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Preface

As a health educator, you already know that personal health is one of the most exciting courses a college stu-dent will take. Today’s media-oriented college students are aware of the critical health issues of the new millen-nium. They hear about environmental issues, substance abuse, sexually transmitted infections, fitness, and nutri-tion virtually every day. The value of the personal health course is its potential to expand students’ knowledge of these and other health topics. Students will then be able to examine their attitudes toward health issues and modify their behavior to improve their health and perhaps even prevent or delay the onset of certain health conditions.

Focus on Health accomplishes this task with a care-fully composed, well-documented text that addresses the health issues most important to both instructors and stu-dents. As health educators, we understand the teaching issues you face daily in the classroom and have written this text with your concerns in mind.

Updated Coverage: New and Expanded TopicsAs experienced health educators and authors, we know how important it is to provide students with the most current information available. The eleventh edition of Focus on Health has been thoroughly updated with the latest information, statistics, and findings. A summary of notable changes for each chapter follows.

Chapter 1

● New life-related terms: span, expectancy, course, style, and fable

● New information on Generation Z● New figures depicting the reciprocal relationships

between health, role fulfillment, and adult develop-mental tasks, at each adult life stage

● New section on personalized medicine and regenera-tive medicine

● Revised information from the Pew Forum on religion and public life

Chapter 2

● Updated statistics and data throughout● New “Learning from Our Diversity” box on regional,

socioeconomic, and racial differences in psychologi-cal health

● New section on mindfulness● New box on cyberviolence

Chapter 3

● Updated statistics and data throughout● New “Learning from Our Diversity” box on

stress-prone personalities● New section on the type D personality type

Chapter 4

● Updated statistics and data throughout● Updated section on physical activity guidelines for

Americans● New Table 4.3 on osteoporosis risk factors

Chapter 5

● Updated statistics and data throughout● New information on the FDA’s “smart choice” food

labeling program● Revised information on USDA dietary

guidelines

Chapter 6

● Updated statistics and data throughout● New box on health halo foods● New information on weight loss drugs Qnexa,

lorcaserin hydrochloride, and Contrave

Chapter 7

● Updated statistics and data throughout● New box on energy drinks● New section on bath salts● New sections on Salvia divinorum and K2 or Spice

Chapter 8

● Updated statistics related to tobacco use (principally cigarette smoking) in the United States

● New information on non-daily smokers● New identified genetic markers for nicotine

dependency● New section on cigarette smoking and cognitive

decline (dementia)● New information on prenatal exposure to second-

hand tobacco smoke● New information on nicotine vaccine development

Chapter 9

● Updated statistics and data throughout

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Chapter 10

● Updated cancer data related to site of development and deaths

● New cancer treatment protocols: advances and disappointments

● New information on metabolic syndrome and the development of type 2 diabetes mellitus (Small Steps, Big Rewards program)

● New information on advancements in the under-standing and diagnosis of Parkinson’s and Alzheimer’s disease

Chapter 11

● New information on illnesses caused by antibiotic-resistant bacteria

● New section on stem cell research and the role of parthenotes

● Revised section on immunization schedules (by age groups), American immunization status, immuniza-tions and autism, and new vaccines

● New information on nosocomial infections, moni-toring staff via “germ cops”

● New information regarding the diagnosis and treat-ment of Lyme disease

● New medications and immunizations for hepatitis B and C

● New section on bed bugs

Chapter 12

● Updated statistics and data throughout● New box on “Don’t Ask, Don’t Tell”● New section on sexting● New section on stalking● New section on same-sex marriage

Chapter 13

● Updated data and statistics throughout● New section on extended-cycle pills

● New information on male birth control pills● New information on emergency contraception● New section on Adiana sterilization

Chapter 14

● New section on physician use of social media● New section on patient-centered medical care● New section on the placebo effect● New information on medical careers: need versus

employment opportunities● New information on direct-to-consumer marketing

(DTC)● Revised section on palliative care● New information on paying for medical care and the

American health care system’s world ranking

Chapter 15

● Updated data and statistics throughout● New box on cell phone safety and distracted driving● New information on cyberstalking● New information on bullying

Chapter 16

● Updated data and statistics throughout● New information on exposure to dangerous indoor

air pollutants● New information on BPA● New information on air toxics hotspots● New section on ionizing radiation● New information on reducing human population

growth● New box on “too clean” environmental effects

Chapter 17

● Updated data and statistics throughout● New information on near-death experiences● New information on living wills● New information on the Five Wishes directive

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Visual Walk-Through

Building Media Literacy Skills These boxes take a critical look at media sources of health information, helping students get the most out of health information.

ads don’t show viewers the whole picture such as caloric count or the fat, sodium, and sugar content of these foods. Nor do they tell viewers that the more people see these ads, the more they eat and the more they weigh.

