HEALTHLifetime Lifetime Copyright © by Holt, Rinehart and Winston. All rights reserved. David P. Friedman, Ph.D. Professor, Department of Physiology & Pharmacology Deputy Associate Dean for Research Wake Forest University School of Medicine Winston-Salem, North Carolina Curtis C. Stine, M.D. Professor Department of Family Medicine and Rural Health College of MedicineFlorida State UniversityTallahassee, Florida Shannon Whalen, Ph.D. Assistant Professor Department of Health Studies, Physical Education and Human Performance Adelphi UniversityGarden City, New YorkAUTHORS iiCopyright ©2004 by Holt, Rinehart and Winston All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Requests for permission to make copies of any part of the work should be mailed to the following address: Permissions Department, Holt, Rinehart and Winston, 10801 N. MoPac Expressway, Building 3, Austin, Texas 78759. For permission to reprint copyrighted material, grateful acknowledgment is made to the following source:Ramano & Associates for Cal Ripkin, Jr.: Quote from “Tips for Injury Prevention” by Cal Ripkin, Jr., from the American Academy of Orthopaedic Surgeons Web site. Copyright ©2001 by Cal Ripkin, Jr. CNN and CNN Student News are trademarks of Cable News Network LP, LLP. An AOL Time Warner Company.HealthLinks is a service mark owned and provided by the National Science Teachers Association. All rights reserved.Current Health is a registered trademark of Weekly Reader Corporation. Printed in the United States of America ISBN 0-03-064614-6 234567048070605040302 Copyright © by Holt, Rinehart and Winston. All rights reserved. iiiMary B. Grosvenor, M.S., R.D. Science and Health Writer Delta, Colorado Shahla Khan, Ph.D. Adjunct Professor Department of Health Science University of North FloridaJacksonville, Florida Mitchell Leslie Science and Health Writer Albuquerque, New Mexico Josh R. Mann, M.D., M.P.H. Clinical Assistant Professor Department of Family and Preventive Medicine University of South CarolinaColumbia, South Carolina Joe S. McIlhaney, Jr., M.D. President The Medical Institute for Sexual Health Austin, Texas Margaret Meeker, M.D., F.A.A.P. Pediatrician Traverse City, Michigan Jane A. Petrillo, Ed.D. Assistant Professor Department of Health, Physical Education, and Sport Science Kennesaw State UniversityKennesaw, GeorgiaLori A. Smolin, Ph.D. Department of Nutritional Sciences University of ConnecticutStorrs, Connecticut Robert Wilson III Chairman Department of Health and Physical Education Morehouse CollegeAtlanta, Georgia Kathleen Young, Ph.D. Research Scientist Center of Health Promotion and Disease Prevention University of New MexicoAlbuquerque, New Mexico Sandra Alters, Ph.D. Science and Health Writer Montreal, Canada Daniel H. Franck, Ph.D. Science and Health Writer Spencertown, New York Linda K. Gaul, Ph.D. Epidemiologist Texas Department of HealthAustin, Texas Rosemary E. Previte Science and Health Writer Lexington, Massachusetts Inclusion Specialist Ellen McPeek Glisan Special Needs Consultant San Antonio, TexasTeacher Edition Development Sandra Alters, Ph.D. Science and Health Writer Montreal, Canada Linda K. Gaul, Ph.D. Epidemiologist Texas Department of Health Austin, Texas Marilyn Massey-Stokes, Ed.D.,C.H.E.S. Associate Professor Health, Exercise, and Sport Sciences Texas Tech UniversityLubbock, Texas Su Nottingham Health and Life Management Teacher Waterford Mott High SchoolWaterford, Michigan Jane A. Petrillo, Ed.D. Assistant Professor Department of Health, Physical Education, and Sport Science Kennesaw State UniversityKennesaw, Georgia Debbie Rummel Health Teacher Antioch Community High SchoolAntioch, Illinois Wendy Schiff, M.S. Adjunct Lecturer St. Louis Community College— Meramec St. Louis, Missouri Joan A. Solorio Special Education Director Austin Independent School District Austin, Texas Kathleen Young, Ph.D. Research Scientist Center of Health Promotion and Disease Prevention University of New MexicoAlbuquerque, New MexicoCONTRIBUTING WRITERSCONTRIBUTING AUTHORSAcknowledgments Copyright © by Holt, Rinehart and Winston. All rights reserved. ivNigel Atkinson, Ph.D. Associate Professor of Neurobiology Institute for Neuroscience Institute for Cellular and Molecular Biology Waggoner Center for Alcohol and Addiction Research The University of TexasAustin, Texas John A. Brockhaus, Ph.D. Director, Mapping, Charting, and Geodesy Program Department of Geography and Environmental Engineering United States Military AcademyWest Point, New York John Caprio, Ph.D. George C. Kent Professor Department of Biological SciencesLouisiana State UniversityBaton Rouge, Louisiana William B. Cissell, M.S.P.H.,Ph.D., C.H.E.S. Professor of Health Studies Department of Health StudiesTexas Woman’s UniversityDenton, Texas Joe W. Crim, Ph.D. Professor of Cellular Biology The Biological SciencesUniversity of GeorgiaAthens, Georgia Susan B. Dickey, Ph.D., R.N. Associate Professor Pediatric NursingTemple UniversityPhiladelphia, Pennsylvania Stephen Dion Associate Professor Sport FitnessSalem CollegeSalem, MassachusettsNorman Ebrune, Ph.D. Professor of Public Health Sciences Department of Public Health Education Western Oregon UniversityCorvallis, Oregon Ronald Feldman, Ph.D. Ruth Harris Ottman Centennial Professor for the Advancement of Social Work Education Director, Center for the Study of Social Work Practice Columbia University New York, New York William Guggino, Ph.D. Professor of Physiology School of MedicineJohns Hopkins UniversityBaltimore, Maryland Katheryn Hilgenkamp, Ed.D.,C.H.E.S. Assistant Professor, Community Health and Nutrition University of Northern ColoradoGreeley, Colorado Cynthia Kuhn, Ph.D. Professor of Pharmacology and Cancer Biology Duke University Medical CenterDuke UniversityDurham, North Carolina Randi Love, Ph.D. Clinical Associate Professor School of Public HealthThe Ohio State University Columbus, Ohio John B. Lowe, M.P.H., Dr.P.H.,F.A.H.P.A. Professor and Head Department of Community and Behavioral Health College of Public HealthThe University of IowaIowa City, Iowa John D. Massengale, Ph.D. Professor of Sport Sociology Department of KinesiologyUniversity of NevadaLas Vegas, NevadaACADEMIC REVIEWERSLeslie Mayrand, Ph.D., R.N., C.N.S. Professor of Nursing Pediatrics and Adolescent Medicine Angelo State University San Angelo, Texas Karen E. McConnell, Ph.D. Assistant Professor School of Physical EducationPacific Lutheran UniversityTacoma, Washington Clyde B. McCoy, Ph.D. Director, Comprehensive Drug Research Center Chairman, Epidemiology and Public Health Health Services Research CenterUniversity of Miami School of Medicine Miami, Florida Hal Pickett, Psy.D. Assistant Professor of Psychiatry Department of PsychiatryUniversity of Minnesota Medical School Minneapolis, Minnesota Philip Posner, Ph.D. Professor and Scholar in Physiology College of MedicineFlorida State UniversityTallahassee, Florida John Rohwer, Ph.D. Professor Department of Health SciencesBethel CollegeSt. Paul, Minnesota Susan R. Schmidt, Ph.D. Postdoctoral Psychology Fellow Center on Child Abuse and NeglectUniversity of Oklahoma Health Sciences Center Oklahoma City, Oklahoma Stephen B. Springer, Ed.D., L.P.C., C.P.M. Director of Occupational Education Southwest Texas State UniversitySan Marcos, Texas (continued on p. 684) Copyright © by Holt, Rinehart and Winston. All rights reserved. CONTENTS IN BRIEF vHealth and Your Wellness 1Leading a Healthy Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2Skills for a Healthy Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 3Self-Esteem and Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4Managing Stress and Coping with Loss . . . . . . . . . . . . . . . . . . . . . 76 5Preventing Violence and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Health and Your Body 6Physical Fitness for Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 7Nutrition for Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 8Weight Management and Eating Behaviors . . . . . . . . . . . . . . . . 188 Drugs 9Understanding Drugs and Medicines . . . . . . . . . . . . . . . . . . . . . . 216 10Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 11Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 12Illegal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282 Diseases and Disorders 13Preventing Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 314 14Lifestyle Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338 15Other Diseases and Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . 364 Adolescence, Adulthood, and Family Life 16Adolescence and Adulthood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386 17Marriage, Parenthood, and Families . . . . . . . . . . . . . . . . . . . . . . 408 Reproductive Health 18Reproduction, Pregnancy, and Development . . . . . . . . . . . . . . 428 19Building Responsible Relationships . . . . . . . . . . . . . . . . . . . . . . . 454 20Risks of Adolescent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . 474 21HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 Express Lessons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516 Life Skills Quick Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614REFERENCE HEALTH Handbook UNIT 6UNIT 6UNIT 6 UNIT 5UNIT 5UNIT 5 UNIT 4UNIT 4UNIT 4 UNIT 3UNIT 3UNIT 3 UNIT 2UNIT 2UNIT 2 UNIT 1UNIT 1UNIT 1CONTENTS In Brief Copyright © by Holt, Rinehart and Winston. All rights reserved. vi TABLE OF CONTENTSLeading a Healthy Life 4 1Health and Teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 3Health in Your Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Skills for a Healthy Life 24 1Building Life Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2Making GREAT Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3Resisting Pressure from Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4Setting Healthy Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Self-Esteem and Mental Health 48 1Building Your Self-Esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 2Using Good Communication Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 3Mental and Emotional Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 4Understanding Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Managing Stress and Coping with Loss 76 1Stress and Your Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 2Dealing with Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 3Coping with Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 4Preventing Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93CHAPTER 4CHAPTER 3CHAPTER 2CHAPTER 1 Health and Your Wellness UNIT 1UNIT 1UNIT 1 UNIT 2UNIT 2 UNIT 3UNIT 3 UNIT 4UNIT 4 UNIT 5UNIT 5 UNIT 6UNIT 6 Copyright © by Holt, Rinehart and Winston. All rights reserved. TABLE OF CONTENTS viiPreventing Violence and Abuse 100 1Conflict Resolution and Violence Prevention . . . . . . . . . . . . . . . . . 102 2Recognizing and Preventing Abuse . . . . . . . . . . . . . . . . . . . . . . . . . 108 3Sexual Abuse and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Physical Fitness for Life 124 1Physical Fitness and Your Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 2Planning Your Fitness Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 3Exercising the Safe Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 4Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Nutrition for Life 152 1Carbohydrates, Fats, and Proteins . . . . . . . . . . . . . . . . . . . . . 154 2Vitamins, Minerals, and Water . . . . . . . . . . . . . . . . . . . . . . . . 161 3Meeting Your Nutritional Needs . . . . . . . . . . . . . . . . . . . . . . . 167 4Choosing a Healthful Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Weight Management and Eating Behaviors 188 1Food and Your Body Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 2Maintaining a Healthy Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 3Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 4Preventing Food-Related Illnesses . . . . . . . . . . . . . . . . . . . . . . . . . . 207CHAPTER 8CHAPTER 7CHAPTER 6CHAPTER 5 Health and Your Body UNIT 1UNIT 1 UNIT 2UNIT 2UNIT 2 UNIT 3UNIT 3 UNIT 4UNIT 4 UNIT 5UNIT 5 UNIT 6UNIT 6 Copyright © by Holt, Rinehart and Winston. All rights reserved. viii TABLE OF CONTENTSUnderstanding Drugs and Medicines 216 1 Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 2 Drugs as Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 3 Drugs and the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Alcohol 240 1 Alcohol Affects the Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 2 Alcoholism Affects the Family and Society . . . . . . . . . . . . . . . . . . . 247 3 Teens and Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Tobacco 262 1 Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 2 Dangers of Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 3 A Tobacco-Free Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 Illegal Drugs 282 1 Drugs of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 2Commonly Abused Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 3Other Drugs of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 4A Drug-Free Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301CHAPTER 12CHAPTER 11CHAPTER 10CHAPTER 9 Drugs UNIT 1UNIT 1 UNIT 2UNIT 2 UNIT 3UNIT 3UNIT 3 UNIT 4UNIT 4 UNIT 5UNIT 5 UNIT 6UNIT 6 Copyright © by Holt, Rinehart and Winston. All rights reserved. TABLE OF CONTENTS ixPreventing Infectious Diseases 314 1What Are Infectious Diseases? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 2Protecting Yourself from Infectious Diseases . . . . . . . . . . . . . . . . . 322 3Common Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Lifestyle Diseases 338 1Lifestyle and Lifestyle Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 2Cardiovascular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 3Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349 4Living with Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355 Other Diseases and Disabilities 364 1Understanding Hereditary Diseases . . . . . . . . . . . . . . . . . . . . . . . . 366 2Understanding Immune Disorders and Autoimmune Diseases . . . 371 3Understanding

Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376CHAPTER 15CHAPTER 14CHAPTER 13 Diseases and Disorders UNIT 1UNIT 1 UNIT 2UNIT 2 UNIT 3UNIT 3 UNIT 4UNIT 4UNIT 4 UNIT 5UNIT 5 UNIT 6UNIT 6 Copyright © by H olt, Rin ehart and Winston. All rights reserved. x TABLE OF CONTENTSAdolescence and Adulthood 386 1Changes During Adolescence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388 2Adulthood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395 Marriage, Parenthood, and Families 408 1Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 2Parenthood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 3Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 Reproduction, Pregnancy, and Development 428 1Male Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430 2Female Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436 3Pregnancy and Early Development . . . . . . . . . . . . . . . . . . . . . . . . . 443 Building Responsible Relationships 454 1Responsible Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456 2Benefits of Abstinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 3Coping with Pressures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464CHAPTER 19CHAPTER 18CHAPTER 17CHAPTER 16 Adolescence, Adulthood, and Family Life UNIT 1UNIT 1 UNIT 2UNIT 2 UNIT 3UNIT 3 UNIT 4UNIT 4 UNIT 5UNIT 5UNIT 5 UNIT 6UNIT 6 Reproductive Health UNIT 1UNIT 1 UNIT 2UNIT 2 UNIT 3UNIT 3 UNIT 4UNIT 4 UNIT 5UNIT 5 UNIT 6UNIT 6UNIT 6 Copyright © by Holt, Rinehart and Winston. All rights reserved. TABLE OF CONTENTS xi Risks of Adolescent Sexual Activity 474 1What Are the Risks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476 2What Are Sexually Transmitted Diseases? . . . . . . . . . . . . . . . . . . . 480 3Common STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484 HIV and AIDS 494 1HIV and AIDS Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496 2Understanding HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500 3Protecting Yourself from HIV and AIDS . . . . . . . . . . . . . . . . . . . . . . 505 HEALTH Handbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92CHAPTER 21CHAPTER 20 Copyright © by Holt, Rinehart and Winston. All rights reserved. xii TABLE OF CONTENTSWhat You Need to Know About... Environment and Your Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548 Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 552 Selecting Healthcare Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556 Financing Your Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 560 Evaluating Healthcare Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 Evaluating Health Web Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564 Caring for Your Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 566 Caring for Your Hair and Nails . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 570 Dental Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 Protecting Your Hearing and Vision . . . . . . . . . . . . . . . . . . . . . . . . . . 574 UNIT 1UNIT 1 REFERENCE XPRES S Lessons EHEALTH Handbook How Your Body Works Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516 Vision and Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520 Male Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 522 Female Reproductive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524 Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526 Muscular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 Circulatory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532 Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 536 Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538 Excretory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 540 Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542 Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545 Copyright © by Holt, Rinehart and Winston. All rights reserved. TABLE OF CONTENTS xiiiFirst Aid and Safety Responding to a Medical Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . 576 Rescue Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 580 CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582 Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586 Wounds and Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588 Heat- and Cold-Related Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . 590 Bone, Joint, and Muscle Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 594 Poisons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596 Motor Vehicle Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598 Bicycle Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602 Home and Workplace Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604 Gun Safety Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606 Safety in Weather Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 608 Recreational Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 The Ten Skills for a Healthy Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 Making GREAT Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616 Using Refusal Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618 10 Tips for Building Self-Esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620 REFERENCE REFERENCE Guide Calorie and Nutrient Content in Selected Foods . . . . . . . . . . . . . . . . 622 Health Agencies and Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . 628 Health Careers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 632 What’s Your Health IQ? Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 642 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 646 Spanish Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 658 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 672 Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686 UNIT 1UNIT 1 REFERENCE QUICK REVIEW LIFE LIFE SKILLS Copyright © by Holt, Rinehart and Winston. All rights reserved. xiv TABLE OF CONTENTSYou’ll use these skills every day to enhance your health. Using Refusal Skills—Role-Playing Refusal Skills. . . . . . . . . . . . . . . . . . . . . . . . . 36 Communicating Effectively—Say What? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Coping—Positive Attitude . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Communicating Effectively—Stopping Abuse Before It Starts. . . . . . . . . . . . . 112Practicing Wellness—Getting Enough Sleep. . . . . . . . . . . . . . . . . . . . . . . . . . . 147Setting Goals—Kicking the Habit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277Using Community Resources—Cancer Resources in Your Community. . . . . . 353Communicating Effectively—Communicating Effectively with Your Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391 Using Refusal Skills—Know What to Say . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467 Using Community Resources—HIV and the Community. . . . . . . . . . . . . . . . . 509 Five easy steps show you how to make the right decisions! Supporting a Grieving Friend. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Getting Help to Prevent Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Advising Your Friend Against Steroid Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . 145Helping a Friend with an Eating Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206Confronting a Friend About Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Getting Home Safely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254Testing for Genetic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369Dealing with Peer Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394Thinking About Marriage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414Confronting STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482Dispelling Myths About STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506 MAKING DECISIONSDECISIONSGREATMAKING Analyzing DATALIFE LIFE SKILL Activity Analyzing DATA FEATURES Copyright © by Holt, Rinehart and Winston. All rights reserved. TABLE OF CONTENTS xvInterpret health data, and draw accurate conclusions. Health Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 How To Use Food Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Understanding Body Mass Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198Reading a Prescription Label . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . 228Costs of Alcohol to Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Cigarette Smoking Is Deadly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265Dangers of Marijuana Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325Checking Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346Menstrual Cycle Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439STD Cases in Teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481U.S. Teens with AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498 Use these hands-on activities to practice what you’ve learned. Speak Out! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Reaching Your Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Sell Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Develop Your Fitness Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137How Healthful Is Your Diet? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Society and Body Image. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203Alcohol and Advertising. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257Drug Abuse Affects Everyone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304Observing Unhealthy Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327Understanding Disabilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377Calculating a Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396Charting Your Course. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477Analyzin gDA TA Analyzing DATA Analyze the influence of media, technology, and culture on your health. Technology: Self-Diagnosis and the Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Media: Healthy Meal—or Good Deal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Media: Prescription Drugs and the Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Technology: Making Sense of Genetic Technology . . . . . . . . . . . . . . . . . . . . . 362 Cultural Diversity: Coming of Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 Cultural Diversity: The Great American Date. . . . . . . . . . . . . . . . . . . . . . . . . 472 HealthWorldHealthWorldHealthWorld YOURYOURAnalyzing DATA real life Activity Copyright © by Holt, Rinehart and Winston. All rights reserved. xvi HOW TO USE YOUR TEXTBOOKYour Road Map for Success with Lifetime Health Read the Objectives Objectives tell you what you’ll need to know. STUDY TIP Reread the objectives when studying for a test to be sure you know the material. Study the Key Terms Key Terms are listed for each section. Learn the definitions of these terms because you will most likely be tested on them. Use the glossary to locate anydefinition quickly. STUDY TIP If you don’t understand a definition, reread the page where the term is introduced. The surrounding text should helpmake the definition easier to understand. Take Notes and Get Organized Keep a health notebook so that you are ready to take notes when your teacher reviews the material in class. Keep yourassignments in this notebook so that you can review them when studying for the chapter test. Every day, about 1 10 Americans are infected with HIV. Three million people died from AIDS in 2000. Currently, there is nocure for AIDS. Do you know how to help fight against the spread of HIV and AIDS? What Are HIV and AIDS? HIV and AIDS are different. isthe virus that primarily infects cells of the immune system and thatcauses AIDS. is the dis-ease that is caused by HIV infection, which weakens the immune system. HIV infection is an infection in which HIV has entered the blood and is multiplying in a person’s body cells. HIV specifically infectscells of the immune system. HIV eventually destroys the body’s abilityto fight off infection. After someone is infected with HIV, the virusAcquired immune deficiency syndrome (AIDS)Human immunodeficiency virus (HIV)HIV and AIDS TodaySECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Distinguish between an HIV infection and AIDS. Name the three areas in the world that have the greatest number of people living with HIV/AIDS. Compare the number of people in the United States living with HIV infection to the number of people in the United States living with AIDS. Summarize why teens are one of the fastest-growing groups infected with HIV.KEY TERMSKEY TERMS human immunodeficiency virus (HIV) the virus that primarily infects cells of the immune system and that causes AIDS acquired immune deficiency syndrome (AIDS) the disease that is caused by HIV infection, whichweakens the immune system pandemic a disease that spreads quickly through human populations all over the world 1 in 4 850,000 to 900,000 22 million 40 millionstatistically speaking . . . Ratio of new cases of HIV infection that occur in teens: Estimated number of Americans who are infected with HIV: Number of people who have died from AIDS worldwide: Estimated number of people who are infected with HIV/AIDS worldwide:HOW TO USE YOUR TEXTBOOK Internet Connect boxes in your textbook take you to resources that you can use for health projects,reports, and research papers. Go to scilinks.org/health, and type in the HealthLinks code to get information on a topic.Visit go.hrw.com Find worksheets, articles from Current Health, and other materials that go with your textbookat go.hrw.com. Click on the textbook icon and the table of contents to see all of theresources for each chapter. Be Resourceful, Use the Web Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW TO USE YOUR TEXTBOOK xvii Use the Illustrations and Photos Art shows complex ideas and processes. Learn to analyze the art so that you better understand thematerial you read in the text. Tables and graphs display important information in an organized way to help you see relationships. A picture is worth a thousand words. Look at the photographs to see relevant examples ofhealth concepts you are reading about. Answer the Section Reviews Section Reviews test your knowledge of the main points of the section. Critical Thinking items challenge you to think about the material in greater depth and to find connections that you infer from the text. STUDY TIP When you can’t answer a question, reread the section. The answer is usually there. Do Your Homework Your teacher will assign Study Guide worksheets to help you understand and remember the material inthe chapter. STUDY TIP Answering the items in the Chapter Review will prepare you for the chapter test. Don’t try to answer the questions without reading the textand reviewing your class notes. A little preparationup front will make your homework assignments alot easier. Visit Holt Online Learning If your teacher gives you a special passwordto log onto the Holt Online Learning site,you’ll find your complete textbook on the Web. In addition, you’ll find some great learning tools andpractice quizzes. You’ll be able to see how well you know thematerial from your textbook. Visit CNN Student News You’ll find up-to-date events in health and fitness atwww.cnnstudentnews.com. SECTION 1 HIV and AIDS Today 497starts making new copies of itself inside the immune system cells. The new copies of the virus destroy the cells they infect. The copies of thevirus are then released into the bloodstream and enter other immunesystem cells. The destructive cycle then continues. Getting AIDS Being infected with HIV doesn’t mean the person has AIDS. A person is said to have AIDS when the virus has destroyedmany immune system cells and has badly damaged the immune sys-tem. It usually takes 5 to 10 years for a person who is infected withHIV to develop AIDS if the person has not received treatment. Peoplewith AIDS cannot fight off illnesses that a healthy person’s immunesystem could easily defeat. AIDS patients suffer from and often diefrom these illnesses. There is still no cure for AIDS. Once the virus infects a person’s body, there is no way to remove the virus. Most people with HIVinfection eventually develop AIDS. So, learning about HIV and AIDSand protecting yourself from being infected are very important. HIV Around the World AIDS is a a disease that spreads quickly through humanpopulations all over the world. More than 20 million people through-out the world have died from AIDS in the last 20 years. HIV was first discovered in the United States in the early 1980s. Most scientists think that HIV came from central Africa. The virusspread very quickly from Africa to other regions and countries. HIV isstill spreading rapidly in many parts of the world, including Asia andEastern Europe (especially in the Russian Federation). However, thehardest hit area is Africa. AIDS is now the leading cause of death insub-Saharan Africa. To get an idea of how widespread HIV and AIDSare in the world, look at the statistics in Figure 1.pandemic, Estimated Number of People Living with HIV/AIDS 940,000560,000 15,0001 million 1 million 420,000440,000 1.4 million6.1 million 28.1 millionNorth America Caribbean Latin AmericaSub-Saharan AfricaNorth Africa and Middle EastWestern EuropeEastern Europe and Central Asia East Asia and Pacific South and Southeast Asia Australia and New Zealand Source: Joint United Nations Program on HIV/AIDS.These statistics show that AIDS has spread through populations around the world. ACTIVITY If the population size of North America is 316 million, what percentage of the population is infected with HIV/AIDS? 1 Figure MATH SKILL www.scilinks.org/health Topic: AIDS HealthLinks code: HH4005 Copyright © by Holt, Rinehart and Winston. All rights reserved. Copyright © by Holt, Rinehart and Winston. All rights reserved.Copyright © by Holt, Rinehart and Winston. All rights reserved.Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 1 Leading a Healthy Life CHAPTER 2 Skills for aHealthy Life CHAPTER 3 Self-Esteem andMental Health CHAPTER 4 ManagingStress and Coping withLoss CHAPTER 5 Preventing Violence andAbuse 3CHAPTER 1 Leading a Healthy Life CHAPTER 2 Skills for aHealthy Life CHAPTER 3 Self-Esteem andMental Health CHAPTER 4 ManagingStress and Coping withLoss CHAPTER 5 Preventing Violence andAbuse UNIT 1UNIT 1UNIT 1 Copyright © by Holt, Rinehart and Winston. All rights reserved.Copyright © by Holt, Rinehart and Winston. All rights reserved.Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 1CHAPTER 1CHAPTER 1 Leading a Healthy LifeLeading a Healthy LifeLeading a Healthy Life 4KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Most deaths are caused by our behaviors. 2.If you have a history of heart disease in your family, there is nothing you can do about yourrisk for heart disease. 3.The leading cause of death in teens is motorvehicle accidents. 4.Smoking is the single leading preventable causeof death in the United States. 5.Eating at least five servings of fruits andvegetables a day can lower your chances ofsuffering from cancer or heart disease. 6.If you are not physically sick, then you arehealthy. Copyright © by Holt, Rinehart and Winston. All rights reserved. 5SECTION 1 Health and Teens SECTION 2 Health and Wellness SECTION 3 Health in YourCommunity go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH01. Copyright © by Holt, Rinehart and Winston. All rights reserved. 6 CHAPTER 1 Leading a Healthy LifeYou have the power to protect yourself from the dangers that threaten your health. The first step to protecting yourself is learning what these dangers are and what you can do to prevent them. Health Today What does being healthy mean to you? Focus on the first thing youthink of when you read the word healthy . Did you think of not having diseases? being physically fit? eating right? Many people think thatbeing healthy simply means not being sick. In the past, this was true. Health in the Past: Infectious Diseases In the 1800s and early 1900s, the leading causes of death in the United States were infectious diseases —diseases caused by pathogens, such as bacteria . Infectious diseases can be passed from one person to another. Examples of infec-tious diseases include polio, tuberculosis, pneumonia, and influenza(the flu). Infectious diseases were a constant threat. That is why peo-ple thought of being healthy as being free from disease! Health Today: Lifestyle Diseases Over the years, medical advances, better living conditions, and a focus on preventative medi-cine have helped bring infectious diseases of the past under control.As a result, most of the diseases that were common 50 to 100 yearsago can now be prevented or cured. Today, most health problems inthe United States are related to the way we live, or our lifestyle. are diseases caused partly by unhealthy behaviors and partly by other factors. They are diseases influenced by thechoices you make that affect your health. Examples of diseases that can be influenced by lifestyle are some types of diabetes, some typesof heart disease, and some types of cancer. Lifestyle diseasesHealth and TeensSECTION 1SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Compare the major causes of death in the past with the major causes of death today. Distinguish between controllable risk factors and uncontrollable risk factors.Compare the major causes of death for teens with those for other age groups in the United States.Listthe six health risk behaviors that lead to health problems in teens.Name three behaviors you can adopt now to improve your health. LIFE LIFE SKILLKEY TERMSKEY TERMS lifestyle disease a disease caused partly by unhealthy behaviors and partly by other factors risk factor anything that increases the likelihood of injury, disease, or other health problems sedentary not taking part in physical activity on a regular basis “Our generation will live longer than people did a hundred years agobecause we are learning to live healthier lives. ” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Health and Teens 7Health Risk Factors All health problems have risk factors. A is anything that increases the likelihood of injury, disease, or other health problems.For example, the risk factors for heart disease include a history ofheart disease in your family, a high-fat diet, stress, being overweight,smoking, and lack of exercise. All of these factors increase a person’schance of developing heart disease. Notice that some of the risk fac-tors can be controlled by your behavior, while others cannot. Controllable Risk Factors Controllable risk factors are risk factors that you can do something about. They can be controlled by yourbehavior. For example, what can you do to decrease your risk ofdeveloping heart disease? As shown in Table 1, you can exercise regu- larly, avoid smoking, manage a healthy weight, and eat healthful,nutritious meals. Uncontrollable Risk Factors Unfortunately, not all health risk factors are controllable. The ones that can’t be changed are calleduncontrollable risk factors . Examples of uncontrollable risk factors for heart disease are age, race, gender, and heredity. For example, theolder a person is, the more likely he or she is to develop heart disease.African Americans are more likely to have high blood pressure, whichcan lead to heart disease, than European Americans are. Men aremore likely to develop heart disease than women are. You can’t make yourself younger or change your race or gender. However, by focusing on controllable risk factors, which you canchange through your behavior, you can protect your health.risk factorControllable factor Physical activity Smoking Weight DietBad >watching TV very often >smoking every day >weighing 20 percent more thanrecommended bodyweight >eating fast foodevery dayTable 1 Controllable Risk Factors for Heart Disease Uncontrollable Risk Factors >Age >Race >Gender >HeredityBetter >walking the stairs instead of takingelevator >smoking every sooften >weighing 10 percentto 20 percent morethan recommendedbody weight >eating junk foodseveral times aweekBest >playing a team sport three times aweek >quit smoking or notsmoking >weighing recom-mended bodyweight >eating healthful, nutritious meals Behavior Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Motor Vehicle Safety HealthLinks code: HH4101 8 CHAPTER 1 Leading a Healthy LifeRisk Factors and Your Health You can’t control the uncontrollable risk factors. However, you can protect your health by focusing on controllable risk factors, whichyou can change through your behavior. What behaviors can youfocus on at this point in your life? First, you should know the leadingcauses of death for people your age in the United States: >motor vehicle accidents >homicide >suicide >other accidents These four causes of death make up almost three-fourths of all teendeaths. For children and infants, motor vehicle accidents are also theNo. 1 cause of death. Your health behaviors affect not only your health today but also your future health. Thus, you should be aware of the leading causesof death for other age groups. For example, the leading cause of deathfor adults between 19 and 65 years of age is cancer. The leading causeof death for adults over 65 years of age is heart disease. The next section describes the health behaviors that most affect you and other teens. By learning these risk behaviors, you can takecontrol in improving your health today and in the future. Everyone, no matter what age, can do things to take control of his or herhealth.HH04PEC01_S1 6/2/04 7:46 PM Page 8 SECTION 1 Health and Teens 9Six Health Risk Behaviors There are six types of risk behaviors that cause the most serious health problems. 1. Sedentary lifestyle Not taking part in physical activity on a regular basis is referred to as being Those who have sedentarylifestyles, even if they are not overweight, raise their risk of certaindiseases such as heart disease and diabetes. 2. Alcohol and other drug use Alcohol abuse can cause liver disease, certain types of cancer, heart disease, and brain damage. Alcoholand drug use are also major factors in car accidents, physicalfights, depression, suicide, and mental disorders . Alcohol and drug use are also factors in the spread of sexually transmitted diseases (STDs). These are diseases that are spread through sexual activity. An example of a sexually transmitted disease is acquiredimmune deficiency syndrome (AIDS), caused by the humanimmunodeficiency virus (HIV). 3. Sexual activity Sexual activity outside of a committed relation- ship, such as marriage, puts people at risk for health problems.These health problems include HIV infection, other sexuallytransmitted diseases, and unplanned pregnancy.sedentary. Analyzin gDA TA Analyzing DATA Health Today Each slice of the pie represents the percentage of deaths among teens that are a result of the cause indicated. Each slice of the pie represents the percentage of deaths for all ages that are a result of the cause indicated.21 33% 27% 16% 13%11%Ages 15 to 24 30% 35% 23% 7%5%All ages Major Causes of Death Source: Centers for Disease Control and Prevention.2 1 Motor vehicle accidents Homicide Suicide Other accidents Other causesStrokes and cerebrovascular disease Heart disease CancerRespiratory disease Other causesYour Turn 1.What is the No. 1 cause of death for your age group? 2.What percentage ofdeaths for all agesare caused by heart diseaseand cancer? 3.Using one or both pie charts,list at least four causes ofdeath that are affected byhealth risk behaviors. 4. CRITICAL THINKING Describe what you can do toprotect yourself from each ofthe causes of death that youlisted in item 3.MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 10 CHAPTER 1 Leading a Healthy Life4. Behaviors that cause injuries As mentioned, the

four major causes of death for teenagers are motor vehicle accidents, other accidents, homicide, and suicide. Forexample, a risk behavior that can lead to homicide is carrying a weapon. Not using a seat belt is a risk behaviorthat can lead to death in a motor vehicle accident. 5. Tobacco use Smoking is the single leading preventable cause of death in the United States. Smoking is a control-lable risk factor for heart disease, cancer, and respiratorydisease. These are three of the leading causes of death forall age groups. The choice to smoke often takes place inhigh school, if not before then. Smoking as a teenagergreatly increases your risk for the three leading causes ofdeath. 6. Poor eating habits Your eating habits can either increase or lower your chances of developing many diseases. Eat-ing at least five servings of fruits and vegetables a day canlower your chances of suffering from cancer or heart dis-ease. On the other hand, eating foods that are high in fatand weighing more than your recommended weight putsyou at risk for heart disease, cancer, and stroke. The choices you make can either raise your risk for certainhealth concerns or lower your risk. Learning about the riskbehaviors summarized in Figure 1 will help you make better choices to protect yourself. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “a disease caused partly by unhealthy behaviors and partly by other factors.” 2.Identify the term for “not taking part in physical activity on a regular basis.” Understanding Key Ideas 3.State the type of disease that causes most deaths in the United States today. 4.List three examples of uncontrollable risk factors. 5.Identify which of the following is nota control- lable risk factor. a.exercise c.age b.diet d.weight6.Compare the leading causes of death for teens with those of all ages. 7.State the six risk behaviors that lead to health problems in teens. 8.Identify the risk behavior that leads to the most deaths in teens. 9.Identify the risk behavior that is the leading preventable cause of death in the United States. Critical Thinking 10. Practicing Wellness List three of your behaviors that you can change to improve your health. 11. Practicing Wellness Use Table 1 to give another example of a “best” behavior youcan do for the controllable factor physical activity.LIFE LIFE SKILLLIFE LIFE SKILLYou have the power to protect yourself from the six types of risk behaviors. ACTIVITY What risk behaviors do you think are the most common at your school? 1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Health and Wellness 11 Health and WellnessSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Iris was in good physical shape. Abel couldn’t remember the last time he had to stay home because he had a cold. Do you thinkIris and Abel are healthy? Six Components of Health Being healthy is much more than being physically fit and free fromdisease. is the state of well-being in which all of the compo-nents of health—physical, emotional, social, mental, spiritual, andenvironmental—are in balance. To be truly healthy, you must takecare of all six components. The six components are described in moredetail below. Physical Health Abel used to think that being physically healthy meant being strong and muscular like an Olympic athlete. Being ingood physical shape is part of physical health. However, you don’thave to be an athlete or even good at sports to be physically healthy.Physical health refers to the way your body functions. Physical health includes eating right, getting regular exercise, and being at yourrecommended body weight. Physical health is also about avoidingdrugs and alcohol. Finally, physical health means being free of dis-ease and sickness. Emotional Health Emotional health is expressing your emotions in a positive, nondestructive way. Everyone experiences unpleasantfeelings at one time or another. Emotionally healthy people can copewith unpleasant emotions and not get overwhelmed by them. Forexample, when Abel feels down, he knows he can go to his bestfriend or his family for support. Are you aware of how you feel and towhom you can go for support?HealthOBJECTIVES Describe each of the six components of health. State the importance of striving for optimal health. Describe four influences on wellness. Describe three ways to take charge of your wellness. Name two ways you can improve two components of your health. LIFE LIFE SKILLKEY TERMSKEY TERMS health the state of well-being in which all of the components of health—physical, emotional, social, mental, spiritual, and environmental—arein balance value a strong belief or ideal wellness the achievement of a person’s best in all six components of healthhealth literacy knowledge of health information needed to make good choices about your health “As long as I work out, I’m healthy.”Myth Being healthy is more than being physically fit.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. 12 CHAPTER 1 Leading a Healthy LifeSocial Health Social health does not mean being the most popu- lar kid in school. A person who is popular can be socially unhealthy! Social health is the quality of your relationships with friends, family, teachers, and others you are in contact with. As listed in Figure 2, a person who is socially healthy respects others. A socially healthy per-son also stays clear of those who do not treat him or her with respectand tolerance. For example, Abel gets together with his friends eachweek. However, he avoids his neighbor who bullies him. He is alsolearning to better work out disagreements with his parents. Mental Health Your mental health can be strongly influenced by your emotional health. Mental health is the ability to recognize real- ity and cope with the demands of daily life. Sometimes people whohave gone through intensely troubling times develop mental ill-nesses. An example of a mental illness is a phobia. A phobia is anirrational and excessive fear of something, such as a fear of heights.But mental health is about more than not having mental illness.Mental health is also having high self-esteem. Having high self-esteem is feeling comfortable and happy about yourself. For exam-ple, Iris is now trying out for the drama club. She had been hesitantto try out because none of her friends liked acting, but she decidedto try out anyway.To be healthy, a person must attend to all six components of health. ACTIVITY Which component of your health do you think needs the most improvement?2 FigureSix Components of Health Physical Health > eats a well-balanced, diet > exercises regularly > avoids tobacco, alcohol, and drugs > is free of disease Emotional Health > expresses emotions constructively > asks for help when sad Social Health > respects others > has supportive relationships > expresses needs to othersMental Health > has high self-esteem > enjoys trying new things > is free of mental illness Spiritual Health > has a sense of purpose in life > follows morals and values > feels a unity with other human beings Environmental Health > has access to clean air and water > has a clean and uncrowdedliving space > recycles used paper, glassproducts, and aluminum Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Health and Wellness 13Spiritual Health Spiritual health is maintaining harmonious rela- tionships with other living things and having spiritual direction and purpose. Spiritual health means different things to different people.For some people, spiritual health is defined by the practice of reli-gion. For others, it is understanding their purpose in life. Spiritual health also includes living according to one’s ethics, morals, and values. A is a strong belief or ideal. Being spiritu-ally healthy may mean you live in harmony with your environment.It may also mean that you are at peace with yourself and thosearound you. For example, Iris says she feels most valuable and unitedwith others when she helps out at her city’s homeless shelter. Environmental Health The environment is made up of the living and nonliving things in your world. The environment includes air,water, and land. Your environment is your surroundings—where youlive, work, or play. Environmental health is keeping your air and water clean, your food safe, and the land around you enjoyable and safe.Iris started a recycling program for her family when she realized theimportance of her environmental health to her well-being. Wellness: Striving for Optimal Health As you may have noticed, many of the components of health can beaffected by the other components. If one component of health isweak, it can affect a person’s overall health. This is why being healthyis defined as the balance of all the components of health. isthe achievement of a person’s best in all six components of health. It would be unrealistic to think that a person could achieve com- plete wellness all of the time. Think of striving for wellness in thesame way you think of always striving to have a good day. Do youalways have a really good day or a really bad day? Most of your daysare most likely somewhere in between. That is how the wellness con-tinuum works, too. The wellness continuum represents the idea that a person is nei- ther completely healthy nor completely unhealthy. Think of the well-ness continuum as resembling the scale on a bellringer, commonlyseen at amusement parks. As shown in Figure 3, at the top of the scale is optimal health, and at the bottom of the scale is illness and death.The harder you strive to hit the hammer on the pedal, the higher theball goes on the scale. For most of us, the ball reaches somewhere inthe middle of the scale. People who can cope with their emotions, have healthy relation- ships, and make smart decisions probably fall near the optimal well-ness side of the continuum. On the other hand, people who eatpoorly, engage in health risk behaviors, never exercise, and areunhappy probably fall closer to the illness side. Where you fall on thecontinuum can change on a yearly, monthly, and even daily basis.Fortunately, you have the power to change your behaviors to movecloser to optimal health.Wellnessvalue The wellness continuum shows that wellness is about always striving foroptimal health, even though mostpeople are never completely healthy.3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 14Influences on Your Wellness As you strive for optimal health, it’s important to recognize that there are many factors that influence your health. Hereditary Influences Your health can be influenced by your heredity —the traits you inherit from your parents. For example, if sev- eral members of your family have developed diabetes, you may be atrisk for diabetes. However, if you have a hereditary disease in yourfamily, it doesn’t mean you will definitely develop that disease. Byfocusing on controllable risk factors, you can decrease your risk forhereditary diseases. Social Influences Your health is also influenced by the relation- ships you have with other people. For example, if your friends con-vince you to go to a party where alcohol is available, your friends areinfluencing your health in a negative way. If your parents or grandpar-ents deal with anger by talking out their problems instead of yellingand fighting, you will be more likely to talk out your problems. Yourparents are influencing your health in a positive way. Cultural Influences Culture is the values, beliefs, and practices shared by people that have a common background. Your culture canstrongly influence your health. For example, some Asian cultures eata lot of vegetables and seafood in their diet. This cultural influence isthought to be one of the reasons people from some Asian cultureshave a lower risk of heart disease. What cultural influences do youthink influence your health? Hereditary “My grandfather had Alzheimer’s disease.”Social “My friends and I would rather play video gamestogether than play sports.”Cultural “My father makes the best shrimp with lemongrass.” Environmental “The air is so fresh in the country. I’m gladwe moved here.”Many factors influence your health, including hereditary, social, cultural,and environmental influences. Copyright © by Holt, Rineh art and Winston. All rights reserved. SECTION 2 Health and Wellness 15Environmental Influences Your surroundings, the area where you live, and all the things you have contact with are part of your environment. Pollutants, safety regulations, and the availability anduse of medical care are aspects of your environment that affect yourhealth. The government enforces air- and water-quality regulations tokeep your environment free from pollutants. The government alsomaintains safety regulations, such as traffic laws, to keep you safe. Taking Charge of Your Wellness Three ways you can take charge of your health are through yourknowledge, through your lifestyle, and through your attitude. Knowledge An important way to improve your health is through your knowledge. is the knowledge of health informa-tion needed to make good choices about your health. Studyinghealth in school will certainly increase your health literacy. However,it’s important to keep up with current health issues. Your parents,teachers, healthcare providers, and library are great resources forhealth information. They can also lead you to other resources forhealth information. Lifestyle One of the most important ways to improve your health is to make behavioral changes in your lifestyle. Putting your knowl-edge into action is a sure way to take charge of your wellness. Unfortunately, most people don’t always behave in a way that shows they know what is healthy. For example, most smokers knowthat smoking cigarettes can lead to lung cancer, but they still smoke. Table 2 shows some examples of consequences that can happen when health behavior doesn’t follow health knowledge. Some ways you canput your health knowledge into action are to exercise regularly, alwayswear a seat belt, and eat healthy and nutritious foods. Health literacy Health knowledge knowing the consequences ofyour behavior on your health Example 1 >Steven knows that eating junk food can make him overweightand may lead to heart diseaselater in life. Example 2 >Karen knows she needs enough sleep to stay healthy. Health behaviortaking action that affects your health,either negatively or positively >Steven eats candy bars and chips and drinks soda almost every day. >Karen doesn’t plan her studyingwell and stays up late all weekcramming for final exams.Consequencesfacing the effect of your behavior on your health >Steven starts putting on weight which increases his risk for dia-betes and heart disease. >Karen does poorly on her exams,gets sick, and misses the juniorprom.Table 2 Health Knowledge Versus Health Behavior Copyright © by Holt, Rinehart and Winston. All rights reserved. 16 CHAPTER 1 Leading a Healthy LifeAttitude A person’s way of thinking, or attitude, greatly affects that person’s health. By changing your attitude, you can act in ways that work to make you a healthier person. For example, you could try tochange your attitude toward stress. You can try to relax and stop let-ting the “little things” bother you. If you can keep stress from affect-ing you, you will find that you feel better mentally and physically.You can also try to change your attitude about anger. Don’t get soworked up about things you can’t control! Your attitude can also help you make the best of a bad situation. People who have suffered through a long-term illness have benefitedby having a positive attitude. People with positive attitudes are morehopeful and will strive harder to overcome illness. Having a positiveattitude can be critical when overcoming an illness. Perhaps the most important attitude you can change is the way you feel about yourself. To achieve wellness, you have to feel goodabout yourself, or have positive self-esteem. Self-esteem is a person’s confidence, pride, and self-respect. You can be free from disease, bephysically active, have a healthy diet, and have many supportive rela-tionships. However, if you don’t feel good about yourself, you willnever be truly healthy. Eventually, low self-esteem can affect yourhealth and actually make you physically ill. As a result, it is importantto build a healthy self-esteem. Taking charge of your wellness will help you lead a healthy life. Leading a healthy life is about balancing the six components ofhealth. Getting the best out of each component of health has a lot todo with the choices you make and the actions you take. The goodnews is that you have the power to make the right choices and live lifeto its fullest! REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term health. 2.Identify the term for “a strong belief or ideal.” 3.Define the term wellness. 4.Identify the term for “knowledge of health infor- mation needed to make good choices about your health.” Understanding Key Ideas 5.Describe each of the six components of health. 6.Identify the health component that involves work- ing on the quality of your relationships with others. a.mental health c.emotional health b.social health d.environmental health7.Describe the importance of striving for wellness. 8.Discuss each of the four influences on your wellness. 9.Describe how your attitude can help you take charge of your health. Critical Thinking 10. Practicing Wellness State two ways you can improve two components of your health. 11.Describe how your family members influence andpromote health in your family. LIFE LIFE SKILL“Health knowledge is useless without positive health behavior. You must put what you know into action for it to work!” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Health in Your Community 17Health in Your Community SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Three years ago, Maureen’s mother was so sick from diabetes that she had to be hospitalized. Thanks to new developments inmedicine, she’s feeling better than she has in years. Maureen’s mother is now more free to do the things she loves. Four Ways Society Addresses Health Problems Everyone has the responsibility of taking care of his or her health. However, many health problems need to be tackled by the coopera-tion and experience of many people. is the practice ofprotecting and improving the health of people in a community. Our community is able to promote and protect the health of peo- ple in many ways. F our ways in which our community addresses health problems are through medical advances, technology, publicpolicy, and education. 1. Medical advances Conducting medical research is one way our society addresses health concerns. One medical advancementthat came about through medical research was the developmentof the insulin pump. The implanted insulin pump is being developed for people with a certain type of diabetes. Diabetes is a serious disease in which the body is not able to obtain glucose (better known assugar ) from the blood. Diabetes kills tens of thousands of people every year in the United States. People who live with diabetesmust constantly manage the levels of glucose in their blood-stream. To do so, diabetics must monitor their diet, exercise regu-larly, and, in many cases, receive daily insulin shots. The surgically implanted insulin pump is being developed to replace the need for daily insulin shots. A microchip embedded inthe pump makes monitoring and controling blood-sugar levelspossible. If a diabetic’s blood-sugar level is low, the pump willrelease insulin. With the insulin pump, the diabetic will no longerneed daily insulin shots and can easily manage blood-sugar levels.Public healthOBJECTIVES Describe four ways society addresses health problems. Listthree ways you can promote an issue to improve the health of others. LIFE LIFE SKILLKEY TERMSKEY TERMS public health the practice of protecting and improving the health of people in a community advocate to speak or argue in favor of something public service announcement (PSA) a message created to educate people about an issue Medical advances and technology have saved lives and helped people recoverfrom many diseases. For more information about public health, see the Express Lesson on p. 552 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 18 CHAPTER 1 Leading a Healthy Life2. Technology Another way in which our society works to solve health problems is through technology. Through the use of com- puters, lasers, and other revolutionary technologies, new and bet-ter products have been made to help people lead healthier lives. One example of a product made through the use of technol- ogy is the glucose meter, such as the one shown in Figure 4. The glucose meter was designed to let diabetics know their blood-sugar level by requiring only a very small amount of blood. Theglucose meter makes monitoring blood-sugar levels easier. 3. Public policy Governmental policies and regulations can also help to address health problems. Tobacco regulation is one waythat laws can help prevent disease. Examples of these laws areplacing taxes on cigarettes, enforcing an age limit to buy tobaccoproducts, and limiting how tobacco companies can advertise.These laws are aimed at trying to keep people from smoking.Smoking can cause diseases such as lung cancer. Congress can also pass laws that provide tax dollars for research on diseases. This money helps fund the development ofproducts such as the glucose meter. The money also helps advancemedical research, such as surgically implanting insulin pumps. 4. Education Health education has been a key factor in the preven- tion of disease and illness in this country. For example, moststates require that students take some form of health class.Health teachers teach students about the benefits of exercisingand eating nutritious foods. Health teachers also discuss the risksof smoking, drinking, and behaving violently. In addition, many community agencies provide health educa- tion. For example, the American Diabetes Association teaches thepublic about diabetes and ways to prevent it. Society has worked in many ways to address health problems such asdiabetes. ACTIVITY Can you think of how another health problem has been addressed for one of these four ways?4 Figure Medical Advances Doctors are developing insulin pumps that can besurgically implanted tomake managing blood-sugar levels easier.Technology Glucose meters indicateblood-sugar levels fordiabetics.Public Policy Congress passes lawsthat provide funds forresearch on diseasessuch as diabetes.Education School health classesteach students how todecrease their risk ofdeveloping diabetes. www.scilinks.org/health Topic: Diabetes HealthLinks code: HH4041 Copyright © by Holt, Rinehart and Winston. All rights reserved. What You Can Do Many people have improved the health of others by speaking out and promoting health issues. To speak out or argue in favor ofsomething is to You may know of people in your commu-nity who work tirelessly to promote health issues. Maybe they helptake hot meals to elderly people in their homes. Or perhaps theyorganize rallies to promote certain health issues. Others may workin a health field. You Can Be an Advocate! Although few people devote their lives to being advocates, we all have the potential to better our ownwellness as well as the wellness of others. For example, you could vol-unteer at a local health clinic or public agency. You could becomeinvolved at school in addressing health issues important to teens.You could serve as an example to others by practicing your besthealth behaviors. You can even be an advocate by training for a careerin a health field!advocate. real life Activity LIFE LIFE SKILL Communicating Effectively SPEAK OUT! ✔magazines ✔scissors ✔colored paper ✔poster board ✔glue ✔markers 1.Choose a health issue in your school or community that you would like to address by supporting others in makingpositive health choices. 2.Think about the message you want to communicate and the audience you want to receiveyour message.ProcedureMaterials3.Cutout magazine pictures that can help you express your health message. 4.Use magazine pictures, colored paper, poster board, glue andmarkers to create a poster thatexpresses your message. 1.Summarizing Results What was the main health message of your poster? 2.Evaluating Information What technique or style did you use to make your health messagestand out? 3.Predicting Outcomes How do you think the audience youwant to send your message towill respond to your poster?Conclusions4.CRITICAL THINKING Using other methods, such as the Internet or a video camera, howwould you communicate yourhealth message differently? For more information about health careers, see the Reference Guide on p. 632 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 20 CHAPTER 1 Leading a Healthy LifeGetting Your Point Across One way to reach many people about health

issues is through a public service announcement. A is a message created to educate people about an issue. Most PSAs are in the form of a commercial that you hear on the radio or on television. You can also create a PSA in other forms.For example, you can publish an essay in the school newspaper. Youcould also create posters and post them around your school. There are several things you should think about when choosing the way to communicate your message: >Make sure you have the most current and accurate information. Be sure to research your topic. Ask a family member or teacherabout an organization that specializes in your topic. Your par-ents can also help you find information on the Internet. >Know your audience. To whom are you trying to send your message? How do you think your audience will respond toyour message? Some issues bring up strong feelings and opin-ions in people. The success of your message can depend onhow sensitive you are to these feelings and opinions. For example, how would you get your best friend to stop smoking? How would she react if you told her that she should quit because herclothes smell and her breath stinks? Your comments likely wouldn’tconvince her to quit. However, what would happen if you recom-mended a technique that would make it easier for her to quit? Youcould offer to buy her favorite CD as she reaches a specific goal. Youcould also suggest that her doctor may have some advice about how toquit smoking. In this way, you are using your health knowledge andshowing your friend that you care about her. Advocating for your health and others’ health is one of the most important things you can do in your life. Being well informed aboutyour health, knowing how you feel about yourself, and making aneffort to maintain a healthy lifestyle are the foundations for your and others’ wellness.service announcement (PSA)public REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term public health . 2.Identify the term for “a message created to edu- cate people about an issue.” Understanding Key Ideas 3.Listfour ways society addresses health issues. 4.Identify the way in which society teaches others to live healthy lives. a.medical advances c.technology b.education d.public policy5.Identify which of the following areas addresses community health through governmental decisions. a.public policy c.technology b.medical advances d.education Critical Thinking 6. Communicating Effectively Describe why good communication skills are important for advocating a health issue. 7. Practicing Wellness List three ways you can communicate a health issue to yourcommunity.LIFE LIFE SKILLLIFE LIFE SKILL“Our mother survived cancer. Now, we’re helping others with cancer and having fun!” Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 1 Highlights 21 CHAP TER 1 CHAP TER 1 CHAPTER 1Highlights Key Terms The Big Picture ✔In the past, deaths were caused mainly by infectious diseases. Today, most health problems are related to the way we live,or our lifestyle. ✔All health problems have risk factors. You have the power tochange controllable risk factors. ✔The major cause of death for adults over the age of 65 isheart disease. The major cause of death for adults between19 and 65 years of age is cancer. The major causes of deathfor teens are motor vehicle accidents, homicide, suicide, andother accidents. The major cause of death for children andinfants is motor vehicle accidents. ✔The six types of behavior that lead to health problems forteens are sedentary lifestyle, alcohol and drug use, sexualactivity, behaviors that result in unintentional and intentionalinjuries, tobacco use, and poor eating habits. SECTION 1 lifestyle disease (6) risk factor (7) sedentary (9) ✔Society addresses health problems in four ways: medicaladvances, technology, public policy, and education. ✔Everyone has the power to try to improve the wellness ofothers. ✔Public service announcements are an effective way to advo-cate for a health issue. ✔Communication skills are very important when you advocatefor a health issue.SECTION 3 public health (17) advocate (19) public service announcement (PSA) (20) ✔Health is the state of well-being in which all of the components of health—physical, emotional, social, mental, spiritual, andenvironmental—are in balance. ✔Wellness is the achievement of your best in all of the compo-nents of health. ✔The four influences on your wellness are hereditary, social,cultural, and environmental influences. ✔You can take charge of your wellness through your lifestyle,through your attitude, and through your knowledge.SECTION 2 health (11) value (13) wellness (13) health literacy (15) Copyright © by Holt, Rinehart and Winston. All rights rese rved. 22 CHAPTER 1 Review CHAP TER 1 CHAP TER 1 CHAPTER 1Review Using Key Terms advocate (19) risk factor (7) health (11) sedentary (9) health literacy (15) value (13) lifestyle disease (6) wellness (13) public health (17) public service announcement (PSA) (20) 1.For each definition below, choose the key term that best matches the definition. a.the practice of protecting and improving thehealth of people in a community b.a message created to educate people about anissue c.the achievement of a person’s best in all sixcomponents of health d.a strong belief or ideal e.not taking part in physical activity on a regularbasis f.anything that increases the likelihood ofinjury, disease, or other health problem g.knowledge of health information needed tomake good choices about your health 2.Explain the relationship between the key terms ineach of the following pairs. a.health andlifestlyle disease b.advocate and public service announcement Understanding Key Ideas Section 1 3.How have the causes of health problems changedfrom the past to today? 4.Heart disease is an example of which type ofdisease: infectious or lifestyle? 5.Which of the following is a controllable risk fac-tor? a.race c.gender b.age d.exercise 6.Which of the following is nota common cause of death for your age group? a.heart disease b.motor vehicle accidents c.suicide d.homicide7.Describe how a sedentary lifestyle can lead tohealth problems. 8.Driving without a seat belt is an example ofwhich of the six health risk behaviors? 9.Describe how the risk behavior tobacco use canlead to health problems. 10.CRITICAL THINKING What are some behaviors you can practice now that will improve yourchances of living a long, healthy life? Section 2 11.Which component of health involves avoidingdrugs and alcohol? 12.The ability to cope with the demands of daily lifeis part of which component of health? 13.Describe how you can reach higher levels on thewellness continuum. 14.Give an example for how each of the followingfactors influences your wellness. a.heredity c.society b.culture d.the environment 15.Describe how you can take charge of your well-ness through your attitude. 16.CRITICAL THINKING Describe how you can use health knowledge to improve the physical com-ponent of your health. Section 3 17.Which of the following is notan example of how society addresses health problems? a.education c.smoking b.public policy d.medical advances 18.Explain why it’s important to know your audi-ence when you advocate for better health. 19.Why is it important to have the most current andaccurate information when you advocate for ahealth issue? 20.CRITICAL THINKING Describe how technology has improved your health and the health of othersin the world.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 1 Review 23Understanding Graphics Study the figure below to answer the questions that follow. 21.What is the motor vehicle death rate for your age group? 22.Which age group has the highest motor vehicledeath rate? 23.CRITICAL THINKING Why do you think the age group that you answered in item 22 has the high-est motor vehicle death rate?Activities 24. Health and Your Community Interview a person over the age of 70 to find outwhat health problems were most common duringhis or her teenage years. Prepare a one-page reportcomparing what you learned in the interview withwhat you learned in this chapter about healthproblems facing teens today. 25. Health and You For 1 week, keep a diary of everything that influences your well-ness. Separate the influences into four categories:hereditary, social, cultural, and environmental. 26. Health and Your Community Collect newspaper or magazine pictures that show healthful behav-iors and harmful behaviors. Glue these pictureson a poster board. Show your poster to the class,and discuss how advertisements can influenceyour health choices. Action Plan 27. Practicing Wellness Create a personal health plan that improves or promotes each ofthe six components of health.LIFE LIFE SKILL 28.In this passage, the word lethargic means Ahungry. Bexcited. Clacking in energy. Dbored. 29.What can you infer from reading this passage? EKent’s health behavior does not reflect hishealth knowledge. FKent has an infectious disease that is makinghim sick. GKent needs more sleep each night. Hnone of the above 30.Explain what may happen to Kent’s energy level ifKent starts exercising at least three times a week. 31.Write a paragraph describing how Kent canchange his daily routine to find more time to exercise.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Kent knows that there are many benefits to exercising regularly. He knows that regularexercise makes him feel as if he has moreenergy. He also knows that it will help himmaintain his weight. However, Kent can’tremember the last time he exercised. Kentprefers to play video games after school.After he gets bored playing video games,he usually watches some TV. When Kentput his jeans on this morning, he noticedthey were tight. Today, he was feeling toolethargic to pay attention in math class. Kent couldn’t understand why he was sotired if he slept 9 hours last night. He feltthat he was getting sick.30 25201510 50 Age (years)Deaths per 100,000 people U.S. Motor Vehicle–Related Death Rates, 1998 10–14 15–24 25–34 35–44 45–54 Source: Centers for Disease Control and PreventionWRITING SKILL WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 2 CHAP TER 2 CHAPTER 2 Skills for a Healthy LifeSkills for a Healthy LifeSkills for a Healthy Life 24BEHAVIOR Indicate how frequently you engage in each of the following behaviors (1 = never; 2 = occasionally; 3 =most of the time; 4 = all of the time). Total yourpoints, and then turn to p. 642. 1.I review all of my choices before I make a decision. 2.I think about the outcome for each possiblechoice. 3.I make decisions that support my beliefs. 4.I think about the decisions I make afterwardso that I can learn from them. 5.I stop to think about who might be affected bythe decisions I make. 6.I usually ask for advice when I have a toughdecision to make. 7.If I make a bad decision, I try to correct anyproblem my decision caused. Copyright © by Holt, Rinehart and Winston. All rights reserved. 25SECTION 1 Building Life Skills SECTION 2 Making GREATDecisions SECTION 3 Resisting Pressurefrom Others SECTION 4 Setting HealthyGoals go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH02. Copyright © by Holt, Rinehart and Winston. All rights reserved. 26 CHAPTER 2 Skills for a Healthy LifeAmin has been so frustrated. He argues with his dad every day. His allergies are driving him crazy, and he doesn’t knowwhich medicine to buy. What’s worse is that the class bully has been following him around school. Amin knows things need toget better, but he isn’t sure where to begin. What Are Life Skills? Like Amin, everybody wants to enjoy the benefits of a healthy life. Weall want to be free from sickness. We want to feel good about who weare. However, having a healthy life doesn’t come without effort. Just like you need skills to build a house, you need skills to build a happy, healthy life. Building a house is not an easy task. Alot of hard work is required, and you need the right tools, such as ahammer, nails, and wood. You need tools for building a healthylife, too. These tools for building a healthy life are called Life skills will help you improve the six components of health: physical, emotional, social, mental, spiritual, and environmental. Forexample, one life skill can improve your social component of healthby teaching you how to communicate more effectively. Another lifeskill can help your emotional health by suggesting ways to deal withdifficult times, such as the death of a family member. Some life skills can affect all components of your health. For example, one life skill provides suggestions for making good deci-sions. From the foods you choose to the friends you choose, the deci-sions you make can affect every component of your health. Learning to use life skills will boost your wellness throughout your lifetime. However, using life skills takes practice. Just as an ex-perienced builder makes a better house, you can practice life skills tobuild a healthier life!life skills.Building Life SkillsSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES State the importance of practicing life skills for lifelong wellness. List10 life skills that you need for a healthy life. Predict how you can use each of the 10 life skills in your daily life. LIFE LIFE SKILLKEY TERMSKEY TERMS life skill a tool for building a healthy life coping dealing with problems and troubles in an effective way consumer a person who buys products or servicesmedia all public forms of communication, such as TV, radio, newspaper, the Internet, and advertisements resource something that you can use to help achieve a goal Just like you need skills to build a house, you also need skills to build ahappy, healthy life. Copyright © by Holt, Rinehart and Winston. All rights reserved. Practicing wellnessPracticingwellnessAssessing your healthAssessing your health UsingrefusalskillsUsingrefusalskillsSettinggoalsSettinggoals CopingCopingCommunicatingeffectivelyCommunicatingeffectively UsingcommunityresourcesUsingcommunityresources EvaluatingmediamessagesEvaluatingmediamessagesBeing a wiseconsumerBeing a wiseconsumerMakingGREATdecisionsMakingGREATdecisions LIFE LIFE SKILLS SECTION 1 Building Life Skills 27Ten Life Skills Figure 1 lists 10 life skills that can help you lead a healthy life. You will find these life skills throughout this textbook. The life skills are iden- tified by this icon: 1. Assessing Your Health How healthy are you? How do you know if you are doing the right thing for your health? This lifeskill will help you evaluate your health. It will also help you to evalu-ate how your actions and behaviors affect your health. This willenable you to find out what you need to do to improve your health! 2. Communicating Effectively Have you ever had trouble dealing with a classmate or your parents? Have you ever struggledfor the right word to say how you feel? This life skill will teachyou good communication skills, which include knowing how tolisten and speak effectively. These skills will help improve yourrelationships with your family, friends, classmates, teachers, andother adults. 3. Practicing Wellness This life skill will show you how to practice healthy behaviors daily so that you can have good life-long health. Examples of healthy behaviors you may practice aregetting enough sleep, choosing nutritious foods, and avoidingrisky behaviors. 4. Coping Dealing with troubles or problems in an effec- tive way is referred to as This life skill will help you dealwith difficult times and situations and with emotions such asanger, depression, and loss of a loved one. 5. Being a Wise Consumer A is a person who buys products (such as food, CDs, or clothing) or services (such asconsumer LIFE LIFE SKILLcoping.LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL Practicing these 10 life skills will help you lead a healthy life.1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 28 CHAPTER 2 Skills for a Healthy Lifemedical care or auto repair). Therefore, you are a consumer! This life skill will help you make good decisions when buying healthproducts and services. It will show you how to decide what isappropriate for your health. 6. Evaluating Media Messages Public forms of commu- nication, such as TV, radio, movies, newspaper, the Internet, andadvertisements are referred to as the The media have a sig-nificant influence on what you learn about the world. This lifeskill will give you the tools to analyze media messages. Knowinghow to analyze media messages will help you make better deci-sions about your health. 7. Using Community Resources A is something that you can use to help achieve a goal. For example, health clinics,libraries, and government agencies are all community resources.Every community has a wealth of services that provide help for allsix components of health. This life skill will help you find theseservices and will describe how they can assist you. The following three life skills will be described in more detail in the next three sections of this chapter. 8. Making GREAT Decisions Everyone wants to make the right decisions for themselves. This life skill will provide you withsteps to help you do just that. Section 2 of this chapter will dis-cuss these steps in more detail. 9. Using Refusal Skills This life skill will provide you with different ways you can say “no” to something you do notwant to do. Section 3 of this chapter will describe refusal skills inmore detail. 10. Setting Goals This life skill will provide you with tips to help you reach your goals. Section 4 of this chapter will discussthese tips on setting goals in more detail.LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLresource LIFE LIFE SKILLmedia.LIFE LIFE SKILL REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term coping. 2.Identify the term for “a person who buys products and services.” 3.Identify the term for “something that you can use to help achieve a goal.” Understanding Key Ideas 4.Summarize the importance of practicing life skills for lifelong wellness. 5.Name the life skill that teaches you good listening skills.6.Identify the life skill that helps you make good deci- sions when buying health products or services. a.Coping c.Assessing Your Health b.Practicing Wellness d.Being a Wise Consumer 7.Name the life skill that will help you say no to something you don’t want to do. Critical Thinking 8. Practicing Wellness Choose three life skills. Then, describe how you can apply each of these life skills in your life. LIFE LIFE SKILLThe average number of advertisements a person sees in 1 day is 3,000. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Making GREAT Decisions 29 Making GREAT DecisionsSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 On her way to school, Sina was daydreaming about Marty, the cute senior she met yesterday. To her surprise, he pulled upin his car with his friends. Marty and his friends were plan- ning to skip school and wanted her to come along. Sina froze as shequickly tried to decide what she should do. Importance of Making Decisions How many decisions have you made today? You’ve probably mademore decisions than you even realize. Every day, people make deci-sions about what clothes to wear, what to eat, what channel to watchon TV, and whether to press the snooze button on the alarm clockagain. These decisions often happen on the spur of themoment. You may even make these decisions without eventhinking about them. Making snap decisions without really thinking about them is alright for the easy things. But if you make impul-sive decisions all of the time, you may run into some nega-tive consequences. are the results of youractions and decisions. Sexually transmitted diseases, preg-nancy, tobacco and alcohol addiction, overdoses, and caraccidents are examples of negative consequences thatmany teens have faced because they made fast decisions. Making decisions is important because you are respon- sible for the consequences of your decisions. The decisionsyou make not only affect your health but also can affectthe health of others. For example, choosing to drink anddrive not only puts the driver in danger but also puts every-one on the road in danger. Your decisions can also promote the health of your family and the health of your community. For example, youcan start a recycling project with your family. You can alsostart a neighborhood watch program in your community. ConsequencesOBJECTIVES Describe the importance of making decisions. Summarize what you should do if you make a wrong decision. Apply the Making GREAT Decisions model to make a decision. Describe a time when you worked with someone else to make a decision. LIFE LIFE SKILLLIFE LIFE SKILLKEY TERMSKEY TERMS consequence a result of your actions and decisions collaborate to work together with one or more people Deciding not to take part in risky behavior will protect you from negativeconsequences. Copyright © by Holt, Rinehart and Winston. All rights reserved. 30 CHAPTER 2 Skills for a Healthy LifeUsing the Making GREAT Decisions Model How many times have you made a decision that you regretted later? This is where the life skill for makingGREAT decisions can help you by providing a decision-making model. The Making GREAT Decisions model isuseful because it requires you to think about the choicesand the consequences before making a decision. If youlearn how to use the decision-making model, you are morelikely to make decisions that have positive consequences. The steps of the Making GREAT Decisions model are listed in Figure 2. Notice that each step uses the first letter of the word great . Let’s use the model for the decision Sina was facing at the beginning of this section. Recall that Sinahas just been asked to skip school with Marty. GIVE Thought to the Problem If Sina doesn’t stop to think about the decision, she might do something she regrets. Therefore,Sina pauses before giving Marty an impulsive answer. REVIEW Your Choices At first glance, you might say that Sina has two choices. One choice is skip school and get into the car withMarty. Another choice is to tell Marty, “No, thanks,” and keep walk-ing to school. Are those two choices the only ones that Sina has? Canyou think of any others? Why is Sina tempted to skip school withMarty in the first place? She probably likes him. Maybe she can sug-gest that they get together at another time. EVALUATE the Consequences of Each Choice In this step, Sina weighs the pros and cons of each possible choice. If Sina skipsschool, she could get caught and could be suspended from school. Ifher parents found out, she would be grounded. These consequenceswould be the short-term consequences. Sina could also face long-term consequences. These conse- quences would affect her years from now. Sina thinks that she spotteda six-pack of beer in the back seat. What would happen if she were inthe car and they were arrested? She could have an arrest on herrecord. Or they could get into an accident! What if Sina follows her second choice—not to get into the car with Marty but to keep walking to school? If she makes this decision,she will not face any serious consequences. But she will miss a chanceto be with Marty. What if she follows her third choice—to turn down Marty’s offer but to suggest that they get together another time? Sina won’t get intotrouble for skipping school. Also, she won’t risk getting into a car withpeople who drink and drive. Wait a minute. If Marty drinks and drivesand skips school now, is he likely to do so again? If Sina gets togetherwith Marty, might she find herself in this situation in the future? Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING The Making GREAT Decisions model will help you make great decisions. ACTIVITY Use the steps of the Making GREAT Decisions model for a decision you need to make today.2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Making GREAT Decisions 31ASSESS and Choose the Best Choice During this step, Sina makes her choice. She decides which choice best reflects her val- ues. You may recall that a value is a strong belief or ideal. For exam-ple, honesty is one of Sina’s values. Values have a big effect on yourdecision making. If you make a decision that goes against your val-ues, you will feel bad about the decision later. Respecting your valuesis respecting yourself. Sina

chose not to skip school with Marty. She also did not offer to get together with him later. Lying to her teachers and parents abouther whereabouts went against her values. She would face too manynegative consequences for skipping school. Going straight to schoolwas a lot less stressful. Sina politely told Marty, “No, thanks.” THINK It Over Afterward Sina thought about her decision. She was glad she didn’t have to lie to her parents. She was also glad that shedidn’t have to worry about getting in trouble. Making GREAT Decisions Together You will likely face situations in which you are not sure what the rightdecision is. These decisions generally affect your life and health sig-nificantly. For this reason, you may feel more pressured to make theright decision. When you have to make difficult decisions, seekingadvice from your friends, teachers, and parents can be very helpful.They might see a positive or negative consequence that you didn’t.They can also support you when you need to make an unpopulardecision. Sometimes, we don’t realize how our decisions affect others. For example, if you decide to baby-sit when you feel sick, you might passthe sickness on to the baby. These are the decisions about which youprobably would want to ask for advice. For some decisions, you may need more than just advice. Many decisions require you to collabo-rate with others. To is to work togetherwith one or more people. For example, working ona science project with your classmate requires youto collaborate. Some collaborations are more seri-ous. For example, you discover your friend hasbeen talking about suicide. You need to collabo-rate with your parents to find out how to help yourfriend. No matter how serious the situation is,learning to work with others helps you find theright solution. As you get older you will find that skills in col- laborative decision making will be very useful. Youwill use these skills to make decisions with co-workers at your current or future jobs. You willalso use collaborative decision making skills withthe family you will form. Learning these skills nowwill help you make better decisions in the future. collaborateCollaborating with parents can help you make GREAT decisions. Copyright © by Holt, Rinehart and Winston. All rights reserved. 32 CHAPTER 2 Skills for a Healthy LifeEveryone Makes Mistakes What happens if you find you made a poor decision? It is possible, even likely—even after practicing your decision-making skills!Sometimes, the consequences of wrong decisions are embarrassingor humiliating. Everybody has had that kind of experience. Some-times, however, wrong decisions can be dangerous to you and to thepeople around you. These kinds of decisions need to be dealt with assoon as possible. Stop, Think, and Go If you made a poor decision, you can use the Stop, Think, and Go process to correct the problem. The Stop,Think, and Go process uses the following steps: >STOP First, stop and admit that you made a poor decision. When you admit that you made a wrong decision, you takeresponsibility for what you’ve done. >THINK Then, think about to whom you can talk about the problem. Usually, a parent, teacher, school counselor, or closefriend can help you. Tell whomever you choose about your deci-sion and its consequences. Discuss ways to correct the situation. >GOFinally, go and do your best to correct the situation. Maybe you simply need to leave the situation you are in. Youmay have to tell someone about an unsafe situation. You mayhave to apologize to someone you hurt. In any case, you havehad the opportunity to learn from your mistake. Admitting that you have made the wrong decision is not always easy. You might risk getting in trouble with your parents or teachers.You might make your friends angry. In the long run, though, you’llfeel better. You will know that you adhered to your values and tried todo the right thing. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “a result of your actions and decisions.” 2.Define the term collaborate. Understanding Key Ideas 3.Describe the importance of making decisions. 4.Identify the step that is nota part of the Making GREAT Decisions model. a.Review your choices. b.Assess and choose the best choice. c.Think it over afterward. d.Think quickly.5.Summarize why it is important to think about deci- sions you make afterward. 6.Describe what you can do if you make a wrong decision. Critical Thinking 7. Making GREAT Decisions Apply the Making GREAT Decisions model to a situation in which you need to make a decision. 8. Making GREAT Decisions Describe a time when you worked effectively with someoneelse to make a decision. LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Resisting Pressure from Others 33Resisting Pressure from Others SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Here, take this! Don’t say anything or I’ll say it was your idea!” Maiyen’s friend Jeff stuffed candy that he was planning tosteal into Maiyen’s pocket. At that moment, Maiyen’s uncle came out from behind the store counter. “Maiyen! How’s your dad?” Who Influences You? What style of clothes do you wear? What kind of hairstyle do youhave? Your behaviors and decisions are often influenced by many peo-ple. For example, your friends can influence you through peer pres-sure. is a feeling that you should do something becausethat is what your friends want. Your family can also influence yourbehaviors and decisions. Even the media (movies, TV, books, maga-zines, newspapers, the Internet, and radio) influence the decisionsyou make every day. These influences can be positive or negative. Positive Influences Having positive role models and being influ- enced to improve yourself can be good. For example, let’s say thatyour closest friends are joining the track team. You decide to join theteam, too, to spend more time with your friends. Running around thetrack improves your physical health, doesn’t it? Negative Influences On the other hand, being pressured to do something that you don’t want to do is not healthy. For example,Maiyen is being pressured to steal from her uncle’s store. The conse- quences of negative pressure can be serious. Some pressures can belife threatening. Examples of pressures that can threaten your lifeinclude smoking, drinking alcohol, and using drugs. These pressuresoften come from your own friends.Peer pressureOBJECTIVES State the people and groups that influence our behavior. Identify three types of direct pressure. Identify three types of indirect pressure. State an example of each of the 12 types of refusal skills. Apply one of the refusal skills to a pressure in your life. LIFE LIFE SKILLKEY TERMSKEY TERMS peer pressure a feeling that you should do something because that is what your friends want direct pressure the pressure that results from someone who tries to convince you to do something you normally wouldn’t do indirect pressure the pressure that results from being swayed to do something because people you look up to are doing it refusal skill a strategy to avoid doing something you don’t want to do Everybody has felt some type of pressure from his or her friends atone time or another. “ Copyright © by Holt, Rinehart and Winston. All rights reserved. 34 CHAPTER 2 Skills for a Healthy LifeTypes of Pressure The people and groups that influence you can pressure you either directly or indirectly. These two types of pressure—direct and indi-rect—are described below. Examples of each type of pressure are givenin Table 1. Direct Pressure The pressure that results from someone who tries to convince you to do something you normally wouldn’t do is referredto as a Refer to Table 1 to determine which kind ofdirect pressure Maiyen faced. If you answered “threat,” you are correct. Indirect Pressure The pressure that results from being swayed to do something because people you look up to are doing it is referred toas Indirect pressure is much more subtle than directpressure. When you are pressured indirectly, you are not directly toldor asked to do something. However, you may still feel pushed to do it. When making a decision, make a conscious effort to determine why you are making that decision. Are you being pressured to behavein a certain way? Does this decision support your values? If yourchoice harms you or someone else in any way, you might want torethink the decision. indirect pressure.direct pressure. Direct pressure Pressure Teasing Persuasion ExplanationsPut-downsThreatsBriberyExample Your friends tease you about your clothes being out of style. You’re too tired to go to the party, but your friend says that a lot ofcool people will be there. The doctor says that your risk of heart disease increases if you donot exercise. Some kids call you a wimp because you won’t try out forthe soccer team. Your sister threatens to tell on you for failing your math test if you tellon her for getting a detention. Your parents tell you that they will give you $10 for every A youget on your report card.Indirect pressure Pressure TV RadioAdvertising Role models Popular peopleFamous peopleExample You start using phrases or slogans from your favorite TV show. A song’s lyrics encourage violent acts or criminal behavior. You buy a product because the ad says the product will solve aparticular problem for you. Your coach volunteers at a fund raiser. You donate money to the fund. You like the way a certain jacket looks on a popularperson, and you want to getone for yourself. Your hairstyle matches the hair style of a famous actress.Table 1 Types of Pressure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Resisting Pressure from Others 35Refusal Skills What happens if someone is directly pressuring you to do something that you do not want to do? There are many different ways to refuseto do something. A is a strategy to avoid doing somethingyou don’t want to do. Table 2 lists and gives examples of twelve different refusal skills. You can use one or more of these refusal skills in any situation whereyou are feeling pressured. For example, Asaf promised his dad hewould help clean out the garage on Saturday afternoon. However, hisfriend Joey wants him to ride bikes instead. Asaf has already told Joeyabout his promise to his dad, but Joey keeps pressuring him. How do you think Asaf can use the twelve refusal skills in this sit- uation? Which ones do you think Asaf should try? Can you think ofany other possible responses Asaf could use? Some of the refusal skills might be familiar to you. You might have even used a couple of them. Some refusal skills are better thanothers for certain situations. Sometimes, you have to refuse in severaldifferent ways before people will accept your answer. The moreoptions you know, the more successful you will be at refusing pres-sure. Practicing each of the refusal skills will help even more.refusal skill Refusal skill 1. Blame someone else. 2. Give a reason.3. Ignore the request or the pressure.4. Leave the situation.5. Say, “no, thanks.”6. Say no, and mean it.7. Keep saying no.8. Make a joke out of it.9. Make an excuse. 10.Suggest something else to do.11.Change the subject.12.Team up with someone.Sample response “My dad would kill me if I didn't help him.” “No, my dad said he’d pay me $20 if I helped out.”Pretend that you don’t hear them asking you. Refuse to talk about it.“I've got to get going. I’m running late.”“No, thanks. I’m not interested.”“NO, I don’t want to!”“How many times do I have to say no? Stop bugging me!”“You probably couldn’t keep up with me on a bike ride anyway.”“No, I’m not feeling well.”“Let’s go on a bike ride on Sunday instead.”“I heard Nick and Mary are dating.”“Hey David, didn’t dad say we had to do the garage or we’d be grounded?”Ask one or more people who share your values to help you in therefusal. Many voices are better than one! Table 2 Twelve Refusal Skills Copyright © by Holt, Rinehart and Winston. All rights reserved. Role-Playing Refusal Skills Drinking alcohol when under the legal drinking age is one of the most common pressures many teens face.Underage drinking has been related to car accidents,suicide, and other accidents that lead to death.Imagine that you have a couple of friends over toplay video games. Your parents went out to dinner soyou have the house to yourselves. One friend findsbeer in the refrigerator. She suggests that you andyour friends drink it. You know your parents willnotice if the beer is gone. Reread the list of refusal skills in Table 2. Apply each one of the refusal skills to the situa-tion described above, and role-play each skillwith a classmate. Using Refusal Skills Describe which refusal skill was the most effective.LIFE LIFE SKILL21 LIFE LIFE SKILL ActivityPracticing Refusal Skills When you do something again and again, you get good at it. That isn’t a surprise. You know that if you practice playing the guitar, you’llget better and better at it. If you practice working on those mathproblems, you’ll get a better grade on the exam. It’s the same thingwith refusal skills. The more you practice them, the more natural theywill sound when you actually have to use them. Practicing refusal skills can help you know what to do when you are in a “real-life” situation. If you are experienced in using refusal skills, youwill probably make better decisions. The reason is that the decisions youmake will be your own, and you will not be pressured by others. Refusal skills will be helpful for you during your entire life, not just now. Usually, when you hear about peer pressure, people aretalking about the teenage years. The truth is that throughout your lifeyou will be in situations in which you feel pressured to do things thatyou don’t want to do. For example, your boss invites you to the gameon Saturday, which happens to be the day your friends planned yourbirthday celebration. Refusal skills can help you gracefully say “no,thanks.” They will also increase your self-confidence. People willnotice your confidence and will be less likely to pressure you. Using Refusal Skills Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Resisting Pressure from Others 37Saying No with Respect When you practice refusal skills, two basic points are important to remember—always respect others, and don’t put anyone down. One reason that people feel pressured to dothings they don’t want to do is that they don’t want to seem disrespect-ful. However, you can deliver a firm no without being disrespectful.You do not have to insult someone when you are refusing to give in totheir pressure. For example, don’t call someone a loser to get the per-son off your back. That isn’t a positive way to deal with the situationand it won’t get a positive reaction either. Disagreeing with others or saying no does not mean that people will stop liking you, although it may seem so at the time. If someonegets angry with you for saying no, you should not feel as if youshould have said yes. Persistent Pressure Some people might not stop bothering you. You might have said no in 10 different w ays, and they are still push- ing you. In this case, you have to leave the situation. (If you can’tleave, find a teacher, a parent, or another trusted adult to help you.)Remember, that even if someone doesn’t respect your no, you don’thave to do what he or she is pressuring you to do. Your values andrights are important. What do you do if the person who won’t stop pushing you is your friend? You may have to ask yourself if this person is a good per-son for you to be around. Does he or she respect you and the thingsthat are important to you? If you stopped hanging around with theperson, would you have less pressure and stress in your life? Practicing refusal skills now will help you cope with difficult situations that you might face. The more you practice, the more confi-dent you will be. Before you know it, you’ll be an expert! REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term peer pressure. 2.Identify the term for “a strategy to avoid doing something that you do not want to do.” Understanding Key Ideas 3.State five things that influence our behavior. 4.Compare three types of direct pressure. 5.Compare three types of indirect pressure. 6.Identify the example of a direct pressure. a.teasing c.radio b.advertising d.popular people7.Identify the example of an indirect pressure. a.persuasion c.bribery b.TV d.threats 8.Apply five refusal skills you can use if a friend sug- gests that you skip school. 9.Describe why people feel pressured to do things that they don’t want to do. Critical Thinking 10. Practicing Wellness Use one of the 12 refusal skills to deal with a pressure you cur- rently have in your life. LIFE LIFE SKILLEven if someone doesn’t respect your NO, you don’t have to do it. Copyright © by Holt, Rinehart and Winston. All rights reserved. Setting Healthy GoalsSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 Beth’s New Year’s resolutions are to apply to colleges, get a part in the school play, and save money to buy the latest CD of her favorite band. Like most people, Beth has a long list of things she plans to do. Kinds of Goals You’ve probably been asked many times about your goals by parents,relatives, teachers, and guidance counselors. A is something thatyou work toward and hope to achieve. If you haven’t been askedabout your goals yet, just wait until you interview for a job or fill outa college application! Questions about goals usually come up atinterviews and on applications. Knowing what your goals are willhelp you answer these questions. Goals are directions for your life. Setting goals can help you stay focused so that you can reach your goals. If you set your goals for thefuture, you will have a map of where to go. Instead of driving aim-lessly around, you know where you are going and what you have todo to get there. There are two types of goals: short-term goals andlong-term goals. Short-Term Goals Goals that can be achieved quickly—in days and weeks—are called short-term goals. What is Beth’s short-termgoal? She wants to save money to buy a CD. Other examples of short-term goals that you might have are doing well on an exam or gettingup the nerve to ask someone on a date. Long-Term Goals Some goals may take months or years to achieve. Those goals are called long-term goals. If you know what youwant to be “when you grow up,” you have a long-term goal. Forexample, you may have goals of being a mechanic, traveling aroundthe world, or getting into college. Achieving long-term goals takes a lot of hard work and determi- nation. You cannot reach them overnight. In fact, some long-termgoals consist of a series of smaller, short-term goals. Setting short-term goals makes achieving the ultimate long-term goal easier. goalOBJECTIVES Differentiate between short-term goals and long-term goals. Describe six suggestions for setting goals. Develop an action plan to achieve a personal goal. LIFE LIFE SKILLKEY TERMSKEY TERMS goal something that you work toward and hope to achieve action plan a set of directions that will help you reach your goal Goals are directions for helping you achieve your dreams. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Setting Healthy Goals 39For example, Beth’s long-term goal is to be an actress. Because she knows there are many steps to reach this goal, she broke the goal into smaller goals. This year, she will apply to several colleges to study act-ing. Also, she will try out for the school play. Six Suggestions for Setting Goals Long-term goals, such as becoming an actress, may seem too hard toaccomplish. Don’t be discouraged. Remember what we said aboutgoal setting being like making a map? You are much more likely toreach your goal if you map out how to get there. Below are six sugges-tions for setting goals. To help you remember them, think of them asthe six S’s. 1. Safe The first thing to ask yourself is if this goal can harm you. For example, let’s say that you are overweight and your goal is tolose weight. Losing weight to get in shape and become healthieris a good thing, right? The question is how do you plan to lose weight? If your goal is to starve yourself until you feel sick and weak, your goal is not safe. A safe goal would be to stop eating junk food and start exercising regularly. Do you see the difference? 2. Satisfying Goals should be satisfying. You should feel good about yourself when you reach your goals. You might think, Whywouldn’t I feel good about reaching any goal that I have set? Let’ssay your goal was to do well on an exam. You did well on theexam, but you cheated. You have no satisfaction because you did-n’t reach your goal using your own effort. But if you had earnedthe grade by studying, you would have felt fantastic! 3. Sensible It’s also important that your goals, especially your short- term goals, be sensible, or realistic. For example, setting a goal tobecome fluent in a second language in a one-month period is notrealistic. This is a good long-term goal, but not a good short-termgoal. However, like Beth, you can break your long-term goals intoshort-term goals. For example, each day make a short-term goalto learn five new words in the second language. Another part of making a sensible goal is to make sure it is a goal that you can achieve. Don’t set a goal that would be impossi-ble for you to achieve. For example, let’s say you have soccer prac-tice and band practice and you are also on the yearbookcommittee. It probably wouldn’t be a sensible goal for you to runfor student council on top of all of your other responsibilities. 4. Similar The goal you set for yourself should be similar to goals you have set in the past. This means that your new goals shouldnot contradict your earlier ones. Let’s go back to the goal of los-ing weight. But now you have another goal. You want to learnhow to bake fancy desserts. Something should tell you that thesegoals might not work well together. When you have a goal to kicka bad habit, don’t create another goal that will make reaching thefirst goal difficult. Beth got the part! When setting a goal, remember the six S’s: safe, satisfying,sensible, similar, specific, and supported. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Setting Goals HealthLinks code: HH4121 40 CHAPTER 2 Skills for a Healthy Life5. Specific Good goals are specific. That is, the steps to achieve those goals are very clear. When people say they want to “be happy,” their goal is not specific. Being happy is a good thing towant to be, but is it a good goal? How do you achieve happiness?Do you plan to be happy by the time you’re 85 or by this week-end? The goal of being happy is too vague. A more specific way to approach the goal of happiness is to identify what makes you happy. Then you can spend more timedoing it. For example, let’s say that you are happiest when youare listening to music. Your goal could be to work in a musicstore. Then you could listen to music at work and get discountson CDs! 6. Supported The last thing to ask yourself when setting a goal is whether your parents or other responsible adults would supportthis goal. Most of the time, your goals are positive and would besupported by others. However, some goals might not be sup-ported. For example, let’s say you set a goal to be more successfulon your athletic team by using

steroids. Most parents would notagree with the way you chose to achieve this goal. Having your family’s support will help you reach your goal. Share with your family how you plan to reach the goal. They may have sug- gestions that can help. They also might find problems that you didn’tnotice. Staying focused on all of the benefits of achieving your goal will be yourstrongest motivation to reach yourgoal. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Setting Healthy Goals 41Make an Action Plan Now that you know six suggestions for setting goals, you can use these suggestions to check your goal. The next step is to create anaction plan. An is a set of directions that will help youreach your goal. An action plan describes the step-by-step process youwill take as you work towards your goal. An action plan also statesthe date you plan to meet the goal. You may want to record youraction plan in a notebook. Rewards Your action plan should contain suggestions that will make reaching your goal easier. One idea that helps is to make a listof rewards you will reap for reaching your goal. This list will remindyou why you are working so hard. For example, let’s return to Beth’slong-term goal of becoming an actress. What would some of Beth’srewards be? She is doing what she enjoys. She feels good about heraccomplishment. Her talent is admired and respected by other peo-ple and by other actors and actresses. If she becomes a really success-ful actress, she might even become rich and famous!action plan real life Activity “If we did all the things we are capable of, we would literally astound ourselves.” — Thomas Edison LIFE LIFE SKILL Setting Goals REACHING YOUR GOALS ✔pencil ✔notebook 1.Choose a short -term health goal for yourself. Record it in your notebook. 2.Write how your goal satisfies each of the six suggestions for setting goals. 3.Create a step-by-step action plan in your notebook. Recordeach action you will need totake. Don’t forget to record agoal date!ProcedureMaterials4.State why you want to reach this goal. 5.Write the positive and negative influences related to reaching your goal. 6.Track your progress daily. Write down each accomplishment and each setback. 1.Analyzing Methods How can you take advantage of the posi- tive influences that you listed? 2.Analyzing Methods What can you do to control or minimizethe negative influences thatyou listed?Conclusions WRITING SKILLWRITING SKILL3.Predicting Outcomes List the benefits and rewards you will gain by achieving this goal. 4.CRITICAL THINKINGDo you think this goal is realistic? Why or why not? Copyright © by Holt, Rinehart and Winston. All rights reserved. 42 CHAPTER 2 Skills for a Healthy LifeInfluences It is important to know what influences can hurt you and what influences can help you when working on your goal. For example, the six risk behaviors that are common among teens aredrug and alcohol use, sexual activity, behaviors that cause injury,poor dietary patterns, tobacco use, and sedentary lifestyle. In Beth’scase, these behaviors not only would harm Beth’s physical health butalso could keep her from reaching her goal. What would happen ifBeth used drugs? What would happen if she became pregnant beforegraduating from high school? How would her plans change? On the other hand, Beth notes the positive influences related to meeting her goal. Your family can be a significant positive influenceon your goals. For example, her parents are a big help when she prac-tices her lines. They also drive her to rehearsals and support her in theaudience on opening night. Tracking Your Progress Another important part of the action plan is to track your progress. Every week, Beth writes down what shehas accomplished and what has set her back on her road to becomingan actress. This record encourages her when she sees progress. Bethremembers how satisfying it was to write in her notebook the day shegot a part in the school play. Writing down how rehearsals have gone also helps Beth see cer- tain problems. For example, Beth has noticed that forgetting herlines during rehearsal distracts her. Beth has solved this problem byspending a few minutes reviewing her lines on the way to schooleach day! Beth also uses her notebook to see which steps she needs to pre- pare for next. Because Beth’s goal is a long-term goal, she broke itdown into smaller, short-term goals. Her next short-term goal is toapply to colleges. She looks forward to the day when she can writedown that her favorite college accepted her! REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “something that you work toward and hope to achieve.” 2.Define action plan. Understanding Key Ideas 3.Compare short-term goals and long-term goals. 4.Summarize the six suggestions for setting goals. 5.Name the suggestion for setting goals that recommends that you avoid a goal that hurts your health.6.Identify the suggestion for setting goals that rec- ommends that you choose a goal that is realistic. a.sensible c.safe b.smart d.simple 7.Listthree things you should do when making an action plan. 8.State the six risk factors that can keep you from reaching any goal. Critical Thinking 9. Setting Goals Create an action plan to achieve one of your personal goals. LIFE LIFE SKILL Achieving long-term goals requires work and determination. Making anaction plan will help you reach yourgoals. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 2 Highlights 43 CHAP TER 2 CHAP TER 2 CHAPTER 2Highlights Key Terms The Big Picture ✔You can be positively or negatively influenced by friends, family, or the media ✔Different types of direct pressures include teasing, persuasion,explanations, put-downs, threats, and bribery. ✔Different sources of indirect pressures include TV, radio, advertising,role models, popular people, and famous people. ✔A refusal skill is a strategy to avoid doing something you don’t wantto do. ✔Practicing refusal skills can help you say no to peer pressure withconfidence and respect.SECTION 3 peer pressure (33) direct pressure (34) indirect pressure (34) refusal skill (35) ✔Short-term goals can be achieved in days or weeks. Long-term goals may takemonths or years to achieve. ✔The six S’s for setting goals are safe, satisfying, sensible, similar, specific, and supported. ✔An action plan is a set of directions that canhelp you reach your goal.SECTION 4 goal (38) action plan (41) ✔Practicing life skills will help you improve your wellness throughout your life. The ten life skills are Assessing Your Health, Communicating Effectively, Practicing Wellness, Coping, Being aWise Consumer, Evaluating Media Messages, Using CommunityResources, Making GREAT Decisions, Practicing Refusal Skills, andSetting Goals. ✔You can use life skills when you buy health products, makedecisions, deal with loss, build relationships, and improve manyaspects of your health.SECTION 1 life skill (26) coping (27) consumer (27) media (28) resource (28) ✔The decisions you make affect not only your health but also otherpeople. ✔The five steps of the Making GREAT Decisions model are as fol-lows: (1) Give thought to the problem. (2) Review your choices. (3) Evaluate the consequences of each option. (4) Assess and choose the best choice. (5) Think it over afterward. ✔Learning to collaborate with others will help you make betterdecisions. ✔If you make a wrong decision, STOP and take responsibility for it.THINK about talking to a trusted adult to help you correct thesituation. GO and do your best to correct the problem.SECTION 2 consequence (29) collaborate (31) Copyright © by Holt, Rinehart and Winston. All rights reserved. 44 CHAPTER 2 Review CHAP TER 2 CHAP TER 2 CHAPTER 2Review Using Key Terms action plan (41) indirect pressure (34) collaborate (31) life skill (26) consequence (29) media (28) consumer (27) peer pressure (33) coping (27) refusal skills (35) direct pressure (34) resource (28) goal (38) 1.For each definition below, choose the key term that best matches the definition. a.all public forms of communication, such as TV, radio, newspaper, the Internet, and advertisements b.something that you can use to help achieve agoal c.to work together with one or more people d.a strategy to avoid doing something you don’twant to do e.a person who buys products or services f.a feeling that you should do somethingbecause your friends want you to g.dealing with problems and troubles in aneffective way h.a result of your actions and decisions i.a tool for building a healthy life 2.Explain the relationship between the key terms ineach of the following pairs. a.direct pressure and indirect pressure b.goal and action plan Understanding Key Ideas Section 1 3.Choose a life skill, and describe how you coulduse it effectively for long-term wellness. 4.Identify the life skill you would use to evaluatehow your actions affect your health. 5.Identify the life skill you would use to help yousay no to peer pressure. a.practicing wellness c.using refusal skills b.setting goals d.coping 6.CRITICAL THINKING Explain how you could use the Communicating Effectively life skill.Section 2 7.Why is it important to evaluate the consequencesof each option before you make a decision? 8.Identify the step in the Making GREAT Decisionsmodel in which you determine whether youmade the right decision. 9.Which of the following is nota step to take if you have made a wrong decision? a.think c.stop b.forget d.go 10.CRITICAL THINKING Write a paragraph about a decision that you made that affected other people. 11.CRITICAL THINKING Name a situation in which you would use collaborative decision-makingskills? Section 3 12.Describe how each of the following influencesaffects your behavior. a.friends c.the Internet b.family d.TV 13.Which three kinds of direct pressure do you ex-perience most often? 14.Which three kinds of indirect pressure do youexperience most often? 15.Describe a refusal skill you have used before. 16.Identify the refusal skill that requires supportfrom others. Section 4 17.What is the difference between a short-term goaland a long-term goal? 18.State an example of a short-term goal that youwould like to reach this week. 19.Which of the following suggestions for settinggoals recommends you choose a goal that willmake you feel good about yourself? a.similar c.satisfying b.specific d.safe 20.State how each of the six risk behaviors couldaffect one of your goals. LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLWRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 2 Review 45Interpreting Graphics Study the table below to answer the questions that follow. 21.Which response above is a good example of a refusal skill? 22.CRITICAL THINKING Change the bad example of a refusal skill into a good example of a refusalskill. 23.CRITICAL THINKING Use a refusal skill to fill in a response for item 3.Activities 24. Health and You Draw a map for a long-term goal you have set for yourself. Draw and label a roadto show the path you will take. Use symbols suchas rivers for challenges you expect to face. Drawand label bridges to symbolize ways to overcomethese challenges. Draw a triumphant image toshow the accomplishment of your goal. 25.Health and Your Family Write about a time when your family made a group decision on something you were going to do,such as where to go for dinner or how to spend a vacation. 26. Health and You Write about a real or imaginary situation in which you used or could use three or more of the life skills discussed in this chapter to improve your life. Action Plan 27. Setting Goals Write an action plan for a long-term goal of yours. Apply the six sugges- tions for setting goals. Break up the goal intoshort-term goals. Set a date to accomplish thelong-term goal. Determine the positive and nega-tive influences that may affect your goal. LIFE LIFE SKILL 28.In this passage, the word ambiguous means Anegative. Bnot clear. Ccomplicated. Dhopeful. 29.What can you infer from reading this passage? ESina skipped school with Marty. FMarty was pulled over by the police. GMarty had a great day with his friends. Hall of the above 30.Write a paragraph describing all of the reasonswhy Sina shouldn’t skip school with Marty.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. As Marty pulled away from the curb, he thought about Sina’s answer. He didn’t understand it. Her response was ambiguous . Marty thought that maybe she wouldn’t skip school with him and his friends becauseshe was afraid to get caught. As Martyreached for a beer, he thought it was silly tofear getting caught. He skips school all thetime. Suddenly, Marty heard sirens. Helooked up in his rearview mirror and saw apolice car behind him. Refusal Skills Pressure 1.“Everyone else is doing it.” 2.“Don’t you want toknow what it’s like?” 3.“Please, do it for me.”Response 1.“Do you have to do what everyone elsedoes?” 2.“Okay, just this once.” 3.__________________WRITING SKILL WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Self-Diagnosis and the Internet Self-diagnosis is our personal evaluation of our own health issues. We usually use self-diagnosis, forexample, when we are coming down with a cold,when we have the flu, or when we have a rash frompoison ivy. In the past, if a condition were morecomplex or more dangerous, people went to a doc-tor for a professional diagnosis. Most people still do,but today many people are turning to the Internet tofind the answers to their medical questions. Web Sites Often Have Inaccurate Information One health issue that many people go to the Inter-net to understand is skin cancer. Doctors at the Uni-versity of Michigan wanted to find out if Internetsites that provide information on skin cancer wereaccurate. What they found was quite alarming. Theirstudy revealed that most sites contained incompleteinformation and that one in eight contained wronginformation. It is important to remember that manyWeb sites lack accurate information about preven-tion, diagnosis, and treatment. Some Sites Are Not What They Claim To Be Unfortunately, some sites contain areas of self-diag-nosis simply to sell you a worthless product. Manyunscrupulous Internet merchants are simply seekingto make a lot of money in a hurry. If someone sellsyou a bracelet to cure a rash, it does more harm thanonly costing you money. If you buy the bracelet, youmay be using a useless trinket to ignore a seriouscondition. Such bogus sites often spring up on theInternet and then disappear just as quickly. Othersites mean well but offer cures that have not beenfully tested. The people behind these sites may haveyour best interest at heart, but their sites may nothave the objectivity of a carefully trained doctor.More and more people are using the Internet to diagnose their medical conditions. This Internet research has some benefits but has a lot of serious drawbacks, too. TECHNOLOGY HealthHealthWorldWorldHealthHealthWorldWorldHealthWorld YOURYOUR 46Copyright © by Holt, Rinehart and Winston. All rights reserved. YOUR TURN How Can the Internet Help? The Internet has many sites that offer self-diagnosis charts, tests, and evaluations. For example, if youhave a skin problem, you can go to a site, answer afew questions, and arrive at a medical conclusion. Inmany cases, such Internet sites can help you under-stand your problem. By comparing your symptomswith those listed on a site, you may figure out whatis wrong. As good as Web self-diagnosis may be, it is also filled with dangers. Self-diagnosis on the Web >is not a substitute for a doctor’s professional evaluation >may be based on information that is inaccurateor false >is often conducted on sites that want to sell yousomething or that contain highly questionablehealth practices Your Doctor Knows A doctor has been trained to look carefully for all of the evidence of a disease or disorder. In addition,your doctor is less likely to make a mistake than youare while you are sitting and worrying in front of acomputer. For example, suppose that moving the leftside of your face became difficult and you couldn’tblink your left eye. If you looked up the symptomson a computer, you might think you had Bell’s Palsy,an annoying disruption of your facial nerves. Accord-ing to the Internet, your problem will go away on its own. Your doctor, however, may ask you if you had arecent rash, had joint pain, or had been hiking. Yourdoctor knows that nerve problems in the face can bea symptom of something else. He or she will evaluateall of your symptoms and might diagnose Lyme disease and take appropriate steps. Your self-diagnosis would have prevented you from getting theantibiotics needed to combat Lyme disease. Wise Use of the Web The Internet can help you see the seriousness of asymptom or can provide additional information. Forexample, if you have already seen a doctor, you canread more about your diagnosis and can educateyourself. In addition, you can use the Internet togather information in private. But the Internet isonly one tool to support your health. Use it wiselyin addition to consulting health professionals. YOUR TURN 1. Summarizing Information What are three dangers of using Internet sites for self-diag- nosis of health issues? 2. Applying Information How has Internet technology changed self-diagnosis from theway people diagnosed themselves in thepast? 3. CRITICAL THINKING How can you deter- mine if a Web site contains medicallyaccepted information? www.scilinks.org/health Topic: Internet HealthLinks code: HH4047 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTERCHAPTER 3 CHAPTERHAPTER 3 CHAPTER 3 Self-EsteemSelf-Esteem and Mental and Mental HealthHealthSelf-EsteemSelf-Esteem and Mental and Mental HealthHealthSelf-Esteem and Mental Health 48BEHAVIOR Indicate how frequently you engage in each of the following behaviors (1 = never; 2 = occasionally;3 = most of the time; 4 = all of the time). Total yourpoints, and then turn to p. 642. 1.I praise myself when I do a good job. 2.I do what I know is right, even if others use pressure to try to stop me from doing theright thing. 3.I am confident enough to try new things, evenif I might fail at them. 4.I ask people for help if I need it. 5.I like to volunteer to help others when I can. 6.I concentrate on my strengths and work toimprove my weaknesses. Copyright © by Holt, Rinehart and Winston. All rights reserved. 49SECTION 1 Building Your Self-Esteem SECTION 2 Using GoodCommunicationSkills SECTION 3 Mental and Emotional Health SECTION 4 UnderstandingMental Disorders go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH03. Copyright © by Holt, Rinehart and Winston. All rights reserved. 50 CHAPTER 3 Self-Esteem and Mental HealthLeyla started taking ballet 3 months ago. She doesn’t dance as well as the rest of the class. The other dancers have been prac-ticing ballet much longer than Leyla has. However, Leyla loves every minute of rehearsal. She can’t wait to perform on stage. What Is Self-Esteem? is a measure of how much you value, respect, and feel confident about yourself. How you feel about yourself affects every-thing you do. It affects how you communicate with people and whatdecisions you make about your health. For example, if you feel goodabout yourself, you can more easily talk with people and share yourfeelings. However, if you don’t feel good about yourself, you mightnot have the confidence to use your refusal skills or to avoid disre-spectful people. Benefits of High Self-Esteem Below is a list of the benefits peo- ple who have high self-esteem experience. >Increased respect People with high self-esteem respect them- selves by taking care of themselves. They will not do anythingto harm themselves, such as smoking or abusing drugs andalcohol. They don’t criticize or put themselves down. Further-more, they exercise, eat right, and get plenty of rest. People with high self-esteem respect their values and beliefs. They are less likely to let others pressure them to take part inrisky behavior. Nor will they pressure others to take part inharmful behavior. >Increased ability to reach goals If you have confidence in your- self, you are more likely to set realistic goals and stick with thegoals you set for yourself until you reach those goals. Thelonger you stick with a goal and the harder you try, the betterthe chance you have at reaching it. Because people with highself-esteem are more likely to reach their goals, they are morelikely to challenge themselves to set higher goals and accom-plish more.Self-esteemBuilding Your Self-EsteemSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Define self-esteem. Listthe benefits of high self-esteem. Identify factors that influence the development of self-esteem. Describe ways you can improve your self-esteem. LIFE LIFE SKILLKEY TERMSKEY TERMS self-esteem a measure of how much you value, respect, and feel confident about yourself self-concept a measure of how you view yourselfintegrity the characteristic of doing what you know is right One characteristic of high self-esteem is not being afraid to try new things. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Building Your Self-Esteem 51>Increased willingness to try People with high self-esteem have the will to try new things and don’t get discouraged easily. For exam- ple, Leyla had the courage to try something new—ballet dancing.More important, when she found out she wasn’t as good as theothers, she didn’t give up. Instead, she kept trying her best. Shedid it for herself, not for competition. >Increased feelings of value People with high self-esteem feel like they are a valuable part of their family, school, and com-munity. They are more likely to ask for help when they need it.They are also more likely to volunteer in their communitiesbecause they know they have the power to help others. Risks of Low Self-Esteem People with low self-esteem share many characteristics as listed in Figure 1. For example, people with low self-esteem are more vulnerable to peer pressure. As a result, theyare more likely to make unhealthy decisions, such as smoking. People with low self-esteem may not be respectful to themselves or others. Those who do not feel good about themselves will oftenput themselves down. They are also more critical of others. Low self-esteem is also harmful to one’s mental health. People with low self-esteem are at risk for depression and suicide. Low self-esteem is also linked to eating disorders, running away, and violence. People with low self-esteem do not have to experience the risks of low self-esteem. Everyone has the power to choose healthy behaviorsthat show respect for others and themselves. You can’t tell if someone has high self- esteem or low self-esteem just bylooking at him or her.1 Figure High Self-Esteem >Speaks up for self >Respects self and others >Has confidence >Tries new things >Feels valuable tosociety >Adjusts to change >Feels optimistic >Makes decisionsbased on valuesLow Self-Esteem >Feels insecure >Disrespects self andothers >Vulnerable to peerpressure >Doesn’t feel valuable >Feels depressed >Fears failure >Uses drugs and alcohol >Feels pessimistic >Behaves destructively Copyright © by Holt, Rinehart and Winston. All rights reserved. 52 CHAPTER 3 Self-Esteem and Mental HealthThe Development of Self-Esteem Self-esteem begins to develop the day you are born. Across your entire life, your level of self-esteem can vary. At one time, it may behigh, and at a different time or in a different situation, it may be low. Self-Concept A measure of how one views oneself is For example, if you think of yourself as a valuable and likeable per-son, you have a positive self-concept. If you have a positive self-con-cept, you have high self-esteem. However, if you don’t think ofyourself as very likeable or valuable, you probably have a negativeself-concept and therefore, have low self-esteem. Interpreting Messages From Others How you interpret mes- sages about yourself has a lot to do with how you view yourself.These messages come from family, friends, teachers, neighbors, andeven strangers. The messages can be positive, such as “You are fun tobe around.” Messages can also be negative, such as “You always com-plain about everything.” These messages shape what you think aboutyourself. How you think about yourself shapes your self-esteem. Some negative messages can serve as good advice. Good advice on how to improve yourself is called constructive criticism . For exam- ple, if you have not been getting along well with your parents, yourbrother might recommend that you try being more cooperative withyour parents. Other negative messages can be hurtful. But your self-esteem doesn’t have to suffer. Remember that self-esteem is how you feel about yourself, not how

others feel about you or what others sayabout you. Only you have the power to control your self-esteem. self-concept. Ten Tips for Building Self-Esteem >Volunteer at a soup kitchen or other community service. >Make a list of your strengths. >Speak positively about yourselfand others. >Take care of your physical health. >Reward yourself when you do well. >Try something new. >Choose friends who support youand your positive choices. >Set a goal to improve a weakness. >Cheer yourself through hardtimes. >Have fun. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Building a Healthy Self-EsteemHealthLinks code: HH4024 SECTION 1 Building Your Self-Esteem 53Improving Your Self-Esteem Everyone can work at improving his or her self-esteem. You can improve your self-esteem by using positive self-talk, acting withintegrity, choosing supportive friends, and accepting yourself. Use Positive Self-Talk You learned that the messages you receive from others influence your self-esteem. The same is true for the mes-sages yousend to yourself. The things you say to yourself strongly influence your self-esteem. We are constantly talking to ourselves, whether we realize it or not. You may say or think things like, “My painting really looks neat!”or “I’m too stupid for this class.” The things you say about yourself canmake you feel good, or they can make you feel not so good. To practice treating yourself well, you can use a technique called self-talk . Self-talk is a way of coaching yourself about your own self- worth. Go ahead and talk to yourself. Tell yourself you can do whatyou set out to do when you set realistic goals and ask for help. Tellyourself that you are a valuable person. real life Activity LIFE LIFE SKILL Practicing Wellness SELL YOURSELF ✔poster board ✔magazines ✔markers ✔scissors ✔paste 1.Think about why you are a wonderful person. 2.Listfive reasons why you are wonderful on your poster board. 3.Think of different techniques advertisers use to sell their products. Use these techniquesProcedureMaterialsin your own advertisement to express why you are fabulous. 4.Cutout magazine clippings to help express the five reasonsyou are great. 1.Summarizing Results What are the five reasons you are great? 2.Evaluating InformationWhat technique or style did you use to make yourself stand out? 3.Analyzing MethodsDescribe why this activity may have been hard for you or easy for you.Conclusions4.CRITICAL THINKING List at least five additional reasons that you are special. Copyright © by Holt, Rinehart and Winston. All rights reserved. 54 CHAPTER 3 Self-Esteem and Mental HealthAct with Integrity The characteristic of doing what one knows is right is For example, your integrity prompts you to be honest and return the extra $10 the cashier mistakenly gave you, even if yourfriends want you to spend it on a movie with them. When you have integrity, you respect others, yourself, and your values. You don’t let people pressure you to go against what is rightand important to you. People who have low self-esteem may beunsure of themselves and can be swayed to do something they don’tfeel right about. On the other hand, people who have high self-esteem recognize when they need to stand up for their beliefs to con-tinue to respect themselves. Choose Supportive Friends It is easier for you to treat yourself well if the people you know also speak well of you. Avoid critical ordisrespectful people. Maintain friendships with people who acknowl-edge your strengths and support you in your goals and values. Accept Yourself People who have high self-esteem do not think they are perfect. They know they are not perfect. People who havehigh self-esteem accept who they are. They see all their imperfectionsand still think of themselves as valuable. People who accept themselves celebrate their strengths and concentrate on what they do well. They also strive to improve weak-nesses by setting short-term goals. However, if they can’t change aweakness, they let it go. For example, if you’re not as tall as youwould like to be, wishing and hoping won’t make you taller. How-ever, dwelling on your height may lower your self-esteem. Once you accept yourself, you’ll find that others will accept you, too. If you project a confident attitude, others will sense—and respectyou for—your confidence. You will then feel better about yourself!integrity. Until you accept who you are, you will never be happy with what you have. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term self-esteem . 2.Identify the term for “the characteristic of doing what one knows is right.” Understanding Key Ideas 3.State the positive benefits of high self-esteem. 4.Identify which of the following is nota characteris- tic of high self-esteem. a.feels valuable c.confidence b.pessimistic d.self-respect 5.Summarize the effects of low self-esteem.6.Identify factors that influence the development of self-esteem. 7.Identify which of the following is nota way to improve your self-esteem. a.using positive self-talk c.acting with integrity b.accepting yourself d.denying your faults Critical Thinking 8.Describe how respecting yourself and respecting your values can improve your self-esteem. 9. Practicing Wellness Describe three ways you can improve your self-esteem.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Using Good Communication Skills 55 Using Good Communication SkillsSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Rina was planning to have some friends over for her birthday. But her friends have been acting strange. They whisper whenthey think she isn’t looking. They pretend not to see her when she walks down the hall. No one will even return her phone calls. Good Communication Is Important Communication is a process through which two or more people exchange information. One person sends the message, and one ormore people receive it. However, if the message is not properly sentor is unclear, misunderstandings can arise. Preventing Misunderstandings Rina’s situation shows how easy it is to miscommunicate. Rina was receiving messages that madeher feel unwanted. What she found out later was almost the opposite.Rina’s friends were being secretive because they were planning a sur-prise for her birthday. Fortunately, her situation had a positive out-come; she was pleasantly surprised. However, miscommunicationcan have some negative effects such as arguments and hurt feelings. Building Healthy Relationships Communication is important for building caring and satisfying relationships with your family,friends, co-workers, and society. How you communicate with othersaffects how people relate to you. For example, if you are mean orinsult others, they probably won’t want to be around you. However,if you let people know how important they are to you, they will bemore likely to treat you the way you want to be treated. Expressing Yourself Good communication skills are also impor- tant for letting others know what you need and want. These skillsalso help you to express how you feel. Just think how difficult lifewould be if you couldn’t tell someone that you needed help.OBJECTIVES Summarize why good communication is important. Differentiate between passive, assertive, and aggressive communication styles. Name five characteristics of good listening skills. Listthree examples of body language. Listfive ways to improve your speaking skills. LIFE LIFE SKILLKEY TERMSKEY TERMS passive not offering opposition when challenged or pressured aggressive hostile and unfriendly in the way one expresses oneselfassertive direct and respectful in the way one expresses oneselfempathy the ability to understand another person’s feelings, behaviors, and attitudes Miscommunication can result in hurt feelings. Copyright © by Holt, Rinehart and Winston. All rights reserved. 56 CHAPTER 3 Self-Esteem and Mental HealthCommunication Styles There are three communication styles: passive, aggressive, and assertive. The following descriptions compare these three commu-nication styles. Passive A person who has a communication style that is does not offer opposition when challenged or pressured. Such a per-son tends to go along with what other people want and does notprotest or resist when challenged. For example, let’s say your brotherborrowed your shirt and tore it. If you had a passive response, youwould give your brother the silent treatment and then just throw yourshirt away. Aggressive To be hostile and unfriendly in the way one expresses oneself is to be For example, an aggressive response in thesame situation with your brother would be to tell him, “You are sucha jerk! Let’s see how you feel when I ruin your things!” Aggressivecommunication is not effective and usually leads to a bigger conflict. Assertive The third and most healthy communication style is the assertive style. To be is to express oneself in a direct, respectfulway. For example, you could say to your brother, “My favorite shirt isruined. I spent a lot of money on this shirt. I would like you to replaceit.” With this response, you calmly expressed to your brother how hisaction affected you. This response was also respectful to your brother,which is an important part of being assertive. Using the assertive communication style might not be easy when someone has done something that really upsets you. However, prac-ticing can help you improve. Table 1 lists more examples of passive, aggressive, and assertive communication responses. See if you canthink of some examples of your own.assertiveaggressive.passive Table 1 Communication Styles Situation Someone cuts in front of you in line. Your best friend tells someone else one of yoursecrets. Your boss asks you to work late for the thirdnight in a row.Passive response You don’t say anything. You don’t say anything, but you vow never to tellher another secret. You agree but feel wor- ried about finishing yourhomework tonight.Aggressive response “Well, you must think you’re special!” “I hate you! I’m never going to trust you again!” “You are so inconsiderate! I quit!”Assertive response “Excuse me, but I believe I’m next in line.” “It hurt me to find out you told my secret tosomeone else. Pleasedon’t repeat my secretsagain.” “Sorry, I can’t work tonight. I have a lot ofhomework do.”Use assertive communication if someone is disrespectful to you, suchas cutting in front of you in line. Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT are you doing? What ARE you doing? What are youDOING? SECTION 2 Using Good Communication Skills 57Speaking Skills Think about the way you communicate. Are there any areas that you would like to improve? Have you ever been at a loss for words? Haveyou ever been frustrated because you can’t get someone to under-stand you? Everyone has felt that way before. There are many skillsyou can learn to help you communicate better. One of the main ways we communicate is verbally. Verbal com- munication refers to the specific words and tones that we use whenwe speak. Because most of us can speak, we frequently use speech tocommunicate. You may ask yourself, what could I possibly need to learn about talking, something I’ve been doing almost my whole life? It is truethat you have a lot of practice with this type of communication.However, learning effective speaking skills can be helpful when youneed to give a speech in class. Effective speaking skills also can giveyou the confidence to discuss sensitive issues with your parents, suchas sexual activity or marriage. Voice Volume How loud or soft you are speaking is called voice volume. If someone increases how loud he or she says something, what does that increase in voice volume generally mean? You don’teven have to know what the person is saying to know that he or shemay be mad. What does it mean if someone lowers the volume ofcommunication to a whisper? That person may be either trying to tellyou a secret or trying not to get caught talking to you in class! Beaware of the voice volume you use when speaking with others. Tone and Pitch Tone of voice and pitch refer to the inflections or emphasis in your voice when you speak. Tone and pitch convey theattitude you are trying to express. For example, if your older sister says, “What are you doing?” the tone and pitch of her voice tell you that she is asking you a question.But if she says, “WHAT are you doing!” you know she is angry. If shesays, “What ARE you doing?” she sounds arrogant. She could also say,“What are you DOING?” and sound very upset. See if you can say,“What are you doing?” and sound questioning, angry, arrogant, andupset. Can you think of any other tones and pitches that you coulduse with the same phrase? “I” Messages and “You” Messages A good technique for communicating assertively is to use “I” messages. An “I” message is away of talking that explains how you feel while remaining firm, calm,and polite. Sometimes, when people are mad or upset, they saythings that seem like they are blaming another person. This type ofstatement is called a “you” message. “You” messages sound like thefollowing: “You did this” or “You are so selfish.” It is very easy to getin a fight when “you” messages are being sent. An “I” message, on theother hand, is a tool that allows you to express your feelings withoutblaming another person.HH04PEC03_S02 6/2/04 7:49 PM Page 57 When using “I” messages, say how you feel and why you feel that way. For example, suppose you put your bag on the front seat of the bus to save it while you run to get something. When you come back,someone has moved your bag and taken your seat. To use an “I” mes-sage, you could say, “I’m upset that you moved my bag and took myseat. I want to sit there because my stop is the first stop.” Let’s say your sister is playing music so loud that you can’t study for your history test. You could use “I” messages to tell her, “I can’tstudy for my test because the music is so loud. Please turn it down.” Empathy The ability to understand another person’s feelings, behaviors, and attitudes is called Showing empathy can bean effective way to communicate. For example, let’s say you ask yourneighbor if you can borrow his bike. He tells you he needs it for his jobdelivering newspapers. If you respond by telling him he can delivernewspapers later, that would not show empathy. Your neighbor wouldprobably respond, “Go take a hike.” However, if you responded by ask-ing to borrow the bike when he’s done, he might be more likely to lendit to you.empathy. LIFE LIFE SKILL ActivitySay What?Communicating Effectively Practicing “I” messages will help you communicate more effectively. Try role-playing a situation in which“I” messages would be helpful.Decide who will be the “parent” and who will be the “teen.” Decide on a situation in which you need to talk to your parent about something that upset you, such as chores or going out with friends. First, use “you” messages to talk to the “parent.” Now, try “I” messages to tell the “parent” how you feel. Switch roles with your partner, and repeat steps 4 and 5. Communicating Effectively 1.When you were the “parent,” describe how you felt when the “teen” was using “you” messages. 2.Now, describe how you felt when the “teen” used “I” messages. Which form of communica-tion do you think would be most effective?Explain your answer.LIFE LIFE SKILL54321 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Using Good Communication Skills 59Listening Skills Have you ever spent a lot of energy explaining how you felt to someone but found out that the person wasn’tpaying attention? How did the situation make you feel?What did it do to your self-esteem? Communication includes not only sending mes- sages but also receiving messages, or listening. It makespeople feel good when they know you are listening andthat you really care about what they are saying. Twoimportant ways to show you are listening are to useactive listening and to paraphrase. Figure 2 lists more suggestions for being a good listener. Active Listening Active listening means letting the speaker know you are listening and clarifying anythingthat is confusing. You can do so by asking the speakerquestions and by using expressions such as >“I guess you must have felt . . . ” >“Tell me about . . . ” >“Hmmm.” >“Really?” >“Uh-huh.” To practice active listening, give the speaker your full attention. Giv-ing your full attention means you should not think about what youare going to say next. Try to identify the main concepts and ideasthat are being communicated. Provide feedback to the speaker, butwait until the speaker is finished before you start talking. Paraphrasing Paraphrasing is using your own words to restate what someone else said. You may have heard teachers use this termwhen telling you how to write a research paper. When writing apaper, you paraphrase other authors to show the teacher that youunderstood what you read. In a conversation, you paraphrase toshow the other person that you understand what he or she is saying. Here is an example of paraphrasing. Your friend spends 10 min- utes telling you how unhappy he is because his parents are divorced,and you say, “The divorce really is making you unhappy, isn’t it?”Paraphrasing allows you to show the person that you care about whathe or she is saying. Paraphrasing may seem like restating the obvious,but you would be amazed how sometimes you hear something dif-ferently from what the speaker means. Paraphrasing helps you toaccurately understand the speaker. Paraphrasing can also be used if you don’t understand what someone is saying. For example, imagine your health teacher is talk-ing about the fat content in food. If you were paraphrasing, youmight say, “So, what you are saying is that white-meat chicken hasless fat than dark-meat chicken does?” Then, the teacher could eitheragree or try to explain the topic in a different way. Do Maintain eye contact. Lean forward and face the speaker. Ask questions.Nod your head. Paraphrase the speaker.Don’t Don’t interrupt orchange the subject. Don’t look at your watch. Don’t tap your foot.Don’t think about something else. Don’t watch TV. Maintaining eye contact is a good way to show that you are listening. Here aresome more tips to show that you arelistening. 2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 60 CHAPTER 3 Self-Esteem and Mental HealthBody Language Earlier, you learned that one way to communicate is to speak. How- ever, you can communicate without saying a word. You reveal a lotabout how you feel through facial expressions, gestures, and posture.This nonverbal communication is called body language. Below are some examples of body language. See if you can guess what each onemay be communicating. >opening your eyes wide >scratching your head >opening your mouth wide >snarling >scrunching your eyebrows in a V shape >standing up straight and tall >winking Can you think of any other examples of body language? Try some body language of your own. Act excited. Go on—do it. What did youdo? You probably smiled, looked alert, and clapped your hands.Now, act bored. You probably slumped your shoulders and droopedyour face. If someone was watching you, he or she would have beenable to tell how you were feeling even though you didn’t say a word.What do you think the people in Figure 3 are feeling? Misunderstandings often occur when our body language says one thing but our mouths say another. Think back to the example of Rinaand her friends. What made her suspicious of her friends? What typeof body language was she receiving from them? Usually, when bodylanguage is giving a message that is different from what you are say-ing, people tend to believe the body language message. Therefore,paying attention to the messages you are sending nonverbally isimportant. Also, you can learn a lot about what others are feeling bywatching their body language. Body language can tell a lot about how a person is feeling. ACTIVITY What are the first three people in line feeling? How can you tell?3 Figure REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “direct and respectful in the way one expresses oneself.” 2.Define the term empathy . Understanding Key Ideas 3.Describe why good communication is important. 4.Identify the communication style that is most likely to lead to conflict. 5.Listfive characteristics of good listening skills.6.Identify which of the following behaviors is notan example of a good listening skill. a.watching TV c.paraphrasing b.facing the speaker d.leaning forward 7.Identify which of the following behaviors is notan example of body language. a.winking c.snarling b.raising your voice d.clapping hands Critical Thinking 8. Communicating Effectively List five ways you can improve your speaking skills.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Mental and Emotional Health 61Mental and Emotional Health SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Last night, John’s girlfriend broke up with him. He layed in bed feeling sad for hours before he fell asleep. The next morning,he still felt sad. He wanted to try to make himself feel better, so he decided to talk to a friend about his sadness. Mental Health is the state of mental well-being in which one can cope with the demands of daily life. Good mental health means havinghigh self-esteem and being able to develop healthy, intimate relation-ships. Having high self-esteem, handling daily frustrations, and build-ing relationships depend on your ability to express and manage youremotions in positive w ays. Therefore, to be mentally healthy, you also must be emotionally healthy. People who are mentally and emotionally healthy have the fol- lowing characteristics: >A sense of control Mentally healthy people have a sense of control and take charge of their lives. Because they feel in con-trol, they also take responsibility for their behavior. They areless likely to blame others for situations they may face. >Ability to endure failures and frustrations Mentally healthy people are more likely to persist through setbacks because theyunderstand that frustrations are part of learning. >Ability to see events positively Mentally healthy people are optimistic and see the challenges of life as opportunities. >Ability to express emotions in a healthy way Mentally healthy people do not hold in emotions or deny how they feel. Theyexpress their emotions in healthy ways and talk with friendswhen they need support. For example, when John was feeling sad he decided to talk with a friend. He did not deny his emotions or express them destructively.John has characteristics of someone who has good mental health.Mental healthOBJECTIVES Describe characteristics of positive mental health. Compare the stages of Maslow’s hierarchy of needs. Describe how you can learn to express emotions in positive ways. Identify the limitations of defense mechanisms. Describe three positive strategies for managing your emotions. LIFE LIFE SKILLKEY TERMSKEY TERMS mental health the state of mental well-being in which one can cope with the demands of daily life self-actualization the achievement of the best that a person can beemotion the feeling that is produced in response to life experiencesdefense mechanism an unconscious behavior used to avoid experiencing unpleasant emotions Crying is a sign of weakness.Myth Holding your emotions in can be destructive to your health.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. 62 CHAPTER 3 Self-Esteem and Mental HealthMaslow’s Hierarchy of Needs Having good mental health has benefits. For example, mentally and emotionally healthy people are more likely to reach self-actualiza-tion. is the achievement of the best that a personcan be. People who have achieved self-actualization have reachedtheir potential and feel that they have received the most out of life. Abraham Maslow, a psychologist, a person who studies emotions and behaviors, believed that everyone has a basic drive to reach self-actualization. Maslow stated that to reach self-actualization, a personhas to first achieve some very basic needs. He listed these needs and called the list the hierarchy of needs , which is shown in Figure 4. According to Maslow, the first needs a person must meet are the basic physical needs of the body, such as the need for food, water,sleep, and exercise. Once these needs are met, the next need is safety.This need includes the needs for shelter and protection from danger.After the need for safety is achieved, the person is

free to strive for social needs, such as love, acceptance, and friendship. Oncesocial needs are met, the person can focus on achieving esteem.Esteem is met through self-respect and the achievement of goals.Finally, after all of the other needs are met, the person could reachself-actualization. Self-actualization Everyone has basic needs he or she strives to meet in order to get the mostout of life.4 Figure Social stage the need for love, affection,and acceptance Safety stagethe need for shelter andprotection from danger Physical stagethe need for food, water,sleep, and exerciseEsteem stagethe need to have self-respect andto achieve goalsSelf-actualizationthe achievement of thebest that a person can be Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Mental and Emotional Health 63Most people work on more than one stage at a time. Even people who have reached self-actualization may have to struggle with hard- ships that threaten their basic needs throughout their lives. Basicneeds such as love and safety may not be met all of the time. However,you can still strive for the higher stages. Some ways you can worktoward self-actualization in your teen years are by building healthyrelationships, setting goals, and working toward achieving those goals. Expressing Emotions An is the feeling that is produced in response to life experi-ences. Emotions aren’t categorized as good or bad. However, theexpression of emotions can have positive or negative effects. Forexample, pretend you can’t study for your test because your family ismaking a lot of noise. Feeling frustrated is normal. But if you runaround the house tearing at your hair and screaming, you probablywon’t get a positive response from your family. Whether the emotion is anger, sadness, or joy, expressing it in a positive way is important. Denying an emotion will not make it goaway. Instead, the emotion can build up inside of you and be expressed in a negative way. Learning to express and manage emo-tions in healthy ways are key to mental and emotional health and toself-actualization. Learning to Express Emotions How you decide to express your emotions is based in large part on how others around you expresstheir emotions. For example, your family might deal with anger byyelling and throwing things. It is likely you would learn to deal withyour anger in the same way. You can learn to express your emotions more constructively regardless of how others around you express their emotions. To relearnhow to express an emotion, practice expressing the emotion in a posi-tive way. For example, role-play with a friend a situation in which youlost your temper with someone. This time, use the speaking skills youlearned earlier to calmly tell that person what made you upset. Practic-ing will help you positively express your emotions naturally.emotion ZITS reprinted with special permission of King Features Syndicate, Inc. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Anger Management HealthLinks code: HH4011 64 CHAPTER 3 Self-Esteem and Mental HealthManaging Emotions Emotions can be overwhelming, especially during your teenage years. Understanding and recognizing the emotions you feel can bechallenging. It is especially difficult if you are feeling more than one emotion at a time. For example, should you go up and talk to that cute, newstudent? Or should you run and hide in the bathroom? Trying to dealwith so many emotions can be frustrating. The following are sugges-tions to help you manage your emotions. 1. Talk it out. One way you can make sense of what you are feeling is by talking with someone you trust. For example, John madeplans to talk with his friend after his girlfriend broke up withhim. Just talking about a problem can help you manage youremotions. 2. Blow off steam. When emotions become bottled up inside of you, releasing that energy in some positive way often helps. Activ-ities such as exercising, building something, or playing a sport arepositive ways to let off steam. 3. Be creative. You can also release emotions in creative w ays. Some people write or draw when they are troubled. Some people enjoysinging, playing a musical instrument, or painting. All of theseactivities help release tension. Some emotions are more difficult to manage than other emo- tions. These emotions deserve special attention and are discussed in more detail below. Anger Often, anger results from frustration or helplessness. For example, the computer crashes and causes you to lose the report thatis due next class. You may want to grab the computer and smash it onthe floor. That response will definitely not get your report back. Infact, that response may get you into a lot of trouble. Understandingthat there was nothing you could do and letting things like this gowill release a lot of tension. Anger can always be dealt with in an appropriate manner. A per- son may make you angry, but that person doesn’t make you hit himor her. You and only youare responsible for how you express your emotions. The first step in keeping your anger from getting out of your con- trol is learning to recognize when you feel angry. If you can recognizequickly when you start to become angry, you can more easily controlyour anger. When you get angry, do you clench your fists? Does yourheart beat faster? When you feel the anger coming on, stop. Count to10, take a deep breath, and calm down before you react. You may wantto walk away and think about how best to deal with the situation. Youmay want to talk with someone or jog a few blocks while you think. Once you feel in control of your anger, you may want to talk with the person who made you upset. This can help resolve your feelings.Be sure to use the “I” messages you learned earlier. Yelling at others when you are angry may make you feel better but it maycause more problems later. Copyright © by Holt, Rinehart and Winston. All rights reserved. Fear Fear may not be a pleasant emotion, but it can be a helpful one. For example, our sense of fear is what helps protect us from danger. You jump out ofthe way of a speeding car because you fear getting runover. Speeding cars are good things to fear. However, many people fear things that are not harmful. Thefear may even get in the way of your normal life. Forexample, the fear of speaking in front of class can pre-vent you from giving a good speech. To get over a fear, you can use self-talk. Instead of thinking about being scared, tell yourself that youhave nothing to be afraid of. Another way to manageyour fear is through controlled exposure to the fearfulsituation. For example, if you are afraid of speaking infront of a large group of people, you can start byspeaking in front of one person. You can then workyour way up to speaking in front of a large group. Guilt Guilt is another emotion that may not be pleasant but can serve a purpose. It alerts you that you are behaving in a way that goesagainst your values. Guilt can keep you true to yourself. The best way to deal with guilty feelings is to do your best to right the wrong. If someone was hurt, apologize. If you stole somethingfrom a store, return it. Making amends lifts the weight of guilt offyour shoulders because you are taking responsibility for your behav-ior. You’ll feel much better in the long run. Jealousy Jealousy is often caused by a fear that something you own or love will be lost. For example, if John’s ex-girlfriend starts todate another person, John may feel jealous. A twinge of jealousy nowand then is natural. However, if jealousy is not controlled, it canmake you bitter and ruin your relationships. If your girlfriend’s or boyfriend’s flirting has been bothering you, try talking about it with your boyfriend or girlfriend. However,remember that dating someone doesn’t mean you own the person. Ifyou don’t trust your partner, you should examine your relationshipand why you feel distrustful. Loneliness Loneliness is an emotion that makes you feel isolated from others—not physically isolated, but emotionally isolated. Youcan be in a room of people, but if you don’t feel close to any of themor feel rejected, you can still feel lonely. On the other hand, you canbe by yourself and not feel lonely at all. In fact, being able to enjoytime by yourself is a sign of positive mental health. A good way to manage loneliness is to join a group or club. You could also do volunteer work or start a job. Don’t wait for people toapproach you. You’ll never be able to make close friends unless yougo out and meet people. SECTION 3 Mental and Emotional Health 65Tips for Managing Emotions >Sing, or play a musical instrument. >Write down how you feel. >Talk to a friend. >Exercise, or play a sport. >Let go of what you can’t control. >Draw or paint a picture. Copyright © by Holt, Rinehart and Winston. All rights reserved. 66 CHAPTER 3 Self-Esteem and Mental HealthDefense Mechanisms Sometimes, painful emotions such as fear and guilt can be difficult to cope with. Even if you deal with a difficult emotion in a healthy way,you may still feel upset. If an emotion gets too overwhelming, you mayuse a technique called a defense mechanism. A is an unconscious thought or behavior used to avoid experiencing unpleas-ant emotions. Table 2 shows a list of these defense mechanisms and some examples. Because defense mechanisms are unconscious behaviors, you don’t plan or decide to use them. However, you can observe yourselfand become aware of how you react and treat others.defense mechanism Table 2 Defense Mechanisms Mechanism Compensation Daydreaming DenialDisplacement Idealization Projection Rationalization Regression RepressionSublimationWhat is it? making up for weakness in one area by achieving in another imagining pleasant things that take your mind off the unpleasant reality refusing to accept reality shifting feelings about one person or situation to another person or situation copying someone you think highly of because you don’t feel good about whoyou are seeing your own faults or feelings in someone else making excuses for or justifying behavior reacting to emotions in a childlike or immature fashion blocking out painful thoughts or feelings redirecting negative impulses into positive behaviorExample trying to get an A in your other classes because you are doing poorly in math daydreaming in detention about what it will be like when you graduate andwhen teachers can’t tell you what to doanymore telling everyone that you are still going out with your boyfriend orgirlfriend even though he or she brokeup with you yelling at your family when you are angry at your teacher copying the clothing and appearance of a famous musician accusing your boyfriend or girlfriend of flirting with others because you flirt not studying for a test because you need the time to practice for the schoolplay kicking the lockers because you were sent to the principal’s office ignoring your memories about all the times your divorced parents had fights painting a mural when you are mad instead of creating graffiti Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Mental and Emotional Health 67Limitations of Defense Mechanisms Some defense mechanisms, such as compensation and sublimation, can be helpful. They can even have a positive outcome.However, most of the defense mechanisms have few ifany long-term benefits. In the short-term, defense mecha-nisms may make a person feel better and allow one to getthrough a tough time. However, they do not make theupsetting emotions disappear. Instead, they tend to maskthe unwanted feelings. Often, the longer a feeling is ignored, the more problematic it becomes. For example, you could use displacement to deal with the frustration of a classmatepicking on you. When you come home from school,you yell at your younger sister. If you do not realizewhat you are doing, you will never solve the problembetween you and your classmate. Displacing your frus-tration on your sister has also put a strain on your relationship with her. Finding the Right Balance Each person needs to find the right balance between managing emotions and using defense mecha-nisms. All people use defense mechanisms at one time or another.These mechanisms can be a healthy way to temporarily cope withone’s feelings. But if the defense mechanisms become the only way aperson can cope, that person is not managing emotions effectively. Your best bet is to take a close look at the way you cope with your own feelings. Are you using the positive methods that were discussedearlier? Practice the tips for managing your emotions on some ofyour small frustrations. Once you have mastered some of the tech-niques, you may find that you don’t need to use defense mechanisms. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term self-actualization . 2.Identify the term for “the feeling that is produced in response to life experiences.” Understanding Key Ideas 3.Identify which of the following characteristics is nota characteristic of positive mental health. a.enduring failures b.seeing life events positively c.having a sense of control d.dening feelings4.Compare the stages of Maslow’s hierarchy of needs. 5.Describe how you can learn to express emotions in a positive way. 6.Summarize the limitations of defense mechanisms. 7.Identify the defense mechanism in which a person makes excuses for a behavior. Critical Thinking 8. Practicing Wellness Describe three strategies you can use to manage your emotions in a positive way.LIFE LIFE SKILLSome defense mechanisms, such as sublimation, can channel unpleasantemotions into positive behaviors. Copyright © by Holt, Rinehart and Winston. All rights reserved. 68 CHAPTER 3 Self-Esteem and Mental HealthUnderstanding Mental DisordersSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 It is just after noon, and Lisa is still in bed. She doesn’t see any point in getting up. She doesn’t want to do anything. She has feltthis way for days. She doesn’t even want to be around her friends. She feels that anything she does is useless. What Are Mental Disorders? In the last section, you learned that mental health is being able tomeet the daily challenges of life, having high self-esteem, and de-veloping healthy relationships. Sometimes, however, people are notmentally healthy. They may suffer from a mental disorder. A is an illness that affects a person’s thoughts, emo- tions, and behaviors. Those who suffer from a mental disorder maynot be able to have fun. They may not feel good about themselves ormay have a difficult time developing intimate relationships. Theymay have difficulty dealing with everyday routines. Many homelesspeople suffer from a mental disorder. Lisa is an example of someone experiencing a mental disorder. She feels hopeless and doesn’t have the energy to do regular activitiesor build relationships. Mental Disorders Are Often Misunderstood Unfortunately, many people who have a mental disorder don’t get help because theydon’t understand mental disorders. Some people are afraid of mentaldisorders or the people who have the disorders. Identifying andunderstanding different kinds of mental disorders can help preventthe fear associated with the disorder. Most of these mental disordersare treatable. To understand mental disorders, you need to learn about their symptoms. A is a change that a person notices in his or herbody or mind and that is caused by a disease or disorder. For exam-ple, Lisa’s symptoms were hopelessness and low energy. symptommental disorderOBJECTIVES Describe what mental disorders are. Listseven signs of a mental disorder. Summarize causes of mental disorders. Identify community resources available for mental health problems.KEY TERMSKEY TERMS mental disorder an illness that affects a person’s thoughts, emotions, and behaviors symptom a change that a person notices in his or her body or mind and that is caused by a dis- ease or disorder. depression a sadness and hopelessness that keeps a person from carrying out everyday activities Anyone can be affected by a mental disorder. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Depression HealthLinks code: HH4040 SECTION 4 Understanding Mental Disorders 69Types of Mental Disorders There are many types of mental disorders, and they have a variety of symptoms. If you experience any of the symptoms listed below, talkto a trusted adult. However, only licensed professionals can diagnosea mental disorder. >too much or too little sleep >feeling of extreme sadness >unexplained mood changes >drug or alcohol abuse >inability to concentrate >extreme anxiety or irrational fear >personality changes >false perceptions of reality Several disorders are common and require some additional description. These disorders are depression, attention-deficit/hyper-activity disorder, and anxiety disorders. Depression Everyone feels sad or down at times. However, sad- ness and hopelessness that keep a person from carrying out every-day activities is called Depression, also known as majordepressive disorder, is a serious disorder that if left untreated canlead a person to consider suicide. Some of the symptoms of depres-sion are listed below. >lack of energy >withdrawal from people >loss of appetite or overeating >too much or too little sleep >feelings of helplessness and hopelessness Experiencing one or more of these symptoms from time to time is not uncommon. However, if you experience several of these symp-toms for several days, you should seek professional help.depression. 9.5% 20% 54 millionstatistically speaking. . . Percentage of Americans suffering from depression: Percentage of children suffering from a mental disorder: Number of Americans that have a mental disorder: Copyright © by Holt, Rinehart and Winston. All rights reserved. 70 CHAPTER 3 Self-Esteem and Mental HealthBelow are suggestions a person can follow if he or she is experi- encing depression. 1. Face the problem. Don’t wait for depression to go away. Seek pro- fessional help immediately. Also, don’t use drugs or alcohol to solve your problems. They will only create more problems. 2. Identify the problem. What is causing the depression? Could it be the result of a loss or loneliness? A licensed professional maydetermine that it’s caused by biological factors, such as a chemi-cal imbalance. 3. Take action. Responding actively to depression can make one feel more in control and can help release unpleasant feelings. The fol-lowing are some examples of actions one can take. >Change negative thinking, and use positive self-talk. >Seek out support from others. >Be active. Physical activity, such as playing a sport, can make your body produce chemicals that can make you feel better. Attention-Deficit/Hyperactivity Disorder Attention-deficit/hyp- eractivity disorder (ADHD) is the most commonly diagnosed disorder of childhood. However, ADHD is a lifelong condition. A person whohas ADHD is frequently inattentive or impulsively hyperactive to thepoint that he or she has problems accomplishing daily activities. Forexample, a teen who has ADHD may have problems doing schoolwork. He or she may become easily distracted, have difficulty follow-ing instructions, or have difficulty completing tasks. The causes of ADHD are unknown. However, treatment is avail- able for those who have ADHD. Some medications have proven to behelpful by increasing one’s ability to concentrate. Anxiety Disorders It is normal to feel nervous or worried in some situations. For example, you may feelanxiety every time you take a test. However, if the anxietygets in the way of taking part in daily activities, if it occursfrequently, or if it causes terror, then it may be an anxiety disorder. Panic disorder is one type of anxiety disorder character- ized by extreme terror. In a panic attack, the person mayfeel extreme fear for his or her life even though they arenot really in danger. Phobias are anxiety disorders characterized by extreme fear of something that causes no real danger. For exam-ple, acrophobia is fear of being in high places. Obsessive-compulsive disorder is an anxiety disorder triggered by uncomfortable thoughts called obsessions and by repetitive behaviors called compulsions . Post-traumatic stress disorder is anxiety over a past traumatic event. To learn more details about these and other mental disor-ders, see Table 3. Phobias, such as the fear of heights, may be learned behaviors that resultfrom an event that was very frightening. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Understanding Mental Disorders 71Causes of Mental Disorders Many mental health specialists believe that some mental disorders, such as phobias, develop from traumatic or stressful experiences in aperson’s life. Some examples of stressful or traumatic experiences area death, an accident, or an abusive event. Other disorders can be inherited. For example, researchers are trying to determine if schizophrenia is an inherited disorder. Somedisorders can be caused by an injury or a physical disorder that affectsthe brain. For example, brain tumors, alcoholism, and some infec-tions can cause mental disorders. Whatever the cause, many disordersare treatable. Some disorders can be cured. A person who has a men-tal disorder must get help to treat the disorder. Table 3 Mental Disorders Disorder Major depression Attention-deficit/hyperactiv- ity disorder (ADHD) Panic disorder Phobias Obsessive-compulsive disorder Post-traumatic stress disorder Eating disorders Hypochondria Bipolar disorderSchizophreniaDescription >feelings of hopeless and sadness that last for more than a few days >inability to take part in daily activities >difficulty concentrating >difficulty completing tasks >difficulty following instructions >impulsive and hyperactive >sudden feelings of terror that strike without warning >putting oneself in danger by desperately trying to escape the situation >irrational fear of something that causes no real danger, such as spiders, elevators, or giving a speech >possible panic attacks >repeated, disturbing, and unwanted thoughts >ritual behaviors that are perceived as impossible to control such asrepeatedly washing one’s hands >avoidance of experiences that could trigger memories of a traumaticexperience such as wartime experiences or abuse >obsessive behavior and thoughts about weight control >starvation of oneself such as anorexia nervosa >consumption of large amounts of food followed by vomiting >belief of illness when none is present >uncontrollable cycles of extreme happiness and then depression >false perceptions of reality >hallucinations and/or delusions Copyright © by Holt, Rinehart and Winston. All rights reserved. 72 CHAPTER 3 Self-Esteem and Mental HealthHelp for Mental Disorders If you think that you or a friend may have a mental disorder, the first step is to talk to a parent, school nurse, religious leader, or othertrusted adult. He or she can then help you find the resources to treatthe disorder. Many resources in your community are available to helpthose who have a mental disorders. Hospitals, clinics, private agencies,and school linked services can provide a variety of treatments. Psychotherapy If a disorder is caused by a traumatic experience, psychotherapy can be useful. Psychotherapy is a form of counselingreceived from a licensed therapist. Psychotherapy can help the personresolve issues from the past trauma. If the mental disorder is a pho-bia, a licensed therapist can help the patient discover the source ofthe fear. Group Therapy Group therapy is led by a licensed therapist. The therapist leads a group of people who have a similar disorder. Thosein the group find it comforting to talk about their problems with oth-ers who are experiencing the same problem. Medication Some people who have a disorder benefit from cer- tain medications. Antidepressants can help treat people who havedepression. People who have schizophrenia and ADHD also benefitfrom medication that eases symptoms and makes the disorder moremanageable. However, prescription drugs are not the answer to all mental health problems. Psychiatrists are trained to prescribe the right drugand the right amount only to those who will benefit. Frequently, apsychiatrist will recommend group therapy or psychotherapy as wellas prescribed medication. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term symptom . 2.Define the term depression. Understanding Key Ideas 3.Describe what is meant by the term mental disorder. 4.Identify which of the following descriptions is nota symptom of a mental disorder. a.personality change c.too much sleep b.crying when sad d.alcohol abuse 5. Describe three things you can do if you are experiencing depression.LIFE LIFE SKILL6.Listsix mental disorders. 7.Describe three possible causes of mental disorders. 8.Identify which of the following is nota treatment for a mental disorder. a.denial c.group therapy b.medication d.psychotherapy Critical Thinking 9. Practicing Wellness If you think that you are suffering from a phobia, what type of treatment should

you seek?LIFE LIFE SKILLTalking about problems to other people who are experiencing thesame problems can be comforting. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 3 Highlights 73 CHAPTERCHAPTER 3 CHAPTERHAPTER 3 CHAPTER 3Highlights Key Terms The Big Picture ✔People who have positive mental health have high self-esteem, meet the daily challenges, and develop healthy relationships. ✔The five stages of Maslow’s hierarchy of needs are the physicalstage, the safety stage, the social stage, the esteem stage, andself-actualization. ✔You can learn to express your emotions in a positive way by practicing a positive example of expressing that emotion. ✔You can manage your emotions by talking about your feelingswith others, by blowing off steam, and by expressing your emotions creatively. ✔Defense mechanisms are often ineffective ways of dealing withunpleasant emotions.SECTION 3 mental health (61) self-actualization (62) emotion (63) defense mechanism (66) ✔A mental disorder is an illness of the mind that affects thinking,behavior, and mood. A mental disorder makes dealing with every-day routines difficult. ✔Learning about the symptoms of mental disorders is important foridentifying the disorder and getting help. ✔Many mental disorders can be caused by heredity, by injury, byphysical illness, or by traumatic experiences. ✔Three forms of treatment for mental disorders are psychotherapy,group therapy, and medication.SECTION 4 mental disorder (68) symptom (68) depression (69) ✔People who have high self-esteem respect themselves and others, reach their goals, recover from disappointment, and feel valuableto family, friends, and community. ✔Our self-esteem is influenced by the messages we receive aboutourselves. ✔You can improve your self-esteem by using self-talk, acting withintegrity, choosing supportive friends, and accepting yourself.SECTION 1 self-esteem (50) self-concept (52) integrity (54) ✔Communication is important for avoiding misunderstandings,building our relationships,and expressing our feelings. ✔Assertive communication is the most effective way to communi-cate because it is direct and respectful to others. ✔When using good speaking skills be aware of your voice volume,tone, and pitch. Also, use “I” messages and show empathy. ✔Some examples of good listening skills are maintaining eye con-tact, nodding your head, and paraphrasing. ✔Misunderstandings can happen if your body language communi-cates a different message than what you say. SECTION 2 passive(56) aggressive (56) assertive (56) empathy (58) Copyright © by Holt, Rinehart and Winston. All rights reserved. 74 CHAPTER 3 Review CHAPTERCHAPTER 3 CHAPTERHAPTER 3 CHAPTER 3Review Using Key Terms aggressive (56) mental health (61) assertive (56) mental disorder (68) defense mechanism (66) passive (56) emotion (63) self-actualization (62) empathy (58) self-concept (52) integrity (54) self-esteem (50) depression (69) symptom (68) 1.For each definition below, choose the key term that best matches the definition. a.the ability to understand another person’sfeelings, behaviors, and attitudes b.the achievement of the best that a person canbe c.a change that a person notices in his or herbody or mind and that is caused by a diseaseor disorder d.the characteristic of doing what one knows isright e.not offering opposition when challenged oracted upon f.an illness that affects a person’s thoughts, emo-tions, and behaviors g.a sadness and hopelessness that keeps a personfrom carrying out everyday activities h.an unconscious behavior used to avoid experi-encing unpleasant emotions 2.Explain the relationship between the key terms ineach of the following pairs. a.aggressive and assertive b.self-concept and self-esteem c.emotion and mental health Understanding Key Ideas Section 1 3.Describe how you can show respect for yourself. 4.List the benefits of high self-esteem. 5.Describe how self-esteem develops. 6.Explain how accepting yourself can improve yourself-esteem.Section 2 7.Which of the following is nota reason why com- munication is important? a.builds healthy relationships b.leads to unclear messages c.lets you express yourself d.prevents misunderstandings 8.Which of the following statements is notan example of assertive communication? a.I don’t want to talk to you ever again! b.I have to go because I’m running late. c.Don’t yell at me. d.I don’t want to see that movie. 9.Describe how to be an active listener. 10.List three examples of body language. 11.CRITICAL THINKING Describe a situation in which you can use “I” messages. Section 3 12.Describe characteristics of positive mental andemotional health. 13.State the stage of Maslow’s hierarchy of needsthat requires food. 14.How can you learn to express your emotions in apositive way? 15.Which defense mechanism is being used whensomeone refuses to accept reality? 16.CRITICAL THINKING Describe a positive strategy for managing your anger. Section 4 17.List three characteristics of mental disorders. 18.Which of the following symptoms is nota sign of depression? a.lack of energy c.high self-esteem b.loss of appetite d.too much sleep 19.Give two examples of disorders that can betreated with medication. 20.CRITICAL THINKING List two mental disorders that could be caused by a traumatic experience.LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Interpreting Graphics Study the figure below to answer the questions that follow. 21.Which response in the table is an assertive response? 22.Which response in the table is an aggressiveresponse? 23.CRITICAL THINKING Fill in an assertive response for the first situation. Assertive Communication Situation 1.Your boyfriend/girl- friend tells you to stopwearing a certain shirt 2.Your mother throws outyour favorite torn jeans. 3.Your little sister bor-rows your tennis racketwithout asking.Response 1.___________________ ______________________________________ 2.You calmly but firmlytell your mother not tothrow out your things. 3.You yell at your sisterand then take her stuffso she can see what itfeels like. CHAPTER 3 Review 75Activities 24. Health and You Optimism helps a person reach his or her goals or overcome hard times. Think of a situation that you will face this week and thatyou have been worried about. Now, write a detailed description of how you want that situation to turn out. 25. Health and Your Community Ask each classmate to write down one nice thing about each otherstudent in the class. Have your classmates givetheir anonymous lists to you. Organize the com-ments according to student names. Hand backthe nice comments to the students so that theycan read the nice things written about them! 26. Health and You Identify a person you admire for their community involvement. Compare this per-son’s characteristics with characteristics you already possess or hope to acquire. Action Plan 27. Communicating Effectively Use the communication skills you learned in this chapterto create a step-by-step action plan to improvecommunication in one of your relationships.LIFE LIFE SKILL 28.In this passage, the word agitated means means Aworried. Bangry. Cjealous. Dcurious. 29.What can you infer from reading this passage? ETessa knows how to manage her anger. FRina will never have another party again. GBoth Jessica and Tessa were hurt by theargument. Hnone of the above 30.Write a paragraph describing how the situationwould have turned out more positively if Jessicaand Tessa used the communication skills listed inthis chapter. READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Rina’s birthday party on Saturday night was a big hit. Everyone had fun except Jessicaand Tessa, who had an argument. Jessicabecame agitated when Tessa broke Jessica’s necklace. Tessa was trying it on when it caught on her watch and the claspsnapped. Jessica called Tessa an idiot andyelled, “Don’t ever touch my things again!”Tessa was so offended that she told Jes-sica she didn’t want to be friends with heranymore. Jessica left the party early. Tessastayed, but she was very quiet and with-drawn.WRITING SKILL WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 4 CHAP TER 4 CHAPTER 4 Mana ging Stress and Coping with LossMana ging Stress and Coping with LossManaging Stress and Coping with Loss 76BEHAVIOR Indicate how frequently you engage in each of the following behaviors (1 = never; 2 = occasionally; 3 =most of the time; 4 = all of the time). Total yourpoints, and then turn to p. 642. 1.I exercise and eat well. 2.I make time in my schedule to do the things that I really enjoy. 3.I ask for support from family and friends whenI feel too much stress. 4.I have an optimistic view of changes in my life. 5.I do the most important projects I want toaccomplish first. 6.I say no if my boss repeatedly asks me to worklate on a school night. Copyright © by Holt, Rinehart and Winston. All rights reserved. 77SECTION 1 Stress and Your Health SECTION 2 Dealing withStress SECTION 3 Coping with Loss SECTION 4 Preventing Suicide go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH04. Copyright © by Holt, Rinehart and Winston. All rights reserved. 78 CHAPTER 4 Managing Stress and Coping with LossIt’s 1:05 P.M. Paula is running down the hall and is late for algebra class. Halfway to class, she realizes that she forgot her algebra homework in her locker. She’ll get a detention if she goes back to get it and is late to class again. When she gets to class, she is markedlate. Paula’s head begins to pound with an intense headache. What Causes Stress? Do you ever feel stressed? is the body’s and mind’s response toa demand. You may not even be aware that you are under stress untilyou get a headache, as Paula did. Stress can be caused by many different situations or events. For example, going out on a date can cause stress and so can taking a testor watching a football game. Stress is caused by stressors. A isany situation that puts a demand on the body or mind. There are sev-eral different types of stressors. Environmental Stressors Environmental stressors are condi- tions or events in your physical environment that cause you stress.For example, pollution, poverty, crowding, noise, and natural disas-ters are things in your environment that can cause you stress. Biological Stressors Some stressors are biological. These are conditions that make it difficult for your body to take part in dailyactivities. For example, having an illness, a disability, or an injury arebiological stressors. Thinking Stressors Any type of mental challenge can cause stress. A good example of this is taking a test. Paula’s algebra home-work is probably a stressor for her.stressorStressStress and Your HealthSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Describe five different causes of stress. Describe the body’s physical response to stress. Differentiate between positive and negative stress. Describe how stress can make you sick. LIFE LIFE SKILLKEY TERMSKEY TERMS stress the body’s and mind’s response to a demand stressor any situation that puts a demand on the body or mindepinephrine one of the hormones that are released by the body in times of stresseustress a positive stress that energizes a person and helps a person reach a goaldistress a negative stress that can make a person sick or can keep a person from reaching a goal Many people experience stress because they take on too many respon-sibilities or don’t manage time well. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Stress and Your Health 79Behavioral Stressors Unhealthy behavior, such as not getting enough sleep or exercise, can lead to stress. Using tobacco, alcohol, or drugs also puts stress on your body. Paula was experiencing behavioralstress because she didn’t manage her time well. Life Change Stressors Any major life change, whether positive or negative, can be a cause of stress. For example, death of a loved one,getting married, and other personal events can cause stress. The teenyears are a time when you experience many changes and, thus, stress. Table 1 lists some common life changes that can lead to stress.ACTIVITY To measure how much your life has changed, add up the life change units below for the changes that youexperienced in the past year. Compareyour score with the scale below. Life event Experiencing the death of a parent Experiencing the death of a brother or sister Going through your parents’ divorce Having a serious illnessHaving a parent go to jailExperiencing the death of a close friend Being pregnantGetting a new jobGaining a new family memberExperiencing a significant change in family’s financial status Experiencing the serious illness of a parent Being excluded from a social circleLife change units >119 >102 >98 >77 >75 >70 >66 >62 >57 >56 >56 >53Life event Having more arguments with parents Getting marriedFailing a grade in schoolSeeing an increase in arguments between parents Beginning or ending schoolBreaking up with a boyfriend or girlfriend Making an outstanding achievment Moving to a new school districtBeing suspended from schoolHaving trouble with a teacherChange in sleeping habitsGoing on vacationGetting a traffic ticketLife change units >51 >50 >42 >40 >38 >37 >36 >35 >29 >28 >26 >25 >22Table 1 Life Changes That Can Lead to Stress Your Life Change Score: If your score is less than 100, your life has changed little. If your score is between 100 and 200, you have experienced moderate change. If your score is more than 200, your life has changed significantly. Adapted from Mark A. Miller and Richard H. Rahe, “Life Changes Scaling for the 1990s,”Journal of Psychosomatic Research 43 (1997). Copyright © by Holt, Rinehart and Winston. All rights reserved. 80 CHAPTER 4 Managing Stress and Coping with LossPhysical Response to Stress Imagine that you are riding your bike and you suddenly find yourself in the path of a fast-moving car. You feel a sudden burst of energythat allows you to get out of the way of the car. Now imagine that youare a goalie in a soccer game. The ball has been kicked by an oppos-ing team player and it’s headed straight to the goal. Your heart startsto beat faster as you jump for the ball and make the block. In both of these situations, your body responded to a stressful situ- ation, but in a different way. When the car was in the path of your bike,the response was to move away, or “take flight.” When the soccer ballwas coming to the goal, the response was to confront the situation, or“fight.” The physical changes that prepare your body to respond quicklyand appropriately to stressors is called the fight-or-flight response. The Fight-or-Flight Response During the fight-or-flight response, your body provides you with the energy, reflexes, andstrength you may need to respond to the stressor. As part of the fight-or-flight response, your body releases epinephrine. ( EPuh NEF rin), formally called adrenaline, is one of the hormones that are released by the body in times of stress. Epinephrine preparesthe body for quick action by triggering the changes listed below. >Your breathing speeds up, which helps get more oxygenthroughout your body. >Your heart beats faster, which increases the flow of blood tocarry more oxygen to your muscles. >Your muscles tense up, which prepares you to move quickly. >The pupils of your eyes get wider, which allows extra light formore sensitive vision. >Your digestion stops, since this is an unnecessary activity dur-ing an emergency. >Blood sugar increases to provide more fuel for fighting or run-ning. Emotional and Behavioral Response to Stress The way you respond to a stress emotionally and behaviorallydepends on whether you consider the stress to be positive or nega-tive, as shown in Figure 1. Positive Stress Let’s say you have to give a speech in front of your class. If you choose to consider this in a positive way, this type of stresscan motivate you to do your best. Positive stress can help you respondwell in a stressful situation. A positive stress that energizes one andhelps one reach a goal is called Eustress will make you feelalert and lively. You will appear confident and in control. A person who presents speeches when experiencing eustress often attracts and holds the attention of the audience. The words rolloff the speaker’s tongue. One point flows into the others, and the speaker rarely forgets what to say next. eustress.Epinephrine For more information about the endocrine system, see the Express Lesson on p. 545.HandbookHEALTH The physical changes in response to stress prepare the body to run away orstay and fight. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Stress and Your Health 81Negative Stress If you choose to consider giving a speech to be a negative stress, you may experience distress. is negative stress that can make a person sick or keep a person from reaching a goal.Distress can keep you from doing your best, no matter how capableyou are. People who attempt to give a speech while experiencing distress may forget the points they want to make. They may have practicedthe speech for days, but when they stand up in front of a room full ofpeople, they lose their concentration. Their words don’t flow well.Their voice may sound too soft and shaky, revealing a lack of confi-dence. The audience may become bored or confused. Try to Make Stress Positive Obviously, it is better to approach stressful situations as positive and not negative. However, it is notalways easy to control your response to a stressor. One way you canhelp yourself experience eustress is to be optimistic about dealingwith a stressor. Instead of thinking, I can’t do this, think, What can Ido to accomplish this? Concentrate only on what you can control inthe situation. Let go of what you cannot control. Do what you can tobuild confidence that you can succeed in the situation. If you set yourmind to it and prepare to meet the challenge, you will find yourselfapproaching situations in a positive way!Distress Everybody experiences the same physi- cal responses to stress—the fight-or-flightresponse. But each person’s emotionaland behavioral response differs depend-ing on whether he or she views the stress as positive (eustress) or negative(distress). ACTIVITY Which student do you think has a better chance at winning the debate? Explain your answer.1 FigureEustress Alert Focused Motivated Energized ConfidentFight-or-Flight Response to Stress Your body releases epinephrine. Your heart beats faster. Your eyes widen. Your breathing speeds up. Your muscles tense up. Your sweating increases. Your blood pressure increases.Distress Nervous Forgetful Frightened Confused Unsure Copyright © by Holt, Rinehart and Winston. All rights reserved. 82 CHAPTER 4 Managing Stress and Coping with LossLong-Term Stress Can Make You Sick If your body experiences stress continuously over a long period of time, you increase your risk for a wide range of stress-related diseases.For example, stress causes the muscles in your neck and head totense, which can cause headaches. Long-term stress can cause changesin your body that can lead to a heart attack. Long-term stress can alsoweaken your immune system, the system of your body that defendsagainst infections. As a result, you are more likely to suffer frominfections, such as colds. The general adaptation syndrome is a model that describes the rela- tionship between stress and disease. Learning the stages will help youunderstand how stress can affect your health. There are three stages inthe model: 1. Alarm stage In the alarm stage, the body and mind become alert. This stage includes the events brought on by the flight-or-flightresponse. All of your body’s efforts go into responding to thedemand. A person in this stage may experience headaches,stomachaches, difficulty sleeping, and anxiety. 2. Resistance stage If the stress continues, your body becomes more resistant to disease and injury than normal. You can copewith added stress, but only for a limited time. 3. Exhaustion stage In this stage, your body cannot take the resist- ance to the stressor any longer, especially if several stressors occur ina row. You become exhausted, not in the normal sense like after along, busy day, but in a more serious way. Organs such as your heartmay suffer, and your immune system can no longer fight illness. By learning to manage stress, you can protect yourself from many illnesses and can enjoy a healthier life. Stress-Related Diseases and Disorders >Tension headache >Cold and flu >Asthma >Migraine headache >Backache >Temporomandibular joint dysfunction (TMJ) >Heart disease >Stroke >High blood pressure >Chronic fatigue >Ulcer >Anxiety disorder >Insomnia >Depression REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Compare the terms stress and stressor. 2.Identify the term for “a positive stress that ener- gizes a person and helps a person reach a goal.” Understanding Key Ideas 3.Listfive different causes of stress. 4.Identify which of the following is nota part of the fight-or-flight response. a.heart rate speeds up c. muscles tense b.increased sweating d.digestion occurs5.Identify a hormone that is released during the fight-or-flight response. 6.Compare positive and negative stress. 7. Assessing Your Health Using the stages of the general adaptation syndrome, describe how stress can make you sick. Critical Thinking 8. Practicing Wellness Describe how two stressors led you to experience eustress. 9.What do you think would be the consequences ofnot having a fight-or-flight response?LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Dealing with StressSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Anthony has a final exam tomorrow. He told his friend Ricardo that he couldn’t help him fix his bike because he needed to study for a couple of hours. It’s now 10 P.M. Anthony has studied for 3 hours and is now listening to music to relax. He plans to go to bed when the CD finishes so that he can get a good night’s sleep. Take Care of Yourself Stressful events will occur throughout your life. At this time, you maybe experiencing stressors such as tests and peer pressure. When youget older, your stressors may be managing money or raising children.Whatever stressors you experience, learning to manage them willhelp you remain healthy throughout your life. In the last section, you learned how your body responds to stress. If stress continues over time, stress-related illnesses can develop. Peo-ple who are in better physical health are more likely than others toresist developing an illness. An important way to defend yourselffrom stress-related illness is to take care of yourself! Exercising regu-larly, getting enough rest, and eating right will help you prevent someof the negative consequences of stress. Exercise Regularly Exercise will not only keep you physically fit, but it will also relieve tension. Tension is a physical effect of stress marked by straining of muscles. During the fight-or-flight response,the body is tensed and ready for a great amount of physical activity.However, many stressors, such as taking a test, don’t require muchphysical activity. Keeping the body in a heightened state of alertnesswhen you don’t need to run or fight stresses your heart, muscles, andimmune system. Health problems such as tension headaches andheart disease can result from such long-term stress. Exercise canrelieve this tension in a healthy way.OBJECTIVES Describe how you can take care of yourself to avoid stress-related illnesses. Describe two relaxation techniques. Listeight skills or resources for building resiliency. Evaluate the effect of a positive attitude on stress reduction. Listthree ways that you can manage your time more efficiently. LIFE LIFE SKILLKEY TERMSKEY TERMS resiliency the ability to recover from illness, hardship, and other stressors asset a skill or resource that can help a person reach a goalprioritize to arrange items in order of importance Taking care of yourself is one of the best ways to fight off the negative effects of stress. 83 Copyright © by Holt, Rinehart and Winston. All rights reserved. 84 CHAPTER 4 Managing Stress and Coping with LossGet Enough Rest You should get at least 9 hours of sleep every night. Not getting enough sleep can lead to exhaustion, which can cause illness. Also, if you haven’t slept enough, you are less alert andless capable of dealing with a stressor. For example, Anthony knowsthat if he has a good night’s sleep, his mind will be prepared and alertfor the exam. Eat Right Eating nutritious foods gives you the vitamins, minerals, and energy you need to deal with everyday demands. You need vita-mins and minerals for your immune system to function properly. Thebetter shape your immune system is in, the better it can defend youfrom stress related illnesses. Learn to Relax During the response to stress, you build up a lot of tension. At thesame time, energy is pulled away from body systems that need theenergy to fight sickness. Using relaxation techniques can help yourelieve tension and

