men and women exer-
b. Welfare d. Spirituality cise regularly.
b. Two-thirds of the population are either over-
(LO 1.2) 2. __________ refers to the ability to learn from life weight or obese.
experience and the capacity to question and evalu- c. Five percent of all Americans over age 20 have
ate information. hypertension.
a. Psychological health d. Almost one-quarter of men and women between
b. Intellectual health ages 18 and 44 saw a health-care professional in
c. Social health the previous year.
d. Spiritual health
(LO 1.6) 5. Which of the following statements is true about the
(LO 1.4) 3. Which of the following statements is true of the impact of unhealthy choices on young Americans?
health differences between men and women? a. Obese children often grow into obese adults,
a. The overall mortality rate of women is higher with risks of diabetes and cardiovascular disease.
than that of men. b. A mild rise in blood pressure during young
b. Girls are more likely to be born prematurely adulthood does not increase the risk of clogged
than boys. heart arteries by middle age.
c. Women die at a younger age than men. c. Young adults who begin using tobacco or alco-
d. Women are more likely to suffer from depres- hol in their teens and 20s are less likely to con-
sion than men. tinue to do so as they get older.
d. Aerobic fitness has little impact on the cardio
vascular health of individuals in later years.
(LO 1.5) 6. Which of the following statements is true about Critical Thinking
risky behaviors among college students?
a. Three-fourths of the deaths in the 15- to 24-year- 1. Where are you on the wellness–illness continuum? What
old age range are men. variables might affect your place on the scale? What do you
b. College-age women are more likely than men to consider your optimum state of health to be?
engage in binge drinking.
2. Talk to classmates from different racial or ethnic backgrounds
c. Suicide rates are higher among women than men.
than yours about their culture’s health attitudes. Ask them what
d. Men are more likely to avoid risky behaviors
is considered healthy behavior in their cultures. For example, is
than women.
having a good appetite a sign of health? What kinds of self-care
(LO 1.7) 7. Which of the following factors that influence health practices did their parents and grandparents use to treat colds,
behavior include knowledge, attitudes, beliefs, val- fevers, rashes, and other health problems? What are their atti-
ues, and perceptions? tudes about the health-care system?
a. Enabling factors
b. Risk factors
c. Reinforcing factors
d. Predisposing factors
(LO 1.8) 8. In the transtheoretical model, which of the follow-
ing processes of change involves acknowledging
—first privately and then publicly—that you are
responsible for your behavior and are the only one
who can change it?
a. Consciousness-raising
b. Self-reevaluation
c. Commitment
d. Social liberation
Answers to these questions can be found on page 503.
What’s Online
Visit www.cengagebrain.com to access MindTap, a complete digital course that includes interactive quizzes,
videos, and more.
Key Terms
The terms listed are used on the page indicated. Definitions of the
terms are in the glossary at the end of the book.
enabling factors 14 protection 13
health 04 reinforcing factors 15
health belief model (HBM) 16 self-efficacy 19
health promotion 05 social norm 12
locus of control 19 transtheoretical model 17
predisposing factors 14 wellness 4
prevention 13
Making This Chapter Work For You 21
WHAT DO YOU THINK?
What are the keys to a happy, satisfying, meaningful life?

How important is a good night’s sleep?
How do depression and anxiety affect students?
What are some reasons why college students commit suicide?
Stefano Cavoretto/Shutterstock.com
2
Your Psychological
and Spiritual Well-Being
F or years, Travis put on his “happy face” around his friends and family.
Popular and athletic in high school, he never let anyone know how des-
perately unhappy he actually felt. “Whatever I was doing during the day,
nothing was on my mind more than wanting to die,” he recalls. On a per-
fectly ordinary day in his senior year, Travis tried to kill himself with an over-
dose of pills. Rushed to a hospital, Travis recovered, resumed his studies,
and entered college. By the middle of his freshman year, he was struggling
once more with feelings of hopelessness. This time he realized what was
happening and sought help from a therapist.
“I thought college was supposed to be the happi- becoming an adult is a challenging one in every
est time of your life,” he said. “What went wrong?” culture and country. Psychological health can make
This is a question many young people might ask. the difference between facing this challenge with
Although youth can seem a golden time, when optimism and confidence or feeling overwhelmed by
body and mind glow with potential, the process of expectations and responsibilities.
After reading this chapter, you should be able to:

2.1 Identify the components of psychological health. 2.5 Summarize four categories of anxiety disorders.
2.2 Discuss the ways in which positive psychology 2.6 Outline the patterns of attempting or committing
enhances quality of life. suicide among Americans.
2.3 Review the relationship of sleep and health. 2.7 List treatment options available for mental
2.4 Describe the key factors related to depressive disorders.
disorders, their symptoms, and treatments.
23
As the burgeoning field of positive psychology • Compassion for others
has resoundingly proved, people who achieve • The ability to be unselfish in serving or relat-
emotional and spiritual health are more creative ing to others
and productive, earn more money, attract more
friends, enjoy better marriages, develop fewer ill- • Increased depth and satisfaction in intimate
nesses, and live longer. relationships
Yet challenges come with the territory of liv- • A sense of control over the mind and body
ing. At some point in life, almost half of Ameri- that enables the person to make health-
cans develop an emotional disorder. Young enhancing choices and decisions
adulthood—the years from the late teens to the
mid-20s—is a time when many serious disorders, Mental health describes our ability to per-
including bipolar illness (manic depression) and ceive reality as it is, to respond to its challenges,
schizophrenia, often develop. The saddest fact is and to develop rational strategies for living. A
not that so many feel so bad but that so few real- mentally healthy person doesn’t try to avoid con-
ize they can feel better. Only one-third of those flicts and distress but can cope with life’s transi-
with a mental disorder receive any treatment at tions, traumas, and losses in a way that allows for
all. Yet 80–90 percent of those treated for psy- emotional stability and growth. The characteris-
chological problems recover, most within a few tics of mental health include:
months.
• The ability to function and carry out
This chapter reports the latest findings on
responsibilities
making the most of psychological strengths,
enhancing happiness, and developing the spiri- • The ability to form relationships
tual dimension of your health and your life. It • Realistic perceptions of the motivations of others
also presents a comprehensive discussion of
common mental and emotional disorders. By • Rational, logical thought processes
learning about these problems, you will deepen • The ability to adapt to change and to cope
your understanding of the connection between with adversity
mind and body and learn how to recognize early
warning signals in yourself or your loved ones.
Like your physical health, the state of your ✓ check-in How would you assess yourself
mind and your feelings is a personal responsibil- on each of these characteristics of emotional
ity too important to ignore or neglect. This chap- and mental health?
ter reports the latest findings on making the most
of psychological strengths, enhancing happiness, Culture also helps to define psychological
and developing the spiritual dimension of your health. In one culture, men and women may
health and your life. express feelings with great intensity, shouting in
joy or wailing in grief, while in another culture,
such behavior might be considered abnormal or
unhealthy. In our diverse society, many cultural
Emotional and influences affect Americans’ sense of who they
are, where they came from, and what they
Mental Health believe. Cultural rituals help bring people
together, strengthen their bonds, reinforce the
values and beliefs they share, and provide a
emotional health The ability to Psychological health encompasses both our emo- sense of belonging, meaning, and purpose.
express and acknowledge one’s tional and mental states—that is, our feelings and
feelings and moods and exhibit our thoughts. Emotional health generally refers
adaptability and compassion for to feelings and moods, both of which are dis-
others. cussed later in this chapter. Characteristics of
emotionally healthy persons include:
The Lessons
mental health The ability to
perceive reality as it is, respond
to its challenges, and develop
• Determination and effort to be healthy of Positive
rational strategies for living. • Flexibility and adaptability to a variety of
circumstances
Psychology
culture The set of shared
• Development of a sense of meaning and affir-
attitudes, values, goals, and
mation of life Positive psychology (the scientific study of ordi-
practices of a group that are
internalized by an individual • An understanding that the self is not the cen- nary human strengths and virtues) and positive
within the group. ter of the universe psychiatry (which promotes positive psychosocial
24 CHAPTER 2 Your Psychological and Spiritual Well-Being
development in those with or at high risk of men-
tal or physical illness) focus on the aspects of
human experience that lead to happiness and
fulfillment—in other words, on what makes life
worthwhile.1 This perspective has expanded the
definition of psychological well-being.
According to psychologist Martin Seligman,
PhD, who popularized the positive psychology
movement, everyone, regardless of genes or fate,
can achieve a happy, gratifying, meaningful life.
The goal is not simply to feel good momentarily
or to avoid bad experiences but to build positive
strengths and virtues that enable us to find mean-
ing and purpose in life. The core philosophy is to
Monkey Business Images/Shutterstock.com

