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Comprehensive Health Assessment

Social and Occupational Health Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I feel loved and supported by my family. 1 2 3 4
2. I establish friendships with ease and enjoyment. 1 2 3 4
3. I establish friendships with people of both genders and all ages. 1 2 3 4
4. I sustain relationships by communicating with and caring about my family and friends. 1 2 3 4
5. I feel comfortable and confident when meeting people for the first time. 1 2 3 4
6. I practice social skills to facilitate the process of forming new relationships. 1 2 3 4
7. I seek opportunities to meet and interact with new people. 1 2 3 4
8. I talk with rather than at people. 1 2 3 4
9. I am open to developing or sustaining intimate relationships. 1 2 3 4
10. I appreciate the importance of parenting the next generation and am committed to supporting it in ways that reflect my own resources. 1 2 3 4
11. I recognize the strengths and weaknesses of my parents, childrearing skills and feel comfortable modifying them if I choose to become a parent. 1 2 3 4
12. I attempt to be tolerant of others whether or not I approve of their behavior or beliefs. 1 2 3 4
13. I understand and appreciate the contribution that cultural diversity makes to the quality of living. 1 2 3 4
14. I understand and appreciate the difference between being educated and being trained. 1 2 3 4
15. My work gives me a sense of self-sufficiency and an opportunity to contribute. 1 2 3 4
16. I have equal respect for the roles of leader and subordinate within the workplace. 1 2 3 4
17. I have chosen an occupation that suits my interests and temperament. 1 2 3 4
18. I have chosen an occupation that does not compromise my physical or psychological health. 1 2 3 4
19. I get along well with my co-workers most of the time. 1 2 3 4
20. When I have a disagreement with a co-worker, I try to resolve it directly and constructively. 1 2 3 4

Spiritual and Psychological Health Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I have a deeply held belief system or personal theology. 1 2 3 4
2. I recognize the contribution that membership in a community of faith can make to a person's overall quality of life. 1 2 3 4
3. I seek experiences with nature and reflect on nature's contribution to my quality of my life. 1 2 3 4
4. My spirituality is a resource that helps me remain calm and strong during times of stress. 1 2 3 4
5. I have found appropriate ways to express my spirituality. 1 2 3 4
6. I respect the diversity of spiritual expression and am tolerant of those whose beliefs differ from my own. 1 2 3 4
7. I take adequate time to reflect on my own life and my relationships with others and the institutions of society. 1 2 3 4
8. I routinely undertake new experiences. 1 2 3 4
9. I receive adequate support from others. 1 2 3 4
10. I look for opportunities to support others, even occasionally at the expense of my own goals and aspirations. 1 2 3 4
11. I recognize that emotional and psychological health are as important as physical health. 1 2 3 4
12. Express my feelings and opinions comfortably, yet am capable of keeping them to myself when appropriate. 1 2 3 4
13. I see myself as a person of worth and feel comfortable with my own strengths and limitations. 1 2 3 4
14. I establish realistic goals and work to achieve them. 1 2 3 4
15. I understand the differences between the normal range of emotion and the signs of clinical depression. 1 2 3 4
16. I know how to recognize signs of suicidal thoughts and am willing to intervene. 1 2 3 4
17. I regularly assess my own behavioral patterns and beliefs and would seek professional assistance for any emotional dysfunction. 1 2 3 4
18. I accept the reality of aging and view it as an opportunity for positive change. 1 2 3 4
19. I accept the reality of death and view it as a normal and inevitable part of life. 1 2 3 4
20. I have made decisions about my own death to ensure that I die with dignity when the time comes. 1 2 3 4

Stress Management Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I accept the reality of change while maintaining the necessary stability in my daily activities. 1 2 3 4
2. I seek change when it is necessary or desirable to do so. 1 2 3 4
3. I know what stress-management services are offered on campus, through my employer, or in my community. 1 2 3 4
4. When necessary, I use the stress-management services to which I have access. 1 2 3 4
5. I employ stress-reduction practices in anticipation of stressful events, such as job interviews and final examinations. 1 2 3 4
6. I reevaluate the way in which I handled stressful events so that I can better cope with similar events in the future. 1 2 3 4
7. I turn to relatives and friends during periods of disruption in my life. 1 2 3 4
8. I avoid using alcohol or other drugs during periods of stress. 1 2 3 4
9. I refrain from behaving aggressively or abusively during periods of stress. 1 2 3 4
10. I sleep enough to maintain a high level of health and cope successfully with daily challenges. 1 2 3 4
11. I avoid sleeping excessively as a response to stressful change. 1 2 3 4
12. My diet is conducive to good health and stress management. 1 2 3 4
13. I participate in physical activity to relieve stress. 1 2 3 4
14. I practice stress-management skills, such as diaphragmatic breathing and guided imagery 1 2 3 4
15. I manage my time effectively. 1 2 3 4

