Challenges and Choices: Deciding to be Healthy

Gail R. Carlson
State Health Education Specialist

Working women often find that there are just not enough hours in the day to meet all the demands placed on them.

Tasks at work are followed by tasks at home, leaving little time for meeting their own needs. This becomes very apparent when looking at women's health practices. More than 30 percent of American women are obese, more than half don't exercise and 23 percent of women still smoke.

All of these lifestyle-related risk factors are known to contribute to chronic health problems such as heart disease, some forms of cancer and diabetes.

While women tend to miss few work days because of their own illnesses, this failure to take care of themselves contributes to the development of chronic health problems as they get older. Problems that are likely to show about the time they reach retirement age.

For more information about women's health see the section below entitled "Women's Health Facts."

It's never too late

A growing body of research suggests that exchanging risky behaviors, like those mentioned above, with healthier ones not only delays the early onset of a number of chronic health problems but also improves the overall quality of a woman's health. This guide will provide you with some basic information about living healthier and will guide you through a process for making a behavior change of your choice.

At least in the area of healthier living, it does not have to be an either/or situation. It is not a question of finding time to do something for yourself at the expense of time for your family.

Some of the changes you decide to make to benefit yourself will also improve your family's health. For example, preparing lower-fat meals will benefit everyone. When you exercise, have your children exercise with you. When you buckle your seat belt, make sure your children are buckled in as well.

Besides, parents who are committed to a healthy lifestyle have a wonderful opportunity to be positive role models for their children.

Children who learn to assume greater responsibility for their health early in life, and who learn how to stay healthy, are more likely to be successful in maintaining health their entire lives.

Preparing for change

You can do more to maintain your health than anyone else, including your health care provider. However, it requires a conscious decision and involves preparation and planning.

Rarely does a behavior change just because you want it to. People who have been successful at changing their behavior have taken the time to plan and prepare. Most have made a number of concerted efforts to change before they are finally successful. So, don't give up if you don't succeed the first time.

There are no quick fixes or shortcuts. As a busy woman, that is probably the last thing you wanted to hear, but the payoffs in terms of your health and the health of your family are worth the effort. Nevertheless, at least at first, it is going to take some work and planning. Below are some of the reasons why.

As an adult, have you ever tried to learn a new health behavior? Think about what it takes to help your children learn something new. Teaching them the skills, encouraging and reminding them, and then following through to make sure they have completed the task.

Adults have to do the same things with themselves. Even simple tasks like using your seat belt, flossing your teeth or eating breakfast require careful thought and preparation. Let's use the example of flossing your teeth. Preparation includes talking to your dentist so you can learn how to floss properly, buying the needed supplies, and deciding on the best time of day to floss.

On a daily basis, it involves reminding yourself to floss and making yourself go back to do it, even though you have already turned off the bathroom light and are dressed for work.

Breaking bad habits

As adults, we also may have developed a number of poor health habits. Old habits that have been reinforced and encouraged over a number of years can be hard to unlearn.

Habits are acts or practices that are repeated so frequently they are almost automatic. We are comfortable with them and carry them out without much thought. Deciding to change these behaviors, like learning new ones, requires a conscious decision and constant alertness.

Most of your health behaviors and attitudes are supported by family and friends. Many of whom act and think much as you do and who may be threatened by your attempts to change.

Family and friends often unintentionally sabotage your efforts to change. If you are not prepared to deal with the pressure, it is easy to return to old habits. Particularly when they are being encouraged and reinforced.

Frequently, when thinking about making health-related changes, we think about changes in behavior. However, making health-related changes also involves changing attitudes. That means being prepared to think differently about yourself, your abilities and your relationships with those around you. Many times these attitudes and perceptions will have to change before you can successfully change your behavior.

One strategy for changing your attitude is positive self-talk. Through positive self-talk, you can convince yourself that you can lose weight, or you can start a regular exercise program, or that you can do anything else you want to do.

Finding your own way

Each woman is unique and has her own interests and needs. As a result, each woman must develop her own approach to staying healthy. Making changes because someone else thinks it is a good idea rarely works. And, rather than comparing yourself to someone else, the important questions are:

  • Do I feel in control of my life?
  • Am I doing all I can, right now, to maintain or improve the quality of my health?
  • If not, am I willing to make the necessary change?

If you are interested in making health-related changes, use Exercise 1 below to help you prepare for making a change of your choice. As the first question implies, the starting point is motivation and attitude.

Maintaining healthy habits

How are you going to maintain the change over time? Many people find that learning new behaviors is not all that difficult. Where they run into trouble is maintaining those behaviors over time. This is where your planning and preparation can really pay off.

Once you have adopted a new health behavior, make sure you have the tools needed to maintain your success. Set some long-term goals for yourself. Use accurate information to find out about the kinds of behavior changes that are beneficial to your health. Identify friends, co-workers and relatives who can provide you with support for maintaining the change.

Keep a positive attitude. Don't give up if you don't succeed the first time. If this is a change you really want to make, convince yourself that you can do it. Changing behavior is rarely a smooth course. Successes are often followed by little setbacks. Getting beyond these slips is easier when you can maintain your faith in yourself and your ability to change.

Exercise 1
Why do you want to adopt a healthier lifestyle? This is the first question to answer for yourself. Don't worry about why someone else wants you to change. Do this for yourself.


I want to improve my health because:
Where are you going to start? Completing the lifestyle appraisal below may give you some ideas of where you want to begin. Most of us could benefit from making a number of changes. You will have more success if you focus your energy on one area of change at a time. Pick an area where making changes would be fun and rewarding. Save the tough issues until you have had some success in making changes.
I will begin by making a change in this area:

If you have an interest in making changes in the areas of nutrition or stress management, consider reading these additional MU publications: GH6651 and GH6655.