add a “build what’s strong” approach to the “fix
what’s wrong” focus of traditional psychotherapy.2
Among the positive psychology interventions
that have proven effective in enhancing emo-
tional, cognitive, and physical well-being, easing
depression, lessening disease and disability, and
even increasing longevity are:
• Counting one’s blessings
Compassion, or
• Savoring experiences
caring for others, is
• Practicing kindness
Develop Self-Compassion a characteristic of an
• Pursuing meaning
Self-compassion is a healthy form of self- emotionally healthy
• Setting personal goals acceptance and a way of conceptualizing our favor-
• Expressing gratitude able and unfavorable attitudes about ourselves and person.
others. Some psychologists describe it as being
• Building compassion for one’s self and others
kind to yourself in the face of suffering and practic-
• Identifying and using one’s strengths (which may ing a “reciprocal golden rule,” in which you treat
include traits such as kindness or perseverance) yourself with the kindness usually reserved for oth-
• Visualizing and writing about one’s best pos- ers. This includes accepting your flaws; letting go
sible self at a time in the future3 of regrets, illusions, and disappointments; and tak-
ing responsibility for actions that may have harmed
Neuroscientists, using sophisticated imaging others without feeling a need to punish yourself.
techniques, have been able to identify specific In contrast, individuals low in self-compassion
areas in the brain associated with positive emo- are extremely critical of themselves, believe they
tions, such as love, hope, and enthusiasm. As are unique in their imperfection, and obsessively
people change, the processing of emotions in fixate on their mistakes. After a traumatic life event,
the brain appears to change, with older adults self-compassion may help individuals recognize
responding more to positive information and fil- the need to care for themselves, reach out for
tering out irrelevant negative stimuli.4 social support, engage in less self-blame and self-
criticism, and look back on the time as an emotion-
✓ check-in Practice positive psychology.
ally difficult event rather than an experience that
• The next time you think, “I’ve never tried defines or changes them.5 Therapists have devel-
that before,” also say to yourself, “This is an oped specific cognitive treatments that can increase
the attributes of compassion for self and others and
opportunity to learn something new.”
alleviate feelings of anxiety and depression.
• When something seems too complicated,
remind yourself to tackle it from another ✓ check-in How do you practice
angle. self-compassion?
• If you get discouraged and feel that you’re

Boost Emotional Intelligence
never going to get better at some new
A person’s “IQ”—or intelligence quotient—was self-compassion A healthy form
skill, tell yourself to give it another try. (See
once considered the leading predictor of achieve- of self-acceptance in the face of
Health Now! for more suggestions.) ment. However, psychologists have determined perceived inadequacy or failure.
The Lessons of Positive Psychology 25
HEALTH
NOW!
Self-
Accentuate the actualization
Positive Fulfillment of
one’s potential
Try some of these strategies from
positive psychology and comment
Self-esteem
on your experience in your online Respect for self,
journal. respected by others
Do Love and affection

Ability to give and receive
Smile. Putting on a happy affection; feeling of belonging
face makes for a happy
spirit. Safety and security
Ability to protect oneself from harm
Focus. By being fully pres-
ent in the moment, you’ll
Physiological needs
experience it more intensely. Fulfillment of needs for food, water, shelter,
Share your joy. Talking sleep, sexual expression
about and celebrating good

experiences extends posi-
tive feelings over and above
the positive event. FIGURE 2.1 The Maslow Pyramid
Travel through time. Vividly To attain the highest level of psychological health, you must first satisfy your needs for safety and
remembering or anticipating security, love and affection, and self-esteem.
positive events—a technique
Source: Maslow, Abraham H., Frager, Robert D., Fadiman, James, Motivation and Personality, 3rd Edition, © 1987. Reprinted by
psychologists call “positive permission of Pearson Education, Inc., Upper Saddle River, NJ.
mental time travel”—boosts
levels of happiness and life
that another “way of knowing,” dubbed No one, however, becomes totally self-sufficient.
satisfaction.
emotional intelligence, makes an even greater As adults, we easily recognize our basic physical
Don’t difference in personal and professional success. needs, but we often fail to acknowledge our emo-
“EQ” (for emotional quotient) is the ability to tional needs. Yet they, too, must be met if we are
Don’t hide your feelings.
monitor and use emotions to guide thinking and to be as fulfilled as possible.
Suppressing positive feelings
actions. Neuroscientists have mapped the brain Humanist theorist Abraham Maslow believed
—because of shyness or
regions involved in emotional intelligence, which that human needs are the motivating factors in
a sense of modesty, for
overlap significantly with those involved in general personality development. First, we must satisfy
instance—diminishes them
and may have physiological intelligence. Among the emotional competencies basic physiological needs, such as those for food,
consequences on your health. that most benefit students are focusing on clear, shelter, and sleep. Only then can we pursue ful-
manageable goals and identifying and understand- fillment of our higher needs—for safety and secu-
Don’t get distracted.
ing emotions rather than relying on “gut” feelings. rity, love and affection, and self-esteem. Few
Unrelated worries and
thoughts detract from the individuals reach the state of self-actualization,
✓ check-in How emotionally intelligent do
here-and-now of a positive in which one functions at the highest possible
experience. you think you are? level and derives the greatest possible satisfaction
Don’t find fault. Pay- People with high EQ are more likely to enjoy from life (Figure 2.1).
ing attention to negative good mental and physical health and are more pro-
aspects of otherwise posi- ductive at work and happier at home. They’re also Boost Self-Esteem
tive experiences sabotages less prone to stress, depression, and anxiety, and they Each of us wants and needs to feel significant as
levels of happiness, opti- bounce back more quickly from serious illnesses.
mism, self-esteem, and life a human being, with unique talents, abilities, and
satisfaction. roles in life. A sense of self-esteem, of belief or
Meet Your Needs pride in ourselves, gives us confidence to dare to
Don’t go there. “Nega-
Newborns are unable to survive on their own. attempt to achieve at school or work and to reach
tive mental time travel”—
reflecting on what went They depend on others for the satisfaction of out to others to form friendships and close rela-
wrong or what may go their physical needs for food, shelter, warmth, tionships. Self-esteem is the little voice that whis-
wrong—can lower self- and protection, as well as their less tangible emo- pers, “You’re worth it. You can do it. You’re okay.”
esteem and foster depres- tional needs. In growing to maturity, children Self-esteem is based not on external factors
sive symptoms. take on more responsibility and become more like wealth or beauty but on what you believe
independent. about yourself. It’s not something you’re born
with; self-esteem develops over time. It’s also not
something anyone else can give to you, although
those around you can either help boost or dimin-
ish your self-esteem.
One of the most useful techniques for bolster-
ing self-esteem and achieving your goals is devel-
oping the habit of positive thinking and talking.
While negative observations—such as constant
criticisms or reminders of the most minor faults—
can undermine self-image, positive affirmations,
compliments, kudos, and encouragements have
proved effective in enhancing self-esteem and
psychological well-being. Individuals who fight
off negative thoughts fare better psychologically
than those who collapse when a setback occurs
or who rely on others to make them feel better.
✓ check-in How positive are the messages