reserve energy for fighting illness. The followingare a couple of relaxation techniques you can try. Breathing Exercises One relaxation technique is deep breathing. It requires completely filling the lungs with air instead of taking shal-low breaths. Deep breathing brings more oxygen to all parts of yourbody. More oxygen helps muscles and organs function more effec-tively. More oxygen also helps keep your brain alert and focused. Deepbreathing also produces a calming effect that helps relax you. Whenyou practice deep breathing, your heart rate slows down and yourblood pressure drops. To practice deep breathing, find a comfortable place to sit. Close your eyes, and concentrate only on your breathing. Inhale slowlyuntil your lungs cannot hold any more air. Then, exhale slowly.Repeat this process for at least 15 minutes. Tension-Releasing Exercises When you are under stress, it’s common to hold the tension in your muscles. You may not evennotice the tension in your muscles until they start to ache. To release tension, start by tensing the muscles in one part of your body, such as your shoulders. Notice how it feels to have thosemuscles tensed. Now, relax those muscles. Notice how those musclesfeel relaxed. You can then move to another muscle group and repeatthe tensing and relaxing until your entire body is relaxed. Deep breathing and tension-releasing exercises are only two ways for you to relax. You can put your body at ease in many other w ays. For example, Anthony relaxes by listening to music. Someone elsemay relax by reading a book. You may already have your own specialtechnique. Keep in mind that although relaxation techniques canhelp you manage the symptoms of stress, this should not stop youfrom dealing with the stressor directly. “Playing guitar ismy way to relax.” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Dealing with Stress 85Build Resiliency The ability to recover from illness, hardship, and other stressors is called Resilient people continue to be optimistic when life gets tough. They seem to struggle less and succeed more. They accomplish difficult tasks and make other people ask, “How did they do that?” Many resilient people get their strength from their assets. An is a skill or resource that can help you reach a goal. For exam- ple, support is an asset. Having people to support you can get youthrough some hard times. You don’t have to have a big family or bepopular to have a strong support system. Resilient people buildstrong support systems by asking for help. They ask for supportfrom their family, friends, teachers, school counselors, neighbors,community leaders, and religious leaders. You have the power to strengthen these assets. Table 2 lists eight assets and provides examples of how each asset can work for you. Forexample, if you want to strengthen the asset entitled “positive iden-tity,” you can use the skills such as positive self-talk to improve yourself-esteem. The stronger you make your assets, the stronger you willfeel, and the healthier you will be.assetresiliency.Asset Support EmpowermentBoundaries Productive use of time Commitment to learningPositive values Social skills Positive identityDescription >having family, friends, and others to help you >feeling as if you are a valuable mem-ber of your community and family >having a clear set of rules and conse-quences for school, family, and relationships >choosing creative and productiveactivities >understanding the value of school-work >having values that include caring,integrity, honesty, self-responsibility,equality, and justice >communicating effectively, respectingothers, and avoiding peer pressure >having high self-esteem, having asense of control, and feeling as if youhave a purposeExample >You talk to the school counselor about a problem. >You volunteer to start a drug-freecampaign at school. >You know that if another teen bul-lies you at school, a teacher willspeak with that teen. >You join a school club instead ofplaying video games after school. >You spend time every day workingon homework assignments. >You support a friend who tells thetruth even though doing so may gethim or her in trouble. >You talk out a disagreement insteadof yelling. >You use positive self-talk to prepareyourself for a speech.Table 2 Eight Assets for Building Resiliency ACTIVITY Provide an additional example of how you can strengthen each asset. www.scilinks.org/health Topic: Stress HealthLinks code: HH4129Source: Adapted from Benson, Peter L., Ph.D., Espeland, Pamela, and Galbraith, Judy, M. A., What Teens Need to Succeed . Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE LIFE SKILL ActivityPositive AttitudeCoping Approaching the stressors in your life with a positive attitude will not only help you produce additional posi-tive effects, but it will also relieve a lot of tension. Howcan you have a positive attitude about the stressors inyour life?List five stressors. If you would like to, you can list your own stressors. Describe how you could have a positive emotional response to each stressor. Describe how you could have a positive physical response to each stressor. Describe a positive outcome to each stressor. Practicing Wellness 1.Predict how this activity will affect your actual responses to these stressors. 2.Describe how you felt when you finished step 4. Did you see the stressors more optimistically?LIFE LIFE SKILL4321 Change Your Attitude You have control over the number of stressors in your life. Because stress is caused by how you perceive a new or potentially threateningsituation, you can choose to see the situation as a challenge insteadof as a problem. Having a positive attitude about the outcome ofpotentially stressful events can eliminate a lot of stress. If youapproach the situation with a positive attitude, you won’t feel asnervous. If you don’t feel so nervous, a positive consequence is morelikely to happen. Use Positive Self-Talk Say or think positive things to yourself. For example, let’s say you are invited to go on a date to go see amovie. You are nervous about the date because you really like the per-son that invited you on the date. You can think to yourself, I must befun and desirable if this person wants to go out with me. You can alsopredict a realistic, positive outcome. You can imagine that you andyour date have a great time and make plans to meet again. Copyright © by Holt, Rinehart and Winston. All rights reserved. Be Confident About Yourself The better you feel about your- self, the more positive your perception of a situation will be. The more positive your perception is, the more positive your responseand the consequences will be! To build your self-confidence, you canremember similar challenges you have met successfully. Don’t Worry About Things Out of Your Control Accept the things you can’t change, and then make the best out of the situation.Put your energy only into things you can control. Manage Your Time One of the most common stressors that people experience is the feelingof not having enough time. Many people feel overwhelmed by the paceof their lives. However, by organizing your time, you can feel in controlof your life. Having a sense of control will minimize the effects of stress. Many of us get into trouble when we take on more things to do than we have time for. Helene is overwhelmed because today she has to go toswim practice, study for a French test, do her history homework, go todance rehearsal, cover the late shift at work, and help prepare dinner. List and Prioritize Your Projects The first step in managing your time is to make a list of your projects and to prioritize yourgoals. To is to arrange items in order of importance. Youmay not be able to do everything on your list. However, if you put themost important items first, you can be sure to get them done. Priori-tizing also helps you decide which activities can be eliminated. Helene organized her priorities as follows: (1) French test, (2) swim practice, and (3) history homework. Helene was able to elimi-nate three activities. She didn’t have to prepare dinner because shetraded nights with her sister. She arranged to have a co-worker coverher shift at work. Finally, she went to dance practiceas a way to relieve stress through exercise and hav-ing fun. Know and Set Your Limits One major reason that some people have hectic schedules is that theydon’t know their limits when they commit to proj-ects. For example, Helene has taken on much morethan she can handle. Signing up for dance, swim-ming, and a part-time job is too much for anybody.If Helene does not drop some of her responsibili-ties, her health will begin to suffer. Helene can also manage her time by learning to say no. Helene shouldn’t have promised her bossthat she would work. Some people have a hard timesaying no. They are afraid people will think that theydon’t care. However, saying no sometimes is ahealthy way of taking care of yourself. prioritize www.scilinks.org/health Topic: Stress Management HealthLinks code: HH4130 “I don’t havetime to be stressed out!” 87 Copyright © by Holt, Rinehart and Winston. All rights reserved. 88 CHAPTER 4 Managing Stress and Coping with LossMake a Schedule Once you have prioritized your projects and have decided what you can accomplish, you can make a schedule. Some people use calendars or planners to keep track of their sched-ule. But all you really need is a pen and a notebook. The followingpoints will help you make your schedule. >Enter your priorities first. When setting aside time for projects, start with the projects at the top of your list to make sure thatyou give them the time needed. Schedule your most difficulttasks for the hours when you are most productive. Considerscheduling your least favorite tasks first. >Be realistic. Set realistic goals. Don’t cram your day with more activities than you can possibly do. Make sure you planenough time for each activity. Break up long-term goals intoshort-term goals. For example, if you have a big research paperto turn in, break the paper down into manageable parts.Schedule one day to gather your references, a second day towrite the outline of your paper, and so on. Your steadyprogress will motivate you to continue. >Prepare for problems. Life is never perfect. Therefore, it helps to think about possible problems ahead of time. You maywant to give yourself a little more time in your schedule, justin case. >Make time to relax. Don’t forget to fit in time to have fun or to do the things you really enjoy. Remember that relaxing isimportant to your health. >Do it. Stop thinking about what you have to do and just do it. Sometimes you can get overwhelmed by just thinking of all ofthe things you have to do. Tackle each task one at a time. If you practice the stress management techniques you learned in thischapter, you can begin to control the stress in your life. Not only willyou protect your health, you will have more time to enjoy your life! Five Tips for Managing Your Time 1Prioritize your goals. 2Learn to say no. 3Keep a schedule. 4Don’t overload yourself. 5Plan for fun activities. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term resiliency. 2.Identify the term for “a skill or resource that can help a person reach a goal.” 3.Identify the term for “to arrange items in order of importance.” Understanding Key Ideas 4.Describe how taking care of yourself can help you avoid stress-related illness.5.Describe two techniques you can use to relax. 6.Name eight assets for building resiliency. 7.Describe how a positive attitude can change your response to stress. 8. Practicing Wellness Describe three ways to manage your time more efficiently. Critical Thinking 9.Why do you think the phrase “burned out” is used to describe a person who has been under a lot ofstress?LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Coping with Loss 89Coping with Loss SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Fidencia cannot imagine life without Ben. She can’t believe her parents are making her moveaway from him. She was so angry with them that she wanted to scream. Today is the day that theymove. She feels as if she is losing a part of herself. Effects of Loss There are many forms of loss. Some examples of lossare the death of a family member, the divorce of one’sparents, the death of a pet, a breakup with a boyfriendor girlfriend, and a move away from your home. All forms of loss can cause you to experience a range of emotions, from sadness to anger to numb-ness. These feelings are normal and common reac-tions to loss. You may not be prepared for howintense your emotions may be or how suddenly yourmoods may change. You may even begin to doubtyour mental stability. It is important to know thatthese feelings are healthy and normal and will helpyou cope with your loss. However, if the feelingsdon’t pass over time, you should seek the help of aparent or trusted adult. Loss Can Cause Stress When you experience loss, you can feel the physical and emotional effects ofstress. For example, after a loss, you may develop tension headachesor an increase in blood pressure. You may also feel irritable and con-fused. Just like other stressors, the stress caused by a loss needs to bemanaged or it can lead to a stress-related illness. The tension-reliev-ing skills that you learned in the last section can keep you healthy.The last thing you need through a trying time is to have a sicknessweigh you down.OBJECTIVES Describe the effects of loss. Name the stages of the grieving process. Describe how funerals, wakes, and memorial services help people cope with the loss of a loved one. Propose three ways you can cope with the loss of a loved one. LIFE LIFE SKILLKEY TERMSKEY TERMS grieve to express deep sadness because of a loss wake a ceremony to view or watch over the deceased person before the funeral funeral a ceremony in which a deceased person is buried or crematedmemorial service a ceremony to remember the deceased person Moving away from someone you care deeply for is an example of a loss thatcan cause stress. Copyright © by Holt, Rinehart and Winston. All rights reserved. 90 CHAPTER 4 Managing Stress and Coping with LossThe Grieving Process To express deep sadness because of a loss is to Allowing your- self to grieve is important because grieving helps you heal from thepain of a loss. When grieving, you may feel agitated or angry. You may find con- centrating, eating, or sleeping difficult. You might even feel guilty. Forexample, you may wish you had told a loved one that died how youfelt about him or her. This period of unpredictable emotions mayturn to short periods of sadness, silence, and withdrawal from familyand friends. During this time, you may be prone to sudden outburstsof tears that are triggered by reminders and memories of this person.Over time, the pain, sadness, and depression will start to lessen. Youwill begin to see your life in a more positive light again. This journey to recovery is called the grieving process. There are five stages of the grieving process. Not everyone goes through all of thestages or goes through the stages in the same order. However, under-standing these stages and the importance of expressing feelings ofgrief will help you recover from a loss.grieve. Stages of Grief >DENIAL “This can’t be happening to me!” >ANGER“Why me? It’s not fair.” >BARGAINING“I’d do anything to have him back.” >DEPRESSION“There is no hope. I’m sosad. I just want to be alone.” >ACCEPTANCE“It’s going to be OK.” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Coping with Loss 91The Five Stages of the Grieving Process Although you may never completely overcome the feelings of loss, the grieving process can help you accept the loss. Try to move forward through the stages.If you feel stuck in a stage, ask your parents or a trusted adult for help. 1. Denial The first reaction you may face when dealing with a loss is denial. In denial, the person refuses to believe the loss occurred.Denial can act as a buffer to give you a chance to think about thenews. However, you must eventually reach the other stages inorder to heal. 2. Anger Experiencing anger or even rage is normal when you face a loss. You may even try to blame yourself or others for the loss. Becareful about accusing others, and use anger management skills. 3. Bargaining Bargaining is the final attempt at avoiding what is true. For example, some people make promises to change if theperson or thing they lost is returned to them. 4. Depression Sadness is a natural and important emotion to express when you experience loss. However, if feeling very sadkeeps you from daily activities for more than a few days, ask aparent or a trusted adult for help. 5. Acceptance During this stage, you begin to learn how to live with a loss. The loss continues to be painful, yet you know youwill get through it and that life will go on. Funerals, Wakes, and Memorial Services Different types of ceremonies may take place after the death of aloved one. These ceremonies honor the person who has passed away.They also help the family and friends of the loved one to get throughthe grieving process. Different cultures and religions have differentceremonies for handling grief. However, most people use some formof service to help them grieve. A is a ceremony that is held to allow family and friends to view or watch over the deceased person before the funeral. Viewingthe body of the deceased can help family and friends accept thedeath. A wake also gives family members and friends an opportunityto come together and to support each other emotionally. For exam-ple, in Ireland, the wake is commonly held in the home of thedeceased’s family. A is a ceremony in which a deceased person is buried or cremated. To cremate means to burn the body by intense heat. During a funeral, the death is formally acknowledged. The funeral honorsthe deceased and offers family and friends the opportunity to paytribute to the loved one. A is a ceremony to remember the deceased per- son. A memorial service provides the same opportunity to mourn theloss of a loved one that funerals and wakes do. However, memorialservices can take place long after the death of the loved one. Theseservices may also present a memorial or structure, such as the Viet-nam War Memorial, to remember and honor the deceased. memorial servicefuneralwakeThe Vietnam Veterans Memorial Wall is dedicated to honoring those who diedin the Vietnam War. Visiting the memo-rial has helped many people cope withthe loss of a loved one who died in thewar. Copyright © by Holt, Rinehart and Winston. All rights reserved. 92 CHAPTER 4 Managing Stress and Coping with Loss Help for Dealing with a Loss There are several things you can do to help yourself as you cope with a loss. >Get plenty of rest and relaxation, but try to stick toany routines you kept before the loss. >Share memories and thoughts about the deceased. >Express your feelings by crying or by writing in ajournal. >If the loss was unintentional, do not blame yourselfor others. Blaming only creates a way of avoidingthe truth about the loss. Helping Others Sometimes people feel uncomfortable in the presence of a person who has experienced a loss. Small, kind actions such as the touch of a hand on a shoulder is apowerful way to show your support. There are other ways you can help a friend cope with a loss. >Show your support through simple actions, such asoffering to run errands or cook a meal. >Let the person know that you are there for him or her, and allow the person to talk about his or herthoughts and feelings. >Tell the person that you have faith that he or she is strong andwill learn to live with this loss. >If the person seems depressed, avoids family and friends, ordoesn’t seem to be making any progress, tell a trusted adult. Your support can help your friend accept his or her loss. He or she will appreciate your help. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term grieve. 2.Identify the term for “a ceremony to view or watch over the deceased person before the funeral.” 3.Identify the term for “a ceremony to remember the deceased person.” Understanding Key Ideas 4.Describe the effects of loss. 5.Identify which of the following is nota stage of the grieving process. a.death c.bargaining b.acceptance d.anger6.Identify in which of the following stages you might say, “Why me?” a.acceptance c.anger b.bargaining d.depression 7.Compare how funerals, wakes, and memorial services help people grieve. 8. Coping Describe three ways that you can help someone cope with a loss. Critical Thinking 9.Why should a person not be afraid to show emotion, such as crying, when faced with a loss?LIFE LIFE SKILL You have mixed feelings about seeing Nate at school this morning. He has just lost his brother, andyou want to show your support. However, youand your friends feel awkward. You are not surehow to relate to Nate after his tragic loss. Write on a separate piece of paper how you might give your friend Nate support. Rememberto use the decision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Preventing Suicide 93Preventing Suicide SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 Kim had six types of pills in a variety of colors in front of her. She didn’t know what half ofthem were for. It didn’t matter. Nothing mattered. Or did it? Kim decided to make one lastphone call. Facts About Suicide is the act of intentionally taking one’s own life. It is shocking to think that someone would wantto die. The truth is that most people who attempt sui-cide don’t really want to die. They feel helpless abouthow to end their emotional pain. However, suicide isnever the solution. There are other ways to deal withemotional suffering. Asking someone for help is thefirst step in making yourself feel better. Suicide is an uncomfortable topic for many people. Because so many people avoid the subject, many myths about it have arisen.Knowing the following truths about suicide can put an end to themyths and can help prevent suicide. >Many people who have considered suicide considered it onlyfor a brief period in their life. >Most people who have attempted suicide and failed are usu-ally grateful to be alive. >Suicide does not happen without warning. People who haveattempted suicide often asked for help in an indirect way. Alltalk of suicide should be taken seriously. >The use of drugs or alcohol can put people at risk of acting onsuicidal thoughts because their judgment is impaired. Suicide is a serious issue for all teens. Any talk or mention of sui- cide by a friend should not be taken lightly. If you think a friend is introuble, talk with your friend. More important, tell a parent or trustedadult about your friend’s intentions right away.SuicideOBJECTIVES Listfour facts about suicide. Describe why teens should be concerned about suicide. State seven warning signs of suicidal behavior. Describe steps that you can take to help a friend who has talked about suicide. LIFE LIFE SKILLKEY TERMSKEY TERMS suicide the act of intentionally taking one’s own life Talking to someone is one of the best things you can do when you feel hopeless or sad. Copyright © by Holt, Rinehart and Winston. All rights reserved. 94 CHAPTER 4 Managing Stress and Coping with LossTeens and Suicide Suicide is the fifth leading cause of death for ages 25 to 64. However, it is the third leading cause of death for people between the ages of15 and 24. Thus, suicide is a

serious problem for your age group. For-tunately, suicide is preventable, and you are the best person to protectyourself from it. Being aware of the challenges of the teen years willhelp. Changes During the Teen Years Sometimes the physical and emotional changes during the teen years may make teens feel moreemotional, impulsive, and focused on today. Some teens may feelconfused and helpless at times, especially if they are having troublesat home or at school. Don’t be tempted to find quick solutions thatmay make the situation worse. Ask a parent or trusted adult for helpif you are not sure about what to do. It is important to realize that feeling impulsive, emotional, or focused on today are part of growing up. As you get older, you willgain more experience, connect with more people, and become moreindependent. You will have a greater awareness of who you are, whatyou value, and what you need. You will then feel better prepared forthe challenges that face you. Teens often feel . . . focused on today What you can do: Hang in there, and talk to yourparents, a friend, or a trustedadult when you need support.What you can do:Don’t use permanent solutionsto solve temporary problems.impulsive What you can do:Stop and think about the consequences before you act. highly emotional Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Preventing Suicide 95Warning Signs for Suicide Recognizing the warning signs of suicide in yourself or in others could help save your life or someone else’s life. If you notice any ofthe following signs in yourself or in another person, talk to a parentor trusted adult. >Feeling hopeless If feelings of sadness interfere with a person’s daily activities, he or she might be depressed. If feelings of hopelessness have lasted for more than a few d ays, the person may be headed in a dangerous direction. The person needshelp right away. >Withdrawing from family and friends Withdrawing from family and friends is a strong sign that someone is considering suicide.However, if you or someone you know is thinking of suicide,this is the most important time to look for support from thepeople closest to you. If you notice a friend becoming with-drawn, talk with him or her to find out if he or she needs help. >Neglecting basic needs People who no longer take care of their appearance, start to lose weight, or have trouble sleepingcould be depressed and suicidal. Some examples of neglectingappearance are not brushing hair, not showering regularly, ornot changing clothes. >Experiencing loss of energy People who feel hopeless and depressed don’t feel like making an effort at anything. They nolonger take part in things that interest them and may sleepmore than usual. >Taking more risks Rebellious, self-destructive, or reckless behavior can be a sign of someone who is struggling aboutwanting to hurt himself or herself. He or she may also becomeviolent toward others or himself or herself. >Using alcohol and drugs In attempts to escape the pain, depressed people will often use drugs and alcohol. However,this behavior not only is self-destructive, but it also leads tomore anxiety and depression. >Giving away personal things When someone feels that he or she is coming to the end of his or her life, the person may feel aneed to take care of things. Giving away personal belongings isa way to say goodbye without words. If someone gives yousomething that is very precious to him or her, you might wantto ask why. These signs indicate that the person is feeling unheard, confused, depressed, and frightened. They are signs that the person needs help. Understand that suicide is not the solution to temporary prob- lems. Suicide is permanent. A person who commits suicide cannot go back and change his or her mind later. Also, find comfort knowingthat if you are depressed, you are not alone. Everyone goes throughhard times. Everyone has experienced loneliness. Learning to copeand manage pain and sadness is an important part of human devel-opment. Usually, the first step is to ask someone for help. Remainingsilent can only cause isolation and further withdrawal from daily life.Words That Warn >“I wish I were dead.” >“I just want to go to sleep and never wake up.” >“I won’t be a problem for youmuch longer.” >“I won’t have to put up with thismuch longer.” >“I can’t take it anymore.” >“This pain will be over soon.” >“Nothing matters.” For more information about depression, see Chapter 3. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. Giving and Getting Help When you or someone you know is thinking of suicide, do not ignore the problem. Thoughts of suicide are a cry forhelp. You should act immediately by talking with a friend,parent, or trusted adult. The following are things that youcan do if a friend has talked about suicide. >Take all talk of suicide seriously. If your friend men- tions suicide, tell a trusted adult even if you thinkyour friend is joking. >Tell your friend that suicide is not the answer. Emphasize to your friend that suicide is not theanswer to temporary problems. Remind your friendof all the things that would be missed if he or shewere no longer alive. Suggest that your friend talk toa trusted adult. >Change negative thoughts into positive thoughts. Help your friend use positive self-talk to look atthings with a different perspective. >Don’t keep a secret. Do not agree to keep a secret if your friend asks you not to tell anyone that he orshe is thinking of suicide. This is a serious situationthat requires the help of a trusted adult. Anyone who is suicidal needs professional help and cannot fix the problem by himself or herself. It is very important that you get helpfor a friend who is suicidal. Likewise, if you are feeling depressed,don’t delay asking a trusted adult for help. Most cities have a variety of health organizations that offer services to people in need. Some of these services are free. A parent or guardiancan help you find the right organization. The important thing is to tellsomeone and to get the help that you or your friend needs. 96 CHAPTER 4 Managing Stress and Coping with Loss REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term suicide . Understanding Key Ideas 2.Name four facts about suicide. 3.Describe why suicide is an especially serious prob- lem for teens. 4.Identify the number that suicide ranks as the cause of death in teens. a.first c.fifth b.third d.ninth5.State seven warning signs that someone may be thinking about committing suicide. 6.Describe how positive self-talk can help a person who is thinking of suicide. 7. Practicing Wellness Describe four things that you can do if your friend is thinking about suicide. Critical Thinking 8. Practicing Wellness Describe how you can protect yourself from the risks of suicideduring the teen years.LIFE LIFE SKILLLIFE LIFE SKILL“I know what it feels like to be really down. I’m glad I talked with someone.” Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 4 Highlights 97 CHAP TER 4 CHAP TER 4 CHAPTER 4Highlights Key Terms The Big Picture ✔Stress is your body’s and mind’s response to a demand. Anything you perceive as threatening can cause stress. ✔The fight-or-flight response is your body’s physical response tohelp you deal with a stressor. ✔Eustress is positive stress and can motivate and energize a personto reach a goal. Distress is negative stress and can make a personsick or keep a person from reaching a goal. ✔If your body is under stress for a long period of time, you maybecome exhausted and may develop a stress-related illness.SECTION 1 stress (78) stressor (78) epinephrine (80) eustress (80) distress (81) ✔Loss may cause the same emotional and physical effects thatcharacterize stress. ✔The stages of the grieving process are denial, anger, bargaining,depression, and acceptance. ✔Funerals, wakes, and memorial services can help you accept theloss of a loved one and receive emotional support from familyand friends. ✔Sharing memories of the deceased and listening to your friendare a couple of ways you can help a friend cope with a loss.SECTION 3 grieve (90) wake (91) funeral (91) memorial service (91)✔Eating right, exercising regularly, and getting enough rest will keepyou healthy so that your body can avoid stress-related illnesses. ✔You can learn to relax by practicing deep breathing exercises andtension-releasing exercises. ✔Assets are skills or resources that can help a person build resilien-cy against stressors. ✔Having a positive attitude about a potentially threatening situa-tion can help relieve stress. ✔You can manage your time more effectively by listing your projectsin order of priority, knowing your limits, and making a schedule.SECTION 2 resiliency (85) asset (85) prioritize (87) ✔Learning the facts about suicide can prevent the development ofmyths about suicide and can help prevent suicide. ✔Teens should be concerned about suicide because it is the fifthleading cause of death in people between the ages of 15 and 24. ✔Giving away personal things, feeling hopeless, and sleeping toomuch are a few of the warning signs for suicide. ✔Taking all talk of suicide seriously, suggesting that your friend talkto a trusted adult, and not keeping any talk of suicide secret are afew ways you can help a friend who may be considering suicide.SECTION 4 suicide (93) Copyright © by Holt, Rinehart and Winston. All rights reserved. 98 CHAPTER 4 Review CHAP TER 4 CHAP TER 4 CHAPTER 4Review Using Key Terms asset (85) prioritize (87) distress (81) resiliency (85) epinephrine (80) stress (78) eustress (80) stressor (78) funeral (91) suicide (93) grieve (90) wake (91) memorial service (91) 1.For each definition below, choose the key term that best matches the definition. a.any situation that puts a demand on the bodyor mind b.the ability to recover from illness, hardship,and other stressors c.to arrange items in order of importance d.a ceremony in which a deceased person isburied or cremated e.a skill or resource that helps a person reach agoal f.the act of intentionally taking one’s own life g.to express deep sadness because of a loss h.the body’s and mind’s response to a demandmade upon it i.one of the hormones that are released by thebody in times of stress 2.Explain the relationship between the key terms ineach of the following pairs. a.wake and memorial service b.distress and eustress Understanding Key Ideas Section 1 3.What is the difference between a biological stres-sor and an environmental stressor? 4.Describe how the fight-or-flight response can helpyou respond to a threatening situation. 5.Which of the following does notdescribe some- one in distress? a.confused c.nervous b.unsure d.motivated 6.In which stage of the general adaptation syn-drome are you most likely to get sick fromresponse to stress?Section 2 7.Explain how exercise can help you deal withstress. 8.Explain how breathing deeply can help you dealwith stress. 9.Which of the following is notan asset for building resiliency? a.occasional exercise c.positive values b.support d.empowerment 10.Explain how self-talk can help you deal with astressor. 11.Which of the following is nota helpful suggestion for making a schedule? a.Be realistic. b.Make time to relax. c.Order your activities randomly. d.Prepare for problems. 12.CRITICAL THINKING Use the tips you learned in the chapter to make a schedule for yourself fortoday. Section 3 13.Describe how loss can cause stress. 14.List the stages of the grieving process. 15.Describe three ceremonies that honor a loved onewho has passed away. 16.Describe why you should not blame others for aloss if the loss was an accident. Section 4 17.Explain why it is important to know the factsabout suicide. 18.Which of the following does notdescribe a behavior that can lead teens to react quickly onthoughts of suicide? a.impulsive c.silent b.highly emotional d.focused on today 19.Explain why giving away personal things mightbe a sign of someone considering suicide. 20.Explain why it is important not to ignore afriend’s talk about suicide. LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 4 Review 99Interpreting Graphics Study the figure below to answer the questions that follow. 21.Which job industry accounts for the highest per- cent of stress cases? 22.What is the total percent of stress cases for theservices and manufacturing job industries? 23.CRITICAL THINKING What types of stress cases do you think workers experience in the job indus-tries listed?Activities 24. Health and You Using the time management skills you learned in this chapter, develop aschedule for the next 7 days. 25. Health and Your Community Research and write a two-page report on the ways that people in the United States cope with loss. 26. Health and You Describe the grieving process as it relates to a loss you have experienced or a lossyou could have experienced. 27. Health and Your Community Create a list of fam- ily members and friends you can turn to for help ifyou or a person you know is considering suicide. Action Plan 28. Practicing Wellness Use the stress management techniques—taking care of yourself,building resiliency, changing your attitude, andmanaging your time—to create a stress manage-ment program. Follow the program for 1 week.Keep track of your stress management activitiesand how these activities affect your stress level.LIFE LIFE SKILL 29.In this passage, the word adamant means Anegative. Bnot clear. Cnot giving in. Dhopeful. 30.What can you infer from reading this passage? EHallie is sad and confused. FCindy will be going to the funeral. GCindy’s sister died. Hall of the above 31.Write a paragraph that describes ways that Cindycould help Hallie with her loss. 32.Write a paragraph that describes why it may helpHallie through the grieving process if she goes toher sister’s funeral.READING SKILLWRITING SKILLWRITING SKILL Read the passage below, and then answer the questions that follow. As Cindy hung up the phone, she thought about Hallie’s comments. Cindy didn’tunderstand why Hallie was so adamant about not going to her sister’s funeral.Cindy tried to talk Hallie into going to thefuneral. She told Hallie that the funeralmight be uncomfortable but that she wouldbe happy later if she went. However, Hallie’slast words to Cindy were “I love my sister,but I hate funerals. My parents will be soangry with me, but I just can’t imagine sit-ting through a funeral.” Cindy sat insilence, thinking. She wanted to help andcomfort her friend, but didn’t know how. 35% 21%14%12%18% Services (ex: restaurant) Manufacturing (ex: shoe factory) Retail trade (ex: clothing store) Finance (ex: bank) Other *Stress cases involve time lost from work.Stress Cases by Job Industry* Source: U.S. Department of Labor Bureau of Statistics. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 5 CHAP TER 5 CHAPTER 5 Preventing Violence and AbusePreventing Violence and AbusePreventing Violence and Abuse 100BEHAVIOR Indicate how frequently you engage in each of the following behaviors (1 = never; 2 = occasionally; 3 =most of the time; 4 = all of the time). Total yourpoints, and then turn to p. 642. 1.I calm down before telling someone that what he or she said or did upset me. 2.I respect others even if they are differentfrom me. 3.I don’t pick on or tease others. 4.I don’t carry weapons. 5.I don’t solve arguments with fights. 6.I am assertive and communicate directly andrespectfully, not aggressively. Copyright © by Holt, Rinehart and Winston. All rights reserved. 101SECTION 1 Conflict Resolution and ViolencePrevention SECTION 2 Recognizing andPreventing Abuse SECTION 3 Sexual Abuse andViolence go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH05. Copyright © by Holt, Rinehart and Winston. All rights reserved. 102 CHAPTER 5 Preventing Violence and AbuseWhen Milos first moved to his new town, older kids made fun of the way he dressed and how he talked. He wasbeaten up three times in the first month. He eventually joined a gang for protection. Now, he’s pushing others around. Violence Around Us is any physical force that is used to harm people or damage property. Unfortunately, violence has started to become a way of lifein our society. We see it on TV, in the movies, in the newspaper, invideo games, in our schools, and even in our own homes. We are lit-erally surrounded by violence. Many have come to think about vio-lence as no big deal. We see violence not only as a quick solution to aproblem, but also as entertainment such as in many action movies. Some people think that if they don’t actually get injured, violence doesn’t affect them. This is not true. Seeing and experiencing violencecan often make a person insensitive to others who might be in trou-ble. For example, kids who frequently observe teasing might considerthe behavior as normal. When teasing becomes common, it is easierto be apathetic, or unconcerned, of others who have been hurt. Observing and experiencing violence can also make a person more violent towards others. For example, Milos was beaten up whenhe moved to his town. Now he beats other kids. Being hardened and becoming violent are responses to experi- encing and seeing violence. These responses to violence don’t makeanyone safer. On the contrary, the responses escalate violence andmake society unsafe and helpless to stop the violence.ViolenceConflict Resolution and Violence PreventionSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Describe how people are affected by the violence around us. Identify five factors that lead to conflict between teens. Describe three ways to resolve a conflict without violence. State four ways you can avoid dangerous situations. Develop a personal plan of how to handle a situation in which you or a friend is bullied. LIFE LIFE SKILLLIFE LIFE SKILLKEY TERMSKEY TERMS violence physical force that is used to harm people or damage property tolerance the ability to overlook differences and accept people for who they arebullying scaring or controlling another person by using threats or physical forcenegotiation a bargain or compromise for a peace- ful solution to a conflictpeer mediation a technique in which a trained outsider who is your age helps people in a con- flict come to a peaceful resolution From the games we play to the music we listen to and the movies we see,violence is all around us. Copyright © by Holt, Rinehart and Winston. All rights reserved. 103Factors That Lead to Conflicts Between Teens A conflict is another name for a fight or a disagreement. A conflict can be small, like a disagreement over how to play a game. A conflict can also be large, like the tensions between two countries. Some people wrongly choose violence to resolve a conflict. Vio- lence does not solve a problem, it makes the problem worse. Violencecan lead to injury and even death. Often, violence provokes furtherviolence in the form of revenge. Understanding the factors that canlead to conflict can help prevent conflicts from getting out of control. Feeling Threatened The stress from being threatened can often lead to violence. Milos’s situation is a good example. He reacted tothreats and violence against him with more violence. Violence isnever a good solution to a problem. Violence only makes the prob-lem bigger. Bringing a gun or a weapon to school will not protectyou. It will put you and others in greater danger. Unmanaged Anger Unmanaged anger can also contribute to conflict. Being fatigued, or very tired, or living in an over-crowded area can cause a person to be more irritable and act out with anger. How-ever, it is important to deal with anger effectively. If you feel you haveproblems managing your anger, ask your parents or a trusted adultwhere you can get help. Remember that only you are responsible forhow you express your anger. Lack of Respect Being disrespectful to others can lead to conflict. For example, picking on someone, or destroying one of his or herbelongings is one form of disrespect. Having negative opinions aboutpeople because of their race, their ethnicity, their gender, their reli-gion, or the way they dress are other ways of being disrespectful. 30% 1 in 312statistically speaking. . .For more information about managing anger, see Chapter 3. linkTOPICTOPIC Percentage of students who are bullied or who bully others: Number of teens who don’t feel safe in school: Number of people under the age of 20 who die from injury by a firearm every day: Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Bullying HealthLinks Code: HH4025 104 CHAPTER 5 Preventing Violence and AbuseA violent act against someone just because he or she is different in race, religion, culture, or ethnic group, is called a hate crime. Many forms of violence could be stopped if people were more tolerant. is the ability to overlook differences and accept people for who they are. Bullying Scaring or controlling another person by using threats or physical force is called Bullies can use physical force, such ashitting, kicking, or damaging one’s property. Bullies can also usewords to hurt or humiliate another person by name-calling, insult-ing, making racist comments, taunting, or teasing. Bullies can be manipulative in less obvious w ays, such as by spreading nasty rumors. Bullies often form cliques . A clique is a close peer group that includes certain people and excludes others. The following list provides suggestions on how to prevent bully- ing or being bullied. >Be tolerant of others. Encourage your friends to respect others. >If you see someone being bullied, tell a trusted adult. >Don’t be embarrassed to ask for help from friends, teachers, orparents. Bullies won’t pick on you if they can’t get away with it. >Be assertive, not aggressive. Bullies like to pick on those theythink are weak, but responding aggressively to a bully maymake the situation worse. >Avoid bullies or any people who are disrespectful or threaten-ing. >Respect yourself. No matter what bullies may say to you, standby what you believe and be proud of who you are. Gangs Gangs often cause conflict and violence. A gang is a group of peers who claim a territory. Most gangs have a leader and use recog-nizable symbols or tattoos. Often gangs commit acts of vandalismand carry weapons. They often use drugs, and alcohol, which canplay a role in many dangerous situations. Gangs are destructive to thecommunity, the people who live in it, and themselves. People join gangs for many reasons. Gangs may make people feel as if they fit in or make them feel safe, or powerful. Some people joingangs for excitement, recognition, or what they think is respect. TVshows and movies often make gangs seem glamorous and may makea person want to join a gang. A gang can provide a lonely person withfriendship. Teens may join gangs because their family members are inthe gang. Regardless of the reason, joining a gang is a bad idea. There are many other choices besides joining a gang. You do not have to support or take part in violence. The following are other waysto find support and your own place in your community. >join a sports team or school club >volunteer with your neighborhood watch group >coach a sports team for younger kids There is no excuse for joining a gang. If you feel unsafe in your community, work with community leaders to fight for improve-ments. bullying.Tolerance Bullies threaten, hassle, or intimidate smaller or weaker people. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Conflict Resolution and Violence Prevention 105Avoiding Dangerous Situations To avoid dangerous situations, you should not only stay clear of potentially violent people, but also avoid situa-tions where you might cause conflict or violence. Forexample, don’t join gangs and don’t carry weapons. Figure 1 shows some other ways to avoid conflicts. Some dangerous situations happen unexpectedly. You may find yourself in a conflict that starts to get outof control and could lead to violence. Follow thesesteps to avoid dangerous situations. 1. Recognize the signs. Part of avoiding dangerous situations is being able to recognize when a situa-tion is getting out of control. People who are begin-ning to lose control of their anger will show it inthe tone and volume of their voice. Nonverbal signsof

anger can also appear in body language. Forexample, clenching one’s fists or teeth, getting redin the face, or narrowing one’s eyes are signs thatanger is getting out of control. Also, look for thesesigns in yourself. 2. Calm things down. If you see signs that a situation might end in conflict, there are things you can do tocalm down the situation and avoid a conflict.Always be respectful to the other person. If some-one says something that makes you upset, take adeep breath and count to 10 before responding.Use the tips for managing anger and using “I”messages you learned in Building Self-Esteem andMental Health. 3. Leave the situation. If things look like they might get out of con- trol, you can arrange to discuss the matter later when you bothcool down. If you no longer feel as if you have control of thesituation or of your own anger, you should leave immediately. 4. Offer alternatives. Even if someone insists that you fight, you don’t have to. Firmly say that you will not fight. You can offeralternatives to a physical battle, such as a basketball contest. Youcan make an excuse for why you need to leave. Act like the otherperson is making a big deal over something small. The importantthing is to get yourself and others out of danger. Everyone deserves to feel safe. People should not be so worried about their safety that they are afraid to go to school or take part in their favorite activities. Every teen should feel confident that there areadults and authorities that are committed to protecting him or her. Ifyou feel unsafe and don’t know what to do about a situation, theseadults and authorities can be your best defense. If someone tells youthat he or she is planning a violent act, tell a responsible adult. Evenif you believe the person is joking, it is important for your safety andthe safety of others that you tell a responsible adult. Do Treat all people with respect, regardless oftheir race, gender, reli-gion, or ethnicity. Join a sports team, act in a theater group,volunteer at a hospital,or get a job. Take a self-defense class. Learn to control your anger.Don’t Don’t make fun ofpeople who aredifferent from you. Don’t join a gang. Don’t buy or carry a weapon. Don’t fight someone to solve an argument. These teens from Pakistan, India, the Middle East, and the Balkans respectand support each other as teammatesin a soccer game. As indicated in thefigure above, showing respect to otherswho are different from you is oneimportant way to avoid conflict.1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. Resolving Conflict Without Violence Let’s say you have followed all the steps to avoid dangerous situations yet find yourself in a serious conflict. There are ways to resolve con-flicts effectively without using violence, but they require work. It’s noteasy to work out a problem with someone who has made your bloodboil. It’s hard to be respectful to someone who hasn’t been respectfulto you. That’s why resolving a conflict nonviolently takes morecourage and strength than using violence does. Conflict Resolution Skills Conflict resolution is a nonviolent way to deal with arguments. All people involved in the conflict sit downtogether and express their points of view. Everyone works together tofind a solution acceptable to all parties involved. A common and suc-cessful approach is through negotiation. A is a bargain orcompromise for a peaceful solution to a conflict. Being able to successfully negotiate a conflict depends on your communication skills. Here are some tips for communicating effec-tively to resolve conflicts. >Be respectful, yet be assertive. >Use the steps of the Making GREAT Decisions model. >Don’t call each other names or raise your voice. >Allow the other person time to speak. >Don’t make assumptions. >Focus on the real issue. >Be open to change and look for shared interests. >Use “I” messages, not “you” messages. >Use listening skills and try to understand what the otherperson wants. If negotiating a conflict on your own isn’t working, don’t give up. You can also try peer mediation . is a technique in which a trained outsider who is your age helps people in a conflictcome to a peaceful resolution. Peer mediationnegotiation For more information about communicating effectively,see Chapter 3. linkTOPICTOPIC Peer mediators help people involved in a conflict work out the problem in anonviolent way. Copyright © by Holt, Rinehart and Winston. All rights reserved. Peer Mediation Having nonbiased outsiders organize a negotiation for you can be a big help in resolving con- flicts. Peer mediators are trained to keep discussions fair.They make sure each person has a chance to speak, andthey make sure the discussion focuses on the real issue. Many schools provide peer mediation services. If stu- dents in the school want help solving a conflict, they usu-ally fill out a form describing the problem and submit theform to the mediation program. Sometimes, mediationreferrals come from third parties, such as students or teach-ers who know trouble is brewing between two people. In peer mediation, each student tells his or her side of the conflict. Students get a chance to vent their feelings andtalk to each other if they want to. They can ask questionsand clarify facts. The parties brainstorm solutions. Usually,at least two mediators keep track of the solutions that arediscussed. However, the mediators don’t make suggestionsunless they are asked. Their job is to ensure that everyonehas a voice to guide the group toward a solution and tomake sure things are worked out “fair and square.” Eventually, the arguing students agree to one of the suggestions on their brainstorming list that they created.Both parties sign a contract agreeing to the solution. Thepeer mediators follow up by checking to see if both sidesare following the agreement. With peer mediation, both parties in a conflict are guaranteed to work out the problem in a safe, nonviolent way. A lot of students likepeer mediation because it is run by students. Adults only supervise. Isthere a peer mediation program in your school? If not, you may wantto talk to a teacher or principal about starting one. SECTION 1 Conflict Resolution and Violence Prevention 107 REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “the ability to overlook dif- ferences and accept people for who they are.” 2.Define the term bullying . 3.Identify the term for “a bargain or compromise for a peaceful solution to a conflict.” Understanding Key Ideas 4.Describe how violence affects us. 5.State five factors that can lead to conflict.6.Identify which of the following is nota skill for successfully resolving conflict. a.negotiation c.bullying b.peer mediation d.compromise 7.Describe why peer mediation has been successful in high schools. 8. Practicing Wellness List four ways you can avoid dangerous situations. Critical Thinking 9. Coping Develop a plan on how to handle a situation in which you are being bullied.LIFE LIFE SKILLLIFE LIFE SKILL Max and Ryan have been friends since kindergarten. Now they are in high school together. One day,Max and Ryan are talking in the cafeteria. Ryanstarts telling Max about some kids who havebeen bullying him after school. Ryan swears Maxto secrecy, unzips his bag, and shows Max a gun.Max asks Ryan why he needs a gun. Ryan says,“Just in case.” Write on a separate piece of paper what you would do if you were in Max’s situation. Remem-ber to use the decision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. 108 CHAPTER 5 Preventing Violence and AbuseRecognizing and Preventing AbuseSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Tad was watching TV when he heard screaming from the apart- ment next door. His neighbors were fighting again, but thistime the fight sounded really bad. He could hear furniture being thrown and something breaking. One of the voices soundedvery frightened. What Is Abuse? is physical or emotional harm to someone. Abuse can take place anywhere, including at school, on the street, or at home. Unfor-tunately, the most common forms of abuse come from people oneshould be able to trust, such as family members, friends, boyfriends,or girlfriends. For this reason, people who are being abused don’t feelas if they can leave the abuser or demand to be treated respectfully.However, it is necessary for them to do so. Many forms of abuse areillegal. No one should have to tolerate abuse. It is difficult to imagine what would make someone inflict harm on a loved one, such as a child, a spouse, a girlfriend, a boyfriend, apeer, or an elderly parent. You may be surprised to find out that theabuser is often someone who was once abused himself or herself. Ifpeople grow up in a family in which they were abused, they learnthat abusive behavior is the normal response to tension or conflict. Abusive Behavior Learning to recognize inconsiderate and disre- spectful behavior will help you avoid abusive people. For example, anabusive relationship may exist if a person is controlling, obsessive,manipulative, selfish, aggressive, or needy. An abusive person may getjealous easily, have difficulty controlling anger, or demand that theother person not see certain people or wear certain clothes. An abuserwill often insult, humiliate, or put down others. Abusers often usecoercion, which is force or threats. If you know of someone who has been abusive to others, chances are that he or she could be abusive toyou, too. AbuseOBJECTIVES Identify abusive behavior. Describe four types of abuse. Summarize the effects of abuse. Identify help that is available for those in abusive relationships. Listactions you can take to protect yourself from abuse. LIFE LIFE SKILLKEY TERMSKEY TERMS abuse physical or emotional harm to someone neglect the failure of a caretaker to provide for basic needs, such as food, clothing, or love domestic violence the use of force to control and maintain power over a spouse in the homehazing harassing newcomers to a group in an abusive and humiliating way Often, people who are abused are abused by someone they should beable to trust. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Abuse and Violence HealthLinks code: HH4003 SECTION 2 Recognizing and Preventing Abuse 109Types of Abuse There are many types of abuse. The following is a description of the most common types of abuse. Child Abuse As many as 3 million cases of child abuse are reported every year in the United States. Many more cases never getreported. Children are frequent targets of abuse because they areyoung and can’t or don’t know how to respond appropriately. Some-times one sibling will abuse another. Child abuse is usually catego-rized in four different ways: physical abuse, emotional abuse, sexualabuse, and neglect. occurs when a caretaker fails to providebasic needs, such as food, clothing, or love. Domestic Violence The use of force to control and maintain power over a spouse in the home is called A for-mer spouse, a fiancé, a boyfriend, or a girlfriend can also commitdomestic violence. Women can abuse their male partners, butwomen are much more likely to be the victims of domestic violence.It is estimated that an act of domestic violence occurs somewhere inthe United States every 15 seconds. Often an abusive relationship goes through a cycle of three stages, as shown in Figure 2. 1. Tension-building phase A time of emotional abuse such as insults or threats. 2. Violent episode phase An act of physical abuse occurs such as choking or hitting. 3. Honeymoon phase The time when the couple makes up. This phase is often the reason people stay in abusive relationships. domestic violence.Neglect Violence in domestic relationships often cycles through three stages. The cyclewill often repeat itself continuously,sometimes for years, until the partnersget help or the relationship ends.2 Figure Tension-Building Phase Violent Episode PhaseHoneymoon Phasethreats reconciliation use of weaponspushinghitting chokingaccusationsinsults arguments apologies promises Copyright © by Holt, Rinehart and Winston. All rights reserved. 110 CHAPTER 5 Preventing Violence and AbuseElder Abuse The elderly are often viewed as the wisest people in the community. Unfortunately, elderly people are not always treated with respect by all people. Because elderly people are often frail, theycan be easily taken advantage of. For example, people will sometimessteal from them. They may be neglected in nursing homes or in theirown homes. Elder abuse can also take the form of physical abuse andemotional abuse. Hazing Harassing newcomers to a group in an abusive and humiliat- ing way is called Hazing may happen when people join sportsteams, gangs, fraternities, or sororities. The idea behind hazing is that itproves you are truly committed to joining the group. However, hazingis unacceptable. When people are beaten up, sexually taken advantageof, or humiliated, hazing becomes abusive and illegal. It’s important to be able to recognize abusive behavior. Abusive behavior can then be reported to stop the immediate violence and toprevent future violent acts. Effects of Abuse After reading about some of the types of abuse, you can imagine thatabuse may have an impact on a person’s life in more ways than one.If a person is physically harmed, he or she might have obvious physi-cal injuries that need to be tended to. However, the effects of abuseare not merely physical. Abuse affects all parts of a person’s health. Take Rosa, for example. Rosa was hazed during her tryouts for the swim team. She really wanted to make the team, so she went throughthe process. In addition to the bruises from the paddling, she feels sohumiliated and depressed at what the team members made her do.She doesn’t think she can ever tell anyone. Now it’s all she thinksabout—night and day. She feels isolated. How can she turn aroundand be friends with people who abused her? The effects of hazing are similar to the effects of other forms of abuse. Some examples of the effects of abuse are as follows: >depression >low self-esteem >poor appetite or overeating >low energy or fatigue >poor concentration and difficulty making decisions >difficulty sleeping >feelings of worthlessness >feelings of guilt, shame, and anxiety An abused person might lose his or her ability to trust or might develop relationship difficulties. Victims of abuse may turn to alco-hol or drugs. Some victims may develop an eating disorder. Others may contemplate suicide or may start to suffer from post-traumatic stress disorder, anxiety disorder, or panic attacks. hazing. Abuse is always physical.Myth Abuse can be emotional as well as physical.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Recognizing and Preventing Abuse 111Protecting Yourself from Abuse If anyone abuses you, tell your parents, the police, or other trusted adult. Tell the abuser you will let an authority know about his or herbehavior. Many forms of abuse, such as physical and sexual abuse, areillegal. Often, the abuser will stop if you threaten to tell because he orshe will be afraid of getting into trouble. Create a Supportive Network of Friends and Family Make sure there are people you can trust and talk to openly. If abuse doesoccur, you want people to whom you can turn for help. The morepositive relationships you have in your life, the more options you willhave in case of abuse. Avoid Disrespectful People If you know of someone who has been abusive to you or to others, you should stay away from that per-son. Whenever possible, don’t go somewhere if you know that personwill be there. Leave where you are if that person arrives. Choosefriends who treat you and others with respect. Choose friends whomake you feel good about yourself. If you let people know that yourespect yourself and expect respect from others, chances are that theywill treat you with respect. Be Assertive Abusers frequently prey on people who appear vul- nerable or who have low self-esteem. Assertive people set downboundaries that let others know they will not accept hurtful behavior.Being assertive toward an abuser will make it difficult for him or herto abuse you. However, if you act passively toward an abuser, thatperson will think he or she can abuse you again and again. If you actaggressively, depending on who the abuser is, that person maybecome angrier and make the abuse worse. Using assertiveness skillscan help you protect yourself from abuse. Figure 3 has examples of assertive statements. Assertive Statements “I don’t like it when you tell me to whom I can and cannot talk.” “You scare me when you yelllike that. ” “It hurts when you criticize me andput me down, especially in frontof other people. ” “I don’t want to be around youwhen you drink or get angry. ”Assertive statements respectfully tell the other person how you feel. ACTIVITY If a boyfriend or girlfriend is wrongfully accusing you of cheating on him or her, how would you respondassertively?3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. Show Disapproval If a person does not treat you in an accept- able way, show your disapproval. Showing disapproval lets the abuser know that his or her behavior is not acceptable, that you won’t toler-ate it, and that you want it to stop. There are many ways you can show disapproval. One subtle way is to refuse to laugh at an offensive joke. One active way is to yell forhelp. Earlier you learned about body language, tone of voice, andother means of communication. Use this knowledge to stand up foryourself and to let others know that their behavior is unacceptable.Because you know it is important to behave and speak politely, it canbe hard to show disapproval. However, showing disapproval is a nec-essary part of stopping abuse. It’s important to know that the abuser probably won’t stop abus- ing on his or her own. You may have to tell an abuser more than oncethat you will not tolerate the hurtful behavior. The refusal skills youlearned earlier can be a big help in saying no to abuse. However, it isalso important to tell your parents or other trusted adult about theabuse. LIFE LIFE SKILL ActivityStopping Abuse Before It StartsCommunicating Effectively Can you think of any situations in which you might need to be assertive or show disapproval? Practicingskills such as showing disapproval and being assertivewill help you use these skills confidently. Choose a partner to practice your assertiveness and disapproval skills with. Think of a potentially abusive situation in which you and your partner would like to useassertiveness and disapproval skills. Write down possible things a disrespectful person might say. Write down ways to show disapproval or to be assertive toward the disrespectful person. Now role-play your responses. Decide which partner will be the disrespectful person andwhich partner will be the victim. After you have gone through all the possible responses, switch roles. If you come up with moreresponses while role-playing, go ahead and trythem. Remember to be assertive, not aggressive. 654321Practicing Wellness Did you find your responses effective as you role-played them? Compare how it felt to take the role of the abusive person tohow it felt to take the role of the assertive person.LIFE LIFE SKILL For more information about practicing refusal skills, see the Express Lesson on p. 618 of thistext.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Recognizing and Preventing Abuse 113Help for The Abused Not only is abuse a crime, but no one should allow abuse to occur. Something can be done to stop the abuse. Tell Someone If you are currently being abused in any way, tell your parents, coach, school administra-tors, school counselor, or any other trusted adult. Thepolice also have information about shelters and otheragencies that help victims of abuse. Go Somewhere Safe If you are in immediate dan- ger, leave the situation and go somewhere safe—afriend’s or relative’s house, the police station, a religiousinstitution, a hospital, a school, or any supervised place where youwill be out of harm. Do not think about running away. Running awayis not a safe way to escape abuse at home. Runa ways almost always find themselves in situations that are worse than the one they left. Consider Counseling Abuse leaves mental and emotional scars that last long after the victim is safe. Counselors and other mentalhealth professionals can help victims of abuse deal with low self-esteem, depression, shame, and guilt. Many times, the family of thevictim takes part in the therapy, too. Victims are not the only ones who need help—abusers also need to get help. Abusers need help to realize that their behavior is hurtful,illegal, and unacceptable. There are programs available to helpabusers change their behavior. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term neglect . 2.Identify the term for “harassing newcomers to a group in an abusive and humiliating way.” Understanding Key Ideas 3.Listfive examples of inconsiderate and disrespect- ful behavior abusive people do. 4.Identify the form of abuse that occurs between a husband and wife or between a boyfriend and girl- friend. a.child abuse c.domestic violence b.elder abuse d.hazing5.Listthe three phases of the cycle of violence. 6.Describe why children and the elderly are especially vulnerable to abuse. 7.Describe the effects of abuse. 8. Coping List people you can go to for help if you or someone you know has beenabused. 9. Practicing Wellness Describe actions you can take to prevent and avoid abuse. Critical Thinking 10.Why do you think abused children often havetrouble making friends?LIFE LIFE SKILLLIFE LIFE SKILLFamily counseling can help family members deal with the long-termeffects of abuse and can also stopfuture acts of abuse. Copyright © by Holt, Rinehart and Winston. All rights reserved. 114 CHAPTER 5 Preventing Violence and AbuseSexual Abuse and ViolenceSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Alex was excited when he got his first job at the ice-cream stand. But, now he hates to go to work. His boss sometimes touches him in places he doesn’t want to be touched. Tonight, he is really worried. He has to close up the stand alone with the boss. Sexual Abuse is any sexual act without consent. Any act in which a person touches you in a sexual way that makes you feel uncomfort- able is an act of sexual abuse. The acts can range from kissing andfondling to forced intercourse. For example, it is considered sexualabuse if the abuser touches the victim in a sexual way or if the victimis forced to touch the abuser in a sexual way. It is also considered sex-ual abuse if either the victim or abuser is indecently exposed or if thevictim is shown pornography. Children and Sexual Abuse Sexual activity between family members who are not husband and wife is known as Incesttraumatizes a child not only physically but also emotionally. Becausethe child is being abused by someone he or she knows and trusts, thechild may find it difficult to tell when he or she is being abused. Another reason children find it hard to admit that they are being sexually abused is that the abuse tends to begin “innocently” withaffectionate hugs and kisses. The abuser may manipulate the childinto feeling special. The behavior progresses to caresses and sexualteasing and then to sexual activity. Because the behavior started in aninnocent fashion, children feel as if they did something to encouragethe abuse. They then feel too ashamed to tell someone. However, ifno one finds out, the abuse can continue. Anyone being sexually abused should tell a trusted adult. All forms of sexual abuse are illegal and should be reported to the police.incest.Sexual abuseOBJECTIVES Define sexual abuse. Describe sexual harassment. Describe facts about sexual assault and rape. Name five things a person should do if he or she has been sexually assaulted. Listthree ways you can protect yourself from sexual abuse and violence. LIFE LIFE SKILLKEY TERMSKEY TERMS sexual abuse any sexual act without

consent incest sexual activity between family members who are not husband and wife sexual harassment any unwanted remark, behavior, or touch that has sexual contentsexual assault any sexual activity in which force or the threat of force is useddate rape sexual intercourse that is forced on a victim by someone the victim knows Boys as well as girls are victims of sexual abuse. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Sexual Abuse and Violence 115Sexual Harassment Every time James sees Tiffany, he has something to say about how she looks. The way he looks up and down her body makes her feelso uncomfortable. She has started wearing baggy clothes. She haseven started walking to school the long way just so she doesn’tbump into him. Matt went out with Lydia. The date turned into a bad evening. She kept pressuring him to have sex. He said no many times. Then,she accused him of not liking girls. She became angry and left early.At school today, she avoided him. He saw her whispering to herfriends and looking at him from across the room. Matt felt so embar-rassed. He couldn’t wait for the bell to ring so that he could leave. The two situations above are examples of sexual harassment. is any unwanted remark, behavior, or touch that has sexual content. Can you identify the harassing behaviors? If thebehavior makes your school, home, or work environment intimidat-ing, hostile, or offensive, the behavior is sexual harassment. In thecases of Tiffany and Matt, the harassers were making the school envi-ronment uncomfortable. When people are confronted about sexual harassment, they will often say they were only flirting. How do you feel when someoneflirts with you? You might feel flattered, respected, and attractive. But,Tiffany and Matt felt uncomfortable, cornered, and ashamed. Do yousee the difference? Whatever intention you may have, if someone tells you that he or she doesn’t like your behavior, you are not flirting.If you are unsure how someone feels about your flirting, you canalways ask. Power and Sexual Harassment Sexual harassment is most dangerous when the harasser holds a position of power, such as adoctor, teacher, boss, or older friend of the family. In such a case, thevictim is often afraid to complain about the behavior. He or shedoesn’t want to risk his or her health, get a bad grade, lose a job, or embarass the family. Victims may even get direct messages, such as“If you have sex with me, I’ll give you a raise.” Responding to Sexual Harassment If you are being sexually harassed, there are things you can do to stop the harassment. 1. Tell the harasser to stop. The harasser might not know that he or she is making you feel uncomfortable. If you never say anything,he or she will never know that you disapprove of the behavior. 2. Report the harassment. If the harassing continues after you told the person to stop, avoid the person and complain about theharassment to a higher authority. The higher authority might be aparent, guidance counselor, principal, or owner of a business.Sexual harassment is illegal. Most schools and businesses haverules prohibiting sexual harassment. Use those rules and govern-ment laws to stop the behavior.Sexual harassmentExamples of Sexual Harassment? >Telling unwanted sexual stories or jokes >Making sexual remarks about aperson’s clothing and the way itfits on the person’s body >Staring at a person’s body orbody parts >Continuously asking a person out orsending gifts, e-mails, or love notesafter he or she asked you to stop >Touching, patting, or pinching aperson in a sexual way >Standing too close to or brushingup against a person’s body >Making sexual gestures >Offering the person something heor she needs in return for sex Copyright © by Holt, Rinehart and Winston. All rights reserved. 116 CHAPTER 5 Preventing Violence and AbuseSexual Assault and Rape is any sexual activity in which force or the threat of force is used. Sexual assault can range from forced kissing to pulling off clothes and grabbing body parts. Forced sexual intercourse, orrape, is an extreme form of sexual assault. Some people think that sexual assault and rape are committed by strangers. The truth is that about 80 percent of victims of sexualassault and rape know their attacker. , also referred to asacquaintance rape, is sexual intercourse that is forced on a victim bysomeone the victim knows. The rapist uses the trust that he or she hasdeveloped with the victim to take advantage of the victim. Rape canalso happen between married couples. This is a form of domestic vio-lence. Some people believe that rape occurs because the attackerwants sexual intercourse. However, the real reason that people rape isto gain power and control. Using alcohol and drugs as well as being around people who use alcohol and drugs can put you in a dangerous situation. About 45percent of rapists were under the influence of alcohol when theyraped somebody. Also, rapists sometimes give alcohol and drugs tovictims so that they will be more vulnerable. Rapists have also beenknown to slip drugs into the victim’s drink. These drugs are com-monly known as date-rape drugs. The drugs cause the victim to lose consciousness. In some cases, date-rape drugs can be fatal. Effects of Sexual Assault and Rape Like victims of other types of violence, victims of rape and sexual assault suffer both physicaland emotional trauma. Survivors may experience injuries such asbruises, cuts, and broken bones. They may also be exposed to preg-nancy and sexually transmitted diseases (STDs). Victims may feelguilt and shame about the assault. They may have trouble sleeping oreating. They may even suffer from post-traumatic stress disorder. Rape and sexual assault are not only morally wrong, they are illegal. Depending on the state, the sentences for a conviction of sexual assaultor rape range from fines and community service to years in prison.Date rapeSexual assault “Only young, beautiful people are raped.” “Men and boys are never raped.” “People who wear sexy clothes are asking to be raped.” “Rape is an act of sexual frustration.” “Most rapes are committed by someone unknown to the victim.”People of all ages are victims of rape. One out of 10 victims of rape is male.It doesn’t matter what a victim wears. No one asks to be raped. Rape is an act of power and control.Most rapes are committed by a person known to the victim.Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. Protecting Yourself from Sexual Abuse and Violence There are many things you can do to decrease your risk of sexual abuse and violence. The following are some suggestions. At Home You can keep your house safe by making sure all the windows and doors are locked. Don’t open the door to strangers.Don’t hide a spare key in an obvious place. Know your neighbors, and make sure your neighbors know you. If everyone knows each other, then people can be on the lookout forstrangers in the community. If you are home alone, make sure you have the phone number where your parents or guardians will be if you need to call them. Donot tell callers that you are home alone. Keep other emergency num-bers readily available. On the Street The first rule of preventing abuse on the street is don’t go out alone, especially at night. Be alert. Walk purposefully,and act as if you know where you are going. If you look lost, you willappear vulnerable. Always make sure you have enough money tomake a phone call if you feel threatened. If you do feel threatened,yell and run into a store or other public place. By People You Know Most of the sexual violence that occurs comes from someone the victim knows. Preventing sexual abuse andviolence from people we know is a little different from preventing itfrom people we don’t know. The people we know don’t have to sneakup next to us on the street. Chances are that we let them into ourhouse or are walking with them on the street. Know signs of abusive people, and don’t get involved with those people. Be careful about people you meet on the internet, especiallyif they discuss or show pornography. Do not agree to meet them inperson. Avoid people who are hostile or disrespectful. Rapists areoften motivated to make the person feel powerless, degraded, dirty,and ashamed. If someone you know makes you nervous or makesoffensive jokes or comments, tell him or her you don’t like the behav-ior and also tell a parent or other trusted adult. No one, not your friends, your family members, or your boyfriend or girlfriend, has a right to sexually abuseyou. Use the communication skills, refusal skills, and deci-sion-making skills you have learned to protect yourself.Use body language and voice tone, volume, and pitch todiscourage a sexual offender. Say no clearly and loudlyover and over again. Make it clear that you think that theperson’s behavior is inappropriate. If you are being attacked, call out for help. Call as much attention to the situation as you can. Break things. Do whatever you can to protect yourself. Protecting Yourself from Date Rape >When going on a date, know who the person is, where you aregoing, and what you will be doing.Make sure friends and familyknow this information too. >Don’t be alone with your date.Go on dates in public places. >Go on double dates or groupdates. >Do not accept drugs or alcohol. >Do not allow anyone to have anopportunity to put drugs in yourbeverage. >Be wary of meeting anyone on theInternet. >Know where a phone is at alltimes. >Set limits, and communicatethese limits clearly and firmlyahead of time. Copyright © by Holt, Rinehart and Winston. All rights reserved. 118 CHAPTER 5 Preventing Violence and AbuseHelp After a Sexual Assault If you have been raped or assaulted, there are several things you should do. 1.Make sure you are away from further harm. 2.Call for help. You can call your family, the police, a neighbor, afriend, or any other trusted adult. 3.Don’t change anything about your body or your environment.Don’t shower or go to the bathroom. Don’t change your clothesor wash or comb your hair. Don’t clean up the place where youare. There might be evidence that can be collected by the policeor at a hospital. You can cover yourself with a blanket to feelmore comfortable. 4.Ask someone to take you to the hospital. 5.Seek therapy or counseling. Remember, abusers want to make thevictim feel ashamed and humiliated. Counselors can help reas-sure victims that they are not to blame for the assault. Sometimes, people who are sexually assaulted just want to forget the whole incident and put it behind them. There are two problems with forgetting the assault. First, if you are in denial about the incident anddon’t seek medical care, then you can’t get physical or emotional treat-ment from trained personnel. The second problem is that if you don’t report it, the abuser can- not be stopped. If you report the attack, you may be preventinganother person from going through what you did. Many victims donot report crimes because they don’t want to go through a trial. How-ever, you can report an assault without prosecuting. This way, the inci-dent is on record, so you can prosecute later. If you do not report theassault immediately and if you destroy any evidence, prosecuting later will be very difficult. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term sexual harassment. 2.Identify the term for “any sexual activity in which force or the threat of force is used.” Understanding Key Ideas 3.Describe sexual abuse. 4.Describe why victims of sexual abuse find it diffi- cult to admit they are being abused. 5.State five examples of sexual harassment. 6.Describe three facts about sexual assault and rape.7.Identify which of the following is nota way to pro- tect yourself from date rape. a.double dating b.going out with people who drink c.going on dates in public places d.being assertive 8.List five things a person should do if he or she has been sexually assaulted. Critical Thinking 9. Practicing Wellness Describe three ways you can protect yourself from sexual abuse and violence.LIFE LIFE SKILL One of the first steps after a sexual assault is calling for help. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 5 Highlights 119 CHAP TER 5 CHAP TER 5 CHAPTER 5Highlights Key Terms The Big Picture ✔Being exposed to violence can make people fearful, unsympa- thetic to others, and more likely to use violence themselves. ✔Factors that lead to violence include feeling threatened, notmanaging anger, not showing respect for others, bullying, andgangs. ✔You can avoid dangerous situations by recognizing signs, calm-ing things down, leaving the situation, offering alternatives,avoiding gangs, and avoiding weapons. ✔Conflict resolution skills, such as negotiation and peer media-tion, are effective, nonviolent ways to deal with arguments. ✔Being assertive and asking for help are two ways you can pro-tect yourself from bullying. SECTION 1 violence (102) tolerance (104) bullying (104) negotiation (106) peer mediation (106) ✔Being able to identify disrespectful and inconsiderate behaviorsuch as selfishness, aggression, and excessive jealousy, will helpyou avoid abusive people. ✔Four types of abuse are child abuse, domestic violence, elderabuse, and hazing. ✔Besides causing physical injury, some effects of abuse aredepression, low self-esteem, guilt, shame, anxiety, distrust, anddifficulty developing relationships. Many who are abused turnto alcohol or drugs. ✔Creating a supportive network, avoiding disrespectful people,being assertive, and showing disapproval will help you protectyourself from abuse. ✔Victims of abuse should tell a trusted adult, go somewhere safe,and get counseling.SECTION 2 abuse (108) neglect (109) domestic violence (109) hazing (110) ✔Sexual abuse is any physical sexual act that happens withoutone’s consent. It can cause physical and emotional trauma. ✔Sexual harassment is unwanted sexual attention, such as tellingoffensive jokes, staring at someone’s body, or touching peoplein sexual ways. ✔Most rapes are committed by someone the victim knows. ✔A few ways you can protect yourself from sexual abuse andviolence are keeping your house locked up, not going outalone, and avoiding disrespectful people. ✔If someone has been sexually assaulted, he or she should findsafety, call for help, not clean up, report the incident to thepolice, and seek counseling.SECTION 3 sexual abuse (114) incest (114) sexual harassment (115) sexual assault (116) date rape (116) Copyright © by Holt, Rinehart and Winston. All rights reserved. 120 CHAPTER 5 Review CHAP TER 5 CHAP TER 5 CHAPTER 5Review Using Key Terms abuse (108) negotiation (106) bullying (104) peer mediation (106) date rape (116) sexual abuse (114) domestic violence (109) sexual assault (116) hazing (110) sexual harassment (115) incest (114) tolerance (104) neglect (109) violence (102) 1.For each definition below, choose the key term that best matches the definition. a.a technique in which a trained outsider who isyour age helps people in a conflict come to apeaceful resolution b.the ability to overlook differences and acceptpeople for who they are c.the use of force to control and maintain powerover a spouse in the home d.sexual activity between family members whoare not husband and wife e.harassing newcomers to a group in an abusiveand humiliating way f.sexual intercourse that is forced on a victim bysomeone the victim knows g.any unwanted remarks, behavior, or touch thathas sexual content h.a bargain or compromise for a peaceful solu-tion to a conflict i.any sexual activity that involves the use of forceor the threat of force j.any sexual act without consent 2.Explain the relationship between the key terms ineach of the following pairs. a.bullying andviolence b.neglect andabuse Understanding Key Ideas Section 1 3.Explain how observing and experiencing violencecan cause a person to become apathetic. 4.Which of the following does notcontribute to conflict? a.gangs c.negotiating b.feeling threatened d.bullying5.Explain how using tolerance can help prevent aconflict. 6.Why might someone join a gang? 7.List the 4 steps for avoiding a dangerous situationin a conflict that is getting out of control. 8.Describe three ways to communicate effectively toresolve conflict. 9.CRITICAL THINKING Create an action plan to help someone who is being bullied. Section 2 10.Which is nota sign of inconsiderate or disrespectful behavior common in abusive people? a.manipulation c.obsession b.aggression d.empathy 11.Neglecting an older person is an example of______ abuse. 12.Why are children frequently targets for abuse? 13.Which of the following is notan effect of abuse? a.eating disorder c.drug and alcohol abuse b.high self-esteem d.depression 14.Describe how you can show disapproval forinconsiderate and disrespectful behavior. 15.CRITICAL THINKING Create a list of trusted adults you could go to for help if you were beingabused. Section 3 16.Give an example of sexual abuse. 17Explain effective ways of dealing with sexualharassment. 18.Explain how being around people who drinkalcohol and use drugs can put you at risk for sex-ual assault. 19.Which of the following should you notdo imme- diately after you have been sexually assaulted? a.call the police c.get to safety b.call a trusted adult d.take a shower 20.What are three ways you can protect yourself from sexual abuse and violence? LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 5 Review 121Interpreting Graphics Study the figure below to answer the questions that follow. 21.What is the difference between homicide rates for your age group and homiciderates for 25- to 34-year-olds? 22.CRITICAL THINKING Why do you think 15–24 year-olds have the highest homicide rate?Activities 23. Health and Your Community Start a neighbor- hood watch program, or join one that alreadyexists in your community. Work with neighborsto write a plan for contacting authorities if a dis-turbance occurs. 24. Health and You Describe an example of a conflict that you have recently had. Evaluate your style ofresolving the conflict. Now, use the conflict man-agement skills you learned to explain all the pos-sible ways you could improve your style ofresolving conflicts. 25. Health and Your Community Meet with a local law enforcement officer to discuss potentiallydangerous situations in your community. Write apaper on these potentially dangerous situationsand ways you can avoid them. Action Plan 26. Practicing Wellness Develop an action plan to deal with a conflict you might have with afamily member or friend.LIFE LIFE SKILL 27.In this passage, the word irate means Aangry. Bsensitive and caring. Csilent. Dplayful. 28.What can you infer from reading this passage? EThe man is happy. FTasi doesn’t know how to say no. GThe man might abuse or assault Tasi. HTasi’s father needs a new job. 29.Write a paragraph that describes how Tasi pro-tected herself. Describe what further action Tasiand her father can take in the future to protect Tasifrom the man.READING SKILLMATH SKILL WRITING SKILLRead the passage below, and then answer the questions that follow. A man moved into the apartment next door to Tasi last week. He makes her nervous. Whenever she passes him in thehall, he looks over her whole body. Yester-day, when Tasi came home from school,the man asked her to come over to hisapartment to watch a movie. When shesaid she didn’t want to, he became irate . His voice started getting louder and he moved closer to her. She ran into herapartment. She locked the door and calledher father at work.16 141210 86420 Age (years)Victims per 1,000 people U.S. Homicide Rates by Age of Victim 5–14 15–24 25–34 35–44 Source: Centers for Disease Control and Prevention. Copyright © by Holt, Rinehart and Winston. All rights reserved. Copyrigh t © by Holt, Rineha rt and W inston. All rights reserved. 123CHAPTER 6 Physical Fitness for Life CHAPTER 7 Nutrition for Life CHAPTER 8 Weight Managementand EatingBehaviors UNIT 2UNIT 2UNIT 2 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 6 CHAP TER 6 CHAPTER 6 Physical Fitness for LifePhysical Fitness for LifePhysical Fitness for Life 124KNOWLEDGE Which of the following statements are true, and which are false? Check your answers on p. 642. 1.To gain the benefits of exercise, you must exer- cise every day. 2.Exercise can help improve depression. 3.Girls will develop large, manly muscles if theylift weights. 4.Lifting weights develops cardiorespiratoryendurance. 5.The longer and harder you train, the betteryour health will be. 6.Anabolic steroids are illegal drugs. 7.Teens need more sleep than their younger sib-lings or their parents need. Copyright © by Holt, Rinehart and Winst on. All rights reserved. 125SECTION 1 Physical Fitness and Your Health SECTION 2 Planning Your Fitness Program SECTION 3 Exercising theSafe Way SECTION 4 Sleep go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH06. Copyright © by Holt, Rinehart and Winston. All rights reserved. 126 CHAPTER 6 Physical Fitness for LifeMiracle Life anti-aging pills will keep you feeling young and give you more energy, guaranteed!” You’ve probably seenor heard ads just like this. The makers of such products claim to have the secret to a long healthy life. Well, the secret is out,and as you’ll discover, it’s not really much of a secret. The Benefits of Being Physically Active An important part of living a long, healthy life is to stay physicallyactive. is the ability of the body to carry out dailyphysical activities without getting out of breath, sore, or overly tired.Regular physical activity leads to a physically fit body. A certain amount of physical activity every day has been shown to keep you healthy and lowers your risk of certain diseases. As shownin Figure 1, many modern conveniences, such as escalators, cars, computers, and even TV remote controls, have reduced the need forus to be physically active in our daily lives. An overall reduction inthe daily activity levels of children, teens, and adults has led to anincreasingly unfit population. Exercise is an excellent way of keeping a high level of activity in your daily life. Exercise is any physical activity that improves or main- tains physical fitness. Exercise can be a formal set of activities or canbe informal play. However, other everyday activities, such as rakingleaves and walking to school, can also help keep you fit and healthy. Stay Active, Stay Alive Having a sedentary lifestyle has been linked to an increased risk of developing many illnesses, such aschronic diseases. A is a disease that develops gradu-ally and continues over a long period of time. A chronic disease cantake a long time to treat. Examples of chronic diseases related to chronic diseasePhysical fitnessPhysical Fitness and Your HealthSECTION 1 SECTION 1 SECTION 1 SECTION 2 SECTION 2 SECTION 3 SECTION 3 SECTION 4 SECTION 4 SECTION 5 SECTION 5OBJECTIVES State the benefits of being fit. Describe the five health-related components of physical fitness. Summarize the role of the skill-related fitnesses. Describe the importance of physical fitness for all ages and abilities. Name three things you can do to be a good sport. LIFE LIFE SKILLKEY TERMSKEY TERMS physical fitness the ability of the body to perform daily physical activities without getting out of breath, sore, or overly tired chronic disease a disease that develops gradually and continues over a long period of timehealth-related fitness fitness qualities that are necessary to maintain and promote a healthy body resting heart rate (RHR) the number of times the heart beats per minute while at rest “ Adding physical activity to your daily life can be easy. ACTIVITY How could these people add more physical activity to their daily lives?1 FigureHH04PEC06_S1 1/9/04 10:36 AM Page 126 SECTION 1 Physical Fitness and Your Health 127 Social Benefits Regular exercise can be a great way to meet people. Physical Benefits Being fit helps prevent thehigh blood cholesterol levelsand coronary plaque buildupthat can lead to a heart attack.Mental Benefits Exercise can help > reduce anxiety > reduce depression > increase self-confidence > improve self-imageBeing fit can increase your enjoyment of life! lifestyle include cardiovascular (heart) disease, stroke, high blood pressure, type 2 diabetes, and certain forms of cancer. Staying fitthrough regular exercise has been shown to be a significant factor inpreventing the development of some of these chronic diseases. Physical Benefits Leading an active lifestyle also has many physi- cal benefits. Most people feel that exercising improves their appearanceand makes them feel good about themselves. Exercise also leads

tomany improvements within your body. >The heart and lungs get stronger, allowing more blood andoxygen to circulate around the body. >Blood cholesterol levels are kept within a healthy range, andblood vessels are kept strong and healthy. >Building muscular strength and endurance and also flexibilityof our joints makes our muscles more efficient at controllingour movements and protects against back injuries. >A good ratio of muscle mass to fat mass is maintained. >Metabolic rate is increased. Your metabolic rate is the rate atwhich your body converts food energy into the energy thatkeeps you alive. >More Calories are burned because of an increase in muscle mass. Blocked coronary arteryHealthy coronary arteriesHH04PEC06_S1 1/9/04 10:38 AM Page 127 128 CHAPTER 6 Physical Fitness for LifeMental Benefits Many people use regular exercise as a way to feel good mentally. Regular exercise has positive effects on feelings of depression and anxiety. Exercise can help reduce your stress levelsand help you sleep better. How? Exercise takes your mind off of yourworries and causes the release of certain body chemicals calledendorphins (en DAWR finz). Endorphins can give you a feeling of wellness and happiness after a good, hard workout. Increased oxy-gen to the brain during exercise can help you feel more alert. This inturn helps you feel more energized and better able to deal with day-to-day tasks. Social Benefits Many people feel increased self-esteem as they exercise to stay fit. Part of this feeling is a result of the positive bodychanges that occur because of exercise. As a result of the increasedself-esteem, such people are more likely to socialize with others. Engaging in physical activity is also an opportunity to socialize with others who have the same interests. Working together on a teamcan help you develop your communication skills. It also gives you achance to interact with many different people of differing abilities. Five Components of Health-Related Fitness Physical fitness can be classified into five components. These are commonly called health-related components of fitness . describes qualities that are needed to maintain and promote a healthy body. The five components of health-related fit-ness are muscular strength, muscular endurance, cardiorespiratoryendurance, flexibility, and body composition. Muscular Strength Muscles move and apply force to objects and to each other by contracting. Muscular strength is the amount of force that a muscle can apply in a given contraction. Lifting a weight,climbing the stairs, and pushing a large piece of furniture are acts ofmuscular strength. During weight (or resistance) training, musclesare challenged to contract more than they are used to doing. Themuscle cells themselves become larger in response to this extra work.This growth increases the overall strength of the muscle. Muscular Endurance Muscular endurance is the ability of the muscles to keep working (contract) over a period of time. Muscularendurance allows you to carry out tasks that require muscles to remaincontracted for a period of time. Examples of sports that require goodmuscular endurance include cross-country skiing and gymnastics.Muscular strength and endurance are closely related; as one improves,the other improves. Both muscular strength and muscular endurancecan be developed by regular weight training. Weight training is considered to be an anaerobic activity . During anaerobic activity, muscle cells produce energy without using oxygen. Anaerobic activity is intense and short in duration.related fitnessHealth- Good muscular strength and endurance are important, even forsmall, everyday activities. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Physical Fitness and Your Health 129Cardiorespiratory Endurance Cardiorespiratory endurance ( KAHR dee oh RES puhr uh TAWR ee en DOOR uhns) is the ability of your heart, blood vessels, lungs, and blood to deliver oxygen and nutrients to all of your body’scells while you are being physically active. It is the singlemost important component of health-related fitness. Asyour cardiorespiratory endurance increases, your heartbeats slower and stronger. An indicator of poor cardiores-piratory endurance is running out of breath while doingstrenuous activity. Resting heart rate and recovery time are indicators of your level of cardiorespiratory endurance. is the number of times the heart beats per minute while at rest, such as just before you getup from a good night’s sleep. Recovery time is the amount of time it takes for the heart to return to RHR after strenu-ous activity. Good cardiorespiratory endurance reducesrecovery time and RHR. Aerobic activity tends to improve your cardiorespiratory endurance. During aerobic activity, muscle cells use oxygen to produce energy for movement. The intensity of aerobic exercise is low enoughso that the heart, lungs, blood vessels, and blood are all able to bringenough oxygen to your muscles. This allows your heart and muscles tocontinue with the activity for a long period of time (at least 20 to 60minutes). Aerobic activity is continuous, uses large muscle groups, andtends to be rhythmic in nature. Examples include walking, jogging,dancing, swimming, cycling, and jumping rope. Flexibility Flexibility is the ability of the joints to move through their full range of motion. Good flexibility keeps joint movementssmooth and efficient. Strong and healthy ligaments and tendonsallow greater flexibility of a joint. Ligaments are the tissues that holdbones together at a joint. Tendons are the tissues that join muscles tobones. Any activity that involves a joint moving through a full rangeof motion will help maintain flexibility. As shown in Figure 2, stretch- ing exercises, when done correctly, improve flexibility. Having good flexibility alone is not the most important compo- nent of physical fitness. However, keeping a good level of flexibility isimportant because lack of use can cause joints to become stiffer asyou become older. Together with muscular strength and muscular endurance, flex- ibility is very important for overall fitness. These three componentspromote the health of bones and muscles. Body Composition Body composition refers to the ratio of lean body tissue (muscle and bone) to body-fat tissue. A healthy body hasa high proportion of lean body tissue compared to body-fat tissue.Women have more body fat than men do. Also, body fat increaseswith age as muscle mass decreases. Resting heart rate (RHR) Maintaining good flexibility through regular stretching as a part of warm-ups and cool-downs can reduce the riskof muscle tears, strains, and stressinjuries. 2 Figure www.scilinks.org/health Topic: Physical Fitness HealthLinks code: HH4113 Copyright © by Holt, Rinehart and Winston. All rights reserved. 130 CHAPTER 6 Physical Fitness for LifeHaving a certain amount of fat is necessary for good health. How- ever, too much body fat increases the risk of getting certain lifestyle- related diseases, such as diabetes and cardiovascular disease. Excessbody fat is almost always due to being inactive as well as having pooreating habits. Also, because of the stress of excess weight on the joints,people who have excess body fat are more likely than people who donot have excess body fat to have joint problems and back pain. Regularexercise and good eating habits are the best ways to develop a favorablebody composition. Skills Developed by Fitness Skill-related fitness describes components of fitness that are important for good athletic performance. The six components of skill-related fit-ness are coordination, balance, agility, power, speed, and reactiontime. The components of skill-related fitness are not as important for developing health as the health-related fitness components are. How-ever, skill-related components are important for good athletic perform-ance. For example, agility, coordination, and power are important insports such as basketball, karate, football, and soccer. Athletic trainingconcentrates on developing components of skill-related fitness. Sport and Fitness A great way to achieve total physical fitness is to get involved in anorganized sport. Organized sports allow you to improve your socialand communication skills and to interact with people of different abil-ities. Taking part in sports such as hiking, fishing, or camping will alsoenable you to explore the natural environment. What Sport Can You Do? Sports are not limited to athletes. What sport you enjoy or choose to participate in is up to you. You shouldconsider several things when deciding what sport to take part in. >Do you want to improve your abilities in a sport you have tried in the past or try something com-pletely new? >Do you want to participate in an individual sport or a team sport? Individual sports are suited to peoplewho enjoy one-on-one competition. Team sportsallow you to interact with many people at one time.Working as a team helps develop problem-solvingand conflict-resolution skills. >What activities are available in your area? Go to your local community center or youth club, and find outwhat activities are offered. Also, your school mayhave after-school activity programs that you can join. >What facilities do you need? If facilities such as a pool are needed, make sure they are easy for you toget to. Total fitness can be achieved by taking part in an activity or sport to improveboth health-related and skill-related fitness. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Physical Fitness and Your Health 131Sport and Competition Competition takes different forms— from the informal games between friends to formal competition with official rules and referees or umpires. Whether you compete in infor-mal or formal play, competition will help develop your motivation,leadership, and cooperation skills. These are life skills that will helpyou in many areas of your daily life. Competition can also be valu-able for the enjoyment you can get from just taking part in a sport. Be a Good Sport To have winners, there must be losers. Losing competitors will naturally be disappointed at the loss. Likewise, win-ning teams have the right to be excited and proud. However, winning isnever an excuse to be inconsiderate or hurtful to the losing team orindividual. Rules and regulations are meant to encourage fair play between competitors. Obeying and respecting game officials’ decisions in anysport is necessary for fair play. Few coaches will tolerate disrespect on the field. Being removed from the game will hurt only yourself andyour team’s chances in competition. Physical Activity Is for Everyone It is never too early for you to develop a healthy lifestyle of lifelongphysical activity. However, the benefits of maintaining fitness can beobtained only through a lifetime commitment to regular exercise. A Lifetime of Physical Activity Even though a person may begin suffering from cardiovascular disease at the age of 60, he or she likelybegan to develop the disease at a much earlier age. By beginninggood habits in your early years and making a commitment to lifelongactivity, you can delay or even prevent some of the chronic diseasesassociated with growing older. Frequent strength training and eatinga healthful diet may help prevent the bone-thinning disease osteoporosis ( AHStee oh puh ROH sis) in later life. Strength training even at an older age will help maintain bone density, muscle tone,muscle strength and endurance, and flexibility. The lifestyle choicesyou make now will affect your health for the rest of your life.Tips on Being a Good Sport >Be a gracious winner. Don’t purposely make the other teammembers feel like losers. >Be mannerly. Thank thecompeting team or individual fora good game when the game isover. >Be a good loser. Accept that youwill win some and you will losesome. >Show respect for others’ abilities.Never use foul or abusivelanguage. >Assume some responsibility. Donot blame others or theirperformance if you lose. You arepart of a team. >Be a good fan. Cheer—don’t jeer. >Above all, remember it is all justfor fun! HH04PEC06_S1 1/9/04 10:39 AM Page 131 132 CHAPTER 6 Physical Fitness for LifeActivity and Asthma and Diabetes People who suffer from exercise-induced asthma often do not want to take part in physical activity or sport. Asthma causes a feeling of tightness in the chest andcan cause coughing during and after exercise. And yet, physical activityis part of the treatment plan for people who have asthma. Gaining fit-ness helps decrease the severity of asthma symptoms. Exercise is also avery important part of the treatment plan for people who have diabetesbecause exercise helps control blood sugar levels. Exercise can also helpwith weight problems that are often associated with diabetes. Fitness and Disability Have you ever thought about how you could dribble a basketball while steering yourself around in a wheel-chair? How could you sprint 100 meters with an artificial leg? Manyindividuals have taken on the challenges of physical and mental dis-abilities and have become great athletes. The Special Olympics and Paralympics show us that mental and physical disabilities do not stop people from becoming world-classathletes. The Special Olympics is an organization that enables and encourages people who are learning disabled to become physicallyfit. The organization also encourages such people to become moreinvolved in society through sports training and competition. The Paralympics are Olympic-style games for athletes with physical disabilities. No matter what your age or abilities are, being physically active— whether it is done through an exercise program, an organized sport,or just your everyday activity—is of great value to everyone. So, inshort, part of the answer to a longer, healthier life is to be active! REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2 SECTION 2 SECTION 3 SECTION 3 SECTION 4 SECTION 4 SECTION 5 SECTION 5Using Key Terms 1.Name the term that means “the ability of the body to carry out daily activities without getting out of breath, sore, or overly tired.” 2. Identify which condition is nota chronic disease. a.diabetes c.heart disease b.cancer d.cold 3.Identify the single most important component of health-related fitness. a.muscular strength b.body composition c.cardiorespiratory endurance d.muscular endurance 4.Define resting heart rate.Understanding Key Ideas 5.Listsix benefits of being fit. 6.Name a health-related component of fitness and a sport that develops that component. 7.Contrast the functions of health-related compo- nents and skill-related components of fitness. 8.Name one common disease for which physical activity can be part of the treatment. 9. Communicating Effectively Identify four ways you can show you are a good sport. Critical Thinking 10. Practicing Wellness Discuss the statement “Physical activity can actually prevent you from having a heart attack.”LIFE LIFE SKILLLIFE LIFE SKILL People of all ages and abilities should take part in regular physical activity toreduce their risks of chronic diseasesand to help them feel their best. HH04PEC06_S1 1/9/04 10:39 AM Page 132 SECTION 2 Planning Your Fitness Program 133 Planning Your Fitness ProgramSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3 SECTION 3 SECTION 4 SECTION 4 SECTION 5 SECTION 5 Maria’s mom has heart disease. Maria has done some research and believes she could develop heart disease, too.Maria also read that regular exercise can help lower her chance of developing heart disease. Now she’s determined to becomemore fit, but she’s not sure where to start. Getting Started with Your Fitness Program You don’t have to be an athlete to be physically fit, and you do nothave to be fit to start a fitness program. Before you start any fitnessprogram, however, there are many factors you should consider. >Do you have any health concerns, such as diabetes or asthma? Be sure to consult your doctor about your program if you dohave health concerns. >Are you healthy enough to start a program? You should sched- ule a physical examination with your doctor. Your doctor willbe able to assess your level of health. He or she will check yourheart rate, blood pressure, height, weight, and reflexes and mayalso check any health concerns you have. >What types of activities do you enjoy? Be sure to choose activ- ities that fit into your schedule and that won’t bore you easily.Ask a friend to join you. >How much will your planned activities cost? Cost is something to think about before choosing an activity. Many fitness activ-ities such as walking or jogging do not require expensive cloth-ing or shoes. However, for activities that require specialequipment, you should rent or borrow the equipment from areliable source. This will allow you to decide if you like theactivity before you buy your own equipment. A little researchmay save you money and time in the long run.OBJECTIVES Describe the important factors to think about before starting a fitness program. Describe the steps involved in designing a fitness program. Calculate your resting heart rate, target heart rate zone, and maximum heart rate.Evaluate the use of the FITT formula in fitness training. Design and implement a personal fitness program and set your fitness goals. LIFE LIFE SKILLKEY TERMSKEY TERMS target heart rate zone a heart rate range within which the most gains in cardiorespiratory health will occur FITT a formula made up of four important parts involved in fitness training: frequency, intensity, time, and type of exercise repetitions the number of times an exercise is performedseta fixed number of repetitions followed by a rest period “ Bob and Ihave started swimming three times a week at the school pool.”HH04PEC06_S2 1/9/04 10:41 AM Page 133 134 CHAPTER 6 Physical Fitness for LifeDesigning a Fitness Program The steps to designing a fitness program are very straightforward. Remember that developing your cardiorespiratory endurance shouldbe part of the foundation of your fitness program. Determine Your Resting Heart Rate (RHR) Ideally, your RHR should be taken three mornings in a row to get your averageRHR. Your RHR should be calculated when you are very relaxed, suchas before getting up from a good night’s sleep. Use step 1 of Figure 3 to find your pulse. Count your pulse for 60 seconds. The averageadult RHR is 50 to 80 beats per minute (bpm); teens’ RHR is a littlehigher. Some of the world’s best endurance athletes have resting heartrates below 40 bpm. Your RHR will decrease as a result of regularlyexercising within your target heart rate zone. Calculate Your Target Heart Rate Zone For you to maximize cardiorespiratory health benefits from exercise, your heart rate rangeshould reach your Your target heart rate zoneis normally between 60 and 85 percent of your maximum heart rate.Maximum heart rate (MHR) is the maximum number of times yourheart should beat per minute while doing any physical activity. Calculate your MHR and then your target heart rate zone to find how hard you should be exercising. Here’s a quick way of estimatingyour MHR and target heart rate zone: 1.Determine your MHR by subtracting your age from 220. 2.Multiply your MHR by 60 percent (0.6) and 85 percent (0.85) tocalculate your target heart rate zone. Using this method, a 16-year-old would calculate his or her targetheart rate zone to be 122 to 173 beats per minute. If you are an ath-lete, your doctor or a sports physician can calculate your MHR moreaccurately by using a special formula.target heart rate zone. Monitoring your heart rate, before, during, and after exercising is an impor-tant part of a personal fitness program.Pushing your heart rate above theupper range of your target heart ratezone is not needed for cardiorespira-tory benefits. ACTIVITY Estimate your MHR and your target heart rate zone.3 Figure How to Calculate Your Heart Rate 1.Using the tips of your index and middle fingers, locate your carotid artery. Your carotid artery is located justbelow your jaw in the groove where your head and neckmeet. Search around until you can feel a steady beatunder the skin. 2. Use a clock or stopwatch to count your pulse for 10 seconds. Multiply the number of beats in 10 seconds bysix to get your heart rate. HH04PEC06_S2 1/9/04 10:43 AM Page 134 SECTION 2 Planning Your Fitness Program 135Assess Your Fitness Assessing your fitness levels will measure your level of fitness against commonly used standards. Table 1 pres- ents fitness standards for components of health-related fitness. The ranges of numbers found in each table represent healthy fitness zones (HFZ). There is an HFZ for boys and girls of each age in each compo-nent of health-related fitness. Achieving scores that place you withinan HFZ indicates that you have a healthy level of physical fitness. Set Your Fitness Goals Setting goals will help make your fitness program more effective. Writing down your fitness goals willhelp you define them. >Make sure your goals are based on your physical abilities andare well planned. For example, if you are at the lower portionof the HFZ for your age, setting a goal of exceeding the HFZ foryour age within 2 weeks would be dangerous. >Choose goals that you want to achieve. Doing so will ensurethat you have the motivation to stick with your fitness program. >Break your goals into short-term and long-term goals. Short-term goals should help divide a fitness program into moremanageable “pieces.” >Write down specific objectives that will help you reach eachshort-term goal. Make sure one of your objectives is to eathealthfully. Keep Track of Your Progress Keep an activity log in which you record the date, how long you trained, what exercises you did andhow you felt. You’ll be able to review the log, check your progress,and make changes to your program when needed. Keeping a log willalso help you stick with your objectives and reach your goals.Table 1 Health Fitness Standards for Teens Age (years) 14 15–17Boys 24 to 4524 to 47Girls 18 to 3218 to 35Muscular Endurance Curl-ups (number completed) Muscular Strength Push-ups (number completed) Age (years) 14 15 16–17Boys 14 to 3016 to 3518 to 35Girls 7 to 157 to 157 to 15 Flexibility Back saver sit and reach (inches) Age (years) 14 15–17Boys 88Girls 1012Cardiorespiratory Endurance One-mile run (minutes:seconds) Age (years) 14 15 16–17 Boys 9:30 to 7:00 9:00 to 7:008:30 to 7:00Girls 11:00 to 8:3010:30 to 8:0010:00 to 8:00 Source: Cooper Institute of Aerobic Research, FITNESSGRAM Test Administration Manual. For more information about setting goals, see Chapter 2. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. 136 CHAPTER 6 Physical Fitness for LifeGetting FITT After you choose an activity you may still have many questions, such as, How many times per week should I do the activity? How hard shouldthe activity be? How long should each workout take? The FITT formula can be used as a helpful guide to answer these questions. The formula is made up of four important parts of fitness training: frequency , intensity , time, and type. For exercise to be effective, it must be done enough times per week ( frequency ), hard enough (intensity ), and for long enough ( time). Finally, the kind ( type) of exer- cise is important. The FITT formula recommendations differ slightlyfor each health-related component of fitness. Figure 4 presents many types of activities that develop the health-related components andidentifies the frequency with which each activity needs to be done. Developing Your Cardiorespiratory Endurance Recommen- dations for cardiorespiratory fitness are as follows: >Frequency Exercise must be performed three to five times a week. >Intensity If you are training at 85 percent of your MHR, 20 minutes per session is enough. If you are training at 50 to 60percent of your MHR, 60 minutes of training per session isneeded to gain health benefits.FITT The Activity Pyramid can help you develop your fitness program. If you arecurrently sedentary, begin at the top ofthe pyramid (everyday activities) andgradually increase your level of activity.If you are already pretty active, you canincrease the amount of time you spenddoing physical activities.4 Figure Household and recreational activities (every day) walking the dog, gardening, cleaning your room, soccer, sweeping the floor, hiking, dancing, golf, walking or cycling to the storeThe Activity Pyramid Muscular strength and endurance, and flexibility (2 to 5 times a week) push-ups, curl-ups, ballet, stretching, martial arts, yoga Cardiorespiratory endurance (3 to 5 times a week) swimming, tennis, running, gym aerobics, jumping rope, aerobic dance Sedentary activities (seldom) watching TV, playing computer games, talking on the phone Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Planning Your Fitness Program 137>Time Twenty to sixty minutes per session is recommended, depending on the intensity of the exercise. Intensity means how hard your heart is working and how difficult the activity isto do. The higher the intensity of the exercise, the less time youneed to do it. >Type Any aerobic activity that keeps heart rate within your tar- get heart rate zone is good. Developing Your Muscles Muscular strength and muscular endurance are closely related. As one improves, so does the other.Training programs are designed to address each of these healthrelated components. FITT recommendations that address musculardevelopment are as follows: >Frequency Weight train 2 to 3 times a week. >Intensity

Select a weight that you can lift at least 8 times but no more than 12 times. The weight being lifted is called the resist- ance. Each lift is called a repetition. are the number of times an exercise is repeated. A fixed number of repetitionsRepetitions real life Activity LIFE LIFE SKILL Setting Goals DEVELOP YOUR FITNESS PLAN ✔paper ✔pencil ✔ruler 1.Draw a table that has seven columns. Title the table “Activity Plan for the Week.”Label the columns with thedays of the week. 2.Write your fitness goal below the table. For example, you might write, “I want to run a 5 kilometer race in under 30minutes.”ProcedureMaterials3.Create a week of activities that are based on developing the five components of physical fitness. Remember to include atleast 60 minutes of activity daily. 1.Summarizing Results What resources in your community can you use to carry out your fitness plan? 2.Applying Information Describe how your fitness plan will helpyou reach your goal. 3. CRITICAL THINKING Develop ways to address possible barriers to your training program, such asbad weather, expensive equip-ment, or lack of time.Conclusions4. CRITICAL THINKING Identify ways you can assess your progress. 5.CRITICAL THINKING How can you reward yourself for following your plan? There is no difference between the same amount of male muscle and female muscle in terms of strength. Copyright © by Holt, Rinehart and Winston. All rights reserved. 138 CHAPTER 6 Physical Fitness for Lifefollowed by a rest period is called a Rest periods between sets are between 1 and 3 minutes long. Do one to three sets of 8to 12 repetitions for all the major muscle groups. >Time A total workout can be about 30 minutes long but should not be longer than 60 minutes. >Type Anaerobic activities such as weight lifting and sit-ups tend to develop muscular strength and endurance. To build muscularendurance, you lift lighter weights (less resistance) with more (8 to 15) repetitions. To build strength, you should lift heavierweights (more resistance) with fewer (3 to 8) repetitions. Increasing Your Flexibility The following are FITT recommen- dations for flexibility: >Frequency Perform stretching 3 to 5 days a week. For the best results, stretch daily. >Intensity Stretch muscles, and hold at a comfortable stretch for about 15 to 30 seconds. Relax into the stretch, and as youbreath out, you will stretch a little further. Never bounce asyou stretch. Repeat each stretch three to five times. >Time Stretch for 15 to 30 minutes. >Type Stretching can be done on its own or as part of a warm- up and cool-down. Yoga is also a popular form of flexibilityexercise. When Will I See Changes? The length of time it takes to see a difference varies from person to person. On average, it takes about 6weeks to really notice the difference in the health-related compo-nents. So, don’t get discouraged! HH4PEC050000010Pset. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term target heart rate zone. 2.Listthe four parts of fitness training that FITT stands for. 3.Name the term that refers to the number of times an exercise is performed. 4.Identify the term that means “a fixed number of repetitions followed by a rest period.” a.frequency c.repetition b.intensity d.set Understanding Key Ideas 5.Listthe important things to consider before beginning a fitness program. 6.Summarize the steps to designing a fitness program. 7.Listthe steps of how to calculate your target heart rate zone. 8.Identify what each letter of the acronym FITT means in relation to a fitness plan. Critical Thinking 9. Practicing Wellness Is it a good idea to do both aerobic exercises and anaerobic exer- cises as parts of a fitness program? Explain. 10.Why is it important to monitor your heart rate before, during, and after exercising or training.LIFE LIFE SKILLTips to Keep You Motivated >Look at it as down time. Training can be the perfect “time out”from a busy day. >Train with a friend. A trainingpartner will keep you companyand may introduce some healthycompetition. >Set realistic goals. Make acontract for yourself, and rewardyourself often for sticking withyour program. >Understand that you’ll have baddays. When you don’t reach aday’s workout goals do not bediscouraged—just start up againthe next day. >Keep the appointment. Consideryour workout an importantappointment that you cannotmiss, and you’ll be more likely tokeep to it. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Exercising the Safe Way 139Exercising the Safe Way SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 An ounce of prevention is worth a pound of cure.” These words are cold comfort to someone who has pulled a muscle or strained a tendon. However, most sports injuries are easy to prevent. Avoiding Sports Injuries The most common sports injuries are injuries to muscles, tendons, ligaments, and bones. These injuries are classified as either acute—having a sudden onset and short duration—or chronic—having agradual onset and long-term effects. Most acute injuries are minor bumps and scrapes that heal quickly and don’t require much treatment. However, some acuteinjuries are more serious. Prompt medical attention is alwaysrequired for a serious injury such as a fracture or concussion. Chronicinjuries can take months or even years to treat. OBJECTIVES Describe six ways to avoid sport injuries. Identify four signs of overtraining. Describe the RICE method of treating minor sports injuries. State the dangers posed by the use of performance enhancing drugs. Summarize the importance of wearing safety equipment to prevent sports injuries. LIFE LIFE SKILLKEY TERMSKEY TERMS dehydration a state in which the body has lost more water than has been taken in overtraining a condition that occurs as a result of exceeding the recommendations of the FITT formula dietary supplement any product that is taken by mouth that can contain a dietary ingredient and is also labeled as a dietary supplement anabolic steroid a synthetic version of the male hormone testosterone used for promoting muscle development “No pain, no gain.” “Doing two or three 30-minute cardiovascular workouts a day will help me lose those extra pounds. ” “Working out in heavy sweats will help burn fat quicker. ”Exercise can sometimes be uncomfortable but should never be painful. Pain means injury. Not allowing your body to rest between training sessions will cause injury. Also, it is wise to reviewyour eating habits as part of any fitness program. Wearing excess clothing during a workout increases water loss and the chance of heat exhaustion or even heatstroke. Beliefs Reality vs.Beliefs Reality vs.“ Copyright © by Holt, Rinehart and Winston. All rights reserved. 140Many sports injuries can be prevented by having a properly conditioned body, by warming up and cooling down, by stretching correctly after a workout, by avoiding dehydration, and by avoidingovertraining. In addition, wearing the correct safety equipment andclothing can prevent many other injuries. Get Conditioned Properly preparing your body for the activity you want to do is a very important step in preventing injury. Sud-denly starting into an intense training program or being a “weekendwarrior” puts strain on unprepared muscles and joints. Lack of condi-tioning is often the reason for injury in the early weeks of schools’sport seasons. Conditioning is an exercise program that promotes cardiorespira- tory and muscular endurance. Conditioning is developed throughthe progressive overload principle. The progressive overload principle states that the physical demands or overload placed on the body willcause the body to develop in response to the overload. The overloadmust be increased or progress over time for continued physicalimprovement to occur. Placing enough overload on muscles will cause them to become fatigued and sore or achy after a workout. This short-term muscle sore-ness (less than 24 hours) is normal. Resting helps develop muscularstrength and endurance as sore muscles need time to recover. Duringrecovery, the body heals the fatigued muscle cells. To prepare the body for similar physical demands in the future, the body increases musclemass and blood flow to the muscles. The body responds best to a grad-ual progression in overload. Excess overload or too fast a progressionwill lead to injury. “Records are meant to be broken, not athletes.” —Cal Ripken, Jr. To reduce the risk of injuries, wear the correct clothing and equipment, con-sider the weather conditions, and obeyposted warning signs. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Exercising the Safe Way 141Warm Up and Cool Down Starting a workout without warming up can cause injury. Warming up increases blood flow to muscles, stretches your muscles and ligaments, and increases your heart rate.About 10 minutes of activities such as slow jogging will increase yourheart rate enough for you to begin a workout safely. An all-over sweatis a good sign that you have warmed up enough. After a workout do not just stop moving. Instead, spend 5 to 10 minutes moving the muscles that were used at a pace that is slowerthan the workout pace. Cooling down will help prevent next-daystiffness and may prevent injuries. Skipping a cool-down may resultin dizziness or feeling faint. Stretch Stretching is an important part of any warm-up and cool- down. Stretching regularly and properly will help you avoid tight mus-cles and injuries. Always stretch slowly; don’t bounce. Stretch only as faras is comfortable. Concentrate on the major muscle groups you will usein your workout. Hold stretches for about 7 to 10 seconds. Hold thestretches for up to 30 seconds to increase flexibility. Avoid Dehydration is a state in which the body has lost more water than has been taken in. Dehydration is a major healththreat in any kind of weather. Drinking water during a workout ensuresthat your blood volume is maintained so that circulation and sweatingcan continue at a normal level. Good blood circulation helps maintaincorrect body temperature and minimizes stress on your heart. Dehydra-tion can negatively affect your athletic performance. Stop your activity immediately if you begin to feel lightheaded or weak, if your muscles begin to spasm, if you get a headache, or if youhave a rapid, weak pulse. Immediately tell your coach or workout part-ner how you feel—don’t go off alone until you feel better. Be sure todrink plenty of cool fluids, such as water or diluted fruit juice. Avoid Overtraining Some people may think that pushing them- selves very hard will help them meet their fitness goals more quicklyor give them the competitive edge. But your body needs rest betweenworkouts so that it can recover from the exertion. iscaused by exceeding the recommendations of the FITT formula—training too much, too intensely, or too quickly for your abilities. Overtraining has many negative effects, many of which are long- term effects. To avoid overtraining, always include periods of rest inyour training program. To rest does not necessarily mean to stopactivity. Active rest involves lowering the intensity of a workout or tak- ing part in other activities. Knowing the warning signs of overtrainingcan help prevent you from developing a serious injury. Recovery fromovertraining can take weeks to months. Avoid Overuse Injuries Repetitive activity causes stress to bones, ligaments, tendons, or muscles. Small, repetitive injuries to the tissuecause swelling and the release of substances that damage the tissue.OvertrainingDehydrationWarning Signs of Overtraining >Feelings of chronic fatigue >Getting injured easily >Feelings of irritability and depression >Dehydration >Loss of interest in working out >Loss of appetite and loss ofweight >Increased resting heart rate(RHR) >Poor athletic performance andpossibly poor schoolperformance Copyright © by Holt, Rinehart and Winston. All rights reserved. est ce ompression levation 142 CHAPTER 6 Physical Fitness for LifeThis damage results in chronic injury. Continued stress on the tissue can lead to weakness, loss of flexibility, and chronic pain. Overuse injuries are becoming more common in adolescents, par- ticularly in adolescents who are gymnasts, runners, or swimmers. Chil-dren and adolescents are very prone to overuse injuries because theirbones are still growing. Damage to growing bones and other tissuescan cause lifelong weakness and loss of flexibility. Treatment of overuseinjuries should include resting the injured site, applying ice or heat asrequired, and undergoing physical therapy and rehabilitation torebuild strength and flexibility at the site of injury. Choose the Correct Equipment and Clothing >Wear comfortable clothing. Your clothing should allow free movement of your body. Choose fabrics that draw moistureaway from the skin. >Dress suitably for the weather and exercise intensity. Many thin layers together insulate better than one or two thick layers. In cold weather, wear thin layers that can be removed if you get too warm. Wearing a brimmed hat, sunscreen, and sunglasses are musts when exercising outdoors, even in winter! >Always wear safety equipment, and wear it correctly. Get train- ing or advice from a reliable person on the correct use and fitof safety equipment. >Choose shoes that are made for your activity. Good shoes play a very important role in preventing injury. However, you donot need an expensive pair of shoes unless you are training alot or have a diagnosed foot problem. Ask for advice from aperson who works in a specialty shoe store. >Make sure you can be seen. Wear bright, reflective clothing if training at night. >Obey laws, regulations, and warning signs. Ignoring these could lead to injury or even death. Treating Minor Sports Injuries Most injuries, regardless of type, have one thing in common:swelling. Swelling causes pressure in the injured area, and thisincrease in pressure causes pain. You must quickly control swellingbecause swelling slows down the healing process. Apply the RICE principle to control swelling: rest, ice, compres- sion, and elevation. As shown in Table 2, the RICE principle can be applied to both acute and chronic injuries. >Rest It is important to protect the injured muscle, ligament, tendon, or other tissue from further injury. >IceApply ice bags or cold packs to the injured site, and leave the ice on the injured site for no longer than 15 to 20 minutes.Leaving ice on any longer or placing ice directly on the skincan damage the skin. www.scilinks.org/health Topic: Overuse Injuries HealthLinks code: HH4111 The RICE technique is used for the early treatment of sports-relatedinjuries. RICE plays a critical role in limiting swelling. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Exercising the Safe Way 143Injury Sunburn (acute) Tendon and muscle strain (acute) Ligament sprain(acute) Fracture (acute) Heat exhaustion (acute) Concussion (acute) Tendinitis (chronic) Stress fracture (chronic) Shin splint (chronic)Cause overexposure of the skin to ultra- violet (UV) rays in sunlight overstretching or over contrac- tion of muscles causes musclefibers or tendons to tear forcing a joint to move beyond its normal limits can cause ligamentfibers to tear extreme stress and strain causes cracks in bone training in hot or humid weather; extreme dehydration a blow to the head, face, or jaw that causes the brain to beshaken in the skull inflammation of a tendon due to trauma or overuse repeated stress or overuse causes tiny fractures in the bone straining of muscles that are attached to the shin boneTreatment drinking plenty of fluids; applying light moisturizer; prevention-wearing sunscreen and protective clothing rest and immobilization (a mildly pulled muscle can recover in as little as a week; tendons cantake longer) RICE and strengthening of the muscles and ten- dons around the joint through rehabilitation immediate medical attention; rest and immobi- lization for 6 to 8 weeks immediate medical attention; moving to a shady spot, drinking plenty of cool water, and applyingcool water to body rest under observation; immediate medical attention if there is unconsciousness, vomiting, aseizure, or a change in the size of the pupils RICE (healing can take from 6 to 8 weeks); apply heat after 36 to 48 hours if swelling is gone RICE and sometimes immobilization; female ath- letes with a stress fracture may need a bone scan RICE; applying ice several times a day; strength- ening of the lower leg musclesTable 2 Common Injuries and Treatments>Compression Compression reduces swelling. Wrap a cloth bandage around the affected area. If you feel a throbbing or the bandage is too tight, remove the bandage and reapply it. >Elevation Raising the injured site above heart level when possi- ble can help reduce swelling. Medical advice must be sought immediately if there is uncon- sciousness or persistent pain or bleeding. It would be a wise decisionto get certified in first aid so that you can confidently and correctlytreat an injury until you get to a doctor or hospital. Recovery from Injury The RICE principle is applied as first aid when an injury occurs, but it is also useful during recovery. Muscles inan injured limb lose strength and flexibility when they are not used.Rehabilitation is the process of regaining strength and coordinationduring recovery from an injury. Returning to activity before an injury isfully healed and rehabilitated puts you at risk of reinjury. Therefore youshould always let an injury completely heal before attempting any activ-ity that may stress the injured site. However, to keep doing activities thatdo not stress the injury is also important.For more information about bones, joints, and muscles, see the Express Lesson on pp. 592–593 of thistext.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 144 CHAPTER 6 Physical Fitness for Life Name Caffeine AmphetaminesEphedrine (ephedra, ma huang) Adrenal androgens (includes DHEA andAndro) Gamma- butyrolactone (GBL) Anabolic steroidsHow does it affect the body? a central nervous system stimu- lant that makes you feel awakeand alert mask fatigue, increase sense of well-being and mental alertness stimulates the brain and nervous system, increases alertness, andmay mask signs of fatigue claimed to increase muscle strength and improve athleticperformance when taken as asupplement claimed to induce sleep, release growth hormone, increase athleticperformance, and relieve stress increase muscle size and strengthDangersraises blood pressure and heart rate if used in excess; affects sleep, mood, and behavior; canlead to dehydration by increasing urination raise blood pressure, increase aggressiveness, increase risk of injury, and circulatory collapse (shock) may lead to abnormal heartbeat, dizziness, psychiatric episodes, and seizures can cause behavioral, sexual, and reproductive problems; causes liver damage, muscle disorders,and increased risk of heart disease; can stuntgrowth in teens can cause vomiting, an increase in aggression, tremors, slow heartbeat, seizures, breathing difficulties, and coma increase aggressive behavior, cholesterol levels, and risk of kidney tumors; can cause severe acne,testicular shrinkage, liver cysts, and fatal damageto heart muscle; can stunt growth in teensTable 3 Common Supplement Ingredients and DrugsSupplements, Drugs, and Athletic Performance Some athletes feel that taking dietary supplements or drugs gives them a competitive edge. A is any product that istaken by mouth that can contain a dietary ingredient, and is alsolabeled as a dietary supplement. Makers of these supplements canclaim that their dietary supplement helps improve athletic perform-ance. For example, some protein supplements are advertised as help-ing to increase muscle mass. Table 3 summarizes some common ingredients of dietary supplements and drugs used by some athletes. Dietary Supplements Supplements are not regulated by the Food and Drug Administration (FDA). Makers of these products canmake claims for their product without any scientific proof. Thestrength of a supplement can vary widely. Claims that dietary supple-ments improve performance are often based on improvements thatare the result of training, not a result of taking supplements. Somesupplements that contain non-nutrient ingredients, such as caffeine,ephedrine, andro, or GBL, may have dangerous side effects or arebanned by certain athletic associations. Athletes and non athletes whohave a wholesome well-balanced diet do not need such supplements.dietary supplement Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Exercising the Safe Way 145Anabolic Steroids are synthetic compounds that resemble the male hormone testosterone . Doctors use small amounts of anabolic steroids to treat some conditions, such as muscle disease, kidney disease,and breast cancer. Men normally produce about 2.5 to 1 1 mg of testosterone a day. A steroid abuser may take asmuch as 100 mg a day. Despite the harmful effects of anabolic steroids and the fact that abusing them is illegal, many men, women,and teens use them. It is estimated that more than a million male and female athletes are taking or have takenanabolic steroids. Reported effects for females includeexcessive growth of facial and body hair, baldness,increased risk of cancer, and menstrual problems. These effects are in addition to the side effects that affect both males and females that are listed in Table 3. Neverthe- less, the incidence of steroid use among high school athletesis estimated to be 6 to 1 1 percent. Many athletes who abuseanabolic steroids start using the drugs as early as age 15. Playing It Safe! Exercising is a great way to stay physically fit. If you follow the basicrules to avoid sport injuries and avoid supplements and drugs, youwill find out how much fun it can be to exercise and be fit. In addition, remember to exercise or train in open areas that have good lighting, bring a friend, and always let someone know whereyou’ll be and what time you’ll return.Anabolic steroids REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “a state in which the body has lost more water than has been taken in.” a.chronic injury c.overtraining b.dehydration d.testosterone 2.Define overtraining . 3.Define what an anabolic steroid is. Understanding Key Ideas 4.Identify three ways to prevent sports injuries. 5. Describe how overtraining can lead to chronic injury.6.State why it is important to follow the RICE steps right after an injury. 7.Evaluate the statement “All athletes need to take some kind of supplement.” Critical Thinking 8. Practicing Wellness How could wear- ing the wrong type or size of safety equipment lead to an injury? 9.What advice would you give a friend who started exercising hard every day and whose body nowhurts too much to move?LIFE LIFE SKILL A close friend of yours has always been into bodybuild- ing and weight lifting. Over the last few months,he has not been doing well in his competitions.He has a few friends who have suggested thattaking a steroid will give him a competitive edgeand will put him back on top. Write on a separate piece of paper the advice that you would give your friend. Remember touse the decision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. 146 CHAPTER 6 Physical Fitness for LifeSleepSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 Can you remember a time when you were so tired that you couldn’t concentrate in class? When you are tired, your con-centration declines, it’s hard to finish your tasks, and you are less able to handle stressful situations. Sleep: Too Little, Too Often A recent poll conducted by the National Sleep Foundation, “Sleep inAmerica,” found that over 60 percent of adults in the United Statesexperience sleep problems. Sleep is not just a “time out”; it is essen-tial for your health and safety. You need sleep for good health, andyou need to get enough of it. What is sleep, and why do we need it? The answer is not com- pletely clear, but we do know that sleep is needed by the brain. Evenmild sleepiness has been shown to hurt all types of performance—inschool, sports, and even when playing video games! is a lack of sleep. People who are sleep de- prived over a long period of time suffer many problems. For example,they may have the following problems: >Stress-related problems Even occasional periods of sleep dep- rivation can make everyday life seem more stressful and cancause you to be less productive. >Increased risk for getting sick Long-term sleep deprivation decreases the body’s ability to fight infections. >Increased risk for dangerous accidents Sleepiness can cause a lack of concentration and a slow reaction time which can leadto dangerous and even fatal accidents. For example, drowsydriving is a major problem for drivers aged 25 or under. Getting enough good quality sleep is as important as being physically fit and having good nutrition. The

amount of sleep a per-son needs varies. Most adults need an average of 8 hours of sleep pernight. But some adults need as little as 6 hours; others need 10 hours.Sleep deprivationOBJECTIVES Describe why sleep is an important part of your health. List the effects of sleep deprivation. Compare how the amount of sleep needed by teens differs from the amount needed by adults or children. Identify the two different types of sleep. Listthree ways that you can improve your sleeping habits. LIFE LIFE SKILLKEY TERMSKEY TERMS sleep deprivation a lack of sleep circadian rhythm the body’s internal system for regulating sleeping and waking patterns insomnia an inability to sleep, even if one is physically exhaustedsleep apnea a sleeping disorder characterized by interruptions of normal breathing patterns during sleep “ I should have stopped playing video games earlier last night.” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION X Title 147Teens and Sleep Teens need more sleep than their parents and younger siblings do. Teens need about 9 hours and 15 minutes of sleep a night. Why do teens need more sleep? When puberty takes place, the timing of a teen’s circadian rhythm is delayed. The (also known as a circadian clock or body clock) is the body’s internalsystem for regulating sleeping and waking patterns. In general, ourcircadian rhythm is timed so that we sleep at night and wake duringthe day. When the rhythm is delayed at puberty, the body naturallywants to go to sleep later at night and wake up later in the morning.So, teens usually have more difficulty falling asleep until late at nightand have a little more difficulty waking up early in the morning.Many teenagers are not alert until after the typical high school dayhas already begun. The good news is that you can adjust your circadian clocks for the school year. This process may take several weeks but it is worth the time.Adjusting your circadian rhythm to fit your schedule can reduce morn-ing crankiness, make you feel happier, and help you face the day ahead. circadian rhythm LIFE LIFE SKILL ActivityGetting Enough SleepPracticing Wellness Does the following passage sound familiar? Greg rolled out of bed after hitting the snooze button for the 10th time. As he shuffled out of the room, heturned off the TV—he had left it on all night. Hisshower woke him up long enough to grab a muffinand get to school. Greg’s first class period was a blur.All he could think of was sleeping. After class, hecouldn’t remember a thing the teacher said. Hegrabbed a soda from the vending machine to helphimself wake up. He had a busy day, but when bed-time arrived, he just couldn’t sleep! You can develop better sleeping habits. Begin by keeping a week-long sleep log that records the following information: The times you go to sleep and wake up The things that affect your sleeping patterns 21The reasons you cannot fall asleep or do not sleep well The ways in which lack of sleep affects your activities or behaviors during the day Assessing Your Health 1.What patterns did you find from your sleep log? 2.What types of things affect your sleep patterns? 3.Write down three things you can do to improve your sleeping habits.LIFE LIFE SKILL43I need only 6 hours of sleep a night.Myth Teens need between 8.5 and 9.25 hours of sleep every night. HHo4PEC05MFT001PFact Copyright © by Holt, Rinehart and Winston. All rights reserved. 148 CHAPTER 6 Physical Fitness for LifeThe Stages of Sleep While you sleep, your brain and body go through cycles of deep and light sleep. These two types of sleep are called NREM and REM.NREM stands for “ nonrapid eye movement,” and REM stands for “rapid eye movement.” In the beginning of a sleep cycle, we go into NREM sleep. The body recovers from the stress of the day’s activities during this part ofthe sleep cycle. Brain activity is at its lowest during NREM sleep. TheREM portion of the sleep cycle is called dream sleep . It first happens about 1.5 hours into sleep. REM sleep got its name from the rapidmovement of the eyes during this phase of sleep. During a normalsleep cycle, periods of NREM sleep alternate with periods of REMsleep. Both types of sleep are essential in helping us lead healthy,active lives. Insomnia and Other Sleep Disorders Sleep deprivation can result from insomnia. is an inability to sleep, even if one isphysically exhausted. Caffeine, alcohol, smoking, stress, and lack ofexercise are all common causes of insomnia. Insomnia seems tobecome more of a problem as we age. Insomnia can often be treated bya simple change in daily habits, such as limiting caffeine late in the day. is a serious sleeping disorder in which there are interruptions in normal breathing patterns during sleep. Thesepauses in breathing can put great stress on the heart. People withsleep apnea can be constantly tired because of nights of disturbedsleep. Sleep apnea is most common in older people and people whoare obese. See your doctor if you have sleeping problems for 3 weeksor longer or if you fall asleep during the day. HSleep apneaInsomnia REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the term that means “lack of sleep.” 2.Define circadian rhythm. 3.Identify the term that means “the inability to fall asleep even if one is physically exhausted.” a.sleep deprivation c.circadian rhythm b.insomnia d.sleep apnea 4.Name the condition in which a person has an interrupted breathing pattern during sleep. Understanding Key Ideas 5.Listthe effects of sleep deprivation on your health.6.Describe how sleep deprivation can affect daily life. 7.Describe what happens during NREM and REM sleep. 8. Assessing Your Health Which com- mon causes of insomnia can you control? What changes would make the most improvement toyour sleep? Critical Thinking 9.Do you think insomnia can affect teens? Explain. 10.Give reasons why teens need more sleep thanadults do.LIFE LIFE SKILLSix Tips for Getting a Good Night’s Sleep 1Develop a routine. Go to bed and get up at the same time, even onweekends! 2Exercise every day. The besttime is in the late afternoon orearly evening, but not too closeto bedtime. 3Limit caffeine. After about lunchtime, stay away from coffee,colas, or foods with caffeine. 4Relax. Avoid heavy reading,studying, and computer gameswithin 1 hour of bedtime. 5Say no to all-nighters. Stayingup all night, even to study for anexam, will disturb your sleeppattern and your ability tofunction the next day. 6Your bed is for sleep. Do not eat,watch TV, or study in bed. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 6 Highlights 149 CHAP TER 6 CHAP TER 6 CHAPTER 6Highlights Key Terms The Big Picture ✔Staying physically fit reduces the risk for certain chronic diseases. ✔There are five components to health-related fitness; muscular endurance, muscular strength, cardiorespiratory endurance, flexibility, and body composition. ✔Developing skill-related fitness is important for good athletic performance. ✔People of all ages can benefit from regular physical activity.SECTION 1 physical fitness (126) chronic disease (126) health-related fitness (128) resting heart rate (RHR) (129) ✔Most sports injuries can be avoided by proper conditioning,warming up and cooling down, stretching, avoiding dehydration,wearing safety equipment, and wearing the correct clothing andshoes. ✔The damaging effects of overtraining and overuse can be long term. ✔Most acute injuries should be treated immediately beforeswelling sets in. Rest, ice, compression, and elevation (RICE) isthe most effective treatment. ✔The usefulness of dietary supplements in improving athletic performance is not scientifically proven. The use of anabolicsteroids for enhancing athletic performance is illegal.SECTION 3 dehydration (141) overtraining (141) dietary supplement (144) anabolic steroid (145) ✔A fitness program must be suited to your abilities, your level offitness, and your access to facilities and equipment. ✔Calculating your resting heart rate (RHR) and your target heartrate zone are some of the first steps to designing a fitness program. ✔Monitoring your heart rate during cardiorespiratory exercise isone of the best ways to monitor the intensity of the activity. ✔Following the FITT formula can help you develop a safe andeffective fitness program. ✔Setting realistic fitness goals is the foundation of any fitness program.SECTION 2 target heart rate zone (134) FITT (136) repetitions (137) set(138) ✔Sleep deprivation can increase stress, reduce productivity, lead to illness, and cause accidents. ✔Teens need more sleep that children and adults. ✔People with normal sleep patterns have a predictable alternatingpattern of REM (dream sleep) and NREM (nondreaming) sleep. ✔Sleeping habits can be improved by making simple dietarychanges and by having a quiet, restful place to sleep. SECTION 4 sleep deprivation (146) circadian rhythm (147) insomnia (148) sleep apnea (148) Copyright © by Holt, Rinehart and Winston. All rights reserved. 150 CHAPTER 6 Review CHAP TER 6 CHAP TER 6 CHAPTER 6 Review Using Key Terms anabolic steroid (145) repetitions (137) chronic disease (126) resting heart rate (RHR) (129) circadian rhythm (147) set(138) dehydration (141) sleep apnea (148) dietary supplement (144) sleep deprivation (146) FITT (136) target heart rate zone (134) health-related fitness (128) insomnia (148) overtraining (141) physical fitness (126) 1.For each definition below, choose the key term that best matches the definition. a.a fixed number of repetitions followed by arest period b.synthetic form of the male hormone testosterone c.a disease that develops over a long period oftime and, if treatable, takes a long time to treat d.the body’s internal “clock” e.a formula used to assess how long, how often,and how hard you should exercise f.the number of times an exercise is performed 2.Explain the relationship between the key terms ineach of the following pairs. a.physical fitness and chronic disease b.overtraining and RICE c.sleep apnea and sleep deprivation d.RHR and target heart rate zone Understanding Key Ideas Section 1 3.Describe five benefits of being physically fit. 4.List the five health-related components of fitnessand an activity that develops each component. 5.What is the importance of skill-related fitness? 6.Explain how being a good sport can help youdevelop healthy life skills. 7.CRITICAL THINKING A friend says, “I don’t have to bother to exercise. There’ll be a cure for all ofthose diseases by the time I’m old!” Reply tothese comments.LIFE LIFE SKILLSection 2 8.What are the important factors to consider before starting a fitness program? 9.Describe each step in designing a fitness program. 10.Calculate the target heart rate zone of a 15-year-old. 11.Explain how the FITT formula can act as a guidewhen you are developing a fitness program. 12.In which of the following is the term repetitions used? a.running c.weight lifting b.cycling d.swimming 13.CRITICAL THINKING Explain the role of health fitness standards in designing a fitness program. Section 3 14.What can you do to help prevent a sports injury? 15.List three signs of overtraining. 16.Describe the first steps in treating a minor sportsinjury. 17.Identify the effects of abusing anabolic steroids. 18.How can the FITT formula help you in avoiding asports injury. 19.CRITICAL THINKING Your little sister who has just learned how to ride her bicycle says sheno longer wants to wear her bicycle helmetbecause she “looks like a baby” while wearing it.What can you say to your sister to highlight theimportance of wearing her bicycle helmet? Section 4 20.Why is sleep so important? 21.Describe four consequences of not gettingenough sleep. 22.How many hours of sleep a night do teens need? 23.In what phase of sleep does dreaming occur? 24.Identify four things you can do to get a goodnight’s sleep. LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 6 Review 151Interpreting Graphics Study the figure below to answer the questions that follow. 25.Equal numbers of people die from heart disease as die from cancer, accidents, and diabetes combined. How can you determine this information from the graph? 26.CRITICAL THINKING Based on the information in this chart, what is one of the most importantlifestyle changes you can make to prevent heartdisease? Activities 27. Health and You Identify your target heart rate zone. Identify the purpose of knowing your targetheart rate zone. 28. Health and You Keep an activity log for 1 day. Write down everything you do in a day and thelength of time you do each activity. Identifywasted time, and see if you can fit in exercise timeand more sleep time. 29. Health and Your Community Prepare a brochure that identifies locations in your community inwhich people of all ages can exercise regularlyand safely. Include facility information, availableclasses, and fees. Action Plan 30. Setting Goals Write a list of reasons you want to get more fit. Identify your short- andlong-term goals. Write out an exercise contractthat shows when, where, and what your programwill be. Write down the day you will start. LIFE LIFE SKILL 31.In this passage, the word deteriorating means Astaying the same. Bgetting better. Cgetting worse. Doften on time. 32.What can you infer from reading this passage? E Jorge is depressed. FJorge is sleep deprived. GJorge is probably going to lose his place on the track team. Hall of the above 33.Write a paragraph describing how Jorge couldchange his life for the better. Suggest healthfulchanges Jorge can make in his lifestyle to feelbetter both physically and emotionally. 34.If Jorge sleeps an average of four and a half hours a night, how much sleep is he missing out on to get the recommended amountof sleep for teens? READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Jorge was always tired. He felt that he was always studying for an exam or writingreports for school. He was also depressedbecause his dad had some kind of heart dis-ease and was in and out of the hospital.Jorge was often so tired after school that allhe wanted to do was to flop down in front ofthe TV. Although he was exhausted, hefound it difficult to fall asleep before mid-night. However, he would often fall asleepmuch later in front of the flickering TV. Hewas on the school track team but had notbeen making training recently. The quality ofhis school work was also deteriorating and he was really fed up. Six Leading Causes of Death Cause of death Heart disease CancerStrokeRespiratory diseaseAccidentsDiabetesPercentage of total deathsLifestyle factors* 30 23 7543I, D, SI, D, S, AI, D, SS I, D * I = inactivity, D = diet, S = smoking, A = alcohol Source: Centers for Disease Control and Prevention. MATH SKILLMATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 7 CHAP TER 7 CHAPTER 7 Nutrition for LifeNutrition for LifeNutrition for Life 152KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Eating too much protein, carbohydrate, or fat will make you gain weight. 2.Peanut butter and potato chips are high in cholesterol. 3.Fiber isn’t important because it cannot beabsorbed. 4.You don’t need to worry about getting enoughvitamins and minerals because they are neededin such small amounts. 5.Water is a nutrient. 6.The Recommended Dietary Allowances are guidelines for the amounts of nutrients we need. 7.Snacking is bad for you. Copyright © by Holt, Rinehart and Winston. All rights reserved. 153SECTION 1 Carbohydrates, Fats, and Proteins SECTION 2 Vitamins,Minerals,and Water SECTION 3 Meeting YourNutritional Needs SECTION 4 Choosing aHealthful Diet go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH07. Copyright © by Holt, Rinehart and Winston. All rights reserved. 154 CHAPTER 7 Nutrition for LifeWould you rather eat spinach, a cheeseburger, or a hot fudge sundae? Each choice contains different amountsand combinations of the nutrients you need to stay healthy. But no one food provides them all. What Is Nutrition? How do you know if you are eating a balanced, healthy diet? is the science or study of food and the ways in which the body uses food. It is also the study of how and why we make foodchoices. Nutrition is also the study of the nutrients foods contain. are substances in food that provide energy or help form body tissues and are necessary for life and growth. Six Classes of Nutrients There are six classes of nutrients in food—carbohydrates, fats, proteins, vitamins, minerals, and water. are a class of energy-giving nutrients that include sugars, starches, and fiber. are a class of energy-giving nutrients that are also the main form of energy storage in the body. (PROH teens) are a class of nutrients made up of amino acids, which are needed to build and repair body structures and toregulate processes in the body. A Balanced Diet Keeps You Healthy To stay alive, healthy, and growing, a person must eat and drink the right amounts of nutrients.Eating too little food causes weight loss, poor growth, and if severeenough, death. But eating too much food can also cause illness. WhenProteinsFatsCarbohydratesNutrientsNutritionCarbohydrates, Fats, and ProteinsSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Name the six classes of nutrients. Identify the functions and food sources of carbohydrates, proteins, and fats. Describe the need for enough fiber in your diet. Identify one health disorder linked to high levels of saturated fats in the diet. Describe how diet can influence health. LIFE LIFE SKILLKEY TERMSKEY TERMS nutrition the science or study of food and the ways in which the body uses food nutrient a substance in food that provides energy or helps form body tissues and that is necessary for life and growth carbohydrate a class of energy-giving nutrients that includes sugars, starches, and fiberfata class of energy-giving nutrients; also the main form of energy storage in the bodyprotein a class of nutrients that are made up of amino acids, which are needed to build and repair body structures and to regulate processes in thebody The saying “You are what you eat” reflects the idea that the food you eataffects how healthy you are. Copyright © by Holt, Rinehart and Winston. All rights reserved. 155too much fat, carbohydrate, or protein is taken into the body, the extra energy is stored as body fat. Excess body fat increases the risks ofdeveloping heart disease, high blood pressure, and many otherchronic diseases and disorders linked to poor nutrition. Thus, if youeat a healthy diet, you are more likely to be healthy and stay healthy. What you eat today not only affects how you look and feel right now but also can affect your health in the long term. The diet you eatduring your teens can affect your risk of developing obesity, heart dis-ease, diabetes, osteoporosis, and cancer when you are in your 30s,40s, or 50s. These diseases, which are common causes of death in theUnited States, are affected by diet. Food Has Fuel for Your Body Food provides the fuel that runs your body. The sum of the chemical processes that take place in yourbody to keep you alive and active is called metabolism . Metabolism requires energy and nutrients. The nutrients in food that provideenergy are carbohydrates, fats, and proteins. In this section, we willlook at carbohydrates, proteins, and fats. Vitamins, minerals, andwater are also nutrients needed for metabolism, but they do not pro-vide energy. These nutrients are discussed in the next section. The energy in food is measured in Calories. Figure 1 shows the amount of energy, in Calories, that certain foods offer. Carbohydrateand protein each provide 4 Calories per gram. Each gram of fatprovides 9 Calories. So, 100 grams of bread, which is mostly carbohy-drate, provides about 250 Calories. But 100 grams of chocolate cake,which contains a large amount of fat, provides about 600 Calories. The number of Calories in a food depends on the amount of carbohy-drate, fat, and protein it contains.1 Figure 1/2 cup of ice cream: 178 Calories Flour tortilla with beans and rice: 218 Calories 1 apple: 81 Calories1 cup of low-fat fruit yogurt: 231 Calories3 slices of Cheddar cheese: 154 Calories1 cup of broccoli: 27 Calories How Much Energy? Copyright © by Holt, Rinehart and Winston. All rights reserved. 156Carbohydrates Carbohydrates, which are found in foods such as fruit, milk, cookies, and potatoes, are all made up of the same thing—sugars. There aretwo basic types of carbohydrates: simple and complex. Simple carbo-hydrates are made up of single or double sugar molecules. Complexcarbohydrates are made of many sugar molecules that are linkedtogether. The different types of carbohydrates are listed in Figure 2 . Sugars: Sweet and Simple Sugars are the simplest form of carbohydrate. The sugar that circulates in your blood and providesenergy for your cells is a single-unit sugar called glucose . That is, glu- cose is a single molecule sugar. Other sugars are made of two singlesugar molecules that are linked together. These are called double sugars . For example, table sugar is a double sugar called sucrose that is made of the single sugars glucose and fructose, which are linked together. Sugars are found naturally in some foods and are added to others. The sweet taste of fresh fruit comes from the single sugar fructose. Andabout half the Calories in low-fat milk come from the milk sugar lac-tose. These unrefined foods are also sources of many other nutrients. Foods such as candy, soda, and cakes are sweetened with added sugars. The sugar added to these foods is called refined because it has been separated from the plant that produced it. Refined sugar pro-vides energy but hardly any nutrients. When you eat a lot of thesefoods you may be missing out on foods rich in nutrients. Starches: Not So Simple Starches are a type of complex carbo- hydrate. Complex carbohydrates are made of many sugars that areconnected together. Starch eaten in food is broken down by the bodyinto sugars that can be used by the body. Complex Glucose a single sugar that circulates in the blood (blood sugar ); the most important sugar in the body because it provides energy to the body’s cells; usually found as a part of the double sugar sucrose or in starch Fructose a single sugar that is called fruit sugar; is sweeter than table sugar; found naturally in fruit andhoney; added to many sweetened drinks Lactose a double sugar made by animals that is also called milk sugar; found in dairy products Sucrose a double sugar refined from sugar beets or sugar cane that we call table sugar; found in candies and baked goods and used as a table sweetenerStarch made of many glucose units linked together; found in foods like potatoes, beans,and grains Glycogen made in the body; made of many glucose units linked together; stored in the mus-cle and liver of humans and animals; can be bro-ken down to provide a quick source of glucose Fiber made of many glucose units linked together; found in fruits and vegetables; cannotbe digested by humans; needed for a healthydigestive systemSimple Below are listed some simple and com- plex carbohydrates. Some foods, suchas fruit, are healthier sources of simplecarbohydrates than cookies are. ACTIVITY Give reasons why fruit is considered to be a healthier source of simple carbohydrates than cookies are.2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Carbohydrates, Fats, and Proteins 157Most of the starches in our diet come from plant foods. Starchy vegetables (such as potatoes), legumes (beans and peas), and grains (rice, corn, and wheat) are allgood sources of complex carbohydrates. It is recom-mended that 45 to 65 percent of the Calories in your dietshould come from carbohydrates. Most of these Caloriesshould come from complex carbohydrates. Glycogen: Storage Carbohydrate If you eat more carbohydrate than your body needs, some will be stored asglycogen (GLIE kuh juhn). Glycogen is your body’s quickenergy reserve. It is made of highly branched chains of glu-cose which can quickly be broken down into individualglucose units to be used by body cells. If glycogen storesbecome full, the body is able to convert carbohydratesfrom the diet into body fat. Fiber Fiber is a type of complex carbohydrate that pro- vides little energy and cannot be digested by humans.However, fiber is very important for your health. Fiber keeps yourintestines healthy, prevents constipation, and may help

prevent coloncancer and heart disease. Fiber increases the amount of fluid and bulk in your digestive tract. Some kinds of fiber, called soluble fiber , dissolve in water. These soluble fibers hold water in your intestines, which increases the vol-ume of material in your digestive tract. Soluble fibers are found inthe soft pulp of oat bran, apples, beans, and some vegetables. Theyhelp protect you against heart disease by “trapping” cholesterol fromeaten food, therefore lowering blood cholesterol. Other fibers do not dissolve in water. These insoluble fibers add bulk to your body’s waste and are found in the hard or stringy partof fruits, vegetables, and grains. Wheat bran, corn, brown rice, andthe skins of fruits and vegetables are good sources of insoluble fiber.Refined-grain products, such as white flour, are made by removingthe germ and bran from each grain. Refining of grains results in afood that is lower in fiber and nutrients. Fats Fat is unhealthy, isn’t it? Well, it depends on how you think about it.Fat is an essential nutrient. You need fat in your diet for your body tofunction properly. Fats also add to the texture, flavor, and aroma ofour food. But eating too much fat and eating the wrong kinds of fatcan increase your risk of weight gain, heart disease, and cancer. What Is Fat? Fats belong to a class of chemical compounds called lipids (LIP idz), which are fatty or oily substances that do not dis-solve in water. Fats are large molecules that are made up of two kindsof smaller molecules— fatty acids and glycerol. Three fatty acids are linked to one glycerol, which is why fats are also called triglycerides. Germ Bran Whole-wheat breadWheat Whole-grain products, such as whole- wheat bread, are made from the entiregrain, including the bran and germ,which are rich in vitamins, minerals,and fiber. Copyright © by Holt, Rinehart and Winston. All rights reserved. 158 CHAPTER 7 Nutrition for LifeFatty acids are long chains of carbon atoms that are chemically bonded to each other and are attached to hydrogen atoms. The length of the carbon chains and the number of hydrogen atomsattached affect how the fatty acid functions in the body. Likewise,the type of fatty acids in each type of fat affects how “good” or“bad” the fat is for you. Saturated Fats Some fatty acids are made up of a chain of car- bon atoms with single bonds between each other. Each carbon atomis said to be saturated because it is bonded to as many hydrogen atoms as is chemically possible. Saturated fats are fats that are made up of saturated fatty acids. Most saturated fats in our diets are solid at room temperature and come from animal foods such as meat and milk. A few vegetableoils such as coconut and palm oil also contain saturated fat. If youeat a lot of meat, whole milk, butter, and ice cream, your diet will behigh in saturated fat. This type of diet can lead to obesity, increaseyour blood cholesterol levels, and increase your risk of heart disease. Unsaturated Fats Some fatty acids are made up of a chain of car- bon atoms with one or more double bonds between the carbonatoms. These fatty acids are said to be unsaturated because the carbon atoms do not hold the maximum number of hydrogen atoms that ischemically possible. Unsaturated fats are fats that are made up of unsaturated fatty acids. They are more common in plants and tend tobe liquid at room temperature. Figure 3 shows the proportions of unsaturated and saturated fats that are found in some common foods. Unsaturated fats that contain fatty acids that have only one set of double bonded carbons are called monounsaturated fats . Monounsatu- rated fats are found in olive oil, canola oil, and peanut oil. Diets in The fat in foods is a mixture of saturated and unsaturated fat. Choosing foodsthat contain lower amounts of saturatedfat can help protect you from heart disease. ACTIVITY Which foods contain the lowest percentage of saturated fats?3 Figure Four Fat Facts 1Too little dietary fat can lead to a fatty-acid deficiency, but eating too much of the wrong types offats can raise blood cholesterollevels. 2Fat in your adipose tissuecushions your body’s organsand helps keep your bodytemperature stable. 3Fat is needed to make regulatorymolecules in the body such ascertain types of hormones. Fat isalso needed to form the coatingon nerves and the membranesthat surround body cells. 4Fats add to the taste and textureof food and help you feel full forseveral hours after you haveeaten.Saturated fatsOlive oilSteak Cheese Peanuts Salmon Unsaturated fats Fat percentageSaturated and Unsaturated Fats in Foods 100 90 8070605040302010 0 Chocolate Source: U.S. Department of Agriculture. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Carbohydrates, Fats, and Proteins 159which the fats are mostly from monounsaturated fats are believed to lower the risk of heart disease. Fats that contain fatty acids with morethan one double bond are called polyunsaturated fats . Corn oil, sun- flower oil, and soybean oil are good sources of polyunsaturated fat.A polyunsaturated fatty acid called omega-3 is found in fish and seafood and may provide extra protection against heart disease. Trans fatsare unsaturated fatty acids that are formed when vegetable oils are made into hard margarines. They may increase the risk of heartdisease. Total fat intake for teens should be 25 to 35 percent of totalCalorie intake with limited amounts of saturated fat, cholesterol, andtrans fat. Cholesterol Cholesterol is another type of lipid. It is found in all human and animal tissues. Cholesterol is needed to make vitamin D,cell membranes, the coverings on nerve fibers, certain hormones, andbile (a substance that aids in fat digestion). Your body makes choles-terol, but you also get cholesterol from your diet. Cholesterol combines with other molecules to circulate in the blood. One kind of cholesterol-containing molecule called low- density lipoprotein (LDL) brings cholesterol to the body cells. When levels of LDL cholesterol in the blood get too high, deposits calledplaque (PLAK) form on the walls of blood vessels. Plaque can block blood flow to the heart muscle. Lack of blood flow starves the heartmuscle of oxygen, causing a heart attack. Therefore, LDL cholesterolis known as “bad cholesterol.” Another molecule, called high-density lipoprotein (HDL), carries cholesterol back to the liver, where it is removed from the blood.High levels of HDL cholesterol called “good cholesterol” are linkedto a reduced risk of developing heart disease. Cholesterol is found only in animal tissue, so dietary cholesterol is found only in foods such as meat, fish, poultry, eggs, and dairyproducts. Cholesterol is not found in plants, so foods that come fromplants are cholesterol free. The amount of cholesterol in the foodsyou eat is of concern because dietary cholesterol, like saturated fat,can increase blood cholesterol levels. When blood cholesterol levelsrise, the risk of heart and blood vessel disease also increases. Proteins Your muscles, skin, hair, and nails are made up of mostly protein.Proteins in the body help build new cells and repair existing ones.Protein is also needed to form hormones, enzymes, antibodies, andother important molecules. If you eat more protein than is neededfor these essential functions, it can be stored as fat. Proteins are made up of chains of molecules called animo acids . The amino acids are linked together like beads on a necklace to makeeach type of protein. Twenty different amino acids make up bodyproteins. Nine of the amino acids needed to make body protein can-not be made in our bodies. These amino acids are called essential Eating extra protein is important if you want to build bigger muscles.Myth Muscles grow in response to strength training, not to an increase in protein intake.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. 160 CHAPTER 7 Nutrition for Lifeamino acids and must be eaten in your diet to meet your body’s needs. The other 1 1 amino acids can be made by the body and are called nonessential amino acids . If one amino acid is missing when making a body protein, the protein cannot be made. If the missing amino acid is one of thenonessential amino acids, the body can make that amino acid andthe protein can continue to be made. If the missing amino acid is anessential amino acid, it must be supplied by the diet or taken fromother body proteins before the protein can be made again. Complete and Incomplete Proteins Protein in our diet comes from both animal and plant foods. For the body to maintain itselfand grow, these proteins must provide all of the essential aminoacids. Animal proteins such as meat, eggs, and dairy products containall the essential amino acids. These proteins are therefore called com- plete proteins . Most plant proteins, found in foods such as legumes, grains, and vegetables, don’t have all the essential amino acids orhave smaller amounts of some essential amino acids than are neededby your body. These proteins are called incomplete proteins . A healthy diet must include all the essential amino acids. A diet that contains both plant and animal foods can easily meet all of youramino acid needs. You can do this by eating a wide variety of foodssuch as red and white meats, fish, dairy foods, legumes, nuts, andgrains. People who don’t eat meat can eat a variety of plant proteinsto get enough amino acid to meet their needs. The combination ofgrains and legumes (as in a peanut butter sandwich) provides twodifferent plant proteins that together supply all of the amino acids tomeet the body’s needs. It is recommended that 10 to 35 percent ofyour total Calorie intake should be from protein. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term nutrition . 2.State two functions of nutrients in your body. 3.Name the class of nutrients to which sugars and starches belong. 4.Name the class of nutrients that is made up of chains of amino acids. 5.State two functions of fats. Understanding Key Ideas 6.Listthe six classes of nutrients. 7.State two functions of complex carbohydrates.8.Describe the benefits of a diet high in fiber. 9.Identify the food that is nota source of cholesterol. a.beef c.chicken b.beans d.cheese Critical Thinking 10.All these foods can have a high fat content. But which contains the healthiest type of fat? (Hint:See Figure 3.) a.olives c.steak b.ice cream d.coconut oil 11. Practicing Wellness How can a per- son’s diet affect his or her quality of life?LIFE LIFE SKILLPlants are sources of incomplete pro- teins. Eating a variety of plant proteinswill supply you with all the essentialamino acids. =+Legumes . . . Grains . . . Complete protein Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Vitamins, Minerals, and Water 161 Vitamins, Minerals, and WaterSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Carbohydrate, protein, and fat alone can’t keep you alive and healthy. You also need the right proportions of vitamins,minerals, and water. Vitamins, minerals, and water do not provide energy but are needed for the body to function normally. Vitamins are a class of nutrients that contain carbon and are needed in small amounts to maintain health and allow growth. Vitamins aresometimes added to foods that are low in certain vitamins. Vitaminsare classified by whether they dissolve in fat or water. This affects howthey are taken into the body, used, stored, and eliminated. Fat-Soluble Vitamins As shown in Table 1, fat-soluble vitamins include vitamins A, D, E, and K. Because they dissolve in fat, mostcan be stored in fat tissue and remain in the body for a long time. VitaminsOBJECTIVES Describe the function and food sources of seven vitamins. Describe the function and food sources of seven minerals. Identify the importance of drinking enough water every day. Name two ways to increase your calcium intake. LIFE LIFE SKILLKEY TERMSKEY TERMS vitamin a class of nutrients that contain carbon and are needed in small amounts to maintain health and allow growth mineral a class of nutrients that are chemical elements that are needed for certain body processes, such as enzyme activity and bone for-mation nutrient deficiency the state of not having enough of a nutrient to maintain good health Vitamin A D E KFoods that have it >milk; yellow and orange fruits and vegetables; dark-green, leafy vegetables; eggs; cheese; butter >fish oils, fortified milk, liver, egg yolk, salmon,butter, tuna; produced in the body by exposureof skin to ultraviolet light (UV) in sunlight >vegetable oils, beans, peas, nuts, dark-greenvegetables, whole grains >leafy vegetables such as spinach, kale, and broc-coli; also produced in the intestine by bacteriaWhat it does >keeps eyes and skin healthy; needed for growth and for strong bones and teeth >promotes absorption of calcium and phos-phorus in the intestine; needed for strongbones and teeth >protects cell membranes from damage byreactive oxygen (free radicals) >aids in blood clottingTable 1 Fat-Soluble Vitamins Copyright © by Holt, Rinehart and Winston. All rights reserved. 162 CHAPTER 7 Nutrition for LifeWater-Soluble Vitamins The eight B vitamins and vitamin C shown in Table 2 are water soluble. Unlike fat-soluble vitamins, most water-soluble vitamins are not stored in the body very well. Although the B vitamins do not provide energy, most of them are needed torelease energy from carbohydrates, fats, and proteins. Some also haveother important functions. For example, folate helps prevent birthdefects. Vitamin C is an antioxidant that probably helps protect usfrom heart disease and cancer. An antioxidant is a substance that is able to protect body structures from a highly chemically reactive formof oxygen called a free radical . Free radicals are normal byproducts of metabolism. Vitamin B1 (Thiamin ) B2 (Riboflavin ) B3 (Niacin ) B5 (Pantothenic acid ) B6 (Pyridoxine ) B12 (Cobalamin ) Folate (Folic acid or folacin ) Biotin C (Ascorbic acid )Foods that have it >most vegetables, pork, liver, peas, beans, enriched and whole grains and cereals,nuts, seeds >milk; meat; eggs; whole grains; green,leafy vegetables; dried beans; enrichedbreads and cereals; pasta >meat, liver, fish, enriched and whole-grain breads and cereals,peas and beans, seeds >whole grains, meat,liver, broccoli, eggs,nuts, peas, beans >whole grains; liver; meat; fish; bananas;green, leafy vegetables; peas; beans >meat, liver, dairy products, eggs >green vegetables, liver, whole and forti-fied grains, peas, beans, orange juice >liver, yogurt, egg yolk,peas, beans, nuts >citrus fruits,melons,strawberries,green vegetables,peppersWhat it does >needed to produce energy from carbohydrates; helps the nervoussystem to function properly >needed to produce energy fromcarbohydrates; important for growthand healthy skin >needed to produce energy from carbo-hydrate, fat, and protein; needed forthe nervous system and healthy skin >needed to produce energy from carbo-hydrate, fat, and protein >needed for protein metabolism, theproduction of hemoglobin in red bloodcells, and for the nervous system >necessary for forming cells (includingred blood cells) and for a healthynervous system >needed for forming cells (including red blood cells); helpsprevent birth defects >necessary formetabolism >promotes healthy gumsand teeth, the healing ofwounds, and the absorption ofiron; acts as an antioxidant toprotect cells from damageTable 2 Water-Soluble Vitamins Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Vitamins, Minerals, and Water 163Minerals More than 20 minerals are essential in small amounts to maintain good health. are a class of nutrients that are chemical ele-ments that are needed for certain processes, such as enzyme activityand bone formation. Many of the common minerals are presented in Table 3.Minerals Mineral Calcium Chromium Copper Fluoride Iodine Iron Magnesium Potassium Phosphorus Selenium Sodium Sulfur ZincFoods that have it >milk; dairy products; dark-green, leafy vegetables; tofu; legumes; shellfish; bonyfish >meat, dairy products, whole grains, herbs,nuts, seeds >liver, shellfish, peas, beans, nuts, seeds >tea, fish, fluoridated toothpaste and water >iodized salt, seafood >red meat, whole and enriched greens, dark-green vegetables, peas, beans, eggs >milk; dairy products; green, leafyvegetables; peas; beans >meat; poultry; fish; bananas; oranges; driedfruits; potatoes; green, leafy vegetables;peas; beans >cereals, meats, milk, poultry >tuna, other seafood,whole grains, liver,meat, eggs >table salt, high-saltmeats (ham),processed foods,dairy products, soy sauce >meat, milk, eggs, nuts, grains >seafood, meat, milk, poultry, eggsWhat it does >needed for development and maintenance of bones and teeth, transmission of nerveimpulses, muscle contraction, blood clotting >helps regulate blood sugar >needed for the production of bone and redblood cells and the absorption of iron >helps the strengthening of tooth enamel;helps in the prevention of cavities >needed for production of thyroid hormones and normal cell function >necessary for production of hemoglobin >needed for bone growth, metabol-ism, and muscle contraction >needed for maintenance of fluid balance, transmission of nerve impulses, and muscle contraction >needed for bone formation and cell reproduction >needed for healthy heart function, antioxidant action, and healthy thyroid function >needed for the regulation of water balance in cells and tissues and for transmission ofnerve impulses >needed for protein metabolism >needed for gro wth and healing and for production of digestive enzymesTable 3 Some Important Minerals Copyright © by Holt, Rinehart and Winston. All rights reserved. 164 CHAPTER 7 Nutrition for LifeVitamin and Mineral Supplements is the state of not having enough of a nutrient to maintain good health. For most of us, a balanced diet can meet all of our vitamin and mineralneeds. Supplements are available for those who cannot meet theirvitamin or mineral needs with foods. However, supplements are notnormally recommended for healthy people who can meet their nutri-ent needs through their normal diet. If you need to take a supplement, take one that meets but does not exceed your needs. Too much or too little of a nutrient can resultin malnutrition (improper nutrition, caused by poor diet or inabilityto absorb nutrients from foods). Most nutrient toxicities result frommisuse of vitamin and mineral supplements. Sodium Unfortunately, most of us eat far more salt than we need or than is healthy. Salt is made up of the minerals sodium and chlo-ride. Sodium is needed by your body in very small amounts—about500 milligrams, or 1/4 teaspoon of salt per day. It is recommendedthat your sodium intake should be no more than 2,400 milligramsper day, or about 1 1/4 teaspoon of salt. For some people, eating toomuch sodium causes an increase in blood pressure. High blood pres-sure can lead to heart disease, stroke, and kidney failure. In the body, sodium and chloride, along with potassium, magne- sium, and calcium act as electrolytes . Electrolytes are vital for processes such as muscle movement, nerve signals, and the transport of nutri-ents into and out of body cells. Electrolytes also help control fluidlevels in your body. Table salt is not the biggest source of sodium in our diets. Most of the sodium we eat comes from processed foods such as baked goods,snack foods, canned goods, and lunchmeats. Unprocessed foods,such as fresh fruits and vegetables, are low in sodium. Calcium How much calcium do you need each day? The recom- mended daily intake for teens is 1,300 milligrams. One cup of milk(8 fluid ounces) has about 300 milligrams of calcium. Milk and otherdairy products are the best sources of calcium in the American diet.Nondairy sources of calcium include >green, leafy vegetables, such as spinach and broccoli >calcium-fortified foods, such as bread and orange juice Most of the calcium in your body is found in bone. About 45 per- cent of your skeleton forms between the ages of 9 and 17. People whodon’t eat or drink enough calcium when they are young have lighter,weaker bones than people who get a lot of calcium do. These peopleare more likely to develop a condition called osteoporosis as they grow older. Osteoporosis is a disorder in which the bones become brittleand break easily. One-half of all women over 50 will break a bonebecause of osteoporosis. Building strong bones now through eating ordrinking foods high in calcium (as well as vitamin D and other min-erals) can prevent such problems in the future. However, as Figure 4 shows, many teens today are not getting enough calcium.Nutrient deficiency Too little calcium in the diet during childhood and the teen years can causeosteoporosis later in life. Osteoporosiscauses bones to become thin andporous and to break easily. Healthy bone Bone with osteoporosis Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Vitamins, Minerals, and Water 165Iron Iron-deficiency anemia (uh NEE mee uh) is one of the most common nutritional deficiencies in the world. Anemia is a condition in which there are not enough red blood cells or hemoglobin to carryoxygen around the body. Iron is needed to make hemoglobin, themolecule in red blood cells that carries oxygen. When there is notenough iron in the diet, the blood cannot deliver enough oxygen tothe cells. Anemia causes you to feel tired and weak. The best sources of iron in the diet are red meats because they contain a form of iron that is easily absorbed. The iron in plant foodssuch as green vegetables is not absorbed as well as iron from meatbut is still an important source of dietary iron. Teen girls need 18 mil-ligrams of iron and teen boys need 12 milligrams of iron daily. Peo-ple who have anemia are often given iron supplements. Too muchiron can be poisonous. Iron toxicity from iron supplements is one ofthe most common forms of poisoning among young children. Water You can live for many weeks without food but only for a few dayswithout water. How can a substance that has no taste, no color, andno Calories be so important? One reason is that about 60 percent ofyour body is water. Water is essential because it is necessary foralmost every function that keeps you alive. Eight Glasses a Day Every day, your body loses a large amount of water by excretion of urine and solid wastes, by evaporationthrough breathing, through your skin, and as you sweat. Extra water cannot be stored in the body, therefore water intake must balancewhat your body loses. Sports drinks are always the best choice during a workout or exercise.Myth Plain water is often the best choice during activity that is less than 60 minutes long.Fact 100% 80% 60%40%20% Girls 15% Boys40% Percentage of Teens Who Get Enough Calcium Source: U.S. Department of Agriculture Getting enough calcium during child- hood and teenage years helps buildbone density. However, most teensdon’t get enough calcium in their diets.4 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 166 CHAPTER 7 Nutrition for LifeTo make up for water loss, you need to take in at least 2.5 quarts of water each day. Some of this can come from the water in food. About 80 to 90 percent of the weight of most fruits and vegetables iswater. The rest of your water needs must be met from fluids youdrink. You can usually get enough water by drinking eight glasses offluid each day. Water, juice, and low-fat milk are healthy sources offluid. Drinks containing caffeine or alcohol are not good watersources. This is because caffeine and alcohol increase the amount ofwater that is excreted in urine. Dehydration Is Dangerous Dehydration occurs when the body loses more water than has been taken in. It can occur when you don’tdrink enough fluid or when you lose more water than normal. Youcan lose even more water when you are ill. For example, a fever, vomiting, and diarrhea all increase water loss. Exercise also makesyou lose water through sweating. When your body becomes too hot,your sweat glands in the skin make sweat. As the water in sweat evap-orates, heat is lost and your body temperature drops. Exercising inhot weather can cause you to lose up to a quart of water in an hour! Even mild dehydration interferes with both mental and physical performance. The early symptoms of dehydration include thirst,headache, fatigue, loss of appetite, dry eyes and mouth, and dark-colored urine. However, thirst is a late sign of dehydration. As dehy-dration becomes more severe it results in nausea, difficultyconcentrating, confusion, and disorientation. If the dehydration issevere enough, death may occur. As you lose water from your body,you lose weight. Weight lost through dehydration is not fat loss, andthe weight is quickly put back on when you replace the lost water. REVIEW Answer the following questions on

