Purpose: The purpose of this lifestyle assessment inventory is to increase your awareness of areas in your life that raise your risk of disease, injury, and possibly premature death. A key point to remember is that you have control over each of the lifestyle areas discussed. Awareness is the first step in making change.
Directions: Place a check mark by each statement that applies to you.
Top of Form
A. Physical Fitness
I exercise for a minimum of 20 to 30 minutes at least 3 days a week.
I play sports routinely (2 to 3 times per week).
I walk for 15 to 30 minutes (3 to 7 days per week).
B. Body Fat
There is no place on my body where I can pinch more than 1 inch of fat.
I am satisfied with the way my body appears.
C. Stress Level
I find it easy to relax.
I rarely feel tense or anxious.
I am able to cope with daily stresses better than most people.
D. Car Safety
I have not been in an auto accident in the past 4 years.
I always use a seat belt when I am in a car.
I rarely drive with someone going above the speed limit.
I always get 7 to 9 hours of sleep.
I do not have trouble going to sleep.
I generally do not wake up during the night.
I have a happy and satisfying relationship with my friends.
I have a lot of close friends.
I have a great deal of family love and support.
I generally eat three balanced meals per day.
I rarely overeat.
I rarely eat large quantities of fatty foods and sweets.
H. Alcohol Use
I consume fewer than two drinks per day.
I never get intoxicated.
I never drink and drive.
I. Tobacco Use
I never smoke (cigarettes, pipe, cigars, etc.).
I am not exposed to second-hand smoke on a regular basis.
I do not use smokeless tobacco.
J. Drug Use
I never use illicit drugs.
I never abuse legal drugs such as diet or sleeping pills.
K. Safe Sex
I always practice safe sex (e.g., always using condoms or being involved in a monogamous relationship).
Bottom of Form
1.) Individual areas: If you have fewer than three checks in categories A through K, you can improve this area of your lifestyle.
2.) Overall lifestyle: Add up your total number of checks. Scoring can be interpreted as follows:
23 - 29 Very healthy lifestyle 17 - 22 Average healthy lifestyle Less than 16 Unhealthy lifestyle (needs improvement)