you send to yourself?
Pursue Happiness
“Imagine a drug that causes you to live eight or nine
years longer, to make $15,000 more a year, to be
less likely to get divorced,” says Martin Seligman,
the “father” of positive psychology. “Happiness
seems to be that drug.” As a meta-analysis of long-
term studies has shown, happiness even reduces
the risk of dying—both in healthy people and in
those with diagnosed diseases. But even if just
about everyone might benefit from smiling more
and scowling less, can almost anyone learn to live
iofoto/Shutterstock.com
on the brighter side of life?
Skeptics who dismiss “happichondria” as
the latest feel-good fad are dubious. However,
happiness researchers, backed by thousands of
scientific studies, cite mounting evidence sug-
Working with young
gesting that happiness is, to a significant degree,
a learned behavior. (See Health on a Budget.) Education may protect against mental disor- children can boost
Among 5,000 students in 280 countries who ders, but it doesn’t guarantee happiness. Asked their self-esteem—
completed a massive online open course (MOOC) if they were “feeling good and functioning well,”
and yours.
on happiness, positive feelings kept going up as people with varying levels of education had simi-
the course progressed. The students registered pro- lar odds of high levels of emotional well-being.8
gressively less sadness, anger, and increasing fear Intelligence, gender, and race do not matter
and more amusement, enthusiasm, and affection.6 much for happiness. Health has a greater impact
on happiness than does income, but pain and
The Roots of Happiness Psychological anxiety take an even greater toll. People seem
to be less able to adapt to the unpredictability of emotional intelligence The
research has identified three major factors that
certain health conditions than they are to others. ability to monitor and use
contribute to a sense of well-being:
The well-being of individuals who can no lon- emotions to guide thinking and
• Your happiness set point—a genetic compo- ger walk after an accident, for example, typically actions.
nent that contributes about 50 percent to indi- returns to its pre-accident levels, while many self-actualization A state of
vidual differences in contentment diagnosed with epilepsy face a lifetime of uncer- wellness and fulfillment that can
• Life circumstances such as income or marital tainty about the occurrence of seizures. be achieved once certain human
status, which account for about 10 percent needs are satisfied; living to one’s
• Thoughts, behaviors, beliefs, and goal-based full potential.
What Does and Doesn’t Make Us Happy
activities, which may account for up to Many people assume that they can’t be happy self-esteem Confidence and sat-
40 percent of individual variations7 unless they get into a certain school, earn a certain isfaction in oneself.
The Lessons of Positive Psychology 27
HEALTH ON A BUDGET
Happiness for Free!
Money can’t buy happiness. As long as you have enough Create a virtual DVD. Visualize several of your happiest
money to cover the basics, you don’t need more wealth or memories in as much detail as possible. Smell the air. Feel
more possessions for greater joy. Even people who win a the sun. Hear the sea. Play this video in your mind when
fortune in a lottery return to their baseline of happiness within your spirits slump.
months. So rather than spend money on lottery tickets, try Fortify optimism. Whenever possible, see the glass as
these ways to put a smile on your face: half full. Keep track of what’s going right in your life. Imag-
Make time for yourself. It’s impossible to meet the needs ine and write down your vision for your best possible future
of others without recognizing and fulfilling your own. and track your progress toward it.
Up your appreciation quotient. Regularly take stock of all the Immerse yourself. Find activities that delight and engage you
things for which you are grateful. To deepen the impact, write a so much that you lose track of time. Experiment with creative
letter of gratitude to someone who’s helped you along the way. outlets. Look for ways to build these passions into your life.
String beads. Think of every positive experience during Seize the moment. Rather than wait to celebrate big
the day as a bead on a necklace. This simple exercise birthday-cake moments, savor a bite of cupcake every day.
focuses you on positive experiences, such as a cheery Delight in a child’s cuddle, a glorious sunset, a lively con-
greeting from a cashier or a funny e-mail from a friend, and versation. Cry at the movies. Cheer at football games. This
encourages you to act more kindly toward others. life is your gift to yourself. Open it!
grade, get a certain job, make a certain income, find ✓ check-in What are the greatest sources of
a perfect mate, or look a certain way. But according happiness in your life?
to psychologist Sonja Lyubomirsky, author of The
Myths of Happiness, such notions are false. “People
find a way to be happy in spite of unwanted life cir- Become Optimistic
cumstances,” she notes, “and many people who are Mental health professionals define optimism as the
blessed by wealth and good fortune aren’t any hap- “extent to which individuals expect favorable out-
pier than those who lack these fortunes.”9 Individu- comes to occur.” Studies have established “significant
als with enough cash in their checking and savings relationships” between optimism and cardiovascular
accounts so they don’t have to worry about money health, stroke risk, immune function, cancer progno-
report more positive perceptions of their financial ses, physical symptoms, pain, and mortality rates.12
well-being and overall life satisfaction,10 but more For various reasons—because they believe in
money doesn’t bring more joy. themselves, because they trust in a higher power,
What does make us happier? According to because they feel lucky—optimists expect positive
recent research: experiences from life. When bad things happen,
• Focusing on time leads to greater happiness they tend to see setbacks or losses as specific, tem-
than focusing on money. porary incidents. In their eyes, a disappointment
is “one of those things” that happens every once
• Spending time and money on others rather
in a while rather than the latest in a long string
than oneself increases happiness.
of disasters. In terms of health, optimists not only
• Spending time and money to acquire expe- expect good outcomes—for instance, that a sur-
riences rather than possessions boosts gery will be successful—but take steps to increase
happiness.11 this likelihood. Pessimists, expecting the worst, are
more likely to deny or avoid a problem, sometimes
Positive activities also boost positive emo- through drinking or other destructive behaviors.
tions like happiness. One of the most effec- Individuals aren’t born optimistic or pessimis-
tive is performing small acts of kindness. While tic. Researchers have documented changes over
there is no set formula for their variety and fre- time in the ways that individuals view the world
quency, Lyubomirsky advises a minimum of and what they expect to experience in the future.13
once a week, which provides as much a boost Cognitive-behavioral techniques (discussed later
as a thrice-weekly activity. She also recommends in this chapter) have proven effective in helping
variety—taking out the trash when it’s your pessimists become more positive.
roommate’s turn one time, for instance, and buy-
optimism The tendency to seek ing a hot chocolate for a homeless person the ✓ check-in Do you usually anticipate the
out, remember, and expect plea- next—because simple repetitions lose their abil-
best or the worst possible outcome?
surable experiences. ity to boost happiness.
Manage Your Moods
Feelings come and go within minutes. A mood is
a more sustained emotional state that colors our
view of the world for hours or days. Most people
experience a range of moods but respond to them
differently. When struggling with a bad mood,
men typically try to distract themselves (a partially
successful strategy) or use alcohol or drugs (an
ineffective tactic). Women are more likely to talk
to someone (which can help) or to ruminate on
why they feel bad (which doesn’t help).
The most effective way to banish a sad or bad
mood is by changing what caused it in the first
place—if you can figure out what made you upset
KidStock/Getty Images
and why. The questions to ask are: What can I
do to fix the failure? What can I do to remedy the
loss? Is there anything under my control that I can
change? If there is, take action and solve it. Ask
to take a makeup exam. Apologize to the friend Volunteering to help
whose feelings you hurt. Tell your parents you feel
everything you say and do. Spiritual health refers others, like these stu-
bad about the argument you had. If there’s noth-
ing you can do, accept what happened and focus to this breath of life and to our ability to identify our dents serving meals
on doing things differently next time. basic purpose in life and experience the fulfillment
to homeless people,
of achieving our full potential. Spiritual readings or
✓ check-in How do you handle sad or bad practices can increase calmness, inner strength, and can contribute to
moods? meaning; improve self-awareness; and enhance your sense of life
your sense of well-being. Religious support has also
been shown to help lower depression and increase satisfaction.
life satisfaction beyond the benefits of social sup-
port from friends and family.
Spirituality is a belief in what some call a higher
power, in someone or something that transcends the
boundaries of self. It gives rise to a strong sense of
purpose, values, morals, and ethics. Throughout life
you make choices and decide to behave in one way
rather than another because your spirituality serves
as both a compass and a guide.
The terms religiosity and religiousness refer
to various spiritual practices. That definition may
seem vague, but one thing is clear. According to
Every day, rate how much each emoji matches thousands of studies on the relationship between
how you have been feeling on a scale of 1 to religious beliefs and practices and health, religious
individuals are less depressed, less anxious, and bet-
10. At the end of the week, average your daily ter able to cope with crises such as illness or divorce
ratings into a collective score. Track how your than are nonreligious ones. The more that a believer
feelings change throughout the term. incorporates spiritual practices—such as prayer,
meditation, or attending services—into daily life, the
greater his or her sense of satisfaction with life.
mood A sustained emotional
state that colors one’s view of the
✓ check-in How would you describe your world for hours or days.
Spiritual Health spiritual self?
spiritual health The ability
to identify one’s basic purpose
Whatever your faith, whether or not you belong to
Spirituality and Physical Health in life and to achieve one’s full
potential.
any formal religion, you are more than a body of a A growing body of scientific evidence indicates
certain height and weight occupying space on the that faith and spirituality can enhance health— spirituality A belief in someone
planet. You have a mind that equips you to learn and perhaps even extend life. Individuals who or something that transcends the
and question. And you have a spirit that animates pray and report greater spiritual well-being boundaries of self.
Spiritual Health 29
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find herself “left alone” with no obsequious nurse ready to attend to her
wants. She shrieked at Innocent to rouse her, and stretching out of bed
shook the girl, who started violently, and sprang up trembling and nervous.
Amanda’s eyes were blazing, her figure trembling with sudden irritation.
“How dare you fall asleep?” she cried, “am I to be left with no one to
take care of me? oh, you all want to kill me. Give me my drops, you cruel,
wicked, sleepy, lazy, wicked girl! You don’t know how?—oh, you know
well enough how to walk about with my husband—how to make love to
him. My drops! can’t you understand?—there, in that bottle; you can read, I
suppose, though you are a fool. Oh, to leave me to this horrid girl! Oh, to
have no one to take care of me! My drops? can’t you hear? I’ll make it
heard all over the house. My drops! Oh, you little idiot, can’t you do that
much? I always said you was a fool; walk about with another woman’s
husband—torment a man with clinging to him—but as for being of use. My
drops! Put them in the glass, idiot! Can’t you see I want to go to sleep?”
Innocent trembling, chilled, ignorant, incapable, only half awake, took
the bottle that was pointed out to her, and endeavoured, as she had seen
people do, to drop the liquid into a glass; she failed twice over in her fright
and tremor. Then she kneeled down by the table to try for the third time,
propping herself up against the chair. I don’t know what thoughts might be
passing unconscious through her mind. I don’t think she was conscious of
anything, except the miserable feeling of sudden waking—the cold, the
sense of being beaten down with angry words—and the frightened attempt
to do what she could not do, in obedience to the fiercest order she had ever
received in her life. Where she knelt, painfully endeavouring to count the
drops of the opiate, she was within reach of Amanda’s arm, who by this
time had worked herself into a wild, shrieking passion. Once more she
dashed aside the curtain, and plucked at Innocent, calling to her with words