So what is the answer? It is very difficult if not impossible to avoid these ads as they bombard us constantly. Do you think there should be regulation for food ads, such as requiring them to list the nutritional information for these foods? Should there be an equal number of ads for fruits, vegetables, and dairy products? One thing that we as consumers can do is educate ourselves about the nutritional information of these foods—that is, be more informed viewers and look at the ads with a more realistic and knowledge-able perspective.

Sources: Approximately how much money is spent each year marketing food products to children? Purdue Extension, March 16, 2010; Story M, French S, Food advertising and marketing directed at children and adoles-cents in the US. International Journal of Behavior, Nutrition, and Physical Activity, 5, 1, 2004; Taylor J, Are fast-food advertisers playing you? WebMD, March 20, 2011; Kids’ cereals pour on the sugar and sodium, USA Today, October 26, 2009.

Does seeing a television advertisement for a juicy, mouth-watering Steak and Shake burger make you hungry? Does a Dove chocolate waterfall cascading down the television screen make you salivate? Advertisers hope so and spend over $10 billion on food and bever-age television ads each year, with the lowest amount of money being spent on advertising fruits, vegetables, and milk. Most of these ads are targeted toward children and adolescents, who view one food ad every five minutes of television screen time. Eighty-nine percent of these ads are for products that are high in sugar, fat, and/or sodium. Children as young as 2 years of age begin asking their parents to buy certain food items seen on television; this is known in the advertising industry as “pestering power” or “nag power.” Most of these requests are for cereal, soft drinks, cookies, and candy, and parents comply with their children’s request 50 percent of the time. The least nutri-tious, high-sugar cereals are the most heavily marketed to children.

Studies have shown that people do eat more after watching tele-vision food ads, regardless of how hungry they reported they were at the time. One study found that children ate 45 percent more after seeing a television food ad, compared to those who didn’t view one, potentially contributing to a weight gain of 10 pounds per year. The

Building Media Literacy Skills

Does Watching Television Influence Your Eating?

Discovering Your Spirituality

Mealtime—A Chance to Share and Bond

Food is important to your physical well-being—for energy, growth, repair, and regulation of your body and its function. But it’s also important to the well-being of your spirit. The sharing of food nour-ishes our spiritual sense of community. This happens through the type of foods selected, the method of preparation, the uniqueness of presentation, and the people involved. From a spiritual perspective, the sharing of food can be a highly satisfying activity.

When food is shared in the company of those who care about us in the deepest and most personal ways, we experience a sense of com-munity and well-being. The simple act of being together and engag-ing in a familiar practice is reassuring. Meals that involve family or friends, especially dinners on special occasions or important holidays, can provide a chance to reconnect and build relationships.

Food is often at the center of the celebration of special occasions. Weddings, birthdays, anniversaries, graduations, promotions, retirements, and funerals take on a special meaning when people come together to share food and drink. From the first birthday cake, to the retirement din-ner, to the lunch provided by neighbors after the funeral of a loved one, food can help to symbolize and acknowledge these events in our lives.

Food has been part of many religious practices and customs for centuries. Some foods have symbolic meanings related to major life

experiences and to ceremonies and religious rites. Food can take on symbolic and spiritual meaning, such as bread representing the body of Christ in the Christian religion. The use of food in spirituality helps to bring groups together to build a stronger sense of community. For example, Ramadan, the ninth month of the Islamic calendar, is considered one of the holiest months of the year in Islam, and from dawn to sunset Muslims abstain from food. The fast is broken at sunset when families and friends come together to enjoy traditional dishes such as fattoush, a salad. In the Jewish religion, the Seder, a ritual feast celebrated on the first day of Passover, features long-held traditions and customs involving food. Food takes on a symbolic meaning and is eaten during the retelling of the story of the Exodus from Egypt and freedom from slavery. In the Christian religion, fam-ily and friends celebrate Easter by having a meal together on Easter Sunday, usually including lamb, which represents Christ and is seen as a good omen.

Finally, food connects people on a spiritual level by allowing them to share traditions, religious practices, and beliefs. These customs help people build a sense of fellowship and can unify them in times of joy and sorrow.

Discovering Your Spirituality These boxes highlight the spiritual dimension of health and its effect on overall wellness.

