Fit & Well: Core Concepts and Labs in

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 9 10
WEIGHT MANAGEMENT 279 STRESS MANAGEMENT AND SLEEP 311

HEALTH IMPLICATIONS OF OVERWEIGHT WHAT IS STRESS? 312

AND OBESITY 280 Physical Responses to Stressors 312
Assessing Weight 280 Psychological and Behavioral Responses
Overweight, Obesity, and Specific Health Risks 281 to Stressors 314

FACTORS CONTRIBUTING TO EXCESS The Stress Experience as a Whole 316

BODY FAT 282 STRESS AND WELLNESS 316
Energy Balance 282 The General Adaptation Syndrome 316
Genetic Factors 282 Allostatic Load 317
Physiological Factors 283 Stress and Specific Conditions 317
Lifestyle Factors 284
COMMON SOURCES OF STRESS 318
Psychosocial Factors 284
Major Life Changes 318
Environmental Factors 285
Daily Hassles 318
ADOPTING A HEALTHY LIFESTYLE FOR College Stressors 318
SUCCESSFUL WEIGHT MANAGEMENT 285 Job-Related Stressors 319
Dietary Patterns and Eating Habits 285 Relationships and Stress 319
Physical Activity and Exercise 288 Social Stressors 319
Thoughts and Emotions 288 Other Stressors 319
Coping Strategies 289
MANAGING STRESS 320
APPROACHES TO OVERCOMING A WEIGHT
Exercise 320
PROBLEM 290
Nutrition 320
Doing It Yourself 290
Social Support 321
Diet Books 292
Communication 322
Dietary Supplements and Diet Aids 292
Conflict Resolution 322
Weight-Loss Programs 293
Striving for Spiritual Wellness 325
Prescription Drugs for Obesity 295
Confiding in Yourself through Writing 325
Surgery 295
Time Management 325
Psychological Help 296
Cognitive Techniques 326
BODY IMAGE 296 Relaxation and Body Awareness Techniques 327
Severe Body Image Problems 296 Other Stress-Management Techniques 328
Acceptance and Change 296 Counterproductive Strategies for Coping
EATING DISORDERS 297 with Stress 329
Anorexia Nervosa 298
GETTING HELP 329
Bulimia Nervosa 298
Peer Counseling and Support Groups 329
Binge-Eating Disorder 298
Professional Help 329
Other Specified Feeding or Eating
Is It Stress or Something More Serious? 330
Disorders (OSFED) 299
Treating Eating Disorders 299 SLEEP 331
Tips for Today and the Future 299 How Sleep Works: The Physiology of Sleep 331
Summary 300 Natural Sleep Drives 331
For Further Exploration 300 Adequate Sleep and Your Health 332
Common Questions Answered 301 Sleep Disorders 332
Selected Bibliography 301 Improving Sleep 334
Tips for Today and the Future 335
LAB 9.1 Calculating Daily Energy Needs 303
Common Questions Answered 336
LAB 9.2 Identifying Weight-Loss Goals 305 Summary 336
LAB 9.3 Checking for Body Image Problems and Eating For Further Exploration 336
Disorders 307 Selected Bibliography 337

 C O N T E N T S     vii
LAB 10.1 Identifying Your Stress Level and Key The Role of DNA 373
Stressors 339 Race/Ethnicity and Poverty 374
LAB 10.2 Stress-Management Techniques 341 Carcinogens in the Environment 375
LAB 10.3 Evaluating and Improving Sleep 343 COMMON CANCERS 376
Lung Cancer 376
Colon and Rectal Cancer 376
11 Breast Cancer 377
Prostate Cancer 379
CARDIOVASCULAR HEALTH AND Cancers of the Female Reproductive Tract 379
DIABETES 347 Skin Cancer 380
MAJOR FORMS OF CARDIOVASCULAR DISEASE 348 Head and Neck Cancers 380
Atherosclerosis 348 Testicular Cancer 382
Heart Disease and Heart Attacks 348 Other Cancers 382
Stroke 350
DETECTING AND TREATING CANCER 383
Congestive Heart Failure 352
Detecting Cancer 383
RISK FACTORS FOR CARDIOVASCULAR DISEASE 352 Stages of Cancer 383
Major Risk Factors That Can Be Changed 352 Treating Cancer 383
Contributing Risk Factors That Can Be Changed 356 Tips for Today and the Future 386
Major Risk Factors That Can’t Be Changed 357 Common Questions Answered 387
Possible Risk Factors Currently Being Studied 357 Summary 387
PROTECTING YOURSELF AGAINST For Further Exploration 387
CARDIOVASCULAR DISEASE 359 Selected Bibliography 388
Eat a Heart-Healthy Diet 359 LAB 12.1 Cancer Prevention 389
Exercise Regularly 360
Avoid Tobacco 360
Know and Manage Your Blood Pressure 360 13
Know and Manage Your Cholesterol Levels 360
Develop Ways to Handle Stress and Anger 360 SUBSTANCE USE AND MISUSE 391

DIABETES 360 ADDICTIVE BEHAVIOR 392

Types of Diabetes 360 How Does an Addiction Develop? 392
Warning Signs and Testing 362 What Is Substance Misuse and Addiction? 393
Treatment 363 Examples of Addictive Behaviors 394
Prevention 363 PSYCHOACTIVE DRUGS 395
Tips for Today and the Future 363 Who Uses Drugs? 395
Summary 363 Opioids and Drug Overdose Deaths 395
Common Questions Answered 364 Other Current Illicit Drugs of Concern 397
For Further Exploration 364 Treatment for Substance Use Disorder and Addiction 398
Selected Bibliography 365 Preventing Substance Use Disorder 398
LAB 11.1 Cardiovascular Health 367 The Role of Drugs in Your Life 398

ALCOHOL 399
Chemistry and Metabolism 399
12 Immediate Effects of Alcohol 399
Alcohol Use Disorder: From Mild to Severe 401
CANCER 369 Effects of Alcohol Use Disorder 402
WHAT IS CANCER? 370 Drinking and Driving 403
Tumors 370 Binge Drinking 403
Metastasis 370 Drinking and Responsibility 403
Dietary Factors 371 TOBACCO 404
THE CAUSES OF CANCER 371 Nicotine Addiction 404
Tobacco Use 371 Health Hazards of Cigarette Smoking 405
Obesity and Inactivity 372 Risks Associated with Other Forms of Tobacco Use 406

viii    C O N T E N T S
Environmental Tobacco Smoke 408 AIR QUALITY AND POLLUTION 442
Smoking and Pregnancy 408 Air Quality and Smog 442
Giving Up Tobacco 409 The Greenhouse Effect and Global Warming 443
Action Against Tobacco 409 Thinning of the Ozone Layer 445
Common Questions Answered 411 Energy Use and Air Pollution 445
Tips for Today and the Future 411 Indoor Air Pollution 447
Summary 411 Preventing Air Pollution 447
For Further Exploration 412 WATER QUALITY AND POLLUTION 448
Selected Bibliography 412 Water Contamination and Treatment 448
LAB 13.1 Is Alcohol a Problem in Your Life? 415 Water Shortages 449
LAB 13.2 For Smokers Only: Why Do You Smoke? 417 Sewage 449
Protecting the Water Supply 449

SOLID WASTE POLLUTION 450

14 Solid Waste 450
Reducing Solid Waste 451
SEXUALLY TRANSMITTED INFECTIONS 419
CHEMICAL POLLUTION AND HAZARDOUS WASTE 451
THE MAJOR STI s 420
Asbestos 452
STIs and Sexual Anatomy 420
Lead 452
HIV Infection and AIDS 420
Pesticides 453
Chlamydia 428
Mercury 454
Gonorrhea 428
Other Chemical Pollutants 454
Pelvic Inflammatory Disease 429
Preventing Chemical Pollution 455
Human Papillomavirus (HPV) 430
Genital Herpes 431 RADIATION POLLUTION 455

Hepatitis B 431 Nuclear Weapons and Nuclear Energy 456

Syphilis 432 Medical Uses of Radiation 456

Other STIs 432 Radiation in the Home and Workplace 456

Avoiding Radiation 456
WHAT YOU CAN DO ABOUT STI s 433
Education 433 NOISE POLLUTION 457

Diagnosis and Treatment 433 Common Questions Answered 458

Prevention 433 Tips for Today and the Future 459

Tips for Today and the Future 434 Summary 459

Summary 434 For Further Exploration 459

Common Questions Answered 435 Selected Bibliography 460

For Further Exploration 436 LAB 15.1 Environmental Health Checklist 461
Selected Bibliography 436
LAB 14.1 Behaviors and Attitudes Related to STIs 437 APPENDIX A

INJURY PREVENTION AND PERSONAL

SAFETY A-1
15
APPENDIX B
ENVIRONMENTAL HEALTH 439

ENVIRONMENTAL HEALTH DEFINED 440 MONITORING YOUR PROGRESS B-1

POPULATION GROWTH AND CONTROL 440

BEHAVIOR CHANGE WORKBOOK W-1
Factors That Contribute to Population Growth 441
How Many People Can the World Hold? 441 INDEX I-1

 C O N T E N T S     ix
 Sunscreens and Sun-Protective Clothing 381
Smoking Cessation Products 409
BOXES
Getting an HIV Test 426
How to Be a Green Consumer 452
TAKE CHARGE
Financial Wellness 5
DIVERSITY MATTERS
Wellness Issues for Diverse Populations 9
Tips for Moving Forward in the Cycle of Behavior Change 18
Fitness and Disability 38
Move More, Sit Less 31
Benefits of Exercise for Older Adults 70
Vary Your Activities 46
Gender Differences in Muscular Strength 103
High-Intensity Conditioning Programs 81
The Female Athlete Triad 186
Rehabilitation Following a Minor Athletic Injury 85
Ethnic Foods 264
Safe Weight Training 112
Gender, Ethnicity, and Body Image 297
Good Posture and Low-Back Health 161
Diverse Populations, Discrimination, and Stress 320
Yoga for Relaxation and Pain Relief 163
Gender, Race/Ethnicity, and CVD 358
Getting Your Fitness Program Back on Track 213
Gender and Tobacco Use 407
Choosing More Whole-Grain Foods 238
HIV/AIDS Around the World 424
Eating for Healthy Bones 243
Poverty and Environmental Health 454
Positive Changes to Meet the Dietary Guidelines 249
Judging Portion Sizes 252
THE EVIDENCE FOR EXERCISE
Eating Strategies for College Students 255
Does Being Physically Active Make a Difference in How Long You Live? 12
Safe Food Handling 262
Exercise Is Good for Your Brain 34
Be More Active During Screen Time 289
Combine Aerobic Exercise with Strength Training 71
Lifestyle Strategies for Successful Weight Management 291
Benefits of Muscular Strength and Endurance 104
If Someone You Know Has an Eating Disorder. . . 300
Does Physical Activity Increase or Decrease the Risk of Bone and Joint
Guidelines for Effective Communication 323
Disease? 150
Dealing with Anger 324
Why Is Physical Activity Important Even If Body Composition Doesn’t
Mindfulness Meditation 328 Change? 192
Overcoming Insomnia 334 The Importance of Reducing Sedentary Time 210
Warning Signs of Heart Attack, Stroke, and Cardiac Arrest 351 Do Athletes Need a Different Diet? 257
Testicle Self-Examination 383 What Is the Best Way to Exercise for Weight Loss? 290
Dealing with an Alcohol Emergency 401 Does Exercise Improve Mental Health? 321
Drinking Behavior and Responsibility 404 How Does Exercise Affect CVD Risk? 361
Using Male Condoms 429 How Does Exercise Affect Cancer Risk? 375
Protecting Yourself from STIs 434 How Does Exercise Help a Smoker Quit? 410
Checking Your Environmental “Footprint” 442 Does Exercise Help or Harm the Immune System? 422
Energy-Efficient Lighting 448
Endocrine Disruption: A “New” Toxic Threat 453 WELLNESS IN THE DIGITAL AGE
Quantify Yourself 14
CRITICAL CONSUMER Digital Workout Aids 47
Evaluating Sources of Health Information 15 Fitness Trackers, Heart Rate Monitors, and GPS Devices 73
Choosing a Fitness Center 48 Improving Your Technique with Video 109
Choosing Exercise Footwear 86 Using BIA at Home 190
Choosing Healthy Beverages 214 Digital Motivation 212
Using Food Labels 258 Apps and Wearables for Weight Management 293
Using Dietary Supplement Labels 260 Digital Devices: Help or Harm for a Good Night’s Sleep? 333
Are All Calories and Dietary Patterns Equal for Weight Loss? 287 Cancer Screening Reminders 385
Choosing and Evaluating Mental Health Professionals 330