which had become unintelligible to the ears of the frightened girl. “Give it
me, you fool—give it me, you fool!” she said, then snatched the glass out of
Innocent’s hand, and lifted it to her lips. Between the fright of the one and
the passion of the other the bottle had been half emptied into the glass.
Amanda held it for a moment in one hand, grasping Innocent with the other,
and trying to recover breath. She was past thinking of any consequences, as
Innocent was past knowing what was happening under her eyes. With a
sudden long effort to regain her breath she put the glass to her panting lips,
and drank it. How much she swallowed no one ever knew; the glass
dropped out of her hand, spilling some dark drops upon the white coverlid,
and Amanda dropped back heavily upon the pillows. Then there followed
such a stillness as seemed to make the whole house, the very walls, shiver.
Innocent, with the little phial clutched in one hand, with Amanda’s fingers
slowly relaxing from the other, stood stupefied, listening to the horrible
stillness. Oh, God, what did it mean?
CHAPTER XXXIII.
FLIGHT.
The inhabitants of the Villa were well used to the sudden sounds and
sudden stillnesses which marked the changes of Amanda’s moods, and on
ordinary occasions no one thought of interfering or taking any notice. So
long as aunty was there these were recognized as her share of the
advantages of this life, and the rest of the household left her in undisturbed
enjoyment of her privileges. But somehow on this evening other sentiments
had been called into being. Aunty herself loved, in her way, the wilful
creature whom she had nursed all her life, notwithstanding the ill
recompense she received, and could not take advantage of the unusual
holiday she was having. Instead of going to bed, she hung about the
passages, sometimes listening at Amanda’s door, more vigilant, more
wakeful than ever. The maids who slept above were wakeful too. They were
interested in the visitor, the curious pale girl who was one of Mr.
Eastwood’s great relations, “a real lady,” and so much unlike the usual
visitors to the house. Besides, though both the patient and her poor little
unaccustomed attendant had slept, it was still comparatively early, about the
hour of midnight. I do not know what there was peculiar in the stillness that
crept through the house. Often enough before Amanda had fainted after one
of her paroxysms of passion, and everything had gone on as usual, no one
except her special nurse being much the wiser. But on this night a still
horror seemed to creep through the place. The women up-stairs rose from
their beds with a sensation of alarm, and poor aunty stood trembling at the
door, not knowing whether to venture in, at the risk of disturbing the quiet,
or stay outside at the risk perhaps of neglecting the patient. The moments
are long in such an emergency. It seemed to her, I think wrongly, that this
stillness had lasted full half an hour, when at last, emboldened by terror, and
stimulated by the appearance on the stairs of the frightened housemaid in
her nightgown, whispering “Was anything the matter?” she opened softly
the door of the room. All that aunty could see was Innocent, standing,
gazing at the bed on which, to all appearance, the patient lay calm, with the
softened reflection of the rose-coloured curtain over her. Innocent stood like
a statue, white, immovable, gazing. Aunty stole in, frightened, with
noiseless steps, afraid lest some creak of the floor should betray her
presence. She laid her hand softly on Innocent’s shoulder.
“Is she asleep?” she asked.
Innocent awoke as from a trance.
“What is it?” she said shivering, and in low tones of terror. “Look, look!
what does it mean——”
Next moment a great cry rang through the silent house—the windows
were thrown open, the bells rung, the maids rushed in, half frantic with
excitement; what was it? A dreadful interval followed while they crowded
about the bed, and while aunty, moaning, weeping, calling upon Amanda,
tried to raise the senseless figure, to bring back animation by all the means
which she had so often used before. The wild yet subdued bustle of such a
terrible domestic incident, the hurried sending for the doctor, the running
hither and thither for remedies, the strange dream-like horror of that one
unresponsive, unmoving figure in the midst of all this tumult of anxious but
bootless effort—how can I describe it? The cold night air poured into the
room, ineffectually summoned to give breath to the lips that could draw
breath no longer, and waved the lights about like things distracted, and
chilled the living to the bone, as they ran to and fro, seeking this and that,
making one vain effort after another. Innocent stood behind, leaning against
the wall, like a marble image. She had been pushed aside by the anxious
women. She stood with her eyes fixed on the bed, with a vague horror on
her face. It was a dream to her, which had begun in her sleep; was she
sleeping still? or was this a horrible reality? or what had she to do with it?
she, a little while ago the chief actor, now the spectator, helpless, knowing
nothing, yet with a chill of dread gnawing at her, like the fox in the fable,
gnawing her heart. Innocent’s head seemed to turn round and round, as the
strange group which had swept in, made all those wild circles round the
bed, doing one strange thing after another, incoherent to her—moving and
rustling, and talking low under the disturbed waving of the lights, and in the
shadow of the curtains. When, after a long terrible interval, these figures
dispersed, and one alone remained, throwing itself upon the bed in wild
weeping, the girl roused herself.
“What is it?” she asked, drawing a step nearer. “What is it?” It seemed to
Innocent that something held her, that she could not look at the figure in the
bed.
“Oh, my darling! my darling! I have nursed her from a baby—she never
was but good to me. Oh, my child, my ’Manda! Will you never speak to me
again! Oh, ’Manda, my darling! Oh, my lovely angel!” Thus poor aunty
moaned and wept.
“What is it?” cried Innocent, with a voice which took authority from
absolute despair.
“Oh, can’t you see for yourself? It’s you as has done it, driving that angel
wild. She’s dead! Oh, merciful Heaven, she’s dead——”
Then a sudden flood of light seemed to pour through Innocent’s
darkened mind. The horror which she had felt vaguely took shape and form.
Heaven help the child! She had done it! She gave a low wild cry, and
looked round her with a despairing appeal to heaven and earth. Was there
no one to protect her—no one to help her? One moment she paused,
miserable, bewildered, then turned and fled out of the awful room, where so
much had befallen her. What could she do? where could she go? She fled as
an animal flies to its cover—to its home, unreasoning, unthinking.
Frederick would have represented that home to her in any other
circumstances; but she had killed Frederick’s wife. This horror seemed to
take form and pursue her. The maids were all gone: one to call the unhappy
father, one to the husband, another to watch for the doctor; this last had left
the door open, through which another blast of night-air swept through the
house. Down the narrow staircase poor Innocent fled noiseless, like a thief.
Upon a table in the passage lay her hat as she had thrown it off when she
came in that afternoon with Frederick, and the warm wrap in which Miss
Vane had enveloped her when they started, so peacefully, so happily, for
their drive. Was it only that morning? The High Lodge, and its orderly life
and its calm inhabitants, seemed to Innocent like things she had known ages
ago; older even than Pisa and Niccolo—almost beyond the range of
memory. She stole out at the open door, drawing Miss Vane’s great shawl
round her, and for a moment feeling comforted in the chill of her misery by
its warmth. For one second she stood on the step, with the moonlight on her
face, wondering where she was to go. The maid who was watching for the
doctor saw her, and cried out with terror, thinking her a ghost. Then a
sudden cloud came over the moon, and in that shelter, like a guilty thing,
Innocent stole away. She did not know where to go. She wandered on
through the dark and still village streets to the great Minster, with some vain
childish imagination of taking refuge there. But here chance befriended the
unhappy girl, or some kind angel guided her. The railway was close by,
with some lights yet unextinguished. Vaguely feeling that by that was the
only way home, she stole into the station, with some notion of hiding
herself till she could get away. The express train to town, which stopped at
Sterborne, though poor Innocent knew nothing of it, was late that night. It
had just arrived when she got in. The little station was badly lighted, the
officials sleepy and careless. By instinct Innocent crept into an empty
carriage, not knowing even that it was going on, and in five minutes more
was carried, unconscious, wrapt in a tragic stupor of woe and terror, away
from the scene of this terrible crisis of her life.
Gradually, slowly, the sense of motion roused her, brought her to herself.
In her hand, firmly clasped, was the little phial which had been so deadly.
She unclosed her fingers with an effort, and looked at it with miserable
curiosity. That had done it—a thing so small that it was hidden altogether in
her small and delicate hand. What had Innocent done? How could she have
helped herself? What could she have done different? For the first time in all
her life she turned her hot confused eyes upon herself. She tried to go back
over the events of the night;—not as in a mental survey with all their
varieties of feeling disclosed, but like an external picture did they rise
before her. First that moment when she (Innocent could think of her now by
no name) was not angry or scolding, when Frederick sat and talked, and she
herself stood and fanned her, the central figure to which henceforward all
her terrified thoughts must cling. Then came the moonlight in the garden,
the smell of the dewy earth, and her hand on Frederick’s arm; then the
reading, which seemed like some strange incantation, some spell of
slumbrous power; then the horrible sudden waking, the clutch of that hot
hand, the incoherent half-conscious effort she made to do what was told her,
the black drops of liquid falling, the interrupted counting which she seemed
to try to take up again and complete—“ten, eleven, fifteen;” and then the
terror of the renewed clutch and grasp, the sudden stillness, the black drops
standing out on the white coverlid, the great open eyes dilated, fixed upon
her, holding her fast so that she could not stir. God help the child! She cried
aloud, but the noise drowned her cry; she struggled under the intolerable
sense of anguish, the burden of the pang which she could not get free from,
could not shake off. So many pangs come in youth which are imaginary,
which can be thrown off, as the first impression fades; but when for the first
time there comes something which fixes like the vulture, which will not be
got rid of!—Innocent writhed under it, holding up her feeble hands in an
appeal beyond words—an appeal which was hopeless and which was vain.
It was still only the middle of the night when she arrived in London, and
by some fortunate chance or other crept out again without being perceived.
Poor child! Far from her distraught soul was any intention of deceiving; she
thought nothing at all about it, and in her innocence, without consciousness
of harm, escaped all penalties and questioning. She did not know her way
about London, but by mere chance took the right direction, and by dint of
wandering on and on, came at last by a hundred detours, as morning began
to break into a region with which she was familiar. The movement did her
good. She felt her misery less when she was walking on and on through
interminable streets, wrapping her shawl about her, feeling her limbs ready
to sink under her, and her power of feeling dulled by fatigue. Probably this
exercise saved her from going mad altogether. Life and more than life hung
on the balance. She was not clever; she had no grasp of mind, no power of
reason, nothing which could be called intellectual development at all, and
yet the difference between sanity and insanity was as much to her as to
others. She kept her reason through the subduing force of this exercise, the
blessed movement and the weariness of body which counteracted the
unaccustomed struggles of her mind.
It was gray dawn, that chill twilight of the morning which is so much
colder and less genial than the twilight of night, when Innocent came at last
in sight of her home. Her strength and courage were almost at an end, but
her feeble heart leapt up within her at sight of the familiar place in which
she knew shelter and comfort were to be found. She had never said
anything which showed her appreciation of her aunt’s tenderness, and had
offered but little response to all the affection that had been lavished on her;
but yet a slow-growing trust had arisen in her mind. She had no doubt how
she was to be received; she knew that kind arms would take her in, kind
eyes pity her, kind voices soothe her trouble—and never in all her life had
Innocent stood in such need of succour. The house was like some one
asleep, with its eyes closed, so to speak, the shutters shut, the curtains
drawn, and no one stirring. Innocent sat down upon the step to wait. She did
not ring or knock for admittance. She sat down and leant upon the pillar of
the porch with a patience which had some hope in it. She could wait now,