a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the term for “a class of nutrients that con- tain carbon and are needed in small amounts to maintain health and allow growth.” 2.Identify the term for “chemical elements that are needed for enzyme activity and bone formation.” a.vitamin c.mineral b.protein d.water 3.Name the term that means “not having enough of a nutrient to maintain good health.” Understanding Key Ideas 4.Listthe functions of vitamin A, vitamin C, and vitamin D. 5.Name the nutrient that may be related to each of the following: a.iron-deficiency anemia b.osteoporosis c.dehydration d.high blood pressure 6.Identify why the following people are at risk of dehydration: Sara, who just ran a marathon, andJeff, who has been vomiting 7. Practicing Wellness Identify some nondairy sources of calcium. Critical Thinking 8. Assessing Your Health Give possible reasons for the decrease in calcium intake by teens.LIFE LIFE SKILLLIFE LIFE SKILLThree Reasons Why Water Is Important 1It transports nutrients and oxygen through the body andhelps to get rid of wastes fromthe body. 2It provides the properenvironment for the body’schemical reactions to occur. 3It helps regulate bodytemperature. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Meeting Your Nutritional Needs 167Meeting Your Nutritional Needs SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Knowing which nutrients your body needs and what foods contain them is a good first step towards a healthy diet. Thegovernment has developed several types of recommenda- tions to help you choose how much of each nutrient you need to eatto have a healthy, balanced diet. How Much of Each Nutrient? Nutrition scientists and public health agencies have developed guide-lines for how much of each nutrient we need. The current guidelinesare the Dietary Reference Intakes (DRIs). The DRIs provide four sets of reference values which are guidelines that recommend amounts ofnutrients and other food components needed to prevent deficiencies,avoid toxicities, and promote best health. Together, these four sets ofvalues replace older recommendations. The DRIs have recommendations for males and females, age groups, and special conditions, such as pregnancy. Two of these setsof reference values—Recommended Dietary Allowances and Tolera-ble Upper Intake Levels—are discussed in more detail below. What Are RDAs? are the recommended nutrient intakes that will meet the needs of almostall healthy people. The RDAs are not exact requirements but aremeant to serve as general guidelines for correct nutrient intake. TheTolerable Upper Intake Levels (ULs) are the largest amount of a nutrient you can take without risking toxicity. The ULs are helpful for check-ing that the amount of a nutrient in a supplement is safe.Recommended Dietary Allowances (RDAs)OBJECTIVES Describe what the Recommended Dietary Allowances (RDAs) are. Analyze the nutritional value of a food by using the information on the food label. Identify the purpose of the Food Guide Pyramid and identify foods from each of its food groups. Summarize the Dietary Guidelines for Americans. Determine whether your daily diet meets the Food Guide Pyramid recommendations. LIFE LIFE SKILLKEY TERMSKEY TERMS Recommended Dietary Allowances (RDAs) recommended nutrient intakes that will meet theneeds of almost all healthy people daily value (DV) recommended daily amount of a nutrient; used on food labels to help people see how a food fits into their diet Food Guide Pyramid a tool for choosing a healthy diet by selecting a recommended num- ber of servings from each of five food groups Dietary Guidelines for Americans a set of diet and lifestyle recommendations developed to improve health and reduce nutrition-relateddisease risk in the U.S. population The aim of the RDAs is to guide you in meeting your nutrition needs withfood. Copyright © by Holt, Rinehart and Winston. All rights reserved. 168Understanding Food Labels Food labels provide a convenient source of nutrition information about foods and the way foods fit into your diet. Food labels includea set of nutrition facts, information about the processing of the food,and a list of ingredients. Serving Size The size of a single serving is shown at the top of the Nutrition Facts panel. The amounts of nutrients given belowthis are the amounts found in this size serving. Often, the portionin which certain foods (such as snacks) are sold is bigger than oneserving size. Calories The label must list total Calories and the Calories from fat in a serving of the food. Labels can also list descriptions for foodsthat are lower in Calories. Daily Values Nutrients are listed on food labels by weight and as a percentage of a 2,000 Calorie diet. are recom-mended daily amounts of a nutrient that are used on food labels tohelp people see how a food fits into their diet. They also help you getenough of some nutrients while not getting more than the recom-mended intakes of others. The percentage DV for a nutrient tells people the amount of this nutrient that is in a serving of the food relative to the recommendedamount for a 2000-Calorie diet. For example, a food that provides 10percent of the DV for fiber provides 10 percent of the amount of fiberrecommended per day for a 2000-Calorie diet. >Total fat Total fat and saturated fat must be listed by weight and as a percentage of the DV. To keep your fat intake at a healthylevel, look for foods that have a low percentage DV for fat. >Cholesterol Cholesterol must also be listed by weight and as a percentage of the DV. To help keep your blood cholesterolwithin a healthy range, look for foods that have a lowpercentage DV for cholesterol. >Sodium Sodium is listed by weight and as a percentage of the DV. To keep your sodium intake at a healthy level choosefoods that have a low percentage DV for sodium. Look for low sodium (140 milligrams of sodium or less) or reduced sodium (25 percent less sodium). >Total carbohydrates The Nutrition Facts label includes all sug- ars, whether they are natural, like the sugar in milk, or added,like the refined sugar in cookies. Fiber, an important complexcarbohydrate, is given in grams and as a percentage of the DVper serving. Choosing foods labeled high fiber (20 percent or more of the DV) or a good source of fiber (10 percent or more of the DV) can help increase your fiber intake. >Protein The amount of protein must be listed in grams. Because protein is plentiful in the American diet, the percent-age of the DV is not usually listed.Daily Values (DVs) Food labels can help you see how a food fits into your daily diet. Foods thatappear to be similar to each other, suchas breakfast cereals, may in fact containdifferent amounts of nutrients. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Meeting Your Nutritional Needs 169Vitamins and Minerals The vitamins and minerals that you need are also listed. Calcium, iron, vitamin C, vitamin A, and some B vitamins are given on labels only as a percentage of the DV. Understanding Other Terms on Food Packaging You may sometimes be confused by the terms used in the ingredients list or on the food packaging. Figure 5 lists and explains what some of these terms are. Ingredient List The ingredients in a product are listed on the label in order of weight—those present in the largest amounts arelisted first. Knowing the ingredients in a food is helpful to peoplewho choose to avoid certain foods or who have food allergies. Forexample, to identify foods with whole grains, look for terms such aswhole wheat or rolled oats in the ingredients list. Additives are substances that are added to foods to keep the foods from spoiling, or to improve the taste, smell, texture, appearance, ornutrient content of a food. Analyzin gDA TA Analyzing DATA How to Use Food Labels “Serving Size” shows the amount of food that counts as one serving. “Calories” lists the number of Calories in one serving and the number of Calories that come from fat. Total fat, saturated fat, cholesterol, sodium, total carbohydrates, dietary fiber, sugars, and protein are listed. “% Daily Value” shows the percentage of the recommended amount of the nutrient that is met by one serving of food. Calcium, iron, vitamin C, vitamin A, and some B vitamins are listed. Recommended daily intakes for 2,000- and 2,500-Calorie diets are listed. Your Turn 1.Calculate the percentage of Calories from fat in the food. 2. CRITICAL THINKING If you needed 2,500 Calories a day, what percentage of DV for fiber does a serving of this food provide? 654321 MATH SKILL MATH SKILL1 2 34 5 6 Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Food Preservation HealthLinks code: HH4065 170 CHAPTER 7 Nutrition for LifeCalories Some foods are calorie free (less than 5 Calories), light or lite(one-third fewer Calories than the regular brand has), low calorie (no more than 40 Calories), or reduced calorie (25 percent fewer Calo- ries than the regular brand has) to help a person reduce his or her Calorie intake. Cholesterol Foods can be called low cholesterol (20 milligrams or less), or cholesterol free (less than 2 milligrams). Sugars Sugars added to foods are included in the ingredient list, but sugars are not al ways called sugar. Look for sucrose, fructose, dex- trose, maltose, lactose, honey, syrup, corn syrup, high-fructose corn syrup,molasses, invert sugar, and fruit juice concentrate. If any of these are listed first or second on the list or if several of them appear, the foodis probably high in added sugar. Foods that have little or no addedsugars can carry the words sugar free (less than 0.5 grams of sugar), no sugar added, without added sugar, or reduced sugar (25 percent less sugar than the regular brand has). Fats Food can be described as fat free (less than 0.5 grams fat), low fat(3 grams of fat or less), or extra lean (less than 5 grams of fat). Foods may also claim to be low in saturated fat (1 gram or less). It is important to remember that even though a food may be labeled low fat,it can still be high in Calories. Other Ingredients and Terms on Food Labels Aspartame, saccharine artificial sweeteners Monosodium glutamate (MSG) flavor enhancerArtificial colors (such as FD&C colors ) food colors added to make the food look more appealing Sulfites, BHA, and BHT food preservativesEnriched a food to which nutrients havebeen added to restore some ofthose lost in the processing of the food Fortified a food to which nutrients havebeen addedTreated by irradiationfood that has been exposed toradiation to kill microorganisms and slow ripening and spoilage Pasteurized food that has been heated to killdisease-causing organisms (seenon the labels of products such as milk, apple juice, and eggs) Genetically modified a food whose genes have beenmodified to produce desirable characteristics Organic a food produced under certainstandards without the use of syn- thetic pesticides or fertilizers Functional food food that provides a health ben-efit beyond that provided by thetraditional nutrients it contains Freshness datethe last day a food should be used to ensure best quality Sell by date the last date a perishable food should be sold Expiration date the last date a food should beused before the chance of spoilage increases Health and disease claims (such as “May help reduce blood cholesterol” ) government approved claims made about therelationship between a nutrient or food and a disease or health condition Trans fat a type of fat found in hydrogenatedoils and may increase the risk ofheart diseaseCertain ingredients in foods and terms used on the food packaging may beconfusing. ACTIVITY List three terms not shown in the table that are commonly found on food labels.5 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Meeting Your Nutritional Needs 171The Food Guide Pyramid The is a visual tool for planning your diet that divides foods into six food groups. The Food Guide Pyramid alsoshows the number of servings needed from each group to make ahealthy diet. The greatest number of servings should come from thebreads, cereals, and grains group. The next largest number of servingsshould come from the fruits and vegetables groups. Smaller numbersof servings are needed from the dairy products and meat groups. Fats,oils, and sweets, found at the top of the pyramid, should be eateninfrequently, so numbers of servings are not given. The serving recommendations are given in ranges (such as 3–5 servings) so that people with different Calorie needs can use the pyra-mid. For example, active teens need more energy than adults do, soactive teens may need to choose from the high end of the range ofservings to get enough energy. It is also important to choose foodsthat are high in nutrients and lower in fat and to choose a variety offoods from each group.Food Guide Pyramid Bread, Cereal, Rice, and Pasta Group 6–11 servingsFruit Group 2–4 servingsVegetable Group 3–5 servingsMilk, Yogurt, and Cheese Group 2–3 servingsFats, Oils, and Sweets Use sparingly Meat, Poultry, Fish, Dried Beans, Eggs, and Nuts Group 2–3 servings Choosing a variety of high-nutrient foods from each of the six food groupsof the pyramid can provide a diet thatmeets all of your nutrient needs. Copyright © by Holt, Rinehart and Winston. All rights reserved. 172 CHAPTER 7 Nutrition for LifeExamples of one serving: •1 slice of bread •1/2bagel, hamburger roll, or English muffin •1 small dinner roll •1 oz cold (ready-to-eat) cereal •1/2cup cooked cereal, rice, or pasta •1 small tortilla •1 small pancake •3 to 4 small crackers Examples of one fruit group serving: •1 whole fruit (medium apple, banana, orange) •1/2grapefruit •1/2cup chopped, cooked, or canned fruit •3/4cup fruit juice •1/4cup dried fruitExamples of one vegetable group serving:•1 cup raw, leafy vegetables (lettuce, spinach) • 1/2cup other vegetables (broccoli, carrots, peas), cooked or chopped raw •3/4cup vegetable juice •1 small baked potato6–11 servings every day The base level of the pyramid is the bread, cereal, rice, and pasta group. Foods in this group are high in complex carbohydrates, protein, fiber, B vitamins, and minerals and low in cholesterol. The best food choices from this group are those containing whole grains. Examples of foods containing whole grains are whole-wheat bread, brown rice, oatmeal, and barley.Bread, Cereal, Rice, and Pasta Group A Closer Look at the Food Guide Pyramid The Food Guide Pyramid is divided into six categories, which are arranged into levels. Foods at the bottom of the pyramid should be eaten more often, whilefoods at the top of the pyramid should be eaten less often. 2–4 servings per day for fruit; 3–5 for vegetables The fruit and the vegetable groups form the second level of the pyramid. Both groups are good sources of vitamins, minerals, and fiber. Fruits and vegetables are usually low in calories and fats and do not have cholesterol. Many fruits, such as apples, bananas, grapes, and oranges, are great snack foods. Don’t forget baby carrot sticks or broccoli stalks either!Vegetable and Fruit Groups Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Meeting Your Nutritional Needs 173 Examples of one serving: •1 cup milk or yogurt •1 1/2oz natural cheese •2 oz processed cheese •1 cup frozen yogurt •2 cups cottage cheese Fats, Oils, and SweetsExamples of one serving:•2 to 3 oz cooked lean meat, poultry, fish, or seafood •1 to 1 1/2cups cooked dry beans •4 to 6 Tbsp peanut butter •2 eggs Use sparingly At the top of the pyramid are foods that are low in nutritional value because they are high in fat or sugar. Table sugar and sweeteners, such as honey, molasses, and maple syrup, are part of this group. So are high-sugar foods, such as soda and candy. High-fat foods, such as oils, butter, margarine, most salad dressings, and mayonnaise, also belong in this group. Foods in this group should be eaten less often.2–3 servings per day Foods in the milk, yogurt, and cheese group give you a large amount of calcium. These foods also give you protein, vitamins A and D, and other minerals. Choose carefully—foods in this group can also be high in fat, saturated fat, and cholesterol. Choose lower fat items to reduce the amount of fat and cholesterol in your diet. All dairy foods are in this group. 2–3 servings per day Foods in this group are high in protein, B vitamins, and minerals. However,because these foods are mostly from animals,they can be high in saturated fat and choles-terol. Choose leaner cuts of meat. Fish andpoultry are more healthful when the skin hasbeen removed. Dry beans are a healthfulchoice because they are low in fat, contain nocholesterol, and are a good source of fiber.Meat, Poultry, Fish, Dried Beans, Eggs, and Nuts Group Milk, Yogurt, and Cheese Group Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Dietary Guidelines for AmericansHealthLinks code: HH4042 174 CHAPTER 7 Nutrition for LifeDietary Guidelines for Americans The are a set of diet and lifestyle recommendations developed to improve health and reduce nutri-tion-related disease risk in the U.S. population. The guidelines aredesigned for all Americans over the age of two. Know the ABCs for Good Health The Dietary Guidelines for Americans are organized into three parts, referred to as the “ABCs forGood Health.” These three parts are summarized below. Aim for fitness 1.Aim for a healthy weight. 2.Be physically active each day. Build a healthy base 3.Let the Food Guide Pyramid guide your food choices. 4.Choose a variety of grains, especially whole grains, on a daily basis. 5.Choose a variety of fruits and vegetables daily. 6.Keep food safe to eat. Choose sensibly 7.Choose a diet that is low in saturated fat and cholesterol andmoderate in total fat. 8.Choose beverages and foods to moderate your intake of sugars. 9.Choose and prepare foods with less salt. 10.Adults who drink alcohol should do so in moderation. The Dietary Guidelines for Americans also recognize the impor- tance of activity and other lifestyle factors in maintaining good nutri- tion and overall health.Dietary Guidelines for Americans REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the standard that is used on food labels to help you find out how a food fits into your daily diet. 2.Determine what you could use to find out how many servings of fruit you should eat each day. 3.Name the set of recommendations that aim to improve lifestyle in the U.S. population. Understanding Key Ideas 4.State the purpose of RDAs. 5.State the function of food labels. 6.Identify the purpose of the Food Guide Pyramid.7.Name the food group that each of these foods belongs to on the Food Guide Pyramid. a.rice c.bean sprouts b.peanut butter d.salmon 8.Describe how the Dietary Guidelines for Americans can fit into your daily life. Critical Thinking 9. Evaluating Information Anne’s diet contains the right number of servings from each of the food groups. The only vegetable she eats isFrench fries, her dairy intake is ice cream, and manyof her grain servings are from baked goods. Is this ahealthy diet? Explain. LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Choosing a Healthful Diet 175 SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 KEY TERMSChoosing a Healthful Diet Potato chips or popcorn? Chicken fried steak or stir fried veg- etables? The foods you choose can make the differencebetween a diet that provides all of your nutrient needs and protects you from disease and one that does not. Simple Steps to a More Healthful Diet Does a healthy diet sound boring and unappetizing? It doesn’t haveto be! Many simple steps can improve your diet without cutting outyour favorite foods. For example, just skipping one can of sodawill cut 10 teaspoons of added sugar from your diet. Is Junk Food a Problem? Depending on whom you talk to, candy bars, potato chips, cookies, tacos, or pizza may becalled junk food . But none of these foods are really junk, and they don’t have to be cut from your diet. The key to whether a food is a healthy food or a junk food is how many nutrients it provides relative to how many Calo-ries it contains. The foods we think of as junk food are usuallyhigh in Calories and have large amounts of fat, sugar, or salt,but contain few other essential nutrients. These foods have alow nutrient density. is a measure of the nutri-ents in a food compared with the energy the food provides. Forexample, a chocolate candy bar may taste good and fill you up,but it provides few nutrients in its 200 or more Calories. There-fore, the candy bar is not a nutrient-dense food and is said tohave “empty” Calories. If you really want a candy bar, having one is OK, but try to make up for the nutrients missing from the candy bar by eatinghealthier foods at other times during the day. The key words toremember are moderation and balance . Junk food is only a prob- lem if it makes up a large part of your diet. Nutrient densityOBJECTIVES Identify why certain foods are called junk foods. Describe examples of healthful snacks. Compare the dietary needs of infants, children, teenagers, and adults. Describe the special dietary needs of athletes, pregnant women, and people who are ill. Identify reasons why vegetarians need to carefully plan their diet. Identify ways to reduce fat, sugar, and salt in your diet. LIFE LIFE SKILLKEY TERMS nutrient density a measure of the nutrients in a food compared with the energy the food provides vegetarian a dietary pattern that includes few or no animal products Choosing healthy snacks throughout the day can keep you from eating toomuch junk food. Copyright © by Holt, Rinehart and Winston. All rights reserved. 176 CHAPTER 7 Nutrition for LifeSome of the foods you think of as junk foods may actually be healthy foods, depending on how they are prepared and what foods you choose. For example, a slice of pizza includes a vegetable in thetomato sauce, a grain in the crust, and a dairy product in the cheese.If you add some pineapple or bell peppers, you are adding to yourfruit and vegetable servings. A taco includes meat, vegetables, cheeseand bread—all part of the Food Guide Pyramid recommendations.Be careful when having these foods at fast food restaurants becausethey may be prepared with more added fat and salt than you woulduse at home. Learning to make these foods at home can save you money, reduce your fat and sodium intakes, and increase your vegetable serv-ings. Preparing foods correctly will also reduce vitamin losses. Choose the Right Snacks Snacking isn’t a “bad habit.” When done right, it increases your nutrient intake and helps you maintain ahealthy weight. A piece of fruit and a yogurt on the way to school ismuch better than not having any breakfast. The problem with snacking is that we don’t always choose healthy foods. Sometimes, chips and a candy bar from the vendingmachine may seem like your only choice. But planning ahead canimprove your options. For example, if you know you will be stayinglate at school, bring an extra sandwich, a carton of yogurt, or an applefrom home. If you do get chips or candy from the vending machine,make sure to balance these low–nutrient density choices with mealsthat include a lot of healthy foods. Instead of this: T ry this: To lower your sugar intake: Soda with your meals Water, real fruit juice, or skim milk Cake for dessert Fresh fruit Candy for snacks Grapes, raisins, or trail mix To lower your fat intake: A hamburger and fries for lunch A broiled chicken sandwich and a shared order of fries with a friend Potato chips Low-salt pretzels Creamy chip dip Salsa Blue cheese salad dressing Low-fat or fat-free dressing Deep fried chicken or fish Baked or broiled fish and skinless chicken To increase your intake of fiber: White rice Brown rice or baked potatoes with the

skin A white bread sandwich A whole-wheat bread sandwich Apple juice A fresh apple Sugary cereal Oatmeal or other whole-grain cereal Copyright © by Holt, Rinehart and Winston. All rights reserved. Nutrition Throughout Life Would you feed an apple to a newborn baby? Of course not—the baby wouldn’t be able to eat it and it certainly wouldn’t meet his orher nutrient needs. Nutrient needs change with each stage of life—infancy, childhood, adolescence, and adulthood. A Healthy Start in Infancy In the first months of your life, your diet was fairly simple: milk from either your mother’s breast or a bot-tle. A baby who is breast-fed gets the best nutrition possible for ahuman infant—the right mix of nutrients, Calories, and substancesthat help protect the baby from infections. Formula-fed infants get adiet designed to provide the same nutrients as breast milk does. Thisliquid diet provides all the energy and nutrients an infant needs untilabout 6 months of age. It is higher in fat than diets recommended forolder children and adults are because infants need fat to provideenergy and to allow their rapid growth and brain development. After 4 to 6 months of life, the infant’s diet can begin to include soft foods such as cereals and puréed fruits or vegetables. And soonthe infant can eat foods such as crackers and soft meats. On this diet,a healthy 1-year-old will have tripled his or her weight since birth. Continuing Good Nutrition in Childhood From 2 years of age onward, children can generally meet their nutrient needs by follow-ing the recommendations of the Food Guide Pyramid but choosingsmaller servings. The amount of food a child eats depends on his orher size, growth rate, and activity level. A larger, more active child willneed more Calories and other nutrients than a smaller, less activechild needs. Like adolescents and adults, children should eat plentyof whole grains, fruits, and vegetables. A person’s nutritional needs change at each stage of life—infancy, childhood,adolescence, and adulthood. For exam-ple, infants and children need morefood energy per pound of body weightthan adults do. Copyright © by Holt, Rinehart and Wins ton. All rights reserved. real life Activity HOW HEALTHFUL IS YOUR DIET? 178 CHAPTER 7 Nutrition for LifeTeens Need to Eat Right to Grow When was the last time you had a fast-food meal? If it was within the past 2 d ays, y ou’re not alone. Many teens have busy schedules, so they frequently eat meals away from home or skip meals altogether. Teenagers also tend to drink too little milk and too many sodas. As a result, teen diets areoften low in important nutrients, such as calcium for strong bonesand iron for blood and muscle growth. Teens’ diets also tend to below in folate for tissue growth and riboflavin for energy production. During your teen years, your body experiences a major growth spurt. As growth and development speed up, your body needs moreenergy, protein, vitamins, and minerals. As a general rule, adolescentboys need to eat the higher number of recommended servings fromthe Food Guide Pyramid groups. Girls need to eat the middle rangeof servings. However, if they are very active, girls may also need thehigher number of servings. Most U.S. teens eat enough to meet their energy needs. In fact, many teens are eating too many Calories and gaining weight. Teensshould choose foods to meet nurtrient needs and not exceed energyneeds. This can be done by eating plenty of nutrient-dense foods andminimizing the amount of high-fat and high-sugar foods. About 35 percent of cancers in the United States are related to diet. Excess fat intake has been linked to an increased risk of colon, prostate, and breast cancer. LIFE LIFE SKILL Assessing Your Health ✔paper ✔pencil ✔ruler 1.Record in your log everything you eat and drink, how much you eat and drink, and how thefoods and drinks are preparedfor 3 days and nights. Instead ofwriting “hamburger,” write“one burger bun, 3 ounces ofpan-fried meat, one slice of rawtomato, one tablespoon ofketchup,” and so on.ProcedureMaterials2.Draw a table with four columns. List the six food groups in the first column. 3.Record in column 2 your serv- ing totals of each food group for each of the 3 days. 4.Listin column 3 the number of servings you should be getting from each food group.5.Compare the number of serv- ings in column 2 with the num-ber of servings in column 3. 1.Predicting Outcomes What could you do to improve your fruit intake?Conclusions My serving Recommended Number overtotals number of or under (+ or –) Food group Day 1 Day 2 Day 3 servings Day 1 Day 2 Day 3 Bread, cereal, rice, and pasta Vegetables FruitsMilk, yogurt, and cheese Meat, poultry, fish, dry beans, eggs, Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Choosing a Healthful Diet 179Adults Aren’t Growing As you enter adulthood, growth in height slows and then stops. As a result, the number of Calories a per- son needs to maintain a healthy weight decreases. Recommended fatintake for adults is 20 to 35 percent of total Calorie intake. With thislower Calorie requirement, one must carefully plan the diet toinclude nutrient-dense foods that provide for nutrient needs withoutexceeding Calorie needs. As adults become less active, their Calorieneeds continue to decrease. This often leads to weight gain that iscommonly known as “middle-age spread.” In addition, in olderadults the absorption of some nutrients decreases, which makes anutrient dense diet even more important. Special Dietary Needs Athletes, pregnant women, and people who are ill have specialdietary needs. Food is fuel and your body is like a machine that cannot run without it. Putting the optimum “mix” of foods into your body will ensure good nutrition, whatever your nutrient needs. Special Requirements of Athletes Whether training, compet- ing, or just wanting to stay fit, athletes need extra energy and water tomaintain their performance and endurance. The best strategy for ath-letes is to follow a diet based on the Food Guide Pyramid and todrink plenty of fluids. Athletes need a diet high in carbohydrate to provide the quick energy required for exercise. Following the Food Guide Pyramid serv-ing recommendations will provide a diet that is high in complex car-bohydrates and rich in the B vitamins. Even athletes who have increased protein needs, such as weight lifters and endurance athletes, get more than enough protein in theirdaily diet. A common misconception is that athletes need to eat largeamounts of protein to build larger muscles. In fact, it is weight train-ing combined with a well-balanced diet that is needed to developmuscles. Protein, especially protein from meat, is also a good sourceof iron. Iron is needed to carry oxygen to tissues and prevent musclefatigue. Female athletes should be extra careful to get enough iron intheir diets as iron is lost each month during menstruation. Athletes Must Eat and Drink to Compete Competitive ath- letes may find that eating specific foods before, during, and aftercompetition can affect their performance. Whatever your sport, exer-cising is never wise when you have not eaten recently. About 2 hoursbefore exercising, you should eat a high-carbohydrate snack, such asa half a bagel, a handful of low-salt pretzels, or yogurt and fruit.However, eating too much just before exercising may cause nauseaand cramping. For an activity lasting longer than 60 minutes, drinking a sports drink containing 6 to 8 percent sugar or a 100- to 300-Calorie snackduring the event will help maintain blood glucose levels. The right foods and beverages in the right amounts are important foroptimum performance. Following the Food Guide Pyramid serving recommendations is the best option for athletes. Copyright © by Holt, Rinehart and Winston. All rights reserved. 180 CHAPTER 7 Nutrition for LifeEven mild dehydration can hurt athletic performance. Dehydra- tion causes the blood to lose water and thicken, which makes the job of pumping the blood to the muscles more difficult. The risk of over-heating increases as a person becomes more dehydrated. Despite the effects of dehydration, athletes who need to fit into specific weight classes, such as wrestlers and rowers, often use dehy-dration to lose weight a day or so before a competition. They reducetheir fluid intake and increase their water losses in sweat or by spit-ting. This strategy may allow them to fit into a weight class, but it canhurt their performance and severely threaten their health. Nutrient Supplements Despite the advertisements, dietary sup- plements are not necessary for optimal athletic performance. Suchsupplements can be dangerous and should be used with caution.Unlike prescription drugs, nutrient supplements are not regulated bythe Food and Drug Administration (FDA). Some supplements mayeven contain ingredients that are banned by athletic associations. Most athletes can meet all of their nutrient needs with a carefully chosen, well balanced diet. If you do choose a nutrient supplement,choose one that does not exceed the Tolerable Upper Intake Level(UL) for any nutrients. Non-nutrient supplements are not needed;the benefits of some are outweighed by the health risks. Eating Well During Pregnancy Food choices during pregnancy must meet the nutrient needs of the mother and the growing baby. Tomeet energy needs, pregnant women need up to 450 additional Calo-ries each day. They also need to add protein, vitamin B 6and B 12, folate (folic acid), iron, and zinc to their daily diet. Additional folateis important before pregnancy and very early in pregnancy to preventcertain birth defects. To meet these needs, the diet must be carefully planned. Meals must be regular, and fasting should be avoided. Recommended Fluid Intake for Athletes Timing Amount of fluid in the 2 hours before activity 2 cups (16 fluid ounces) immediately before activity 2 cups (16 fluid ounces) every 15 minutes during activity 1 cup (8 fluid ounces) after activity 2 to 3 cups for every pound of body weight lost Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Choosing a Healthful Diet 181In addition to the extra energy needs that pregnancy brings, expectant mothers may also need to take supplements to meet their nutrient needs. Supplements of folic acid and iron are usually recom-mended. Before a woman takes supplements during pregnancy sheshould consult her doctor. Eating Well During Poor Health “Starve a cold, feed a fever,” or is it “feed a cold, starve a fever”? Meeting your nutrient needs is impor-tant to keep you healthy. However, what you eat for a few days whileyou have a cold or flu really doesn’t affect your overall health much—as long as you drink plenty of fluids. When you have a cold and arebreathing through your mouth, you lose extra fluids. And if you havethe flu, fever, vomiting, or diarrhea, your fluid losses will increase.Drinking plenty of fluids will prevent dehydration and speed recovery. If you have a long-term illness, then your energy and nutrient intake become extremely important for maintaining your ability tofight the disease. Diet is also important in managing chronic disease.For example, people who have diabetes must balance their carbohy-drate intake with their insulin doses to keep their blood sugar at ahealthy level. Choosing a Vegetarian Diet A diet is one in which few or no animal products areeaten. Vegetarians limit their intake of animal foods, such as meat,poultry, fish, dairy foods, and eggs, but don’t necessarily leave themout completely. A semivegetarian may choose not to eat red meat butto eat poultry, fish, or both. A lacto-ovo vegetarian will not eat anymeat but will eat eggs and dairy products. Only the strictest vegetar-ians, called vegans , do not eat any animal products. More than 12 million Americans are vegetarians, and the number appears to be increasing. People choose to be vegetarian for many rea-sons, ranging from religious, ethical, and dietary to personal taste. Avegetarian diet can be very healthy and is not difficult to prepare foodfor, as Figure 6 shows. A plant-based diet usually provides more fiber, vitamin A, and vitamin C than meat-based diets do. Also, because veg-etarian diets contain less animal fat, they are lower in saturated fat andcholesterol than a meat-based diet is. This can reduce the risk of heartdisease. Vegetarians appear to have lower risks for obesity, heart dis-ease, diabetes, high blood pressure, and certain types of cancer. Protein in a Meat-Free Diet The protein in animal foods pro- vides enough of all the amino acids that are essential for humans, sowe need less animal protein than plant protein to meet our dietaryneeds. Vegetarians who eat some animal foods, such as fish, eggs, ordairy products, should have no trouble meeting their protein needs.Vegans, however, must choose more carefully to meet their needs.Plant foods contain protein, but not enough of all the essentialamino acids. By eating proteins from different plant sources, veganscan get all the amino acids to meet their needs. vegetarian A vegetarian diet can be a healthy choice, but it takes careful planning to get all the needed nutrients. Many of our favorite meals are already vegetarian. ACTIVITY Suggest how this recipe could be adapted to make a healthy meat lover’s meal.6 Figure VEGGIE TACOS 2 corn taco shells1/2 cup vegetarian refried beans 4 tablespoons chopped lettuce 2 tablespoons chopped tomatoes 1 tablespoon chopped onions2 tablespoons salsa1/4 cup shredded cheese (optional) Fill the taco shells with refriedbeans, and top with salsa,chopped lettuce, tomatoes,onions, and shredded cheese. Serves one to two people Copyright © by Holt, Rinehart and Winston. All rights reserved. 182 CHAPTER 7 Nutrition for LifeA carefully planned vegetarian diet that provides plenty of nutri- ent dense plant foods, such as legumes, nuts, seeds, and whole grains, can easily meet the protein needs of vegetarian and vegan athletes. A common misconception about vegetarian diets is that they are always h ealthier than diets in which meats are eaten. In general, vege- tarian diets offer many health benefits, but it is possible for vegetari-ans to make poor food choices. For example, potato chips, fries,cookies, and sugar candies are all foods vegetarians can eat. A dietmade up of a lot of these foods will be high in fat and sugar and lowin other nutrients. Meeting Other Nutrient Needs Despite their health benefits some vegetarian diets may be lacking in certain vitamins and miner-als. Vegan diets, especially, may be low in iron, zinc, calcium, vitaminD, and vitamin B 12. Iron and zinc may be deficient because meats are the best sources of these minerals. Vegans must eat a lot of plantfoods that are high in these minerals. Good vegan sources of ironinclude beans; dried fruits; green, leafy vegetables; tofu; and enrichedcereals and grains. Whole grains, dried beans, and nuts are goodsources of zinc. Because the form of iron in plants is not absorbed aswell by the body as the form of iron from meat is, the RDA for ironfor vegetarians is higher than the RDA for meat eaters. Most of the calcium in the American diet comes from dairy prod- ucts, so vegans need other sources of calcium. Calcium is found inspinach and other green leafy vegetables; dried beans; and in fortifiedfoods such as breakfast cereals. Most vitamin D in the American dietcomes from fortified dairy products, so vegans must get their vitaminD by getting enough exposure to sunshine or eating other vitamin D-fortified foods. Vitamin B 12is found only in animal foods, so veg- ans must eat foods fortified with vitamin B 12such as breakfast cereals or take a vitamin B 12supplement to meet their needs. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the correct term for the measure of the amount of nutrients in a food compared to the energy the food provides. Understanding Key Ideas 2.Explain what is meant by “junk food.” 3. Practicing Wellness Give reasons why a pizza can be a healthier fast food than a burgerand fries are. 4.Compare the energy needs of adults with those of teens.LIFE LIFE SKILL5.Identify a nutrient that is at risk of deficiency for each of the following groups: a.teens c.athletes b.pregnant women d.vegans 6. Practicing Wellness Identify foods that are lower in fat or sugar than the choices below. a.French fries c.creamy chip dip b.soda d.fried chicken Critical Thinking 7.Your friend on the school wrestling team uses diuretics to help him “make weight.” He says it’snot harmful. What would be your reply?LIFE LIFE SKILL A well-planned vegetarian diet can be very healthy, and vegetarian meals canbe easy to prepare. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 7 Highlights 183 CHAP TER 7 CHAP TER 7 CHAPTER 7Highlights Key Terms The Big Picture ✔Food provides six classes of nutrients: carbohydrates, fats, proteins, vitamins, minerals, and water. ✔Carbohydrates, including sugars and starches, are the body’s mainenergy source. ✔Essential amino acids are needed by the body to make proteinsthat provide structure and regulation and in some cases, energy. ✔Fat is a concentrated source of energy that is needed in the diet. ✔Fiber is important for healthy digestion. ✔Diets high in saturated fat and cholesterol increase the risk ofheart disease. SECTION 1 nutrition (154) nutrient (154) carbohydrate (154) fat(154) protein (154) ✔Vitamins and minerals are found in all foods in varying amounts.A well-planned diet can meet all your vitamin and mineral needs. ✔Too little calcium in the diet early in life increases the risk ofosteoporosis later in life. ✔The body is about 60 percent water. To maintain health and toprevent the dangerous effects of dehydration, one must replacelost water. ✔Increasing your intake of low-fat dairy products and calcium-fortified foods can help meet calcium needs.SECTION 2 vitamin (161) mineral (163) nutrient deficiency (164) ✔The RDAs are nutrient intakes that are sufficient to meet the needs of almost all healthy people. ✔The Nutrition Facts section of a food label provides informationon how much energy and nutrients a serving of a food gives. ✔The Dietary Guidelines for Americans is a set of recommendationson diet and lifestyle that are designed to promote health, to sup-port active lives, and to reduce chronic disease risk in the generalpopulation.SECTION 3 Recommended Dietary Allowances(RDAs) (167) daily value (DV) (168) Food Guide Pyramid (171) Dietary Guidelines for Americans (174) ✔Healthy snacks, such as fresh fruit, low-fat yogurt, or low-salt pretzels, provide a good source of essential nutrients withoutexcessive Calories and fat. ✔As children grow, their total nutrient and energy requirementsincrease, with total needs being greatest in the teenage years. ✔Athletes need a well balanced diet that is higher in energy andfluids than the diet of a less active person. ✔Simple dietary changes, such as switching to low-fat dairy productsand eating fresh fruits and vegetables in place of sweet or saltysnacks, can reduce the amount of fat, sugar, and salt in your diet.SECTION 4 nutrient density (175) vegetarian (181) Copyright © by Holt, Rinehart and Winston. All rights reserved. 184 CHAPTER 7 Review CHAP TER 7 CHAP TER 7 CHAPTER 7Review Using Key Terms carbohydrate (154) nutrient deficiency (164) daily value (DV) (168) nutrient density (175) Dietary Guidelines for nutrition (154) Americans (174) protein (154) fat(154) Recommended Dietary Food Guide Pyramid (171) Allowances (RDAs) (167) mineral (163) vegetarian (181) nutrient (154) vitamin (161) 1.For each definition below, choose the key term that best matches the definition. asomeone who eats few or no animal foods b.the ABCs of healthful living 2.Explain the relationship between the key terms ineach of the following pairs. a.nutrition and nutrient b.vitamin and mineral 3.For each set of key terms, choose the term thatdoes not fit and explain why it does not fit. a.vitamin, mineral, and carbohydrate b.carbohydrate, protein, and water Understanding Key Ideas Section 1 4.Name the six classes of nutrients. 5.Carbohydrates a.provide energy. b.prevent obesity. c.are not needed. d.cause weight loss. 6.Whole-grain products are high in what indigestiblecarbohydrate? 7.Why are saturated fats considered “bad”? 8.Name the “building blocks” that make up protein. 9.Can your current diet affect your future health?Explain. Section 2 10.Name three fat-soluble vitamins and three water-soluble vitamins and the foods in which they arefound.11.Name two mineral deficiencies and identify theminerals involved. 12.If you usually eat less than the recommendedamount of calcium, what symptoms do youexpect to experience immediately? in 5 years? in45 years? 13.Which of the following statements aboutdehydration is false? a.Dehydration is not common. b.Dehydration can be life threatening. c.Dehydration is a deficiency of water. Section 3 14.Are the RDAs exact requirements? Explain. 15.For breakfast you eat a bowl of oatmeal and 1/4cup of added raisins, for lunch, a turkey sandwichand a glass of fresh orange juice. How many servings of fruit and cereal have you had? 16.List five foods from each of the six Food GuidePyramid food groups. 17.Summarize what the Dietary Guidelines forAmericans recommend. 18.CRITICAL THINKING Why do you think the information on recommended daily servings offoods are presented in the form of a pyramid? Section 4 19.Can junk food be part of a healthful diet? 20.Give an example of a healthful snack, and explainwhy it is healthful. 21.Explain how the Food Guide Pyramid can beused to plan a diet for an athlete . 22.Why do pregnant women need more energy andprotein than nonpregnant women do? 23.Vegetarian diets a.can contain beef. c.are al ways healthy. b.are boring. d.can be low in iron. 24.CRITICAL THINKING The typical U.S. teen diet is low in fruits and vegetables, fiber, and dairy prod-ucts. Suggest how teens could increase theirintake of each of these foods. LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 7 Review 185Interpreting Graphics Study the figure below to answer the questions that follow. 25.How many gallons of soda did the average person drink per year in 1960? in 1995? 26.How has the consumption of milk and sodachanged over time? 27.CRITICAL THINKING Predict how the change in the consumption of milk and soda may affect the health of the American people.Activities 28. Health and Your Community Do a snack survey at your school. Make a list of what kinds ofsnacks are available. Write up a plan forhow you could improve the choices thatare available. 29. Health and Your Family Select a recipe for a meal that you or your family enj oys. C reate a poster in which you show how you could reduce the fat,sugar, or salt content of the recipe, and increaseits fiber, vitamin, and mineral content. 30. Health and You Make a list of seven foods that you snack on. Write the Food Guide Pyramidgroup that each food belongs to. If the snack isfrom the tip of the pyramid, list a food you couldeat with it that would increase your intake of theother food groups. Action Plan 31. Practicing Wellness List five changes you could make in your diet to reduce your riskof heart disease and osteoporosis.LIFE LIFE SKILLLIFE LIFE SKILL 32.In this passage, the word cholesterol means Aa type of fat that, when present in high levels in the blood, increases the risk of heart disease. Bthe fat found in plant foods. Ca nutrient made up of amino acids. Dthat Mark’s father has high blood pressure. 33.What can you infer from reading this passage?EMark is not getting enough food energy fromfoods at home. FMark eats too much fat. GFat is bad for you. HMark doesn’t like his father. 34.For what reasons did Mark’s mother decide toplan a new diet for the family? READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Mark’s father recently found out he has high blood cholesterol and is worried that he might have a heart attack. Mark’s mother is planning a new heart-healthy diet for thewhole family. Mark is only 14 years old, buthis mother believes that the foods he eatsnow could affect his health later. She plansto start serving more vegetarian meals andbuying more fruit, vegetables, and otherlow-fat snacks. After a week of the new diet,Mark can’t wait to go out with his friends forburgers and ice cream. Mark tells hismother that he likes the foods he eats athome but seems to get hungry more often. 60 5040302010 0 1960 1965Gallons per person 1970 1975Milk Soda 1980 1985 1990 1995 YearMilk and Soda Consumption Source: U.S. Department of Agriculture. WRITING SKILLWRITING SKILLMATH SKILL Copyright © by Holt, Rinehart and

Winston. All rights reserved. Healthy Meal— or Good Deal? The last time you went into a restaurant and ordered a hamburger or a fish sandwich, did someone askyou if you wanted a bigger size for just a few penniesmore? Did you order the “Super Portion” or the“Gigantic Burger?” Did the waitperson bring you aplate that had enough food to feed a football team?Many of us would answer yes to these questions. Big—and Bigger Study after study has shown that the average size of aserving in a restaurant, fast-food establishment, orconvenience store has skyrocketed over the past 10years. The message is More is better. In the past, the average soda serving was about 8 ounces. Today, a20-ounce soda is not unusual. It’s almost impossibleto find an 8-ounce soda. One convenience store nowsells a soda portion that is 64 ounces—a half gallon—and that contains more than 600 Calories.Most fast-food restaurants offer super or extra-largeportions that were unheard of even 5 years ago. Think Before You Buy The excessiveness of our food culture is also reflectedin advertising. The food industry spends more than$7 billion a year on food advertisements. The major-ity of this money goes to promote processed foods.For example, hardly anyone advertises potatoes, yetmillions of dollars are spent to advertise potatochips. For food companies, processed foods bring inmuch more profit than nonprocessed foods do. When you see food advertisements, pay attention to what they are trying to tell you. Most people know achicken sandwich tastes good, so the ads often sellyou something else. “Triple-burger for just 99 cents;extra-large fries for only 29 cents more.” How manyads are actually telling you that what you’re buyingis not a good meal but a good deal? Restaurant and fast-food serving sizes are increasing dramatically. We are told thatwe can eat more food for less money. But is all of this food making us less healthy? MEDIA HealthHealthWorldWorldHealthHealthWorldWorldHealthWorld YOURYOUR 186Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Portion Size HealthLinks code: HH4187Portion Sizes Affect People Doctors, nutritionists, and health experts argue that people are at greater of obesity and other disorderswhen they are constantly bombarded with messagesto eat more food. In fact, many people are eatingmore because they don’t know when to stop. Forexample, people who are served large food portionsoften eat all that they are served. This tendency mayreflect our cultural training to “clean one’s plate.”Many doctors and nutritionists suggest that the foodportions served greatly exceed the amounts that aperson needs for good health. Eating Smart in a Huge Food Culture Healthful living is about making smart choices. Having some good strategies for eating helps youstay healthy in a world of giant-sized portions.Nutritionists have some good advice that you mayconsider as you make your choices about how muchfood to eat. > Serve yourself. If possible, be the one to put your food on your plate. You can ask your parents to place all of the food on the table “family style.”This way, each member of the family can putfood on his or her own plate. This approachgreatly reduces overeating. > Be aware of portion sizes. Recognize that the modern world is telling you to eat, eat, eat. Adsoften direct you to spend less to eat more. Whatyou have to do is see through all of this advertis-ing and make smart eating choices. Take controlof your health by making your own decisions onhow much you eat. If you have doubts abouthow much you eat, talk about your eating withsomeone you trust. > Be aware of messages to eat more. Messages to eat more food are all around you. To make your-self more aware, keep a list of all of the ads andcultural messages that you see in a week. Aware-ness of how our culture affects us is a great toolthat you can use to stay healthy. YOUR TURN 1. Summarizing Information In what three ways may modern food ads take your atten- tion away from healthful eating choices? 2. Inferring Relationships Name three things in our culture other than food ads thatencourage overeating. 3. CRITICAL THINKING Find one food ad that stresses large portions. Discuss how thead goes about influencing the amount thatpeople eat. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 8 CHAP TER 8 CHAPTER 8 Weight Mana gement and Eating BehaviorsWeight Mana gement and Eating BehaviorsWeight Management and Eating Behaviors 188KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Your friends, family, and environment can influence what foods you eat. 2.Eating breakfast can help your performance inschool. 3.It is possible for a person with a high bodyweight to have a healthy level of body fat. 4.Weight loss is the focus of any weight manage-ment plan. 5.Eating disorders are serious problems thatrequire medical help. 6.Diarrhea can be life threatening. 7.Most food-borne illnesses are caused by foodeaten at restaurants. Copyright © by Holt, Rinehart and Winston. All rights reserved. 189SECTION 1 Food and Your Body Weight SECTION 2 Maintaining aHealthy Weight SECTION 3 Eating Disorders SECTION 4 Preventing Food-Related Illnesses go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH08. Copyright © by Holt, Rinehart and Winston. All rights reserved. 190 CHAPTER 8 Weight Management and Eating BehaviorsHave you ever found yourself feeling full after a meal and then digging into a piece of pie for dessert? You’ve probably neverthought of how you seem to make room for more food, even when you feel full. Many things influence why and when you eat. Why Do You Eat? Why do people eat even when they aren’t hungry? is thebody’s physical response to the need for food. It is triggered by sig-nals in your body that tell you to eat. The food you eat provides youwith energy and nutrients that you need to remain healthy. Are You Really Hungry? But most people don’t eat just to stay healthy. Most people also eat because of their appetite. is adesire, rather than a need, to eat certain types of foods. For example,the decision to eat an ice-cream cone with your friends, even thoughyou just ate a meal, was triggered by appetite rather than hunger.Appetite may be triggered by many factors, including the sight or smellof food, the time of day, or the time of year. What your friends are eat-ing—and even what mood you are in—can trigger your appetite. You skipped breakfast because you got up late. You’re in class, and your stomach is growling. It is almost lunchtime, and you arefeeling a little lightheaded and are unable to concentrate. These feel-ings are your body’s way of telling you that you are hungry and yourbody needs fuel. They are caused by a number of different signals inyour body. Some of these signals come from your digestive tract, and some come from other parts of your body. For example, your emptyAppetiteHungerFood and Your Body Weight SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Discuss the difference between hunger and appetite. Summarize why eating a healthy breakfast is important. Describe how the balance between food intake and exercise affects body weight. Describe how obesity is linked to poor health. Name three factors that influence the foods you choose to eat. LIFE LIFE SKILLKEY TERMSKEY TERMS hunger the body’s physical response to the need for food appetite the desire, rather than the need, to eat certain foodsbasal metabolic rate (BMR) the minimum amount of energy required to keep the body alive when in a rested and fasting state overweight being heavy for one’s height obesity having excess body fat for one’s weight; the state of weighing more than 20 percent above your recommended body weight Both hunger and appetite play impor- tant roles in our eating habits. Animbalance between the two can lead tohealth problems. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Food and Your Body Weight 191stomach tells you to eat by sending messages to your brain. The levels of nutrients and other substances in your bloodstream also signal thebrain that you need to eat. When you have eaten enough, other signals from the brain and digestive system make you feel full andsatisfied. This full feeling is called satiety (suh TIE uh tee). Food in your stomach causes the stomach to stretch. This stretching is sensedby nerves, which send a “stop eating” message to the brain. The sensations of hunger and satiety help you eat the right amount tofeed your body and to stay at a healthy weight. What Foods Do You Choose? The amount and type of food you choose to eat are affected by many factors as shown in Figure 1. These factors include >the smell and taste of the food >mood >family traditions and ethnic background >social occasions >religious traditions >health concerns >advertising >cost and availability For example, you may eat sandwiches for lunch because they are easyto carry to school. Americans often eat turkey on Thanksgiving daybecause of tradition. Where you grew up also plays a role in what yougenerally eat. If you grew up in the southwestern United States, youmay eat Mexican food regularly, even if it isn’t part of your ethnicbackground. And someone who is growing up on the East Coast mayeat more seafood than someone in the Midwest does. Some of us eatwhen we are bored or upset. We also avoid foods because we thinkthey are unhealthy. There are many reasons for choosing the foods we eat. Some of these reasonscan lead you to choose healthy orunhealthy foods. ACTIVITY List the reasons why these teens are eating. Did they make healthy choices?1 Figure“I’m bored.” “I’m glad Michael is here.” “Now I have all the pieces in my collection.”“I’m starving afterthe game!” Copyright © by Holt, Rinehart and Winston. All rights reserved. 192 CHAPTER 8 Weight Management and Eating BehaviorsFood Provides Energy Carbohydrates, fats, and proteins are the energy-giving nutrients. This energy is measured in units called Calories . The amount of energy in a certain food depends on how much carbohydrate, fat, and proteinthe food contains. Carbohydrates and proteins each provide 4 Calo-ries per gram. Fats provide 9 Calories per gram. Foods high in fat arehigh in Calories because fat provides the most Calories per gram. After you have eaten a meal, your digestive system breaks down the food. Some of the energy released from food is used almostimmediately to fuel the thousands of reactions in your body thatkeep you alive. Extra food energy that is not needed immediately isstored by the body in two forms—glycogen and fat. Figure 2 shows how excess food energy is stored by the body. Most of the energystored in the body is stored as fat. Fat can provide most of the body’senergy, but small amounts of glucose are also needed. Glycogen canbe broken down quickly to glucose. When the limited glycogen storesare used up, body proteins are needed to form glucose. The Right Breakfast Keeps You Going When you wake up in the morning, you usually haven’t eaten for 10 to 12 hours. If you goto school without breakfast, you must depend on stored energy tofuel your body and brain. By lunchtime, you may not have eaten formore than 16 hours! The food you eat at breakfast gives you a quicksource of energy for your body and glucose for your brain. How long your breakfast or any other meal keeps you going depends on how much you have eaten and what foods you eat. Mealswith fat and protein keep you feeling full longer than meals made ofmostly carbohydrates. So a slice of dry toast and orange juice forbreakfast will likely cause you to feel hungry long before lunchtime.However, a meal with a mixture of carbohydrate, protein, and somefat, such as yogurt, cereal, and fruit, will keep you feeling full andenergized longer. How Much Energy Do You Need? How much food energy, or Calories, you need depends on how much energy your body is using.Everyone knows you need energy for running, swimming, and play-ing basketball. But did you know that your body needs energy evenwhen you aren’t moving? Most of the food energy the body needs is used for basic func- tions, such as breathing, circulating blood, and growing. The amountof energy needed for these basic functions is called the basal meta-bolic rate. is the minimum amount ofenergy needed to keep you alive when you are in a rested, fastingstate, such as just after you wake up in the morning. The amount ofenergy that is used for BMR is different for each person. Also, the Calorie requirements of boys and girls differ. On aver- age, boys require more Calories per day than girls do. For example,active 15-year-old boys need about 3,000 Calories per day, and active15-year -old girls need about 2,300 Calories per day. Basal metabolic rate (BMR) How Excess Food Energy Is Stored Excess dietary fats and proteins are stored in the body as fat. When glycogen stores are full, excess dietarycarbohydrates are then stored as fat. 2 Figure For more information about exercising and keeping fit, seeChapter 6. linkTOPICTOPIC Excess protein Excess fat Glycogen Body fat Excess carbohydrate Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Food and Your Body Weight 193The more active you are, the more energy your body uses. Figure 3 provides several examples of the amount of energy burned during different activities. For example, it takes more energy for a per- son to run for 15 minutes than to walk for the same amount of time.But if you walk for an hour, you may use more energy than youwould during a 15-minute run. The amount of energy needed for anactivity also increases as body weight increases. For example, it takesmore energy for a 130-pound person to walk a mile than for a 1 10-pound person to walk the same distance. Balancing Energy Intake with Energy Used When the amount of food energy you take in is equal to the amountof energy you use, you are in energy balance . Eating more or less food than you need will cause you to be out of energy balance. Eating extrafood energy increases the body’s fat stores and causes weight gain.Eating less food than you need decreases the body’s fat stores andcauses weight loss. Some body fat is essential for health. It is needed for normal body structures and functions, as an energy store, for insulation, andfor protection of the body’s internal organs. A healthy amount ofbody fat for young women is 20 to 30 percent of body weight. Foryoung men, the amount is 12 to 20 percent of body weight. We buildup storage fat when we put on weight. Most people who are over-weight have excess stored fat. is the term used to describe a person who is heavy for his or her height. Generally, people who are overweight have excessbody fat. Overweight 0 100 200 300 400 500 Calories burned per hourWatching TV Walking Skating Mountain biking Running Research has shown that students who eat breakfast perform better in school than those who skip breakfast. Different activities have different energy demands. The more intense theactivity level, the greater the numberof Calories that are burned per hour.3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 194 CHAPTER 8 Weight Management and Eating BehaviorsBeing Overweight Can Cause Health Problems Having excess body fat increases the risk of suffering from many long-term diseases. Some of these health problems include >heart disease and high blood pressure >certain forms of cancer, including prostate, colon, and breast cancer >type 2 diabetes >sleeping problems such as sleep apnea Overweight and Obesity: A Growing Problem (oh BEE suh tee) is a condition in which there is an excess of body fat for one’s weight. A person is considered obese if he or sheweighs more than 20 percent above his or her recommended weightrange. Being obese or being overweight is most common in devel-oped countries, such as the United States. More people are overweight or obese than ever before. As Figure 5 shows, more than 60 percent of all adult Americans are currentlyoverweight, and almost 30 percent of those who are overweight areobese. Adults are not the only ones getting heavier. About 14 percentof children and teenagers in the United States are overweight. Thistrend is worrisome because being overweight, especially whenyoung, increases the risk of suffering from chronic diseases such asdiabetes and heart disease. Overall, physical inactivity and poor dietpose the greatest risk to health. However, an overweight person whois active regularly is at lower risk than a person of correct weight whois not active.Obesity 1980 1999Percentage of U.S. Adults Who Are Overweight or Obese 47%61%70 605040302010 130% increase! 1980 1999Percentage of U.S. Teens Who Are Overweight or Obese 6%14%14 1210 8642 233% increase! Over the years, the size and the number of Calories in a fast-food meal haveincreased dramatically. ACTIVITY Use the Calorie table on pp. 622–627 to compare the Calories in a plain, single-patty hamburger, a smallorder of fries, and a small soda with theCalories in an extra large meal. Lack of physical activity and poor dietary habits have lead to an increase in the percentage of people who areoverweight or obese. 5 Figure4 Figure Source: Centers for Disease Control and Prevention and National Center for Health Statistics.MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Food and Your Body Weight 195Why Are So Many People Overweight? There are two main rea- sons why increasing numbers of Americans are overweight. The first reason is our lack of physical activity. Many modern convenienceshave helped decrease our daily levels of activity. We drive more oftenthan we walk, and we play video games and watch TV more often thanwe ride our bikes. The second reason people are gaining so much body fat is our changing diet. Many Americans eat more food than they need to, andchoose foods high in fat and sugar. Supermarkets, fast-food restau-rants, and all-night shopping marts provide easy access to food.High-Calorie snack foods, drinks, baked goods, and candy tempt usat the checkout counter of the supermarket. In these busy days, grab-bing a snack from the vending machine or buying lunch at a fast-food restaurant is far more convenient for many people thanpreparing a healthy meal is. What Can You Do? With a little preplanning and goal setting, maintaining a healthy weight is something everyone can do. It isimportant to avoid becoming overweight in the first place. Exerciseand a healthy diet can help you stay in a healthy weight range. Every year, about 44 percent of American women and 29 percent of American men try to lose weight. Many never lose any weight, andmost who do lose weight eventually regain it. When trying to loseweight, people often have unrealistic goals (such as losing 7 poundsper week) and try very strict diets. Failure to achieve these unrealisticgoals often causes a cycle of dieting and disappointment throughoutlife. A weight management plan that is suited just to you will have themost success. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term that means “the body’s physical response to the need for food.” a.appetite c.basal metabolic rate b.obesity d.hunger 2.Name the term used to describe the minimum amount of energy that is needed to keep you alive when your body is in a rested and fasting state. 3.Compare the terms overweight and obesity . Understanding Key Ideas 4. Summarize why appetite is more likely to lead to overeating than hunger is. 5.State the advantages of eating breakfast.6. Describe how your energy balance and body weight would be affected if you walked homefrom school every day instead of taking the bus. 7. Describe what happens when energy intake exceeds the body’s energy needs. 8. Describe how excess body fat affects health. 9.Name two reasons for the increase in the number of overweight or obese people. Critical Thinking 10. Being a Wise Consumer You are cooking dinner for your family. You go to the grocery store to buy the ingredients. List four factors that may influence your food choices. LIFE LIFE SKILL Regardless of age or level of fitness, everyone can benefit from regular exercise. Copyright © by Holt, Rinehart and Winston. All rights reserved. 196 CHAPTER 8 Weight Management and Eating BehaviorsMaintaining a Healthy Weight SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Do you know someone who appears to eat and eat and never gain an ounce? Do you know someone who is overweightyet seems to eat nothing at all? You are not imagining these differences. Some people gain weight more easily than others. Why Do You Weigh What You Weigh? Whether you gain or lose weight easily is in large part due to heredity. is the passing down of traits from parent to child. Having a body shape that is similar to the body shape of one of yourparents is due to heredity. In fact, all of your genes, including theones that control your energy balance, body size, and body shape, areinherited from your parents. Genes are pieces of the hereditary material called DNA . Genes carry information on how your body is built and how your bodyworks. Many genes play a role in controlling body weight. Some ofthese genes control the amount of body fat that you have, some con-trol the signals of hunger and satiety, and some regulate activity. Ifone of these genes is defective, information about body fat, hunger,satiety, and activity levels may not be sent and received correctly. If one or both of your parents are obese, your chances of becom- ing obese are high. However, the genes you inherit are not completelyresponsible for determining your body weight. Some of the differ-ences in our body shapes and sizes are caused by lifestyle. For exam-ple, the choices you make about what you eat and how much youexercise affect your energy balance and body weight. Someone whohas obese parents but who makes healthy food choices and exercisesregularly may never be overweight.HeredityOBJECTIVES Describe how heredity and lifestyle affect body weight. Summarize the components of a healthy weight management plan. Evaluate the dangers of fad diets and weight-loss practices. Calculate your body mass index. Determine if your weight is in a healthy weight range. LIFE LIFE SKILLLIFE LIFE SKILLKEY TERMSKEY TERMS heredity the passing down of traits from parents to their biological child body composition the proportion of body weight that is made up of fat tissue compared to lean tissue body mass index (BMI) an index of weight in relation to height that is used to assess healthy body weight weight management a program of sensible eating and exercise habits that keep weight at a healthy level fad diet a diet that requires a major change in eating habits and promises quick weight loss The genes you inherit from your parents influence your body size and shape. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Maintaining a Healthy Weight 197What Is a Healthy Weight for Me? There is more to a healthy body weight than just what the scales read. Healthy weights are different for different people, so weight recom-mendations are given as a range. When your weight is within ahealthy weight range, your risk of getting diseases from having toomuch or too little body fat is low. Body Composition is a measure of the propor- tion of body weight that is made up of fat tissue compared to boneand muscle (lean tissue). The percentage of body weight that is bodyfat is affected by sex and age. Women have a higher percentage ofbody fat than men do, and body fat percentage increases with age. The term overweight makes no allowances for body composition. Therefore, using body weight alone to decide the need for fat loss

isunreliable. A person can have excess body weight (be overweight) butnot be obese. Obese individuals carry a large propor-tion of their body weight as fat tissue rather than aslean tissue. Because health risks are linked to amountof excess body fat, not body weight, it is important tobe able to measure body composition. Many methods of measuring body composition require large, expensive equipment. A simplermethod is the measurement of skinfold thickness . An instrument called a caliper is used to pinch a portionof skin and the underlying fat at one or more loca-tions on the body. The caliper measures the thicknessof the pinched skin and fat. Body fat percentage canthen be worked out using a mathematical equation.Another common method measures the flow of alow-level electric current through the body. Body Mass Index (BMI) A popular way to find out if you are in a healthy weight range is to calculateyour body mass index. is anindex of weight in relation to height that is used toassess healthy body weight. The BMI is commonlyused because it correlates well with body composi-tion measurements. Adults are said to have a healthy body weight if their BMI is between 18.5 and 25. Generally, adultswho are overweight (BMI of 25.1 to 29.9) or obese(BMI of 30 or more) have too much body fat and areat a higher risk for diseases, but there are someexceptions. For example, athletes who have a lot ofmuscle and little fat, such as a weight lifter, mayappear to have an unhealthy BMI. But if their bodycomposition is measured, it can be seen that theirlevel of body fat, and therefore their risk for disease,is low.Body mass index (BMI)Body composition People who have a lot of muscle may appear to have an unhealthy BMI. So,an athlete who is 5 feet 11 inches talland weighs 240 pounds would appearto be obese! HH04PEC08_SEC2 6/2/04 7:52 PM Page 197 198 CHAPTER 8 Weight Management and Eating BehaviorsChildren, Teens, and BMI Adult BMI guidelines are not suitable for people younger than 20 years old. The definitions of overweight and underweight for children and adolescents are less clear because young people grow and develop at such different rates. Achart that compares BMI to age has been developed specifically forchildren and teens to account for changing body shapes and sizes.One chart is used for boys, and another chart is used for girls. A Healthy Weight Management Plan Once you have determined whether you are within a healthy weightrange, you can develop your weight management plan. is a program of sensible eating and exercise habits that will help keep weight at a healthy level. For most overweight childrenand teens, the focus of weight management programs should be toslow or stop weight gain, not to cause weight loss. This approachallows the child or teen to continue to grow in height so they “growinto” their weight. Weight loss in children and teens is recommendedonly for those whose excess weight has caused health problems suchas high blood pressure or difficulty breathing. Regular exercise in aweight management plan is just as important as a healthful diet.managementWeight Analyzin gDA TA Analyzing DATA Understanding Body Mass Index Your Turn 1.Calculate your BMI. 2.Is your BMI in the healthy range? 3.Why is the healthy BMI rangedifferent for each age group? 4. CRITICAL THINKING Let’s say your BMI is slightly abovethe healthy range for yourage. Predict what will happento your BMI over the nextyear if your weight remainsthe same, but you grow aninch taller. Malik is 15. He is 5 feet 8 inches tall and weighs 158 pounds. He wants to find out if he is at a healthy weight. To do this, he needs tofind his BMI by using the following equation: BMI /H11005weight (lb)/H11004 height (in.) /H11004height (in.) /H11003703 Malik’s BMI calculations would be 158/H1100468/H1100468/H11003703 /H1100524.0 Malik has a BMI of 24. Malik now needs to find the healthy BMI range for 15-year-old boys. His BMI of 24 is higher than the healthy range for his age. If he has a lot of muscle mass, the BMIchart may not be right for him. Ifhe does not have a lot of musclemass, he should then change fac-tors such as his activity level andhis snacking habits. Doing so willhelp him grow in height withoutgrowing in weight. 321 Age Boys Girls 12 14.9–21 14.8–21.6 13 15.4–21.8 15.3–22.5 14 15.9–22.6 15.8–23.3 15 16.5–23.4 16.2–24 16 17.1–24.2 16.7–24.6 17 17.6–25 17.3–25.2 18 17.8–25.6 17.5–25.7 Source: National Center for Health Statistics and National Center for Chronic Disease Prevention and Health Promotion. Healthy BMI RangeMATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Maintaining a Healthy Weight 199Eat Smart, Exercise More The simplest and healthiest way to decrease the number of Calories you eat is to reduce portion sizes and to keep high-Calorie choices as a treat. This decision can be difficult tomake if your friends are going out for ice cream. Sometimes the bestway to avoid excess Calories is to skip the outing. But another way isto learn some lower-Calorie options. For example, instead of a doublescoop ice cream, choose an ice pop, low-fat frozen yogurt, or sherbet.These options have fewer Calories than ice cream does. Exercise increases your energy needs and makes managing your weight easier. Even small changes in activity levels, as shown in Figure 6, can result in weight loss. Exercise will also increase your muscle strength, improve fitness, and relieve boredom and stress. Therecommended exercise goal for teens is at least 60 minutes of moder-ate activity daily. Changing either eating habits or exercise involves changing your behavior. Keeping a log of your food intake and exercise may helpyou to make such changes. You can then review the log to see whenyou are likely to eat more than you intend or to see what preventsyou from getting the exercise you planned. Lose Fat, Not Muscle! For those who need to lose weight, the goal for weight loss is to lose fat without losing muscle. A weight-lossrate of a half pound to one pound per week is recommended to pre-vent the loss of muscle. Faster weight loss is usually due to the loss ofwater and muscle, not fat. To lose a pound a week, an average personwould need to eat 500 fewer Calories each day or burn 500 moreCalories each day. Weight loss while dieting often stops and starts.Weight can drop one week and stay the same the next. This processcan be frustrating to the dieter and can sometimes lead to dangerousweight-loss practices. SCHOOL Watching TV Take your dog for a all evening . . . brisk 15-minute walkUsing the Take the elevator . . . stairsRiding the Ride your bike or bus . . . walk to school“Your choice of diet can influence your long- term health prospects more than any other action you can take.” —Former Surgeon General C. Everett Koop Even small changes in your daily activity levels can lead to weight loss. ACTIVITY Record and analyze your food intake and level of activity for a week. Do you need to make changes toimprove your activity levels and eatinghabits? 6 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 200 CHAPTER 8 Weight Management and Eating BehaviorsIf You Are Underweight Consult with your doctor to help deter- mine if your low weight is due to an illness. If you are otherwise healthy, a low weight may result from eating too little or exercising toomuch or may be due to heredity. To gain weight, gradually increaseyour food intake by having meals and snacks more frequently. Insteadof junk food, choose nutritious foods that are high in Calories. Exer-cise, especially strength training, can also help an underweight persongain lean mass. Increasing muscle mass increases body weight. Dangerous Weight-Loss Practices People spend millions of dollars each year on weight-loss programs,low-Calorie foods, and diet aids. Many of these products and programspromise quick and easy weight loss. Programs that promise quick fixesgenerally do not promote long-term weight management. Some ofthese diets are presented in Table 1. Such diets do nothing to encour- age exercise or promote permanent changes in eating habits that willmaintain a healthy body weight for the long term. Many of these pro-grams can even be dangerous. Fad Diets A is a diet that requires major changes in your eating habits and promises quick results. Some fad diets suggest thatspecific foods, such as grapefruit, have weight-reducing properties.Others are based on incorrect ideas that the wrong combination offad diet Diet or product Very low carbohydratediets Liquid formulas Stimulants ephedra, caffeine Fasting Diuretics water pillsHow it works >Restricting carbohydrate intake causes fat to be broken down to provide energy. >A low-Calorie liquid “meal” is takenin combination with one regularmeal per day to lower the numberof Calories a person eats. >They reduce one’s appetite and givea feeling of extra energy. >Energy intake is drastically reducedby cutting down on food consump-tion and, therefore, the number ofCalories. >Increasing the amount of waterlost through urination causesweight loss.Is it dangerous? >They are not healthy in the long term because they are low in grains, fruits, andvegetables. >Consuming only the liquid formula can bedangerous and should not be done withoutmedical supervision. >Side effects can range from nervousness,dizziness, and headache to increased bloodpressure, heart attacks, and seizures. >Weight loss is initially rapid as the body uses fatstores for energy. Then, body proteinsare broken down to provide themissing energy which willcause loss of muscle mass. >Taking diuretic pills cancause dehydration and doesnothing to reduce body fat.Table 1 Types of Diets and Diet Products Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Maintaining a Healthy Weight 201foods or the times at which you eat promote weight gain. Some fad diets do result in some weight loss, but the weight loss is usually dueto the decrease in energy intake that occurs while trying to eat theodd mix of foods. However, these diets often do not meet nutrientneeds and are difficult and boring to follow. Diet Pills Many attempts have been made to develop the perfect pill to cause weight loss without the need for low Calorie diets andexercise. However, no such safe drug exists. Drugs that do help withweight loss are available, but the lost weight is usually regained whenthe drug is no longer taken. Surgery Surgery is a drastic method of reducing body weight. One such procedure changes the structure of the digestive tract bybypassing part of the stomach and sometimes the intestine. Thisprocedure is called a gastric bypass . It reduces the amount of food you can eat, the nutrients absorbed, or both. This surgery is very riskyand is recommended only for individuals whose weight-relatedhealth risks are so great that the health risks are more serious thanthe risk of surgery. What Should You Do? Remember that the only safe and reliable way to manage your weight is to balance your food intake with yourexercise. Also, work to change the habits that lead to weight gain.Although there is no single quick way to lose weight, many good dietprograms promote healthy weight reduction and management. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the term that means “the passing down of traits from parents to their biological child.” 2.Identify the term that describes the proportion of body weight that is lean tissue compared to fat tissue. a.BMI c.body composition b.weight management d.heredity 3.Write the term that means “an index of weight in relation to height that is used to assess healthybody weight.” 4.Name the term for “a diet that requires a major change in eating habits and promises quick weight loss.” 5.Define the term weight management.Understanding Key Ideas 6.Compare the roles of heredity and lifestyle in determining your body shape and body weight. 7.Identify which of the following is notan important part of a healthy weight management program. a.well-balanced diet c.diet supplements b.exercise program d.changes in behavior 8. Assessing Your Health Calculate what your BMI will be next year if yougrow 1 inch and gain 5 pounds. Critical Thinking 9.Should you expect your BMI to change in thenext year? Explain.LIFE LIFE SKILLThe only safe and reliable way to lose weight is to reduce portion sizes, increase exercise, and work to change the habits that led to weight gain. For more information about health product claims, see the Express Lesson on p. 562.HandbookHEALTH MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 202 CHAPTER 8 Weight Management and Eating BehaviorEating DisordersSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Jenny had carried her dieting too far. She barely ate a thing and exercised all the time. When she was rushed to the hospital afterfainting, she weighed only 85 pounds. Jenny didn’t listen when her friends said that she was too thin. She hated how “fat” she looked. What Are Eating Disorders? Normally we eat when we are hungry and stop eating when we arefull. However, eating patterns that are inflexible and highly structuredare not normal. Abnormal eating patterns may include never eatingenough, dieting excessively, eating only certain types of foods, eatingtoo much, and not responding to natural feelings of fullness orhunger. These patterns may be warning signs of an eating disorder. Eating disorders are conditions that involve an unhealthy degree of concern about body weight and shape and that may lead to effortsto control weight by unhealthy means. Examples of eating disordersinclude starving oneself, overeating, and forcefully ridding the bodyof food by vomiting or using laxatives. Eating disorders greatly affectall aspects of the sufferer’s life and the lives of his or her loved ones. Body Image and Eating Disorders Your is how you see and feel about your appearance and how comfortable you arewith your body. Your body image can change with your mood, yourenvironment, and your experiences. Your body image can also affectyour eating habits and health. People who believe they are too fatmay limit the food they eat even if they are not overweight. Peoplebody imageOBJECTIVES Discuss the relationship between body image and eating disorders. Describe the type of individual who is most at risk for an eating disorder.List the symptoms and health dangers of the most common eating disorders.Identify ways to help a friend who you think is developing an eating disorder. Identify health organizations in your community that help people with eating disorders. LIFE LIFE SKILLLIFE LIFE SKILLKEY TERMSKEY TERMS body image how you see and feel about your appearance and how comfortable you are with your body anorexia nervosa an eating disorder that involves self-starvation, a distorted body image, and low body weight bulimia nervosa an eating disorder in which the individual repeatedly eats large amounts of food and then uses behaviors such as vomiting orusing laxatives to rid the body of the food binge eating /bingeing eating a large amount of food in one sitting; usually accompanied by a feeling of being out of control purging engaging in behaviors such as vomiting or misusing laxatives to rid the body of food Eating disorders are complex illnesses that can involve having a distortedbody image. For more information about self-concept, see Chapter 2. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Eating Disorders 203with eating disorders often do not see themselves as they really are. In other words, they have a distorted body image. Culture and society often define what we think of as a perfect body. In the 1950s, many women wanted to look like Marilyn Mon-roe—curvy and full figured. In the United States today, clothing stylesand fashion models on television and in magazines suggest that thinis in and a perfectly toned, muscular body is best. The models we seein magazines and on television act as a standard for attractivenessand acceptability. But in fact, the women and men on magazine covers represent less than 1 percent of the population! A Healthy Body Image Having a healthy body image means you accept your body’s appearance and abilities. It also means that youlisten to what your body tells you. Developing a healthier bodyimage requires paying attention to, appreciating, and caring for yourbody. You should have realistic expectations about your size that arebased on your heredity and should realize that weight and bodyshape can change frequently and rapidly in teens. real life Activity LIFE LIFE SKILL Evaluating Media Messages SOCIETY AND BODY IMAGE ✔colored paper ✔teen, fashion, and fitness magazines ✔scissors ✔paste 1.Cutout images of teenage girls and boys from the magazines. 2.Paste the images onto the colored paper to create a collage.ProcedureMaterials 1.Summarizing Results Describe the body sizes and shapes in the images that you have collected. 2.Comparing Information How are these images like those of your friends and classmates? Howare they different? 3.Analyzing Results Are these images used to sell a product? If so, what product is each imageselling? 4.CRITICAL THINKINGHow can behaviors such as druguse and dieting develop from having an unrealistic body image?Conclusions5.CRITICAL THINKING From what other sources do youget messages about body image?The men and women on magazine covers represent less than 1 percent of the population. Copyright © by Holt, Rinehart and Winston. All rights reserved. 204A Closer Look at Eating Disorders Thousands of people die each year from complications related to eat- ing disorders. Eating disorders often develop during adolescence,when children’s bodies and responsibilities change from those ofchildren to those of adults. Many factors contribute to the development of eating disorders. Genetics, culture, personality, emotions, and family are all believedto play a role. Eating disorders are on the rise among athletes insports that require athletes to be thin, such as gymnastics and figureskating. Eating disorders are also found in athletes who must fit intoa particular weight class, such as wrestlers. Eating disorders are mostcommon in young women, overachievers, perfectionists, and adoles-cents who have a difficult family life. Eating disorders are also mostcommon in people from cultures in which being thin is equated withbeing attractive, successful, and intelligent and also in people whosejobs depend on their body shape and weight, such as dancers, gym-nasts, and models. Common Eating Disorders Three of the most common eating disorders, anorexia nervosa, bulimia nervosa, and binge eating disor-der are summarized in Table 2. is an eating disorder that involves self-starvation, a distorted body image, and low body weight. is aneating disorder in which an individual repeatedly eats large amountsof food and then uses behaviors such as vomiting or using laxativesto rid the body of the food. or is the eating of alarge amount of food in one sitting. In some eating disorders, bingeing may be followed by purging. is behavior thatinvolves vomiting or misusing laxatives to rid the body of food. Purgingbinge eating BingeingBulimia nervosaAnorexia nervosa Dangers of Eating Disorders >Hair loss >Dental problems >Broken blood vessels in the face and eyes >Dry, scaly skin >Severe dehydration >Loss of menstrual period infemales >Low bone density >Heart irregularities >Organ failure >Death www.scilinks.org/health Topic: Eating Disorders HealthLinks code: HH4055 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Eating Disorders 205Table 2 Common Eating Disorders What is it? Anorexia nervosa is an obsession with being thin that leads to extreme weight loss. Some peoplewith anorexia binge and then purgeas a means of weight control. Suf-ferers often have very low self-esteem and feel controlled byothers. The average teen consumesabout 2,500 Calories per day. Butsomeone with anorexia may con-sume only a few hundred Calories.Signs and symptoms >intense fear of weight gain >overexercising >preferring to eat alone >preoccupation with Calories >extreme weight loss >loss of menstrual periods for at least 3 months >hair loss on head >depression and anxiety >weakness and exhaustion Treatment >medical, psychological, and nutri- tional therapy to help the personregain health and develop healthyeating behaviors >family counseling Bulimia nervosa is a disorder that involves frequent episodes of bingeeating that are almost always fol-lowed by behaviors such as vomit-ing, using laxatives, fasting oroverexercising. A person withbulimia may consume as many as20,000 Calories in binges that lastas long as 8 hours.>preoccupation with body weight >bingeing with or without purging >bloodshot eyes and sore throat >dental problems >irregular menstrual periods >depression and mood swings >feeling out of control >at least two bulimic episodes perweek for at least 3 months>therapy to separate eating fromemotions and to promote eatingin response to hunger and satiety >nutritional counseling to reviewnutrient needs and ways to meetthem Binge eating disorder is a disorder that involves frequentbinge eating but no purging. It isfrequently undiagnosed. Aboutone-quarter to one-third of peoplewho go to weight-loss clinics mayhave binge eating disorder.>above-normal body weight >bingeing episodes accompaniedby feelings of guilt, shame, andloss of control >psychological and nutritionalcounseling Disordered eating patterns are disordered eating behaviors thatare not severe enough to be classified as a specific eating disorder. They are often referred toas “disordered eating behaviors.”Many teens are believed to havedisordered eating behaviors thatcould lead to serious health problems.>weight loss (less than anorexia) >bingeing and purging less frequently than in bulimia >purging after eating smallamounts of food >deliberate dehydration forweight loss >hiding food >overexercising >constant dissatisfaction withphysical appearance>psychological and nutritionalcounselingExtreme weight loss Copyright © by Holt, Rinehart and Winston. All rights reserved. 206 CHAPTER 8 Weight Management and Eating BehaviorCould You Be at Risk? People at risk of developing an eating disorder may find they have traits such as preferring to eat alone, being overly critical about their body size and shape, thinking about food often, weighing themselvesevery day, and/or eating a lot of “diet” foods. If your con-cerns about food or your appearance have led to trouble inschool, at home, or with your friends, you should discussyour situation with a parent, a school nurse, a counselor, adoctor, or another trusted adult. Getting Help Professional help from physicians, psy- chologists, and nutritionists is essential to manage andrecover from an eating disorder. Unfortunately, peoplewith eating disorders often deny that they have a problemand believe that their behavior is normal and a chosenlifestyle. As a result, they may not seek help early on whentreatment can help prevent severe physical problems. If you believe a friend has an eating disorder, it is important to encourage your friend to seek help. In pri-vate, let your friend know of your concern for his or herhealth. Listen to your friend. If you are unsuccessful, tell atrusted adult, or contact an agency that provides eating dis-order counseling in your area. Remember, even if you are sworn to secrecy by your friend, it is important that a responsibleadult knows about your fears. When a life is in danger, there is noconfidentiality to keep. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term body image . 2.Identify the eating disorder that involves extreme weight loss. a.anorexia nervosa c.purging b. bulimia nervosa d.binge eating disorder 3.Listthe symptoms of bulimia nervosa. 4.Name the term that means “a rapid consumption of a large amount of food.” Understanding Key Ideas 5.Describe how a negative body image can affect eating behavior.6. Describe how you could tell if a friend or family member was at risk of an eating disorder. 7.Compare the symptoms of anorexia with those of bulimia, and describe how the disorders affect health. 8. Communicating Effectively Describe how you could help a friend you think is develop-ing an eating disorder. 9. Using Community Resources Identify resources in your local community that help peo-ple with eating disorders or their families. Critical Thinking 10.Should someone who binges and purges aboutonce a month be worried about the consequencesof bulimia? Explain.LIFE LIFE SKILLLIFE LIFE SKILL You’re worried about your best friend, Samantha. When she goes out to eat with you and yourother friends, she talks about food a lot, but allshe ever orders is a diet soda. She has lostweight and seems tired and cold all the time.You tell her that she looks too thin, but she com-plains that she is fat. You suspect Samantha mayhave an eating disorder. Write on a separate sheet of paper the steps that you would take to

help your friend. Remember touse the decision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Preventing Food-Related Illnesses 207Preventing Food-Related Illnesses SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 While in the library, Aaron started to feel bad. His stomach hurt, and he felt a little sick. It couldn’t have been theburger he’d had for lunch—it was so good! He had barely packed up his bag before he had to run for the bathroom. Food and Digestive Problems To provide the body with nutrients, food must be digested and thenthe nutrients must be absorbed. Problems in any part of the digestivesystem can affect your health. Most digestive problems like Aaron’sare not serious. But if you have severe or persistent symptoms, youshould see a doctor. Heartburn Have you ever had a burning feeling in your chest after a large meal? This burning feeling is called heartburn and is caused by stomach acid leaking into the esophagus. The esophagus is the tubethat connects your throat with your stomach. The main cause ofheartburn is overeating foods that are high in fat. Stress and anxietycan also cause heartburn by increasing the amount of acid made bythe stomach. Heartburn is usually a minor problem that can be pre-vented by eating small, low-fat meals frequently and by not lyingdown soon after eating. Ulcers Pain after eating can also be a symptom of a more serious ailment, such as an ulcer. Ulcers are open sores in the lining of thestomach or intestine. Recent studies have shown that most ulcers arecaused by a bacterial infection of the stomach lining. Fortunately, theinfection is treatable with antibiotics. Stress and an unhealthy dietcan make ulcers worse.OBJECTIVES Describe three of the most common digestive disorders. Describe how diarrhea can be life threatening. Discuss how food allergies can affect health. Identify a common cause of food intolerances. Listthings you can do to reduce your chances of getting a food- borne illness. LIFE LIFE SKILLKEY TERMSKEY TERMS food allergy an abnormal response to a food that is triggered by the immune system lactose intolerance the inability to completely digest the milk sugar lactosefood-borne illness an illness caused by eating or drinking a food that contains a toxin or disease- causing microorganism cross-contamination the transfer of contami- nants from one food to another Digestive problems can sometimes develop quickly. Copyright © by Holt, Rinehart and Winston. All rights reserved. 208 CHAPTER 8 Weight Management and Eating BehaviorEmbarrassing Digestive Problems Some intestinal problems are as embarrassing as they are uncomfortable. Gas, diarrhea, and constipation can be difficult to discuss. However, they can often beavoided by changes in the diet. Gas is produced when bacteria living in the large intestine break down undigested food. Normally, you don’t notice the daily activitiesof these bacteria. Some foods, such as beans, contain a large amountof indigestible material. Although you cannot digest this material, itacts as a huge meal for the millions of bacteria that live in your largeintestine. The bacteria produce a lot of gas while feasting on thebeans. The end result for you is gas, or flatus. The buildup of this gascan make you feel bloated and can give you flatulence . Diarrhea refers to frequent watery stools. Diarrhea can be caused by infections, medications, or reactions to foods. Occasional diarrheais common and mostly harmless. But because diarrhea increaseswater loss from the body, prolonged diarrhea can lead to dehy-dration. Dehydration occurs when the amount of water in the bodydecreases enough to cause a drop in blood volume. Dehydration canmake it difficult for the blood to carry nutrients and oxygen aroundthe body and can become life threatening. Every year dehydrationfrom diarrhea kills millions of children in the developing world. Ifyou experience diarrhea, drink a lot of fluid, such as water or sportsdrinks, to replace lost water. Constipation is difficulty in having bowel movements or is having dry, hard stools. Constipation can be caused by weak intestinal mus-cles or by a diet that is low in fiber or fluid. It can be prevented by get-ting plenty of exercise, drinking a lot of water (at least eight glasses aday), and eating a diet high in whole grains, fruits, and vegetables. Food Allergies A is an abnormal response to a food that is triggered bythe body’s immune system. The immune system reacts to the food asif it were a harmful microorganism. The allergic reaction can causesymptoms throughout the body. Sometimes reactions are mild, butthey can be life threatening. An upset stomach, hives, a runny nose,body aches, difficulty breathing, and a drop in blood pressure can allbe food allergy symptoms. In some cases, these symptoms appearimmediately. In others, they take up to 24 hours to appear. Is It a Food Allergy? True food allergies are relatively rare. To find out if symptoms are due to a specific food, you must cut fromyour diet for 2 to 4 weeks all foods suspected of causing an allergicreaction. Then, a “food challenge” can be done by eating a smallamount of one suspected food. You should do a food challenge in adoctor’s office in case you have a serious reaction. If a reaction occurs,a diagnosis of a food allergy can be made. If no reaction occurs, alarger amount of the food can be eaten. If you still have no reaction,then an allergy to that food may be ruled out. food allergy Common Causes of Food Allergies >Peanuts >Eggs >Wheat >Strawberries >Soy foods >Seafood >Milk Some Food Intolerances Copyright © by Holt, Rinehart and Winston. All rights reserved. roblems 209A food challenge should not be done with a suspected allergy to peanuts because reactions to peanuts can be deadly. Individuals who are allergic to peanuts can be so sensitive that exposure to tinyamounts, such as contamination from peanut-containing foodsnearby, can cause serious reactions. Once this allergy is suspected,peanuts must be avoided. Managing Food Allergies The best way to prevent an allergic reaction to food is to avoid eating the food to which you are allergic.Don’t be afraid to ask about ingredients in food served in restaurantsor at a friend’s house. Food labels can help you find out if a food con-tains the ingredient. Individuals who have serious food allergies needto carry epinephrine with them. Injecting themselves with this hor- mone after exposure to the food can prevent a fatal reaction. Food Intolerances Although the symptoms of a food intolerance can be similar to thoseof a food allergy, food intolerances do not cause a specific reaction ofthe immune system. Food intolerances can be caused by eating foodsor ingredients in a meal that irritate the intestine (such as onions). An example of a food intolerance is lactose intolerance. is a reduced ability to digest the milk sugar lactose. It is not an allergy to milk. Lactose is found in dairy products, such asmilk and cheese. Lactose intolerance causes gas, cramps, and diar-rhea. These symptoms occur because undigested lactose passes intothe large intestine, where it is digested by bacteria that produce acidsand gas from the lactose. Lactose intolerance is rare in children butaffects about a quarter of the American adult population. The inci-dence of lactose intolerance varies worldwide. Lactose intoleranceaffects less than 5 percent of people in northwestern Europe butnearly 100 percent of people in some parts of Asia and Africa. Food-Borne Illness A is an illness caused by eatingor drinking a food that contains a toxin or disease-causing microorganism. Each year, about 76 mil-lion people in the United States suffer fromfood-borne illness. Food-borne illness can becaused by any kind of contamination in food.However, most food-borne illnesses in the UnitedStates are caused by eating food contaminatedwith pathogens, such as bacteria, viruses, fungi, orparasites. Many cases of food-borne illness are somild that they are not reported to a doctor. So, inmost cases the cause of the food-borne illness isnever discovered. Most cases of food-borne illnessare due to foods that are prepared or eaten athome.food-borne illnessintoleranceLactose “Many cases of food poisoning could be prevented if people washed their hands before handling food.” www.scilinks.org/health Topic: Lactose Intolerance HealthLinks code: HH4092 Copyright © by Holt, Rinehart and Winston. All rights reserved. 210 CHAPTER 8 Weight Management and Eating BehaviorIs It the Flu? Symptoms of food-borne illness (nausea, vomiting, and diarrhea) are often thought to be a stomach flu. These symptoms may appear as soon as 30 minutes after eating a contaminated food,or they may take several days or weeks to appear. When treated withrest and a lot of fluids the symptoms usually last only a day or two.However, sometimes food-borne illnesses can be life threatening,especially for young children, pregnant women, the elderly, and theill. When symptoms are severe, the patient should see a doctor assoon as possible. Preventing Food-Borne Illness The majority of food-borne illnesses can be avoided by selecting, storing, cooking, and handlingfood properly. Proper handling and storage of food is vital to avoidcross-contamination. is the transfer of contami-nants from one food to another. Cross-contamination can occur athome, for example, if the same cutting board is used to cut up rawchicken and to prepare vegetables for a salad or if raw and cookedfoods are stored together. Cross-contamination can also happen infood-processing plants and restaurants. Contamination of foods inthese locations could potentially affect hundreds of people. There-fore, there are many strict federal hygiene regulations that apply tofood-processing plants and restaurants and that aim to minimizehealth risks to the public. To reduce the risk of food-borne illness in the kitchen >replace and wash dishcloths and hand towels frequently >keep your refrigerator at 41 °F >wash your hands, cooking utensils, and surfaces with warmsoapy water between each food preparation step >cook food to the recommended temperatures to kill microorganismsCross-contamination Selecting and Storing Foods Safely >Avoid dented, rusting, or bulging cans. >Meat and fish should be veryfresh and free of odor. >Refrigerate leftovers promptly. >Store eggs in the refrigerator. >Never defrost foods at roomtemperature. Leave them in therefrigerator to defrost overnight. >If you suspect a food is unsafe,play it safe. When in doubt, throwit out. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term used to describe an abnormal response to a food that is triggered by the immune system. a.food allergy c.constipation b.lactose intolerance d.food intolerance 2.Write the term that means “an inability to digest lactose.” 3.Name the term for “an illness caused by eating a food that contains a contaminant such as a microorganism.” 4.Define cross-contamination .Understanding Key Ideas 5.Describe how excess gas can form in the intestines. 6.Describe how diarrhea can cause dehydration. 7.Compare the symptoms of a food allergy to the symptoms of a food intolerance. 8. Practicing Wellness Identify steps to reduce your chances of getting a food borne illness. Critical Thinking 9.Can the bacteria on raw chicken that you buy fromthe store end up in your fresh fruit salad? Explainyour answer.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 8 Highlights 211 CHAP TER 8 CHAP TER 8 CHAPTER 8Highlights Key Terms The Big Picture ✔What you eat and how much you eat are affected by both hunger and appetite. ✔Personal choices as well as friends, tradition, ethnic background,availability of food, and emotions affect food choices. ✔Your body weight is affected by your food intake and by youractivity levels. ✔Eating breakfast every day is important for good health. ✔Being overweight or obese increases the risk of heart disease, dia-betes, cancer, and other chronic diseases.SECTION 1 hunger (190) appetite (190) basal metabolic rate (BMR) (192) overweight (193) obesity (194) ✔Individuals with eating disorders often have a distorted bodyimage. ✔Eating disorders are more common in teenage girls, especiallyoverachievers who have a poor self-image, and in athletes whomust restrict their weight. ✔Anorexia nervosa is an overwhelming fear of gaining weight andcan result in self-starvation. Bulimia nervosa involves frequentbingeing and purging, which can cause many health problems. ✔Eating disorders should be identified and treated early to avoidlong-term health problems.SECTION 3 body image (202) anorexia nervosa(204) bulimia nervosa (204) binge eating (bingeing) (204) purging (204)✔The genes you inherit from your parents and your lifestyle choices determine your body size and shape. ✔Body mass index is an index of weight in relation to height that isused to assess healthy body weight. ✔Keeping body weight in the healthy range requires a plan thatencourages healthy food choices and good exercise habits. ✔Fad diets may cause initial weight loss but can be dangerous and do not promote behaviors for long-term weight management.SECTION 2 heredity (196) body composition (197) body mass index (BMI) (197) weight management (198) fad diet (200) ✔Common digestive disorders include heartburn, ulcers, constipation, diarrhea, and flatulence. ✔Diarrhea causes water loss and can result in dehydration, which is very dangerous, especially to children and the elderly. ✔A food allergy involves a reaction by the body’s immune systemto particular foods. A food intolerance may cause symptoms similar to those of an allergic reaction, but it is not a specificimmune reaction. ✔Proper handling and storage of food can prevent a food-borne illness.SECTION 4 food allergy (208) lactose intolerance (209) food-borne illness (209) cross-contamination (210) Copyright © by Holt, Rinehart and Winston. All rights reserved. 212 CHAPTER 8 Review CHAP TER 8 CHAP TER 8 CHAPTER 8 Review Using Key Terms anorexia nervosa (204) food allergy (208) appetite (190) food-borne illness (209) basal metabolic rate (BMR) (192) heredity (196) binge eating/bingeing (204) hunger (190) body composition (197) lactose intolerance (209) body image (202) obesity (194) body mass index (197) overweight (193) bulimia nervosa (204) purging (204) cross-contamination (210) weight management (198) fad diet (200) 1.For each definition below, choose the key term that best matches the definition. a.eating a large amount of food at one time b.forcefully ridding the body of Calories c.heavy for one’s height d.how you see and feel about your appearance e.sensible eating and exercise habits that keepweight at a healthy level f.a diet that promises quick weight loss 2.Explain the relationship between the key terms ineach of the following pairs. a.anorexia nervosa andbulimia nervosa b.hunger and appetite c.obesity and body mass index d.food allergy and lactose intolerance e.cross-contamination and food-borne illness f.body composition and heredity Understanding Key Ideas Section 1 3.Is eating a piece of chocolate cake for dessert aftera big dinner more likely to be motivated byhunger or by appetite? Explain your answer. 4.Why does eating breakfast each morning helpyou perform better in school? 5.Explain what happens to the extra energy if youeat more food than your body needs. 6.For what health conditions are people with excessbody fat at increased risk? 7.What is the best plan for avoiding obesity? Section 2 8.Explain why a person whose parents are obesemay not necessarily become obese. 9.What is the BMI of an individual who is 5 feet 1 inch tall and weighs 127 pounds? 10.Explain why following a weight managementplan that has a menu for only one week of mealsis unlikely to promote long-term weight loss. 11.CRITICAL THINKING A magazine features the “tomato and lemon juice” diet. The diet promisesa weight loss of 5 pounds a week. Why is this dietnot a good way to manage weight? Section 3 12.Explain why someone who has a poor body imageis more likely to develop an eating disorder. 13.What types of individuals are most at risk for eat-ing disorders? 14.Which of the following is nota symptom of an eating disorder? a.healthy body image b.fear of gaining weight c. extreme weight loss d. bingeing and purging 15.Identify people or health organizations you couldlook to for help with a friend who has an eatingdisorder. Section 4 16.Identify actions you can take to help preventheartburn and constipation. 17.Identify the main reason why diarrhea can be lifethreatening. 18.Identify ways you can avoid having a food intol-erance. 19.Describe how washing your hands can protectyou from food-borne illness. 20.CRITICAL THINKING You are at camp with a friend who is allergic to peanuts. How can you helpdetermine which foods are safe for him to eat?LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLMATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 8 Review 213Interpreting Graphics Study the figure below to answer the questions that follow. 21.Which of these activities requires the least bodily movement? 22.Estimate how many Calories in total are burned during 30 minutes of housework and 30 minutes of swimming. 23.CRITICAL THINKING Which of these activities would be most effective as part of your weightmanagement plan? Activities 24. Health and You Find an advertisement for a diet plan in a magazine or in another source. Does thediet contain all of the components of a healthyweight management plan? Would it be safe to fol-low this plan for an extended period of time? 25. Health and Your Community Prepare a poster display that explores how body images havechanged over the past 30 years. 26. Health and Your Family Write a short report that describes ways to avoid a food-borne illness in a home kitchen. 27. Health and You Think about how the availability of food can affect what you eat and when you eat.Write a healthy meal plan from what ison your school’s lunch menu today. Action Plan 28. Assessing Your Health List five things that you can do to improve your body image andto keep your weight in the healthy range. LIFE LIFE SKILL 29.In the passage, the word apply means Ato put into action or use. Bto concentrate one’s efforts. Cto ask for something. Dto select something. 30.What can you infer from reading this passage? EAnn has an eating disorder. FAnn is obese. GAnn eats junk food when she is bored. HAnn is not a good cook. 31.By skipping tennis, Ann uses 150 fewer Calories than usual that day. By eating popcorn and a bagof chips, she eats about 500 extra Calories. Whathas that done to her energy balance that day? 32.Write a paragraph describing some of the things Ann can do to help her study without gainingweight. READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Ann is studying for a history test. She had to cancel tennis after school because sheneeded the time to study. But now she isbored. To help apply herself to her studies she makes a bowl of buttery popcorn.When that is gone, she gets a bag of chipsfrom the kitchen. When she discovers shehas finished off the bag of chips too, she isangry with herself. She has been putting onweight lately. Skipping tennis and eating allthis junk food is going to add to her weightgain. She decides that she needs a plan tohelp her focus on studying without gainingweight. 500 400300200100 0Playing computer gamesBowling Housework Easy swimmingCalories Burned During Different Activities Calories burned per hourWRITING SKILL MATH SKILL MATH SKILLWRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Copyright © by Holt, Rinehart and Winston. All rights reserved. 215CHAPTER 9 Understanding Drugs and Medicines CHAPTER 10 Alcohol CHAPTER 11 Tobacco CHAPTER 12 Illegal Drugs UNIT 3UNIT 3UNIT 3 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 9 CHAP TER 9 CHAPTER 9 Understanding Drugs and MedicinesUnderstanding Drugs and MedicinesUnderstanding Drugs and Medicines 216KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1. Side effects of over-the-counter medicines are rare. 2. Cold medicines can cause drowsiness when they are taken with antihistamines. 3. Not following doctor’s orders while taking a prescription medicine can be dangerous. 4. Generic drugs work equally as well as brand- name drugs. 5. Nutritional supplements are not approved by the Food and Drug Administration, as are medicines. 6. Drugs that come from natural products are safer than drugs made from chemicals. 7.People cannot become addicted to prescription drugs. Copyright © by Holt, Rinehart and Winston. All rights reserved. 217SECTION 1 Drugs SECTION 2 Drugs as Medicines SECTION 3 Drugs and the Brain go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH09. Copyright © by Holt, Rinehart and Winston. All rights reserved. 218 CHAPTER 9 Understanding Drugs and MedicinesWhat do aspirin, caffeine, cortisone, and cocaine all have in common? They are all drugs. You encounter somedrugs every day. Some drugs help sick people feel better. Some of these drugs you can get only from a doctor. Still, other drugsare taken for their effect on the brain. What Are Drugs? How can one class of substances be so many different things? A is any substance that causes a change in a person’s physical or psy-chological state. Thousands of different drugs exist and they can havemany different kinds of effects. Some drugs have one specific effect,while other drugs have many effects. Some drugs kill invading organ-isms. Other drugs, like the ones used for treating cancer, may evenmake someone who has cancer feel sick while they are helping theperson to get better. Some Drugs Are Medicines Any drug that is used to cure, pre- vent, or treat illness or discomfort is called a For example,the antibiotic penicillin is considered a medicine because it kills cer-tain types of bacteria that can infect us and make us sick. To be agood medicine, a drug must have the following qualities: >Effectiveness When a medicine is good at carrying out its task, doctors say it is effective. For example, penicillin is effective at killing certain types of bacteria. >Safety Good medicines also have to be safe. For example, penicillin wouldn’t be very useful if it damaged the heart whileit was killing bacteria. But penicillin does not damage theheart. So for most people, penicillin is safe to use.medicine.drugDrugsSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Listthree qualities that make a drug useful as a medicine. Name the two sources of all drugs. Identify four different types of medicines and their effects on the body. Identify five different ways that drugs can enter the body. Describe why some drugs are considered drugs of abuse.KEY TERMSKEY TERMS drug any substance that causes a change in a person’s physical or psychological state medicine any drug used to cure, prevent, or treat illness or discomfortside effect any effect that is caused by a drug and that is different from the drug’s intended effectprescription a written order from a doctor for a specific medicineover-the-counter (OTC) medicine any medicine that can be bought without a prescription Taking medicine is serious business. Always make sure you are wellinformed about the medicines you aretaking or need to take. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Drugs 219>Minor side effects No medicine is perfectly safe for everyone. Any effect that is caused by a drug and that is different from the drug’s intended effect is called a Common sideeffects of medicines include headache, sleepiness, or diarrhea.Most drugs have very minor side effects. If a medicine has toomany side effects or if the side effects are too severe, the medi-cine may not be safe to use, at least not by everyone. For exam-ple, some people can have an allergic reaction to penicillin.The reactions to penicillin can range from a rash to a feverand, very rarely, to death. Some Drugs Are “Drugs of Abuse” Drugs that are not medi- cines, such as cocaine, nicotine, alcohol, and marijuana, change theway the brain works in ways that are not healthy. A person takes drugslike these to change how he or she feels or how he or she senses theworld. The person may want to feel happier, or less sad or less anx-ious. Drugs that people take for mind-altering effects that have nomedical purpose are called drugs of abuse. Drugs that dramatically change your mood can be very danger- ous. Over time, any drug that affects the brain can change yourbehavior so that you can’t control your behavior.

This loss of controlcan lead to serious long-term health problems. Where Do Drugs Come From? Despite their differences, all drugs have one thing in common—they are all chemicals. In the past,all drugs came from natural sources such as plants, animals, andfungi. For example, opium, which has been used for thousands ofyears to treat pain and diarrhea, comes from the unripe seed capsulesof the opium poppy. Figure 1 shows a willow tree, the bark of which is the source of salicin, the chemical from which aspirin was developed. Many drugs are now created by scientists working in laboratories. Scientists can work on the structure of chemicals to change existingdrugs or develop new drugs. Every year, drug companies test thousandsof new chemicals to see if the chemicals might be effective as drugs.side effect.Some medicines, such as aspirin, were originally developed from substancesproduced by plants. Today manymedicines, including aspirin, arecreated by scientists in laboratories andare made by drug companies.1 Figure www.scilinks.org/health Topic: Drugs and Drug Abuse HealthLinks code: HH4050 Copyright © by Holt, Rinehart and Winston. All rights reserved. 220 CHAPTER 9 Understanding Drugs and MedicinesTypes of Medicines Medicines can be classified in many w ays. One useful way is to clas- sify them by what they do. This is how you will find medicines organ- ized in the drugstore or pharmacy. Table 1 lists some common kinds of medicines. Among the most common medicines are analgesics,antihistamines, and antacids. Some of these medicines require a pre-scription (pree SKRIP shuhn), while over-the-counter medicines do Classification Analgesic Antihistamine Antacid Antibiotic Bronchodilator Steroid anti-inflammatory Hormone Stimulant Antianxiety VaccineSedativeExample >acetaminophen >diphenhydramine >aluminum hydroxide >amoxicillin >salmeterol >cortisone cream >insulin >methylphenidate >alprazolam >meningitis vaccine >temazepamEffect>relieves pain >helps relieve minor allergy symptoms >neutralizes stomachacid for relief fromheartburn >kills bacteria to helpcure infections >opens airways to makebreathing easier forpeople with asthma >reduces inflammationand itching of skin >different hormoneswork differently;insulin lowers bloodglucose levels to helptreat diabetes >increases alertness;methylphenidate helpspeople with attentiondeficit hyperactivitydisorder (ADHD) tofocus their attention >helps people who areexcessively nervous orpanicked to calm down >prevents infections inpeople exposed to theinfectious agent >causes sleepinessAvailability >OTC >OTC >OTC >prescription >prescription >OTC >prescription >prescription >prescription >prescription >prescriptionTable 1 Types of Medicines Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Drugs 221not require a prescription. A is a written order from a doctor for a specific medicine. are medicines that can be bought without a prescription. Analgesics are medicines that relieve pain. Three com- mon types of OTC analgesics are aspirin, acetamino-phen, and ibuprofen. However, some very powerfulanalgesics may be bought only with a prescription.Examples of such analgesics are the opiates codeine andmorphine. Antihistamines are medicines that block the action of the body chemical histamine, which can causeallergy symptoms. Antacids are medicines that work against stomach acids which can cause heartburn. How Drugs Enter Your Body Most drugs are taken orally as capsules, liquids, or tablets. But Figure 2 shows many other ways that drugs can be taken into the body.These methods include >Implanted pumps Surgically implanted specialized pumps inject drugs directly into a specific part of the body. >Inhalation The drug enters the body through blood vessels in the lungs when it is inhaled. >Injection The drug is injected by using a hypodermic needle. >Transdermal patches The drug is packaged into patches that are placed on the skin. >Ingestion The drug is swallowed and absorbed through blood vessels in the intestines. >Topical application The drug is applied directly to certain areas of the body and absorbed into the skin.Over-the-counter (OTC) medicinesprescription REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Compare the term drug with the term medicine. 2.State the term used to describe an effect that is caused by a drug and that is different from the drug’s intended effect. 3.Compare prescription medicines to OTC medicines. Understanding Key Ideas 4.Listthree characteristics that make a drug useful as a medicine. 5.Name the two sources of all medicines and drugs.6.Name four medicines and their effects on the human body. 7.Identify the delivery method of a drug that enters the body through the intestine. a.inhalation c.transdermal patches b.ingestion d.topical application 8.State the reason why some drugs are considered drugs of abuse. Critical Thinking 9.Identify the best method for a doctor to give amedicine to a patient if the medicine is required to act very quickly. Explain your answer. Implanted pumps Injection beneath the skin (subcutaneous), into a vein (intravenous), or into a muscle (intramuscular)Inhalation Transdermal patches Ingestion Topical application Drugs can enter the body in many different ways. The need to keep thecorrect concentration of a drug at theright place for the right amount of timeis the reason behind the many deliverymethods. 2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 222 CHAPTER 9 Understanding Drugs and MedicinesDrugs as MedicinesSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Acentury ago, anyone could put some chemicals in a bottle and call it a medicine. Men traveled across the country sell-ing cures they had created themselves. Most of the time these cures did nothing but cost people money. On occasion the cures hurtor killed people. Approving Drugs for Medical Use Fake and dangerous drugs became such a problem that in the earlypart of the 20th century, the U.S. government started to make laws tohelp ensure that drugs were safe to use. In 1906, a government agencycalled the Food and Drug Administration (FDA) was created to con-trol the safety of food, drugs, and cosmetics. Testing a Drug The FDA has developed an approval process for companies that want to sell a drug in the United States. This process isneeded to prove the drug is safe and effective. After scientists developor discover a new drug, they test it. Initial testing takes place in labora-tories and may include chemical tests or tests on cell cultures (cellsgrown in a lab). After the initial tests are completed, all drugs aretested again on animals to be sure that they work and are safe. If the animal testing shows that the drug is safe, then testing for safety may begin on healthy human volunteers. If the drug passesthese first tests on humans, the drug is then tested on humans whohave the illness that the drug is meant to treat. These larger tests arecalled clinical trials. During clinical trials, the new drug is compared to existing drugs to see if it is safe and effective. If the clinical trials show that the drug is effective and safe, then the drug company can apply to the FDA for approval of the drug. TheFDA then approves or rejects the drug for sale to the public. OBJECTIVES Describe the process by which drugs are approved for medical use. State two reasons why prescriptions are required for some medicines. State two factors to consider when choosing over-the-counter (OTC) medicines. Describe three problems that can occur when taking some medicines. Listsix things you should do to be able to use medicines wisely. LIFE LIFE SKILLKEY TERMSKEY TERMS psychoactive describes a drug or medicine that affects the brain and changes how a person perceives, thinks, or feels generic medicine a medicine made by a company other than the company that developed the original medicine active ingredient the chemical component that gives a medicine its action drug interaction when a drug reacts with another drug, food, or dietary supplement such that the effect of one of the substances is greater or smaller If stores are allowed to sell dietary supplements, they must really work.Myth Dietary supplements are not regulated by the FDA. Their makers can sell them without proving they are effective.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Drugs as Medicines 223Prescription Medicines Even though the FDA has approved a drug or medicine as safe, some medicines can be bought only with a prescription. Such medicines oftentreat serious health conditions or are very powerful medicines. Prescrip-tion medicines should only be taken on recommendation by a doctor. Why Do I Need to Follow a Prescription? Prescriptions are always for a limited amount of a medicine, and they contain instruc-tions on when and how often the medicine should be taken. If youdon’t follow the instructions for prescription medicines, the medi-cine may not work or the medicine may be harmful. Antibiotics are examples of prescription medicines. You must continue taking antibiotics for a bacterial infection for as long as yourdoctor instructs. Even though you may start to feel better after a fewdays, the bacteria that caused the infection may not be completelyeliminated. If you stop taking the antibiotic too soon, the remainingbacteria can cause the infection to return. Because not all antibioticswork against all bacteria, your doctor will prescribe a specific antibi-otic for a specific illness. What Information Does a Prescription Have? When the doctor writes a prescription, the following information is included: >the dose (how much of the medicine you should take) >when you should take the medicine >how often you should take the medicine >the length of time you should take the medicine When the prescription is filled at the pharmacy, the pharmacist should make sure you receive the correct medicine. Specific instruc-tions are printed on the container. The pharmacist should also tellyou the information you need in order to take your medicine safely. Many pharmacies will also give you a drug information sheet. This sheet has all the information about the medicine, such as possible sideeffects and known interactions with other medicines. You should askfor this drug information sheet if you do not get it with your medicine. Misuse of Prescription Medicines The only person who should take a prescription medicine is the person whose nameappears on the label. For example, even if you and your friend thinkyou have the same illness, never take your friend’s prescription medi-cine. You may not have the same illness, or the strength of yourfriend’s medicine may be more or less than you need, or you could beallergic to the medicine. Many prescription drugs are abused. This abuse can involve taking medicine when it is not needed, taking too much medicine, or mixingmore than one kind of medicine. Drugs and medicines that affect the brain and change how we perceive, think, or feel, are called Psychoactive medicines and drugs are especially likely to be abused. You should take a psychoactive medicine only if it hasbeen prescribed for you by a doctor. psychoactive. Questions to Ask When Your Doctor Prescribes a Medicine >Why do I need to take this medicine? >When should I take the medicine? >For how long should I take themedicine? >Are there any side effects? >What should I do if a side effectoccurs? >Should I avoid any other medica-tions, dietary supplements, foods,drinks, or activities while I takethe medicine? >What do I do if I miss a dose? >What are the brand names andgeneric names of this medicine? >Can I take the generic medicine? Copyright © by Holt, Rinehart and Winston. All rights reserved. 224 CHAPTER 9 Understanding Drugs and MedicinesOver-the-Counter (OTC) Medicines Most grocery stores and drugstores have at least one aisle of OTC medicines. You can buy OTC medicines without a prescription. Over-the-counter medicines include analgesics, cold remedies, antacids,and medicines to treat rashes and other skin problems. Benefits of OTC Medicines Most OTC medicines are used for common illnesses, injuries, and disorders. For example, you can treata headache with acetaminophen ( ASi tuh MIN uh fuhn), a seasonal allergy with diphenhydramine ( DIEfen HIE druh meen), an itchy skin rash with a cortisone cream, and a stuffy nose with pseu-doephedrine ( SOO doh e FE drin). If you use OTC medicines care- fully, they can help relieve your minor illnesses. Choosing an OTC Medicine A wide variety of OTC medicines are available. But there are often many different brands of medicinesthat have different prices and that are used to treat the same problem.How should you choose one medicine over another? 1. Decide what kind of OTC will work for you. Read the list of uses to find out if the medicine can relieve your illness. Some OTC drugsmay sound like they do the same thing but they have very differ- ent effects on the body. Take cough suppressants and coughexpectorants for example. Both are called cough medicines, but acough suppressant stops a dry, tickly cough whereas a coughexpectorant loosens up chest congestion in a person with a chestinfection. 2. Decide whether you want generic or a brand-name medicine. There are both brand-name and generic formulations of manyOTC medicines. A is a medicine that is made bya company other than the company that developed the originalmedicine. Generic drugs are chemically identical to the originaldrug. Both generic medicines and brand-name medicines containthe same active ingredient. The is the chemical active ingredientgeneric medicine Sometimes, choosing an OTC medicine can be overwhelming. “OTC medicines are sold without a prescription, so they must be completely safe. ” “OTC medicines can cure diseases so that you don’t have to go to the doctor. ” “Herbal medicines are safe because they’re natural.” “I should take more of a medicine if my symptoms get worse. ”OTC medicines can be dangerous when used improperly or if you are allergic to them. OTC medicines treat symptoms but cannot cure an illness. Herbal medicines are not regulated by the FDA, so they’re not proven safe or effective. You should never increase your dose of medicine without first checking with your doctor.Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Drugs as Medicines 225component that gives a medicine its action. For example, ibupro- fen is made by many companies and is the active ingredient inmany products that relieve pain. The difference between genericand brand-name medicines is mainly in the inactive ingredients.These ingredients include fillers that give pills their size, shape,color, and coating and that add to the color and flavor of liquidmedicines. 3. Read the label. All medicines can be dangerous if they are not taken properly. Because of this, all OTC medicines have very specific warnings on their labels. These warnings, as shown in Figure 3, alert you to potential dangers. The label also tells you what dose of medicine you should take. Misuse of OTC Medicines In general, OTC medicines treat symptoms, not the disease that causes the symptoms. For example,you may use ibuprofen for a headache that lasts an evening. Or youmay use a decongestant, such as pseudoephedrine, to help youbreathe easier for a few days while you have a cold. However, long-term use of OTC medicines can cover up pain or discomfort that is your body’s way of telling you something is wrong.Treating a chronic headache or any other pain with regular use ofpainkillers may delay the diagnosis of a more serious condition. Ifsymptoms last longer than a few days you should consult a doctor.Examining your daily habits may help you find the reasons for someof your symptoms. Chronic stress, for example, can lead to headachesand stomachaches. A change in lifestyle could solve those problems. The labels on OTC medicines provide the information you need to take themedicine safely. ACTIVITY Compare the recommended dose for an adult with the dose for a 10- year-old child.3 FigureUses The list of uses helps you find out if themedicine can relieveyour symptoms.Directions Directions indicate thecorrect dosage andfrequency of dosage foradults and children.Ingredients Active ingredients are listed byamount, usually in milligrams(mg) per dose or half dose.Inactive ingredients are alsosometimes listed. Warnings The warnings informyou of possible sideeffects, unfavorabledrug interactions,and the likelihood ofoverdose. For more information about evaluating health products, see the Express Lesson on pp. 562–563 ofthis text.HandbookHEALTHHow to Read an OTC Label Copyright © by Holt, Rinehart and Winston. All rights reserved. 226 CHAPTER 9 Understanding Drugs and MedicinesHerbal Remedies and Dietary Supplements Most pharma- cies now sell herbal remedies and dietary supplements. The makers of these products may claim their product prevents or treatscertain diseases and conditions. However, dietary supplements andherbal remedies do not have to be approved by the FDA. Therefore,they do not have to be proven to be safe and effective as OTC andprescription medicines do. The health claims made about prescription and OTC medicines are supported by scientific research that has been evaluated by theFDA. The only way claims about a dietary supplement can be similarto health claims about OTC medicines is if supplement makers puton the label a disclaimer that says, “This statement has not been eval-uated by the FDA. This product is not intended to diagnose, treat,cure, or prevent any disease.” Evidence from scientific research, espe-cially well-designed clinical trials, is the best way to know if a drugworks and if it is safe. Many people think that products derived from plants and ani- mals—natural products—are purer and safer than products that aremade in a laboratory. However, anything, including a plant, that isput into a bottle to be sold as a supplement has been purified in alaboratory. Also, even though something is a natural product, it doesnot mean it is safer. Some of the most toxic compounds known toscience are completely natural! Possible Problems with Medicines When taken as directed, most medicines are safe. However, problemscan occur when using medicines. These problems include allergicreactions, side effects, and drug interactions. Allergic Reactions Allergic reactions are the most serious risks to taking medicines. Medicines such as penicillin and some relatedantibiotics are known to cause allergic reactions in some people.Insulin derived from animals, medicines used to treat epilepsy, andsome sleeping pills are also known to cause allergic reactions. Allergic reactions can range from mild itchiness to severe skin rashes, as shown in Figure 4. A life-threatening condition called ana- phylactic shock (ANuh fuh LAK tik SHAHK) is the most serious kind of allergic reaction. Anaphylactic shock is a severe allergic response ofalmost the entire body that includes the following conditions: >itching all over the body >swelling, especially in the mouth or throat >wheezing or difficulty in breathing >a pounding heart >fainting and unconsciousness These symptoms signal a life-threatening medical emergency that needs immediate medical attention. If you or anyone you knowdevelop these symptoms shortly after taking a medicine, emergency medical help should be sought right away. This is an example of someone who had an allergic skin reaction to a medicine. ACTIVITY Identify what this person should do.4 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. The first place to spot most allergic reactions is on your skin. So if you start to itch or if you get a rash after taking a medicine, stop taking it immediately and call your doctor.Be sure to tell your doctor about your allergic reactionbefore the doctor prescribes any kind of medicine for youagain or before you decide to take an OTC medication. Side Effects Another potential problem with medi- cines is that they may produce side effects. While medicineallergies are rare, side effects are common. Antibiotics, forexample, not only kill invading bacteria, but they also killbacteria that normally live in your intestines and help keepyou healthy. When these helpful bacteria are killed, youcan get diarrhea. Drowsiness is a common side effect ofmany antihistamines and cough medicines. Aspirin is another example of a frequently used medi- cine that can have side effects. One of its side effects is to cause dam-age to the lining of the stomach. This side effect can lead to bleedingor ulcers. So if you get pains in your stomach while taking aspirin,you should stop taking the drug right away. Drugs that containibuprofen and related pain relievers can also cause stomach ulcers. In addition, any child or teen who has symptoms of a cold, the flu, chickenpox, or a disease that causes a fever should never takeaspirin. The combination of aspirin and these diseases can cause orincrease the risk for a dangerous condition called Reye’s (RIEZ) syn-drome. Reye’s syndrome is a relatively rare disease that primarilyaffects children and teens under the age of 16. Reye’s syndrome cancause liver failure and brain damage, and the syndrome can some-times be fatal. Drug Interactions Drug interactions are another potential prob- lem with medicines. occur when a drug reacts withanother drug, food, or dietary supplement to increase or decrease theeffect of one of the substances. Drug interactions are described on thelabel on any OTC package or the drug information sheet that comeswith a prescription medicine. For example, sedatives, tranquilizers, alcohol, and some antihis- tamines cause drowsiness. Taking any combination of these drugs atthe same time could make you very drowsy and decrease your coordi-nation. At that point, driving a car or doing anything else thatrequires concentration and coordination could be dangerous. You must know about drug interactions before you start mixing medicines. Always check the label or drug information sheet beforeyou take any medicine. You should tell your doctor and pharmacist ifyou are taking any other medicines or herbal remedies or dietary sup-plements before you start to take a new prescription or OTC medi-cine. By volunteering information about yourself and askingquestions about new medicines, you can reduce your risk of drugallergies, side effects, and drug interactions. Drug interactions SECTION 2 Drugs as Medicines 227“I took anantihistamine with my cold medicine before I read the label. The cold medicine had an antihistamine too. I couldn’t stay awake for the rest of the day.” Copyright © by Holt, Rinehart and Winston. All rights reserved. 228 CHAPTER 9 Understanding Drugs and MedicinesUsing Medicines Wisely Taking the correct amounts of the correct medicine is very important. There are several important things you can do to make your medi-cines as safe and as effective as possible. 1. Make yourself a part of your own healthcare team. This team includes you, at least one parent or guardian, and any healthcareproviders. Once you realize that you are part of the team, and notjust a passive recipient of care, you have taken a big step towardsensuring your own health and safety. You must speak up. Yourhealthcare team can only do its best job caring for you if it knowsall about you. Tell members of the team your complete medicalhistory and be especially careful to mention any previous drugreactions or known allergies. Also, be sure to note any medicinesand dietary supplements you already take. Your parents can helpwith your childhood medical history. 2. Be prepared to ask questions. Make sure you know and under- stand what is going on with your health. You may want to writedown important questions ahead of time. You can also take notesor have a parent or other adult with you to hear what the doctoror healthcare professional is saying. Analyzin gDA TA Analyzing DATA Reading a Prescription Label Patient’s name and address Prescription number and dates prescription was written and filledInstructions for taking medicineQuantity of medicine provided, name and strength of medicine, and doctor’s name Side-effect warningsRefill information and expiration date 654321 Your Turn 1.How often should this patient take her medicine? 2.When the patient finishes themedicine, will she be able toget a refill? 3.What is a possible side effectof this medicine? 4.How many days will it take for the person to finish the medicine provided? 5. CRITICAL THINKING Do you think it’s safe for this per-son to stop taking this medi-cine once she begins to feelbetter? 1 43 5 62MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 3. Learn the facts about any medicine you are going to take. If you are considering an OTC medicine, talk to the pharmacist about drug interactions and side effects. 4. Listen to your body. Once you have the medication, make sure that you read the label and drug information sheet carefully. Be sure to follow the instructions com-pletely. You must pay attention to your own body. Ifyou notice anything strange (like itching or headaches)or anything your doctor didn’t warn you about, tellyour parents and talk to your doctor right away. 5. It’s not always safe to suddenly stop taking a drug. Try to get your doctor’s advice before changing yourdosage or intervals between doses, unless you havesymptoms

of an allergic reaction. 6. Speak up and enlist your parents’ help. If you feel uneasy about your medicine, speak up. Even thougha medicine is effective, it may be the wrong medicinefor you. It’s your job to protect yourself by beingcareful about how you use medicines and by becom-ing an active member of your healthcare team. Remember, when you take medicines, knowledge is power. You can get the best results from your medicine and take your medicine in the safest way by knowingabout the medicine you have to take and by following thetips in Figure 5. If you’re not sure about something, ask your doctor or pharmacist. SECTION 2 Drugs as Medicines 229 REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the term that describes a drug that changes how a person perceives, thinks, or feels. 2.Define the term generic medicine. 3.Distinguish the active ingredient from other ingredients in medicines. 4.Name the term for what can happen if you take an antihistamine and cold medicine together. Understanding Key Ideas 5.Summarize the role of the FDA in the drug approval process.6.Listthree reasons you need a prescription to get certain medicines. 7.Listthe important things to consider when choosing an OTC medicine.8.Describe three problems that can occur when taking a medicine.9. Communicating Effectively List five questions you should ask your doctor if you are given a prescription for a medicine. Critical Thinking 10. Practicing Wellness Your friend regularly takes an antacid after meals. She saysthey are harmless and “help settle her stomach.”Is your friend using her medicine wisely? Explain. LIFE LIFE SKILLLIFE LIFE SKILLTell your doctor your health history and anydrug reactions youhave. Pay attention to warning labels. Ask your doctor or pharmacist beforecombining medicines. Call your doctor immediately if younotice signs of anallergic reaction. Complete the whole prescription ofantibiotics.Don’t hide healthinformation from yourdoctor—even theembarrassing stuff. Don’t mix medicines that cause drowsiness. Don’t take medicines that are prescribed forsomeone else. Don’t continue to take medicines thatmake you feel worse. Don’t stop taking your antibiotics when youfeel better. Do Don’t Failing to use prescription medicines correctly can havevery serious consequences.5 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 230 CHAPTER 9 Understanding Drugs and MedicinesDrugs and the BrainSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Your brain creates all of your thoughts, perceptions of the world, feelings, personality, and physical responses. Drugsthat affect your brain can change all of these things. How Drugs That Affect the Brain Work Your brain is made up of billions of nerve cells called neurons . Each neuron makes many connections with other neurons .The brain uses all these neurons and their billions of connections to process information. How Messages Are Sent in the Brain The information proc- essing in the brain takes place at the connections between neurons.These connections are called synapses. Synapses are tiny spaces between two neurons. What happens in these tiny spaces is veryimportant. As shown in Figure 6 ,for the brain to send a message, one neuron releases a special chemical messenger, called a neurotransmit- ter,into the synapse. There are many different types of neurotransmit- ters. The neurotransmitter moves across the synapse and attaches to the neuron that is to receive the message. This attachment, calledbinding, is the actual receiving of the chemical message. Examples of neurotransmitters are serotonin ( SIRuh TOH nin), dopamine (DOH puh MEEN ), and epinephrine ( EPuh NEF rin). Drugs Can Change How Messages Are Sent Some drugs can change the way neurons communicate with each other. These drugsact like neurotransmitters, block neurotransmitters, or change theamount of a neurotransmitter in synapses. Changing the communi-cation between neurons by interfering with neurotransmitterschanges the way we sense, feel, and respond to the world around us.Changing chemical messages between neurons by use of drugs can insome cases benefit health but in other cases is harmful.OBJECTIVES Describe how drugs that affect the brain work. State how drugs can affect a person’s emotions. Describe how addiction can develop from experimentation. Summarize the role of withdrawal in maintaining a drug addiction. Describe why addiction is considered a treatable and avoidable disease. LIFE LIFE SKILLKEY TERMSKEY TERMS addiction a condition in which a person can no longer control his or her drug use drug tolerance a condition in which a user needs more of a drug to get the same effect physical dependence a condition in which the body relies on a given drug in order to functionwithdrawal uncomfortable physical and psycho- logical symptoms produced when a physically dependent drug user stops using drugs People abuse drugs that affect only the brain. No one abuses a drug because of what it does to his or her stomach, lungs, or liver. Copyright © by Holt, Rinehart and Winston. All rights reserved. Vision Emotion Reflexes Speech Judgment CoordinationNeuron sending messageNeuron receivingmessage Neurotransmitter Synapse SECTION 3 Drugs and the Brain 231Messages in the Brain Determine Our Moods When you are feeling relaxed, having your dog nuzzle you and lick your face is fun. When you are feeling rushed and stressed, her playfulness is annoy-ing, so you push her away. The action of certain neurotransmitters isthe basis for our different moods and emotions. How you view yourdog’s behavior on those two different days depends on which neuro-transmitters are released in your brain. Serotonin, for example, is aneurotransmitter that greatly affects our actions and reactions to theoutside world. People who are depressed may have a reducedamount of the neurotransmitter serotonin to activate neurons. Drugs Can Affect Emotions Antidepressants are examples of drugs that change the way the brain works in a beneficial way. By cor-recting the levels of serotonin in synapses, certain antidepressant med-icines can help reduce depression. Other mood-altering medicineswork by changing the levels or effectiveness of other neurotransmitters. Drugs of abuse, such as marijuana, cocaine, and nicotine, inter- rupt the balance between the many neurotransmitters needed fornormal brain functioning. These drugs alter our judgment in waysthat affect our ability to understand and deal with reality. If drugs likethese are taken over a long period of time, they can create the power-ful changes in feelings and behavior that lead to addiction. is a condition in which a person can no longer control his or her druguse. When a person becomes addicted to a drug, he or she has devel-oped a physical need for the drug, and can’t function without it. AddictionNeurons communicate with each other by neurotransmitters. Drugs that affectthe brain change how the neurotrans-mitters are sent or received. Thus, such drugs can change one’s feelings,perceptions, and actions.6 Figure For more information about your brain, see the Express Lesson on pp. 516–519 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 232 CHAPTER 9 Understanding Drugs and MedicinesThe Path to Addiction Almost all drugs of abuse activate one set of brain structures. These parts of the brain are together called the brain reward system. This sys- tem serves to reinforce healthy behavior, such as eating when you arehungry. To encourage the body to repeat such healthy behaviors, theneurons of the brain reward system release the neurotransmitterdopamine. Dopamine lets us feel pleasure. The pleasure or “reward” we get from activities like eating is rela- tively small. But when drugs of abuse, such as cocaine or alcohol,turn on the brain reward system, the reward or pleasure can be verypowerful. The pleasure that these drugs produce tricks the brain intobelieving that taking the drug is good for the body. The Dangers of Drug Use Getting pleasure is one reason why people repeatedly abuse drugs. But the pleasure alone does notexplain how people get addicted. No one starts using drugs tobecome an addict. But every addict starts as someone experimentingwith drugs. At some point, people who become addicts move fromexperimentation to a more regular pattern of abuse. Drug use produces biological changes in the brain that change the way the brain works—possibly permanently. Adolescent brainsare more vulnerable to the effects of drugs than adult brains are. Thisis because the adolescent brain, along with the adolescent personalityand body, is still growing and developing. Taking drugs interfereswith the normal changes that occur at this important time of life. Tolerance The first change in a drug user’s body is a condition called drug tolerance . develops after repeated drug use when the user finds that it takes more of a drug to get the same effect.Because drug tolerance requires a person to take more drug to get thesame effect, it sets the stage for another biological response to con-tinue drug use—physical dependence.Drug tolerance Behavioral Warning Signs of Addiction >Loss of interest in schoolwork >Dramatic change of appearance >Change of friends >Unexplained mood swings >Absences from school >Dramatic change in eating habits >Excessive secretiveness or lying >Unexplained need for money www.scilinks.org/health Topic: Drug and Alcohol Abuse HealthLinks: HH4048 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Drugs and the Brain 233Physical Dependence After repeated high-dose drug use, a per- son finds that he or she cannot function properly without taking the drug. The condition in which the body relies on a given drug in orderto function is known as When people becomedependent, the brain neurons and body cells respond to the presenceof the drug by changing how they work. The body cells of a drug-dependent person need the drug in order to work normally. Becausedrugs of abuse interfere with the production of certain neurotrans-mitters, the neurons then try to “cancel out” such effects by becomingmore or less responsive to those neurotransmitters. Addiction While drugs are changing the abuser’s brain, he or she is also learning drug abuse behaviors and attitudes. When peoplebecome addicted to drugs, they lose control of their behavior. Theystop doing almost everything else and need to seek and use drugs.Addicts even use drugs when drug use leads to severe consequencessuch as dropping out of school or being arrested. An addict learns how to get drugs, how to take them, and, some- times, how to lie and steal to get drugs. Also, an addict learns to bedistrustful and paranoid. But most of all, addicts learn to use drugs todeal with their emotional problems. This way of dealing with prob-lems prevents the development of normal coping skills that are a partof growing up. An addict’s brain is not like a normal brain. This iswhy drug addiction is now known as a brain disorder. Figure 7 out- lines how this complex disorder develops. Withdrawal Neurons can keep the working balance that has been established during physical dependence as long as the personkeeps taking the drug. But if the drug is suddenly removed, the neu-rons work abnormally. The uncomfortable physical and psychologi-cal symptoms produced when a physically dependent drug userstops using drugs is called Withdrawal is characterized mostly by symptoms that are oppo- site of the drug’s effect. Withdrawal keeps addiction going becausethe distressing symptoms drive the addict to take more drug to alle-viate the symptoms. Craving the drug is the brain’s way of telling thebody it needs more of the drug. By now, the addict feels normal onlywhen he or she has the drug in his or her body. withdrawal.physical dependence. Drug Addiction Drug Use Drug use activates the brain reward system (pleasure system). Tolerance Dependence Addiction The drug user needs more of the drugto produce thesame effect.The drug user experiencesuncomfortable withdrawalsymptoms if he or she tries to stop using the drug.The drug user is both physically and psychologically dependent on the drug. Addiction is a complex disorder in which the addict has developed aphysical and psychological need for adrug and can’t function without it.7 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 234 CHAPTER 9 Understanding Drugs and MedicinesAddiction Is a Treatable Disease Many people believe that when a person becomes addicted, he or she will use drugs for the rest of his or herlife. This belief is not true. Many drug abusers and addictsfree themselves from drug dependency every day. However,fighting an addiction to any drug is not easy because allpeople who are addicted to drugs are both physically andpsychologically dependent on drugs. Most communities offer a variety of treatment pro- grams. In treatment, patients receive help in getting off thedrug to which they are addicted, as well as counseling tounderstand why they have become addicted. Counselingalso helps the addict cope with life without the drug. Thesooner treatment is started, the easier it is to do. So thesooner an addict, or a drug abuser who is on his way tobecoming an addict, starts treatment, the better. Anddespite all the brain changes that happen and behaviorsthat addicts learn, they can recover. There is one foolproof way to avoid addiction—don’t use drugs of abuse. Nicotine and alcohol, both of whichare highly addictive, are illegal for teens to use. So youdon’t need an excuse not to use them. And despite the wayit may seem, everybody is not doing drugs. Three-quartersof 16-year-olds don’t drink alcohol or use marijuana, and98 percent don’t use cocaine or heroin. Fifty percent of 16- year-olds have never smoked a single cigarette. You can find friendswho don’t do drugs because you know it’s the smart thing to do. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term addiction. 2.Differentiate drug tolerance from physical dependence. 3.Name the term that means “the uncomfortable physical and psychological symptoms produced when a physically dependent drug user stopsusing drugs.” Understanding Key Ideas 4.Describe how drugs can change the way the brain works. 5.Describe how drugs can affect your emotions.6.Identify the term that is nota stage in the path to addiction. a.tolerance c.drug use b.dependence d.side effect 7.State reasons why addiction can be difficult to overcome. 8.Describe the relationship between physical dependence and withdrawal. 9. Using Community Resources What resources are available to a drug addict to help him or her begin recovery from a drug addiction? Critical Thinking 10. Practicing Wellness Why is it important to avoid starting to take drugs?LIFE LIFE SKILLLIFE LIFE SKILL You and Dave used to spend a lot of time together shooting hoops and surfing the Internet. But forthe last few months, Dave has been hanging outwith a new group. He used to really care abouthow he looks, but now he looks terrible. Todayhe asked you for the third time if he could bor-row $10. When you told him he hadn’t paid youback from the last time, he stormed off andwarned you to stay away from him. You suspectthat Dave is using drugs. Write on a separate piece of paper how you would ask your friend if he has a drug problem.Remember to use the decision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 9 Highlights 235 CHAP TER 9 CHAP TER 9 CHAPTER 9Highlights Key Terms The Big Picture ✔Drugs that affect your emotions do so by changing the way neurons send and receive neurotransmitters. ✔Areas of the brain called the brain reward system are involved in feelings of pleasure. These areas are stimulated by almost alldrugs of abuse. ✔Becoming addicted to a drug over time involves drug use,tolerance, and physical dependence on the drug. ✔The unpleasant physical and mental effects of withdrawal cankeep an addiction going. ✔Addiction is a brain disorder. Treating an addict involves helping the addict get over his or her physical dependence, learning newbehaviors to stay drug free, and understanding the reasons that thedrug use started. ✔The majority of teens do not use illegal drugs.SECTION 3 addiction (231) drug tolerance (232) physical dependence (233) withdrawal (233) ✔A drug is any substance that causes a change in a person’s physical or emotional condition. ✔The term drug can refer either to a medicine or to a drug of abuse. ✔Drugs come from nature and are also created in laboratories. ✔Good medicines are safe and effective and have few side effects. ✔Drugs are classified by what they do. ✔Drugs can enter the body in many ways, including by inhalation,ingestion, transdermal application, injection, as well as topicallyand through implanted pumps.SECTION 1 drug (218) medicine (218) side effect (219) prescription (221) over-the-counter (OTC) medicine (221) ✔The Food and Drug Administration (FDA) is the governmentagency that regulates the safety and effectiveness of medicines. ✔A doctor’s prescription is needed to get medicines that treatserious health conditions or that are very powerful drugs. ✔Over-the-counter medicines usually treat symptoms rather thancure diseases. When choosing an OTC medicine, you should consider whether the OTC medicine is best suited to treating yourillness. ✔Some medicines can cause allergic reactions or side effects or canreact negatively with other medicines. ✔To use a medicine properly, safely, and effectively, be sure youare informed about the medicine before you take it. ✔Health claims made about herbal remedies and dietary supple-ments do not have to be not backed by scientific research. SECTION 2 psychoactive (223) generic medicine (224) active ingredient (224) drug interaction (227) Copyright © by H olt, Rinehart and Winston. All rights rese rved. 236 CHAPTER 9 Review CHAP TER 9 CHAP TER 9 CHAPTER 9Review Using Key Terms active ingredient (224) addiction (231) drug (218) drug interaction (227) drug tolerance (232) generic medicine (224) medicine (218) over-the-counter (OTC) medicine (221) physical dependence (233) prescription (221) psychoactive (223) side effect (219) withdrawal (233) 1.For each definition below, choose the key term that best matches the definition. a.a medicine that can be obtained only with awritten order from a doctor b.a term used for a drug or medicine that has aspecific effect on the brain c.a medicine that is made by a company otherthan the company that developed the medicine d.an unintended and sometimes harmful effectof a drug e.condition in which a drug user needs more ofa drug to get the same effect 2.Explain the relationship between the key terms ineach of the following pairs. a.physical dependence and withdrawal b.drug and medicine c.drug tolerance and addiction d.over-the-counter medicine and prescription e.active ingredient and drug interaction Understanding Key Ideas Section 1 3.Why are all drugs not medicines? 4.What are three key characteristics of a goodmedicine? 5.From what two sources do all drugs and medicinescome from?6.Analgesics a.relieve allergy symptoms. b.kill harmful bacteria. c.relieve pain. d.soothe itchy skin. 7.List the ways that drugs can enter the body. 8.Explain why some drugs are called drugs of abuse. 9.CRITICAL THINKING How do you think medi- cines have affected how long you will live? Section 2 10.What is the role of clinical trials in the drugapproval process? 11.Why are some medicines available only byprescription? 12.Which of the following is the least important toconsider when choosing an OTC medicine? a.active ingredient b.possible side effects c.brand name d.drug interactions 13.List four side effects of some medicines. 14.List the things you should ask your doctor about any medicine she or he prescribes to you. 15.CRITICAL THINKING Explain the advantages of being an active member of your healthcare team. Section 3 16.Describe how messages are sent in the brain. 17.How do some drugs affect emotions? 18.Identify four behaviors that could be warningsigns of drug abuse and addiction. 19.Describe the role of withdrawal in maintaining adrug addiction. 20.CRITICAL THINKING Evaluate the following statement: “Drug addiction is preventable.” LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 9 Review 237Interpreting Graphics Study the figure below to answer the questions that follow. 21.What are the most commonly abused prescrip- tion drugs? 22.Using the data in the graph, estimatethe total number of people who abuseprescription drugs. 23.CRITICAL THINKING Why do you think these particular drugs are the most commonly abused?Activities 24. Health and You Select an advertisement for an OTC drug. Analyze the claims and benefits givenin the advertisement. How does the advertisementtry to sell the drug? Rewrite the advertisement,and give suggestions for relieving the problemwithout use of the drug. 25. Health and Your Community Long-term self- medication with OTC medicines is becomingmore common. Write a one-page report thatpresents possible reasons for this trend. Explainpossible health problems the overuse of OTCmedicines can lead to. 26. Health and You Write a reply to the following statement: “Just try it once; one try won’t harmyou. It’s not like you’ll become an addictovernight!” Action Plan 27. Setting Goals You have a choice about how much you rely on drugs to relievesymptoms brought on by stress. Create a plan torestrict your reliance on drugs. LIFE LIFE SKILL 28.In this passage, the word harnessed means Amade. Bpromoted. Ccaptured. Ddistributed. 29. What can you infer from reading this passage? EStar Energy will work for you. FThis is an advertisement. GStar Energy is an OTC medicine. HStar Energy has been approved by the FDA. 30.Write a paragraph on the methods that are used in this advertisement to make the product soundeffective. 31.Because it is natural, is Star Energy any safer ormore effective than a drug made in a laboratory?Explain. 32.Do you think this product could be abused? READING SKILLWRITING SKILLMATH SKILL Read the passage below, and then answer the questions that follow. We have created a product to blast your body with pure energy. Star Energy is anall-natural substance made from the flowers of Grameninis energicium. We have now harnessed the natural goodness of Grameninis for you to enjoy its health ben- efits. Star Energy is the most complete anddynamic natural energy formula ever devel-oped. You’ll instantly feel the difference inyour energy levels. M any nutrition experts use Star Energy as a part of their weight-training program to boost muscle develop-ment. Just one tablet a day! 2.5 2.0 1.5 1.00.5 0Millions of people who misuse drugs StimulantsAntianxiety medicinesPain relieversMisuse of Prescription Drugs in the U.S. Source: National Household Survey on Drug Abuse. Copyright © by Holt, Rinehart and Winston. All rights reserved. Prescription Drugs and the Media In 1555, the Royal College of Physicians in London declared that no doctor could tell a patient anythingabout a medicine, including its name. Doctors inthose days were concerned that patients would hurtthemselves by using medicines unwisely. This cautious attitude persisted in the medical commu-nity for more than 450 years, but things havechanged in modern times. Direct-to-Consumer Advertising Prescription drugs are now so widely advertised inmagazines, on the Internet, on the radio, and especially on TV that they affect every person livingin this country. This kind of advertising is calleddirect-to-consumer (DTC) advertising. In 2001, the pharmaceutical industry spent $2.5 billion on DTCadvertising in the United States. Pharmaceuticalcompanies spent $1.5 billion on TV advertisingalone. Drug Advertising Affects People’s Actions In 1999, one national newsmagazine containedmore than 18 pages of advertisements for prescrip-tion drugs. Does all of this advertising affect people’s choices about medicine? The answerappears to be yes. Thirty percent of all people whosee these ads and then go to a doctor ask for anadvertised product. More astoundingly, almost halfof the doctors give the patient a prescription for thespecific drug requested. Only one in four doctorsrecommends another drug. In short, people aremotivated by the ads, and their doctors are likely togive them requested drugs.There was a time when drug companies did not advertise prescription drugs on TVor in magazines. Now, we see such adsoften. But are these advertisements goodfor your health? MEDIA HealthHealthWorldWorldHealthHealthWorldWorldHealthWorld YOURYOUR 238Copyright © by Holt, Rinehart and Winston. All rights reserved. Advertising Prescription Drugs Has Benefits Many people in the drug and medical field suggestthat these ads provide great benefits to you, the consumer. They argue that a consumer has a right tolearn about the drugs that are available to treat asymptom. Advertising, they say, is a form of educa-tion. If you have asthma, for example, shouldn’t youhave a right to know which asthma drugs you canuse? Why should only a doctor have access to suchinformation? Another argument in favor of DTC advertising is that it makes money for the pharmaceutical industry.This money, supporters of DTC

argue, helps pay forthe costly development of current drugs and for thedevelopment of new drugs. Drug Advertising Has Drawbacks Along with the growth in drug advertising has comea steady growth of criticism. Consumer groups andphysicians have complained that advertising sometimes causes people to make bad choices. Oneargument is that drug ads blur the distinctionbetween providing information and promoting goodhealthcare. When doctors tell patients that the spe-cific drug they asked for may not be good for them,the patients often react with anger and frustration.They may demand a specific drug even when anotheris as good, better, or even cheaper. Many doctors saythat they feel pressured by patients who had read ads. Being Aware of the Media’sInfluence The media—TV, radio, Internet, newspapers, andmagazines—affects everybody’s life. The suddengrowth in DTC advertising of prescription drugsmeans that all of us must become wise consumers.Advertising should not be accepted without ques-tion. Your best course of action is to use your physician as a partner in your healthcare. Ask your doctor ques-tions, and listen responsibly to the answers and sug-gestions. Likewise, all of us must bring skepticism towhat we see and hear, especially when someone istrying to sell us something. Drug advertisementsmay indeed help us make better choices, but if usedunwisely, they may compromise our health. YOUR TURN 1. Summarizing Information Give one argument for and one argument against advertising prescription drugs. 2. Analyzing Methods Check some current magazines in terms of numbers and types ofdrug advertisements. How does each adattempt to sell the drug? Discuss your findings. 3. CRITICAL THINKING How can you deter- mine if a drug advertisement is telling youall of the facts about treating a specific illness or using a specific drug? www.scilinks.org/health Topic: Prescription Drugs HealthLinks code: HH4239 Copyright © by Holt, Rinehart and Winston. All rights reserved. 240KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.A shot of vodka has the same amount of alcohol that a can of beer has. 2.Most of the problems caused by alcohol aredue to loss of judgment. 3.One drink can affect a person’s ability to drive. 4.Alcohol overdose can be fatal. 5.Children of alcoholics have an increased riskof becoming alcoholics. 6.Alcoholism affects only the alcoholic. 7.Drunk driving is the No. 1 cause of deathamong teens in the United States. CHAP TER 10 CHAP TER 10 CHAPTER 10 AlcoholAlcoholAlcohol Copyright © by Holt, Rinehart and Winston. All rights reserved. 241SECTION 1 Alcohol Affects the Body SECTION 2 Alcoholism Affectsthe Family andSociety SECTION 3 Teens and Alcohol go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH10. Copyright © by Holt, Rinehart and Winston. All rights reserved. 242 CHAPTER 10 AlcoholAlicia was throwing a party. David thought the party would be fun, but he was nervous. There was going to be beer at the party, but he didn’t want to drink. Would others think he wasn’t cool if they found out he wouldn’t drink? Alcohol Is a Drug is the drug found in beer, wine, and liquor that causes intoxi- cation. Alcohol is considered a drug because it causes a change in aperson’s physical and emotional state. The physical and mentalchanges produced by drinking alcohol are called All forms of alcohol are dangerous. Many people think that beer is safer than liquor because beer is not as strong. This is not true. Onebeer contains the same amount of alcohol as a glass of wine or a shotof vodka. No alcoholic beverage is safe. And for people in the UnitedStates under the age of 21, no alcoholic beverage is legal to consume.intoxication.AlcoholAlcohol Affects the BodySECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES State why alcohol is considered a drug. Listthe short-term effects of alcohol use. Describe the long-term damage that alcohol does to the organs of the body. Identify three reasons you should not drink alcohol. LIFE LIFE SKILLKEY TERMSKEY TERMS alcohol the drug in wine, beer, and liquor that causes intoxication intoxication the physical and mental changes produced by drinking alcoholblood alcohol concentration (BAC) the amount of alcohol in a person’s blood, expressed as a percentage binge drinking the act of drinking five or more drinks in one sittingcirrhosis a deadly disease that replaces healthy liver tissue with scar tissue; most often caused by long-term alcohol abuse “Drinking a beer will make me look more mature. ” “If alcohol were that dangerous, it wouldn’t be legal for adults. ” “If I’ve had a few beers, I can drink some coffee before I drive and still be safe. ” “Parties make me nervous, so I need a beer to loosen up. ”Stumbling around and acting silly will not make you look mature. Alcohol is dangerous for adults as well as teens. Coffee can make you feel more awake, but it can’t make you sober. Only time can do that. When people “loosen up” with alcohol, they often say and do things they will regret later. Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Alcohol Affects the Body 243Short-Term Effects of Alcohol Many people are not aware of alcohol’s dangerous and unhealthy effects. The short-term effects of alcohol depend on several factors,including the amount of alcohol consumed, the presence of food inthe person’s stomach, and the person’s gender and size. Effects on the Body When alcohol enters the stomach, it is quickly absorbed into the bloodstream and carried throughout the body. Theshort-term effects of alcohol on the body include the following: 1. Alcohol irritates the mouth, throat, esophagus, and stomach. Alcohol can cause a person to feel nauseated and to vomit. 2. Alcohol makes the heart work harder. Alcohol dilates, or widens, the blood vessels. The heart has to work harder to pump bloodthrough the wide vessels. 3. Alcohol makes the body lose heat. When the blood vessels in the skin widen, they make the person feel warm and look flushed.But, the person may actually be getting too cold. Drinking alco-hol in cold weather or while in the water can drain too muchheat from the body, which leads to hypothermia. 4. Alcohol causes the liver to work harder. The liver breaks down toxic substances, such as alcohol, to neutralize any poisonouseffects. But the liver can break down only about one alcoholicdrink per hour. Drinking more than that amount causes alcoholto build up and to stress the liver. 5. Alcohol causes dehydration. Dehydration occurs because break- ing down alcohol requires water. As a result, the kidneys producemore urine. The water used to break down alcohol is taken fromthe rest of the body, including the brain. The cells of the brainshrink and may even begin to die. Many of the symptoms of ahangover, such as headache, nausea, and dizziness, are a result ofsevere dehydration. A hangover is a set of uncomfortable physical effects that are caused by excessive alcohol use. Effects on the Mind Alcohol has dramatic effects on the brain. As a depressant, alcohol slows down the nervous system. About 15 minutesafter finishing one or two drinks, most people begin to feel morerelaxed and more talkative, and they laugh more easily. The relaxingeffects are what make alcohol a popular drug. But after only two drinks, the drinker loses the ability to make good decisions, pay attention, follow complex thoughts, or cope withdifficult situations. The drinker loses his or her inhibitions. Inhibitions are the natural limits that people put on their behavior. After a few more drinks, a person loses the ability to focus his or her eyes. The person slurs his or her speech, loses coordination, andmay experience drastic mood swings. The person loses judgment andmay do things he or she would never do sober. For example, an intox-icated person may become sexually aggressive or engage inunplanned or unprotected sexual activity. Short-Term Effects of Alcohol >Nausea >Vomiting >Dehydration >Loss of judgment and self-control >Reduced reaction time >Poor vision >Memory loss >Blackout >Coma >Death Copyright © by Holt, Rinehart and Winston. All rights reserved. 244 CHAPTER 10 AlcoholEffects at Different Blood Alcohol Concentrations is the amount of alcohol in a person’s blood, expressed as a percentage. Table 1 shows the BACs for men and women depending on the person’s weight and the number of drinks consumed per hour. The list next to the table summarizes theeffects of alcohol depending on the person’s BAC. A BAC of 0.08 isthe legal limit for driving under the influence of alcohol (DUI). How-ever, even a BAC of 0.02, which is much lower than the legal limit,can affect a person’s ability to drive. The Dangers of Binge Drinking The act of drinking five or more drinks in one sitting is called A person candrink a fatal amount of alcohol before the effects of severe intoxica-tion set in. For most people, eight drinks or more in an hour cause the areas of the brain that control breathing and heart rate to become danger-ously depressed. The brain and heart may stop working. This is called alcohol poisoning, or alcohol overdose, and it can be fatal. binge drinking.alcohol concentration (BAC)Blood Weight 90 to 110 pounds 110 to 130 pounds 150 to 170 poundsDrinks per hour* 1 35 1 35 1 35BAC Male 0.04 Female 0.05 Male 0.11 Female 0.14 Male 0.19 Female 0.23 Male 0.03 Female 0.04 Male 0.09 Female 0.11 Male 0.16 Female 0.19 Male 0.02 Female 0.03 Male 0.07 Female 0.09 Male 0.12 Female 0.14Table 1 Blood Alcohol Concentration (BAC) Effects of alcohol at different blood alcohol concentrations 0.02 slowed reaction time; feeling of relaxation, warmth, and well-being 0.05 feeling of euphoria; loss of inhibitions; decreased judgment 0.10 impaired vision, judgment, reflexes, and coordination; mood swings 0.15 seriously affected coordination; blurred vision; severely impaired speech; difficulty walking and standing; memory problems, mood swings;violent behavior 0.2blackouts; memory loss; stomach irritation; vomiting0.25 loss of consciousness; numbness; danger- ously slowed breathing0.3coma 0.4–0.5 death from alcohol poisoning ACTIVITY If a girl weighs 120 pounds and has three drinks in 1 hour, what will her BAC be? How will she be affected? If I weigh 160 lbs, I can drink three beers without affecting my driving because I’ll still be under the legal limit of 0.08. Myth The ability to drive is affected even at a BAC of 0.02. Just one drink can affect a person’s ability to drive safely.Fact*A 12-ounce beer, a 6-ounce glass of wine, and a 1.25-ounce glass of whiskey each qualify as one drink and have the same alcohol content. Source: National Clearinghouse for Alcohol and Drug Information. Copyright © by Holt, Rinehart and Winston. All rights reserved. Brain Brain damage, including shrunken brain and dead brain cells Mouth, esophagus, and stomachIrritation to the esophagus and stomach;stomach bleeding; cancer of themouth, esophagus, and stomachHeart Irregular heartbeat, high blood pressure (hypertension),enlargement of the heart, anemia Liver Hepatitis, cirrhosis, liver cancerImmune system Diminished immune system function,which makes fightingoff disease difficult Small intestine Decreased ability to absorb vitamins 245Three symptoms of alcohol poisoning are extreme vomiting, loss of consciousness, and dangerously slowed breathing. If a person has passed out from drinking alcohol, get medical help immediately.Then turn the victim onto his or her side. Alcohol overdose causesvomiting, even when a person is unconscious. If the person is lyingface up, he or she may choke and die. If the person is not breathingand has no pulse, someone certified in cardiopulmonary resuscita-tion (CPR) should administer CPR. Long-Term Effects of Alcohol The long-term effects of alcohol use are serious. You do not have to bean alcoholic to suffer the effects in Figure 1. Repeatedly stressing your body with a toxic chemical eventually takes a toll on your health. Permanent Damage to the Body Alcohol can damage the heart. Alcohol can cause an irregular heartbeat, high blood pressure(hypertension), and enlargement of the heart. Alcohol can also causeanemia , a decrease in red blood cells or hemoglobin. Red blood cells carry oxygen to the body. For more information about CPR, see the Express Lesson on pp. 582–585 of this text.HandbookHEALTH Long-term alcohol use damages the body in many ways.1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 246 CHAPTER 10 AlcoholAlcohol can have devastating effects on the liver. Long-term drinking can lead to hepatitis (inflammation of the liver), liver cancer, and cirrhosis. (suh ROH sis) is a disease that replaces healthy liver tissue with scar tissue and is usually caused by long-termalcohol use. Cirrhosis is the 12th leading cause of death in the UnitedStates. Half of these deaths are due to chronic alcohol abuse. Alcohol can also damage the esophagus and stomach. For exam- ple, alcohol causes irritation and bleeding of the stomach lining.Long-term alcohol abuse has been linked to cancer of the mouth,esophagus, and stomach. Alcohol also damages the small intestine and makes absorbing vitamins and minerals difficult. It irritates the pancreas and mayincrease the risk of pancreatic cancer. It also affects the body’simmune system—it reduces the body’s ability to fight disease. Over time, heavy drinking can put too much strain on the kid- neys. Excessive drinking can also result in loss of bladder control. Permanent Damage to the Brain Alcohol causes permanent changes in the brain due to cell death from repeated dehydration andlack of oxygen. Alcoholism is the second leading cause of dementiain the United States. Dementia is a decrease in brain function that includes personality changes and memory loss. While alcohol-relateddementia is seen only in people who have been alcoholic for a verylong time, some evidence suggests loss of brain function occurs invirtually all heavy drinkers. Cirrhosis REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “the drug in wine, beer, and liquor that causes intoxication.” 2.Define intoxication . 3.Identify the term for “the amount of alcohol in a person’s blood, expressed as a percentage.” 4.Define cirrhosis . Understanding Key Ideas 5.Identify why alcohol is considered a drug. 6.Summarize the short-term effects of alcohol on the body. 7.Identify which of the following is nota short-term effect of alcohol. a.poor vision c.reduced reaction time b.poor judgment d.increased self-control8.Compare the BAC that represents the legal limit for DUI with the BAC at which driving is first impaired. 9.Describe the dangers of binge drinking. 10.Identify which of the following is a long-term effect of alcohol use. a.dead brain cells c.irregular heart beat b.stomach bleeding d.all of the above 11. Practicing Wellness Name three rea- sons you should not drink alcohol. Critical Thinking 12.What type of behavior would you expect to find at a party where people are drinking? Why do youthink teens drink? 13.If a 160-pound boy drank five beers in 2 hours,what effects might the boy experience?(Hint: See Table 1.)LIFE LIFE SKILLAlcoholism is the second leading cause of dementia in the United States, after Alzheimer’s disease. MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 247 Alcoholism Affects the Family and SocietySECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Eva was in her room when she heard the arguing begin. “Where have you been?” her mother asked. “Don’t start with meagain,” said her father, “I can have a beer if I want to.” Eva knew the yelling would start, and then the crying would begin. Whenwas this ever going to end? What Is Alcoholism? Alcohol is the most widely used and abused drug in our society. is drinking too much alcohol, drinking it too often, or drinking it at inappropriate times. is a disease thatcauses a person to lose control of his or her drinking behavior. Thedrinker is both physically and emotionally addicted to alcohol.Alcoholics don’t just crave alcohol. They suffer painful physicalsymptoms when they do not have alcohol.AlcoholismAlcohol abuseOBJECTIVES State the difference between alcohol abuse and alcoholism. Describe the stages in which alcoholism develops. Identify the warning signs of alcoholism. Listthree ways that alcohol use can have a negative effect on family life. Describe how alcoholism affects society. Summarize two treatment options for overcoming alcoholism.KEY TERMSKEY TERMS alcohol abuse drinking too much alcohol, drinking it too often, or drinking it at inappropriate times alcoholism a disease that causes a person to lose control of his or her drinking behavior; a physical and emotional addiction to alcohol enabling helping an addict avoid the negative consequences of his or her behaviorcodependency a condition in which a family member or friend sacrifices his or her own needs to meet the needs of an addict fetal alcohol syndrome (FAS) a set of physical and mental defects that affect a fetus that has been exposed to alcohol because of the mother’sconsumption of alcohol during pregnancy 20% 11 million75%statistically speaking. . . The percentage of adults who lived with an alcoholic at some point while growing up: The number of children currently living in homes with an alcoholic: The percentage of domestic violence cases in which alcohol is involved: Copyright © by Holt, Rinehart and Winston. All rights reserved. Alcoholism Problem drinking Drinker cannot drink alcohol inmoderation or atappropriate times. Tolerance Dependence Alcoholism Drinker needsmore alcoholto produce thesame effect.Drinker feels he orshe needs alcoholto function properly. Drinker is both physicallyand emotionallyaddicted to alcohol. 248 CHAPTER 10 AlcoholAlcoholism Develops in Stages When Eva’s dad lost his job, he started drinking more frequently. He had a new job now, but he couldn’t seem to quit drinking. Like all types of drug addiction, alcoholism develops over time. Figure 2 shows how the stages of alcoholism are the same as those of any type of drug addiction. 1. Problem drinking Alcoholism begins with experimentation. No one who experiments with alcohol believes that he or she willbecome an alcoholic. Most alcoholics say that they first begandrinking to have fun. At some point, people who become alco-holics move from experimental use to a regular pattern of abuse. In many cases, initial experimentation gradually becomes social drinking. Social drinking is drinking alcohol as part of a social situation, such as on a date or at a party. Social drinking hasrules: Do not drink alone, and do not drink just to get drunk. Thealcohol abuser starts drinking to avoid boredom, to escape anxiety,to relieve stress, or to cope with depression. 2. Tolerance As alcohol abuse continues, the person becomes toler- ant to alcohol. Tolerance develops after repeated drinking when the user finds that it takes more alcohol to get the same effect. Ifalcohol abuse increases, the drinking or recovering from beingdrunk take up most of the individual’s time. Family life, friends,work, schoolwork, and other activities are neglected. Drinkersbecome secretive, paranoid, and defensive as they try to hide theirdrinking behavior. 3. Dependence Over time the drinker’s body begins to need alco- hol to feel normal. Without alcohol, the drinker experienceswithdrawal symptoms such as anxiety, sweating, shaking, andnausea. This stage is called dependence. 4. Alcoholism Eventually, the drinker is addicted to alcohol. The person craves alcohol and cannot control his or her drinking. Thealcoholic drinks and gets drunk nearly every day. Being addictedto alcohol means putting the drug before everything else. Somealcoholics will substitute alcohol for food, which can lead to seri-ous health problems such as malnutrition. Each stage leading to alcoholism may last a long time. However, by the time the alcoholic seeks help, he or she may look back and wonder how his or her drinking got so out of control. www.scilinks.org/health Topic: Alcoholism HealthLinks code: HH4007 Like any type of drug addiction, alcoholism happens gradually.2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. Risk Factors for Alcoholism It’s not clear why some people can drink alcohol without becoming addicted, while others become alcoholics. Alcoholismprobably results from a combination of psychological,environmental, behavioral, and physical factors. Exam-ples of these factors are discussed below. >Age For teens, the most important risk factor for alcoholism is age. Teens who start drinking beforeage 15 are four times more likely to become alco-holics than people who wait until they’re 21 todrink. The brains of adolescents are undergoingtremendous growth and development, so they areparticularly vulnerable to the effects of alcohol. >Social environment Hanging out with friends who drink alcohol increases the chance that aperson will drink. Peer pressure, persuasiveadvertising, and the desire to fit in can influencea person to drink. >Genetics Research has shown that genetics may play a part in whether a person becomes analcoholic. Alcoholism tends to run in families.The male children of alcoholic fathers have a 25percent risk of becoming alcoholics. Children of nonalcoholics have a 7 to 9 percent risk. >Risk-taking personality People who are impulsive, like novelty, and enjoy taking risks have a greater chance of becoming alcoholics than people who do not engage in risky behavior. It is important to remember that a risk factor may increase the chance that something will happen, but risk factors can’t determine your future. Regardless of how many risk factors you have, you stillhave a choice about whether or not to drink. Warning Signs of Alcoholism There are some warning signs that a person may be suffering from alcohol addiction. For example,as alcoholism develops, alcohol becomes an increasingly importantpart of a drinker’s life. Alcohol may be used to deal with anger, disap-pointment, and frustration. The drinker begins to have a difficulttime putting limits on drinking. The person finds it almost impos-sible to resist having another drink. Alcoholics may be uncomfortable around friends who don’t drink. Personal and professional relationships suffer, which causesadditional stress for the alcoholic. Alcoholics usually battle feelingsof depression or hopelessness. They might even talk about or try tocommit suicide. Most drinkers can’t recognize these symptoms in themselves. The inability to see these symptoms is called denial. Denial is an impor- tant component of all addictions. Because addicts deny having aproblem, friends or family members, employers, and sometimes thecourts usually have to step in to stop the addictive process. SECTION 2 Alcoholism Affects the Family and Society 249 Warning Signs of Alcoholism >Drinking to deal with anger, frustration, and disappointment >Changing friends, personalhabits, and interests >Being defensive about drinking >Feeling depressed >Drinking more for the same high >Drinking alone >Drinking to get drunk >Experiencing memory lapses as a result of drinking alcohol Copyright © by Holt, Rinehart and Winston. All rights reserved. 250 CHAPTER 10 AlcoholAlcoholism Affects the Family Getting up in the morning is hard on Eva. She knows that she’ll see her mom’s red, swollen eyes. Eva always thinks that if she had helpedout more when her dad lost his job, he might not drink so muchnow. She knows it isn’t her fault, but she still feels guilty. Alcoholismaffects everyone who interacts with the alcoholic. Families of alco-holics suffer in many w ays, including >Guilty feelings Family members often feel guilty, as if their loved one’s alcoholism is somehow their fault. It is not. >Unpredictable behavior The families of alcoholics never know what to expect. An alcoholic may be depressed in the morning,happy in the afternoon, and violently angry by nighttime. >Violence Families of alcoholics are more likely to become victims of violence than families of nonalcoholics are. >Neglect and isolation Alcoholics usually spend their time preoccupied with drinking. Children of alcoholics often feel asif the alcoholic parent does not have time to care for them. >Protecting the alcoholic Family, friends, or employers some- times enable an alcoholic. means helping an addictavoid the negative consequences of his or her behavior. Forexample, when Eva’s dad has a hangover and can’t go to work,her mom often calls his boss to say that he is sick. >Ignoring one’s own needs is the condition in which a family member or friend sacrifices his or her ownneeds to meet the needs of an addict. Family members are sowrapped up in taking care of the drinker that their own livessuffer. In the end, alcoholism affects both the drinker and the people the drinker loves the most. Families of Teen Alcoholics When teens drink they hurt not only themselves but also their families. Teens