Fitness Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I participate in recreational and fitness activities both to minimize stress and to improve or maintain my level of physical fitness. 1 2 3 4
2. I select some recreational activities that are strenuous rather than sedentary in nature. 1 2 3 4
3. I include various types of aerobic conditioning activities among the wider array of recreational and fitness activities in which I engage. 1 2 3 4
4. I engage in aerobic activities with appropriate frequency, intensity, and duration to provide a training effect for my heart and lungs. 1 2 3 4
5. I routinely include strength training activities among the wider array of fitness activities in which I engage. 1 2 3 4
6. I routinely vary the types of strength training activities in which I participate in order to minimize injury and strengthen all of the important muscle groups. 1 2 3 4
7. I do exercises specifically designed to maintain joint range of motion. 1 2 3 4
8. I believe that recreational and fitness activities can help me improve my physical health and my emotional and social well-being. 1 2 3 4
9. I include a variety of fitness activities in my overall plan for physical fitness. 1 2 3 4
10. I take appropriate steps to avoid injuries when participating in recreational and fitness activities. 1 2 3 4
11. I seek appropriate treatment for all injuries that result from fitness activities. 1 2 3 4
12. I believe that older adults should undertake appropriately chosen fitness activities. 1 2 3 4
13. My body composition is consistent with a high level of health. 1 2 3 4
14. I warm up before beginning vigorous activity, and I cool down afterward. 1 2 3 4
15. I select properly designed and well-maintained equipment and clothing for each activity. 1 2 3 4
16. I avoid using performance-enhancing substances that are known to be dangerous and those whose influence on the body is not fully understood. 1 2 3 4
17. I sleep seven to eight hours daily. 1 2 3 4
18. I refrain from using over-the-counter sleep-inducing aids. 1 2 3 4
19. I follow sound dietary practices as an important adjunct to a health-enhancing physical activity program. 1 2 3 4
20. My current level of fitness allows me to participate fully and effortlessly in my daily activities. 1 2 3 4

Nutrition And Weight Management Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I balance my caloric intake with my caloric expenditure. 1 2 3 4
2. I obtain the recommended number of serving from each of the food groups. 1 2 3 4
3. I select a wide variety of foods chosen from each of the food groups. 1 2 3 4
4. I understand the amount of a particular food that constitutes a single serving. 1 2 3 4
5. I often try new foods, particularly when I know them to be healthful. 1 2 3 4
6. I select breads, cereals, fresh fruits, and vegetables in preference to pastries, candies, sodas, and fruits canned in heavy syrup. 1 2 3 4
7. I limit the amount of sugar that I add to foods during preparation and at the table. 1 2 3 4
8. I consume an appropriate percentage of my total daily calories from carbohydrates. 1 2 3 4
9. I select primarily non-meat sources of protein, such as peas, beans, and peanut butter, while limiting my consumption of red meat and high-fat dairy products. 1 2 3 4
10. I consume an appropriate percentage of my total daily calories from protein. 1 2 3 4
11. I select foods prepared with unsaturated vegetable oils while reducing my consumption of red meat, high-fat dairy products, and foods prepared with lard (animal fat) or butter. 1 2 3 4
12. I carefully limit the amount of fast food that I consume during a typical week. 1 2 3 4
13. I consume an appropriate percentage of my total daily calories from fat. 1 2 3 4
14. I select nutritious foods when I snack. 1 2 3 4
15. I limit my use of salt during food preparation and at the table. 1 2 3 4
16. I consume adequate amounts of fiber. 1 2 3 4
17. I routinely consider the nutrient density of individual food items when choosing foods. 1 2 3 4
18. I maintain my weight without reliance on over-the-counter or prescription diet pills 1 2 3 4
19. I maintain my weight without reliance on fad diets or liquid weight loss beverages. 1 2 3 4
20. I exercise regularly to help maintain my weight. 1 2 3 4