for her difficulties were over, and her goal within reach. She had fallen half
asleep when the housemaid undid the door, and with a scream perceived the
unexpected watcher.
“Miss Innocent!” cried the woman, half in terror, half in disapproval; for
indeed Innocent’s odd ways were the wonder of the house, and the servants
professed openly that they would not be surprised whatever she might
choose to do. Innocent opened her eyes and roused herself with an effort.
“Yes, it is me,” she said softly. “I had to come home—by the night
train.”
“Oh, how could any one let you wander about like this!” cried the maid,
“and where is your luggage? Come to the kitchen, miss, there’s no other fire
lighted. You are as cold as ice, and all of a tremble. Come in, come in for
goodness’ sake, and I’ll make you a cup of tea.”
Innocent smiled her habitual smile of vague and dreamy sweetness in
acknowledgment of this kindness—but she shook her head and went
straight up-stairs to the door of Mrs. Eastwood’s room. Her first arrival
there came up before her as she paused at the door—her dissatisfaction, her
indifference—oh, if she had stayed in the little room, within Nelly’s, within
the mother’s, could this thing have happened to her, could any such harm
have reached her? This question floated wistfully before her mind,
increasing the strange confusion of feelings of which she was vaguely
conscious; but she did not pause for more than an instant. Mrs. Eastwood
was still asleep, or so at least Innocent thought; but the very aspect of the
familiar room was consolatory. It seemed to protect her, to make her safe.
She stole softly to the alcove where the grey morning light struggled in
through the closed curtains. As Innocent approached Mrs. Eastwood opened
her eyes, with the instinctive promptitude of a mother, used to be appealed
to at all times and seasons. She started at the sight of the strange figure in
hat and shawl, and sat up in her bed, with all her faculties suddenly
collecting to her, to prepare her for the something, she knew not what,
which she instinctively felt to have befallen.
“Innocent! Good heavens, how have you come? What is the matter?” she
cried. Innocent fell down on her knees by the bed; the fatigue, the cold, the
personal suffering of which up to this moment she had been scarcely
conscious, seemed suddenly to overflow, and become too much for her to
bear. She clasped Mrs. Eastwood’s arm between her own, and looked up to
her with a ghastly face, and piteous looks of appeal; her lips moved, but no
words came. Now she had got to the end of her journey, the end of her
troubles; but now all capacity seemed to fail her. She could not do more.
“My child—my poor child!” said Mrs. Eastwood. “Oh, Innocent, why
did I let you go from me? Speak, dear, tell me what it is? Innocent, speak!”
“Do not be angry,” said poor Innocent, raising her piteous face, with a
child’s utter abandonment and dependence upon the one standard of good
and evil which alone it understands. And yet the face was more woeful,
more distraught, than child’s face could be. Mrs. Eastwood, anxious yet
reassured, concluded that the poor girl, weary and frightened of strangers,
had run away from the High Lodge to come home, an offence which might
well seem terrible to Innocent. What could it be else? She bent over her and
kissed her, and tried to draw her into her arms.
“My poor child, how you are trembling. I am not angry, Innocent; why
are you so frightened? Sit down and rest, and let me get up, and then you
can tell me. Come, dear, come; it cannot be anything so very bad,” said
Mrs. Eastwood with a smile, endeavouring to disengage her arm from
Innocent’s hold.
But the girl’s fixed gaze, and her desperate clasp did not relax. Her white
face was set and rigid. “Do not be angry!” she said again, with a voice of
woe strangely at variance with the simple entreaty; and while Mrs.
Eastwood waited expecting to hear some simple confession, such as that
Innocent had been frightened by the strange faces, or weary of the
monotonous life, and had run away—there suddenly fell upon her horrified
ears words which stunned her, and seemed to make life itself stand still.
They came slow, with little pauses between, accompanied by a piteous gaze
which watched every movement of the listener’s face, and with a
convulsive pressure of the arm which Innocent held to her bosom.
“I have killed Frederick’s wife,” she said.
“What does she say? She must be mad!” cried Mrs. Eastwood. The
housemaid had followed Innocent into the room with officious anxiety,
carrying the cup of tea, which was a means of satisfying her curiosity as to
this strange and sudden arrival. Just as these terrible words were said she
appeared at the foot of the bed, holding the tray in her hand.
“No,” said Innocent, seeing nothing but her aunt’s face; “no, I am not
mad. It was last night. I came home somehow, I scarcely know how—it was
last night.”
“And, Innocent, Innocent—you——?”
“Oh, do not be angry!” cried Innocent, hiding her piteous face upon her
aunt’s breast. The woe, the horror, the distracting sense of sudden misery
seemed to pass from the one to the other in that rapid moment. But the
mother thus suddenly roused had to think of everything. “Put down the
tray,” she said quickly to the staring intruder at the foot of the bed, “call
Alice to me, get Miss Innocent’s room ready, and send some one for the
doctor. She is ill—quick, go and call Alice, there is not a moment to lose.
Innocent,” she whispered in her ear as the woman went away, “Innocent, for
God’s sake look at me! Do you know what you are saying? Innocent!
Frederick’s wife?”
Innocent raised herself up with a long-drawn sigh. Her face relaxed; she
had put off her burden. “It was last night,” she repeated, “we were alone; I
did not want to go, but they made me. She was angry—very angry—and
then—oh! She opened her eyes and looked at me, and was still—still.—Till
they came I did not know what it was.”
“And it was——? For God’s sake, Innocent, try to understand what you
are saying. Did she die—when you were with her? You are not dreaming?
But, Innocent, you had nothing to do with it, my poor, poor child?”
Once more Innocent unfolded the fingers which she had clenched fast
upon something. She held out a small phial, with some drops of dark liquid
still in it. “It was this,” she said, looking at it with a strange, vacant gaze.
And then a horrible conviction came to poor Mrs. Eastwood’s mind. Out
of the depths of her heart there came a low but terrible cry. Many things she
had been called upon to bear in her cheerful life, as all stout hearts are—
now was it to be swallowed up in tragic disgrace and horror at the end?
The cry brought Nelly, wondering and horror-stricken, from her innocent
sleep, and old Alice, forecasting new trouble to the family, but nothing so
horrible, nothing so miserable as this.
CHAPTER XXXIV.
A BEREAVED HUSBAND.
I will not attempt to describe the state of the house out of which Innocent
had fled—the dismal excitement of all the attendants, the sudden turning of
night into day, the whole household called up to help where no help was
possible, and the miserable haste with which the two men, of whose lives
Amanda was the centre and chief influence, came to the room in which she
lay beyond their reach. Batty, roused from his sleep, stupid with the sudden
summons and with the habitual brandy and water which had preceded it,
stumbled into the room, distraught but incapable of understanding what had
befallen him; while Frederick, stunned by the sudden shock, came in from
the room where he had been dozing over a novel, and pretending to write
letters, scarcely more capable of realizing the event which had taken place
in his life than was his father-in-law. It was only when the doctor came, that
any one of the party actually believed in the death which had thus come like
a thief in the night. After he had made his dismal examination, he told them
that the sad event was what he had always expected and foretold. “I have
warned you again and again, Mr. Batty,” he said, “that in your daughter’s
state of health any sudden excitement might carry her off in a moment.”
There was nothing extraordinary in the circumstances, so far as he knew, or
any one. The often-repeated passion had recurred once too often, and the
long-foreseen end had come unawares, as everybody had known it would
come. That was all. There was no reason for doubt or inquiry, much less
suspicion. The glass which had fallen from the dead hand had been taken
away, the black stain on the coverlit concealed by a shawl, which aunty in
natural tidiness had thrown over it. Poor Batty, hoarsely sobbing, calling
upon his child, was led back to his room, and with more brandy and water
was made to go to bed, and soon slept heavily, forgetting for an hour or two
what had befallen him. With Frederick the effect was different. He could
not rest, nor seek to forget in sleep the sudden change which had come upon
his life. He went out into the garden, in the broad, unchanged moonlight,
out of sight of all the dismal bustle, the arrangements of the death-chamber,
the last cares which poor aunty, weeping, was giving to the dead. The dead!
Was that his wife? Amanda! She whom he had wooed and worshipped; who
had given him rapture, misery, disgust, all mingled together; who had been
the one prize he had won in his life, and the one great blight which had
fallen upon that life? Was it she who was now called by that dismal title?
who lay there now, rigid and silent, taking no note of what was done about
her, finding no fault? Frederick stood in the moonlight, and looked up at her
window with a sense of unreality, impossibility, which could not be put into
words; but a few hours before he had been there, with his little cousin, glad
to escape from the surroundings he hated, from Batty’s odious
companionship, from Amanda’s termagant fits. He had felt it a halcyon
moment, a little gentle oasis which refreshed him in the midst of the desert
which by his own folly his life had become. And now—good heavens! was
it true?—in a moment this desert was past, the consequences of his folly
over, his life his own again to do something better with it. The world and
the garden, and the broad lines of the moonlight, seemed to turn round with
him as he stood and gazed at the house and tried to understand what had
come upon him.
It may be thought strange that this should have been the first sensation
which roused him out of the dull and stupefying pain of the shock he had
just received. Frederick was not a man of high mould to begin with, but he
was proud and sensitive to all that went against his self-love, his sense of
importance, his consciousness of personal and family superiority—and he
had the tastes of an educated man, and clung to the graces and refinements
of life, except at those moments which no one knew of, when he preferred
pleasure, so-called, to everything, moments of indulgence which had
nothing to do with his revealed and visible existence. He had been wounded
in the very points at which he was most susceptible, by Amanda and her
belongings. She, herself, had been an offence to him even in the first
moments of his passion, and, as his passion waned and disappeared
altogether, what had he not been compelled to bear? He had brought it upon
himself, he was aware, and he had believed that he would have to bear it all
his life, or most of his life. And now, in a moment, he was free! But
Frederick was not unnatural in exultation over his deliverance. The shock of
seeing her lying dead upon that bed, the strange, pitiful, remorseful sense,
which every nature not wholly deadened feels at sight of that sudden blow
which has spared him and struck another—that sudden deprivation of the
“sweet light,” the air, the movement of existence which we still enjoy, but
which the other has lost—affected him with that subduing solemnity of
feeling which often does duty for grief. How could any imagination follow
Amanda into the realms of spiritual existence? Her life had been all
physical—of the flesh, not of the spirit; there had been nothing about her
which could lead even her lover, in the days when he was her lover, to think
of her otherwise than as a beautiful development of physical life, a creature
all made of lovely flesh and blood, with fascinations which began and
ended in satiny gloss and dazzling colour, in roundness and brightness, and
softness and warmth. What could he think of her now? She had gone, and
had left behind all the qualities by which he knew her. Her voice was silent,
that one gift she possessed by which she could call forth any emotion that
was not of the senses; with it she could rouse a man to fierce rage, to wild
impatience, to hatred and murderous impulses; but that was silent, and her
beauty was turned into marble, a solemn thing that chilled and froze the
beholder. What else was there of her that her husband could think of, could
follow with his thoughts? Her soul—what was it? Frederick had never cared
to know. He had never perceived its presence in any secret moment. But he
was not impious, nor a speculatist of any kind; he indulged in no questions
which the most orthodox theologian could have thought dangerous. He tried
even to think piously of his Amanda as passed into another, he hoped a
better, world; but he stood bewildered and saddened on that threshold, not
knowing how to shape these thoughts, nor what to make of the possibility
of spiritual non-bodily existence for her. He could not follow her in idea to
any judgment, to any heaven. He stood dully sad before the dim portals