must acquire alcoholillegally. Teen alcoholics lie to their families to avoid getting caught.They often become angry or abusive when confronted about theirdrinking problem. Just as a parent’s alcoholism puts stress on chil-dren, a teen’s alcohol problem puts stress on his or her parents. Alcohol and Pregnancy Alcoholism is so difficult to overcome that alcoholics who become pregnant find it difficult to stop drink-ing. In 1999 and 2000 combined, about 12 percent of pregnantwomen continued to use alcohol. Heavy drinking during pregnancycan lead to fetal alcohol syndrome. is aset of physical and mental defects that affect a fetus that has beenexposed to alcohol because of the mother’s consumption of alcoholduring her pregnancy. Children with FAS have various physical defor-mities and mental retardation. Some babies have to be cared for therest of their lives. FAS is the leading preventable cause of mental retar-dation in our country. Fetal alcohol syndrome (FAS)CodependencyEnabling “When my dad drinks everybody suffers.” Copyright © by Holt, Rinehart and Winston. All rights reserved. Analyzin gDA TA Analyzing DATA SECTION 2 Alcoholism Affects the Family and Society 251Alcoholism Affects Society If someone tells you that his or her drinking does not affect others, don’t believe him or her. The truth is that alcoholism touches every-one. Society pays huge emotional, physical, and financial costs forthe misuse of alcohol and for alcoholism. For example, alcohol abuseoften leads to car wrecks, drowning, and other accidents that kill orinjure both drinkers and nondrinkers. Do you know anyone in yourcommunity who has been injured or has died because of an alcohol-related accident? Many cases of murder, family violence, child abuse, rape, and assault are attributed to alcohol-related voilence. Alcohol plays amajor role in violence and crime. Alcoholism leads to the destructionof the family. Alcoholism takes away money and resources from society. For example, drinkers get sick far more often than nondrinkers do. Alco-holism leads to missing days of school or work. Money is spent ontreating alcohol-related illnesses, including alcohol abuse. Money isspent to cover losses due to alcohol-related crime. As a result of alco-hol-related crime, more public services, such as ambulances, lawenforcement, and legal services are needed. Costs of Alcohol to Society Each slice of the pie indicates a percentage of the total cost of alcohol to society. The asterisk indicates the total cost of alcohol to society.21 Your Turn 1.What percentage of the total costs ofalcohol to society aredue to health problems? 2.What was the cost of alcohol due to crime, expressed in dollars?(Hint: Use the informationnext to the asterisk.) 3.What fraction of the costs ofalcohol to society are due tomedical bills? 4. CRITICAL THINKING Why do you think the majority of the costs of alcohol to society are related to healthproblems? Costs of Alcohol to Society* 48% 20%14%9%9% Lost productivity due to alcohol-relatedillness Lost productivity due to premature death Medical bills CrimeAuto crashes *Costs equaled $185 billion in 1998. Source: National Institute on Alcohol Abuse and Alcoholism.1 2MATH SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 252 CHAPTER 10 AlcoholAlcoholism Can Be Treated Overcoming alcohol addiction is not easy, but it can be done. Because addiction changes the brain, freeing oneself from alcoholismtakes a lot of support and, above all, help. Treatment Programs To get help learning to live without drink- ing, alcoholics should participate in some form of treatment. Thetreatment helps the alcoholic endure the difficult stages of with-drawal (the process of discontinuing use of a drug to which the bodyis addicted). During withdrawal, a person may suffer extreme nerv-ousness, headaches, chills, nausea, seizures, and uncontrollable shak-ing. Treatment programs also try to help the alcoholic understandwhy he or she became addicted to alcohol. There are a variety of treatment options for alcoholics. Treatment programs include both inpatient and outpatient care. Inpatient centersprovide a sheltered place to go through withdrawal while getting coun-seling. Alcoholics Anonymous (AA) is the most widely used programfor treating alcoholism. The AA method for recovery involves 12 steps.Through regular meetings and shared experiences, AA members bringthemselves and each other closer to a life that is free of alcohol and fullof emotional, physical, social, and spiritual well-being. Al-Anon and Alateen Al-Anon and Alateen are programs that provide treatment and support to the families of alcoholics. Al-Anon is designed to help family members talk about and share advice onthe problem of living with an alcoholic. Alateen is specifically designed to help teenagers cope with this situation. There are localchapters of AA, Al-Anon, and Alateen in just about every communityin the United States. Check the phone book for local chapters. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define alcohol abuse. 2.Compare the terms enabling and codependency . 3.Identify the term for “the physical and mental defects that affect a fetus that has been exposed to alcohol because of the mother’s consumptionof alcohol during pregnancy.” Understanding Key Ideas 4.Distinguish between alcohol abuse and alco- holism. 5.Describe the stages leading to alcoholism.6.Name six warning signs of alcoholism. 7.Summarize the effects of alcoholism on the family. 8.Identify which of the following is a way in which alcoholism affects society. a.destruction of the family b.increased medical costs c.increased crime d.all of the above 9.Compare two programs for treating alcoholism. Critical Thinking 10. Making GREAT Decisions What would you do if you noticed a friend displaying several ofthe warning signs of alcohol abuse?LIFE LIFE SKILL Coping with alcoholism can be difficult, confusing, and lonely. But many organi-zations offer teens support. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Teens and Alcohol 253Teens and Alcohol SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 David heard the news on Sunday. Four people from his Eng- lish class were in a car accident coming home from Alicia’sparty. The driver and one of the girls were seriously injured. The other two students were killed. David couldn’t believe it. If hehad asked the driver for a ride home after the party, he might havebeen killed or injured, too. Drinking and Driving, a Deadly Combination The No. 1 cause of death among teens is motor vehicle accidents. Themajority of these accidents are alcohol related. All of the skills youneed to drive are impaired by alcohol. For example, alcohol >slows your reaction time >affects your vision >makes you drowsy >reduces your coordination >affects your judgment As you learned earlier, even a small amount of alcohol can impair your ability to drive. Asingle drink can make you unsafe behind thewheel! An estimated 513,000 people in the United States are injured in alcohol-related car crashesevery year. About 3 in every 10 people in theUnited States will be involved in an alcohol-related crash at some point in their lives. Whendrunk driving results in an accident, the out-come is often deadly. While only 7 percent ofmotor vehicle crashes involve alcohol, about 39percent of fatal crashes involve alcohol. Drunkdriving is the nation’s most frequently com-mited violent crime.OBJECTIVES Identify the role alcohol plays in teen driving accidents. Listthe legal consequences of underage drinking. Summarize how underage drinking can harm a teen’s future. Listthree ways you could refuse alcohol if it were offered to you. Identify student groups and organizations that are involved in educating people about the dangers of alcohol. LIFE LIFE SKILLLIFE LIFE SKILLKEY TERMSKEY TERMS designated driver a person who chooses not to drink alcohol in a social setting so that he or she can safely drive himself or herself and others When alcohol and driving mix, the result is often tragic. Copyright © by Holt, Rinehart and Winston. All rights reserved. 254 CHAPTER 10 AlcoholDrinking, Driving, and the Law Alcohol use is illegal for people under 21 years of age. To prevent drunk driving from claiming lives, the law has set heavy penalties for people caught driving drunk. Anyone caught driving with a bloodalcohol concentration (BAC) of 0.08 percent or greater willbe arrested for driving under the influence (DUI). In some states, a higher limit, about 0.10 percent, puts you into amore serious category, driving while intoxicated (DWI ). Zero Tolerance All 50 states have enacted zero tolerance laws for people under the age of 21. This means that it is ille-gal for people under the age of 21 to drive with any amountof alcohol in their systems. Educational campaigns havebeen spreading the word to teens that zero tolerance meanszero chances. Violating zero tolerance laws can result in lossof driver’s license, expensive fines, and community service. Among adults, penalties for drunk driving have been increasing to discourage people from driving drunk. Cur-rently, penalties include arrest, heavy fines, suspension ofone’s driver’s license, and possible jail time. Getting Home Safe and Sober Although you cannot control other people’s drinking and driving behavior, thereare ways you can protect yourself from dangerous ditua-tions caused by intoxicated drivers. So what can you do toprotect yourself from the dangers of alcohol on the road? 1. Don’t drink. Use the methods discussed later to resist the pres- sures to drink. 2. Plan ahead. Before you go anywhere that alcohol may be served, plan a safe way home. You or someone else may need to volun-teer to be the designated driver. A is a personwho chooses not to drink in a social setting so that he or she cansafely drive himself or herself and others. 3. Have an arrangement with your parents or guardian to pick you up if you need a safe ride home. Discuss this arrangement with your parents in advance. You may want to design a contract inwhich you promise never to drink and drive and your parents orguardian promises to provide you with a safe ride at any hour, noquestions asked. 4. Call a cab. Many cities have programs that provide safe rides for free or at reduced rates to people who have been drinking. It’sworth a cab fare to live to see tomorrow. Whatever you do, don’tget into a car with someone who has been drinking. What can you do if a friend is going to drink and drive? If all else fails, take their keys. They will probably be angry with you, but at least they’ll be alive to thank you later. Once they sober up, they’ll beglad to know that someone cares enough about them to save theirlives.designated driver Every day, eight teens die in alcohol- related car crashes in the United States. Oh, no! It was already 1:00 A.M., and Beto had prom- ised his parents that he’d be home by 12:30 A.M. Beto wanted to ask Sarah for a ride home, but she had been drinking. On the other hand, hewould have the chance to ask her out. Betoremembered that his parents had always saidthat they would pick him up if he needed a saferide home. But Beto had wanted to go out withSarah all year. He didn’t want her to think hewasn’t cool. Write on a separate piece of paper the advice you would give Beto. Remember to use the decision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. 255Drinking Puts Your Future at Risk Alcohol use is a high-risk behavior for many reasons. Drinking and driving claims the lives of thousands of teenagers every year. How-ever, drinking and driving is not the only risk of alcohol use. Drinking and Jail Because the legal age for drinking alcohol is 21, buying, trying to buy, or possessing alcohol is illegal for teens. Teensare automatically charged with minor in possession (MIP). And if teens are drinking in a public place, the charge of public intoxication (PI)i s usually added on. Having a fake identification can cause a teen to getarrested, too. If you get caught doing any of these things, you can end up in jail, on probation, and with a police record. You also risk losing the trustand respect of your family. A criminal record can also affect yourchances of getting a job or getting into college. Drinking and Sexual Activity Alcohol makes it hard to think clearly. For example, drinking can lead a person to participate inunplanned sexual activity. Sexual activity can result in an unplannedpregnancy, a sexually transmitted disease (STD), and the emotionalpain of an unhealthy sexual relationship. Alcohol is also the mostcommon drug associated with date rape. By choosing not to drink,you’ll stay in control of your mind and your body. Drinking and Diving Alcohol use plays a role in more than 38 percent of all drowning accidents in the United States. Diving underthe influence of alcohol can lead to head and neck injury, brain dam-age, spinal cord injury, and paralysis. Drinking and Teen Brains Alcohol use also affects the develop- ment of the brain. The effects of alcohol are much more potent inbrains that are still rapidly developing, such as the brains of teens.The changes that alcohol causes in young brains greatly increases therisk of alcoholism. Drunk driving is a serious crime that has very serious consequences. www.scilinks.org/health Topic: Drunk Driving HealthLinks Code: HH4053 Copyright © by Holt, Rinehart and Winston. All rights reserved. 256 CHAPTER 10 AlcoholSaying No to Alcohol Being a teenager is challenging. Teens face many kinds of pressures. Peer pressure is the most common reason teens start drinking. Teensalso face pressure to drink from advertising, TV, and movies. Most ofthe time, teens aren’t pressured directly. But just because no one says“drink this beer or I won’t be your friend any more” doesn’t meanthat the pressure isn’t there. It can be hard to say no to your friends ifthey want you to drink with them. To stick to your decision not todrink, you have to know how to say no. Don’t Set Yourself Up The most effective way to avoid alcohol is to stay away from people who drink and places where others aredrinking. If you’re not there when the beer is passed around, youwon’t be tempted to take one or feel forced to join in. Surround your-self with friends who share your views about avoiding alcohol. Practice Saying No Even if you try, staying away from alcohol is not always possible. If you find yourself in a situation in which someoneoffers you a drink, you can use some of the ideas below. 1. Buy yourself time. Find a place where you can be alone to think about what you can do to get out of the situation. For example,you can go to another room, to the bathroom, or outside. Onceyou have time to collect your thoughts, saying no will be easier. 2. Give good reasons why you choose not to drink. For example, Hannah went to a party with her friend Angela. Angela said,“Come on Hannah, one wine cooler isn’t going to hurt you.”Hannah responded, “I promised I would get us both home safely.Do you want me driving you home if I’m drunk?” 3. State the consequences that could result if you do drink. For example, Angela said, “Hannah, give me a break. When did youbecome such a goody-two-shoes? It’s just like drinking a fruitpunch.” Hannah then replied, “Angela, you know my parentswould ground me forever if I came home drunk.” Can you resist the pressure to use alcohol? Know how to say no. “Come on, just one.” “Everyone is doing it.” “It’ll be fun.” “What are you worried about?” “Don’t you want to party?”“One is more than I want.” “Then, at least one of us will be sober enough to drive home. ” “I’m already having a great time without it.” “I’m worried about how I’ll look with my head in the toilet. ” “That’s what I’m doing. Come on; let’s go dance.” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Teens and Alcohol 2574. Say no firmly. Nois a simple and powerful word. It sends a clear message about your intentions. If you say it clearly and look the other person in the eye while you’re talking, the meaning isunmistakable. When Angela grabbed a wine cooler and stuck itright into Hannah’s hand, Hannah said, “Angela, listen to me. Isaid no!” 5. If necessary, say no again and include an alternate activity. Angela pressured Hannah again. “Just have one. You’ll be soberby the time we’re ready to leave.” Hannah responded, “Nothanks, Angela. I really don’t want to. Why don’t we go danceinstead?” 6. Walk away. What do you do if saying no isn’t enough? You’ve stated your position. You’ve defended your decision. The personstill insists. You have the option to walk away. Friends who don’trespect your values and opinions aren’t true friends anyway. Offeryour friends the opportunity to join you. You may find that yourfriends will want to follow your example. For example, at thispoint, Hannah can say, “Angela, I’m going to go dance with John.Do you want to come, or should I meet you later?” real life Activity LIFE LIFE SKILL Evaluating Media Messages ALCOHOL AND ADVERTISING ✔5 popular magazines ✔scissors ✔poster board ✔glue ✔markers 1.Look through several magazines for alcohol advertisements. 2.Cutout two ads to include in a poster. 3.Glue the ads to the top third of the poster board.ProcedureMaterials4.Describe below each ad ways you think companies try to get people to buy alcohol. 5.Design new advertisements on the bottom third of the posterthat show the true conse-quences of alcohol use. 1.Evaluating Information Do alcohol ads represent the true results of alcohol use? Explain. 2.Summarizing Results What are some of the most commonways companies try to convincepeople to buy alcohol? 3.Predicting Outcomes How do you think ads for alcohol influ-ence teens?Conclusions4.CRITICAL THINKING What can you do to help keep alcohol use from negatively affecting thelives of your friends and family? 5.CRITICAL THINKING What alternative activities can yousuggest to a friend who wantsto drink alcohol? Copyright © by Holt, Rinehart and Winston. All rights reserved. 258 CHAPTER 10 AlcoholJoining the Fight Against Drunk Driving People and organizations are aware of the great damage caused by alcohol and are doing something about it. For example, MothersAgainst Drunk Driving (MADD) and Students Against DestructiveDecisions (SADD), formerly Students Against Drunk Driving, areinvolved in this fight. MADD is an organization that promotes stricterpenalties for people who drive drunk. SADD is a school-based organi-zation dedicated to addressing underage drinking, impaired driving,drug use, and other destructive decisions and killers of young people. You can join a SADD chapter at your high school. If your school doesn’t have a chapter you can start one yourself. Planning and par-ticipating in alcohol-free activities, such as those shown in Figure 3, can help people see that no one needs alcohol to have a good time. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term that means “a person who chooses not to drink alcohol in a social setting so that he or she can safely drive himself or herself and others.” Understanding Key Ideas 2.Identify the No.1 cause of death among teens. a.heart disease c.motor vehicle accidents b.suicide d.AIDS 3.Listthe legal charges that a teen can face if he or she is caught drinking and driving. 4.Identify three ways that alcohol use can harm a teen’s future. 5.Evaluate how alcohol use can affect a person’s behavior.6. Practicing Wellness Identify three ways that you can help prevent alcohol from harm-ing your friends and loved ones. 7. Refusal Skills State five ways to refuse if a friend offers alcohol to you. 8.Identify two organizations that are invoved in edu- cating people about the dangers of alcohol. Critical Thinking 9. Evaluating Media Messages Movies, TV, and advertisements often encourage audiencesto drink by making alcohol consumption seemappealing and sophisticated. What is the medianot telling viewers about alcohol?LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL Life’s healthiest and happiest activities never include drinking alcohol. ACTIVITY Plan a fun activity the whole class could participate in that does not include alcohol. Be sure to keepthe cost per person very low.3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 10 Highlights 259 CHAP TER 10 CHAP TER 10 CHAPTER 10Highlights Key Terms The Big Picture ✔Motor vehicle accidents are the No. 1 cause of death among teens. The majority of these deaths are alcohol related. ✔It is illegal for anyone under the age of 21 to possess alcohol. ✔Teens caught with alcohol can be charged with minor in posses-sion, driving under the influence, or public intoxication. ✔Alcohol use has many negative effects on a teen’s future, includinga police record, unwanted sexual activity, unplanned pregnancy,sexually transmitted disease, rape, violence, injury, and death. ✔The best way to protect yourself and your future from the dangersof alcohol is not to drink. ✔There are many effective ways to refuse alcohol. Don’t set your-self up, and practice saying “No.” ✔Teens can become involved in Students Against Destructive Decisions (SADD) to help educate other teens about the dangersof drinking alcohol.SECTION 3 designated driver (254) ✔Alcohol is a dangerous drug that has serious short- and long-term effects on the body and brain. ✔The short-term effects of alcohol on the body include nausea,loss of body heat, dehydration, loss of judgment, reduced reac-tion time, memory loss, coma, and even death. ✔The long-term effects of alcohol use include heart damage, severalkinds of cancer, liver damage, kidney damage, and brain damage. ✔Alcohol changes the brain in ways that lead to and maintainaddiction.SECTION 1 alcohol (242) intoxication (242) blood alcohol concentration (BAC) (244) binge drinking (244) cirrhosis (246) ✔Alcoholism is a disease that causes a person to lose control of hisor her drinking behavior. Alcoholism develops in four stages:problem drinking, tolerance, dependence, and alcoholism. ✔The warning signs of alcoholism include drinking more in order tofeel the same effect, drinking alone, drinking to get drunk, andchanging one’s friends, personal habits, and interests. ✔Alcoholism is a disease that affects the entire family. ✔If a pregnant woman drinks, she can cause her unborn child tosuffer from fetal alcohol syndrome (FAS). ✔Alcoholism affects society in many ways, including increased vio-lence and crime, lower academic performance and productivity,and increased medical problems. ✔Alcoholism can be treated. People who recover from alcoholismcan lead happy and healthy lives.SECTION 2 alcohol abuse (247) alcoholism (247) enabling (250) codependency (250) fetal alcohol syndrome (FAS) (250) Copyright © by Holt, Rinehart and Winston. All rights reserved. 260 CHAPTER 10 Review CHAP TER 10 CHAP TER 10 CHAPTER 10Review Using Key Terms alcohol (242) alcohol abuse (247) alcoholism (247) binge drinking (244) blood alcohol concentration (BAC) (244) cirrhosis (246) codependency (250) designated driver (254) enabling (250) fetal alcohol sydrome (FAS) (250) intoxication (242) 1.For each definition below, choose the key term that best matches the definition. a.the act of drinking five or more drinks in onesitting b.a disease that replaces healthy liver tissue withscar tissue c.helping an addict avoid the negative conse-quences of his or her behavior d.the set of physical and mental defects thataffect a fetus that has been exposed to alcoholbecause of the mother’s consumption of alco-hol during pregnancy e.the drug in wine, beer, and liquor that causesintoxication f.a person who agrees not to drink in order todrive themselves and others safely 2.Explain the relationship between the followingkey terms. a.alcohol abuse and alcoholism b.intoxication and blood alcohol concentration c.codependency andenabling Understanding Key Ideas Section 1 3.State why alcohol is considered a drug. 4.List five short-term effects of alcohol use on thebody. 5.List five long-term effects of alcohol on the body. 6.Describe the physical and mental effects of alco-hol for each of the following blood alcohol con-centrations: a.0.05 c.0.2 b.0.1 d.0.4 7.CRITICAL THINKING Give three reasons why the following statement is not true: “If alcohol weredangerous, it wouldn’t be legal for adults.” Section 2 8.What is the difference between alcohol abuse andalcoholism? 9.Describe each of the following stages that lead toalcoholism. a.dependence c.problem drinking b.addiction d.tolerance 10.List five warning signs of alcoholism. 11.Describe three ways alcoholism affects the family. 12.What condition is caused by using alcohol duringpregnancy? 13.Describe some

of the ways that alcohol reachesevery member of a community. 14.CRITICAL THINKING Explain how you would address the following statement: “I’m too embar-rassed to go to meetings to talk about my dad’salcoholism.” Section 3 15.What role does alcohol play in motor vehicleaccidents involving teens? 16.Identify the laws that protect society from drunkdriving. 17.How can alcohol use affect a teen’s future? 18.List three things you would say to refuse alcohol. 19.What organizations are involved in educatingpeople about the dangers of alcohol? 20.CRITICAL THINKING Write three things you might do to help reduce the number of teens atyour school who drink alcohol.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 10 Review 261Activities 24. Health and Your Community Imagine that you notice a friend displaying many of the signs of alcoholism. How could you approach that friendand encourage him or her to seek help?Write a short report summarizing yoursuggestions. 25. Health and You Think about the goals you have for your future. Write a list of your goals. Evaluatehow alcohol use could prevent you from reachingthose goals. 26. Health and Your Community Work with a partner to organize a social group thatwould agree not to drink. Write a contract thatlists the reasons that members do not drink andexplains the promise that members makewhen they agree to live free of alcohol. Action Plan 27. Practicing Wellness Make a plan to protect yourself from the dangers of drunk driving.LIFE LIFE SKILLLIFE LIFE SKILL 28.In this newspaper article, the word pronounced means Asaid to be. Bspoken. Cseverely injured. Dnoticed to be. 29.What can you infer from reading this newspaperarticle? EMary and Sammy didn’t know the driver. FThe driver probably didn’t think it was unsafe tobe driving. GMary and Sammy were also very drunk. HNobody at the party had noticed that the driverhad been drinking. 30.Write a paragraph that describes the options thatMary and Sammy had to avoid riding with some-one who had been drinking.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Students, faculty, and staff of Davis High School are still in shock after the deaths ofMary Jones and Sammy Gray. Mary andSammy were pronounced dead at the scene of a car accident last night. Theywere riding home from a party in a cardriven by a friend who had been drinking.Although others at the party knew that thedriver was impaired by alcohol, nobodythought to take his keys. Memorial serviceswill be held tomorrow at Jackson FuneralHome. Contributions in memory of Maryand Sammy can be made to the Davis HighSchool chapter of Students AgainstDestructive Decisions (SADD). Pressure 1.“Come on, one beer won’t hurt you.” 2.“Here, this beer will give you the courage to talk to Steve.” 3.“If you aren’t going to drink with me, I’m leaving without you.”Response 1.“OK. But just one.” 2.“No way. I’ll just end up doing something stupid.” 3.__________________ __________________ __________________Refusal Skills WRITING SKILL WRITING SKILL WRITING SKILLUnderstanding Graphics Study the figure below to answer the questions that follow. 21.Which of the responses above is a good example of a refusal to drink alcohol? 22.Write a response that shows the use of a refusalskill to pressure item number three. 23.CRITICAL THINKING Why do you think people who drink try to pressure others to drink? Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTERCHAPTER 1111 CHAPTERHAPTER 1111 CHAPTER 11 262KNOWLEDGE Which of the following statements are true, and which are false? Check your answers on p. 642. 1.At high doses, nicotine is a nerve poison. 2.Chewing tobacco is safer than smoking tobacco because no smoke gets into the lungs. 3.Herbal cigarettes are safer than tobacco cigarettes because they don’t contain tobacco. 4.You can smoke for many years before you startto harm your lungs. 5.The smoke that escapes from a burning cigarette is dangerous to others. 6.The placenta protects a fetus from smoke inwomen that smoke during pregnancy. 7.Nonsmokers get fewer colds than smokers. Copyright © by Holt, Rinehart and Winston. All rights reserved. 263SECTION 1 Tobacco Use SECTION 2 Dangers of Tobacco Use SECTION 3 A Tobacco-FreeLife go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH11. Copyright © by Holt, Rinehart and Winston. All rights reserved. 264 CHAPTER 11 TobaccoMarcus pulled out a box of bidis. “Hey, you want one?” he asked Blanca. “I didn’t know you smoked,” repliedBlanca. “Just herbal cigarettes,” said Marcus. “They aren’t bad for you like regular cigarettes are.” All Tobacco Products Are Dangerous There are many types of tobacco products, including cigarettes, chew-ing tobacco, snuff (dip), pipe tobacco, cigars, and herbal cigarettes.Despite what many people think, all tobacco products have danger-ous chemicals. is the addictive drug that is found in all tobacco products. At low doses, it is a mild stimulant and muscle relaxant. Athigher doses, it is a powerful nerve poison. Sixty milligrams of nicotineare enough to kill most people. One or two milligrams are inhaled whena cigarette is smoked. Cigarette Smoke Has Poisonous Chemicals There are more than 4,000 chemicals in cigarette smoke. At least 40 of the chemicalsin cigarette smoke are (kahr SIN uh juhnz), chemicals oragents that cause cancer. is a sticky, black substance in tobaccosmoke that coats the inside of the airways and that contains manycarcinogens, including the following: >cyanide—a poisonous gas used to develop photographs >formaldehyde—a substance used to preserve laboratoryanimals and as embalming fluid >lead—a dangerous metal >vinyl chloride—a flammable gas used to make plastic products Other dangerous chemicals in cigarette smoke include carbon monoxide and ammonia. is a gas that blocks oxy-gen from getting into the bloodstream. It can be deadly. Ammonia isa chemical found in bathroom cleaners. Carbon monoxideTarcarcinogensNicotineTobacco UseSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Listsix types of tobacco products. Identify the drug that makes all forms of tobacco addictive. Name six dangerous chemicals found in tobacco smoke. Identify four carcinogens found in smokeless and other forms of tobacco. State the reasons why herbal cigarettes are not a healthy choice for teens.KEY TERMSKEY TERMS nicotine the highly addictive drug that is found in all tobacco products carcinogen any chemical or agent that causes cancer tara sticky, black substance in tobacco smoke that coats the inside of the airways and that con- tains many carcinogens carbon monoxide a gas that blocks oxygen from getting into the bloodstream You’d never guess what’s hiding in cigarette smoke. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Tobacco Use 265Other Forms of Tobacco Have Poisonous Chemicals Tobacco products that don’t produce smoke are also harmful. Snuff contains two to three times more nicotine than cigarette smoke does. Eightdips per day have the same amount of nicotine that about 30 ciga-rettes do. In addition to containing nicotine and tar, smokeless forms of tobacco, such as snuff (dip) and chewing tobacco, contain many differ-ent carcinogens. These carcinogens include arsenic, nickel, benzopy-rene, and polonium (which gives off radiation). Snuff and chewingtobacco lead to mouth sores and oral cancer. Oral cancer can be severelydisfiguring when large amounts of tissue and bone must be removed totreat it. Gruen Von Behrens, shown here, started using smokelesstobacco at age 13 to “fit in.” By age 17 he was diagnosed with cancer. Many teens think herbal cigarettes, such as cloves, bidis, and kreteks, are safe because they don’t contain tobacco. This belief is not true. Herbal cigarettes do contain tobacco and a spice that makesthem taste better, so their flavor is more attractive to teens. Pipe tobacco and cigars may seem safer because they are usually not inhaled deeply. However, pipe tobacco and cigars have beenlinked with oral cancer. There is NO safe form of tobacco. Gruen Von Behrens has had almost 30 surgeries to remove cancerous tumorsresulting from smokeless tobacco use.Now he travels and shares his experiencewith young people so that others canlearn about the dangers of tobacco. Analyzin gDA TA Analyzing DATA Cigarette Smoking Is Deadly Each slice of the pie indicates a percentage of the total number of deaths due to cigarette smoking. The asterisk indicates the average number of deaths per year from 1995 to 1999 in the United States. 21 Causes of Deaths Due to Cigarette Smoking* 31% 21% 20%17%4% 7%Lung cancer Heart disease Chronic lung disease Other cancers StrokeOther diagnoses (ex: sudden infant death syndrome) * Shown as percentages of the average number of deaths per year (406,290) for the years 1995–1999 in the U.S. Source: Centers for Disease Control and Prevention.1 2MATH SKILLMATH SKILL Your Turn 1.What is the total percentage of deaths due to smoking-related cancers? 2.Calculate the total number of smoking-related deaths due to chroniclung diseases. (Hint: Use theinformation indicated by theasterisk.) 3.What percentage of smoking-related deaths result from damage tothe circulatory system? 4. CRITICAL THINKING What might be some of thesmoking-related causes ofdeath included in the grouplabeled “Other cancers”? Copyright © by Holt, Rinehart and Winston. All rights reserved. 266 CHAPTER 11 TobaccoNicotine Is Addictive Cigarette smoking kills more than 400,000 people in the United States each year. Almost all smokers start as teenagers. No one everthinks he or she will become addicted. However, like all other addic-tive drugs, nicotine has effects on the brain and other parts of thebody. The effects of nicotine on the brain and body lead to physicaldependence and addiction. Tobacco companies once claimed thatnicotine was not addictive. This claim has been proven to be false. Nicotine addiction leads people to smoke over long periods of time despite the many health problems that smoking has beenproven to cause. Even after losing her larynx to throat cancer, DebbieAustin, pictured above, still continued to smoke. She struggled toovercome addiction and is now working to educate young peopleabout the dangers of cigarette smoking. Quitting smoking is difficult,and withdrawal is unpleasant. But the dangerous effects of tobaccouse are far worse than withdrawal. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define carcinogen. 2.Identify the term that means “a sticky, black sub- stance in tobacco smoke that coats the inside of the airways and that contains many carcinogens.” Understanding Key Ideas 3.Identify three kinds of tobacco products. 4.Identify the addictive substance found in all tobacco products. a.tar c.cyanide b.nicotine d.carbon monoxide 5.Listfour dangerous chemicals in cigarette smoke. 6.Listthree carcinogens found in smokeless tobacco products. 7.State the reason clove cigarettes, bidis, and kreteks are dangerous for teens. Critical Thinking 8.What would you tell a friend who thinks smokingherbal cigarettes is safe? 9. Practicing Wellness List four chemi- cals that are found in tobacco products and thatalso have other uses in society. Would you expectany of these chemicals to be healthy for you basedon their other uses? Why or why not?LIFE LIFE SKILL Debbie Austin warns teens about the dangers of cigarettes. After years ofsmoking, she had to have her larynxremoved. She can speak only if she cov-ers a hole in her throat that helps herbreathe and cough. In the background,the poster shows Debbie still smokingthrough the hole. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Dangers of Tobacco Use 267 Dangers of Tobacco UseSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Geoff, are you OK?” Asked Julian. Geoff had been coughing for about 5 minutes. “Sure, I’m fine,” Geoff replied, stillcoughing. “Maybe you should cut back on the smoking,” Julian suggested. “No way. I’m too young for smoking to cause meproblems,” said Geoff. Short-Term Effects of Tobacco Use Tobacco has many effects on the body. Some of these effects can beseen very soon after a person starts smoking. Because it takes onlyseconds for the nicotine inhaled from a cigarette to get into thebloodstream, the nicotine starts to act almost immediately. Nicotinehas the following effects: >stimulates the brain reward system >increases heart rate and blood pressure >increases breathing rate >increases blood-sugar levels >stimulates the vomit reflex The other harmful substances in tobacco smoke cause other short- term effects. For example, carbon monoxide blocks oxygen from gettinginto the bloodstream. Tar irritates the insides of the lungs, which leadsto coughing and to many of the long-term dangers of tobacco smoke. The chemicals in dip damage the inside of the mouth. The gums become irritated and raw, which leads to open sores and cancer of themouth. In addition to the effects on your health, tobacco makes your breath and clothes stink and leaves black specks between your teeth.Snuff and chewing tobacco also cause you to spit often. None ofthese effects are very attractive.OBJECTIVES State the short-term effects of tobacco use. Summarize the long-term health risks associated with tobacco use. State the effects of secondhand smoke on a nonsmoker. Describe how smoking affects unborn children whose mothers smoke during pregnancy. Listthree reasons you would give a friend to encourage him or her not to smoke. LIFE LIFE SKILLKEY TERMSKEY TERMS emphysema a respiratory disease in which air cannot move in and out of alveoli because they become blocked or lose their elasticity sidestream smoke smoke that escapes from the tip of a cigarette, cigar, or pipe mainstream smoke smoke that is inhaled through a cigarette and then exhaled by a cigarette smoker environmental tobacco smoke (secondhand smoke) a combination of exhaled mainstream smoke and sidestream smoke Smoking causes diseases only when you are old.Myth If you start smoking at 15, you can start to develop bronchitis, sinus infections, and a chronic cough almost immediately.Fact“ Copyright © by Holt, Rinehart and Winston. All rights reserved. 268 CHAPTER 11 TobaccoLong-Term Effects of Tobacco Use As summarized in Figure 1, the long-term effects of tobacco use aren’t just unpleasant—some of them can be deadly. Tobacco use is the lead- ing cause of preventable death in the United States. Twenty percent ofpeople who die each year are killed by tobacco-related illnesses. Addiction Nicotine, the drug in tobacco products, stimulates the brain reward system (the area of the brain that registers pleasure) andchanges the way the brain functions. These changes lead to addiction. Bronchitis and Emphysema The damage from tobacco smoke is most devastating in the respiratory system. The lungs are made upof large tubes called bronchi and smaller tubes called bronchioles. The tubes deliver oxygen to alveoli, tiny air sacks in the lungs. Oxygen passes from the alveoli into the bloodstream. Healthy people secretea thin layer of mucus in their bronchi to trap harmful particles thatthey may inhale. This mucus is constantly removed from the lungs bytiny hairs, called cilia. Cigarette smoke paralyzes and then kills cilia. As a result, mucus and inhaled particles (along with tar and other chemicals fromtobacco products) build up deep within the lungs, which givessmokers a chronic cough. In addition, constant irritation of thebronchi causes them to swell, which makes breathing more difficult.This inflammation, combined with the built-up particles, tar, andmucus in the lungs, can lead to chronic bronchitis and infection. is a respiratory disease in which air cannot move in and out of the lungs because the alveoli become blocked or lose theirelasticity. A person who has emphysema cannot breathe normallyand is unable to get enough oxygen to the body. Emphysema worsensover time. Chronic obstructive pulmonary disorder (COPD) is a disorder that is a combination of chronic bronchitis and obstructive (blocked)emphysema. COPD causes chronic coughing, difficulty breathing,frequent infections, and eventually death due to respiratory failure.COPD is almost al ways linked with smoking. Heart and Artery Diseases Nearly 170,000 people die each year from heart and artery disease caused by cigarettes. Nicotine increasesheart rate, narrows blood vessels, and eventually causes arteries tobecome hardened and clogged. All of these effects combine toincrease the risk of heart attack, blood clots, and stroke. Cancer Cigarettes promote several kinds of cancers, including lung, pancreas, bladder, cervix, and kidney cancer. Tobacco productsare the major causes of cancers of the mouth and throat. Lung canceroften spreads to other parts of the body, which is one of the factorsthat makes lung cancer so deadly. Lung cancer currently kills morepeople than any other form of cancer does.Emphysema Ronald Bowell testified in a lawsuit against the tobacco industry. Tobaccocompanies once claimed that tobac-co use was safe and not addictive. Mr. Bowell smoked cigarettes for over30 years. Now he suffers from emphy-sema and must use an oxygen tank atall times. For more information about the respiratory system, see the Express Lesson on pp. 536–537 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 269Long-Term Effects of Tobacco on the Body Long-term tobacco use damages the body in many ways. Healthy lung Lung with cancer1 Figure Mouth Smoking changes the natural chemical balanceinside the mouth,leading to increased plaque, gum disease, and tooth decay. Tar in tobacco smoke stains teeth yellow. Lungs Cigarette smoke puts carcinogens directly into the lungs. It kills thetiny hairs that remove harmfulsubstances from the lungs. Theloss of these hairs increases therisk of bronchitis, emphysema,and lung cancer.Brain Smoking reduces oxygen to thebrain, narrows blood vessels,and can lead to strokes. Nico-tine also changes the brain inways that lead to addiction. Heart Nicotine increases heart rateand blood pressure and narrowsthe blood vessels. It alsoincreases the risk of hardenedand clogged arteries, which canlead to a heart attack. Skin Smoking breaks down the pro-teins that give skin elasticity.This leads to wrinkles and premature aging of the skin.Smoking also increases a per-son’s chances of developingskin cancer. Immune system Chemicals in smoke reduce the activity of immune system cells.Damaging the immune systemincreases the chances of sufferingfrom diseases such as cancer. Healthy artery Blocked artery Copyright © by Holt, Rinehart and Winston. All rights reserved. Immune System Suppression Chemicals in smoke reduce the activity of immune system cells. This makes the body more vulner- able to disease. The immune system is less able to fight lung diseasesand remove cancer cells that are caused by smoking. Other Long-Term Effects of Tobacco Use Smoking damages the stomach’s ability to neutralize acid after a meal. This causesexcess acid to build up and damage the stomach and small intestine,which leads to ulcers and to cancer. Tobacco also makes you unattractive. Smokers have stains on their fingers. Both smokers and users of snuff develop discoloredteeth and bad breath. People who dip also develop receding gumsand sores in their mouths. Smoking leaves an odor of smoke and afilm of tar on your clothes. Smoking also dulls the senses of smelland taste—you can no longer appreciate the good taste of foods. Effects of Smoke on Nonsmokers Unfortunately, even if you don’t smoke, you can still be exposed tothe harmful chemicals in cigarettes. When a smoker lights a cigarette,he or she creates two sources of smoke. The first source is called side-stream smoke. is the smoke that escapes from thetip of a cigarette, cigar, or pipe. Sidestream smoke can be as much as half of the smoke from a cigarette. The second source of smoke is mainstream smoke. is smoke that is inhaledthrough a tobacco product and exhaled by a tobacco smoker. is a combination of exhaled mainstream smoke and sidestream smoke. Environmentaltobacco smoke is inhaled by anyone near the smoker. Environmental tobacco smoke (secondhand smoke)Mainstream smokeSidestream smoke The deadly contents of cigarette smoke affect everyone exposed to thesmoke. For every eight people killed bytheir own smoke, a nonsmoker is killedby exposure to secondhand smoke. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Dangers of Tobacco Use 271Dangers of Secondhand Smoke Lung cancer caused by envi- ronmental tobacco smoke kills 3,000 nonsmokers in the United States each year. For every eight people killed by their own smoking,a nonsmoker is killed by exposure to secondhand smoke. Secondhand smoke also causes illness. For example, heart func- tion in healthy young men has been shown to be reduced by second-hand smoke. Secondhand smoke also causes headaches, nausea, anddizziness. The children of smokers suffer from more lower respiratory infec- tions, more asthma, and more ear infections than children who livein smoke-free homes do. Dangers of Tobacco Use During Pregnancy Women who smoke while pregnant risk the health of their unborn child. Chemi-cals from cigarette smoke pass through the placenta to the develop-ing infant and affect the baby the same way they affect the mother. Smoking while pregnant can lead to miscarriage, premature birth, low birth weight, and sudden infant death syndrome. Sudden infant death syndrome (SIDS) is a condition in which infants die in their sleep for unknown reasons. Smoking can also affect a fetus’s brain, causing developmental difficulties. Infants whose mothers smoke while pregnant can bephysically dependent on nicotine when they are born. If the pregnant mother does not smoke but lives with a smoker during her pregnancy, her baby faces many of the same risks faced bya baby born to a mother who smokes. Each year, passive smokingcontributes to more than 150,000 cases of bronchitis and pneumo-nia in babies. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the disease in which air cannot move in and out of alveoli because they become blocked or lose their elasticity. 2.Compare mainstream smoke to sidestream smoke. 3.Define environmental tobacco smoke. Understanding Key Ideas 4.Identify the short-term effect of smoking. a.emphysema c.heart disease b.cancer d.increased blood sugar 5.Describe the damage caused by long-term use of tobacco products. 6.Listthe effects that secondhand smoke has on nonsmokers. 7.Listfive problems that infants can have if they are born to mothers who smoke. 8. Practicing Wellness What would you tell a friend to discourage him or her from begin-ning to smoke? Critical Thinking 9. Practicing Refusal Skills Imagine a friend responds to your efforts to discourage himor her from smoking by saying, “Just one cigarettewon’t hurt.” What would your reply to this state-ment be?LIFE LIFE SKILLLIFE LIFE SKILLEffects of Tobacco on the Fetus and Baby >Risk of miscarriage >Risk of premature birth >Low birth weight >Slow growth rate >Risk of sudden infant death syndrome (SIDS) >Risk of developing respiratory illness >Risk of developing learning difficulties Copyright © by Holt, Rinehart and Winston. All rights reserved. 272 CHAPTER 11 TobaccoA Tobacco-Free LifeSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Delaine was walking with her friend, Miguel, after school. Miguel pulled a pack of cigarettes out of his pocket andstarted to light one. “Hey, you want one?” he asked Delaine. “No thanks, you know I don’t smoke,” she answered. Why Do People Use Tobacco? Most tobacco users can name reasons they like tobacco. Some peoplesay they use cigarettes to deal with stress. Some say smoking makesthem look older; others say tobacco energizes them. But what makespeople want to try tobacco in the first place? >Family and friends If your parents smoke, smoking may seem normal to you. If your friends smoke, they’ll almost certainlyurge you to smoke, too. Being around smokers increases thepossibility that you will try cigarettes. >Misconceptions Messages about the dangers of tobacco to health are often not believed. People see others who have usedtobacco for many years and who seem to be fine. Unfortu-nately, the effects of tobacco use may not be visible. Tobacco-related cancer is often not detected until it is large and mayhave spread. >Advertising Tobacco advertising has been very effective in the past. Tobacco products have been marketed by the tobaccoindustry using rugged-looking cowboys, attractive models, andeven cartoon animals. The idea they are selling is obvious—smoking makes men handsome and women attractive, andsmoking is fun and makes people look cool. >Curiosity Some people try tobacco because they’re curious. They may see other people smoking and wonder what it’s like. >Rebellion Almost all adults tell you that you shouldn’t try tobacco. Sometimes, teens get tired of being told what theycan and can’t do. Using tobacco can be one way to rebelagainst authority. But you can’t prove your independence bybecoming addicted to tobacco. OBJECTIVES Discuss the factors that contribute to tobacco use. Summarize three ways that tobacco use affects

families and society. Listfour things a person can do to make quitting smoking easier. Name five benefits of being tobacco free. Listfive ways to refuse tobacco products if they’re offered to you. LIFE LIFE SKILLKEY TERMSKEY TERMS nicotine substitutes medicines that deliver small amounts of nicotine to the body to help a person quit using tobacco Smoking affects smokers and everyone around them. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 A Tobacco-Free Life 273Tobacco Use Affects the Family and Society Tobacco use causes health and financial problems for the family and costs society a lot of money. Costs to Families Many of the costs of tobacco use to the family are related to health problems. For example, tobacco use costs thefamily >over $1,500 per year for buying tobacco products >lost wages due to illness >medical bills >funeral costs Despite the best doctors and the most caring families, tobacco kills. Twenty percent of premature deaths in the United States arecaused by tobacco use. Think of the devastation that loss causes fami-lies. After having cared for a sick smoker, family members have towatch him or her die. Then, they have to live without their loved one,who could be a father, mother, sister, or brother. Costs to Society In addition to the cost of tobacco use to families, tobacco use creates a high cost to society. In fact, society is estimatedto pay about $138 billion per year in financial costs due to smoking.These costs are related to medical care that cannot be paid by smokers.Businesses often pay part of a person’s insurance costs, which can bevery high when treating tobacco-related diseases. Another cost ofsmoking is the high number of accidental fires that are started by care-less smokers. Tobacco and the Law Selling tobacco to anyone under 18 years of age is illegal. Companies can pay very high fines if they are caught sell-ing tobacco to a minor. In many states, teens are also fined or assignedcommunity service if they are caught using tobacco. $138 billion 400,000 89% 75%statistically speaking. . . The amount smoking costs society per year: The number of premature deaths caused by tobacco use each year: Percentage of movies released in 1996–1997 in which cigarettes appeared: Percentage of society that does not smoke: Copyright © by Holt, Rinehart and Winston. All rights reserved. “Smoking makes me look more mature.” “Smoking makes me look sexy.” “I can stop whenever I want.” “All the cool kids smoke.”Smoking can’t make you look mature, but it can make you look older because smoking damages your skin. Smokers get stained teeth, receding gum lines, bad breath, wrinkled skin, and stained fingers—traits notusually considered sexy. Cigarettes are addictive. Three thousand teens start smoking every day; most will not be able to stop. Does being hooked on tobacco really seem that cool?Beliefs Reality vs.Beliefs Reality vs. For more information about making decisions, such as to quit smoking, see How to Make GREATDecisions on pp. 616–617 of this text. HandbookHEALTH 274 CHAPTER 11 TobaccoTips for Quitting If you are a smoker, you may be wondering why you should quit. There are plenty of reasons to quit. >Smoking is unhealthy. Obviously, the most important reason to quit smoking is for your health. The damage smoking doesto your lungs and cardiovascular system makes smoking toodangerous to be worth the risk. >Smoking is expensive. Twenty-five to fifty dollars a week is a lot to pay for a bad habit. >Smoking stinks. Most people don’t enjoy being around the smoke or the smell of cigarettes. Cigarettes also give you badbreath. >Smoking looks unattractive. Many people start smoking think- ing it will make them look attractive, but yellow fingers andteeth aren’t attractive. >Smoking damages your skin. Smoking can cause your skin to age prematurely, which causes you to look old before you actually are. Decide That You Can Do It Quitting on your own requires dedi- cation and determination. If you smoke regularly, you are probablyaddicted to nicotine. Withdrawal symptoms from stopping tobaccouse can include nervousness, irritability, or difficulty sleeping. Thereare medical products available to help ease withdrawal. medicines that deliver a small amount of nicotine to the body to help people quit smoking, include nicotine patches andnicotine gum. Consult a doctor before using any medicine. Many people find that withdrawal is actually easier to deal with than overcoming the psychological addiction that developed as ciga-rette smoking became part of their daily activities. People trying toquit will have many cues that trigger an urge to smoke as they gothrough their day. The things a person usually did with a cigarette in hand will be difficult to do without wanting one.substitutes,Nicotine Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 A Tobacco-Free Life 275Get Started There are things you can do to make quitting easier. First, set a quitting date. Decide in advance when you want to quit using tobacco, and keep that date. Collect all your cigarettes, ashtrays,and lighters, and get rid of them all so you aren’t tempted to startagain. Change Your Habits Start healthy habits before you try to quit smoking. People who exercise are more likely to quit, so this is agood time to start exercising. Engaging in other activities will alsohelp take your mind off quitting. The less time you spend sittingaround thinking about how hard quitting is, the easier it will be. This is also a good time to look at your diet and make sure it’s healthy. Most people do gain some weight when they quit, but eatingwell and exercising will minimize any weight gain. Set Goals After you’ve quit, staying free of tobacco can be diffi- cult. To help you stay tobacco free, set goals for yourself. Keep a cal-endar, and celebrate each week you don’t use tobacco. You canreward yourself with the money you save by not buying tobacco. Ifyou smoked a pack a day, you will have saved at least $25 in the firstweek. Twenty-five dollars a week really adds up. You will probablyhave a lot of money to celebrate quitting smoking. Celebrating yoursuccess can make quitting easier. Get Support Quitting can be hard, but you don’t have to quit alone. There are many kinds of support groups that can help you.Your parents, teacher, school nurse, doctor, local health department,and local American Cancer Society or American Lung Associationbranches can help you find those groups. Another approach is to join an after-school club that will keep you busy and take your mind off smoking. The new friends you makein these groups can encourage you when you’re feeling like you justcan’t do it. Reasons to Quit Smoking >You’ll live longer. >You’ll smell better. >You won’t have bad breath. >You’ll have whiter teeth. >You’ll be able to taste food. >You’ll have extra money. >You won’t cough all the time. >You’ll be able to sit through a whole movie without shaking. >You won’t need a chemical tomake you feel good. Copyright © by Holt, Ri nehart and Winston. All rights reserved. 276 CHAPTER 11 TobaccoSkills for Refusing Tobacco Have you ever been offered something you don’t want? Sometimes, convincing people that you’re not interested is difficult. Practicingeffective refusal skills can help you know what you want to say beforeyou’re in a high-pressure situation. The following scenario is anexample of using effective refusal skills to resist peer pressure tosmoke. “Hilary, come on. It’s so boring in here. Let’s go have a smoke.”“You know I don’t smoke, Tiffany.”“Oh don’t be such a goody-two-shoes. Just relax.”“Tiff, I spent all afternoon getting ready for this party. I’m wearing my favorite perfume. I really don’t want to smell like a cigarette.” “Oh, Hilary. Don’t you want to look cool?” “Tiffany, you know I don’t want to smoke. Why do you try to force me? Hey, look. There’s Ian. You’ve wanted to go out with himall year, right? He won’t even know you’re here if you’re out backsmoking. Why don’t we go dance? Maybe you can get his attention.” Refusing Effectively Hilary did a good job of saying no without hurting her friendship. You can learn to do this by following the stepsbelow. 1. Be honest. Hilary was direct with her friend. She stayed calm and didn’t attack Tiffany or put her down. 2. Give a reason. Hilary gave her friend a reason she didn’t want to smoke. It was a simple reason but one that made sense to herfriend at that moment. 3. Suggest an alternative. Hilary suggested another activity that would appeal to both of them. Of course, using effective refusal skills is not always easy. Telling your friends no can be very difficult. Many people find it impossible to keep resisting under pressure. But you know you don’t want tosmoke. And you don’t want to lose your friends over a cigarette. Practicing refusal skills can help you turn down tobacco, or anythingelse you don’t want, without losing your confidence or your friends. “Come on; just try one. ” “Smoking is sexy. ” “Don’t be so paranoid. These are made from cloves, so they’re healthy. ” “Dipping makes you look as cool as a sports star. ” “Everyone else is smoking. ”“Isn’t that how yougot addicted?” “There’s nothing sexy about smelling like an ashtray.” “They have tobacco, so they’re still bad for you.” “I don’t think I’ll look cool with brown spit.” “So, not smoking makes me unique? I like being unique.”“Thanks, but I don’t smoke.” Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE LIFE SKILL Activity www.scilinks.org/health Topic: Anti-Smoking Campaigns HealthLinks code: HH4012 Benefits of Being Tobacco Free What are the benefits of notusing tobacco? All the studies agree that people who don’t use tobacco are healthier. They tend to live longer and are at a lower risk of lung cancer, oral cancer, heart disease,emphysema, and bronchitis. People who don’t use tobacco also haveother benefits, such as >getting fewer colds, sore throats, and asthma attacks >not coughing if they’re not sick >being less likely to have stained teeth, bad breath, or chronicgum disease >being able to taste their food and smell flowers >not smelling like smoke all the time >not exposing loved ones to the harmful chemicals in smoke >not having black bits of tobacco in their teeth >not having to carry around a cup of brown spit Finally, people who stay tobacco free never have to break an addiction to tobacco. Almost everyone who uses tobacco regularly formore than a few months becomes addicted. Staying tobacco free pro-tects your brain from the changes caused by an addictive drug. Kicking the HabitSetting Goals Imagine that you had decided to help a friend quit smok- ing. Design a plan of goals and rewards to encourageyour friend to quit using tobacco and stay tobacco free. Set a time limit. Decide with your friend that on a certain day your friend will quit smoking. Have everything organized so that your friendwill have no temptations once he or she quits. Set milestones. Mark dates on the calendar to divide up the one big goal into several smallerones. Reward your friend. List things you can do to cel- ebrate your friend’s achievement. As he or shereaches each milestone, mark the occasion with a reward for your friend’s self-discipline and determination. 321Setting Goals 1.Describe ways that you can provide support and encouragement to someone who is trying to quitsmoking. 2.List some of the situations that may make itdifficult for a person to stay tobacco free. Listsituations to avoid. 3.In what other situations might these goal-settingskills help?LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 278 CHAPTER 11 TobaccoLife Without Tobacco What does it mean if you’ve used tobacco? Is it too late to protect your health? Studies show that the sooner you quit using tobacco, the sooneryour body can get back to normal. Within half an hour after quitting smoking, your blood pressure and heart rate will fall back to normal.Eight hours later, you will have rid the carbon monoxidefrom your bloodstream, and you will have normal blood-oxygen levels. Within a few days, your sense of smell andtaste will improve, and breathing will be easier. During the following months, your lung health will improve, and you won’t be short of breath anymore. You’llbe reducing your risk of lung cancer by about 10 times, thethreat of emphysema will almost disappear, and your riskof heart disease will decrease as well. Even in such a shorttime, living without tobacco makes a big difference. Live Healthy and Tobacco Free Life is better without tobacco. The 80 percent of teens who don’t smoke agree. Tobacco is a dangerous and addictive drug. All forms oftobacco have been proven to cause major health problems that can be deadly. As a result of lawsuits, tobacco companies havepaid billions of dollars to the states for exactly that reason. People may have many reasons for trying tobacco. Friends, family, media influence, rebellion, boredom, and curiosity are all rea-sons people may smoke or dip for the first time. Most tobacco usersgenerally have only one reason for continuing to use tobacco—addiction. And the best reason for staying tobacco free is life. Yourlife, your friends’ lives, and the lives of all your loved ones will be bet-ter without tobacco. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define nicotine substitute . Understanding Key Ideas 2.Listthree reasons people may begin using tobacco. 3.State two ways that tobacco use affects families and society. 4.Identify which of the following is nota cost of tobacco use to society. a.tobacco products c.fetal alcohol syndrome b.funeral costs d.medical costs5.Describe a strategy a person could use to make quitting smoking easier. 6.Identify five benefits of living tobacco free. Critical Thinking 7. Using Refusal Skills List five reasons you can give for refusing to use tobacco. Which of these reasons is most important to you? 8. Communicating Effectively Imagine that you have a family member who smokes heavily. What do you think would be the best wayto try to convince them to quit smoking?LIFE LIFE SKILLLIFE LIFE SKILL World Cup Mountain Bike Champion Alison Dunlap and New Orleans Saintswide receiver Willie Jackson signcopies of a book that promotes ahealthy lifestyle as an alternative totobacco use for young people. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 11 Highlights 279 CHAPTERCHAPTER 1111 CHAPTERHAPTER 1111 CHAPTER 11Highlights Key Terms The Big Picture ✔People begin smoking for many reasons. Some want to fit in with friends who smoke, some find it normal after growing up aroundfamily members who smoke, and others want to look cool. ✔Using tobacco is expensive. It costs families and society billions ofdollars each year in healthcare and lost productivity. ✔Quitting smoking can be difficult, but setting a quitting date,marking your progress, getting involved in other activities, andrewarding yourself can help make quitting easier. ✔Refusing tobacco may be difficult, but practicing effective refusalskills makes it easier to resist pressure. ✔There are many benefits to being tobacco free, including lookingyounger, feeling healthier, and living longer than you would if youused tobacco. ✔Whether a person has used tobacco or not, choosing to live with-out tobacco dramatically improves a person’s quality of life.SECTION 3 nicotine substitutes (274) ✔There are many kinds of tobacco products, such as cigarettes, dip, snuff, chew, bidis, kreteks, and pipe tobacco. ✔All forms of tobacco are dangerous because they contain manyharmful chemicals and carcinogens, including nicotine, tar, carbonmonoxide, cyanide, and formaldehyde. ✔Nicotine can enter the body through the lungs, the gums, and the skin. ✔Herbal cigarettes are thought to be more healthy but are actuallyjust as dangerous as conventional cigarettes. ✔People who use tobacco products find it very hard to quitbecause nicotine is a highly addictive drug.SECTION 1 nicotine (264) carcinogen (264) tar (264) carbon monoxide (264) ✔The short-term effects of tobacco use include increases in heartrate, blood pressure, and breathing rate, as well as a reduction inthe amount of oxygen that reaches the brain. ✔Long-term tobacco use leads to oral and lung cancer, bronchitis,emphysema, heart disease, artery disease, and other health problems. ✔People who breathe environmental tobacco smoke are exposedto the same dangerous chemicals as smokers. ✔Smoking while pregnant can lead to several kinds of problems for the infant, including miscarriage, developmental difficulties,and SIDS. ✔There are many reasons not to smoke, including protecting yourfamily, friends, and loved ones from the harmful effects of envi-ronmental tobacco smoke.SECTION 2 emphysema (268) sidestream smoke (270) mainstream smoke (270) environmental tobacco smoke (secondhand smoke) (270) Copyright © by Holt, Rinehart and Winston. All rights reserved. 280 CHAPTER 11 Review CHAPTERCHAPTER 1111 CHAPTERHAPTER 1111 CHAPTER 11Review Using Key Terms carbon monoxide (264) carcinogen (264) emphysema (268) environmental tobacco smoke (secondhand smoke) (270) mainstream smoke (270) nicotine (264) nicotine substitutes (274) sidestream smoke (270) tar(264) 1.For each definition below, choose the key term that best matches the definition. a.the smoke inhaled and exhaled by the smoker b.a gas that blocks oxygen from entering thebloodstream c.a lung disease in which the alveoli lose theirelasticity or become blocked d.any chemical or agent that causes cancer e.a sticky substance in tobacco smoke that coatsthe inside of the airway and contains many carcinogens f.the addictive drug found in tobacco 2.Explain the relationship between the key terms ineach of the following pairs. a.nicotine and carbon monoxide b.tarand emphysema c.environmental tobacco smoke and carcinogen d.mainstream smoke and sidestream smoke Understanding Key Ideas Section 1 3.Name four types of tobacco products. 4.State the reason it is difficult for people to quitusing tobacco products. 5.Identify the carcinogens found in tobacco. a.benzene c.vinyl chloride b.formaldehyde d.all of the above 6.Compare the amount of nicotine in snuff with theamount in cigarette smoke. 7.Are herbal cigarettes safer than regular cigarettes? 8.CRITICAL THINKING Would you consider nico- tine a dangerous drug? Explain.Section 2 9.List three short-term effects of tobacco use. 10.Which of the following is a long-term effect oftobacco use? a.heart and artery disease b.cancer c.receding gums and mouth sores d.all of the above 11.Why is smoking dangerous to nonsmokers? 12.Women who smoke while pregnant are morelikely to a.suffer miscarriage. c.cause SIDS. b.have bronchitis. d.All of the above 13.List four reasons not to smoke that you could giveto a friend. 14.CRITICAL THINKING One of the negative aspects of smoking is that the clothes of smokers usuallysmell like tobacco smoke. Explain why smokersgenerally cannot smell tobacco smoke on theirclothes. Section 3 15.What factors do you think contribute to peopleusing tobacco in your school? 16.Describe the financial and health costs of smok-ing on both the family and the community. 17.Which technique does nothelp a person quit smoking? a.setting a goal b.punishing yourself for failing c.changing your habits d. getting support 18.List five benefits both smokers and smokelesstobacco users can expect after quitting. 19.Describe an effective refusal method you coulduse if someone were to tell you, “Here, try thesenew cigarettes, almost everyone in our schoolsmokes these.” 20.CRITICAL THINKING Why might it be harder for a person to quit smoking if his or her friends andparents smoke?LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 11 Review 281Interpreting Graphics Study the figure below to answer the questions that follow. 21.What do you think the word sophisticated, as used in the ad above, means? 22.What message is this ad trying to convey about tobacco use? 23.CRITICAL THINKING Do you think this ad might encourage a young person to smoke? Explain.Activities 24. Health and You Imagine you are riding in a car with someone who smokes. Write a paragraph explaining how you mightpolitely and effectively ask the person not tosmoke in the car. 25. Health and Your Community Environmental tobacco smoke is just as dangerous as mainstream smoke. Write a one-page report advocating for smoke-free environ-ments for nonsmokers. 26. Health and You Write a reply to the following statement: “Just try this cigarette once; one trywon’t harm you. It’s not like you’ll become anaddict.” Action Plan 27. Take Charge of Your Health Use of clove ciga- rettes, bidis, and kreteks has become more popu-lar among teens. Research these products, andwrite a one-page report explaining why teens usethese tobacco products. 28.In this paragraph, the word finite means Alimited. Bendless. Cspendable. Dfree. 29.What can you infer from reading this paragraph? ETobacco products are cheap. FTony makes more money than Cameron does. GTony thinks tobacco is worth the expense. HCameron is probably addicted to nicotine. 30.Write a paragraph discussing things that Cameroncould do to make quitting easier. What could Tonydo to help his friend quit smoking? 31.CRITICAL THINKING One reason that tobacco products are so expensive is that the U.S. govern-ment charges taxes that consumers must paywhen they buy tobacco. Why do you think thegovernment keeps raising these taxes?READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Cameron and Tony walked up to the counter at the convenient store. “What areyou getting?” asked Tony. “Nothing. I’mout of cash,” replied Cameron. “Didn’t youhave a bunch of money last week?” askedTony. “Yeah, but I spent it on cigarettes.”“Man, that just doesn’t seem worth it. If youhave a fi niteincome, you should save it for the stereo system you want.” “I know. Cigarettes keep getting more and moreexpensive, but I’ve been smoking for years.I can’t stop,” said Cameron. “It’s not likequitting is impossible,” replied Tony. READING SKILLWRITING SKILL WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 12 CHAP TER 12 CHAPTER 12 Illegal DrugsIllegal DrugsIllegal Drugs 282KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.If illegal drugs were really dangerous, people wouldn’t use them. 2.People can’t get addicted to marijuana. 3.Stimulants can help you study more effectively. 4.Anabolic steroids are male hormones, so theyshould make guys appear more masculine. 5.Barbiturates are safe because they’re used asmedicine. 6.Most prison inmates committed their crimewhile high on drugs. 7.Because I’m young, any damage drugs do tomy brain will heal by the time I’m an adult. Copyright © by Holt, Rinehart and Winston. All rights reserved. 283SECTION 1 Drugs of Abuse SECTION 2 Commonly Abused Drugs SECTION 3 Other Drugs ofAbuse SECTION 4 A Drug-Free Life go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH12. Copyright © by Holt, Rinehart and Winston. All rights reserved. 284 CHAPTER 12 Illegal DrugsTonya was the best point guard on the team until she tried cocaine. She liked how it made her feel, so she tried it again.Soon she was spending up to $100 a day on crack. When the team went to the state championship, Tonya couldn’t go. She had beenarrested for stealing. She had stolen to support her drug habit. Illegal Drug Use Is Dangerous is the intentional improper or unsafe use of a drug. Drugs that are used for recreational purposes are called drugs of abuse. Many drugs of abuse are illegal drugs. This means that possessing, using, buying, or selling these drugs is against the law for people ofany age. It may sometimes seem that our society is full of messages that tell us illegal drug use is normal and not dangerous. For example,characters in the movies and on television can make it seem asthough illegal drug use is “cool.” Many popular rock bands singabout illegal drugs. You can buy clothes and posters showing illegaldrugs. But using illegal drugs is very dangerous for several reasons: >Illegal drugs can have dangerous and permanent effects on thebrain and the body. >You can become addicted to almost all illegal drugs. >Illegal drugs are a major factor in many suicides, motor vehicleaccidents, and crimes. >With illegal drug use that involves sharing needles, there isalso the risk of catching infectious diseases such as hepatitis Band human immunodeficiency virus (HIV). >Illegal drug use can result in overdose. is the takingof too much of a drug, which causes sickness, loss of con-sciousness, permanent health damage, or even death. >While using illegal drugs, a person loses the ability to makeresponsible decisions. Having

poor judgement while on drugscan result in risky sexual behavior, sexually transmitted dis-eases, car accidents, and other unsafe situations.OverdoseDrug abuseDrugs of AbuseSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Listsix ways illegal drug use can be dangerous. State five reasons a person might try illegal drugs. Identify the reason drug abuse is especially dangerous to teens. Describe two ways illegal drug use conflicts with your values and goals. LIFE LIFE SKILLKEY TERMSKEY TERMS drug abuse the intentional improper or unsafe use of a drug overdose the taking of too much of a drug, which causes sickness, loss of consciousness, permanent damage, or even death Drug abusers can be any age and be from any background. Each has a differ-ent reason for using drugs. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Drugs of Abuse 285Why Do People Begin Using Drugs? If illegal drug use is so dangerous, why does anyone even try illegal drugs? People try illegal drugs for many reasons, including the following: >desire to experiment >desire to escape from depression or boredom >enjoyment of risk-taking behaviors >belief that drugs solve personal, social, or medical problems >peer pressure >glamorization of drug use by the media Often, people begin taking a drug because they like the way it makes them feel. Soon, however, they may find that they must keeptaking the drug just to feel normal. Repeated use of drugs thatchange how the brain works can lead to addiction. Addiction to anillegal drug can be very difficult to overcome. Regardless of a person’s reason for trying an illegal drug, one thing remains the same—the physical, mental, social, and legal con-sequences for illegal drug use make it not worth the risk. Teens and Illegal Drug Use Teens face many challenges during adolescence. These challenges include expectations on the part ofparents and teachers and the desire for more freedom and responsi-bility. These challenges can make adolescence a very stressful time oflife and can put teens at a greater risk for abusing illegal drugs. Other challenges that teens face are intense peer pressure and a strong desire to fit in. There are many other reasons that teens mightbe tempted to try illegal drugs. The most common reasons that teensgive for trying illegal drugs are listed below. >Sometimes, just being around a group of people using drugscreates pressure to join in. This is a common type of peer pres-sure that doesn’t involve direct pressure. Teens may give in andtry a drug when they feel everyone else is trying drugs. Being caught in possession of illegal drugs is a crime that has seriouspenalties. Copyright © by Holt, Rinehart and Winston. All rights reserved. 286 CHAPTER 12 Illegal Drugs>When faced with direct pressure to use drugs, teens who lack refusal skills orwho feel intimidated may give in to pres-sure and use drugs. >Many teens think that using illegal drugsis a way to escape from feelings of stress,anger, depression, or frustration. How-ever, after a teen takes drugs, the problemthat caused the negative feeling is stillthere, but now the teen may also have todeal with the consequences of drug use. >Many teens try drugs out of curiosity.This seems natural when the media givesso much attention to drug abuse. Teensmay see or hear of another person’s expe-riences with drug use and wonder whatit’s like. >Other teens may try drugs because theyare risk takers or thrill seekers searchingfor a way to satisfy their desire for newexperiences. Unfortunately, teens have a higher risk of addiction to drugs than adults do. The risk of addiction is higher because young brains arestill developing. Drug use or abuse can have irreversible effects on thefunction of the brain. Altering brain development with drug use canresult in a lifetime of struggle to overcome addiction and to remaindrug free. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term drug abuse. 2.Identify the term for “the taking of too much of a drug, which causes sickness, loss of consciousness, permanent damage, or even death.” Understanding Key Ideas 3.Identify which of the following is a type of media that seems to advocate drug use. a.music c.television b.movies d.all of the above 4.Identify the reasons illegal drugs are dangerous. 5.Name five factors that influence a person’s choice to use illegal drugs.6.State the reasons why teens might try illegal drugs. 7.Defend the statement that teens should never use illegal drugs. 8.Predict the outcome of using an illegal drug to escape from personal problems. 9. Setting Goals Describe two ways illegal drug use would affect your personal valuesand goals. Critical Thinking 10. Practicing Wellness Why is it impor- tant to have healthy alternatives to drug use?LIFE LIFE SKILLLIFE LIFE SKILLSome people start using drugs to get away from their problems and thencan’t get away from their drug problem. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Commonly Abused Drugs 287 Commonly Abused DrugsSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Hey, you want a hit of this joint?” offered Randall. “No way. Do you know what that stuff can do to you?” Jen replied.Randall looked surprised. “Pot isn’t dangerous, is it?” “It’s dangerous” said Jen, “and it’s addictive. Why would I want that?” Types of Illegal Drugs There are many types of illegal drugs. As shown in Table 1, each type of illegal drug has different effects on the body and the brain. Despitethe differences in their effects, all illegal drugs have three things incommon. 1.They affect the function of the brain. 2.They are dangerous to your health. 3.They can result in drug dependence and addiction. Four commonly abused illegal drugs—marijuana, inhalants, club drugs, and anabolic steroids—will be described in this section.OBJECTIVES Listthree things all types of illegal drugs have in common. Summarize the effects of four commonly abused illegal drugs on the body. Describe the effects of marijuana on a person’s behavior. Identify the reason abusing inhalants can be deadly after only one use.Compare the dangerous effects of five types of club drugs. Summarize the dangerous effects of anabolic steroids.KEY TERMSKEY TERMS marijuana the dried flowers and leaves of the plant Cannabis sativa that are smoked or mixed in food and eaten for intoxicating effects inhalant a drug that is inhaled as a vapor club (designer) drug a drug made to closely resemble a common illegal drug in chemical structure and effect anabolic steroid a synthetic version of the male hormone testosterone that is used to promote muscle development “ “Marijuana is a safe drug.” “It’s okay to try a drug just once.” “I can stop any time I want.” “If I want to use drugs, I only affect myself.”Driving high on marijuana can be just as dangerous as driving drunk. Some drugs, such as crack cocaine or inhalants, can be fatal the first time they are used. The more often you use drugs, the more difficult it can be to stop. Drug use affects you, your family, your friends, and society.Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. 288 CHAPTER 12 Illegal Drugs Drug and common orstreet names Marijuana pot, weed, dope, blunt, grass,reefer, Mary Jane Hashish boom, chronic,hash, hemp Inhalants glue, paint thinner, propane,nitrous oxide,NO, poppers,snappers, whippets Club (designer) drugs Ecstasy MDMA, Ecstasy,X, XTC, Adam GHB G, liquid X,grievous bodilyharm Ketamine and PCPSpecial K, K,Vitamin K, angel dust (PCP) Anabolic steroidsroids, juiceHow it is taken smoked or mixed in foodand eaten inhaled swallowed or snorted swallowed or snorted injected, snorted, orsmoked swallowed or injectedPossible intoxication effects >relaxation >feelings of well being >distortion of time and distance >loss of short-term memory >loss of balance and coordination >increased appetite >stimulation >loss of inhibitions >dizziness >loss of coordination >nausea and vomiting >headache >increased awareness of senses >mild hallucinations >increased energy >loss of judgment >relaxation >nausea >loss of inhibitions >euphoria >confusion >distortions of reality >numbness >no intoxication effectsPossible health consequences*>frequent respiratory infection >impaired learning and memory >panic attack >heart attack >liver damage >kidney damage >brain damage >coma >death >impaired learning and memory >hyperthermia (overheating) >rapid or irregular heartbeat >high blood pressure >heart attack >death >dangerously slowed breathing >seizures >coma >loss of memory >loss of muscle control >dangerously slowed breathing >increased aggression >shrinking of testes >infertility >growth of breasts in men >growth of facial hair in women >deepening of voice in women >liver rupture/liver cancer >heart damage/heart attackTable 1 Common Illegal Drugs and Their Effects *All of the drugs listed in this table can result in physical dependence, and some can result in addiction. Copyright © by Holt, Rinehart and Winston. All rights reserved. Marijuana (MAR uh WAH nuh), also called pot, weed, reefer, or dope, is the dried flowers and leaves from the plant Cannabis sativa. The active chemical in marijuana is tetrahydrocannabinol (THC). THC can be detected in the urine for up to several weeks after use. Different mari- juana plants may contain very different levels of THC. Marijuana isusually smoked, but it can also be mixed with food and eaten. Effects of Marijuana The effects of smoked marijuana are felt within minutes and may last for 2 or 3 hours. The effects of swal-lowed marijuana are felt within 30 to 60 minutes. Although theshort-term effects of marijuana differ depending on the person andthe strength of the drug, they can include the following: >slowed thinking ability >difficulty paying attention >distorted sense of time and distance >giddiness >loss of short-term memory >loss of balance and coordination >increased appetite >anxiety >panic attack Smoking marijuana over a long period of time can cause some of the same health effects as smoking cigarettes. Marijuana smoke hasbeen found to contain many of the same carcinogens as cigarettesmoke. Long-term marijuana use may lead to chronic bronchitis,damaged lung tissue, and increased risk of lung cancer. Marijuana use has a negative effect on learning and social behav- ior. THC changes the way sensory information gets into the brain.Long-term marijuana use can cause difficulty in remembering, pro-cessing, and using information. Marijuana users can have difficultymaintaining attention and shifting attention to meet changingdemands in the environment.Marijuana Stopping marijuana growers is a major part of the war on drugs. Law enforce-ment officials frequently destroy largefields of marijuana. Copyright © by Holt, Rinehart and Winston. All rights reserved. 290 CHAPTER 12 Illegal DrugsDependence on Marijuana People who use marijuana regu- larly build up a tolerance to the drug, so they need more and more to get high. This can lead to dependence on marijuana. After the effectsof marijuana wear off, some users feel tired, unmotivated, anddepressed. Once a marijuana user becomes dependent, he or she willexperience the effects of withdrawal each time the drug wears off. Marijuana and Driving Because marijuana makes it difficult to pay attention and makes it harder to judge time and distance, mari-juana use is dangerous when driving. People high on marijuana canshow the same lack of coordination on standard drunk-driver tests aspeople who are drunk. The danger of driving under the influence ofmarijuana is increased when marijuana is combined with alcohol. Hashish Hashish (HASH EESH), also known as hash, is the dark- brown resin collected from the tops of the cannabis plant. The resinis compressed into various forms, such as balls or flat sheets. Piecesare then broken off, placed in pipes, and smoked. The effects ofhashish are the same as those of marijuana, but stronger. Analyzing DATA Analyzin gDA TA Analyzing DATA Analyzing DATADangers of Marijuana Abuse The horizontal axis ( x-axis) shows the year. The vertical axis ( y-axis) shows the number of marijuana-related emergency room visits.21 Your Turn 1.Approximately how many people visited the emergencyroom because of marijuanause in the year 1996? 2.How many more people wereadmitted to the emergencyroom with marijuana-relatedinjuries in 2000 than in 1996? 3.Using the trend shown in thegraph, predict how manypeople might visit the emer-gency room in 2004. How many personsmight visit it in 2008? 4. CRITICAL THINKING What do you think is the maincause of marijuana-relatedinjury? 1996 Year100 80 604020 0Visits (in thousands) 1997 1998 1999 2000 Marijuana-Related Emergency Room Visits Source: U.S. Drug Enforcement Agency.12 MATH SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Commonly Abused Drugs 291Inhalants Drugs that are inhaled as vapors are called (in HAYL uhnts). Some inhalants have medical uses.For example, nitrous oxide (NIE truhs AHKS IED), also called laughing gas, is used by physicians and dentists as an anesthetic. Medicines to treat asthmaalso come in the form of inhalants. But many inhalants are not used for medical rea- sons. For example, some people inhale commonhousehold chemicals, such as glue, paint thinner,gasoline, and felt-tip marker fluid. Other commonlyabused inhalants include propane, butane, andnitrous oxide. Inhalants can be sniffed (or huffed ) directly from an open container or from a rag soaked in the sub-stance. Sometimes, the container or the soaked rag isplaced in a plastic bag where the vapors can becomeconcentrated before they are inhaled. Effects of Inhalants The effects of inhalants range from mild to severe. The effects include hyper-activity, loss of inhibition, and dizziness. Strongereffects include loss of coordination, difficulty speak-ing or thinking, fear, anxiety, depression, nausea,vomiting, headache, and loss of consciousness. Dangers of Inhalants As summarized in Figure 1, inhalants are very dangerous. Although different kinds of inhalants have differenteffects, almost all of them are damaging to the body. >Inhalants damage many organs. Chemicals, such as solvents, in inhalants can cause permanent hearing loss, bone marrow dam-age, liver damage, kidney damage, and loss of bladder control. >Inhalants kill brain cells. Inhalant vapors replace the oxygen found in the blood and can cause brain cells to die from lackof oxygen. Breathing high concentrations of inhalants cancause brain damage, coma, and death from suffocation. >Inhalants can cause sudden death. Some people’s bodies are sensitive to the solvents in some inhalants. The heart may sud-denly stop beating, and the person may die. This is called sud- den sniffing death syndrome. Unfortunately, people only discover that they are sensitive to organic solvents after it’s too late. Teens and Inhalants Because the substances used by people who huff drugs are easy to get, inexpensive to buy, and legal, huffingis often seen among younger teens. Huffing can be a first step on thepath to trying other illegal drugs. Drugs that often lead to abuse ofother drugs are called gateway drugs. Inhalants are a common gateway drug among teens, along with tobacco and alcohol.inhalants Brain loss of vision and coordination,death of brain cells, brain damage, coma Heart and Bloodirregular heartbeat,heart attack, decreased abilityto carry oxygen Lungs irritation, suffocation Liver liver damage Kidneys kidney damage Bladder loss of bladder control Simple household substances can be incredibly dangerous to the body whenthey’re inhaled. Some of these effectsare summarized above.1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Drugs and Drug Abuse HealthLinks code: HH4050 292 CHAPTER 12 Illegal DrugsClub (Designer) Drugs are drugs designed to closely resemble com- mon illegal drugs in chemical structure and effect. These drugs used to be called designer drugs, but they are now more often called club drugs. Club drugs became very popular at parties and clubs but can now be found other places as well. At one time, only drugs specifically listed under the law were ille- gal. A new drug with effects similar to those of an illegal drug butwhose chemical structure differed slightly from that of the illegal drugwas legal. Manufacturers became skilled at mixing legal versions of ille-gal drugs. The laws have now been changed to include all related formsof an illegal drug. Club drugs are made in secret, illegal labs, so their strength and quality are unpredictable and unknown. Thus, the drugs can haveunexpected effects. Overdose from club drugs may be hard to treatbecause no one can know for sure what drugs the user took. Clubdrugs include Ecstasy, GHB, ketamine, PCP, and look-alike drugs. Ecstasy The most commonly abused club drug is Ecstasy, or MDMA (methylenedioxymethampetamine). Ecstasy is also called X, Adam, or XTC. Ecstasy has both stimulant and hallucinogenic proper- ties. Ecstasy is normally taken as a pill, although it can also becrushed and snorted. The intoxication effects of Ecstasy includeincreased awareness of the senses, hallucinations, increased energy,and loss of judgment. The side effects of Ecstasy can include muscletension, teeth clenching, impaired learning and memory, nausea,chills, rapid or irregular heartbeat, high blood pressure, heart attack,brain damage, and even death. Ecstasy decreases the body’s ability to control its temperature. As a result, it is easy to become overheated. People dancing in a nightclub, such as those shown in Figure 2, can pass out and even die from heatstroke while high on Ecstasy. GHB Gamma hydroxybutyrate (GHB) is a clear liquid or a white powder that causes euphoria, relaxation, dizziness, and loss of inhi-bitions. Higher doses cause vomiting, memory loss, respiratory prob-lems, loss of consciousness, seizures, coma, and death. Some peoplewho lose consciousness from GHB stop breathing and die. When it iscombined with other depressant drugs, such as alcohol, death is evenmore likely. GHB can be highly addictive. Some people incorrectly believe that taking GHB with Ecstasy can cancel out the effects of each of the drugs. Some also mistakenlybelieve that GHB makes Ecstasy last longer. However, GHB mixedwith Ecstasy puts the user at a much higher risk of seizure. GHB has been used in many sexual assaults because it makes the victim incapable of resisting and can cause memory problems.For this reason, GHB is part of a group of drugs known as date-rape drugs .Club (designer) drugs People are often pressured to use club drugs at parties and dance clubs. ACTIVITY State two ways you can refuse designer drugs if you are ever pres- sured. (Hint: Refer to the Life Skills QuickReview on p. 618 for ideas.)2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Commonly Abused Drugs 293Ketamine Ketamine (KEET uh MEEN ) is another type of club drug. Ketamine is also known as Special K, Kit Kat, or Vitamin K. The effects of ketamine include hallucination, numbness, inability to move, loss of memory, and dissociation (separation from reality). Some users ofketamine hurt themselves because they are unable to feel pain. Keta-mine has also been known to cause memory loss and coma. PCP PCP (phencyclidine), also called angel dust, can produce effects that range from mild euphoria to distortions of reality, out-of-bodyexperiences, and psychotic behavior. People on PCP often act violentlytoward others or toward themselves. Suicide, accidental suicide, seizures,and coma are risks when one is under the influence of PCP. Mental dis-turbances caused by PCP can last from a few hours to a few weeks. Look-Alike Drugs Look-alike drugs are abused substances that are only slightly different from other, better-known drugs. As with any street drug, users can never know exactly what drug they are getting,how strong it is, and what other drugs might be in it. For example,look-alike drugs such as PMA and DXM areoften sold as Ecstasy. Look-alike drugs are often cheaper than well-known drugs but are just as dangerous.Depending on what is in them, look-alikes cancause similar effects to any other club drug. Iflook-alike drugs are taken with other drugssuch as alcohol, dangerous reactions can occur. Anabolic Steroids Hormones are substances that are made andreleased in one part of the body and thatcause a change in another part of the body. are synthetic versions of the male hormone testosterone that are used topromote muscle development. Anabolic means “muscle building.” When prescribed, anabolic steroids are used to treat muscle wasting in AIDS patients,to assist with wound healing in the elderly,and to treat abnormally low levels of testos-terone in males. Most people who use steroidsto build muscles use them illegally and with-out the guidance of a doctor. Steroids are unique among abused drugs because they don’t have immediate psychoac-tive effects. People take anabolic steroids fortheir effect on the body, not the brain. Unfor-tunately, steroids have severe side effects, asshown in Figure 3. Abusing anabolic steroids can lead to serious health problems.Anabolic steroids Male >stunted growth >aggression >paranoia >liver cancer >increased cholesterol >heart disease >severe acne >baldness >shrinking of testes >reduced sperm count >infertilityFemale >severe acne >increased cholesterol >increased facial hair >baldness >deeper voice >disrupted menstrual cycle >infertility >bloating >rapid weight gain >liver cancerMost athletes work hard to build strength. Those who rely on anabolicsteroids for muscle building risk notonly dangerous effects but also beingbanned from their sport. 3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 294 CHAPTER 12 Illegal DrugsEffects of Steroids on the Body If adolescents take steroids, their bones will mature too early and their growth will be stunted. Steroids can also cause severe acne, increased cholesterol, rapidweight gain, liver damage, kidney tumors, heart disease, and heartattack in both men and women. In males, steroids shut down normal testosterone production and can shrink the testes and reduce sperm production. Steroids cancause breasts to grow because the body breaks anabolic steroidsdown into compounds that act like the female hormone estrogen. In females, steroids can cause facial hair to grow, toughen the skin, and deepen the voice, making a woman seem more like a man.Steroids can also disrupt the menstrual cycle, leading to infertility. Effects of Steroids on the Mind Large doses of steroids tend to make abusers more irritable and aggressive. Aggression caused by steroidabuse is called roid rage. Roid rage can lead to violent crime, assault, and rape. People who abuse steroids may also experience hyperactivity,bizarre sounds, feelings of paranoia, panic attacks, depression, anxiety,and even suicidal urges. Many abusers also find that they have with-drawal symptoms, including depression, if they stop taking steroids. Being the Best Drug Free Teens who want to win on the field should be aware that the only real way to win is naturally. Almost allsports now ban steroid use. If an athlete tests positive for steroids, heor she can be banned from the sport. Along with sparing your bodythe damaging side effects of steroids, you can have the satisfaction ofknowing that any victory you achieve is a result of your own hardwork. You don’t need help from an illegal drug to succeed. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “drugs that are inhaled as vapors.” 2.Define the term club drugs. Understanding Key Ideas 3.Summarize three effects common to all illegal drugs. 4.Compare the effects of the following four commonly abused illegal drugs. a.marijuana b.inhalants c.club (designer) drugs d.anabolic steroids5.Identify which of these are noteffects of mari- juana on the brain. a.impaired memory c.increased alertness b.loss of coordination d.increased appetite 6.Identify three dangers of inhalant abuse. 7.Listthe effects of five types of club drugs on the body. 8.Compare the effects of anabolic steroids on men with the effects of anabolic steroids on women. Critical Thinking 9. Communicating Effectively If a friend told you he bought some pills at a party, what advice would you give him about trying the pills?LIFE LIFE SKILL “I don’t need steroids to be a good baseball player.” Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Other Drugs of Abuse 295Other Drugs of Abuse SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Ihave a huge test tomorrow, and I’ll be up all night studying,” Gilberto told Eric. “I’ve got some stuff that can help keep youawake,” said Eric. “No, thanks. I heard it’s easy to get hooked on those types of drugs,” Gilberto replied. Other Types of Abused Drugs Besides the drugs listed in the previous section, there are many otherdrugs of abuse that teens may encounter, including stimulants,depressants, opiates, and hallucinogens. > are drugs that temporarily increase a person’s energy and alertness. > are drugs that cause relaxation and sleepiness. > (OH pee its) are a group of highly addictive

drugs derived from the poppy plant that are used as pain relievers,anesthetics, and sedatives. > (huh LOO si nuh juhnz) are drugs that distort perceptions andcause a person to see or hear things thatare not real. Many of these drugs have medical pur- poses. For example, the stimulant Ritalin ®is used to treat attention deficit hyperactivity dis-order (ADHD). Depressants can be used tohelp people who have difficulty sleeping. Someopiates are used as anesthetics during surgery.But despite their medical uses, all of these drugscan be highly addictive and very dangerouswhen abused. Most of these drugs have a veryhigh risk of overdose and should never be usedwithout a doctor’s supervision. The effects ofthese drugs are summarized in Table 2.HallucinogensOpiatesDepressantsStimulantsOBJECTIVES Describe the dangerous risks of using stimulants, depressants, opiates, and hallucinogens for nonmedical uses. Compare the dangers of two different types of stimulants. Summarize the dangerous effects of the depressants Rohypnol and dextromethorphan (DXM).Describe the dangerous physical and social effects of addiction to opiates such as heroin.Summarize the dangerous emotional effects that can result from hallucinogen abuse.KEY TERMSKEY TERMS stimulant a drug that temporarily increases a person’s energy and alertness depressant a drug that causes relaxation and sleepinessopiates a group of highly addictive drugs derived from the poppy plant that are used as pain reliev- ers, anesthetics, and sedatives hallucinogen a drug that distorts perceptions, causing the user to see or hear things that are not real Some drugs, such as the stimulant methamphetamine, can have manyappearances. All forms of metham-phetamines are dangerous.“ Copyright © by Holt, Rinehart and Winston. All rights reserved. 296 CHAPTER 12 Illegal Drugs Drug and common orstreet names Stimulants cocaine, coke,crack, snow,methampheta-mines, uppers,candy, ice, meth,crystal, speed,crank, cross-tops Depressants Rohypnol TM, roofies, downers,barbs, tranqs Opiates heroin, H, horse,smack, junk Hallucinogens acid, dots, snow-men, mesc, but-tons, magicmushrooms, topsHow it is taken snorted, injected,smoked, orswallowed swallowed smoked, injected,swallowed, orsnorted swallowed or smokedPossible intoxication effects >increased alertness and energy >loss of appetite >euphoria >hyperactivity >restlessness >anxiety >increased heart rate >increased breathing rate >elevated blood pressure >euphoria >reduced anxiety >loss of inhibitions >drowsiness >euphoria >feelings of well-being >relaxation >drowsiness >pain relief >sensory illusions >distortions of reality >dizziness >weakness >enhanced emotions >feelings of being outside of the bodyPossible health consequences* >nervousness >irritability >panic >aggressive behavior >confusion >loss of awareness of reality >kidney damage >liver damage >heart failure >death >loss of coordination >slurred speech >confusion >slowed heart rate >dangerously slowed breathing >loss of consciousness >loss of memory >coma >death >nausea/vomiting >constipation >confusion >loss of consciousness >dangerously slowed breathing >coma >death >panic >self-injury >chronic mental disorders >recurring distortion of perception (flashbacks)Table 2 Other Drugs of Abuse *All of the drugs listed here can result in tolerance. All, except for some hallucinogens, can result in physical dependence and addiction. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Other Drugs of Abuse 297Stimulants Stimulants are drugs that temporarily increase a person’s energy and alertness. Stimulants include caffeine, nicotine, methylphenidate(Ritalin ®), amphetamines (am FET uh meenz), cocaine, and crack cocaine. Caffeine and nicotine are relatively mild, legal stimulants.Methylphenidate is a prescribed stimulant that helps people withattention deficit hyperactivity disorder (ADHD) control their behav-ior. Cocaine and amphetamines are very potent illegal drugs. Regard-less, all stimulants can be addictive and dangerous drugs. Amphetamines Amphetamines are a group of stimulants pro- duced in laboratories. Some types of amphetamines are prescribed totreat neurological disorders and life-threatening obesity. However, onetype of amphetamine, methamphetamine ( METH am FET uh MEEN ), is highly abused. Methamphetamine Illegal methamphetamine, commonly called meth, crystal, or ice,usually appears as white or yellowish crystals called “rocks” that are crushed and then either smoked, injected, orinhaled through the nose (snorted). Methamphetamine’s intenseeffects, which can last for hours, include >euphoria >loss of appetite >increased alertness >hyperactivity Repeated use of methamphetamine causes severe damage to the body, including permanent brain, kidney, or liver damage. Overdosecan cause brain damage or death. Methamphetamine is extremelyaddictive, and tolerance develops very rapidly. Methamphetamine is produced in illegal laboratories called meth labs. The byproducts of methamphetamine production include poi- sonous gas, toxic chemicals, and highly explosive substances. Thesehazardous wastes are an added danger of methamphetamine abuse. Cocaine and Crack Cocaine Cocaine comes from the coca plant, which grows in South America. The leaves are processed into afine, white powder that is snorted through the nose or injected. Pow-dered cocaine can be converted into crack cocaine, a crystallized form that is smoked. The effects of cocaine are very similar to those ofmethamphetamine. The effects of crack cocaine are more intensethan those of powdered cocaine, but they do not last as long. Large doses or repeated use of cocaine cause agitation, para- noia, and aggression. Users can’t eat or sleep and at times may losetouch with reality. When the drug wears off, the aftereffects, called acrash, include agitation, extreme sleepiness, depression, and intense craving for more of the drug. Addiction to these stimulants is verydifficult to escape. Overdose can cause heart attack, stroke, seizures,or death. Doctors and nurses treat a crack cocaine user in the emergency room ofHighland Hospital in Oakland, Califor-nia. An overdose of crack cocaine cancause a heart attack, stroke, seizures,or death. Copyright © by Holt, Rinehart and Winston. All rights reserved. 3 Tips for Protecting Your- self from Date-Rape Drugs 1Never leave your drink unattended. 2Never accept an open drink orglass from a stranger. 3Never drink a beverage that hasan abnormal taste orappearance.Depressants Depressants are drugs that cause relaxation and sleepiness. Depressants slow down a person’s breathing and reduce brain activity. Depressantsinclude tranquilizers (mild depressants used to treat anxiety) and hyp-notics (powerful depressants that are used to treat sleep disorders andseizures). When abused, depressants are highly addictive. Most depressants have similar effects on the body. These effects include relaxation, loss of inhibition, drowsiness, loss of coordina-tion, slurred speech, disorientation, loss of consciousness, and possi-ble memory loss. An overdose may cause a person to stop breathing altogether and may result in brain damage, coma, or death. Using depressants incombination with alcohol increases the effects. Most deaths due todepressants occur when they are used in combination with alcohol. Rohypnol RohypnolTM(roh HIP nahl) is a powerful hypnotic. Rohypnol, also called roofies or the forget pill, has developed a reputa- tion as the most frequently used date-rape drug .It is easy to mix with alcohol, in which its bitter taste may not be noticed. A person on Rohypnol will lose his or her inhibitions, become disoriented, and may not be able to remember what happened whileon the drug. DXM Dextromethorphan (DXM) is a legal ingredient in cough syrups that helps stop coughing. In high doses, its effects are similarto PCP’s. The user feels spacey and may lose muscular control. DXMcan also produce hallucinations and bizarre sensations. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Other Drugs of Abuse 299Opiates Opiates are a classic example of a drug that can be both a highly val- ued medicine and a deadly drug of abuse. Opiates come from theflowering opium poppy plant ( Papaver somniferum ). Used as medi- cine, opiates reduce pain, relieve diarrhea, suppress coughing, andinduce relaxation. Examples of opiates include heroin (HER oh in),opium, codeine (KOH DEEN ), and morphine (MAWR FEEN). When opiates are abused, they can result in addiction very quickly. People addicted to opiates experience very unpleasant with-drawal symptoms if they try to quit. These symptoms include cramps,vomiting, muscle pain, shaking, chills, and panic attacks. Heroin Heroin is the most commonly abused opiate. It is a chem- ically altered form of morphine that can be swallowed, snorted,smoked, or injected. It creates an initial “rush” that quickly subsidesinto a dreamlike state, feelings of well-being, and drowsiness. Tolerance to heroin develops rapidly. Smoking or snorting heroin loses its effectiveness, and users often begin to inject heroin toachieve the same high. Heroin is a very addictive drug. Heroin abuseand addiction are associated with a host of problems. Each year,thousands of people die under the influence of heroin. It is notuncommon for heroin users to >lose their jobs because they can’t stay sober long enough towork >have poor living conditions >suffer from many health problems >engage in crime to finance their addiction >choke on their own vomit when passed out Along with cocaine, heroin is the drug most closely linked with violent crime. Because withdrawal symptoms are extremely unpleas-ant, heroin addicts will do almost anything to get another dose whenthe drug wears off. This is one reason heroin is such an addictive anddestructive illegal drug. Repeatedly injecting heroin can cause skin infections, open wounds, and scarring. Injected heroin use has also become an impor-tant factor in the spread of some diseases. Heroin addicts who shareneedles run a high risk of infecting themselves with hepatitis orHIV/AIDS. Opium Opium, also called black or dream stick, is a bitter, brown- ish drug that is made of the dried juice of the opium poppy. It is amild painkiller, but it also causes slowed heart beat, slowed breath-ing, loss of appetite, and loss of inhibitions. Morphine and Codeine Morphine, also called mister blue or morpho, is very similar to heroin. It is used legally for patients in severe pain, such as terminal cancer patients. Codeine is used for therelief of milder pain and sometimes to stop coughing. When you’re high on heroin, nothing else matters.Myth It may seem like nothing matters until you’re living on the street, infected with HIV/AIDS, or dying from an overdose.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. 300 CHAPTER 12 Illegal DrugsHallucinogens Hallucinogens are drugs that distort perception and cause the user to experience things that are not real. Hallucinogens include LSD (lyser-gic acid diethylamide), peyote, and mushrooms. While a person is onhallucinogens, his or her emotional experiences seem deeper and moreimportant. Hallucinogens can also produce extreme anxiety, fear, andparanoia. LSD LSD is usually taken in the form of tablets or absorbed through the tongue on small paper squares. The effects of LSD are noteasy to predict. Sometimes, LSD can increase energy, alter mood, andcreate strange thoughts and sensations. LSD can cause nausea andvomiting, dizziness, and bizarre body sensations. People on LSD mayexperience huge emotional swings. Some LSD experiences are extremely frightening. Users may become panicked and confused when they find they can’t control theirthoughts and feelings. In addition, a person may feel the effects of ahallucinogen long after the drug has worn off. This is called a flashback. Flashbacks can be frightening even if the initial LSD experience wasn’t. Mushrooms Mushrooms (psilocybin) are hallucinogenic drugs with effects similar to LSD. Mushrooms are either eaten raw or mixedwith food. Commonly called magic mushrooms, psilocybin produce altered perceptions of sight, sound, taste, smell, or touch. Other effectscan include confusion, anxiety, and panic. Occasionally, flashbacksmay be experienced d ays, weeks, or even months after use. It is difficult to distinguish psilocybin from more-toxic varieties of mushrooms. Ifan abuser takes the wrong kind, the mushroom can result in stomachpains, vomiting, diarrhea, and even death. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define stimulant. 2.Identify the term that means “a drug that causes relaxation and sleepiness.” 3.Identify the term that means “a drug that distorts perception, causing users to see or hear things that are not real.” Understanding Key Ideas 4.Listmedical uses for three drugs of abuse. 5.Summarize why stimulants, depressants, opiates, and hallucinogens are dangerous when used fornonmedical uses.6.Compare the effects of stimulants, depressants, opiates, and hallucinogens on the body andbehavior. 7.Evaluate the reason Rohypnol and other depres- sants are especially dangerous for women. 8.State five reasons why heroin is a physically and socially destructive drug. Critical Thinking 9. Practicing Wellness Why should police be cautious when confronting someone on PCP?LIFE LIFE SKILL People who are high on some types of drugs may accidentally hurt or killthemselves. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 A Drug-Free Life 301A Drug-Free Life SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 Tina’s newborn baby had not quit crying for hours. Because Tina had frequently abused heroin while she was pregnant, Kayla wasborn dependent. Now Kayla was going through withdrawal. “My poor baby. I’m so sorry,” Tina whispered as she rocked her baby. Drug Abuse Affects the Individual When people abuse drugs, they risk losing the things that are good inlife. Think for a moment about your goals. Do you want to do well incollege, get a good job, or travel all over the world? Now think abouthow drug use would affect your goals. Drug use, abuse, or addiction candestroy your dreams. For a few moments of feeling “high,” you riskeverything else that is important to you. Risks of Drug Use Illegal drugs cause damage to your body. Most illegal drugs can be deadly. Despite this, many people would like tobelieve that the consequences of drug use won’t affect them. However,no matter how you try to manipulate the facts to make drugs seem safer,thousands of people are hospitalized because of drug use each year. The dangerous intoxication and side effects are not the only risks of illegal drug abuse. Drug use can lead to >car accidents >accidental injury or death >violence and other criminal activity >unplanned pregnancy >sexually transmitted diseases (STDs) Most of the time, the activities that get people into trouble are things a person would never do if he or she were not high on drugs. It takes getting high only one time to engage in a behavior that willchange the rest of your life.OBJECTIVES Summarize how drug abuse can negatively affect a person’s life. Identify the ways that drug abuse can affect a family. Listfour ways that drug abuse impacts society. Describe the principles that describe effective drug abuse treatment. Listfive ways that you could refuse illegal drugs. LIFE LIFE SKILLKEY TERMSKEY TERMS neonatal abstinence syndrome drug withdrawal that occurs in newborn infants whose mothers were frequent drug users during pregnancy recovering the process of learning to live with- out drugsintervention confronting a drug user about his or her drug abuse problem to stop him or her from using drugs relapse a return to using drugs while trying to recover from drug addiction Hal Carter has turned his life around. With treatment, hard work, and sup-port, he was able to overcome anaddiction to painkillers. Copyright © by Holt, Rinehart and Winston. All rights reserved. 302 CHAPTER 12 Illegal DrugsDrug Abuse and Crime Many abused drugs are illegal, so sim- ply having them is a crime. People get arrested every day for posses- sion of illegal drugs or the supplies for making them. Addiction to anillegal drug is expensive. Many illegal drug users will steal or selldrugs to get money to buy their drugs. Making and selling illegaldrugs is a crime that can result in many years of prison time. In both small and large cities, between two-thirds and three- quarters of people arrested for violent crimes were on drugs whentheir crimes were committed. Some do not even remember commit-ting their crime. Drug Abuse Affects the Family Drug abuse isn’t just a problem for drug abusers. Drug abuse alsoaffects a family in many ways. Drug Abuse and Trust Among the first things a family loses when a teen starts using drugs is trust. Parents don’t want their chil-dren using drugs, so teens have to hide their drug use and lie aboutwhat they’re doing. Eventually, parents find out. Once drug abusebecomes regular, finding money to buy drugs becomes more difficult.This can lead addicts to steal from their parents and siblings. Goodrelationships need trust to thrive. There are warning signs you can look for if you suspect that someone you care about is using drugs. A person might be usingdrugs if he or she >has unusual emotional reactions to situations >withdraws from family intimacy and activities >repeatedly breaks household or school rules >hangs out with different friends >starts to dress differently 20% 81%25–50%3.2%statistically speaking. . . Percentage of people who say drug abuse has caused a problem in their family: Percentage of families reported for child maltreatment in which drug abuse is a key problem: Percentage of domestic violence that is drug related: Percentage of pregnant women who use drugs regularly: Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 A Drug-Free Life 303Drug Abuse and Violence Drug addicts are also at risk of physically hurting their family members or of being hurt themselves. Twenty-five to fifty percent of all family violence is drugrelated. Seventy-five percent of female victims ofdomestic violence were attacked by someonewho was high or drunk. You or someone in yourclass may have been a witness to or even a victimof drug-related family violence. It’s a terriblething, but it’s not uncommon. Drug Abuse Affects Pregnancy Drug use can be dangerous to pregnant women and to thefetus developing inside the womb. In general,babies exposed to drugs in the womb are at riskof premature birth, low birth weight, and a vari-ety of developmental problems. Mothers who are addicted to certain drugs are at risk of delivering a baby who is physicallydependent on that drug. This means the babyundergoes withdrawal after being born. Drugwithdrawal occurring in newborn infants whose mothers were frequentdrug users during pregnancy is called The withdrawal process can be uncomfortable and distressing. These infants may be more difficult to care for than normal babies.Caring for a drug-dependent baby is a challenge that many drug-addicted mothers may not be able to handle. If the child is kept bysomeone who is a frequent drug user, the infant may be neglected,abused, or abandoned. Children who are raised by drug abusers alsohave a higher risk of becoming drug abusers than children raised bydrug-free parents do. Drug Abuse Affects Society In 1962, only 4 million Americans had tried an illegal drug. By 1999,that number had climbed to almost 90 million. This rise in drug usehas had a profound effect on society. Drug Abuse and Economics Drug abuse has become a very costly problem for society. The economic costs of drug abuse to the United States were estimated to be $1 10 billion in 1995. The healthcare costs resulting from drug abuse alone were $38 billion in 1995. AIDSaccounted for $4 billion of these costs. Intravenous drug use is a majorfactor in the spread of AIDS and hepatitis. Although many programshave been initiated to help combat the spread of AIDS among IV drugusers, AIDS still remains a serious problem. Drug abuse costs society money in other ways as w ell. Drug- related costs resulting from lost productivity at work, accidentalinjuries, car crashes, suicide, and overdose all take a toll on society.neonatal abstinence syndrome. A healthcare worker checks the pulse of an infant whose mother went intolabor while smoking crack cocaine. Copyright © by Holt, Rinehart and Winston. All rights reserved. 304 CHAPTER 12 Illegal DrugsDrug Abuse and Crime The link between drugs and crime is undeniable. In 1995, the cost of drug-related crime was $64 billion. That is how much all of the 50 states together spent on their state-supported colleges in 2002. In 1983, only 1 prisoner in 1 1 was jailedfor a drug-related crime. Now, that ratio is 1 in 4. There are so manyarrests for drug possession that many states have been forced toestablish special drug courts just to deal with the huge number ofnonviolent drug offenders. There is no way to estimate the costs of violent crime to the vic- tims. Assault, rape, and murder take a toll on society that is morecostly than can be assigned a financial value. Many people in prisonfor violent crimes were high on drugs when the crime was committed.Innocent victims of drug-related violence suffer physically, mentally,and emotionally. Odds are that in our lifetime, each of us will know someone who has been a victim of a drug-related theft or violent crime. Therefore,how can anyone say that drug use is only dangerous to the abuser?The costs of drug use make it worthwhile for all of us to be involvedin the effort to stop drug abuse. real life Activity LIFE LIFE SKILL Setting Goals DRUG ABUSE AFFECTS EVERYONE ✔local newspaper ✔scissors ✔glue ✔poster board ✔markers 1.Use a copy of your local newspa- per to look for some articles that indicate the effects that drug usehas on your community. 2.Cutout several articles or photos and glue them to your poster board.ProcedureMaterials3.Write below each photo how the articles or photos you chose illustrate a cost of drug use inyour community. 4.Write one thing that can be done in your community tohelp combat each of the drug-related costs to society. 5.Draw a circle around any of the articles or photos that haveaffected you or your family insome way. 1.Summarizing Results Write a short paragraph summarizingthe ways you think illegal druguse has had an effect on yourcommunity.Conclusions2.Predicting Outcomes How can your community work together to decrease drugabuse and its effects? 3.Predicting Outcomes If drug use increased in your commu-nity, how might it affect yourlife? 4.CRITICAL THINKING What are some ways that you andyour friends might help combatdrug use in your school? Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 A Drug-Free Life 305Drug Abuse Affects Everyone It is easy to see how drug abuse can hurt the abuser. However, many other people are affected as well. The costs of illegal drug use on people other than the drug abuserinclude the following: >physical, mental, and emotional injuries from drug-relateddomestic violence >health problems in babies born to mothers who abused drugs >injury resulting from drug-related car accidents >loss of job productivity resulting from drug use >diseases caused by drug abuse When you add up all of the ways that illegal drug abuse affects families and society, the users of illegal drugs are costing all of us. Treatment for Drug Addiction Because drugs affect the brain, addiction is a difficult and long- lasting problem. For people who are addicted to drugs, there are ways to escape the cycle of addiction. is the process of learningto live without drugs. Most addictions cannot be overcome without support. No one should try to overcome a drug dependency on his or her own.Because recovering from a drug addiction is difficult, to be successful,treatment should be managed by a professional. There are a variety oftreatment approaches, including 12-step programs, outpatient coun-seling, and residential communities. The goal of all drug treatmentprograms is to help the person battle both the drug dependency andthe reasons why the drug abuse started in the first place.Recovering “ We didn’t think we were hurting anyone else until we heard thecars crash. Now four people are dead.” Copyright © by Holt, Rinehart and Winston. All rights reserved. 306 CHAPTER 12 Illegal Drugs Group therapy plays an important role in most drug treatment programs.Group therapy helps build skills forresisting drug use and developinghealthy relationships.Research on drug addiction and recovery has produced a set of principles that describe effective drug abuse treatment. 1.No single treatment works for everyone. 2.Treatment should be available and easy to access. 3.The best treatment addresses other problems that the abuser has, not just the drug addiction. 4.Treatment should offer multiple services, including medical serv-ices, family counseling, job training, and legal services. 5.The longer an abuser stays in treatment, the more effective it is. 6.Group therapy is useful for building skills for resisting drug useand developing interpersonal relationships that do not involvedrugs. 7.Medications can be an important part of treatment. Methadone is a long-lasting synthetic opiate used to treat heroin addiction. 8.Mental illness should be treated at the same time as addiction. 9.Treatment does not need to be voluntary to be effective. involves confronting a drug user about his or her problem to stop him or her from using drugs. Family and friendsoften have to intervene to get someone to seek treatment for drugaddiction. 10.Patients should be monitored for continued drug use. 11.Treatment programs should test for HIV/AIDS, hepatitis B and C,and other infectious diseases. 12.Recovery from addiction may require several periods of treatmentto combat relapse. is a return to using drugs while tryingto recover from drug

addiction. RelapseIntervention Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 A Drug-Free Life 307Saying No to Drugs One of the best ways to protect yourself from drugs is to be involved in activities with others who want to stay drug free. You could get involved in a school activity. Or you could try volunteering for anorganization in your community. You should also stay away from people who do drugs or from sit- uations where there may be pressure to use drugs. At some point,however, someone you know may pressure you to use drugs. If so,you are not alone—even adults have this problem. Often the peoplewho pressure you are your friends, which can make the situationeven more difficult. When this type of situation arises, it is importantto remember that only you can protect your dreams and your future.If someone stops being your friend just because you refuse to takedrugs, that person was not a true friend to begin with. Friendships arebased on respect. Anyone who forces you to do something that couldhurt your body, mind, relationships, and future does not respect you. Practice Saying No Despite your efforts, you may someday be offered drugs. To protect yourself from being pressured into takingdrugs, prepare ways in which you can turn down drugs using activi- ties like the one in Figure 4 or techniques such as the following: 1. Say no firmly. You can al ways say, “No, thanks.” Make your refusal calmly, firmly, and confidently. If you seem unsure of yourself,others will think they can argue with you. 2. Buy yourself time. Find a place where you can be alone to think about what you can do to get out of the situation. For example,go to the bathroom or go to another room. 3. Give good reasons why you choose not to do drugs. For example, you might say, “No, thanks. I don’t want to risk getting kicked offof the football team.” Practicing refusal skills can ensure that you can say no to drugs when youneed to. ACTIVITY In pairs, practice resisting pressure to use drugs. Make a list of dif- ferent ways you can say no to somebodypressuring you to use drugs.4 Figure “Try this—only losers don’t do drugs.” “Come on; everyone’s doing it.” “Here, try this. It’s so cool.” “So what do you do for fun?” “When are you gonna wise up and try some of this? ” “Just try one. It’ll make you feel good.” “Are you scared or something?”“What loser told you that?” “I don’t care that much about fitting in.” “I’m cool enough already.” “I definitely don’t sit around and kill my brain cells. ” “I’ll try it when I see smart people using it.” “I feel fine already.” “Yeah, I’m scared of ending up addicted.” Copyright © by Holt, Rinehart and Winston. All rights reserved. 308 CHAPTER 12 Illegal Drugs 4. State the consequences that could result if you do use drugs. “I don’t want to get arrested like Mary. Besides, I have a track meet tomorrow, and I don’t want to be strung out.” 5. If necessary, say no again and include an alternate activity. Come up with an idea for something that you could do that doesn’t involved taking drugs. For exam-ple, you might say, “No thanks. Let’s go get somethingto eat. I’m starving!” 6. Walk away. Sometimes the person offering you drugs will keep persisting. Or sometimes you may find yourselfweakening even though doing drugs is not somethingyou want to do. In these situations, just walk away.Nobody can pressure you to do drugs if you aren’t there. Live Drug Free Refusing drugs may be difficult, but choosing to be drug free will make your life a lot easier. Organizations such as Mothers Against Drunk Driving (MADD) andStudents Against Destructive Decisions (SADD) work to reduce druguse among teens. Student organizations help promote activities thatdo not involve drug use. They provide a safe place for young peopleto have fun without having to face the pressure to use illegal drugs. Teens these days are facing new challenges and many changes. Life can be stressful in many ways. F acing these challenges with courage and maturity are part of making the transition to adulthood.Living a healthy life without getting caught in a web of drug abuseand addiction can help you accomplish your goals for the future. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term that means “drug withdrawal that occurs in newborn infants whose mothers were frequent drug users during pregnancy.” 2.Define intervention. 3.Identify the term that means “a return to using drugs while trying to recover from drug addic-tion.” Understanding Key Ideas 4.Listthree ways that drug abuse can negatively affect a person’s life. 5.Summarize the ways in which families may suffer as a result of illegal drug abuse.6.Describe the ways that illegal drug abuse can have a negative effect on society. 7.Summarize the principles involved in successful drug treatment and recovery. 8.Evaluate three techniques for avoiding pressure to use illegal drugs. 9.Sequence how you would react to a situation in which you are pressured to use drugs. Critical Thinking 10.Why do you think it is so difficult for people tostay off drugs once they have become addicted? 11. Using Community Resources Why do you think drug treatment doesn’t have to be voluntary to be effective?LIFE LIFE SKILL “Some of us have tried drugs and some of us haven’t. None of usneed drugs to have fun.” Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 12 Highlights 309 CHAP TER 12 CHAP TER 12 CHAPTER 12Highlights Key Terms The Big Picture ✔Illegal drug use results in many risks, including addiction, damage to the brain and the body, the contraction of diseases, suicide,violent crime, and overdose. ✔People who try drugs often end up abusing drugs because mostdrugs are highly addictive. ✔People begin using drugs for many reasons, including peer pressure. ✔Teens can be under a lot of pressure to use drugs. Teens have a high-er risk for addiction because their brains are still changing rapidly.SECTION 1 drug abuse (284) overdose (284) ✔Many types of illegal drugs have medical uses but are unsafe if they are used without a doctor’s supervision. ✔Stimulants such as methamphetamines and cocaine are highlyaddictive and dangerous. ✔Depressants are highly addictive and dangerous drugs. ✔Hallucinogens such as LSD and PCP are dangerous drugs becausetheir effects on the brain are unpredictable. ✔Intravenous heroin use is a major factor in the spread ofHIV/AIDS and hepatitis.SECTION 3 stimulant (295) depressant (295) opiates (295) hallucinogen (295) ✔Drug abuse hurts the individual addict and damages relationshipswith family and friends. ✔Drug abuse damages a fetus exposed to illegal drugs in the womb. ✔Drug abuse costs society billions of dollars every year in medicalcosts, injuries, accidents, lost productivity, and crime. ✔There are many programs available to help drug addicts recover. ✔Practicing refusal skills can help you avoid the dangers of drugabuse and addiction.SECTION 4 neonatal abstinence syndrome (303) recovering (305) intervention (306) relapse (306) ✔All illegal drugs affect the brain, are dangerous to a person’s health,and can result in abuse and addiction. ✔Marijuana causes loss of concentration, disorientation, loss of senseof time and distance, paranoia, drowsiness, and several other effects. ✔Huffing inhalants damages many organs of the body, includingthe brain, liver, kidneys, bone marrow, and bladder. ✔Club drugs are addictive and can cause brain damage and death. ✔Look-alike drugs are especially dangerous because there is no wayto know what is in them. ✔Anabolic steroids are used to increase muscle mass, but they havevery harmful side effects.SECTION 2 marijuana (289) inhalant (291) club (designer) drug (292) anabolic steroid (293) Copyright © by Holt, Rinehart and Winston. All rights reserved. 310 CHAPTER 12 Review CHAP TER 12 CHAP TER 12 CHAPTER 12Review Using Key Terms anabolic steroid (293) neonatal abstinence depressant (295) syndrome (303) club (designer) drug (292) opiates (295) drug abuse (284) overdose (284) hallucinogen (295) recovering (305) inhalant (291) relapse (306) intervention (306) stimulant (295) marijuana (289) 1.For each phrase below, choose the most appropri- ate key term from the list above. a.the improper or unsafe use of a drug b.a drug that is inhaled as vapors c.a drug that temporarily increases energy andalertness d.drug withdrawal occurring in newborn infants e.laboratory-made drugs that closely resemblecommon illegal drugs in chemical structureand effect f.a drug that slows the body and the brain 2.Explain the relationship between the key terms ineach of the following pairs. a.drug abuse and overdose b.recovering and relapse Understanding Key Ideas Section 1 3.Which of the following is a danger of illegal druguse? a.overdose c.poor judgment b.car crash d.all of the above 4.Evaluate the reasons people often give for tryingillegal drugs. 5.List two reasons teens may be under pressure touse illegal drugs. 6.State the reason teens are at a higher risk of addic-tion from drug use than adults are. 7.CRITICAL THINKING Do you think using an il- legal drug only once is safe? 8List two goals you have after you graduate fromhigh school. How would illegal drug use affectthose goals? LIFE LIFE SKILLSection 2 9.What are three effects that are common to all types of illegal drugs? 10.Which of the following is notan effect of mari- juana use? a.poor concentration c.drowsiness b.giddiness d.increased alertness 11.List three long-term effects of inhalants on the body. 12.Compare the dangerous effects of Ecstasy and ketamine. 13.Women who take steroids are likely to a.have deeper voices. b.have increased body hair. c.develop severe acne. d.All of the above 14.List four reasons you would give your friend todiscourage him or her from using steroids toenhance athletic performance. Section 3 15.List three medical uses for drugs of abuse. 16.What dangerous effects do stimulants have? 17.List three effects of depressants on the body. 18.Why do you think heroin addiction is so difficultto overcome? 19.Describe how hallucinogens affect the mind. Section 4 20.How can drug abuse make a person’s life moredifficult? 21.In what ways does family life suffer when a fam- ily member abuses illegal drugs? 22.What aspects of society are affected by drug abuse? 23.Name three types of treatment for drug addiction. 24.List five ways you could refuse illegal drugs if they were offered to you. 25.CRITICAL THINKING What healthy activities can teens participate in on weekends to help avoidthe pressure to use drugs?LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 12 Review 311Interpreting Graphics Study the figure below to answer the questions that follow. 26.Which of the items above costs the most? 27.Do the costs of a stereo and a computer combined equal the cost of cocaine? 28.CRITICAL THINKING Explain why people may be driven to steal in order to support a cocaine habit.Activities 29. Health and You Write down three things you may have heard about illegal drug use. Research eachstatement, and explain whether or not it is a myth. 30. Health and Your Community Find a newspaper or magazine article about a planned drug prevention event in your commu-nity. Analyze how much you think this event willaffect your community. For example, do youthink teens from your school will attend? Howwell is the event advertised? Suggest ways to make the event more successful. 31. Health and You Write a reply to the following statement: “Just try it; one time won’t harm you.It’s not like you’ll become an addict overnight!” Action Plan 32. Setting Goals List three goals you have for your future. Write down how these goalscould be affected by illegal drug use. Write a planfor how you can avoid illegal drugs and acom-plish your goals.LIFE LIFE SKILL 33.In this passage, the word serving means Ahelping other people. Bpassing out food to the homeless. Cspending time in jail. Dvolunteering at a prison. 34.What can you infer from reading this passage? EDrug addictions are easy to recover from. FPeople can easily control their addictions. GDrug addictions can make people do things they wouldn’t otherwise do. HDrugs are a cheap and harmless habit. 35.Write a paragraph discussing how a drug abusecan develop from experimentation into addiction. 36.Do you think it will be easy for Wayne to stay offcocaine when he gets out of jail? If you wereWayne, what steps would you take to make sureyou stay clean and drug free?READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Wayne grew up in a middle-class family in Wisconsin. When he was 17, he tried smok-ing marijuana. After marijuana, he triedEcstasy and then crack cocaine. Soon hewas spending over $100 a day on hiscocaine habit. He started stealing smallamounts of money from his family. Whenthey noticed things missing from the house,they made him move out. He lived withsome friends until they got kicked out. Hestarted breaking into homes and wasarrested. Wayne is currently serving 2 years. But he is off cocaine and plans tostay that way when he gets out.2,500 2000 1,500 1,000 500 0Cost (dollars) Costs of Cocaine Abuse Cocaine (1 month)Big- screen TVNew computer100 movie ticketsNew stereo system Source: U.S. Drug Enforcement Agency. MATH SKILLREADING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Copyright © by Holt, Rinehart and Winston. All rights reserved. 313CHAPTER 13 Preventing Infectious Diseases CHAPTER 14 Lifestyle Diseases CHAPTER 15 Other Diseasesand Disabilities UNIT 4UNIT 4UNIT 4 Copyright © by Holt, Rinehart and Win ston. All rights reserved. CHAP TER 13 CHAP TER 13 CHAPTER 13 Preventing Infectious DiseasesPreventing Infectious DiseasesPreventing Infectious Diseases 314BEHAVIOR Indicate how frequently you engage in each of the following behaviors (1=never; 2=occasionally;3=most of the time; 4=all of the time). Total yourpoints, and then turn to p. 642. 1.I cover my mouth while sneezing or coughing. 2.I eat at least five servings of fruits and vegetables each day. 3.I exercise at least five times a week. 4.I have regular check-ups with my dentist anddoctor. 5.I wash my hands before eating a meal. 6.When my doctor prescribes antibiotics, I follow and complete the prescription. 7.I drink 8 to 10 glasses of water each day. 8.I get extra sleep when I am sick. Copyright © by Holt, Rinehart and Winston. All rights reserved. 315SECTION 1 What Are Infectious Diseases? SECTION 2 Protecting Yourselffrom InfectiousDiseases SECTION 3 Common Infectious Diseases go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH13. Copyright © by Holt, Rin ehart and Winston. All rights reserved. 316While walking to his friend’s house, Paul stepped on a rock and cut his foot. Because the cut was small, Paul just kepton walking. Paul didn’t know, however, that a hidden army of organisms was starting an attack on his cut. What Causes Infectious Diseases? An (in FEK shuhs di ZEEZ) is any disease that iscaused by an agent that has invaded the body. Infectious diseases maybe passed to a person from another person, from food or water, fromanimals, or from something in the environment. Colds, the flu, headlice, and tuberculosis (TB) are examples of infectious diseases.infectious diseaseWhat Are Infectious Diseases?SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Identify five different agents that can cause infectious diseases. Listfour ways that infectious diseases spread. Describe two different treatments for infectious diseases. Name two ways you can help prevent the development of antibiotic resistant bacteria. LIFE LIFE SKILLKEY TERMSKEY TERMS infectious disease any disease that is caused by an agent that has invaded the body pathogen any agent that causes disease bacteria tiny, single-celled organisms, some of which can cause disease virus a tiny disease-causing particle that consists of genetic material and a protein coat fungus an organism that absorbs and uses nutrients of living or dead organismsantibiotic resistance a condition in which bacteria can no longer be killed by a particular antibiotic Virus Chickenpox, a commonchildhood illness, iscaused by a virus.BacteriaEven small cuts canbecome infected bybacteria.Infectious diseases are caused by manydifferent pathogens, such as viruses,bacteria, fungi, protozoa, and animalparasites. 1 Figure Staphylococcus bacteriaVaricella virus Copyright © by Holt, Rinehart and Winston. All rights reserved. All infectious diseases are caused by pathogens. A is any agent that causes disease. Figure 1 shows some of the different kinds of pathogens that cause infectious diseases. Bacteria Individually, bacteria are too small to be seen without a microscope. are tiny, single-celled organisms, some of which can cause disease. Bacteria live almost everywhere on Earth. Somebacteria are even found in the frozen Arctic and in the boiling watersof hot springs. You have more than 300 kinds of bacteria living in your mouth right now! There’s no need to reach for the mouthwash, though,because most bacteria are harmless. Many are actually helpful. Forexample, bacteria living in your intestines make vitamins that youneed to live. However, some kinds of bacteria make you sick whenthey grow on or inside your body. Some bacteria give off poisons,while other bacteria enter and damage cells. Tuberculosis, tetanus,and sinus infections are examples of diseases caused by bacteria. Viruses Viruses are even smaller than bacteria. are tiny disease-causing particles made up of genetic material and a proteincoat. The genetic material in the virus contains the instructions formaking more viruses. Viruses survive and replicate only inside livingcells. They reproduce by taking control of body cells and forcingthem to make many new viruses. After escaping from the cell, thesenew viruses seek out other cells to attack. Viral diseases include colds,the flu, measles, AIDS, and severe acute respiratory disease (SARS). Fungi Organisms that absorb and use the nutrients of living or dead organisms are called (singular fungus). The mushrooms in yoursalad are fungi. They don’t cause disease, but other fungi do. Maybeyou’ve had athlete’s foot, which is caused by a fungus that lives and feedson your feet and makes them burn and itch. A fungus, not a worm, isalso responsible for the scaly, circular rash known as ringworm.fungiVirusesBacteriapathogen Fungus Athlete’s foot is ahighly contagiousfungal disease.ProtozoanMalaria is a protozoandisease that is spread tohumans by mosquitoes. ParasiteLice are parasites that attach tothe hair on a person’s headand cause itching. 317Head louseTinea fungusPlasmodium protozoaninvading a redblood cell Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Infectious Diseases HealthLinks code: HH4087 318 CHAPTER 13 Preventing Infectious DiseasesProtozoans Single-celled, microscopic organisms called protozoans are larger and more complex internally than bacteria. Protozoans account for diseases that are leading causes of death throughout someparts of the world. For example, malaria is a disease caused by proto-zoans. Malaria kills approximately 1 million people every year intropical countries. Parasites Bacteria, viruses, fungi, and protozoans account for almost all the infectious diseases in the United States. Animal para-sites, however also cause a large number of diseases throughout theworld. Animal parasites get their energy and nutrients by feeding onother living things. Examples of harmful animal parasites includehead lice, tapeworms, and certain roundworms. How Are Infectious Diseases Spread? Before you can have the symptoms of a cold, the virus that causes thecold has to enter your body. This means that the virus has to travelfrom someone who has a cold to your body. Knowing how pathogensare spread will help you protect yourself against infectious diseases.Infectious diseases are spread in four main w ays, as shown in Figure 2. Person to Person One way that pathogens can be spread is from person to person. For example, when you sneeze or cough, you sendthousands of tiny drops of saliva and mucus into the air. The dropscan remain in the air for quite a while and carry many pathogenswith them. Anyone who breathes in one of these infected drops canbecome sick from the pathogens. Also, anyone who touches anythingthe drops fall on, such as a book, can become infected by thepathogens. Diseases such as the flu, colds, and measles are spreadfrom person to person through the air. Other ways pathogens can be spread from one person to another are by kissing, drinking from the same glass, and having sexual con-tact. Mononucleosis, commonly known as the “kissing disease,” isspread through person-to-person contact. Although the disease canbe passed through kissing, it may also be spread by drinking from thesame glass or eating the food of someone who is infected. Food and Water The food you eat and the water you drink can also bring pathogens into your body. Foodborne diseases are oftenspread when pathogens from an infected person or animal contami-nate food. This is why people who work with food are required towash their hands thoroughly. Foodborne disease can also be spreadwhen the food itself is contaminated. For example, meat frominfected animals may contain the eggs of parasitic worms. Foodbornediseases include hepatitis A and botulism. In the United States, it is relatively safe to drink tap water. Water from streams and lakes, however, must be purified before the watercan be used for drinking. Water can become contaminated if it is For more information about food safety, see Chapter 8. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 What Are Infectious Diseases? 319exposed to sewage or animal wastes that have not been treated. Water can be purified by boiling, by using water purification tablets, or byusing a filtering system. Diseases caused by contaminated waterinclude typhoid, cholera, giardiasis, and dysentery. Environment Pathogens are present on most of the objects around you. Although many pathogens cannot live long outside ofthe human body, some are tougher and can survive on objects in theenvironment. These pathogens are on the phone you used this morn-ing and even the money in your pocket. Many pathogens live in soiland can enter your body through cuts in your skin. The tetanus bac-terium is an example of a pathogen that may be present in soil. Animals Many pathogens live in or on animals’ bodies and can carry diseases from one person to another. For example, you can getdiseases from your pets. Children often contract ringworm by pettinga dog or cat that has the fungus. The pathogens that cause malaria, yellow fever, and encephalitis are carried by mosquitoes. When a mosquito carrying one of thesepathogens bites you, it pierces your skin and can inject the pathogensinto your blood. Certain ticks, such as the one shown in Figure 2, carry Lyme disease and Rocky Mountain spotted fever, which arebacterial diseases. Person to Person People’s body fluids maycontain pathogens.Sneezing, coughing,sharing drink containers,and having sexual contactcan spread diseases fromperson to person. Food and Water Many types of food can contain pathogens. Withoutproper cooking or treatment of foodsthese pathogens can be passed on tothe humans that eat the food. Unpuri-fied water also carries pathogens.Environment Look around you—almosteverything you see iscovered with micro-organisms, a few ofwhich can causedisease. Animals Like humans, animals can carry disease. When humanscome into contact with infectedanimals, diseases can be spread.Infectious diseases are spread in manyways. ACTIVITY List two ways that diseases can be spread in your home. 2 Figure How Infectious Diseases Are SpreadWestern black- legged tick Copyright © by Holt, Rinehart and Winston. All rights reserved. the antibiotics and the immune system kill offall of the bacteria. most bacteria die,but some more resistant bacteria survive and multiply. Antibiotic-sensitive bacteria Antibiotic-resistant bacteriaIf a person finishes all the antibiotics prescribed... If a person stopstaking antibioticsbefore the prescription is finished... Antibiotic-resistantbacteria can spreadto others.Person has pneumonia. 320 CHAPTER 13 Preventing Infectious DiseasesHow Are Infectious Diseases Treated? When you are sick from an infectious disease, your doctor will treat you based on what pathogen made you sick. For example, your doc-tor will treat a strep throat differently from athlete’s foot. This isbecause each type of pathogen has its own characteristics. Treating Bacterial Diseases Medicines used to kill or slow the growth of bacteria are called antibiotics . The discovery of these bacteria-killing compounds completely changed medicine. Beforethe discovery of antibiotics, even a small cut on your finger couldlead to a deadly bacterial infection! Antibiotics work by preventing the growth and division of bacterial cells. Eventually, antibiotics cause antibiotic sensitive bacteria to die.Some of the antibiotics in use today include penicillin, tetracycline,and streptomycin. Because antibiotics have no effect on

viruses, theycan’t be used to treat colds or other viral diseases. Doctors and the public are worried about a growing problem called antibiotic resistance. is a condition inwhich bacteria can no longer be killed by a particular antibiotic. Asshown in Figure 3, improper use of an antibiotic promotes the growth of antibiotic-resistant bacteria. The antibiotic-resistant bacte-ria can spread to other people. Antibiotic resistance is a threat toeveryone’s health. Today, people are dying from infections that wouldhave been easy to treat 10 to 15 years ago. You can help prevent antibiotic resistance. First, you should not ask your doctor for antibiotics if you have a viral disease. Second, ifyour doctor does give you a prescription to treat a bacterial infection,be sure to follow the prescription and finish your medication. Antibiotic resistance Antibiotic-resistant bacteria can grow and multiply if a person does not finishhis or her antibiotic prescription. Thesemore resistant bacteria can then bespread to other people.3 FigureProper Uses of Antibiotics 1Antibiotics should not be taken for a viral infection, such as acold or the flu. 2Antibiotics should not be savedfor the next time you get sick.Finish the prescription. 3Antibiotics should not be takenby anyone other than the personfor whom they were prescribed. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 What Are Infectious Diseases? 321Treating Viral Diseases Currently, there is less known about how to destroy viruses than bacteria. Unlike bacteria, viruses do not grow as living cells. Thus, viral infections cannot be treated with thesame medications as bacterial infections can. Most antiviral medica-tions concentrate on relieving symptoms and stopping the produc-tion of viruses inside the human cells. These medications must betaken early in the illness to have an effect. Treating Fungal Infections Fungal infections are usually not as common as bacterial or viral infections, but they can sometimes beserious. Fungal infections of the skin, such as athlete’s foot, can usu-ally be treated with an over-the-counter antifungal medicine. Otherfungal infections such as candidiasis (yeast infection), however, aremore serious and often require stronger prescription medicines. Treating Protozoan Infections Prevention is the best way to protect yourself from protozoan infections. Simple precautions suchas maintaining good hygiene and sanitation keep many protozoansfrom being able to survive, reproduce, and spread. It is important fora person who has a protozoan infection to see a doctor to receivetreatment with prescription medicines. Treating Parasitic Infections Although parasites such as round- worms and tapeworms are found throughout the world, head lice aremore common in the United States. To prevent infection from headlice, people should not share combs and brushes with others or wearother people’s clothes. Fortunately, head lice can usually be treatedwith medicated shampoos. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term infectious disease. 2.Identify the term for “an agent that causes disease.” 3.Define the term antibiotic resistance. Understanding Key Ideas 4.Identify the five types of pathogens that cause infectious diseases. 5.Differentiate between environmentally spread diseases and diseases that are spread from person to person.6.Identify which disease can be spread by water. a.ringworm c.Lyme disease b.cholera d.head lice 7.Identify three ways to purify water before using it. 8.State how antibiotics work to treat bacterial diseases. 9.Describe how bacteria develop antibiotic resistance. 10.Describe two types of fungal infections, and explain how they are treated. Critical Thinking 11. Practicing Wellness How can the failure to take antibiotics properly pose a risk toother peoples’ health?LIFE LIFE SKILLFor more information about the proper use of medicines, seeChapter 9. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. 322 CHAPTER 13 Preventing Infectious DiseasesProtecting Yourself from Infectious DiseasesSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Your head aches, your throat burns, and your muscles feel like you’ve just been tackled by a football team. When you’ve gotthe flu, you feel as if you’ll never get better. But in a couple of weeks, your symptoms are usually gone. What happened? Althoughyou were not aware of it, during those 2 weeks, your body was able toget rid of the flu virus and allowed you to recover. How Your Body Fights Disease Your body has many ways of fighting disease-causing bacteria,viruses, and other pathogens. Your body uses your skin and chemi-cals to fight pathogens. Your body also has more specialized defenses,such as the inflammatory response and the immune system. Becauseof these defenses, your body is able to protect itself from thepathogens that are continually attacking it. Physical Barriers To make you sick, most pathogens have to enter your body, start growing, and cause damage. Luckily for most ofus, this infection process is not easy! As shown in Figure 4, your body’s first line of defense helps to keep many pathogens from enter-ing your body. Your body’s first line of defense includes >Skin Your skin keeps pathogens from entering your body. Your skin also uses chemicals, such as sweat and oil, to killpathogens that have settled on your skin. Your skin is alwaysrepairing and rebuilding itself by quickly closing any gaps(cuts) that pathogens could get through. OBJECTIVES Describe how the body fights infectious diseases. Summarize five things a person can do to stay well. Describe how immunity to a disease develops. State three things you should do when you are sick. Listthree things you can do to prevent the spread of infectious diseases. LIFE LIFE SKILLKEY TERMSKEY TERMS inflammation a reaction to injury or infection that is characterized by pain, redness, and swelling lymphatic system a network of vessels that carry a clear fluid called lymph through the body white blood cell a blood cell whose primary job is to defend the body against diseasevaccine a substance usually prepared from killed or weakened pathogens or from genetic material and that is introduced into a body to produceimmunity symptom a change that a person notices in his or her body or mind and that is caused by a disease of disorder The best way to protect yourself from disease is to practice a healthy lifestyle. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Protecting Yourself from Infectious Diseases 323>Mucous membranes The soft tissues that line the nose, mouth, throat, digestive tract, urethra, and vagina are all mucous membranes. Like the skin, mucous membranes form a barrierto pathogens. Mucous membranes make a slimy materialknown as mucus. One function of mucus is to trap pathogens. Bacteria you breathe in may get caught in mucus lining thetubes that carry air to the lungs. Tiny, hairlike structures calledcilia grow from the lining of these tubes. Like an escalator, thewaving cilia move the mucus and its bacterial passengers to theback of your throat. Then, by swallowing, you send these bac-teria into your stomach where they are destroyed. >Chemicals Many of the chemicals your body makes destroy pathogens. For example, sweat is acidic, and inhibits thegrowth of bacteria. Your stomach secretes acids that not onlyhelp you digest your food but also kill bacteria. Tears contain aprotein that kills bacteria. Inflammatory Response Sometimes pathogens are able to cross the protective barriers that are your skin and mucous membranes.This can happen, for example, when you cut or burn yourself.Inflammation is a second way your body protects itself frompathogens. is a reaction to injury or infection that ischaracterized by pain, redness, and swelling. When the protective barriers are broken and a part of your body becomes infected, the area around the injury becomes inflamed, andgets hot. This is caused by the small blood vessels that expand tobring more blood to the injured area. Sometimes, a yellowish sub-stance called pusbuilds up around the injury. Pus includes dead and injured body cells that were fighting the bacteria and dead andinjured bacteria. The inflammatory response shows that your body isattacking pathogens.Inflammation Skin Your skin helps keep pathogens from getting inside your body. Mucous membranes The slimy mucus that covers yournose and mouth helps trappathogens and keep them fromcausing harm to your body.Chemicals Sweat, tears, and stomach acids all work to breakdown any pathogens that mayhave attached to your body. For more information about the immune system, see the Express Lesson on p. 542 of this text.HandbookHEALTHThe body has many defenses to protect itself from pathogens. The first line ofdefense includes the skin, mucousmembranes, and chemicals.4 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 324 CHAPTER 13 Preventing Infectious DiseasesImmune System Even though the skin and mucous membrane barriers and the inflammatory response are very effective, they can’t protect against all pathogens. So your immune system gets ready foraction. The immune system is made up of certain types of blood cellsand certain proteins called antibodies . The blood cells and antibodies move through the blood vessels and are within your organs. These infection-fighting cells also move through the a network of vessels that carry a clear fluid called lymph throughout the body. The lymphatic system picks up fluid from allover the body. This system often sweeps up bacteria or viruses andcarries them to your lymph nodes . You can feel one set of lymph nodes in your neck just below your ears and jaw. Lymph nodes are filledwith white blood cells that scan the lymph for pathogens. are cells in the blood whose primary job is to defend the body against disease. Certain white blood cells produceantibodies that then bind to specific pathogens and warn other whiteblood cells to destroy the pathogens. When you are sick, your lymphnodes often swell because of the growing number of white bloodcells fighting the infection. The immune system’s defenses take time to defeat pathogens. The cells of the immune system typically attack a specific pathogen.In contrast, the body’s other defenses—skin, mucous membranes,and inflammation—work to react to and fight any pathogen. What You Can Do to Stay Well Your immune system is always working to keep you well. But thereare several things you can do to stay well. Here are a few tips. >Protect yourself. Keeping your body healthy helps your immune system to fight infectious diseases. >Eat a healthy, balanced diet. A lack of certain nutrients in your diet can weaken your immune system. Extreme dieting or fasting can reduce your defenses. >Drink water. Drink 8 to 10 glasses of water a day to keep your immune system working effectively. >Reduce your stress levels. While everyone feels stress at some time, stress that lasts weeks or months can weaken yourimmune system and may leave you more vulnerable to illnesses such as colds. >Exercise regularly. Get at least 60 minutes of activity daily such as walking, running, cycling, or even doing housework. >Get regular medical checkups. Seeing your doctor and dentist regularly can help prevent you from getting sick. >Try to avoid close contact with sick people. When you must be exposed to people who are sick, wash your hands often. Do not share personal items, such as hairbrushes, or sharedrinks from the same container. >Get enough sleep. Sleep is important to keep your body functioning properly. White blood cellssystem,lymphatic For more information about stress management skills, seeChapter 4 . linkTOPICTOPICIf I spend all day outside on a chilly day, I’ll get a cold.Myth Being cold does not make you more likely to get a cold.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Protecting Yourself from Infectious Diseases 325Get Vaccinated One of the most important ways to stay healthy is to stay up to date on all your vaccinations. are substances usually prepared from killed or weakened pathogens or from genetic material and that is introduced into a body to produce immunity. When a vaccine is injected or swallowed, the immune systemresponds to the vaccine material by making white bloodcells called memory cells. In the future, if the pathogenagainst which the vaccine was made enters the body, thememory cells and their antibodies fight the pathogen beforeit can cause disease. Having a disease or being immunized for it may give many years of protection, but periodic boosters may beneeded. Boosters are extra doses of a vaccine that help the body maintain the production of memory cells for a par-ticular disease. It is also possible to be immunized for diseases that develop new strains, such as the flu. However, every timea new strain of the flu virus appears, a new vaccine mustbe developed to protect against it. Thus, people must geta flu vaccine every year for maximum protection againstthe illness.Vaccines Analyzin gDA TA Analyzing DATA Vaccinations In the “Vaccine” column are listed the diseases that each vaccination protects against. The age ranges indicate the age when each vaccination should be received. The blue boxes indicate that the vaccine can be received anytime during that period.21 Your Turn 1.At what ages must a person receive the MMR vaccination? 2.What three diseases does theDTaP vaccination protectagainst? 3.At what age should a personreceive his or her first varicellavaccination ? 4. CRITICAL THINKING Why do you think people must bevaccinated for polio morethan once? Keeping vaccinations up to date throughout life can help a person avoidmany infectious diseases. Diphtheria, tetanus, pertussis (DTaP)DTaP (3 doses)DTaP DTaP Measles, mumps, rubella (MMR)MMR MMR Vaccine Age Varicella (chicken- pox) (Var)Var Birth– 6 mos– 6 mos 2 yrs 2–6 yrs 11–12 yrs 14–18 yrs Td (tetanus and diphtheria booster) Inactivated polio (IPV)IPV (3 doses) IPV2Sample Vaccination Schedule for Several Diseases Sample Vaccination Schedule for Several Diseases 1 Copyright © by Holt, Rinehart and Winston. All rights reserved. What to Do When You Are Sick Think back to the last time you had a cold. Do you remember how you felt? You probably had a runny nose and a sore throat and wereweak and tired. These are the typical symptoms of a cold. Symptoms of Infection are the changes that you notice in your body or mind that are caused by a disease or disorder.Common symptoms of infection include fever, rash, sore throat,headache or muscle aches, fatigue, tired eyes, nausea, vomiting, anddiarrhea. Some symptoms are caused by the pathogens themselves as they multiply within your body. For example, the Salmonella bacteria that may be in raw eggs or in raw or undercooked chicken and meatscause diarrhea when they invade cells lining the intestine. Some other symptoms are part of your body’s response to infec- tion. Fever, for instance, is an increase in body temperature. Some-times fever is caused by the invading microorganisms, but sometimesit is a defense against pathogens. For example, some bacteria can’tfunction or survive at higher temperatures, so your body temperaturerises in an attempt to stunt their growth. Taking Care of Yourself Following a few simple rules can make your illness less unpleasant. >Unless you have no other choice, stay home when you’re sick.You’ll get more rest, and you won’t pass your illness to others. >Drink plenty of fluids such as water and juice. >Be sure to follow all the directions the doctor gives. Take allthe medicine prescribed to you. >Throw away any tissues you use right away. Wash y our hands frequently.Symptoms Five Signs That You Need to Seek Medical Care 1You have difficulty in breathing. 2You have severe pain somewhere. 3Your temperature is 101°For more and lasts for morethan 2 days. 4You have a cut that doesnot heal properly. 5Mucus from your nose,throat, or lungs is thick andyellowish green. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Protecting Yourself from Infectious Diseases 327How to Prevent the Spread of Disease Infectious diseases in the United States are common and can spread quickly. As a result, it is important that everyone works to prevent thespread of disease. There are several things you can do to prevent thespread of disease. Get Vaccinated Public vaccination programs have been largely responsible for preventing the spread of infectious diseases. Vaccinescan help protect people against certain diseases for long periods oftime. Vaccines are particularly important for fighting viral diseasesbecause few drugs can stop a virus once it has begun to reproduceinside the body. Scientists are currently developing vaccines for moreinfectious diseases. Keep Clean Even with medical advancements, maintaining good hygiene is still one of the best ways you can help prevent the spreadof disease. For example, bathing and washing with soap daily helpsprotect against infection by washing away many bacteria. real life Activity LIFE LIFE SKILL Practicing WellnessOBSERVING UNHEALTHY BEHAVIORS ✔pen or pencil ✔paper 1.Choose two students in your class to observe. 2.Write the following behaviors down the left side of the paper: “moving an object with hands,”“tapping feet,” “touching pencilor pen to mouth,” and “touch-ing any part of the face withthe hands.” 3.Note the time, and then begin observing your subjects. ProcedureMaterials4.Use tick marks to record the number of times that each sub- ject performs the activities onyour list. Continue observing for10 minutes. Add up the numberof tick marks for each behavior. 5.Record your results on the board. 1.Summarizing Results Calculate the average numberof times subjects engaged ineach of the observedbehaviors. 2.Analyzing Results Which behavior did the subjects engage in the most? Which behavior didthey engage in the least?Conclusions3.CRITICAL THINKING What are some consequences of the behaviors you observed on thespread of infectious diseases?Why might these behaviors beunhealthy? 4.CRITICAL THINKING Based on your results and analyses,what recommendations wouldyou make that could improveindividual health and helpreduce the spread of diseasesfrom person to person?For more information about public health, see the Express Lesson on p. 552 of this text.HandbookHEALTH MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 328 CHAPTER 13 Preventing Infectious DiseasesThe most effective way to wash your hands is to count to ten while rubbing your hands in the soap and then rinse well. When should you wash your hands? >before eating or preparing a meal >after handling uncooked meats or raw vegetables >after going to the bathroom or changing a baby’s diaper >after touching or playing with animals or working outdoors >after you sneeze or cough into your hand >after coming into contact with a sick person Don’t Share Personal Items You should also avoid sharing per- sonal items, such as toothbrushes. Avoid sharing the same food ordrink with others. Sharing these things increases the chance that youmight pass an illness to another person or contract a disease fromsomeone who is infected. Cover Your Mouth! You should cover your mouth when you sneeze or cough. After sneezing, you should wipe your nose with dis-posable tissues and throw them away immediately. This practicehelps reduce the chance that others will become infected. Be On Guard Outdoors Following a few simple rules while out- doors can greatly reduce your chances of contracting a disease fromanimals or insects. >When in long grass, wear long-sleeved shirts and pants. >Use a safe and effective insect repellant when necessary. >Avoid contact with animals that behave strangely. >Avoid drinking and swimming in remote streams, rivers, orlake waters. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term inflammation . 2.Define the term vaccine . 3.Name the term for a “cell in the blood whose pri- mary job is to defend the body against disease.” Understanding Key Ideas 4.Name two physical barriers that your body has to guard against pathogens. 5.Identify which of the following is nota part of the body’s immune system. a.antibodies c.lymph nodes b.white blood cells d.heart6.Identify which of the following activities can help you stay well. a.avoiding exercise c.sharing a toothbrush b.getting enough sleep d.sharing a drink 7.Describe how vaccinations work to protect the body from illness. 8. Setting Goals State three things you can do to help yourself when you are sick. 9. Practicing Wellness List four times when you should wash your hands. Critical Thinking 10.Explain why it is important that your body has several different defenses to protect you from pathogens.LIFE LIFE SKILLLIFE LIFE SKILL Count to 10,and then rinse well. Copyright © by Holt, Rinehart and Winston. All rights reserved. 329Common Infectious Diseases SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Camelia could not believe that she was home in bed and sick with pneumonia. She did not understand how she couldhave become sick. After all, she ate a healthy diet, exercised regularly, and always had her yearly checkups at the doctor. Why wasshe sick? Diseases Affect Everybody No matter how healthy we are, we all become ill from infectious dis-eases sometime during our lives. There are so many differentpathogens in so many places that it is impossible to avoid them. Some-times, the illness may be minor. At other times, however, serious com-plications may arise. Although the young and the elderly are mostsusceptible to infectious diseases, we are all capable of being infected. Our best defense against pathogens is to avoid behaviors that increase our chances of becoming infected. In general, the more youknow about preventing a disease and identifying its symptoms, thebetter your chances are of avoiding it.OBJECTIVES State why diseases affect everybody. Identify two bacterial diseases, and describe their symptoms and ways that they are spread. Identify two viral diseases, and describe their symptoms and ways that they are spread.Listexamples of fungal, protozoan, and parasitic infections, and describe their symptoms.Name two organizations in your community that help treat and prevent the spread of infectious diseases. LIFE LIFE SKILLKEY TERMSKEY TERMS meningitis an inflammation of the membranes covering the brain and spinal cord salmonellosis a bacterial infection of the digestive system, usually spread by eating contaminated food hepatitis an inflammation of the liver amebic dysentery an inflammation of the intestine caused by an ameba 38 million $5 to $6 billion$120 billionstatistically speaking. . . The number of school days missed each year in the United States because of the flu: The amount that is spent in medical costs and lost work each year in the United States because of foodborne illnesses: The amount the United States spends each year to treat infectious diseases: Copyright © by Holt, Rinehart and Winston. All rights reserved. 330Common Bacterial Diseases Bacteria are found on almost everything around us, from our books and clothes to our food. Many bacteria, however, prefer to live indark, warm, and moist places such as inside our bodies. In thehuman body, bacteria can grow and multiply quickly. As a result, it isnot surprising that diseases caused by bacteria are very common. Treatment antibiotics Strep throat Symptoms sore throat, fever, and yellow or whitespecks on tonsils Transmission spread by contact with mucus from aninfected person Prevention avoiding contact with infected personTetanus Symptomssevere muscle spasms Transmission tetanus causing bacteriaare commonly found insoil; can enter bodythrough cuts or wounds Prevention series of vaccinations during childhood; boosters every 5 to 10years as an adultTreatmentantibiotics Tetanus immune globulin Copyright © by Holt, Rinehart and Winston. All rights reserved. 331Maybe you’ve had strep throat or a sinus infection, or maybe you have gotten food poisoning after eating chicken that wasn’t thor- oughly cooked. Bacteria are responsible for causing these illnesses, inaddition to and many others. salmonellosis, meningitis, Sinus infections Symptoms headache; tenderness of the sinuses;thick, greenish mucus; and feeling ofpressure in your head Transmission bacteria are spread by contact withmucus from the nose or throat of aninfected person Prevention avoiding infected person and allergens,such as cigarette smoke and other airpollutants TreatmentantibioticsSalmonellosis a bacterial infection of the digestive system, usually spread by eating contaminated foods Symptoms headache, cramps, diarrhea, nausea,vomiting Transmission eating food from an infected animal or foodcontaminated by an infected person Prevention thorough cooking of animal food products,hand washing, refrigeration Treatmentover the countermedicines to treatsymptoms, sometimesrequires antibioticsMeningitis an inflammation of the membranes covering the brain and spinal cord; can also be causedby viruses or sometimes by fungi or parasites Symptoms severe headache, fever, stiff neck, sensitivityto light, and nausea Transmission pathogen is spread by contact with saliva or mucus from an infected person Prevention vaccination for some bacterial forms of meningitis, avoiding contact with infected personsTreatmentantibiotics, if bacterial disease iscaught early Copyright © by Holt, Rinehart and Winston. All rights reserved. 332 CHAPTER