x    C O N T E N T S
 LAB 3.1 Assessing Your Current Level of Cardiorespiratory
Behavior change Endurance 89
workbook activities LAB 3.2 Developing an Exercise Program for Cardiorespiratory
Endurance 97
LAB 4.1 Assessing Your Current Level of Muscular Strength 135
PART 1
LAB 4.2 Assessing Your Current Level of Muscular Endurance 141
DEVELOPING A PLAN FOR BEHAVIOR CHANGE
LAB 4.3 Designing and Monitoring a Strength Training Program 145
AND COMPLETING A CONTRACT
LAB 5.1 Assessing Your Current Level of Flexibility 169
1. Choosing a Target Behavior W-1
LAB 5.2 Creating a Personalized Program for Developing
2. Gathering Information About Your Target Behavior W-1
Flexibility 175
3. Monitoring Your Current Patterns of Behavior W-2
LAB 5.3 Assessing Muscular Endurance for Low-Back Health 177
4. Setting Goals W-3
LAB 6.1 Assessing Body Mass Index and Body Composition 195
5. Examining Your Attitudes About Your Target Behavior W-3
LAB 6.2 Setting Goals for Target Body Weight 203
6. Choosing Rewards W-4
LAB 7.1 A Personal Fitness Program Plan and Agreement 227
7. Breaking Behavior Chains W-4
LAB 7.2 Getting to Know Your Fitness Facility 229
8. Completing a Contract for Behavior Change W-7
LAB 8.1 Your Daily Diet versus MyPlate 273
LAB 8.2 Dietary Analysis 275
PART 2
OVERCOMING OBSTACLES TO BEHAVIOR LAB 8.3 Informed Food Choices 277

CHANGE LAB 9.1 Calculating Daily Energy Needs 303

9. Building Motivation and Commitment W-8 LAB 9.2 Identifying Weight-Loss Goals 305

10. Managing Your Time Successfully W-9 LAB 9.3 Checking for Body Image Problems and Eating
Disorders 307
11. Developing Realistic Self-Talk W-10
LAB 10.1 Identifying Your Stress Level and Key Stressors 339
12. Involving the People Around You W-11
LAB 10.2 Stress-Management Techniques 341
13. Dealing with Feelings W-12
LAB 10.3 Evaluating and Improving Sleep 343
14. Overcoming Peer Pressure: Communicating Assertively W-13
LAB 11.1 Cardiovascular Health 367
15. Maintaining Your Program over Time W-13
LAB 12.1 Cancer Prevention 389
LAB 13.1 Is Alcohol a Problem in Your Life? 415
LAB 13.2 For Smokers Only: Why Do You Smoke? 417
laboratory
LAB 14.1 Behaviors and Attitudes Related to STIs 437
activities
LAB 15.1 Environmental Health Checklist 461

LAB 1.1 Your Wellness Profile 25

The Behavior Change Workbook
LAB 1.2 Lifestyle Evaluation 27 and the laboratory activities are
LAB 2.1 Safety of Exercise Participation: PAR-Q+ 51 also found in an interactive format in Connect (connect.mheducation.com).
LAB 2.2 Overcoming Barriers to Being Active 55
LAB 2.3 Using a Fitness Tracker or Smartphone Exercise App to
Measure Physical Activity 59

 C O N T E N T S     xi
LEARN WITHOUT LIMITS
McGraw-Hill Connect® is a reliable, easy-to-use homework
and learning management solution that uses learning science
and award-winning adaptive tools to improve student results.
Connect’s assignments help students contextualize what
they’ve learned through application, so they can better under-
stand the material and think critically. Connect content is avail-
able through a simple and intuitive interface. Connect for Fit &
Well offers a wealth of interactive online content, including fit-
ness labs and self-assessments, video activities on timely health
topics and exercise techniques, a behavior change workbook,
and practice quizzes with immediate feedback.
New to this edition are assignable and assessable Concept
Clips, which help students master key fitness and wellness
concepts. Using colorful animation and easy-to-understand
audio narration, Concept Clips provide step-by-step presenta-
tions to promote student comprehension; topics covered include
the stages of change model, types of diabetes, and the stress
response. Also new are NewsFlash activities, which tie current
news stories to key fitness and wellness concepts. After inter-
acting with a contemporary news story, students are assessed on
their understanding and their ability to make the connections
xii    P R E F A C E
between real-life events and course content. Examples of
NewsFlash topics include food fads, stress and obesity, and fac-
tors affecting life expectancy.
Connect Insight® is a visual analytics dashboard—now
available for both instructors and students—that provides
­
immediately actionable, at-a-glance information to empower
learners and help improve student performance. Connect
Insight presents assignment, assessment, and topical perfor-
mance results along with a time metric that is easily visible
for aggregate or individual results. Using robust visual data
displays that are each framed by an intuitive question, Connect
Insight gives both instructors and students the ability to take a
just-in-time approach to teaching and learning. By providing
actionable recommendations, Connect Insight guides students
toward behaviors that could increase performance and enables
instructors to give targeted tuition precisely when and where it
is needed.
Available within Connect, SmartBook® makes study time as
productive and efficient as possible by identifying and clos-
ing knowledge gaps. SmartBook is powered by the proven
LearnSmart® engine, which identifies what an individual stu-
dent knows and doesn’t know based on the student’s confidence
level, responses to questions, and other factors. LearnSmart
builds an optimal, personalized learning path for each student,
so students spend less time on concepts they already under-
stand and more time on those they don’t. As a student engages
with SmartBook, the reading experience continuously adapts
by highlighting the most impactful content a student needs to
learn at that moment in time. Students can enjoy convenient,
anywhere, anytime access to SmartBook via iOS and Android
tablet and smartphone apps.
PROVEN, SCIENCE-BASED CONTENT

The digital teaching and learning tools within Connect are built on the solid foundation of Fit &
Well’s authoritative, science-based content. Fit & Well is written by experts who work and teach
in the fields of exercise science, physical education, and health education. Fit & Well provides
accurate, reliable current information on key health and fitness topics while also addressing
issues related to mind-body health, diversity, research, and consumer health.

Wellness in the Digital Age sections Diversity Matters features address

focus on the many fitness- and wellness- the ways that our biological and
related devices and applications that are cultural differences influence our health
appearing every day. strengths, risks, and behaviors.

Evidence for Exercise sections Fitness Tips and Wellness Tips catch
demonstrate that physical activity and students’ attention and get them thinking
exercise recommendations are based on about—and acting to improve—their
solid scientific evidence. fitness and wellness.

Critical Consumer boxes help students Hands-on lab activities give students
navigate the numerous and diverse set of the opportunity to assess their current
health-related products currently available. level of fitness and wellness and to create
their own individualized programs for
improvement.

Take Charge features provide a wealth Exercise photos and online videos
of practical advice for students on how to demonstrate exactly how to correctly
apply concepts from the text to their own perform exercises described in the text.
lives.

Wellness in Digital Age (smartwatch): ©Hong Li / Getty Images RF; Evidence for Exercise (sneakers & stethoscope):
©Vstock LLC / Getty Images RF; Critical Consumer (businessman): ©sam74100/Getty Images; Take Charge (woman
in red shirt): ©VisualsCommunications/Getty RF; Diversity Matters(large group): ©Rawpixel Ltd/Getty Images; Fitness
Tips (dumbbells): ©Fuse/GettyImages; Hands-on lab activities (smartphone): ©McGraw-Hill Education. Mark Dierker,
photographer; Exercise photos and online videos (squat): ©Taylor Robertson Photography

 P R E F A C E     xiii
WHAT’S NEW IN FIT & WELL,
13TH EDITION

UPDATES INFORMED BY STUDENT DATA

Changes to the 13th edition reflect new research findings, updated statistics, and current hot topics that impact students’ fitness and
wellness behaviors. Revisions were also guided by student performance data collected anonymously from the tens of thousands of
students who have used LearnSmart with Fit & Well. Because virtually every text paragraph is tied to several questions that students
answer while using LearnSmart, the specific concepts that students are having the most difficulty with can be pinpointed through
empirical data.

CHAPTER-BY-CHAPTER CHANGES • New Physical Activity Readiness Questionnaire for

Chapter 1: Introduction to Wellness, Fitness, and Lifestyle
Management
• New Wellness in the Digital Age feature about health
behavior tracking apps
• New information on the obesity epidemic and life
­expectancy, on the costs of cardiovascular disease
(CVD), and on the importance of exercise in reducing
CVD risk
• Updated statistics on leading causes of death, key
­contributors to death among Americans, changes in life
expectancy, progress toward Healthy People 2020 targets,
and health problems among college students
Chapter 2: Principles of Physical Fitness
• Updated American College of Sports Medicine (ACSM)
recommendations for frequency, intensity, time, type,
­volume, and progression (FITT-VP) for fitness programs
• New and updated information on benefits of fitness, on
exercise as a means for reducing anxiety, and on good
nutritional choices to support an exercise program
• New information on digital workout aids in the Wellness in
the Digital Age feature and on fitness trackers in Lab 2.3
Everyone (PAR-Q+) in Lab 2.1
Chapter 3: Cardiorespiratory Endurance
• New and expanded information on the cardiorespiratory
system, on the benefits of endurance exercise, and on
applying the FITT-VP principle
• Updated discussion and illustration of ratings of perceived
exertion (RPE), including the 0–10 scale
• Updated Wellness in the Digital Age feature about fitness
trackers, heart rate monitors, and GPS devices
Chapter 4: Muscular Strength and Endurance
• New section on supplements and drugs, including
­cautions related to anabolic steroids
• New program planning table that includes major muscles,
their functions, and related strength training exercises
• Updated coverage of the FITT-VP principle, weight train-
ing safety, strength ­training apps, and the McGill curl-up
technique
Chapter 5: Flexibility and Low-Back Health
• Updated information on joint health and on exercises for
low-back health