within which she had passed, with a heavy aching in his heart, a blank and
wondering sense of something broken off. He was not without feeling; he
could not have gone to bed and slept stupefied as did the father, who had
lost the only thing he loved. A natural awe, a natural pang, were in
Frederick’s mind; he felt the life run so warm in his own veins, and she was
dead and ended. Poor Amanda! he was more sorry for her than he was for
himself. The anguish of love is more selfish; it is its own personal loss, the
misery of the void in which it has to live alone, which wrings its heart. But
Frederick, for once, felt little for himself. To himself the change was not
heart-breaking; he was free from much that had threatened to make his life
a failure; but for once his mind departed from selfish considerations. He
was sorry for her. Poor Amanda! who had lost all she cared for, all she
knew.
This is not a bitter kind of grief, but so far as it went it was a true feeling.
He had more sympathy with his wife in that moment than he had had
throughout all their life together. Poor Amanda! it might be that he had
gained, but she had lost. I need not say what a different, far different,
sentiment this was, from that which feels with an ineffable elevation of
anguish that she, who is gone, has gained everything, and that it is the
survivor whose loss is unspeakable, irremediable. Frederick’s loss was not
irremediable. But he was sorry, very sorry for her; the tears came into his
eyes as he thought of the grave, and the silence, for Amanda. Poor Amanda!
so fond of sound, and bustle, and motion; so confident in her own beauty;
so bent upon gratification—all taken away from her at a stroke. He looked
up at her window through his tears; the flickering lights had been put out,
the movement stilled; no more shadows flitted across the white blinds; the
windows were open, the place was quiet, one small taper left burning—the
room given over to the silence of death. And all this in a few hours! It was
then the middle of the night, three or four o’clock; he had been wandering
there a long time, full of many thoughts. When he saw that all was still, he
went back softly to the house. He had nowhere to go to but the little parlour
in which he had been writing, where he threw himself on the sofa to get a
few hours’ rest; and then it suddenly occurred to him to think of Innocent.
Where was she? how had she disappeared out of that scene of consternation
and distress? Frederick was cold and weary; he had wrapped a railway rug
round him, and he could not now disturb himself and the house to inquire
after his cousin. She must have gone to bed before it happened, he said to
himself. He had not seen her, or heard her referred to, and doubtless it had
been thought unnecessary to call her when the others were called. No doubt
she was safe in bed, unconscious of all that had happened, and he would see
her next morning. Thus Frederick assured himself ere he fell into a dreary
comfortless doze on the sofa. Nothing could have happened to Innocent;
she was safe and asleep, no doubt, poor child, slumbering unconsciously
through all these sorrows.
It was not till late next morning that he found out how it really was.
Neither aunty nor any one else entertained the slightest suspicion that
Innocent had anything to do with Mrs. Frederick’s death. She had
disappeared, and no one thought of her in the excitement of the moment.
The very maid who had seen her leave the house had not identified the
figure which had appeared and disappeared so suddenly in the moonlight.
She thought first it was a ghost, and then that it was some one who had been
passing and had been tempted to look in at the open door. In the spent
excitement of the closed-up house next day—it was Sunday, most terrible
of all days in the house of death—when the household, shut up, in the first
darkness, had to realise the great change that had happened, and the two
men, who had been arbitrarily drawn together by Amanda, were thrown
upon each other for society in the darkened rooms, at the melancholy meals,
with now no bond whatever between them—Frederick asked, with a kind of
longing for his cousin. “Is Miss Vane still in her room? Is she ill?” he asked
of the maid who attended at the luncheon which poor Batty swallowed by
habit, moaning between every mouthful.
“Miss Vane, sir? oh, the young lady. She went away last night, when—
when it happened,” answered the maid.
“Went away last night? Where has she gone?” cried Frederick, in
dismay.
“That none on us knows. She went straight away out of the house, sir,
the next moment after—it happened,” said the maid.
“She was frightened, I suppose, poor young lady. She took the way to
the Minster, up the street. It was me that saw her. I didn’t say nothing till
this morning, for I thought it was a ghost.”
“A ghost! My poor Innocent!” said Frederick. “Did she say nothing?
Good heavens! where can the poor child have gone?”
He started up in real distress, and got his hat.
“Stay where you are,” said Batty. “You are not going out of my house
this day, and my girl lying dead. My girl!—my pretty ’Manda!—none of
them were fit to tie her shoes. Oh Lord, oh Lord! to think an old hulk like
me should last and my girl be gone! You don’t go a step out of my house,
mind you, Eastwood—not a step—to show how little you cared for my girl,
if I have to hold you with my hands.”
“I have no desire to show anything but the fullest respect for Amanda,”
said Frederick; “poor girl, she shall have no slight from me; but I must look
after my little cousin. Miss Vane trusted her to me. My mother will be
anxious——”
“D—— Miss Vane,” said poor Batty, “d—— every one that comes in the
way of what’s owed to my poor girl, my pretty darling. Oh, my ’Manda, my
’Manda! How shall I live when she’s gone? Look you here, Frederick
Eastwood, I know most of your goings on. I know about that cousin. You
shan’t step out of here, not to go after another woman, and the breath scarce
out of my poor girl.”
“I must know where Innocent has gone,” cried Frederick, chafing at this
restriction, yet moved by so much natural emotion as to hesitate before
wounding the feelings of Amanda’s father. “I have little wish to go out,
Heaven knows; but the poor child——”
“I will find out about the child,” said Batty; and Frederick did not escape
till the night had come again, and he could steal out in the darkness to
supplement the information which Batty’s groom managed to collect.
Innocent had been seen by various people in her flight. She had been
watched to the shadow of the Minster, and then to the railway, where
nobody had seen her go into the train, but which was certainly the last spot
where she had been. Frederick was discomposed by this incident, more
perhaps than became a man whose wife had died the day before. He could
not leave the house in which Amanda lay dead to follow Innocent; but in
his mind he thought a great deal more of her than of his wife on the second
night of his bereavement. Where was she—poor, innocent, simple-hearted
child? He sent a messenger to the High Lodge, hoping she might be there.
He felt himself responsible for her to his mother, to Miss Vane, to all who
knew him. As it was Sunday, however, he had no means—either by post or
telegraph—to communicate with his mother. He had to wait till morning,
with burning impatience in his mind. Poor Innocent! how his heart warmed
to the little harmless, tender thing, who had nestled to him like a child, who
had always trusted him, clung to him, believed in him. Nothing had ever
shaken her faith. Even his marriage, which had detached many of his
friends from him, had not detached her. She had believed in him whatever
happened. I have said that Frederick had always been kind to Innocent. It
had not indeed always been from the most elevated of motives; her
supposed love for him had pleased his vanity, and he had indulged himself
by accepting her devotion without any thought of those consequences to her
which his mother feared; he had, indeed, believed as firmly as his mother
and her maids did, that Innocent was “in love” with him—and instead of
honourably endeavouring to make an end of that supposititious and most
foolish passion he had “encouraged” Innocent, and solaced himself by her
childish love. But through all this vanity and self-complacency there had
been a thread of natural affection, which was perhaps the very best thing in
Frederick, during that feverish period of his life which had now suddenly
come to an end. He had always been “fond of” his little cousin. Now this
tender natural affection came uppermost in his mind. Real anxiety
possessed him—painful questionings and suspicions. Where had she fled to
in her terror? She was not like other people, understanding how to manage
for herself, to tell her story, and make her own arrangements. And then
there was the strange alarming fact, that though she had been seen to enter
the railway station she had not gone away, so the officials swore, by any
train, and yet had disappeared utterly, leaving no trace. It seemed natural
enough to Frederick that she should have fled in terror at thus finding
herself face to face with death. Neither aunty nor the maids had as yet
sufficiently shaped their recollections to give a very clear idea as to the
moment at which poor Amanda died, and no one knew how deeply Innocent
was involved in that terrible moment. But yet no one wondered that she had
“run away,” partly because the excitement of the great event itself still
possessed the house, and partly because the girl’s abstracted visionary look
impressed upon all vulgar spectators a belief that “she was not all there,” as
the maids said. She was supposed to be a little “weak,” even at the High
Lodge, where her piety had procured for her a kind of worship. That she
should be driven wild by fright and should fly out of the house seemed no
wonder to any one. Frederick lay awake all night thinking of her; he could
not turn his thoughts to any other subject. How soon the mind gets
accustomed to either gain or loss when it is final! Twenty-four hours before,
his brain had been giddy with the awful thought that Amanda was dead, that
the bonds of his life were broken, and that she who had been his closest
companion, the woman he had loved and loathed, had suddenly and
mysteriously departed from him, without notice or warning, into the unseen.
The shock of this sudden interruption to his life had for the moment
disturbed the balance of earth and heaven; in that terrible region of mystery
between the seen and the unseen, between life and death, he had stood
tottering, wondering, bewildered—for a moment. Now, after twenty-four
hours, Amanda’s death was an old, well-known tale, a thing that had been
for ages; it was herself who began to look like a shadow, a dream. Had she
really been his wife, his fate, the centre of his life, colouring it wholly, and
turning it to channels other than those of nature? Already this began to seem
half incredible to Frederick—already he felt that his presence in Batty’s
house was unnatural; that he was a stranger altogether detached from it and
its disagreeable associations, waiting only for a point of duty, free from it
henceforward for ever. He was there “on business” only, as any other
stranger might be. And his whole mind was now occupied by the newer,
more hopeful mystery, the fate of his cousin. Poor little Innocent! how
sweet she had always been to him, how soothing in her truth and faith.
Perhaps in the halcyon time to come, free of all the bonds which his folly
had woven round him, might he not reward Innocent for her love? If he
could only be sure she was safe—if he but knew where she was!
Early on the Monday morning he rushed to the telegraph-office to
communicate with his mother, and ascertain if she had gone home. How he
chafed at his bondage here, and that he could not go to satisfy himself, to
secure the poor child’s safety! No one, however, who saw Frederick with
his melancholy aspect passing along the street, had any suspicion that
Amanda’s memory was treated with less “respect” than that of the most
exemplary of wives. The village was full of the sad story, and people looked
at him curiously as he passed. Poor fellow, how he seemed to feel it! and no
doubt she was very pretty, and men thought so much of beauty. Frederick’s
solemn aspect gained him the sympathy of all the villagers. They spoke
more tenderly of Batty’s daughter when they saw the bereaved husband. No
doubt it had been a love match on his side at least, and whatever her faults
might have been it was dreadful to be taken so young and so sudden! Thus
Sterborne murmured sympathetically as Frederick went to send off his
telegram, with very little thought of his wife, and a burning impatience to
escape from all her belongings, in his heart.
He went to the railway before he went back, to ask if any further
information about Innocent had been obtained. The early train from town
had just arrived, and to his astonishment he was met by his mother, looking
very pale, anxious, and almost frightened, if that could be. “Mother, this is
kind,” he cried, rushing up to her, touched for the moment by a sudden
sense of the faithful affection that never failed him; and then he added
hurriedly, “Innocent! is she with you? do you know where she is?”
“She is safe at home,” said Mrs. Eastwood, with a heavy sigh.
“Thank God!” he cried; and it did not occur to him that his mother did
not share his thankfulness, and that the cloud on her face was more heavy
than any he had before seen there through all her troubles.
CHAPTER XXXV.
MRS. EASTWOOD’S INVESTIGATION.