13 Preventing Infectious DiseasesCommon Viral Diseases You have probably contracted one or more viral diseases before. Maybe you have suffered through a few colds and the flu. Some viraldiseases, such as the flu, can often be handled by your body, whileothers, such as are more serious. In Table 1, you’ll learn about the symptoms, transmission, prevention, and treatment of sev-eral viral diseases. hepatitis, Type Flu Cold Mumps Measles Mononucleosis Hepatitis Symptoms headache, sore muscles, sorethroat, fever, vomiting, fatigue,and cough scratchy, sore throat; sneezingand runny nose;and mild cough pain and swelling of glands in thethroat, fever, andheadache fatigue, runny nose, cough, slightfever, small whitedots in mouth, andrash covering body fever, swollen lymph nodes, sore throat, andweakness inflammation of the liver, jaundice(yellowing of theskin), fever, anddarkening of theurine Transmission spread by contact with saliva ormucus of aninfected person andby personal contact spread by contact with saliva ormucus of aninfected person spread by contact with infected air-borne droplets andpersonal contact spread by contact with saliva ormucus of infectedperson spread by contact with saliva ormucus of aninfected person spread by contact with bodily fluids ofinfected person andby eating infectedfood or waterPrevention vaccination and avoiding contactwith infected person washing hands regularly andavoiding contactwith infected person vaccination vaccination avoiding drinking from the sameglass and eatingfrom the samefood as other people vaccination for hepatitis A and B,washing handsregularly, andavoiding contactwith infected personTreatment rest and plenty of fluids; no specifictreatments; see doctorif symptoms becomesevere rest and plenty of fluids; no specifictreatments; see doctorif symptoms becomesevere see doctor; rest and plenty of fluids; nospecific treatments see doctor; rest and plenty of fluids; nospecific treatments see doctor; rest and plenty of fluids; nospecific treatments see doctor; rest and medications for hepatitis A; no curefor hepatitis B and C Table 1 Common Viral Diseases Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Head Lice HealthLinks code: HH4072 SECTION 3 Common Infectious Diseases 333Other Common Infections When we think of infections, we often think of infections caused by bacteria or viruses. We may forget that there are several otherkinds of pathogens in our environment, such as fungi, protozoa,and parasites. Fungal Infections Fungi are an important source of food and drugs, but some kinds of fungi can actually be harmful. Athlete’sfoot, jock itch, and ringworm are examples of infections caused byfungi. These infections occur most often when the specific type offungus comes into contact with skin that is warm and moist. Withfungal infections, the skin can become itchy and red and lesionsmay appear. The best way to prevent fungal infections is to keep clothing, such as socks and underwear, dry and to maintain good personal hygiene.If a fungal infection does arise, over-the-counter medications willusually kill the fungus. If the symptoms continue or become severe, itis important to see a doctor immediately. Protozoan Infections Protozoa are most often found in water and soil. About 20,000 kinds of protozoa exist, but only a smallnumber of them cause disease. Some infections caused by protozoainclude amebic dysentery, malaria, and African sleeping sickness. (uh MEE bik DIS uhn TERee) is an inflammation of the intestine caused by an ameba. Symptoms of amebic dysenteryinclude nausea, diarrhea, and sometimes fever. The most widespread and serious of the protozoan infections worldwide is malaria. Worldwide, several million people are infectedwith malaria each year. Approximately one million people die frommalaria each year. Malaria is caused by a protozoan that is passedfrom one person to another by mosquitoes. Symptoms include fever,chills, headache, fatigue, and nausea. Malaria can be prevented andtreated with antimalarial drugs prescribed by a doctor. Parasitic Infections Diseases can also be caused by animal para- sites. Animals such as hookworms, flukes, pinworms, and tapewormscan live inside the body and cause disease. Examples of animal para-sites that live on the body are lice, leeches, ticks, and fleas. Animalparasites can be spread to and infect the body in several w ays. Eating infected food, drinking infected water, having contact with infectedsoil, and being bitten by infected insects are some of the ways that aperson can contract a parasitic infection. Body lice are one of the most common parasitic infections in the United States. Body lice can often be seen with the naked eye andoften cause itchiness and sores on the head. The best way to treatbody lice is through a combination of using over-the-countermedications, washing linens, soaking brushes and combs in hotwater and soap, and vacuuming carpet and furniture.Amebic dysentery Tapeworms attach to the intestinal wall using suckers and hooks on theirheads. Among the tapeworms that caninfect humans are beef, pork, dog, rat,and fish tapeworms. Copyright © by Holt, Rinehart and Winston. All rights reserved. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Describe the symptoms of salmonellosis. 2.Identify the term for “inflammation of the liver.” 3.Define the term amebic dysentery . Understanding Key Ideas 4.Identify why anyone can become affected by an infectious disease. 5.Identify one method used to prevent tetanus. a.antibiotics c.series of vaccinations b.skin test d.muscle spasms 6.Identify three symptoms of bacterial meningitis.7.Classify the following as bacterial diseases or viral diseases. a.strep throat c.measles b.tuberculosis d.mononucleosis 8.Describe the symptoms of hepatitis. 9.Identify the most widespread disease caused by protozoa. 10.Name three ways to treat body lice. Critical Thinking 11. Using Community Resources Explain why it is important to have organizations in every community that help treat and prevent the spreadof disease.LIFE LIFE SKILL 334 CHAPTER 13 Preventing Infectious DiseasesWorking Toward a Healthy Future Today you can travel almost anywhere in the world in just a few hours. International air travel not only has made it easier for peopleto see the world but also has made it easier for diseases to spreadfrom country to country. Because diseases can be spread so easily, it isimportant for everyone throughout the world to work together tofight disease. Because diseases can be spread so quickly and easily, doctors have had difficulty controlling infectious diseases. Government scien-tists at the Centers for Disease Control and Prevention (CDC) andthe National Institutes of Health (NIH) are now watching for newdiseases that may enter the country. It is important to have an efficient and effective public health sys- tem to prevent or manage an infectious disease outbreak. Eventhough great progress has been made in the ability to protect thepublic’s health, the methods and financial resources needed for suchprogress are not available in many parts of the world. As a result,public health problems and priorities vary throughout the world. Public health organizations also work to control or eliminate diseases. Health organizations are working hard to control or elimi-nate diseases such as measles, mumps, rubella, and polio. Smallpoxis an example of a disease that has been declared eradicated innature. However, even with advances in medicine and great effort,eliminating a disease is very difficult. Even if we are able to control or eliminate many diseases, new diseases may be discovered and diseases that we have under controlmay become resistant to our medicines. Thus, we must maintainhealthy habits and lifestyles to ensure global health for the future. Because it is so easy for diseases to travel from one country to another, itis important that the effort to improvepublic health be a global one. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 13 Highlights 335 CHAP TER 13 CHAP TER 13 CHAPTER 13Highlights Key Terms The Big Picture ✔An infectious disease is any disease that is caused by an agent that has invaded the body. ✔Infectious diseases can be caused by several kinds of pathogens,such as bacteria, viruses, fungi, protozoa, or parasites. ✔Infectious diseases can be spread from one person to another or through food, water, the environment, or animals. ✔Specific types of pathogens have specific treatments. Antibiotics are used to treat bacterial infections. Viral diseases cannot be treated with antibiotics. ✔Antibiotic resistance is a growing problem that is a threat to everyone’s health. SECTION 1 infectious disease (316) pathogen (317) bacteria (317) virus (317) fungus (317) antibiotic resistance (320) ✔Infectious diseases can affect everyone, especially the young and the elderly. ✔Bacteria are found everywhere and are a common cause of disease. Strep throat, salmonellosis, and sinus infections are common bacterial diseases. ✔Although there are no cures for many viral diseases, rest and fluids can help speed recovery. The common cold, flu, hepatitis,mononucleosis, and chickenpox are diseases caused by viruses. ✔Diseases caused by fungi, protozoa, and animal parasites aretreated differently than diseases caused by bacteria and virusesare. Worldwide, protozoa are the cause of several serious infec-tions, such as malaria. ✔Increases in world travel and poverty in many parts of the worldhave made it more difficult for doctors to fight infectious diseases. ✔Public health organizations work to control or eliminate diseases.SECTION 3 meningitis (331) salmonellosis (331) hepatitis (332) amebic dysentery (333)✔The body’s first line of defense against pathogens includesthe skin, mucous membranes, and body chemicals. ✔Inflammation protects your body from pathogens that crossthe body’s first line of defense. The injured area swells andturns red. ✔The immune system uses immune cells to target and killspecific pathogens. ✔Eating a balanced diet, reducing stress, exercising regularly,and keeping up to date on all your vaccinations are things aperson can do to help maintain his or her health. ✔When you are sick, it is important to stay home, rest, andfollow the directions of your doctor. ✔Being vaccinated, washing hands frequently, and not sharingpersonal items help prevent the spread of disease.SECTION 2 inflammation (323) lymphatic system (324) white blood cells (324) vaccine (325) symptom (326) Copyright © by Holt, Rinehart and Winston. All rights reserved. 336 CHAPTER 13 Review CHAP TER 13 CHAP TER 13 CHAPTER 13Review Using Key Terms amebic dysentery (333) meningitis (331) antibiotic resistance (320) pathogen (317) bacteria (317) salmonellosis (331) fungus (317) symptom (326) hepatitis (332) vaccine (325) infectious disease (316) virus (317) inflammation (323) white blood cell (324) lymphatic system (324) 1.For each definition below, choose the key term that best matches the definition. a.a bacterial infection of the digestive system,usually spread by eating infected food. b.a network of vessels that carries a clear fluidcalled lymph throughout the body c.any agent that causes disease d.a reaction to injury or infection, characterizedby pain, redness, and swelling e.a change that a person notices in his or herbody or mind that is caused by a disease ordisorder f.blood cells whose primary job is to defend thebody against disease 2.Explain the relationship between the key terms in each of the following pairs. a.hepatitis and virus b.bacteria and antibiotic resistance c.amebic dysentery and meningitis Understanding Key Ideas Section 1 3.Which of the following do not cause infectiousdiseases? a.bacteria c.fungi b.white blood cells d.viruses 4.Describe the differences between bacteria andviruses. 5.List four ways that infectious diseases can bespread. 6.What kinds of diseases can antibiotics cure? 7.What are three ways that you can help help pre-vent the spread of antibiotic resistant bacteria?Section 2 8.Which of the following is part of the body’s firstline of defense? a.the skin c.white blood cells b.red blood cells d.immune system 9.Which of the following is part of the body’sinflammatory response? a.sleeping c.sweating b.swelling d.tears 10.What are three activities we can do to stay well? 11.Name three signs that indicate you need to seekmedical care. 12.Describe the role of white blood cells in develop-ing immunity from pathogens. 13.What are three things you should do when youare sick? 14.What are three things you can do to prevent thespread of infectious diseases? Section 3 15.Which of the following statements describes whyall people can become infected by an infectiousdisease? a.Pathogens are in so many places. b.Bacteria live inside our bodies. c.The elderly are more susceptible to infectiousdiseases than the young are. d.none of the above 16.What is the best way to keep from being infectedwith strep throat? 17.Tetanus is a ______ disease. a.viral c.parasitic b.fungal d.bacterial 18.Which of the following are symptoms of measles? a.inflammed liver c.muscle spasms b.swollen glands d.rash covering body 19.Worldwide, what is the most common protozoandisease? 20.CRITICAL THINKING Explain why it is important to have an efficient public health system if an outbreak of a disease occurs.WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 13 Review 337Interpreting Graphics Study the figure below to answer the questions that follow. 21.What is the number of deaths due to acute respiratory infections? 22.What is the total number of deaths dueto AIDS and tuberculosis? 23.CRITICAL THINKING Why do you think acute respiratory infections are the cause of such a largenumber of deaths?Activities 24. Health and You Contact your doctor, and ask for a copy of your immunization record. Make a listof diseases you have been vaccinated for, andresearch when you need your next booster shots. 25. Health and Your Community Choose a disease listed on pp. 326 and 327 and research thatdisease. Explore what measures are being takenby public health organizations to preventthe disease. Write a one-pagereport toexplain your findings. 26. Health and You Work with a partner to create a list of all of the objects that come into contactwith your eyes, nose, and mouth eachday that could contain pathogens. Action Plan 27. Assessing Your Health Establishing healthy patterns of living can help reduce thechance of spreading disease. Explain five habitsthat you can begin now to help keep you fromspreading infectious diseases.LIFE LIFE SKILL 28.In this passage, the word adequate means Awrong. Bunfortunate. Cenough. Dexpensive. 29.What can you infer from reading this passage? ETanita does not like band practice. FTanita did not take enough medicine to com-pletely cure her infection. GTanita works at a bank. Hnone of the above 30.Write a paragraph describing why Tanita mighthave become sick again. Explain what mighthappen if she takes the same antibiotic again. 31.Write a paragraph describing how Tanita couldhave prevented herself from getting strep throat inthe beginning.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Tanita went to the doctor 2 weeks ago for a sore throat. Her doctor told her that shehad strep throat and that she needed totake antibiotics for 2 weeks and rest. Aftera few days of rest and taking her medicine,Tanita felt much better. She decided thatshe had taken an adequate amount of antibiotics to cure her strep throat. So shedecided to stop taking the pills and wentback to school. Yesterday, however, afterband practice, she began to have a feverand sore throat again. Tanita couldn’tunderstand why she felt bad again. Afterall, she had taken medicine and rested, asher doctor ordered. 3.5 3.0 2.52.01.5 1.0 0.5 0Number of deaths (in millions) Top Four Infectious Disease Killers in the World AIDS Diarrheal diseasesTuber- culosisAcute respiratory infections Source: World Health Organization.WRITING SKILL WRITING SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 14 CHAP TER 14 CHAPTER 14 Lifestyle DiseasesLifestyle DiseasesLifestyle Diseases 338BEHAVIOR Indicate how frequently you engage in each of the following behaviors (1 = never; 2 = occasionally; 3 =most of the time; 4 = all of the time). Total yourpoints, and then turn to p. 642. 1.I eat foods that are low in saturated fats and high in fiber. 2.I eat and drink foods that are low in addedsalt and sugar. 3.I exercise at least 60 minutes every day. 4.I avoid tobacco products and being in smokyenvironments. 5.I have yearly medical exams. 6.When outside, I wear sunscreen. 7.I eat at least 2 servings of fruit a day. Copyright © by Holt, Rinehart and Winston. All rights reserved. 339SECTION 1 Lifestyle and Lifestyle Diseases SECTION 2 CardiovascularDiseases SECTION 3 Cancer SECTION 4 Living withDiabetes go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH14. Copyright © by Holt, Rinehart and Winston. All rights reserved. 340 CHAPTER 14 Lifestyle DiseasesEven though Devon is only 16 years old, he is worried about his health. Both his father and one of his grandfathers have diabetes. Devon worries that he will also develop diabetes, but he doesn’t know what to do. He decides to talk to his doctorabout ways to reduce his risk. What Are Lifestyle Diseases? A hundred years ago, the main causes of death in the United Stateswere infectious diseases, such as tuberculosis (TB) and the flu. Today,however, we are better protected from infections because of goodhygiene practices, better living conditions, and medical advances. So,although infectious diseases are still a serious health problem, thetop causes of death in the United States today are lifestyle diseases. are diseases that are caused partly by unhealthy behaviors and partly by other factors. What Causes Lifestyle Diseases? Lifestyle diseases are so called because a person’s lifestyle (habits, behaviors, and practices)largely determine whether the person develops a lifestyle disease.Lifestyle diseases include cardiovascular disease, many forms of can-cer, and two types of diabetes. Personal habits, behaviors, and practices, however, are not the only factors that determine whether a person develops a lifestyle disease.Other factors that we cannot control, such as age, gender, and genes,also contribute to a person’s chances of developing a lifestyle disease. It is important to know the factors that contribute to lifestyle diseases, because behaviors that lead to lifestyle diseases later in lifecan start when you are very young. In Devon’s case, diabetes runs inhis family. The chance that Devon will develop diabetes is greater thanit would be if there was not a history of diabetes in his family. How-ever, by practicing a healthy lifestyle now, Devon can reduce his risk ofdeveloping diabetes. Lifestyle diseasesLifestyle and Lifestyle DiseasesSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Describe how lifestyle can lead to diseases. Listfour controllable and four uncontrollable risk factors for lifestyle diseases. State two actions you can take now to lower your risk for developing a lifestyle disease later in life. LIFE LIFE SKILL Because diabetes runs in my family, I will get it, too.Myth Many factors, some of which you can control, contribute to diabetes. FactKEY TERMSKEY TERMS lifestyle disease a disease that is caused partly by unhealthy behaviors and partly by other factors Copyright © by Holt, Rinehart and Winston. All rights reserved. Your Future HealthSun exposure Physical activity DietSmoking Risk Factors for Lifestyle Diseases When determining if a person might develop a disease, a doctor looks at the person’s risk factors. A risk factor is anything that increases the likelihood of injury, disease, or other health problems. Controllable Risk Factors Taking charge of the risk factors that you can control may greatly decrease your chances of developing alifestyle disease. Controllable risk factors include habits, behaviors,and practices that you can change, as shown in Figure 1. For example, controllable risk factors include >your diet and body weight >your daily levels of physical activity >your level of sun exposure >smoking and alcohol abuse Thus, exercising regularly, eating a healthy diet, and not smoking willhelp you reduce your risk of lifestyle diseases later in life. Becausethere are many risk factors that you have little or no control over, it isimportant to start healthy habits that you can control early. Uncontrollable Risk Factors Some risk factors that contribute to your chances of developing a lifestyle disease are out of your control. However, it is important to understand what these factors areand how they affect your health. Uncontrollable risk factors include >Age As you age, your body begins to change. As a result of aging, the body has a harder time protecting itself. Therefore,the chances of developing a lifestyle disease increase as you age.Some of the risk factors for lifestyle diseases are beyond your control. Butyou can control many risk factors, suchas smoking, physical activity, sun expo-sure, and diet.1 Figure SECTION 1 Lifestyle and Lifestyle Diseases 341 Copyright © by Holt, Rinehart and Winston. All rights reserved. 342 CHAPTER 14 Lifestyle Diseases>Gender Certain diseases are more common among members of one gender. For example, men have a greater risk of heart disease than women do, especially earlier in life. Women havea greater risk of breast cancer than men do. >Ethnicity Your ethnicity can also influence your chances of developing a lifestyle disease. For example, African Americansare more likely to develop high blood pressure than individ-uals of European descent are. Mexican Americans have ahigher risk of developing diabetes than individuals of Euro-pean descent do. Asian Americans historically have had alower incidence of heart disease than people of Europeandecent have had. However, Asian Americans have recentlybegun to develop heart disease in greater numbers. It isbelieved that a change to eating a high-fat, low-fiber diet is the main reason for the increase. >Heredity In the same way that genes determine your natural hair color, genes can also determine your chances of develop-ing certain lifestyle diseases. For example, in some familiesheredity may increase the chances that a family member willdevelop cancer. However, it is important to remember that just because you have an uncontrollable risk factor for a lifestyle disease, you will not neces-sarily develop that disease. For example, if you have a hereditary ten-dency to develop heart disease, you can make healthy food choicesand exercise regularly and you may never develop heart disease. Youmay, however, need to work harder to prevent heart problems thanother people do. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term lifestyle disease. Understanding Key Ideas 2.Describe how a person’s lifestyle can increase his or her chances of developing a lifestyle disease. 3.Identify the term for “anything that increases the like- lihood of injury, disease or other health problems.” a.unavoidable chance c.hereditary tendency b.risk factor d.none of the above 4.Listthree controllable risk factors for lifestyle diseases. 5.Classify each of the following risk factors as controllable or uncontrollable . a.age c.diet b.smoking d.genes6.Summarize how each of the following can increase your risk of developing a lifestyle disease. a.age c.ethnicity b.gender d.heredity 7. Setting Goals Describe two actions you can take today to help reduce your chances of developing a lifestyle disease. Critical Thinking 8.Why might a person who has lead a healthylifestyle develop a lifestyle disease? 9.Do people have an obligation to take the best careof themselves that they can? Explain.LIFE LIFE SKILL Although we all have uncontrollable risk factors such as age, gender, ethnicity,and heredity, there are still many behav-iors you can practice to help lower yourrisk of developing a lifestyle disease. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Cardiovascular Diseases 343 Cardiovascular DiseasesSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Xavier just got back from a physical exam. The doctor told Xavier that he had high blood pressure. Xavier knew thathigh blood pressure was common in his family. He felt that he had already taken some steps to lower his risk. What Are Cardiovascular Diseases? Together, the heart and blood vessels make up the cardiovascular system. The diseases and disorders that result from progressivedamage to the heart and blood vessels are called You may not have heard that term before, but you’ve probably heard of some kinds of cardiovascular disease: heartattack, stroke, atherosclerosis, and high blood pressure. Cardiovascular disease is the leading cause of death in the United States. Nearly all of the people who die from CVD are over the age of40. So why should you worry about CVD now? The damage thatleads to CVD builds up over many years and may begin as early aschildhood. So, the sooner you start taking care of your heart andblood vessels, the more likely you are to avoid developing a CVD. Lifestyle and Cardiovascular Disease Why do some people die from cardiovascular disease while others never have any prob-lems? Genetic differences between people are one reason. Butwhether you develop a cardiovascular disease and how serious itbecomes also depend on how you live. For example, smoking, beingoverweight, having high blood pressure, having high blood choles-terol, or having diabetes greatly increase your risk of developing a cardiovascular disease.diseases (CVDs).cardiovascularOBJECTIVES Summarize how one’s lifestyle can contribute to cardiovascular diseases. Describe four types of cardiovascular

diseases. Identify two ways to detect and two ways to treat cardiovascular diseases.Listfour things you can do to lower your risk for cardiovascular diseases. LIFE LIFE SKILLKEY TERMSKEY TERMS cardiovascular disease (CVD) a disease or disorder that results from progressive damage to the heart and blood vessels stroke a sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted blood pressure the force that blood exerts against the inside walls of a blood vesselheart attack the damage and loss of function of an area of the heart muscleatherosclerosis a disease characterized by the buildup of fatty materials on the inside walls of the arteries “High blood pressure runs in my family. So, my dad and I arecutting down on the amount of salt we eat.” Copyright © by Holt, Rinehart and Winston. All rights reserved. Types of Cardiovascular Diseases About 60 million Americans have some form of cardiovascular disease. Heart attacks, strokes, and other kinds of cardiovascular dis-ease kill about 1 million Americans every year. This number is twicethe number of people who die from cancer. Stroke Each year about 160,000 people die from strokes. are sudden attacks ofweakness or paralysis that occur when blood flow to an area of the brain is interrupted.In some cases, a blood clot (shown in yellow)lodges in one of the arteries in the brain. Theclot cuts off circulation to nearby brain cells. If the clot isn’tremoved, the cells begin to die. Strokes can also occur whena hole forms in one of the vessels inside the skull, and bloodleaks into the brain. Internal bleeding can severly damagethe brain. Get medical help immediately if you or anyone around you has the following symptoms: >sudden numbness or weakness of the face, an arm, or a leg >trouble seeing in one or both eyes >sudden dizziness or loss of coordination >sudden, severe headache with no known causeStrokes High Blood Pressure Doctors call high blood pressure, or hypertension, the silent killer, because many people don’t know that their blood pressure is high until they have a heart attack or stroke. is the force that blood exerts againstthe inside walls of a blood vessel. When blood pressure is toohigh, it puts extra strain on the walls of the vessels and on theheart. High blood pressure can injure the walls of the blood vessels, which canlead to other cardiovascular diseases. Italso makes the heart work harder,which can cause the heart to weakenor fail. High blood pressure can eventu-ally damage the kidneys and eyes, too. Blood pressure Copyright ©by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Cardiovascular Diseases 345Heart Attack The narrow coronary arteries that cover the heart deliver the nutrients and oxygen that the cells of the hard-working heart require. If a blood clot gets stuck in one of thecoronary arteries, it can sharply reduce or shutoff blood flow to the heart. As the heart cells diefrom lack of oxygen, the victim often has a crushingpain in the chest. The result of the reduced bloodflow is a heart attack. A is the damageand loss of function of an area of the heart muscle.About one-third of heart attacks injure the heart sobadly that they are fatal. Heart attacks can happen at any time, and sometimes they happen without any previous symptoms. There-fore, it is important to knowthe warning signs of a heartattack. heart attack Normal arteryWarning Signs of a Heart Attack >Uncomfortable pressure, squeezing, or pain in the center of the chest thatlasts for more than a fewminutes >Pain spreading to shoul- ders, neck, and arms >Chest discomfort combinedwith lightheadedness,fainting, sweating, nausea,or shortness of breath Atherosclerosis If you looked inside an old water pipe, you might find it clogged with buildup. Much less water can flow through such a pipe thanthrough a new, clean one. Something similar can happen inside blood vessels. Fatty deposits known as plaques build up on the inside walls of arteries and interfere with blood flow. The disease character-ized by the buildup of fatty materials on the inside walls of the arteriesis called ( ATHuhr OHskluh ROH sis). Atherosclerosis is dangerous for two reasons. First, it can reduce or stop blood flow to certain parts of the body. Second, these deposits can break free and release clots intothe bloodstream. If one of these clotsgets stuck in one of the coronaryarteries, the result is a heart attack.If the clot lodges in the brain, astroke results.atherosclerosis Artery with fatty buildup (Atherosclerosis) Copyright © by Holt, Rinehart and Winston. All rights reserved. 346 CHAPTER 14 Lifestyle DiseasesDetecting and Treating Cardiovascular Diseases The earlier you detect and treat a cardiovascular disease, the greater your chance of reducing the damage or danger of the disease. Detecting Cardiovascular Diseases Doctors today can diag- nose CVD earlier and more accurately than they could before. Meth-ods to detect CVD include >Blood Pressure To check your blood pressure, a healthcare provider wraps a cuff around your upper arm. The cuff isinflated until it is tight enough to stop bloodflow through themain artery in the arm. As air is slowly released from the cuff,the healthcare provider uses a stethoscope to listen for theheartbeat sound as blood begins to flow through the artery. Heor she records the number that appears on the instrumentrecording the pressure. This number indicates the systolic pres- sure, the maximum blood pressure when the heart contracts. As the cuff deflates further, the healthcare provider listens until the sound of the heartbeat disappears and theblood flows steadily through the artery. He or she records thissecond number. The second number, the diastolic pressure , indicates the blood pressure between heart contractions. Analyzin gDA TA Analyzing DATA Analyzing DATA Checking Blood Pressure Blood pressure is measured in millimeters of mercury (mm Hg). Blood pressure is expressed as two numbers. In the diagram, the number atthe end of the red bar indicates the pressure. The first number measured indicates the systolic pressure. Systolic pressure is the maximum pressure when the heart contracts. The second number measured indicates the diastolic pressure. Diastolic pressure is the pressure between heart contractions. Your Turn 1.What is this person’s systolic pressure? 2.What is this person’s diastolic pressure? 3. CRITICAL THINKING Does this person have high blood pressure? If so, what can he or she do to reduce it? 4. CRITICAL THINKING If a woman has a blood pressure of 100/70, what is the systolic pressure? What is the diastolic pressure? Is herblood pressure low, normal, or high?21For more information about the circulatory system, see the Express Lesson on pp. 532–535 of this text.HandbookHEALTH Blood Pressure Readings 160 140120100 80604020 0 Systolic readingDiastolic reading160140120100 80604020 01 2 Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Cardiovascular Problems HealthLinks code: HH4030 SECTION 2 Cardiovascular Diseases 347Normal blood pressure generally falls between 80/50 and 130/85 mm Hg (a unit for measuring pressure). Blood pres- sure over 140/90 is considered high. >Electrocardiogram One of the most common cardiovascular tests is the electrocardiogram, sometimes called an ECG or EKG. An EKG measures the electrical activity of the heart. EKGs candetect damage to the heart and an irregular beat. >Ultrasound To look at the heart in action, doctors sometimes use ultrasound, which is also used to take pictures of babies inthe womb. Doctors can see the pumping of the heart and theaction of the heart valves. >Angiography Angiography ( ANjee AHG ruh fee) is a test in which dye is injected into the coronary arteries. An instrumentcalled a fluoroscope is used to see where the dye travels and tolook for blockages in the coronary arteries. Treating Cardiovascular Diseases Today, we have many choices for treating cardiovascular disease (CVD). >Diet and Exercise Changing the diet and exercise habits of a patient is an important step in treating CVD. A low-fat, low-salt, and a low-cholesterol diet, along with light physical activ-ity, is often prescribed to people with signs of CVD. Exercise isnormally carried out under a doctor’s supervision. >Medicines Many medicines are available to treat CVDs. For example, some medicines keep the blood vessels from con-stricting. This helps keep blood pressure down. >Surgery If the coronary arteries are badly clogged, doctors often perform a coronary artery bypass operation. Surgeons remove a length of vein from the patient and transplant it to the heart.They attach one end of the vein to the aorta and the other end tothe coronary artery just below the blockage. Thus, blood candetour around the blockage and reach the heart muscle. >Angioplasty A technique called angioplasty requires a doctor to insert a tube with a balloon at the tip into a blood vessel in thepatient’s leg. The tube and balloon are guided through vesselsinto the blocked artery. Once the balloon is in place, it is inflatedto flatten the plaque and open the artery. Sometimes, a metal cagecalled a stent is left in the artery to prop open the artery walls. >Pacemakers Sometimes, the heart needs help to keep beat- ing. If the heart cannot keep a steady rhythm, surgeons mayimplant an artificial pacemaker in the chest. Artificial pace- makers are small, battery-powered electronic devices that stimulate the heart to contract. >Transplants If the heart becomes so weak or diseased that it can’t do its job, surgeons may replace it. Depending on theemergency, doctors may use artificial hearts or hearts taken from people who gave permission for their organs to beremoved after their death. An operation to replace a heart iscalled a heart transplant . Using an EKG machine, doctors can detect damage to the heart and an irreg-ular beat by monitoring the electricalimpulses of the heart. Copyright © by Holt, Rinehart and Winston. All rights reserved. 348 CHAPTER 14 Lifestyle DiseasesPreventing Cardiovascular Diseases The doctors and surgeons who treat CVD would prefer that you pro- tect your heart and blood vessels before you get sick. Because CVD canbegin as early as childhood, it is important to take steps now, such asdoing the healthy activity shown in Figure 2, to ensure a healthy future. The following advice can help you lower your risk of CVD. >Trim the fat, and hold the salt. Limit your consumption of saturated fats, cholesterol, and salt. Instead, eat more fruits and vegetables, lean meats, and plenty of products made from whole grains. >Keep your weight near recommended levels. Being overweight increases your risk of CVDs. Try to keep your weight near thatrecommended for your height and build. >Don’t smoke. Smoking speeds up atherosclerosis and increases your risk of having a stroke or heart attack. If you don’t smoke,don’t start. If you do smoke, the sooner you quit, the better. >Get moving. Regular exercise benefits your cardiovascular sys- tem in many ways. It helps you feel less stressed by daily life and is also a good way to keep your weight under control. >Watch those numbers. Have your blood pressure and choles- terol checked regularly. If you have a family history of CVD,you should get checked now. It may be wise to start a programto control your cholesterol, even this early. >Relax. Stress, feelings of aggression, hostility, and anger have been shown to increase the risk of CVD. The increase in riskmay be due to the physical effects of stress, such as raisedblood pressure, or due to smoking, drinking, or poor eating—behaviors people sometimes use to deal with stress. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “a disease or disorder that results from progressive damage to the heart and blood vessels.” 2.Define the term stroke. 3.Name the term for “the force that blood exerts against the inside walls of a blood vessel.” Understanding Key Ideas 4.Describe how lifestyle contributes to cardiovascular disease. 5.Name four types of cardiovascular diseases. 6.Compare the meaning of systolic pressure and diastolic pressure readings. 7.Classify each of the following as either a detection method or a treatment for cardiovascular diseases. a.EKG c.angiography b.angioplasty d.heart transplant 8. Practicing Wellness Identify the action that would help protect you from cardiovas-cular diseases. a.increasing salt intake c.exercising regularly b.smoking d.eating a high-fat diet Critical Thinking 9.Why do you think cardiovascular diseases are socommon in the United States?LIFE LIFE SKILLExercising can help to lower your chance of developing a cardiovasculardisease. ACTIVITY List two exercise activities that you enjoy or might enjoy doing to keep your heart healthy.2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. Cancer SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Every day, millions of your body’s cells die. At the same time, millions of cells divide to take the place of the dying cells.Healthy cells divide at a regulated rate. Sometimes, the cells keep dividing uncontrollably. The result is a common but dangerousdisease called cancer . What Is Cancer? is a disease caused by uncontrolled cell growth. More than 1 million people in the United States are diagnosed with cancer everyyear. Cancer is the second leading cause of death, after CVD. Cancer begins when the way that the body normally repairs and maintains itself breaks down. To replace cells that have died or areworn out, your body makes new ones. This process is usually care-fully controlled to produce only a limited number of replacementcells. Sometimes, however, these controls break down, and some cellscontinue to divide again and again. These out-of-control cells quicklygrow in number. Tumors As the body produces more and more of these faulty cells, they form a clump known as a tumor. A (muh LIG nuhnt TOO muhr) is a mass of cells that invades and destroyshealthy tissue. When a tumor spreads to the surrounding tis-sues, it eventually damages vital organs. Sometimes, masses of cells that aren’t cancerous develop in the body. A (bi NIEN TOOmuhr) is an abnormal, but usually harmless cell mass.Benign tumors typically do not invade and destroy tis-sue and do not spread. But these tumors can growlarge enough that they negatively affect the nearbytissues and must be removed. benign tumormalignant tumorCancerOBJECTIVES Describe what cancer is. Identify three causes of cancer. Describe four types of cancer. Identify three ways to detect and three ways to treat cancer. Listfive things you can do to lower your risk for cancer. LIFE LIFE SKILLKEY TERMSKEY TERMS cancer a disease caused by uncontrolled cell growth malignant tumor a mass of cells that invades and destroys healthy tissuebenign tumor an abnormal, but usually harmless cell masschemotherapy the use of drugs to destroy cancer cells Teens who have successfully battled cancer, as Nicole Childs has, can con-tinue to take part in normal activitiesand be successful in life. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Cancer Cells HealthLinks code: HH4028 350 CHAPTER 14 Lifestyle DiseasesCancer Cells Are Destructive Cancer cells are very destructive to the body. They tear through and crush neighboring tissues, stran- gle blood vessels, and take nutrients that are needed by healthy cells.But what makes cancer especially dangerous is that the cells travel, asshown in Figure 3. This process is called metastasis (muh TAS tuh sis). The cancer cells get into the blood or lymph and move to other partsof the body. They then settle down and grow into new tumors. Forexample, lung cancer cells typically travel to the brain. Breast andprostate cancer cells often travel to the bones. Sometimes, the cancercells that spread, not the original tumor, are what kill a person. What Causes Cancer? Uncontrolled cell growth comes from damage to the genes that regulate the making of new cells. Genes thatregulate cell division can become damaged in a variety of w ays. A per- son can inherit “damaged,” or mutated, genes from his or her parents.These genes make the person more likely to develop cancer thansomeone without those genes is. Cancer-causing agents or substancesknown as carcinogens can also be responsible for damaging genes. Some examples of carcinogens include >certain viruses, such as human papilloma virus (HPV) >radioactivity and ultraviolet (UV) radiation, an invisible typeof energy from the sun (people are exposed to ultraviolet radi-ation while outside or in a tanning bed) >chemicals found in tobacco smoke (for example, arsenic, ben-zene, and formaldehyde) >asbestos (a material used to make fireproof materials, electricalinsulation, and other building supplies) All of us are exposed to some carcinogens in our daily lives. They may be in our food, water, air, or environment. However, as you’lllearn later, many cancers are caused by carcinogens that you canavoid. You can control how close you come to many of these carcino-gens. Choosing to work, study, and live somewhere free from thesecarcinogens can reduce your chance of developing cancer. Normal cells divide uncontrollably.Cancer cells join to form a tumor.Cancer cells break away from the tumor and invade blood and lymph vessels.The cancercells then travel to other parts of the body and can form new tumors. Occasionally, cells grow uncontrollably and become cancerous. Once this happens, the cancerous cells can thentravel to other parts of the body. 3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Cancer 351Types of Cancer Although all kinds of cancer are the result of uncontrolled cell growth, each kind of cancer has its own characteristics. For example,cancer of the pancreas is very difficult to treat, while certain forms ofskin cancer can be removed easily. Table 1 describes several types of cancer. Name of cancer Breast Prostate Respiratory Colon UrinaryLymphomaSkinLeukemia (loo KEE mee uh) Ovarian Nervous systemCervical (SUHR vi kuhl)What is it? >cancer of the tissue and organs of the breast; more common in womenbut can also be found in men >cancer of the prostate, a part of themale reproductive system >cancer of the respiratory organs,such as the lungs, larynx, andbronchus; most forms linked to theuse of tobacco >cancer of the colon, an organ in thedigestive system >cancer of the urinary organs, such asthe bladder and kidneys >cancer of the lymph nodes or lymphtissue >cancers that affect the skin, such asbasal cell carcinoma and melanoma >cancer of the tissues that produceblood; more common in males thanin females >cancer of the ovaries, a part of thefemale reproductive system >cancer of the brain, spinal cord, and other parts of the nervous system >cancer of the cervix, a part of the female reproductive system Estimated new cases each year 205,000 189,000 183,200 107,300 90,700 60,90058,30030,800 23,300 17,00013,000 Estimated deaths each year 40,000 30,200 161,400 48,100 24,900 25,800 9,600 21,700 13,900 13,100 4,100Table 1 Types of Cancer Colon cancer Basal cell carcinoma Source: American Cancer Society. Copyright © by Holt, Rinehart and Winston. All rights reserved. 352 CHAPTER 14 Lifestyle DiseasesDetecting and Treating Cancer Although all cancers have similar characteristics, they differ in how they are detected, how they are treated, and how they affect the per-son with the cancer. Detecting Cancer In addition to annual medical exams, there are many ways that cancer is detected. >Self-exams Regular self-examinations of the skin, breasts, or testicles are important. Because skin cancer is so common,watch for any new growths; a sore that doesn’t heal; and forshape, size, texture, or color changes to a mole or wart. >Biopsy A biopsy is a sample of tissue taken from the body that is then examined. Biopsies are commonly used to determinewhat type of cancer a person has and whether a tumor ismalignant or benign. >X rays An X ray of the breasts to detect tumors is called a mammogram. Doctors recommend regular mammograms for women over the age of 40. Computerized axial tomography(CAT scan or CT) takes multiple X rays of some part of thebody, which a computer then assembles into one image. >MRI Magnetic resonance imaging, or MRI, uses a massive mag- net and a computer to gather images of the body. >Blood and DNA tests Blood tests can detect some cancers. For example, older men are often given a prostate specific antigen(PSA) test. This test looks for a protein produced by theprostate, a small gland near the bladder. DNA tests are used todetect the likelihood of developing cancer. More tests willbecome available as we learn more about human genes andthe ways in which cancer develops and spreads. You and your parents should talk to your doctor about getting regular cancer-screening tests. Use the CAUTION acronym in themargin to help you remember the warning signs of cancer. Treating Cancer Cancer is most treatable when it is caught early. Doctors battle the disease with several weapons. Techniques used totreat cancer include the following. >Surgery An operation can remove some tumors. Surgery is most effective when the tumor is small, has not spread,and is located where removing it will not damage surround-ing tissue. >Chemotherapy (KEEmoh THER uh pee) is the use of drugs to destroy cancer cells. Unfortunately, chemotherapy also kills some of the body’s healthy cells. It can cause side effects such as nausea, fatigue, vomiting, andhair loss. >Radiation therapy As you learned earlier, radiation can cause cancer. But doctors also use radiation to destroy cancer cells,an approach called radiation therapy. Usually, a beam of radia- tion is fired at the tumor from outside the body.Chemotherapy Warning Signs of Cancer Change in bowel or bladder habits Asore that doesn’t heal Unusual bleeding or discharge T Indigestion or difficulty swallowing ON agging cough or hoarsenesshickening or a lump anywhere in the body bvious change in a wartor mole Copyright © by Holt, Rinehart and Winston. All rights reserved. Often, doctors recommend a combination of surgery, chemotherapy, and radiation. The success of any treatment depends on the type of cancer, how long the tumor has been growing, andwhether the cancer has spread to other parts of the body. Onepromising treatment scientists are developing is to “starve” tumorsby cutting off their blood supply. Another possibility is to create acancer “vaccine” that would stimulate the immune system todestroy cancer cells. Living with Cancer Cancer is difficult for the person who has cancer, as well as for loved ones. A person with cancer may often betired or weak. They may also feel down. Children with cancer areoften scared, confused, and upset by medical procedures and strangesurroundings. How can you help a person who has cancer? Be patient. Offer to spend time doing quiet things, such as talking, reading, or watchingTV. Many people recover from cancer and go on to lead healthy lives.So, a positive outlook during the treatment process greatly helps. LIFE LIFE SKILL ActivityCancer Resources in Your CommunityUsing Community Resources Using Community Resources 1.Identify programs offered by cancer resource centers in your community. 2.What are two ways that you can promotecancer awareness in your community?LIFE LIFE SKILL The first step toward learning more about cancer is to use the resources in your community. Taking advantageof these resources will help you protect yourself fromhaving cancer in the future. Your doctor can help you find reliable informa- tion on cancer. Find out about nonprofit organizations in your city that are devoted to cancer awareness, such as the American Cancer Society. The Internet can also provide valuable resources related to cancer. But be carefulwhen using the Internet. Although many Web sites have reliable information, some have misleading and false information.321 For more information about evaluating health Web sites, see the Express Lessonon pp. 564–565 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 354 CHAPTER 14 Lifestyle DiseasesPreventing Cancer Taking charge of these five controllable risk factors can greatly reduce your risk of getting cancer. 1. No butts about it: don’t smoke. Tobacco use is responsible for about one-third of the cancer deaths in the United States. People who use tobacco are prone to cancers of the mouth,throat, esophagus, pancreas, and colon. Despite what you mighthear, there is no safe form of tobacco. 2. Safeguard your skin. Limit your exposure to the damaging UV radiation that causes skin cancer. You can do so by protectingexposed areas of skin with sunscreen and clothing, even oncloudy days. Do not sunbathe, use tanning beds, or use sunlamps. 3. Eat your veggies, and cut the fat. No diet can guarantee that you won’t get cancer. However, people who eat

large amounts of satu-rated fat are more likely to get cancer of the colon and rectum.Studies suggest that people who eat fruits, vegetables, and foodshigh in fiber have a lower risk of some cancers. 4. Stay active, and maintain a healthy weight. Studies have shown that regular physical activity helps protect against some types ofcancers. Exercising also helps prevent obesity, another risk factorfor developing cancer. Teens should get at least 60 minutes ofactivity daily. 5. Get regular medical checkups. Your doctor can answer questions you may have about cancer risk factors, preventions, and treat-ments. He or she will also be able to advise you on self-examina-tions and when to begin regular cancer screening tests. When we make positive choices with regard to these controllable riskfactors, we can work toward a healthy future for ourselves. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term cancer. 2.Compare a benign tumor to a malignant tumor. 3.Define the term chemotherapy. Understanding Key Ideas 4.Describe how cancer cells differ from normal body cells. 5.State three common carcinogens. 6.Identify the form of cancer that has the highest death rate. (Hint: See Table 1 on p. 351.) a.pancreas c.lung b.liver d.colon7.Describe three methods that doctors use to detect cancer. 8.Describe how chemotherapy works to treat cancer. 9.Identify which of the following actions would help reduce your chances of developing cancer. a.not smoking c.eating fruits b.wearing sunscreen d. all of the above 10. Practicing Wellness Identify one part of your lifestyle that you can change to decrease your chance of developing cancer. Critical Thinking 11.Why do you think cancer is more common in somefamilies than in others?LIFE LIFE SKILLKick Butts Day is a national campaign that encourages students to speak outagainst tobacco use. Tobacco useincreases your risk of certain cancers.TheKickButtsDaylogoisthepropertyoftheCampaignforTabacco-FreeKids.FormoreinformationaboutKickButtsDayortheCam paign,visittheirwebsiteattabacco-freekids.org Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 4 Living with Diabetes 355Living with Diabetes SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5 Estimates indicate that 16 million people in the United States have diabetes. Unfortunately, about 5 million people whohave diabetes do not know that they have it and are not being treated for it. What Is Diabetes? When you eat, the nutrients in foods are broken down to provideyour cells with energy. Carbohydrates are broken down to glucosewhich then enters your bloodstream where it can circulate to the restof your body. Once glucose reaches the cells, it moves from thebloodstream into the cells. The cells then use the glucose for energy. Insulin The body can’t use glucose without insulin. is a hormone that causes cells to remove glucose from the bloodstream.Thus, insulin lowers the amount of glucose traveling free in thebloodstream. Insulin is produced by special cells in the the pancreas.When blood glucose levels are high, insulin is released into thebloodstream. When glucose levels are lower, insulin is no longerreleased into the bloodstream. Insulin and Diabetes Sometimes, the pancreas doesn’t produce enough insulin, or the body’s cells don’t respond to insulin. Theresult is diabetes. is a disorder in which cells are unable toobtain glucose from the blood such that high blood-glucose levelsresult. The kidneys excrete water, resulting in increased urinationand thirst. Cells then use the body’s fat and protein for energy,which causes a buildup of toxic substances in the bloodstream. Ifthis continues, a diabetic coma can result. A is a lossof consciousness that happens when there is too much blood sugarand a build up of toxic substances in the blood. Without treatment,diabetic comas can result in death. diabetic comaDiabetesInsulinOBJECTIVES Describe the role of insulin in diabetes. Compare type 1 and type 2 diabetes. Identify two ways to detect and two ways to treat type 1 and type 2 diabetes. Name two ways that you can prevent type 2 diabetes. LIFE LIFE SKILLKEY TERMSKEY TERMS insulin a hormone that causes cells to remove glucose from the bloodstream diabetes a disorder in which cells are unable to obtain glucose from the blood such that high blood-glucose levels result diabetic coma a loss of consciousness that hap- pens when there is too much blood sugar and a buildup of toxic substances in the blood Testing blood glucose is one way that people with diabetes can deal withtheir illness. Blood glucose is theamount of glucose in the blood. Copyright © by Holt, Rinehart and Winston. All rights reserved. 356 CHAPTER 14 Lifestyle DiseasesTypes of Diabetes The three most common forms of diabetes are type 1 diabetes, type 2 diabetes, and gestational diabetes. As shown in Table 2, each kind of diabetes has its own characteristics. Type 1 Diabetes Type 1 diabetes accounts for only 5 to 10 per- cent of diabetes cases in the United States. Type 1 diabetes developswhen the immune system attacks the insulin-producing cells of thepancreas. Once these cells are destroyed, the body is unable to makeinsulin. Scientists believe that type 1 diabetes is caused by bothgenetic factors and viruses. Type 1 diabetes is sometimes called insulin-dependent or juvenile diabetes . This type of diabetes is treated with daily injections of insulin and is usually diagnosed before the age of 18. Symptoms are usuallysevere and develop over a short period of time. Common symptomsinclude increased thirst, frequent urination, fatigue, and weight loss. Type 2 Diabetes The most common form of diabetes in the United States is type 2, sometimes called noninsulin-dependent diabetes . Unlike type 1 diabetes, type 2 diabetes is most common amongadults who are over 40 years of age and among people who are over-weight. In type 2 diabetes, the pancreas makes insulin, but the body’s cells fail to respond to it. The result is the buildup of glucose in theblood and the inability of the body to use the glucose as a source offuel. Common symptoms of type 2 diabetes include frequent urina-tion, unusual thirst, blurred vision, frequent infections, and slow-healing sores. These symptoms usually appear gradually. Type of Diabetes Type 1 Type 2GestationalWhat is it? >diabetes resulting from the body’s inability toproduce insulin >diabetes resulting fromthe inability of the body’scells to respond to insulin >diabetes that developsduring pregnancySymptoms >increased thirst, frequent uri- nation, fatigue, weight loss,nausea, abdominal pain, andabsence of menstruation infemales >frequent urination,increased thirst, fatigue,weight loss, blurred vision,frequent infections, andslow-healing sores >frequent urination,increased thirst, fatigue,weight loss, blurred vision,frequent infections, andslow-healing soresTreatment >diet and insulin >diet, exercise, and occasionally insulin >diet and occasionallyinsulin Table 2 Types of DiabetesMedical alert bracelets alert medical personnel that a person, such as adiabetic, needs special care. Somewarning signs of a diabetic emergencyinclude feelings of weakness or faint-ness, irritability, rapid heartbeat,nausea, and drowsiness. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Diabetes HealthLinks code: HH4041 SECTION 4 Living with Diabetes 357Gestational Diabetes Occasionally, a pregnant woman can develop diabetes near the end of her pregnancy. Usually, the diabetes goes away after the baby is born. Gestational diabetes can increase thechances of complications during the pregnancy. The symptoms are thesame as those of type 2 diabetes but milder. The risk of developing ges-tational diabetes increases if the mother has a family history of dia-betes, is obese, is over 25 years of age, or has previously given birth to achild who weighed more than 9 pounds at birth. Detecting and Treating Diabetes Detecting and getting medical care for diabetes as early as possible candecrease your chances of developing serious side effects. Detecting Diabetes Early detection is important in cases of dia- betes. Diabetes patients risk complications such as blindness, kidneydisease, strokes, and amputations of the lower limbs. The first step indetecting diabetes is to see your doctor if you have symptoms. Yourdoctor will use a variety of lab tests, such as urinalysis, a glucose-tol-erance test, or an insulin test to determine if you have diabetes. Oncediagnosed, a person can work with his or her doctor to keep the dia-betes under control. Unfortunately, there is no cure for diabetes yet. Treating Type 1 Diabetes The goal of treatment is to keep blood- glucose levels as close to normal as possible. People who have type 1diabetes usually must test their blood glucose several times a day. Manypeople who have type 1 diabetes also need several doses of insulin eachday to keep their blood-glucose levels within a normal range. Most dia-betics must learn to give themselves insulin injections. Treating Type 2 Diabetes Although insulin is sometimes used to treat type 2 diabetes, more common control measures focus ondiet and exercise. A healthy diet can help people with type 2 diabetescontrol the amount of glucose they eat and can help them control People who have, or may be at risk for, type 2 diabetes need tocarefully watch their Calorie,fat, sugar, cholesterol, and fiberintake. Copyright © by Holt, Rinehart and Winston. All rights reserved. 358 CHAPTER 14 Lifestyle Diseasestheir weight. Foods with sugar do not need to be avoided completely, but must be eaten in moderation. Physical activity is also importantbecause it helps the body use more of the glucose in the blood andkeeps the person’s weight at a healthy level. New Treatments Researchers are working on new treatments for diabetes. The researchers are hoping that these new treatments willhelp diabetics monitor their blood-glucose better, will provide newmethods of delivering insulin, and will help reduce the severity ofsymptoms. Scientists are also working on ways to transplant insulin-producing cells into people with type 1 diabetes. Preventing Diabetes As in so many diseases, genes play a role in diabetes. For example,people who have diabetes in their family are at a greater risk of de-veloping diabetes. People in certain ethnic groups, particularly AfricanAmericans, Hispanics, and Native Americans, are also at a greater riskfor developing certain forms of diabetes. There is currently no way to prevent type 1 diabetes. But exercise, a healthy diet, and insulin injections as needed can allow a person tolead a healthy life. There are several things a person can do to reduce his or her risk of developing type 2 diabetes including: >Maintain a healthy weight. Exercise regularly and eat a healthydiet. Physical activity and a healthy diet can greatly reduce therisk of developing type 2 diabetes in people who are overweight. >Avoid tobacco products. >Reduce the amount of stress in your life. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4 SECTION 4 SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Name the term for “a hormone that causes cells to remove glucose from the bloodstream.” 2.Define the term diabetes. 3.Define the term diabetic coma. Understanding Key Ideas 4.Describe the role of insulin in the body. 5.Compare type 1 and type 2 diabetes. 6.Identify when a person may develop gestational diabetes. a.as a child c.after age 65 b.as a teen d.during pregnancy7.Name three risk factors for developing type 2 diabetes. 8.Listthree symptoms that help a person detect type 1 and type 2 diabetes. 9.Identify which of the following is nota treatment for diabetes. a.urinalysis c.healthy diet b.insulin injections d.regular exercise 10.Describe why it is important for a person who has diabetes to eat a healthy diet. Critical Thinking 11.Why do you think type 2 diabetes is more com- mon in the United States than in other countries? Staying active through regular exercise can help reduce your risk of developingtype 2 diabetes. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 14 Highlights 359 CHAP TER 14 CHAP TER 14 CHAPTER 14Highlights Key Terms The Big Picture ✔Lifestyle diseases are caused partly by a person’s lifestyle, which includes habits and behaviors. ✔Many risk factors, some controllable and some uncontrollable,contribute to a person’s chances of developing a lifestyle disease. ✔Diet, physical activity, smoking, sun exposure, and body weightare controllable risk factors. Age, gender, ethnicity, and genes areuncontrollable factors. ✔People who inherit a tendency for a lifestyle disease can still do alot to reduce their chances of developing such a disease.SECTION 1 lifestyle disease (340) ✔A person’s lifestyle influences their chances of developing cardio-vascular diseases such as strokes, high blood pressure, heartattacks, and atherosclerosis. ✔Doctors use many different methods, such as EKG, ultrasound,and angiography, to diagnose cardiovascular diseases. ✔There are many treatment options for cardiovascular diseasesincluding a healthy diet, exercise, medicine, and surgery. ✔Eating sensibly, avoiding cigarettes, exercising, and having yourblood pressure and cholesterol checked regularly can help preventcardiovascular diseases. SECTION 2 cardiovasculardisease (CVD) (343) stroke (344) blood pressure(344) heart attack (345) atherosclerosis (345) ✔Cancer occurs when cells divide uncontrollably. Certain “damaged” genes can make a person more likely to develop cancer. Exposureto viruses, radioactivity, ultraviolet radiation, and tobacco can damage genes. ✔There are many types of cancer. Each type has its own characteristics. ✔Early detection and treatment of cancer can increase a person’schances of survival. ✔Not smoking, protecting your skin from the sun, following a bal-anced diet, staying active, and getting regular medical checkupshelp reduce your chances of developing cancer.SECTION 3 cancer (349) malignant tumor (349) benign tumor (349) chemotherapy (352) ✔Diabetes occurs when cells are unable to obtain glucose from theblood such that high blood-glucose levels result. ✔Type 1 diabetes is believed to be caused by an autoimmuneresponse. Type 2 diabetes is usually the result of lifestyle choices. ✔Although there is no cure for diabetes, lifestyle changes andmedicines can often keep the disorder under control. ✔The best way to prevent diabetes is to take control of the riskfactors that you can change, such as diet, exercise, and weight.SECTION 4 insulin (355) diabetes (355) diabetic coma (355) Copyright © by Holt, Rinehart and Winston. All rights reserved. 360 CHAPTER 14 Review CHAP TER 14 CHAP TER 14 CHAPTER 14Review Using Key Terms atherosclerosis (345) diabetes (355) benign tumor (349) diabetic coma (355) blood pressure (344) heart attack (345) cancer (349) insulin (355) cardiovascular disease lifestyle disease (340) (CVD) (343) malignant tumor (349) chemotherapy (352) stroke (344) 1.For each definition below, choose the key term that best matches the definition. a.a disease caused by uncontrolled cell growth b.the force that blood exerts against the insidewalls of a blood vessel c.an abnormal, but usually harmless cell mass d.a hormone that causes cells to remove glucosefrom the bloodstream e.the damage and loss of function of an area ofthe heart muscle 2.Explain the relationship between the key terms ineach of the following pairs. a.malignant tumor and benign tumor b.insulin and diabetic coma Understanding Key Ideas Section 1 3.Explain why infectious diseases have become lesscommon and why lifestyle diseases are the mostcommon causes of death. 4.____ are uncontrollable risk factors for lifestylediseases. a.Tobacco use, gender, and age b.Genes, age, and gender c.Age, exercise level, and family history of disease d.Gender, exercise level, and tobacco use 5.To help prevent the development of a lifestyledisease, a person should a.not smoke. c.have a low-fat diet. b.exercise. d.All of the above 6.What two steps could you take during school tolower your risk of developing a lifestyle disease? LIFE LIFE SKILLSection 2 7.How can lifestyle contribute to cardiovascular disease? 8.Which of the following is nota type of cardiovas- cular disease? a.stroke c.cancer b.atherosclerosis d.high blood pressure 9.Which of the following is nota treatment for cardiovascular disease? a.angioplasty c.heart transplant b.bypass surgery d.echocardiography 10.How can regular exercise reduce your chances ofdeveloping cardiovascular disease? 11.CRITICAL THINKING Smoking decreases the amount of oxygen that the blood can carry. Howcan this effect increase the chances that a smokerwill develop cardiovascular disease? Section 3 12.Describe what cancer is and why it is sodangerous. 13.Refer to Table 1 on p. 351.What is the main cause of the type of cancer that results in the most deaths each year? 14.____ is nota method of detecting cancer. a.Prostate specific antigen testing b.MRI c.Regular self-examination d.Chemotherapy 15.Identify three cancer treatments used today. 16.What are two ways that a person can safeguardtheir skin from ultraviolet radiation? Section 4 17.What is the relationship between insulin and glucose in diabetes? 18.What are the major differences between type 1and type 2 diabetes? 19.What are two ways to detect and two ways to treattype 1 and type 2 diabetes? 20.List two steps you can take to lower your risk ofdeveloping type 2 diabetes. LIFE LIFE SKILLLIFE LIFE SKILL READING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 14 Review 361Interpreting Graphics Study the figure below to answer the questions that follow. 21.How many people were diagnosed with diabetes in 1978? 22.What is the difference in the numberof people diagnosed with diabetes in1988 and the number diagnosed in 1998? 23.CRITICAL THINKING Why do you think diabetes has become more common since 1958?Activities 24. Health and You Make a list of the uncontrollable risk factors for lifestlye diseases. Create a posterthat explains how a person can reduce the healthrisks posed by uncontrollable risk factors. 25. Health and Your Community Research one of the cancers listed in Table 1. Prepare an informational handout that describeshow to detect, treat, and prevent the cancer. 26. Health and You Research a new approach to treating cancer. Write a one page paper that describes what the approach is,how it works, and when it is expected to be available to cancer patients. Action Plan 27. Assessing Your Health Establishing healthy patterns of living during adolescencereduces the risks of developing a lifestyle disease.Discuss two risk factors over which you have control. How can you reduce or eliminate theserisk factors? LIFE LIFE SKILL 28.In this passage, the word constitute means Apropose. Bmake up. Cfollow. Dconcern. 29.What can you infer from reading this passage? EThere are more deaths due to heart disease in the United States thanthere are anywhere else in the world. FThe number of deaths due to heart disease has not changed since 1985. GChanges in lifestyle risk factors have decreased the number of deaths due to heartdisease. HNothing can be done to prevent deaths from heart disease. 30.Write a paragraph describing how changes inlifestyle could reduce the number of deaths due toheart disease in the United States.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Heart disease is the leading cause of death in the United States. Heart disease causesover 900,000 deaths per year. These deathsconstitute 40 percent of all deaths in the United States. Twenty-five percent ofdeaths due to heart disease occur in peo-ple under the age of 65. Death rates for the10-year period ending in 1985 were 30 per-cent less than they were for the previous10-year period. This decline in mortality isrelated to improvements in heart diseaserisk factor levels, as well as in diagnosisand treatment.WRITING SKILL WRITING SKILL MATH SKILL 10 8 6420 1958Number of people (in millions) 1968 1978 1988 1998 YearPersons with Diabetes in the U.S. Source: National Institutes of Health and Centers for Disease Control and Prevention. Copyright © by Holt, Rinehart and Winston. All rights reserved. 362Making Sense of Genetic Technology In 2001, scientists published a complete list of all human genes. Genes are the set of instructionsfound in every person’s body that describe how thatperson’s body will look, grow, and function. Manyscientists have now turned their attention to figuringout what each gene does. The application of ourknowledge about genes to help meet human needsis known as genetic technology. Our Growing Knowledge of Human Genetics Scientists are asking how our genes determine thekind of blood that we have, the way that our skin cellswork, or the color of our eyes. In addition, otherresearchers are working hard to apply this new knowl-edge to detect and cure genetic disorders. There aremany kinds of genetic disorders. Down syndrome,sickle cell anemia, hemophilia, cystic fibrosis, andmuscular dystrophy are only a few well-known ones.In fact, more than 4,000 different human disordersare caused by errors in our genes. Someone you knowmight have cancer that has a genetic basis. In yourlifetime, cures for cancers are likely to arise fromtoday’s research in genetic technology. In addition to studying genetic disorders, scientists are using techniques in genetic technology in otherways. For example, scientists in pharmaceutical companies use genetic technology with bacteria toproduce medicines that help humans. Doctors treatdwarfism by using human growth hormones madewith the new genetic technology. Drug companiesare manufacturing new vaccines, by using moderntechniques. In fact, so much genetic work is beingdone that understanding these new developmentscan seem overwhelming.Every day, the newspapers are full of new discoveries in genetics, the science ofheredity. How could the latest develop-ments in genetics affect your health or thehealth of a family member? TECHNOLOGY HealthHealthWorldWorldHealthHealthWorldWorldHealthWorld YOURYOUR Copyright © by Holt, Rinehart and Winston. All rights reserved. Genetics and Technology Let’s look at some specific examples of the new genetic technology and see how it is affecting theworld around us. > Transplanted Genes It is possible to take a cer- tain gene from one kind of organism, such as a human, and place it into another organism, suchas a bacterium. This idea may seem strange, butthe results can be remarkable. For example, a sci-entist can take the human gene that makes thehormone insulin out of a human cell and placeit in a bacterial cell. Millions of these bacterialcells can then make pure human insulin. Many very pure substances can be made in this way. The transfer of genes from one organism toanother for medical or industrial use is calledgenetic engineering. Today genetic engineering is used to change the nature of many of ourdomestic plants and animals. > Genetic fingerprinting Scientists are now able to take a sample of genetic material from a personand develop a “fingerprint” of that person’sgenetic makeup. The genetic material is first broken up into smaller fragments. These fragments are then placed into a gelatinous substance, and under the influence of an electriccurrent, the pieces of genetic material are separated from one another. The way in whichthey separate is unique to each person. Theresult is a “fingerprint.” Genetic fingerprintingcan be used to research family trees, or to identify an adult who carries a gene that causes agenetic disorder. It can also be used as legal evidence in criminal trials. Understanding a New Technology As you get older, scientists will make more and more discoveries in genetics. These discoveries are likely tochange the way you live. Genetic disorders, such asTays-Sachs, sickle cell anemia, and thousands ofother diseases, may be a thing of the past. The possi-bility of real change is awesome. For example, willyou be able to ensure that your children have certaintraits? Will you or your children be able to eliminategenetic diseases? Genetics is the most powerful andexciting science to affect our lives, and its effects willbe more profound as the years go by. How do youmake sense of so many important discoveries? Hereare some suggestions: > Read the latest news about science in newspa- pers, in magazines, and on the Internet. The most important discoveries will be presented here for everyone to read and understand. However, be skeptical of what you read. So manyexciting discoveries are being made that it is onlynatural that writers and reporters will sometimesexaggerate. Use your common sense. Get infor-mation from more than one source. > Use your research skills to look up information that you don’t understand. Books and reputable Internet sites are sources you can rely on to learn more about genetic technology. YOUR TURN 1. Summarizing Information Why should all citizens become informed about genetic technology and modern genetic research? 2. Inferring Conclusions In what ways has modern medical and genetic technologyimproved our lives since the days of yourgrandmother and grandfather? 3. CRITICAL THINKING Do you think that people should be allowed to choose thetraits of their children by changing their children’s genes? How would you go aboutfinding the information to make your pointin a discussion? www.scilinks.org/health Topic: Genome HealthLinks code: HH4363 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTERCHAPTER 1515 CHAPTERHAPTER 1515 CHAPTER 15 OtherOther Diseases andDiseases and DisabilitiesDisabilitiesOtherOther Diseases andDiseases and DisabilitiesDisabilitiesOther Diseases and Disabilities 364KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.A person’s chances of developing a hereditary disease are determined only by his or her genes. 2.The Human Genome Project has allowedscientists to develop new treatments forhereditary diseases. 3.Autoimmune diseases are caused by virusesthat attack

the immune system. 4.Allergies, asthma, and arthritis are all examplesof autoimmune disorders. 5.The most common cause of disabilities involvingmovement is injury to the nervous system. Copyright © by Holt, Rinehart and Winston. All rights reserved. 365SECTION 1 Understanding HereditaryDiseases SECTION 2 UnderstandingImmune Disordersand AutoimmuneDiseases SECTION 3 UnderstandingDisabilities go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH15. Copyright © by Holt, Rinehart and Winston. All rights reserved. 366 CHAPTER 15 Other Diseases and DisabilitiesJulia has been lucky—she has had only a few colds, the flu, and chickenpox during her 16 years of life. Others in her family havehad more serious diseases, such as diabetes and cancer. Julia is curious about whether she has inherited some of these diseases. What Are Her editary Diseases? Unlike infectious diseases, hereditary diseases aren’t caused by patho-gens. Instead, are diseases caused by abnormalchromosomes or by defective genes inherited from one or both parents. Genes are segments of DNA located on a chromosome that code for a specific hereditary trait. Genes are passed from parent to off-spring. The genes that you inherited from your parents determine many of your characteristics. For example, whether you have blue orbrown eyes is determined by your genes. The color of your hair isdetermined by your genes. Together, your genes tell your body how togrow, develop, and function throughout life. Your genes also deter-mine your chances of developing certain diseases—hereditary diseases. Genes and Hereditary Diseases How are genes involved in hereditary diseases? Occasionally, the instructions that a gene is car-rying contain an error. When a gene carries incorrect instructions, thisis called a mutation . Sometimes, a mutation can have a harmful effect on the person. In hereditary diseases, a mutation can cause a disease or increase a person’s chances of getting a disease. Geneshereditary diseasesUnderstanding Hereditary DiseasesSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Identify how genes are involved in hereditary diseases. Compare the three different types of hereditary diseases. Summarize three ways that a person with a genetic disease can cope with the disease. Describe a future medical treatment for hereditary diseases.KEY TERMSKEY TERMS hereditary disease a disease caused by abnor- mal chromosomes or by defective genes inherit- ed by a child from one or both parents gene a segment of DNA located on a chromo- some that codes for a specific hereditary trait and that is passed from parent to offspring genetic counseling the process of informing a person or couple about their genetic makeupHuman Genome Project a research effort to determine the locations of all human genes on the chromosomes and to read the coded instruc-tions in the genes gene therapy a technique that places a healthy copy of a gene into the cells of a person whose copy of the gene is defective Just as hair color and height are deter- mined by the genes that a personreceives from his or her parents, so arecertain diseases. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Understanding Hereditary Diseases 367Types of Hereditary Diseases Hereditary diseases can result from a mutation on one gene, on sev- eral genes, or from changes to an entire chromosome where the genesare found. Thus, hereditary diseases are sometimes classified assingle-gene, complex, or chromosomal diseases. Single-Gene Diseases Single-gene diseases occur when 1 gene out of the 30,000 to 40,000 genes in the body has a harmful muta-tion. The severity of the illness depends on what instructions the genenormally carries. Table 1 summarizes the symptoms and treatments for several single-gene diseases. Huntington’s disease is an example of a disease caused by one defective gene. When people with Huntington’s disease reach the ageof 35 to 40, cells in their brain begin to die. Over time, their move-ments become jerky and uncontrollable, their personality changes,and their mental abilities deteriorate. Huntington’s disease is alwaysfatal. Another example of a single-gene disease is sickle cell anemia . Sickle cell anemia occurs when the body makes a faulty version ofhemoglobin , the protein that carries oxygen to your cells. Hemoglobin is found in red blood cells. As shown in Figure 1, the red blood cells of someone with sickle cell anemia have an abnormal shape. Thesecells tend to clog up small blood vessels, cutting off blood flow tosome tissues. Disease Huntington’s disease Sickle cell anemia Hemophilia Cystic fibrosisDescription >inherited disease that leads to the degenera-tion of brain cells >inherited blood disease inwhich the body producesdefective hemoglobin >inherited blood diseasein which the body pro-duces little of or none ofthe blood proteins neces-sary for clotting >inherited disease of thebody’s mucous glands;primarily affects the res-piratory and digestivesystems of children andyoung adultsSymptoms >involuntary movements, mood swings, depression,irritability, and inability toremember facts >fatigue, paleness, short-ness of breath, pain, infections, and stroke >severe bruising, excessivebleeding after a simple cut,hemorrhaging (internalbleeding), chronic jointdisease, and joint pain >difficulty breathing, cough, accumulation ofmucus in the intestinesand lungs, infections, andweight lossTreatment >no cure; medicines to help control symptoms,such as emotional andmovement problems >no cure; medicine to treatpain; blood transfusions >no cure; blood transfu-sions; blood-clotting proteins >no cure; medicines totreat symptoms, such asdifficulty breathing andinfections Table 1 Single-Gene DiseasesNormal red blood cells have a circular, biconcave shape. In sickle cell anemia,the red blood cells have an abnormal,sickle shape, making it difficult for thecells to carry oxygen to the body.1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 368 A genetic counselor can help potential parents understand the chances ofpassing on a hereditary disease to theirchild. Genetic counselors often exam-ine each parent’s chromosomes.2 Figure For more information about diabetes, see Chapter 14. linkTOPICTOPICSickle cell anemia is the most common genetic disease among African Americans. This disease affects about 1 in 500 African Ameri- cans. Although sickle cell anemia isn’t curable, with medical carepeople who have the disease usually live into their 50s. Cystic fibrosis is another single-gene disease. It affects nearly 30,000 people in the United States. Cystic fibrosis causes largeamounts of thick mucus to clog the lungs, the pancreas, and the liver.This buildup of mucus leads to malnutrition, breathing difficulties,and infections that can damage the lungs. Although there is currentlyno cure for cystic fibrosis, scientists are developing new treatments,such as gene therapy to help reduce the effects of this disease. Complex Diseases In complex diseases, more than one gene influences the onset of the disease. Lifestyle behaviors also contributeto a person’s chance of developing a complex disease. Cardiovasculardiseases (strokes, heart attacks, high blood pressure, and atherosclero-sis), type 2 diabetes, and cancer are examples of complex diseases.Many genes influence whether you get these diseases. Is there anything you can do about complex diseases? Yes! Because you have control over your lifestyle, you can help lower your risk ofdeveloping a complex disease by making healthy lifestyle choices. Eat-ing healthy foods and exercising regularly are two good ways to reduceyour chances of developing a complex disease. Chromosomal Diseases Genes are located on chromosomes. Humans normally have 23 pairs of chromosomes inside each of theircells (except for sperm and egg cells). Sometimes, a disease can occurwhen a person inherits the wrong number of chromosomes or whenone of the chromosomes is incomplete. Because each chromosome car-ries a large number of genes, chromosomal diseases are usually fatal. The most common chromosomal disease in the United States is Down syndrome . Down syndrome, also called Trisomy 21, occurs when a person inherits an extra copy of the 21st chromosome. Peoplewho suffer from Down syndrome often have varying degrees of men-tal retardation and difficulties with physical development. Down syn-drome is typically not fatal. Coping with Hereditary Diseases Coping with a hereditary disease can be difficult. There are severalthings you can do if you or someone in your family has a hereditarydisease. 1. Genetic counseling A genetic counselor is a specialist in human genetics. is the process of informing a personor couple about their genetic makeup. As shown in Figure 2, the genetic counselor can study a family’s chromosomes and medicalhistory and explain the risks of passing on a hereditary disease toa child. Genetic counselors also provide information to help peo-ple accept a diagnosis and cope with a genetic disease.Genetic counseling Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Understanding Hereditary Diseases 3692. Personal health records Most of us can’t remember all the details of our medical history, but this information is important for our doctors. You should keep yourrecords up to date. Get copies of your health records ifyou change doctors. It’s also important to know what illnesses your rel- atives have experienced. Try to collect information onwhat hereditary diseases your relatives had, when thesediseases appeared, and what your deceased relativesdied from. 3. Health information Read the latest information about the hereditary disease. This will help you know what toexpect and how to help a person with a specific heredi-tary disease. Knowing about the hereditary disease is agood first step in helping yourself or another personcope. Future Medical Treatment for Hereditary Diseases We know a lot more about human genes than we did in the past. This information is currently being used in treat-ing hereditary diseases and developing treatments for thefuture. Human Genome Project Scientists are trying to learn what all of our genes do and how they affect the development of diseases likecancer, heart disease, and diabetes. One major advancement in thisresearch was the completion of the Human Genome Project. The was a research effort to determine the loca- tions of all human genes on the chromosomes and to read the codedinstructions in the genes. The collection of all of our genes make upour genome . You can think of the genome as an instruction manual for human beings. The project was completed in 2003. With the genetic information gathered from the Human Genome Project, scientists hope to treat hereditary diseases in different w ays, including >designing powerful drugs that target a particular hereditarydisease >making drugs to prevent diseases >improving a technique that places a healthycopy of a gene into the cells of a person whose copy of thegene is defective >creating genetic tests that can tell you which hereditary diseasesyou might develop in your lifetime With the information from genetic tests, you can take steps early in life to head off the disease. For example, for heart dis-eases, these steps may include eating a diet low in saturatedfats, exercising regularly, or controlling your weight. gene therapy,Human Genome Project www.scilinks.org/health Topic: Human Genome Project HealthLinks code: HH4084 Imagine that your friend’s father has just been diag- nosed with Huntington’s disease. There’s a 50percent chance that your friend has the defec-tive gene too. She can know for sure by getting agenetic test that requires only a sample of blood.The problem is that there is no treatment orcure for Huntington’s disease. However, even ifshe does have the faulty gene, she may not startto get sick for 10 years or even longer. Shouldshe get tested? Write on a separate piece of paper the advice you would give your friend. Remember to use thedecision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. 370 CHAPTER 15 Other Diseases and DisabilitiesGene Therapy Scientists are improving their ability to treat hered- itary diseases by gene therapy. They are inserting working genes to cancel the effects of defective genes. Getting a gene into the body andmaking it work has been very difficult, but some diseases have beentreated in this way. In the future, scientists hope to use gene therapyto insert missing genes or to replace the faulty genes that cause cysticfibrosis, sickle cell anemia, and other hereditary diseases. Concerns About Genetic Information Our growing knowl- edge of human genes raises concerns about how the information willbe used. Some people worry that insurance companies might dis-criminate against people based on results of genetic tests. This iscalled genetic discrimination . Another worry is that genetic techniques might be abused to change characteristics such as eye color, height, orintelligence. In the next few years, society will be trying to decidewhat kinds of genetic changes are acceptable. The issue of geneticinformation may raise some troubling questions, but this new infor-mation is expected to help save many lives. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term hereditary disease . 2.Compare the terms gene and gene therapy . 3.Define the term Human Genome Project. Understanding Key Ideas 4.Summarize how genes are involved in hereditary diseases. 5.Classify each of the following as a single-gene dis- ease or a complex disease. a.hemophilia c.cystic fibrosis b.diabetes d.cancer6.Compare three types of hereditary diseases. 7.State three ways that people can cope with a genetic disease. 8.Identify two ways information from the Human Genome Project may help treat hereditary dis- eases in the future. Critical Thinking 9.What are two ways that society could deal withfuture concerns about genetic information? 10.Imagine you are a scientist working on the HumanGenome Project. What would you say to newsreporters about your research? LIFE LIFE SKILLDNA molecules like this one are what make up our genes, the coded instruc-tions for building our bodies. Positive Uses of Genetic Information >improved diagnosis of disease >gene therapies >vaccines incorporated into foods >customized drugs for specific diseases >improved ability to predict genetic diseases >help in studying our past Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Understanding Immune and Autoimmune Disorders 371 Understanding Immune Disorders and Autoimmune DiseasesSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Imagine that your body begins to destroy its own cells. Even though this idea sounds far fetched, many common diseasesoccur when the immune system does just this. What Are Immune Disorders and Autoimmune Diseases? Your immune system is made up of special cells that protect your body from disease. These cells are constantly patrolling your blood and tis-sues. When an immune system cell does not recognize an object as partof the body, it attacks the foreign particle. Your immune system guardsyou from viruses, bacteria, foreign substances, and cancer cells. Immune Disorders If the immune system does not function prop- erly, the result is an immune disorder. Some immune disorders are rel-atively mild; others can be life threatening. Examples of immunedisorders include allergies, asthma, human immunodeficiency virus(HIV), and severe combined immunodeficiency disease (SCID). Autoimmune Diseases In people with the immune system attacks the cells of the body that the immune systemnormally protects. Depending on the cells that are destroyed, theseattacks can result in many conditions. For example, rheumatoid arthri-tis is caused when the immune system attacks the joints. In multiplesclerosis, the immune system attacks myelin, the fatty insulation ofnerves in the brain and spinal cord. autoimmune diseases,OBJECTIVES Compare immune disorders and autoimmune diseases. Describe two types of immune disorders. Describe two types of autoimmune diseases. Summarize how people can cope with immune disorders and autoimmune diseases.KEY TERMSKEY TERMS autoimmune disease a disease in which the immune system attacks the cells of the body that the immune system normally protects allergy a reaction by the body’s immune system to a harmless substanceasthma a disorder that causes the airways that carry air into the lungs to become narrow and to become clogged with mucus arthritis inflammation of the joints multiple sclerosis (MS) an autoimmune disease in which the body mistakenly attacks myelin, the fatty insulation on nerves in the brain andspinal cord Preventive medications are one way that many people are able to controlimmune disorders such as asthma. Copyright © by Holt, Rinehart and Winston. All rights reserved. 372 CHAPTER 15 Other Diseases and DisabilitiesTypes of Immune Disorders When immune system cells encounter a foreign particle, they send out chemical signals that cause the body to react. Usually, this reac-tion helps the immune system fight disease. Sometimes, however, thereaction causes more problems than the foreign particle would. Allergies An is a reaction by the body’s immune system to a harmless substance. A long list of things, including foods, dust,plant pollen, and animals, can cause allergic reactions. Do yousneeze when a cat comes around? Do your eyes itch and water whenyou go outside on a spring day? If so, you may have an allergy. When inhaled substances, such as the pollen grains shown in Figure 3, cause an allergic attack, a person may experience a runny nose, sneezing, and itchy, watery eyes. Allergies to foods or certain drugs cansometimes cause hives, itchy swellings on the skin. Most allergies are a nuisance. But some people have extreme and life-threatening reactionsto allergies. Their blood pressure falls, and the tubes carrying air intothe lungs constrict, making it difficult to breathe. One way to prevent allergic symptoms is to avoid things that cause a reaction. Some ways you can help reduce allergic symptoms include >avoiding substances that you are allergic to >washing sheets and blankets weekly >cleaning bathrooms and kitchens to avoid molds Avoiding allergenic substances is not always possible. Some peo- ple use over-the-counter drugs called antihistamines . Antihistamines work to suppress the symptoms of an allergy. A doctor can also pre-scribe a series of injections containing gradually larger doses of thesubstance to which the person is allergic. Over the course of 2 or 3years, the person’s sensitivity to the substance declines. Asthma is a disorder that causes the airways that carry air into the lungs to become narrow and to become clogged with mucus.This causes shortness of breath, wheezing, and coughing. The air-ways, called bronchioles , are shown in Figure 4. The bronchioles are covered with rings of muscle that adjust the width of the tubes. Thisallows your lungs to take in more or less air. For example, the widthof the airways increase when you excercise. Occasionally, the muscles covering the airways overreact to sub- stances in the air, causing the airways to narrow. These airways can betoo sensitive and tighten in response to things like dust, cigarettesmoke, stress, exercise, foods, and pollution. The result is an asthmaattack. During an asthma attack, the lining of these air passages mayalso swell and become inflamed, making breathing difficult. When the tubes narrow, drawing a breath is very hard. Asthmatics often explain that breathing during an asthma attack is like trying tobreathe through a straw. Other symptoms of asthma are coughing,wheezing, and chest tightness. Asthma attacks are very serious. Someattacks can even be life threatening. More than 5,000 people die fromasthma each year.Asthmaallergy Sinuses are hollow areas in the skull that open into the nasal cavity. Whenallergens, such as pollen grains, enterthe sinuses, they can trigger an allergicreaction.3 Figure Sinuses Pollen grains Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Understanding Immune and Autoimmune Disorders 373People can often prevent asthma attacks by avoiding the sub- stances that irritate their lungs. Two kinds of drugs are also available to relieve asthma symptoms. Long-term control drugs are taken everyday to soothe the airw ays. It is important that people with asthma take these drugs every day. For emergencies, asthmatics also havequick-relief drugs that, when inhaled, open the airw ays. These treat- ments have made it easier for people with asthma to lead normal,active lives. Moderate exercise can also strengthen the lungs of peoplewho suffer from asthma. Types of Autoimmune Diseases When a person’s immune system attacks the cells of the body it ismeant to protect, the person has an autoimmune disease. There maybe several factors that start the immune attack. An infection causedby pathogens with molecules similar to the body’s own cells maycause the immune system to attack the cells in the body. If an infec-tion enters a body tissue that is usually not patrolled by immunecells, the tissue may be attacked as well. Arthritis Your joints move smoothly because the ends of the bones are covered with a smooth layer of cartilage that allows the bones toglide across one another. When this layer of cartilage is damaged,moving the bones and joints becomes difficult and painful. The resultis or inflammation of the joints. Arthritis is one of the mostcommon joint diseases in the United States. There are two main kindsof arthritis: rheumatoid arthritis and osteoarthritis. The disease known as rheumatoid arthritis is an autoimmune dis- ease. For unknown reasons, the immune system begins to destroy thelining of the joints. The joints swell, become painful, and maybecome stiff or unable to move. This stiffness may be worse in themorning, just after waking, or after being inactive. Eventually, thebones of the joints may begin to deteriorate. arthritis,An asthma attack occurs when the muscles that encircle the airways of thelung (bronchioles) constrict, making itdifficult to breathe. ACTIVITY Why do you think there are so many cases of asthma in 5- to 7-year- olds?4 Figure Muscles around bronchioles tighten Bronchioleswells Extra mucus linesthe airway Normal airway Asthma Cases by Age 8.6% 27.2% 36%19.4%8.7% Less than 5 years old 5–17 years old18–44 years old 65 or older45–64 years old Source: American Lung Association.Airway under asthma attack Muscles around bronchioles Bronchiole Mucus liningthe airway Alveoli Copyright © by Holt, Rinehart and Winston. All rights reserved. 374 CHAPTER 15 Other Diseases and DisabilitiesOsteoarthritis is different from rheumatoid arthritis in that it is not an autoimmune disease. Instead, with osteoarthritis, the joints of the skeleton begin to wear out as a person grows older. This is similar tothe way that a hinge on a car door will wear out if it is opened andclosed enough times. The cartilage inside a joint begins to deteriorate,and movement, or even changes in the weather, can cause intensepain. The joint can swell, distort, or even develop bony knobs. A plan that mixes medications, rest, and gentle exercise can help treat moderate forms of rheumatoid arthritis and osteoarthritis.Severe damage to a vital joint, such as the hip or knee, however, mayrequire surgery to install a replacement joint made from plastic,metal, or porcelain. Drugs are also being developed to help reduceinflammation of the joints and to slow or stop joint damage. Multiple Sclerosis Just like the power lines that carry electricity to your home, the nerves that carry impulses through the body arecovered by a layer of insulation that speeds up nerve signals. Theautoimmune disease known as occurs whenthe body attacks myelin, the fatty insulation on nerves in the brainand spinal cord. This damage causes the transmission of nerveimpulses to slow down or stop. Multiple sclerosis is twice as common in women as in men and usually strikes young adults. It can be hard to diagnose. Symptomsinclude blurred vision, tingling or burning sensations, weakness,numbness, mental problems, unsteadiness, slurred speech, or loss ofbladder control. The symptoms of multiple sclerosis usually comeand go. Months and sometimes years may pass between episodes.However, the disease usually gets worse over time and may eventuallyinterfere with vision, balance, and walking. Patients may eventuallybecome paralyzed. In some cases, the disease can be fatal. multiple sclerosis (MS) Many people with arthritis continue to lead active lives. Gentle exercise canhelp relieve some of the pain associatedwith damaged joints (as shown in the X ray at right) caused by arthritis. www.scilinks.org/health Topic: Multiple Sclerosis HealthLinks code: HH4102 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Understanding Immune and Autoimmune Disorders 375Although there is currently no cure for multiple sclerosis, many drugs and treatments can ease the symptoms and slow the deterioration of the nerves. Drugs such as steroids can reduce the length and severityof attacks. New drugs are currently being developed. Coping with Immune Disorders and Autoimmune Diseases Understanding immune disorders and autoimmune diseases can help you treat people with these types of diseases with compassionand respect. If you are diagnosed with an immune or autoimmunedisease, be sure to do the following: >Understand your disorder and your doctor’s treatment plan. Ask questions, especially about the changes and symptoms you canexpect to encounter. Learn about the side effects of medicationsand medical tests. Be aware of all

aspects of your condition. >Follow the treatment plan designed by your physician. Play an active role in determining your treatment plan. Do not beafraid to get a second or third opinion. Once you and yourfamily are satisfied that the treatment is right for you, follow it. >Let your doctor know if a new symptom is occurring. New symptoms can signal important changes in your disorder. It isvery important to discuss any changes in your condition withyour doctor. This is the only way to find out what the changemight mean and how it might be treated. >Be honest with your doctor. You hurt only yourself if you are not honest with your physician. A doctor cannot give yougood advice without accurate information. Your health is tooimportant to leave anything out. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term autoimmune disease . 2.Compare allergy and asthma . 3.Identify the term for “inflammation of the joints.” Understanding Key Ideas 4.Differentiate between immune disorders and autoimmune diseases. 5.Describe two different types of immune disorders. 6.Summarize how common substances can trigger allergic reactions.7.Compare the causes of rheumatoid arthritis and multiple sclerosis. 8.Identify the disease in which the body mistakenly attacks the fatty insulation on nerves in the brain and spinal cord. a.allergies c.arthritis b.asthma d.multiple sclerosis 9.State three ways that a person can better manage his or her autoimmune disease. Critical Thinking 10.Identify how people with allergies or asthma canreduce the allergens in their homes. People with multiple sclerosis, such as Sharon Jodoin, can enjoy physicalactivities. Being active helps maintaintheir health. Copyright © by Holt, Rinehart and Winston. All rights reserved. 376 CHAPTER 15 Other Diseases and DisabilitiesUnderstanding DisabilitiesSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 In the past, people with disabilities were often discriminated against. They were believed to be unable to hold jobs or partici-pate in other activities. Today, however, attitudes in society are changing as many people with disabilities are succeeding in all areasof life, despite their disabilities. What Are Disabilities? are physical or mental impairments or defi- ciencies that interfere with a person’s normal activity.Disabilities can take many forms, including forms thatinvolve vision, hearing, and movement. Myths About Disabilities Over the years, there have been many myths about people who have disabili-ties. For example, one myth is that people with disabilitiesprefer to be around only other people with disabilities.Another common myth is that people with disabilitiesalways need help. In reality, many people with disabilitieslive independantly and are part of mainstream society. Actors living with disabilities, such as Christopher Reeve and Michael J. Fox, help obtain funding forresearch to treat disabilities and bring special concernsto the attention of lawmakers and the public. Peoplewith disabilities also work as congressmen, artists,lawyers, doctors, and in many other careers. Limitscaused by disabilities do not limit a person’s ability toachieve their goals. Educating others about the different types of dis- abilities is an effective way to help eliminate suchmyths and to build a positive atmosphere for all mem-bers of society.DisabilitiesOBJECTIVES Listthree myths about disabilities. Describe three different types of disabilities. Identify two ways people cope with disabilities. Identify one way that you can help create a positive environment for people with disabilities. LIFE LIFE SKILLKEY TERMSKEY TERMS disability a physical or mental impairment or deficiency that interferes with a person’s normal activity tinnitus a buzzing, ringing, or whistling sound in one or both ears that occurs even when no sound is present Americans with Disabilities Act (ADA) wide-ranging legislation intended to makeAmerican society more accessible to people who have disabilities People in many different careers, such as artist Chuck Close, have been ableto excel despite their disabilities.Chuck Close was partially paralyzed bya blood clot in his spinal cord. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Understanding Disabilities 377Types of Disabilities Disabilities are typically classified according to the body function that is affected by the disability. For example, disabilities involvingvision include all disabilities that affect a person’s ability to see.Although there are a variety of disabilities, the severity of the disabili-ties in each category can range from moderate to severe. Moderatedisabilities may only slightly affect a person’s ability to do everydayactivities. Severe disabilities can sometimes require that a personhave constant medical attention. Disabilities Involving Vision When people think of disabilities involving vision, they usually think of people who are completelyblind. Although there are about 1.3 million Americans who arelegally blind, there are nearly 10 million Americans with impairedvision. Thus, there are many people in the United States with disabil-ities involving vision who are not completely blind. Accidents, diabetes, glaucoma, and macular degeneration account for most blindness in the United States. For example, in a condition real life Activity LIFE LIFE SKILL Coping UNDERSTANDING DISABILITIES ✔bandana 1.Choose two paths through the classroom. Make sure that the paths do not cross. 2.Form teams, with two people in each team. 3.Choose one team member to be blindfolded and one teammember to be his or her guide. 4.Tiethe bandana so that it com- pletely covers the eyes of the “blind” team member so thathe or she cannot see.ProcedureMaterialseasier for a person with a vision disability to move around? 4.CRITICAL THINKINGOther than moving around,what other daily activities mightpose a problem for people whoare blind?5.Line up, two teams at a time, at the beginning of each path. 6.Guide the blindfolded person through the path. 7.Switch roles, and repeat the activity. 1.Summarizing Results What did it feel like to walk throughthe classroom without anysense of sight? 2.Summarizing Results What challenges did you face when leading the person who wasblindfolded? 3.Predicting Outcomes What changes could you make inyour classroom to make it Conclusions Copyright © by Holt, Rinehart and Winston. All rights reserved. 378 CHAPTER 15 Other Diseases and Disabilitiescalled glaucoma , increased pressure inside the eye causes vision impair- ment and eye damage. Damage to an area on the retina of the eye called the macula also leads to vision impairment. Worldwide, how- ever, vitamin A deficiency is the leading cause of blindness. Luckily,many of the causes of visual impairment are controllable. Regularmedical and vision checkups can help your doctor find problems early. Currently, there are many treatment options for people with all levels of visual impairment. Traditionally, people with moderatevision problems have turned to eyeglasses or contact lenses for help.New treatments such as laser eye surgery are giving people moreoptions in vision correction. If you have vision problems that cannot be corrected, here are a few suggestions to help you cope with your disability: >Communicate with your doctor about your condition andwhat to expect in the future. >Educate yourself on your condition and the treatments that arebeing researched for the future. >Find others with a similar disability for support. Disabilities Involving Hearing Nearly 28 million Americans are hard of hearing or deaf. The majority of this group are over 65.The reason for this is that over time, noise contributes to hearing lossby damaging parts of the inner ear. A lifetime of excessive noisebegins to destroy the cells of the inner ear that are involved in hear-ing. Many musicians suffer from severe hearing loss as a result ofyears of exposure to loud music. Exposure to loud noises can also lead to a condition called tinnitus. (ti NIET es) is a buzzing,ringing, or whistling sound in one or both ears that occurs evenwhen no sound is present. Tinnitus 50 million 4,00020%statistically speaking. . . Approximate number of adults in the United States that have tinnitus to some degree: Number of children who are born deaf each year: Percentage of people in industrialized countries who experience tinnitus at some time in their lives:For more information about how to protect your vision and hearing, see the Express Lesson on pp. 574–575 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Motor Disabilities HealthLinks code: HH4100 People with disabilities involving move- ments, such as Tom Mosca, enjoy manydifferent hobbies and pastimes. Hearing loss can also be caused by genetic and environmental factors, medicines, infections, and inherited genes. For example, the most common cause of hearing loss in children is otitis (oh TIETis) media, an infection of the ear. To find out the extent of a person’s hearing impairment, a doctor may complete a general screening test or a more thorough test using adevice called an audiometer ( AWdee AHM uht uhr). Once the problem has been diagnosed, treatment options include the following: >Hearing aids Although hearing aids cannot help with all forms of hearing loss, they can help improve hearing for many peo-ple. Hearing aids work by amplifying sounds through a speaker. >Cochlear implants Cochlear (KAHK lee uhr) implants are small electronic devices that are surgically implanted underthe skin behind the ear. Unlike hearing aids, cochlear implantsdo not restore normal hearing. Instead, they bypass damagedparts of the inner ear and provide direct electrical stimulationto the nerve that sends signals to the brain. The result is a better understanding of the surrounding voices and noises. Disabilities Involving Movement Normally, we have control over the movements of our bodies. We decide when to walk, run, orlie down. Unfortunately, for millions of people these simple acts aredifficult or impossible. Most disabilities involving movement (motordisabilities) are the result of a disorder of or an injury to the nervoussystem. Movement disorders include multiple sclerosis, Parkinson’s dis- ease, Rett syndrome, and Tourette’s syndrome. Although the symp-toms of a movement disorder are usually apparent, diagnosing thecause of the problem can sometimes be difficult. A doctor may uselaboratory tests, imaging techniques, or even surgical procedures todetermine the cause of a movement disorder. Copyright © by Holt, Rinehart and Winston. All rights reserved. 380 CHAPTER 15 Other Diseases and DisabilitiesOne of the most common causes of movement disabilities is spinal cord injury (SCI). About 80 percent of people who suffer SCIs are young men in their late 20s to early 30s. SCI can result in partial orcomplete loss of body movement. Paralysis affecting only the lowerhalf of the body, not including arms, is called paraplegia . Paralysis affecting the upper and lower body is called quadriplegia . In the past, most people did not recover from paralysis due to SCI. New treat-ments make it more likely that a person will regain some movementafter injury. Regular, intense therapy is the key to maximizing poten-tial recovery. Recent research indicates that a cure for paralysis couldbe developed in the near future. Coping with Disabilities Learning to deal with disabilities in a positive way can help make dis-abilities more manageable. Becoming educated about a disability,maintaining a positive outlook, and taking an active role in treatmentare a few ways to make living with a disability more tolerable. No matter how moderate or severe, all disabilities challenge the person affected and those around him or her. In the United States, theAmericans with Disabilities Act has resulted in many positive changesfor people with disabilities. The is wide-ranging legislation intended to make American society moreaccessible to people with disabilities. The ADA has led to an increase inthe number of handicapped parking spaces and wheelchair-accessibleramps to buildings. With new research and changing attitudes, the outlook for people with disabilities has become increasingly positive. To continue thistrend in the future, people with disabilities and those around them willhave to continue to educate each other and work to create a positiveenvironment. Americans with Disabilities Act (ADA) REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term disability . 2.Identify the term for “a buzzing, ringing, or whistling sound in one or both ears that occurs even when no sound is present.” 3.Define the term Americans with Disabilities Act . Understanding Key Ideas 4.Identify three myths about disabilities. 5.Summarize three different types of disabilities. 6.Describe two treatments for people with disabili- ties involving vision. 7.Identify which of the following treatments is used for disabilities involving hearing. a.contact lenses c.cochlear implants b.spinal cord surgery d.none of the above 8.State two examples of disorders that affect movement. 9.Describe two ways that the Americans with Dis- abilities Act helps people cope with disabilities. Critical Thinking 10. Practicing Wellness How can you work to create a positive environment for peoplewith disabilities? LIFE LIFE SKILLLearning how to sign is one way to gain a better understanding of deafness. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 15 Highlights 381 CHAPTERCHAPTER 1515 CHAPTERHAPTER 1515 CHAPTER 15Highlights Key Terms The Big Picture ✔Disabilities are physical or mental impairments or deficiencies that interfere with a person’s normal activities. ✔Accidents, diabetes, glaucoma, and macular degenerationaccount for most blindness in the United States. ✔A lifetime of excessive noise can destroy the sound receptor cellsin the ear, which leads to deafness. ✔New medicines and surgical procedures are helping people withdisabilities involving movement to have more-productive lives. ✔The Americans with Disabilities Act has made American societymore accessible to people with disabilities. ✔Educating people is one way to help create a positive environ-ment for people with disabilities.SECTION 3 disability (376) tinnitus (378) Americans with Disabilities Act (ADA)(380) ✔Hereditary diseases are caused by defective genes inherited by a child from one or both parents. ✔Hereditary diseases can be the result of a single-gene mutation,the mutation of several genes, or chromosome abnormalities. ✔Examples of single-gene diseases include Huntington’s disease,sickle cell anemia, hemophilia, and cystic fibrosis. ✔Diseases that have both genetic and lifestyle risk factors arecalled complex diseases. Cardiovascular disease, cancer, and Type II diabetes are examples of complex diseases. ✔Down syndrome is an example of a chromosomal disease. ✔Receiving genetic counseling and keeping personal health recordscan make coping with hereditary diseases easier. ✔In the future, the Human Genome Project will provide many newtreatments for hereditary diseases.SECTION 1 hereditary disease (366) gene (366) genetic counseling (368) Human Genome Project (369) gene therapy (370) ✔Immune disorders can occur when the immune system does notfunction normally. ✔Autoimmune diseases occur when the immune system attacks the cells of the body it normally protects. ✔Allergies and asthma are immune disorders. Allergies are causedby an immune response to a harmless substance. When a person’sairways narrow and become swolen, the result is an asthma attack. ✔Rheumatoid arthritis and multiple sclerosis are autoimmune dis-eases. Rheumatoid arthritis is caused when the immune systemattacks the joints. Multiple sclerosis is caused by the body attackingmyelin, the fatty insulation on nerves in the brain and spinal cord. ✔Understanding the illness and following a treatment plan are twoways to cope with immune disorders and autoimmune diseases.SECTION2 autoimmune disease (371) allergy (372) asthma (372) arthritis(373) multiple sclerosis (MS)(374) Copyright © by Holt, Rinehart and Winston. All rights reserved. 382 CHAPTER 15 Review CHAPTERCHAPTER 1515 CHAPTERHAPTER 1515 CHAPTER 15Review Understanding Key Terms allergy (372) Americans with Disabilities Act (ADA) (380) arthritis (373) asthma (372) autoimmune disease (371) disability (376) gene (366) gene therapy (370) genetic counseling (368) hereditary disease (366) Human Genome Project (369) multiple sclerosis (MS) (374) tinnitus (378) 1.For each definition below, choose the key term that best matches the definition. a.a buzzing, ringing, or whistling sound in oneor both ears that occurs even when no sound ispresent b.inflammation of the joints c.a technique that places a healthy copy of agene into the cells of a person whose copy ofthe gene is defective d.a reaction by the body’s immune system to aharmless substance e.the process of informing a person or coupleabout their genetic makeup f.a research effort to determine the locations ofall human genes on the chromosomes andread the coded instructions in the genes 2.Explain the relationship between the key terms ineach of the following pairs. a.genes and hereditary disease b.disability and Americans with Disabilities Act c.autoimmune disease and multiple sclerosis Understanding Key Ideas Section 1 3.Describe how genes are involved in hereditarydiseases. 4.A person’s eye color is determined by his or her a.age. c.gender. b.genes. d.All of the above 5.Describe one example of each of the three typesof hereditary diseases. 6.Identify how keeping personal health records canhelp a person cope with hereditary diseases. 7.Describe how gene therapy might help peoplewho have cystic fibrosis. 8.CRITICAL THINKING Explain why couples who are even distantly related might have a greaterchance of having a child with a hereditary disease. Section 2 9.What is the difference between immune disordersand autoimmune diseases? 10.Which of the following is an immune system disorder? a.multiple sclerosis c.allergies b.rheumatoid arthritis d.all of the above 11.Describe two treatments for asthma. 12.Which of the following is an autoimmune disease? a.multiple sclerosis c.osteoarthritis b.flu d.cardiovascular disease 13.What are three symptoms of multiple sclerosis? 14.How can asking questions of their doctors helppeople cope with their autoimmune diseases? Section 3 15.State the reason it is important to know thedifference between myths and truth aboutdisabilities. 16.Describe three ways that people with uncor-rectable vision problems can cope with their dis-ability. 17.State the most common cause of hearing loss inchildren. 18.Compare the two different levels of paralysis. 19.Identify ways that you can help create a positiveenvironment for people living with disabilities. 20.CRITICAL THINKING Why might a misconcep- tion that recovery cannot occur after a spinal cordinjury prevent a person from maximizing his orher potential for recovery? Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 15 Review 383Interpreting Graphics Study the figure below to answer the questions that follow. 21.How many people in the United States had arthritis in 1985? 22.How many more people are expected to have arthritis in 2020 as compared to 1985? 23.CRITICAL THINKING Why do you think the num- ber of people diagnosed with arthritis is expectedto rise so dramatically from 1995 to 2020?Activities 24. Health and Your Family Research the diseases that are common in your family. What hereditarydiseases have been the cause of death for mem-bers of your family? 25. Health and Your Community Research several facilities in your community that are designed tohelp people who have disabilities. Create a posterdetailing the different ways one of these facilitieshelps these people. 26. Health and You Research a new approach to treating hereditary diseases that has come from the Human Genome Project. Write a one-page paper describing the treatment and the way it works. Action Plan 27. Communicating Effectively In the past, myths have led to many mis-conceptions about people with disabilities. Writeone page summarizing how you could help elimi-nate these myths and help people better understanddisabilities.LIFE LIFE SKILL 28.In this passage, the word faulty means Aimportant. Cunnecessary. Bdefective. Dpreferred. 29.What can you infer from reading this passage? EThere are more deaths due to sickle cell anemia in the United States than anywhereelse in the world. FHaving ancestors from Africa increases a person’s chances of developing sickle cell anemia. GResearchers expect a cure for sickle cell anemia very soon. HBlood tests for sickle cell anemia are inaccurate. 30.Write a paragraph describing how early diagnosis of sickle cell anemia could affect a person’s life.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Sickle cell anemia affects millions of people throughout the world. The majority of thesepeople have ancestors who came fromAfrica. In order for people to receive propertreatment for this disease, early diagnosis iscritical. Approximately 40 U.S. states nowperform a blood test to detect faulty ver- sions of hemoglobin on all newborn infants.Hemoglobin is the protein in red blood cellsthat carries oxygen. If a child is found tohave the disease, treatments begin immedi-ately. Although there is currently no cure forsickle cell anemia, treatments can help con-trol the side effects.60 5040302010 0 YearPersons (in millions) Arthritis in the U.S. Population 1985 projected1990 1995 2020 Source: Arthritis Foundation.WRITING SKILL READING SKILL WRITING SKILL WRITING SKILLMATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Copyright © by Holt, Rinehart and Winston. All rights reserved. 385CHAPTER 16 Adolescence and Adulthood CHAPTER 17 Marriage,Parenthood,and Families UNIT 5UNIT 5UNIT 5 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 16 CHAP TER 16 CHAPTER 16 Adolescence and Adultho odAdolescence and Adultho odAdolescence and Adulthood 386KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Breast development is the first sign of puberty in girls. 2.With successful dieting, a girl can avoiddeveloping extra body fat. 3.Only boys experience voice changes duringpuberty. 4.The leading causes of death in young andmiddle adulthood are cancer and heart disease. 5.Most older adults eventually developAlzheimer’s disease. 6.With stimulating activities, mental capacity canbe maintained throughout adulthood. Copyright © by Holt, Rinehart and Winston. All rights reserved. 387SECTION 1 Changes During Adolescence SECTION 2 Adulthood go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH16 . Copyright © by Holt, Rinehart and Winston. All rights reserved. 388 CHAPTER 16 Adolescence and AdulthoodFranco was both excited and nervous about his driving test. He had always looked forward to the day when he would get hisdriver’s license. Now, though, he was beginning to realize all of the responsibilities that come with driving a car. He thought to him-self, Am I ready for this? Physical Changes Franco’s worries about the changes in his life are common to manyteens during adolescence. is the period of time betweenpuberty and full maturation. It is a time of change—changing body,changing emotions, changing mental abilities, and changing sociallife. All these changes can cause teens to feel awkward and unsure ofthemselves. Knowing as much as possible about the changes that aretaking place helps adolescents realize that these changes are normal. The beginning of adolescence is typically marked by the onset of puberty. is the period of human development during whichpeople become able to produce children. Puberty begins when spe-cific hormones are released. are chemical substancesmade and released in one part of the body that cause a change inanother part of the body. The changes typical of puberty start whenthe female and male reproductive organs begin to release hormones.The male hormone is called testosterone. The female hormones are called estrogen and progesterone . Physical Changes in Both Girls and Boys Most girls start puberty between 8 and 14 years of age. Boys usually begin pubertylater, between 10 and 16 years of age. While some changes are com-mon to both girls and boys, many of the changes are unique to eachHormonesPubertyAdolescenceChanges During AdolescenceSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Compare the physical changes that occur in boys and girls during adolescence. Describe the mental and emotional changes that occur during adolescence.Describe the social changes that occur during adolescence. Identify added responsibilities teens have during adolescence. Name three ways that changes during adolescence have affected your life. LIFE LIFE SKILLKEY TERMSKEY TERMS adolescence the period of time between the start of puberty and full maturation puberty the period of human development during which people become able to produce children hormone a chemical substance made and released in one part of the body that causes a change in another part of the body testes the male reproductive structures that make sperm and produce the male hormone testosterone Adolescence brings many changes and responsibilities. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Changes During Adolescence 389sex, as shown in Figure 1 .Some of the changes that both girls and boys can expect to experience include facial acne, growth spurts, and an increase in muscle strength. Also, girls experience voice changes,just as boys do. Physical Changes in Girls Girls experience many changes during puberty, all of which occur at different times for different girls. As girlsreach puberty, they naturally develop more body fat than boys do. Thefat is needed for normal development during puberty. Hormonescause the hip bones to widen and fat to be deposited around the hips.Fat is also used for development of the breasts. Shortly after develop-ment of the breasts, hair begins to appear under the arms and in thepubic area. These changes are typically followed by a

growth spurt. Menarche, or the start of menstruation, begins when estrogen and progesterone levels begin to rise. The average age for menarche is12 years old, although the age range for menarche varies widely. Girlsshould remember that these physical changes are a natural andhealthy part of puberty. Physical Changes in Boys As testosterone levels rise in boys, the first physical change seen is an increase in the size of the testes. The are the male reproductive structures that make sperm and pro- duce the male hormone testosterone. Afterwards, hair begins toappear under the arms and in the pubic and facial areas. At this time,many people notice that the voice deepens. A growth spurt usuallyoccurs toward the end of puberty. Because growth spurts occur earliertestes For more information about skin care, see the Express Lesson on pp. 566–569 of this text.HandbookHEALTH Girls Appearance of hair on underarms andaround genitals Development of the breasts Widening of hips and pelvis Start of menstruation and ovulationBoth Growth spurts Facial acne Change in muscle strength Rise in sex hormones Boys Appearance of hairon face, onunderarms, andaround genitals Deepening of voiceBroadening of shoulders Enlargement of testes and penis Physical Changes of PubertyAs boys and girls go through puberty, they experience many changes. Themost obvious are the physical changes.1 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 390 CHAPTER 16 Adolescence and Adulthoodin puberty for girls than for boys, girls are usually taller than boys during these first years of puberty. Boys develop larger, stronger mus-cles throughout puberty. Because puberty is a time of dramatic change, the body needs special attention during this period. Increases in height and weightmean that the body has greater nutritional needs. Adolescence is agood time to set healthy diet and exercise habits that can be con-tinued throughout adulthood. Mental and Emotional Changes While physical changes during puberty are easily seen, mental andemotional changes may not be as noticeable. Coping with mentaland emotional changes can be difficult because they are felt by theperson but are not visible to others. Mental changes are changes thatoccur in the thinking process. These changes happen because thebrain is still developing. Emotional changes occur as teens learn tocope with all of the changes that occur during adolescence. A New Way of Thinking Intellectually, teens undergo enormous changes. During earlyadolescence, boys and girls process informationin a simple way. Situations are usually seenfrom only one side without considering theother person’s point of view. During the middle adolescent period, teens often believe that nothing bad will ever happento them. For example, teens believe that othersmay get into accidents but that they themselveswill not. They may think this way because thebrain is still maturing. As adolescence progresses, teens can learn to think in a more sophisticated and complexmanner. They are able to understand thatactions taken today can have consequences thefollowing day or in 10 years. They are able toreason more effectively, compare options, andmake logical, mature decisions. They are alsoable to view situations from another person’sperspective. This development helps teensbecome more compassionate toward othersand greatly improves their relationships. A New Way of Feeling Emotional changes may be the toughest part of adolescence. Manynew feelings arise, particularly during adoles-cence. These new feelings come not only fromchanges in thinking but also from differencesin the way teens see themselves. The new feel-ings also come when adolescents are treated Most adolescents feel that their parents don’t understand them. Hang on,because these feelings will pass.2 Figure Teen Says “You just don’t understand! ” “All my friends get tostay out as late as theywant. I’m the only onewho has a curfew! ” “I’m old enough to havea job. Why should I stillhave to do work aroundthe house? ”Parent Says “Of course I understand. I was your age once, too, you know. ” “I’m not their parent— I’m yours. ” “You have to do choresbecause you’re part ofthis family. ” Copyright © by Holt, Rinehart and Winston. All rights reserved. differently by friends and parents. Both boys and girls may find that their feelings get hurt more easily than they did before. Sometimes,these new feelings can cause teens to feel alone, insecure, and con-fused. These feelings are common during adolescence. A New Desire for Independence Anger, loneliness, and even depression can be common during adolescence. Many of these feelingscome from the teen’s desire to become more independent. Frustrationand confusion about how to become independent can sometimesseem overwhelming, as seen in Figure 2. These feelings arise mostly because up to this point teens have been dependent on other people. The process of leaving dependence behind and forming a new identity is complex and sometimes scary. Teens may desire independ-ence but feel dependent. These conflicting emotions exist togetherbecause the processes of leaving some emotions behind and gettingnew ones occur at the same time. Having conflicting emotions ishealthy and normal. If prolonged periods of sadness or anxietybecome too overwhelming, seeking help from a parent, school coun-selor, or doctor is important. LIFE LIFE SKILL ActivityCommunicating Effectively with Your ParentsCommunicating Effectively Conflict with parents can be frustrating, but you can learn to resolve it. Consider the following situation. John was tired when he came home from school.He put off cleaning his room until later. WhenJohn’s mom came home, his room was a mess andhe was watching TV. She started to yell at him.John ran to his room and yelled back, “You nevergive me a chance to get things done.” John’s momcalled him disrespectful and lazy. John felt that hismom just did not understand. Follow these guidelines to help you communicate moreeffectively with your parents and others. Vent frustration and anger in a healthy way. Call a friend, or write about how you feel. Evenwhen you are angry, hurting others, their stuff,or yourself is not an appropriate response. Assess what happened. How were you right or wrong? How were your parents right or wrong? 21Take action to resolve the conflict. Go to your parents, and apologize. Express how you felt during the argument. Listen to your parents’ side, and try to under- stand their point of view. Chances are that theyare right in some way and are frustrated, too. Plan with your parents to avoid conflict in the future. Ask for ways that you can show themthat they can trust you. Communicating Effectively Write down two ways that John could have resolved the conflict with his mother. Then, writedown two ways that John could build trustwith his mother.LIFE LIFE SKILL543For more information about dealing with conflict, see Chapter 3. linkTOPICTOPIC WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 392 CHAPTER 16 Adolescence and AdulthoodDealing with New Feelings Learning how to deal with new, strong feelings is an important part of becoming a mature teenager. Along with these new feelings comes a greater desire to act on them.Controlling these desires is a serious challenge during adolescence.For example, when we are mad, we may want to express our anger byyelling. Feeling anger can be healthy, but yelling because one is angryis immature. Emotional maturity means learning to handle thosestrong feelings in an emotionally healthy way. Controlling Your Emotions Sometimes mental, emotional, or sexual emotions during adolescence can feel so strong that someteens believe that they do not have control over what they do. Thisbelief is not true. Teens are very capable of learning to feel intenseemotions and not act on them. Successfully separating feelings frombehaviors makes a teen truly more mature and independent. Social Changes What is most important in our lives is not necessarily how manyclothes we own or how much money we have in the bank. Our rela-tionships with people are what matter most. Social changes refer tothose changes that occur within the relationships in a teen’s life.These relationships may be intimate ones with family or they may bemore impersonal ones, such as with a boss at work. During adoles-cence, relationships change because mental, emotional, and physicalchanges are happening all at once. Parents, teachers, and siblingsbegin to respond differently to an adolescent because, in a sense, anew person is evolving in their presence. Increased Expectations As you mature, you may find that your parents expect more from you. And hopefully, you will find that yourexpectations of yourself increase as well. Evaluating these expecta-tions and discussing which are negotiable and which are not areimportant for teens. It is normal for curfew, chores, and dating rulesto change. It is also important to talk to parents about these expecta-tions and to be willing to negotiate with your parents about them. ZITS reprinted with special permission of King Features Syndicate, Inc. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Changes During Adolescence 393Teens must also expect that some rules will be nonnegotiable, because everyone lives with some fixed rules. For example, no matter how old a person is, stopping at red traffic lights and abiding by othercommunity rules are required. Social maturity means understanding,accepting, and living by each negotiable and nonnegotiable rule. Changing Relationships Your relationships with your friends also change and become increasingly important during adolescence.As a teen, you may find yourself wanting to spend more time withfriends than with family. Your changing relationships with yourfriends can be stressful for parents, too. Parents may feel hurt thattheir teen prefers spending more time with their friends than withthem. Or parents may worry that their teenager is engaging in friend-ships that are unhealthy. Evaluating Your Relationships Friendships can be difficult to assess during the teen years because emotions run high and canchange quickly. Teens must take a hard look at their friendships anddecide whether the friendships are good for them. You can evaluateyour friendships by asking the following questions: >Does this friendship bring out the best in me, or does it discourage me? >Does the friendship make me a stronger or a weaker person? >Does this person respect me and allow me to share my opinions and beliefs, or does this person insist that I conformto his or her ways? A healthy friendship is one in which each person encourages the other. If the answers to the questions above indicate that a relation-ship is unhealthy, then the problems in the relationship must beaddressed to resolve them. If they can’t be resolved, then you musthave the strength to end the relationship. A teen’s desire to be accepted can be very strong. Teens usually look to friends to find acceptance. But sometimes this strategy doesn’twork. Take teen cliques, for example. Cliques are small, exclusive groups of friends that are judgmental of both their friends and others.Cliques can be painful to those on the outside, who may feel rejected.Gangs are another example of groups that can cause more harm thangood. Increased Responsibilities Independence is really about tak- ing responsibility for one’s feelings, thoughts, and behaviors. If ateen is to mature into an independent adult, taking responsibilityin the teen’s relationships at home is the best place to begin. As ateen’s feelings and thoughts about his or her parents and siblingschange, the teen’s responsibilities toward them also change. Teensmust start to communicate in a more mature manner, which entailslistening well, allowing others to talk, and respectfully consideringothers’ feelings and ideas. Good communication skills can alsohelp to strengthen relationships with others. Some examples ofEvaluating Changing Relationships 1Ask questions. Is this a healthy friendship? Is this friendshipallowing me to grow? 2Take charge. You can now thinkmore like an adult, so decide onpositive changes you can maketo improve your relationships. 3Get tough. Some of yourfriendships may becomeunhealthy. If you have difficultybreaking those relationships off,ask a good friend or teacher tohelp you. 4Commit yourself to improving.You’ll make some mistakes inyour relationships, but you willlearn from your mistakes. Copyright © by Holt, Rinehart and Winston. All rights reserved. 394 CHAPTER 16 Adolescence and Adulthoodhow you can take more responsibility in relationships at home include >showing concern for how people are feeling by ask- ing how they are doing >listening to another’s tone of voice, ideas, and opin- ions. If the person sounds tired or sad, ask what you can do to help >looking for ways to encourage other people and support them with kind words As teens begin to take on more responsibility, they will find that those around them will trust them more. Teensoften complain that parents don’t trust them, but trust issomething that has to be demonstrated and earned. Teensmust look for opportunities to show their trustworthiness. Working Outside the Home The teen years often bring the first opportunity for a paid job outside of thehome. This experience is exciting but requires maturity andresponsibility. Employers expect workers to perform to thebest of their ability. The consequences of a job poorly donecan range from receiving a pay cut to being fired. A teen whohasn’t been responsible around the house will likely havemany problems at work. Teens must realize that in familiesand in the world at large, many rules exist. Some rules are negotiable, but many are not. Thus, the demand for teens to act mature,to dress appropriately and to have good hygiene habits is greater thanever on the job. Teens can behave maturely by understanding the expec-tations of their boss and following through with commitments. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Compare the terms adolescence and puberty. 2.Identify three hormones that contribute to the start of puberty. 3.Describe the role of the testes in physical development. Understanding Key Ideas 4.Identify a change that is common to boys and girls during puberty. a.broadening of the shoulders b.widening of hips and pelvis c.facial acne d.facial hair5.Describe how teens’ ways of thinking change during puberty. 6.Describe three ways that teens can take on more responsibility at home. 7.State three ways that teens can be more mature while working outside the home. Critical Thinking 8. Practicing Wellness Identify ways that you can tell if a relationship is healthy. Discuss what you can do if the relationship isn’t healthy. 9. Coping State three changes that you have experienced during adolescence. Then,identify two ways to cope with these changes.LIFE LIFE SKILLLIFE LIFE SKILL Your best friend is 16 years old, and she is at a sleep- over with eight other girls. At midnight, a goodfriend of hers sneaks over to the house, taps onthe bedroom window, and asks her to a party athis friend’s house. No parents are at the party.She tells her friend that she doesn’t want to gobecause she doesn’t feel right sneaking out. Theothers at the slumber party ask her to drivethem to the party. What should she do? Write on a separate piece of paper the advice you would give your best friend. Remember to use thedecision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Adulthood 395 AdulthoodSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Do you ever dream of the day when you will be completely independent? When you’ll own your own car? Independencecomes with many responsibilities. Knowing what is expected of adults will allow you to start now to prepare yourself for adulthood. Young Adulthood Even though Americans are considered legal adults at the age of 18, aperson who is 18 is still technically a teenager. Young adulthood isconsidered to be the period of adulthood between the ages of 21 and35. This period is full of changes, challenges, and decisions. Physical Changes During young adulthood, the growth rate of adults begins to slow down. As young adults’ bodies begin tomature, they also enter a time of peak physical health. Many youngadults take advantage of their health by playing sports or taking partin outdoor activities. Mental and Emotional Changes With the changing emotions of the teen years behind, many young adults experience a sense ofsettling. Many of the conflicting feelings that occur during adoles-cence disappear and allow young adults to feel better about life. Theyenjoy the independence from their family but continue developingclose relationships. Young adults begin to relate to their parents onan adult level. Keeping in touch with family is one way to adjust tothe separation young adults may feel. Intellectually, young adults think more abstractly. They can more consistently make mature, responsible choices. All of these changesgive young adults a clearer sense of their identity: who they are, whatthey want from friendships, and what job they want to have.OBJECTIVES Describe the changes that occur during young adulthood. Identify the opportunities middle adulthood offers. Name three concerns that an older adult might have. Listbehaviors that promote healthy aging. State three ways in which you can help an older adult you know lead a healthy life. LIFE LIFE SKILLKEY TERMSKEY TERMS menopause the time of life when a woman stops ovulating and menstruating midlife crisis the sense of uncertainty about one’s identity and values that some people experience in midlife Alzheimer’s disease a disease in which one gradually loses mental capacities and the ability to carry out daily activities life expectancy the average length of time an individual is expected to live Along with the increased responsibil- ities of young adulthood come manyrewards. Copyright © by Holt, Rinehart and Winston. All rights reserved. 396 CHAPTER 16 Adolescence and AdulthoodSocial Changes Many young adults choose to marry and start a family during this time in their life. Before entering into such strong commitments, one must know oneself well—one’s skills, values,strengths, weaknesses, and beliefs. Commitment in relationships is very important. Some young adults choose to remain single. Others are afraid to marry. One rea-son may be that they have never seen a positive relationship. As aresult, they may wonder if their marriage will fall apart. It is impor-tant that they know that they can make their marriage work. Seeking advice from older adults who have successful marriages is helpful. Financial Concerns One exciting aspect of young adulthood is that you can start working toward your dream job. You might get ajob or continue your education. You make decisions about the thingsyou thought, planned, and prepared for as an adolescent. Youngadults enjoy financial independence and freedom, perhaps for thefirst time in their lives. They are responsible for earning and spendingtheir own money. While such independence can be scary, it can alsobe exciting. With this financial freedom comes the ability to choosewhere to work, where to live, and what car to buy. real life Activity LIFE LIFE SKILL Setting Goals CALCULATING A BUDGET ✔paper ✔calculator ✔list of salaries and monthly expensesMaterials 1.Divide into groups of three stu- dents. Each group should be assigned a salary and given alist of monthly expenses. 2.Divide your salary by 12 to cal- culate your monthly allowance. 3.Calculate how much money you need per month for each expense category. 4.Analyze with your partners how much money you need intotal. Divide the monthly salaryaccordingly. Some categorieswill need more money thanothers. 5.Decide as a group which cat- egories are more important than others.Procedure 1.Calculating Data What is your group’smonthly salary? 2.Calculating DataHow much money doyou need per month for eachexpense category? 3.Summarizing Results Does your salary meet the needs of your budget? Discuss ways tohelp your budget meet yoursalary. 4.CRITICAL THINKING For most jobs, the higher the edu-cation level, the higher thesalary. Discuss the decisionsthat you can make now toaffect your future job. How willyou carry out those decisions?Conclusions 123 Week Housing Food Transportation Entertainment Total$300 $100$100$50$550 MATH SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Maintaining Wellness Young adults face many of the same health risks as adolescents. The No. 1 cause of death in people between the ages of 15 and 24 is unintentional injuries. Auto acci-dents, many of which involve alcohol, account for most of theseaccidents. The second and third leading causes of death are homicideand suicide, respectively. Young adults who smoke, drink, and fail to exercise may feel healthy for a number of years and believe that these habits aren’tharmful. But later in life, the ill effects of these bad habits appear.Suddenly, it may be too late to reverse the effects of bad habits.Because patterns developed during young adulthood affect your lifelater on, it is important to develop healthy habits during this time. Middle Adulthood We often hear the teen years described as being the best years of life.In fact, for many adults, this is not true. Middle adulthood, theperiod between 35 and 65 years of age, can prove to be “the bestyears” for many reasons. Physical Changes The body goes through many changes during middle adulthood. Middle age used to be seen as a time when yourbody would start to slow down. Fortunately, with changes in attitude,diet, and physical exercise, adults have enjoyed greater physicalstamina. Muscle tone and strength naturally begin to diminish, butwith regular, moderate exercise, they can be maintained. Women typically begin menopause between the ages of 50 and 55. is the period of time in a woman’s life when thewoman stops ovulating and menstruating. As awoman’s estrogen and progesterone levels fall, thebody’s reproductive capacity begins to slow down.After menopause, women no longer menstruate orovulate (produce eggs). Changes that accompanymenopause may include hot flashes, a decrease inbreast size, anxiety, and sometimes depression.Lower levels of estrogen put women at risk forosteoporosis, or thinning of the bones. Taking sup-plemental calcium and exercising can decrease therisk of developing osteoporosis. Men also experience many physical changes during middle adulthood. Just as women experi-ence a decline in their ability to reproduce, so domales. As men age, their sex hormone and spermproduction gradually decrease. Mental and Emotional Changes Many middle-aged adults begin to accept their mortality asthey see friends and loved ones die. They reflect onthese changes and begin to evaluate their lives. Ahealthy mind will see mistakes made, accept them,Menopause Many rewards accompany the added responsibilities of middle adulthood,such as a rewarding career and friend-ships with co-workers. 397 Copyright © by Holt, Rinehart and Winston. All rights reserved. 398 CHAPTER 16 Adolescence and Adulthoodand move forward by trying to learn and change. Accepting the passage of time brings maturity.Satisfaction is gained from reflecting on the birthand growth of children, job accomplishments,and healthy relationships. A healthy, maturemind can accept changes and look forward to thelater parts of life with hopeful anticipation. Occasionally, an adult may experience a midlife crisis. A is the sense ofuncertainty about one’s identity and values thatsome people experience in midlife. If someoneexperiences a midlife crisis, it usually begins inthe person’s forties. Adults may feel that theirlife is slipping away and that they are losingtheir youth. Thus, they try to hold onto thatyouth rather than accept their maturation. Theymay make dramatic changes in their life, such as taking a new job, in an effort to feel better about themselves. How-ever, such changes do not solve their problem because they do notdeal with the root of the problem, which is fear of accepting the lossof their youth. Many middle-aged adults experience psychologicalchanges. These changes are healthy and normal. Social Changes Adults in this stage often enjoy clearer identity formation—they know who they are. By the time adults reach themiddle years, they are able to positively focus on their family andtheir job. They understand their role in each area and make choicesaccordingly. They guide their family through changes in life and takeon leadership roles in child-rearing and in their job. Stresses do arise.When handled in a healthy manner, though, these stresses canmature a person and deepen one emotionally and intellectually. Financial Concerns Most adults learn to accept more respon- sibility during middle adulthood because other people depend onthem for financial and emotional support. As with any responsibility,there are pleasures in addition to the strains. Some adults experienceimmense satisfaction from providing for others. These greater finan-cial needs can also bring on greater stress. The effects of stress can be serious, and adults must learn to cope. But for some people, the stress may get overwhelming. Health prob-lems from stress can erupt. Such problems may include depression,ulcers, high blood pressure, or heart

disease. Mental health deeplyaffects physical health during these years, and caring for both aspectsof health is very important. Maintaining Wellness The leading cause of death during middle adulthood is cancer. Cancer is followed closely by heart disease as acause of death. Adults can reduce their risks of cancer and heartdisease by exercising, not smoking, and eating a low-fat diet tomidlife crisis Midlife years are the best years of life for many people. Many are able to enjoyand focus on their families and job. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Adulthood 399prevent high blood cholesterol. Many young adults do not feel the effects of eating a poor diet, smoking or chewing tobacco, not exercis-ing, and being overweight. As these young adults grow older, how-ever, they may begin to experience the ill effects of these habits. Receiving yearly medical care from a physician is very important for preventing and treating problems. For example, one may havehigh blood pressure or cancer and not know it. To ensure goodhealth, both women and men need regular medical exams from aphysician. Older Adulthood The population of older adults (those 65 years of age and older) inthe United States has grown rapidly during the past decade. Thistrend is predicted to continue well into the new century. Some rea-sons for this trend are improved understanding of nutrition, exer-cise, and disease prevention as well as advances in medical care.Sadly, our cultural attitudes have encouraged young people to viewolder adults as uninformed, unproductive, and unable to enjoy life.In reality, older adults may enjoy experiences that are not possiblein the early or middle adult years. Descriptions of this and otherstages of adulthood can be seen in Table 1. Physical Changes As adults move into older adulthood, they continue the aging process. As they age, they may find that their abil-ity to recover from illnesses or injuries is not as quick as before. Inaddition, the effects of years of unhealthy habits started during ado-lescence may become evident during this time of life. For example,smoking-related lung cancer and obesity-related diabetes are twocommon concerns for older adults. Mental and Emotional Changes Most older adults are more emotionally stable than they were earlier in life. This stability is anatural consequence of maturity. They have endured hardships suchas the death of a close friend, spouse, or family member. Many cometo terms with the meaning of life—what is important and what isnot. Young adults can learn much from older adults. Table 1 Stages of Adulthood Age Stage Description 21–35 young adulthood This period of life is marked by a first career job, marriage, children, and financial independence. 35–65 middle adulthood Greater financial security, satisfaction with a growing family, and emotional maturity mark this time of life. 65 and older older adulthood Wisdom accumulated from a variety of life experiences marks this stage. Loneliness and isolation can be serious problems. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Alzheimer’s Disease HealthLinks code: HH4009 400 CHAPTER 16 Adolescence and AdulthoodDespite the extensive life experiences they have had, older adults are not immune from many of the same mental problems that are possible in the earlieryears. Depression, anxiety, or loneliness may alsoplague the elderly. Younger family members must bealert for signs of such problems in older familymembers. The younger family members too can ben-efit from helping older loved ones. Such help couldbe as simple as an occasional visit or phone call. Ifwe take time to listen to older adults, we find thatmany of their feelings are similar to ours—whetherwe are a teen or a middle-aged adult. Many younger adults believe that older adults lose their intelligence and wisdom to age and dis-ease. This belief is not true for most older adults. Forexample, Alzheimer’s disease occurs in only a small percentage of the population of adults between the ages of 65 and80. is a disease in which one gradually losesmental capacities and the ability to carry out daily activities. Alzheimer’s disease affects the brain and usually progresses slowly. A person with this disease first begins losing short-termmemory and then long-term memory. Sometimes the patient forgetswhere he or she is. Sometimes the patient does not recognize lovedones. Alzheimer’s is an emotionally painful disease to both thepatient and the family. Social Changes Many adults look forward to retirement after age 65. Leaving a career of many years can be enjoyable but also stressful.Any major lifestyle change is hard. Adapting to retirement usuallyrequires time. Adapting may take a few weeks or even months.Believe it or not, when an adult has focused for many years on acareer, shifting that focus onto an enjoyable hobby or recreation canbe difficult. Most people eventually come to appreciate the freedomsand free time retirement offers. Financial Concerns Older adults who do decide to work less or retire may find that their financial situation has changed. Althoughtaking advantage of this time period by enjoying such activities astraveling and visiting family members is important, planning aheadis also important. Some adults may require expensive healthcare. Insome cases, they may even have to face moving into a retirementhome and losing their independence. Maintaining Wellness Health problems that the elderly face are similar to those of middle-aged adults. Cancer and heart disease arethe leading causes of illness in older adults. So, maintaining healthyhabits is very important for older adults. There is no reason that agealone should make a person less productive in society or prohibithim or her from fully enjoying life.Alzheimer’s disease Ways to Interact with Older Adults 1Visit them. Sit and listen to them. Ask them what they would do incertain situations. Ask for theiropinion. 2Offer to do simple householdchores. They’ll love having youaround while you get work donethat perhaps they can’t do. 3Bring them food. Bake cookies,and deliver them personally. Askif they need groceries, and thenget them. Copyright © by Holt, Rinehart and Winston. All rights reserved. Healthy Aging When we look at the big picture of life from adolescence to older adulthood, we see the health risks shift from accidents and injuries toillnesses such as heart disease and various forms of cancer. We can seethe importance of establishing healthy patterns of behavior early inadolescence to reduce serious health risks during the teen years aswell as later in life. As a teen, you may rarely think of how eating,exercising, and risk-taking affect your health later in life. The truth isthat healthy changes in your behavior during these critical years areextremely important to your health in older adulthood. Common Concerns During Aging Building a positive attitude about each stage of life can ensure that a person will care for his orher health. Having a positive outlook is important because mentalhealth and physical health affect each other. For example, physicalexercise can reduce psychological depression by increasing the circu-lation of certain brain chemicals. One of the tragic myths of aging is that as we age, we lose our intellectual sharpness and our ability to enjoy life and be productive.The truth is that advancing age brings greater wisdom and, in manyways, an ability to enjoy life more than we did during early adult- hood. As adults mature, however, they must keep their minds stimu-lated. This can be accomplished through active work, such as reading,listening to music, and talking to others, rather than passively watch-ing television and movies. Many emotional challenges arise throughout adulthood. Loneliness, depression, or variousstages of grief occur as we move through difficultlife experiences, such as the death of friends,the death of a spouse, or perhaps divorce. It isvery important for adults to pay attention totheir feelings and moods and to seek help fromloved ones. “All old people get Alzheimer’s, so I don’t want to get old. ” “The teen years are always the best years of life. ” “Most older people are sickly and are unable to take care of themselves. ” “Older people should stop exercising and get a lot of rest. ”Only 2 percent of people aged 65 to 80 get Alzheimer’s disease. The teen years can be difficult. Often, people feel more settled and satisfied with relationships and life later in adulthood. The majority of older people are fairly healthy and self-sufficient. Exercise at any age strengthens heart and lung function. Older people can benefit from exercising asmuch as anyone else.Beliefs Reality vs.Beliefs Reality vs. “Who says we don’t get smarter as we age?” 401 Copyright © by Holt, Rinehart and Winston. All rights reserved. 402 CHAPTER 16 Adolescence and AdulthoodTips for Healthy Aging The average length of time an individual is expected to live, or has risen dramatically since 1960. Most men and women who live to be 65 can also expect to liveuntil age 80. Scientists predict that the greatest increase in populationover the next few decades will occur in people over the age of 85.Thus, making certain that older adults are independent, healthy,mentally keen, and productive is important. The most important habits to form during adolescence and early adulthood are those that keep us physically healthier, as seen in Figure 3. >Establishing regular exercise can actually help us live longer.Regular exercise improves quality of life and may prevent premature death and disease. >Even the simple measure of not smoking can dramaticallyreduce the risks of developing heart disease, cancer, and otherdiseases. >Not drinking alcohol also decreases the risk of death by caraccidents, alcoholism, and liver disease. >Maintaining a healthy weight helps to prevent diabeteslater in life. >Lowering salt intake and keeping total Calories at a level atwhich normal weight for height is maintained are importantto a person’s health as they age. The development from adolescence to adulthood is a miraculous journey, and life can get better with each passing year. Growing olderis a privilege and process worthy of our respect and care. We shouldnot reject the process but should look forward to and enjoy every partof this journey.life expectancy, REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Describe the symptoms of Alzheimer’s disease. 2.Define life expectancy. Understanding Key Ideas 3.Describe how emotions change during young adulthood. 4.Identify the leading cause of death in young adults, and describe actions they can take to reduce the risk of dying during this period. 5.Describe three changes that you might face dur- ing middle adulthood. 6.State the leading causes of illness in older adults. 7.State whether our culture portrays older adults as having less intelligence. Explain why this portrayalis true or why it isn’t true. 8. Practicing Wellness State three ways that you can help an older adult to lead a health-ier life. 9. Practicing Wellness Identify four habits that you can begin today to improve thequality of your life in 10 years. Critical Thinking 10.Some people describe the teen years and youngadulthood as the “best years of life.” Do you agreeor disagree? Why? LIFE LIFE SKILLLIFE LIFE SKILL Regular exercise is one way to maintain your health now and in the future. ACTIVITY What is one form of exercise you can start now?3 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 16 Highlights 403 CHAP TER 16 CHAP TER 16 CHAPTER 16Highlights Key Terms The Big Picture ✔Changes in hormone levels mark the beginning of puberty. ✔Puberty involves many physical changes, some of which are unique to boys and girls. ✔As teens mature, they begin to think in a more complexand sophisticated manner. ✔Adolescence is a process of gradually accepting moreresponsibility for one’s behaviors, thoughts, and feelings. ✔Mental maturity allows adolescents to see life from anotherperson’s viewpoint, not simply from their own. This matu-rity helps them respect others. ✔During adolescence, teens’ relationships change as more isexpected from them. ✔Working outside the home requires a high level of maturityand commitment on the part of the teen.SECTION 1 adolescence (388) puberty (388) hormone (388) testes (389) ✔Moving from young adulthood into older adulthoodinvolves many mental, physical, and emotional changes. ✔Young adulthood is a time marked by increased independence. ✔Young adults can exert great influence over all areas oftheir health and can reduce their risk of developing dis-eases by making healthy lifestyle choices. ✔During middle adulthood, the different aspects of adults’lives become more stable. This stability allows for greaterfocus on their job and family. ✔With the increased financial responsibilities of middle adult-hood also comes satisfaction from providing for others. ✔Keeping physically, mentally, and socially active can ensurethat older adulthood is an enjoyable time marked by goodhealth. ✔The older adult years can be a time of great satisfaction,productivity, and wisdom. Aging is a natural process thatshould be viewed positively.SECTION 2 menopause (397) midlife crisis (398) Alzheimer’s disease (400) life expectancy (402) Copyright © by Holt, Rinehart and Winston. All rights reserved. 404 CHAPTER 16 Review CHAP TER 16 CHAP TER 16 CHAPTER 16Review Understanding Key Terms adolescence (388) menopause (397) Alzheimer’s disease (400) midlife crisis (398) hormone (388) puberty (388) life expectancy (402) testes (389) 1.For each definition below, choose the key term that best matches the definition. a.the sense of uncertainty about one’s identityand values that some people experience inmidlife b.a chemical present in the bloodstream thatbrings about changes during puberty c.the male reproductive structures that makesperm and produce the male hormone testosterone d.the average length of time that an adult isexpected to live e.the years during which a woman makes thetransition from menstruating to having herlast period f.the period of human development duringwhich people become able to bear children 2.Explain the relationship between the key terms ineach of the following pairs. a.adolescence and puberty b.hormone and testes Understanding Key Ideas Section 1 3.Name one hormone responsible for changes inmales during puberty. 4.Name one hormone responsible for changes infemales during puberty. 5.Describe the changes in thinking that adolescentsundergo as they mature. 6.Describe why it is important for teens to separatefeelings and behaviors. 7. Important actions that an adolescent can take to protect their health during the teen years include a.refusing to smoke. c.avoiding alcohol. b.exercising moderately. d.All of the above8.Adolescence is a time for taking greater responsi-bility in what areas of life? 9.Communicating more maturely involves whichof the following actions? a.listening actively c.focusing on your feelings b.venting frustration d.getting your way 10.CRITICAL THINKING List two ways that relation- ships change during adolescence. How can youcope with these changes? Section 2 11.Which social change is one that young adultsoften face? a.Alzheimer’s disease c.midlife crisis b.menopause d.marriage 12.In general, do young adults enjoy greater finan-cial independence than adolescents do or lessfinancial independence? 13.The No. 1 health risk that a young adult faces is a.cancer from smoking. b.heart attacks. c.unintentional injuries. d.diabetes. 14.At what age do women typically beginmenopause? 15.Why is it important for middle-aged adults tovisit the doctor annually? 16.The chance of developing osteoporosis, or thin-ning of the bones, can be reduced by a.getting extra rest. c.exercising regularly. b.reading. d.avoiding calcium. 17.Describe the types of financial concerns manyolder adults experience. 18.Since 1960, the life expectancy of Americans has a. stayed the same. c.decreased slightly. b.increased. d.decreased greatly. 19.CRITICAL THINKING Explain how someone might appropriately deal with a midlife crisis. 20.CRITICAL THINKING Why do you think that having a positive attitude about growing older isimportant? LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 16 Review 405Interpreting Graphics Study the figure below to answer the questions that follow. 21.How many more people were 65 or older in the year 2000 than in 1970? 22.How has the number of people who are85 or older changed over time? 23.CRITICAL THINKING Why do you think the number of people who are 65 or older has risenso dramatically?Activities 24. Health and You Interview one person from each stage of adulthood. Ask them about the concernsand advantages of their stage. Create a chart tosummarize your results. 25. Health and You List each of the following problems on one side of a piece of paper: highblood pressure, heart attack, stroke, car accidents,and cancer. Now, beside each health hazard, writeone thing that you can do to reduce the risk ofthe problem. 26. Health and Your Community Create a brochure explaining the changes that adolescents experi-ence during puberty. Explain ways that the ado-lescents can positively cope with these changes. Action Plan 27. Assessing Your Health Establishing healthy patterns of living during adolescencereduces the risks of dying early and makes life moreenjoyable. Explain five habits that you can beginnow that will make your life healthier and moreenjoyable. How will you make these changes?LIFE LIFE SKILL 28.In this passage, the word badgered means Asaddened. Basked to do something. Ccomforted. Dlaughed at. 29.What can you infer from reading this passage? EJuan does not like to jog. FSmoking may have contributed to Juan’s can-cer and high blood pressure. GJuan has lived in San Francisco for 10 years. HNone of the above 30.Write a paragraph describing Juan and his fam-ily’s life after finding out that Juan has lung cancerand high blood pressure. 31.Write a paragraph describing the factors that mayhave contributed to Juan’s cancer and high bloodpressure. Explain how Juan could have madehealthier lifestyle choices to reduce his chances ofdeveloping these diseases. READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Juan was a successful architectural engi- neer in San Francisco, California. He hadtwo children and a wife. At age 42, hefinally quit his smoking habit, which hestarted when he was 18. He began to jogevery day and completed a marathon onhis 45th birthday. After being badgered by his family, he finally went to see his doctor when he was 46. His physician told himthat he had early lung cancer and highblood pressure. Juan was shockedbecause he felt that he was in the bestshape of his life. 60 5040302010 0 1950 196065 or older 85 or older 1970 1980 1990 2000 2010 2020 Projected YearElderly Population in the United States Number of people (in millions) Source: U.S. Census Bureau. MATH SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 406Coming of Age What does it mean to be an adult? In answering this question, scientists and social scientists look at cultures all over the world to find what we have incommon. One thing most cultures share is somesort of ritual marking the transition from childhoodor adolescence to adulthood. The rituals associatedwith this transition are called rites-of-passage or coming-of-age ceremonies. Rites of Passage Think about your own life. What incidents do weuse to mark your maturity? When does our societysay to you, “Now you are an adult with its rights andresponsibilities”? Some of our rituals are informal.For example, obtaining a driver’s license has greatsignificance to many teenagers. Voting at 18 givesyou the rights and responsibilities of a politicalvoice. Turning 21 gives you new rights and responsi-bilities. More-formal rites of passage may includeyour school’s most formal dance. Many religions have a very formal coming-of-age rite called confirmation. In the Catholic Church, forexample, a bishop places his hands on a young person’s head to signify that they have received thewisdom to make their own decisions about faith. Coming of Age Around the World All over the world, people just like you engage inrites of passage. Although some of these rites mayseem unusual, each has the same kind of signifi-cance that the various ways our society marks the transition to adulthood do. > Maasai As part of elaborate coming-of-age cere- monies, Maasai boys from the African nation of Kenya go to live in manyattas, camps built by adult women of the society. Adult women alsochaperone the girls who live in the camp. Boyspractice ancient rituals, including using spearsand wielding shields, to become morans (warriors). Almost every society has a ritual to mark the transition from childhood to adulthood.Some coming-of-age rituals are quite infor-mal, while others are ceremonial. CULTURAL DIVERSITY HealthHealthWorldWorldHealthHealthWorldWorldHealthWorld YOURYOUR Copyright © by Holt, Rinehart and Winston. All rights reserved. >Mexico When a girl reaches 15 years of age, many people mark that milestone with a rite of passage called a quinceañera. A girl of 15 arrives at a thanksgiving mass in a traditional white orpastel Mexican dress full of frills. Her friends,who act as attendants, may accompany the girl.After mass, there may be a birthday party, atwhich a dance with the girl’s favorite boy highlights the festivities. > Navaho Nation When a Navaho girl comes of age, she participates in a traditional ceremonycalled Kinaalda. This ceremony lasts for 4 d ays. It is based on a cycle of songs called the Blessing Way. The ritual ends on the fourth day with a traditional campfire in which the girl bakes aspecial corn cake to symbolize her acceptance ofthe hard work that comes with adulthood. > Judaism Many coming-of-age rituals are religious in nature. When a young boy of theJewish faith makes a transition into manhood,he is part of a ceremony called a bar mitzvah. This ceremony takes place around his 13th birthday.The ceremony takes place in a day, but learningabout the Jewish faith may take months or yearsof preparation. Girls participate in a bat mitzvah. Both terms mean “commandment age” and signify that one has become an adult of thefaith. > Japan Coming of age in Japan takes on a national significance. Seijin-no-hi —”Coming of Age Day”—takes place every year on January 15in Japan. This day is set aside to honor anyonewho has turned 20 during the past year. Twentyis a significant legal age in Japan, too. People canvote, and other options become open to them.The day often begins with athletic events or towncelebrations. People who are 20 dress up and goout with their friends for a night on the town. One thing that characterizes all of these rituals is the society’s enthusiasm for children. Although the mes-sage that one is becoming an adult is serious, therites and rituals themselves can be exciting and showthat the adults accept the youth as one of their own.YOUR TURN 1. Summarizing Information Why does almost every society have coming-of-age rituals and rites? 2. Interpreting Information Research one culture, and write a paragraph about howthat culture marks the transition from childhood to adulthood. 3. CRITICAL THINKING How do you think that coming-of-age rituals in your societyhelp you focus on your rights and responsibilities? www.scilinks.org/health Topic: Coming of Age HealthLinks code: HH4579The quinceañera celebrates this teen’s entry into young adulthood. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 17 CHAP TER 17 CHAPTER 17 Marria ge, Parentho od, and F amiliesMarria ge, Parentho od, and F amiliesMarriage, Parenth ood, and Families 408KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.In healthy marriages, the spouses try to meet each other’s needs. 2.The serious emotional consequences of divorceare felt only by the couple divorcing. 3.A spouse should depend on his or her partnerto solve all conflict in the marriage. 4.A parent’s behavior affects how his or her children feel about themselves. 5.An increasing number of single fathers areraising their children. Copyright © by Holt, Rinehart and Winston. All rights reserved. 409SECTION 1 Marriage SECTION 2 Parenthood SECTION 3 Families go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH17. Copyright © by Holt, Rinehart and Winston. All rights reserved. Two halves of one whole. The resting place for deep friendship. The blending of souls. All of these phrases have been used todescribe marriage. But marriages do not form easily. Marriages are created by the strength of loving actions, commitment,compromise, and emotional intimacy. Healthy Marriages: Working Together You have probably observed many married couples. Have younoticed how the interactions of each couple differ? A is alifelong union between a husband and a wife, who develop an intimate relationship. Deciding whether to marry is one of the most serious decisions a person can make. Marriage can provide greatrewards for both partners, such as deep friendship, emotional intimacy, and children. Knowing the responsibilities of a healthymarriage can help you prepare for this decision. marriageMarriageSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES

Describe the responsibilities of married partners. Listfive things couples should discuss if they are considering marriage. Name three difficulties that teenagers who are married may face. Identify four ways in which a teen can cope with a divorce or remarriage in the family.KEY TERMSKEY TERMS marriage a lifelong union between a husband and a wife, who develop an intimate relationship emotional intimacy the state of being emotion- ally connected to another personemotional maturity the ability to assess a rela- tionship or situation and to act according to what is best for oneself and for the other person in therelationship divorce the legal end to a marriage Mature love takes time to develop. To develop a serious relationship, thepartners must be willing to learn abouteach other. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Marriage 411Responsibilities of Marriage A healthy marriage requires that both partners work together to meet each other’s needs. Other responsi- bilities for each partner include the following: >Love In a healthy marriage, spouses show their love for each other through actions and do not depend solely on feelings oflove. Feelings of love change over time. Sometimes, couplesmay not feel the same intensity of love they felt when theywere first married. However, if the spouses are patient andwork together, they can regain feelings of love and support.Often, a couple’s love grows deeper and stronger after the cou-ple has worked through a hard time. >Commitment A commitment is an agreement or pledge to do something. In a healthy marriage, spouses make a commitmentto work through their differences, remain faithful to oneanother, and to make their relationship work. Commitment inmarriage requires that both partners be willing to change them-selves for the good of the couple. A person cannot change his orher spouse’s habits; the person can change only his or her own. >Compromise Compromise is essential in a healthy marriage. Compromise in marriage means not al ways getting your way and sometimes giving up what you want. Each partner mustprioritize needs and desires and then discuss these prioritieswith his or her spouse. Although compromise requires sacri-fice, both partners benefit from the stronger relationship thatcompromise brings. >Emotional intimacy Intimacy, or familiarity with each other, is important in a healthy marriage. is thestate of being emotionally connected to another person. Themost common way for a couple to develop emotional inti-macy is through good communication. Each partner is respon-sible for expressing feelings in a truthful, loving way if therelationship is to grow. A person can have a healthy marriage even if he or she has not seen an example of one. Those who have not seen a healthy marriage need toknow that a healthy marriage is possible for them through lovingactions, commitment, compromise, and emotional intimacy. Engagement: Developing Your Relationships Developing emotional maturity is an important part of the engage- ment period. is the ability to assess a relationshipor situation and to act according to what is best for oneself and for theother person in the relationship. It is important for the couple tomake sure that the relationship is built on mature love, not on in- fatuation, or exaggerated feelings of passion. In mature love, each part- ner tolerates and accepts the other person’s flaws. With emotionalmaturity you can better determine what is needed to improve a rela-tionship and to allow it to grow.Emotional maturityEmotional intimacyBenefits of Marriage >Emotional and physical intimacy >Companionship and deep friendship >Financial support system >Greater emotional stability Copyright © by Holt, Rinehart and Winston. All rights reserved. 412 CHAPTER 17 Marriage, Parenthood, and FamiliesDiscussing Important Issues Using the engagement period to talk about the commitment ahead is essential to building a strong relationship. Talking seriously can be difficult because each personfeels intense love and is eager to marry. Each partner must ask someimportant questions and gain advice from others to make the bestdecisions possible. During the engagement period, couples shoulddiscuss issues such as the following: >What are our values and beliefs? >Should we have children? >How will we handle conflict between family members? >Should both of us work outside of the home? >Where should we live? >What are our economic expectations? Couples should come to agreement on these issues to clearly under-stand each person’s desires and goals. Premarital Education Classes Premarital education classes can help couples openly discuss their goals and expectations of mar-riage. Major differences may surface, and a counselor can help thecouple decide if those differences can or cannot be resolved. If theycannot be resolved, couples may decide to break the engagement.Other good reasons to break an engagement include physical or emo-tional abuse or alcohol and drug abuse. Teen Marriages The teen years are a time of dramatic changes. As a teen, you leavebehind old ways of thinking and behaving and emerge as a more grown up person. Your interests and concerns will be different fromthose you had when you were younger. When teens marry, changes in thinking and behavior are not yet complete. Thus, the spouse a teenager chooses may be different fromthe spouse the teen would choose later in life. When teens marry, they must cope with many stresses in addition to their physical and emotional changes. The stresses of teen mar-riages include >independence from parents and family >financial worries >changes in relationships with close friends >interaction with in-laws >concern for a spouse’s emotional and physical well-being >possible parenthood Many married teens also put education plans on hold. They are financially unable to meet the expenses of marriage and tuition.Delaying education can cause resentment and can keep a personfrom reaching his or her potential. Some teenagers are unable to mentally, physically, and intellectu- ally mature into adulthood while married. Those who can success-fully mature into adulthood while married have a lot of help fromparents or other adults. For more information about relationships, see Chapter 19. linkTOPICTOPIC “We never thought being married could be so hard.” Copyright © by Holt, Rinehart and Winston. All rights reserved. Divorce and Remarriage Unfortunately, not all marriages are successful. When a marriage has trouble, sometimes the couple tries separating , or living apart for awhile. If one or both partners decide that the marriage is over, theymay seek a divorce. A is a legal end to a marriage. Going through a divorce is often difficult not only for the adults, but also forthe other family members. Everyone in the family must adjust to thenew situation. Reasons for Divorce Many times, divorce seems like the best solution to an unhappy marriage. Problems such as abuse and addic-tion are often grounds for divorce. But marriages end in divorce formany other reasons including emotional immaturity, maritalunfaithfulness, conflicts with family, and selfishness. Additional rea-sons for divorce include the following: >Communication problems Breakdown in good communication is a common cause of divorce. If a couple fails to communicatewell, anger may accumulate over the years. The spouses may thenturn away from each other emotionally and refuse to openlycommunicate. >Unfulfilled expectations Lack of fulfilled expecta- tions accounts for other divorces. One partnermay enter marriage hoping that life will becomedifferent or that his or her spouse can be changedas time passes. These expectations are unrealistic.Partners should enter marriage with the under-standing that marriage will not solve life’s prob-lems and that one person cannot change thehabits of another. >Different financial habits and goals Differences in financial habits can also lead spouses to divorce.Before and during marriage, it is important todiscuss finances, to make a budget, and to figureout how each partner will stay within the budget. Impact of Divorce on Teens Numerous losses occur in a teen’s life after divorce. Some teens experi-ence a change in the relationship with their parents.Others feel the financial stress of a divorce. Many teensface other emotional stresses. For example, some teensmay experience feelings of abandonment. Others mayfeel angry at themselves for not having been able tochange the situation. Many of these feelings are hard to identify when experiencing them. Counseling can help a teen under-stand these feelings better. The tips listed in Figure 1 can help teens cope with divorce. divorce Do Separate yourself from your parents’ problems. Recognize that being mad at parents andloving them at thesame time is normal. Realize that you are not alone—many teensare going throughsimilar situations. Ask for help.Don’t Don’t feel responsible for the divorce. Don’t isolate yourself from loved ones andfriends. Don’t think you are alone. Others havehad similar feelings. Don’t refuse help from adults around you. A divorce or remarriage in the family can be difficult. A few tips for copingwith these situations appear below.1 Figure SECTION 1 Marriage 413 Copyright © by Holt, Rinehart and Winston. All rights reserved. 414 CHAPTER 17 Marriage, Parenthood, and FamiliesImpact of Parents’ Remarriage on Teens If a par- ent chooses to remarry, new problems may confront a teen. The teen may not have begun healing from his or herparent’s divorce. Teens often feel resentment toward theremarrying parent, the step-parent, and any step-siblings.Teens may want their mother and father to remarry eachother and see this new family as a threat to that happen-ing. They may blame the remarrying parent for the distressof the other parent. Coping with Divorce or Remarriage Teens will find the transitions involved in a divorce or remarriage easier ifthey keep a few things in mind. >Your parents are doing their best to make their waythrough a difficult time. Even though you may beangry with them, it’s normal to also love them. >Although you may be angry with one or both ofyour parents, don’t take your anger out on others. >Find a way to constructively deal with your feelings.For example, write or talk out your feelings withfriends or a close relative. >Don’t blame yourself for your parents’ divorce. It isnot your fault. Accept the fact that you can’t change your parents’ decisions. Make the best of your situation. Patience and a positive attitude canhelp teens get through the difficult times of divorce and remarriage. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term marriage . 2.Identify the term for “the state of being emotion- ally connected to another person.” a.emotional maturity c.emotional intimacy b.custody d.None of the above 3.Identify the term for “a legal end to a marriage.” Understanding Key Ideas 4.Name four responsibilities of married partners. 5.Describe characteristics that you would expect to see in an emotionally mature person. 6.List five things couples should discuss if they are considering marriage.7.Name three difficulties that two teens who are married might face. 8.Identify which of the following are healthy ways teens can cope with a divorce. a.Don’t blame yourself. c.Be patient. b.Express your feelings. d.all of the above 9.Describe three things that teens should avoid doing or feeling if their parents divorce. (Hint: See Figure 1.) Critical Thinking 10.List three difficulties a teen may face if his or herparents divorce. Then, discuss how you could helpthe teen. Support your answers. When Carlos was 8, his mom and dad divorced. Carlos and his brother, Enrique, were devasted.They remember how sad and hard it was tocope after that. Enrique is 26 now and is considering getting married, but he is afraid. Hedoesn’t want to go through a divorce. How willhe know if he is making the right decision aboutmarriage? Write on a separate piece of paper the advice you could give Enrique. Remember to use thedecision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Parenthood 415 ParenthoodSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Leon could not remember feeling such joy. He looked down and saw his baby smiling for the first time. As he saw hisbaby’s beautiful smile and tiny hands, he realized how special having a child is. Responsibilities of Parents Nothing in life is as joyful, meaningful, or exhausting as being a par-ent. Raising children can be one of the richest experiences an adultcan have. The decision to have a child is not to be taken lightly, how-ever. Children require a lifetime of commitment, love, and support. Parenting can seem like a frightening task—the moment a child is born, the child is completely dependent on the parents. Themother and father become the most important influences on theirchild’s well-being and must take on many parental responsibilities. is the duty of a parent to provide for the physical, financial, mental and emotional needs of a child. Being a parentmeans caring and providing completely for another human being. Responsibilities Before Birth Parental responsibilities do not begin at their child’s birth, though. Parenting begins at pregnancy. Amother’s and father’s habits before and during pregnancy directlyaffect the health of the baby. Smoking, drinking alcohol, and takingdrugs can have serious effects on a developing baby. For example,alcohol consumed by a mother during pregnancy can cause fetalalcohol syndrome. Fetal alcohol syndrome is a set of physical and men- tal problems that affect a fetus because of the mother’s consumptionof alcohol during her pregnancy. Emotional Responsibilities The early years of a child’s life are very demanding on parents. Children look to parents to have theiremotional needs met. Children need to be assured that they areloved. Children also need time with parents. Nothing can replacespending time alone with parents. Secure and healthy parents make certain that they meet the emotional needs of their children.Parental responsibilityOBJECTIVES Name three responsibilities of parenthood. Identify how a parent’s behaviors can affect his or her children. Describe three traits you would like to develop before becoming a parent. LIFE LIFE SKILLKEY TERMSKEY TERMS parental responsibility the duty of a parent to provide for the physical, financial, mental, and emotional needs of a child discipline the act of teaching a child through correction, direction, rules, and reinforcement Parenting requires time, patience, love, responsibility, and a great deal ofemotional maturity. Copyright © by Holt, Rinehart and Winston. All rights reserved. 416 CHAPTER 17 Marriage, Parenthood, and FamiliesSafety Responsibilities Parents must al ways m ake sure that their child is safe. The number one cause of death in toddlers and young children is accidents. Most of these accidents happen in thehome while a parent is present. Keeping watch over a child can be agreat strain on the parents. If you have ever been a babysitter, youprobably know how stressful ensuring a child’s safety can be. Financial Responsibilities Children also need basic items such as food, clothes, and medicines, all of which cost money. So, parentshave to make sure that they have enough income to take care of theirchild’s needs. Disciplinary Responsibilities Healthy parenting requires disci- pline as well as love. is the act of teaching a child throughcorrection, direction, rules, and reinforcement. Beginning disciplinein a child’s toddler years is necessary for the child to mature into ahappy and secure person. Proper discipline can be difficult for par-ents because children naturally resist discipline. But when disciplineis given with realistic expectations and support, the child will feelmore secure, loved, and safe. As children enter the early elementary years, parents must teach their children to show respect for themselves and for other people.Children learn from their parents’ actions, so parents need to be goodrole models for their children. Parents and Teens Parenting can be especially challenging as chil- dren move into the teen years. As children grow, parents’ care-takingresponsibilities—such as expenses and safety concerns—change tomatch the children’s changing needs. As teens mature, their relation-ship with their parents may change. This change can be hard on boththe teens and the parents. It is important both for parents to be sup-portive of their teens and for teens to try to understand their parents’point of view. Effective communication, trust, and understandingallow a relationship to grow.Discipline ZITS reprinted with special permission of King Features Syndicate, Inc. www.scilinks.org/health Topic: Parenting HealthLinks code: HH4112 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Parenthood 417Effects of Parental Behavior Before people become parents, they need to know that their behav- ior affects the children they raise. Children develop understandingabout their worth from their relationship with their parents. Parentswho communicate their love for their children from the momentthe children are born give the children a secure emotional basefrom which to grow into confident adults. Children learn to read their parents’ behavior and speech. When parents are happy, children can feel secure about themselves. If a par-ent is unhappy, children can feel anxious and uncertain. The childrenmay wonder if they are loved. When parents are emotionally or phys-ically unavailable to children for extended periods, children may feelflawed and abandoned. Parents must realize that children are highly attentive to parents’ behavior. The security of their children’s world depends on the par-ents’ behavior. Parental behavior affects how children feel aboutthemselves, life, and the future. Common parental behaviors thatbuild healthy self-esteem in children include >giving children time, attention, and physical intimacy >establishing clear rules and limits >taking the time to listen and communicate with children >praising positive behaviors and good choices Sometimes parents have trouble emotionally connecting with their children. This lack of connection is not related to anything thechild did. Instead, the parents lack the skills to connect emotionally.Regardless of how parents behave, it is possible for their children tolater develop positive parental behaviors. Parenting classes, mentors,support groups, and books can help people learn to be good parents. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term parental responsibility. 2.Identify the term for “teaching a child through correction, direction, rules, and reinforcement.” Understanding Key Ideas 3.Name the major influences in a child’s life. 4.Describe one way that a parent’s behaviors before birth can affect his or her child. 5.Identify which of the following is the responsibil- ity of a parent to a child. a.safety c.finances b.discipline d.all of the above6.Summarize why disciplining a child is important. 7.Describe the effects that a parent’s behavior can have on a child. 8.Identify four ways that a parent can help to increase a child’s self-esteem. Critical Thinking 9.Why do you think that a parent modeling good behavior is more effective for teaching childrenabout good behavior than telling them what to do is? 10. Setting Goals What are three character traits you would like to build before you become a parent?LIFE LIFE SKILL It is important for parents to model positive behaviors for their children,such as showing affection, communi-cating, and listening. Copyright © by Holt, Rinehart and Winston. All rights reserved. FamiliesSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Have you ever noticed how many different types of families there are? Although families may have different structures,the relationships between family members are the most important part of all families. Family Relationships Are Important For most people, the relationships they have with their mother,father, sister, brother, aunts, grandparents, or other family membersare sources of much joy and love. Family relationships teach us howto love and what being loved is like. They teach us who we are, whowe want to be, and what feeling accepted or rejected is like. Family relationships are powerful because they influence our emo- tions and help shape our character, either positively or negatively.Think about your own experiences with your family. Families providefor the emotional and physical needs of their members. Families helpfamily members develop their individual identities. Families alsoinstill moral values. Families Need Time Because our families are so important, it makes sense for us to put energy into ourfamily relationships. Unfortunately, not all of us do so.We sometimes spend more time concentrating on friend-ships, schoolwork, or athletic pursuits because doingthese things is easier. As you mature, it is important to refocus on family relationships and take responsibility forworking harder on them. This is particularly true if yourfamily relationships are troubled or strained.OBJECTIVES Discuss why family relationships are important. Describe different types of families Name the characteristics of healthy families. State four ways to cope with family problems. Listthree ways that you could help make your family healthier. LIFE LIFE SKILLKEY TERMSKEY TERMS sibling a brother or sister related to another brother or sister by blood, the marriage of the individuals’ parents, or adoption nuclear family a family in which a mother, a father, and one or more biological or adopted children live together extended family the people who are outside the nuclear family but are related to the nuclear fami- ly, such as aunts, uncles, grandparents, and cousins family counseling counseling discussions that are led by a third party to resolve conflict among family members Regardless of the makeup of a family, the relationships between family mem-bers are the most important part of thefamily. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Families 419Types of Families The members that make up a family of today may be different from those of families in years past. Children in a family are referred to as or brothers or sisters related to another brother or sister by blood, the marriage of the individual’s parents, or adoption. Today,there are many different types of families. Nuclear Families The traditional family structure is the nuclear family. A consists of a family in which a mother, afather, and one or more biological or adopted children live together.Traditionally, the parents in a nuclear family have clearly-definedroles, such as providing for the family’s needs and raising the children. Blended Families Over the past few decades, family structures have changed for many reasons, including an increase in the numberof divorces. A blended family may result if a divorced or widowedparent chooses to remarry. Blended families are made up of the bio- logical mother or father, a step-parent, and the children of one orboth parents. The parents may decide to have children together. Theparent who is not a child’s biological parent is known as a step-parent. Single-Parent Families Some families consist of a single mother and her children or a single father and his children. This type offamily is a single-parent family . Single-parent families can occur if the parent was divorced, never married, or widowed. Most single-parentfamilies are headed by a mother. But, in recent years, an increasingnumber of single fathers are raising their children.nuclear familysiblings, 19.8 million 16,39627.2 millionstatistically speaking. . . Number of children living in single-parent families in 1999: Number of children adopted from other countries by U.S. families in 1999: Number of people living alone in 2000:HH04PE_C17_S03 1/9/04 10:44 AM Page 419 420 CHAPTER 17 Marriage, Parenthood, and FamiliesExtended Families Occasionally, nuclear families are joined by other relatives to form extended families. are the people who are outside the nuclear family but are related to the nuclearfamily, such as aunts, uncles, grandparents, and cousins. Extendedfamilies can offer great emotional support to all members because theresponsibilities of the family can be shared among the members. Adoptive Families In some instances, parents are unable to con- tinue parenting for a variety of reasons. They may decide that in theinterest of providing the best for their child, the child should beoffered up for adoption. Adoption is a legal process through which adults are given permanent guardianship of children who are nottheir biological children. When a child is adopted, he or she is placedwith adoptive parents and a new nuclear family is formed. Foster Families Children sometimes live in foster families when their own parents are unable to care for them. In foster families, a person or a married couple who is not related to the children agreesto house and raise the children for a period of time. Foster familiesare arranged through government agencies. Characteristics of Healthy Families Parents usually set the tone for the family; therefore, much of a fam-ily’s health depends on the parents. Healthy families are ones inwhich the family members learn to cope with difficulties and grow stronger because of them. Regardless of the type of family,

allhealthy families share some basic characteristics: effectivecommunication, respect, commitment, and love. Effective communication The purpose of effective com- munication is to prevent misunderstanding, build healthyrelationships, and to express yourself. When families com-municate in a positive manner, the family strengthens as aunit. Effective communication should be taught by parents. Unfortunately, many parents were not taught good commu-nication skills when they were young. As a result, parents mayhave problems communicating with their children or witheach other. Thus, the children become frustrated and occa-sionally discouraged. Mature communication means express-ing feelings in a positive, truthful manner. Respect As healthy families grow, the members learn to show respect for each other. Respect means refraining fromverbally or physically hurting another person. Respect alsomeans honoring each other’s privacy and treating eachother’s possessions with care. Showing respect to a sibling orparent is particularly difficult when you are angry. Respectdemands self-control and discipline. Extended families Healthy families depend on good communication, respect, commitment,and love. ACTIVITY What is one activity that you could do to improve communication in your family?2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Families 421Commitment Commitment in healthy family relationships means being dedicated to recognizing and achieving what is best for family members. Part of our commitment to siblings and parentscomes naturally, but much of it comes from hard work. Members ofhealthy families learn to accept one another in spite of each other’sdifferences. Love Love is the feeling we receive when others in the family express affection and unconditional support to us. Love is also theeffort we expend to build better relationships with our siblings andparents. Healthy family members encourage, strengthen, and showcompassion toward each other and are accountable to each other. Unfortunately, many families do not express love in a healthy manner. For instance, a father may believe that he is expressing loveto his children by buying them many gifts. He may not realize thatthe children would rather spend time with him than receive giftsfrom him. Family members should set their priorities together.Expressing love may require great effort and sacrifice, but love withina family is one of the greatest experiences in life. Building Healthy Family Relationships Although everyone would love to have positive, rewarding family relationships, suchrelationships require much work from all members of the family.How can you improve how you behave in your family? How can youshow your family love, compassion, and respect? When you behavein a mature and healthy manner toward parents and siblings, theyoften behave that way in return. Growing up under the authority of parents commonly makes children feel that they are helpless to change anything. In particular,sometimes being told what to do causes teens to feel that their par-ents are too controlling. If you feel frustrated in your relationshipwith your family members, you can be sure that they hurt too. So, itbenefits all of you when you all begin working on the relationship. Coping with Family Problems Your family has probably had problems. All families experienceproblems from time to time. Since family relationships are impor-tant, though, each member will benefit if the problems are resolvedas soon as possible. Problems in family relationships can occur because of many stresses. Financial problems, difficulty controlling anger, depression,and grief cause many family conflicts. When a family experiences oneof these stresses, everyone can be affected. Thus, it is important foreach member in a family to participate in solving the problem. More serious family problems include cases of abuse. For exam- ple, one parent may abuse the other parent or the children. Familymembers should never find acts of verbal, sexual, or physical violenceacceptable. Family members should seek help from a trusted adult.Tips for Coping with Family Problems >Confront the problem. Ignoring the problem may make it worse. >Evaluate the problem as best youcan. Figure out what needs tochange for the problem to besolved. >Take action. Determine what canand cannot be changed, and workto change what you can. >Don’t give up. Decide that you will keep working toward resolvingthe problem despite the difficultyof doing so.For more information aboutcommunicating with familymembers, see Chapter 3. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. 422 CHAPTER 17 Marriage, Parenthood, and FamiliesWhile the strategy for coping with each family prob- lem may differ according to the problem, some methods are better than others. One good way to deal with youremotions is to communicate them to people you trust. Ina situation like divorce, you might want to spend timetalking with your friends, especially those who have alsohad a divorce in their family. Also, trusted adults, such asa grandparent, aunt, uncle, school guidance counselor,teacher, or religious leader, can sometimes give you someof the emotional support that you may be missing. Another thing you could do is get involved in a new hobby or sport. Find something that absorbs your inter-est and takes your mind off problems that you cannotsolve. Family Counseling Family counseling is sometimes necessary to help a family improve its relationships. involvescounseling discussions that are led by a third party to resolve conflictamong family members. Family counselors can give another perspective, help family mem- bers see each other’s point of view in a positive way, and help to eval-uate the family’s problems. But the real work comes from the familymembers themselves. If a family needs counseling, it is more helpful ifthe entire family receives counseling. But if that is not possible, onefamily member should not hesitate to go by himself or herself. Good family relationships are important to your emotional and physical well-being. Although it is often difficult to confront familyproblems and take action, by staying encouraged and not giving upyou can be a part of the solution to the problem. The rewards areworth the effort!Family counseling REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term nuclear family . 2.Identify the term for “the people who are outside the nuclear family but related to the nuclear family, such as aunts, uncles, grandparents and, cousins.” 3.Define the term family counseling. Understanding Key Ideas 4.Identify two reasons that family relationships are important. 5.Compare three types of families.6.Identify which one of the following is nota charac- teristic of a healthy family. a.commitment c.love b.selfishness d.good communication 7. Coping List four ways you can cope with problems in your family. Critical Thinking 8.How would you help your family if a parent wasrecently diagnosed with cancer? 9. Coping Identify a problem a family might face and outline how a teen might work toresolve the problem. LIFE LIFE SKILLLIFE LIFE SKILL If your family is experiencing problems, help can be found. Find someone youtrust who is willing and available tolisten. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 17 Highlights 423 CHAP TER 17 CHAP TER 17 CHAPTER 17Highlights Key Terms The Big Picture ✔Families provide guidance and support, help develop family mem- bers’ identities, and instill moral values. ✔As family structures have changed over the past few decades,many more children now live in different types of families including blended, single-parent, extended, adoptive, and fosterfamilies. ✔Healthy family relationships are developed through effective com-munication, respect, commitment, and love. ✔It is important that all family members try to work together tosolve family problems.SECTION 3 sibling (419) nuclear family (419) extended family (420) family counseling (422) ✔Love, commitment, compromise, and communication are essential to developing a healthy marriage. ✔Couples should use the engagement period to ask questions andmake decisions about the commitment of marriage. ✔Teen marriages are often extremely difficult because the teenyears involve many dramatic changes. ✔Lack of communication, unfulfilled expectations, and differentfinancial goals are common causes of divorce. ✔Although parental divorce and remarriage affect many teens, it isimportant for teens to accept the situation, avoid blaming them-selves, and to use healthy strategies to cope with their feelings.SECTION 1 marriage (410) emotional intimacy (411) emotional maturity (411) divorce (413) ✔Parenting requires commitment, love, discipline, and support. ✔Parents are responsible for the physical and emotional needs oftheir children from before birth through the teen years. ✔Discipline provides guidance for children. ✔It is important for parents to be supportive of their children, especially during the teen years. ✔Because children learn from their parents, parents’ behavior greatly affects children.SECTION 2 parental responsibility (415) discipline (416) Copyright © by Holt, Rinehart and Winston. All rights reserved. 424 CHAPTER 17 Review CHAP TER 17 CHAP TER 17 CHAPTER 17Review Understanding Key Terms discipline (416) divorce (413) emotional intimacy (411) emotional maturity (411) extended family (420) family counseling (422) marriage (410) nuclear family (419) parental responsibility (415) sibling (419) 1.For each definition below, choose the key term that best matches the definition. a.the people who are outside the nuclear familybut are related to the nuclear family, such asaunts, uncles, grandparents, and cousins b.counseling discussions that are led by a third party to resolve conflict among familymembers c.a brother or sister related to another brother orsister by biology, marriage, or adoption d.teaching a child through correction, direction,rules, and reinforcement e.the duty of a parent to provide for the physical,financial, mental, and emotional needs of achild 2.Explain the relationship between the key terms ineach of the following pairs. a.divorce and marriage b.emotional maturity and emotional intimacy Understanding Key Ideas Section 1 3.Name two responsibilities of partners in ahealthy marriage. 4.The benefits of marriage include a.deep friendship. c.emotional intimacy. b.financial stability. d.All of the above 5.What is the purpose of premarital educationclasses? 6.Why is it important for individuals in a relation-ship to have realistic expectations of each other?7.Explain why it is difficult for teen marriages tosucceed. 8.Many marriages fail because of a.poor communication. b.lack of commitment. c.emotional immaturity. d.All of the above 9.Name four ways in which a t een can cope with a divorce or remarriage in the family. 10.CRITICAL THINKING Write one paragraph explaining why you think compromise plays such an important role in the success of a marriage. Section 2 11.Describe what is meant by the term parental responsibility. 12.The responsibilities of parents begin a.before their child’s birth. b.when their child can walk. c.after their child is born. d.during their child’s teen years. 13.Describe the responsibilities of a parent. 14.CRITICAL THINKING Describe traits a person should work on before becoming a parent. 15.CRITICAL THINKING Write two paragraphs on why you think parents’ behaviors have such a great effect on their children throughout the children’s lives. Section 3 16. What are two important things that family rela-tionships teach us? 17.Compare two different family structures. 18.List qualities that are necessary for a healthyfamily. 19.Explain how family counseling might help fami-lies experiencing conflict. 20.CRITICAL THINKING List three ways you could help make your family relationships healthier. LIFE LIFE SKILLWRITING SKILL WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 17 Review 425Interpreting Graphics Study the figure below to answer the questions that follow. 21.What percentage of households are made up of married couples who have children and in whichboth parents work outside the home? 22.CRITICAL THINKING Why do you think the households made up of married couples whohave children and in which only the husbandworks outside the home is the smallest category?Activities 23. Health and Your Community Imagine you are a counselor advising a man and a woman who are engaged to be married in 3 months. Write three questions that you feel willhelp them decide if their marriage will be healthy.State why these questions are important. 24. Health and Your Community Choose a television program that portrays a marriage, and watch theprogram. Answer the following questions aboutthe program: How is marriage portrayed? Do youagree or disagree with the show’s portrayal ofmarriage? Support your answers. 25. Health and You Write five positive character traits that you possess and that you believe willmake you a good parent. Then, explain why each trait is important to good parenting. Action Plan 26. Coping It is important for families to develop problem-solving skills. Devise a plan fora family to work out its problems.LIFE LIFE SKILL 27.In this passage, the word relent means to Aresist. Bstate your desires clearly. Cgive way under pressure. Dinsist on something. 28. What can you infer from reading this passage? EMarriage requires that spouses consider each other’s needs. FMarriage always interferes with your career plans. GParenthood reduces one’s chances of promotion. HThe reason that most couples stay married is that they live close to their families. 29.Write a paragraph that compares the benefits ofworking through difficulties in marriage.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Since Anne and Collin were married, Anne has wanted to move back to her home state.When they had a son, Anne went back towork to help pay bills. She loved her job, butCollin wanted her to stay home with thebaby. One day, Collin told Anne that he hadreceived a promotion. Anne knew the pro-motion meant they wouldn’t move and thatCollin might want her to quit her job. BothAnne and Collin told each other what theywanted. Then, each decided to relent . Collin took his promotion. They did not move back to Anne’s home state. However, Annerequested a flexible work schedule and wasable to keep her job. 31% 31%25%13% Married couple with children, both parentswork outside the home Other (ex: single-parent families, households headed by older adults) Married couple without children, both partnerswork outside the home Married couple with children, husband worksoutside the homeHouseholds by Type of Family Source: U.S Census Bureau.WRITING SKILL WRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. Copyright © by Holt, Rinehart and Winston. All rights reserved. 427CHAPTER 18 Reproduction, Pregnancy, andDevelopment CHAPTER 19 BuildingResponsibleRelationships CHAPTER 20 Risks of Adolescent Sexual Activity CHAPTER 21 HIV and AIDS UNIT 6UNIT 6UNIT 6 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 18 CHAP TER 18 CHAPTER 18 Repro duction, Pregnancy , and DevelopmentRepro duction, Pregnancy , and DevelopmentReproduction, Pregnancy, and Development 428KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Sperm are made in the vas deferens. 2.Both sperm and urine travel through a man’s urethra, although not at the same time. 3.Testicular cancer is most common among menwho are over the age of 50. 4.Estrogen is the primary hormone in males. 5.Eggs are made in the ovaries. 6.The uterus is the organ in which a fetus develops. 7.A woman produces several eggs every month. 8.Fertilization of the egg usually occurs in thefallopian tubes. 9.By the end of the sixth month of pregnancy, allthe baby’s major body structures are formed. Copyright © by Holt, Rinehart and Winston. All rights reserved. 429SECTION 1 Male Reproductive System SECTION 2 FemaleReproductiveSystem SECTION 3 Pregnancy andEarly Development go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH18. Copyright © by Holt, Rinehart and Winston. All rights reserved. 430 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentLance Armstrong raced through the Tour de France on the streets of Paris. He was minutes from winning his fourth victory. Winning the race 4 years in a row was special enough. Winning the race after recovering from testicular cancer was evenmore incredible! What the Male Reproductive System Does Maintaining good reproductive health is important to your totalhealth. Lance Armstrong first noticed something was wrong with hisreproductive health when he found a lump on his testicle. When hestarted to cough up blood, he went to the doctor. His cancer hadspread, but luckily, it was treatable. Armstrong learned how impor-tant it is to be aware of health problems that can occur and to knowhow to keep the reproductive system healthy. He went on to createthe Lance Armstrong Foundation for cancer research and awareness. The male reproductive system works to produce sperm and deliver it to the female reproductive system. are sex cells that are pro-duced by the male reproductive organs called the testes and that areneeded to fertilize an egg. or (singular, ovum ), are the sex cells that are produced by the female reproductive organs calledovaries. The process by which a sperm and an egg and their geneticmaterial join to create a new human life is called When a human sperm and egg combine, a new human being begins to grow. In most cases, about 9 months later, a mother givesbirth to her baby. The process of producing a new human is calledreproduction. fertilization.ova Eggs,SpermMale Reproductive SystemSECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES State the role of the male reproductive system. Describe the function of each of the organs of the male reproductive system. Summarize four problems that can occur with the male reproductive system.Listfive things a male can do to keep his reproductive system healthy. LIFE LIFE SKILLKEY TERMSKEY TERMS sperm the sex cell that is produced by the testes and that is needed to fertilize an egg egg (ovum) the sex cell that is produced by the ovaries and that can be fertilized by spermfertilization the process by which a sperm and an egg and their genetic material join to create a new human life testis (testicle) the male reproductive organ that makes sperm and testosteronepenis the male reproductive organ that removes urine from the body and that can deliver sperm to the female reproductive system semen a fluid made up of sperm and other secretions from the male reproductive organs Lance Armstrong survived testicular cancer and went on to win the Tour deFrance bike race several years in a row. Copyright © by Holt, Rinehart and Winston. All rights reserved. Vas deferens Urethra Penis Epididymis Bladder Prostate gland Bulbourethral(Cowper’s)gland ScrotumTestisSeminalvesicle SECTION 1 Male Reproductive System 431How the Male Reproductive System Works The male reproductive system is made up of internal and external organs. Figure 1 shows the organs of the male reproductive system. Testes The (singular, testis) are the male repro- ductive organs that make sperm and testosterone. At puberty andcontinuing throughout a male’s life, the testes produce several hun-dred million sperm each day. The sperm are made inside the testes intightly coiled tubules called seminiferous tubules. Testosterone is the major sex hormone of males. During puberty, testosterone causes facial and body hair to grow, the shoulders tobroaden, and the voice to deepen. Testosterone also influences spermproduction. The two testes rest in the scrotum, a skin-covered sac that hangs from the body. The small muscles in the scrotum move the testes closer orfarther from the body. This movement keeps the sperm a little coolerthan normal body temperature. Sperm cannot develop properly at thehigher temperatures of the inner body. Penis The is the male reproductive organ that removes urine from the male’s body and that can deliver sperm to the female repro-ductive system. The penis is made of soft tissue and blood vessels.During sexual activity, the penis becomes erect, or firm. The erectionoccurs as the blood vessels in the penis fill with blood. The penismust be erect during ejaculation (ee JAKyoo LAY shuhn). Ejaculation occurs when sperm are released from the penis after sexual excite-ment. It is also normal for males to ejaculate while they are sleeping.These ejaculations are called nocturnal emissions or “wet dreams.”penistestes (testicles)The male reproductive system produces and delivers sperm.1 Figure For more information about the excretory system, see the Express Lesson on pp. 540–541 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. Vas deferens Prostate glandBladder ScrotumTestisEpididymis Bulbourethral(Cowper's) glandRectumSeminalvesicle Anus UrethraPubic bone Penis www.scilinks.org/health Topic: Male Reproductive System HealthLinks code: HH4094 432 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentThe penis also provides a passage for urine to leave the body. Urine passes through the urethra, a tube that starts at the bladder and ends at the opening of the penis. Sperm also pass through the urethra during ejaculation, but not at the same time as urine is carried. The tip of the penis is covered by a sheath of skin called the foreskin. The foreskin is sometimes surgically removed shortly after birth in aprocedure called circumcision . The health advantage of circumcision is under debate. Some parents circumcise their infant for religious or cul-tural reasons. Many males are never circumcised. Epididymis and Vas Deferens From the testes, the sperm travel, as shown by the arrows in Figure 2. Sperm first travel into a tightly coiled tube called an epididymis (EPuh DID i mis), which is where sperm mature and are stored. The mature sperm in each epi-didymis then move into a long tube called the vas deferens . As sperm travel through the vas deferens, they mix with fluids made by threeaccessory reproductive organs—the seminal vesicles, the prostategland, and the bulbourethral glands. The mixture of sperm and othersecretions from the male reproductive organs is a fluid known as Semen leaves the male body by passing through the urethra. Seminal Vesicles The seminal vesicles are found near the base of the urinary bladder. They produce thick secretions that nourish thesperm and help sperm move easier. Prostate Gland The prostate gland encircles the urethra near the bladder. The prostate gland secretes a thin, milky fluid that protectsthe sperm from acid in the female reproductive system. Bulbourethral (Cowper’s) Glands The bulbourethral (buhl boh yoo REE thruhl), or Cowper’s, glands are found near the urethra below the prostate. Prior to ejaculation, this gland secretes a clear fluid thatprotects the sperm from acid in the male urethra.semen. As sperm (photo inset) mature, they move (shown by black arrows) throughthe reproductive system and mix withfluids from several accessory organs. ACTIVITY Summarize the path that sperm take from the testes to the outside of the body.2 FigureSperm Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Male Reproductive System 433Problems of the Male Reproductive System Good hygiene and preventive healthcare are important for maintain- ing reproductive health. However, even with good care, problemswith the male reproductive system can occur. Some of these problemsare described in Table 1. Problem Jock itch Cystitis (bladder infection) Prostatitis Inguinal hernia Testicular torsion Undescended testes Prostate cancer Testicular cancerWhat is it? >fungal infection of groin area; exposure to mois-ture and heat increasesthe risk of jock itch >inflammation of the uri-nary bladder; usually dueto a bacterial infection >bacterial infection of theprostate; may be relatedto a sexually transmitteddisease >bulging of portion of theintestines or other struc-ture through a weaknessin the abdominal wall >twisting of a testis on thenerves and blood vesselsattached to it; can hap-pen during athletic orother physical activities >failure of one or bothtestes to move from theabdomen to the scrotumduring fetal development >abnormal division of cellsin the prostate; may behereditary >abnormal division of cellsin the testes; may behereditarySymptoms >itchy rash in groin >inflammation of the blad- der, burning during uri-nation, blood in urine,strong-smelling urine,and fever >inflammation of theprostate, fever, pain inthe pelvis, abdomen,testes, or lower back, anddiscomfort with urination >abnormal bulge in theabdomen, groin, or scro-tum; can cause a sense ofheaviness, fullness, or pain >elevation of a testis,swelling and tendernessof the scrotum, or abdom-inal pain accompanied bynausea or vomiting >one or no testes in thescrotum >difficulty urinating ordefecating, burning dur-ing urination, or blood inurine >lump on testes, enlarge-ment of testes, or senseof heaviness or fullnessin the scrotumTreatment >keeping area cool and dry; over-the-counterantifungal creams >antibiotics prescribed bya doctor >antibiotics prescribed bya doctor >immediate medical care;surgery >immediate medical care;surgical removal of theaffected testis may benecessary if not treatedimmediately >surgery or hormonetherapy >surgery, radiation,and/or chemotherapy >surgery, radiation,and/or chemotherapy Table 1 Problems of the Male Reproductive System Testicular cancer cells Copyright © by Holt, Rinehart and Winston. All rights reserved. 434 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentKeeping the Male Reproductive System Healthy Protecting your reproductive health is important because your reproduc- tive health is an essential part of your total health. Decisions you makeand actions you take now can affect your health in the years ahead. Preventing Problems Males should watch for any changes or symptoms that might indicate a problem. If symptoms of any prob-lem are present, see a doctor right away. In many cases, prompt care isthe key to avoiding future problems. Here are