Alcohol, Tobacco, and Other Drug Use Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I abstain or drink in moderation when offered alcoholic beverages. 1 2 3 4
2. I abstain from using illegal psychoactive (mind-altering) drugs. 1 2 3 4
3. I do not consuming alcoholic beverages or psychoactive drugs rapidly or in large quantities. 1 2 3 4
4. I do not use alcohol or psychoactive drugs in way that causes me to behave inappropriately. 1 2 3 4
5. My use of alcohol or other drugs does not compromise my academic performance. 1 2 3 4
6. I refrain from drinking alcoholic beverages or using psychoactive drugs when engaging in recreational activities that require strength, speed, and coordination. 1 2 3 4
7. I refrain from drinking alcoholic beverages while participating in occupational activities, regardless of the nature of those activities. 1 2 3 4
8. My use of alcohol or other drugs does not generate financial concerns for myself or for others. 1 2 3 4
9. I refrain from drinking alcohol or using psychoactive drugs when driving a motor vehicle or operating heavy equipment. 1 2 3 4
10. I do not drink alcohol or use psychoactive drugs when I am alone. 1 2 3 4
11. I avoid riding with people who have been drinking alcohol or using psychoactive drugs. 1 2 3 4
12. My use of alcohol or other drugs does not cause family dysfunction. 1 2 3 4
13. I do not use marijuana. 1 2 3 4
14. I do not use hallucinogens. 1 2 3 4
15. I do not use heroin or other illegal intravenous drugs. 1 2 3 4
16. I do not experience blackouts when I drink alcohol. 1 2 3 4
17. I do not become abusive or violent when I drink alcohol or use psychoactive drugs. 1 2 3 4
18. I use potentially addictive prescription medication in complete compliance with my physician's directions. 1 2 3 4
19. I do not smoke cigarettes. 1 2 3 4
20. I do not use tobacco products in any other form. 1 2 3 4
21. I minimize my exposure to second-hand smoke. 1 2 3 4
22. I am concerned about the effect that alcohol, tobacco, and other drug use is known to have on developing fetuses. 1 2 3 4
23. I am concerned about the effect that alcohol, tobacco, and other drug use is known to have on the health of other people. 1 2 3 4
24. I seek natural, health-enhancing highs rather than relying on alcohol, tobacco, and illegal drugs. 1 2 3 4
25. I take prescription medication only in the manner prescribed, and I use over-the-counter in accordance with directions. 1 2 3 4

Disease Prevention Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. My diet includes foods rich in phyto-chemicals. 1 2 3 4
2. My diet includes foods rich in folic acid. 1 2 3 4
3. My diet includes foods that are good sources of dietary fiber. 1 2 3 4
4. My diet is low in dietary cholesterol. 1 2 3 4
5. I follow food preparation practices that minimize the risk of food-borne illness. 1 2 3 4
6. I engage in regular physical activity and am able to control my weight effectively. 1 2 3 4
7. I do not use tobacco products. 1 2 3 4
8. I abstain from alcohol or drink only in moderation. 1 2 3 4
9. I do not use intravenously administered illegal drugs. 1 2 3 4
10. I use safer sex practices intended to minimize my risk of exposure to sexually transmitted diseases, including HIV and HPV. 1 2 3 4
11. I take steps to limit my risk of exposure to the bacterium that causes Lyme disease and to the virus that causes hantavirus pulmonary syndrome. 1 2 3 4
12. I control my blood pressure with weight management and physical fitness activities. 1 2 3 4
13. I minimize my exposure to allergens, including those that trigger asthma attacks. 1 2 3 4
14. I wash my hands frequently and thoroughly. 1 2 3 4
15. I use preventive medical care services appropriately. 1 2 3 4
16. I use appropriate cancer self-screening practices, such as breast self-examination and testicular self-examination. 1 2 3 4
17. I know which chronic illnesses and diseases are part of my family history. 1 2 3 4
18. I know which inherited conditions are part of my family history and will seek preconcep-tional counseling regarding these conditions. 1 2 3 4
19. I am fully immunized against infectious diseases. 1 2 3 4
20. I take prescribed medications, particularly antibiotics, exactly as instructed by my physician 1 2 3 4