“I feel for you very deeply,” said Mrs. Eastwood. “It is a terrible calamity.
Your child, whom you hoped would close your eyes, whom you never
thought to see taken before you——”
“She was the apple of my eye,” said poor Batty, sobbing. Except when
he stupefied himself with drink, or rushed into his business, and swore and
raged at every one round him, which were the only ways he had of seeking
a momentary forgetfulness, the man, coarse and sensual as he was, was
tragic in his grief. “There was never one like her, at least to me. I do not say
but she might have been faulty to others; but to her old father she was
everything. I thank you from my heart for this respect. You mightn’t be
fond of my girl, while she lived. I ask no questions. It was because you
didn’t know her—how could you?—like I knew her, that have nursed her,
and have doted on her from a baby; but thank you all the same for the
respect. It would have gone to her heart—my poor ’Manda! Oh, ma’am, the
beauty that girl was! I never saw anything to come nigh to her. Her temper
was quick, always hasty, ready with a word or a blow—but always the first
to come round and forgive those that had crossed her. My life’s over, my
heart’s broken. I don’t care for nothing, horses nor houses, nor my garden,
nor my bit of money—nothing, now she’s gone.”
“Indeed, I feel for you very deeply,” said Mrs. Eastwood, “and at her
age, so young, it is doubly hard—and so unexpected.”
She recurred to this with a reiteration which was unlike her usual
sympathetic understanding of others. There was an eager anxiety in her
eyes when she suggested that Amanda’s death was unlooked for. Frederick
sat by with a countenance composed to the woe of the occasion, and
strangely impressed by the profound feeling in his mother’s face, watched
her anxiously, but could not understand. What did she mean? Was she really
so grieved for Amanda? Had the shock and pain of so sudden an ending
really produced this profound effect upon her? or was she so conscious of
the advantage which Amanda’s death would bring with it, that natural
compunction made her exaggerate her expressions of sympathy? Frederick
could not tell, but he watched his mother, wondering. There were circles of
weariness and care round her eyes, and signs of suppressed and painful
anxiety, and an eager watchfulness, which was incomprehensible to him,
were visible in her whole aspect. She even breathed quickly, as with a
feverish excitement, all the more painful that it was suppressed.
“I thought you were aware, mother,” he said, “that poor Amanda had
been threatened for years with this which has happened now in so terrible a
way. The doctors have always said——”
“The doctors, confound ’em!” cried Batty. “I beg your pardon, ma’am,
but it’s hard for a man to keep his patience. They’re ready enough to talk,
but what can they do, these fellows? Keep her quiet, they told me. My God!
didn’t I do everything a man could do to keep her quiet, gave her all she
wanted, never crossed her, let her have her way in everything! There is
nothing I wouldn’t have done for my girl. She’d have had gold to eat and
drink if that would have done it. I’d have took her anywhere, got her
anything. But no. Ask ’em, and they tell you all that is unpleasant, but give
you a way to mend it—no. They do it, I sometimes think, to make their own
words come true. ‘She’ll go off one day, all in a moment,’ they said to me,
years and years ago. Says I, ‘I’ll give you half I’ve got, all I’ve got, if you
will make it so as this shan’t be.’ Trust them for that. They gave her physic
and stuff, and shook their wise heads, and said she was to be kept quiet.
What had keeping quiet to do with it? We’ve all quick tempers. I never
could master mine myself, and how was she to be expected to master hers?
From father to son and from mother to daughter, the Battys were always a
word and a blow. I’d rather that a deal than your slow, quiet, sullen ones,
that hides their feelings. No, you may say it was unexpected, for how was I
to believe them? A bit of a flare-up never did me no harm. I never believed
them. But now here’s their d——d artfulness—it’s come true.”
“And she knew it herself?” said Mrs. Eastwood, with searching, anxious
gaze. “Oh, Mr. Batty, try and take a little comfort! It must have made her
think more seriously than you suppose, if she knew it herself.”
Batty gave her a dull look of wonder from his tearful blood-shot eyes;
and then he launched forth again into panegyrics upon his lost child. “She
was none of your quiet, sullen ones—still water as runs deep. She said what
she thought, did my ’Manda. She might be too frank and too open to please
them as hide their thoughts, but she always pleased her father. There’s