xiv    P R E F A C E
 • Updated information on applying the FITT-VP principle
to stretching programs
Chapter 6: Body Composition
• Updated statistics on obesity rates and trends in the
United States; updated information on the complex
­relationship between energy intake and body weight
• Expanded discussion of factors that limit the accuracy of
body mass index (BMI) as a tool for classifying health risks
Chapter 7: Putting Together a Complete Fitness Program
• New section on exercise guidelines for people with spe-
cial health concerns (formerly in an appendix)
• Updated information on smartphone apps that support an
exercise program
Chapter 8: Nutrition
• New information on the 2015–2020 Dietary Guidelines
for Americans; the FDA’s nutrition facts and food package
nutrient claims; and the USDA’s MyPlate and recom-
mended food patterns
• New Take Charge feature with specific recommendations
for how to meet the Dietary Guidelines
• New tables focused on dietary fiber and major dietary
guidelines; new figure comparing the current U.S. diet
versus recommendations
• New and updated information on added sugars, benefits
of dietary fiber, nutrient density, the relationship between
fats and health, and vegetarian diets
Chapter 9: Weight Management
• Updated discussion on the health effects of overweight/
obesity; includes a new figure on the relationship between
BMI and mortality
• New material on environmental and physiological factors
that affect body composition, as well as how changes in
metabolic rate affect weight loss and maintenance
• New information on energy balance and updated discussion
of lifestyle factors that affect body fat and body weight
• New Critical Consumer feature on research into dietary
patterns that promote weight loss; new Take Charge
­feature on techniques for being active during screen time
Chapter 10: Stress Management and Sleep
• New major section on sleep and its role in stress,
­including the biology of sleep, a new figure on the stages
of sleep, sleep drivers, and features on ­overcoming insom-
nia and how digital devices affect sleep
• New Lab 10.3: Evaluating and Improving Sleep
 P R E F A C E     xv
• New Diversity Matters feature on diverse populations,
­discrimination, and stress; new Take Charge feature on
mindfulness meditation
Chapter 11: Cardiovascular Health and Diabetes
• Expanded coverage of diabetes, including a new
­illustration of the underlying processes of normal and
­disrupted metabolism
• Updated statistics and information on cardiovascular
­disease (CVD) types, heart-healthy diet recommenda-
tions, and tobacco use and CVD, including e-cigarettes
Chapter 12: Cancer
• New illustration of the stages in the development and
spread of cancer; new material on genetic changes that
contribute to cancer risk and on treatment innovations
• Updated statistics on cancer cases and deaths, and updated
recommendations on mammography and breast awareness
and on HPV vaccination
• New Common Questions Answered section on the types
of cancers most common in young adults
Chapter 13: Substance Use and Misuse
• New sections on how the American Psychiatric
Association defines and identifies substance misuse and
addiction; on opioids and drug overdose deaths; and on
evaluating the severity of alcohol use disorder
• Expanded discussion of addictive behaviors, including
Internet gaming disorder, and compulsive exercising
• Updated statistics and information on nonmedical drug
use among Americans, medical marijuana, rates of binge
drinking, and rates of tobacco use
Chapter 14: Sexually Transmitted Infections
• Updated statistics on major STIs, HIV/AIDS, HIV
­transmission, and use of condoms by college students
• Updated Diversity Matters feature on the global HIV/
AIDS epidemic; updated Critical Consumer feature on
HIV testing
Chapter 15: Environmental Health
• Updated statistics on world population growth,
­components of solid waste, and the hole in the ozone
layer
• Updated information about the greenhouse effect and
global warming, including the primary economic sectors
responsible for emission of greenhouse gases
• New information on lead poisoning and the drinking
water crisis in Flint, Michigan
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ACKNOWLEDGMENTS
Fit & Well has benefited from the thoughtful commentary, expert
knowledge, and helpful suggestions of many people. We are
deeply grateful for their participation in the project.
Academic Advisors and Reviewers
Ari B. Fisher, Louisiana State University
Brandy Schneider, Truman State University
Ellen Garrison, University of North Carolina Asheville
Greg Bullock, William Carey University
xvi    P R E F A C E
McGraw-Hill Campus® is a groundbreaking service that puts
world-class digital learning resources just a click away for all
faculty and students. All faculty—whether or not they use a
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have single sign-on access to McGraw-Hill digital platforms,
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INSTRUCTOR RESOURCES
Instructor resources available through Connect for Fit & Well
include a course integrator guide, test bank, image bank, and
PowerPoint presentations for each chapter.
Jamie L. Famiglietti, Indiana University Bloomington
Karen K. Dennis, Illinois State University
Phyllis Eckler, Los Angeles City College
Rick Canter, Longwood University
Ronnie Nespeca, Lone Star College
Shinya Takahashi, University of Nebraska
Shrehan Lynch, University of Alabama
Teresa Moore, University of South Carolina
Virginia Trummer, University of Texas San Antonio
 Introduction to Wellness,
1 Fitness, and Lifestyle
Management
L O O KI N G AH E AD... TE ST YOU R K NOWLE DGE
After reading this chapter, you should be able to 1. Which of the following lifestyle factors is the leading preventable
cause of death for Americans?
■ Describe the dimensions of wellness. a. excess alcohol consumption
■ Identify the major health and lifestyle problems in the United b. cigarette smoking
States today. c. obesity
■ Describe the behaviors that are part of a wellness lifestyle. 2. The terms health and wellness mean the same thing. True
or false?
■ Explain the steps in creating a behavior management plan.
3. A person’s genetic makeup determines whether he or she will
■ Evaluate some of the available sources of wellness information.
develop certain diseases (such as breast cancer), regardless of
that person’s health habits. True or false?
See answers on the next page.

© Hero Images/Getty Images RF

A
college sophomore sets the following goals for
herself:
• Join new social circles and make new friends
whenever possible.
• Exercise every day.
• Clean up trash and plant trees in blighted neighborhoods
in her community.
These goals may seem unrelated, but they have one thing
in common. Each contributes, in its own way, to this student’s
health and well-being. Not satisfied merely to be free of illness,
she wants more. She has decided to live actively and fully—not
just to be healthy, but to pursue a state of overall wellness.
WELLNESS: NEW HEALTH GOALS
Generations of people have viewed health simply as the absence
of disease, and that view largely prevails today. The word
health typically refers to the overall condition of a person’s
body or mind and to the presence or absence of illness or injury.
­Wellness expands this idea of health to include our ability to
achieve optimal health. Beyond the simple presence or absence
of disease, wellness refers to optimal health and vitality—to
living life to its fullest. Although we use the terms health and
wellness interchangeably, they differ in two important ways:
Answers (Test Your Knowledge)
1. b. Smoking causes about 480,000 deaths per year. Obesity is responsible
for as many as 400,000 premature deaths, and alcohol is a factor in
90,000 deaths per year.
2. False. Although the words are used interchangeably, they have different
meanings. The term health refers to the overall condition of the body or
mind and to the presence or absence of illness or injury. The term wellness
refers to optimal health and vitality, encompassing all the dimensions of
well-being.
3. False. In many cases, behavior can tip the balance toward good health
even when heredity or environment is a negative factor.
• Health—or some aspects of it—can be determined or
influenced by factors beyond your control, such as your
genes, age, and family history. For example, a man with a
family history of prostate cancer will have a higher-than-
average risk for developing prostate cancer.
• Wellness is largely determined by the decisions you make
about how you live. That same man can reduce his risk of
cancer by eating sensibly, exercising, and having regular
screening tests. Even if he develops the disease, he may
still reduce its effects and live a rich, meaningful life. This
means not only caring for himself physically, but also
maintaining a positive outlook, keeping up his relation-
ships with others, challenging himself intellectually, and
nurturing other aspects of his life.
Wellness, therefore, involves making conscious decisions to
control risk factors that contribute to disease or injury. Age and
family history are risk factors you cannot control. Behaviors
such as exercising, eating a healthy diet, and choosing not to
smoke are well within your control.
The Dimensions of Wellness
Here are nine dimensions of wellness:
• Physical
• Emotional
• Intellectual
• Interpersonal
• Cultural
• Spiritual
• Environmental
• Financial
• Occupational
Each dimension affects the others. Furthermore, the p­ rocess
of achieving wellness is constant and dynamic (Figure 1.1),
involving change and growth. Ignoring any dimension of
wellness can have harmful effects on your life. The following

F IGURE 1.1 The wellness continuum.

The concept of wellness includes vitality in Low level Physical, mental, Change High level
nine interrelated dimensions, all of which of wellness emotional symptoms and growth of wellness
contribute to overall wellness.
INTELLE SS
CTU AL LNE
AL SON EL WE
EMOTIO P ER PH W LL
NA R YS WELLNE
L TE IC SS NE
IN WE A SS
CU LL N L
LTU E SS
EN RA
L WELLNESS
VIR A L
O N M E N TA L I T U W E LL N E S S W S
ELL N E WS
S PIR ELL
O C C UPATI O N AL W E L L NESS NES
S
FIN A
N C IAL

Malaise Vital, meaningful life

2    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t

 PHYSICAL WELLNESS EMOTIONAL WELLNESS INTELLECTUAL WELLNESS
• Eating well • Optimism • Openness to new ideas
• Exercising • Trust • Capacity to question
• Avoiding harmful habits • Self-esteem • Ability to think critically
• Practicing safer sex • Self-acceptance • Motivation to master new skills
• Recognizing symptoms of disease • Self-confidence • Sense of humor
• Getting regular checkups • Ability to understand and accept • Creativity
• Avoiding injuries one’s feelings • Curiosity
• Ability to share feelings with others • Lifelong learning

INTERPERSONAL WELLNESS CULTURAL WELLNESS SPIRITUAL WELLNESS

• Communication skills
• Capacity for intimacy
• Ability to establish and maintain
satisfying relationships
• Ability to cultivate a support system
of friends and family
• Creating relationships with those • Capacity for love
who are different from you • Compassion
• Maintaining and valuing your own • Forgiveness
cultural identity • Altruism
• Avoiding stereotyping based on • Joy and fulfillment
ethnicity, gender, religion, or sexual • Caring for others
orientation • Sense of meaning and purpose
• Sense of belonging to something
greater than oneself

ENVIRONMENTAL WELLNESS FINANCIAL WELLNESS OCCUPATIONAL WELLNESS

• Having abundant, clean natural
resources
• Maintaining sustainable development
• Recycling whenever possible
• Reducing pollution and waste
• Having a basic understanding of
how money works
• Living within one’s means
• Avoiding debt, especially for
unnecessary items
• Saving for the future and for
emergencies
• Enjoying what you do
• Feeling valued by your manager
• Building satisfying relationships
with coworkers
• Taking advantage of opportunities
to learn and be challenged

F I G URE 1 .2 Qualities and behaviors associated with the dimensions of wellness.

sections briefly introduce the dimensions of wellness. Figure 1.2
lists specific qualities and behaviors associated with each
dimension. Lab 1.1 will help you learn what wellness means to
you and where you fall on the wellness continuum.
Physical Wellness Your physical wellness includes not
just your body’s overall condition and the absence of disease
but also your fitness level and your ability to care for yourself.
The higher your fitness level, the higher your level of physi-
cal wellness will be. Similarly, as you take better care of your
own physical needs, you ensure greater physical wellness. To
achieve optimum physical wellness, you need to make choices
that help you avoid illnesses and injuries. The decisions you
make now—and the habits you develop over your lifetime—
will largely determine the length and quality of your life.
Emotional Wellness Your emotional wellness reflects
your ability to understand and deal with your feelings. Emo-
tional wellness involves attending to your own thoughts and
feelings, monitoring your reactions, and identifying obstacles
to emotional stability. Self-acceptance is your personal satis-
faction with yourself, which might exclude society’s expecta-
tions, whereas self-esteem relates to the way you think others
perceive you. Self-confidence can be a part of both accep-
tance and esteem. Achieving this type of wellness means
finding solutions to emotional problems, with professional
help if necessary.
Intellectual Wellness Those who enjoy intellectual well-
ness continually challenge their minds. An active mind is essen-
tial to wellness because it detects problems and finds solutions.
People who enjoy intellectual wellness never stop learning.
They seek out and relish new experiences and challenges.
Interpersonal Wellness Satisfying and supportive rela-
tionships are important to physical and emotional wellness.
Learning good communication skills, developing the capac-
ity for intimacy, and cultivating a supportive network are all
important to interpersonal (or social) wellness. Social wellness
requires participating in and contributing to your community
and to society.
health The overall condition of body or mind and T E RMS
the presence or absence of illness or injury.
wellness Optimal health and vitality, encompassing all
dimensions of well-being.
risk factor A condition that increases one’s chances of
disease or injury.