specific ways to preventsome problems. >Preventing sexually transmitted diseases Some male reproduc- tive infections are transmitted by sexual activity. Chapters 19and 20 discuss the prevention and treatment of STDs. >Preventing jock itch Jock itch is a fungal infection that occurs in a male’s groin area. Males who are physically active in hotand humid locations may be more likely to get jock itch.Males can usually prevent jock itch by wearing cotton clothingand by drying themselves thoroughly after a shower. It is alsoimportant to avoid wearing damp clothes for too long and toavoid sharing towels or clothes with others. >Preventing trauma Trauma refers to injuries that are due to an external force, such as being hit in the genitals. Such injuriescan happen while playing sports, from car or bicycle accidents,or during “horseplay” with friends. One way to reduce the riskof traumatic injuries to the testes is to wear protective gear (a“cup”) when playing sports. >Preventing hernias A hernia happens when a piece of the intestine bulges into a weak place in the wall of the abdomen or groin. Her-nias often appear when abdominal pressure is increased by strain-ing to lift or push something heavy. It can also appear whencoughing or sneezing. Doctors check for signs of a hernia by feel-ing for bulges in the groin while a male coughs. One way formales to prevent hernias is to avoid strenuous lifting. For example,use your knees, and not your back, when lifting heavy objects. >Preventing infertility Male infertility is the inability to fertilize an egg. Infertility can be genetic, but can also be caused byenvironmental conditions such as heat and trauma to thetestes area. A young male can protect his fertility by avoidinginjury to the genitals. Males should also avoid hot tempera-tures in the testes, which can lead to low sperm counts. Early Detection of Testicular Cancer Testicular cancer is a dis- ease that can occur in young men. In fact, testicular cancer is the mostcommon cancer in males between the ages of 15 and 35. A man isparticularly at risk for testicular cancer if he had undescended testesas a child, or if testicular cancer runs in his family. However, ifdetected early, testicular cancer can be treated very effectively. Six Ways to Keep Healthy 1Wear appropriate protective gear (a “cup”) when playingcontact sports. 2Avoid wearing tight clothing. 3Wash the penis and scrotumevery day, and dry yourselfcarefully after showering. 4If you are not circumcised,wash underneath the foreskin. 5Perform a monthly testicularself-exam. 6Have an annual checkup with adoctor. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Male Reproductive System 435All males who have reached puberty should do routine testicular self-examinations about once per month. Males should also have an annual checkup by a doctor. Talk with a doctor or other healthcareprovider to find out how to perform the exam correctly. Here is abrief summary of how to perform a testicular self-exam: 1.Perform the self-exam during or after a warm bath or shower,when the skin of the scrotum is relaxed. 2.Stand in front of a mirror, and hold the penis out of the way. 3.Examine each testicle separately. Hold each testicle between thethumbs and fingers with both hands, and roll each testicle gentlybetween the fingers. 4.Look and feel for any lumps or any change in the size, shape, orconsistency of the testicle. 5.Contact your doctor if you detect any troublesome signs. Males should be aware of the signs for testicular cancer even if it does not run in his family. However, do not confuse lumps with blood vessels, supporting tissues, and tubes that carry sperm. Look forunusual lumps, swelling, or a feeling of heaviness, pain, and discom-fort in your scrotum or abdomen. If you notice any of these signs orhave any doubts, tell your parents and see a doctor right away. Early Detection of Prostate Cancer Prostate cancer occurs pri- marily in older males. When men become older, testosterone can causethe prostate gland to enlarge. The gland can enlarge in either a cancer-ous or a noncancerous fashion. Prostate cancer can be found early dur-ing a physical examination or blood test given by a doctor. Treatment ismore effective when prostate cancer is detected early. Males shouldn’twait until it’s too late. Delaying treatment can be deadly. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “the sex cell that is produced by the testes and that is needed to fertilize an egg.” 2.Define the term testis . Understanding Key Ideas 3.State the functions of the male reproductive system. 4.Identify one of the functions of the penis. a.delivers sperm to the female b.makes sperm more mobile c.carries sperm to the epididymis d.produces and stores sperm5.Order the path of the sperm through the following male reproductive organs: penis, urethra, vas deferens, testes, and epididymis. 6.Compare the symptoms of testicular cancer with those of inguinal hernia. 7. Practicing Wellness List five things a male can do to keep his reproductive systemhealthy. Critical Thinking 8.Why do you think the male reproductive system produces so many sperm cells? 9.How might the male reproductive system beaffected if the seminal vesicles did not function?LIFE LIFE SKILL “My dad survivedprostate cancer because his dad taught him the symptoms of the disease. I am going to make sure I stay healthy, too.” Copyright © by Holt, Rinehart and Winston. All rights reserved. 436 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentFemale Reproductive SystemSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Ann Curry was scared when she found out her sister had breast cancer. This was the first case of cancer in her family. Ms. Curry, a TV news anchor, helped her sister fight the cancer. Then she became dedicated to the fight against breast cancer. A sis- ter’s love is saving thousands of lives! What the Female Reproductive System Does Keeping your reproductive system healthy is important for your totalhealth. Ann Curry began spreading the message about the impor-tance of maintaining good reproductive health after her sister’s battlewith and recovery from breast cancer. She often reports about breastcancer. Ms. Curry is involved with the Susan G. Komen Breast CancerFoundation to support the fight against breast cancer. Ms. Curry hasalso appeared in public service announcements about the impor-tance of early detection of breast cancer. She continues to empowerwomen and their families with the knowledge that they need to pro-tect their reproductive health. So, how can you maintain good reproductive health? You should learn about how the reproductive system works. Another importantpart of maintaining good reproductive health is being aware of possi-ble problems that can occur. You should also know important skillsfor keeping your reproductive system healthy. Like the male reproductive system, the female reproductive sys- tem is well suited for reproduction. The function of the female repro-ductive system is to make eggs and to provide a place to support and nourish a developing human. OBJECTIVES State the role of the female reproductive system. Describe the function of each of the organs of the female reproduc- tive system. Describe the changes in the body during the menstrual cycle. Summarize four problems that can occur with the female reproduc- tive system.Listfive things a female can do to keep her reproductive system healthy. LIFE LIFE SKILLKEY TERMSKEY TERMS ovary the female reproductive organ that produces eggs and the hormones estrogen and progesterone vagina the female reproductive organ that con- nects the outside of the body to the uterus and that receives sperm during reproduction fallopian tube the female reproductive organ that transports an egg from the ovary to the uterus uterus the female reproductive organ that provides a place to support a developing humanmenstrual cycle a monthly series of hormone- controlled changes that prepare the uterine lining for a pregnancy Ann Curry, a news anchor and breast cancer awareness activist, carries theOlympic torch in Rockefeller Center,New York. Copyright © by Holt, Rinehart and Winston. All rights reserved. Uterus Cervix RectumOvary Bladder Urethra VaginaFallopian tube AnusPubic bone SECTION 2 Female Reproductive System 437How the Female Reproductive System Works The female reproductive system is made up of several internal and external organs. Figure 3 shows the primary organs of the female reproductive system. Although breasts are not directly involved inproducing a human life, they are considered secondary reproductiveorgans because they produce milk for the child. Ovaries The two ovaries are found deep in the pelvic area. The (singular, ovary ) are the female reproductive organs that pro- duce eggs and the hormones estrogen and progesterone. Recall thateggs (ova) are the sex cells that are produced by the ovaries and thatcan be fertilized by sperm. All of the eggs that a female will ever haveare in her two ovaries when she is born. The ovaries make the hormones estrogen and progesterone. Dur- ing puberty, estrogen causes the reproductive organs to mature intotheir adult shape and size. Estrogen also causes the growth of pubicand underarm hair and helps strengthen the bones. Both estrogenand progesterone regulate the monthly release of an egg and preparethe body for a pregnancy. Vagina The is the female reproductive organ that connects the outside of the body to the uterus and that receives sperm duringreproduction. This tubular organ runs from the lower end of theuterus to the outside of the body. In addition to functioning in repro-duction, the vagina allows menstrual flow to exit the body. Thevagina is also part of the birth canal through which a baby is deliv-ered. Above and separate from the vagina is a tube called the urethra, which carries urine from the bladder to the outside of the body. vaginaovariesThe female reproductive system produces eggs and supports a developing human.3 Figure For more information about hormones, see the Express Lesson on pp. 545–547 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Female Reproductive System HealthLinks code: HH4060 438 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentFallopian Tubes and Uterus From the ovaries, the egg travels into the fallopian tube, as shown by the black arrows in Figure 4. The are the female reproductive organs that transport an egg from the ovary to the uterus. The is the female reproduc- tive organ that provides a place to support a developing human. It isa muscular cavity (the size of a fist) found at the top of the vagina andbetween the bladder and rectum. The uterus meets the vagina at itslower end, called the cervix . How the Menstrual Cycle Works The menstrual cycle occurs in most females from puberty tomenopause. The is a monthly series of hormone-controlled changes that prepare the uterine lining for a pregnancy. The menstrual cycle, shown in Figure 5, is a complex combination of hormonal and physical changes in the body. Increasing levels of two hormones (follicle stimulating hormone [FSH] andluteinizing hormone [LH]) cause the maturation and release of anegg. The release of an egg from a follicle in the ovary is called ovulation . Prior to ovulation, increasing levels of estrogen cause the uterine lin-ing to thicken. This lining nourishes and supports the growing humanduring a pregnancy. Following ovulation, high levels of estrogen andprogesterone further thicken and maintain the uterine lining. If pregnancy does not occur (the egg is not fertilized), estrogen and progesterone levels quickly fall. Menstruation, or the breakdown and discharge of the uterine lining out of the vagina, then occurs. Duringthis time, females use sanitary napkins or tampons to absorb the bloodand tissue released during menstruation. Menstruation usually lastsbetween 3 and 7 d ays. menstrual cycleuterusfallopian tubes During ovulation, the egg (photo inset) is released from the ovary and travelsthrough the female reproductive sys-tem, as shown by the black arrows. ACTIVITY Summarize the path that an egg takes from the ovary to the uterus.4 Figure VaginaCervixUterusFallopian tube Egg Ovary Egg Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Female Reproductive System 439The Menstrual Cycle Can Vary The average menstrual cycle lasts 28 days. However, this length can vary from one individual to another and from month to month. Ovulation usually occurs on the14th day of the cycle. Environmental factors, such as stress, diet,travel, exercise, weight gain or loss, and illness, can influence the timing of a female’s cycle. It is important for a female to check withher healthcare professional if she has any questions about irregularityin her menstrual cycle. Menstruation Ovulation yDay Menstruation, ovulation, and thickening of the uterine lining, are the events thatmake up the menstrual cycle.5 Figure Analyzin gDA TA Analyzing DATA Menstrual Cycle Hormones The horizontal ( x) axis shows the independent variable, Day of cycle. The vertical ( y) axis shows the dependent variable, Hormone level . Each line shows the level of a hormone at each day in the cycle.321 Estrogen Luteinizing hormone (LH) ProgesteroneFollicle-stimulating hormone (FSH) 02468 1 0 1 2 1 4 Ovulation Menstruation16 18 20 22 24 26 28 Day of cycle Hormonal Changes During the Menstrual Cycle Hormone level Source: Clinical Gynecologic Endocrinology and Infertility.123Your Turn 1.Which day of the cycle has the largest rise in estrogenlevels? 2.On what day is the eggreleased from the ovary? 3. CRITICAL THINKING Why do you think luteinizinghormone reaches its highestlevel around day 14? Copyright © by Holt, Rinehart and Winston. All rights reserved. 440 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentProblems of the Female Reproductive System Table 2 describes some problems and conditions of the female repro- ductive system. Problem Cystitis (bladder infection) Vaginitis Delayed puberty (amenorrhea) Menstrual crampsPremenstrual syndrome(PMS) Toxic shock syndrome(TSS) Endometriosis Ovarian cyst Cervical cancerWhat is it? >inflammation of the uri- nary bladder; usually dueto a bacterial infection >vaginal infection by fun- gus, bacteria, or protozoa;may also be from an STD >late puberty due toanorexia, endocrineproblems, excessiveweight loss, and/oroverexercise >cramps due toprostaglandin (hormone-like substance) produc-tion during menstruation >mental and physicalchanges related to men-strual cycle, but not com-pletely understood >poisoning of body frombacteria in vagina; oftenrelated to tampon use >growth of tissue fromuterine lining outside theuterus >failure of follicle in ovaryto rupture and release anegg; may also be fromgrowths or cancer >abnormal division of cellsin the cervix; may also befrom an STDSymptoms >burning during urination, strong-smelling urine,fever, or blood in urine >irritation or itching aroundthe vagina, vaginal secre-tions of unusual colorand/or unpleasant odor >no breast developmentand/or no menstrual periods >contractions of uterinemuscles, lower abdominalpain, and occasional nau-sea and vomiting >irritability, mood swings,depression, abdominalbloating, and breasttenderness >fever, chills, weakness,and rash on palms ofhands >severe cramping and painin lower abdominal areaor pelvis >pain in lower abdomen orpelvis for a month >vaginal bleeding, dis-charge, or pelvic pain;may not be any symptomsTreatment >antibiotics prescribed by a doctor >over-the-counter vaginalcream or medicationprescribed by a doctor >determined by a doctor >over-the-counter medica-tions and a warm bath;further treatment pro-vided by a doctor >determined by a doctor >antibiotics and immedi-ate medical treatment >determined by a doctor;hormone therapy orsurgery may be required >determined by a doctor;cysts often go away ontheir own but sometimesrequire surgery >surgery, radiation,and/or chemotherapy Table 2 Problems of the Female Reproductive System A dividing cervical cancer cell Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Female Reproductive System 441Keeping the Female Reproductive System Healthy Most healthy teenage females do not have any major problems with their reproductive system. But it is important to be on the lookout forany problems that may arise. Preventing Problems Females can protect their reproductive health with good hygiene, self-examinations, and regular visits to thedoctor. Here are some other specific ways to prevent problems: >Preventing sexually transmitted diseases Some female repro- ductive infections are transmitted by sexual activity. Chapters19 and 20 discuss the prevention and treatment of STDs. >Preventing vaginal irritation One common problem that is confused with vaginitis is vaginal irritation. Vaginal irritation is redness, itching, or mild pain around the opening of thevagina. However, unlike vaginitis, no vaginal discharge is pres-ent. A female can reduce the chance of irritation by wearingloose cotton underclothes. Washing underclothes in mild,unscented soap, and avoiding soaps, toilet paper, and femi-nine products that are scented also help reduce the chance ofirritation. Finally, avoid wearing pantyhose, tight jeans, or wetclothes for long periods of time. >Relieving menstrual cramps Some females have cramps before or during a menstrual period. Menstrual cramps are cramps caused by contractions of the uterine muscles. Many over-the-counter, anti-inflammatory medicines are available for thetemporary relief of menstrual cramps. Taking a warm bath, eat-ing a balanced diet, exercising regularly, and reducing caffeineand sugar intake may also help reduce cramps. Females shouldsee a doctor if cramps become very painful. >Preventing infertility Infertility , the inability to get pregnant, is a problem that occurs in some females. Infertility may begenetic. However, endometriosis and STDs can also lead toinfertility. Women can protect their future ability to have chil-dren by preventing STDs. Annual Pelvic Exam Females should have an annual pelvic exam with a doctor. A doctor can find problems that females may not beable to detect. The annual exam includes a breast and genital exam,and a Pap smear. A Pap smear examines the cells of the cervix. A Pap smear is important for detecting and preventing cervical cancer. Cer-vical cancer rates are higher among older women. However, this can-cer is on the rise in younger women due to certain STDs and the lackof regular screening with a Pap test. Ovarian cancer can also be detected during an annual exam, but it is difficult to find in the early stages of the disease. Ovarian canceris usually discovered late in its development during a physical exami-nation. Ovarian cancer occurs primarily in older women and may behereditary. Seven Ways to Keep Healthy 1Exercise regularly, and maintain a balanced diet. 2Gently wash the genital areaevery day with warm water andmild soap. Do not use femininehygiene sprays and powders. 3Wipe the vaginal opening fromfront to back after urination. 4Change sanitary napkins ortampons every 4 to 6 hourswhen menstruating. 5Avoid wearing tight clothing thatcan cause discomfort. 6Have an annual pelvic exam witha doctor. 7Do a breast self-exam eachmonth. Copyright © by Holt, Rinehart and Winston. All rights reserved. 442 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentEarly Detection of Breast Cancer Breast cancer is a disease that occurs primarily in older women. In fact, over 77 percent of the cases occur in women who are over the age of 50. However, females of anyage (and some males too) can get breast cancer. Females are at riskfor breast cancer if the disease runs in their family. Yet many womenwho do not have a family history of the disease get breast cancer. The good news is breast cancer can often be treated effectively if it is detected early. A mammogram test usually detects breast cancer.Women should also have their breasts checked annually by a doctor.Another way to check for breast cancer is to do a breast self-examina-tion (BSE) each month. To find out how to perform a BSE correctly,talk with a doctor. Here is a brief summary of how to perform a BSE: 1.Perform the BSE during or after a warm bath or shower, and atleast 1 week after a menstrual period. 2.Stand in front of a mirror. Place one hand over your head and usethe other hand to examine each breast separately. 3.Use your thumb and index finger to gently squeeze each nippleand look for any unusual discharge. 4.Check each breast for swelling, dimpling, or scaliness. 5.Use three or four fingers to feel each breast for unusual lumps orthickening under the skin. Check under the armpits and betweenthe armpits and breasts, too. Lumps, called cysts, may occur in breast tissue. Most cysts are noncancerous and do not need to be removed. Also, most breasts contain normal lumps. Be aware of any changes in your breasts frommonth to month. If you detect any signs or have any doubts, tell yourparents and contact your doctor. Recognizing breast cancer early isimportant. It could save your life! REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term ovaries . 2.Identify the term for “the female reproductive organ that provides a place to support a developing human.” Understanding Key Ideas 3.Describe the role of the female reproductive system. 4.Identify the female reproductive organ that trans- port eggs from the ovary to the uterus. a.ovary c.fallopian tube b.uterus d.urethra 5.Summarize the path of the egg through the female reproductive system.6.Describe the changes that occur in the female reproductive organs during the menstrual cycle. 7.Compare the symptoms of the female reproduc- tive problems, menstrual cramps and vaginitis. 8. Practicing Wellness List five things a female can do to keep her reproductive system healthy. Critical Thinking 9.What should a girl do if she has severe menstrualcramps? 10.What do you think happens to the ovulated egg ifit is not fertilized by a sperm?LIFE LIFE SKILL A mammogram is a procedure for detecting breast cancer that is veryimportant for women over the age of 40or anyone who has symptoms. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Pregnancy and Early Development 443Pregnancy and Early Development SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 How extraordinary it is that the female body can support the growth of a new human life. Isn’t it amazing that one of themost complex and important events of your life took place inside your mother’s body? How Life Begins Life begins with the union of an egg from a female and a sperm froma male. Fertilization (conception) , or joining of the sperm and egg, can occur because of sexual intercourse. is the repro-ductive process in which the penis is inserted into the vagina andthrough which a new human life may begin. During sexual inter-course, the penis can deliver millions of sperm to the female. Fertilization From the vagina sperm travel through the uterus and into the fallopian tubes, where fertilization normally occurs. Only asmall fraction of the sperm complete the journey to the egg. How-ever, it takes only one sperm to fertilize an egg. Once a sperm penetrates the egg, a chemical change prevents other sperm from entering the egg. The genetic material of the eggand sperm combine to form one cell, called a zygote . Genes play an important role in the development of a human. In fact, all of thegenetic information needed to create a human is found in the zygote. The Fertilized Egg Divides The zygote travels down the woman’s fallopian tube toward her uterus. The journey takes about 3to 5 days. As the zygote moves down the fallopian tube, it dividesinto two cells, then into four cells, and then into a ball of many cells. Sexual intercourseOBJECTIVES Describe how a human life begins. Summarize how a baby develops during the three trimesters of pregnancy. Identify five things a couple can do to stay healthy before and during pregnancy.Summarize four problems that can occur during pregnancy. Describe the stages of childbirth. Listthree changes that occur during early child development.KEY TERMSKEY TERMS sexual intercourse the reproductive process in which the penis is inserted into the vagina and through which a new human life may begin embryo a developing human, from fertilization through the first 8 weeks of developmentplacenta a blood vessel–rich organ that forms in a mother’s uterus and that provides nutrients and oxygen to and removes wastes from a devel-oping human fetus a developing human, from the start of the ninth week of pregnancy until deliveryprenatal care the healthcare provided for a woman during her pregnancy A sperm is about to penetrate the egg during fertilization. Notice the differ-ence in size between the sperm andegg. Copyright © by Holt, Rinehart and Winston. All rights reserved. 444 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentThe Embryo Implants in the Uterus A developing human from fertilization through the first 8 weeks of development is called an The embryo travels from the fallopian tube into the uterus. Within 3 to 5 days, this ball of hundreds of cells becomes embedded in the uterine

wall. This event is called implantation . Once implanta- tion of the embryo happens, the female is considered to be pregnant.The uterus will be the embryo’s home until the baby is born. A Placenta Supports the Baby The baby’s growth in the uterus is dependent on a placenta. The is a blood vessel–rich organ that forms in a mother’s uterus and that provides nutrients and oxygento and removes wastes from a developing human. Most substances,including drugs and alcohol, can pass through the placenta into thebaby. If a mother eats, injects, or inhales anything harmful, her baby canbe affected. How a Baby Develops The growth of a baby is a fascinating process. What begins as one celldevelops into a baby made of trillions of cells over a 38 to 40 weekperiod. Figure 6 summarizes some of the developmental changes in the growing baby. First Trimester The first trimester , or first 3 months, is a major time of growth and change. After implantation, the embryo startsgrowing rapidly. By the fourth week of development, the heart startsbeating, arm and leg buds appear, and the eyes and brain begin todevelop. The embryo is less than a fourth of an inch long, or aboutthe size of a BB pellet. Surrounding the embryo is a thin, fluid-filled membrane called the amnion . The amnion protects the growing embryo. The umbilical cord is another new development. It connects the embryo to the placenta. The term for a developing human from the start of the ninthplacentaembryo. 4 Early Signs of Pregnancy 1A missed menstrual period; often feels like a period is about tostart 2Positive urine or blood test forhuman chorionic gonadotropinhormone (HCG) 3Tenderness and enlargement ofthe breasts and darkening of thenipples 4Nausea (“morning sickness”)and fatigue “A missed menstrual period is a sure sign of pregnancy. ” “It takes the entire 38 to 40 weeks for the major structures in a growing baby to develop. ” “Drugs cannot cross the placenta into the baby during pregnancy. ” “Pregnant women do not have to visit the doctor until the last 3 months of pregnancy. ”It is common for women to have irregular periods. A woman is not necessarily pregnant if shemisses a period. By the end of the first 3 months, all of the baby’s major body structures have formed. Most drugs can cross the placenta into the baby’s body. Regular doctor visits from the first sign of pregnancy are necessary to ensure the mother’s and baby’s health.Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. www.scilinks.org/health Topic: Growth and Development HealthLinks code: HH4070 SECTION 3 Pregnancy and Early Development 445week of pregnancy until delivery is Brain waves can be detected and muscle movement begins in the fetus. The bones and muscles aredeveloping. By the end of the first trimester, all of the major bodyparts, such as the heart, brain, lungs, eyes, arms, and legs, haveformed. The most critical development is complete. However, not allparts can function fully. Second Trimester The second trimester , or months 4 through 6, is a time when the organ systems continue to develop. By 4 months, themother can feel the fetus move or “kick.” The reproductive organs canbe recognized as distinctly male or female. By the end of thistrimester, the fetus can hear and recognize voices. Hair forms on thebody. Head and facial features become apparent, and fingers and toesgrow nails. Although development is not complete, a fetus born pre-maturely at the end of this trimester may be able to survive with med-ical assistance and support. Third Trimester The third trimester , or months 7 through 9, is a time when the fetus gains most of its weight. A fetus requires a lot ofnutrients from the mother. A large percent of the iron and calcium inthe mother’s food will be delivered to the growing fetus. By 8months, most fetuses are about 20 inches long. The brain developsfurther, and all other organs are almost complete. The fetus can evengrasp with his or her hands. Fat deposited underneath the skin makesthe fetus’s skin become very smooth. By the end of 36 weeks, thefetus is almost ready to live outside the mother’s body. However, thefetus’ nervous system will continue to develop after birth.fetus. Development of the Fetus First trimester At 6 weeks the embryo is almost aninch long. Eyelids and ears are form-ing. Even the tip of the nose can beseen.Third trimesterAt 32 weeks the fetus is about 20inches long and weighs almost 5pounds. A layer of fat forms under-neath the skin. The fetus can prac-tice opening his or her eyes.Second trimesterAt 16 weeks the fetus is 5 to 6 incheslong and weighs about 5 ounces.The fetus can yawn, stretch, andeven make facial expressions. The fetus steadily grows and developsthroughout the 38 to 40 weeks of pregnancy. 6 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. Keeping Healthy Before and During Pregnancy Preparing for a pregnancy can help reduce the chance of problems during pregnancy. Both parents should support each other in leadinga healthy life. The baby’s health is affected by the parents’ healthbefore and during pregnancy. For example, sperm and eggs are suscep- tible to damage by environmental toxins, such as lead. Here are some tips pregnant women can follow: 1. Avoid alcohol and other drugs (including caffeine and tobacco), and exposure to cigarette smoke. Alcohol can interrupt the fetus’ brain development. Smoking while pregnant can lead to miscarriage, sud-den infant death syndrome (SIDS), premature birth, and low birthweight. 2. Maintain a nutritious diet that follows the Food Guide Pyramid and eat regular meals. A pregnant woman needs up to 450 extra Calories a day, but she should not eat for two people. Consult ahealthcare provider about how to make those Calories count. 3. Take prenatal vitamins, prescribed by a healthcare provider, before and throughout a pregnancy. A very important element in a prenatal vitamin is folic acid(folate). Taking folate has been found to reduce thechance of birth defects in the baby. 4. Get regular, moderate levels of exercise, if approved by a doctor. Exercise improves circulation, prevents excessive weight gain during pregnancy, and prepares amother for labor. However, do not overexercise duringpregnancy, and avoid injury. 5. Have all medical conditions evaluated by a doctor early in the pregnancy. Pregnant women are routinely tested for diseases such as STDs, HIV, diabetes, andrubella (German measles). If a woman is not immuneto rubella, she should be vaccinated before pregnancy.Rubella can lead to heart defects and mental retarda-tion in a child. Also, illnesses such as STDs, HIV, orhereditary diseases in either parent, can hurt a fetus. Prenatal Care During Pregnancy A pregnant woman should visit a doctor on a regular basis throughoutpregnancy. The healthcare provided for a woman duringher pregnancy is called The visits help makesure that the mother and baby are healthy, and provideeducation about fetal growth. The father can play an activerole in a pregnancy by going to all doctor visits. During the first visit, the doctor will do a complete physical examination. This includes blood tests and a dis-cussion of childbirth options. Thereafter, prenatal visitsshould take place at least every 3 to 4 weeks.prenatal care. Moderate exercise, if approved by a doctor, is good for pregnant women.Here are some other ways a womancan stay healthy before and during her pregnancy. Take 0.4 to 0.8 milligrams of folate per day. Eat regular meals, and do not fast. Avoid tobacco, alcohol, and other drugs. Have regular checkups with a healthcare provider. 446 CHAPTER 18 Reproduction, Pregnancy, and Development Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Pregnancy and Early Development 447Some of the routine procedures that are done during prenatal visits are blood pressure, weight, urine, and fetal heartbeat checks. The doctor will be on the lookout for any problems. Several tests also helpprovide information on the health of the baby. An ultrasound uses sound waves to draw pictures of a baby on a monitoring screen. Thistest can be used to determine if the baby is a boy or girl, how manybabies there are, and whether the baby is growing in a healthy way.Amniocentesis tests the amniotic fluid to detect any genetic problems. Problems During Pregnancy Even with the best of prenatal care, problems such as those listed in Table 3 can occur during pregnancy. Problem Fetal alcohol syndrome (FAS) Miscarriage (spontaneous abortion) Ectopic (tubal) pregnancy Toxemia (preeclampsia) Gestational diabetes Rh incompatibility Premature birthWhat is it? >a set of birth defects that affect a fetus that hasbeen exposed to alcoholduring pregnancy >death of fetus from natural complicationsbefore the 20th week ofpregnancy >implantation of thefertilized egg in thefallopian tube >medical problem withunknown cause, but com-mon in pregnant teens;may be related to the placenta or hormones >diabetes during pregnancy >a condition in whichmother’s immune systemreacts against the fetus’sblood due to an incompat-ibility in blood cell type >early birth of baby due toabnormal uterus, bleedingbehind placenta, STD, mul-tiple pregnancy, or othercausesSymptoms >physical and mental problems, such as mentalretardation, growth defi-ciency, and hyperactivityin newborn baby >vaginal bleeding or preg- nancy tissue expelledfrom uterus >abdominal pain early inthe pregnancy, weak-ness, and faintness >swelling of face andankles, high blood pres-sure, and protein in urineof mother; convulsions ifsevere >high blood sugar levels inmother >anemia (low red bloodcell count) in fetus orfetal death >delivery of baby before38th weekTreatment or prevention >none; prevented by a woman completelyavoiding alcohol duringher pregnancy >treatment determined by a doctor >surgery or medicaltreatment is requiredimmediately >medications, frequentcheckups, and, in somecases, early delivery ofbaby; may be preventedwith good prenatal care >change in diet, medica-tion, and, in some cases,early delivery of baby >immunization of motherbefore and after preg-nancy prevents this condition; monitoring ofhealth of fetus >good postnatal care inhospital’s premature babynursery Table 3 Problems During Pregnancy A young boy with fetal alcohol syndrome Copyright © by Holt, Rinehart and Winston. All rights reserved. 448 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentStages of Childbirth Childbirth begins with the onset of labor and goes through three stages, as shown in Figure 7. Contractions, or tightening of the uter- ine muscles, are the major sign of the onset of labor . The contractions feel like a bad cramp, which is why mothers call them “labor pains.”The contractions help push the baby out of the uterus and throughthe vagina for delivery of the baby. Dilation In the first stage of birth, called dilation , the uterus con- tracts, which causes the cervix to dilate or open up. The membranessurrounding the baby rupture. At this point, the mother’s “waterbreaks”—the amniotic fluid surrounding the baby is released out ofthe vagina. The baby’s head begins to push into the birth canal. Thecervix and vagina have to dilate enough for the head and body of thebaby to pass through it. The first stage ends when the cervix is fullydilated to 10 centimeters. Expulsion During the second stage, called expulsion , the baby’s head emerges fully and the shoulders rotate. An episiotomy may bedone at this stage. An episiotomy is a surgical incision of the outer end of the vagina to allow more room for delivery of the baby. The secondstage ends with delivery of the baby. Placental The third, or placental, stage begins after the delivery of the baby and ends when the uterus expels the placenta (or “after-birth”) and umbilical cord out of the mother’s body. After the baby is Childbirth begins with the onset of labor and goes through three stages.7 Figure Before childbirth The fetus usually drops to a lower position in the mother’s uterus about 1 month before childbirth.First stage: Dilation During the dilation stage, the mother’s cervix dilates and themembranes surrounding the baby rupture. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Pregnancy and Early Development 449 Third stage: Placental During the placen- tal stage, the placenta and the umbilical cord are expelled after the baby is born.Second stage: Expulsion During the expul- sion stage, the baby’s head emerges from thebirth canal (vagina) and the shoulders rotate.born, the doctor suctions mucus from the baby’s mouth so the baby can breathe. The umbilical cord is tied and cut. Then, both the babyand mother are checked for signs of problems. After birth, the mother may breast-feed her baby immediately if the baby is not ill. Most doctors recommend breast-feeding becausebreast milk provides all of the nutrients an infant needs and helpsprotect the baby from infections and stomach problems. Breast-feed-ing also helps establish the bond between a mother and her baby.However, some mothers prefer to bottle-feed their baby. Types of Childbirth The doctor and parents decide at the time of birth what type of birth is best for keeping the mother and her babyhealthy. Most mothers can deliver a baby naturally through thevagina. This type of delivery is called natural childbirth . Sometimes, for health reasons, a woman cannot safely have a vaginal delivery. The baby is then delivered by Cesarean section , or C-section . A C-section is a type of childbirth in which the baby and placenta are carefully lifted out of the mother’s body by surgery. Inthis procedure, an incision is made in the mother’s lower abdomenand then into the uterus. The baby is then lifted out. There are manyreasons that a baby would be born by C-section. A C-section is oftenperformed if a baby is under stress inside the uterus. For example,babies may not be in the correct position, with the baby coming “rearend” first ( breech birth ). Another reason for a C-section is if a baby is too large to fit through the birth canal. Copyright © by Holt, Rinehart and Winston. All rights reserved. 450 CHAPTER 18 Reproduction, Pregnancy, and DevelopmentEarly Child Development The fastest period of growth after birth takes place from birth to the age of one. By 2 months, a baby will spend several hours a day awakebut mostly sleeps. Babies can raise their head at this age because ofgood neck control. Babies also begin smiling at faces they recognize. At 4 months, babies are rolling from front to back, making “cooing” sounds, smiling, and spending more time awake. Their feeding sched-ules become more regular, and many babies can sleep through the night. By 6 months, babies can sit up and have excellent head control. Most babies will crawl at 9 months and begin walking and talking by1 year. The nervous system undergoes extraordinary developmentduring the first year of life. The “twos” are marked by social independence. “Temper tantrums” may occur as children desire healthy independence. Toilettraining often begins this year. Encouraging a healthy diet at this agecan help establish future healthy eating habits. Between 5 and 6 years, most children are ready to begin school. By this age, they are toilet trained, have well-developed speech, andare ready for more social interactions with other children. The late childhood years from age 6 to 12 are marked by dra- matic intellectual and psychological changes. Children experience animportant part of their social development in school. Children learnto read, do math, and interact with others. Parents should encouragetheir children to eat nutritious food, communicate their feelings, andrespect all people. It is important for parents to be positive rolemodels for their children. Childhood ends with the beginning ofadolescence, which brings changes and responsibilities. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term embryo . 2.Identify the term for “the healthcare provided for a woman during her pregnancy.” Understanding Key Ideas 3.Describe how a life begins. 4.Identify the development that occurs during the first trimester of pregnancy. a.baby moves c.lungs mature b.arms and legs form d.body hair grows 5.Describe the importance of prenatal care for keeping healthy before and during pregnancy.6.Identify how fetal alcohol syndrome is prevented during pregnancy. (Hint: See Table 3.) 7.Distinguish the event that occurs during stage three of childbrith. a.“water breaks” c.baby’s head emerges b.cervix dilates d.uterus expels placenta 8.Summarize the changes that occur in a baby during early child development. Critical Thinking 9.Why do you think genes are so important in the development of a fetus? 10.What factors should a couple consider before theydecide to have children? Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 18 Highlights 451 CHAP TER 18 CHAP TER 18 CHAPTER 18Highlights Key Terms The Big Picture ✔The role of the male reproductive system is to produce sperm and deliver it to the female reproductive system. ✔The penis deposits semen into the reproductive tract of a femaleto bring about fertilization of an egg. The penis also provides apassage for urine to leave the body. ✔The testes are the primary organs of the male reproductive sys-tem. They produce both sperm and testosterone. ✔Some problems of the male reproductive system include infections,trauma injuries, and cancer. ✔Keeping the male reproductive system healthy requires practicinggood hygiene, being able to detect problems, and getting checkupseach year.SECTION 1 sperm (430) egg (ovum) (430) fertilization (430) testis (testicle) (431) penis (431) semen (432) ✔The joining of an egg from a female and a sperm from a malebegins the process of a pregnancy and the development of a newhuman life. ✔Development of a baby occurs over 3 trimesters, or 9 months.All of the major body structures are formed by the end of thefirst trimester. ✔Maintaining a healthy diet, avoiding alcohol and drugs, doingmoderate exercise, taking prenatal vitamins, and seeing a doctoron a regular basis are very important to have a healthy pregnancyand baby. ✔Childbirth begins with the onset of labor and goes through 3 stages. ✔Early development includes gaining head control, learning towalk, getting toilet trained, learning to speak, and learning tosocialize.SECTION 3 sexual intercourse (443) embryo (444) placenta (444) fetus (445) prenatal care (446) ✔The role of the female reproductive system is to make eggs and to provide a place to support and nourish a developing baby. ✔The ovaries are the primary organs of the female reproductivesystem. They produce eggs and the female hormones estrogenand progesterone. ✔The menstrual cycle functions to produce and release a matureegg each month and to prepare a female’s body for pregnancy. ✔Some problems of the female reproductive system includeinfections, menstrual cycle problems, and cancer. ✔Keeping the female reproductive system healthy involves practicinggood hygiene, being able to detect problems, and getting checkupseach year.SECTION 2 ovary (437) vagina (437) fallopian tube (438) uterus (438) menstrual cycle (438) Copyright © by Holt, Rinehart and Winston. All rights reserved. 452 CHAPTER 18 Review CHAP TER 18 CHAP TER 18 CHAPTER 18Review Using Key Terms egg (ovum) (430) placenta (444) embryo (444) prenatal care (446) fallopian tube (438) semen (432) fertilization (430) sexual intercourse (443) fetus (445) sperm (430) menstrual cycle (438) testis (testicle) (431) ovary (437) uterus (438) penis (431) vagina (437) 1.For each definition below, choose the key term that best matches the definition. a.the organ that produces sperm and testosterone b.healthcare for a woman during her pregnancy c.the female organ in which a human develops d.the organ through which sperm and urine exita man’s body e.the process by which a sperm and an egg join f.the female reproductive organ that receivessperm during reproduction 2.Explain the relationship between the key terms ineach of the following pairs. a.semen and sperm b.eggand menstrual cycle c.fetus and placenta Understanding Key Ideas Section 1 3.What is the role of the male reproductive system? 4.Where is sperm produced in the male body? a.testes c.vas deferens b.seminal vesicles d.prostate 5.Summarize the journey of the sperm within themale reproductive system. 6.What causes jock itch? 7.Which of the following is most likely to occur inolder males? a.prostate cancer c.undescended testes b.testicular cancer d.inguinal hernia8.Wearing a protective cup when playing sports canhelp prevent a.jock itch. c.cystitis. b.testicular cancer. d.testicular injury. Section 2 9.What is the function of the female reproductivesystem? 10.What organ transports an egg from the ovary tothe uterus after ovulation? 11.During the menstrual period, blood and tissuethat exit the body are derived from the a.follicle. c.uterine lining. b.vaginal lining. d.fallopian tubes. 12.Which of the following problems may be due tothe entry of bacteria into the urinary bladder? a.cystitis c.menstrual cramps b.breast cancer d.endometriosis 13.Which of the following will be least likely to helpa woman stay healthy? a.good hygiene c.annual checkups b.scented soaps d.breast self-exams 14.CRITICAL THINKING What might happen if 2 eggs were released from the ovaries during 1 menstrual cycle? Section 3 15.What events lead to the beginning of a new life? 16.Summarize what happens to the fetus during thesecond trimester of pregnancy. 17.Which of the following is notpart of prenatal care? a.regular visits to a doctor c.blood tests b.ultrasound tests d.fertility testing 18.Summarize what happens during the secondstage of childbirth. 19.During what time period of child developmentdoes the fastest period of growth occur? 20.CRITICAL THINKING How do you think both parents’ lifestyle and responsibilities change afterthe birth of their baby? Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 18 Review 453Interpreting Graphics Study the figure below to answer the questions that follow. 21.On what day of the menstrual cycle is the proges- terone level the highest? 22.Which hormones peak prior to ovulation? 23.CRITICAL THINKING Why do you think estrogen and progesterone levels decrease toward the endof the menstrual cycle?Activities 24. Health and You Choose one type of cancer of the reproductive system (for example, testicular,prostate, or breast). Write a one-page report thatdescribes the cancer. Include information on thesymptoms of the cancer, ways the cancer can be prevented, and treatments. 25. Health and You Choose an environmental toxin that is harmful to the fetus, such as lead, alcohol,or tobacco. Write a one-page report that describes the effects of the hazard on the growing fetus. 26. Health and Your Family Write an essay about two hypothetical pregnant females who have differentbackgrounds, such as age, culture, financial status,or family support. Compare their experiences through pregnancy and delivery of the baby. Action Plan 27. Practicing Wellness Discuss five things you can do as a teen to improve and protect your current and future reproductive health.LIFE LIFE SKILL 28.In this passage, the word laborious means Asimple Bnice Cdifficult Deasy 29.What can you infer from reading this passage? EPregnancy does not change the body. FEating fatty foods is healthy for pregnantwoman. GAvoiding excess salt is healthy for pregnantwomen. HCramps can occur during pregnancy. 30.Write a paragraph describing some of the things that Roberta could do to feel better and to protect her health during her pregnancy. 31.Write a paragraph describing Roberta and herhusband’s life after the birth of their child.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Being pregnant is laborious . This is some- thing Roberta and her husband, Ben, knowfirsthand. “A lot of changes started to hap-pen soon after I got pregnant,” Robertasays. “I couldn’t lift grocery bags anymore. Igot nauseated a lot at first and couldn’t keepany of my food down.” Roberta also sufferedfrom swelling in her feet and face. Sheexplains, “I had too much salt in my body.”Excessive salt intake, even from eatingpotato chips, can cause swelling of the feetand other changes in the body. It is not easybeing pregnant.Hormone levelLH Progesterone 0 4 8 1 21 62 02 42 8 Day of cycle Hormonal Changes During the Menstrual Cycle Source: Clinical Gynecologic Endocrinology and InfertilityFSH EstrogenWRITING SKILL WRITING SKILL WRITING SKILLWRITING SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 19 CHAP TER 19 CHAPTER 19 Building Resp onsible RelationshipsBuilding Resp onsible RelationshipsBuilding Responsible Relationships 454KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Differences in values and personality don’t really matter when choosing a dating partner. 2.There’s really nothing a teen can do to avoidthe pressures to become sexually active. 3.The majority of high school students havenever had sexual intercourse. 4.Many teens who have had sex wish they’dwaited. 5.Taking drugs or drinking alcohol can lead tounwanted sexual activity. Copyright © by Holt, Rinehart and Winston. All rights reserved. 455SECTION 1 Responsible Relationships SECTION 2 Benefits ofAbstinence SECTION 3 Coping withPressures go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out

articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH19. Copyright © by Holt, Rinehart and Winston. All rights reserved. 456 CHAPTER 19 Building Responsible RelationshipsTonight, Carlos and Anne were going on their first date. Carlos had been on several dates before, but this date was different.He thought Anne was very special. And he wanted to make sure their first date was special. So, he felt nervous. Teen Relationships Are Important During the teen years, young people begin to form their own identity.Developing relationships with others of the same age is part of form-ing your own identity. Interest in dating and in serious relationshipsusually increases during the teen years. Reasons for Dating Dating is one way for teens to get to know each other. Some teens decide to date because they want to developfriendships. Some teens date to find companionship and support.Others date to explore the characteristics they would like in a futurespouse. Some teens, however, may have to wait to date until theyreach an age set by their parents. Some are shy and may decide todelay dating. Others may choose not to date. People who choose notto date may focus primarily on building friendships with many people of both sexes. Benefits of Dating Dating during your teen years has many ben- efits. Dating allows you to find out what different types of people arelike. Dating also helps you find out to whom you relate most easily.You learn how to resolve disagreements and communicate moreeffectively. Finally, dating can enrich your life by providing emotionalsupport during a challenging period of your life. Possible Problems of Dating When teen dating relationships become more serious, they may become more difficult. Engaging in sex-ual activity poses a risk to your emotional and physical health. is any activity that includes intentional sexual contact for the purpose of sexual arousal. Refraining from sexual activity is oneof the most important ways to create and sustain healthy relationships. Sexual activityResponsible Relationships SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES State why teen relationships are important. List positive characteristics to look for in a dating partner. Describe appropriate dating behavior. State two things you can do to maintain a healthy relationship with your partner. LIFE LIFE SKILLKEY TERMSKEY TERMS sexual activity any activity that includes inten- tional sexual contact for the purpose of sexual arousal Good relationships are likely to develop when you make an effort to get toknow the people around you. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Responsible Relationships 457 Two people are attracted to each other and want toget to know each other better.As the two people get to knoweach other better, they find theyhave some things in common.The two people get to knoweach other’s values and feelingsand enjoy doing things together.This is considered “dating”. The two people confide in,trust, and support each other.This is considered “going steady”.Two people feel theycan commit to each otherfor life. This relationship may lead to marriage. Healthy relationships develop graduallyand can exist on many levels of closeness. ACTIVITY Think of a personal relation- ship that is current or past. What path did the relationship follow? 1 Figure Developing Healthy Relationships Fortunately, youhave the ability to make your relationships develop into a positive aspect of your life. The first step in a healthy relationship is to treat the peopleyou date with respect and require that they treat you with respect.And remember, healthy relationships develop gradually. Figure 1 shows the path that healthy relationships usually follow. A relation-ship can stop anywhere on this path and still be satisfying. Finding the Right Person Feeling both excitement and fear about dating is normal. It’s alsonormal to be unsure about who to date. One of the best ways to make relationships and dating “work” is to make good decisionsabout the people you date. Unfortunately, the characteristics thatmake a person a good date are not al ways obvious at first glance. Looking for the Right Person One of the most important things to know about a potential date is the quality of the person’s character.It doesn’t matter how attractive or popular a person is if he or she isselfish, inconsiderate, or abusive. Any one of these characteristics canmake someone difficult to be around. Look for a friend or datingpartner who >is unselfish >treats others well >is tolerant and respectful >has similar morals and values >is fun to be with >respects himself or herself Copyright © by Holt, Rinehart and Winston. All rights reserved. 458 CHAPTER 19 Building Responsible RelationshipsA person with these characteristics is likely to make you feel better about yourself and to be a great friend, even if a lasting relationship never develops. Datingshould be fun, so date someone you enjoy beingaround. If you decide not to continue dating each other,you can still remain good friends. Avoiding the Wrong Person If someone hurts you physically or emotionally, do not date that person. If someone doesn’t respect your morals and values ormakes you feel badly about yourself, do not date them. You are too special to be treated in such unhealthyways. A relationship cannot grow and survive without mutual respect. Jealousy can also cause problems in teen relation- ships. This happens when your dating partner feels likeanother person is receiving too much of your attention.People who are jealous tend to be very possessive.Therefore, dating jealous individuals should be avoidedas well. Being the Right Person Becoming a good friend or dating partner is important. A good friend or datingpartner is a person of integrity and character. Be thekind of person that you and others respect. Such a person is honest, trustworthy, generous, and not posses-sive. These characteristics will make you a great dateand a great friend. They will also help you feel goodabout yourself because you will respect the kind of person you are becoming. Appropriate Dating Behavior Sometimes people do not have trouble finding the rightperson to date, but they are not sure how to act on theirdate. They may be nervous about dating because theyare afraid that they won’t know how to act or where togo on their date. Figure 2 gives suggestions for how to act on a date. Dating in Groups When young people are ready to date, they often begin dating in groups. Teens may attend movies, dances,or sporting events as a group. Dating in groups is a good ideabecause it allows you to get to know the other person without thepressure of being alone. Dating in groups also reduces the pressureto participate in sexual activity or other risky behaviors. Choose to go out with groups of people who will not pressure you into high-risk behaviors, such as using alcohol or drugs or engaging insexual activity. Do find out some of the activities thathe or she likes to do—even if they’renot your favoriteactivities. Do focus on getting to know your date. Do be respectful of your date’s wishes andindependence. Do observe the rules your parents and yourdate’s parents set fordating.Don’t always insist onbeing the one todecide what to do. Don’t focus only on having a good-lookingor popular boyfriendor girlfriend. Don’t be manipulative or arrogant. Don’t cause difficulty by going against thewishes of your parentsor your date’s parents.Do Don’t The suggestions above will help make dating easier and more enjoyable. 2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 Responsible Relationships 459Acting Appropriately When you are on a date, remember to treat the other person the way you want to be treated. Be prompt. Being late makes you appear to be either unreliable or uninterested in thedate. Be courteous and polite. Think of activities you will both enjoydoing. Ask your date what he or she would like to do. Don’t break a date unless absolutely necessary. Breaking a date just because something better came along is not acceptable. Finally,let your date know if you had a good time. Saying “Thanks, you’re funto be with” is all you need to do. Following the Rules Find out and follow the rules your parents and your date’s parents have for your dating. Don’t make your parentsthink you are untrustworthy or they may hesitate to offer you otherprivileges. If your date’s parents think you are untrustworthy, they maynot want you to go out with their son or daughter. Ending Relationships When two people are dating each other, they usually don’t think about the relationship ending. However, mostdating relationships that begin during adolescence eventually end. A person who has been rejected may find it difficult to believe the other person really wants to break up. Once the reality of the breakup isaccepted, the rejected person may be hurt and angry. That emotionalenergy should be used instead to think of ways to become happy again. When you are recovering from a breakup, remember that you will feel better eventually. Healing may take longer than you would like,but be patient. Stay in touch with your friends, and do the things thatyou enjoy doing most. If you feel seriously depressed for more than afew d ays, speak with an adult who you feel you can confide in. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define sexual activity . Understanding Key Ideas 2.Summarize the reasons that relationships are important during the teen years. 3.Listthe reasons a teen might want to date. 4.Distinguish between a casual friendship and a deep friendship. (Hint: See Figure 1.) 5.State the most important thing to know about a person you plan to date. 6.Summarize why dating in groups is a good idea for teens.7.Describe how to maintain a healthy relationship with your date. 8.Identify which of the following actions is a “do” of dating. a.being prompt b.talking as much as possible c.being nervous d.making all decisions Critical Thinking 9. Setting Goals Describe the type of person you would like to have as a friend and the type of person you would like to have as a datingpartner. Are the two types similar? LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 460 CHAPTER 19 Building Responsible RelationshipsBenefits of AbstinenceSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Carlos was finally feeling comfortable around Anne each time they went out on a date. But now his friends were pressuringhim to go further in his relationship with her. He knew that he didn’t want to be sexually active, but he wasn’t sure how totell Anne. What Is Abstinence? As teens begin to date, they have to make important decisions. Dur-ing the teen years, a person’s interest in sexual activity often increases.This increased interest is a normal part of becoming an adult. Theability to make good decisions about sexual activity is very impor-tant, not only to your current and future romantic relationships, butalso to your health. Sexual intimacy is a positive, pleasurable part of a married adult relationship. Sexual intimacy means sharing sexual feelings and sexual contact. Teen relationships, however, should focus on emotional inti-macy, not sexual intimacy. Emotional intimacy means sharing thoughts and feelings, caring for and respecting others, and learningto trust one another. Avoiding All Sexual Contact In broad terms, abstinence means the conscious decision not to participate in a behavior, and the skillsto support that decision. For example, a person can choose to beabstinent from alcohol or tobacco. In this textbook, we will use theword abstinence to refer to sexual abstinence. is the conscious decision not to partcipate in sexual activity and the skills tosupport that decision. When some people talk about abstinence, they are referring only to the avoidance of sexual intercourse. They believe that onecan participate in other forms of sexual activity and still be con-sidered abstinent. This mistaken idea can put teens in very danger-ous situations. There are forms of sexual activity that don’t causepregnancy but can cause a sexually transmitted disease. AbstinenceOBJECTIVES Define the term abstinence. Describe the health benefits of teen sexual abstinence. Describe the emotional and social benefits of teen sexual abstinence. Name two ways abstinence can help teens achieve their goals. LIFE LIFE SKILLKEY TERMSKEY TERMS abstinence the conscious decision not to partici- pate in sexual activity and the skills to support that decision sexually transmitted disease (STD) an infectious disease that is spread by sexual contact “I’m not ready to be a dad.” www.scilinks.org/health Topic: Abstinence HealthLinks code: HH4002 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Benefits of Abstinence 461A is an infectious disease that is spread by sexual contact. Frequently, these types of activities lead tosexual intercourse, which can result in pregnancy or infection with asexually transmitted disease. Remaining Abstinent Until Marriage For teens who have never been sexually active, abstinence means waiting until marriage tobegin sexual activity. For teens who have already been sexually active,abstinence means making a decision to refrain from further sexualactivity until marriage. The benefits of remaining abstinent are just asimportant to teens who have been sexually active as they are for teenswho have never been sexually active. Remaining abstinent until you are in a stable, committed relationship, such as marriage, will help you to avoid feeling regretfullater. Married individuals who were not sexually active before theirmarriage don’t have to worry about sexually transmitted diseases.Remaining abstinent until you are married will also help you avoidbecoming a single parent. Remember, a responsible relationship is much more than just physical contact. A responsible relationship should include the ele-ments of emotional intimacy, such as trust, mutual respect, and love.These elements are most likely to be present when a couple has madea long-term commitment to each other through marriage. When emo-tional intimacy is missing from a sexually active relationship, it cancreate negative feelings between the two people in the relationship. The teen years are often busy, and teens have a lot to think about. There are so many things that you want or need to do as a teen. It isdifficult for teens to devote the amount of time and emotional energyneeded to handle all of the demands created by a sexually active rela-tionship. Handling the demands of a sexual relationship may be difficult for many adults also. sexually transmitted disease (STD), 27% 58%25%statistically speaking. . . Three Rs for Remaining Abstinent >Respect for self >Respect for others >Responsibility for your own actionsThe percentage of high school students who have had sexual intercourse, but not in the past 3 months: The percentage of high school–age teens who said sexual activity is unacceptable for high school–age teens: The percentage of sexually active teens who reported using alcohol or drugs the last time they were sexually active:HH04PE_C19_S02 1/9/04 10:45 AM Page 461 462 CHAPTER 19 Building Responsible RelationshipsHealth Benefits There are many benefits for teens who practice sexual abstinence. The most obvious benefits are the health benefits. By avoiding all sexualactivities, an adolescent does not risk becoming pregnant or beinginfected with a sexually transmitted disease. Some STDs can cause seri-ous consequences, such as cancer and the inability to have children inthe future. In some cases, sexually transmitted diseases can be fatal. The younger you are when you become sexually active, the more sexual partners you are likely to have over the course of your lifetime.The more sexual partners you have in your lifetime, the more likelyyou are to contract a sexually transmitted disease. Waiting until mar-riage will decrease the number of sexual partners you have in yourlifetime and therefore will reduce your risk of contracting a sexuallytransmitted disease. Emotional and Social Benefits In addition to the health benefits, there are also significant social andemotional benefits for those who avoid sexual activity during theirteen years. The social benefits of abstinence include >the freedom to pursue a variety of friendships >less complicated relationships >the ability to focus on interpersonal aspects of relationships >better relationships with parents and other trusted adults >the chance to learn to build strong, lasting relationships basedon mutual trust and respect >better reputation among peers The emotional benefits of abstinence include >being free from worry and stress about sexually transmitteddiseases and pregnancy >allowing time to develop the maturity needed to make important decisions >avoiding being manipulated or used by others >having an increased sense of self-control and self-respect >staying true to your personal values, such as respect, honesty,and morality Teens have enough to juggle in their lives without having to deal with thestress of being sexually active. “Sexual activity shows that a couple is in love.” “Sexual activity will make our relationship better.” “Sexual activity is a healthy part of being a teen.” “If a person has been sexually active in the past, there is no reason to avoid sexual activity in the future. ”Love can be expressed in many nonsexual ways. Sexual activity creates stress in a teen relationship. Many teens are physically and emotionally hurt by sexual activity. Teen pregnancy and STDs are always good reasons to avoid sexual activity.Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Benefits of Abstinence 463Other Benefits of Abstinence Being sexually active can prevent a young person from achieving his or her goals. Teens who are not sexuallyactive can more easily focus on school and on accomplish-ing long-term personal, family, and career goals. Being sexually active may simply distract you from other things that are more important, such as pursuingyour education so that you can get a college degree and agood job. Adolescent girls who become mothers typicallyface difficulties finishing high school and supportingthemselves financially. Adolescent boys who becomefathers may need to find work to help support their child. Sexual abstinence can also create a feeling of trust between teens. If a teen couple becomes sexually active,either partner may begin to have doubts about the otherpartner’s values and ability to make good decisions. Andwhen these relationships fail, they can be much more diffi-cult to end than a failed friendship that did not includesexual activity. The best way to avoid the health, emotional, and social risks of adolescent sexual activity is for both members of a couple to waituntil marriage before becoming sexually active. Abstinence will allowyou to enter into a long-term relationship without any worry expos-ing your family to an STD. It will also allow you to achieve the goalsyou have set for yourself. But remaining abstinent isn’t al ways easy. It will require some planning and thought on your part ahead of timeto be prepared for the possible challenges. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define abstinence. Understanding Key Ideas 2.Explain why it is important to abstain from all types of sexual activity. 3.Listthe health benefits of remaining sexually abstinent. 4.Determine which of the following is a social benefit of abstinence. a.less complicated relationships b.increase in self-esteem c.not getting pregnant d.not getting an STD5.Listthe emotional benefits of remaining sexually abstinent. 6.Determine which of the following is an emotional benefit of sexual abstinence. a.better relationship with parents b.not getting an STD c.increased sense of self-control d.all of the above 7.Discuss how remaining sexually abstinent can help you achieve your future goals. Critical Thinking 8.Why do you think some teens believe that they can’t get pregnant the first time they are sexuallyactive? Agreeing as a couple to remain sexually abstinent can help form a respectfulrelationship. Copyright © by Holt, Rinehart and Winston. All rights reserved. 464 CHAPTER 19 Building Responsible RelationshipsCoping with PressuresSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Iwish I had waited.” This was the general response of the majority of sexually active teens in a survey about sexual activity. It is notunusual for teens to feel pressure to be sexually active. When teens are unprepared to deal with the pressures to become sexuallyactive, however, the pressures become serious sources of stress. Pressures to Be Sexually Active If you plan ahead, you can learn how to successfully resist the pressuresto be sexually active. Most teens experience two general types of pres-sure to be sexually active. The two types of pressure are internal pressureand external pressure. is an impulse a person feels toengage in a behavior. is pressure a person feels fromanother person or from a group to engage in a behavior. Internal Pressures The internal pressure one feels to become sexually active comes from within oneself. All of us have an instinc-tive interest in sexual activity because sex is necessary for reproduc-tion and the survival of humanity. Although teens experience anincrease in hormone levels, it is important to remember that we allhave self-control. Internal pressure can also come from a desire for emotional intimacy. Emotional intimacy and sexual feelings are two differentthings. It may seem that sexual activity will help you become closerto another person. However, being sexually active as a teen canactually complicate your life and create distance in your relation-ship with a person. External Pressures External sources of pressure to be sexually active include boyfriends or girlfriends, the media, and your peers.Remember, people who want you to go against your morals are usu-ally not concerned with your well-being. External pressureInternal pressureOBJECTIVES Describe the two types of pressures to become sexually active. Discuss how to verbally and nonverbally refuse sexual advances. Describe protective factors that help teens remain abstinent. List risk factors that can cause teens to become sexually active. Discuss nonsexual ways to show someone that you care. LIFE LIFE SKILLKEY TERMSKEY TERMS internal pressure an impulse a person feels to engage in a behavior external pressure pressure a person feels from another person or group to engage in a behaviorprotective factor anything that keeps a person from engaging in harmful behavior “ Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Coping with Pressures 465Setting Personal Limits Given all of the pressures around you, you might think it is difficult to remain sexually abstinent. But in reality, you can learn ways to remain sexually abstinent and to resist the pressures to be sexuallyactive. Earlier in this chapter, you learned the importance of being sexu- ally abstinent to avoid negative consequences. Sometimes a personunderstands the importance of abstinence but he or she has never setfirm personal limits regarding sexual activity. When setting personal limits, you should commit not only to being abstinent but also toavoiding situations that could lead to sexual activity. Tell your datingpartner when you begin dating that you have made a commitment to remain sexually abstinent. Avoiding Pressure Situations Even when you intend to be abstinent, you should avoid situations inwhich resisting sexual activity is difficult. Here are some suggestionsfor avoiding pressure situations. >Identify situations that could lead to sexual activity. One such situation is being alone with your date. If you are alone withyour date, avoid places or situations in which you may feeltempted. Avoid being home alone together and parking in carsin remote areas. >Avoid drinking alcohol or taking illegal drugs. These substances impair your judgment and self-control. Avoid going out withothers who drink alcohol or use drugs. >Look for dating partners who share your values about abstinence. You are more likely to stick to your commitment to abstinence if you date someone who has made a similar commitment. Having other friends that share your values willalso help you achieve your goals. Dating in groups is a great way to avoid the pressures to be sexually active. Copyright © by Holt, Rinehart and Winston. All rights reserved. 466 CHAPTER 19 Building Responsible RelationshipsRefusing Verbally and Nonverbally Even if you follow the suggestions for avoiding pressure situations, you may still find yourself being pressured to be sexually active. Thereare verbal and nonverbal ways to resist the pressures. Verbal Refusals Use these steps to get out of a pressure situation. 1. Clearly identify the problem. In this case, the problem is that your dating partner is trying to convince you to be sexually active.

2. State your thoughts and feelings about the problem. For example, say “I’ve decided to remain abstinent until marriage, and I’msticking with my decision.” 3. State what you would like to have happen instead. For example, ”Instead of staying here, let’s go to a movie.” 4. Explain the results if the change in plans is made. For example, say “If we go to the movies, we’ll have a great time.” 5. Explain the results if the requested change in plans is not made. For example, say “If you don’t stop pressuring me, I’m going home.” Use a firm tone of voice, and be clear you that mean what you say. If you practice refusal lines ahead of time, figuring out what to say when you hear pressure lines is easy. People rarely come up with newlines. Figure 3 gives examples of responses to such lines. Nonverbal Refusal Your body language should match what you are saying. Stand up straight, and look the other person in the eyeswhile talking. Avoid laughter or other nervous behaviors, such asfidgeting. Good nonverbal skills are important because sending amixed message may confuse the other person and weaken yourrefusal. “Everybody’s doing it.” “If you loved me, you’d let me.” “No one has to know.” “Don’t you want to know what it’s like?” “What are you afraid of?” “Come on, just this once.”“I guess you don’t know everybody, because more than half of high school students aren’tsexually active. ” “If you loved me, you wouldn’t ask.” “I’ll know, and that’s one person too many.” “I do NOT want to know what it’s like to get anSTD, get pregnant, or live with memories I’drather forget. ” “AIDS, HPV, gonorrhea, syphilis, chlamydia, herpes, and about a dozen other STDs. ” “That’s exactly what I’m afraid of. I’d rather savemyself for someone who will love me for life. ”IfYouHear This. . . IfYouHear This. . . YouCanSayThis. . . YouCanSayThis. . .Practicing refusal responses ahead of time will help you deal with the pressures to be sexually active.3 Figure www.scilinks.org/health Topic: Dating Responsibly HealthLinks code: HH4039 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Coping with Pressures 467Standing Firm Sometimes, your date may keep pressuring you after the first time you say no. In that case, keep restating your posi- tion or remove yourself from the situation. If someone you are datingcontinues pressuring you to do something you do not want to do,stop dating that person. The continued pressure shows they don’t have your best interests at heart. Protective Factors and Risk Factors Being sexually active is a risky behavior. There are many things inyour environment that can either decrease or increase your likeli-hood of engaging in risky behaviors. Protective Factors A is anything that decreases the likelihood of someone engaging in a risky behavior. Protective fac-tors include a good relationship with parents and being involved inschool and in the community. Teens who have protective factors aremore likely to avoid sexual activity. Having made a personal commit-ment to remain abstinent may be the most important protective factor.protective factorTop 5 Protective Factors 1A close relationship with parents or guardians 2Being involved in schoolactivities 3Good performance in school 4Practicing religious beliefs 5Being committed to being sexually abstinent LIFE LIFE SKILL ActivityKnow What to SayRefusal Skills You may find yourself wanting to get out of a situation where you are being pressured. Knowing what to sayahead of time can help you out of these situations.Below are some scenarios where teens may feelpressures to be sexually active. You are at the movies when your date says “Let’s leave now and go to my brother’sapartment. Your parents will never know.” You are spending the night at the house of a friend whose parents are out for the evening.Your friend wants to invite over the two peopleyou double-dated with a week ago. Your date has a big surprise when picking you up—a bottle of wine his or her older sisterbought. Your date has driven to a secluded area and has stopped the car. You’re uncomfortable andwould like to leave. 4321 Communicating Effectively 1.What would you say to get out of each of these situations? 2.What other pressure situations do teens often findthemselves in?LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 468 CHAPTER 19 Building Responsible RelationshipsRisk Factors A risk factor is anything that increases the likelihood of injury, disease, or other negative health problems. Some of the more common risk factors for sexual activity include: >Alcohol and drugs Drugs and alcohol reduce your inhibitions and make you more likely to engage in sexual activity. >Dating older people Sometimes, resisting sexual pressure is harder when it comes from someone who is significantly older.Most states have laws prohibiting adults and older teens fromhaving sex with teens that are significantly younger. >Sexually active friends Hanging out with people who are sexually active may result in increased peer pressure to be sexually active. Spending your time with people who shareyour commitment to abstinence will make remaining abstinent much easier. Teens are more likely to avoid sexualactivity if their friends are also abstinent. >Previous sexual activity Previous sexual activity increases the likelihood of current sexual activity. However, teens who havebeen sexually active can choose to be sexually abstinent. Thisdecision is the healthiest one. Showing Someone You Care There are many ways to show som eone affection other than by being sexually active. Examples include making each other inexpensivegifts, spending time in conversation, or just being together. Sometimes, the best way to show someone you care is simply to support the person during good times and bad times. Sharing common interests and supporting each other’s individual interestsare both good ways to show someone you care. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term internal pressure. 2.Define the term external pressure . 3.Identify the term for “anything that helps someone from becoming involved in harmful behavior.” Understanding Key Ideas 4.Compare the two types of pressure to become sexually active. 5.Identify pressure situations that could lead to sexual activity and that should be avoided. 6.Describe the two types of resistance that you can use against external pressure.7.Identify which of the following is nota risk factor for sexual activity. a.using alcohol and drugs b.having sexually active friends c.dating someone significantly older d.dating in groups 8. Communicating Effectively List three ways other than sexual activity to show someone that you care. Critical Thinking 9. Using Refusal Skills What would you do if someone was trying to pressure you to dosomething that you didn’t want to do? LIFE LIFE SKILLLIFE LIFE SKILL There are many nonsexual ways to show someone that you care. ACTIVITY Think of three ways you have shown someone that you care for them. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 19 Highlights 469 CHAP TER 19 CHAP TER 19 CHAPTER 19Highlights Key Terms The Big Picture ✔Internal and external pressures can cause teens to become sexually active. ✔Situations that create pressure to become sexually active shouldbe avoided. Those situations include using drugs or alcohol, and dating someone that does not share your commitment toabstinence. ✔You can refuse someone’s sexual advances both verbally and nonverbally. ✔Risk factors for sexual activity include using alcohol or drugs, dating someone considerably older than you are, and having sexually active friends. ✔A good relationship with your parents, involvement in schoolactivities, and your own morals are protective factors that helpyou remain abstinent. ✔Making someone dinner or giving someone support during difficult times are good ways to show someone that you care.SECTION 3 internal pressure (464) external pressure (464) protective factor (467) ✔The benefits of dating include learning to treat each other with respect, learning how to communicate more effectively, and providing emotional support during difficult times. ✔Characteristics of a good dating partner include unselfishness,respectfulness, tolerance, and good moral values. ✔Being prompt, courteous, polite, and observing parents’ datingrules are all examples of good dating behavior. ✔Having good character and treating others well are two things thatyou can do to maintain a healthy relationship with your partner.SECTION 1 sexual activity (456) ✔Abstinence is defined as the conscious decision not to participatein sexual activity and the skills to support that decision. ✔By avoiding all sexual activities, an adolescent does not riskbecoming pregnant or being infected with a sexually transmitteddisease. ✔Some of the benefits that practicing abstinence can offer to teensare less complicated relationships and having an increased senseof self-control and self-respect. ✔Abstinence can help teens achieve their goals by freeing them topursue their education and their relationships with their friends.SECTION 2 abstinence(460) sexually transmitteddisease (STD)(461) Copyright © by Holt, Rinehart and Winston. All rights reserved. 470 CHAPTER 19 Review CHAP TER 19 CHAP TER 19 CHAPTER 19Review Using Key Terms abstinence (460) external pressure (464) internal pressure (464) protective factor (467) sexual activity (456) sexually transmitted disease (STD) (461) 1.For each definition below, choose the key term that best matches the definition. a.anything that keeps a person from becominginvolved in a harmful behavior such as adoles-cent sexual activity b.an impulse a person feels to become involvedin a behavior c.the decision not to participate in sexual activityand the skills to support that decision d.any activity that includes intentional sexualcontact for the purpose of sexual arousal e.pressure a person feels from another person tobecome involved in a behavior Understanding Key Ideas Section 1 2.What are two possible reasons for dating? 3.Describe each step in the path of relationships.(Hint: See Figure 1.) a.initial attraction b.close friendship c.deep friendship d.lifelong love 4.What are positive characteristics to look for in apotential date? 5.Why is it best to avoid dating jealous people? 6.What are the benefits of dating in groups? 7.List three examples of behaviors that you shouldfollow on a date. 8.CRITICAL THINKING What types of behavior would a date have to exhibit before you decidednot to go on a second date with someone? Section 2 9.Why should all types of sexual activity beincluded when talking about abstinence?10.What is the percentage of high school-age teenswho said sexual activity is unacceptable for highschool-age teens? a.10% c.58% b.32% d.44% 11.Explain why people are more likely to contract asexually transmitted disease during their lifetimeif they become sexually active at a younger age. 12.What are some of the more serious consequencesof contracting a sexually transmitted disease? 13.For each of the following choices, determinewhether it is a health benefit, emotional benefit,or social benefit of remaining abstinent. a.avoiding infection with an STD b.avoiding a bad reputation c.avoiding being sexually manipulated by others d.having less complicated relationships 14.What goals can remaining sexually abstinent helpteens achieve? 15.CRITICAL THINKING Teens often overestimate the percentage of their peers who are sexuallyactive. Why do you think they do this? Section 3 16.Define internal pressure and external pressure, and list sources for both types of pressure. 17.How does drinking alcohol or using drugs affectyour decision making about being sexuallyactive? 18.List and explain the steps to follow when verballyrefusing another person’s pressure to be sexuallyactive. 19.Which of the following is nota protective factor for teens wishing to remain sexually abstinent? a.having a good relationship with one’s parents b.being involved in school activities c.having a job d.practicing religious beliefs 20.CRITICAL THINKING Discuss three risk factors for teen sexual activity. What can teens do toavoid these factors? Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 19 Review 471Interpreting Graphics Study the figure below to answer the questions that follow. Factors % of teens surveyed Morals, values, and beliefs 39% Concerns about STDs 17% Concerns about pregnancy 15% Information about sex 10% Other 19% Source: National Campaign to Prevent Teen Pregnancy 21.Which factor influenced the most teens to prac- tice abstinence? 22.What percentage of the teens surveyedwere encouraged to remain sexuallyabstinent by one of the top four factors? 23.CRITICAL THINKING What other factors might influence teens to remain sexually abstinent?Activities 24. Health and You Watch two different television programs that portray teens. Write a paragraph for each program explainingwhether the teens in these programs are makingresponsible decisions regarding relationships andpossible sexual activity. 25. Health and Your Community Write one page describing what you think an ideal date wouldbe like. Discuss details such as where youwould go and what you would do in your community. 26. Health and Your Community Ask classmates for examples of adults who the classmates feel comfortable talking to about dating. Summarize thebehaviors that make these adults easy to talk with. Action Plan 27. Practicing Wellness Make a list of steps you can take to maintain healthy datingrelationships.LIFE LIFE SKILL 28.In this passage, the word commencement means Ameeting. Britual. Ctrip. Dassembly. 29.What can you infer from reading the passage? ERich is only concerned for himself. FKim and Rich have little in common. GKim and Rich are concerned about the possible consequences of their actions. HKim’s and Rich’s parents do not approve oftheir dating. 30.In this passage, Kim and Rich areIa couple just starting to date. Ja high school couple in a dating relationship. Kjust friends who enjoy each other’s company. Labout to break up. 31.Describe three benefits for Kim and Rich if theydon’t skip class.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Kim and Rich are both seniors in high school and have been dating since theywere freshmen. They only have one moreweek of school until graduation. Threeother couples in their class are planning toskip school the last day of class to go havefun in a nearby large city. Kim and Richknow that it would be a fun day, but theyare worried that if they are caught skipping,they may not be allowed to participate intheir class’s graduation commencement. They also know that their parents would beangry with them, and this would make theirsummer before leaving for college a diffi-cult one at home.WRITING SKILLWRITING SKILL Primary Factors Encouraging Teen Abstinence MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. The Great American Date Going on a date can be fun, awful, wonderful, and nerve wracking all at the same time. Whom do youask out? How do you ask? Where do you go? If youthink these questions are new ones, think again. Dating in Early America When America was new, people often lived far apart.Most teenagers didn’t go to high school, and travelwas difficult. So, boys and girls had few opportu-nities to meet. Young people often met at church onSunday or perhaps at a dance on Saturday night. Inaddition, teenagers usually worked. They had tohelp on the farm or with the family business. Lifewas harder, and people expected teenagers to takelife as seriously as adults did. Because life was more demanding, early Americans were less tolerant about lighthearted teenage relationships. Early marriage not only was acceptedbut also was demanded by society. Young peoplewere expected to go on a date only when they hadthe intention of getting engaged or marrying. A datemeant that things were getting really serious—andeveryone in town knew it. Dating in the 1800s As American society loosened up, more freedom andgreater opportunities for teenagers to be alone fright-ened some adults. Dating became more formal. Theteenage boy was expected to arrive on time, be welldressed, and bring a gift, such as flowers. The dateconsisted of sitting down and talking. Perhaps theboy and girl would sing at the piano. If the date wasgoing well, the girl’s parents might leave the roomfor a while. If the girl liked the boy, she would askhim to come again. Dating has been an issue for American teenagers throughout the ages. As societyand culture change, so do their effects ondating. CULTURAL DIVERSITY HealthHealthWorldWorldHealthHealthWorldWorldHealthWorld YOURYOUR 472Copyright © by Holt, Rinehart and Winston. All rights reserved. The Twentieth-Century Date By the turn of the 20th century, America had changed again, and so had dating. Many adults feltthat teenage girls no longer needed to be protectedby a formal dating system. By the 1920s, teenageboys asked girls to go on dates, and teenagers hadgreater freedom to meet and socialize. A typical datemight be picking up a girl in a car with a rumble seatand taking her to a dance. By the 1950s, after-schooldates were also popular. A boy and girl might get ahamburger together at the local drugstore or meet ata friend’s house to listen to records. Greater freedom brought new challenges, however. The boy was expected to pay for things, which meanthe had to have money. Although the 20th centurybrought greater freedom, this freedom placed morestress on girls and boys to control their behavior. Dating Today We live in a society that gives teenagers a lot morefreedom than they had in the past. These days, it isnot unusual for a girl to ask a boy out on a date,something that was unthinkable in past. This free-dom can be wonderful, but unlike their counterpartsfrom the 1800s, today’s teenagers can face enormousemotional stresses because of these freedoms. Bothboys and girls feel pressure to be cool, to havemoney, to look good, and to keep the date entertain-ing. Despite the stress and awkwardness, dating isstill a great way to get to know someone, test thewaters of a relationship, and have a lot of fun. YOUR TURN 1. Summarizing Information How has dating changed in American life from early days to the present? 2. Inferring Conclusions How does parents’ influence today differ from their influence inthe past? 3. CRITICAL THINKING Do you think that dating is easier and more fun today than itwas in the past? Explain your answer. www.scilinks.org/health Topic: Dating Responsibly HealthLinks code: HH4473 Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 20 CHAP TER 20 CHAPTER 20 Risks of Adolescent Sexual ActivityRisks of Adolescent Sexual ActivityRisks of Adolescent Sexual Activity 474KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Only about one-third of pregnant teenagers ever complete high school. 2.Most teen mothers eventually marry the fatherof their child. 3.Teen parents usually must interrupt theireducation to work. 4.Babies born to teen mothers are more likely tosuffer health problems. 5.There is no effective way to prevent all of therisks of teen sexual activity. Copyright © by Holt, Rinehart and Winston. All rights reserved. 475SECTION 1 What Are the Risks? SECTION 2 What Are SexuallyTransmittedDiseases? SECTION 3 Common STDs go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH20. Copyright © by Holt, Rinehart and Winston. All rights reserved. 476 CHAPTER 20 Risks of Adolescent Sexual ActivitySex is not a game, and neither is having a baby or a sexually transmitted disease. Yet many teens ignore the risks ofteenage sexual activity. Ignoring the risks won’t make the consequences go away. Risks of Teen Sexual Activity Although many teens don’t want to admit it, a sexually active teenfaces many risks. These risks include emotional and social conse-quences, such as feeling troubled about lying to one’s parents. Manyteens lose self-esteem and self-respect when they go against their ownvalues and religious beliefs. Other serious consequences can include >unplanned pregnancy > infectious diseases that are spread by sexual contact, such as HIV/AIDS In spite of the risks, many teens have not thought about the realities of teenage sexual activity. Knowing the realities helps teensto be prepared when situations arise. Shown below are just some ofthe beliefs—and the realities—about teen sexual activity and its consequences. sexually transmitted diseases (STDs),What Are the Risks?SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Identify the possible consequences, especially for teens, of sexual activity before marriage. Describe how pregnancy can affect the lives of teen parents and babies of teens.Identify how abstinence eliminates the risks of teen sexual activity. Predict how a pregnancy now (yours or your partner’s) would affect your life goals. LIFE LIFE SKILLKEY TERMSKEY TERMS sexually transmitted disease (STD) an infectious disease that is spread by sexual contact “If I have a baby, I’ll be the center of attention.” “He won’t leave me if I’m pregnant with his baby.” “I can’t get pregnant the first time I have sex.” “Jan is a really nice girl. She’d never have a sexu- ally transmitted disease (STD). ”Few teenagers want to constantly be around a baby. Teen pregnancy adds stress to a teen relationship. You CAN get pregnant the first time you have sex.All sexually active individuals are at risk of catching an STD regardless of their background.Beliefs Reality vs.Beliefs Reality vs. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 What Are the Risks? 477Teen Pregnancy Many teenage pregnancies occur because teens think, “It won’t hap- pen to me.” But in fact it does happen to between 800,000 and900,000 female teenagers each year. This means that 1 in 10 femaleteenagers gets pregnant each year. One in 5 sexually active femaleteenagers gets pregnant each year. Four in 10 of all girls become preg-nant at least once before they reach the age of 20. With so many teengirls getting pregnant, it is not surprising to find out that the teenbirth rate in the United States is very high. In fact, both the teen preg-nancy rate and the teen birth rate are among the highest of any indus-trialized nation in the western world. The majority of these pregnantyoung women are not married. Teen pregnancies are hard on the mother’s health. The bones and muscles of teenagers are not ready for the physical stresses of preg-nancy. Teenagers are still developing physically. Pregnant teens musteat well and get adequate medical care in order to stay healthy and toincrease their chances of delivering a healthy baby. Otherwise, boththe mother and the baby can have health problems. real life Activity LIFE LIFE SKILL Setting Goals CHARTING YOUR COURSE ✔8 1⁄2 in. x 11 in. sheet of paper ✔pencil ✔ruler 1.Draw a line lengthwise across the paper to represent your life. 2.Draw marks every inch along the line. 3.Write “0” at the left end of the line to show your birth. Label the first mark “10 years.” Labeleach mark after that in 10-yearincrements (20 years, 30 years,etc.).ProcedureMaterials4.Use an X to mark the point that shows your current age. 5.Draw marks at four points that represent important events in your life. Label each mark witha descriptive phrase, such as“Moved to California.” 6.Draw marks at four points that represent events that you hopewill take place in the future.Label each mark with a descrip-tive phrase, such as “Buy a car.” 1.Summarizing Results What future events did you mark? 2.Predicting Outcomes What things could change the ex- pected events of your future?Conclusions3.Predicting Outcomes How might becoming a single teen parent change the expectedevents of your future? 4.CRITICAL THINKINGWhat short-term goals do youneed in order to reach each ofthe expected events of yourfuture?One in five sexually active female teenagers gets pregnant each year. Copyright © by Holt, Rinehart and Winston. All rights reserved. 478 CHAPTER 20 Risks of Adolescent Sexual ActivityTeen Parents Caring for a baby is hard work. Teen parents must take on adult responsibilities at an early age. As shown in Figure 1, teen parents must make personal, social, and financial sacrifices. Many times they must interrupt their education. Often they have lim-ited job options. Parents are legally responsible for the care and well-being of their children. Many teen parents are not prepared to makethese sacrifices or to take on adult responsibilities. Babies of Teen Parents Expectant teens often delay getting med- ical care. Thus, babies born to teen mothers are more likely to sufferfrom health problems. Babies born to teen mothers are also morelikely to be born premature and to have a low birth weight (less than5.5 lb). Babies with low birth weights are more likely to have physicaland mental problems than babies with normal birth weights are. The responsibilities of teen parenthood require personal, social, educational,and financial sacrifices. 1 Figure On average, teen fathers make lessmoney per year thanmale teens who arenot fathers. Only about 20 percent of single teenmothers eventuallymarry the father

oftheir child. Only about 30 percentof pregnant teenagersever finish high school. Parents are legally responsiblefor their child’s well-being. Being a teen parent means having lessfree time for yourself. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 What Are the Risks? 479If someone you know thinks she may be pregnant, encourage her to see a doctor right away. She and her partner should also talk to a parent or trusted adult. Many communities offer counseling, prenatalcare, and classes on childbirth and parenting to pregnant teens. Abstinence Eliminates the Risks of Teen Sexual Activity Your dreams and goals for the future often begin during your high school years. One way you can protect your future is to remain absti-nent from sexual activity. Only abstinence eliminates the risks of teensexual activity. Remember that there are many ways to show love and affection nonsexually. Make your partner feel special. Find hobbies to dotogether. When you go out on a date, get to know the person you’reinterested in. What builds a good relationship is the time two peoplespend together and the respect they show each other. Closeness andcaring are as important as sexual attractiveness. Many communities offer programs to help teenagers think more carefully about the decision to become sexually active. These pro-grams often contain activities that help teenagers improve the skillsthey need to help them say no to sexual activity. Other programs con-nect teenagers with adult or peer mentors. Some high school students say that it seems as if everyone around them has become sexually active. The reality is that a majorityof teens in high school choose abstinence. Abstinence allows you tobe in charge of your future and makes many options possible. Absti-nence allows you to protect your health. By practicing abstinence,you can make sure that you will be able to finish your education andprepare for your career. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “an infectious disease that is spread by sexual contact.” Understanding Key Ideas 2.Identify the risks of teen sexual activity before marriage. 3.Identify the ratio of sexually active female teenagers who get pregnant each year. a.1 in 2 c.1 in 5 b.1 in 10 d.1 in 20 4.Describe why teen pregnancies are hard on the mother’s health.5.Classify the following as risks to teen mothers, to teen fathers, or to teen parents. a.interrupted c.physical stress education to bones b.limited job options d.lower income 6.State the health risks that a baby born to a teen mother could face. 7.Describe the activities that many community pro- grams offer to help teenagers remain abstinent. Critical Thinking 8. Assessing Your Health How would your life change if you became a parent today? LIFE LIFE SKILLFor more information about the benefits of abstinence, seeChapter 19. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. 480 CHAPTER 20 Risks of Adolescent Sexual ActivityWhat Are Sexually Transmitted Diseases?SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Describe why sexually transmitted diseases (STDs) are said to be a “silent epidemic.” Identify why teenagers are particularly at risk for being infected with STDs.Liststeps you can take to prevent the spread of STDs. LIFE LIFE SKILLKEY TERMSKEY TERMS epidemic the occurrence of more cases of a dis- ease than expected asymptomatic showing no signs of a disease or disorder even though an infection or disease is present Mike is not the first teen treated by his doctor for an STD. About 25 percentof all new cases of STDs occur inteenagers between the ages of15 and 19.Not me! That’s what many sexually active teens think when they find out they have a sexually transmitted disease(STD). Each year about 15 million Americans are infected with an STD. Teenagers make up only 8 percent of the U.S. popula-tion. But about 25 percent of all new cases of STDs occur in teenagersbetween the ages of 15 and 19. STDs: The Silent Epidemic The occurrence of more cases of a disease than expected is called an STDs are considered an epidemic among teens and young adults. Mike was surprised to learn that he had a sexually transmitted disease (STD). The doctor wasn’t. Mike’s doctor told Mike that theSTD epidemic is a “silent epidemic.” The doctor explained that manySTDs are asymptomatic. means “showing no signs ofa disease or disorder even though an infection or disease is present.”Symptoms warn a person that he or she may be ill. Without symp-toms, many people infected with an STD don’t recognize that theyare infected. So they don’t get treatment, but they can spread theinfection. Sexually transmitted diseases that are asymptomatic can bedetected only by laboratory tests. Also, the symptoms of some STDsmay not appear until many years after the person is infected. The epidemic is also said to be silent because people don’t often talk about sexually transmitted diseases. Many people feel tooembarassed to see a doctor. People that are too embarassed to see adoctor may go untreated. This can increase the chance that the personwill spread the disease to others. STDs Are Serious STDs can cause serious problems, even years after one is infected. If not treated, some STDs can cause infertility,the inability to have children. Other STDs can cause serious illness oreven death. Doctors recommend that people who are sexually activeundergo regular testing, or screening, for STDs.Asymptomaticepidemic. Copyright © by Holt, Rinehart and Winston. All rights reserved. STDs and Teens Teen behavior often places teens at higher risk for catching sexually transmitted diseases. One in 10 teenagers isinfected with an STD. Among teens who are sexuallyactive, 1 in 5 has an STD. Each of the following high-riskbehaviors puts a teen at risk for STDs: >Being sexually active Only abstinence eliminates the risk of catching an STD. >Having more than one sexual partner The more sex- ual partners a person has, the higher the risk of get-ting an STD. Promiscuity, or engaging in sexualactivity with many different people, puts one at anespecially high risk for an STD. >Having a sexual partner who has had multiple sexual partners A person can be exposed to any STDs that his or her partner was exposed to by other partners. >Using alcohol or drugs People who use drugs or alcohol may make poor choices that they might nothave made if they had been sober. SECTION 2 What Are Sexually Transmitted Diseases? 481 Analyzin gDA TA Analyzing DATA STD Cases in Teens The horizontal ( x) axis shows the independent variable, age. The vertical ( y) axis shows the dependent variable, number of cases per 100,000 people. The bars show the number of cases of chlamydia, a common STD, for each age group.321 Your Turn 1.What age group has the high- est rate of infection? 2.Estimate the differencebetween the rate of chlamy-dial infection in people whoare 15 to 19 years old and therate in peoplewho are 25 to 29years old. 3.CRITICAL THINKING Why do you think the rate of chlamydial infection in people who are 15 to 19years old is higher than therate in people who are 30 to34 years old? Rates of Chlamydia in U.S. Teens and Adults Cases per 100,000 people 15–19 20–24 25–29 30–342,400 2,100 1,800 1,5001,200 900600300 0 Age (years) Source: Centers for Disease Control and Prevention.12 3 Communication between partners about STDs is difficult but important. MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. 482 CHAPTER 20 Risks of Adolescent Sexual ActivityThe most effective way to protect yourself from STDs is to remain abstinent before marriage and marry someone who has also been abstinent and is uninfected. Teens Are at Higher Risk Teenagers are also at higher risk of getting STDs because their bodies may not fightinfections as well as the bodies of healthy adults can. Inaddition, females have a higher risk of catching STDs thanmales do. First, females have large areas of mucous mem-branes that can be exposed to infectious particles duringsexual intercourse. (Mucous membranes are the moist,pink tissues that line the openings into the body.) Second,during sexual intercourse, females receive a larger volumeof potentially infected body fluid than males do. Finally,teenage females are especially at risk because the cells onthe cervix of teenage females are more susceptible to infec-tion than the cells of the adult cervix. Preventing STDs Mike suffered in many ways as a result of his STD. Besides dealing with the pain and discomfort of the disease, herisked causing permanent damage to his health. He alsohad to go through the embarrassment and emotional pain of telling his girlfriend and parents. Looking back, Mike realized thathe had not made good decisions. What can you do to make good decisions? First, remember that you are special. Your friends and family care about you. Next, remem-ber that no one can protect you from STDs but YOU! Make the deci-sion to stand up for yourself and take control. Follow these steps toprotect yourself from STDs. 1. Practice abstinence. The best way to prevent STDs is to remain abstinent. Even if you have been sexually active, you can chooseabstinence now. However, if you have been sexually active, youshould be tested for STDs. 2. Stay away from alcohol and drugs. Alcohol and drugs will dull your ability to think clearly and make good decisions. 3. Respect yourself. Individuals with high self-esteem are less likely to let anyone pressure them into something they don’t feel com-fortable doing. 4. Learn the facts about STDs, and use those facts to make good decisions. You can do your part to fight the “silent epidemic” by learning about STDs. Knowledge helps you know the risks.Knowledge helps you make good decisions. 5. Choose friends who influence you in a positive way. The people you hang out with have a big influence on you. Choose friendswho share your values and beliefs. You’ll be more comfortablewith people that won’t ask you to do things that go against yourbetter judgment. You and your best friend, Carl, are making plans for this weekend. Carl says he’s been a bit worriedlately. He tells you that it’s painful when he uri-nates and that he’s noticed a strange discharge.You know Carl has been sexually active. You askhim if he thinks he might have an STD. He saysthat it’s probably a fall he took in practice theother day and that it will clear up on its own. Write on a separate piece of paper the advice you would give your friend. Remember to use thedecision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING www.scilinks.org/health Topic: Sexually Transmitted DiseasesHealthLinks code: HH4482 Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 What Are Sexually Transmitted Diseases? 4836. Get plenty of rest. When you’re tired, it’s hard to think clearly. Don’t put yourself in a situation in which you have to make a tough choice when you are tired. 7. Go out as a group. As shown in Figure 2, besides being lots of fun, you’re a lot less likely to make poor decisions when you are aroundothers. You can also take the pressure off by double-dating. 8. Be aware of your emotions. Don’t try to ease the hurt of a painful emotional experience in your past by engaging in sexual behaviorthat does not agree with your beliefs and values. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term epidemic. 2.Identify the term that means “showing no signs of illness or disease, even though an infection is present.” Understanding Key Ideas 3.Describe why STDs are called a “silent epidemic.” 4.State two serious problems that sexually transmit- ted diseases can cause. 5.Identify the ratio of sexually active teens that have an STD. a.1 in 2 c.1 in 10 b.1 in 5 d.1 in 206.Identify why each of the following behaviors puts a teen at high risk for catching STDs. a.having more than one sexual partner b.using alcohol or drugs 7.Name three reasons why teens are particularly at risk for being infected with STDs. 8. Practicing Wellness Describe steps you can take to prevent the spread of STDs. Critical Thinking 9.Can someone transmit a sexually transmitted disease to another person without realizing it?Explain your answer.LIFE LIFE SKILL Going out with a group of friends reduces thepressures you may feelwhen dating. ACTIVITY Create a list of healthy activities that you can do with agroup of friends.2 Figure Copyright © by Holt, Rinehart and Winston. All rights reserved. 484 CHAPTER 20 Risks of Adolescent Sexual ActivityCommon STDsSECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Some STDs can be fatal. Others have symptoms that are mild or unnoticeable. If untreated, all STDs eventually harm aperson’s health. How Are STDs Spread? Some sexually transmitted diseases are caused by bacteria. OtherSTDs are caused by viruses or parasites. Many of the bacteria, viruses,or parasites that cause STDs can be found in body fluids. These bodyfluids include semen, vaginal secretions, blood, and breast milk. Sex-ually transmitted diseases can be spread by >any type of sexual activity that brings an uninfected person incontact with body fluids from an infected person >any sexual activity that results in contact between one person’sgenitals and another person’s skin or mucous membranes, inwhich one of the persons is already infected with an STD >direct contact with open sores >a mother to her baby before birth, during birth, or duringbreast-feeding Mistaken Ideas In most cases, the bacteria and viruses that cause sexually transmitted diseases cannot survive outside of the humanbody. For example, most of the bacteria and viruses that cause STDscannot be spread through kissing, sharing eating utensils, holdinghands, or using public toilets. And not all STDs can be treated andcured. Some, such as herpes are permanent. OBJECTIVES Describe how STDs can be spread from one person to another. Listexample of ways in which STDs can damage a person’s health. Identify the symptoms and treatments of common bacterial STDs. Describe the symptoms and treatments of common STDs caused by viruses and parasites. State the responsibilities of people who think they may be infected with an STD.KEY TERMSKEY TERMS chlamydia a bacterial STD that infects the repro- ductive organs and that causes a mucous discharge pelvic inflammatory disease (PID) an inflam- mation of the upper female reproductive tract that is caused by the migration of a bacterialinfection from the vagina gonorrhea an STD that is caused by a bacterium that infects mucous membranes, including the genital mucous membranes syphilis a bacterial STD that causes ulcers or chancres; if untreated, it can lead to mental and physical disabilities and premature death human papilloma virus (HPV) a group of viruses that can cause genital warts in males and females and can cause cervical cancer in females You can catch herpes by holding hands with an infected person.Myth Most STDs cannot be transmitted by holding hands, sharing eating utensils, kissing, or using public toilets.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Common STDs 485STDs Can Cause Permanent Damage All sexually transmitted diseases can harm a person’s health. How- ever, many people are not aware that sexually transmitted diseasescan cause permanent damage. For example, there are some sexuallytransmitted diseases that can result in painful sores that can recurthroughout one’s life. Some STDs can lead to brain damage or cancer.Other sexually transmitted diseases can leave a person unable to havechildren. Some sexually transmitted diseases can even be fatal. Babies and STDs Many people do not know that a sexually transmitted disease in a pregnant woman can threaten the health ofher unborn baby, or fetus. Some STDs can cause a pregnant womanto have a miscarriage. Some STD infections in a newborn can resultin blindness for the infant. The blindness is caused by certain bacte-rial STDs. These bacteria infect the baby’s eyes as the baby passesthrough the birth canal. Most newborn babies in the United Statesare treated with medicated eyedrops soon after birth to eliminatethe risk of transmission of bacterial STDs during birth. The eye-drops contain an antibiotic or other substance that kills the bacte-ria. The drops are given to all babies, even if the mother is notbelieved to be infected. The Facts About STDs Being informed about the facts of sexu- ally transmitted diseases can help you avoid behaviors that lead toSTDs. Being informed about sexually transmitted diseases also makespeople aware of the symptoms of STDs. It is important to see a doctoror other health care professional as soon as you may have beenexposed to a sexually transmitted disease. Early diagnosis and treat-ment of sexually transmitted diseases are essential to preventinglong-term health effects. Common sexually transmitted diseases andtheir treatments are described on pp. 486–489. “It is best to see if an STD goes away on its own before going to a doctor. ” “Washing the genitals after sex prevents STDs.” “Birth-control pills prevent STDs.” “The medicine prescribed for one kind of STD will cure any STD. ” “If one sex partner is treated for an STD, the other partner does not need to be treated. ”Most STDs do not go away on their own. Even if the symptoms go away, the STD is not necessarily cured. Washing is not an effective way to prevent STDs.Birth-control pills do not provide protection against STDs. Each STD requires different treatment. A doctor must be consulted for proper treatment. Both sex partners must be treated so that they will not reinfect each other.Beliefs Reality vs.Beliefs Reality vs. For more information about male and female reproductive systems, see the Express Lessons onpp. 522–525 of this text.HandbookHEALTH“ I took a risk as a teen and didn’t see a doctor when I should have. As a result, my wife and I are unable to have children.” Copyright © by Holt, Rinehart and Winston. All rights reserved. 486 CHAPTER 20 Risks of Adolescent Sexual ActivitySTDs Caused by Bacteria Table 1 describes the four most common bacterial STDs— and Although most bacterial STDs can be cured by antibiotics, early detection and treatment of STDs are very important. If left untreatedfor too long, each of these STDs can cause serious damage to thebody. For example, some untreated bacterial STDs can scar the fallop-ian tubes. This scarring can later result in an ectopic pregnancy—thefertilized egg implants in the fallopian tube instead of the uterus.syphilis. gonorrhea, pelvic inflammatory disease (PID), chlamydia, Table 1 Bacterial STDs What is it? Chlamydia (kluh MIDee uh) is an STD caused by a bac- terium that infects the repro-ductive organs and thatcauses a mucous discharge.Chlamydia can be passedfrom pregnant women toinfants during childbirth.The highest rates of chlamy-dial infections in the UnitedStates are found in 15- to 19-year olds. There are morenew cases of chlamydia thanany other STD reportedeach year in the UnitedStates.Symptoms Often no symptoms Females:>pain during urination >vaginal discharge or bleeding >pelvic pain Males: >pain during urination >discharge from the penis >pain in the pelvicarea or abdomen >vaginal discharge >unusually long andpainful menstrualperiods >spotting betweenperiods >fever >painful urination >nauseaTreatment Both partners take antibiotics at the sametime. Antibiotics are used to treat PID. Antibiotic treatment does not repair damagethat has alreadyoccurred. Surgery maybe needed if infection isleft untreated for toolong.If untreated Females: >infertility >pelvic pain >ectopic pregnancies >pelvic inflammatory disease (PID) Males: >can injure reproduc- tive organs >swollen and tendertesticles Infants of infected mothers: >illness >blindness >scars in the fallopiantubes or uterus thatcan lead to infertilityor ectopic pregnancies >chronic pelvic pain Pelvic inflammatorydisease (PID) is an inflam- mation of the upper femalereproductive tract caused bythe migration of a bacterialinfection from the vagina.PID is a common and seri-ous complication of someSTDs. Ectopic pregnancy Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Common STDs 487Table 1 Bacterial STDs, continued What is it? Gonorrhea (gahn uh REE uh) is an STD caused by a bacterium that infectsmucous membranes, includ-ing the genital mucousmembranes. Gonorrhea canbe passed to infants duringchildbirth. Syphilis (SIF uh lis) is an STD caused by a bacterium that can cause ulcers orchancres (SHANG kuhrz).Syphilis can spread throughthe blood, damaging thenervous system and otherbody organs. Syphilis can bepassed to infants duringchildbirth.Symptoms Females: Often no obvious symptoms >pain during urination >vaginal discharge or bleeding >pain in the abdomenor pelvic area Males: >pain during urination >discharge from the penis Males and Females: Phase 1 (10 to 90 days after infection):>painless ulcer, called a chancre at theplace where the bac-teria entered thebody Phase 2 (2 to 8 weeks after infection): >fever >rash >swollen lymph nodes >joint pain >muscle aches Phase 3 (2 or more years after infection):>heart and nervous system damage,including blindnessand loss of mentalabilities >possible deathTreatment Both partners take antibiotics at the sametime. Gonorrhea isbecoming more difficultto treat because thebacteria that cause ithave become moreresistant to antibiotics. Both partners take antibiotics at the sametime. If treated in the early stages, syphilis can becured.If untreated Females: >pelvic inflammatory disease (PID), whichcan result in ectopicpregnancies or infertility Males: >scarring of the urethra, which makesurination difficult >painful swelling of thetesticles, which maylead to infertility Newborns of infected mothers: >blindness >joint infection >life-threatening bloodinfections Males and Females: >mental and physical disabilities >premature death Infants of infected mothers: >premature birth >severe mental disabilities >deafness >death Syphilis chancre Eyedrops are given at birth to prevent blindness caused by STDs passed from mother to newborn. Copyright © by Holt, Rinehart and Winston. All rights reserved. 488 CHAPTER 20 Risks of Adolescent Sexual ActivitySTDs Caused by Viruses or Parasites Table 2 describes the most common STDs caused by viruses. The symptoms of many viral STDs can be treated with drugs, but viral STDs, such as cannot be cured. Table 3 describes some STDs caused by parasites.human papilloma virus (HPV), Table 2 Viral STDs What is it? Human papilloma virus (HPV) is an STD caused by a group of viruses that cancause genital warts in malesand females and cervicalcancer in females. HPV isresponsible for more newSTD cases than any otherSTD in the United States.Symptoms Often no symptoms Females:>genital and anal warts (pink or reddish wartsthat appear on thegenitals) >abnormal Pap smear(a screening test forcervical cancer) Males: >genital and anal warts Males and Females:>jaundice (yellowing of the skin) >tiredness and muscleaches >fever >loss of appetite >darkening of theurineMales and Females: HSV-1:>cold sores and fever blisters around themouth HSV-2: >very mild symptoms or no symptoms >red bumps, blistersand recurrent sores onor around the genitals >fever with first infection >swollen lymph nodesTreatment There is no cure. Warts can be treated by surgical removal, freezing,or medication but willoften return. There is no cure. Antiviral medications can shorten outbreaksand reduce theirfrequency. There is no cure for hepatitis B or hepatitis C. Individuals with severe liver damage may need aliver transplant. A vaccine is available to prevent hepatitis B. Novaccine is available forhepatitis C.If untreated Females: Women have a higher risk of developing cervical cancer with certain types of HPV. Males:Men have an increased risk of developing genital cancers. An infected person remains infected for life. Newborns of infected mothers: >Infections of liver, brain, skin, eyes, andmouth >Death Males and Females: >liver damage >liver failure >liver cancer >premature death Genital herpes is an STD caused by a viral infection in the genital area. Genital her-pes is caused by the herpessimplex virus (HSV). Thereare two types of herpes sim-plex viruses: HSV-1 andHSV-2. Most cases of genitalherpes are HSV-2. Bothtypes can be passed to new-born infants if the motherhas genital sores at the timeof delivery. Hepatitis is an inflammation of the liver. T wo different viruses cause hepatitis B and hepatitis C, which are life-threatening forms of hepati-tis. Both hepatitis B andhepatitis C can be sexuallytransmitted. There are otherhepatitis viruses that are notsexually transmitted. A jaundiced eye caused by hepatitis. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Common STDs 489Table 2 Viral STDs, continued What is it? Human immuno-deficiency virus (HIV) is a virus that primarily infects

cells of theimmune system and causesAIDS. HIV is passed byexchange of infected body fluids—usually blood, semen, vaginal fluid, orbreast milk. Exchange usu-ally takes place during sex-ual activity or by sharingdrug injection equipment.Symptoms Males and Females: Phase 1 (initial exposure to ten years or more)>fatigue >weight loss >fever >diarrhea Phase 2>Phase 1 symptoms >swollen lymph nodes >forgetfulness >difficulty thinking Phase 3>weakened immune system >infections >weight lossTreatment There is no cure for AIDS. A combination of drugs can delay the start ofserious symptoms.If untreated Males and Females: >weight loss >malnutrition >loss of mobility >opportunistic infections (such aspneumonia andtuberculosis) >cancer >premature death Table 3 STDs Caused by Parasites What is it? Pubic lice are a strain of lice found in pubic hair of those infected. The lice crawl on the skin and lay eggs on thehairs. The lice are spread byskin-to-skin contact. Scabies (SKAY beez) are tiny mites that burrow into the skin of an infected per-son. Scabies are spread byskin-to-skin contact. Trichomoniasis ( TRIK oh moh NIE uh sis) is an STD caused by a proto-zoan, a single-celled animalthat is just a little larger thana bacterium. Males may nothave symptoms but can givethe disease to others.Symptoms Males and Females: Pubic lice can cause intense itching in thepubic area. Males and Females: Scabies can cause intense itching in theinfected area. Females: >itching in genital area >discharge from the vagina >painful urination Males: >usually no symptomsTreatment Medication can kill the lice. Infected individualsmust wash clothes andbed linens in hot waterto kill any remaining liceand their eggs. Medication can kill the mites. Infected individu-als must wash clothesand bed linens in hotwater to kill any remain-ing mites and their eggs. It can be cured with a prescribed medicine.If untreated Skin damage can occur. Skin damage can occur. Females: >bladder and urethral infections >premature birth inpregnant women Males: >inflammed urethra Copyright © by Holt, Rinehart and Winston. All rights reserved. 490 CHAPTER 20 Risks of Adolescent Sexual ActivityBeing Responsible About STDs Sometimes people are too embarrassed or frightened to ask for help or information about sexually transmitted diseases. But sexuallytransmitted diseases are serious diseases. People who are sexuallyactive must get screened regularly. People who think they might havea sexually transmitted disease should do the following: 1. Seek medical help right away. The earlier a person seeks treat- ment, the less likely the disease will do physical damage andspread to others. 2. Complete the full course of medications. The patient being treated should finish all prescribed medication, even if the symp-toms disappear. 3. Have follow-up testing done. The patient should also undergo a follow-up test to ensure that the infection has been cured. 4. Avoid all sexual activity while being treated. Most sexually trans- mitted diseases can be spread while a person is being treated. 5. Notify all sexual partners. All previous and current sexual part- ners should be urged to get a check-up. One partner in a currentrelationship may be free of the sexually transmitted disease, butthe other partner may not. Receiving treatment at the same timehelps the couple avoid reinfecting each other. Sexually transmitted diseases can affect anyone. Your behavior nowwill affect you the rest of your life. It is important to understand andavoid behavior that places you at risk for contracting a sexually trans-mitted disease. The most effective way to prevent a sexually transmitteddisease is to avoid sexual contact of any kind. Practicing abstinence isthe only sure way to prevent sexually transmitted diseases. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the bacterial STD that causes ulcers or chancers. 2.Classify each of the the following STDs as bacterial or viral. a.gonorrhea c.chlamydia b.HPV d.syphilis 3.Identify the possible symptom caused by HPV. a.fever c.jaundice b.genital warts d.blisters Understanding Key Ideas 4.Listthree ways in which sexually transmitted diseases can be spread.5.Describe the health damage that STDs can cause. 6.State the symptoms of each of the following STDs: a.chlamydia c.HPV b.gonorrhea d.scabies 7.State the treatment of each of the following STDs: a.HIV c.trichomoniasis b.genital herpes d.syphilis 8. Practicing Wellness List four things you should do if you suspect you have been exposed to an STD. Critical Thinking 9.Can a person have more than one STD at onetime? Explain your answer.LIFE LIFE SKILLSeeking medical treatment right away is the responsibility of any couple thatsuspects one partner may have an STD. Copyright © by Holt, Rinehart and Winston. All rights reserved. ✔The risks of being sexually active include social and emotional consequences, unplanned pregnancy, and sexually transmitteddiseases (STDs). ✔Teen parents must make social, personal, educational, and financial sacrifices. ✔Babies born to teen mothers are morelikely to suffer from health problems. ✔The risks of teen sexual activity can beavoided by practicing abstinence.SECTION 1 sexually transmitted disease (STD)(476) CHAPTER 20 Highlights 491 CHAP TER 20 CHAP TER 20 CHAPTER 20Highlights Key Terms The Big Picture ✔Sexually transmitted diseases are spreading at an epidemic rate among teens and young adults. ✔High-risk behaviors for getting STDs include being sexually active,having more than one sexual partner, and using alcohol or drugs. ✔Teenagers are at a greater risk for contracting an STD than areadults because of their behavior. Also, teen bodies may not fightinfections as well as the bodies of healthy adults can. ✔Teens can protect themselves from STDs in several ways, includ-ing practicing abstinence, staying away from alcohol and drugs,and learning the facts about STDs.SECTION 2 epidemic (480) asymptomatic (480) ✔STDs can be spread by any type of sexual activity. Some STDs are also spread by direct contact with open sores and from a motherto her baby. ✔Early detection and treatment of STDs can help prevent seriousdamage to one’s health. ✔Bacterial STDs include chlamydia, gonorrhea, pelvic inflammatorydisease (PID), and syphilis. Most bacterial STDs can be cured withantibiotics. ✔Viral STDs include human papilloma virus (HPV), genital herpes,hepatitis B, hepatitis C, and HIV/AIDS. Although the symptoms ofmany viral STDs can be treated with drugs, viral STDs cannot becured. ✔Pubic lice, scabies, and trichomoniasis infections cause intenseitching in the pubic area and can be cured with medication. ✔Anyone who suspects they may have an STD should seek testingand treatment immediately.SECTION 3 chlamydia (486) pelvic inflammatory disease (PID) (486) gonorrhea (486) syphilis (486) human papilloma virus (HPV) (488) Copyright © by Holt, Rinehart and Winston. All rights reserved. 492 CHAPTER 20 Review CHAP TER 20 CHAP TER 20 CHAPTER 20Review Using Key Terms asymptomatic (480) chlamydia (486) epidemic (480) gonorrhea (486) human papilloma virus (HPV) (488) pelvic inflammatory disease (PID) (486) sexually transmitted disease (STD) (476) syphilis (486) 1.For each definition below, choose the key term that best matches the definition. a.bacterial STD that causes ulcers b.showing no signs of illness or disease c.most common bacterial STD in the UnitedStates d.inflammation of the upper female reproductivetract e.virus that causes genital warts 2.Explain the relationship between the key terms ineach pair below. a.epidemic and sexually transmitted disease b.chlamydia and pelvic inflammatory disease Understanding Key Ideas Section 1 3.Name one emotional consequence teens risk ifthey become sexually active. 4.One in _________ female teenagers gets pregnanteach year. a.5 c.20 b.10 d.100 5.Describe how the life of a teen parent differs fromthe life of a teen without a child. 6.Describe why babies born to teen mothers aremore likely to have health problems than babiesborn to adult mothers are. 7.Name three ways that teenagers can show affec- tion nonsexually. 8. Setting Goals How would becoming a parent now affect your goals for the future?LIFE LIFE SKILL9.CRITICAL THINKING Look at the Beliefs Vs. Real- ity feature on p. 476. Suppose your friend says she is not worried about STDs because her boyfrienddoesn’t seem like the type of guy who would havean STD. What would you say to your friend? Section 2 10.List two reasons STDs in teens are considered a“silent epidemic” . 11.What percentage of all new STD cases occur inpeople between the ages of 15 and 19? a.1 percent c.25 percent b.10 percent d.50 percent 12.What are three reasons that teens are at high riskfor being infected with STDs? 13.Describe how each of the following steps canprotect you against STDs. a.practicing abstinence b.avoiding alcohol and drugs Section 3 14.Describe four ways in which sexually transmitted diseases can be spread. 15.Why are most babies born in the United Statestreated with eyedrops at birth? 16.What symptom may occur in both males andfemales who have gonorrhea? a.fever c.bleeding b.painful urination d.blisters 17.Describe the health effects that can result if eachof the following STDs is untreated. a.chlamydia c.genital herpes b.syphilis d.HPV 18.Which viral STD increases a woman’s risk ofdeveloping cervical cancer? a.HPV c.gonorrhea b.HIV d.genital herpes 19.Describe the treatment of common STDs causedby parasites. 20.List four responsibilities of a person who suspectshe or she is infected with an STD. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 20 Review 493Interpreting Graphics Study the figure below to answer the questions that follow. 21.What was the rate of chlamydial infections in 1996? 22.How has the number of cases of chlamydiachanged over time? 23.CRITICAL THINKING Why do you think the number of cases of chlamydia changed so muchbetween 1984 and 1996?Activities 24. Health and Your Community What suggestions as to how to reduce the number of cases of STDs would you give your local health agency? Write a short report summarizing your suggestions. 25. Health and You Write a short report describing the benefits of waiting untilyou are a married adult before becominga parent. 26. Health and Your Community Work with two classmates. Choose two of the STDs discussed onpp. 486–489. Then collect the Centers for DiseaseControl and Prevention (CDC) statistics on thesetwo STDs. For each STD, draw a graph that showsthe number of new cases each year since 1985. Action Plan 27. Setting Goals Make a plan to protect yourself from becoming a teen parent or becom-ing infected with an STD.LIFE LIFE SKILL 28.Write a paragraph describing the sacrifices Gloria is referring to in the last sentence of the readingpassage. Explain why she has to make thesesacrifices. 29.In this passage, the word brooding means Acelebrating. Bworrying about in a troubled way. Cfeeling sick. Dfeeling angry. 30.What can you infer from reading this passage?EGloria does not like to dance. FGloria is a teen parent. GJuan is Gloria’s boyfriend. Hnone of the above 31.Write a paragraph describing Gloria’s life aftergraduation.READING SKILLWRITING SKILLRead the passage below, and then answer the questions that follow. Gloria was brooding because she couldn’t go with her friends to see a movie. She couldn’t afford a babysitter, and she had tostudy. She had to pass all of her classes sothat she could graduate from high school.Otherwise, she wouldn’t be able to get ajob that paid well. When her friend Juancalled her, she talked about her feelings. “Iwish I could go to the movie. I never real-ized that I would have to make so manysacrifices.” Rates of Chlamydia in the U.S. Population Cases per 100,000 people350 300250200150100 50 0 Year1984 86 88 90 92 94 96WRITING SKILL WRITING SKILL Source: Centers for Disease Control and Prevention. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAP TER 21 CHAP TER 21 CHAPTER 21 HIV and AIDSHIV and AIDSHIV and AIDS 494KNOWLEDGE Which of the statements below are true, and which are false? Check your answers on p. 642. 1.Even young and healthy people are at risk of becoming infected with HIV. 2.You cannot tell if a person is infected with HIVjust by looking at him or her. 3.You can get HIV after shaking hands with aperson infected with HIV. 4.If you drink from a water fountain after aperson infected with HIV has, you are at riskof becoming infected with HIV. 5.You cannot become infected with HIV by using a toilet after a person infected with HIV has used it. 6.You are not at risk of becoming infected withHIV by kissing the cheek of a person infectedwith HIV. 7.If you donate blood at the blood bank, you areat risk of becoming infected with HIV. 8.Most people who are infected with HIV knowthey are infected and will warn others that theyare infected. Copyright © by Holt, Rinehart and Winston. All rights reserved. 495SECTION 1 HIV and AIDS Today SECTION 2 UnderstandingHIV and AIDS SECTION 3 Protecting Yourselffrom HIV andAIDS go.hrw.com www.scilinks.org/health www.cnnstudentnews.comVisit these Web sites for the latest health information: Check out articles related to this chapter by visiting go.hrw.com. Just type in the keyword HH4 CH21. Copyright © by Holt, Rinehart and Winston. All rights reserved. Every day, about 1 10 Americans are infected with HIV. Three million people died from AIDS in 2000. Currently, there is nocure for AIDS. Do you know how to help fight against the spread of HIV and AIDS? What Are HIV and AIDS? HIV and AIDS are different. isthe virus that primarily infects cells of the immune system and thatcauses AIDS. is the dis-ease that is caused by HIV infection, which weakens the immune system. HIV infection is an infection in which HIV has entered the blood and is multiplying in a person’s body cells. HIV specifically infectscells of the immune system. HIV eventually destroys the body’s abilityto fight off infection. After someone is infected with HIV, the virusAcquired immune deficiency syndrome (AIDS)Human immunodeficiency virus (HIV)HIV and AIDS TodaySECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5OBJECTIVES Distinguish between an HIV infection and AIDS. Name the three areas in the world that have the greatest number of people living with HIV/AIDS. Compare the number of people in the United States living with HIV infection to the number of people in the United States living with AIDS. Summarize why teens are one of the fastest-growing groups infected with HIV.KEY TERMSKEY TERMS human immunodeficiency virus (HIV) the virus that primarily infects cells of the immune system and that causes AIDS acquired immune deficiency syndrome (AIDS) the disease that is caused by HIV infection, whichweakens the immune system pandemic a disease that spreads quickly through human populations all over the world 1 in 4 850,000 to 900,000 22 million 40 millionstatistically speaking . . . Ratio of new cases of HIV infection that occur in teens: Estimated number of Americans who are infected with HIV: Number of people who have died from AIDS worldwide: Estimated number of people who are infected with HIV/AIDS worldwide: Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 HIV and AIDS Today 497starts making new copies of itself inside the immune system cells. The new copies of the virus destroy the cells they infect. The copies of thevirus are then released into the bloodstream and enter other immunesystem cells. The destructive cycle then continues. Getting AIDS Being infected with HIV doesn’t mean the person has AIDS. A person is said to have AIDS when the virus has destroyedmany immune system cells and has badly damaged the immune sys-tem. It usually takes 5 to 10 years for a person who is infected withHIV to develop AIDS if the person has not received treatment. Peoplewith AIDS cannot fight off illnesses that a healthy person’s immunesystem could easily defeat. AIDS patients suffer from and often diefrom these illnesses. There is still no cure for AIDS. Once the virus infects a person’s body, there is no way to remove the virus. Most people with HIVinfection eventually develop AIDS. So, learning about HIV and AIDSand protecting yourself from being infected are very important. HIV Around the World AIDS is a a disease that spreads quickly through humanpopulations all over the world. More than 20 million people through-out the world have died from AIDS in the last 20 years. HIV was first discovered in the United States in the early 1980s. Most scientists think that HIV came from central Africa. The virusspread very quickly from Africa to other regions and countries. HIV isstill spreading rapidly in many parts of the world, including Asia andEastern Europe (especially in the Russian Federation). However, thehardest hit area is Africa. AIDS is now the leading cause of death insub-Saharan Africa. To get an idea of how widespread HIV and AIDSare in the world, look at the statistics in Figure 1.pandemic, Estimated Number of People Living with HIV/AIDS 940,000560,000 15,0001 million 1 million 420,000440,000 1.4 million6.1 million 28.1 millionNorth America Caribbean Latin AmericaSub-Saharan AfricaNorth Africa and Middle EastWestern EuropeEastern Europe and Central Asia East Asia and Pacific South and Southeast Asia Australia and New Zealand Source: Joint United Nations Program on HIV/AIDS.These statistics show that AIDS has spread through populations around the world. ACTIVITY If the population size of North America is 316 million, what percentage of the population is infected with HIV/AIDS? 1 Figure MATH SKILL www.scilinks.org/health Topic: AIDS HealthLinks code: HH4005 Copyright © by Holt, Rinehart and Winston. All rights reserved. 498 CHAPTER 21 HIV and AIDSIn some African countries, more than 30 percent of adults are infected with HIV. Nearly all infected people will die because treat- ment is not readily available or affordable. Many children are leftwithout parents. The loss of human life will also affect the economiesof these countries. Many important jobs in fields such as teachingand farming will be left without anyone to fill them. The AIDS epidemic is also very serious in the United States. An estimated 850,000 to 900,000 people are currently living with HIVinfection. Of those infected with HIV in the United States, over300,000 people are living with AIDS. Each year, another 40,000 peopleare infected with HIV. Teens and HIV AIDS is most common among young adults, but many of these adultsbecame HIV-infected as teens. Many teens do not know they areinfected and may be passing the virus to others. T eenagers are one of the fastest-growing groups to become infected with HIV. More than10,000 teens between 13 and 19 years of age have been diagnosedwith HIV in the United States. More than 4,000 of these kids havedeveloped AIDS. Furthermore, these numbers may underestimate thereal numbers, because not all cases are reported. Analyzin gDA TA Analyzing DATA U.S. Teens with AIDS The horizontal ( x) axis shows the independent variable, Year. The vertical ( y) axis shows the dependent variable, Number of teens. Each bar represents the number of teens with AIDS at each of the four time intervals.321 Your Turn 1.How many teens were diagnosed with AIDSbetween bars b and c? 2.What is the percentageincrease in the number of teens with AIDS between bars a and b? 3. CRITICAL THINKING Why do you think that the numberof AIDS cases in teens hasincreased steadily since 1981? 4. CRITICAL THINKING Why do you think that the currentnumber of teens with HIV islikely to be greater than thenumber of teens with AIDS? 1,800 1,5001,200 900600300 0 1981–1987 1988–1992 1993–1995 1996–2000 Year Number of Teens with AIDS in the United States Number of teens Source: Centers for Disease Control and Prevention.abcd 12 3MATH SKILL MATH SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 1 HIV and AIDS Today 499HIV Is Rising in Teens HIV cases are rising in teens because many do not take the risks of HIV and AIDS seriously, and thus, engage in high-risk behaviors. Many believe common myths. Forexample, some teens believe that one can tell by looking at someoneif that person is infected. However, many HIV-infected people look“normal” and healthy, especially in the early stages of infection. Another myth teens have is that HIV/AIDS is a problem only for homosexual males. However, HIV can happen in anyone who engagesin high-risk behavior, regardless of sexual orientation, gender, or age.In fact, heterosexual females represent a growing number of newcases. The face of the HIV epidemic is changing, and individuals fromall populations are being infected. So, you not only need to know thefacts about HIV/AIDS but also need to take the risks seriously. REVIEW Answer the following questions on a separate piece of paper.SECTION 1 SECTION 1 SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “the virus that causes AIDS.” 2.Define the term acquired immune deficiency syndrome. Understanding Key Ideas 3.Describe the relationship between an HIV infection and AIDS. 4.Identify which of the following geographic areas has the highest number of people infected with HIV/AIDS. a.Latin America c.sub-Saharan Africa b.Western Europe d.North America5.Compare the number of people in the United States living with HIV infection to the number ofpeople in the United States living with AIDS. 6.Summarize why the number of new cases of HIV infection is increasing in teens each year. Critical Thinking 7. Practicing Wellness State three ways you can help other teens take the risks of HIV andAIDS seriously. 8.Your friend tells you, “My boyfriend is a star ath-lete. He couldn’t be infected with HIV.” Whatcould you tell your friend? 9.Your friend tells you that she heard on the radiothat HIV infection is not the cause of AIDS. Whatcould you tell your friend?LIFE LIFE SKILLTeens may think that they are not at risk for HIV and AIDS, but teens are one of the fastest-growing groups of people being infected with HIV . Copyright © by Holt, Rinehart and Winston. All rights reserved. 500 CHAPTER 21 HIV and AIDSUnderstanding HIV and AIDSSECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Have you ever been near someone with a contagious infec- tion, such as a cold, but you didn’t get sick? One possiblereason you didn’t get sick is that your body’s immune system was able to fight the infection. Now, imagine what life wouldbe like if your immune system did not work properly. This is whathappens after HIV infects the body. HIV Infects the Body HIV is found in the body fluids, including blood, of an infected person.After HIV enters the bloodstream, the virus attaches to specific whiteblood cells. The white blood cells are an important part of the body’simmune system, which fights infection and protects us from disease. HIV Infects Helper T Cells are the white blood cells that activate the immune response and that are theprimary target cells of HIV infection. Healthy people carry about 500to 1,500 helper T cells in a milliliter of blood (about 20 drops). After HIV attaches to a helper T cell, the virus’s genetic material enters the cell. The virus then forces the T cell to make many copies ofHIV in a process called replication . After viral replication, the new viruses are released from the T cell and attach to other new helper Tcells. The process of viral attachment, entrance, replication, andrelease is then repeated. At first, the immune system fights the HIV infection. However, HIV infection isn’t like a cold in which the immune system com-pletely kills the virus in time. The immune system of a person infected with HIV cannot defeat all the viruses. Eventually, HIVdestroys enough helper T cells to cripple the body’s immune system. Helper T cells (CD4+ cells)OBJECTIVES Describe how HIV infects the body’s immune system. Summarize the symptoms in each of the phases of HIV infection. Identify three ways that HIV is spread. List five ways that HIV is not spread. State how a teen can know if he or she is at risk for HIV infection.KEY TERMSKEY TERMS helper T cell (CD4+ cell) the white blood cell that activates the immune response and that is the primary target cell of HIV infection opportunistic infection (OI) an illness due to an organism that causes disease in people with weakened immune systems; commonly found inAIDS patients asymptomatic stage a stage of an infection in which the infectious agent, such as HIV, is pres- ent but there are few or no symptoms of theinfection Many new viruses (shown as red dots) are being released from an HIV-infectedhelper T cell. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Understanding HIV and AIDS 501Helper T Cell Counts Drop In most HIV-infected people, the virus takes years to destroy the immune system. As more helper T cells are lost, the immune system is less able to fight off other infec-tions

and certain cancers. The number of new viruses made and thenumber of immune cells destroyed determine how quickly a person develops AIDS. Figure 2 shows how the number of T cells drops as an HIV infection progresses. AIDS is diagnosed when the number of helper T cells falls below 200 per milliliter of blood or when at least one AIDS-defining condition ispresent. AIDS-defining conditions include opportunistic infections andother diseases, such as cervical cancer. An isan illness due to an organism that causes disease in people with weak-ened immune systems. OIs are commonly found in people with AIDS.One example of an OI is a special kind of pneumonia. Phases and Symptoms of HIV Infection HIV infection doesn’t progress to AIDS on a specific timetable, butpeople tend to go through three phases of infection. Phase I Phase I of HIV infection is called the asymptomatic phase. The is a stage of an infection in which the infec-tious agent, such as HIV, is present but there are few or no symptomsof the infection. Phase I can last from the initial infection for as longas 10 years or more. Some infected individuals will briefly develop ashort flu-like illness, swollen glands, fatigue, diarrhea, weight loss, orfevers. These mild symptoms may be ignored because they are com-mon to many diseases. However, although infected people may feelwell, they can still transmit the virus to others.asymptomatic stageopportunistic infection (OI) The Onset of AIDS as Indicated by T Cell Count 1,200 1,000 800600400200 0 6Number of helper T cells per milliliter of blood 12 11 123456789 1 0 TimeHIV infection AIDS Clinical diagnosis of AIDS Weeks YearsPhase III • AIDS begins.Phase I and II• There are few or no symptoms in Phase I.• Symptoms begin or worsen in Phase II. Source: Annals of Internal Medicine.The graph shows that the number of helper T cells in the bloodstream of aperson with AIDS decreases graduallyover time. ACTIVITY How many years after infec- tion does the onset of AIDS occur in this AIDS patient?2 FigureFor more information about infectious diseases, see the Express Lesson on pp. 542–544 of this text.HandbookHEALTH Copyright © by Holt, Rinehart and Winston. All rights reserved. 502 CHAPTER 21 HIV and AIDSPhase II The beginning or worsening of symptoms marks the start of the second phase of HIV infection. As the immune system fails, lymph glands become swollen, and fatigue, weight loss, fever, or diar-rhea develop or worsen. Some infected people may notice mentalchanges, such as forgetfulness and abnormal thinking patterns. Phase III The third phase of HIV infection marks the beginning of AIDS. This phase is characterized by a helper T cell count of 200 orless and the development of AIDS-defining conditions such as oppor-tunistic infections. Opportunistic infections are caused by organisms that survive and flourish in an HIV-infected person. These organisms usually donot cause problems in people with a healthy immune system. Oppor-tunistic infections include pneumocystis pneumonia , tuberculosis, and a rare infection of the brain called toxoplasmosis . Kaposi’s sarcoma is an example of a cancer found in AIDS patients that causes purple-red blotches on the skin. Gradually, an AIDS patient may appear chronically ill and show weight loss, malnutrition, and little movement. Drug therapy canslow the progress from HIV infection to AIDS. However, AIDS is fatal.Many people with AIDS die from opportunistic infections. Ways That HIV Is Spread The body fluids that carry enough of the HIV virus to infect otherpeople are blood, vaginal fluid, semen, and breast milk. HIV infec-tion can occur when the virus from these infected body fluids entersthe bloodstream of another person. On the contrary, saliva, sweat,tears, vomit, feces, and urine do not contain enough of the virus tospread HIV to another person. “HIV is spread by coughing or sneezing.” “A person can’t get an HIV infection from sharing needles or other injection equipment. ” “HIV is spread by mosquito and tick bites.” “Sharing toilet seats can spread HIV.” “Teenagers seldom get HIV infection.”HIV is not spread through the air. The amount of HIV in mucus or saliva is not enough to spread HIV. People who share injection equipment used for legal and illegal drugs, tattooing, and body piercing are atrisk of becoming infected. Mosquitoes and other biting animals such as ticks, bed bugs, and fleas do not spread HIV. HIV is not spread by sharing bathroom facilities because HIV does not live long outside the body. HIV does not discriminate by age. Teens who practice risky behaviors are at risk of becoming infected.Beliefs Reality vs.Beliefs Reality vs.People with AIDS have a severely weakened immune system and oftensuffer from AIDS-defining conditions. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 2 Understanding HIV and AIDS 503Transmission of HIV There are three main ways to spread HIV. Each is a high-risk behavior for getting HIV infection. Remember, HIV must enter a person’s bloodstream for an infection to occur. Theway that the virus enters the bloodstream depends on the way it istransmitted. 1. HIV is spread during sexual activity, which includes vaginal, oral, and anal sex, with an infected person. Infected fluids may enter the bloodstream of an uninfected person through tiny cuts, opensores, or tears in the lining of the mouth, vagina, rectum, oropening of the penis. If either the HIV-infected person or theuninfected person has another sexually transmitted disease(STD), the risk of contracting or spreading HIV increases. This isbecause helper T cells are more abundant in cervical mucus ofwomen and semen of men who have an STD. 2. HIV is spread through sharing needles or other intravenous injection equipment with an infected person. This includes nee- dles used to inject drugs as well as needles for body piercingand tattoos. When an HIV-infected person uses injection equip-ment, small amounts of infected blood may remain on theequipment. If an uninfected person uses the same equipment,the infected blood may be injected directly into his or herbloodstream. 3. HIV is spread from an infected mother to her infant before or dur- ing the birth process or by breast-feeding. During the birth process, an HIV-infected mother can spread HIV to her babythrough one of the baby’s body openings or through a smallbreak in the skin. Infected mothers who breast-feed can also passthe virus to their infant through breast milk. However, mother-to-infant transmission has been reduced to just a few cases each yearin the United States because pregnant women are tested for HIV. Risks to Healthcare Workers Healthcare workers are also at risk for HIV infection if they come in contact with body fluids froman infected person. This may occur if they are accidentally stuck withan infected needle. This may also happen if infected body fluids entertheir bloodstream through open cuts or sores. Although such eventsare rare, the risk for people with these jobs is real. Behaviors That Are Safe Getting a blood transfusion from an infected person used to be a common way to get an HIV infection.Early in the HIV/AIDS epidemic, many patients received blood orblood products that contained HIV. However, screening the bloodsupply for HIV in the United States has practically eliminated therisk of infection through blood transfusion. Also, potential high-risk blood donors are discouraged from donating blood. Further-more, you will not get an HIV infection if you donate blood at ablood bank or any established blood collection center. This isbecause sterile, single-use needles are used by medical professionalsin the United States. Ways HIV Is Spread 1Sexual activity with an infected person 2Sharing needles, syringes, or anyother injection equipment withan infected person 3Contact with body fluids from anHIV-infected mother to her infantbefore or during birth or bybreast-feeding Copyright © by Holt, Rinehart and Winston. All rights reserved. 504 CHAPTER 21 HIV and AIDSCasual contact does not result in significant HIV exposure or HIV infection. Casual contact includes shaking hands, holding hands, kiss- ing, hugging, or playing sports with friends. HIV is not spread by sharing bathroom facilities or utensils. You will not get an HIV infection by using the same toilet seat as aninfected person. You will also not contract an HIV infection by shar-ing a water glass or spoon, using the same water fountain, or drinkingfrom the same can of soda. Furthermore, you will not get an HIVinfection by eating in the same restaurant or by working alongside aninfected person. Teens at Risk for HIV Teens are at risk of getting an HIV infection. Almost a third of the 40million people living with HIV/AIDS are teens and young adults. HIVremains the eighth leading cause of death in the United States for teensbetween the ages of 15 and 24. The situation is worse for teens in Africa. How do you know if youare at risk for HIV? Most teens that are infected acquire the virus through high-risk behavior. If you engagein behaviors known to spread HIV, you are putting yourself at highrisk of being infected. You are not at risk if you do not engage in anybehaviors known to transmit HIV. How does a person know if someone he or she knows is at risk for HIV? If a person has engaged in behaviors known to spread HIV,he or she is at risk of being infected with the virus. If someone youknow has participated in risky behaviors before, the only way toknow if he or she is infected is an HIV test. Encourage this person tobe tested for HIV and other STDs. You will read more about HIV test-ing later in the chapter. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2 SECTION 2 SECTION 2 SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Identify the term for “the white blood cell that activates the immune response and is the primary target cell of HIV infection.” 2.Define the term opportunistic infection . Understanding Key Ideas 3.List the events that occur when HIV infects a helper T cell. 4.Classify each of the following symptoms or ill- nesses as part of Phase I, Phase II, or Phase III ofHIV infection: a.AIDS c.opportunistic infections b.mental changes d.flu-like symptoms5.Name the body fluids of an HIV-infected person that can spread HIV to another person. 6.Compare the ways that HIV can and cannot be transmitted. 7.Identify which behavior does notput a teen at risk for HIV. a.sexual activity c.holding hands b.oral sex d.sharing needles Critical Thinking 8.Your friend tells you that she could not possiblyhave been infected by HIV because she feelshealthy. What do you tell her? There are many ways that HIV cannot be spread. For example, you cannot get HIV by playing contact sports withyour friends. Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Protecting Yourself from HIV and AIDS 505Protecting Yourself from HIV and AIDS SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5 Since AIDS first appeared in the 1980s, doctors have learned a lot about treating HIV infection. New drugs can keep HIVunder control for years. However, even with treatment, AIDS is still fatal because there is no vaccine or a cure. The only defenseagainst HIV and AIDS is to prevent infection. Preventing HIV and AIDS The most important thing to know about HIV infection is that it ispreventable. You can avoid HIV infection by learning about how HIVis spread and by avoiding those behaviors and situations that put youat risk for HIV infection. You have the responsibility to take care ofyourself. If you don’t take care of yourself, who else will? Get Educated The first thing to do to prevent HIV infection is to educate yourself. There are many good sources of information aboutHIV infection. For example, many health professionals have informa-tion about HIV and AIDS. The Centers for Disease Control and Pre-vention (CDC) also provides reliable information about HIV andAIDS. In addition, many communities have education and serviceorganizations devoted to HIV and AIDS education and care. Eliminate the Risks The only way to eliminate the risks of HIV infection is to avoid risky behaviors. Don’t take a chance with your life! 1. Practice abstinence. Make the decision now to practice abstinence until marriage. Abstinence is the only method that is 100 percenteffective in preventing the sexual transmission of HIV. Try to avoidall situations in which you may be pressured to engage in sexualactivity. For example, avoid being alone with someone you donot know very well. Instead, go out in groups of friends. OBJECTIVES Listfour ways to protect yourself from HIV and AIDS. Describe the process of getting tested for HIV. Summarize the treatment for HIV infection and AIDS. State three ways a person living with HIV infection can delay the progression from HIV infection to AIDS. Identify four ways you can help an HIV/AIDS program in your community. LIFE LIFE SKILLKEY TERMSKEY TERMS universal precautions the set of procedures used to avoid contact with body fluids and to reduce the risk of spreading HIV and other diseases HIV-antibody test a test that detects HIV antibodies to determine if a person has been infected with HIV HIV positive describes a person who tests posi- tive in two different HIV tests drug combination therapy an AIDS treatment program in which patients regularly take more than one drug “Remember— it’snotwho you are but what you dothat puts you at risk forHIV .” Copyright © by Holt, Rinehart and Winston. All rights reserved. Procedures of universal precautions >Wear latex or vinyl gloves when touching the patient or handling potentially infected fluids. >Wear protective clothing such as laboratory coats, goggles, face masks, and hats during activities that may cause exposure to the patient’s body fluids. >Handle and dispose of all bodily fluids or tissues in a safe manner. >Handle safely and dispose of properly all supplies and equipment that have been contaminated with body fluids. >Use single-use supplies or equipment when practical. >Clean and sterilize equipment that will be used on more than one patient. Table 1 Universal Precautions 506 CHAPTER 21 HIV and AIDS2. Avoid multiple partners. To prevent the risk of spread- ing diseases such as HIV to each other, neither partner should be sexually intimate with anyone else. When acouple is ready for marriage, both partners shouldmaintain a monogamous relationship. 3. Don’t share needles, syringes, drug injection equipment, or any items that may put a person in contact with blood .If an HIV-infected person uses these devices, infected blood may remain on or in the equipment and can infect another person. If a person gets a tattoo orbody piercing, he or she should choose a professionalwho uses single-use needles. Single-use needles are ster-ile and are disposed of properly after one use. 4. Avoid drinking alcohol and taking illegal drugs. Remember that alcohol and other drugs can influenceyour ability to think clearly and to make good deci-sions. If a person is under the influence of alcohol orother drugs, he or she is more likely to engage in ahigh-risk behavior. Unless a doctor is supervising youfor a medical problem that requires medications to beinjected, never inject yourself with drugs of any kind. Practice Universal Precautions are the set of procedures used to avoid contact with body flu- ids and to reduce the risk of spreading HIV and other dis-eases. Health professionals regularly practice this preventionmethod to protect both the health professional and thepatient. Each person examined or cared for in any way by ahealthcare professional is assumed to be possibly infectedwith a pathogen that can be spread through body fluids. Thisassumption allows the provider to take the necessary actionsto prevent the spread of disease. Table 1 shows examples of universal precautions. Universal precautions A new student transfers to your school. You become friends with her. She tells you and others thatshe is HIV positive. Another group of yourfriends is planning a big party, but these friendssay they don’t want your new friend to come.They say they are worried about getting AIDS bybeing around her. You know they are wrong.However, you are worried that they’ll get mad atyou if you speak up for her. What would you do? Write on a separate piece of paper the advice you would give your friends. Remember to use thedecision-making steps. Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING Copyright © by Holt, Rinehart and Winston. All rights reserved. SECTION 3 Protecting Yourself from HIV and AIDS 507Testing for HIV People infected with HIV may have few or no symptoms for many years after infection. Without symptoms to indicate infection, theonly way to know if one is infected is to get tested. If you haveengaged in any high-risk behaviors, get tested. When you are readyfor marriage and a sexual relationship, make sure you and your part-ner get tested. HIV-Antibody Tests HIV tests are readily available at doctors’ offices, clinics, hospitals, and specific AIDS-testing places. All HIVtests are confidential. First, call for an appointment. Once you arrive,you will meet with a counselor. The counselor will ask you to fill outa questionnaire and ask you questions about risk behaviors. It isimportant to answer those questions honestly. Next, the counselor will prepare you for the HIV test. A test that detects antibodies to determine if a person has been infected withHIV is known as an Antibodies are proteins thatare made when the immune system prepares to attack an infectiousagent in the body. If the initial test is positive for HIV antibodies, adifferent test is done to confirm the result. A person who tests posi-tive in two different HIV tests is and thus, HIV-infected. HIV-antibody tests require a blood sample. Newer HIV tests use urine, saliva, and other body fluids instead of blood, but the blood testis the most accurate and reliable test. While the current HIV-antibodytests require a laboratory, some of the newer tests can be performed athome. However, the FDA has not approved these newer tests. Further-more, counseling by a healthcare professional that precedes and fol-lows a lab test is important for answering a person’s questions. A Retest for HIV Is Best HIV antibodies may be found within 6 to 12 weeks after infection with HIV. However, antibodies may not bepresent until 6 to 12 months after infection. An initial negative testcan be misleading if the test is done too soon after infection. If a per-son thinks he or she has had a recent exposure to HIV, then this per-son should avoid all high-risk behaviors and be tested. After 6months, this person should be retested. If the test is negative againand the person has not been exposed to additional risks, he or she isprobably not infected. Lab Tests for HIV-Infected People Two lab tests can help doc- tors monitor the health of their patients who are HIV positive. Onetest measures the number of helper T cells in the blood, a value calleda T cell count or CD4+ count. The result of this test can show the strength of the patient’s immune system. This test can also tellwhether a person has developed AIDS. Another lab test measures viral load. Viral load is a measure of the number of viruses in the blood. The higher the viral load, the moreinfectious the person’s body fluids are likely to be and the closer thatperson is to having AIDS.HIV positive,HIV-antibody test.A negative HIV test is a guarantee that you are not infected.Myth Antibodies to HIV may not show up until 6 to 12 months after infection.Fact Copyright © by Holt, Rinehart and Winston. All rights reserved. 508 Treating HIV and AIDS When a person first discovers that he or she is HIV positive, that per- son should see a doctor as soon as possible. Like almost all otherchronic viral infections, no cure exists for HIV infection and AIDS.However, new drugs developed in the 1990s can keep the virus undercontrol for years. Importance of Treatment All HIV-infected people whose immune system shows signs of impairment or who have developedAIDS should consider a drug treatment plan. Today, many drugs areused to treat HIV infection and AIDS. The key decision is when tostart the drugs. Once the decision has been made to start the medica-tions, the doctor will help select a drug regimen and a treatment plan. The availability of these new HIV and AIDS drugs has caused the average survival time of AIDS patients to increase and the AIDS deathrate to drop. New drugs can decrease the viral load, maintain the per-son’s helper T cell counts, and even treat some opportunistic infec-tions. In some rare cases, treatment can reverse the disease and allowthe body’s immune system to repair itself. However, HIV and AIDSdrugs can cause serious side effects, the drugs do not work for everypatient, and no drug can cure AIDS. Drug Combination Treatment is an AIDS treatment program in which patients regularly take more thanone drug. Researchers have learned that three or more drugs given at thesame time are more effective than one drug by itself. These differentdrugs stop HIV from multiplying at different steps in the virus’s replica-tion process. A common drug used in drug combination therapy is called azidothymidine (AZT). Another group of powerful drugs are called protease inhibitors. AZT and protease inhibitors prevent HIV frommaking copies of itself inside a T cell. However, even combinationdrugs cannot completely eliminate the virus from the body.Drug combination therapy HIV and AIDS drug treatment plans may require taking many pills each day. This is the medicine cabinet of aperson who has been living with HIVsince 1980. Copyright © by Holt, Rinehart and Winston. All rights reserved. Limits of HIV/AIDS Drugs After drugs for HIV infection have been started, the patient is checked for side effects. Drugs are con- tinued until side effects become serious or the HIV infection worsens.Side effects can include kidney and liver damage. About 30 percent ofthe people who start taking some of these drugs become so sick thatthey have to stop taking them. Because of these side effects, doctorswait to prescribe drugs until the virus has caused noticeable damageto the patient’s immune system. In addition to side effects of the drugs, taking HIV/AIDS drugs can be difficult for the following reasons: >These drugs can lose their effectiveness over time because thevirus can develop resistance to the drugs. >The cost of these drugs and of treatment is very high. >The drug treatment plans are very complicated and requiretaking many pills per day on a strict schedule. >The lab tests that monitor treatment progress require that patientsbe motivated, committed, and involved in their progress. Drugs may slow the development of the disease and extend the qual-ity of life for AIDS patients. However, drugs do not cure the disease. LIFE LIFE SKILL ActivityHIV and the CommunityUsing Community Resources You may be saying to yourself, “I want to do my part to help stop the HIV/AIDS epidemic. But what can I do?”Here are some ways to get started: Make a commitment to yourself to tell one other person that you won’t put yourself at riskof becoming infected. Write down a plan abouthow you will avoid behaviors that put you atrisk for infection. Educate your friends about preventing HIV infec- tion. Encourage them to avoid risky behavior. Make a commitment to participate in preventing HIV/AIDS in your community. Write down threecommunity organizations that support HIV/AIDSeducation and prevention. Find out if there is anAIDS hot line. If so, find out how you can help. Find out if an organization in your community sponsors an AIDS walk and when the walk isscheduled. Find out if the AIDS walk providesopportunities for walkers to raise funds for localAIDS organizations or patients. Sign up for thewalk, and encourage your friends to participate. 4321One way people honor those who have died of AIDS is by making an AIDS quilt. Find out other ways to honor people who have died of AIDS inyour community. Using Community Resources 1.What can you do to support HIV/AIDS education and prevention programs in your community? 2.How might you help raise funds for an AIDS edu-cation program?LIFE LIFE SKILL5 Drugs to treat one person with AIDS cost between $10,000 and $15,000 per year. Copyright © by Holt, Rinehart and Winston. All rights reserved. 510

CHAPTER 21 HIV and AIDSLiving with HIV Infection Maintaining good health through treatment, diet, exercise, and rest is important for delaying the progression from HIV infection to AIDS.Counselors at clinics and in health facilities can provide informationabout keeping healthy. Counselors can also help people deal with theemotional aspects of finding out that they are infected. Supportgroups and outreach programs for HIV and AIDS patients and theirfamilies are available in most large communities. Most HIV-infected people continue doing almost everything they did before they got infected. Infected people continue to work, go toschool, participate in sports and other activities, and be aroundothers. However, all HIV-infected people should remember that theycan transmit this deadly virus to others. To avoid infecting others,HIV-infected people must avoid participating in activities that mayexpose others to infected body fluids. Some HIV-infected people become activists and spokespeople for HIV/AIDS prevention. Ervin “Magic” Johnson is a former basketballstar who is HIV positive. He speaks to many people every year aboutpreventing HIV infection. Johnson often talks about how he deniedbeing at risk for HIV. He encourages others to realize the risk of HIVinfection. He stresses that HIV infection can happen to anyone, evena famous athlete. We can all make a difference in small ways and in big ways in the fight to stop the spread of HIV and AIDS. REVIEW Answer the following questions on a separate piece of paper.SECTION 1SECTION 1 SECTION 2SECTION 2 SECTION 3SECTION 3SECTION 3 SECTION 4SECTION 4 SECTION 5SECTION 5Using Key Terms 1.Define the term universal precautions. 2.Identify the term for “describes a person who tests positive for two different HIV tests.” Understanding Key Ideas 3.Listfour things a person can do to prevent HIV infection and AIDS. 4.Identify which of the following is nota universal precaution procedure. a.wearing gloves when handling blood b.disposing of blood-contaminated supplies c.avoiding single-use equipment d.sterilizing supplies 5.Describe the relationship between the HIV-antibody test and being HIV positive.6.Propose which of the following responses a person should have if he or she may have been exposed to HIV but tested negative for HIV. He or she should a.take the test again in 6 months. b.repeat the test next week. c.take an at-home HIV test. d.none of the above 7.Name one advantage and one disadvantage of drug combination therapy. 8.Propose four things an HIV-infected person can do to delay the development of AIDS. 9. Using Community Resources State four things you can do to contribute to a commu-nity HIV and AIDS program. Critical Thinking 10.You and your friend find a syringe in the schoolparking lot. Your friend thinks it’s OK to pick it up.What would you do?LIFE LIFE SKILLMany people infected with HIV, such as “Magic” Johnson, become AIDSactivists and speak to groups about HIVand AIDS prevention. Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 21 Highlights 511 CHAP TER 21 CHAP TER 21 CHAPTER 21Highlights Key Terms The Big Picture ✔Human immunodeficiency virus (HIV) is a virus that primarily infects cells of the immune system and that causes AIDS. ✔Acquired immune deficiency syndrome (AIDS) is a fatal disease that results from HIV infection. ✔AIDS is a worldwide epidemic that continues to spread. ✔An estimated 850,000 to 900,000 Americans are living with HIVinfection. ✔Teenagers are one of the fastest-growing groups with HIV and AIDS because they engage in high-risk behaviors.SECTION 1 human immunodeficiency virus (HIV)(496) acquired immune deficiency syndrome (AIDS) (496) pandemic (497) SECTION 3 universal precautions (506) HIV-antibody test (507) HIV positive (507) drug combination therapy (508)✔HIV primarily infects important immune cells called helper Tcells. The number of helper T cells decreases as HIV increases inthe body. ✔There are three phases of HIV infection. In the early stages ofHIV-infection, people often do not know they are infected because they have few or no symptoms. ✔The most common ways HIV is spread is throughsexual contact, through shared drug injectionequipment, and through contact with bodyfluids from a mother to her baby before orduring birth or by breast-feeding. ✔HIV is not spread by casual contact. ✔Teens are at risk for HIV infection ifthey engage in high-risk behavior.SECTION 2 helper T cell (CD4+ cell) (500) opportunistic infection (OI) (501) asymptomatic stage (501) ✔HIV can be prevented by abstinence and avoiding the high-risk behaviors known to transmit HIV. ✔If a person has engaged in any behaviors that put him or her at risk for an HIV infection, he or she should get an HIV-antibodytest. ✔Although drug combination treatment can slow down the replication of HIV in the body, drugs cannot cure AIDS. ✔People living with HIV can delay the progression from HIV infection to AIDS by getting treated, eating well, and getting sup-port from the community. ✔You can contribute to a community AIDS program by volunteering for an AIDS hot line, joining an AIDS walk, or justtalking to your friends about what you know about preventingHIV infection. Copyright © by Holt, Rinehart and Winston. All rights reserved. 512 CHAPTER 21 Review CHAP TER 21 CHAP TER 21 CHAPTER 21Review Using Key Terms acquired immune deficiency syndrome (AIDS) (496) asymptomatic stage (501) drug combination therapy (508) helper T cell (CD4+ cell) (500) HIV-antibody test (507) HIV positive (507) human immunodeficiency virus (HIV) (496) opportunistic infection (OI) (501) pandemic (497) universal precautions (506) 1.For each definition below, choose the key term that best matches the definition. a.an AIDS treatment program in which patientsregularly take more than one drug b.a stage of an infection in which the infectiousagent is present but there are few or no symp-toms c.the white blood cell that is the primary targetof HIV infection d.the virus that causes AIDS e.a disease that spreads quickly through humanpopulations all over the world 2.Explain the relationship between the key terms ineach of the following pairs. a.HIV-antibody test and HIV positive b.HIV and universal precautions Understanding Key Ideas Section 1 3.How does HIV cause AIDS? 4.Which geographic area has the greatest numberof people with HIV/AIDS? 5.About how many people in the United States areinfected with HIV? a.100–200 c.850,000–900,000 b.10,000–12,000 d.3,000,000 6.Why is HIV infection on the rise in teens? 7.CRITICAL THINKING Propose possible ways that teens can help reduce the rate of HIV infectionamong teenage populations.Section 2 8.What happens when HIV infects helper T cells? 9.What can happen during Phase III of HIV infection? a.opportunistic infection c.low T cell count b.few symptoms d.both (a) and (c) 10.Name three ways that HIV is spread. 11.Which of the following behaviors has the highestrisk for spreading HIV? a.shaking hands with an infected person b.sexual intercourse with an infected person c.using a glass used by an infected person d.kissing an infected person 12.State five behaviors that do not put someone atrisk for an HIV infection. 13.How would a teen know if he or she is at risk forHIV infection? Section 3 14.Which of the following is one way you caneliminate the risks of HIV and AIDS? a.drug use c.sexual activity b.abstinence d.sharing needles 15.What is the relationship between alcohol andother drugs and the risk of HIV infection? 16.How does the HIV-antibody test work? 17.Which of the following statements is true aboutdrug combination therapy? a.It is not costly. c.It can prolong life. b.It is a cure for AIDS. d.It has few side effects. 18.How can people living with HIV infection delaythe progression of HIV to AIDS? 19.Propose how you can contribute to an AIDSprogram in your community. 20.CRITICAL THINKING Which of the following do you think shows that drug combination therapy is working? a.increased T cell count b.increased viral load c.reduced T cell count d.pneumoniaLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. CHAPTER 21 Review 513Interpreting Graphics Study the figure below to answer the questions that follow. 21.How many reported cases of HIV infection occurred in the United States in 1999? 22.What is the percentage increase in the reported number of people with HIV infection from 1999 to 2000?Activities 23. Health and You Write a short report about the benefits of abstaining from sexualactivity and other high-risk behaviorsfor contracting HIV. 24. Health and You Research one of the following AIDS-related illnesses:Kaposi’s sarcoma, “thrush,” or pneumocystispneumonia. Write a short report describing theinfection. Include information on the causes,symptoms, and treatment of the infection. 25. Health and Your Community Research one local HIV/AIDS community program, and write down some ways the pro gram can help reduce the number of new cases of HIV infection. 26. Health and Your Community Research HIV infec- tion rates in your state, and compare that numberto the national figure. Action Plan 27. Practicing Wellness Discuss at least four things you can do to contribute to HIV andAIDS education and prevention. LIFE LIFE SKILL 28.In this passage, the word lividmeans Afeeling very cold. Bfeeling very angry. Cfeeling very sick. Dfeeling very happy. 29.What can you infer from reading this passage? EMario had cancer. FMario had AIDS. GMario had an alcohol problem. HMario survived to tell us his story. 30.Write a paragraph describing some of the things Lena can do to protect herself from HIV and AIDS. 31.Write a paragraph describing some of the thingsLena can do to help stop the spread of HIV andAIDS in her community.READING SKILLWRITING SKILLWRITING SKILL Read the passage below, and then answer the questions that follow. My name is Lena. At the age of 18, I was on my way to college. The year was 2002. Ineeded to find housing, learn my wayaround the campus, and sign up for theright classes. I was not thinking about HIV.I never thought anyone around my agewould get HIV. I thought we were invincibleand that nothing would happen to us. I nowknow about HIV, and I am livid that it took my brother Mario away from me. Why didn’t someone tell Mario about HIV?MATH SKILLWRITING SKILL WRITING SKILL Reported Cases of HIV in the U.S. 450 400350300250 0 1996Number of people (in thousands) 1997 1998 1999 2000 Year Source: Centers for Disease Control and Prevention. Copyright © by Holt, Rinehart and Winston. All rights reserved. 514 HEALTH Handbook Copyright © by Holt, Rinehart and Winston. All rights reserved. These quick lessons cover healthcare basics. How Your Body Works p. 516 What You Need to Know About . . . p. 548First Aid and Safety p. 576 p. 614 Use these fundamental skills for a lifetime of good health. p. 622XPRES SLessons E REFERENCE QUICK REVIEW REFERENCE LIFE LIFE SKILLS 515REFERENCE REFERENCE Guide Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Nervous System The nervous system is your body’s control center and communi- cations network. 516 HOW YOUR BODY WORKS Brain Spinal cord Peripheralnerves Central Nervous System Peripheral Nervous SystemWhat does the nervous system do? The nervous system works with the endocrine system tocontrol how your bodyworks and to help your bodyrespond to changes in itssurroundings. Messagespicked up from inside andoutside of the body causethe nervous system to createsignals. These signals coordi-nate the body’s thoughts,senses, movements, balance,and many automaticresponses. Specialized cells,called receive andsend the signals. Neuronsform all the tissues of thenervous system. What are the parts of the nervous system? The brain, the spinal cord, and many nerves make upthe nervous system. are bundles of tissue thatcarry signals from one placeto another. The isthe column of nerve tissuethat runs through the back-bone. The nervous system isdivided into two main parts.The brain and spinal cordmake up the The nerves that connect thebrain and spinal cord toother parts of the bodymake up the How do the parts of the nervous system work together? Some nerves of the PNS gather messages from insideand outside the body andcarry signals to the CNS. TheCNS interprets the incomingsignals. If a response isneeded, the CNS sends sig-nals back to the muscles andthe organs of the bodythrough other nerves of thePNS. The signals from theCNS cause a response. nervous system (PNS).peripheralnervous system (CNS).central spinal cordNervesneurons,The nervous system enables these volleyball players to coordinatetheir movements. Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 517 Dendrite Synapse AxonNeuron Cell body Synaptic vesicles NeurotransmittermoleculesReceptor Ionchannel SynapticcleftAxonterminalWhat do neurons look like? A neuron has three parts. The central part of a neuron is thecell body . Branches from the cell body, called dendrites, receive signals. A long exten-sion of the cell body, calledan axon, carries signals to the next cell. One nerve cellmeets another at a synapse. A is a tiny spaceacross which nerve impulsespass from one neuron to thenext. The ends of axonsrelease chemicals called which move across the synaptic cleft and bind to receptors on thesurface of the next cell. Whenthe chemicals bind, they passa signal on to the next cell. How does the nervous system work? Sensory receptors detect mes- sages for the nervous system and create signals. Examplesof these receptors are thetaste buds and the receptorsfor touch, smell, tempera-ture, and light. are nerves that carry the signals from the senseorgans toward the CNS,where they are processed orrelayed. arenerves that carry signalsfrom the brain or the spinalcord to the muscles andglands. These nerves causethe body to respond. The nervous system responds in two basic ways. Some of the responses bythe nervous system are vol-untary, which means thatyou can make them happen. These responses includemoving your arms and legsto walk or run and turningyour head to look in a par-ticular direction. Otherresponses are involuntary, orautomatic. They happenwhether you think aboutthem or not. For example,shivering when you’re coldand pulling your hand away from a very hot object areinvoluntary responses.Reflexes and the control ofinternal body organs areinvoluntary. Motor nervesnervesSensory neurotransmitterssynapse A neuron is made up of a cell body, an axon, and many dendrites. Theaxon of one neuron meets anothercell at a point called a synapse. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Nervous System continued Do nerves grow back after an injury? Doctors once thought that injured nerves could not healor be repaired. But recentstudies now show that somenerve tissue can be repairedor can heal to some degree.Sensory and motor nervescan heal completely, but theprocess is very slow. Spinalnerves have also shown theability to grow, but they generally do not grow wellenough to repair significantdamage. This is why spinalcord injuries and the resulting paralysis are oftenpermanent. Researchers are studying the nature of the spinal cordand spinal nerves to deter-mine why they do not heal.Nerves of the brain can healsomewhat. Some types ofbrain cells can also rearrangetheir function to make up forcells that are lost because ofsevere injury. The olfactorynerve, which creates thesense of smell, is uniqueamong all nerves. It is able toheal rapidly, even after beingcompletly severed. Themechanism for this healing isnot yet known. Intense studyis underway to unlock thesecret and pass this ability onto other nerve cells. What do the parts of the brain do? The is the main con- trol center for the body.Three major areas make upthe brain. These are the cere-brum, the cerebellum, andthe brain stem. The largest,most complex part of thebrain is the It isthe center for thought, imag-ination, and emotions. Thecerebrum has two halves, orhemispheres . Each half has four lobes that act as controlcenters for different activi-ties. These activities includethe control of movementand the processing of signalsthat create vision, hearing,taste, and touch.The is the part of the brain that controlsbalance and posture. It alsosmooths out movement thatrequires fine coordination. The is the part of the brian that guides sig-nals coming from the spinalcord to other parts of thebrain. There are three partsto the brain stem. The pons is the wider area just below thecerebrum. The midbrain is above the pons. Below thepons, the brain stem narrowsinto the medulla oblongata . The medulla oblongatahelps control many auto-matic actions such as heart-beat, breathing, digestion,swallowing, vomiting, sneez-ing, and coughing. brain stemcerebellum cerebrum.brain Cerebrum Cerebellum Brain stemSpeech, thought, taste, and movement Touch Hearing Vision Balance and coordination BreathingControl Centersof the Brain 518 HOW YOUR BODY WORKS Copyright © by Holt, Rinehart and Winston. All rights reserved. How does the brain send messages to the body? The spinal cord is the major line of communicationbetween the brain and thebody. It is a cylinder of nervetissue about 18 in. long andabout as thick as your indexfinger. The bones of thespine, the spinal fluid, andthree layers of tissue sur-round and protect the spinalcord. arenerves that branch from thespinal cord and that go tothe brain and to the tissuesof the body. Unfortunately,despite all its protection, thespinal cord is still delicateand subject to injury.How do reflexes work? A is an involuntaryresponse that enables thebody to react immediately toa stimulus, such as a possi-ble injury. Some reflexesinvolve the brain, but manydo not. Many reflexes, suchas the reaction to intensepain, result from signals thattravel to the spinal cordthrough one or more sensory nerves. The signalsmove to association neuronsin the spinal cord and thento a motor nerve. The motornerve returns a signal thatcauses you to pull away from the source of the pain. reflex Spinal nerves HOW YOUR BODY WORKS 519 Spinal cord SensoryneuronAssociation neuron Motorneuron Muscle EX P R E S SLesson REVIEW 1.Summarize the functions of the central nervous system and the peripheral nervous system. 2. Explain how the signals carried by nerves pass from one neuronto the next. 3.Describe the functions of the cerebrum, the cerebellum, and thebrain stem. 4.CRITICAL THINKING If all nerves could be made to heal rapidly, what groups of people might benefit?The signal for a reflex goes directly to the spinal cordand then back to a muscle.This reflex arc allows thebody to react quickly with-out thinking. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Vision and Hearing Your vision and hearing enable you to sense the world around you. How do we see? Your eyes and brain enable you to see. The is thesense organ that gathers andfocuses light and that gener-ates signals that are sent tothe brain. Light that entersthe eye falls on the retina.The is the light-sensitive inner layer of theeye. Two basic types of cellsthat respond to light—rodsand cones—are found in theretina. Rods, which produce black-and-white vision,receive dim light and detectshape and motion. Cones , which produce color vision,receive bright light andsharpen your vision. Rods and cones respond to light by creating nerve sig-nals. These signals leave theeye by the optic nerve, which extends from the back of the eye to the area of thebrain that processes sight.Your brain interprets thenerve signals created inresponse to light, whichenables you to see the objectthe light came from. What is the blind spot? The blind spot is the place where the optic nerve meetsthe retina. There are no pho-toreceptors in this area ofthe retina. So, any imagethat forms on the blind spotcannot be seen.Do you see only in black and white if you are colorblind? No, people who are color- blind see some colors. Threedifferent types of cones col-lect three basic colors oflight—red, green, and blue. Aperson who is colorblind hasa deficiency, but not a totallack, of cones that detect oneor more of these basic colorsof light. How does the eye focus? Light rays enter the eyethrough the lens, which changes shape to focus thelight on the retina. It is inter-esting to note that imagesform upside down on theretina. The brain corrects theimages, and thus we seethings right side up. What happens when you’re nearsighted? If you are nearsighted, your eyes are elongated from frontto back. This causes distantobjects to focus in front ofthe retina rather than on it.As a result, distant objectslook fuzzy. Images of nearbyobjects are still in focus onthe retina. This condition iscalled myopia .retinaeye 520 HOW YOUR BODY WORKS RetinaOptic nerveLens Cornea Pupil Iris Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 521How do we hear? Your ears and your brain enable you to hear. The isthe sense organ that func-tions in hearing and balance.The outer ear gathers in vibra- tions that cause sound anddirects them to the eardrum.The is a membranethat transmits sound wavesfrom the outer ear to themiddle ear. Sound vibrationscause the eardrum to vibrate.The middle ear has three tiny bones—the hammer, theanvil, and the stirrup—thattransmit vibrations from theeardrum to the inner ear. Thebones also increase the forceof vibrations. The inner ear contains the fluid-filled semicircularcanals and the cochlea. The is a coiled, fluid- filled tube. Tiny hairs in thecochlea are the receptors forsound. Signals created bythe receptors go through theauditory nerve from the cochlea to the temporal lobeof the brain. There, the braininterprets the signals as dif-ferent sounds. What part of the ear controls balance? Movement of the sensory receptors in the inner earcontrols balance. Some ofthe receptors detect gravityand changes in speed.Receptors in the semicircularcanals detect rotationalmotions, such as spinning.Why do ears pop in an airplane? A tube called the connects the middle ear to the throat. The eustachian tubes maintainequal air pressure on bothsides of your eardrums. Airpressure is much lower athigh altitudes, where air-planes fly. You do not usu-ally notice any changes in air pressure as you slowlygain altitude. But when youexperience a rapid changefrom high altitude to lowaltitude, the air pressure onyour eardrums increases sud-denly. This causes theeardrums to be pushedinward, impairing your hear-ing temporarily. When thepressure on both sides of aneardrum is equalized, theeardrum moves back to itsnormal position. As a result,you hear a popping sound,and normal hearing isrestored. tubeeustachian cochleaeardrumear EX P R E S SLesson REVIEW 1.List and describe the two basic types of light receptors in the retina of the eye. 2.Explain what causes a person to be nearsighted. 3.List in order the series of structures through which sound vibrations pass in the ear. 4. Practicing Wellness Research several causes of deafness. What can a hearing person do to protect himself orherself from hearing loss?LIFE LIFE SKILL Semicircular canals Auditorynerve Cochlea Stirrup EardrumHammer AnvilEarcanalInner ear Middle earOuter ear Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Male Reproductive System The male reproductive system makes male reproductive cells and hormones that cause male characteristics to appear. What does the male reproductive system do? The male reproductive sys- tem makes sperm and deliv-ers them to the femalereproductive system. are the sex cells that aremade by males and that areneeded to fertilize an egg. Where are sperm made? Sperm are made in the male repro- ductive organs that alsomake testosterone. Insidethe testes, there are tightlycoiled tubes called seminifer- ous tubules , which makesperm. About 100 millionsperm are made each day!The testes must be keptcooler than normal bodytemperature. Sperm made athigh temperatures are defec-tive and cannot fertilizeeggs. The testes, therefore,are not inside the body cav-ity but outside of it. Testesare found in a skin-coveredsac called the Thescrotum contracts andrelaxes to make the testesmove closer to or fartherfrom the body. When thetestes are away from the body, sperm stay cooler.What do sperm look like? Sperm are the smallest cells in the human body. Eachmature sperm is made up ofthree basic parts: a head, amidpiece, and a tail. Thehead contains substancesthat help the sperm enter anegg. The head also holdshalf the genetic informationrequired to start a new life.The midpiece of the spermcontains structures thatmake the energy needed forthe long trip through thefemale reproductive system.The tail is made of proteinsthat help the sperm move. scrotum. (testicles),testesSperm 522 HOW YOUR BODY WORKS Vas deferens Prostate glandBladder ScrotumTestisEpididymis Bulbourethral(Cowper's) glandRectumSeminalvesicle Urethra PenisPubic bone 12 3Anus The testes continually make sperm, which mature in theepididymis.1Mature sperm move througha vas deferensand into theurethra.2 Semen, sperm mixed with fluids,leaves the bodythrough the penis.3 TailMid piece HeadSperm cell Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 523What happens to sperm once they are made? Once sperm are made, they move into a coiled tubecalled the epididymis . Here, immature sperm take 2 to 10 days to fully mature. Themature sperm then travelinto another tube, called thevas deferens . The sperm are stored here until they leavethe body or are reabsorbed. How do sperm survive the long travel? As sperm move through the body, several organs add fluids to the sperm. Theseorgans are the seminal vesicles , the bulbourethral glands (Cowper’s glands), and the prostate gland. The is a gland in males that adds fluids thatnourish and protect spermwhen the sperm are in thefemale body.