Sexual Health Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I know how sexually transmitted diseases are spread. 1 2 3 4
2. I can recognize the symptoms of sexually transmitted diseases. 1 2 3 4
3. I know how sexually transmitted disease transmission can be prevented. 1 2 3 4
4. I know how safer sex practices reduce the risk of contracting sexually transmitted diseases. 1 2 3 4
5. I follow safer sex practices. 1 2 3 4
6. I recognize the symptoms of premenstrual syndrome and understand how it is prevented and treated. 1 2 3 4
7. I recognize the symptoms of endometriosis and understand the relationship of its symptoms to hormonal cycles. 1 2 3 4
8. I understanding the physiological basis of menopause and recognize that it is a normal part of the aging process in women. 1 2 3 4
9. I understand and accept the range of human sexual orientations. 1 2 3 4
10. I encourage the development flexible sex roles (androgyny) in children. 1 2 3 4
11. I take a mature approach to dating and mate selection. 1 2 3 4
12. I recognize that marriage and other types of longterm relationships can be satisfying. 1 2 3 4
13. I recognize that a celibate lifestyle is appropriate and satisfying for some people. 1 2 3 4
14. I affirm the sexuality of older adults and am comfortable with its expression. 1 2 3 4
15. I am familiar with the advantages and disadvantages of a wide range of birth control methods. 1 2 3 4
16. I understand how each birth control method works and how effective it is. 1 2 3 4
17. I use my birth control method consistently and appropriately. 1 2 3 4
18. I am familiar with the wide range of procedures now available to treat infertility. 1 2 3 4
19. I accept that others may disagree with my feelings about pregnancy termination. 1 2 3 4
20. I am familiar with alternatives available to infertile couples, including adoption. 1 2 3 4

Safety Practices and Violence Prevention Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I attempt to identify sources of risk or danger in each new setting or activity. 1 2 3 4
2. I learn proper procedures and precautions before undertaking new recreational or occupational activities. 1 2 3 4
3. I select appropriate clothing and equipment for all activities and maintain equipment in good working order. 1 2 3 4
4. I curtail my participation in activities when I am not feeling well or am distracted by other demands. 1 2 3 4
5. I repair dangerous conditions or report them to those responsible for maintenance. 1 2 3 4
6. I use common sense and observe the laws governing non-motorized vehicles when I ride a bicycle. 1 2 3 4
7. I operate all motor vehicles as safely as possible, including using seat belts and other safety equipment. 1 2 3 4
8. I refrain from driving an automobile or boat when I have been drinking alcohol or taking drugs or medications. 1 2 3 4
9. I try to anticipate the risk of falling and maintain my environment to minimize this risk. 1 2 3 4
10. I maintain my environment to minimize the risk of fire, and I have a well-rehearsed plan to exit my residence in case of fire. 1 2 3 4
11. I am a competent swimmer and could save myself or rescue someone who was drowning. 1 2 3 4
12. I refrain from sexually aggressive behavior toward my partner or others. 1 2 3 4
13. I would report an incident of sexual harassment or date rape whether or not I was the victim. 1 2 3 4
14. I would seek help from others if I were the victim or perpetrator of domestic violence. 1 2 3 4
15. I practice gun safety and encourage other gun owners to do so. 1 2 3 4
16. I drive at all times in way that will minimize my risk of being carjacked. 1 2 3 4
17. I have taken steps to protect my home from intruders. 1 2 3 4
18. I use campus security services as much as possible when they are available. 1 2 3 4
19. I know what to do if I am being stalked. 1 2 3 4
20. I have a well-rehearsed plan to protect myself from the aggressive behavior of other person in my place of residence. 1 2 3 4

Health Care Consumerism Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I know how to obtain valid health information. 1 2 3 4
2. I accept health information that has been deemed valid by the established scientific community. 1 2 3 4
3. I am skeptical of claims that guarantee the effectiveness of a particular healthcare service or product. 1 2 3 4
4. I am skeptical of practitioners or clinics who advertise or offer services at rates substantially lower than those charged by reputable providers. 1 2 3 4
5. I am not swayed by advertisements that present unhealthy behavior in an attractive manner. 1 2 3 4
6. I can afford proper medical care, including hospitalization. 1 2 3 4
7. I can afford adequate health insurance. 1 2 3 4
8. I understand the role of government health care plans in providing health care to people who qualify for coverage. 1 2 3 4
9. I know how to select health care providers who are highly qualified and appropriate for my current health care needs. 1 2 3 4
10. I seek a second or third opinion when surgery or other costly therapies are recommended. 1 2 3 4
11. I have told my physician which hospital I would prefer to use should the need arise. 1 2 3 4
12. I understand my rights and responsibilities as a patient when admitted to a hospital. 1 2 3 4
13. I practice adequate self-care to reduce my health care expenditures and my reliance on health care providers. 1 2 3 4
14. I am open minded about alternative health care practices and support current efforts to determine their appropriate role in effective health care. 1 2 3 4
15. I have a well-established relationship with a pharmacist and have transmitted all necessary information regarding medication and use. 1 2 3 4
16. I carefully follow labels and directions when using health care products, such as over-the-counter medications. 1 2 3 4
17. I finish all prescription medications as directed, rather than stopping use when symptoms subside. 1 2 3 4
18. I report to the appropriate agencies any providers of health care services, information, or products that use deceptive advertising or fraudulent methods of operation. 1 2 3 4
19. I pursue my rights as fully as possible in matters of misrepresentation or consumer dissatisfaction. 1 2 3 4
20. I follow current health care issues in the news and voice my opinion to my elected representatives. 1 2 3 4