 W E LLN E SS : N E W H E A L T H GO A LS    3

Wellness Tip Enhancing one dimension of wellness can
have positive effects on others. For example, joining a meditation
group can help you enhance your spiritual well-being, but it can also
affect the emotional and interpersonal dimensions of wellness by
enabling you to meet new people and develop new friendships.
© Jonathan Goldberg/Alamy Stock Photo
Cultural Wellness Cultural wellness refers to the way you
interact with others who are different from you in terms of eth-
nicity, religion, gender, sexual orientation, age, and customs
(practices). It involves creating relationships with others and
suspending judgment on others’ behavior until you have lived
with them or “walked in their shoes.” It also includes accept-
ing, valuing, and even celebrating the different cultural ways
people interact in the world. The extent to which you main-
tain and value cultural identities is one measure of cultural
wellness.
TE R MS
infectious disease A disease that can spread
from person to person; caused by microorganisms
such as bacteria and viruses.
4    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t
Spiritual Wellness To enjoy spiritual wellness is to pos-
sess a set of guiding beliefs, principles, or values that give
meaning and purpose to your life, especially in difficult
times. The well person uses spirituality to focus on posi-
tive aspects of life and to fend off negative feelings such as
­cynicism, anger, and pessimism. Organized religions help
many people develop spiritual health. Religion, however, is
not the only source or form of spiritual wellness. Many peo-
ple find meaning and purpose in their lives on their own—
through nature, art, meditation, or good works—or with their
loved ones.
Environmental Wellness Your environmental wellness is
defined by the livability of your surroundings. Personal health
depends on the health of the planet—from the safety of the food
supply to the degree of violence in society. To improve your
environmental wellness, you can learn about and protect your-
self against hazards in your surroundings and work to make
your world a cleaner and safer place.
Financial Wellness Financial wellness refers to your abil-
ity to live within your means and manage your money in a way
that gives you peace of mind. It includes balancing your income
and expenses, staying out of debt, saving for the future, and
understanding your emotions related to money. For more on
this topic, see the box “Financial Wellness”.
Occupational Wellness Occupational wellness refers to
the level of happiness and fulfillment you gain through your
work. Although high salaries and prestigious titles are gratify-
ing, they alone do not bring about occupational wellness. An
occupationally well person likes his or her work, feels a con-
nection with others in the workplace, and takes advantage of
opportunities to learn and be challenged. Another important
aspect of occupational wellness is recognition from managers
and colleagues. An ideal job draws on your interests and pas-
sions, as well as your vocational skills, and allows you to feel
that you are making a contribution.
New Opportunities
for Taking Charge
One hundred and sixty-five years ago, Americans considered
themselves lucky just to survive to adulthood. A boy born in
1850, for example, could expect to live only about 38 years,
and a girl, 40 years. Many people died from common i­ nfectious
diseases (such as pneumonia, tuberculosis, or diarrhea) and
poor environmental conditions (such as water pollution and
poor sanitation).
By 2015, however, life expectancy nearly doubled, to
78.8 years (Figure 1.3). This increase in life span is due
largely to the development of vaccines and antibiotics to fight
infections, and to public health measures to improve living
conditions. But even though life expectancy has increased,
poor health limits most Americans’ activities during the last

Researchers surveyed nearly 90,000 college students about
their financial behaviors and attitudes. According to results
released in 2016, a large percentage of students feel less
prepared to manage their money than to handle almost any
other aspect of college life. They also express distress over
their current and future financial decisions. Front and center in
their minds is how to manage student loan debt. Financial well-
ness means having a healthy relationship with money. Here
are strategies for establishing that relationship:
Follow a Budget
A budget is a way of tracking where your money goes and
making sure you’re spending it on the things that are most
important to you. To start one, list your monthly income and
your expenditures. If you aren’t sure where you spend your
money, track your expenses for a few weeks or a month.
Then organize them into categories, such as housing, food,
transportation, entertainment, services, personal care, clothes,
books and school supplies, health care, credit card and loan
payments, and miscellaneous. Knowing where your money
goes is the first step in gaining control of it.
Be Wary of Credit Cards
Students have easy access to credit but little training in finances.
The percentage of students who have access to credit cards
has increased from 28% in 2012 to 41% in 2015. This increase
in credit card use has also correlated with an increase in pay-
ing credit card bills late, paying only the minimum amount, and
having larger total outstanding credit balances.
Shifting away from using credit cards and toward using
debit cards is a good strategy for staying out of debt. Familiarity
with financial terminology helps as well. Basic financial literacy
with using credit cards involves understanding terms like APR
(annual percentage rate—the interest you’re charged on your
balance), credit limit (the maximum amount you can borrow),
minimum monthly payment (the smallest payment your creditor
will accept each month), grace period (the number of days you
have to pay your bill before interest or penalties are charged),
and over-the-limit and late fees (the amounts you’ll be charged
if you go over your credit limit or your payment is late).
Manage Your Debt and Get
Politically Active
A 2016 study indicated that the average student loan debt was
$37,000—and this number is expected to rise. When it comes
to student loans, having a personal plan for repayment can
save time and money, reduce stress, and help you prepare for
the future. However, only about 10% of students surveyed feel
they have all the information needed to pay off their loans. Work
with your lender and make sure you know how to access your
balance, when to start repayment, how to make payments, what
your repayment plan options are, and what to do if you have
trouble making payments. Information on managing federal stu-
dent loans is available from (https://studentaid.ed.gov/sa/).
Your student debt may reflect circumstances beyond your
control. For example, financial aid programs may require
 W E LLN E SS : N E W H E A L T H GO A LS    5
TAKE CHARGE
Financial Wellness
students to hold down jobs while also maintain-
ing certain grade point averages. Consider con-
tacting policymakers and asking them to pass
measures to help students in need. One sug-
gestion is for the Free Application for Federal
Student Aid (FAFSA) to take into account how
much debt a family or student already has when determining
how much aid to grant.
Start Saving
If you start saving early, the same miracle of compound interest
that locks you into years of credit card debt can work to your ben-
efit (for an online compound interest calculator, visit http://www
.interestcalc.org). Experts recommend “paying yourself first” every
month—that is, putting some money into savings before you start
paying your bills, depending on what your budget allows. You
may want to save for a large purchase, or you may even be look-
ing ahead to retirement. If you work for a company with a 401(k)
retirement plan, contribute as much as you can every pay period.
Become Financially Literate
Most Americans have not received basic financial train-
ing. For this reason, the U.S. government has established
the Financial Literacy and Education Commission (MyMoney
.gov) to help Americans learn how to save, invest, and manage
money better. Developing lifelong financial skills should begin
in early adulthood, during the college years, if not ­earlier, as
money-management experience appears to have a more direct
effect on financial knowledge than does education. For example,
when tested on their basic financial literacy, students who had
checking accounts had higher scores than those who did not.
© Robin Lund/Alamy Stock photo RF
SOURCES: Smith, C., & G. A. Barboza. 2013. The role of trans-generational
financial knowledge and self-reported financial literacy on borrowing
practices and debt accumulation of college students. Social Science
Electronic Publishing, Inc. (http://ssrn.com/abstract=2342168); Plymouth
State University. 2013. Student Monetary Awareness and Responsibility
Today! Plymouth State University. (http://www.plymouth.edu/office/financial-
aid/smart/); U.S. Financial Literacy and Education Commission, MyMoney.
gov, 2013. (http://www.mymoney.gov); Mitchell, J., “Student Debt Is About
to Set Another Record, But the Picture Isn’t All Bad,” Wall Street Journal,
May 2, 2016. (https://blogs.wsj.com/economics/2016/05/02/student-
debt-is-about-to-set-another-record-but-the-picture-isnt-all-bad/); and
EverFi, Money Matters on Campus: Examining Financial Attitudes and
Behaviors of Two-Year and Four-Year College Students. www
.moneymattersoncampus.org.
Box icon: © VisualCommunications/Getty Images RF
 Control of Recognition of Affordable Care Act
infectious Safer tobacco use as a Implementation
Vaccinations diseases workplaces health hazard
for childhood 77.9 78.8
75.4 76.9
diseases
73.7
Fluoridation of 69.7 70.8
drinking water 68.2

62.9
59.7

54.1 Decline in deaths

50.0 from heart disease
47.3 and stroke
Motor Healthier
Safer and vehicle safety Family planning mothers
Life
healthier foods and babies
expectancy

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2015
Year

F IGURE 1.3 Public health and life expectancy of Americans from birth, 1900–2015. Public health achievements during the 20th
century are credited with adding more than 25 years to life expectancy for Americans, greatly improving quality of life, and dramatically reducing
deaths from infectious diseases. Public health improvements continue into the 21st century, including greater roadway safety, a steep decline in
childhood lead poisoning, and an expansion of health insurance coverage.
SOURCE S:Xu, J., et al. 2016. “Mortality in the United States, 2015,” NCHS Data Brief, No. 267; Centers for Disease Control and Prevention. “Ten great public health
achievements—United States, 2001–2010,” MMWR 60(19): 619–623; Centers for Disease Control and Prevention 1999. “Ten great public health achievements—United States,
1900–1999,” MMWR 48(50): 1141.

10–15% of their lives, resulting in some sort of impaired life
(Figure 1.4).
Today, a different set of diseases has emerged as our major
health threat: Heart disease, cancer, and chronic lower respi-
ratory diseases are now the three leading causes of death for
Americans (Table 1.1). While life expectancy has consistently
increased each decade in the United States since 1850, the rate
of improvement has slowed (and as of 2015 actually dropped
for the first time in decades). A recent increase in deaths from
heart disease, stroke, and diabetes may be linked to the obe-
sity epidemic that began in the late 1970s. Medical treatments
may be reaching their limits in treating heart disease and in
preventing other early deaths related to obesity. Moreover,
people are becoming obese at earlier ages, exposing them to
the adverse effects of excess body fat over a longer period of
time. Obesity and poor eating habits can lead to all the major
chronic diseases.
The good news is that people have some control over
whether they develop chronic diseases. Every day people
can make choices that increase or decrease their risks. These
­lifestyle choices include decisions regarding smoking, diet,
exercise, sleep, and alcohol use. Table 1.2 shows the esti-
mated number of annual deaths tied to selected underlying
causes. For example, the estimated 90,000 deaths due to alco-
hol include deaths due directly to alcohol poisoning as well
as alcohol-related deaths from liver cancer and accidents. As
Table 1.2 makes clear, lifestyle factors contribute to many
deaths in the United States, and people can influence their own
health risks. The need to make good choices is especially true
for teens and young adults. For Americans aged 15–24, for
example, the leading cause of death is unintentional injuries
(accidents), with the greatest number of deaths linked to car
crashes (Table 1.3).
Healthy life
70.4 years

chronic diseases A disease that develops and TE R MS Impaired life

continues over a long period of time, such as heart 8.4 years
disease or cancer. Life expectancy
78.8 years
lifestyle choice A conscious behavior that can
increase or decrease a person’s risk of disease or FIGU R E 1. 4 Quantity of life versus quality of life. Years of
injury; such behaviors include decisions regarding smoking, healthy life as a proportion of life expectancy in the U.S. population.
eating a healthy diet, exercising, and using alcohol. SOURCE: National Center for Health Statistics, 2016. “Healthy People 2020,”
Midcourse Review, Hyattsville, MD.

6    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t

 V I T A L S T AT I S T I C S

Table 1.1 Leading Causes of Death in the United States, 2015

NUMBER OF PERCENTAGE OF LIFESTYLE

RANK CAUSE OF DEATH DEATHS TOTAL DEATHS FACTORS
  1 Heart disease 633,842 23.4 D I S A O
  2 Cancer 595,930 22.0 D I S A O
  3 Chronic lower respiratory diseases 155,041 5.7 D I S O
  4 Unintentional injuries (accidents) 146,571 5.4 I S A
  5 Stroke 140,323 5.2 D I S A O
  6 Alzheimer’s disease 110,561 4.1 I S
  7 Diabetes mellitus 79,535 2.9 D I S A O
  8 Influenza and pneumonia 57,062 2.1 S A
  9 Kidney disease 49,959 1.8 D S A O
10 Intentional self-harm (suicide) 44,193 1.6 A
All causes 2,712,630 100.0

Key     D   Diet plays a part        S Smoking plays a part

       I    Inactive lifestyle plays a part   A Excessive alcohol use plays a part    O Obesity is a contributing factor
NOTE: Although not among the overall top 10 causes of death, HIV/AIDS (6,465 deaths in 2015) is a major killer. In 2015, HIV/AIDS was the 13th leading cause of
death for Americans aged 15–24 years and the 9th leading cause of death for those aged 25–34 years.