Changing for the BetterThese unique question-and-answer boxes show students how to put health concepts into practice, beginning with a real-life question, followed by helpful tips and practical advice for behavior change.

I am always in a hurry and don’t have time to cook, and so a lot

of my meals end up being fast food. Are there better choices I

can make when eating on the run?

The typical American eats about three hamburgers and four orders of French fries each week, so you aren’t alone. With over 300,000 fast-food restaurants in the United States, fast food is definitely part of the American lifestyle. Here are some things to consider when eating at fast-food restaurants:

• Don’t supersize! Go for the “small” or “regular” size. • Don’t wait until you are starving because that leads to overeating

and supersizing! • Decide what you want to order ahead of time, and don’t be

swayed by “value meal” or what “looks good.” • Ask for a nutritional guide for the menu. Look at the calories, fat

grams, and sodium when making your selection.

• Order grilled instead of fried chicken or fish. • Look for the “light” choices. • Limit your condiments. Mustard, ketchup, salsa, and low-fat or

fat-free condiments and dressings are preferable to regular may-onnaise or high-fat dressings.

• Bring fast food from home! Buy portable foods at the grocery store to take with you that can be eaten quickly and easily, such as portable yogurt, a banana or apple, low-fat granola bar, or breakfast bar.

• Order low-fat or skim milk or water instead of soda. • Go to a variety of different kinds of fast-food restaurants so you

aren’t eating hamburgers every day, and set a limit on how many meals you are going to eat out each week.

Changing for the Better

Eating on the Run

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Learning from Our DiversityThese boxes expose students to alternative viewpoints and highlight what we can learn from the differences that make us unique. You are in London, England, and decide to buy some of the latest

British fashions. You find a pair of pants you like and try them on. They don’t fit. In fact, nothing in your size fits. Why not? Because not all sizes are the same for women.

As you can see from the table below, if you wear a size 12 in American stores, you will need to find a size 14 in British stores or an 11 in Japanese stores or a 42 in Parisian boutiques. * Is this true for men’s clothing? No, you will find that a waist size of 38 is the same in American, British, and Japanese clothing. Why is this? Well, it is the same reason that you will find that not all women’s size-12 clothing is the same even in the same country! What you will find is that the more expensive the clothing, the smaller the size compared to its true size. In other words, you can compare a pair of jeans from a discount store to the identical pair of pants in an expensive department store and find that the expensive pants are labeled one to two sizes smaller than the pants in the discount store. You will also discover that the smaller-size pants have

Learning from Our Diversity Gender, Clothing Sizes, and Body Image Around the World

a much larger price tag. Again, does this hold true for men’s clothing? No, it doesn’t. The reason is that women will pay more for a smaller size, a lot more, while most men will not. There is not a market for smaller-size clothing for men the way there is for women. The fashion industry calls this “faith-based sizing” because consumers want to believe that they are the size the label tells them they are even if the scale says something different. This is also referred to as “vanity sizing.” †

Men, however, are not immune to the trend of rising obesity around the world. In Cyprus, the Czech Republic, Finland, Germany, Greece, Malta, and Slovakia, proportionately more men are overweight or obese than in America. Although the Mediterranean diet has been touted as a healthy diet, the rate of obesity is also higher in the Mediterranean countries. ‡

Eating disorders and distorted eating are more prevalent in cultures adopting Westernized values. One startling example of how quickly and significantly Western ideals of beauty can influence others was seen when television first came to the island of Fiji in 1995. Before the introduction of television, a common compliment given to someone was “you’ve gained weight,” and dieting was almost nonexistent. Telling someone that he or she looked thin was a way of saying that the person didn’t look well. Within three years of having television, the number of teenagers at risk for eating disorders more than doubled; 74 percent of teens said they felt too big or too fat, and 62 percent reported that they had been dieting in the past month. §

In the United States and other Westernized societies, the cultural id l f b t i b i thi d thi A ti

Clothing Size Comparisons

Women’s Clothing

USA 4 6 8 10 12 14 16 18 20UK 6 8 10 12 14 16 18 20 22Russia 40 42 44 46 48 50 52 54 56Spain/France

34 36 38 40 42 44 46 48 50

It l 38 40 42 44 46 48 50 52 54

Special TopicsThese boxes encourage students to delve into a particular topic or closely examine an important health issue.

Should You Take a Dietary Supplement?

