HEALTHSTYLE SELF-TEST
| Stress Control | Almost Always | Sometimes | Almost Never |
| 1. I have a job or do other work that I enjoy. | 2 | 1 | 0 |
| 2. I find it easy to relax and express my feelings freely. | 2 | 1 | 0 |
| 3. I recognize early, and prepare for, events or situations likely to be stressful for me. | 2 | 1 | 0 |
| 4. I have close friends, relatives, or others whom I can talk to about personal matters and call on for help when needed. | 2 | 1 | 0 |
| 5. I participate in group activities (such as church and community organizations) or hobbies that I enjoy. | 2 | 1 | 0 |
| Stress Control Score: ____________ |
| Safety | | | |
| 1. I wear a seat belt while riding in a car. | 2 | 1 | 0 |
| 2. I avoid driving while under the influence of alcohol and other drugs. | 2 | 1 | 0 |
| 3. I obey traffic rules and the speed limit when driving. | 2 | 1 | 0 |
| 4. I am careful when using potentially harmful products or substances (such as household cleaners, poisons, and electrical devices). | 2 | 1 | 0 |
| 5. I avoid smoking in bed. | 2 | 1 | 0 |
| Safety Score: ____________ |
| Cigarette Smoking | | | |
| 1. If you never smoke, enter a score of 10 for this section and go to the next section on Alcohol and Drugs. | | | |
| 2. If you have been smoke-free for 10 years or more and are under the age of 60, enter a score of 10 points and go to the next section on Alcohol and Drugs. | | | |
| 3. If you have been smoke-free for 1-9 years, enter a score of 8 points and go to the next section on Alcohol and Drugs. | | | |
| 4. If you have been smoke-free for less than a year, enter a score of 6 points and go to the next section on Alcohol and Drugs. | | | |
| 5. I avoid smoking cigarettes. | 2 | 1 | 0 |
| 6. I smoke only low tar and nicotine cigarettes or I smoke a pipe or cigar. | 2 | 1 | 0 |
| Safety Score: ____________ |
| Exercise / Fitness | | | |
| 1. I maintain a desired weight, avoiding overweight and underweight. | 2 | 1 | 0 |
| 2. I do vigorous exercises for 20-30 minutes at least 3 times a week (examples include running, swimming, brisk walking). | 2 | 1 | 0 |
| 3. I do exercise that enhance my muscle tone/strength at least 2 times a week (examples include weight training and calisthenics). | 2 | 1 | 0 |
| 4. I do exercise that enhances my flexibility at least 3 times a week (examples include calf and hamstring stretches). | 2 | 1 | 0 |
| 5. I use part of my leisure time participating in individual, Family, or team activities that increase my level of fitness (such as gardening, bowling, golf, and baseball). | 2 | 1 | 0 |
| Exercise/Fitness Score: ____________ |
| Alcohol and Drugs | | | |
| 1. I avoid drinking alcoholic beverages or I drink no more than 1 or 2 drinks a day. | 2 | 1 | 0 |
| 2. I avoid using alcohol or other drugs (especially illegal drugs) as a way of handling stressful situations or the problems in my life. | 2 | 1 | 0 |
| 3. I am careful not to drink alcohol when taking certain medicines (for example, medicine for sleeping, pain, colds, and allergies), or when pregnant. | 2 | 1 | 0 |
| 4. I read and follow the label directions when using prescribed and over-the-counter drugs. | 2 | 1 | 0 |
| . I use a designated driver when drinking alcohol. | 2 | 1 | 0 |
| Alcohol and Drugs Score: ____________ |
| Eating Habits | | | |
| 1. I eat a variety of foods each day, such as fruits and vegetables, whole grain breads and cereals, lean meats, dairy products, dry peas and beans, and nuts and seeds. | 2 | 1 | 0 |
| 2. I limit the amount of fat, saturated fat, and cholesterol I eat (including fat on meats, eggs, butter, cream, shortenings, and organ meats, such as liver). | 2 | 1 | 0 |
| 3. I limit the amount of salt I eat by cooking with only small amounts, not adding salt at the table, and avoiding salty snacks. | 2 | 1 | 0 |
| 4. I avoid eating too much sugar (especially frequent snacks of sticky candy or soft drinks). | 2 | 1 | 0 |
| . I eat 5 servings of fruits and vegetables a day. | 2 | 1 | 0 |
| Eating Habits Score: ____________ |
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WHAT YOUR SCORES MEAN TO YOU
Scores of 9 and 10 - Excellent! Your answers show that you are aware of the importance of this area to your health. More important, you are putting your knowledge to work for you by practice good health habits. As long as you continue to do so, this area should not pose a serious health risk. It's likely that you are setting an example for your Family and friends to follow. Since you got a very high-test score on this part of the test, you may want to consider other areas where your scores indicate room for improvement.
Scores of 6 to 8 - Your health practices in this area are good, but there is room for improvement. Look again at the items you answered with a "Sometimes" or "Almost Never." What changes can you make to improve your score? Even a small change can often help you achieve better health.
Scores of 3 to 5 - Your health risks are showing! Would you like more information about the risks you are facing and about why it is important for you to change these behaviors? Perhaps you need help in deciding how to successfully make the changes you desire. In either case, help is available.
Scores of 0 to 2 - Obviously you were concerned enough about your health to take the test, but your answers show that may be taking serious and unnecessary risks with your health. Perhaps you are not aware of the risks and what to do about them. You can easily get the information and help you need to improve, if you wish. The next step is up to you.
Provided by ODPHP National Health Information Center;
Modified by United States Army Center for Health Promotion and Preventive Medicine |
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US Army Center for Health Promotion and Preventive Medicine.
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