What do you want to accomplish? Begin by creating a short-term goal for yourself. Think in terms of a week and then expand it to a month.

In the area selected above, I will accomplish:

Then ask yourself the following two questions.

  •   Is the goal realistic?

  •   Does it fit with my values and beliefs?
Also decide what activities you are going to do to reach this goal. Be realistic and be kind to yourself. Starting with a few activities and actually doing them is much better than planning many activities and than feeling like a failure if you find you can't do them all.
During the next week, then month, I plan to:
When are you going to start? Pick a date to begin. What day of the week is going to be best? What time of day will be better for you?
This will be my daily schedule with the new activities:

Who are you going to get to help you? It is difficult to adopt new health behaviors if those in your immediate environment are encouraging you to maintain your old ones. Gather support from your family and friends. Help them understand why this is so important to you, and ask for their help. Plan to involve your children and partner in at least some of the activities so you don't feel like you are in this alone.

I am going to ask for help from the following people:

Women's health facts

Women are more likely to die from cancer than any other disease.
Heart disease accounts for more than 50 percent of all deaths among women and claims more women's lives than cancer, accidents and diabetes combined.

Women with Type II diabetes don't need to worry because they have a milder form of the disease.
Type II (adult-onset diabetes) can be just a deadly as Type I (insulin-dependent diabetes). Both can result in heart disease, loss of vision and kidney failure.

The chances of a woman getting breast cancer have increased greatly.
According to the American Cancer Society, in 1980 the average women's chances of developing breast cancer was 1 in 11. By 1992, the rate was 1 in 8. However, unlike earlier years, the 1992 figure includes women over the age of 85. Older women are among those most likely to develop the disease. It is important to remember that this rate looks at the average woman's chance of getting the disease over her lifetime. It does not say that one in eight women has breast cancer. The risk is creeping up, but at a much slower rate than the risk figures indicate.

More women die from breast cancer than any other form of cancer.
While breast cancer is the most common form of cancer in women, women are more likely to die from lung cancer. This year, 62,000 American women will die from lung cancer, and 46,000 from breast cancer. Much of the increase is due to increased smoking among women.

As a woman, I don't have to worry about osteoporosis until I reach menopause.
About 45 percent of a person's bone mass is formed during the teen years. Prevention needs to begin early. No matter what your age, make weight-bearing exercise such as walking, running or dancing part of your daily activity, get enough calcium, if you smoke—stop, and if you drink, drink only lightly or moderately. If you are going through menopause, talk to your health care provider about hormone replacement therapy.

Hormone replacement is necessary during menopause.
Menopause is not a disease, it is a normal life transition. To maintain your health, keep a positive attitude, eat a low-fat, high-fiber diet, exercise regularly, avoid smoking and talk to your health care provider about hormone replacement therapy. Like any drug therapy, HRT has risks and benefits. The decision about its use is very individualized and must be a joint decision between you and your provider.

Women who work outside the home are more likely to suffer from stress than women who stay at home.
Whether at home or in the workplace, the nature of a woman's job is the most important factor. Women are more likely to be stressed by their jobs, paid or not, when their jobs are demanding, they have limited personal control over the situation and there is little opportunity for making decisions. For many employed women, the fact that a job at work is followed by a job at home is an added stressor.

Healthy lifestyles appraisal
For each question, circle the one answer that best applies to you. The plus (+) sign next to some numbers indicates more than that number.

Personal healthABC
Are you familiar with first-aid procedures?YesNo 
Do you always make use of clothing and equipment provided for your safety at work?YesOccasionallyNo
Do you wear a seat belt?AlwaysOccasionallyNever
On the average, how many hours of TV do you watch per day?0 to 11 to 44+
Do you get seven to eight hours of sleep most nights?YesNoRarely
Do you do breast self-examination?RegularlyOccasionallyNever
Do you experience periods of depression?SeldomOccasionallyFrequently
What kind of physical effort is mostly expended during the workday?Active and physical workDesk work 
How often do you participate in regular, moderate exercise?3 times weeklyDailySeldom
Are you overweight?No5-19 pounds20+ pounds
Do you eat a wide variety of foods, using MyPlate as a guide?Each day3 times weekly 
Alcohol, tobacco and other drugs
What is the total number of drinks you have per week, including beer, liquor and wine?0-78-1516+
Do you follow directions when taking over-the-counter and prescribed drugs?AlwaysOccasionallyRarely
Do you avoid illegal drugs?YesNo 
Do you drive under the influence of alcohol or drugs?NoYes 
How many cigarettes do you smoke per day?NoneUnder 1010+
Do you ever smoke in bed?NoYes 
Total circled from each column:   

Now add up the number of items circled under each letter, multiply by the amounts shown, and figure your totals.

LetterTotal circledMultiply byTotal
A 1 
B 3 
C 5 

Total of all three items: 
17 to 25 = Great, keep up the good work
26 to 34 = Good, but look for ways to improve
35 to 43 = You're taking too many risks
44 or more = Start today to reduce your risks
Adapted from a Health Risk Appraisal developed by the Health and Welfare Department of Canada.


  • Kemper, Donald W., Jim Giuffre, and Gene Drabinski. Pathways: A Successful Guide for a Healthy Life. Boise, Idaho: Healthwise Inc. 1985.
  • Margen Sheldon, MD; Joyce C. Lashof, MD and Patricia A. Buffler, MPH, PhD. Women's Health, CA: University of California at Berkeley Wellness Reports. 1995
  • Ratcliff, Lydia. Health Hazard Appraisal: Clues for a Healthier Lifestyle. NY: Public Affairs Pamphlet. 1980.
  • Vickery, Donald MD and James Fries, MD. Take Care of Yourself. Reading, MA: Addison-Wesley Publishing Company. 1993.