Half of Americans take a dietary supplement for health, weight management, and athletic performance enhancement, spending $23 bil-lion on them in 2009. But what are the risks? Dietary supplements do not have to have clini-cal trials to prove their safety or effectiveness and are not subject to regulation by the FDA. Due to the lack of quality control, supple-ments have been routinely found to contain metals, pesticides, high amounts of selenium and chromium, and prescription drugs. People have reported problems with breathing, liver failure, kidney failure, stroke, high blood pres-sure, heart attacks, joint pain, diarrhea, hair loss, finger- and toenails falling off, skin turn-ing blue, whites of eyes turning yellow, and fatigue. Fatalities have been associated with taking dietary supplements as well.

Consumer Reports, along with the Natural Medicines Comprehensive Database, devel-oped a list of the most dangerous supple-ments, ones they say should be avoided due to lack of safety and to adverse side effects. They are aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celadine, kava, lobelia, and yohimbe. They have been associ-ated with liver damage, kidney damage, heart failure, cancer, respiratory problems, and death.

If you do take a dietary supplement, be a cautious and informed consumer. Look for the “USP Verified” mark on the product indicating that the manufacturer has volun-tarily undergone quality control testing by U.S. Pharmacopeia. USP is a nonprofit, private

standard-setting authority that verifies the quality, purity, and potency of the product.

You can check out a list of verified prod-ucts at www.uspverified.org . If the promises seem too good to be true, they probably are. It is illegal for dietary supplement compa-nies to claim that their product can prevent, treat, or cure any disease other than ones caused by nutrient deficiencies. Be sure to tell your doctor or pharmacist if you are taking any dietary supplements to avoid negative interactions with prescription medications. If you experience any problems, consult your doctor immediately.

Source: Dangerous supplements, Consumer Reports, September 2010.

S

f f

Rate Your Plate

Personal Assessment

Take a closer look at yourself, your current food decisions, and your lifestyle. Think about your typical eating pattern and food decisions.

Do You . . .

Usually Sometimes Never

Consider the MyPlate nutrition model when you make food choices?

❏ ❏ ❏

Try to eat regular meals (including breakfast), rather than skip or skimp on some?

❏ ❏ ❏

Choose nutritious snacks? ❏ ❏ ❏

Try to eat a variety of foods?

❏ ❏ ❏

Include new-to-you foods in meals and snacks?

❏ ❏ ❏

Try to balance your energy (calorie) intake with your physical activity?

❏ ❏ ❏

Now for the Details

Do You . . .

Consume half your grains as whole-grain products?

❏ ❏ ❏

Eat at least 2½ cups of vegetables daily?

❏ ❏ ❏

Eat at least 2 cups of ❏ ❏ ❏

Score Yourself

Usually 5 2 points Sometimes 5 1 point Never 5 0 points

If you scored . . .

24 or more points —Healthful eating seems to be your fit-ness habit already. Still, look for ways to stick to a healthful eating plan—and to make a “good thing” even better. 16 to 23 points —You’re on track. A few easy changes could help you make your overall eating plan healthier. 9 to 15 points —Sometimes you eat smart—but not often enough to be your “fitness best.” 0 to 8 points —For your good health, you’re wise to rethink your overall eating style. Take it gradually—step by step!

TO CARRY THIS FURTHER . . .

Whatever your score, make moves for healthful eating. Gradually turn your “nevers” into “sometimes” and your “sometimes” into “usually.” Try some of the suggestions from the discussion of MyPlate and the Dietary Guidelines for Americans.

Source: Adapted from The American Dietetic Association’s Monthly Nutrition Companion: 31 Days to a Healthier Lifestyle, by R. Duyff, Chronimed Publishing, 1997. Copyright © 1997 American Dietetic Association. Reproduced with permission of John Wiley & Sons, Inc. and the Leap First Literary Agency.

Personal AssessmentsEach chapter ends with at least one Personal Assessment that helps capture students’ attention, serves as a basis for introspection and behavior change, and provides sugges-tions for carrying the applications further.

TALKING POINTS Which fast-food restaurants

are your favorites? Are you surprised at any of

the information in this chapter regarding your

favorite meals? Will you change your order next time you

visit a fast-food restaurant?

Talking PointsInterspersed throughout each chapter, this feature offers students opportunities to start a dialogue about specific health-related issues and situations.