Sperm and theadded fluids make up semen . How do sperm leave the body? Sperm leave the body during ejaculation via the urethra , a tube that passes through thepenis. The is the organthat removes urine from themale body and that candeliver sperm to the femalereproductive system. A flapin the urethra prevents urineand semen from goingthrough the penis at thesame time.What does testosterone do? Testosterone is the male hor- mone made by the testes. Itcauses many of the changesthat happen when malesreach puberty, or sexual maturity. For example, theshoulders get wider, themuscles get larger, hairgrows on the face and otherparts of the body, and thevoice deepens. At this time,testosterone also causes thebody to start making sperm. penisprostate gland EX P R E S SLesson REVIEW 1.Identify the locations where sperm are made and where they mature. 2.List the three main parts of a sperm. 3.List the components of semen. 4. Practicing Wellness Prostate cancer is one of the leading causes of cancer in men. Read more about the prostategland. What are other problems that can affect the prostate?LIFE LIFE SKILL The male hormone testos- terone causes masculinecharacteristics (such as amustache) to appear. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Female Reproductive System The female reproductive system makes female reproductive cells and hormones that cause female characteristics to appear. 524 HOW YOUR BODY WORKS Uterus Cervix RectumOvary Bladder Urethra VaginaFallopian tube AnusPubic bone If fertilization occurs, the fertilized egg develops inthe uterus.32 12 3What does the female reproductive system do? The female reproductive sys- tem makes eggs and givesthem a place to develop. or ova, are the sex cells of females and can be fertil-ized by sperm. When an eggand a sperm join, a new lifebegins. Organs of the femalereproductive system nurtureand protect developinghumans. Parts of the systemalso make female hormones,which cause young girls todevelop breasts and otherfeatures of women. Thefemale hormones also helpeggs to mature and preparethe body for pregnancy.Where are eggs made? Eggs are made in ovaries.The are the femalereproductive organs thatproduce eggs and the hor-mones estrogen and proges-terone. Girls already have alltheir eggs at birth. On aver-age, there are about two mil-lion! But the eggs areimmature. The eggs begin tomature when a girl reachespuberty . One egg matures about every 28 d ays. The process by which the ovariesrelease mature eggs is calledWhere are eggs fertilized? Eggs are fertilized in the fallopian tubes. A is a female reproduc- tive organ that connects anovary to the uterus. After amature egg is released, itmoves into one of the fal-lopian tubes. The ends ofthese tubes do not reallytouch the ovaries. Tiny hairsaround the opening of afallopian tube draw an egginto the tube. If there aresperm in the tubes, a spermmay fuse with the egg andfertilize it.tubefallopian ovulation.ovaries Eggs, An ovary releases a mature egg, or ovum,about once a month.1The egg moves through a fallopiantube toward theuterus. Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 525Where do fertilized eggs develop? Fertilized eggs develop in the which is a muscular organ about the size of a fist. The is the narrow baseof the uterus. As an eggmatures, the lining of theuterus, or the thickens. Many tiny bloodvessels feed this lining. Theseblood vessels will bring foodand oxygen to a growingbaby and will carry away itswastes. This exchange hap-pens via the ablood vessel–rich tissue thatforms in a mother’s uterus. When a baby is ready to be born, the cervix expandsto allow the baby to pass intothe vagina. The is thereproductive organ that con-nects the uterus to the out-side of the body. What happens if an egg isn’t fertilized? If an egg is not fertilized, the blood vessels in the endo-metrium break down. Bloodand tissue that built up in theuterus flow out of the bodythrough the vagina in aprocess called What happens during the menstrual cycle? The is a monthly series of hormone-controlled changes thatmature an egg and preparethe uterus for pregnancy.Days 1–5 Menstruation begins. Blood and the liningof the uterus (the menstrualfluid) flow out of the body. Days 6–14 The hormone estrogen helps prepare thebody for pregnancy. The hor- mones FSH and LH cause an egg to mature in an ovary. Asthe egg matures, the endo-metrium thickens. Ovula-tion occurs on about day 14.Days 15–28 The hormone progesterone helps maintainthe lining of the uterus asthe uterus waits for a fertil-ized egg. Hormone levelsremain fairly steady for sev-eral d ays. If a fertilized egg has not attached to the wallof the uterus by about day28, hormone changes causethe blood vessels in the uter-ine lining to break down. menstrual cyclemenstruation.vaginaplacenta,endometrium,cervixuterus, EX P R E S SLesson REVIEW 1.List the functions of the female reproductive system. 2.Describe the pathway an egg takes after it is released from an ovary. 3.Summarize the steps of the menstrual cycle. 4. Evaluating Media Messages Some products claim to be able to treat premenstrual syndrome (PMS). After readingmore about PMS, discuss whether you think these drugs arelikely to be effective.LIFE LIFE SKILL Uterus VaginaCervixFallopian tube Egg Ovary Black arrows show the path of an eggthrough the body.About the size of theperiod at the end ofthis sentence, an eggis one of the largestcells in the body. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Skeletal System Your skeletal system gives your body shape and support, provides protection for vital organs, and produces blood cells. What does the skeletal system do? The skeletal system gives your body the shape it has.Without bones, you wouldbe a shapeless blob pooledon the floor. The isa framework of bones thatsupport the muscles andorgans and protect the innerorgans. Bones also serve aspoints to which the musclesattach and create bodymovement. Inside somebones, there is a soft tissuethat makes new blood cells.How do bones grow? At birth, the skeletal systemis soft and made mostly ofcartilage . As a child grows, bone tissue begins to replacethe cartilage. At the end oflong bones is a band of car-tilage called the epiphysis , or growth plate. Cartilage thatwill be replaced by bone tis-sue grows here. When a per-son reaches full height, thecartilage stops growing. Atthis point, bone tissue hascompletely replaced the car-tilage, except at the very tipsof the bones in the joints.What is the “soft spot” on a baby’s head? The bones of an infant’s skull are not fully devel-oped. Areas of soft cartilagecalled fontanels separate the bones. These “soft spots”allow the skull bones tomove as a baby passesthrough the birth canal.After birth, the skull bonesgrow until the soft cartilageis completely replaced. Thejoints where the skull bonesmeet are called sutures . Some fontanels close up withintwo months after birth. Butthe one at the top of thehead takes about a year toclose completely.skeleton 526 HOW YOUR BODY WORKS Understanding how the bones act as levers can helpa baseball pitcher learn howto throw the ball faster andharder. Copyright © by Holt, Rinehart and Winston. All rights reserved. How many bones do we have? Your skeleton has 206 bones and has two main parts. Theaxial skeleton is made up of the skull, the spinal column,the rib cage, and the ster-num. These central boneswork together to protectvital organs. The bones ofthe skull, for example, sur-round and protect the brain.The appendicular skeleton is made up of 126 bones.These bones form the frameto which the muscles areattached. Are mature bones alive? Bone is very much alive.Cells called osteoblasts form new bone continuously. Thisallows bones to heal whenthey are broken. Lumps ofnew bone may also form onparts of bones that arerepeatedly stressed. HOW YOUR BODY WORKS 527NEEDS SOME DESIGN HELP. SEE MARKED PAGES. Cranium MaxillaMandibleClavicleScapulaSternumRibsHumerusRadiusUlnaPelvisCarpalsMetacarpalsPhalangesFemurPatellaTibiaFibulaTarsalsMetatarsalsPhalanges Cervical vertebrae(7) Thoracicvertebrae(12) Lumbarvertebrae(5) Sacralvertebrae(5) Coccyx Spine The skeleton is made up of 206 bones, including the 30 bones of the spine. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Skeletal System continued 528 HOW YOUR BODY WORKSHow do broken bones heal? The human femur (upper leg bone) is stronger than abar of iron of the sameweight. Even so, bonessometimes break. When abone breaks, the outer layertears, causing severe painand some bleeding. Bloodclots form inside the breakand seal both sides. Next,white blood cells come andclean out fragments of bro-ken bone and dead cells.Fibrous strands of cartilagebegin to fill in the fractureand bridge the gap betweenthe two sides. The final stepin the healing process occurswhen compact bonereplaces the cartilage.What are bones made of? Bones generally have three layers. The top layer, calledthe periosteum , is a tough membrane that forms asmooth seal over the surfaceof a bone. This layer hasmany nerves and blood ves-sels that transport food andoxygen to the inner layers ofthe bone. The second layer,called the bony layer , consists of the white, hard substancethat gives bones their greatstrength. The bony layer isnot just a solid mass of cal-cium but is made up ofmany tiny cells that are sur-rounded by rings of calcium.At the center of many bones,there is a layer of soft tissuecalled Thebone marrow is one of thekey places that the bodymakes new blood cells.How are bones held together? Muscles, tendons, and liga- ments hold bones together.Two or more bones meet atplaces in the body called which are tough bands of tissue, holdthe ends of bones togetherat joints. are cordsof connective tissue thatattach muscles to bones.Muscles and tendons attachto the bones on either sideof a joint, holding the jointtogether tightly. Is it bad to crack my knuckles? No, the popping or cracking sound made by some jointsis very normal. Pulling on ajoint creates a vacuum insidethe joint. This vacuumcauses tiny air bubbles inthe joint fluid to burst. Theresult is a “pop” or a “crack”that you can hear. Poppingjoints is not clearly linked togetting a painfulinflammation of the joints. What keeps joints from scraping? Joints that move contain a very slippery liquid calledsynovial fluid. The pads of cartilage that serve as shockabsorbers at the ends ofbones also help bones glidesmoothly across each other. arthritis,TendonsLigaments, joints. bone marrow. Periosteum Marrow Bony layer Blood vessels Layers of different types of material make up a long bone,such as the arm and leg bones. Copyright © by Holt, Rinehart and Winston. All rights reserved. Do all joints move? No, some joints are fixed, such as the ones between thebones in the skull. A fixed joint does not allow any movement. Other joints, such as the semimovable joints between the vertebrae in the spine, allow only a small amount ofmovement. Several differentkinds of joints allow thebody to move in differentways. The simplest is the hinge joint . This is the type found in your elbows andknees. There, bones attach toeach other in such a way thatthe joint can bend only backand forth. One more flexible type of joint is the ball-and-socket joint. This is the type of joint found in your hips andshoulders. On one bone, aknoblike piece, or ball, sticksout. On the other bone or setof bones, there is a cup thatthe ball fits into. The ball isfree to rotate inside the cupin almost any direction. Thefirst two vertebrae allow yourhead to rotate right and left.This is called a pivot joint . Pivot joints in the elbowenable the forearms to rotateback and forth, as well. Thelast type of joint allowsmovement in all ways except rotation. The wrists andankles are of this type, calledan ellipsoidal joint . HOW YOUR BODY WORKS 529 Fixed joint Pivot jointSemimovable joints Ball-and-socket joint Ellipsoidal jointHinge joint EX P R E S SLesson REVIEW 1.Name the three layers found in most bones, and identify the function of each. 2.Describe how bones grow. 3.List three types of joints. 4. Practicing Wellness Your bones store calcium for your body. If you do not get enough calcium from your diet, cal-cium will be taken from your bones for use where it is needed.Research the roles of calcium in the body, the sources of calciumin your diet, and the consequences that may result for yourskeletal system if you eat a diet that is deficient in calcium.LIFE LIFE SKILLBones come together at joints. Several different types of jointsare found in the body. Ball-and- socket joint Hinge jointPivot joint Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Muscular System Your muscular system moves all your moving parts. What does the muscular system do? The muscular system accounts for all of the ways that the parts of the bodymove. This includes actionssuch as running, eating,breathing, digesting food,and pumping blood. Themuscular system also helpsprotect your joints and helpscreate the heat that keepsyour body warm. What are muscles made of? Bundles of special cells called fibers make up the muscles. Muscle fibers havelong strands of proteins thatare able to contract. Pairedstrands of these proteinslatch together like the twoparts of an extension ladder.When muscle fibers contract,one half of each protein lad-der moves up along theother half. This makes theprotein ladders, and thus thewhole muscle, shorten.Are all muscles the same? There are three types of mus- cle tissue in the body. Skeletal muscle , or striated (striped) muscle, is the type that youcan move voluntarily. Smooth muscle causes the involuntary movements of the eyelids,internal organs, and bloodvessels. Cardiac muscle is a special kind of involuntary,striated muscle found only inthe walls of the heart. How do muscles move the body? Muscles move the body by pulling on bones that meetat joints. Muscles are con-nected to the bones by ten-dons. Muscles at a movablejoint either pull the jointinto a bent position or pullit straight. Muscles usuallywork in pairs, one on eitherside of the joint. When onecontracts, the other relaxes. 530 HOW YOUR BODY WORKS Frontalis Trapezius Deltoid Triceps brachii Biceps brachii Latissimus dorsi Abdominal muscles Gluteus maximus Sartorius Biceps femoris Rectus femoris GastrocnemiusPectoralis major Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 531What causes muscles to get bigger when youexercise? When you exercise a muscle by lifting something heavy,the muscle fibers in the mus-cle contract. Repeated strongcontractions cause the mus-cle fibers and the muscleitself to grow in diameterand strength. In contrast,moderate contractions, suchas those that result fromwalking, do not increase thediameter of a muscle asmuch. However, repeatedmoderate exercise greatlyincreases a muscle’sendurance by enabling it toobtain more oxygen.Why do muscles get tired? Your muscles need oxygen in order to produce the energyneeded for contracting. Mus-cles that are working veryhard use up all the oxygen athand. When this happens,less energy is available forcreating contractions, whichmakes you feel weak ortired. But if you’re runningfrom a tiger, you can’t quitjust because your musclesrun out of oxygen.In order for muscles to keep working without oxy-gen, a process that makesthe chemical lactic acid pro- vides a small amount ofenergy. Unfortunately, lacticacid is poisonous to cells.Muscle cells need extra oxy-gen to get rid of lactic acidbefore they can make moreenergy. The extra oxygenneeded to return conditionsto normal is called an oxygen debt. Only time and rest can erase an oxygen debt. EX P R E S SLesson REVIEW 1.Identify the components of muscle tissue. 2.Name the tissue that connects muscle to bone. 3.Explain how the process that causes muscle tiredness can be reversed. 4. Practicing Wellness In the past, people thought that they couldn’t build muscle without going into an oxygendebt. Think about how muscles increase in size, and explainwhy this belief is not true.LIFE LIFE SKILL Tendon Knee cap Tibia (bone)Muscle Cartilage Ligaments Muscles help hold bones together in joints such as the knee. Strong muscles help prevent kneeinjuries in soccer players and other athletes. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Circulatory System Your circulatory system is your body’s internal transport system. 532 HOW YOUR BODY WORKS Heart ArteriesVeinsWhat does the circulatory system do? The circulatory system moves blood all through thebody. is a tissue that ismade up of cells and fluidand that carries oxygen, car-bon dioxide, and nutrientsin the body. Blood flowsinside of tubes called The is the organ that pumps theblood through the body. Is blood really red and blue? is the oxygen- carrying pigment in the blood. Hemoglobin is brightred when oxygen is attachedto it. Blood is very dark redwhen the hemoglobin in itdoes not carry oxygen. Someveins are close enough to thesurface of your skin to beseen. These veins appear tobe blue because differentcolors of light reach differ-ent depths in the skin. Redlight penetrates farther intothe body than other colorsof light. Blue light, however,does not go very far beforebeing reflected back by theveins. This makes the veinslook blue. Arteries are usu-ally so deep that they cannot be seen.How does the heart work? The heart beats constantly without rest. With everybeat, the heart pushes bloodthrough the vessels of thebody. Blood that carries car-bon dioxide returns fromthe body and enters the rightatrium of the heart. An is a chamber of the heart that receivesblood from the body. Theblood in the right atrium ispushed through an A-V valve (atrioventricular valve) intothe right ventricle. A is one of the two large, mus-cular chambers that pumpblood out of the heart. Theright ventricle squeezesblood out of the heart andpushes it toward the lungs.There, carbon dioxide isexchanged for oxygen.Oxygen-rich blood comes back to the heart atthe left atrium. The blood inthe left atrium is pushedthrough an A-V valve into theleft ventricle. From there,blood is pushed out to allparts of the body. ventricleatrium Hemoglobinheart blood vessels.Blood Copyright © by Holt, Rinehart and Winston. All rights reserved. What makes the heart beat? The heartbeat is a rhythmic contraction of the heart. Sig-nals that begin at the top ofthe heart cause the heartbeat.A group of cells at the top ofthe right atrium, called the starts a signal. This group of cells isalso called the S-A node (sinoatrial node). First, thesignal causes the atria to contract. Then, the signalgoes down through the heart to another group ofcells near the bottom of theseptum between the twoatria. This group of cells, theA-V node (atrioventricular node), passes the signalalong to the ventricles. As aresult, the ventricles contracta split second after the atria. What causes the sound of a heartbeat? As it beats, the heart makes two distinct sounds that arecaused by the closing of thevalves in the heart. The clos-ing of the A-V valves makesthe first sound, or S1. Theclosing of the valves thatallow blood from the ventri-cles to enter the arteries thatleave the heart makes thesecond sound, or S2. cardiac pacemaker, HOW YOUR BODY WORKS 533 Right atrium RightventricleLeftventricleLeftatriumLungs ValvesSeptum1 254 63 1 23 4 5 6Blood circulates in two great loops from the heart. One loop goes to the lungs and back. The other loopgoes to the rest of the body and back. Blood from the body enters the right atrium of the heart.1 The blood from the right atrium goes to the right ventricle.2 The blood in the right ventricle is pumped to the lungs.3 Blood from the lungs re-enters the heart at the left atrium.4 The blood from the left atrium goes to the left ventricle.5 Blood is pumped from the left ventricle to the body.6 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Circulatory System continued What is the difference between arteries, veins,and capillaries? Three types of vessels carry blood through the body. are blood vessels that carry blood away from the heart to all parts of thebody. Thick walls help thesevessels withstand the pres-sure of the blood that ispushed out of the heart. are blood vessels that carry blood from all parts ofthe body back to the heart.Their walls are thinner, andthe blood inside is notunder as much pressure.Some veins have valves thatopen in only one directionto help bring blood back upto the heart. The valves keepthe blood from flowingbackward. aretiny blood vessels that con-nect arteries to veins. Bloodcells pass through capillariesin single file. The walls ofcapillaries are very thin,which allows nutrients andwastes to pass into and outof the blood. Capillaries Veins Arteries 534 HOW YOUR BODY WORKS Venule (connects veins to capillaries)Arteriole (connects arteries to capillaries) Connective tissue Smooth muscle Endothelium ValveCapillaries (exchange gases, nutrients, wastes, and hormones) Vein (returns blood to the heart)Artery (carries blood away from the heart) The inset shows red blood cells moving through a capillary. Thediameter of a capillary is so smallthat blood cells can move throughthe capillary only in single file. Copyright © by Holt, Rinehart and Winston. All rights reserved. What is blood made of? About 55 percent of blood is plasma. Plasma is a clear liq- uid that is about 92 percentwater. Plasma also has nutri-ents, salts, proteins, andother chemicals. Three kindsof blood cells make up therest of the blood. are full of hemoglobin and carry oxygen to thebody. Red blood cells alsoreturn carbon dioxide to the lungs. are blood cells that protectthe body from disease. are cell fragments that cause blood to clot,which stops blood loss.How do white blood cells fight disease? White blood cells, or leuko- cytes, protect the body from disease by recognizing and destroying matter that doesnot belong to the body. Some types of white bloodcells kill bacteria and otherinvaders by surrounding anddigesting them. Other typesof white blood cells killinvaders by producing anti-bodies. PlateletsWhite blood cellscellsRed blood HOW YOUR BODY WORKS 535EX P R E S SLesson REVIEW 1.Diagram the path that blood takes through the heart. 2.Describe how the heartbeat is produced. 3.List the differences between arteries, veins, and capillaries. 4. Practicing Wellness Research sickle cell anemia. What advantage does a person have if he or she carries the genetic trait for this disease?LIFE LIFE SKILL Plasma White blood cells Platelets Red blood cellsBlood separates into a liquid part, called plasma, and a solid part thatis made up of three types of cells.Aerobic exercise, such as running,increases blood flow, which suppliesmore oxygen to body cells. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Respiratory System Your respiratory system brings oxygen in and lets carbon dioxide out of the body. What does the respiratory system do? The respiratory system brings life-giving oxygeninto the body. It also helpsthe body get rid of carbondioxide, a waste productmade by cells. The process ofbringing in oxygen and get-ting rid of carbon dioxide iscalled respiration. The are the main organs of gasexchange in the respiratorysystem. What path does air take as it enters my body? Air enters the body through the mouth and nasal cavities . The air is warmed and mois-tened so it does not dry outthe delicate lung tissue. Airthen flows into the pharynx , or throat . At the base of the pharynx is the larynx , or voice box, where the vocalcords are located. Attached to the voice box is the or windpipe, which carries air to the lungs. Ringsof cartilage strengthen thetrachea and protect it frominjury and collapse. The trachea branches into two tubes. Each tube, called a sends air to a lung. In the lungs, the bronchibranch many times intosmaller and smaller tubes.The smallest of these tubes iscalled a At theend of each bronchiole is acluster of thin-walled air sacs.Each air sac, called an is a site for gas exchange. Capillaries aroundeach alveolus pick up oxygenand get rid of carbon dioxide. How does oxygen get into my blood? Oxygen molecules naturally move from the alveoli,where oxygen is more plen-tiful, into the capillaries,where there is less oxygen.Alveoli and the capillariesaround them have very thinwalls that gases easily movethrough. Red blood cellspick up the oxygen mol-ecules and release carbondioxide. alveolus,bronchiole.bronchus, trachea,lungs 536 HOW YOUR BODY WORKS Nasal cavities Pharnyx Larynx Trachea Right lung Bronchus Bronchioles DiaphragmLeft lung AlveoliCapillariesBronchiole The lungs and the tubes that lead intothe lungs make upthe respiratory system.Lung tissue is made of the clusters ofalveoli surrounded by capillariesfound at the ends of the bronchioles.HH04PE_EXPRESS_HYBW 6/2/04 8:22 PM Page 536 HOW YOUR BODY WORKS 537What makes air flow into and out of my lungs? Movement of the rib muscles and the diaphragmpull air into the lungs andpush air out. The is a sheet of muscle that sep-arates the chest cavity, whichholds the lungs and heart,from the abdominal cavity,which holds the digestivesystem. When you breathein, the diaphragm contractsand moves downward. Therib muscles contract andpull the chest wall up and outward. This causes air torush in and fill the lungs.When the diaphragm andrib muscles relax, thediaphragm bows

upwardand the chest cavity becomessmaller, forcing air back outof the lungs. What controls how fast I breathe? Breathing rate is controlled by centers in the brain stemthat detect carbon dioxide inthe blood. Because carbondioxide is toxic to tissues, itmust not build up in theblood. When the amount ofcarbon dioxide in the bloodrises, the breathing center inthe brain stem signals thediaphragm to contract moreoften. So, you breathe faster.The reverse happens whenthe amount of carbon diox-ide in the blood drops.Why does the respiratory system make mucus? is a thick, slimy fluid that coats the lining of organs and glands. Mucuslines the bronchi, trachea,and nasal passages. It servestwo purposes. First, it addsmoisture to the air enteringthe lungs. Second, it trapsparticles and bacteria thatmight otherwise clog thetiny bronchioles or causeinfection in the lungs. What causes hiccups? Hiccups are tiny spasms ofthe diaphragm. We do notknow for certain what causesthe diaphragm to spasm.Irritation of the diaphragmis one possibility. Manystudies have been done totry to find guaranteed curesfor the hiccups. Mucusdiaphragm Ribs Ribs EX P R E S SLesson REVIEW 1.Trace the path of air through the lungs. 2.Name the region of the airway that contains the voice box. 3. Identify the small tubes that attach to alveoli. 4. Practicing Wellness When you run, your body automatically starts breathing faster. What causes this increase in breathing rate?LIFE LIFE SKILLWhen you breathe in, your diaphragm moves down, and your chest cavity gets larger.When you breathe out, yourdiaphragm moves up, and yourchest cavity gets smaller. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Digestive System Your digestive system breaks down food into the nutrients your body needs. 538 HOW YOUR BODY WORKS Pharynx Esophagus Stomach Duodenum Pancreas Small intestine Colon RectumMouth Salivary glands Liver Gallbladder Large intestineWhat does the digestive system do? The digestive system breaks down food into the things itis made of. This process iscalled digestion . As a result, the body is able to absorband use the nutrients infood for energy, growth, andrepair. The digestive systemalso eliminates undigestedfood from the body. How are teeth involved in digestion? Teeth begin the process of digestion. They break fooddown into smaller piecesthat can be swallowed. Teethalso help mix food withsaliva, which has an enzymethat begins to break downstarch. are proteinsor other types of moleculesthat help chemical processeshappen in living things. What path does food take in the body? Food taken in by the mouth is chewed and swallowed.The food then moves downthrough the long, straighttube called the and into the stomach. Fromthere, it passes through thesmall intestine. Finally, food moves through the large intestine.From there, the food movesinto the the last partof the large intestine whereundigested waste is storeduntil it leaves the body. Thisseries of organs throughwhich food passes is calledthe How does food move through the digestive tract? Waves of rhythmic motion, called peristalsis, run through the walls of organs in thedigestive tract. These wavesgently push food throughthe digestive tract. digestive tract.rectum, esophagusEnzymes Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 539What happens as food moves from the stomachto the colon? In the stomach, a strong acid and powerful enzymes mix with the food. These chemi-cals kill bacteria that can beharmful and begin to breakdown proteins. A mixture ofpartly digested food andstomach enzymes, calledchyme, results. Digestion continues in the small intestine, which also absorbs nutrients fromdigested food. Secretionsfrom the liver and pancreasfinish breaking down carbohydrates, fats, and pro-teins. The lining of the smallintestine has millions of tiny,fingerlike projections, calledvilli. Capillaries in the villitake up nutrients as thedigested food works its wayto the large intestine. The major part of the large intestine is called the There, bacteria that live on the undigested foodmake important vitamins,such as vitamins A, B 6, and K, for the body. The vitamins,along with water and miner-als, are taken from undi-gested food before the wasteis removed from the body.What do the liver and pancreas do? The liver and pancreas are important to digestion butare not part of the digestivetract. Chemicals secreted bythe liver help with the diges- tion of fats in the smallintestine. Your body alsodepends on the liver inother ways. The liver stores energy reserves, iron, andvitamins A, D, and B 12. The liver also takes chemicalwastes and poisons from theblood and breaks themdown. Enzymes secreted bythe pancreas break down car- bohydrates and proteins inthe small intestine. The pan-creas also produces insulin, which regulates blood-sugarlevels. Why doesn’t stomach acid burn the stomach? The acid in your stomach is strong enough to “dissolve”metal. Luckily, the lining ofthe stomach secretes a coatof mucus that protects thewall of the stomach. Mucus is a thick, slimy fluid that coats the lining oforgans and glands. Without acoat of mucus, the stomachwould digest itself. Some-times, stomach acid leaksinto the esophagus, whichdoes not have a protectivelining of mucus. The result isGERD (gastroesophageal reflux disorder), or acid reflux . is the pain that is caused by GERD and hasnothing to do with the heart. Heartburn colon. EX P R E S SLesson REVIEW 1.Name the process that moves food through the digestive tract. 2.List the major organs of the digestive tract, and describe what each organ does. 3.Describe the functions of the liver and the pancreas. 4. Practicing Wellness When a person has cirrhosis of the liver, the healthy liver tissue turns to scar tissue and stopsworking. Look up some of the problems that can arise if a per-son’s liver is not working properly.LIFE LIFE SKILL The uncomfortable feeling of heartburn results when stomachacid leaks into the esophagus. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Excretory System Your excretory system removes harmful wastes from your body and maintains the body’s water and salt balance. 540 HOW YOUR BODY WORKS Lungs The lungs excrete carbon dioxide and water vapor in exhaled air. Kidneys The kidneys excrete nitro gen wastes, salts, water, and other substances in urine. Skin The skin excretes water, salts, small amounts of nitrogen wastes, and other substances in sweat. What does the excretory system do? The excretory system takes the wastes made by cells outof the blood and moves thewastes out of the body. Italso keeps up the body’sproper salt content, watercontent, blood pressure, and acid-base balance. The are the main organs of the excretory system. Theyfilter about 1,200 mL ofblood per minute. The lungsand the skin are also part ofthe excretory system. Carbondioxide is excreted by thelungs. Many substances areexcreted by the skin throughthe sweat glands. How do the kidneys work? The kidneys filter all of your blood about 10 times everyday. A kidney has millionsof tiny blood filtering unitscalled Blood withwastes is brought to the kid-neys by renal arteries. Each nephron takes water, salts,minerals, and cell wastes outof the blood. If wastes werereleased from your body atthis stage, you would losetoo much water. Before wastes leave a kidney, capillaries in the kidney reclaim about 99 percent of the waterremoved by the nephrons.The concentrated liquidwaste that leaves the kidneyis called Renal veins carry filtered blood back tothe heart. What is the urinary tract? The urinary tract is the path taken by urine as it exits the body. A tube called a ureter takes urine from each kidneyto the urinary bladder. The is the hol- low, muscular sac that storesurine until there is enoughto release. Another tube,called the urethra, leads from the urinary bladder to theoutside of the body.urinary bladderurine. nephrons.kidneys Copyright © by Holt, Rinehart and Winston. All rights reserved. HOW YOUR BODY WORKS 541What is urine made of? Urine is mostly water mixed with things your body needsto get rid of. These thingsinclude minerals such assodium, calcium, and potas-sium and cellular wastessuch as ammonia, urea, anduric acid. Urine may alsocontain bacteria that havebeen killed by the immunesystem and dead blood cellsthat must be removed. How much urine can the bladder hold? On average, the bladder can hold about 600 mL of urine.You feel the need to urinateat about 200–300 mL. At600 mL, holding the urinebecomes painful. With morethan 1,000 mL, the bladdermay become dangerouslyswollen.How does the body control urination? Two circular muscles control the flow of urine out of thebladder. Adults have volun-tary control of these musclesand can hold or release urineat will. Stretching of the blad-der triggers a reflex that givesyou the urge to urinate. Stressand illness can interfere withthe voluntary control of uri-nation. Loss of voluntarycontrol of urination is calledWhat can happen if you are unable to urinate? If a person is unable to uri- nate, for example because ofspinal cord injury, his or herbladder can become toostretched to hold its shape. If the bladder is emptied too suddenly, there is a riskthat it will collapse. If thebladder is not emptied,stress on the body can raisethe person’s blood pressure.If the problem is notresolved, this condition canlead to a stroke . incontinence. EX P R E S SLesson REVIEW 1.Name the structures that filter blood in the kidneys. 2.List the parts of the urinary tract. 3.Describe how urine is made in the kidneys. 4. Setting Goals Drinking plenty of water can help you keep your urinary tract healthy. Make a chart to monitor your water-drinking habits. Set a goal to drink six to eightglasses of water a day, and evaluate your progress.LIFE LIFE SKILL Nephron Renal artery Renal vein Ureter Inside the kidney, filtering units called nephrons filter wastes from the blood. Drinking several glasses of water daily replaces the water lost as the kidneys, skin, and lungs do theirwork. Not drinking enough water can lead to dehy-dration and the buildup of toxins in the body. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Immune System Your immune system protects you from disease. What does the immune system do? The immune system defends the body against disease. Itworks by recognizing, attack-ing, and destroying foreigninvaders such as viruses andbacteria. It also destroys deadand damaged body cells andstops some cancer cellsbefore they can spread. Thecells of the immune systemmove about the body in thefluids of the circulatory andlymphatic systems. What does the lymphatic system do? The lymphatic system gathers fluid that leaks from the circu-latory system and strains for-eign and dead cells from thefluid. is the clear, yellowish fluid that leaks from capillar-ies and fills the spacesaround the body’s cells.Lymph is made up of water,nutrients, and white bloodcells that are part of theimmune system. A net oflymphatic vessels, which are similar to veins and capillar-ies, collect lymph from thebody and return it to the cir-culatory system. What is a lymph node? are small, bean-shaped masses that canbe found at certain placesalong the lymphatic vessels.Lymph nodes hold manylymphocytes. are white blood cells thatdestroy bacteria, viruses, anddead or damaged cells. Thisprocess removes these parti-cles from lymph before it re-enters the circulatory system.Groups of lymph nodes canalso be found in the armpitsand groin and at the base ofthe neck. The “swollen glands”that go with some infectionsare lymph glands that havegrown larger from filtering outmany germ particles and dam-aged cells. The are themasses of lymph tissue foundin the throat. How is the spleen part of the immune system? The spleen does the same thing for the blood that thelymph nodes do for lymph.It serves as a filtering stationwhere white blood cells ridthe blood of particles thatshould not be there. The fil-tered blood then returns tothe circulatory system. tonsilsLymphocytesLymph nodesLymph 542 HOW YOUR BODY WORKS Tonsils Thymus Lymph node Spleen Lymphatic vessel Bone marrow Copyright © by Holt, Rinehart and Winston. All rights reserved. How is bone marrow part of the immune system? Bone marrow is the main place where blood cellsform. Red blood cells, whiteblood cells, and platelets areall made in the marrow ofyour bones. is acancer of the tissues thatmake white blood cells. Thecancer causes the tissues tomake white blood cells thatnever mature. Immaturewhite blood cells take overthe bone marrow and keepit from making the otherblood cells that the bodyneeds. Bone marrow or stemcell transplants can help thebody replenish blood cellsupplies. But there is still nocure for most leukemias.What are white blood cells? are the blood cells whose main job is to defend the body againstdisease. The lymphocytes arewhite blood cells that aremade by the immune sys-tem. There are two types oflymphocytes. whichare made in bone marrow,are lymphocytes that makeantibodies that attack virusesin the blood. whichare made in the thymus, are lymphocytes that attack cellsthat have been infected byviruses. Macrophages and neutrophils are two other types of white blood cellsthat kill bacteria by engulf-ing and digesting them.How does the body recognize bacteria and virus invaders? Bacteria, viruses, and cells that have been infected byviruses all have somethingin common that lets thebody know they do notbelong. The coating of everycell and virus has identifyingproteins called Theantigens on viruses and bac-teria are not found on any ofthe body’s own normal cells.White blood cells can recog-nize antigens that do notbelong to the body andattach to them. Anythingthat carries the antigen isthen destroyed. antigens. T cells,B cells,White blood cells Leukemia HOW YOUR BODY WORKS 543 Type of white blood cell Neutrophil (phagocyte) Macrophage (phagocyte) T cell (lymphocyte) B cell (lymphocyte)Plasma cell (lymphocyte)What it does engulfs and destroys bacteria and releases enzymes that kill bacteria engulfs and digests damaged cells and disease-causing agents reacts to foreign antigens by attacking and destroying particlesthat carry them reacts to foreign antigens by dividing and forming two types of cells—plasma cells and memory B cells produces antibodies that bind to particles that carry specific foreignantigens Types of White Blood Cells This image shows a macrophage engulfing the bacterium Neisseria gonorrhoeae. Copyright © by Holt, Rinehart and Winston. All rights reserved. Title continued 544 HOW YOUR BODY WORKSXPRES SLesson E 544 HOW YOUR BODY WORKSHow do antibodies fight disease? are proteins the immune system makes in response to specific antigens.White blood cells that areexposed to a bacterium or toa virus make antibodies thatcan attach only to that bac-terium or virus. In this way,antibodies stop bacteria andviruses from invading bodycells and keep them in thebloodstream. This processgives white blood cells timeto locate and destroy thesedisease-causing agents.Can the immune system work against you? Yes, your immune system will attack a transplantedorgan if it carries antigensthat differ from your own.An isone in which the immunesystem attacks the cells ofthe body that the immunesystem normally protects. autoimmune disease AntibodiesImmune System continued EX P R E S SLesson REVIEW 1.Describe three body parts that help the immune system. 2.List the types of white blood cells. 3.Explain how the immune system identifies invaders. 4. Practicing Wellness Does your immune system respond to stress? Keep a calendar and a journal. Write in advance all the tests, reports, projects, and extracurricular activ-ities that you have coming up for a month. In your journal, keeptrack of how you feel each day. Are there any patterns?LIFE LIFE SKILL 6 1 2 3 4 5 7Viral antigenReceptor B cell with receptorsActivatedB cell dividing Clump of virusesand antibodies Plasma cell Macrophageengulfing clumpAntibodies Memory B cellWeakenedviruses1 23 45 6 7 A vaccination triggers a series of events that creates immunity to a pathogen.Killed or weakened virusenters blood and lymph.1 B cells with proper receptors bind to viralantigens.2 Activated B cells divide and develop into plasmacells or memory B cells.3 Plasma cells produce and release antibodies.4 Antibodies bind to viruses, causing them to clump.5 Antibodies remain in the blood on memory B cellsfor long-term protection.7Macrophages engulf and destroy clumps.6 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Endocrine System Your endocrine system regulates your growth, development, and body chemistry. HOW YOUR BODY WORKS 545What does the endocrine system do? The endocrine system works with the nervous system tocoordinate and regulate thebody. Hormones do the workof the endocrine system. are chemicals that are made and released inone part of the body andcause a change in anotherpart of the body. Organs thatrelease hormones are called How is the endocrine system different from thenervous system? The nervous system reacts instantly to a stimulus buthas a short-lived effect. Theendocrine system respondsmore slowly and has alonger-lasting effect. Bothnerves and chemical mes-sengers carry signals in thenervous system. These sig-nals affect only certain partsof the body. But only hor-mones carry signals for theendocrine system. Thechemical messengers in thenervous system work only atthe gaps between nerve cells.Carried by blood, hormonescan spread all over the bodyand can affect many organs.How do hormones work? Hormones work by bindingto receptors either outside orinside a cell. Each kind ofhormone molecule has ashape that fits only certainreceptors. Each organ hascells with receptors for cer-tain kinds of hormones.When a hormone binds to areceptor on a cell, the cellreacts. The result depends onthe kind of hormone andthe organ the cell is in.What are the endocrine glands? Several different endocrine glands are scattered aboutyour body. They are thepituitary gland, the thyroidgland, parathyroid glands,adrenal glands, gonads, thepancreas, the thymus gland,and the pineal gland. Thetable on the next page showsthe hormones and functionsof each endocrine gland. endocrine glands.Hormones Pineal gland Thyroid gland Thymus gland Pancreas Testis (male gonad)Pituitarygland Adrenalgland Ovary(female gonad) Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Endocrine System continued Do all diabetics have to take insulin? No, usually only type 1 dia- betics have to take insulininjections. Type 2 diabeticscontrol their blood-sugarlevel with oral medications,diet, and exercise. Most dia-betics have type 2 diabetes,which normally developsafter the age of 40. Lowblood sugar, or hypoglycemia, is also related to insulin andis more common in teens. Ahigh-carbohydrate diet canstimulate the release of toomuch insulin, which causesthe body to use blood sugartoo quickly. Low bloodsugar makes you feel weakand interferes with yourability to think. 546 HOW YOUR BODY WORKSGland Pituitary (anterior) Pituitary (posterior) Thyroid Adrenal (medulla) Adrenal (cortex) PancreasParathyroidThymusPinealGonadsHormone human growth hormone (HGH) thyroid stimulating hormone (TSH)adrenocorticotropic hormone (ACTH)follicle stimulating hormone (FSH)luteinizing hormone (LH)prolactin antidiuretic hormone (ADH) oxytocin thyroxine epinephrine, norepinephrinecortisol aldosterone glucagon, insulinparathyroid hormone (PTH)thymosinmelatoninestrogen, progesterone, testosteroneFunction regulates growth directs thyroid glanddirects adrenal glandsdirects reproductive organsdirects reproductive organsstimulates production of breast milk regulates amount of water released by the kidneys stimulates uterine contractions and breast-milk flow regulates metabolism, body-heat production, and bone growth stimulate “fight-or-flight” response regulates carbohydrate and protein metabolism maintains salt and water balance regulate blood-sugar levelregulates blood-calcium levelinfluences maturation of some immune system cellscontrols internal clock and sleep rhythmstimulate development of sex characteristics, affect egg and sperm formation, and control reproductive cycles Glands of the Endocrine System Copyright © by Holt, Rinehart and Winston. All rights reserved. Is it true that everyone has both male andfemale hormones? We used to think that only men had male hormonesand that only women hadfemale hormones. Now weknow that both men andwomen have both kinds ofsex hormones but in differ-ent amounts. The male hor-mone testosterone governs the changes in boys as theymature. In women, the“male” hormone causes thenormal growth of body hair.The female hormones estro- genand progesterone govern the changes in girls. In men,the “female” hormones helpkeep body fat at a safe level. What determines how tall I am? Nutrition and other environ- mental factors affect growth,but genes ultimately deter-mine how tall you are.Genes act by causing thebody to make hormones.Human growth hormone(HGH ) is the main hormone that promotes growth inchildren. HGH is made bythe pituitary gland. Dwarfism is an inherited trait thatresults from the underpro-duction of HGH. Gigantism is an inherited trait thatresults from the overproduc-tion of HGH.What is the “fight-or- flight” response? Your body responds to stressful situations by getting ready to either fightor run away to protect itself. This “fight-or-flight”response is directed in partby two hormones made bythe adrenal glands. ( EPuh NEF rin) is one of the hormonesreleased by the body in times of stress. Epinephrineis also known as adrenaline.Norepinephrine is anotherhormone released in timesof stress. These stress hor-mones raise your heart rate,blood pressure, and breath-ing rate and slow your diges-tion. As a result, more bloodflows to your muscles, bring-ing them plenty of oxygen—just in case you have to runfor your life! Epinephrine HOW YOUR BODY WORKS 547 An event such as taking a test causesstress. Your bodyresponds to thisstress in the sameway that itresponds to fear. EX P R E S SLesson REVIEW 1.Compare the endocrine system and the nervous system. 2.List three glands of the endocrine system. 3.Describe the way that hormones work. 4. Evaluating Media Messages A new trend in ath- letic training involves using human growth hormone (HGH) to increase muscle growth. After researching the topic, explainwhether you think this is a safe practice.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Environment and Your Health There was a big meeting tonight at Daniel’s school. The community wanted to discuss what to do about the recent news that the water supply might be contaminated. What’s the big deal, thought Daniel. Why should I care about the environment? The is the living and nonliving things thatsurround an organism. Theenvironment includes plants,animals, air, water, and land.Your health and the health ofyour community is affectedby your environment. If theenvironment in which youlive is unhealthy, the chancesincrease that your health andthe health of your commu-nity will suffer. What makes an environment healthy? A healthy environment is one in which the air is clean,the water is clear, and theland is fertile. It is one inwhich there is plenty of foodfor all the inhabitants. Ahealthy environment is freeof pollutants and wastes thatcan make water, air, andland unsafe for living things.A healthy environment is abalanced environment. Why are ecosystems important to our health? An is a commu- nity of living things and thenonliving parts of the com-munity’s environment. Theliving and nonliving parts ofan ecosystem interact anddepend on each other. If onepart of an ecosystem is dam-aged, the whole ecosystemcould become unhealthy. Wedepend on the ecosystem we live in to produce theresources we need to survive.We can be healthy only if ourecosystem is healthy.ecosystem environment 548 WHAT YOU NEED TO KNOW ABOUT . . . Copyright © by Holt, Rinehart and Winston. All rights reserved. How can pollution be harmful? Pollution can harm your ecosystem and thus, yourhealth in several ways, as shown in the table. Forexample, many chemicalpollutants such as smog cancause respiratory problemsand eye irritation. Gases produced by the burning of fossil fuels canreact with water vapor in theair and produce acid rain. is any precipitation that has a below-normal pH(acidic). are pollutants released by certain coolantsand aerosol spr ays. Chloro- fluorocarbons are anothertype of pollution that canharm your health. CFCs canincrease your risk of skin can-cer. CFCs move into theEarth’s upper atmosphereand destroy ozone. Ozone is a gas in the upper atmospherethat reduces the amount ofultraviolet radiation from thesun. is radiation in sun- light that is responsible fortanning and burning skin. Excessive exposure to UVincreases your risk of skincancer and premature agingof the skin. The ozone isbeneficial because it absorbsharmful UV radiation. What is conservation? A resource is a material that can be used to meet a need. is the wise use and protection of naturalresources. To protect ourhealth and improve our environment, we need toconserve several specificresources in the environment.>Water Fresh, clean water is needed for us to live; tokeep clean; to grow,prepare, and process ourfood; and to make itemswe use. ConservationradiationUltraviolet (UV)(CFCs)ChlorofluorocarbonsAcid rain WHAT YOU NEED TO KNOW ABOUT . . . 549Pollutants Water pollutants Sewage PesticidesFertilizersMercury and other metals Indoor and outdoor air pollutants Smog and other gases Carbon monoxide Cigarette smoke Radiation NoiseSoil pollutants Acid rain Radon Pesticides and herbicidesEffects on your health breeds pathogens that cause hepatitis, cholera, typhoid fever, and amebic dysentery cause brain and nerve disorders, birth defects, and cancer cause damage to ecosystems and death of fish cause brain damage, mental retardation, nerve disorders, kidney disorders, paralysis,and loss of vision cause or worsen respiratory illnesses such as asthma prevents red blood cells from carrying oxygen; causes weakness, loss of consciousness, or death causes lung cancer, asthma, emphysema, and sudden infant death syndrome (SIDS) causes sunburn, glaucoma, and cancercauses hearing damage causes lower soil fertility, damages vegetation and buildings, and causes famine causes cancercause brain disorders and nerve disorders, birth defects, and cancer Pollution and Your Health Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E 550 WHAT YOU NEED

TO KNOW ABOUT . . . >AirTo live, we need certain gases that are in the air. For example, weneed oxygen in order toget energy from our food.Carbon dioxide is usedby plants to make food.Ozone, in the upperatmosphere, reduces theamount of UV radiationfrom the sun. >Minerals We need minerals such asphosphorus, calcium, andsodium to carry out ourbodies’ activities. We getminerals from the plantsand animals we eat andfrom our drinking water.>Food Our bodies need energy in order to live.We get nutrients forenergy from plants andanimals. >Land All living things need a certain amount ofland in order to live. Landalso provides a growingspace for trees. Treesprovide food for animals,shelter from the weather,and oxygen. Why should we conserve natural resources? Conserving our natural resources helps ensure thatresources will be available inthe future. A naturalresource that can be replacedover a short period of time iscalled a Trees and crops are renew-able resources. are natural resources that can be used up faster thanthey can be replenished naturally. Oil and naturalgas are examples of non-renewable resources. Some renewable resources can also be used uptoo quickly to be replaced.Resources such as fresh water,topsoil, timber, and oceanfish must be conserved.How does overpopulation affect our health andenvironment? The point at which a popu- lation is too large to be sup-ported by the availableresources is called Earth’s human population has beenincreasing rapidly. Over-population can lead tomany problems. Low food supplies Over- population makes it difficultto find and produce enoughfood to support the commu-nity. Famine is common inoverpopulated areas. Polluted water Polluted water from bathing, wash-ing, and dumping wastes is afrequent result of overpopu-lation. Drinking, swimming,and bathing in pollutedwater spread disease. Poverty, poor sanitation, and disease These prob- lems are common in over- populated parts of theworld. Overuse of the land and resources In order to feed, clothe, and shelter a growing population, we must usemore natural resources. Non-renewable resources canbecome depleted because ofoveruse, which results fromsupplying a large population. overpopulation. Nonrenewable resourcesrenewable resource.Environment and Your Health (continued) Copyright © by Holt, Rinehart and Winston. All rights reserved. Deforestation Many coun- tries do not have enough farmland to feed their popu-lations. Populations in tropi-cal areas have little clear landfor farming. isthe clearing of trees from natural forests to make spacefor crops or development.When crops are grown onsoil from tropical forests, thenutrients in the soil aredepleted quickly. More forestmust be cleared for people tocontinue farming. Overfishing Overpopu- lation can also lead to over-fishing. Because oceans donot belong to any one coun-try, regulating the amount offishing in oceans is difficult.Our government places limits on the fishing indus-try in the United States topreserve species. However,not all countries do thesame. How does our government protect our environment? One approach to protecting our environment has beento make pollution moreexpensive by placing a taxon it. The gasoline tax is agood example of such a tax.A second approach has beento pass l aws. The United States has many laws aimed at protecting the environment. >The Clean Air Act of 1970limits the release ofpollutants into theenvironment and sets safelevels of several airpollutants. >The Clean Water Act of1972 limits the release ofsewage and chemicalsinto water in the UnitedStates. The U.S. Environmental Protection Agency (EPA) isthe agency that sets andenforces the standards estab-lished by these l aws. Who else protects the environment? A number of local, national, and international organiza-tions also work to protectthe environment. Membersof these organizations talkto lawmakers, raise moneyto help preserve land, andpublish educational materialto teach people about theimportance of protecting the environment.How can you help improve the environment? >Recycle or reuse products. is reusing materials from used products to makenew products. >Conserve electricity and water. Take showers instead of baths, water lawns in the evenings toprevent evaporation, andfix leaky faucets. >Become involved in a local environmentalissue. Support recycling and conservation projects in your school. Join orstart a group that keepslitter off school andneighborhood lawns.Recycling Deforestation WHAT YOU NEED TO KNOW ABOUT . . . 551EX P R E S SLesson REVIEW 1.What do living things need from their environment to live a healthy life? 2.How do pollution and overpopulation affect an ecosystem? 3. CRITICAL THINKING What are three ways you can help reduce each of the following: water pollution, air pollution, andsoil pollution? 4. Using Community Resources Describe how you can plan a school or community effort to improve the environ-ment around your school.LIFE LIFE SKILL www.scilinks.org/health Topic: Solving Environmental Problems HealthLinks code: HH4128 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Public Health Nurse García was concerned. Another patient came into the Emergency Room with nausea, vomiting, and diarrhea. It could be food poisoning, she thought.This patient was the seventh one in 2 days with these symptoms. She worriedthat this could be the beginning of an epidemic. Why is public health important? is the practice of protecting and improving the health of people in acommunity. Because the peo-ple living in a communityinteract with one another,they affect each other’s healthand well-being. The public health system is important in fighting infec-tious diseases and preventingother health problems, manyof which are related to peo-ple’s behaviors. Infectious diseases can spread rapidly through acommunity and cause manypeople to become ill. Thisunexpected increase in illnessis called an Thecause of an outbreak must beidentified and treated quicklyto keep the disease frombecoming an epidemic. An is the occurrence of more cases of a disease thanexpected. Noninfectious diseases are caused by genetic, envi-ronmental, or behavioral fac-tors. Noninfectious diseasesoften affect a communitybecause the people in thecommunity have manybehavioral and environmen-tal factors in common. Non-infectious diseases are harderto eliminate because theirtreatment requires animprovement in the environ-ment or a change in people’s lifestyle. Why do epidemics spread? A is anygroup of people who havean increased chance of get-ting a disease. Epidemics canspread quickly through cer-tain high-risk populations. high-risk populationepidemicoutbreak.Public health 552 WHAT YOU NEED TO KNOW ABOUT . . .Restaurant inspections by public health work-ers help to ensure ourfood is safe. Copyright © by Holt, Rinehart and Winston. All rights reserved. Populations that have a high risk of developing an epi-demic include the following: >Populations with poor sanitation is the practice of providing sewage disposal andtreatment, solid wastedisposal, clean drinkingwater, and clean living andworking conditions.Bacteria breed in wastesand unsanitary water,which easily spreadsdisease. >Populations with poor nutrition Poor nutrition makes it difficult for the body to fight disease. >Populations with low rates of immunization Many diseases have been controlled throughimmunization.Unfortunately, there aremany populations that donot have access to suppliesfor immunization. >Populations with overcrowding is the condition in which there are too many inhabitantsin an area to live healthily.What public health concerns do we have inthe United States? Cardiovascular disease, can- cer, stroke, and respiratorydiseases are leading causes ofdeath in the United States.These diseases threaten public health because thebehaviors that can lead tothem are common amongmany members of the com-munity. These are —diseases that are caused partly byunhealthy behaviors andpartly by other factors. Preventing infectious diseasesis also a major concern.What do public health agencies do? Public health agencies at several levels of governmenthelp protect public health. Local and state health departments These agencies protect the health of the community in many ways. They regulate communityfood and water supplies, help prevent infectious andlifestyle diseases, work tocontrol epidemics, educatethe public to improve personal and communityhealth, and keep health statistics to watch for trendsin illness or injury. lifestyle diseasesOvercrowdingSanitation WHAT YOU NEED TO KNOW ABOUT . . . 553Agency Centers for Disease Control and Prevention(CDC) Food and Drug Administration (FDA) National Institutes of Health (NIH) Substance Abuse and Mental Health ServicesAdministration (SAMHSA) World Health Organization (WHO) United Nations Children’s Fund(UNICEF)Function works with state health departments to monitor health trends, detect healthproblems, and control epidemics works to ensure that food and medi- cines are safe, healthy, and effective directs and promotes research on pre- vention, diagnosis, and treatment of disease researches problems related to alcohol, drug abuse, and mental health issues works to control AIDS worldwide, moni- tors emerging infections, such as Ebolaand Hanta virus, and administers child-hood immunizations in many countries assists children with healthcare, nutrition, education, and sanitation Public Health Agencies Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E 554 WHAT YOU NEED TO KNOW ABOUT . . .National health agencies These agencies set broad public health objectives; regulate food and drug pro-duction; fight epidemics;organize, fund, and conductresearch to find cures for diseases; regulate healthywork practices; and sponsorprograms that help peoplestay healthy. International health agencies International health agencies such as the World Health Organization(WHO) work to fight globalhealth problems. Some ofthe issues they addressinclude poor nutrition, lackof basic medical care, poorsanitation, lack of cleanwater supplies, natural disas-ters, and disease. How do private health organizations affect public health? Private organizations also provide important publichealth support around theworld. The International RedCross, for example, providesfood, clothing, temporaryshelter, and medical care topeople affected by wars, otheracts of aggression, and naturaldisasters. Many other private organizations work to solvepublic health problems.Usually, they focus on a specific group in the popula-tion or a specific disease. Private organizationsdepend on donations andvolunteers to fund theirwork.How do public health policies affect publichealth? Public health policies are based on laws designed toprotect citizens and promotethe health of a community.Examples of these policiesare as follows: >Laws and programs that promote mass immunization All states have laws that require children to be immunizedbefore they can attendpublic schools. These lawsand programs have beenvery effective ineliminating diseases suchas smallpox and polio andcontrolling other diseasessuch as measles andwhooping cough. Public Health (continued) The Food and Drug Administration(FDA) works toensure the food weeat is safe.The Red Cross worksto help those inneed around theworld.Government lawsand regulations helpprevent our waterfrom being contami-nated.Health clinics offer immu-nizations to help keepchildren healthy and diseases under control. Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 555>Waste disposal laws Laws regulating waste disposal and dumpingprevent an increase in rat,mice, and insectpopulations, whichspread disease. >Standards for sanitation and health and safetypractices Safe standards for food preparation, seat belt use, and blood-alcohol concentrations arepublic health policies. TheOccupational Safety andHealth Administration(OSHA) is a federal agencythat sets safety standards inthe workplace. >Requirements for medical licensing Doctors must have a license to practicemedicine in the UnitedStates. Licensing ensuresthat doctors have theknowledge and training toprovide medical treatmentfor a community.What is Healthy People 2010? is a set of health objectives estab- lished by the U.S. Depart-ment of Health and HumanServies for improving thenation’s health by 2010.These objectives are goalsbased on risk factors for dis-eases that are at least partlypreventable. Eliminating risk factors usually requires significantchanges in personal habits,such as eating, smoking, andexercising. The benefits frommaking these changes areimprovements in both personal and public health. Healthy People 2010 EX P R E S SLesson REVIEW 1.What kinds of factors increase the risk of an epidemic spreading throughout a population? 2.Summarize the functions of local, state, and national publichealth agencies. 3. Using Community Resources You recently noticed that the water in your school has an unpleasant taste andsmell. What could you do to start an investigation of the cause? 4. Practicing Wellness Name two behaviors you can change today to reach one or more of the Healthy People2010 goals. LIFE LIFE SKILLLIFE LIFE SKILL www.scilinks.org/health Topic: Modern Epidemics HealthLinks code: HH4099 Goals of Healthy People 2010 >Reduce the number of deaths from heart disease. >Reduce the number of deathsfrom cancer. >Reduce the number of deathsfrom AIDS. >Reduce the percentage of overweight people. >Increase the percentage of people who exercise regularly.>Reduce the percentage of adolescents who smoke cigarettes. >Reduce the number of childrenexposed to cigarette smoke. >Reduce the number of womenwho smoke while pregnant. >Reduce the number of deathsfrom car accidents. >Reduce the number of deathsfrom drunk driving. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E How do I select a healthcare provider? Selecting a healthcare provider usually begins with choosing a primary care physician. A is a family doctor who handlesgeneral medical care. Thisdoctor is the first one you seewhen you have a health con-cern. If your parents plan touse insurance to pay for yourvisit, your doctor must beable to accept payment fromyour insurance company. What kind of healthcare provider can I choose? There are several different types of healthcare providersfrom which to choose: >Doctor of medicine (M.D.) An M.D. is a physician who is trained in the diagnosis andtreatment of disease. >Doctor of osteopathy (D.O.) A D.O. is a doctor who has the same training as an M.D. butalso specializes in thecare of the muscular andskeletal system.>Physician’s assistant (PA) A PA carries out medical procedures under the supervision of aphysician. In rural areas,physician’s assistants havebecome very popularproviders of healthcare. >Nurse practitioner (NP) An NP is a registerednurse who has additionaltraining and expertise incertain medical practices. Depending on your needs, you and your parentsmay choose any of thesekinds of medical profes-sionals.What is a specialist? If your primary care physi-cian encounters a complexor serious condition or acondition that he or she cannot identify or treat, heor she will send you to aspecialist for an accuratediagnosis. A specialist is a doctor who studies andbecomes an expert in onespecific area of medicine. Aspecialist will have extensiveknowledge of a certain bodypart or illness. The processof sending a patient fromone healthcare provider toanother is called a referral . care physician (PCP)primarySelecting Healthcare Services After spending the weekend hiking with his friends, Isaac woke up Monday morning to find his legs covered with red, itchy bumps. His mom opened thephone book to look for a doctor and discovered three pages of listings for doctors. How could they choose which doctor to see? 556 WHAT YOU NEED TO KNOW ABOUT . . . Copyright © by Holt, Rinehart and Winston. All rights reserved. How do I know my doctor is qualified? You and your parents should check your healthcareprovider’s qualifications.According to the law, yourdoctor must be licensed. It isillegal for a doctor to practicemedicine without a license inthe United States. It is a goodidea to choose a doctor whois board certified. This meansthat the doctor has passedspecial tests given by a physi-cians’ association to verify hisor her skill and knowledge. You may also want to talk with other medical profes-sionals to find out who theywould recommend. Familyand friends can also help bytelling you what they like ordon’t like about their doctors.How do I prepare for my visit to the doctor? Patients meet doctors through get-acquainted visitsor during the first checkup.At that time you’ll meet thedoctor’s office staff. The staffwill schedule appointmentsand answer questions aboutinsurance and referrals.Find out from the office staff how the doctor’s prac-tice operates. Will a nurseobtain routine medical infor-mation from you? Are sickpatients separated from wellpatients while waiting to seethe doctor? Do several doc-tors share patient careresponsibilities? Are therespecific hours to speak to thedoctor by phone? How areemergencies handled duringevening and weekend hours? Making out a fact sheet like the one on the next pagewill help you prepare foryour visit. Your list shouldinclude the following: >your basic medicalhistory >any medications you aretaking >any allergies you have,especially if you have anallergy to a medicine >a list of questions youwant to ask your doctor >the reason for your visit WHAT YOU NEED TO KNOW ABOUT . . . 557>Is this doctor a member of your insurance plan? >Where did this doctorattend medical school? >How long has this doctorbeen practicing medicine? >Is this doctorrecommended bypeople you respect? >Does this doctorcommunicate in a waythat you understand?>Do you feel comfortablewith this doctor? >Are this doctor’s officehours and locationconvenient? >Are the prices fair andreasonable? >How long do you have towait for an appointment? >How long do you usuallywait in the doctor’s office?Questions to ask: Choosing a Doctor Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E 558 WHAT YOU NEED TO KNOW ABOUT . . .Selecting Healthcare Services (continued) How do I make sure I understand my doctor? When speaking with your doctor, make sure your doc-tor explains your illness sothat you understand theproblem and the recom-mended treatment plan. Ifyour doctor’s advice isunclear, you may not be ableto follow the treatment plan. Ask your doctor to clarify anything you do notunderstand about your visit.If your doctor is in a hurryto see another patient,something important maybe overlooked. Make sure your doctor takes the time to answer yourquestions. You must feelcomfortable and confidentwith your doctor.How do I evaluate my doctor? Choose a few of these ques- tions to ask your familyphysician. Discuss his or heranswers with your parents,and decide as a familywhether you are happy withyour doctor or would like tochoose another. >How long do you have towait for an appointment? >How long do you have towait in the waiting room?>Does your doctor seem tobe rushed when seeingyou? >Do you feel comfortableasking your doctorquestions? >Does your doctor explainthe diagnosis andtreatment clearly? HEALTHCARE PROVIDER VISIT FACT SHEET Date: ________ Healthcare Provider: ___________ 1.Reason(s) for seeing doctor: ________________ ________________________________________ 2.Symptoms and when they started: __________ ________________________________________ 3.Current medicines and dosage: ____________ ________________________________________ 4.Family health history: ____________________ ________________________________________ 5.Allergies: ________________________________ ________________________________________ 6.Recommended treatment: ________________ ________________________________________ 7.Cost of treatment: ________________________ ________________________________________ 8.Other treatment options: __________________ ________________________________________ 9.Questions and concerns: __________________ ________________________________________ Copyright © by Holt, Rinehart and Winston. All rights reserved. What are a patient’s rights? Every patient has the right and responsibility to >receive accurate, easilyunderstood information >receive assistance inmaking informedhealthcare decisions >have a choice ofhealthcare providers >have access to emergencyhealth services when andwhere the need arises >participate in all health-related decisions >make wishes abouthealthcare known, suchas being an organ donor >receive considerate,respectful care >not be discriminatedagainst in the delivery ofhealthcare services >have confidentialcommunication withhealthcare providers >have a fair and efficientprocess for resolvingcomplaints ordisagreements What should I do if my doctor is too busy tosee me? Many times the healthcare providers are very busy. Ifyour doctor has to rushthrough your evaluation tohurry on to the next patient,you may not feel that you’regetting the best care. Feelingrushed may also keep youfrom asking questions andmaking sure you understandyour doctor’s advice andtreatment. When you chooseyour primary care physician,make sure your doctor hasenough time to spend withyou. You and your parentsmay need to visit with sev-eral doctors before choosingone who will be your pri-mary care physician. What types of patient care are available? is medical care that requires a person to stay in a hospital for morethan a day. is medical care that requiresa person to stay in the hospi-tal only during his or hertreatment. are medical services, treatment, or equipment pro-vided for the patient in his orher home. servicesHome healthcareOutpatient careInpatient care WHAT YOU NEED TO KNOW ABOUT . . . 559 EX P R E S SLesson REVIEW 1. Being a Wise Consumer If you were dissatisfied with your healthcare provider, what steps could you take to find a new provider you would be happy with? 2.Explain why a patient might need a referral. 3. Communicating Effectively What information should you take to the doctor with you if you have a healthproblem? What are three questions you could prepare to askyour doctor?LIFE LIFE SKILLLIFE LIFE SKILL www.scilinks.org/health Topic: Consumer Protection and Education HealthLinks code: HH4037WORDS TO KNOW primary care physician (PCP) a family or personal doctor you visit when youhave a healthcare concern specialist a healthcare provider trained to treat a specific medical condition orarea of the body referral a written recommen- dation from your PCP to see a specialist inpatient care medical care that requires an extended hospital stay outpatient care medical care that requires a hospital stay only during treatment home healthcare services medical care that is providedat the patient’s home Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Financing Your Healthcare A visit to the emergency room can cost from 150 dollars to several thousand dollars. Very few people can afford to pay medical bills without any help. Having health insurance can help you afford medical costs. What does health insurance actually do? Many healthcare services are too expensive for people toafford on their own. Healthinsurance allows people topay a set amount of moneyeach month in exchange forprotection against large medical bills. If you wereever to have an accident orbecome seriously ill, healthinsurance would help youpay your medical bills. How do I get health insurance? There are two ways people can get health insurance in the United States. One wayis through work. Many com-panies offer insurance as abenefit to their employeesby paying all or part of thecost. Other people purchasetheir own health insurance. What kind of health insurance is available? The three major types of health insurance plans are >fee-for-service plans >managed-care plans >government-assistedhealth plansWhat is a fee-for-service plan? are traditional insur- ance plans, in which the patient must pay a premiumand a deductible. A is a monthly fee for insur-ance. A is theamount that the subscribermust pay before an insurancecompany begins paying formedical services. Fee-for-service plans can be expen-sive, but patients are free tochoose any healthcareprovider they wish to see. deductiblepremiumplansFee-for-service insurance 560 WHAT YOU NEED TO KNOW ABOUT . . . >Can I afford this insurance? >Do I have to pay a deductible? How much isthe deductible? >Do I have to pay a copay-ment? How much is thecopayment? >Do I get hospital, surgical,medical, and prescriptionbenefits? >Can I visit any doctor, ordo I have to choose from alist of doctors? >If I have a preexisting condition, is the conditioncovered?>How much does going tothe emergency room cost? >What conditions orservices are excluded? >Is part of the cost of insur-ance covered by my job orparent’s job? >Can I get a cheaper rate bybelonging to a group ofsubscribers? >Can I continue my insur-ance if I lose my job? >Can I cancel my insuranceif I need to?Questions to ask: Choosing Health Insurance Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 561What are managed-care plans? are plans in which an insurance company makes a contractwith a group of doctors.These doctors provide careand services at a lower fee topatients who have this insur-ance. Usually, the patientpays a yearly (or monthly)premium and a copaymentfor each doctor visit. Acopayment is the amountthat the patient pays eachtime medical care is received.Managed-care plans are gen-erally less expensive thanother types of insurance, butpatients have a limitedchoice of providers. What is an HMO? A is a managed-care plan in whichpatients must use a doctorwho contracts with the insur-ance company. If the patientuses a doctor who is not partof this contract, the insurancecompany will not pay for theservices. The only exception isin the case of an emergency. What is a PPO? A allows the patient to see a doctorwho does not contract withthe insurance company. Thepatient pays a higher fee todo this.What happens if you can’t afford healthinsurance? Local health departments provide many health services,including information,immunizations, andHIV/AIDS testing and coun-seling, either free or for a verysmall fee. The Children’sHealth Insurance Program(CHIP) provides health insur-ance in most states for chil-dren who are not covered byinsurance. This programhelps ensure that all childrenreceive quality healthcare. What is government- assisted healthcare? Medicare and Medicaid are healthcare programs provided by the government. is a healthcare program for people who are65 years old or older and foryounger individuals who aredisabled. is ahealthcare program for peo-ple who are on welfare, havedependent children, or areelderly, blind, or disabled. MedicaidMedicare organization (PPO)preferred providerorganization (HMO)health maintenanceManaged-care plans EX P R E S SLesson REVIEW 1.Describe three types of health insurance. 2.List three groups of people who can receive healthcare through Medicaid. 3. Being a Wise Consumer Your family has been offered a fantastic deal on a traditional health insurance policy.What questions should you ask the insurance agent before purchasing the policy? LIFE LIFE SKILL WORDS TO KNOW premium the monthly or yearly fee for insurance provider a doctor or a person who gives medical care or services deductible the amount that the subscriber must pay before the insurance companybegins paying for medicalservices copayment the amount the subscriber must pay each time medical care is receivedinstead of paying a deductible exclusion a medical problem or service that is not covered by insurance preexisting condition any health problem that the patient had before buyinginsurance www.scilinks.org/health Topic: Healthcare Systems HealthLinks code: HH4075 Copyright © by Holt, Rinehart and Winston.

All rights reserved. XPRES SLesson E Evaluating Healthcare Products Lose 20 pounds in 5 days! Get rid of acne while you sleep! If you have been tempted by claims like these, don’t be embarrassed. Each year, consumers are cheated out of billions of dollars for healthcare information, services, andproducts that don’t work. How can companies sell fraudulent products? is the marketing and selling of products or services by making false claims. a type of fraud, is the promotion of healthcareservices or products that areworthless or not proveneffective. Several governmentagencies watch for fraudulentproducts. However, theseagencies do not have enoughmoney or staff to check everyreported case of fraud. Why do people buy fraudulent products? People believe false advertise- ments and buy fraudulentproducts for several reasons.Companies use scientific-sounding phrases to maketheir ads seem legitimate.Some ads use exaggerations,vague statements, opinions,and pressure to convince people to buy the product.People with severe illness maybe desperate for a cure. Companies take advantage ofpeople’s emotions, illnesses,weaknesses, and fears to sellfraudulent products.Is quackery really dangerous? Most quackery only wastes people’s money and givesthem false hopes. However,quackery can injure or killpeople who are seriously ill by convincing them tobuy useless products insteadof effective, proven medicaltreatment. In addition, theproduct itself may be harmful.How does the government protect us from fraud? Several government agencies protect us from fraud. >U.S. Food and Drug Administration (FDA) The FDA regulates the content and labeling offoods, drugs, and medicaldevices. The FDA can uselaw enforcement actionto seize and prevent thesale of products that arefalsely labeled. Quackery,Fraud 562 WHAT YOU NEED TO KNOW ABOUT . . .>Does the ad claim the product will treat a varietyof health problems? >Does the ad promise theproduct will provide aquick cure or miracle? >Is the product unavailableanywhere else or at anyother time? >Is the product marketed asa secret remedy or miracledrug? >Is the only proof that theproduct works the story ofsomeone who used it? >Do the methods seemstrange or unconventionalbut promise to produceresults?>Is the product sold door-to-door by a so-called healthadvisor? >Is the product marketedthrough the use of scaretactics? >Is the product availablethrough the mail only? >Does the company have apost office box number butno street address? >Does the ad claim that theproduct is a scientificbreakthrough that themedical community hasheld back or overlooked?Questions to ask: Identifying Fraudulent Products Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 563>U.S. Federal Trade Commission (FTC) The FTC prevents unfair, false, or untrue advertising andmarketing of foods, over-the-counter drugs,medical devices, andhealthcare services. >Consumer Product Safety Commission(CPSC) The CPSC protects consumers from harmful products. TheCPSC can requirecompanies to removedangerous products fromstores. This removal iscalled recalling a product. They can also requirecompanies to place healthwarnings on labels.How can I protect myself from quackery? Talk with your parents or a physician before buying anymedical product. If you sus-pect a product or service isfraudulent, you shouldinvestigate the product, serv-ice, or information morecarefully. You can also callthe Better Business Bureauor Consumer Affairs Office. EX P R E S SLesson REVIEW 1.Why are people willing to believe false advertising claims? 2.Name four questions you should ask as a healthcare consumer if you suspect a product is fraudulent. 3. Being a Wise Consumer Look through a maga- zine or newspaper for three ads that you suspect are fraudulent.What tactics or phrases does the ad use that would make youdoubt the validity of the product? 4. CRITICAL THINKING How do you think market- ing and advertising influence a person’s choice of products? LIFE LIFE SKILLLIFE LIFE SKILL www.scilinks.org/health Topic: Fraud, Quackery, and Health HealthLinks code: HH4067 At a grocery store, look at the price of two similarproducts. Find the priceper unit on the label. ACTIVITY How can you use this information to decide which product is abetter value? Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Evaluating Health Web Sites If a health Web site claimed that fluorescent lightbulbs are scientifically proven to cause pink eye, would you believe that claim? Probably not. Sorting outaccurate health information on the Internet can be confusing if you don’t knowwhat to look for. How can you tell if a health Web site isreliable? Anyone can give health information or sell health-care products through theInternet. Some Web sitesmay seem very reliable andmay be full of health advicethat sounds very convincing.Some Web sites may sellhealthcare products by giv-ing information that soundsscientific. To determine if a health Web site is reliable, assess thefollowing features. Author Who sponsored or created the Web site? Becareful if you cannot tellwho the author is. Is theauthor qualified to publishhealth information? Healthinformation is generallymore reliable if it comesfrom a medical professional.Does the author objectivelypresent health information?Be wary if the author is try-ing to sell a product.Information Is the informa- tion outdated? When wasthe Web site last updated?Information more than ayear old may not be accu-rate. Is the health Web sitetrying to inform or adver-tise? Web sites that are pro-viding reliable informationusually have links to otherreliable Web sites.Web sites that sell prod- ucts based on only the testi-mony of people who usedthe product are often fraudu-lent. This fact may seemstrange. However, there is noway to prove that any of thepeople listed ever actuallyused the product. References The Web site should provide the readerwith complete references.Make sure the references arefrom science journals or U.S.government publications. 564 WHAT YOU NEED TO KNOW ABOUT . . .>Is the Web site designed primarily to promote or sell a product? >Is the purpose of the Website unclear? >Does the Web site givehealth advice without identifying a source of information? >Does the Web site useevidence based mostly on the testimony of users? >Does the Web site have a lotof “pop-up” advertising?>Are you required to open amembership and give yourcredit card number? >Were you linked to the Website by unsolicitede-mail? >Does the Web site promisefree trial offers? >Does the Web site sende-mail that says you werereferred to them by anunidentified friend? >Is the content of the Web site outdated?Questions to ask: Identifying Fraudulent Health Web Sites Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 565Which health Web sites can I trust? Health information that you can trust is provided by gov-ernment agencies such as >the National Institutes ofHealth (NIH) >the Centers for DiseaseControl and Prevention(CDC) >the Food and DrugAdministration (FDA) Health information foundon educational Web sitessponsored by universities isalso probably trustworthy. Is there any group that monitors health Web sites? The is an organiza- tion of Web sites that agree to follow a code of ethicsregarding health information.The HONcode lists rules that its member Web sites mustfollow regarding the healthinformation they provide,which include the following: >The Web sites must offerhealth advice fromtrained healthprofessionals unless aclear statement is madethat the advice is from anonmedical individual ororganization. >The Web sites arerequired to honor doctor-patient confidentiality. >The Web sites arerequired to provideinformation about whowrote the text and paidfor the Web site. >Any claims relating to aspecific treament orcommercial product orservice must be supportedwith scientific evidence. A complete list of HON- code rules can be found at the HON Foundation Web site.Web sites that are membersof the Health On the NetFoundation are allowed toadd a symbol to their Website so that readers know theyfollow HONcode rules.What else can I do to make sure health Websites are providing reliable information? Other ways that you can evaluate health Web sites include the following: >Always cross-check information betweenseveral reliable Web sites. >Do plenty of researchbefore you believeanything as fact. >Check with your parents,your doctor, or yourpharmacist before you tryany health recommen-dations from a Web site. FoundationHealth on the Net (HON) EX P R E S SLesson REVIEW 1.List three health Web sites that would be likely to have accurate information. 2.List five signs that a health Web site is not a reliable source ofinformation. 3. Being a Wise Consumer Explain why a health Web site that is selling a product might not offer accurate information.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Caring for Your Skin Ouch! Jim’s skin felt like it was on fire. The day at the beach was fun, but Jim was sorry he forgot to use sunscreen. What does skin do? The skin has more functions than any other organ of thebody does. The skin >helps control your bodytemperature >keeps germs from gettinginto your bloodstream >senses temperature,texture, pressure, andpain >releases oils, wastes insweat, and excess salts >protects you and keepsyou warm >shields you fromultraviolet (UV) rays anduses these rays to makevitamin D >provides a waterproofcovering that preventsdehydration What is your skin made of? Your skin has two main lay- ers. The outermost layer ofthe skin is made of one toseveral layers of dead cellsand is called the Beneath the epidermis is thefunctional layer of skin,called the The epidermis is the layer you see when you lookin a mirror. The dead cells ofthe epidermis contain kera-tin. is a strong, flexi-ble protein found in skin,hair, and nails. Keratinmakes skin tough and water-proof. The epidermis hassmall openings called pores. Pores deliver oil and sweatto the skin’s surface. The epidermis also con- tains a pigment thatgives skin its color and shieldsskin from ultraviolet radia-tion. Ultraviolet (UV) radiation is radiation in sunlight that isresponsible for tanning andburning skin.The dermis is the thick inner layer of the skin, whichhas nerves, blood vessels,sweat glands, oil glands, andhair follicles. Protein fibersthat make skin flexible, called are also found in the dermis. Under the two layers of the skin is the subcutaneous layer. This fatty tissue insu- lates the body, acts as a shockabsorber, stores energy, andconnects the skin to thebody. collagen, melanin,Keratin dermis.epidermis. 566 WHAT YOU NEED TO KNOW ABOUT . . . Vein ArteryPore Epidermis (outer layer) Dermis(inner layer) SubcutaneoustissueHairfollicleHairshaft Oil gland SweatglandMusclefibersNervecells Copyright © by Holt, Rinehart and Winston. All rights reserved. What causes body odor? Sweat makes a perfect home for bacteria, which arealways present on your skin. The waste products of thesebacteria are what cause bodyodor. The best way to prevent body odor is to bathe regu-larly and use antiperspirantor deodorant. Foot odor is also caused by bacteria growing in thesweat on your feet. Washingyour feet daily, wearing cot-ton socks, and wearing shoesthat allow sweat to evaporatecan help prevent foot odor.Deodorant powders andshoe inserts with charcoalcan also help eliminate thisproblem. What causes acne? is an inflammation of the skin that occurs whenthe openings in the skinbecome clogged with dirtand oil. Acne is the mostcommon skin problem dur-ing adolescence. Acne cantake the form of whiteheads,blackheads, or pimples. Whiteheads and black- heads are pores that are plugged with oil. Blackheadsget their color from melaninin dead skin cells that areplugging the pore. A pimple forms when oil builds upinside the clogged pore. Bacteria living in the oilrelease w astes that add to the buildup. This waste irritatesthe skin and causes rednessaround the pimple. Acne is a normal part of being a teen. Hormonesreleased during adolescencecause the oil glands to pro-duce excess oil. Usually, acne goes away on its own when the body stops pro-ducing such large amountsof hormones. People used to think that chocolate, French fries, andother foods could cause acne.Research now shows thatthey do not cause acne. How-ever, avoiding greasy foods,eating more fruits and veg-etables, and drinking plentyof water help skin look andfeel better. How do I get rid of acne? Acne can be managed with proper skin care. The bestway to reduce acne is towash your face twice a daywith a gentle soap and warmwater. Using astringents andmedicated products may alsohelp. Do not scrub, pick, or squeeze your pimples. Pop-ping pimples can lead to permanent scars. Severelyinfected acne may need to betreated with antibiotics.Consult a dermatologist (a doctor who specializes inskin care) if you have severeor persistent acne.Acne WHAT YOU NEED TO KNOW ABOUT . . . 567 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E If I tan easily, do I still need sunscreen? Melanin is the body’s natu- ral protection against UVradiation. The skin producesmore melanin when it isexposed to the sun. How-ever, melanin can’t com-pletely block the sun’s UVrays. Prolonged exposure to the sun will lead to sunburnin even the darkest-skinnedpeople. Sunburns can leadto skin cancer and prema-ture aging of the skin. So,even if you tan easily, youshould still use sunscreen. What causes sunburns? Ultraviolet radiation isdivided into two types, UVAand UVB r ays. Both types of radiation are found in sun-light. UVB rays cause sun-burn when you spend toomuch time outside. If a burnis not too severe, the skinwill be red but will not haveblisters. Aloe vera gel orcool, wet cloths can soothethe burn until the skin hashealed. If your sunburncauses blistering or affectsyour vision, you should seea doctor right away. Are all sunscreens the same? Everyone should use some form of sunscreen whenspending prolonged timeoutside. For most people, asun protection factor (SPF)of 30 or more will preventburning for about 1.5 hours.Babies and people who havepale skin should use an SPFof 45 or more. Are tanning beds safe? Even though UVA rays donot cause sunburn, they arenot safe. The UVA radiation,which is used in commercialtanning beds, penetratesdeeper into the skin thanUVB rays do. This kind ofradiation damages DNA andhas been linked to sometypes of skin cancer.What causes skin cancer? Skin cancer can be caused byseveral factors, includinggenetics and UV radiation.The most common types ofskin cancer are carcinomas( KAHR suh NOH muhz). Carcinomas are masses of cells that begin in the skin or layersthat line organs. Carcinomasoriginate in skin cells that donot produce pigments. If theyare detected early, carcinomascan be treated. In its earlystages, a carcinoma may looklike a wart. A small percentage of skin cancers are caused bymutations that occur in pigment-producing skincells. These cancers are calledmelanomas ( MELuh NOH muhz). Melanomas are can- cerous tumors that begin inthe cells that producemelanin. Melanomas mayspread quickly to other partsof the body. A melanomaoften looks like a mole withan unusual color and shape. You can reduce the risk of skin cancer by avoidingoverexposure to both naturaland artificial UV radiation.Use sunscreens and wearlong sleeves and a hat whenexposed to the sun for anextended period of time. 568 WHAT YOU NEED TO KNOW ABOUT . . .Caring for Your Skin (continued) Copyright © by Holt, Rinehart and Winston. All rights reserved. Are tattoos and body piercings safe? Tattoos and body piercings have become very popularforms of decoration. How-ever, because tattooing andbody piercing involve punc-turing the skin, they canpose health risks. Diseasessuch as hepatitis and AIDSare spread easily throughneedles. Using sterile prac-tices can help reduce the riskof contracting such a dis-ease. A tattoo or piercingartist should >wash his or her hands for15 to 20 seconds with anantibacterial solutionbefore and after eachsession >wear protective latex orvinyl gloves at all timesduring the procedure >use individual sterileneedle packets andmaterials (which shouldbe opened in front of the client) >have a machine forsterilizing equipment on site >properly dispose ofcontaminated materialsafter each session(needles should bediscarded in biohazardcontainers) >provide adequateinformation for propercare of tattoo or piercingWhat other problems can piercing and tattooingcause? Some body parts are more prone to infection than oth-ers. The upper ear is mostlycartilage and has little bloodflow. If bacteria enter here, itis difficult for the body tofight the infection. The navel is also very prone to infection. This areaheals slowly and is con-stantly rubbed by clothing. Piercing in areas that havenaturally high bacteriacounts, such as the tongueand nose, can cause severeinfections. Tattoos can also become infected if not cared for prop-erly. Infected tattoos are verypainful. Some people develop large scars as a result of pierc-ings and tattoos. These large,raised scars are called keloids . What if I change my mind about a piercingor tattoo? Most holes from body pierc- ing will eventually close ifleft alone. However, it is easier to get a tattoo than toremove one. Laser removal isexpensive, very painful, andcauses scarring. Be sure tocarefully consider the dan-gers and consequencesbefore doing anything per-manent to your body. WHAT YOU NEED TO KNOW ABOUT . . . 569EX P R E S SLesson REVIEW 1.What should you do to get rid of acne? 2.How can you protect yourself from overexposure to the sun? 3. Being a Wise Consumer Check the phone book for tattoo artists. How many advertise that they comply with the U.S. Environmental Protection Agency (EPA) standards?LIFE LIFE SKILL www.scilinks.org/health Topic: Skin Cancer HealthLinks code: HH4126 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Caring for Your Hair and Nails Chrishelle wanted a completely different look for summer. She wondered if extensions would damage her hair. How do you know what’s healthy for your hair? Why should I care about my hair? Everyone has heard the say- ing “When you look good,you feel good.” But, besidesaffecting your appearance,taking good care of your hairis an important part of yourtotal health. In addition, yourhair is one of the features bywhich people identify you.Your hair reflects your indi-vidual style and shows yourunique personality. What is hair made of? Hair is made of dead cellsthat grow from the hair root.The roots of hairs are madeup of living cells. The root of a hair is found in a tiny pitin the skin called a Afolicle is embedded in thelayer of skin called the dermis. Hair cells are made of a protein called keratin. Keratin is a strong, flexible proteinfound in skin, hair, and nails.The visible part of the hair iscalled the shaft. The shape of the hair shaft determines whetherhair will be straight, curly, orwaxy. areglands in the skin that addoil to the skin and hair shaftto keep skin and hair lookingsmooth and healthy. What is a split end? A single strand of hair hasthree layers. The inner layer,called the medulla, is made of large cells that are par-tially separated by air spaces.The middle layer is calledthe cortex . The outer layer is the cuticle. The cortex and cuticle are made of overlap-ping rings of dead cells. When hair strands are damaged, the cells in thecuticle separate from eachother and the hair splitsopen, which forms a “splitend.” Hot blow-dryers, curl-ing irons, and harsh chemi-cals can dry out hair andcause split ends. Sebaceous glandsfollicle. 570 WHAT YOU NEED TO KNOW ABOUT . . . Hair Care Tips >Most people should shampoo every 2 days. Shampoo oily hair more frequently and delicate or dry hair less frequently. >When shampooing, massage your scalp gently with your fingertips. >Use a comb instead of a brush on wet hair. >Brush your hair by starting at the ends and working your way up to the scalp. >Avoid frequent use of blow-dryers and curling irons if possible. >Avoid harsh bleaches and dyes. >Use conditioner to improve the appearance of dry or damaged hair. >Get your hair trimmed regularly. Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 571 www.scilinks.org/health Topic: Head Lice HealthLinks code: HH4072Harsh bleaches and hair dyes can also damage your hair. Trimming your hair regularly will get rid of mostsplit ends and will keep yourhair from looking frayed anddull. How do I get rid of dandruff? is made of flaky clumps of dead skin cells from the scalp. Cold or verydry weather can cause skinto flake. The little whitespecks of skin fall out ofyour hair and onto yourshoulders. Dandruff can betreated with a medicatedshampoo. If you have severedandruff, you may need toconsult a dermatologist. What are head lice? are tiny parasites that feed on blood vessels inthe scalp. They crawl onto thehair shaft to lay their eggs.The egg sacs are visible aswhite spots in the hair. Lice can be spread by sharing brushes or hair acces-sories, pillows, or clothing.You should never sharecombs, brushes, hats, or hairaccessories. Getting rid of licerequires treatment with amedicated shampoo. Youshould also wash and dryanything that may have comein contact with the lice.How fast do fingernails grow? Fingernails grow from the base of the fingernail, whichis called the matrix. Finger- nails grow about an eighthof an inch per month,depending on the person’sage, gender, genetics, activitylevel and the season. Why do fingernails break and split? Proper nutrition plays the biggest role in keeping fin-gernails strong and healthy.Moisturizer can also helpkeep nails from becomingdry and splitting.Are artificial nails safe? Artificial nails can posesome health risks. >Some nail glues and nailglue removers containpoisonous substances. >Artificial nails can damagethe natural nails if they areleft in place too long. >The chemicals used toapply artificial nails arehighly flammable. >The tools used in a saloncan spread bacterial andfungal infections. Head liceDandruff EX P R E S SLesson REVIEW 1.Name four ways to keep your hair healthy. 2.Name four ways to keep your nails healthy. 3. Practicing Wellness Why should you take good care of your hair and nails? LIFE LIFE SKILL Nail Care Tips >Keep your fingernails and toenails clean and dry. >Use a soft brush to clean under nails. >Use lotion regularly. >Cut your nails straight across top, and file thetip and corners smoothto avoid ingrown nails. >Use a nail clipper to clip hangnails. >Do not bite your fingernails. >Notify your parents at the first sign of an infection, and visit yourdoctor or dermatologist. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Dental Care Have you ever noticed that a model’s teeth are always perfect? Models spend lots of money on dental work to improve their teeth. But if you take care ofyour teeth now, you can have beautiful teeth without spending a lot of money. 572 WHAT YOU NEED TO KNOW ABOUT . . .What are the parts of a tooth? A tooth can be divided into three parts—the visible part,called the crown, the neck of the tooth just below thegum line, and the rootbelow the gum line. The root holdsthe tooth in the jaw. A tooth also has three lay- ers. Enamel, the outermostlayer, protects the crown andis the hardest substance in thebody. The middle layer iscementum—a thin, bone-likelayer that covers and protectsthe root. The innermost layeris dentin—a hard tissue thatmakes up most of the toothand surrounds the pulp. Thepulp is the living center of thetooth and contains nervesand blood vessels. How do I whiten my teeth? Certain substances, such as coffee, tea, and tobacco stainthe enamel of teeth. Dentistsuse special bleaches toremove stains from teeth.Some over-the-counter prod-ucts claim to remove thesestains. Consult a dentist tomake sure any product youuse is safe for your teeth.What causes cavities? If you don’t brush your teethafter you eat, bacteria thatlive in your mouth willdigest food stuck to yourteeth. The mixture of foodparticles, saliva, and bacteriaon the tooth is called If plaque is not removed by brushing andflossing, it will harden intotartar. Tartar must beremoved at a dentist’s office. Both plaque and tartar are slightly acidic. The acidirritates the gums and slowlydissolves the hard surfaces ofthe teeth. This process iscalled Eventu-ally, the acid from tartar willeat through the dentin andinto the pulp of the tooth. tooth decay. plaque. Crown RootCavity Enamel Dentin PulpSealants are applied to the enamel to protect the tooth from cavities. As a cavity becomes deeper it is harder to treat.A cavity in the enamel is easily treated. Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 573The hole in the tooth produced by tooth decay is called a When decayreaches the pulp, the pulpbecomes infected with bacte-ria. Because the pulp containsnerves, cavities can be painful. How are cavities treated? Dentists can put a plasticsealant on teeth to keep acidsfrom damaging the enamel. Ifa cavity is treated early, a den-tist can clean the hole and fillit with metal or other hardsubstances to prevent furtherdecay. When a cavity reaches the pulp, the dentist must drillinto the pulp of the tooth toremove the infection causedby a cavity. This procedure iscalled a If theinfection is too deep for aroot canal to be effective, thetooth must be removed. What is gum disease? Bacteria on the teeth can irri-tate and infect the gums,which can lead to gingivitis. is a condition in which the gums become redand infected and begin to pullaway from the teeth. Onceyou have gingivitis, more bac-teria can

fill the pocketsbetween the teeth and gums.If gingivitis is not treated, thetooth will become loose andwill eventually fall out.What other problems can teeth have? Tobacco use, chronic infec- tions, and poor oral hygieneincrease a person’s chances ofdeveloping oral cancer. Oralcancer must be surgicallyremoved. If it is not removed,it could spread to other partsof the body.How can I protect my teeth? You can easily prevent bad breath, cavities, and gumdisease. Follow the guide-lines listed to brush andfloss your teeth after everymeal. Eat a balanced diet.Avoid food high in sugar oracid and foods that stick toyour teeth. Get dental checkups twice a year. Gingivitisroot canal.cavity. EX P R E S SLesson REVIEW Proper Flossing Technique > Use about 18 inches of dental floss. > Wind the ends of the flossaround your middle fingers. > Gently, insert the flossbetween two teeth. > Rub the side of the toothwith the floss. > Repeat steps 1 through 4on the rest of your teeth. > Rinse your mouth withwater.Proper Brushing Technique > Place the toothbrush at a 45-degree angle to yourgums. > Gently, brush teeth in short strokes away from the gum. > Brush the outer, inner, andtop surfaces of your teeth. > Brush your tongue. > Rinse your mouth withwater. 1.Describe the process that leads to a cavity. 2.Explain why gingivitis can cause you to lose a tooth. 3. Practicing Wellness List three things you can do that will help prevent tooth decay.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Protecting Your Hearing and Vision After the rock concert, Julie’s ears were ringing. “That’s how you know you were at a good concert!” Julie shouted. “I’m not so sure about that,” said herbest friend, “I heard loud music can make you deaf.” Can loud music make me lose my hearing? The ears are delicate and sensitive organs. Unfortu-nately, they have no way toshut out loud noises.Sounds above a certain levelcan permanently damagethe ear. That’s why you mustprotect your hearing. How can I tell if I’ve damaged my hearing? By the time teens become young adults, many havealready suffered some degreeof hearing loss. After the earshave been exposed to loudnoise, the ears may ring and words may seem muffled.The effect usually disappearsin a day or two, but damagefrom noise adds up overtime. A buzzing, ringing, orwhistling sound in one orboth ears that occurs evenwhen no sound is present iscalled (ti NIET es).Some people are born withtinnitus; others may developit as a result of damage tohearing. How loud is too loud? Sound is measured in unitscalled (DES uh BUHLZ ). The abbreviation for decibels is dB. The faintest sound a per- son can hear is 0 decibels. Prolonged exposure to noiseabove 70 decibels may beginto damage hearing. Seriousdamage occurs if a person isexposed to sounds above 120decibels. Sounds of 140 decibels or more can causepain. Sounds of 180 decibelsor more cause immediateand irreversible hearing loss. The length of time you are exposed to sounds is alsoimportant. For example, lis-tening to loud music for acouple of hours is just asdamaging as hearing a muchlouder sound for a short time. decibelstinnitus 574 WHAT YOU NEED TO KNOW ABOUT . . . 0 dB 30 dB 60 dB 90 dB 120 dB 150 dBThreshold of hearingNormal conversation WhisperThreshold of painHearing damage The loudness of different sounds (in decibels, dB) is shown below. Noticethat exposure to noisesabove 70 dB can begin todamage your hearing. Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT YOU NEED TO KNOW ABOUT . . . 575How can I protect my hearing? Following these tips can help you make sure you canenjoy a good concert formany years to come. > Keep your ears clean. Use a soft cotton swab toremove dirt and wax. > Do not push a cotton swab into your ear canal. > Never use a pencil or sharp object to clean your ear. > Protect your ears from the cold to prevent frostbiteand inner ear infections. > Avoid loud noises and keep volume low whenusing headphones. > Have your hearing checked once a year. Can using a computer damage my eyes? Reading in dim light or from a computer screen cannotdamage your eyes. However,these activities do cause tem-porary eye strain. Part of thereason for the strain is thatpeople engaging in theseactivities do not blink asoften as they usually would.Not blinking enough cancause the eyes to feel dryand irritated. Refresh youreyes by taking frequentbreaks to blink. Look upfrom your work, and focuson distant objects to relieveeye strain.How can I protect my vision? Follow these tips to keep your eyes as healthy as possible. > Be sure to eat a healthful diet rich in dark greenand orange vegetables. > Take regular breaks when you are reading or usingthe computer. Focus youreyes on distant objects. > If you have glasses or contacts, wear them.Trying to focus withoutyour corrective lenses willstrain your eyes. > Choose sunglasses that block 90 to 100 percentof UVA and UVBradiation (the two typesof ultraviolet radiationfrom the sun). > Any time you’re working with chemicals or powertools, be sure to wearsafety goggles. > Sit at least 5 feet from the television.> Use a room light and a reading lamp to reduceglare. > Because infections can be spread by your hands,avoid touching orrubbing your eyes unlessyour hands have beenwashed with soap andwater. > To avoid infection, do not share contacts or contactsolutions. > Visit your eye doctor once a year. What should I do if I hurt my eyes? Even the best protection can’t ensure you’ll never injureyour eyes. Any injury to theeye should be treated seriously. Often, the eye mayseem fine at first, but symp-toms of vision loss maybegin to appear later. If youexperience any eye injury, you must see a doctor immediately. Eye injuries canbe treated, but only if you getprofessional medical help. EX P R E S SLesson REVIEW 1.Name five things you can do to protect your vision. 2.According to the figure on the pervious page, what noises fall within the range of 120 to 140 dB? 3. Practicing Wellness What activities do you do that may put your eyes at risk for injury? What can you do todecrease this risk? 4. Assessing Your Health What noises are you exposed to in your daily life that could possibly damage your hearing? LIFE LIFE SKILLLIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E 576 FIRST AID AND SAFETYResponding to a Medical Emergency Sam was riding his bike along a trail near a campground. He suddenly came upon someone who was unconscious and bleeding. What should he do? What should I do if I encounter a medicalemergency? Quickly survey the scene for hazards that might harm youor the victim. Call out tobystanders for help. Deter-mine how many people (ifthere is more than one victim)are injured or ill. Ask each per-son, “Are you OK?” If a persondoes not respond, you or abystander should immediatelycall for medical help. Check for life-threaten- ing injuries. Then ask, “May Itouch you?” Do not touchthe person without consent. If there is no response, youhave implied consent tohelp. Try to determine the cause of the injuries or illnessto tell medical personnelwhen they arrive. Check to seeif the victim has a medical-alert necklace or bracelet. What medical conditions should I look for? If needed and if you can do so safely, give life-saving firstaid and then obtain medicalhelp if you have not alreadydone so. If the person mighthave a head or spinal injury,do not allow the head orneck to move. Remain withthe person until help arrives.How do I know whether to go for help if I amalone with a victim? A person needs medical attention if he or she is notalert, is not aware of the surroundings, and does notrespond to questions. If you can get to a phone or to others and returnwithin 3 minutes, then go forhelp. If not, stay with the vic-tim, check for life-threatening injuries, and give life-saving first aid. After these measures, if the victim remains unrespon-sive or needs medical atten-tion, you must decidewhether it is better to go forhelp or to stay. Consider fac-tors such as the following: >how long it might be beforesomeone finds you >whether the person will survive if you leave >whether the person will survive if you do not obtainmedical help Do not risk your own safety.1Look for hazards and remove them. 2Determine the cause ofinjury or nature of illness. 3Determine the number of victims. 4If the victim is unrespon-sive, seek medical help. 5If the victim is responsive,obtain consent to touchhim or her. 6Check the ABCs (Airway,Breathing, Circulation).7Give first aid for life-threatening conditions. 8Seek medical help if notdone previously. 9Stay with the victim untilhelp arrives. *Do not risk your own safety in order to rescue or provide first aidto another person. For moreinformation on these and othertopics, see the Express Lessons onpp. 576–613.Steps to Take When You Encounter a Medical Emergency Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 577What can I do to aid the victim until help arrives? To aid the victim, you must know what is wrong. First,check the ABCs .ABC is an acronym to remind you tocheck three important vitalsigns during an emergency.The reminds you to checkwhether or not a person’s airway is obstructed (blocked). The remindsyou to check if the person is breathing. The reminds you to check the person’s cartoid pulse. How do I check if a person’s airway isobstructed? If a person is talking or cry- ing, his or her airway isopen. If the person cannottalk but is alert and aware,he or she might have anobstructed airway. In thiscase, administering abdomi-nal thrusts (the Heimlichmaneuver) may clear the air-way. (See the Express Lesson “Choking” on p. 586.) If the person is unre- sponsive and does notappear to have a spinalinjury, place the victim faceup. Open the airway by tilt-ing the head back and liftingthe chin. If the victimappears to have a spinalinjury, ask others to helpyou roll the victim so thatno twisting of the bodyoccurs. Lift the victim’slower jaw without tilting thehead. Remove any visibleobject or vomit from themouth.How do I determine if the victim is breathing? Always ask the victim, “Are you all right?” If there is no response or if he or she isbreathing less than 8 timesper minute or more than 24times per minute or is hav-ing trouble breathing, seekmedical assistance. To detect breathing in an unresponsive person, lookfor movement of the chest.Then, listen and feel for airmovement by placing firstyour ear and then your cheekat the mouth and nose of thevictim. If the victim is notbreathing, keep the airwayopen and provide rescuebreathing. (See the Express Lesson “Rescue Breathing” on p. 580.)CBA Carotid Pulse— Place your index and middle fingers into the groove of the necknext to the voice box to feelthe cartoid artery pulse.Breathing— Look for movement of the chest. Listen and feel for airmovement by placing your ear andthen your cheek at the mouth andnose of the victim.Airway— Open the airway by tilt- ing the head back and lifting thechin. Make sure the tongue is notblocking the airway.How to Check the ABCs of Life-Threatening Conditions in an Unresponsive Person A B C Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Responding to a Medical Emergency continued How do I check for circulation? To check circulation, check the victim’s carotid pulse.The is thepulse felt at the carotid arter-ies, the major arteries of theneck. A carotid artery runsalong each side of the voicebox (Adam’s apple). Take thecarotid pulse by placing yourindex and middle fingersinto the groove of the necknext to the voice box. Do notuse your thumb; it has apulse of its own. Do not takethe pulse on both sides atthe same time, as it can cutoff blood flow to the brain.What if there is no pulse? If the victim has no pulse,has no other signs of circula-tion, and is not breathing,perform CPR (see the Express Lesson “CPR” on p. 582) if you are certified in this technique and call for medical assistance. If you arenot certified to performCPR, call for medical assis-tance immediately, and thenremain with the victim untilhelp arrives.Can I be held responsible for the death or injuriesof the person I am tryingto help? Good Samaritan laws have been designed and enactedto encourage people to helpothers in an emergency.These laws vary from state tostate. Generally, if you pro-vide help during an emer-gency, you are protectedfrom lawsuits if you obtainconsent, act in good faith,are not paid, use reasonableskill and care, are not negli-gent (careless), and do notabandon the person.carotid pulse 578 FIRST AID AND SAFETYSymptoms of Shock A person experiencing shock may >appear anxious, restless, or combative >be lethargic, difficult to arouse,or unconscious >have pale, cold, and “clammy”skin >become nauseated and vomit >experience increased pulse andrespiration rates >have a bluish tinge to his or her skin >be thirsty >have dilated (enlarged) pupils Shock can be a life-threatening event if not treated properly. Copyright © by Holt, Rinehart and Winston. All rights reserved. What is shock, and when do people usually experi-ence it? Many types of trauma can cause a person to go intoshock, which can be lifethreatening. is a con-dition in which some bodyorgans are not gettingenough oxygenated blood.Shock may occur when theheart is not pumping prop-erly, when a considerableamount of blood is lostfrom the body because ofhemorrhaging, dehydration,or a systemic infection, orwhen the nervous system isdamaged because of injuryor drugs. Significant injuriesusually cause shock, so auto-matically treat injured vic-tims for shock. What should you do if someone is in shock? >First, check the ABCs and treat a victim for any injuriesyou know how to. >Lay the victim on his or her back. >Raise the legs 8 to 12 inches. >Cover the victim with blan-kets, coats, or other coverings. >Call for medical assistance. >Do not give the victim any-thing to eat or drink.How should you treatsomeone for shock if heor she has head or spinalinjuries or is havingtrouble breathing? If the victim has head injuries, assume the neckand spine are also affected.If the victim has spinalinjuries, do not raise thehead or feet. Place victimswith breathing difficulties,chest injuries, eye injuries,or a heart attack in a half-sitting position. This posi-tion will help breathing. How should you treat an unconscious person forshock? If a shock victim becomes unconscious, lay the personon his or her left side. To dothis, move to the victim’s leftside and outstretch his orher left arm. Bend the rightarm, placing the back of theright hand on the left cheek.Roll the victim toward youby pulling on the far knee. Shock FIRST AID AND SAFETY 579EX P R E S SLesson REVIEW 1.List the steps you should take when encountering an emergency medical situation. 2.If you were alone with an accident victim, how would you deter-mine whether to stay and help the victim or go for help? 3.Describe the steps you should follow to help someone in shock. 4. Communicating Effectively Imagine that you found someone who was injured in an accident. A bystander hasgone to seek help. What questions would you ask the victim ifhe or she is responsive? What would you tell emergency med-ical help if he or she is unresponsive?LIFE LIFE SKILL www.scilinks.org/health Topic: First Aid HealthLinks code: HH4063 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Rescue Breathing Naveen saw flames coming from David’s house. Then he saw David stumble from the house and collapse on the lawn. David wasn’t breath-ing. David needed Naveen’s help quickly! What is rescue breathing? is an emergency technique in which a rescuer gives air tosomeone who is not breath-ing. To perform rescuebreathing, a person blowsair into a victim’s lungs togive him or her oxygen. Youmay hear rescue breathingreferred to as artificial respira- tionor “mouth to mouth .” How do I know if a person has stoppedbreathing? In responding to a medical emergency, you will need todetermine if a person hasstopped breathing by check-ing the person’s ABCs (air-way, breathing, and carotidpulse). To determine if a per-son has stopped breathing, see the Express Lesson “Responding to a MedicalEmergency” on p. 576. If the victim is not breathing, keep the airway open and providerescue breathing. How do I help an adult who has stoppedbreathing? Follow these steps to help an adult: Tilt Head Be certain that the head is properly tilted bygently pressing the victim’sforehead back with onehand while raising the chinwith the other. If the person appears to have a spinal injury, do nottilt the head. Instead, lift the jaw by placing yourpalms on the victim’s cheek-bones and lifting the jawwith your fingers. Administer Breath Now that the airway is open, pinch thevictim’s nostrils closed, andseal your mouth around themouth of the victim. Blowgently into the victim’smouth for 2 seconds andwatch for the chest to rise.Unpinch the nostrils, andremove your mouth so thatthe victim can “exhale.”Watch for the chest to fall, listen for air sounds, and feelfor a flow of air from the victim’s mouth and nose. Rescue breathing 580 FIRST AID AND SAFETYIf the person does not have a spinal injury, tilt the head backand raise the chin.Check for pulse and signs of breathing. Administer breath as described above. Performing Rescue Breathing on an Adult Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 581If the chest rose and fell, give another rescue breath. If not, retilt the head and checkthe mouth and nose seals; tryanother rescue breath. If air is still not entering the victim’s lungs, check thehead tilt, check for an airwayobstruction, and administerabdominal thrusts. (See the Express Lesson “Choking” on p. 586.) Then try rescue breathing again. Check for Signs of Breathing After two successful rescue breaths (chest rises and falls),look, listen, and feel for signsof breathing. Also, check thevictim’s pulse. If the victim isstill not breathing, give rescuebreaths once every 5 seconds. How do I help a young child or infant who hasstopped breathing? Rescue breathing for a young child ages 1 to 8 years or for an infant is performed asfor an adult, with theseexceptions: >First, tilt the head of a childless than the head of an adult,and the head of an infant lessthan the head of a child. >Second, in the case of aninfant, seal your moutharound its mouth and nose. >Third, each rescue breathshould last only 1 secondrather than the 2 seconds for an adult. CAUTION: blow slowly and gently, using only enough air to make the chest rise. >Fourth, breathe into the vic-tim once every 3 seconds,rather than the once every 5seconds for adults. How do I know when to stop rescue breathing? After performing rescue breathing for 1 minute,look, listen, and feel forsigns of breathing. If the vic-tim is breathing on his orher own, stop rescue breath-ing. If not, continue rescuebreathing until the victim isbreathing on his or her ownor until medical help arrives. EX P R E S SLesson REVIEW 1.What is rescue breathing? 2.When is rescue breathing used? 3.Compare rescue breathing in adults with rescue breathing in young children and infants. 4. Practicing Wellness In a short paragraph, describe two situations that may cause a person to stop breathing.LIFE LIFE SKILLTo position a child for opening of the airway, tilt the child’s head lessthan you would tilt an adult’s.Blow gently once every three sec-onds. Each rescue breath shouldlast only one second. www.scilinks.org/health Topic: Rescue Breathing HealthLinks code: HH4118Performing Rescue Breathing on a Young Child To position an infant for opening of airway, tilt the infant’s head lessthan you would a child’s. Blow gen-tly once every three seconds foronly one second. You should sealyour mouth around the infant’smouth and nose. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E CPR Nigel’s grandfather grabbed his chest and fell to the floor. Nigel thought that his grandfather was having a heart attack and that his heart may havestopped. Panicked, he didn’t know what to do. What is CPR? CPR stands for cardiopulmonary (heart- lung) resuscitation. is a life-saving technique that combines rescue breathingand chest compressions.During CPR, the rescuer per-forms the job of the heart,artificially pumping blood tothe body. The pumping pro-vides oxygen to the lungs. What is the difference between a heart attackand cardiac arrest? A heart attack is the damage and loss of function of anarea of the heart muscle. Aheart attack occurs when partof the heart muscle does notreceive enough oxygen as aresult of insufficient bloodflow. As the heart muscle dies,it may trigger the heart to stopbeating, a condition knownas cardiac arrest. Other causesof cardiac arrest includestroke (an attack of weaknessor paralysis that occurs whenblood flow to the brain isinterrupted), severe injuries,electrical shock, drug over-dose, chest trauma, drowning,and suffocation.How do I know if some- one is in cardiac arrest? A person in cardiac arrest is unconscious, has no pulse (athrobbing that can be felt incertain arteries as the bloodrushes through), and has nosigns of circulation. There-fore, victims who are alertand responsive are not incardiac arrest. If a victim is unrespon- sive, quickly look for signsof circulation, which includepinkness of the nail bedsand warm skin. If the nailbeds or skin are blue-gray, orif the skin is cool, circula-tion may be poor or mayhave stopped. Next, turn thevictim face up and check thecarotid pulse. The is felt at the carotid arteries, the major arteries ofthe neck. One carotid runsalong each side of the voicebox (Adam’s apple). Takethe carotid pulse by placingyour index and middle fin-gers into the groove of theneck next to the voice box.Do not use your thumb; ithas a pulse of its own. Donot take the pulse on bothsides at the same time. What should I do if a person is in cardiacarrest? A victim can die from cardiac arrest in minutes. Therefore,get medical help immediatelyfor an adult, or after 1 minuteof CPR for a child or infant. Perform CPR only if you are certified in this technique.CPR is a technique that can-not successfully be learnedfrom a book. Any trainingthat you might receive in CPR or any other emergencyprocedure will help you per-form competently and effec-tively in case of an emergencysituation. pulsecarotidCPR 582 FIRST AID AND SAFETYWarning: Do not perform CPR unless you have been trained to do so. Copyright © by Holt, Rinehart and Winston. All rights reserved. How do I give CPR to an adult? Only give CPR to a victim in cardiac arrest and only if youare certified to perform thistechnique. To perform CPRon an adult, do the follow-ing steps: 1. Open and clear the airway. Do this by tilting the headback and lifting the chin.Remove any objects or vomitblocking the throat. 2. Give two slow rescue breaths. Be sure to pinch the nostrils and seal your moutharound the victim’s mouth. Watch for the chest to rise,and then unpinch the nos-trils and remove your mouthto allow the victim to “exhale.” (See the Express Lesson “Res- cue Breathing” on p. 580.) 3. Perform chest compressions. Place the heel of one hand in the center of the victim’schest between the nipples,and place the heel of theother hand on the back ofthe first. Depress the chest 1 1/2 to 2 inches. Give 15chest compressions at a rateof about 5 every 3 seconds.After 15 chest compressions,repeat cycle steps 2 and 3. 4. Check for signs of circula- tion and breathing. After 4 cycles of compressions andbreaths (about 1 minute),check the carotid pulse andother signs of circulationand breathing. If the victim still has no pulse, continue with cycles ofcompression and breathing,rechecking the signs of circu-lation every few minutes.Continue until medical helparrives or until you areunable to continue. FIRST AID AND SAFETY 583Open and clear the airway.1 Give two slow rescue breaths.2 Perform chest compressions.3 Check for signs of circulation and breathing.4 Giving CPR to an Adult Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E CPR continued How do I give CPR to a child or infant? To perform CPR on a child between the ages of 1 and 8years or on an infant youngerthan 1 year, do the following: 1. Tilt head to open and clear the airway.

Do this by tilting the head back and lifting thechin. Clear the throat. 2. Give two slow rescue breaths. For a child, pinch the nostrils and seal yourmouth around the child’smouth. For an infant, sealyour mouth around theinfant’s mouth and nose.Blow slowly and gently.When the chest rises,unpinch the nostrils andremove your mouth. 3. Perform chest compressions. Place the heel of one handin the center of the child’schest between the nipples,and place the other hand onthe child’s forehead. For an infant, place the middle and ring finger ofyour hand nearest theinfant’s feet in the center ofthe infant’s chest, one fingerwidth below the nipple line.Rest the other hand on theinfant’s forehead. Depress the chest 1 inch for a child and 1/2 to 1 inchfor an infant. Give 5 chestcompressions at a rate ofabout 5 every 3 seconds forthe child and at a slightlyfaster rate for the infant. 4. Check for signs of circula- tion and breathing. After 5 chest compressions, give oneslow rescue breath. After 10cycles of compressions andbreaths (about 1 minute),check the carotid pulse inthe child and the brachial(arm) pulse in the infant.The brachial pulse can befelt on the inside of the armbetween the elbow and thearmpit. Check for signs ofbreathing. If the victim stillhas no pulse, continue withcycles of compressions andbreathing, rechecking thepulse every few minutes.Continue until medical helparrives or until you areunable to continue. 584 FIRST AID AND SAFETY Perform chest compressions.3 Check for signs of circulation and breathing.4 Give two slow rescue breaths.2 Tilt head to open airway. Check for breathing.1Giving CPR to a Child or Infant Copyright © by Holt, Rinehart and Winston. All rights reserved. I’ve heard about shocking the heart into beatingagain. How is that done? Shocking the heart into beating again is called defib- rillation. Defibrillators are instruments that deliver anelectrical current to theheart, which can help restorea regular rhythm to theheart. Today, portable defib-rillators, which are designedto be used by minimallytrained people, are availablein many public areas. Thedefibrillator first determineswhether shocking the heartis necessary. If so, it guidesthe rescuer through thedefibrillation procedure. TheAmerican Heart Associationestimates that defibrillatinga victim within minutes aftercardiac arrest could raise hisor her survival rate to 30percent or higher. Currently,the national survival rate of victims of cardiac arrest is 5 percent. FIRST AID AND SAFETY 585EX P R E S SLesson REVIEW 1.What is CPR, and when is it used? 2.Compare CPR for adults with CPR for young children and infants. 3. Using Community Resources Find out where CPR training is offered in your community. LIFE LIFE SKILLHand position Compression depth Cycle Rate When to call for medical help when aloneAdult (>8 years) Place heel of hand in center of chest betweennipples. Place heel ofother hand on back offirst hand. 1 1/2 to 2 inches 2 breaths after every 15 chest compressions About 5 compressions every 3 seconds Immediately with an unresponsive victimChild (1–8 years) Place heel of hand near- est the victim’s feet incenter of chest betweennipples. Rest other handon child’s forehead. 1 to 1 1/2 inches 1 breath after every 5 chest compressions About 5 compressions every 3 seconds After 1 minute of CPR or immediately if you arenot certified for CPRInfant (<1 year) Place middle and ring finger of hand nearest feet in center ofchest one finger widthbelow nipple line. Restother hand on infant’sforehead. 1/2 to 1 inch 1 breath after every 5 chest compressions About 5-6 compressions every 3 seconds After 1 minute of CPR or immediately if you arenot certified for CPR Chest Compressions During CPR www.scilinks.org/health Topic: CPR HealthLinks code: HH4038 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Choking Elisa and Carlos were having lunch when Elisa suddenly stopped talking, looked scared, and put her hands up to her throat. Carlos wasn’t sure what to do. How do I know if some- one is choking? occurs when the windpipe is partly or com- pletely blocked. A chokingperson usually grabs his orher throat, the universal sign of choking. As the vic-tim coughs, wheezes, andgags, his or her face turnsred. A choking person can-not breathe or talk. The face of this person will turn bluish. How do I help a person who is choking? If a person eight years of age or older is choking, con-scious, and can speak, askhim or her to try to cough up the object. After a fewminutes, seek medical help if the person is unsuccessful. If the victim cannot cough, speak, or breathe, orif a victim’s ability to breathedecreases, use abdominalthrusts immediately. (also known as the Heimlich maneuver ) are the act of applying pres-sure to a choking person’sstomach to force an objectout of the throat. To give abdominal thrusts, stand behind the victim, facing his or her back. Posi-tion a fist just above the navel(bellybutton). Grab your fistwith your other hand.Quickly and forcefully pressinward and upward with yourfist (not your arms). With a pregnant or obese person, give chest thrusts likeabdominal thrusts but posi-tion your fist in the center ofthe chest. Continue thrustsuntil the object is dislodgedor until the victim becomesunconscious because of alack of oxygen. For a child between the ages of 1 and 8 years, kneelbehind the child to adminis-ter abdominal thrusts.What should I do if the choking person becomesunconscious? If the victim becomes unconscious, lower him orher to the floor. Send some-one for medical help im-mediately. Open the victim’smouth and look for theobject blocking the airway. Ifyou see it, try to remove itwith your finger. Try toadminister rescue breathing. (See the Express Lesson “Rescue Breathing” on p. 580.) Or if you are certi- fied in CPR, give CPR if needed. (See the Express Lesson “CPR” on p. 582.) Each time you give a breath,first look for an object in thethroat and try to remove itwith your finger. dominal thrustsAb-Choking 586 FIRST AID AND SAFETY Knowing how to administer abdominal thrusts (HeimlichManeuver) could help save a life.The universal sign for choking willlet people know you are chokingwhen you are unable to speak. Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 587How do I help an infant who is choking? If an infant (child under 1 year) suddenly has troublebreathing, suspect choking. Ifthe infant is coughing, allowthe coughing for a few min-utes. If the object is notcoughed up, seek medicalhelp right away. If the infant cannot breathe, is wheezing, or startsto turn blue, you mustadminister chest thrusts andback blows immediately. Turnthe infant face down. Withthe infant’s head lower thanthe rest of the body, use theheel of your hand to give fiveforceful back blows. Turn theinfant face up, reversing theprocedure for turning theinfant face down. Place yourmiddle and ring finger in thecenter of the infant’s chest,one finger width below thenipple line. While holding theinfant’s head lower than hisor her chest, give five chestthrusts. Continue giving backblows then chest thrusts untilthe object becomes dislodgedor until the infant becomesunconscious. If the infant loses con- sciousness, send someone formedical help immediately.Attempt rescue breaths orCPR if there is no pulse (ifyou are certified). (See the Express Lesson “CPR” on p. 582.)What should I do if I am choking and alone? If you are alone, are choking, and cannot cough up theobject blocking your airway,self-administer abdominalthrusts. Place your fist justabove your navel. Cover yourfist with your other hand andthrust upward and inward. Ifa chair, table, or other firmobject is available, lean overthe back of the chair or edgeof the object and swiftlypress your abdomen upwardand inward. EX P R E S SLesson REVIEW 1.Describe the steps you should follow to help a choking adult who becomes unconscious while you are giving him or herabdominal thrusts. 2.What should you do if you are alone and choking? 3. Communicating Effectively Compare the steps you should follow when helping a choking adult with those youshould follow when helping a choking infant. LIFE LIFE SKILLIf you are choking and are alone, lean over a chair and press yourabdomen upward and inward. www.scilinks.org/health Topic: Choking HealthLinks code: HH4032 Try to clear the infant’s airway. Turn the infant face down. Administer back blows. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Wounds and Bleeding Stopping severe bleeding can save a person’s life. Rapid blood loss can lead to shock and even death. What are the different types of wounds? A is a break or tear in the soft tissues of thebody. An open woundbreaks the surface of theskin. Open wounds, such ascuts, result in or bleeding at the body surface. A closed wound does not break the surface ofthe skin. Closed wounds,such as bruises, result in or bleed- ing within the body. How should I care for a minor wound? Minor wounds usually stop bleeding by themselves aftera few minutes. If not, followthese steps: 1.Wash your hands, and puton disposable gloves if youhave them. 2.Place a sterile or clean clothon the wound and applydirect pressure. 3.After the bleeding hasstopped, rinse the woundwith water and use a cleancloth and mild soap to gentlywash the wound. Rinse withwater again, and pat dry.4.If you cannot remove all thedebris, dirt, or grit from awound with gentle washing,seek medical help. You mayapply an antibacterial oint-ment to the wound. 5.Cover the wound with a ster-ile or clean dressing (a pro- tective covering), and secureit with a bandage (something used to hold the dressing inplace). Change the dressingat least once a day, keepingthe wound clean and dry. Ifthe wound becomes tender,swollen, and red, it may beinfected. Seek medical help.How should I care for a person who has a seriouswound with severe bleeding? 1.Seek medical help immedi- ately, if possible. Protectyourself from the blood bywearing disposable gloves orother protection. 2.Lay the victim down, andelevate the feet and legs. Ifthe bleeding is from a headwound, place the victim in areclining (half-seated) posi-tion. 3.Follow the blood to find thewound. Expose the wound ifit is covered with clothing. 4.Place a dressing, such as aclean cloth, handkerchief, ortowel, over the wound, andapply direct pressure withyour hand. 5.If an arm or leg is wounded,raise the wound above thelevel of the heart, and con-tinue to apply direct pressure.internal bleeding,bleeding,externalwound 588 FIRST AID AND SAFETY Make sure that minor wounds are washed until clean and free fromdebris. Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 589 pressure points EX P R E S SLesson REVIEW 1.Describe how to clean a minor wound. 2.Where do you apply pressure to stop bleeding? 3. Practicing Wellness List the steps you would take to stop bleeding in a severe wound. LIFE LIFE SKILL6.If bleeding continues, apply pressure at a pressure point.A pressure point is a place where an artery near theskin’s surface lies over abone. Using your hand topress the artery against thebone reduces blood flow.Use the pressure point thatlies between the heart andthe wound. 7.When the bleeding stops,release the pressure pointand secure the dressing witha bandage. Do not removeany dressings. Place newdressings on top of theblood-soaked ones. Victimswith puncture wounds(those made with blunt orpointed instruments) mayneed a tetanus booster (aninjection that preventstetanus, otherwise known as“lockjaw”).How do I recognize internal bleeding? You may not be able to see internal bleeding unless it isnear the surface of the skin,as in a bruise. If a person hasblood coming from the ears,nose, mouth, or eyes or ifthe victim is coughing up orvomiting blood, he or she islikely to be bleeding inter-nally. Lay the person downand raise the legs 8 to 12inches unless he or she has ahead injury. If the personhas a head injury, put himor her in a reclining posi-tion. Lay a vomiting personon his or her left side. Coverthe victim for warmth, andseek medical help immedi-ately, as this may be a life-threatening condition. Pressure Points To stop severe bleeding, apply pressure to a pressure point between the heart andwound. If there is more than one pressurepoint between the heart and wound, applypressure to the pressure point nearest thewound, if this will not traumatize the woundor the victim. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Heat- and Cold-Related Emergencies People who spend time outside in either extreme heat or extreme cold have special concerns regarding their health. What is hyperthermia? Hyperthermia is a condition in which the body’s internaltemperature is higher thannormal. It occurs in twostages—heat exhaustion andheatstroke. What is heat exhaustion? is a condi- tion in which the bodybecomes heated to a highertemperature than normal.Heat exhaustion can occurwhen people exercise orwork in a hot, humid placewhere body fluids are lostthrough heavy sweating.Heat exhaustion may resultin a mild form of shock. Symptoms The physical symptoms of heat exhaus-tion include cold, moistskin, normal or below-normal body temperature,headache, nausea, andextreme fatigue. Treatment People experi- encing heat exhaustion needto have their bodies cooled.The victim should be moved to a shady place or an air-conditioned room. Cool thevictim by removing his orher clothes and applyingcool, wet towels. A fan willhelp speed up the coolingprocess. Give the victimsomething cool (not cold) todrink, about half of a glass ofcool water every 15 minutes.Observe the victim closelyfor changes in his or her con-dition. Seek medical atten-tion if the person’s conditiondoes not change. A personsuffering from heat exhaus-tion left untreated may sufferheatstroke. What is Heatstroke? is a condition in which the body loses itsability to cool itself by sweat-ing because the victim hasbecome dehydrated. Symptoms The symptoms of heatstroke include hot, dryskin; higher than normalbody temperature; rapidpulse; rapid, shallow breath-ing; and possible loss of con-sciousness. Treatment Because heat- stroke is life-threatening,seek emergency medical helpimmediately. If there are noemergency facilities nearby,move the person to a coolplace, and try to cool thebody rapidly. The victim canbe cooled by immersing himor her in a cool (not cold)bath or by the methods forcooling a heat exhaustionvictim. If the person is vom-iting or unconscious, do notgive him or her water orfood. Seek medical attentionas soon as possible. HeatstrokeHeat exhaustion Keeping oneself hydrated is the best way to prevent heat exhaus-tion and heatstroke. 590 Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 591How can I prevent heat exhaustion and heat-stroke? Heat exhaustion and heat- stroke can best be preventedby drinking 6 to 8 ounces ofwater at least 10 times a daywhen you are active inwarm, humid weather. What is frostbite? is a condition in which body tissues becomefrozen. Ice forms within thetissues and cuts off circula-tion to the area. Frostbite caninvolve the skin and muchdeeper tissues. Symptoms Symptoms of frostbite include a change inthe skin color to white, gray,or blue. The part of the bodythat has been frostbittenmay feel numb. Whenwarmth is restored to thebody part affected, the paincan be severe. Treatment Warmth must be restored to the affected partof the body. Do not rub thearea; rubbing can causedamage to the tissue. Han-dle the areas gently. Removewet or tight clothing. Coverthe affected area with a dry,sterile dressing. If you areunable to get medical atten-tion immediately, warm theaffected area slowly in warm(not hot) water. Bandage thebody part loosely with gauzeand seek medical attentionas soon as possible.What is hypothermia? is a condition in which the internal bodytemperature becomes dan-gerously low because thebody loses heat faster than itcan generate heat. Whenhypothermia occurs, thebrain loses its ability tofunction at cold body tem-peratures, and body systemsshut down. Hypothermia isusually associated withcold weather, but can alsooccur in windy or rainyweather when the bodybecomes cold and can’twarm itself. Symptoms Symptoms of hypothermia include stiffmuscles, shivering, weak-ness, dizziness, cold skin,and slow breathing andheart rate. Treatment To treat a person experiencing hypothermia,first remove any wet clothingand then wrap the person inblankets, towels, or newspa-pers. Offer warm food ordrink. Do not try to heat thebody with hot drinks, hotwater, or electric blankets. Seek medical attention assoon as possible. How can I prevent frost- bite and hypothermia? Frostbite and hypothermia can best be prevented bywearing several layers ofwarm clothing and a warmhat. Also, going inside fre-quently to warm oneself willhelp prevent frostbite andhypothermia.Hypothermia Frostbite EX P R E S SLesson REVIEW 1.How can you tell if someone is suffering from heat exhaustion or heatstroke? 2.What should you do to treat someone with heatstroke? 3. Practicing Wellness Describe what you would do to prevent frostbite and hypothermia if you were going to beout in cold weather for a long period of time.LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Bone, Joint, and Muscle Injuries Bill injured his arm while he and Tim were mountain biking. Tim wasn’t sure whether or not he should splint Bill’s arm. What are fractures? A is a crack or break in a bone. In a closed fracture, the skin is unbroken. In anopen fracture, the skin is bro- ken and bone ends may stickout from the skin. An openfracture has the obvious signsof the wound and visiblebones. Signs and symptomsof a closed fracture includeone or more of the following:pain and tenderness, loss offunction, deformity, unnatu-ral movement, swelling,bruising, and a grating sensa-tion or sound. An X ray usu-ally determines with certaintywhether a bone is fractured. How do you treat a fracture? Check for bleeding and call for medical help. Splint thearea of the fracture. A is a device used to stabilize(hold secure) a body part.Stabilizing a fracture will helpreduce pain, prevent furtherdamage to tissues surround-ing the fracture, and reducebleeding and swelling. Splint the area in the position it was found. Coverany open wounds with aclean, dry dressing, and applythe splint, placing paddingbetween the splint and thebody. Be certain that thesplint is long enough toextend beyond the jointabove and the joint below thefracture. (joints are placeswhere two bones meet.) Things you can use to make a splint include heavycardboard, rolled newspa-pers, or even an adjacentbody part (for example, youcan tape two fingers or twolegs together). Tie the splint or self- splint to the body tightlyenough to prevent movementbut not so tightly as to cut offcirculation. When possible,place splints on both sides ofthe injured part. What is a dislocation? A is an injury inwhich a bone has been forcedout of its normal position ina joint. Usually the joint isswollen and looks deformed.A dislocation is usuallypainful, and the dislocatedjoint may be “locked” inposition. Splint a dislocationas you would a bone fracture,and seek medical help.dislocationsplintfracture 592 FIRST AID AND SAFETYHow to Apply a Splint >Find materials to make a splint. >Hold the splint close to theinjured area. >Place padding between thesplint and the body. >Use extra padding in bodyhollows and around deformities. >Be sure that the splintextends beyond the jointabove and the joint belowthe fracture. >Tie the splint comfortably tothe body. Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 593What are the differences between sprains andstrains? A is an injury in which the ligaments in ajoint are stretched too far ortorn. Ligaments are bands ofconnective tissue that holdbones to bones. A isan injury in which a muscleor tendon has beenstretched too far or torn.Tendons are bands of con-nective tissue that hold muscles to bones. What should you do to treat injuries to bones,joints, and muscles? Use the RICE technique: Rest—don’t use the injured area Ice—use an ice pack or cold pack on the injured area to reduce swelling Compression —wrap the injured area with an elasticbandage to prevent move-ment and swelling Elevation —raise the injured area above heart level whenlying or sitting down How do you know if someone has a neck orspinal injury? A person with spinal injuries may have no obvious signsand symptoms. However,some signs and symptomsof spinal injuries areswelling and bruising at thesite of the injury; numbness,tingling, or a loss of feelingin the arms and legs; inabil-ity to move the arms or legs;pain; difficulty breathing,and shock. If the victim wasinjured in a way that is likelyto have caused a neck orspinal injury, assume thatsuch an injury exists. How do you treat an injury to the neck orspine? An injury to the bones of the neck or spine can damagethe spinal cord and thenerves that branch out fromthe spine. Therefore, do notmove a person that mayhave a neck or spinal injury.Get medical help immedi-ately. If the person must bemoved, steady and supportthe head and neck by hold-ing it in the position inwhich you find it. Keep yourarms steady by placing themon your thighs, or placeheavy objects on either sideof the head. Steady and sup-port the victim’s feet as well. strainsprain EX P R E S SLesson REVIEW 1.Explain the difference between a fracture, a dislocation, a strain, and a sprain. 2.What danger exists in moving a person with a neck or spinalinjury? 3. Practicing Wellness Make a list of things in your home that could be used for splints. Identify objects of varioussizes.LIFE LIFE SKILL How To Care For Fractures and Dislocations >Check for bleeding. Cover open wounds with a clean,dry dressing. >Seek medical help. >Stabilize the fracture or dislocation with a splint. www.scilinks.org/health Topic: Joints and Muscles in the Body HealthLinks code: HH4090 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Burns Recognizing burns and giving proper, immediate burn treatment will reduce tissue damage and relieve pain. What are the different types of burns? are injuries to the skin and other tissues caused by heat, chemicals, electricity,or radiation. The degree of aburn refers to the depth oftissue damage. > are burns that affect only the outer layerof the skin and look pink.First-degree burns includeminor sunburns and burnscaused by a very short expo-sure to intense heat, such asan explosion. First-degreeburns take about 3 to 6 daysto heal, and they heal with-out scarring. > are burns that extend into theinner skin layer and are red,swollen, and blistered. Sec-ond-degree burns are causedby brief exposures to flashesof intense heat, such asspilling hot liquid on your-self or grabbing a curlingiron by the heated end. Sec-ond-degree burns usuallytake less than 3 weeks toheal. Deeper second-degreeburns may take longer toheal. Scarring is possible ifthe wounds are not treatedproperly. > are full- thickness burns. They pene-trate all skin layers as well astissue beneath the skin.These burns appear pearlywhite, tan colored, orcharred. Third-degree burnsare caused by extended expo-sure to steam or fire or toimmersion in scalding water. There is usually no immedi-ate pain because of damagedone to underlying nerves,but there is severe pain later.A skin graft must be performed if healing is tooccur. Some scarring isinevitable, and these burnscan take months to heal. Third-degree burnsSecond-degree burnsFirst-degree burnsBurns 594 FIRST AID AND SAFETY1st degree burn Treatment >Apply cool water until the pain stops. >Apply moisturizing lotion. 2nd degree burn Treatment >Apply cool water until the pain stops. >Apply antibacterial ointment. >If burn is severe, seek medicalattention. 3rd degree burn Treatment >Cover with a clean, dry cloth. >Treat victim for shock (raise feet if safe; cover with blanket) >Seek medical attention immediately. Recognizing and Treating Burns Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 595What should I do if I or someone elsereceives a burn? For first- and second-degree burns, cool the burn im-mediately. Do this byimmersing the burn in coolwater, pouring cool waterover the burn, or coveringthe burn with a clean, cool,wet cloth. Cool the burnuntil it is pain free both inand out of water. You may apply a mois- turizing ointment to a first-degree burn. It may beappropriate to apply anantibiotic cream to a second-degree burn. For third-degree burns, cover the burn with a cleancloth. (Do not cool theburn.) Treat the victim forpossible shock. What are the major sources of burns? There are three major sources of burns. The sourceof the burn will influencehow it should be treated. 1. Thermal burns Thermal burns are caused by contactwith open flames, hotliquids or surfaces, or othersources of high heat. 2. Chemical burns Contact with certain chemicals canburn the skin. 3. Electrical burns Direct exposure to electricity canalso cause burns.Do I treat thermal, chemical, and electricalburns in the same way? No. For thermal burns, remove the victim from the heat source and cool theburn with water. Check forbleeding and for shock, andseek professional medicalattention immediately. Chemical burns caused by liquid chemicals shouldbe flushed with largeamounts of cool water toremove the chemical fromthe body. For chemical burnscaused by dry or powderedchemicals, brush the chemi-cal off of the skin

with aclean cloth. Water may acti-vate a dry chemical and causemore damage than hasalready occurred. For electrical burns involving an appliance, shutoff the current to the house.Be sure the area is safe beforeapproaching. Cool the burnwith cool water. Check thevictim’s breathing, and stopany bleeding. Treat for shockif necessary, and seek profes-sional medical attentionimmediately. EX P R E S SLesson REVIEW 1.Differentiate between the first, second, and third degree burns. 2.What is the first thing you should do to treat first- and second- degree burns? 3. Practicing Wellness List three ways that you can prevent thermal, chemical, and electrical burns in your home. LIFE LIFE SKILLSpecial Considerations for Burns >Obtain medical attention immediately for severe second-degree burns, third-degree burns, chemicalburns, or electrical burns. >Seek medical attention for severesunburns. >Never apply ointment or creamto a severe burn. >Never try to remove clothing thatis stuck to a burn wound. >Always treat burns on the face,hands, and feet as severe, andseek prompt medical attention. www.scilinks.org/health Topic: Burns HealthLinks code: HH4026 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Poisons In 2000, over 2 million poisonings were reported by poison control centers in the United States. Nearly all poisonings happen in the home, and over halfoccur among young children. What are the different types of poisoning? A is a substance that can cause illness or deathwhen taken into the body.Poisons can be swallowed(ingested), inhaled,absorbed through the skinby contact, or can occur as aresult of being bitten orstung by an insect or animal.The table shows these typesof poisonings. What are the signs of poisoning? Suspect poisoning whenever someone becomes ill sud-denly and for no apparentreason. Search for clues,such as chemical odors, left-over food, or suspicious con-tainers. Any poisoningvictim may lose conscious-ness and have troublebreathing, but other signsand symptoms depend onthe poison and how itentered the body. Signs and symptoms of ingested poisons includenausea, vomiting, abdomi-nal cramps, diarrhea, discol-oration of the lips, burns inand around the mouth, andan odor on the breath. Signs and symptoms of inhaled poisons includebreathing difficulty, cough-ing, chest pain, headache,and dizziness. Signs and symptoms of contact poisons include red-dening of the skin, blisters,swelling, and burns. Poisonsinjected through the skinusually irritate the spotwhere they were injected. poison 596 FIRST AID AND SAFETYInhalation Possible Sources >paints >gasoline >solvents >glue >toxic gases Bites and stingsPossible Sources >bites from >stings from spiders, snakes, wasps, etc. bees, hornets, and scorpions Contact Possible Sources >chemicals >plants IngestionPossible Sources >medications >chemicals >household >certain plants products Types of Poisoning and Their Possible Sources Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 597What should I do if someone has been poisoned? Poisoning is a medical emergency. You should call91 1 immediately, then callthe Poison Control Center in your area, or the AmericanAssociation of Poison Con-trol Centers at 1-800-222-1222. Staff there can judgethe seriousness of the poi-soning and provide advice. If you suspect inhaled poisoning, move the victimaway from the poison andinto fresh air immediately.Seek medical help promptlyif the victim is unconscious.Take the container of the sus-pected poison along withyou to the emergency roomto aid the staff in treating thepoisoning. Check the victim’sABCs. (See the Express Lesson “Responding to a Medical Emergency” on p. 576). If you need to give rescue breaths or administer CPR (if you are certified in this tech-nique), be certain that nopoison is on the victim’smouth. (See the Express Lesson “CPR” on p. 582.) If so, hold the victim’s mouthclosed, seal your moutharound the victim’s nose, andprovide rescue breathsthrough the nose. Open thevictim’s mouth to allow himor her to “exhale.” (See the Express Lesson “Rescue Breathing” on p. 580).How can I prevent poi- sonings from occurringin my home? There are many areas of the home where poisonings canoccur. Taking precautionscan help stop poisoningsfrom occurring. In house-holds with small children,install child-safety latches on all cabinets and drawerscontaining harmful products. Kitchen Keep products in original containers and outof reach of children. Thisincludes detergents andother cleaning products. Bathroom Keep all medica- tions in their original, child-proof containers. Discard all old medica-tions. Keep all medications,cosmetics, petrochemical-based lotions, and groomingproducts out of reach ofchildren.Garage Keep all products in their original containerswith their original labels.Lock up all harmful prod-ucts, or at least place themout of reach of children.This includes gasoline andother products for your car,solvents, and pesticides. EX P R E S SLesson REVIEW 1.Find the number of the poison control center in your area. Post this number at home and at school. 2.List the steps you should follow to help an individual whoappears to have been poisoned. 3. Practicing Wellness Make a list of things in your home that may be considered poisons and where they arelocated. What can be done to keep these items from small chil-dren? Check your responses with information you obtain fromthe poison control center.LIFE LIFE SKILL www.scilinks.org/health Topic: Poisons HealthLinks code: HH4114 The best way to avoid an acciden- tal poisoning is to avoid exposureto sources of poison. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Motor Vehicle Safety Brittany read the headlines: “Automobile accidents are the leading cause of death for 15- to 20-year-olds.” She wondered what she could do to drivemore safely. What factor contributes most often to automobileaccidents? The factor that contributes most often to automobileaccidents is driver behavior.Unsafe driving behavior maybe due to a lack of drivingskills or due to inexperiencebehind the wheel. Therefore,it is important for youngdrivers to take a driver educa-tion course and to gain driv-ing experience with a skilleddriver in the car. Addition-ally, driving behaviors thatshould be avoided includespeeding, aggressiveness,impaired driving, and dis-tractions such as cell phonesand adjusting stereos. Speeding The greater the speed of a car, the longer ittakes to stop. Therefore,driving more slowly helps adriver avoid crashes becausehe or she can stop morequickly. Although manyautomobile accidents occurat low speeds, these acci-dents are more likely toresult only in injuries orproperty damage. Accidentsoccurring at 45 miles perhour (mph) or faster aremore likely to result indeath than those occurringunder 45 mph. Aggressiveness Aggressive drivers not only speed butalso tend to tailgate, makefrequent or unsafe lanechanges, disregard traffic sig-nals, fail to signal whenchanging lanes or makingturns, and fail to yield theright of way. These behaviorsare all unsafe driving prac-tices. They increase thechances of having an auto-mobile accident. Impaired Driving Alcohol, other drugs, and sleepinesscan impair driving abilities.The chances of beinginvolved in a car crash andthe seriousness of a crashincrease with alcoholinvolvement. Additionally,drivers who have beendrinking are less likely to useseat belts. Wearing seat beltscuts the risk of dying in carcrashes in half. Young peo-ple are also at risk fordrowsy-driving crashes. Dri-vers aged 29 years andyounger are involved innearly two-thirds of alldrowsy-driving crashes. 598 FIRST AID AND SAFETY Even single car accidents can be very devastating. Copyright © by Holt, Rinehart and Winston. All rights reserved. What does it mean to be a “defensive driver”? A defensive driver practices behaviors that help avoid car crashes. Follow these stepsto be a defensive driver: >Do not drive while underthe influence of alcohol orother drugs that may impairyour reflexes, judgment, andability to stay awake. >Avoid fatigue by gettingplenty of rest. On longdrives, stop at least onceevery three hours and rotatedrivers. >Stay far behind the car infront of you. Leave at least 1car length for every 10 mphyou are traveling. Whenroads are wet, snowy, or icy,leave more room. >Drive within posted speedlimits, and slow down dur-ing poor weather. Use yourdirectional signals whenmaking turns and changinglanes. Obey all traffic l aws.>Continually monitor theroad for pedestrians, cyclists,stopped vehicles, or otherpersons or obstacles. Beaware of the space aroundyou to determine where youcould move if a person orobstacle suddenly appeared. >Be a courteous driver. Ifsomeone else makesunwanted gestures or unsafedriving maneuvers near you,avoid that driver. Do notengage in unsafe drivingpractices for revenge. What else can I do to keep myself and otherssafe when I am driving? 1. Maintain your vehicle prop- erly. Complete maintenance and safety checks as sug- gested by the manufacturer.Be certain that your tires areappropriate for the weatherconditions in your area. 2. Insist that all passengers in your vehicle wear seat belts. Put children under 12 yearsin the back seat, away from air bags. Use child safetyseats according to manufac-turer’s instructions. Personsin the front seat should sitback 10 inches from air bags. 3. Plan your route. Be sure that you are familiar with mapsand directions in order toavoid confusion. For longtrips, tell others what yourroute is and when you planto depart and arrive. 4. Have necessary emergency and first-aid equipment in the car. See the list “Things You Should Carry in Your Car.” 599In all types of weather: >Flashlight >Jumper cables >Warning devices >First-aid Kit >Cell phoneIn addition, in cold and snowyconditions: >Shovel >Ice scraper/snowbrush >Sand, kitty litter,or traction mats >Blanket(s)In addition, forlong trips: >Water >Food >Medications, ifneededThings You Should Carry in Your Car All persons traveling in a vehicle should use proper safety restraints. Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Motor Vehicle Safety continued Are there any unique safety concerns for driving a motorcycle? Yes, a motorcycle provides no protection for its driveror passenger, unlike a car. Amotorcyclist has no vehiclesurrounding him or her, noair bag, and no seat belts. If a motorcycle crashes, the persons on the motorcy-cle are ejected. Therefore,motorcyclists should wear >protective clothing, includinga properly designed helmetand eye protection >a leather or heavy denimjacket >long pants and gloves >sturdy low-heeled boots thatextend above the ankles. Motorcycles are also less visible than cars. Motorcy-clists can increase their visi-bility by wearing brightlycolored clothing and apply-ing reflective material to theirmotorcycles and helmets.Also, motorcyclists shouldhave their vehicle lights onwhen operating the motorcy-cle, even in the daylight. Along with following the defensive driving tips men-tioned previously, motorcy-clists should be particularlywatchful at intersections,where most motorcycle-automobile collisions occur. What can I do to be safer on a motorcycle? Additionally, many of the causes of motorcycle crashes are linked to the dri-ver’s inexperience or inabilityto handle the vehicle prop-erly. Therefore, motorcyclistsshould attend motorcycletraining courses prior toobtaining their motorcyclelicenses. What safety precautions should I take when operating recreationalvehicles? Before using any recreational vehicle, such as a snowmo-bile, mini-bike, personalwatercraft, or all-terrainvehicle, be sure that it is intop-notch mechanical condi-tion. If your vehicle is small,use a safety flag to helpothers see you. Wear protective clothing appropriate for the weatherand the vehicle, and check 600 FIRST AID AND SAFETYMotor Vehicle Safety >Operate the vehicle only if you are skilled and experiencedand have a required license. >Operate the vehicle at reason-able speeds. >Operate the vehicle in a cour-teous and defensive manner,not in an aggressive manner.>Do not operate the vehiclewhile drowsy or under theinfluence of alcohol or otherdrugs. >Wear protective clothing, head-gear, and footgear when oper-ating open vehicles. >Be certain that your vehicle isin proper working condition. Copyright © by Holt, Rinehart and Winston. All rights reserved. weather reports before you leave. When riding any ofthese vehicles, wear a helmetwith goggles or a face shieldto protect yourself from fly-ing debris, such as twigs,stones, and ice chips. Avoidtrailing clothing, such as along scarf, which can getcaught in vehicle parts. What do I need to know about the terrain I willdrive over? If you are unfamiliar with the terrain over which you’ll be riding, discuss itscharacteristics with someonewho has traveled it. If youare riding over frozen lakes,ponds, or streams, be surethat the ice is thick enoughto support your weight andthat of your vehicle. On apersonal watercraft, it isimportant to know wheretree stumps or other obsta-cles may lie hidden in thewater. Al ways ride with another person; never ridealone. As with the operation of other types of vehicles, donot operate recreationalvehicles while under theinfluence of alcohol or drugsor while dr owsy. And before you drive a recreational vehi-cle, receive instruction froman experienced driver. Are there any general rules for driving thatapply to all motor vehicles? Yes, some rules that apply when driving any type ofmotor vehicle are as follows: >Don’t eat while you are driv- ing.You can’t pay full atten- tion to the road when you are trying to handle food. Ifyou have something to drink,make sure you have a propercup holder and a cup thathas a lid. >Don’t wear headphones. It is difficult to hear what is goingon around you in traffic evenif you have the volumeturned down low. >Don’t talk on the phone while you are driving. If you need to talk on the phone, pull over to a safe area on the sideof the road or into a reststop. >Don’t look down, even for a second. If you drop some- thing on the floor, pull over to a safe area on the side ofthe road to pick it up, or dowithout it until you stop.>Don’t try to tend to children in the back seat while you aredriving. Again, pull over to a safe area and tend to the chil- dren. >Don’t drive if your vision is obstructed. If it is raining too hard to be able to see, pull over to a safe area and waitfor the rain to subside. Turnyour hazard lights on if youpull over to the side of theroad so that you will be visi-ble to other drivers. Your windshield may become covered with bugs,pollen, dirt, or other thingsthat can obstruct your vision. Clean your windshield each time you put gas in your car, and carry some window cleaner and papertowels along in your car foremergencies. FIRST AID AND SAFETY 601EX P R E S SLesson REVIEW 1.List and describe three unsafe driver behaviors. 2.List three things you should do to protect yourself while operat- ing a small, open vehicle that you would not have to do whiledriving a car. Explain. 3. Making GREAT Decisions While driving on the highway, a passing motorist makes an angry gesture toward youbecause you are driving 5 mph below the speed limit. Howshould you respond? LIFE LIFE SKILL www.scilinks.org/health Topic: Motor Vehicle Safety HealthLinks code: HH4101 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Bicycle Safety Four out of five collisions involving bicycles and cars are caused by bicyclists who do not follow traffic and safety rules. Read the information below tolearn how to protect yourself while riding your bike. What can I do to be safer on a bicycle? Most bicycle accidents are caused by rider error. Thefollowing guidelines willhelp reduce your risk ofunintentional injury whilebicycling. 1.Ride solo on a bicycledesigned for one person.Don’t give rides to others—the bicycle will be unstable,and the risk of injury willincrease. 2.Ride responsibly. Thisincludes obeying traffic signsand signals. Ride in thesame direction as the traffic,do not weave in and out ofparked cars, and signalbefore you make a turn orstop. Keep both hands onthe handlebars except whensignaling. 3.Remain visible. Install reflec-tors on the back of your bikeand a light on the front fornighttime riding. Wearbright colors in the daytime,and don’t ride in betweenlines of cars where you maynot be seen. 4.Remain watchful. Look outfor pedestrians and turningcars at intersections. Mid-block, watch for cars pullingout of drive ways and park- ing spaces. Stay away fromthe curb to avoid debris inthe gutter. Leave 3 feetbetween you and parkedcars to avoid being hit by anopening car door. And don’twear audio headphones;they impair your ability tohear cars driving near you. 5.Do not ride while under theinfluence of alcohol or otherdrugs. Drugs and alcoholimpair your judgment andreflexes. 6.Keep your bike in properworking condition. Makesure that it is the right sizefor you, and adjust your seatso that your toes touch theground when you arestopped. 7.Finally, ALWAYS wear a bicy-cle helmet when you ride. 602 FIRST AID AND SAFETY OVERFLOW Bicycle-related head injuries account forabout >500 deaths per year >17,000 hospitalizations >153,000 emergency room visits >two-thirds of bicycle-relateddeaths >one-third of nonfatal bicycle injuries Source: Centers for Disease Control. Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 603What should I consider when buying a bicyclesafety helmet? Buy a helmet that is com- fortable and that fits yourhead properly. Follow theguidelines for selecting ahelmet as suggested by theSnell Memorial Foundation,The American Society forTesting and Materials, or theAmerican National Stan-dards Institute. What are bicycle hand signals? Bicycle show pedestrians, automobiledrivers, and others on theroad when you intend tomake a turn or stop. Look atthe three photos aboveshowing bicycle hand sig-nals. The photo on the leftshows the hand signal for aleft turn. The arm isextended from the body at a90° angle, with the palm fac-ing down toward the road. The center photo shows a right turn hand signal. Theleft arm is extended outaway from the body at a 90° angle, and the forearm isbent upward at a 90°angleat the elbow, with the palmfacing forward. In many states, you may also signal a right hand turnby using your outstretchedright arm and hand to pointright, similar to using theleft hand to signal a leftturn. The right photo showsthe signal for a slow downor stop. Extend the left armout at a 90° angle to thebody, and bend the armdown at a 90° angle fromthe elbow with the palmfacing backward. Are bicyclists supposed to follow the same trafficrules as cars? Yes. Obey all traffic l aws, signs, and signals as if you were driving a car. Drive onthe road instead of the side-walk, and al ways yield to pedestrians. Such behaviorassures continuity and pre-dictability for bicyclists andother drivers alike. hand signals EX P R E S SLesson REVIEW 1.List seven behaviors that will reduce your risk of unintentional injury while bicycling. 2.Describe the proper hand signals to use when riding a bike. 3. Making GREAT Decisions After school, your friend asks you to give him a lift home on your bike. Whatwould you tell your friend? Why?LIFE LIFE SKILL www.scilinks.org/health Topic: Bicycle Safety HealthLinks code: HH4017 Left turn hand signal Stop or slow hand signal Right turn hand signal Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Home and Workplace Safety Because most people spend their days at home or work, it is no surprise that many unintentional injuries occur in these places. What are the most common types of unintentional injuries in the home? The most common types of unintentional injuries in thehome are electrocution, suf-focation, and injuries fromfires and falls. is a fatal injury caused byelectricity entering the bodyand destroying vital tissues. is a fatal injury caused by an inability tobreathe when the nose andmouth are blocked or whenthe body becomes oxygen-deficient. What can I do to help prevent unintentionalinjuries in my home? Preventing Injuries from Fires First, prevent fires from occur- ring. Never leave the stoveunattended when cooking.Be sure that portable heatersare 3 feet from anything thatcan burn, and never leavethem on when you go out orgo to bed. Keep matches andlighters away from children. Unplug and repair any elec-trical appliance that has anunusual smell, and do notoverload electrical outlets. Second, plan your escape route from every room in thehouse and where everyonewill meet outside. If yourclothes catch fire when youare escaping, stop, drop, androll. Crawl out of the houseto avoid breathing smokeand poisonous gases. Installsmoke detectors on everyfloor of your home, test themperiodically, and change thebatteries once a year. Preventing Injuries from Falls About 40 percent of fall-related deaths occur in the home. Some of thethings you can do to helpprevent falls includeinstalling handrails on stair-ways; getting rid of clutteron stairs and floors; keepinglamp, extension, telephone,and other cords out of walk-ways; and refinishing slip-pery surfaces. Preventing Suffocation This type of unintentional injuryoccurs most frequently withinfants and small children. Tolower the risk, be sure thatinfant bedding is safe. Use afirm, flat mattress that fits thecrib snugly. Do not use pil-lows and comforters. Addi-tionally, make sure that noplaces exist that a small child could enter, become trapped,and suffocate, such as a lid-ded toy chest, an old refriger-ator, or an unlocked cartrunk. And finally, keep allplastic bags out of the reachof infants and small children.SuffocationElectrocution 604 FIRST AID AND SAFETYClean up clutter on stairs and floors. Unplug all appliancesthat arenear water.Test your firedetectorsregularly. Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 605Preventing Electrocution One aid to preventing elec- trocution is the ground faultcircuit interrupter (GFCI). AGFCI turns off electricitybefore electrocution canoccur. Install and test GFCIoutlets or plug-ins in placeswhere both water and elec-tricity are used, such askitchens and bathrooms.When small electrical appli-ances are not in use, unplugthem. And never reach intowater to get an applianceunless it is unplugged. Ifsmall children are in thehouse, cover unused electricaloutlets with child-safetyplugs. Finally, do not removethe grounding pin (thirdprong) from power tools orother electrical items. Instead,use a three-prong adapter toconnect a three-prong plug toa two-hole outlet. What are the most common types of unintentional injuries in the workplace? The most common types of unintentional injuries in theworkplace are the result of atravel-related accident. Work-ers are also injured from falls,from fires and explosions, byexposure to harmful sub-stances, and by contact withequipment or electricity.What responsibilities do employers have regardingsafety in the workplace? The is a government agency created to prevent work-related injuries, illness,and death. Since the cre-ation of OSHA in 1970,work-related injuries havedropped by 40 percent andwork-related deaths havebeen cut in half. Employersmust obey OSHA regula-tions, properly train work-ers, and provide appropriatesafety gear. What responsibilities do employees have regardingsafety in the workplace? Employees are expected to follow OSHA and employerhealth and safety guidelines.They are expected to wear oruse the protective equipmentgiven them, report hazardousconditions, and report andseek treatment for job-relatedinjuries or illnesses. (OSHA)Health AdministrationOccupational Safety and EX P R E S SLesson REVIEW 1.What safety concerns are particularly relevant in homes with small children? 2. Communicating Effectively Describe what you would do if you saw a co-worker committing serious safety vio-lations at work.LIFE LIFE SKILL Every workplace has its own safety concerns. www.scilinks.org/health Topic: Fires HealthLinks code: HH4062 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Gun Safety Awareness While Ashley was jogging along a path in the woods, she spotted a gun among the leaves under a tree. The gun scared her, and she wasn’t surewhat she should do. What should I do if I find a gun? If you find a gun, do NOT touch it. Also, do not disturbanything in the area sur-rounding it. Along withbeing unsafe to handle, thegun may be evidence in acrime. Other things in thearea may provide evidenceas well. Note landmarks sothat you can lead the policeto the location. Leave thearea and call the police, orhave a responsible adult callthe police.Where can I enroll in a gun safety class? There are many groups throughout the country thatoffer courses in firearmsafety as well as many othercourses. These firearm safetycourses explain how differ-ent types of firearms operateand how to handle and storethem safely. To find firearmsafety classes in your area,contact your local wildlifeconservation office or locallaw enforcement agency.What are safe ways to store guns? Firearms should be stored so that unauthorized persons,such as children, cannot usethem. First, firearms shouldbe stored separately fromtheir ammunition. Second,firearms should be stored ina locked gun case, gun cabi-net, or safe. Unloaded gunsmay be stored with a lockingsafety cable or a a device that helps prevent agun from being fired. How-ever, even with these safetydevices, a firearm can some-times still be fired, so al ways be cautious. How do I increase my safety while walking inthe woods during hunt-ing season? Try to avoid walking in hunting areas during hunt-ing season. If you must,carry a whistle. If you hearshots, blow the whistle untilthe hunter acknowledgesyour presence and leaves thearea. Avoid being mistakenfor game by wearing brightcolors, such as blaze orangeor fluorescent yellow. trigger lock, 606 FIRST AID AND SAFETY Always respect firearms, and take a firearm safety course. Copyright © by Holt, Rinehart and Winston. All rights reserved. FIRST AID AND SAFETY 607In the movies and on TV, I see people fire gunsinto the air. Is that safe? No. A bullet fired upward will come down. It couldseverely wound someone onits descent. This is especiallydangerous in urban areasand in crowds. I inherited a gun from my grandfather. Is it safeto shoot? You cannot know whether a used gun from any source issafe to shoot. The gun couldmisfire, causing severeinjury. Always take a used gun to a

reputable gunsmithwho can determine its safetyand make any repairs thatmay be necessary. Why do I need to wear ear and eye protectionwhen firing a gun? Exposure to gunfire can cause hearing damage orloss if proper ear protectionis not worn. Different typesof hearing protectiondevices can be purchased atsporting goods and drugstores. Additionally, gunscan emit debris and hot gaswhen fired. These substancescan cause eye injury withoutthe protection of propershooting glasses. EX P R E S SLesson REVIEW 1.Describe a safe way to store a gun. 2.List four rules for the safe use of firearms. 3. Using Community Resources Speak with a policeman, a judge, or another official in your community to find out about local gun laws.LIFE LIFE SKILL>Never point a loaded or unloaded gun at anythingyou do not want to shoot. >When handling a gun, alwayspoint the barrel in a safedirection. >Keep the safety on until youare ready to shoot. >Keep firearms and ammuni-tion stored separately underlock and key and away fromchildren. >Know how to use a firearmsafely; enroll in a firearmsafety course.>Wear eye and ear protectionwhen shooting. >Keep a record of firearmserial and model numbersstored in a secure place. >Know and obey all gun lawsfor your state. >Make sure you are aware ofwhat lies in front of andbeyond your target. >Never use alcohol or otherdrugs prior to or whenshooting. Firearm Safety Awareness Mishaps with guns can be avoided by following some basic safety rules, which include the following: www.scilinks.org/health Topic: Gun Safety HealthLinks code: HH4607 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Safety in Weather Disasters Every year about 800 tornadoes occur in the United States. Knowing what to do in tornadoes or other hazardous weather conditions could mean the differ-ence between life and death. What is meant by the terms hazardous weatherand natural disaster? Weather is the state of the atmosphere at a particularplace and time. It includesfactors such as temperature,cloudiness, sunshine, wind,and precipitation. is dangerous weather that causes concernsfor safety. It puts propertyand human life in peril. Haz-ardous weather may result ina natural disaster. A is a natural event that causes widespreadinjury, death, and propertydamage. An example of anatural disaster produced byweather is the severe floodingof a city. An example of anonweather-related naturaldisaster is widespreaddestruction resulting from anearthquake.What should I do to remain safe from lightning? Lightning is caused when there is a separation of dif-ferent charges. For cloud-to-ground lightning, theground has an excess of pos-itive charges, and cloudsusually have negativecharges. Just as a spark canjump from your finger to adoorknob to reunite sepa-rate charges, a lightning boltcan result. A lightning bolt can strike when a storm isapproaching, during astorm, and after a storm haspassed. If you can hear thun-der, you are close enough tobe struck by lightning. To reduce your risk of beingstruck by lightning, avoidbeing >the tallest thing in the area(as in standing in an openfield) or near the tallestthing, such as a lone tree >near metal things, such asmetal fences or buildings >in a small, open structure,such as a baseball dugout ora gazebo >near water Seek shelter inside a large, enclosed structure orinside a car or school bus.When inside, avoid waterand conductive substances.Therefore, do not use thephone, put any part of yourbody in water, or touch metaldoors or window frames dur-ing a storm. disasternaturalweatherHazardous 608 Copyright © by Holt, Rinehart and Winston. All rights reserved. How do I know if a tor- nado is likely to strike? A tornado is a violently rotat- ing funnel-shaped column ofair associated with a thunder-storm. The National WeatherService (NWS) issues a tor- nado watch when tornadoes are possible in an area. TheNWS issues a tornado warning when a tornado has beensighted or indicated byweather radar. However, atornado may developquickly, without warning. Oryou may not hear the warn-ing. Therefore, look for thesetornado signs: dark, greenishsky; large hail; and a loudroar. You may or may not beable to see the tornado. What safety measures should I take if a tor-nado is likely to strike? If a tornado warning has been issued or you see signs of acoming tornado, go immedi-ately to an underground shel-ter, a basement, or a smallinterior room without win-dows on the lowest floor. Stayaway from windows and cor-ners. If you are in a mobilehome, leave it and seek shel-ter in a nonmobile building.If you are in a car, seek shelterin a building if possible. Oth-erwise, get out of the car andlie in a ditch or other lowarea, covering your neck andhead with your arms. What do I need to know aboutsafety and hur-ricanes? A hurricane is a type of storm thatforms over tropical areas ofoceans. However, it canmove inland along thecoastline. In the United States, hur- ricane season runs fromJune through November. Ina hurricane, rain is heavyand winds blow greater than75 miles per hour. A hurricane watch means hurricane conditions arepossible within 36 hours. A hurricane warning means hurricane conditionsare expected within 24 hours. If you live in or visit hur- ricane-prone areas, be sureto prepare an evacuationplan prior to hurricanewatches or warnings. If a hurricane watch or warning has been issued,bring in all outdoor itemsthat could be blown by thewind. If a hurricane warninghas been issued, listen tothe radio or television forevacuation instructions. Close hurricane shutters or board windows from theoutside with plywood. If you do not have to evacuate,stay indoors and away from wind ows. 609 Items Needed During Any Weather Emergency >weather radio or other battery- powered radio or television >battery-powered lights and flash-lights >candles and dry matches >extra batteries >gallon of water per person perday for at least 3 days >first-aid kit >medicines family members mightneed >blankets and/or sleeping bags >canned food and a manual canopener Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E 610 FIRST AID AND SAFETYSafety in Weather Disasters continued What should you do in case of a blizzard? A blizzard is a heavy snow- storm with high winds anddangerous wind chill. If youlive in or visit an area proneto severe winter weather, besure that each family mem-ber has a warm coat and hat,insulated gloves or mittens,and water-resistant boots.Add extra blankets to yourweather emergency items(see list). A winter storm watch means a winter storm is pos-sible in your area. A winter storm warning (or blizzard warning ) means that a winter storm (or blizzard) isheaded for your area. If a winter storm watch is issued, listen to the radio ortelevision for updates, andnote any change in weatherconditions. If a winter stormwarning is issued, stayindoors if possible, wear lay-ers warm of clothing andcover your nose and mouthif you go outside, and avoidtravel by car. If you do travelby car, keep emergencyitems in the trunk, tellsomeone when you are leav-ing and where you aregoing, and carry a cell phoneto call for help should youget stuck. What do you need to know about safety andfloods? Floods occur when water accumulates faster than thesoil can absorb it or riverscan carry it away. If you livein a flood-prone area, addraingear to your weatheremergency items (see list).During periods of heavy orprolonged rain, listen to theradio or television for floodinformation. A flood watch means a flood is possible. A flood warning means flood- ing is already occurring orwill occur soon. If you live in or visit flood-prone areas, be sure to prepare an evacuationplan prior to flood watchesor warnings. Check for flashflooding (sudden flooding)in your area. When a floodwarning is issued, evacuateimmediately. Move to higher ground. If your carstalls in rising water, aban-don it and walk or climb to higher ground. EX P R E S SLesson REVIEW 1.Make a list of at least seven things that you and your family should have ready in case of a weather-related emergency. 2.What should you do if you think that a tornado might beapproaching? 3. Using Community Resources Find out how to get emergency weather information in your community. 4.For which types of weather-related emergencies should youhave a pre-planned evacuation route and destination? 5.In general, what is the difference between a weather-relatedwatch and a warning? 6.What is the best course of action to avoid being struck by lightning?LIFE LIFE SKILL Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E FIRST AID AND SAFETY 611Recreational Safety Recreational activities are meant to be fun, relaxing, and good exercise. However, many people are injured each year during these activities becausethey fail to follow a few safety precautions. What should I know about safety and watersports? Water sports include swim- ming, diving, and watercraftsports. To be safe whileswimming, do the following: >Always swim with a buddy. >Do not swim in unknownwaters or where “no swim-ming” or other swimmingwarning signs are posted.>Do not swim outdoorswhen an electrical storm isapproaching. >Avoid swimming in frigidwater; it could cause yourbody temperature to drop. >Avoid running and horse-play near water. Slips andfalls can cause serious injury. >Never throw anyone into apool headfirst. >Wear a life jacket and swimin shallow water if you arejust learning to swim. >Learn drownproofing, a sur-vival floating technique. >Do not swim while underthe influence of alcohol orother drugs. >Never dive into water thatmay be shallow or have con-cealed hazards, such as treestumps or rocks. Four Stages of Drownproofing Relax while you float with your face in the water, and dangle your arms and legs freely. After a few seconds, slowly raise your arms, separate your legs, raise your head so your mouth is out of the water, and exhale. Slowly press your arms down, bring your legs together, and raise your head well out of the water. Take a bigslow breath. Slowly relax your body to the natural floating position. 4321 1 2 3 4 Copyright © by Holt, Rinehart and Winston. All rights reserved. XPRES SLesson E Recreational Safety continued What should I know about diving into water? There are certain things you need to consider before div-ing into water. To be safewhile diving, dive only intowater you are certain is deepenough and free of obstruc-tions. In pools, the watermust be a minimum of sixfeet deep for a dive. If you swim and dive in natural bodies of water,remember that water levelsmay change. Therefore, walkinto the water first, andcheck water depth. Alsocheck for hidden objects inthe diving area. Do not divein unfamiliar waters. What should I know about operating personalwatercraft? Here are some general safety tips for persons operatingwatercraft, such as motor-boats, personal watercraft,canoes, and kayaks. >Make sure that the watercraftis working properly. >Know how to navigate andoperate your watercraftproperly. >Take an approved watersafety or boating class beforeoperating any watercraft. >Have all safety equipmentrequired by law on boardand in working condition.>Always w ear a life jacket, and be sure that it fits properly. >Tell a friend or relativewhere you will be. >If you are in a motorizedboat, maintain a safe speedat all times. >Be alert for changingweather conditions, andhead to shore if conditionslook threatening. >Always s can the waterway in the front and on the sides ofyou, giving a wide berth toother watercraft. >Obey federal and state boat-ing laws and laws applyingto other types of watercraft. >Never operate a watercraftwhile under the influence ofalcohol or other drugs. How can I keep myself safe when playingsports? There are a few general safety tips to keep in mindto play any sport safely.Always m ake sure to warm up before and cool downafter your activities. Warm-ing up helps your muscles toextend easily, your joints tobe more flexible, and yourheart and breathing rates toincrease gradually. Coolingdown slows your heart rate,relaxes your muscles, andhelps your body recoverfrom the stress of the physi-cal activity. Warming up andcooling down may reducethe likelihood of injuries. 612 FIRST AID AND SAFETY Wearing the proper safety gear when doing any sport is essential. Copyright © by Holt, Rinehart and Winston. All rights reserved. Another general safety rule for sports activities is to wear the proper safety equip-ment. Many sports, such asbiking, football, ice hockey,and skateboarding, requirehelmets. A helmet that fitswell touches your head allaround, is comfortably snugbut not tight, and shouldnot move more than an inchin any direction. Other typesof safety equipment are spe-cific to the sport, such asknee pads and elbow padsfor skateboarding, ridingscooters, and inline skating. What should I know about safety in thewilderness? If you will be hiking or camping in the wilderness, itis essential to have propertraining. Take an approvedwilderness-survival and first-aid course to learn how tohandle serious emergencies.Plan your trip carefully.Know the trail conditionsand weather forecasts beforeyou set out. Bring water withyou but also know the wateravailability and qualitywhere you will be. Leave detailed plans of your trip with a responsibleadult, including when youwill return. Bring a cellphone, emergency numbers,and a weather radio withyou, and carry a whistle anda small mirror for emergencyuse. Always have a map of the area and a compass.Bring the proper campingequipment for the terrain and weather conditions.Wear sturdy hiking bootsand appropriate hikingclothes along with sun-screen, insect repellent, sunglasses, and a hat. Addi-tionally, carry extra food andwater, a flashlight with extrabatteries, a first-aid kit, a firestarter, and matches. Learn to build, maintain, and extinguish campfires sothat they do not pose a forestfire danger. Some tipsinclude the following: >Check that fires are permittedwhere you will be camping. >Clear an area 3 feet wide ofdead leaves and debrisaround the site of the fire.>Do not build fires underoverhanging tree branches. >Find an area shielded fromstrong winds. >Never leave the fire unattended. >Extinguish a campfire withwater or dirt. >Before you leave the area,feel for heat from the fire. Becertain that it is out andcompletely cool. FIRST AID AND SAFETY 613EX P R E S SLesson REVIEW 1.List the basic safety guidelines you should observe while playing sports. 2.What are some things that should cause you to cancel an activ-ity involving a watercraft? 3. Practicing Wellness Choose your favorite recre- ational activity. Discuss things that can affect your safety doingthis activity, such as the weather. 4.John and his family own a cottage at a lake. John likes to run thelength of the pier and dive into the water as soon as they arrive.Why is this unsafe to do? LIFE LIFE SKILL Containing a campfire is important to yoursafety as well as preserving the surroundings www.scilinks.org/health Topic: Water Safety HealthLinks code: HH4143 Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE LIFE SKILLS QUICK REVIEW 614 LIFE SKILLS QUICK REVIEWThe 10 Skills for a Healthy Life Some people have the skills needed for working with computers. Others have the skills for playing music or sports. There are alsoskills that are needed for leading a healthy life. What is a healthy life? A healthy life is a life where the components of health—physical,emotional, social, mental, spiritual andenvironmental—are in balance. Leading ahealthy life requires some skills that areeasily learned. The 10 skills for a healthy lifeare called life skills. are tools forbuilding a healthy life. You will find theselife skills throughout this textbook and beable to use them throughout your life. Thelife skills are identified by this icon:How does each of the 10 life skills help me to lead a healthy life? Assessing Your Health This life skill requires that you evaluate the actions and behaviors that affect your health.Learning the things that have negativeeffects on your health and avoiding them isvery important. Communicating Effectively This life skill is important in dealing with family,friends, teachers, and anyone else youencounter throughout the day.Communicating effectively will help you toget your point across and avoidmisunderstandings with others. You willalso learn listening skills. Being able tolisten to someone is as important as beingable to express yourself. Practicing Wellness This life skill will help you practice healthybehaviors, maintain good health, and avoidsickness. You can do this by doing suchthings as getting enough sleep, choosingnutritious foods, and avoiding riskybehaviors. Coping Coping means dealing with troubles or problems in an effectiveway. Things don’t al ways go the way that we would like them to. Accepting this fact isimportant to your overall health. This lifeskill will help you deal with emotions suchas anger and depression.LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL LIFE LIFE SKILLLife skills Practicing wellnessPracticingwellnessAssessing your healthAssessing your health UsingrefusalskillsUsingrefusalskillsSettinggoalsSettinggoals CopingCopingCommunicatingeffectivelyCommunicatingeffectively UsingcommunityresourcesUsingcommunityresources EvaluatingmediamessagesEvaluatingmediamessagesBeing a wiseconsumerBeing a wiseconsumerMakingGREATdecisionsMakingGREATdecisions LIFE LIFE SKILLS Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE SKILLS QUICK REVIEW 615Being a Wise Consumer A consumer is a person who buys products or services, such as food, clothing, or CDs. Aconsumer also does things like get his orher car repaired. Being a wise consumer willallow you to buy health care products andservices without paying too much money. Itwill help you decide what products areappropriate for you. It will also help you todetermine if the claims an advertiser makesare true or false. Evaluating Media Messages The media is all public forms ofcommunication, such as TV, radio, movies,newspaper, and advertising. Many times you are influenced by messages the media sends. This life skill willgive you the tools to analyze mediamessages so you can make better judgmentsabout the accuracy and validity of themessage. Using Community Resources A resource is something that can be used totake care of a need. Most communities offera number of services that can help youmaintain good health. This life skill willshow you where to find these services anddescribe how they can keep you healthy. Making GREAT Decisions Making decisions is something that you doevery day. Making the right decisions canaffect every aspect of your life. If you makethe wrong decisions, the consequences canbe tough. Use the Making GREAT Decisionsmodel to help you make decisions and theSTOP process to correct your mistakes. Using Refusal Skills A refusal skill is a way you can decline to dosomething you don’t want to do. Learninghow to say no to others will help you makebetter decisions. Base your decisions onyour values and on what is best for you—not necessarily what is more fun for you orfor others. Setting Goals A goal is something that you want to do or hope toachieve in the future. Setting goals helpsyou stay focused on the future. This life skillwill show you how to set your long- andshort-term goals.LIFE LIFE SKILLLIFE LIFE SKILL LIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILLLIFE LIFE SKILL For more information about the ten skills for a healthy life, see Chapter 2. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE LIFE SKILLS QUICK REVIEW 616 LIFE SKILLS QUICK REVIEWMaking GREAT Decisions Should I study for my exam or hang out with friends? Should I get a tattoo? Am I willing to smoke if it makes me look cool? Givethought to the problem. Review your choices. Evaluate the consequences of each choice. Assess and choose the best choice. Think it over afterward. MAKING DECISIONSDECISIONSGREATMAKING What’s so GREAT about decision making? Every day teens are faced with some very difficult choices. Some of the decisions youmake can affect you for the rest of your life.The Making GREAT Decisions model is atool that you can use to help make thesedifficult decisions a little easier. Taking thetime to consider your goals and values canassist you in making the decisions that areright for you. So how does using this model work in the real world? Imagine you were trying to decide whether you should study for your exam or go to themovies. Look at the table below to see howthe Making GREAT Decisions model canguide you through this decision-makingprocess. GIVE thought to the problem. Stop to think about the situation before making anyhasty decisions. REVIEW your choices. In this case, your choices are to stay home and study or go tothe movies. EVALUATE the consequences of each choice. Staying at home and studying will help you to get a good grade. If you go tothe movies and then do poorly on the exam,you may not be allowed to participate insports and other extracurricular activities. ASSESS and choose the best choice. Staying home to study will help your gradeand keep you out of trouble. If you do poorlyon the exam, you’ll probably lose privileges THINK it over afterward. If you decided to study, think about how not only did youimprove your chances for a good grade, youcan go see the movie later. If you decided togo to the movie, think about howimportant your grades are and how yourdecision will affect you down the road. Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE SKILLS QUICK REVIEW 617If I use the Making GREAT Decisions model, will I always make the right decision? Even if you use the model when you are trying to make a decision, it is still possible(and completely normal!) that you willmake a wrong decision. Sometimes the results of making the wrong decision can be embarrassment orhumiliation. Don’t worry! The feeling ofembarrassment will pass, and friends won’thold your mistake against you or think lessof you. Sometimes, however, making the wrong decision can have serious consequences.When this happens, you can use the STOP, THINK, GO process. This process has three simple steps and can be very helpful inturning around the damage caused by awrong decision. The steps of the process are as follows: 1. STOP and admit that you made a wrong decision. Take responsibility for whatyou’ve done. Stop whatever it was youwere doing that was undesirable. Thiswill help minimize the damage from thewrong decision and will allow you tostart taking control of the situationagain. 2. THINK about with whom you can talk about the problem. Usually a parent,guardian, or other responsible adult canhelp you. Tell this trusted adult aboutyour decision and what its consequencesare. Discuss with them ways to co rrect the situation, and what the possibleoutcomes are.3. GO and do your best to correct the situation. Sometimes just walking awayis the best way to deal with a situation.It may prevent the problem from gettingworse. Sometimes the only way to correct a situation is to “tell on” someone. Manytimes the decisions that we make areinfluenced by the actions of otherpeople. Other times, it may be that youneed to apologize to someone that youhave hurt. This can be difficult, but bothyou and the other person will feel betterafterward. For more information about making GREAT decisions, see Chapter 2. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE LIFE SKILLS QUICK REVIEW 618 LIFE SKILLS QUICK REVIEWUsing Refusal Skills Have you ever heard any of the pressure lines below? Every now and then, you may feel pressured to do something that you don’twant to do or that goes against your beliefs and values. Whenyou need to stand up to someone, it helps if you already knowwhat you’re going to say. How do I stand up to someone who is pressuring me? are strategies a person can use to avoid doing something they do not want to do. Sometimes, certain strategies are moreappropriate for certain situations. Some-times, you might have to refuse in a coupleof different ways for people to accept your answer. Why do I need to practice using refusal skills? Most people are a little uncomfortable saying no to their friends. Practicing refusalskills can help you know what to do if youare ever in a “real life” refusal situation.Practicing these skills in low-pressuresituations increases the odds that you’ll havethe confidence to hold your ground when itreally matters to you. How can I resist pressure? >Say no, and mean it. Keep saying no. >Make up an excuse to leave the situation. >Arrange a code beforehand with a parentor someone you trust that indicates thatyou need to be picked up to get out of abad situation. >Make a joke out of the situation, andchange the subject. >Practice responses like those in the table.Refusal skills Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE SKILLS QUICK REVIEW 619What do I do if someone is pressuring me and won’t stop? The first thing you should do is seek help and advice from a trusted adult. See if thetwo of you can figure out why someone isso concerned with pressuring you. If theperson pressuring you has been a friend inthe past, you may need to stop hanging outwith him or her. If the person is not afriend, you may need to take steps to tryand avoid seeing this person. How