SOURCE: Centers for Disease Control and Prevention. 2017. 10 Leading Causes of Death by Age Group, United States, 2015. Web-based Injury Statistics Query and
Reporting System (www.cdc.gov/injury/wisqars); Centers for Disease Control and Prevention. 2016. Cause of Death 1999-2015 on CDC WONDER Online Database
(http://wonder.cdc.gov/ucd-icd10.html).

National Health
Wellness is a personal concern, but the U.S. government has
financial and humanitarian interests in it, too. A healthy popu-
lation is the nation’s source of vitality, creativity, and wealth.
Poor health drains the nation’s resources and raises health care
costs for all.
A Plan for National Health Care Total health care
expenditures in the United States are the highest in the world
and growing; by 2016, they exceeded $10,000 per person each
year, including both out-of-pocket payments by individuals
and costs paid by private and government health insurance.
These costs are not distributed evenly across individuals, and
people’s healthcare costs may vary significantly from year to
year. Health insurance helps people pay for routine preventive
care and protects them financially in the event of a serious and
expensive illness or injury. Many people obtain health insur-
ance through an employer, while others qualify for government-
sponsored programs, such as Medicare, which covers nearly all
adults age 65 and older. Still, the United States over time has
had a high number of people who lacked insurance, peaking
at approximately 50 million (16% of the population) in 2010.
People without insurance are less likely to receive preventive
care or treatment for major health problems.
The 2010 Affordable Care Act (ACA), also called
“Obamacare,” aimed to both reduce the number of uninsured
and control the rise in healthcare costs. It mandated that most
people obtain health insurance or pay a federal penalty. It
provided financial assistance for people with low incomes by
expanding Medicaid (a joint federal/state insurance program)
and by providing tax credits and income-based subsidies for
people who obtained insurance through newly established
insurance exchanges. The ACA also broadened requirements
for all health insurance plans, including those offered by
employers; these provisions allowed young adults to stay on
their parents’ plans until age 26, eliminated annual and lifetime
coverage limits, capped annual out-of-pocket payments, and
provided protections for people with pre-existing conditions.
According to the National Center for Health Statistics,
between 2010 and 2016, the overall number of Americans
without insurance dropped by 20 million, down to 9% of the
population, the lowest rate in decades. In 2016, among adults
age 18-64 years, about 12% were uninsured (down from 22% in
2010), 20% were covered under a government-sponsored health
plan, and 69% were covered by private insurance, including
about 5% using an ACA insurance exchange. Defenders of the
ACA argue that in addition to reducing the number of people
without insurance, the act slowed the rise in health care costs
and increased quality of care through changes in payment struc-
tures and delivery methods. Detractors of the law cite higher
premiums and fewer insurance options as reasons to repeal and
replace some or all of the law.
At this writing, major changes to the law have been pro-
posed by Congress, and debate is ongoing about the costs and
benefits of key ACA provisions. The ACA insurance require-
ments and expansion set new benchmarks for this debate over
national health care policy.

 W E LLN E SS : N E W H E A L T H GO A LS    7
 V I TA L S TAT I S T I C S V I T A L S T AT I S T I C S

Table 1.2 Key Contributors to Death Table 1.3 Leading Causes of Death
among Americans among Americans Aged
15–24, 2015
NUMBER OF PERCENTAGE OF
DEATHS PER TOTAL DEATHS NUMBER OF PERCENTAGE OF
YEAR PER YEAR RANK CAUSE OF DEATH DEATHS TOTAL DEATHS
Tobacco 480,000 18.3 1 Unintentional injuries
Diet/activity patterns (obesity)* 400,000 15.2 (accidents) 12,514 41.0
Alcohol consumption 90,000 3.4 Motor vehicle 6,787 22.3
Microbial agents** 80,000 3.0 Poisoning* 3,920 12.9
Firearms 30,000 1.1 All other unintentional
Illicit drug use*** 25,000+ 1.0 injuries 1,807 5.9
Motor vehicles 20,000 0.8 2 Suicide 5,491 18.0
Sexual behavior**** 15,000 0.6 3 Homicide 4,733 15.5
4 Cancer 1,469 4.8
*Thenumber of deaths due to obesity is an area of ongoing controversy
and research. Recent estimates have ranged from 112,000 to 400,000. 5 Heart disease 997 3.3
All causes 30,494 100.0
**Microbialagents include bacterial and viral infections, such as influenza,
pneumonia, and hepatitis. Infections transmitted sexually are counted in *Poisoning deaths in this age group are primarily due to drug and alcohol
the “sexual behavior” category, including a proportion of deaths related overdose.
to hepatitis, which can be transmitted both sexually and nonsexually.
SOURCE: Centers for Disease Control and Prevention. 2017. 10 Leading
***Drug overdose deaths have increased rapidly in recent years, making it Causes of Death by Age Group, United States, 2015. Web-based Injury
likely that this estimate will rise. Statistics Query and Reporting System (www.cdc.gov/injury/wisqars).

****Estimated
deaths linked to sexual behavior include deaths from
cervical cancer and sexually acquired HIV, hepatitis B, and hepatitis C.

SOURCES: Kochanek, K. D., et al. 2016. “Deaths: Final data for 2014,”
National Vital Statistics Reports 65(4).; National Research Council,
Institute of Medicine, Measuring the Risks and Causes of Premature
Death: Summary of Workshops, 2015. Washington, DC: National
Academies Press; Stahre, M., et al. 2014. “Contribution of excessive
alcohol consumption to deaths and years of potential life lost in the
United States,” Preventing Chronic Disease: Research, Practice, and
Policy 11: 130293; U.S. Department of Health and Human Services. The
Health Consequences of Smoking—50 Years of Progress: A Report of
the Surgeon General. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention.
The Healthy People Initiative The national Healthy
­eople initiative aims to prevent disease and improve
P • Promote healthy development and healthy behaviors
­Americans’ quality of life. Healthy People reports, published
each decade since 1980, set national health goals based on
10-year agendas. The initiative’s most recent iteration, Healthy
People 2020, was released to the public in 2010. Healthy People
2020 envisions “a society in which all people live long, healthy
lives” and proposes the eventual achievement of the following
broad national health objectives:
• Eliminate preventable disease, disability, injury, and
premature death. This objective involves taking more
concrete steps to prevent diseases and injuries, promoting
healthy lifestyle choices, improving the nation’s prepared-
ness for emergencies, and strengthening the public health
infrastructure.
• Achieve health equity, eliminate disparities, and
improve the health of all groups. This objective involves
identifying, measuring, and addressing health differences
between individuals or groups that result from social or
economic disadvantage. (See the box “Wellness Issues for
Diverse Populations.”)
• Create social and physical environments that promote
good health for all. This objective involves the use of
health interventions at many levels (such as anti-smoking
campaigns by schools, workplaces, and local agencies),
providing a broader array of educational and job opportu-
nities for undereducated and poor Americans, and actively
developing healthier living and natural environments for
everyone.
across every stage of life. This goal involves taking
a ­cradle-to-grave approach to health promotion by
encouraging disease prevention and healthy behaviors in
Americans of all ages.
In a shift from the past, Healthy People 2020 emphasizes
the importance of health determinants—factors that affect the
health of individuals, demographic groups, or entire popula-
tions. Health determinants are social (including factors such
as ethnicity, education level, and economic status) and envi-
ronmental (including natural and human-made environments).
Thus, one goal is to improve living conditions in ways that
reduce the impact of negative health determinants.
Table 1.4 shows examples of individual health promotion
goals from Healthy People 2020, as well as estimates of how
well Americans are achieving those goals. To gain an idea of

8    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t

 DIVERSITY MATTERS
Wellness Issues for Diverse Populations
We all need to exercise, eat well, ­manage
stress, and cultivate positive relation-
ships. Protecting ourselves from dis-
ease and injuries is important, too.
But some of our differences—both
as individuals and as members of
groups—have important implications
for wellness. These differences can be
biological (determined genetically) or
cultural (acquired as patterns of behav-
ior through daily interactions with family,
community, and society). Many health
conditions are a function of biology and
culture combined. You share patterns of
influences with others; and information
about groups can be useful in identify-
ing areas that may be of concern to you
and your family. Wellness-related differ-
ences among groups can be described
in terms of a number of characteristics,
including the following:
Sex and Gender. Sex represents the
biological and physiological characteris-
tics that define men, women, and inter-
sex people. In contrast, gender refers
to how people identify themselves and
also the roles, behaviors, activities, and
attributes that a given society consid-
ers appropriate. A person’s gender
is rooted in biology and physiology,
but it is shaped by experience and
­environment—how society responds to
individuals based on their sex. Exam-
ples of gender-related characteristics
that affect wellness include the higher
rates of smoking and drinking found
among men and the lower earnings
found among women compared with
men doing similar work. Although men
are more biologically likely than women
to suffer from certain diseases (a sex
issue), men are less likely to visit their
physicians for regular exams (a gender
issue). Men have higher rates of death
from injuries, suicide, and homicide,
whereas women are at greater risk for
Alzheimer’s disease and depression.
Men and women also differ in body
composition and certain aspects of
physical performance.
Race and Ethnicity. Although the con-
cept of race is complex, with the num-
ber of people who identify themselves
as biracial or multiracial growing, it is still
useful to identify and track health risks
among population groups. Some dis-
eases are concentrated in certain gene
pools, the result of each racial or ethnic
group’s relatively distinct history. Diabe-
tes is more prevalent among individuals
of Native American or Latino heritage,
for example, and African Americans
have higher rates of hypertension. Racial
and ethnic groups may vary in their
traditional diets; their family and interper-
sonal relationships; their attitudes toward
tobacco, alcohol, and other drugs; and
their health beliefs and practices.
Income and Education. Of all the vari-
ables, inequalities in income and edu-
cation are the most highly correlated
to health status. Income and education
are closely related, and groups with the
highest poverty rates and least educa-
tion have the worst health status. These
Americans have higher rates of infant
mortality, traumatic injury, violent death,
and many diseases. They are more likely
to eat poorly, be overweight, smoke,
drink, and use drugs. They are exposed
to more day-to-day stressors and have
less access to health care services.
Disability. People with disabilities have
activity limitations or need assistance
due to a physical or mental impairment.
About one in five people in the United
States has some level of disability, and
the rate is rising, especially among
younger segments of the population.
People with disabilities are more likely
to be inactive and overweight. They
report more days of depression than
people without disabilities. Many also
lack access to health care services.
Box icon: © Rawpixel Ltd/Getty Images RF

Table 1.4 Progress toward Healthy People 2020 Targets

BASELINE MOST RECENT

(% MEETING PROGRESS (% MEETING TARGET PROGRESS
OBJECTIVE GOAL IN 2008) GOAL IN 2014–15) (% BY 2020) TOWARD GOAL
Increase proportion of people with health insurance 83.2 89.4 100.0 ◦
Help adults with hypertension get blood pressure under control 43.7 50.3 61.2 +
Reduce proportion of obese adults 33.9 37.7 30.5 −
Reduce proportion of adults who drank excessively in past 30 days 27.1 27.0 24.4 ◦
Increase proportion of adults who meet federal guidelines for exercise 18.2 21.4 20.1 ✓
Reduce proportion of adults who use cigarettes 20.6 15.3 12.0 +

Key        ✓ Target met                +   Significant progress

           ◦ Insignificant progress           −   Getting worse

SOURCE: U.S. Department of Health and Human Services. Healthy People 2020 data search (https://www.healthypeople.gov/2020/data-search/Search-the-Data).