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Focus on Health in Loose-Leaf FormatMcGraw-Hill has done a considerable amount of research with college students, not only asking them questions about how they study and use course materials, but also using ethnographic research tools to observe how they study. Based on what we heard from students, we are introducing Focus on Health in a three-hole-punched, loose-leaf format that offers these advantages:

● Light and easy to carry● Engaging and relevant to their own lives● Inexpensive● Supported by digital activities that help them learn

and succeed in their course

Would you still like your students to have a bound book? You will be able to order one through our CREATE sys-tem. While you’re at it, you can pull out any of the chapters of the book you don’t assign. This ensures that students are purchasing only the content that is being assigned to them, making the book 100 percent relevant to your course, more affordable for students, and lightweight and portable.

CREATE, Because Customization Matters

Design your ideal course materials with McGraw-Hill’s CREATE (www.

mcgrawhillcreate.com). Rearrange or omit chapters, combine material from other sources, and/or upload your syllabus or any other content you have written to make the perfect resource for your students. Search thousands of leading McGraw-Hill textbooks to find the best con-tent for your students, then arrange it to fit your teaching style. You can even personalize your book’s appearance by selecting the cover and adding your name, school, and course information. When you order a CREATE book, you receive a complimentary review copy. Get a printed copy in three to five business days or an electronic copy (eComp) via e-mail in about an hour.

Register today at www.mcgrawhillcreate.com, and craft your course resources to match the way you teach.

Instructor and Student Online ResourcesThe Online Learning Center (www.mhhe.com/hahn11e)includes valuable teaching and learning tools such as assessment tools, classroom presentations, practice quiz-zes, and updated reference materials.

AcknowledgmentsWhile producing textbooks for nearly three decades, we realize that it takes many talented, dedicated people to develop, write, and publish successful books. For this eleventh edition of Focus on Health, we again used the professional expertise and writing talents of a team of three contributing authors, all professors at Ball State University. Lenny Kaminsky, Ph.D., professor of Exer-cise Science and coordinator of the Clinical Exercise Physiology and Adult Physical Fitness programs, took on the task of revising and updating Chapter 4, “Becom-ing Physically Fit,” and Chapter 9, “Enhancing Your Cardiovascular Health.” Robert Pinger, Ph.D., professor emeritus in the Department of Physiology and Health Science, revised Chapter 15, “Preventing Injuries.” David LeBlanc, professor of Biology, revised Chapter 16, “The Environment and Your Health.” We thank these expe-rienced contributors for their professional dedication to this book and their personal commitment to the health of college students with whom they work on a daily basis.

Focus on Health has benefited from the expert knowl-edge and helpful suggestions of many people. We are grateful for their participation in this edition:

Zuzana Bic, California State Polytechnic University–PomonaSheri Bollinger, Northampton Community CollegeJan Dowell, Prairie State CollegeStephanie Duguid, Copiah Lincoln Community CollegeKeri Kulik, Indiana University of Pennsylvania–IndianaHelene Washington, Black Hawk College

The sponsoring editor for this eleventh edition of Focus on Health is Chris Johnson. Chris is also the executive editor for Health and Human Performance at McGraw-Hill Higher Education. With his good sense of humor, his vision and level-headed thinking, we hope to work with him on many future book projects.

New to this edition is our developmental editor, Lynda Huenefeld. We have known Lynda for many years, but have never worked with her so closely on a book project. Lynda deserves a lot of praise for her editorial efforts on this comprehensive book. She is a great communicator and wonderful problem-solver, with a knack for finding quick consensus on thorny issues. We are indeed thank-ful for having Lynda as the person most closely attached to this edition.

On the production end of this textbook, we have three people that particularly stand out: Holly Irish, Tom Briggs, and Melanie Field. Holly was our production editor. Her duties were to oversee the entire production end of this project. Although we did not have day-to-day contact with Holly, we knew that our revised manuscript was being carefully watched over by Holly’s experienced eyes. Thank you for coordinating this massive effort, Holly.

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Tom Briggs worked with us for the first time as our manuscript editor. In this capacity, he made certain that all of the text revisions, updated sections, and new information fit well together in the chapters. Much of the clarity of this manuscript is due to Tom’s watchful eyes. Thank you, Tom for your ability to work well with all of us.

We were quite fortunate to have Melanie Field serve as our production manager. Melanie has worked on many of our recent book projects and she is a gem. She knows how to juggle the many tasks that come with working

with multiple authors and contributors, the permis-sions editor, the manuscript editor, the book designers, the proofreaders, the compositors, and the printers. We think of Melanie as a head chef in a five-star restaurant, working behind the scenes to produce a product that will be remembered for years. Thank you, Melanie.

Finally, we would like to thank our families for their continued support and love. More than anyone else, they know the energy and dedication it takes to write and revise textbooks. To them we continue to offer our sin-cere admiration and loving appreciation.

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