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CHAPTER 6 Weight Management 147

CHAPTER 7 Physical Activity and Fitness 169

Answers for Making This Chapter Work for You 503

What does “health” mean to you?

After reading this chapter, you should be able to:

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(STI) skyrockets. health

4 CHAPTER 1 The Power of Now

Social Health Social health refers to the

✓ check-in How do you think your life

Healthy People 2020

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6 CHAPTER 1 The Power of Now

Diabetes American Indians and Alaska

Infant Mortality African American, Ameri-

Mental Health American Indians and Alaska

John Lund/Marc Romanelli/Getty Images

Infectious Disease Asian Americans and

8 CHAPTER 1 The Power of Now

10 CHAPTER 1 The Power of Now

Top Ten Health Problems Percent

2. Sinus infection 18.8

3. Back pain 13.7

4. Strep throat 12.1

5. Urinary tract infection 10

6. Migraine headache 9.9

8. Ear infection 6.9

9. Broken bone/fracture/sprain 6.8

10. Bronchitis 6.2

Why “Now” Matters a reduced risk of cardiovascular disease later in

12 CHAPTER 1 The Power of Now

✓ check-in Do you think your peers have

The Promise Regular screening

of Prevention of vital signs, such

14 CHAPTER 1 The Power of Now

Enabling Factors Enabling factors alth Behav

may be praise from family members and friends,

studied how people intentionally change and

How and Why People Change 15

Readiness to act on health beliefs, in this model,

16 CHAPTER 1 The Power of Now

How and Why People Change 17

18 CHAPTER 1 The Power of Now

WHAT DID YOU DECIDE?

What does “health” mean to you?

How and Why People Change 19

MAKING THIS CHAPTER WORK FOR YOU

20 CHAPTER 1 The Power of Now

Making This Chapter Work For You 21

What are the keys to a happy, satisfying, meaningful life?

After reading this chapter, you should be able to:

24 CHAPTER 2 Your Psychological and Spiritual Well-Being

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• If you get discouraged and feel that you’re

The Lessons of Positive Psychology 25

Do Love and affection