 W E LLN E SS : N E W H E A L T H GO A LS    9

Wellness Tip In Table 1.1, notice how many causes
of death are related to lifestyle. This is an excellent motivator for
adopting healthy habits and staying in good condition. Maintaining
physical fitness and a healthy diet can lead to a longer life. It’s
a fact!
© Pablo Hidalgo/123RF
how you can make these national goals your own, visit www
.healthypeople.gov. There you can find organizations that have
affiliated themselves with Healthy People 2020, as well as
publications and other resources detailing what it takes to get
healthy.
Behaviors That Contribute
to Wellness
A lifestyle based on good choices and healthy behaviors maxi-
mizes quality of life. It helps people avoid disease, remain
strong and fit, and maintain their physical and mental health as
long as they live.
Be Physically Active The human body is designed to be
active. It readily adapts to nearly any level of activity and exer-
tion. Physical fitness is a set of physical attributes that allows
10    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t
the body to respond or adapt to the demands and stress of phys-
ical effort. The more we ask of our bodies, the stronger and
more fit they become. When our bodies are not kept active, they
deteriorate: Bones lose density, joints stiffen, muscles become
weak, and cellular energy systems degenerate. To be truly well,
human beings must be active.
Unfortunately, a sedentary lifestyle is common among
Americans. According to a 2013 survey, only about half of
adult Americans met the federal physical activity guidelines in
2013 (150 minutes or more per week of moderate aerobic exer-
cise or 75 minutes per week of vigorous aerobic exercise). The
older the adults, the less likely they were to meet the guidelines.
The benefits of physical activity are both physical and
­mental, immediate and long term (Figure 1.5). In the short
term, being physically fit makes it easier to do everyday tasks,
such as lifting; it provides reserve strength for emergencies;
and it helps people look and feel good. In the long term, being
physically fit confers protection against chronic diseases and
lowers the risk of dying prematurely. (See the box “Does Being
Physically Active Make a Difference in How Long You Live?”)
Physically active people are less likely to develop or die from
heart disease, respiratory disease, high blood pressure, cancer,
osteoporosis, and type 2 diabetes (the most common form of
diabetes). As they get older, they may be able to avoid weight
gain, muscle and bone loss, fatigue, and other problems associ-
ated with aging.
Choose a Healthy Diet In addition to being seden-
tary, many Americans have a diet that is too high in calories,
unhealthy fats, and added sugars, as well as too low in fiber,
complex carbohydrates, fruits, and vegetables. Like physical
inactivity, this diet is linked to a number of chronic diseases.
A healthy diet provides necessary nutrients and sufficient
energy without also providing too much of the dietary sub-
stances linked to diseases.
Maintain a Healthy Body Weight Overweight and obe-
sity are associated with a number of disabling and potentially
fatal conditions and diseases, including heart disease, cancer,
and type 2 diabetes. Researchers estimate that obesity kills
between 112,000 and 400,000 Americans each year. Healthy
body weight is an important part of wellness—but short-term
dieting is not part of fitness or wellness. Maintaining a healthy
body weight requires a lifelong commitment to regular exer-
cise, a healthy diet, and effective stress management.
Manage Stress Effectively Many people cope with stress
by eating, drinking, or smoking too much. Others don’t deal with
it at all. In the short term, inappropriate stress management can
T E RMS
physical fitness A set of physical attributes that
allows the body to respond or adapt to the demands
and stress of physical effort.
sedentary Physically inactive; literally, “sitting.”
lead to fatigue, sleep disturbances, and other symptoms. Over • Developing meaningful relationships—for example, learn-
longer periods of time, poor stress management can lead to less ing to communicate and dealing with anger
efficient functioning of the immune system and increased sus- • Planning for successful aging—for example, anticipating
ceptibility to disease. Learning to incorporate effective stress physical challenges and maintaining hobbies
management techniques into daily life is an important part of a
• Learning about the health care system—for
fit and well lifestyle.
­example, knowing what treatment options are avail-
able to you
Avoid Tobacco and Drug Use and Limit Alcohol
Consumption Tobacco use is associated with 9 of the • Acting responsibly toward the environment—for example,
top 10 causes of death in the United States; personal tobacco helping to reduce pollution and encouraging sustainable
use and secondhand smoke kill nearly 500,000 Americans practices
each year, more than any other behavioral or environmen-
tal factor. In 2015, 15% of adult Americans described them-
selves as current smokers. Lung cancer is the most common
Wellness Factors That Seem Outside
cause of cancer death among both men and women and Our Control
one of the leading causes of death overall. On average, the Heredity, the environment, and adequate health care are other
direct health care costs associated with smoking exceed important influences on health and wellness. These factors can
$170 ­billion per year. If the cost of lost productivity from interact in ways that raise or lower the quality of a person’s life
sickness, disability, and premature death is included, the and the risk of developing particular diseases. For example,
total exceeds $300 billion. a sedentary lifestyle combined with a genetic predisposition for
Excessive alcohol consumption is linked to 8 of the top 10 diabetes can greatly increase a person’s risk of developing the
causes of death and results in about 90,000 deaths a year in disease. If this sedentary, genetically predisposed person also
the United States. The social, economic, and medical costs of lacks adequate health care, he or she is much more likely to suf-
alcohol abuse are estimated at more than $250 billion per year. fer dangerous complications from diabetes.
Alcohol or drug intoxication is an especially notable factor in But in many cases, behavior can tip the balance toward
the death and disability of young people, particularly through health even if heredity or environment is a negative factor.
unintentional injuries (such as drownings and car crashes Breast cancer, for example, can run in families, but it is also
caused by drunken driving) and violence. associated with overweight and a sedentary lifestyle. A woman
with a family history of breast cancer is less likely to die from
Protect Yourself from Disease and Injury The most the disease if she controls her weight, exercises, and has regular
effective way of dealing with disease and injury is to prevent mammograms to help detect the disease in its early, most treat-
them. Many of the lifestyle strategies discussed here help pro- able stage.
tect you against chronic illnesses. In addition, you can take spe-
cific steps to avoid infectious diseases, particularly those that
are sexually transmitted.
College Students and Wellness
Each year, thousands of students lose productive academic
Take Other Steps toward Wellness Other important time to activities causing stress and other physical and emo-
behaviors contribute to wellness, including these: tional health problems—some of which can continue for a
lifetime. According to the fall 2016 American College Health
Association National College Health Assessment II, the fol-
lowing were commonly reported factors affecting academic
• Increased endurance, • Reduced risk of dying performance:
strength, and flexibility prematurely from all causes
• Healthier muscles, bones, • Reduced risk of developing
• Stress (32.2% of students affected)
and joints and/or dying from heart • Anxiety (24.9%)
• Increased energy (calorie) disease, diabetes, high blood
expenditure pressure, and colon cancer • Sleep difficulties (20.6%)
• Improved body composition • Reduced risk of becoming • Depression (15.4%)
• More energy obese
• Work (14.2%)
• Improved ability to cope with • Reduced anxiety, tension,
stress and depression
• Cold/flu/sore throat (13.0%)
• Improved mood, higher
• Reduced risk of falls and
• Concern for a troubled friend/family member (10.1%)
self-esteem, and a greater
sense of well-being fractures • Internet use/computer games (9.0%)
• Improved ability to fall asleep • Reduced spending for
and sleep well health care
unintentional injury An injury that occurs TE RMS
without harm being intended.
F IG UR E 1 .5 Benefits of regular physical activity.