Environmental Health Not true/rarely Somewhat true/some-times Mostly true/usually Very true/always
1. I avoid use of and exposure to pesticides as much as possible. 1 2 3 4
2. I avoid use of and exposure to herbicides as much as possible. 1 2 3 4
3. I am willing to spend the extra money and time required to obtain organically grown produce. 1 2 3 4
4. I reduce environmental pollutants by minimizing my use of the automobile. 1 2 3 4
5. I avoid the use of products that contribute to indoor air pollution. 1 2 3 4
6. I limit my exposure to ultraviolet radiation by avoiding excessive sun exposure. 1 2 3 4
7. I limit my exposure to radon gas by using a radon gas detector. 1 2 3 4
8. I limit my exposure to radiation by promptly eliminating radon gas within my home. 1 2 3 4
9. I limit my exposure to radiation by agreeing to undergo medical radiation procedures only when absolutely necessary for the diagnosis and treatment of an illness or disease. 1 2 3 4
10. I avoid the use of potentially unsafe water, particularly when traveling in a foreign country or when a municipal water supply or bottled water is unavailable. 1 2 3 4
11. I avoid noise pollution by limiting my exposure to loud noise or by using ear protection. 1 2 3 4
12. I avoid air pollution by carefully selecting the environments in which I live, work, and recreate. 1 2 3 4
13. I do not knowingly use or improperly dispose of personal care products that can harm the environment. 1 2 3 4
14. I reuse as many products as possible so that they can avoid the recycling bins for as long as possible. 1 2 3 4
15. I participate fully in my community's recycling efforts. 1 2 3 4
16. I encourage the increased use of recycled materials in the design and manufacturing of new products. 1 2 3 4
17. I dispose of residential toxic substances safely and properly. 1 2 3 4
18. I follow environmental issues in the news and voice my opinion to my elected representatives. 1 2 3 4
19. I am aware of and involved in environmental issues in my local area. 1 2 3 4
20. I perceive myself as a steward of the environment for the generations to come, rather than as a person with a right to use (and misuse) the environment to meet my immediate needs. 1 2 3 4

Total Points _______

Interpretation

715-800 points
Congratulations! Your health behavior is very supportive of high-level health. Continue to practice your positive health habits, and look for areas in which you can become even stronger. Encourage others to follow your example, and support their efforts in any way you can.

550-714 points
Good job! Your health behavior is relatively supportive of high-level health. You scored well in several areas; however, you can improve in some ways. Identify your weak areas and chart a plan for behavior change.

385-549 points
Caution! Your relatively low score indicates that your behavior may be compromising your health. Review your responses to this asssessment carefully, noting the areas in which you scored poorly. Then chart a detailed plan for behavior change. Be sure to set realistic goals that you can work toward.

Below 385
Red flag! Your low score suggests that your health behavior is destructive. Immediate changes in your behavior are needed to put you back on track. Review your responses to this assessment carefully. Then begin to make changes in the most critical areas, such as harmful alcohol or other drug use patterns. Seek help promptly for any difficulties that you are not prepared to deal with alone, such as domestic violence or suicidal thoughts. Remember, it's not too late to improve your health!

To Carry This Further . . .
Most of us can improve our health behavior in a number of ways. We hope this assessment will help you identify areas in which you can make positive changes and serve as a motivator as you implement your plan for behavior change. If you scored well, give yourself a pat on the back. If your score was not as high as you wuold have liked, take heart. This assessment can help you get started on the road to wellness. Good luck!


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