 W E LLN E SS : N E W H E A L T H GO A LS    11
 THE EVIDENCE FOR EXERCISE
Does Being Physically Active Make
a Difference in How Long You Live?
How can we be sure that physical activity
and exercise are good for our health? To
answer this question, the U.S. Department of Health and Human
Services asked a committee to review scientific literature. The
committee’s mission was to determine if enough evidence exists
to warrant the government making physical activity recommen-
dations to the public. The committee’s report, the Physical Activ-
ity Guidelines Advisory Committee Report, 2008, summarizes
the scientific evidence for the health benefits of regular physical
activity and the risks of sedentary behavior. The report provides
the rationale for the federal government’s physical activity guide-
lines, and its findings were confirmed in the Scientific Report of
the 2015 Dietary Guidelines Committee.
The Physical Activity Guidelines Advisory Committee
started by asking whether physical activity actually helps peo-
ple live longer. The committee investigated the link between
physical activity and all-cause mortality—deaths from all
causes—by looking at 73 studies dating from 1995 to 2008.
The studies included men and women from all age groups
(16 to 65+) and from different racial and ethnic groups.
The data from these studies strongly support an inverse
relation between physical activity and all-cause mortality; that
is, physically active people were less likely to die during a
study’s follow-up period (ranging from 10 months to 28 years).
The review found that active people have about a 30% lower
risk of dying compared
with inactive people.
These inverse associa-
tions were found not
just for healthy adults
but also for older adults
(age 65 and older); for
people with coronary
artery disease, diabe-
tes, or impaired mobil-
ity; and for people
who were overweight
or obese. Poor fitness
and low physical activ-
ity levels were found to
be better predictors of
premature death than
smoking, diabetes, or
obesity. Based on the
evidence, the commit-
© yellowdog/Getty Images RF tee determined that
Each of these factors is related to one or more dimensions of
wellness, and most can be influenced by choices students make
daily. For example, there are many ways to manage stress: By
reducing unhealthy choices, such as using alcohol to relax, and
by increasing healthy choices, such as using time-management
techniques, even busy students can reduce the impact of stress.
What about wellness choices in other areas? The American
College Health Association survey found the following:
12    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t
about 150 minutes (2.5 hours) of physical activity per week
is enough to reduce all-cause mortality (see Chapter 2 for
more details). It appears that it is the overall volume of energy
expended, no matter which kinds of activities are done, that
makes a difference in risk of premature death.
The committee also looked at whether there is a dose-
response relation between physical activity and all-cause
­mortality—that is, whether more activity reduces death rates
even further. Again, the studies showed an inverse relation
between these two variables. So, more activity above and
beyond 150 minutes per week produces greater benefits. Sur-
prisingly, for inactive people, benefits are seen at levels below
150 minutes per week. In fact, any increase in physical activity
resulted in reduced risk of death. The committee refers to this
as the “some is good; more is better” message. A target of
150 minutes per week is recommended, but any level of activ-
ity below the target is encouraged for inactive people.
Looking more closely at this relationship, the committee
found that the greatest risk reduction is seen at the lower end
of the physical activity spectrum (30–90 minutes per week).
In fact, sedentary people who become more active have the
greatest potential for improving health and reducing the risk
of premature death. Additional risk reduction occurs as physi-
cal activity increases, but at a slower rate. For example, peo-
ple who engaged in physical activity 90 minutes per week
had a 20% reduction in mortality risk compared with inactive
people, and those who were active 150 minutes per week,
as noted earlier, had a 30% reduction in risk. But to achieve
a 40% reduction in mortality risk, study participants had to be
physically active 420 minutes per week (7 hours).
A 2017 American Heart Association report projected that
­cardiovascular disease costs in the United States will exceed
$1 trillion by 2035. Regular exercise reduces the risk of cardiovas-
cular disease and related health problems such as hypertension,
high cholesterol, and diabetes. The message from the research is
clear: It doesn’t matter what activity you choose or even how much
time you can devote to it per week, as long as you get moving!
SOURCE: American Heart Association. 2017. Cardiovascular Disease: A
Costly Burden for America; Projections through 2035. Dallas, TX: American
Heart Association; 2015 Dietary Guidelines Advisory Committee. 2015.
Scientific Report of the 2015 Dietary Guidelines Advisory Committee.
­Washington, DC: U.S. Department of Health and Human Services; Physical
Activity Guidelines Advisory Committee, Physical Activity Guidelines Advi-
sory Committee Report, 2008. Washington, DC: U.S. Department of Health
and Human Services.
Box icon: © Vstock LLC/Getty Images RF
Ask Yourself
QUESTIONS FOR CRITICAL THINKING AND REFLECTION
How often do you feel exuberant? Vital? Joyful? What makes you
feel that way? Conversely, how often do you feel downhearted,
de-energized, or depressed? What makes you feel that way? Have
you ever thought about how you might increase experiences of
vitality and decrease experiences of discouragement?
 • Only 48.4% of sexually active students reported that they
used a condom mostly or always during vaginal inter-
course in the past 30 days.
• About 18.3% of students had seven or more drinks the last
time they partied.
• About 11.7% of students used one or more prescription
drugs that were not prescribed to them within the past year.
• About 10.1% of students smoked cigarettes, and 4.3%
used e-cigarettes, at least once during the past month.
How do your daily wellness choices compare to those of
other students? What is recommended to promote wellness?
Remember: The sooner you trade an unhealthy behavior for a
healthier one, the longer you’ll be around to enjoy the benefits.
REACHING WELLNESS THROUGH
LIFESTYLE MANAGEMENT
Moving in the direction of wellness means cultivating healthy
behaviors and working to overcome unhealthy ones. This
approach to lifestyle management is called behavior change.
As you may already know from experience, changing an
unhealthy habit can be harder than it sounds. When you embark
on a behavior change plan, it may seem like too much work at
first. But as you make progress, you will gain confidence in your
ability to take charge of your life. You will also experience the
benefits of wellness—more energy, greater vitality, deeper feel-
ings of appreciation and curiosity, and a higher quality of life.
The rest of this chapter outlines a general process for changing
unhealthy behaviors that is backed by research and has worked
for many people. You will also find many specific strategies and
tips for change. For additional support, work through the activi-
ties in the Behavior Change Workbook at the end of the text.
Getting Serious about Your Health
Before you can start changing a wellness-related behavior, you
have to know that the behavior is problematic and that you can
change it. To make good decisions, you need information about
relevant topics and issues, including what resources are avail-
able to help you change.
Examine Your Current Health Habits Consider how your
current lifestyle is affecting your health today. How will it affect
your health in the future? Do you know which of your current hab-
its enhance your health and which ones may be harmful? Begin
your journey toward wellness with self-assessment: Think about
your own behavior, complete the self-assessment in Lab 1.2, and
talk with friends and family members about what they’ve noticed
about your lifestyle and your health. Digital trackers can also help
with your self-assessment; see the box “Quantify Yourself.”
Choose a Target Behavior Changing any behavior can
be demanding. This is why it’s a good idea to start small, by
choosing one behavior you want to change—called a target
 R E A C H I NG W E LLN E SS T H R OUG H L I F E S T YL E M A N A G E M E N T     13
behavior—and working on it until you succeed. Your chances
of success will be greater if your first goal is simple, such as
resisting the urge to snack between classes. As you change one
behavior, make your next goal a little more significant, and
build on your success over time.
Learn about Your Target Behavior After you’ve cho-
sen a target behavior, you need to learn its risks and benefits
for you—both now and in the future. As a starting point, use
this text and the resources listed in the For Further Explora-
tion section at the end of each chapter; see the box “Evaluating
Sources of Health Information” for additional guidelines. Ask
these questions:
• How is your target behavior affecting your level of
­wellness today?
• Which diseases or conditions does this behavior place you
at risk for?
• What effect would changing your behavior have on your
health?
Find Help Have you identified a particularly challenging
target behavior or mood—something like overuse of alcohol,
binge eating, or depression—that interferes with your ability to
function or places you at a serious health risk? If so, you many
need help to change behaviors or conditions that are too deeply
rooted or too serious for self-management. Don’t be discouraged
by the seriousness or extent of the problem; many resources are
available to help you solve it. On campus, the student health
center or campus counseling center can provide assistance. To
locate community resources, consult yellowpages.com, your
physician, or the Internet.
Building Motivation to Change
Knowledge is necessary for behavior change, but it isn’t usually
enough to make people act. Millions of people have sedentary
lifestyles, for example, even though they know it’s bad for their
health. To succeed at behavior change, you need to be moti-
vated and to know that even though an active lifestyle may be
inconvenient, it may be required.
Examine the Pros and Cons of Change Health
behaviors have short-term and long-term benefits and costs.
Consider the benefits and costs of an inactive lifestyle:
• Short-term. Such a lifestyle allows you more time to
watch TV and hang out with friends, but it leaves you less
fit and less able to participate in recreational activities.
behavior change A lifestyle management T E RMS
process that involves cultivating healthy behaviors
and working to overcome unhealthy ones.
target behavior An isolated behavior selected
as the object of a behavior change program.
 WELLNESS IN THE DIGITAL AGE
Quantify Yourself
You feel stressed and under the weather.
How can you feel better? Do you have a habit you want to
kick. Where to start?
People’s increasing desire to track their moods, sleep,
exercise, and diet patterns has brought about some 165,000
health-related apps and movements, like Quantified Self—a
California-based company that promotes self-tracking tools
among communities across the world. By giving you numerical
data related to your daily behaviors, digital trackers provide
objective feedback about what is going on with your health.
The technology also helps you describe your behaviors to
doctors and can be integrated with behavior change strate-
gies learned through counseling. Here are three steps to mak-
ing good use of technology for wellness:
1. Monitor yourself. How much are you smoking? Sleeping?
Exercising? What are you eating? Digital trackers can help
answer these questions for you. A wristband can record
whether you are getting enough restful sleep. Your smart-
phone can tell you how many steps you took to get across
campus.
2. Analyze your data. You’ve tracked your sleep, your blood
pressure, and your steps. You’ve kept a journal related to
your diet. You’ve taken your body measurements. What
patterns do you notice? What time of day do you tend
to need food? Cigarettes? Sleep? How do your patterns
match up with your goals?
Standard weight-loss apps allow users to input weight
goals and monitor progress toward those goals; more
sophisticated apps can analyze users’ data and offer daily
physical-activity goals, or help them establish a regular eating
schedule. You can now find advice, education, e-mail remind-
ers, alerts for lapses in progress, motivational messages, and
journals to record and track negative emotion. Many weight-
loss apps also link to social media for encouragement and
Wellness Tip Look for behavior-change support if you
need it. Certain health behaviors are exceptionally difficult to change.
Some people can quit smoking on their own; others get help from a
smoking cessation program or a nicotine replacement product.
© baona/iStock/Getty Images RF
14    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t
social support, or rewarding games and challenges. Addi-
tional features can be critical; tracking alone isn’t sufficient for
successful behavior change. You need to apply change strat-
egies such as those described later in the chapter.
3. Extend the list of behaviors you’d like to change. You
can track more than just your diet and exercise habits with
digital assistance. Electronic devices and smart programs
are available to help with many aspects of wellness, includ-
ing the following:
● Stress management
● Meditation and spirituality
● Heart rate and respiration
● Menstrual cycles
● Family medical history
● Journaling
With so many possibilities, how do you choose what to
monitor? Start with one or two variables. The interactive labs
at the end of each chapter focus on aspects of fitness and
wellness to get you going. Also, you’ll find a variety of digital
devices and apps discussed in later chapters, in “Wellness in
the Digital Age” boxes. You may find one or more apps (many
of which are free) that appeal to you and can help you make
progress toward your fitness and wellness goals.
SOURCES: IMS Institute for Healthcare Informatics. September 17, 2015. IMS
health study: Patient options expand as mobile healthcare apps address
wellness and chronic disease treatment needs. (http://www.imshealth.com
/en/about-us/news/ims-health-study:-patient-options-expand-as-mobile-
healthcare-apps-address-wellness-and-chronic-disease-treatment-needs);
and Schoeppe, S., et al. 2016. “Efficacy of interventions that use apps
to improve diet, physical activity and sedentary behaviour: A systematic
review,” International Journal of Behavioral Nutrition and Physical Activity,
13(127).
Box icon: © Hong Li/Getty Images RF
• Long-term. This lifestyle increases the risk of heart dis-
ease, cancer, stroke, and premature death.
To successfully change your behavior, you must believe that
the benefits of change outweigh the costs.
Carefully examine the pros and cons of continuing your cur-
rent behavior and of changing to a healthier one. Focus on the
effects that are most meaningful to you, including those tied
to your personal identity and values. For example, engaging in
regular physical activity and getting adequate sleep can support
an image of yourself as an active person who is a good role
model for others. To work toward being independent and tak-
ing control over your life, quitting smoking can be one way to
eliminate a dependency. To complete your analysis, ask friends
and family members about the effects of your behavior on them.
For example, a younger sister may tell you that your smoking
habit influenced her decision to take up smoking.
The short-term benefits of behavior change can be an impor-
tant motivating force. Although some people are motivated by
 CRITICAL CONSUMER
Evaluating Sources of Health Information
Surveys indicate that college students are smart about eval-
uating health information. They trust the health information
they receive from health professionals and educators and are
skeptical about popular information sources, such as maga-
zine articles and websites.
How smart are you about evaluating health information?
Here are some tips.
General Strategies
Whenever you encounter health-related information, take the
following steps to make sure it is credible:
● Go to the original source. Media reports and social media
posts often simplify the results of medical research. Find out for
yourself what a study really reported, and determine whether
it was based on good science. What type of study was it? Was
it published in a recognized medical journal? Was it an ani-
mal study, or did it involve people? Did the study include a
large number of people? What did the study’s authors actually
report?
● Watch for misleading language. Reports that tout “break-
throughs” or “dramatic proof” are probably hype. A study
may state that a behavior “contributes to” or is “associated
with” an outcome, but this does not prove a cause-and-effect
relationship.
● Distinguish between research reports and public health
advice. Do not change your behavior based on the results of a
single report or study. If an agency such as the National ­Cancer
Institute urges a behavior change, however, you should follow
its advice. Large, publicly funded organizations issue such
advice based on many studies, not a single report.
● Remember that anecdotes are not facts. A friend may tell
you he lost weight on some new diet, but individual success
stories do not mean the plan is truly safe or effective. Do any
scientific studies back up the claims of the article?
● Be skeptical. If a report seems too good to be true, it prob-
ably is. Be wary of information contained in advertisements. An
ad’s goal is to sell a product, even if there is no need for it, and
sometimes even if the product has not been proven to be safe
or effective.
long-term goals, such as avoiding a disease that may hit them
in 30 years, most are more likely to be moved to action by
shorter-term, more personal goals. Feeling better, doing better
in school, improving at a sport, reducing stress, and increasing
self-esteem are common short-term benefits of health behavior
change. Many wellness behaviors are associated with immedi-
ate improvements in quality of life. For example, surveys of
Americans have found that nonsmokers feel healthy and full
of energy more days each month than do smokers, and they
report fewer days of sadness and troubled sleep. The same is
 R E A C H I NG W E LLN E SS T H R OUG H L I F E S T YL E M A N A G E M E N T     15
● Make choices that are right for
you. Friends and family members can
be a great source of ideas and inspira-
tion, but you need to make health-related choices that work
best for you.
Internet Resources
Online information sources pose special challenges. When
reviewing a health-related website, ask these questions:
● What is the source of the information? Websites main-
tained by government agencies, professional associations, or
established academic or medical institutions are likely to pres-
ent trustworthy information. Many other groups and individu-
als post accurate information, but it is important to look at the
qualifications of the people who are behind the site. (Check
the home page or click the “About Us” link.) Verify information
you get from social media by visiting the originating organiza-
tion’s website and evaluating the source.
● How often is the site updated? Look for sites that are
updated frequently. Check the “last modified” date of any web
page. Newer studies may contradict the results of earlier ones.
● Is the site promotional? Be wary of information from sites
that sell specific products, use testimonials as evidence,
appear to have a social or political agenda, or ask for money.
● What do other sources say about a topic? Be wary of
claims and information that appear at only one site or come
from a chat room, bulletin board, or blog. Do other authors cite
the same studies as the ones in this article?
● Does the site conform to any set of guidelines or criteria
for quality and accuracy? Look for sites that identify them-
selves as conforming to some code or set of principles, such
as those set forth by the Health on the Net Foundation or the
American Medical Association. Medical and health journals
that have been peer reviewed (edited by experts in the field),
and websites maintained by government agencies, profes-
sional associations, or established academic or medical insti-
tutions are most likely to present trustworthy information.
Box icon: © sam74100/Getty Images RF
true when physically active people are compared with seden-
tary people. Over time, these types of differences add up to a
substantially higher quality of life for people who engage in
healthy behaviors.
Boost Self-Efficacy When you start thinking about chang-
ing a health behavior, a big factor in your eventual success is
whether you have confidence in yourself and in your ability to
change. Self-efficacy refers to your belief in your ability to suc-
cessfully take action and perform a specific task. Strategies for
boosting self-efficacy include developing an internal locus of
control, using visualization and self-talk, and getting encour-
agement from supportive people.
LOCUS OF CONTROL Who do you believe is controlling
your life? Is it your parents, friends, or school? Is it “fate”?
Or is it you? Locus of control refers to the figurative “place”
a ­person designates as the source of responsibility for the
events in his or her life. People who believe they are in con-
trol of their own lives are said to have an internal locus of
control. Those who believe that factors beyond their control
determine the course of their lives are said to have an external
locus of control.
For lifestyle management, an internal locus of control is an
advantage because it reinforces motivation and commitment.
An external locus of control can sabotage efforts to change
behavior. For example, if you believe that you are destined to
die of breast cancer because your mother died from the disease,
you may view screening mammograms as a waste of time.
In contrast, if you believe that you can take action to reduce
your risk of breast cancer in spite of hereditary factors, you
will be motivated to follow guidelines for early detection of
the disease.
If you find yourself attributing too much influence to outside
forces, gather more information about your wellness-related
behaviors. List all the ways that making lifestyle changes will
improve your health. If you believe you’ll succeed, and if you
recognize that you are in charge of your life, you’re on your way
to wellness.
VISUALIZATION AND SELF-TALK One of the best ways to
boost your confidence and self-efficacy is to visualize yourself
successfully engaging in a new, healthier behavior. Imagine
yourself going for an afternoon run three days a week or no
longer smoking cigarettes. Also visualize yourself enjoying
all the short-term and long-term benefits that your lifestyle
change will bring. Create a new self-image: What will you and
your life be like when you become a regular exerciser or a
nonsmoker?
You can also use self-talk, the internal dialogue you carry
on with yourself, to increase your confidence in your ability
to change. Counter any self-defeating patterns of thought with
more positive or realistic thoughts: “I am a strong, capable
person, and I can maintain my commitment to change.” See
Chapter 10 for more on self-talk.
ROLE MODELS AND OTHER SUPPORTIVE INDIVIDUALS
Social support can make a big difference in your level of
self-efficacy The belief in one’s ability to take TE R MS
action and perform a specific task.
locus of control The figurative “place” a person designates
as the source of responsibility for the events in his or her life.
self-talk A person’s internal dialogue
16    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t
Fitness Tip Visualization is such a powerful technique
that Olympic athletes learn how to harness it for peak performance. It
works for average people, too. Set a small fitness goal, then imagine
yourself doing it—as clearly and as often as you can. Visualization can
help you believe in yourself, and belief can be a step toward success!
© Hero Images Inc./Alamy Stock Photo RF
motivation and your chances of success. Perhaps you know
people who have reached the goal you are striving for; they
could be role models or mentors, providing information and
support for your efforts. Gain strength from their experiences,
and tell yourself, “If they can do it, so can I.” In addition, find
a buddy who wants to make the same changes you do and
who can take an active role in your behavior change program.
For example, an exercise partner can provide companionship
and encouragement when you might be tempted to skip your
workout.
Identify and Overcome Barriers to Change Don’t
let past failures at behavior change discourage you; they
can be a great source of information you can use to boost
your chances of future success. Make a list of the problems
and challenges you faced in any previous behavior change
attempts. To this list, add the short-term costs of behavior
change that you identified in your analysis of the pros and
cons of change. After you’ve listed these key barriers to
change, develop a practical plan for overcoming each one.
For example, if you always smoke when you’re with certain
friends, decide in advance how you will turn down the next
cigarette you are offered.
Enhancing Your Readiness
to Change
The transtheoretical, or “stages-of-change,” model is an effec-
tive approach to lifestyle self-management. According to this
model, you move through distinct stages as you work to change
your target behavior. It is important to determine what stage
you are in now so that you can choose appropriate strategies
for progressing through the cycle of change. (Figure 1.6) This
approach can help you enhance your readiness and intention to
change. Read the following sections to determine what stage
you are in for your target behavior.

Li fe!
Precontemplation People at this stage do not think they for
h ing
have a problem and do not intend to change their behavior. They T
od
M aintaining a Go
may be unaware of the risks associated with their behavior or
may deny them. They may have tried unsuccessfully to change Relapse—slipping
in the past and may now think the situation is hopeless. They back to a previous
Ta k i n g A c t i o n stage—is a common
may also blame other people or external factors for their prob- part of the cycle of
lems. People in the precontemplation stage believe that there Not change
are more reasons or more important reasons not to change than Ready
Yet ion
there are reasons to change. ct
Preparing for A

Contemplation People at this stage know they have a prob-

lem and intend to take action within six months. They acknowl-
edge the benefits of behavior change but worry about the costs
of changing. To be successful, people must believe that the
­benefits of change outweigh the costs. People in the contem-
plation stage wonder about possible courses of action but don’t
know how to proceed. There may also be specific barriers to
change that appear too difficult to overcome.
Preparation People at this stage plan to take action
within a month or may already have begun to make small
changes in their behavior. They may be engaging in their
new, healthier behavior but not yet regularly or consistently.
They may have created a plan for change but may be worried
about failing.
Action During the action stage, people outwardly modify
their behavior and their environment. The action stage requires
the greatest commitment of time and energy, and people in
this stage are at risk for reverting to old, unhealthy patterns of
behavior.
Maintenance People at this stage have maintained their
new, healthier lifestyle for at least six months. Lapses may have
occurred, but people in maintenance have been successful in
quickly reestablishing the desired behavior. The maintenance
stage can last for months or years.
Termination People at the termination stage have exited
the cycle of change and are no longer tempted to lapse back
into their old behavior. They have a new self-image and total
self-efficacy with regard to their target behavior. For ideas on
changing stages, see the box “Tips for Moving Forward in the
Cycle of Behavior Change.”
Thinking About
It
FIGU R E 1. 6 The stages of change: A spiral model.
SOURCE: Centers for Disease Control and Prevention. (n.d.) PEP guide: Personal
empowerment plan for improving eating and increasing physical activity. Dallas,
TX: The Cooper Institute.
(bike): © Adam Brown/Getty Images RF; (desk): © Ray Kachatorian/Getty
Images
make several attempts before they successfully change a behav-
ior; four out of five people experience some degree of backslid-
ing. For this reason, the stages of change are best conceptualized
as a spiral in which people cycle back through previous stages
but are further along in the process each time they renew their
commitment.
If you experience a lapse—a single slip—or a relapse—a
return to old habits—don’t give up. Relapse can be demor-
alizing, but it is not the same as failure. Failure means stop-
ping before you reach your goal and never changing your
target behavior. During the early stages of the change pro-
cess, it’s a good idea to plan for relapse so that you can avoid
guilt and self-blame and get back on track quickly. Follow
these steps:
1. Forgive yourself. A single setback isn’t the end of the
world, but abandoning your efforts to change could have
negative effects on your life.
2. Give yourself credit for the progress you have already
made. You can use that success as motivation to
continue.
3. Move on. You can learn from a relapse and use that knowl-
edge to deal with potential setbacks in the future.

Dealing with Relapse

People seldom progress through the stages of change in a
straightforward, linear way. Rather, they tend to move to a new
stage and then slip back to a previous stage before resuming
their forward progress. Research suggests that most people
Developing Skills for Change:
Creating a Personalized Plan
Once you are committed to making a change, put together a
plan of action. Your key to success is a well-thought-out plan

 R E A C H I NG W E LLN E SS T H R OUG H L I F E S T YL E M A N A G E M E N T     17

 TAKE CHARGE
Tips for Moving Forward in the Cycle of Behavior Change
Precontemplation
● Raise your awareness. Research your target
behavior and its effects.
● Be self-aware. Look at the mechanisms you
use to resist change, such as denial or rationalization. Find
ways to counteract these mechanisms.
● Seek social support. Friends and family members can help
you identify target behaviors and understand their impact on
the people around you.
● Identify helpful resources. These might include exercise
classes or stress-management workshops offered by your
school.
Contemplation
● Keep a journal. A record of your target behavior and the
circumstances that elicit the behavior can help you plan a
change program.
● Do a cost-benefit analysis. Identify the costs and benefits
(both current and future) of maintaining your behavior and of
changing it. Costs can be monetary, social, emotional, and so on.
● Identify barriers to change. Knowing these obstacles can
help you overcome them.
● Engage your emotions. Watch movies or read books
about people with your target behavior. Imagine what your life
will be like if you don’t change.
● Create a new self-image. Imagine what you’ll be like after
changing your target behavior. Try to think of yourself in new
terms right now.
● Think before you act. Learn why you engage in the target
behavior. Determine what “sets you off” and train yourself not
to act reflexively.
Preparation
● Create a plan. Include a start date, goals, rewards, and
specific steps you will take to change your behavior.
that sets goals, anticipates problems, and includes rewards. This
plan includes the following steps:
1. Monitor your behavior and gather data. Keep a record
of your target behavior and the circumstances surround-
ing it. Record this information for at least a week or two.
Keep your notes in a health journal or notebook or on your
­smartphone or computer (see the sample journal entries
in Figure 1.7). Record each occurrence of your behavior,
­noting the following:
• What the activity was
18    C H A P T E R 1 I n tr o d u cti o n t o W e l l n e s s , F it n e s s , a n d Life s t y l e M a n a g eme n t
● Make change a priority. Create and sign a contract with
yourself.
● Practice visualization and self-talk. These techniques can
help prepare you mentally for challenging situations.
● Take short steps. Successfully practicing your new b
­ ehavior
for a short time—even a single day—can boost your confidence
and motivation.
Action
● Monitor your progress. Keep up with your journal entries.
● Change your environment. Make changes that will dis-
courage the target behavior—for example, getting rid of snack
foods or not stocking the refrigerator with beer.
● Find alternatives to your target behavior. Make a list of
things you can do to replace the behavior.
● Reward yourself. Rewards should be identified in your
change plan. Give yourself lots of praise, and focus on your
success.
● Involve your friends. Tell them you want to change, and
ask for their help.
● Don’t get discouraged. Real change is difficult.
Maintenance
● Keep going. Continue using the positive strategies that
worked in earlier stages.
● Be prepared for lapses. Don’t let slip-ups set you back.
● Be a role model. After you have successfully changed your
behavior, you may be able to help someone else do the same
thing.
If relapses keep occurring or if you can’t seem to con-
trol them, you may need to return to a previous stage of the
behavior change process. If this is necessary, reevaluate
your goals and your strategy. A different or less stressful
approach may help you avoid setbacks when you try again.
• When and where it happened
• What you were doing
• How you felt at that time
If your goal is to start an exercise program, track
your activities to determine how to make time for
workouts.
2. Analyze the data and identify patterns. After you have col-
lected data on the behavior, analyze the data to identify
patterns. When are you most likely to overeat? To skip a
meal? What events trigger your appetite? Perhaps you are
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

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

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

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

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

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

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

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

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

Some consolation was afforded me by a brassfounder, whom I

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

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

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

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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