do I say no and still sound cool? Here are 10 ways to insist that you do things your way: 1.Blame someone else. My parents would ground me for life. Besides, it’s just notworth it. 2.Give a reason. No, my dad said he’ll pay me if I stay home and help him. 3.Ignore the request or the pressure. Pretend you don’t hear them and avoidtalking about the issue.4.Leave the situation. Sorry, guys, but I need to get going. 5.Say no thanks. No, thanks. I’m just not interested. 6.Say no, and mean it. No, I mean it! How many times do I have to say no? 7.Keep saying no. How many times do I have to tell you no? Forget it! 8.Make a joke out of it. Do you guys HAVE to do everything everyone else does? 9.Make an excuse. I can’t tonight. I have football practice. 10.Suggest something else to do. Why don’t we go get some pizza or something elseinstead? 11.Change the subject. So, anyway, what was Angela talking about today at lunch? 12.Team up with someone. Sarah and Marcia don’t want to go either, so we’regoing to do something else. Do youwant to come with us? For more information about practic- ing refusal skills, see Chapter 2. linkTOPICTOPICDo you always do what your parents tell you to? Come on, please? For me? No one has to know.You’re just chicken.Don’t you want to know what it’s like? If you loved me, you’d let me.Do you HAVE to do everything that everyone else does? No! I’m thinking about ME because obviously YOU’RE not! I’ll know, and that’s one too many people for me. It takes a lot more guts to hold out than to give in. Sorry guys, but I need to get going. If you loved me, you wouldn’t ask.If you hear this . . . You can say this . . . Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE LIFE SKILLS QUICK REVIEW 620 LIFE SKILLS QUICK REVIEW10 Tips for Building Self-Esteem How many times has there been something that you really wanted to do? Maybe you’ve wanted to try out for the trackteam or the band, but you just didn’t feel like you had what ittakes to make it. Feeling confident about yourself and your abil-ities is one important part of self-esteem. What is self-esteem? A very important part of your personality is your self-esteem. Self-esteem is a measure ofhow much you value, respect, and feelconfident about yourself. The better you feelabout yourself, the more self-confident youwill feel and appear to others. Where does self-esteem come from? Self-esteem, as the name implies, comesfrom within a person. Others may help liftyour self-esteem by giving compliments orby cheering you on, but you are the onlyone that will feel self-esteem’s influence.You gain self-esteem by trying new things orby trying to improve the things that youalready do.What are the benefits of high self-esteem? People who have high self-esteem respect themselves and take better care ofthemselves. They are more likely to stickwith their goals and try new things. Peoplewho have high self-esteem are also morelikely to be valuable members of theirfamily, school, and community. How can I improve my self-esteem? There are many ways that you can build your self-esteem. 1.Make a list of your strengths and weaknesses. Identify the things you are successful at and try to find time to do those things. 2.Develop a support system of friends. Choose friends who will support youand encourage you to do your best.Avoid people who put you down, even if they are joking. 3.Practice positive self-talk. Substitute positive thoughts like “I’ll figure thisout” for negative thoughts like “I’ll neverfigure out how to do this.” 4.Practice good health habits. A healthy diet, regular exercise, and goodgrooming habits will help you feel goodabout yourself. If you look bad, you’llprobably feel bad. Copyright © by Holt, Rinehart and Winston. All rights reserved. LIFE SKILLS QUICK REVIEW 6215.Avoid doing things just to “go along with the crowd.” Sometimes people with low self-esteem do things they normally wouldn’t do, just to fit in. In the shortrun, this may work, but in the long run,you’ll feel better about yourself whenyou do the things that support yourvalues. 6.Give credit where credit is due. Reward yourself for doing something well. Treatyourself to a movie, a meal at arestaurant, or a new CD. You workedhard and deserve a treat. 7.Set short-term goals that will strengthen your weaknesses. Map out a plan to help you reach your goals. Even small improvements are better than not tryingat all. 8.Don’t be afraid to try something new. Sign up for the class you have al ways wanted to take. Take a swimming ordance lesson. You’ll never know if you’regood at something until you try it.9.Nothing puts things in perspective better than volunteering for those in need does. Spend time working at a soup kitchen, deliver meals to those who can’t leavetheir homes, or spend time visitingpeople at a nursing home. Yourproblems will probably seem lesssignificant than those of the people youhelp. Helping others can also give you asense of purpose. 10.If you experience defeat, don’t dwell on it.Try to learn something positive from the experience and move on. Don’t make the mistake of running it over andover again in your mind. Remember, “Ifat first you don’t succeed, try, try again!” For more information about self-esteem, see Chapter 3. linkTOPICTOPIC Copyright © by Holt, Rinehart and Winston. All rights reserved. Calories(kcal) Calories from fat(kcal) % Calories from fat(%) Total fat(g) Saturated fat(g) Cholesterol(mg) Total carbohydrate(g) Dietary fiber(g) Protein(g) Calcium(mg) Iron(mg) Vitamin C(mg) Vitamin A(µg RE)Food and serving size BEVERAGES REFERENCE REFERENCE GuideGuide 622 REFERENCE HANDBOOKCalorie and Nutrient Content in Selected Foods This table is organized into 14 categories: beverages; breads and grains; cereals; condiments; crackers; dairy and eggs; desserts; fast foods; fruits; meat, fish, poultry, and eggs; mixed dishes; nuts and seeds; snack foods; and vegetables. Carbonated beverage (soda) 12 fl oz 184 0 0 0.0 0.0 0 38 0.0 0.0 13 0.0 0 0 24 fl oz with ice 221 0 0 0.0 0.0 0 57 0.0 0.0 16 0.5 0 0 (approximate values) 32 fl oz with ice 295 0 0 0.0 0.0 0 76 0.0 0.0 25 0.6 0 0 (approximate values) diet, 12 fl oz 0 0 0 0.0 0.0 0 0 0.0 0.0 0 0.0 0 0 Fruit punch, 1 cup 1 17 0 0 0.0 0.0 0 30 0.3 0.0 20 0.5 4 0 Milk chocolate, 2%, 1 cup 179 45 25 5.0 3.1 17 26 1.2 8.0 285 0.6 2 143 lowfat, 1%, 1 cup 102 27 26 3.0 1.6 10 12 0.0 8.0 300 0.1 2 144 reduced fat, 2%, 1 cup 122 45 37 5.0 2.9 18 12 0.0 8.1 298 0.1 2 139 skim (fat free), 1 cup 91 0 0 0.0 0.0 4 12 0.0 8.0 301 0.1 2 149 whole, 1 cup 149 72 48 8.0 5.1 33 1 1 0.0 8.0 290 0.1 2 76 Milkshake, 12 fl oz 414 90 22 10.0 6.0 25 60 1.5 10.6 459 0.4 0 72 Orange Juice, 1 cup 105 0 0 0.0 0.0 0 25 0.5 2.0 20 1.1 147 43 Sports drink, 24 fl oz 150 0 0 0.0 0.0 0 42 0.0 0.0 0 0.0 0 0 Tea, unsweetened, 1 cup 2 0 0 0.0 0.0 0 1 0.0 0.0 8 0.0 0 0 Water, bottled, 12 fl oz 0 0 0 0.0 0.0 0 0 0.0 0.0 5 0.0 0 0 Bagel, plain, 4 in. diameter 314 16 5 1.8 0.3 0 51 0.1 10.0 50 2.4 0 0 Biscuit, 1 medium 101 45 45 5.0 1.2 1 13 0.4 2.0 67 0.8 7 0 Bread white, 1 slice 76 9 12 1.0 0.4 1 14 0.6 2.0 24 0.8 0 0 whole wheat, 1 slice 86 9 10 1.0 0.3 0 16 2.4 3.0 25 1.2 0 0 Doughnut cake type, with chocolate 21 1 1 17 55 13.0 3.5 26 21 0.9 2.0 22 0.7 0 10 frosting cake type, plain 204 99 49 1 1.0 1.8 18 25 0.8 2.0 15 0.6 0 16 yeast, with glaze 242 126 52 14.0 3.5 12 27 0.7 4.0 20 1.6 0 16 French Toast, plain, 1 slice 149 63 42 7.0 1.8 75 16 0.1 5.0 65 1.1 0 86 Fried rice, no meat, 1⁄2cup 132 54 41 6.0 0.9 21 17 0.7 3.0 15 0.9 2 10 Muffin, blueberry 155 36 23 4.0 0.8 17 27 1.5 3.1 32 0.9 1 5Pancake, 4 in. diameter 86 0 0 0.0 0.0 4 19 0.7 2.4 26 0.7 0 4 Pasta, noodles, 1⁄2cup 99 0 0 0.0 0.1 0 20 1.2 3.0 5 1.0 0 0 Pita bread, wheat, 165 9 5 1.0 0.1 0 33 1.3 5.0 52 1.6 0 0 1 medium Rice brown, 1⁄2cup 1 10 9 8 1.0 0.2 0 23 1.8 2.0 1 1 0.7 0 0 white, enriched, 1⁄2cup 133 0 0 0.0 0.1 0 29 0.3 2.0 3 1.5 0 0BREADS AND GRAINS Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE Calories(kcal) Calories from fat(kcal) % Calories from fat(%) Total fat(g) Saturated fat(g) Cholesterol(mg) Total carbohydrate(g) Dietary fiber(g) Protein(g) Calcium(mg) Iron(mg) Vitamin C(mg) Vitamin A(µg RE)Food and serving size Roll dinner 141 31 22 3.4 0.8 0 24 1.0 3.0 1 1.0 0 0 hamburger/hot dog 123 20 16 2.2 0.5 0 22 1.3 3.0 56 1.3 0 0 Tortilla corn, plain, 6 in. diameter 58 6 10 0.7 0.1 0 12 0.0 2.0 52 0.4 0 0 flour, 8 in. diameter 104 20 20 2.3 0.6 0 18 1.7 3.0 71 1.9 0 0 Waffle, from frozen, plain 88 25 28 2.7 0.5 1 1 14 1.2 2.0 38 0.0 0 150 Cereal corn flakes, not sweetened, 91 0 0 0.0 0.0 0 22 0.7 2.0 1 7.8 12 188 1cup cornflakes, presweetened, 146 0 0 0.0 0.1 0 34 0.8 1.0 1 5.5 18 274 1 cup Oatmeal flavored instant, 1⁄2cup 125 9 7 1.0 0.3 0 26 2.5 3.0 104 3.9 0 305 plain,1⁄2cup 72 9 13 1.0 0.2 0 13 2.0 3.0 0 0.8 0 2 Butter, 1 tsp 36 33 93 3.7 2.4 10 0 0.0 0.0 1 0.0 0 33 Honey, 1 Tbsp 64 0 0 0.0 0.0 0 18 0.0 0.0 1 0.1 0 0 Ketchup, 1 Tbsp 16 0 3 0.1 0.0 0 4 0.2 0.2 3 0.1 2 15 Margarine, stick or tub, 1 tsp 34 34 101 3.8 0.7 0 0 0.0 0.0 1 0.0 0 50 Mayonnaise, regular, 1 Tbsp 57 44 77 4.9 0.7 4 4 0.0 0.1 2 0.0 0 32 Salad dressing, Italian, 1 Tbsp 69 64 93 7.1 1.0 10 1 0.0 0.1 1 0.0 0 1 1 Salsa, 1 Tbsp 4 0 8 0.0 0.0 0 1 0.3 0.2 5 0.2 2 22 Spaghetti sauce, 1⁄2cup 136 36 26 4.0 1.5 0 21 4.0 2.2 35 1.4 13 96 Sugar, white, 1 tsp 16 0 0 0.0 0.0 0 4 0.0 0.0 0 0.0 0 0 Syrup chocolate, 2 Tbsp 50 1 3 0.1 0.1 0 12 0.7 0.6 4 0.0 0 0 pancake, 1 Tbsp 25 0 0 0.0 0.0 0 7 0.0 0.0 0 0.0 0 0 Crackers cheese with peanut butter, 6 210 90 43 10.0 2.5 0 23 1.0 5.0 80 0.9 0 0 graham, 4 crackers 59 2 3 0.2 0.0 1 1 1 0.5 1.0 1 1 0.6 0 0 soda crackers, 5 squares 70 18 26 2.0 0.0 0 12 0.6 1.0 18 0.7 0 4 Matzo, 1 matzo cracker 1 1 1 1 1 0.2 0.0 0 22 0.8 3.5 1 1 0.8 0 0 Cheese American, prepackaged, 70 45 64 5.0 2.0 15 2 0.0 4.0 100 0.0 0 46 1 slice cheddar, 1 oz 1 14 81 71 9.0 6.0 30 0 0.0 7.1 204 0.2 0 78 cottage, lowfat, 1⁄2cup 102 12 12 1.4 0.9 2 4 0.0 7.0 78 0.2 0 82 cream, 1 Tbsp 51 45 89 5.0 3.2 32 0 0.0 1.1 12 0.2 0 55 cream, fat free, 1 Tbsp 13 1 8 0.1 0.0 0 1 0.0 2.0 26 0.0 0 130 string, 1 stick 72 45 63 5.0 2.9 16 1 0.0 7.0 183 0.1 0 50 Egg, boiled, 1 large 78 48 61 5.3 1.0 212 0 0.0 6.0 25 0.6 0 84 Egg, scrambled, plain, 1⁄4cup 74 45 61 5.0 1.0 212 0 0.0 6.0 25 0.6 0 84 Frozen yogurt cone, chocolate, 1 single 157 63 40 7.0 3.9 1 22 1.1 4.0 1 15 0.6 1 42 nonfat, chocolate, 1⁄2cup 104 9 9 1.0 0.5 1 21 1.5 5.0 163 0.9 1 2 Whipped cream, 2 Tbsp 15 14 90 1.5 1.0 4 1 0.0 0.0 0 0.0 0 0 Yogurt, lowfat, fruit flavored, 231 27 12 3.0 2.0 12 47 0.0 12.0 372 0.2 1 27 1 cupCEREALS CONDIMENTS CRACKERS DAIRY AND EGGS REFERENCE HANDBOOK 623 Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide 624 REFERENCE HANDBOOKCalories(kcal) Calories from fat(kcal) % Calories from fat(%) Total fat(g) Saturated fat(g) Cholesterol(mg) Total carbohydrate(g) Dietary fiber(g) Protein(g) Calcium(mg) Iron(mg) Vitamin C(mg) Vitamin A(µg RE)Food and serving size DESSERTS Brownie, 1 square 227 90 40 10.0 2.0 14 30 1.4 1.5 1 1 0.9 0 6 Cake, chocolate with 41 1 153 37 17.0 5.0 45 61 3.1 4.6 48 2.5 0 25 chocolate frosting, 1 piece Candy, candy-coated 34 9 26 1.0 0.9 0 5 0.2 0.0 1 0.1 0 4 chocolate, 10 pieces with peanuts, 10 pieces 103 45 44 5.0 2.1 1 12 0.7 2.0 20 0.2 0 5 Candy, chocolate bar, 1.3 oz 226 126 56 14.0 8.1 10 26 1.5 3.0 84 0.6 0 24 Cheesecake, 1 piece 660 414 63 46.0 28.0 220 52 0.2 1 1.0 106 2.0 1 520 Cinnamon roll with nuts 217 63 29 7.0 1.4 8 34 1.1 3.2 36 1.6 0 60 and raisins, 2 oz Cookies chocolate chip, 1 cookie 59 23 38 2.5 0.8 3 8 0.2 0.6 3 0.3 0 7 oatmeal, 1 cookie 1 13 27 24 3.0 0.8 9 20 0.3 1.0 10 1.3 0 1 sugar, 1 cookie 72 27 38 3.0 0.8 7 10 0.1 0.8 3 0.3 0 4 Fruit juice bar, 1 bar 63 0 0 0.0 0.0 0 16 0.0 0.9 4 0.1 7 22 Gelatin dessert, flavored,1⁄2cup 80 0 0 0.0 0.0 0 19 0.0 2.0 0 0.0 0 0 Ice cream bar, vanilla with 171 99 58 1 1.0 6.4 1 17 0.3 2.0 136 0.4 25 0 chocolate coating, 1 bar Ice cream cone one scoop 178 72 40 8.0 4.9 32 22 0.1 3.0 102 0.2 0 84 regular ice cream, 1 single Ice cream, chocolate, 1⁄2cup 143 40 28 4.5 22.4 7 19 0.8 2.5 72 0.6 0 275 Ice slushy, 1 cup 151 0 0 0.0 0.0 0 63 0.0 1.0 4 0.3 2 0 Pie, apple, double crust, 41 1 162 39 18.0 4.0 19 58 0.0 3.7 1 1 1.7 3 9 1 piece Pudding, chocolate, 1⁄2cup 160 27 17 3.0 1.8 5 27 1.2 3.2 153 0.6 2 43 Burrito, beef and bean 520 207 40 23.0 10.0 150 55 1 1.0 24.0 150 2.7 5 600 Cheeseburger 1⁄4lb, on bun, with lettuce, tomato, mus- 520 261 50 29.0 12.6 97 37 1.7 28.0 127 4.3 2 33 tard, ketchup, and pickles regular size mustard, 319 1 17 37 13.0 5.6 42 36 1.9 15.0 144 2.7 2 64 ketchup, onions, pickles Chicken nuggets, 4 198 108 55 12.0 2.5 42 10 0.0 12.0 9 0.6 1 0 Chicken sandwich breaded chicken breast on 492 261 53 29.0 5.5 52 42 1.7 17.0 129 2.5 1 29 bun, with lettuce, tomato, and mayonnaise grilled chicken breast, on 361 63 17 7.0 2.0 54 44 2.6 27.0 132 2.5 4 19 bun, with lettuce, tomato, and mayonnaise French Fries 1 small order 199 90 45 10.0 2.0 0 26 2.0 2.0 10 0.4 10 1 1 large order 430 198 46 22.0 5.0 0 56 5.0 5.0 23 0.9 20 2 1 supersize order 545 234 43 26.0 6.0 0 67 6.0 6.0 27 1.0 25 2 Hamburger, regular size, on bun, with mustard, 266 81 30 9.0 3.2 28 36 1.9 12.0 126 2.7 2 23 ketchup, and pickles double meat, double bun, 510 234 46 26.0 9.3 76 46 3.3 25.0 202 4.3 3 66 cheese, sauce, lettuce, andtomatoesCalorie and Nutrient Content in Selected Foods (continued) FAST FOODS Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 625Calories(kcal) Calories from fat(kcal) % Calories from fat(%) Total fat(g) Saturated fat(g) Cholesterol(mg) Total carbohydrate(g) Dietary fiber(g) Protein(g) Calcium(mg) Iron(mg) Vitamin C(mg) Vitamin A(µg RE)Food and serving size Sub sandwich Italian, 6 in. long 467 216 46 24.0 9.0 57 38 3.0 20.0 40 4.0 15 169 vegetarian, 6 in. long 222 27 12 3.0 0.0 0 38 3.0 9.0 25 3.0 15 120 Taco crispy, with ground beef, 180 90 50 10.0 4.0 25 12 3.0 9.0 80 1.1 0 100 cheese, lettuce, and tomato soft, with beans and rice 218 27 12 3.0 0.0 0 19 3.0 7.0 60 0.8 1 60 and no cheese soft, with chicken, cheese, 212 63 30 7.0 2.6 37 22 2.1 15.0 85 0.8 1 64 lettuce, and tomato Apple, raw, with skin, 81 1 1 0.1 0.1 0 21 3.5 0.2 9 0.2 8 7 1 medium Applesauce, unsweetened, 52 0 1 0.0 0.0 0 14 1.5 0.2 5 0.4 2 14 1⁄2cup Banana, fresh, 1 medium 1 14 9 8 1.0 0.2 0 27 2.7 1.0 7 0.4 10 9 Blueberries, 1⁄2cup 41 0 1 0.0 0.0 0 10 2.0 0.5 4 0.1 10 7 Cantaloupe, 1⁄4medium 44 1 2 0.1 0.0 0 10 1.0 1.1 14 0.3 53 403 Cherries, sweet, fresh, 1 cup 84 2 3 0.3 0.0 1 19 2.7 1.4 18 0.5 8 25 Grapes, 1⁄2cup 62 1 2 0.1 0.0 0 16 0.9 0.6 13 0.3 4 9 Mango, 1⁄2medium 68 1 1 0.1 0.0 0 18 1.9 0.5 1 0.0 23 321 Olive, ripe, 1 large 5 9 178 1.0 0.1 0 1 0.2 0.0 4 0.1 0 1 Orange, fresh, 1 large 85 0 0 0.0 0.0 0 21 4.3 1.7 52 0.1 70 28 Peach, fresh, 1 medium 37 0 0 0.0 0.0 0 9 1.7 1.0 4 0.1 6 42 Pineapple chunks, canned 84 0 0 0.0 0.0 0 22 1.1 0.6 20 0.4 13 18 in juice, 1⁄2cup Plum, fresh, 1 36 0 1 0.0 0.0 0 9 1.0 0.5 3 0.1 6 21 Raisins, seedless, dry, 1 cup 495 2 0 0.2 0.0 1 131 6.6 5.3 81 3.4 6 1 Strawberries, fresh, 1 cup 46 0 1 0.0 0.0 1 1 1 3.5 0.9 21 0.6 86 41 Watermelon, 1⁄2cup 26 0 0 0.0 0.0 0 6 0.4 0.0 6 0.1 8 30 Bacon, 3 slices 109 81 74 9.0 3.3 16 0 0.0 6.0 2 0.3 0 0 Beef jerky, 1 piece 81 46 56 5.1 2.1 10 2 0.4 6.6 4 1.1 0 0 Bologna, beef and pork, 73 58 80 6.5 2.5 13 1 0.0 2.7 3 0.3 0 0 1 slice Chicken breast fried with skin, 1 split breast 364 166 46 18.5 4.9 1 19 13 0.4 34.8 28 1.8 0 17 grilled and skinless, 142 27 19 3.0 0.9 44 73 0.0 27.0 13 0.9 0 5 1 split breast Chicken drumstick, fried, 193 102 53 1 1.3 3.0 62 6 0.2 15.8 12 1.0 0 19 meat and skin of 1 drumstick Chicken strips, breaded 218 54 25 6.0 1.7 102 0 0.0 37.0 18 1.3 0 33 white meat, no skin, 2 strips, 3 in. /H110031 in. Chicken wing, fried, 159 96 61 10.7 2.9 39 5 0.1 9.7 10 0.6 0 12 meat and skin of 1 wing Chorizo, 1 link 273 207 76 23.0 8.6 53 1 0.0 14.5 5 1.0 0 0 Corndog, chicken 272 1 17 43 13.0 3.0 65 26 0.0 13.0 90 2.0 0 30Ham, lunchmeat, 2 ounces 70 27 39 3.0 1.0 30 1 0.0 10.0 0 0.7 0 0 Hot dog regular, no bun 220 153 70 17.0 6.0 50 5 0.0 6.0 0 0.7 0 0low fat, no bun 70 23 32 2.5 1.0 2 7 0.0 6.0 0 0.7 2 0FRUITS MEAT, FISH, POULTRY, AND EGGS Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide 626 REFERENCE HANDBOOKCalories(kcal) Calories from fat(kcal) % Calories from fat(%) Total fat(g) Saturated fat(g) Cholesterol(mg) Total carbohydrate(g) Dietary fiber(g) Protein(g) Calcium(mg) Iron(mg) Vitamin C(mg) Vitamin A(µg RE)Food and serving size MEAT, FiSH, POULTRY, AND EGGS (continued) Pork chop, 3 oz 300 216 72 24.0 9.7 72 0 0.0 19.7 9 2.0 0 0 Ribs, pork, 3 oz 315 306 97 34.0 12.6 100 0 0.0 20.6 38 1.2 1 2 Roast beef, 3 oz 179 58 33 6.5 2.3 86 0 0.0 28.1 8 3.2 0 0 Sausage, breakfast, pork, 70 57 81 6.3 2.3 15 1 0.0 2.3 40 0.4 0 0 1 link or patty Shrimp, breaded and fried, 73 32 43 3.5 0.6 4 3 0.1 6.4 20 0.4 0 57 4 large Steak, beef, broiled, 6 oz 344 126 37 14.0 5.2 152 0 0.0 52.0 18 5.8 0 0 Tuna canned in oil, 3 oz 158 62 39 6.9 1.4 26 0 0.0 22.6 3 0.6 0 18 canned in water, 3 oz 109 23 21 2.5 0.7 36 0 0.0 20.1 12 0.8 0 16 Turkey lunchmeat, 2 oz 83 36 43 4.0 1.2 24 0 0.0 1 1.0 23 0.7 0 0 roasted, 3 oz 145 38 26 4.2 1.4 65 0 0.0 24.9 21 1.5 0 0 Vegetable burger 70 9 13 1.0 0.5 0 7 3.0 10.0 80 1.8 1 16 Chicken chow mein, crispy 155 36 23 4.0 0.5 8 24 2.4 7.0 47 1.7 12 29 noodles, 1 cup Chicken noodle soup, 60 18 30 2.0 0.5 10 8 0.0 3.0 0 0.4 0 32 canned, 1 cup Chili with meat and beans, 286 126 44 14.0 6.0 43 30 1 1.2 15.0 120 8.8 4 87 1 cup Coucous, 1⁄2cup 100 1 1 1 1 1.2 0.0 0 21 1.2 3.0 0 0.2 0 0 Egg roll, shrimp, 3 in. long 190 54 28 6.0 1.0 10 29 3.0 5.0 20 0.4 4 20 Fajita, flour tortilla, chicken 418 126 30 14.0 3.0 66 42 3.0 30.0 104 3.0 30 50 and vegetables, 1 cup Falafel, 1 patty 67 27 40 3.0 0.5 10 7 1.0 2.3 9 0.6 0 5 Lasagna, with meat, 1 cup 382 135 35 15.0 7.8 56 39 3.3 22.0 258 3.2 16 158 Macaroni and cheese, 410 164 40 18.2 4.6 9 47 1.0 1 1.0 100 2.7 0 120 packaged, 1 cup Pizza frozen, with pepperoni, 440 252 57 28.0 8.0 15 33 1.0 15.0 250 2.7 12 120 regular crust, 1⁄3of 12 in. pizza restaurant, thick crust, 360 90 25 10.0 4.6 19 52 3.0 15.0 286 4.4 13 99 with vegetables, 2 slices restaurant, hand tossed, 452 135 30 15.0 7.6 46 55 3.8 23.0 192 3.0 12 177 pepperoni, 2 slices Quesadilla 199 90 45 10.0 3.6 14 21 1.2 6.0 123 0.7 3 55 Spaghetti and meatballs, 258 90 35 10.0 2.2 22 28 5.8 12.0 52 3.2 5 100 1 cup Tuna salad, 1⁄2cup 192 81 42 9.0 1.6 13 10 0.0 16.0 17 1.0 2 28 Mixed nuts, roasted and 219 180 82 20.0 3.1 0 8 3.2 6.0 38 1.1 0 1 salted, 1⁄4cup Peanut butter, 2 Tbsp 190 144 76 16.0 3.0 0 7 2.0 8.0 12 0.7 0 0Calorie and

Nutrient Content in Selected Foods (continued) MIXED DISHES NUTS AND SEEDS Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE Calories(kcal) Calories from fat(kcal) % Calories from fat(%) Total fat(g) Saturated fat(g) Cholesterol(mg) Total carbohydrate(g) Dietary fiber(g) Protein(g) Calcium(mg) Iron(mg) Vitamin C(mg) Vitamin A(µg RE)Food and serving size REFERENCE HANDBOOK 627Peanuts, dry roasted, 207 153 74 17.0 2.3 0 7 3.2 9.0 31 0.6 0 0 salted, 1⁄4cup Sunflower seeds, 1⁄4cup 208 171 82 19.0 2.0 13 5 2.3 7.0 19 2.3 0 2 Cheese puffs, 1 oz (1⁄2cup) 160 90 56 10.0 2.5 0 15 1.0 2.0 0 0.4 0 3 Granola bar, plain 134 51 38 5.6 0.7 0 18 1.5 2.9 17 0.8 0 43 chocolate coated 132 64 48 7.1 4.0 1 18 1.0 1.6 29 0.7 0 1 1 Nachos, 1 cup 330 162 49 18.0 5.9 22 33 6.6 10.0 1 10 2.0 3 73 Popcorn, micro wave, butter, 170 108 64 12.0 2.5 0 26 3.0 2.0 20 0.7 0 10 1⁄3bag Potato chips, 1 oz (15 chips) 150 90 60 10.0 3.0 0 10 1.0 1.0 0 0.0 6 0 Pretzels, 10 twist 229 19 8 2.1 0.5 0 48 1.9 5.5 22 2.6 0 0 Tortilla chips, plain, 1 oz 140 66 47 7.3 1.4 0 18 1.8 2.0 43 0.4 0 55 Trail mix with chocolate 169 100 59 1 1.2 2.1 1 16 0.0 5.0 38 1.2 0 15 chips and nuts, 1⁄4cup Asparagus, cooked, 4 spears 14 0 0 0.0 0.0 0 3 1.0 1.6 12 0.4 15 49 Beans baked, with pork, 1⁄2cup 134 18 13 2.0 0.8 9 25 7.0 7.0 67 2.1 3 23 green, cooked, 1 cup 44 3 7 0.4 0.0 0 10 4.0 2.4 58 1.6 12 84 refried, canned, 1⁄2cup 127 9 7 1.0 0.1 0 23 9.3 8.0 65 2.5 0 0 Broccoli, cooked, 1 cup 27 0 0 0.0 0.0 0 5 2.8 3.0 47 0.5 37 174 Carrot, raw 28 1 4 0.1 0.0 0 7 1.9 0.7 17 0.6 6 1800 Celery, raw, 4 small stalks 10 1 8 0.1 0.0 0 2 1.0 0.5 24 0.2 4 8 Cole-slaw, 1⁄2cup 41 14 34 1.6 0.0 5 7 0.9 0.8 27 0.4 20 38 Collards, cooked, 1 cup 49 6 12 0.7 0.0 0 9 5.3 4.0 226 0.9 35 595 Corn, cooked, 1 ear 83 9 1 1 1.0 0.0 0 19 2.1 2.6 2 0.5 5 16 Cucumber, raw with peel, 25 1 5 0.1 0.0 0 6 0.4 0.6 1 0.1 2 3 1⁄8cup French fried potatoes, 257 1 17 46 13.0 2.0 0 28 3.0 3.0 1 1 0.5 0 1 homemade, 20 each Humus, 1⁄4cup 106 47 44 5.2 0.0 0 13 3.2 3.0 31 1.0 5 16 Mixed vegetables, cooked, 53 1 2 0.1 0.0 0 12 4.0 2.6 23 0.7 3 389 1⁄2cup Mushrooms, raw, slices, 5 1 12 0.1 0.0 0 1 0.2 0.5 1 0.2 1 0 1⁄4cup Onions, raw, sliced, 1⁄4cup 1 1 0 4 0.0 0.0 0 3 0.5 0.3 17 0.3 3 3 Pepper, chili, raw 18 1 5 0.1 0.0 0 4 0.7 0.9 8 0.5 109 43Pepper, green, raw, 12 1 6 0.1 0.0 0 3 0.8 1.0 4 0.2 40 40 1 medium Potato salad with mayo, 358 185 52 20.5 1.0 170 28 3.3 6.7 48 1.6 24 82 1 cup Potatoes baked with skin, 1⁄2cup 66 1 1 0.1 0.0 0 15 1.5 1.4 6 0.8 8 0 hash browns, 1 cup 326 162 50 18.0 7.0 0 33 3.1 3.8 24 2.6 9 0 mashed with whole milk 223 80 36 8.9 6.0 4 35 4.2 3.9 55 0.5 20 44 and butter, 1 cup Salad, mixed green, no 10 9 90 1.0 0.0 0 2 1.0 0.0 15 0.4 4 75 dressing, 1 cup Spinach, fresh, 1 cup 7 1 14 0.1 0.0 0 1 0.8 0.9 30 0.8 8 360 Tofu, 1⁄2cup 97 51 52 5.6 0.8 0 4 0.5 10.1 204 1.8 1 0 Tomatoes, raw, 1 cup 31 4 14 0.5 0.0 0 7 1.6 1.3 7 0.7 28 93SNACK FOODS VEGETABLES Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide 628 REFERENCE HANDBOOKHealth Agencies and Organizations The list of health agencies and organizations below can provide you sources for answering your health-related questions and finding information on a variety of health-related topics. Agriculture Research Service USDA 3700 East West Highway Hyattsville, MD 20782 Al-Anon, Alateen Family Group Hotline 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617(888) 4-AL-ANON (425-2666) Alliance for Children and Families 1 1700 West Lake Park Drive Milwaukee, WI 53224(800) 221-2681 American Academy of Pediatrics 141 Northwest Point BoulevardElk Grove Village, IL 60007-1098(847) 434-4000 American Anorexia/Bulimia Association, Inc. 165 W. 46th Street Suite 1 108 New York, NY 10036(212) 575-6200 American Association for Active Lifestyles and Fitness 1900 Association Drive Reston, VA 20191(800) 213-7193 American Alliance for Health, Physical Education, Recreation & Dance 1900 Association Dr. Reston, VA 20191-1598American Association for Health Education 1900 Association Drive Reston, VA 22091(703) 476-3437 American Association for Retired Persons 601 East Street NW Washington, DC 20049(202) 434-2277 American Cancer Society 1599 Clifton Road NEAtlanta, GA 30329(800) ACS-2345 (227-2345) American College of Sports Medicine P.O. Box 1440 Indianapolis, IN 46206(317) 637-9200 American Council for Drug Education 164 West 74th Street New York, NY 10023(800) 488-3784 American Dental Association 21 1 East Chicago AvenueChicago, IL 6061 1(800) 621-8099 American Diabetes Association 1701 N. Beauregard StreetAlexandria, VA 2231 1(800) 342-2383American Dietetic Association 216 West Jackson BoulevardChicago, IL 60606-6995(800) 366-1655 American Foundation for the Blind 1 1 Penn Plaza New York, NY 10001(800) AFB-LINE (232-5463) American Heart Association 7272 Greenville AvenueDallas, TX 75231-4596(800) 242-8721 American Institute for Preventive Medicine 30445 Northwestern Highway Suite 350Farmington Hills, MI 48334(800) 345-AIPM (345-2476) American Institute of Stress 124 Park AvenueYonkers, NY 10703(800) 24-RELAX (247-3529) American Liver Foundation 75 Maiden LaneSuite 603New York, NY 10038(800) GO LIVER (465-4837) American Lung Association 1740 BroadwayNew York, NY 10019-4274(800) 586-4872 Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 629American Medical Association 515 N. State Street Chicago, IL 60610(312) 464-5000 American Public Health Association 800 I Street NW Washington, DC 20001-3710(202) 777-APHA (777-2742) American Red Cross, National Headquarters 81 1 1 Gatehouse Road Falls Church, VA 22042-1203(800) 375-2040 American Running and Fitness Association 4405 East-West Highway Suite 405Bethesda, MD 20814(800) 776-2732 American School Health Association 7263 State Route 43 P.O. Box 708Kent, OH 44240(303) 678-1601 American Society for Deaf Children P.O. Box 3355 Gettysburg, PA 17325(800) 942-ASDC (942-2732) Arthritis Foundation 1330 West Peachtree StreetAtlanta, GA 3 0309 (800) 283-7800 Asthma and Allergy Foundation of America 1233 20th Street NW Washington, DC 20036(800) 7-ASTHMA (727-8462)Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333(800) 31 1-3435 Eat Right Hotline 1675 University BoulevardUAB StationBirmingham, AL 35294(800) 231-DIET (231-3438) Environmental Protection Agency Ariel Rios Bldg. 1200 Pennsylvania Avenue NWWashington, DC 20460 Family Resource Center on Disabilities Douglas Building 20 East Jackson BoulevardSuite 900Chicago, IL 60604-208(800) 952-4199 Federal Trade Commission (FTC) Consumer Response CenterWashington, DC(202) 326-2222 Food Allergy Network 104000 Eaton PlaceSuite 107Fairfax, VA 22030-2208(800) 929-4040 Food and Drug Administration 5600 Fishers LaneRockville, MD 20857-0001(888) INFO-FDA (463-6332) Food and Nutrition Information Center National Agriculture Library Room 30410301 Baltimore Blvd.Beltsville, MD 20705Food Safety and Inspection Administration USDA Washington, DC 20250 Juvenile Diabetes Foundation International 120 Wall Street 19th FloorNew York, NY 10005(800) 533-2873 Lupus Foundation of America 1300 Piccard DriveRockville, MD 20850(800) 558-0121 Lyme Disease Foundation 1 Financial PlazaHartford, CT 06103-261 1(800) 886-5963 Medic Alert International 2323 Colorado AveTurlock, CA 95382-2018(800) ID-ALERT (432-5378) Mothers Against Drunk Driving 51 1 E. John Carpenter FreewaySuite 700Irving, TX 75062(800) GET-MADD (438-6233) National Association for Family Child Care 525 SW 5th Street, Suite A Des Moines, IA 5030 9-4501 (800) 359-3817 National Cancer Information Center of the American Cancer Society P.O. Box 142302 Austin, TX 78714-2302(800) 225-2345 Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide 630 REFERENCE HANDBOOKNational Cancer Institute NCI Public Inquiries Office 61 16 Executive Blvd., MSC8322 Suite 3036ABethesda, MD 20892-8322(800) 4-CANCER (422-6237) National Center for Victims of Crime 2100 Wilson Boulevard Suite 300Arlington, VA 22201(800) FYI-CALL (394-2255) National Child Abuse Hotline (800) 4-A-CHILD (422-4453) National Child Care Information Center 243 Church Street NW 2nd FloorVienna, VA 22180(800) 616-2242 National Child Safety Council 4065 Page AvenueP.O. Box 1368Jackson, MI 49204(800) 222-1464 National Clearinghouse for Alcohol and Drug Information P.O. Box 2345 Rockville, MD 20847-2345(800) 729-6686 National Council on the Aging 409 Third Street SW, Suite 200Washington, DC 20024(202) 479-1200National Criminal Justice Reference Service (NCJRS) P.O. Box 6000 Rockville, MD 20849-6000 National Dairy Council 6300 North River RoadRosemont, IL 60018-4233 National Depressive and Manic Depressive Association 730 North Franklin Suite 501Chicago, IL 60610(800) 82-NDMA (862-3632) National Domestic Violence Hotline P.O. Box 161810 Austin, TX 78716(800) 787-3224 National Easter Seals Society 230 West MonroeSuite 1800Chicago, IL 60606(800) 221-6827 National Eating Disorders Organization (NEDO) 6655 South Yale Avenue Tulsa, OK 74136(918) 481-4044 National Eye Institute (800) 869-2020 National Family Caregivers Association 10400 Connecticut Avenue Suite 500Kensington, MD 20895(800) 895-3650National Fire Protection Association 1 Batterymatch Park Quincy, MA 02269(800) 344-3555 National Foundation for Depressive Illness P.O. Box 2257 New York, NY 101 16(980) 248-4344 National Health Information Center P.O. Box 1 133 Washington, DC 20013-1 133(800) 336-4797 National Hospice Organization 1901 Monroe StreetArlington, VA 22209(703) 243-5900 National Information Center for Children and Youth with Disabilities (800) 695-0285 National Inhalant PreventionCoalition 2904 Kerby Lane Austin, TX 78703(800) 269-4237 National Institute of Allergy and Infectious Disease NIAID Building 31, Room 7A-50 31 Center DriveMSC 2520Bethesda, MD 20892-2520 National Institute of Health 9000 Rockville PikeBldg 1, Room 344Bethesda, MD 20892-0188(800) 633-3425Health Agencies and Organizations (continued) Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 631National Institute of Mental Health (NIMH) RM 8184 MSC 9663 6001 Executive BoulevardBethesda, MD 20892(800) 64-PANIC (647-2642) National Institute on Deafness and Other CommunicationDisorders (NIDCD) 1 Communication Avenue Bethesda, MD 20892-3456(800) 241 1-1044 National Institute on Drug AbuseNational Institute of Health 6001 Executive Blvd. Room 5213Bethesda, MD 20892-9561(301) 443-1 124 National Kidney Foundation 30 East 33rd StreetNew York, NY 10016(800) 622-9010 National Mental Health Association Information Center 1021 Prince Street Alexandria, VA 22314-2971(800) 969-6642 National Rehabilitation Information Center 1010 Wa yne Avenue Suite 800 Silver Springs, MD 20910(800) 34-NARIC (346-2742) National Safety Council 1 121 Spring Lake DriveItasca, IL 60143(800) 621-7615National Vaccine Information Center 512 West Maple Avenue Suite 206Vienna, VA 22180(800) 909-7468 National Wellness Institute, Inc. 1300 College CourtP.O. Box 827Stevens Point, WI 54481-0827(800) 243-8694 Office of National Drug Control Policy Clearinghouse 2277 Research Boulevard Rockville, MD 20850(800) 666-3332 Paws With a Cause 4646 South Division StreetWayland, MI 49348-9792(800) 253-7297 President’s Council on Physical Fitness and Sports Room 738H Humphrey Building 200 Independence Avenue SWWashington, DC 20201(202) 690-9000 Prevent Child Abuse America 332 South Michigan AvenueSuite 1600Chicago, IL 60604(800) 835-2671 Recordings for the Blind and Dyslexic 20 Roszel Road Princeton, NJ 08540(800) 221-4792 Stepfamily Association of America 650 J Street Suite 205Lincoln, NE 68508(800) 735-0329Students Against Drunk Driving P.O. Box 800Marlboro, MA 01752(877) SADD-INC Substance Abuse and Mental Health Services Administration Parklawn Building, Room 13C-05 5600 Fishers LaneRockville, MD 20857(800) 789-2647 Susan G. Komen Breast Cancer Foundation (800) IM-AWARE (462-9273) U.S. Department of Agriculture Information Line Washington, DC(202) 720-2791 U.S. Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201(877) 696-6775 U.S. Government Consumer Information Center Pueblo, CO 81009 (719) 948-3334 Women’s Health America P.O. Box 259690Madison, WI 53725(800) 558-7046 YMCA of the USA 101 North Wacker DriveChicago, IL 60606(800) USA-YMCA (872-9622) Youth Development International 5331 Mount Alifan Drive San Diego, CA 92177-8408(800) 448-4663 Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide Medical and Dental Careers Medical workers provide different types of care to improve a person’s health. Many medical workers diagnose illnesses and injuries and provide specialized treatment.Others operate highly specialized medical equipment orwork in laboratories. Registered Nurse What Registered Nurses Do Registered nurses (RNs) interpret and respond to a patient’s symptoms, reactions, and progress.They teach patients and families about properhealthcare, assist in patient rehabilitation, andprovide emotional support to promote recovery.RNs use a broad knowledge base to administertreatments and make decisions about patient care.RNs may be responsible for supervising aides,assistants, and LPNs. Often nurses choose to workin specialized areas such as obstetrics (childbirth)or public health. Where Registered Nurses Work Registered nurses are employed in places such ashospitals, public health departments, nursinghomes, and public schools. What Is Required to Become a Registered Nurse >associate’s degree or bachelor’s degree >individual state licensingPhysician What Physicians Do Physicians perform medical examinations,diagnose, and treat patients who have illnessesand injuries. They help people understand how toprevent disease. Physicians are also known asmedical doctors (MDs) and they are licensed toperform surgery and prescribe medications.General practitioners or family doctors treatpatients for a variety of illnesses. Other doctorschoose an area of specialization, such as obstetricsand gynecology, dermatology, and neurologicalsurgery. Where Physicians Work Some physicians have their own private practice.Others are employed at hospitals, researchfacilities, and different specialty clinics. What Is Required to Become a Physician >a bachelor’s degree >4 years of medical school >3- to 5-year residency to specialize and be certified 632 REFERENCE HANDBOOK Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 633Emergency Medical Technician (EMT) What Emergency Medical Technicians Do Emergency medical technician (EMT) is a broad term used to address emergency medical staff. These technicians respond to healthcare crises.They drive ambulances, give emergency medicalcare, and, if necessary, transport patients tohospitals. EMTs respond to emergencies such asheart attacks, unexpected childbirth, car accidents,and fires. They explain the situation to localhospital staff. Under the direction of a physician,EMTs are told how to proceed with medical care.They perform CPR (cardiopulmonaryresuscitation), control bleeding, place splints onbroken bones, and check pulse and respiration.Paramedics receive additional training andtherefore may be given more responsibilities. Where Emergency Medical Technicians Work Emergency medical technicians work in hospitals, for fire departments, or in an ambulance if theyhave more advanced training. What Is Required to Become an Emergency Medical Technician >training appropriate to duties >basic classes for certification >numerous college courses, depending upon career goalDental Laboratory Technician What Dental Laboratory Technicians Do Dental laboratory technicians construct and repairdentures, crowns, and other dental appliances formissing, damaged, or poorly positioned teeth.They follow a dentist’s prescription to makeplaster models of the patients’ jaws and teeth. Thetechnicians then use acrylic, molding equipment,and porcelain to create an exact copy of the teeth. Where Dental Laboratory Technicians Work Some dental laboratory technicians work in dentists’ offices. Other technicians work forhospitals, including U.S. Department of VeteransAffairs’ hospitals. Still other technicians work inlaboratories or within their own homes. What Is Required to Become a Dental Laboratory Technician >a high school diploma >3 to 4 years as an apprentice or 2 years of college in an associate’s degree or certification program Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide Healthcare Administration Hospitals and other healthcare facilities must employ administrators to coordinate the activities of all employees—both medical and nonmedical—so thatpatients receive the best possible care. Healthcare administrators range from housekeepers and computerspecialists to hospital directors. Medical Coder What Medical Coders Do A medical coding professional uses a classification system to assign code numbers and letters to eachsymptom, diagnosis, disease, procedure, andoperation that appears in a patient’s chart. Thesecodes are used for insurance reimbursement, forresearch, for health planning analysis, and tomake clinical decisions. A high degree of accuracyand a working knowledge of medical terminology,anatomy, and physiology are important skills forthese professionals to have. Where Medical Coders Work Medical coders are employed by hospitals,insurance companies, doctors’ offices, and healthmaintenance organizations (HMOs). What Is Required to Become a Medical Coder >high school diploma or equivalent >associate’s degree or a 24- to 36-month home study course through the American Health Information Management Association >certification by the American Health Informa-tion Management Association to work in certainstatesMedical Transcriptionist What Medical Transcriptionists Do A medical transcriptionist listens to an audio-recorded summary of a patient’s condition andtreatment. The transcriptionist types theinformation and then places the information inthe patient’s permanent record. This typedinformation provides a clear, concise, writtenrecord, which must contain correct spelling,grammar, and punctuation. Transcriptionists usecomputers and word processors to complete manymedical documents, which include medicalhistories, physicals, consultations, and operativereports. They record procedures and treatments forthe medical record and for the medical staff’sreference. Where Medical Transcriptionists Work Medical transcriptionists are employed by clinics,hospitals, insurance companies, physicians’offices, and private transcription companies, orthey may be self-employed. What Is Required to Become a Medical Transcriptionist >high school diploma or equivalent >classroom and clinical experience (from 9 months for a certificate to 2 years for an associate’s degree) >pass certification exam of the American Association of Medical Transcriptionists tobecome a certified medical transcriptionist(CMT) 634 REFERENCE HANDBOOK Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE Medical Claims Examiner What Medical Claims Examiners Do Medical claims examiners review charges on health-related claims to see if the costs arereasonable based on the diagnosis. If a medicalclaims examiner feels that an error has been madeon an insurance claim, he or she will try to workout the problem before the insurance companywill pay the claim. Examiners will then eitherauthorize the appropriate payment or refer theclaim to an investigator for a more thoroughreview. Where Medical Claims Examiners Work Medical claims examiners work for insurancecompanies. What Is Required to Become a Medical Claims Examiner >a bachelor’s degree (no specific course of study is required, but business or accounting coursesmay be useful) >a general understanding of medical terminologyand proceduresSystems Analyst What Systems Analysts Do Systems analysts solve computer problems andenable computer technology to meet theindividual needs of an organization, includinghealth care agencies. They help an organizationrealize the maximum benefit from its investmentin equipment and personnel. Systems analystsalso work on making the computer systems withinan organization compatible so that informationcan be shared. This process may include planningand developing new computer systems or devisingways to apply existing systems’ resources to additional operations. Systems analysts maydesign new systems, including both hardware andsoftware, or add a new software application toharness more of the computer’s power. Where Systems Analysts Work Most systems analysts work with a specific type ofsystem such as business, accounting, financial,scientific, or engineering systems that varies withthe type of organization they work for. Systemsanalysts who have a general knowledge ofhealthcare facilities and the functions the facilitiesperform usually find jobs in hospitals, insuranceagencies, and health maintenance organizations. What Is Required to Become a Systems Analyst >a bachelor’s degree in computer science, information science, or management information systems (MIS) >other qualifications that vary with area of service Copyright © by Ho lt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide Health Education There are many types of healthcare professionals who specialize in educating people about how to improve theiroverall physical and mental health. Education is part ofalmost any healthcare worker’s job. Mental Health Counselor What Mental Health Counselors Do Mental health counselors help people and their families cope with emotional and mental trauma.In individual or group counseling sessions, thesecounselors help patients learn how to manageproblems with family, depression, stress,addiction, substance abuse and more. Thecounselors work closely with other healthprofessionals to recommend treatments andassistance programs to patients. Mental healthcounselors are often referred to as therapists,psychologists, and analysts. Many mental healthcounselors specialize in areas of counseling suchas family and parent-child relationships, domesticviolence, or chemical dependency. Where Mental Health Counselors Work Some places where mental health counselors maywork are private practices, clinics, and mentalhospitals. What Is Required to Become a Mental Health Counselor >a bachelor’s degree >at least 2 years postgraduate study to achieve a master’s degree or 3 to 5 years to achieve adoctoral degree (Ph.D)Community Health Educator What Community Health Educators Do Community health educators try to improve thegeneral health of the community by informingpeople about important topics such as pollution,disease, drug abuse, nutrition, safety, and stressmanagement. Community health educators try toteach people how to avoid contracting diseasesand how to manage the disease when it iscontracted. These educators lead presentationsand write educational brochures and reports toteach people about health and disease and waysto meet specific health needs. Where Community Health Educators Work Community health educators usually work for local or state governments or for privateorganizations. What Is Required to Become a Community Health Educator >training appropriate to duties >usually a bachelor’s degree or a master’s degree focusing on public health or education 636 REFERENCE HANDBOOK Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 637Dietitian What Dietitians Do Dietitians help people learn about and follow healthy eating habits. These professionals oftencreate personalized diets for patients according tothe person’s health status and nutritional needs.Dietitians may also oversee a hospital or healthclinic’s food preparation service. Dietitians help toprepare and inspect food and help clients improveor create a personalized healthy eating plan. Forexample, a dietitian may work in a clinic orhospital teaching patients who have diabetes orhigh blood pressure about which types of foodthey should eat or try to avoid. Where Dietitians Work Dietitians work at places such as hospitals, healthclinics, schools, public health agencies, orbusinesses, such as a food service managementcompany. What Is Required to Become a Dietitian >a bachelor’s degree in dietetics or nutrition (theprogram must be approved by the AmericanDietetic Association) >a master’s degree or doctoral degree, dependingon career goalsHealth Writer and Editor What Health Writers and Editors Do Health writers and editors research, write, andcommunicate health information. They contributearticles and other forms of writing to health-related publications such as hospital newslettersand medical journals. Health editors and writersalso work writing and editing for health sites onthe Internet. They may write about a specifichealth topic such as cancer or health insuranceissues, or they may write about many differenttopics. They will often write for a specific audience(such as medical doctors). Therefore, they knowhow to use the same medical terminology andlanguage used by doctors. Where Health Writers and Editors Work Health writers or editors work for publishingcompanies, radio or television stations,professional medical journals, Internet companies,universities, health foundations, or governmentagencies. What Is Required to Become a Health Writer and Editor >a bachelor’s degree and coursework in science and health-related classes Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide Community Service Many people working in community service provide services and products to medical personnel, patients, andthe general public. Some of these professions requireextensive training, while others only require a few coursesafter high school. Home Health Aide What Home Health Aides Do Home health aides provide personal care in the home to people who are elderly, handicapped, or recovering from an illness or injury. Theresponsibilities of home health aides includegetting the patient out of bed, as well as helpingthe patient bathe and groom, dress, and exercise.The aide also helps the patient remember to takehis or her medication, helps with housecleaningand meal preparation, and provides emotionalsupport. Where Home Health Aides Work Home health aides are usually employed by anagency but work in their patient’s homes. What Is Required to Become a Home Health Aide >certification and training, which vary by state (federal law requires a person to have at least 81hours of classroom and practical training under thesupervision of a registered nurse for the person tobe eligible to take the national certification exam) Medical Social Worker What Medical Social Workers Do Medical social workers assist patients and their families with health-related problems andconcerns. These social workers lead support groupdiscussions, help patients locate appropriatehealthcare and other health services, and providesupport to patients who have serious or chronicillnesses. These professionals help patients andthe patient’s families find resources to overcomeunhealthy conditions, such as child abuse,homelessness, and drug abuse. Social workers alsohelp patients find legal resources and financial aidto pay for health services. Where Medical Social Workers Work Medical social workers usually work for hospitals,nursing homes, health clinics, or communityhealth agencies. What Is Required to Become a Medical Social Worker >a bachelor’s degree or a master’s degree 638 REFERENCE HANDBOOK Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 639Biomedical Equipment Technician What Biomedical Equipment Technicians Do Biomedical equipment technicians specialize in electronic

and mechanical equipment used todiagnose and treat diseases. These technicianswork with equipment ranging from electronicswitches to sophisticated diagnostic equipment.Biomedical equipment technicians adjust and testequipment for proper operation. They periodicallyinspect and repair machines. They also install newequipment, such as electrocardiographs (EKGs)and artificial kidney machines. These techniciansalso perform safety inspections on electrical andradiation equipment, demonstrate the use ofequipment for other medical personnel, andpropose new equipment purchases ormodifications. Where Biomedical Equipment Technicians Work Biomedical equipment technicians work in places such as hospitals, clinics, and medical equipmentmanufacturing plants. What Is Required to Become a Biomedical Equipment Technician >1 to 3 years in a technical program or a bachelor’s degreeHealth Insurance Agent What Health Insurance Agents Do Health insurance agents sell health insurance tothe public. Health insurance is used to help payfor medical expenses if a person needs to go tothe doctor or hospital or to receive some othertype of medical treatment. A health insuranceagent helps people determine what the properinsurance policy for them would be. Theyconsider factors such as how many people are tobe covered, what the ages of the people to becovered are, and what level of coverage is needed.Health insurance agents also help their customersby answering questions and acting as a liaisonbetween the insurance company and a customerwho needs to file a claim. Where do Health Insurance Agents Work? Health insurance agents are located throughoutthe country and usually work in a private office orin the office of an insurance agency. What Is Required to Become a Health Insurance Agent >a bachelor’s degree or education needed per company of employment >specified amount of continuing education(required per state) Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE GuideGuide Sports and Recreation Helping people maintain life-long health through sports and recreation is a rapidly growing area in health careers.The ability of exercise to reduce stress has also created animportant new field of jobs. Occupations in this arearange from trainers to therapists. Certified Athletic Trainer What Certified Athletic Trainers Do Athletic trainers are health professionals who work with athletes from sports teams andorganizations to prevent, recognize, treat, andrehabilitate sports-related injuries. They providefirst aid and nonemergency medical services atsporting events and practices, and they help teammembers get long-term medical help, if needed. Where Certified Athletic Trainers Work Certified athletic trainers usually work for collegeor professional sport teams, or train amateurathletes. What Is Required to Become a Certified Athletic Trainer >a bachelor’s degree from a National Athletic Trainer’s Association (NATA) program or attendance at an NATA internship (Either pathrequires training in CPR and NATA certification.)Occupational Therapist What Occupational Therapists Do Occupational therapists help patients adjust to andrecover from physical illnesses and injuries, such asspinal cord injuries or partial paralysis. Occupa-tional therapists lead patients through rehabilitativeexercises and show the patients new ways toperform simple tasks such as getting dressed,cooking, and eating. These professionals also helppeople who have been injured at work find care andresources and to learn new work duties if necessary.Depending upon the patient’s needs, the therapistsprovide each patient with a personalizedrehabilitation plan and may teach him or her howto use equipment such as wheelchairs, walkers, andother aids. Where Occupational Therapists Work Occupational therapists work in hospitals, inclinics, or in private business. What Is Required to Become an Occupational Therapist >a bachelor’s degree or a certification program in occupational therapy followed by passing anational certification exam 640 REFERENCE HANDBOOK Copyright © by Holt, Rinehart and Winston. All rights reserved. REFERENCE REFERENCE HANDBOOK 641High School Coach What High School Coaches Do High school coaches are responsible for training young athletes to play sports well and safely.Coaches usually coach one or more sports, andthey may have other duties, such as teaching orworking in school administration. Coaches alsoteach sportsmanship, leadership, and how to worktogether as a team. High school coaches areresponsible for the safety and well-being of theirplayers both on the field and in transit to andfrom games or competitions. Where High School Coaches Work High school coaches work at public and privatehigh schools. What Is Required to Become a High School Coach >a bachelor’s degree >sometimes a master’s degree or a Ph.D.Recreational Therapist What Recreational Therapists Do Recreational therapists plan and carry out treatment programs for people who have physical,mental, or social disabilities or for individualsrecovering from substance, sexual, and physicalabuse. Therapists use art, music, recreation, anddance to help patients relieve stress, expressthemselves, and build self-confidence.Motivational and creative programs are used toencourage behavior change, improvecoordination, and increase social skills. Where Recreational Therapists Work Some places where recreational therapists workinclude hospitals, adult and child day care centers,and nursing homes. What Is Required to Become a Recreational Therapist >a bachelor’s degree >at least 6 months of clinical training Copyright © by Holt, Rinehart and Winston. All rights reserved. 642 WHAT’S YOUR HEALTH IQ? ANSWERS AND SCORINGCHAPTER 1 Leading a Healthy Life 1.true 2.false, there are many behavioral risk factors for heart disease. You can follow healthy behaviorsto help reduce your chances of developing heartdisease 3.true 4.true 5.true 6.false, physical health is just one aspect of overallhealth Knowledge—What’s Your Health IQ? Scoring Calculate the percentage of questions you answeredcorrectly by dividing the number of questions youanswered correctly by the total number of questions. Then, multiply that number by 100. Check yourpercentage correct below: 80–100 percent correct Excellent! Your high score shows you have a strong knowledge withthe health topics in the chapter. Use thisknowledge to make good health choices andyou’ll be on your way to leading a healthy life! 60–79 percent correct Good You are aware of some of the health topics in the chapter.Learning more about these issues can help youto make better decisions about your health. 0–59 percent correct Needs Improvement It is important to understand the health issues thataffect you. Having a high health knowledge caninfluence you to choose healthy behaviors soyou can enjoy a healthy life. Read the chaptercarefully, and then retake the What’s YourHealth IQ? to see if your score improves. CHAPTER 2 Skills for a Healthy Life If you scored: 20–28 points You are doing an excellent job of evalu- ating and learning from the decisions you make thatrelate to your overall health. 11–19 points You are doing well overall. However, you have a number of areas in which you canimprove decisions about your health.0–10 points You may need to make some major changes in the way you make decisions. You canlearn to make changes in your decision-making byreading Chapter 2. CHAPTER 3 Building Self-Esteem and Mental Health If you scored: 19–24 points You show respect for yourself and others and probably have high self-esteem. 10–18 points You probably have a healthy self-esteem but could improve the way you treat yourself and others. 0–9 points You should make some major changes in the way you treat yourself and others. You can learnabout factors that affect your self-esteem and how toimprove it by reading Chapter 3. CHAPTER 4 Managing Stress and Coping with Loss If you scored: 19–24 points You are doing an excellent job of managing stress. 10–18 points You are doing very well overall but have areas in which you can improve how you manage stress. 0–9 points You should be making some major changes in the way you deal with stress or you may develop a stress-related illness. You can learn moreabout how to manage stress by reading Chapter 4. CHAPTER 5 Preventing Violence and Abuse If you scored: 19–24 points You are doing an excellent job of avoiding conflict and violence. 10–18 points You are doing very well overall but have areas in which you could improve your interactionswith other people. 0–9 points You should be making some major changes in the way in which you interact with otherpeople. You can learn more about how to betteravoid conflict and violence by reading Chapter 5.WHAT’S YOUR HEALTH IQ? Answers and Scoring Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT’S YOUR HEALTH IQ? ANSWERS AND SCORING 643CHAPTER 6 Physical Fitness for Life 1.false, benefits can be obtained from exercising less often (5 days a week) 2.true 3.false, girls will increase their muscle mass but willnot develop bulky muscles typical of males 4.false, lifting weights is anaerobic exercise 5.false, the body needs rest from exercise or injurywill occur 6.false, anabolic steroids are used to treat medicalproblems, but their use to improve athleticperformance is illegal 7.true To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 7 Nutrition for Life 1.true 2.false, plant foods do not contain cholesterol 3.false, fiber is important because it enables food tomove through the intestines efficiently 4.false, you need to consume vitamins and mineralsin your diet because your body can’t producethem and many of them cannot be stored verylong in the body 5.true 6.true 7.false, choosing the right kind of snacks canprovide energy and nutrients needed for active,growing people To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 8 Weight Management and Eating Behavior 1.true 2.true 3. true 4.false, a weight management program includes healthy eating and exercise habits that maintain ahealthy weight5.true 6.true 7.false, most food-borne illnesses are caused byfoods that are prepared or eaten at home To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 9 Understanding Drugs and Medicines 1.false, minor side effects of OTC medicines are common 2.true 3.true 4.true 5. true 6.false, all drugs, despite their source, are madefrom chemicals 7.false, people can become addicted to prescriptiondrugs such as painkillers To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 10 Alcohol 1.true 2.true 3.true 4.true 5.true 6.false, alcoholism affects all people who know thealcoholic 7.false, motor vehicle accidents is the No. 1 causeof death among teens; the majority of theseaccidents are alcohol related. To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 11 Tobacco 1.true 2.false, chewing tobacco causes serious problems tomouth, throat, and stomach 3.false, herbal cigarettes do contain tobaccoWHAT’S YOUR HEALTH IQ? Answers and Scoring Copyright © by Holt, Rinehart and Winston. All rights reserved. 644 WHAT’S YOUR HEALTH IQ? ANSWERS AND SCORING4.false, smoking can harm your lungs after smoking for only a short time 5.true 6.false, chemicals in tobacco smoke readily passthrough the placenta 7.true To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 12 Illegal Drugs 1.false, most people try drugs for various reasons,such as peer pressure 2.false, marijuana is an addictive drug 3.false, stimulants can give you increased energyand alertness yet can be extremely harmful to thebody 4.false, anabolic steroids can actually cause malesto develop breasts, have a lower sperm count,and have shrunken testes 5.false, medicinal barbituates are given underphysician supervision; however, they are stilldangerous and addictive 6.true 7.false, damage to the brain due to drug use isusually permanent To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 13 Preventing Infectious Diseases If you scored: 22–32 points You are doing an excellent job of preventing the spread of infectious diseases and ofprotecting yourself from infectious diseases. 11–21 points You are doing well overall. However, there are a number of areas in which you couldimprove your behavior to prevent the spread of infec-tious diseases. 0–10 points You should make some major changes in your behavior to protect yourself from infectiousdiseases and prevent the spread of infectious diseases.You can learn to protect yourself from infectiousdiseases by reading Chapter 13.CHAPTER 14 Lifestyle Diseases If you scored: 20–28 points You are doing an excellent job of protecting yourself from lifestyle diseases. 11–19 points You are doing well overall but have areas in which you could improve your health-relatedbehaviors and protect yourself from lifestyle diseases. 0–10 points You have a number of areas in which you could make improvements in your health-relatedbehaviors. You can learn how to protect yourself fromlifestyle diseases by reading Chapter 14. CHAPTER 15 Other Diseases and Disabilities 1.false, the development of some hereditarydiseases is influenced by behavioral factors 2.false, scientists hope to develop such treatmentsbut have not done so yet 3.false, autoimmune diseases are caused primarilyby defective genes 4.false, allergies and asthma are types of immunedisorders while rheumatoid arthritis is an auto-immune disease 5.true To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 16 Adolescence and Adulthood 1.true 2.false, girls naturally have more body fat than boys 3.true 4.false, the leading cause of death in young adultsis unintentional injuries; in middle adulthood,the leading cause is cancer 5.false, most older adults do not experienceAlzheimer’s disease 6.true To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 .WHAT’S YOUR HEALTH IQ? Answers and Scoring Copyright © by Holt, Rinehart and Winston. All rights reserved. WHAT’S YOUR HEALTH IQ? ANSWERS AND SCORING 645CHAPTER 17 Marriage, Parenthood, and Families 1.false, it’s not realistic to expect one’s spouse to meet all of his or her partner’s needs 2.false, the consequences can also be felt by thecouples children, family, and friends 3.false, a mature person initiates resolution tomarital conflicts 4.true 5.true To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 18 Reproduction, Pregnancy, and Development 1.false, sperm are made in the testes 2.true 3.false, most cases of testicular cancer occur among men aged 15 to 35 4.false, testosterone is the primary hormone inmales 5.true 6.true 7.false, women typically produce and release onlyone mature egg each month 8.true 9.false, the baby’s major body structures are formedby the end of the first trimester To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 19 Building Responsible Relationships 1.false, differences in values and personality are a significant thing to consider when datingsomeone 2.false, as in any situation in life, each individualhas choices, and there are many ways to av oid the pressures of becoming sexually active3.true 4.true 5.true To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 20 Risks of Adolescent Sexual Activity 1.true 2.false, only about 20 percent of teen mothers eventually marry the father of the child 3.true 4.true 5.false, abstinence eliminates all of the risks of teensexual activity To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 . CHAPTER 21 HIV and AIDS 1.true 2.true 3.false, HIV is not transmitted through casualcontact, such as shaking hands 4.false, HIV is not transmitted through casualcontact, such as drinking from a water fountainafter a person infected with HIV has 5.true 6.true 7.false, sterile, single-use needles are used duringblood donations in the U.S., so blood donors arenot at risk of HIV infection 8.false, many HIV-infected people are unaware oftheir infection and therefore cannot warn anyoneelse of their infection To check your score, refer to Knowledge—What’s YourHealth IQ? Scoring on p. 642 under Chapter 1 .WHAT’S YOUR HEALTH IQ? Answers and Scoring Copyright © by Holt, Rinehart and Winston. All rights reserved. 646 GLOSSARYabdominal thrusts (Heimlich maneuver) the act of applying pressure to a choking person’s stomach to force an object out of the throat abstinence the conscious decision not to participate in sexual activity and the skills to support that decision abuse physical or emotional harm to someone acid rain any precipitation that has a below-normal pH (acidic) acne an inflammation of the skin that occurs when the openings in the skin become clogged with dirtand oil acquired immune deficiency syndrome (AIDS) the disease that is caused by HIV infection, whichweakens the immune system action plan a set of directions that will help you reach your goal active ingredient the chemical component that gives a medicine its action addiction a condition in which a person can no longer control his or her drug use adolescence the period of time between the start of puberty and full maturation advocate to speak or argue in favor of something aggressive hostile and unfriendly in the way one expresses oneself alcohol the drug in wine, beer, and liquor that causes intoxication alcohol abuse drinking too much alcohol, drinking it too often, or drinking it at inappropriate times alcoholism a disease that causes a person to lose control of his or her drinking behavior; a physicaland emotional addiction to alcohol allergy a reaction by the body’s immune system to a harmless substance alveolus a thin-walled air sac that is found in clusters in the lungs and that is the site of gas exchange Alzheimer’s disease a disease in which a person gradually loses mental capacities and the ability tocarry out daily activities Aamebic dysentery (uh MEE bik DIS uhn TERee) an inflammation of the intestine that is caused by an ameba Americans with Disabilities Act (ADA) wide-ranging legislation intended to make American society moreaccessible to people who have disabilities anabolic steroid a synthetic version of the male hormone testosterone that is used to promote muscledevelopment anorexia nervosa an eating disorder that involves self-starvation, a distorted body image, and low bodyweight antibiotic resistance a condition in which bacteria can no longer be killed by a particular antibiotic antibody a protein that is made by the immune system in response to a specific antigen antigen an identifying protein on the coating of every cell and virus appetite the desire, rather than the need, to eat certain foods artery a blood vessel that carries blood away from the heart to other parts of the body arthritis inflammation of the joints assertive direct and respectful in the way one expresses oneself asset a skill or resource that can help a person reach a goal asthma a disorder that causes the air ways that carry air into the lungs to become narrow and to becomeclogged with mucus asymptomatic showing no signs of a disease or disorder even though an infection or disease is present asymptomatic stage a stage of an infection in which the infectious agent, such as HIV, is present but thereare few or no symptoms of the infection atherosclerosis (ATHuhr OHskluh ROH sis) a disease characterized by the buildup of fatty materials on theinside walls of the arteries atrium a chamber of the heart that receives blood that is returning to the heart autoimmune disease a disease in which the immune system attacks the cells of the body that the immunesystem normally protectsGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. GLOSSARY 647bacteria tiny, single-celled organisms, some of which can cause disease basal metabolic rate (BMR) the minimum amount of energy required to keep the body alive when in a rested and fasting state B cell a type of lymphocyte that is made in bone marrow and that makes antibodies benign tumor (bi NIEN TOO muhr) an abnormal, but usually harmless cell mass binge drinking the act of drinking five or more drinks in one sitting binge eating/bingeing eating a large amount of food in one sitting; usually accompanied by a feeling ofbeing out of control blood a tissue that is made up of cells and fluid and that carries oxygen, carbon dioxide, and nutrients inthe body blood alcohol concentration (BAC) the amount of alcohol in a person’s blood, expressed as a percentage blood pressure the force that blood exerts against the inside walls of a blood vessel blood vessels the tubes, including arteries, veins, and capillaries, through which the blood moves throughthe body body composition the proportion of body weight that is made up of fat tissue compared to lean tissue body image a measure of how you see and feel about your appearance and how comfortable you are withyour body body mass index (BMI) an index of weight in relation to height that is used to assess healthy body weight bone marrow a layer of soft tissue at the center of many bones brain the main control center of the nervous system that is located inside the skull brain stem the part of the brain that filters and guides signals coming from the spinal cord to otherparts of the brain bronchiole the smallest of the tubes that branch from the bronchus in a lung bronchus one of the two tubes that branch from the trachea and send air into each lung Bbulimia nervosa an eating disorder in which the individual repeatedly eats large amounts of food and then uses behaviors such as vomiting or usinglaxatives to rid the body of the food bullying scaring or controlling another person by using threats or physical force burn an injury to the skin and other tissues that is caused by heat, chemicals, electricity, or radiation cancer a disease caused by uncontrolled cell growth capillary a tiny blood vessel that carries blood between arteries and veins and through whichnutrients and waste pass into and out of the blood carbohydrate a class of energy-giving nutrients that includes sugars, starches, and fiber carbon monoxide a gas that blocks oxygen from getting into the bloodstream carcinogen (kahr SIN uh juhn) any chemical or agent that causes cancer cardiac pacemaker a group of cells that are at the top of the right atrium and that control the heartbeat cardiopulmonary resuscitation (CPR) a life-saving technique that combines rescue breathing and chestcompressions cardiovascular disease (CVD) a disease or disorder that results from progressive damage to the heart andblood vessels carotid pulse the pulse that is felt at the carotid arteries, the major arteries of the neck cavity a hole in the tooth produced by tooth decay central nervous system (CNS) the part of the nervous system made up of the brain and spinal cord cerebellum the part of the brain that controls balance and posture cerebrum the largest, most complex part of the brain that receives sensations and controls movement cervix the narrow base of the uterus that leads to the vagina chemotherapy (KEEmoh THER uh pee) the use of drugs to destroy cancer cells CGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 648 GLOSSARYchlamydia (kluh MID ee uh) a bacterial STD that infects the reproductive organs and that causes a mucous discharge chlorofluorocarbons (CFCs) pollutants released by certain coolants and aerosol sprays choking the condition in which the trachea (windpipe) is partly or completely blocked chronic disease a disease that develops gradually and continues over a long period of time circadian rhythm the body’s internal system for regulating sleeping and waking patterns cirrhosis (suh ROH sis) a deadly disease that replaces healthy liver tissue with scar tissue; most often causedby long-term alcohol abuse club (designer) drug a drug made to closely resemble a common illegal drug in chemical structure andeffect cochlea a coiled, fluid-filled tube that is found in the inner ear and that is involved in hearing codependency a condition in which a family member or friend sacrifices his or her own needs tomeet the needs of an addict collaborate to work together with one or more people collagen protein fibers that make skin flexible colon the major part of the large intestine consequence a result of one’s actions and decisions conservation the wise use and protection of natural resources consumer a person who buys products or services coping dealing with problems and troubles in an effective way cross-contamination the transfer of contaminants from one food to another daily value (DV) the recommended daily amount of a nutrient; used on food labels to help people seehow a food fits into their diet dandruff flaky clumps of dead skin cells from the scalp date rape sexual intercourse that is forced on a victim by someone the victim knows Ddecibels (DES uh BUHLZ ) the units used to measure sound deductible the amount that the subscriber must pay before an insurance company begins paying for medical services defense mechanism an unconscious behavior that is used to avoid experiencing unpleasant emotions deforestation the clearing of trees from natural forests to make space for crops or development dehydration a state in which the body has lost more water than has been taken in depressant a drug that causes relaxation and sleepiness

depression sadness and hopelessness that keeps a person from carrying out everyday activities dermis the functional layer of skin beneath the epidermis designated driver a person who chooses not to drink alcohol in a social setting so that he or she can safelydrive himself or herself and others diabetes a disorder in which cells are unable to obtain glucose from the blood such that high blood-glucose levels result diabetic coma a loss of consciousness that happens when there is too much blood sugar and a buildup oftoxic substances in the blood diaphragm the sheet of muscle that separates the chest cavity from the abdominal cavity and thatfunctions in respiration Dietary Guidelines for Americans a set of diet and lifestyle recommendations developed to improvehealth and reduce nutrition-related disease risk inthe U.S. population dietary supplement any product that is taken by mouth, that can contain a dietary ingredient, andthat is labeled as a dietary supplement digestive tract the series of organs through which food passes direct pressure the pressure that results from someone who tries to convince you to do somethingyou normally wouldn’t do disability a physical or mental impairment or deficiency that interferes with a person’s normalactivity GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. GLOSSARY 649discipline the act of teaching a child through correction, direction, rules, and reinforcement dislocation an injury in which a bone has been forced out of its normal position in a joint distress a negative stress that can make a person sick or can keep a person from reaching a goal divorce the legal end to a marriage domestic violence the use of force to control and maintain power over a spouse in the home drug any substance that causes a change in a person’s physical or psychological state drug abuse the intentional improper or unsafe use of a drug drug combination therapy an AIDS treatment program in which patients regularly take more than one drug drug interaction a condition in which a drug reacts with another drug, food, or dietary supplement suchthat the effect of one of the substances is greater orsmaller drug tolerance a condition in which a user needs more of a drug to get the same effect earthe sense organ that functions in hearing and balance eardrum a membrane that transmits sound waves from the outer ear to the middle ear ecosystem a community of living things and the nonliving parts of the community’s environment egg (ovum) the sex cell that is made by the ovaries and that can be fertilized by sperm electrocution a fatal injury caused by electricity entering the body and destroying vital tissues embryo a developing human, from fertilization through the first 8 weeks of development emotion the feeling that is produced in response to life experiences emotional intimacy the state of being emotionally connected to another person emotional maturity the ability to assess a relationship or situation and to act according to what is best foroneself and for the other person in the relationship Eempathy the ability to understand another person’s feelings, behaviors, and attitudes emphysema a respiratory disease in which air cannot move in and out of alveoli because they become blocked or lose their elasticity enabling helping an addict avoid the negative conse- quences of his or her behavior endocrine gland an organ that releases hormones into the bloodstream or into the fluid around cells endometrium the lining of the uterus environment the living and nonliving things that surround an organism environmental tobacco smoke (secondhand smoke) a combination of exhaled mainstream smoke andsidestream smoke enzyme a protein or other type of molecule that helps chemical processes happen in living things epidemic the occurrence of more cases of a disease than expected epidermis the outermost layer of the skin, made of one to several layers of dead cells epinephrine (EPuh NEF rin) one of the hormones released by the body in times of stress; also calledadrenaline esophagus a long, straight tube that connects the pharynx (throat) to the stomach and through whichfood moves to get into the stomach estrogen a hormone that regulates the sexual devel- opment and reproductive function of females eustachian tube the tube that connects the middle ear to the throat eustress a positive stress that energizes a person and helps a person reach a goal extended family the people who are outside the nuclear family but are related to the nuclear family,such as aunts, uncles, grandparents, and cousins external bleeding bleeding at the surface of the body external pressure pressure that a person feels from another person or group to engage in a behavior eye the sense organ that gathers and focuses light, generates signals that are sent to the brain, andallows one to seeGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 650 GLOSSARYfad diet a diet that requires a major change in eating habits and promises quick weight loss fallopian tube the female reproductive organ that connects an ovary to the uterus and that transports an egg from the ovary to the uterus family counseling counseling discussions that are led by a third party to resolve conflict among familymembers fata class of energy-giving nutrients; alsothe main form of energy storage in the body fee-for-service insurance plan a traditional insurance plan in which the patient must pay a premium and adeductible fertilization the process by which a sperm and an egg and their genetic material join to create a newhuman life fetal alcohol syndrome (FAS) a set of physical and mental defects that affect a fetus that has beenexposed to alcohol because of the mother’sconsumption of alcohol during pregnancy fetus a developing human, from the start of the ninth week of pregnancy until delivery first degree burn a burn that affects only the outer layer of the skin and looks pink FITT a formula made up of the four parts of fitness training: frequency, intensity, time, and type follicle a tiny pit in the skin that holds the root of a hair food allergy an abnormal response to a food that is triggered by the immune system food-borne illness an illness caused by eating or drinking a food that contains a toxin or disease-causing microorganism Food Guide Pyramid a tool for choosing a healthy diet by selecting a recommended number of servingsfrom each of six food groups fracture a crack or break in a bone fraud the marketing and selling of products or services by making false claims frostbite a condition in which body tissues become frozenFfuneral a ceremony in which a deceased person is buried or cremated fungus an organism that absorbs and uses nutrients of living or dead organisms gene a segment of DNA located on a chromosome that codes for a specific hereditary trait and that is passed from parent to offspring generic medicine a medicine made by a company other than the company that developed the originalmedicine gene therapy a technique that places a healthy copy of a gene into the cells of a person whose copy of thegene is defective genetic counseling the process of informing a person or couple about their genetic makeup gingivitis a condition in which the gums become red and infected and begin to pull away from the teeth goal something that you work toward and hope to achieve gonorrhea (GAHN uh REE uh) an STD that is caused by a bacterium that infects mucous membranes,including the genital mucous membranes grieve to express deep sadness because of a loss hallucinogen a drug that distorts perceptions, causing the user to see or hear things that are not real hand signals signals used by cyclists that show pedestrians, automobile drivers, and others on theroad when they intend to make a turn or stop hazardous weather dangerous weather that causes concern for safety hazing harassing newcomers to a group in an abusive and humiliating way head lice tiny parasites that feed on blood vessels in the scalp health the state of well-being in which all of the components of health—physical, emotional, social,mental, spiritual, and environmental—are in balance health literacy knowledge of health information needed to make good choices about your health HGGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. GLOSSARY 651health maintenance organization (HMO) a managed- care plan in which patients must use a doctor who contracts with the insurance company Health on the Net (HON) Foundation an organi- zation of Web sites that agree to follow a code ofethics regarding health information health-related fitness fitness qualities that are necessary to maintain and promote a healthy body Healthy People 2010 a set of health objectives estab- lished by the U.S. Department of Health and HumanServices for improving the nation’s health by 2010 heart the organ that acts as a pump that pushes the blood through the body heart attack the damage and loss of function of an area of the heart muscle heartburn the pain that is felt behind the breastbone and that is caused by GERD (gastric esophageal refluxdisorder) heat exhaustion a condition in which the body becomes heated to a higher temperature than normal heatstroke a condition in which body loses its ability to cool itself by sweating helper T cell (CD4+ cell) white blood cell that activates the immune response and that is theprimary target cell of HIV infection hemoglobin the oxygen-carrying pigment in red blood cells hepatitis an inflammation of the liver hereditary disease a disease caused by abnormal chromosomes or by defective genes inherited by achild from one or both parents heredity (huh RED i tee) the passing down of traits from parents to their biological child high-risk population any group of people who have an increased chance of getting a disease HIV-antibody test a test that detects HIV antibodies to determine if a person has been infected with HIV HIV positive describes a person who tests positive in two different HIV tests home healthcare services medical services, treatment, or equipment provided for the patient inhis or her homehormone a chemical substance that is made and released in one part of the body and that causes achange in another part of the body Human Genome Project a research effort to determine the locations of all human genes on thechromosomes and to read the coded instructions inthe genes human immunodeficiency virus (HIV) the virus that primarily infects cells of the immune system and thatcauses AIDS human papilloma virus (HPV) a group of viruses that can cause genital warts in males and females and cancause cervical cancer in females hunger the body’s physical response to the need for food hypothermia a condition in which the internal body temperature becomes dangerously low incest sexual activity between family members who are not husband and wife incontinence loss of voluntary control of urination indirect pressure the pressure that results from being swayed to do something because people you look upto are doing it infectious disease (in FEK shuhs di ZEEZ) any disease that is caused by an agent that has invadedthe body inflammation a reaction to injury or infection that is characterized by pain, redness, and swelling inhalant a drug that is inhaled as a vapor inpatient care medical care that requires a person to stay in a hospital for more than a day insomnia an inability to sleep even if one is physi- cally exhausted insulin a hormone that causes cells to remove glucose from the bloodstream integrity the characteristic of doing what one knows is right internal bleeding bleeding within the body internal pressure an impulse a person feels to engage in a behavior IGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 652 GLOSSARYsperm the sex cell that is made by the testes and that is needed to fertilize an egg from a female spinal cord the column of nerve tissue that runs through the backbone from the base of the brain spinal nerves nerves that branch from the spinal cord and that go to the brain and to the tissues of the body splint a device used to stabilize (hold secure) a body part sprain an injury in which the ligaments in a joint are stretched too far or are torn stimulant a drug that temporarily increases a person’s energy and alertness strain an injury in which a muscle or tendon has been stretched too far or has torn stress the body’s and mind’s response to a demand stressor any situation that is a demand on the body or mind stroke a sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted suffocation a fatal injury caused by an inability to breathe when the nose and mouth are blocked orwhen the body becomes oxygen-deficient suicide the act of intentionally taking one’s own life symptom a change that a person notices in his or her body or mind and that is caused by a disease ordisorder synapse a tiny space across which nerve impulses pass from one neuron to the next syphilis (SIF uh lis) a bacterial STD that causes ulcers or chancres; if untreated, it can lead to mental andphysical disabilities and premature death tara sticky, black substance in tobacco smoke that coats the inside of the airways and that containsmany carcinogens target heart rate zone a heart rate range within which the most gains in cardiorespiratory health will occur T cell a white blood cell that is made in red bone marrow, matures in the thymus, and that attacks cellsthat have been infected by viruses Ttendon a strong connective tissue that attaches muscles to bones testis (testicle) the male reproductive organ that makes sperm and testosterone testosterone the male hormone that is made by the testes and that regulates male secondary sex charac- teristics and the production of sperm third -degree burn a burn that penetrates all layers of skin as well as the tissue beneath the skin andappears pearly white, tan colored, or charred tinnitus (ti NIET es) a buzzing, ringing, or whistling sound in one or both ears that occurs even when nosound is present tolerance the ability to overlook differences and to accept people for who they are; alsoa condition in which a user needs more of a drug to get the sameeffect tonsils small, rounded masses of lymph tissues found in the throat tooth decay the process in which acid from plaque and tartar slowly dissolve the hard surfaces of theteeth trachea the long tube that carries air from the larynx to the lungs; also called the windpipe trigger lock a device that helps prevent a gun from being fired ultraviolet (UV) radiation radiation in sunlight that is responsible for tanning and burning skin universal precautions the set of procedures used to avoid contact with body fluids and to reduce the riskof spreading HIV and other diseases urinary bladder the hollow, muscular sac that stores urine urine waste liquid excreted by the kidneys, stored in the bladder, and passed through the urethra to theoutside of the body uterus the female reproductive organ that provides a place to support a developing human UGLOSSARYHH04PEGLOSS 1/9/04 10:46 AM Page 652 GLOSSARY 653mineral a class of nutrients that are chemical elements that are needed for certain body processes, such as enzyme activity and bone formation motor nerve a nerve that carries signals from the brain or spinal cord to the muscles and glands mucus a thick, slimy fluid that is secreted by the lining of organs and glands multiple sclerosis an autoimmune disease in which the body mistakenly attacks myelin, the fattyinsulation on nerves in the brain and spinal cord natural disaster a natural event that causes widespread injury, death, and property damage neglect the failure of a caretaker to provide for basic needs, such as food, clothing, or love negotiation a bargain or compromise for a peaceful solution to a conflict neonatal abstinence syndrome drug withdrawal that occurs in newborn infants whose mothers werefrequent drug users while pregnant nephron a tiny, blood-filtering unit in the kidney nerve a bundle of nerve cells (neurons) that carry electrical signals from one part of the body toanother neuron a specialized cell that receives and sends electrical signals neurotransmitter a chemical released at the end of a neuron’s axon nicotine the highly addictive drug that is found in all tobacco products nicotine substitutes medicines that deliver small amounts of nicotine to the body to help a personquit using tobacco nonrenewable resource a natural resource that can be used up faster than it can be replenished naturally nuclear family a family in which a mother, a father, and one or more biological or adopted children livetogether nutrient a substance in food that provides energy or helps form body tissues and that is necessary for lifeand growth Nnutrient deficiency the state of not having enough of a nutrient to maintain good health nutrient density a measure of the nutrients in a food compared with the energy that the food provides nutrition the science or study of food and the ways in which the body uses food obesity (oh BEE suh tee) the state of having excess body fat for one’s weight; the state of weighing more than 20 percent above one’s recommended bodyweight Occupational Safety and Health Administration (OSHA) a government agency created to prevent work-related injuries, illnesses, and death opiates a group of highly addictive drugs derived from the poppy plant that are used as pain relievers, anesthetics, and sedatives opportunistic infection (OI) an illness that is due to an organism that causes disease in people withweakened immune systems; commonly found inAIDS patients outbreak an unexpected increase in illness outpatient care medical care that requires that a person stay in the hospital only during his or hertreatment ovary the female reproductive organ that produces eggs and the hormones estrogen and progesterone overcrowding condition in which there are too many inhabitants in an area to live healthily overdose the taking of too much of a drug, which causes sickness, loss of consciousness, permanentdamage, or even death over-the-counter (OTC) medicine any medicine that can be bought without a prescription overpopulation the point at which a population is too large to be supported by the available resources overtraining a condition that occurs as a result of exceeding the recommendations of the FITT formula overweight heavy for one’s height ovulation (AHVyoo LAY shuhn) the process in which the ovaries release a mature egg every month OGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 654 GLOSSARYpandemic a disease that spreads quickly through human populations all over the world parental responsibility the duty of a parent to provide for the physical, financial, mental, and emotional needs of a child passive not offering opposition when challenged or pressured pathogen any agent that causes disease peer mediation a technique in which a trained outsider who is your age helps people in a conflictcome to a peaceful resolution peer pressure a feeling that you should do something because that is what your friends want pelvic inflammatory disease (PID) an inflammation of the upper female reproductive tract that is caused bythe migration of a bacterial infection from the vagina penis the male reproductive organ that removes urine from the body and that can deliver sperm tothe female reproductive system peripheral nervous system (PNS) the part of the nervous system made up of the nerves that connectthe brain and spinal cord to other parts of the body physical dependence a condition in which the body relies on a given drug in order to function physical fitness the ability of the body to perform daily physical activities without becoming short ofbreath, sore, or overly tired placenta a blood vessel–rich organ that forms in a mother’s uterus and that provides nutrients andoxygen to and removes waste from a developing baby plaque a mixture of food particles, saliva, and bacteria on the tooth platelet a cell fragment that is needed to form blood clots poison a substance that can cause illness or death when taken into the body preferred provider organization (PPO) a managed- care plan that offers the patient an option to see adoctor who does not contract with the insurancecompany; the patient pays a higher fee to use thisoptionPpremium the monthly fee for insurance prenatal care the healthcare provided for a woman during her pregnancy prescription (pree SKRIP shuhn) a written order from a doctor for a specific medicine primary care physician (PCP) family doctor who handles general medical care prioritize to arrange items in order of importance prostate gland a gland in males that adds fluids that nourish and protect sperm as the sperm move through the female body protective factor anything that keeps a person from engaging in a harmful behavior protein a class of nutrients that are made up of amino acids, which are needed to build and repairbody structures and to regulate processes in the body psychoactive describes a drug or medicine that affects the brain and changes how a person perceives,thinks, or feels puberty the period of human development during which people become able to produce children public health the study and practice of protecting and improving the health of people in a community public service announcement (PSA) a message created to educate people about an issue purging engaging in behaviors such as vomiting or misusing laxatives to rid the body of food quackery a type of fraud; the promotion of healthcare services or products that are worthless or not proven effective Recommended Dietary Allowances (RDAs) recom- mended nutrient intakes that will meet the needs of almost all healthy people recovering the process of learning to live without drugs rectum the last part of the large intestine in which undigested wastes are stored RQGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. GLOSSARY 655recycling reusing materials from used products to make new products red blood cell blood cell that carries oxygen to the body cells and that returns carbon dioxide to the lungs reflex an involuntary and almost immediate movement in response to a stimulus refusal skill a strategy to avoid doing something you don’t want to do relapse a return to using drugs while trying to recover from drug addiction renewable resource a natural resource that can be replaced over a short period of time repetitions the number of times that an exercise is performed rescue breathing an emergency technique in which a rescuer gives air to someone who is not breathing resiliency the ability to recover from illness, hardship, and other stressors resource something that you can use to help achieve a goal resting heart rate (RHR) the number of times that the heart beats per minute while the body is at rest retina the light-sensitive inner layer of the eye, which receives images formed by the lens and transmitsnerve signals through the optic nerve to the brain risk factor anything that increases the likelihood of injury, disease, or other health problems root canal a procedure in which a dentist drills into the pulp of a tooth to remove the infection from acavity salmonellosis a bacterial infection of the digestive system that is usually spread by eating contaminatedfood sanitation the practice of providing sewage disposal and treatment, solid waste disposal, clean drinkingwater, and clean living and working conditions scrotum a skin-covered sac that holds the testes and that hangs from the male body sebaceous gland gland in the skin that adds oil to the skin and hair shaft to keep skin and hair lookingsmooth and healthy Ssecond -degree burn a burn that extends into the inner skin layer and is red, swollen, and blistered sedentary not taking part in physical activity on a regular basis self-actualization the achievement of the best that a person can be self-concept a measure of how one views oneself self-esteem a measure of how much one values, respects, and feels confident about oneself semen a fluid made up of sperm and other secretions from the male reproductive organs sensory nerve a nerve that carries signals from a sense organ to the central nervous system, where the signals are processed or

relayed seta fixed number of repetitions followed by a rest period sexual abuse any sexual act that happens without consent sexual activity any activity that includes intentional sexual contact for the purpose of sexual arousal sexual assault any sexual activity in which force or the threat of force is used sexual harassment any unwanted remark, behavior, or touch that has sexual content sexual intercourse the reproductive process in which the penis is inserted into the vagina and throughwhich a new human life may begin sexually transmitted disease (STD) an infectious disease that is spread by sexual contact shock a condition in which some body organs do not get enough oxygenated blood sibling a brother or sister related to another brother or sister by blood, the marriage of the individuals’parents, or adoption side effect any effect that is caused by a drug and that is different from the drug’s intended effect sidestream smoke smoke that escapes from the tip of a cigarette, cigar, or pipe skeleton a framework of bones that support the muscles and organs and protect the inner organs sleep apnea a sleeping disorder characterized by inter- ruptions of normal breathing patterns during sleep sleep deprivation a lack of sleep GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 656 GLOSSARYsperm the sex cell that is made by the testes and that is needed to fertilize an egg from a female spinal cord the column of nerve tissue that runs through the backbone from the base of the brain spinal nerves nerves that branch from the spinal cord and that go to the brain and to the tissues of the body splint a device used to stabilize (hold secure) a body part sprain an injury in which the ligaments in a joint are stretched too far or are torn stimulant a drug that temporarily increases a person’s energy and alertness strain an injury in which a muscle or tendon has been stretched too far or has torn stress the body’s and mind’s response to a demand stressor any situation that is a demand on the body or mind stroke a sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted suffocation a fatal injury caused by an inability to breathe when the nose and mouth are blocked orwhen the body becomes oxygen-deficient suicide the act of intentionally taking one’s own life symptom a change that a person notices in his or her body or mind and that is caused by a disease ordisorder synapse a tiny space across which nerve impulses pass from one neuron to the next syphilis (SIF uh lis) a bacterial STD that causes ulcers or chancres; if untreated, it can lead to mental andphysical disabilities and premature death tara sticky, black substance in tobacco smoke that coats the inside of the air ways and that contains many carcinogens target heart rate zone a heart rate range that should be reached during exercise to gain cardiorespiratoryhealth benefits T cell a white blood cell that is made in the thymus and that attacks cells that have been infected by viruses Ttendon a strong connective tissue that attaches muscles to bones testis (testicle) the male reproductive organ that makes sperm and testosterone testosterone the male hormone that is made by the testes and that regulates male secondary sex charac- teristics and the production of sperm third -degree burn a burn that penetrates all layers of skin as well as the tissue beneath the skin andappears pearly white, tan colored, or charred tinnitus (ti NIET es) a buzzing, ringing, or whistling sound in one or both ears that occurs even when nosound is present tolerance the ability to overlook differences and to accept people for who they are; alsoa condition in which a user needs more of a drug to get the sameeffect tonsils small, rounded masses of lymph tissues found in the throat tooth decay the process in which acid from plaque and tartar slowly dissolve the hard surfaces of theteeth trachea the long tube that carries air from the larynx to the lungs; also called the windpipe trigger lock a device that helps prevent a gun from being fired ultraviolet (UV) radiation radiation in sunlight that is responsible for tanning and burning skin universal precautions the set of procedures used to avoid contact with body fluids and to reduce the riskof spreading HIV and other diseases urinary bladder the hollow, muscular sac that stores urine urine waste liquid excreted by the kidneys, stored in the bladder, and passed through the urethra to theoutside of the body uterus the female reproductive organ that provides a place to support a developing human UGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. GLOSSARY 657vaccine a substance that is usually prepared from killed or weakened pathogens or from genetic material and that is introduced into a body toproduce immunity vagina the female reproductive organ that connects the outside of the body to the uterus and thatreceives sperm during reproduction value a strong belief or ideal vegetarian dietary pattern that includes few or no animal products vein a blood vessel that carries blood toward the heart ventricle one of the two large, muscular chambers that pump blood out of the heart violence physical force that is used to harm people or damage property virus a tiny disease-causing particle that consists of genetic material and a protein coat vitamin a class of nutrients that contain carbon and that are needed in small amounts to maintain healthand allow growth wake a ceremony to view or watch over the deceased person before the funeral weight management a program of sensible eating and exercise habits that keep weight at a healthy level wellness the achievement of a person’s best in all six components of health white blood cell a blood cell whose primary job is to defend the body against disease withdrawal uncomfortable physical and psycho- logical symptoms produced when a physicallydependent drug user stops using drugs wound a break or tear in the soft tissues of the body WVGLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 658 SPANISH GLOSSARYabdominal thrusts (Heimlich maneuver)/empuje abdominal acción de aplicar presión al estómago de una persona atragantada para lograr que un objeto salga por la garganta abstinence/abstinencia decisión consciente de no participar en actividades sexuales y las capacidades necesarias para respaldar esa decisión abuse/abuso daño físico o emocional a una persona acid rain/lluvia ácida toda precipitación que tenga un pH inferior a lo normal (acídico) acne/acné inflamación de la piel que se produce cuando los poros de la piel se tapan con suciedad ygrasa acquired immune deficiency syndrome (AIDS)/ síndrome de inmunodeficiencia adquirida (SIDA) enfermedad producida por la infección del VIH, que debilita el sistema inmunológico action plan/plan de acción conjunto de instrucciones que te ayudarán a alcanzar una meta active ingredient/ingrediente activo componente químico que hace que un medicamento tenga efecto addiction/adicción estado de dependencia a una droga adolescence/adolescencia período de tiempo entre el comienzo de la pubertad y la maduración completa advocate/defender hablar o discutir a favor de algo aggressive/agresivo modo hostil y poco amable de expresarse alcohol/alcohol droga presente en el vino, la cerveza y el licor, que produce intoxicación alcohol abuse/abuso de alcohol beber demasiado alcohol, con demasiada frecuencia o en horarios noadecuados alcoholism/alcoholismo enfermedad que hace que una persona pierda el control de su conductacomo bebedor; adicción física y emocional al alcohol allergy/alergia reacción exagerada del sistema inmunológico a una sustancia del medio ambienteque es inofensiva para la mayoría de las personas Aalveolus/alvéolo bolsa de aire de paredes delgadas que se encuentra en grupos en los pulmones y es el lugar donde se produce el intercambio de gases Alzheimer's disease/enfermedad de Alzheimer enfermedad que hace que una persona pierda poco apoco las capacidades mentales y la habilidad derealizar las actividades cotidianas amebic dysentery /disentería amibiana inflamación del intestino producida por una amiba Americans with Disabilities Act (ADA)/Ley de Estadounidenses Discapacitados (ADA, por sunombre en inglés) ley de amplio alcance que se creó para que sea más accesible la sociedad estadounidense a las personas con discapacidades anabolic steroid/esteroide anabólico versión sintética de la hormona masculina testosterona que se utiliza para aumentar el desarrollo muscular anorexia nervosa/anorexia nerviosa trastorno alimenticio en el que la persona deja de comer, tieneuna imagen distorsionada de su cuerpo y sufre unapérdida de peso extrema antibiotic resistance /resistencia al antibiótico condición en la que un antibiótico en particular yano puede matar a una bacteria antibody/anticuerpo proteína que produce el sistema inmunológico en respuesta a una antígenoespecífico antigen/antígeno proteína que se encuentra en la superficie de todas las células y virus y sirve paraidentificarlos appetite/apetito deseo, más que necesidad, de comer algunos alimentos artery/arteria vaso sanguíneo que transporta la sangre desde el corazón hacia otras partes del cuerpo arthritis/artritis inflamación de las articulaciones assertive/acertado directo y respetuoso en la manera de expresarse asset/don habilidad o recurso que ayuda a una persona a lograr sus metas asthma/asma trastorno que hace que las vías respira- torias que transportan aire hacia los pulmones seestrechen y se obstruyan con mucosidades SPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. SPANISH GLOSSARY 659asymptomatic/asintomático que no presenta síntomas de enfermedad o trastorno pero padece una infección o enfermedad asymptomatic stage/estado asintomático estado de una infección en el que el hay un agente infeccioso,tal como el VIH, pero se presentan pocos o ningúnsíntoma de la infección atherosclerosis/aterosclerosis enfermedad caracter- izada por la formación de materia grasa en el interiorde las paredes de las arterias atrium/aurícula cámara del corazón que recibe la sangre que regresa al corazón autoimmune disease/enfermedad autoinmune enfer- medad en la que el sistema inmunológico de unapersona ataca a ciertas células, tejidos u órganos delcuerpo bacteria/bacteria organismos unicelulares muy pequeños, algunos de los cuales pueden causar enfer-medades basal metabolic rate (BMR)/índice metabólico basal (IMB) cantidad mínima de energía necesaria para mantener el cuerpo con vida en estado de reposo y ayuno B cell/célula B tipo de linfocito que se produce en la médula ósea y fabrica anticuerpos benign tumor/tumor benigno masa celular anormal, pero generalmente inofensiva binge drinking/beber compulsivamente acción de beber cinco o más bebidas en un corto tiempo binge eating/bingeing/comer compulsivamente acción de comer una gran cantidad de alimentos enuna comida; generalmente acompañada por unasensación de descontrol blood/sangre tejido formado por células y líquidos que transportan oxígeno, dióxido de carbono y nutri-entes en el cuerpo blood alcohol concentration (BAC)/concentración de alcohol en la sangre (CAS) cantidad de alcohol en la sangre de una persona, expresada en porcentaje blood pressure/presión arterial fuerza que la sangre ejerce en el interior de las paredes de un vaso sanguíneo Bblood vessels/vasos sanguíneos tubos, incluyendo las arterias, las venas y los capilares, a través de los cuales la sangre circula por el cuerpo body composition/composición corporal proporción del peso corporal formada por tejido de grasa encomparación con los huesos, músculos y órganos body image/imagen corporal medición de cómo te ves y te sientes con respecto a tu aspecto y qué tan agusto te sientes con tu cuerpo body mass index (BMI)/índice de masa corporal (IMC) índice de peso con relación a la altura que se utiliza para evaluar el peso de un cuerpo sano bone marrow/médula ósea tejido blando que está dentro de los huesos brain/cerebro centro de control principal del sistema nervioso que está ubicado dentro del cráneo brain stem/tronco encefálico parte del cerebro que filtra y dirige señales desde la médula espinal hacia otras partes del cerebro bronchiole/bronquiolo tubo respiratorio que envía aire desde la tráquea a cada pulmón bronchus/bronquio tubo respiratorio delgado que se ramifica a partir de un bronquio dentro del pulmón bulimia nervosa/bulimia nerviosa trastorno alimen- ticio en el que una persona come constantementeuna gran cantidad de alimentos y luego vomita otoma laxantes para eliminar la comida del cuerpo bullying/gandallismo acción de asustar o manipular a otra persona mediante amenazas o la fuerza física burn/quemadura lesion de la piel y otros tejidos producida por calor, sustancias químicas, electricidado radiación cancer/cáncer enfermedad en la que las células crecen de manera incontrolable capillary/capilar pequeño vaso sanguíneo que trans- porta sangre entre las arterias y las venas, y por dondelos nutrientes y los desechos entran y salen deltorrente sanguíneo carbohydrate/carbohidrato tipo de nutriente que aporta energía e incluye azúcares, féculas y fibras carbon monoxide/monóxido de carbono gas que impide que el oxígeno ingrese al torrente sanguíneo CSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 660 SPANISH GLOSSARYcarcinogen/carcinógeno toda sustancia química o agente que causa cáncer cardiac pacemaker/marcapasos cardíaco grupo de células que se encuentran en la parte superior de la aurícula derecha y controlan los latidos del corazón cardiopulmonary resuscitation (CPR)/resucitación cardiopulmonar (CPR, por su nombre en inglés) técnica para salvar la vida que combina la recuperación de la respiración y compresiones en elpecho cardiovascular disease (CVD)/enfermedad cardiovas- cular trastorno del sistema circulatorio causado por daño al corozón y vaso sanguíneo carotid pulse/pulso carotideo pulso que se siente en las arterias de las carótidas, arterias principales del cuello cavity/caries cavidad en la dentadura de una persona producida por la degeneración dental central nervous system (CNS)/sistema nervioso central (SNC) el cerebro y la médula espinal cerebellum/cerebelo parte del cerebro que controla el equilibrio y la postura cerebrum/córtex parte más grande y compleja del cerebro que recibe sensaciones y controla el movimiento cervix/cuello de la matriz base angosta de la matriz que conduce a la vagina chemotherapy/quimioterapia uso de drogas con la finalidad de destruir células cancerosas chlamydia /clamidia ETS causada por una bacteria que infecta los órganos reproductores y provoca lasecreción de una sustancia mucosa chlorofluorocarbons (CFCs)/clorofluorocarbonos (CFC) contaminantes que despiden ciertos pulver- izadores en aerosol y líquidos refrigerantes choking/atragantamiento trastorno en el que el tubo digestivo se obstruye de manera parcial o total chronic disease/enfermedad crónica enfermedad que se desarrolla poco a poco y continúa durante un período prolongado de tiempo circadian rhythm/ritmo circadiano sistema interno del cuerpo encargado de regular los patrones desueño y actividad cirrhosis/cirrosis enfermedad mortal que reemplaza los tejidos sanos del hígado por tejidos cicatrizadosinservibles; en la mayoría de los casos es causada por elabuso de alcohol durante un largo período de tiempo club (designer) drug/droga de club (de diseño) droga elaborada de modo que su estructura química yefectos son similares a los de una droga ilegal común cochlea/cóclea tubo en forma de espiral, lleno de líquido, que se encuentra en el oído interno yparticipa en la audición codependency/codependencia condición en la que un integrante de la familia o un amigo sacrifica susnecesidades para satisfacer las necesidades de unadicto collaborate/colaborar trabajar juntos con una o más personas collagen/colágeno fibras de proteínas que hacen que la piel sea flexible colon/colon porción principal del intestino grueso consequence/consecuencia resultado de las acciones y las decisiones de una persona conservation/conservación uso correcto y la protección de los recursos naturales consumer/consumidor persona que compra productos o servicios coping/sobrellevar manejar los problemas y los inconvenientes de manera eficaz cross contamination/contaminación cruzada traspaso de contaminantes de un alimento a otro daily value (DV)/valor diario (VD) cantidad diaria recomendada de un nutriente; se utiliza en las etiquetas de los alimentos y permite a las personassaber qué aporta un alimento a su dieta dandruff/caspa trocitos escamosos de células de piel muertas en el cuero cabelludo date rape/violación en una cita relación sexual forzada por alguien que la víctima conoce decibels (dB)/decibeles (dB) unidades utilizadas para medir el sonido DSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. SPANISH GLOSSARY 661deductible/deducible monto que el abonado debe pagar antes de que una compañía de seguro comience a pagar los servicios médicos defense mechanism/mecanismo de defensa pensamiento o conducta inconsciente que se utilizapara no experimentar emociones desagradables deforestation/deforestación eliminación de árboles de los bosques naturales con la finalidad de hacerlugar para cosechas o construcciones dehydration/deshidratación condición en la que el cuerpo no contiene suficiente agua depressant/depresivo droga que produce relajación y somnolencia depression/depresión trastorno del ánimo en el que una persona se siente muy triste y desesperanzadadurante un período largo de tiempo dermis/dermis capa funcional de la piel debajo de la epidermis designated driver/conductor asignado persona que decide no beber alcohol en un evento social parapoder manejar de manera segura, ya sea que viajesolo o acompañado diabetes/diabetes trastorno en el que las células no pueden obtener glucosa de la sangre y que resulta enniveles altos de glucosa en la sangre diabetic coma/coma diabético pérdida del conocimiento que ocurre cuando el nivel de azúcaren la sangre es muy alto y se forma una acumulaciónde sustancias tóxicas en la sangre diaphragm/diafragma lámina de músculo que separa la cavidad torácica de la cavidad abdominal y queparticipa de la respiración Dietary Guidelines for Americans/Guía Alimenticia para los Estadounidenses conjunto de recomenda- ciones alimenticias y sobre el estilo de vida desarrollado para mejorar la salud y reducir el riesgode enfermedades relacionadas con la nutrición en lapoblación estadounidense dietary supplement/suplemento alimenticio todo producto que se tome vía oral y contenga un ingre-diente dietario y lleve una etiqueta que lo identifiquecomo un suplemento dietario digestive tract/tracto digestivo serie de órganos por los que pasan los alimentos direct pressure/presión directa presión ejercida por una persona para de convencer a otra de que hagaalgo que normalmente no haría disability/discapacidad incapacidad o deficiencia mental o física que afecta la actividad normal discipline/disciplina acción de enseñar a un niño a través de la corrección, indicaciones, reglas y refuerzo dislocation/dislocación lesión en la que un hueso sale de su posición normal en una articulación distress/alteración estrés negativo que puede hacer que una persona se enferme o no logre alcanzar una meta divorce/divorcio terminación legal de un matrimonio domestic violence/violencia doméstica uso de la fuerza para controlar y mantener poder sobre elconyuge en el hogar drug/droga toda sustancia química que provoca un cambio en el estado físico o emociónal de unapersona drug abuse/abuso de drogas uso indebido e inten- cional de una droga legal o uso de una droga ilegal drug combination therapy/terapia de combinación de drogas programa de tratamiento para el SIDA en el que los pacientes toman más de una droga regularmente drug interaction/interacción de drogas condición en la que una droga reacciona al ser combinada con otra droga, un alimento o un suplemento alimenticio; porejemplo, el efecto de una de las drogas puede sermayor o menor drug tolereance/tolerancia a la droga condición en la que una persona necesita aumentar la dosis dedroga para obtener el mismo efecto ear/oído órgano sensorial que participa en la audición y el equilibrio eardrum/tímpano membrana que transmite ondas de sonido del oído externo al oído medio ecosystem/ecosistema comunidad de seres vivos y los elementos no vivientes de su entorno egg (ovum)/óvulo célula sexual producida por los ovarios que puede ser fecundada por un espermatozoide ESPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 662 SPANISH GLOSSARYelectrocution/electrocución lesión fatal que ocurre cuando ingresa electricidad al cuerpo y se destruyen tejidos vitales embryo/embrión ser humano en desarrollo, desde el momento de la fecundación hasta la semana 8 degestación emotion/emoción sentimiento producido como respuesta a un hecho de la vida emotional intimacy/madurez emocional conjunto de emociones ordenadas según el grado de placer queproporcionan emotional maturity/espectro emocional capacidad de evaluar una relación o una situación y actuarsegún lo que resulta más favorable para uno mismo ypara la otra persona involucrada en la relación empathy/empatía capacidad de comprender los sentimientos, conducta y actitudes de otra persona emphysema/enfisema enfermedad respiratoria en la que el aire no puede entrar y salir de los alvéolosporque están obstruidos o han perdido elasticidad enabling/habilitar ayudar a un adicto a evitar las consecuencias negativas de su conducta endocrine gland/glándula endocrina órgano que libera hormonas en el torrente sanguíneo o en ellíquido que rodea las células endometrium/endometrio pared interior de la matriz environment/entorno seres vivos y elementos no vivientes que rodean a un organismo environmental tobacco smoke/humo de tabaco ambiental (HTA) combinación del humo exhalado por el fumador y el emanado por el cigarrillo enzyme/enzima proteína u otro tipo de molécula que permite el desarrollo de procesos químicos en los seres vivos epidemic/epidemia desarrollo de más casos de los esperados de una enfermedad epidermis/epidermis capa más externa de la piel formada por una o varias capas de célulasmuertas epinephrine/epinefrina una de las hormonas de estrés que el cuerpo libera en situaciones de estrés esophagus/esófago tubo recto y largo que conecta la faringe con el estómago y a través del cual pasan losalimentos para llegar al estómago estrogen/estrógeno hormona que regula el desar- rollo sexual y la función reproductiva de las mujeres eustachian tube/conducto de Eustaquio tubo que conecta el oído medio con la garganta eustress/estrés positivo estrés positivo que energiza a la persona y le ayuda a alcanzar una meta extended family/familia extendida personas que no están incluidas dentro del núcleo familiar pero estánrelacionadas con el éste, tales como, tías, tíos,abuelos y primos external bleeding/sangrado externo sangrado en la superficie del cuerpo external pressure/presión externa presión que una persona siente de parte de otra persona o grupo de personas para actuar de una manera determinada eye/ojo órgano sensorial que recoge y enfoca la luz y genera señales que se envían al cerebro fad diet/dieta de moda dieta que requiere un cambio importante en los hábitos alimenticios yprometa bajar de peso rápidamente fallopian tube/trompas de Falopio órgano de reproducción femenino que transporta al óvulodesde el ovario hasta la matriz family counseling/consejería familiar charlas de asesoramiento a cargo de un tercero para resolverconflictos entre los integrantes de una familia fat/grasa tipo de nutrientes que aportan energía; también es la principal forma de almacenamiento de energía en el cuerpo fee-for-service insurance plan/plan de seguro de pago por servicio plan de seguro tradicional en el que el paciente debe pagar una prima y un deducible fertilization/fecundación proceso mediante el cual un espermatozoide y un óvulo y el material genético del que están compuestos se unen para crear unavida humana fetal alcohol syndrome (FAS)/síndrome de alcohol fetal (SAF) conjunto de defectos físicos y mentales que afectan a un feto que estuvo expuesto al alcohol debido al consumo de alcohol de la madre durante elembarazo FSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. SPANISH GLOSSARY 663fetus/feto ser humano en desarrollo, desde el inicio de la novena semana de embarazo hasta el parto first-degree burn/quemadura de primer grado quemadura que afecta sólo la capa externa de la piel y deja una marca de color rosa FITT/FITT formula para los cuatro componentes del entrenamiento físico: frecuencia, intensidad, tiempo y tipo follicle/folículo orificio muy pequeño en la piel que sostiene la raíz del cabello food allergy/alergia a alimentos respuesta anormal a un alimento que manifiesta el sistema inmunológico food-borne illness/enfermedad por alimentos enfer- medad causada por comer o beber un alimento quecontiene una toxina o un microorganismo capaz deprovocar una enfermedad Food Guide Pyramid/Pirámide alimenticia herramienta para escoger una dieta sana mediante laselección de un número de porciones recomendadasde cada uno de los cinco grupos de alimentos fracture/fractura fisura o rotura de un hueso fraud/fraude comercialización y venta de productos o servicios sobre los que se da información falsa frostbite/congelación daño a la piel y a los tejidos debajo de la piel provocado por un frío intenso funeral/funeral ceremonia de entierro o cremación de una persona fallecida fungus/hongo organismo que absorbe y utiliza nutri- entes de organismos vivos o muertos gene/gen segmento de ADN ubicado en un cromosoma que lleva el código de un rasgo heredi-tario específico y que se transmite de padres a hijos generic medicine/medicamento genérico medica- mento elaborado por una empresa diferente a laempresa que creó el medicamento original gene therapy/terapia de genes técnica que coloca una copia sana de un gen en las células de unapersona cuya copia del gen tiene algún defecto genetic counseling/asesoría genética proceso de informar a las personas o parejas sobre sucomposición genética Ggingivitis/gingivitis trastorno en el que las encías se infectan y se enrojecen y empiezan a separarse de los dientes goal/meta algo por lo que te esfuerzas y que esperas alcanzar gonorrhea/gonorrea ETS causada por una bacteria que infecta

las membranas mucosas, incluyendo lasmembranas de la mucosa genital grieve/estar de duelo expresar una profunda tristeza por una pérdida hallucinogen/alucinógeno una droga que desfigura percepción, capaz de hacer que la persona que lastoma vea o escuche cosas que no son reales hand signals/señales manuales señales que utilizan los ciclistas para indicar a los peatones,automovilistas y demás personas que transitan lascalles cuando van a cruzar o detenerse hazardous weather/clima peligroso clima peligroso que despierta preocupaciones sobre la seguridad hazing/novatadas acoso a los nuevos integrantes de un grupo de manera abusiva y humillante head lice/piojos parásitos muy pequeños que se alimentan de los vasos sanguíneos del cuerocabelludo health/salud estado de bienestar en el que todos los componentes de la salud (físicos, emocionales,sociales, mentales, espirituales y ambientales) estánen equilibrio health literacy/educación para la salud conocimiento de la información sobre la saludnecesario para tomar decisiones acertadas sobre ésta health maintenance organization (HMO)/organización de mantenimiento de la salud (HMO, por su nombre eninglés) plan de salud administrado en el que los pacientes deben utilizar los servicios de un médico que trabaje bajo contrato con la compañía de seguro Health on the Net (HON) Foundation/Fundación Salud en la Red (HON, por su nombre en inglés) organización de sitios Web que aceptan seguir un código de ética con respecto a la información de lasaludHSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 664 SPANISH GLOSSARYhealth-related fitness/estado físico relacionado a la salud cualidades de estado físico necesarias para mantener y promover un cuerpo sano Healthy People 2010/Gente sana 2010 conjunto de objetivos para la salud establecidos por el Departa- mento de Salud y Servicios Humanos de EstadosUnidos con el propósito de mejorar la salud de lanación para el año 2010 heart/corazón órgano que funciona como una bomba que hace fluir la sangre a través del cuerpo heart attack/ataque al corazón condición en la que el corazón no recibe suficiente sangre y el tejido delcorazón se daña o se destruye heartburn/acidez estomacal dolor que se siente detrás del esternón provocado por el TREG (trastornode reflujo esofagogástrico) heat exhaustion/agotamiento por calor trastorno de salud en el que el cuerpo adquiere una temperaturasuperior a la temperatura normal heat stroke/insolación trastorno de salud en el que el sistema que controla la capacidad del cuerpo paraenfriarse mediante la transpiración deja de funcionar helper T cell (CD4+ cell)/célula T colaboradora (célula CD4+) glóbulo blanco que activa la respuesta inmunológica y que es la célula objetivo principal de la infección por VIH hemoglobin/hemoglobina pigmento presente en los glóbulos rojos encargado de transportar oxígeno hepatitis/hepatitis inflamación del hígado hereditary disease/enfermedad hereditaria enfer- medad causada por cromosomas anormales o porgenes defectuosos que un niño hereda de uno oambos padres heredity/herencia transmisión de rasgos de los padres a sus hijos biológicos high-risk population/población de alto riesgo todo grupo de personas que tienen mayores probabili-dades de contraer una enfermedad HIV-antibody test/prueba de anticuerpo del VIH prueba que detecra los anticuerpos del VIH, lo quepermite determinar si una persona está infectada porel VIH HIV positive/VIH positivo describe a una persona que tiene dos pruebas diferentes de VIH conresultado positivo home healthcare services/servicios de salud en el hogar servicios médicos, tratamientos o equipo que se le proporcionan al paciente en su casa hormone/hormona sustancia química que se elabora y se libera en una parte del cuerpo y produce un cambio en otra parte del cuerpo Human Genome Project/Proyecto del genoma humano trabajo de investigación con el objetivo de determinar las ubicaciones de todos los genes humanos en los cromosomas e interpretar lasinstrucciones codificadas en los genes human immunodeficiency virus (HIV)/virus de inmun- odeficiencia humana virus que infecta principalmente las celulas del sistema inmunológico y causa el SIDA human papilloma virus (HPV)/virus de papilomahumano (VPH) grupo de virus que puede causar verrugas genitales en hombres y mujeres y cáncer de cuello de la matriz en las mujeres hunger/hambre respuesta física del cuerpo a la necesidad de alimentos hypothermia/hipotermia temperatura corporal inferior al valor normal immunity/inmunidad enfermedad causada por un agente patógeno que se puede transmitir de unapersona a otra incest/incesto relación sexual entre los integrantes de una familia que no son marido y mujer incontinence/incontinencia pérdida del control voluntario de la orina indirect pressure/presión indirecta presión para hacer algo porque las personas que admiras lo hacen infectious disease/enfermedad infecciosa toda enfer- medad causada por un agente o un patógeno queinvade el cuerpo inflammation/inflamación reacción a una lesión o infección caracterizada por dolor, enrojecimiento ehinchazón inhalant/inhalante una droga que se inhala en forma de vapor inpatient care/hospitalización atención médica que requiere que una persona permanezca en el hospitaldurante más de un día ISPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. SPANISH GLOSSARY 665insomnia/insomnio incapacidad para dormir aun si la persona está físicamente agotada insulin/insulina hormona que permite que la glucosa pase del torrente sanguíneo a las células integrity/integridad característica de hacer lo que uno sabe que es correcto internal bleeding/sangrado interno sangrado dentro del cuerpo internal pressure /presión interna impulso que siente una persona de actuar de una manera deter- minada intervention/intervención acción de enfrentar a un consumidor de drogas con su problema para quedeje de consumirlas intoxication/intoxicación cambios físicos y mentales producidos por beber alcohol joint/articulación parte del cuerpo en la que dos o más huesos se encuentran keratin/queratina proteína fuerte y flexible que se encuentra en la piel, el pelo y las uñas kidney/riñón uno de los órganos que filtra el agua y los desechos de la sangre, elimina productos enforma de orina y regula la concentración de ciertassustancias en la sangre lactose intolerance/intolerancia a la lactosa incapacidad de digerir completamente la lactosa, elazúcar de la leche leukemia/leucemia cáncer de los tejidos del cuerpo que producen glóbulos blancos life expectancy/esperanza de vida tiempo de vida promedio que se espera viva una persona life skill/destreza para la vida herramienta para construir una vida sana lifestyle disease/enfermedad causada por el estilo de vida enfermedad causada en parte por conductas no saludables y en parte por otros factores LKJligament/ligamento tipo de tejido que mantiene unidos los extremos de los huesos en las articula- ciones lung/pulmón órgano principal del aparato respira- torio en el que el oxígeno del aire se intercambia conel dióxido de carbono de la sangre lymph/linfa líquido transparente y amarillento que sale de los capilares, llena los espacios alrededor delas células del cuerpo y es absorbido por los vasos yganglios linfáticos lymphatic system/sistema linfático red de vasos que transportan la linfa por todo el cuerpo lymph node/ganglio linfático órgano pequeño en forma de frijol que contiene fibras pequeñas queeliminan partículas de la linfa lymphocytes/linfocitos glóbulos blancos que destruyen bacterias, virus y células muertas o dañadas mainstream smoke/humo emanado por fumador humo que un fumador inhala a través de un cigar-rillo y luego exhala malignant tumor/tumor maligno masa de células que invade y destruye el tejido sano managed-care plan/plan de atención de salud administrada plan en el que una compañía deseguros firma un contrato con un grupo de médicos marijuana/marihuana flores y hojas secas de la planta Cannabis sativa marriage/matrimonio unión para toda la vida entre marido y mujer, quienes mantienen una relacióníntima media/medios de comunicación todas las formas públicas de comunicación; por ejemplo, televisión,radio, periódicos, Internet y avisos publicitarios Medicaid/Medicaid programa del cuidado de la salud disponible para personas que tienen un plan deasistencia, tienen hijos dependientes, o son ancianos,ciegos o discapacitados Medicare/Medicare programa de salud para personas de 65 años de edad o mayores y parapersonas más jóvenes con discapacidades MSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 666 SPANISH GLOSSARYspinal cord/médula espinal columna de tejido nervioso que recorre la espalda desde la base del cerebro spinal nerves/nervios espinales nervios que se ramifican de la médula espinal y llegan al cerebro y a los tejidos del cuerpo splint/férula elemento utilizado para estabilizar (mantener firme) una parte del cuerpo sprain/esguince lesión en la que los ligamentos de una articulación se estiran demasiado o se desgarran stimulant/estimulante droga que aumenta temporal- mente la energía y capacidad de atención de unapersona strain/distensión lesión en la que un músculo o un tendón se estiró demasiado o se desgarró stress/estrés respuesta del cuerpo y la mente a una amenaza real o percibida stressor/factor estresante toda situación que es una amenaza o que se percibe como una amenaza stroke/apoplejía ataque repentino de debilidad o parálisis que se produce cuando se interrumpe elflujo de sangre a una zona del cerebro suffocation/sofocación lesión fatal causada por la incapacidad de respirar cuando la nariz y la bocaestán obstruidas o cuando el cuerpo tiene unadeficiencia de oxígeno suicide/suicidio acción intencional de quitarse la vida symptom/síntoma cambio que una persona nota en su cuerpo o mente, causado por una enfermedad oun trastorno synapse/sinapsis espacio muy pequeño que atraviesan los impulsos nerviosos al pasar de unaneurona a otra syphilis/sífilis ETS bacteriana que ocasiona úlceras o chancros; si no se trata, puede ocasionar discapaci-dades físicas y mentales y muerte prematura tar/alquitrán sustancia negra y pegajosa del humo del tabaco que cubre el interior de las vías respira-torias y que contiene muchos carcinógenos target heart rate zone/zona de frecuencia cardíaca deseable rango de frecuencia cardíaca en el que se obtiene para obtener los mayores beneficios para la salud cardiorespiratoriaTT cell/célula T glóbulo blanco que se forma en el timo y ataca a las células que han sido infectadas por virus tendon/tendón tejido conectivo fuerte que une los músculos a los huesos testis (testicle)/testículo órgano reproductor masculino que produce espermatozoides y testos-terona testosterone/testosterona hormona masculina que elaboran los testículos y que regula característicassexuales masculinas secundarias y la producción deespermatozoides third-degree burn/quemadura de tercer grado quemadura que penetra en todas las capas de la piely los tejidos subyacentes y tiene una apariencia decolor blanco perlado, color tostado o carbonizada tinnitus/zumbido de oídos sonido semejante a un zumbido, timbre o silbido en uno o ambos oídos que ocurre aun cuando no se oye ningún ruido tolerance/tolerancia capacidad de aceptar a las personas por lo que son a pesar de las diferencias;tambien una condición en la que una persona necesita más cantidad de una droga para sentir susefectos originales, condición en la que una personanecesita más cantidad de una droga para sentir susefectos originales tonsils/amígdalas masas pequeñas y redondas de tejido linfático que se encuentran en la garganta tooth decay/degeneración dental proceso en el que el ácido de la placa bacteriana y el sarro destruyenlentamente las superficies duras de los dientes trachea/tráquea tubo largo que transporta aire de la laringe a los pulmones trigger lock/traba de seguridad del gatillo dispos- itivo que ayuda a impedir que un arma se dispare ultraviolet (UV) radiation/radiación ultravioleta (UV) radiación de la luz solar capaz de broncear o quemar la piel universal precautions/precauciones universales conjunto de precauciones que se utilizan para evitar el contacto con líquidos del cuerpo y reducir el riesgode transmisión del VIH y otras enfermedades USPANISH GLOSSARYHH04PEGLOSS 1/13/04 1:48 PM Page 666 SPANISH GLOSSARY 667nutrient density/densidad nutricional medida de los nutrientes en un alimento en función de la energía que ese alimento aporta nutrition/nutrición ciencia o estudio de los alimentos y la forma en que el cuerpo los utiliza obesity/obesidad estado en el que una persona tiene un exceso de grasa en el cuerpo en proporción con elpeso corporal; estado en el que una persona pesa másdel 20% del peso corporal recomendado Occupational Safety and Health Administration (OSHA)/Administración de la Salud y la SeguridadOcupacional (OSHA, por su nombre en inglés) organismo gubernamental que ayuda a prevenir lesiones, enfermedades y muertes relacionadas con eltrabajo opiates/opiáceos drogas muy adictivas producidas a partir de la adormidera de amapola que se usancomo analgésicos, anestésicos, y sedativos opportunistic infection (OI)/infección oportunista (IO) enfermedad causada por un organismo que provoca enfermedades en personas con sistemas inmunológicos débiles; se encuentra frecuentementeen pacientes con SIDA outbreak/brote aumento inesperado de una enfer- medad outpatient care/atención a pacientes externos atención médica que requiere que la personapermanezca en el hospital sólo mientras se le realizael tratamiento ovary/ovario órgano reproductor femenino que produce los óvulos y las hormonas estrógeno yprogesterona overdose/sobredosis consumo excesivo de una droga que produce enfermedad, pérdida delconocimiento, daño permanente o hasta la muerte over-the-counter (OTC) medicine/medicamentos de venta sin receta (VSR) todo medicamento que se puede comprar sin receta médica overpopulation/sobrepoblación cuando una población es demasiado grande para ser cubierta por los recursos de asistencia disponibles overtraining/sobreentrenamiento condición causada por el exceso de ejercicio Ooverweight/sobrepeso excedido de peso en relación a su estatura ovulation/ovulación proceso mensual mediante el cual los ovarios liberan un óvulo maduro pandemic/pandémica enfermedad que se transmite rápidamente a través de las poblaciones humanas en todo el mundo parental responsibility/responsabilidad de los padres el deber de los padres de satisfacer las necesidadesfísicas, financieras, mentales y emocionales de unniño passive/pasivo que no presenta oposición ante desafíos o presiones pathogen/patógeno todo agente, especialmente un virus u otro microorganismo, que provoca una enfer-medad peer mediation/mediación de pares técnica en la que un tercero de tu misma edad, capacitado en el tema,ayuda a las personas involucradas en un conflicto asolucionarlo de manera pacífica peer pressure/presión de pares sensación de que debes hacer algo porque así lo quieren tusamigos pelvic inflammatory disease (PID)/enfermedad inflamatoria de la pelvis (EIP) inflamación del tracto reproductivo superior femenino causada por la migración de una infección bacteriana en la vagina penis/pene órgano reproductor masculino que elimina la orina del cuerpo y que puede colocarespermatozoides en el aparato reproductor femenino peripheral nervous system (PNS)/sistema nervioso periférico (SNP) nervios que conectan al cerebro y la médula espinal con otras partes del cuerpo physical dependence/dependencia física estado en el que el cuerpo químicamente necesita de una droga para funcionar normalmente physical fitness/buen estado físico capacidad de realizar actividades físicas todos los días sin sentirfalta de aire, dolor o cansancio extremos PSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 668 SPANISH GLOSSARYplacenta/placenta organo rico en vasos sanguíneos que se forma en la matriz de la madre, proporciona nutrientes y oxígeno al bebé en desarrollo y eliminasus desechos plaque/placa mezcla de bacterias, saliva y partículas de alimentos que se deposita en los dientes platelet/plaqueta fragmento de célula necesario para formar coágulos de sangre poison/veneno sustancia que puede ocasionar enfer- medad o muerte si ingresa al cuerpo preferred provider organization (PPO)/organización de proveedor seleccionado (PPO, por su nombre eninglés) plan de salud administrado en el que el paciente tiene la opción de consultar a un médico que no tiene contrato con la compañía de seguro; elpaciente paga una tarifa más elevada por uilizar estaopción premium/prima tarifa mensual de un seguro prenatal care /atención prenatal cuidado de la salud que se proporciona a una mujer durante el embarazo prescription/receta orden escrita de un médico para un medicamento específico primary care physician (PCP)/médico de cabecera (PCP, por su nombre en inglés) médico personal o de la familia que se encarga de los cuidados médicos generales prioritize/dar prioridad disponer elementos por orden de importancia prostate gland/próstata glándula masculina que aporta líquidos que nutren y protegen a los esperma-tozoides a medida que se desplazan por el cuerpo dela mujer protective factor/factor protector cualquier cosa que impide a una persona adoptar una conducta ofensiva protein/proteína clase de nutrientes formados por aminoácidos, sustancias necesarias para construir yreparar estructuras del cuerpo y regular procesos delcuerpo psychoactive/psicoactivo describe a una droga o un medicamento que afecta al cerebro, que cambiacómo percibimos, pensamos o sentimos puberty/pubertad período del desarrollo humano durante el que las personas adquieren la capacidadde tener hijos public health/salud pública práctica de proteger y mejorar la salud de personas en una comunidad public service announcement (PSA)/anuncio de servicio público (PSA, por su nombre en inglés) mensaje creado para educar a las personas sobre un tema purging/purgar llevar a cabo acciones tales como vomitar o consumir laxantes de forma indebida para eliminar la comida del cuerpo quackery/curanderismo un tipo de fraude; promoción de servicios o productos de salud sinvalor o comprobación Recommended Dietary Allowances (RDAs)/cuotas dietarias recomendadas (CDR) consumo de nutri- entes recomendados que satisfacen las necesidades de casi todas las personas sanas recovering/recuperando proceso de aprender a vivir sin drogas rectum/recto porción final del intestino grueso donde se almacenan los desechos no digeridos recycling/reciclaje reutilización de materiales a partir de productos usados para elaborar productosnuevos red blood cell/glóbulo rojo célula de la sangre que transporta oxígeno a las células del cuerpo y quetransporta dióxido de carbono de regreso a lospulmones reflex/reflejo movimiento involuntario y casi inmediato en respuesta a un estímulo refusal skill/habilidad de negación estrategia para evitar hacer algo que no quieres hacer relapse/recaída regresar a utilizar drogas mientras se recupera de una adicción renewable resource/recurso renovable recurso natural que se puede reemplazar en un período cortode tiempo repetitions/repeticiones número de veces que se realiza un ejercicio rescue breathing/respiración de rescate técnica de emergencia mediante la cual una persona le propor-ciona aire a la que no respira RQSPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. SPANISH GLOSSARY 669resiliency/resilencia capacidad para recuperarse de una enfermedad, una dificultad u otro factor estre- sante resource/recurso algo que puedes utilizar para alcanzar una meta resting heart rate (RHR)/índice de pulsaciones en reposo (IPR) número de veces que el corazón late por minuto mientras el cuerpo está en reposo retina/retina capa interna del ojo que es sensible a la luz, recibe imágenes formadas por el cristalino y transmite señales nerviosas a través del nervio ópticoal cerebro risk factor /factor de riesgo todo aquello capaz de aumentar la probabilidad de lesión, enfermedad uotros problemas de salud root canal/endodoncia procedimiento mediante el cual un dentista perfora la pulpa dental para eliminarla infeccíon producida por una caries salmonellosis/salmonelosis infección del aparato digestivo causada por una bacteria que suelecontraerse al comer alimentos contaminados sanitation/saneamiento práctica de proporcionar drenaje y tratamiento de aguas residuales, el desechode residuos sólidos, agua potable limpia y condi-ciones de trabajo y vivienda limpias scrotum/escroto bolsa de piel que contiene los testículos sebaceous gland/glándula sebáceas glándula que aporta grasa a la piel y al cuero cabelludo paramantenerlos suaves y saludables second-degree burn/quemadura de segundo grado quemadura que atraviesa la primera capa de la piel yproduce enrojecimiento, inflamación y ampollas sedentary/sedentario persona que no practica ninguna actividad física regularmente self-actualization/autorealización máximo potencial de una persona self-concept/autoconcepto medición de cómo una persona se ve a sí misma self-esteem/autoestima medición de cuánto se valora, respeta y cuánta confianza en sí misma setiene una persona Ssemen/semen líquido formado por espermatozoides y otras secreciones de los órganos reproductores masculinos sensory nerve/nervio sensorial nervio que transmite señales desde un órgano sensorial al sistema nerviosocentral, donde se procesan y se organizan set/serie número fijo de repeticiones seguidas por un período de descanso sexual abuse/abuso sexual acto sexual que se produce sin el consentimiento de una persona sexual activity/actividad sexual toda actividad que incluye contacto sexual intencional con la finalidadde excitación sexual sexual assault/agresión sexual toda actividad sexual en la que se utiliza la fuerza o se amenaza conhacerlo sexual harassment/acoso sexual todo comentario, comportamiento o contacto no deseado que tengacontenido sexual sexual intercourse/relación sexual proceso de repro- ducción en el que el pene se introduce en la vagina, ymediante el cual se puede dar comienzo a una vidahumana sexually transmitted disease (STD)/enfermedad de transmisión sexual (ETS) enfermedad infecciosa que se transmite por contacto sexual shock/choque respuesta del cuerpo a un flujo de sangre reducido sibling/hermano hermano o hermana relacionado con otro hermano u otra hermana de sangre, el casamiento de sus padres o la adopción side effect/efecto secundario todo efecto producido por una droga que es diferente al efecto intencionalde la droga sidestream smoke/humo del cigarrillo humo que emana la punta de un cigarrillo skeleton/esqueleto estructura de huesos que sostiene los músculos y órganos y protegen losórganos internos sleep apnea/apnea del sueño trastorno del sueño caracterizado por interrupciones de los patrones derespiración normales durante el sueño sleep deprivation/ausencia de sueño falta de sueño sperm/espermatozoide célula sexual producida por los testículos necesaria para fecundar el óvulo de unamujer SPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 670 SPANISH GLOSSARYspinal cord/médula espinal columna de tejido nervioso que recorre la espalda desde la base del cerebro spinal nerves/nervios espinales nervios que se ramifican de la médula espinal y llegan al cerebro y a los tejidos del cuerpo splint/férula elemento utilizado para estabilizar (mantener firme) una parte del cuerpo sprain/esguince lesión en la que los ligamentos de una articulación se estiran demasiado o se desgarran stimulant/estimulante droga que aumenta temporal- mente la energía y capacidad de atención de unapersona strain/distensión lesión en la que un músculo o un tendón se estiró demasiado o se desgarró stress/estrés respuesta del cuerpo y la mente a una amenaza real o percibida stressor/factor estresante toda situación que es una amenaza o que se percibe como una amenaza stroke/apoplejía ataque repentino de debilidad o parálisis que se produce cuando se interrumpe elflujo de sangre a una zona del cerebro suffocation/sofocación lesión fatal causada por la incapacidad de respirar cuando la nariz y la bocaestán obstruidas o cuando el cuerpo tiene unadeficiencia de oxígeno suicide/suicidio acción intencional de quitarse la vida symptom/síntoma cambio que una persona nota en su cuerpo o mente, causado por una enfermedad oun trastorno synapse/sinapsis espacio muy pequeño que atraviesan los impulsos nerviosos al pasar de unaneurona a otra syphilis/sífilis ETS bacteriana que ocasiona úlceras o chancros; si no se trata, puede ocasionar discapaci-dades físicas y mentales y muerte prematura tar/alquitrán sustancia negra y pegajosa del humo del tabaco que cubre el interior de las vías respira-torias y que contiene muchos carcinógenos target heart rate zone/zona de índice cardíaco objetivo rango de índice cardíaco que se debe alcanzar durante el ejercicio para obtener los beneficios de salud cardiorrespiratoriaTT cell/célula T glóbulo blanco que se forma en el timo y ataca a las células que han sido infectadas por virus tendon/tendón tejido conectivo fuerte que une los músculos a los huesos testis (testicle)/testículo órgano reproductor masculino que produce espermatozoides y testos-terona testosterone/testosterona hormona masculina que elaboran los testículos y que regula característicassexuales masculinas secundarias y la producción deespermatozoides third-degree burn/quemadura de tercer grado quemadura que penetra en todas las capas de la piely los tejidos subyacentes y tiene una apariencia decolor blanco perlado, color tostado o carbonizada tinnitus/zumbido de oídos sonido semejante a un zumbido, timbre o silbido en uno o ambos oídos que ocurre aun cuando no se oye ningún ruido tolerance/tolerancia capacidad de aceptar a las personas por lo que son a pesar de las diferencias;tambien una condición en la que una persona necesita más cantidad de una droga para sentir susefectos originales, condición en la que una personanecesita más cantidad de una droga para sentir susefectos originales tonsils/amígdalas masas pequeñas y redondas de tejido linfático que se encuentran en la garganta tooth decay/degeneración dental proceso en el que el ácido de la placa bacteriana y el sarro destruyenlentamente las superficies duras de los dientes trachea/tráquea tubo largo que transporta aire de la laringe a los pulmones trigger lock/traba de seguridad del gatillo dispos- itivo que ayuda a impedir que un arma se dispare ultraviolet (UV) radiation/radiación ultravioleta (UV) radiación de la luz solar capaz de broncear o quemar la piel universal precautions/precauciones universales conjunto de precauciones que se utilizan para evitar el contacto con líquidos del cuerpo y reducir el riesgode transmisión del VIH y otras enfermedades USPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. SPANISH GLOSSARY 671urinary bladder/vejiga urinaria bolsa hueca y muscular que almacena orina urine/orina líquido segregado por los riñones, que se almacena en la vejiga y atraviesa la uretra al salir del cuerpo uterus/matriz órgano de reproducción femenino que proporciona el lugar donde se contendrá al serhumano en desarrollo vaccine/vacuna sustancia utilizada para hacer que una persona sea inmune a ciertas enfermedades vagina/vagina órgano de reproducción femenino que conecta el exterior del cuerpo con la matriz y querecibe espermatozoides durante la reproducción value/valor una creencia fuerte o ideal vegetarian/vegetariano una dieta alimenticia que incluye poco o nada de productos derivados deanimales vein/vena vaso sanguíneo que transporta la sangre hacia el corazón ventricle/ventrículo una de las dos cámaras muscu- lares grandes que bombean sangre hacia afuera delcorazón violence/violencia fuerza física que se utiliza

para dañar a una persona o una propiedad virus/virus partícula pequeña capaz de causar enfer- medades, formada por material genético y unrevestimiento de proteína vitamin/vitamina una clase de nutrientes que contiene carbono y que es necesaria en pequeñas cantidadespara mantener la salud y permitir el crecimiento wake/velatorio ceremonia para ver a una persona fallecida antes del funeral weight management/manejo del peso programa de hábitos alimenticios y de ejercicios razonables quepermite mantener el peso a un nivel sano wellness/bienestar estado en el que una persona logra los mejores niveles en los seis componentes dela salud WVwhite blood cell/glóbulo blanco célula de la sangre que tiene como función principal defender el cuerpo contra enfermedades withdrawal/supresión síntomas psicológicos y físicos molestos que se producen cuando una persona quetiene dependencia a una droga deja de consumirla wound/herida rotura o desgarro de los tejidos blandos del cuerpo SPANISH GLOSSARY Copyright © by Holt, Rinehart and Winston. All rights reserved. 672 INDEXINDEX Boldface page numbers indicate primary discussions. Numbers followed by a tindi- cate tables, and numbers followed by an f indicate figures. AA (Alcoholics Anonymous), 252 ABCs of first aid, 577, 577 f abstinence, 460–463, 464–468, 479 avoiding sexual contact, 460–461 benefits of, 462factors encouraging, 471 f prevention of STDs, 482, 505waiting until marriage, 461 abuse, 108–1 13 help for victim of, 1 13, 1 13 f protecting yourself from, 1 1 1–1 12, 1 1 1 f types of, 109–1 10 abusive behavior, 108 accidents, fatal, 8, 10 acetaminophen, 220t, 221 acid rain, 548 acne, 567 acquired immune deficiency syndrome (AIDS), 496–497. See also human immunodeficiency virus deaths from, 337 f diagnosis of, 501prevention of, 505–506, 506 t treatment of, 508–509, 508 f action plan, 41–42 active ingredient, 224–225, 225 f active listening, 59 active rest, 141 Activity Pyramid, 136f ADA (Americans with Disabilities Act), 380 addiction, 231,233, 233f. See also alcoholism; drug abuse; tobacco path to, 232–233, 233 f treatment of, 234warning signs of, 232 additives, food, 169 ADHD (attention-deficit/hyperactivity disorder), 70, 71 t adipose tissue, 158 adolescence, 388–394. See also teens mental and emotional changes in, 390–392, 390 f physical changes in, 388–390social changes in, 392–394 adoption, 420 adoptive families, 420 adrenal androgens, 144t adrenaline, 80, 547 adulthood, 179, 395–402 advertising, 34t. See also media messages advocate, 19 aerobic activity, 129 affection, 468, 468 f African sleeping sickness, 333 age, lifestyle diseases and, 341 aggressive communication, 56, 56 tAanimals, diseases spread by, 319, 319 f anorexia nervosa, 204, 205 t antacids, 221 antianxiety medicines, 220t,237f antibiotic resistance, 320, 320 f antibiotics, 220t,223, 227, 320 antibodies, 324, 544 antidepressants, 72, 231 antihistamines, 220t,221, 227, 372 antioxidants, 162 anxiety, 128 anxiety disorders, 70, 71 t apathy, 102 appetite, 190–191 Armstrong, Lance, 430, 430 f arteries, 532f,534, 534 f arthritis, 373–374, 383f,528 artificial colors, 170f artificial nails, 571 ascorbic acid (vitamin C), 162 t aspartame, 170f aspirin, 219, 221 assertive communication, 56, 56 f,56t,75f assertiveness, 1 1 1, 1 1 1 f,11 2 asset, 85, 85 t asthma, 132, 371, 371 f,372–373, 373f asymptomatic infections, 480 atherosclerosis, 343, 345 athletes. See also exercise; sports eating disorders in, 204 nutritional needs of, 179–180safety tips for, 612–613, 612 f use of anabolic steroids by, 144 t,145, 293–294 use of dietary supplements by, 144, 145, 180 water requirements of, 179–180 athlete’s foot, 317, 317 f,321, 333 athletic trainer, 640 atrium, 532, 533, 533 f attention-deficit/hyperactivity disorder (ADHD), 70, 71 t attitudes positive, 86stress and, 86–87wellness and, 16 autoimmune diseases, 371–375, 544 axon, 517, 517 f azidothymidine (AZT), 508 BAC (blood alcohol concentration), 244, 244t,254 bacteria, 316f,317 bacterial diseases, 316f,317 common diseases, 330–331sexually transmitted, 486, 486–487 t treatment of, 320, 320 f balanced diet, 154–155 ball-and-socket joints, 529, 529 f basal metabolic rate (BMR), 192 B cells, 543, 543 tBagility, 130 aging, 401–402 AIDS (acquired immune deficiency syndrome), 496–497. See also human immunodeficiency virus deaths from, 337 f diagnosis of, 501 prevention of, 505–506, 506 t treatment of, 508–509, 508 f air pollutants, 549t airway, checking in emergency, 577, 577 f Al-Anon, 252 Alateen, 252 alcohol, 219, 247. See also drinking avoidance of, 465drunk driving, 253–254, 255effects on body, 232, 242–246, 245 f, 255 as health risk behavior, 9, 10 f lifestyle diseases and, 341, 341 f pregnancy and, 250–251, 446rape and, 1 16saying no to, 256–257, 261 f sexual activity and, 255, 468, 481, 482, 506 teens and, 253–258water loss and, 166 alcohol dependence, 248, 248 f alcohol-free life, 402 Alcoholics Anonymous (AA), 252 alcoholism, 247–252. See also addiction effect on family, 250–251effect on society, 251risk factors for, 249stages in, 248, 248 f teens and, 250treatment of, 252warning signs of, 249 alcohol poisoning, 244–245 alcohol tolerance, 248, 248 f allergies, 371,372, 372f to food, 208–209to medicines, 226–227, 226 f all-terrain vehicle safety, 600–601 alprazolam, 220t aluminum hydroxide, 220t alveoli, 268, 536, 536 f Alzheimer’s disease, 400 amebic dysentery, 333 Americans with Disabilities Act (ADA), 380 amino acids, 160 amniocentesis, 447 amnion, 444 amphetamines, 144t,297 anabolic steroids, 144t,145, 288 t, 293–294 anaerobic activity, 128 analgesics, 220t,221 anaphylactic shock, 226 Androstenidione (Andro), 144 t anemia, 165, 245, 245 f angel dust, 300 anger, 64, 64f, 103 Copyright © by Holt, Rinehart and Winston. All rights reserved. INDEX 673INDEX benign tumor, 349 BHA (food preservative), 170 f BHT (food preservative), 170 f bicycle safety, 602–603 bidis, 265 binge drinking, 244–245 binge eating disorder, 204, 205 t bingeing, 204 biological stressors, 78 biotin, 162t bipolar disorder, 71t birth defects, 180 birth weight, low, 271, 446 bladder, 269f,540, 541 bleeding, 588–589, 588 f blended families, 419 blindness, 377–378 blood, 532–535, 535 f blood alcohol concentration (BAC), 244, 244t,254 blood clots, 270 blood donors, 503 blood glucose, 355, 355 f,356, 358 blood pressure, 344, 346 blood products, spread of HIV by, 503, 506 blood sugar, 17, 18, 132, 156 f BMI (body mass index), 197–198, 197 f BMR (basal metabolic rate), 192 body composition, 129–130, 197 body fat, 155, 197, 389 body composition, 129–130 diet and, 192, 192 f,193 heredity and, 196 body image, 202–203 body language, 60, 60 f body lice, 333 body mass index (BMI), 197–198, 197 f body odor, 567 body piercings, 569 bone injuries, 592–593 bones, 526–528, 527f, 528 f calcium in, 164, 164 f, 165 f healing process of, 528structure of, 528, 528 f boosters, 325 botulism, 318 brain, 516, 516 f, 518–519 drugs and, 230–234effects of alcohol on, 243, 245 f, 246, 255 effects of anabolic steroids on, 294effects of tobacco on, 266, 269 f message sent to the, 230–231, 231 f brain reward system, 232, 286 bran, 157, 157 f brand-name medicines, 224–225 breakfast, 192f breast cancer, 342, 350, 351 t, 352, 436 detection of, 442, 442 f breast cyst, 442 breast-feeding, 177, 449, 503 breast self-examination, 442caring, 468, 468 f carotid pulse, 577f, 578, 582 cartilage, 526, 528, 531 f CAT scan (computerized tomography), 352 CAUTION (acronym), 352 cavities, 572–573 CD4+ cells (helper T cells), 500, 500 f,501, 501f, 507 CDC (Centers for Disease Control and Prevention), 553 t, 565 Centers for Disease Control and Prevention (CDC), 553 t, 565 central nervous system (CNS), 516, 517 certified athletic trainer, 640 cervical cancer, 351t, 440 t, 441 cervix, 437f, 438, 438 f, 448, 448 f, 524 f, 525, 525 f Cesarean section (C-section), 449 CFCs (chlorofluorocarbons), 549 chemical burns, 595 chemotherapy, 352 chest compressions, 583, 583 f, 584, 584 f, 585t chewing tobacco, 264, 265, 267 chickenpox, 316f child abuse, 109 childbirth, 448–449, 448f, 449 f, 525 child development, 450 children first aid for, 581, 581 f, 584, 584 f, 586, nutrition for, 177sexual abuse of, 1 14 Children’s Health Insurance Program (CHIP), 561 chlamydia, 486t, 493 f chlorofluorocarbons (CFCs), 549 choking, 577, 586–587, 586f, 587 f cholera, 319 cholesterol, 159 blood, 127, 157, 158, 159, 168dietary, 159food label information, 168, 170 chromium, 163t chromosomal diseases, 368 chronic diseases, 126–127, 155, 181 chronic obstructive pulmonary disease (COPD), 268 chyme, 539 cigarette smoking, 264, 268. See also tobacco deaths due to, 265effects of smoke on nonsmokers, 270–271 cigars, 264, 265 circadian rhythm, 147 circulatory system, 532–535, 532 f, 533 f, 534f checking circulation in emergency, 577f, 578 circumcision, 432 cirrhosis, 246 clinical trials, 222 cliques, 104breathing, 537, 537 f checking in emergency, 577 f, 578, 579 breathing exercises, 84 breathing rate, 537 breech birth, 449 bronchi, 268, 536, 536 f bronchioles, 268, 372, 373 f, 536, 536 f bronchitis, 268 bronchodilators, 220t budget, 396 bulbourethral gland, 431f, 432, 432 f, 522f, 523 bulimia nervosa, 204, 205 t.See also eating disorders bullying, 104, 104 f burns, 594–595, 594t caffeine, 144t, 148, 166, 200 t calcium, 163t, 164, 164f, 165 f, 182, 528 Calories, 168, 170, 192–193 activities and, 193, 193 f, 213f food and, 155–156, 155 f, 194 f camping safety, 613 cancer, 340, 349–354, 368 causes of, 350community resources for, 353detection of, 352lifestyle and, 6living with, 353metastasis of, 350, 350 f prevention of, 127, 181, 354risk factors for, 10, 155, 178, 194, 341–342 tobacco-related, 268treatment of, 352–353, 352 f types of, 351, 351 t warning signs of, 352 candidiasis, 321 carbohydrates, 154, 156–157, 156f Calories per gram, 155–156, 155 f, 192, 192f complex, 156–157, 156 f food label information, 168, 170simple, 156, 156 f carbon monoxide, 264, 267 carcinogens, 264, 350 carcinoma, 568 cardiac arrest, 582 cardiopulmonary resuscitation (CPR), 578, 582–585, 583f, 584 f cardiorespiratory endurance, 129 fitness standards for teens, 135 t FITT and, 136–137, 136 f cardiovascular diseases, 340, 343–348, 368 detection of, 346prevention of, 348risk factors for, 341–342, 343treatment of, 347types of, 344–345C Copyright © by Holt, Rinehart and Winston. All rights reserved. 674 INDEXINDEX cloves, 265 club drugs, 288t, 292–293, 292 f CNS (central nervous system), 516, 517 cobalamin (vitamin B 12), 162 t, 180, 182, 539 cocaine, 219, 231, 296 t, 297, 311f cochlear implants, 379 codeine, 221, 299 codependency, 250 coercion, 108 coke, 296t cold-related emergencies, 590–591 colds, 318, 324, 332 t collaboration, 31, 31 f collagen, 566 colon cancer, 157, 351 t, 354 colorblindness, 520 coming-of-age ceremonies, 406–407 commitment, 41 1, 421 communication, 55–60 advocacy for health issues and, 20 body language, 60, 60 f effective, 27, 27 f, 614 family, 391, 420importance of, 55listening skills, 59, 59 f speaking skills, 57–58 communication styles, 56 community resources, 27f, 28, 615 compensation, 66t, 67 competition, sports and, 131 complete proteins, 160, 160 f complex diseases, 368 compromise, in marriage, 41 1 compulsions, 70 computerized tomography (CAT scan, CT), 352 conception, 443 concussion, 143t conditioning, 140 confidence, 54 conflict resolution, 106–107 conflicts, 103–104, 103f avoidance of, 105, 105 f consequences, 29, 30 conservation, 549, 550 constipation, 208 constructive criticism, 52 Consumer Product Safety Commission (CPSC), 563 consumers, 27–28, 27 f, 615, 615 f controllable risk factors, 7, 7t cool down, 141 coordination, 130 COPD (chronic obstructive pulmonary disease), 268 coping skills, 27, 27 f, 89–92, 614 copper, 163t corn syrup, 170 coronary artery bypass operation, 347 cortisone cream, 220t coughing, 318, 319 f, 328 cough medicines, 224, 227diet and, 181history of, 361physical fitness and, 132prevention of, 127, 358risk factors for, 130, 155, 194, 341–342treatment of, 17, 18, 18 f, 357–358 type 1, 356, 356 t, 357, 358, 546 type 2, 356, 356 t, 357–358, 546 diabetic coma, 355 diarrhea, 166, 208 diarrheal diseases, 337f diastolic pressure, 346 diet, 84. See also nutrition balanced, 154–155body fat and, 192, 192 f, 193 cancer and, 354cardiovascular disease and, 7 t, 347 choosing snacks, 176diabetes and, 181, 357–358fad, 200–201, 200 t fast-food meals, 186–187healthy aging and, 402junk food, 175–176lifestyle diseases and, 341, 341 f pregnancy and, 446risks for health problems, 10vegetarian, 181–182, 181 f Dietary Guidelines for Americans, 174 Dietary Reference Intakes (DRIs), 167 dietary supplements, 144, 144t, 222, 226 use by athletes, 144, 145, 180 diet pills, 201 digestive problems, 207–208 digestive system, 538–539, 538 f dilation of cervix, 448, 448 f dip, 264, 265, 267 diphenhydramine, 220t direct pressure, 34, 34 t disabilities, 132, 132 f,376–380 disapproval, ways to show, 112 discipline, 416 disease claims, on food labels, 170 f diseases, bacterial, 316 f, 317 common diseases, 330–331sexually transmitted, 486, 486–487 t treatment of, 320, 320 f dislocation, 592, 593 disordered eating pattern, 205t displacement, 66t, 67 disrespectful people, 111 distress, 81, 81 f diuretics, 200t diving safety, 612 divorce, 413–414, 413 f DNA, 196, 370 f Doctor of Medicine (MD), 556, 632 Doctor of Osteopathy (DO), 556 domestic violence, 109, 109f,11 6 dopamine, 232 double sugars, 156, 156 f Down syndrome, 362, 368 dream sleep, 148counseling, for abuse victim, 1 13, 1 13 f Cowper’s gland, 431f, 432, 432 f, 522 f, 523 CPR (cardiopulmonary resuscitation), 578, 582–585, 583f, 584 f CPSC (Consumer Product Safety Commission), 563 crack cocaine, 296t, 297 crash, after cocaine use, 297 cremation, 91 crime, drug abuse and, 302, 304 cross-contamination, 210 C-section (Cesarean section), 449 CT (computerized tomography), 352 culture dating patterns in U.S. and, 472–473influences on wellness and, 14 cyst, 442 cystic fibrosis, 362, 367 t, 368 cystitis, 433t, 440 t Daily Values (DVs), 168 dandruff, 571 dangerous situations, avoidance of, 105, 106f date rape, 1 16, 1 17 date-rape drugs, 1 16, 292, 298 dating. See also teen relationships appropriate dating behavior, 458–459, 458f avoiding the wrong person, 458benefits of, 456changes in U.S. culture, 472–473finding the right person when, 457–458possible problems of, 456 daydreaming, 66t deafness, 378–379 death, leading causes of, 8, 9, 23 f, 121f, 141f decibels, 574, 574 f decision making, 27f, 28, 29–32 Making GREAT Decisions model, 30–31, 30 f, 615, 616–617 deep breathing, 84 defense mechanisms, 66–67, 66 t defensive driving, 599 defibrillation, 585 deforestation, 551 dehydration, 141, 166, 180, 208, 243 delayed puberty, 440t dementia, 246 denial, 66t, 249 dental care, 572–573 depressants, 295, 296 t, 298–299 depression, 51, 68–70, 71t, 95, 128 designated driver, 254 designer drugs, 288t, 292–293, 292 f dextromethorphan (DXM), 299 dextrose, 170 DHEA (dietary supplement), 144 t diabetes, 66, 340, 355–358, 377, 546 detection of, 357D Copyright © by Holt, Rinehart and Winston. All rights reserved. INDEX 675INDEX drinking. See also alcohol binge, 244–245 risks involved in, 255social, 248 DRIs (Dietary Reference Intakes), 167 driving drinking and, 253–254, 253 f,255, 255 f marijuana use and, 290motor vehicle safety, 598–601, 598 f driving under the influence (DUI), 254 driving while intoxicated (DWI), 254 drownproofing, 61 1, 61 1 f drug abuse, 284, 503. See also addiction crime and, 302, 304economic issues of, 303–304, 31 1 f effect on individual, 301–302effect on society, 303–305families and, 302–303as health risk behavior, 9, 10 f pregnancy and, 303, 303 f, 415, 446 rape and, 1 16recovering from, 305risks of, 301–302sexual activity and, 299, 468, 481, 482, 506 violence and, 303 drug addiction, 285, 306 drug combination therapy, for HIV infection, 508, 508 f drug-free life, 301–308 drug information sheet, 223 drug interactions, 227 drugs, 218–221. See also medicines; over- the-counter medicines;prescription medicines brain and, 230–234definition of, 218delivery methods of, 221, 221 f effectiveness of, 218, 222interference with neurotransmitters, 230 medically approved, 222as medicines, 218–219, 222–229safety of, 218, 222side effects of, 219, 227sources of, 219, 219 f drugs of abuse, 219, 223, 231, 284–286, 295–300 avoidance of, 465commonly abused drugs, 287–294, 288t effect on brain, 232, 233path to addiction, 232–233, 233 f physical dependence, 233, 233 f reasons for trying illegal drugs, 285–286 saying no to, 307–308teen use of, 285–286withdrawal from, 233, 233 f drug tolerance, 232, 233 f drug treatment programs, 234, 306 drunk driving, 253–254, 255, 258, 258 f DUI (driving under the influence), 254 DVs (Daily Values), 168environmental stressors, 78 environmental tobacco smoke, 271 ephedra, 144t, 200 t ephedrine, 144t epidemic, 552 epididymis, 431f, 432, 522f, 523 epinephrine, 80, 547 episiotomy, 448 esophagus, 538, 538 f essential amino acids, 160 estrogen, 388, 389, 397, 437, 438, 525, 547 ethnicity, health and, 342 eustress, 80, 81 f excretory system, 540–541, 540 f, 541f exercise, 126. See also athletes; physical fitness Calories use in different activities, 193, 193f, 213f cancer and, 354cardiovascular disease and, 7 t, 347, 348 diabetes and, 358effect on muscles, 531healthy aging and, 402, 402 f lifestyle diseases and, 341, 341 f for stress reduction, 83weight management and, 198–199, 199f expiration date, for food, 170 f expulsion (childbirth), 448, 449 f extended families, 420 external pressure, to be sexually active, 464 eye contact, 59f eye injuries, 575 eyes, 520, 520 f fad diets, 200–201, 200 t fallopian tubes, 437f, 438, 438f, 524, 524f, 525 f families, 418–422 effect of alcoholism on, 250–251effect of drug abuse on, 302–303effect of tobacco on, 273healthy, 420–421, 420 f importance of family relationships, 418types of, 419–420, 425 f family counseling, 422 family problems, 421–422 FAS (fetal alcohol syndrome), 250–251, 415, 447 f, 447 t fast-food meal, 186–187, 194 f fasting, 200t fat-free foods, 168 fatigue, 103 fats, 154, 157–159 Calories per gram, 155–156, 155 f, 192, 192f food label information, 168, 170function in body, 158 fat-soluble vitamins, 161, 161 t FDWI (driving while intoxicated), 254 DXM (dextromethorphan), 299 dysentery, 319 ear, 521, 521 f eating disorders, 51, 71 t, 202–206, 205t athletes and, 204 body image and, 202–203, 202 f professional help for, 206risk factors for, 206 ECG (electrocardiogram), 347, 347 f ecosystem, 549 Ecstasy, 288t, 292, 293 ectopic pregnancy, 447t effectiveness, of drugs, 218, 222 eggs, 430, 438 f, 524, 524 f, 525 f ejaculation, 431, 432, 523 EKG (electrocardiogram), 347, 347 f elder abuse, 110 electrical burns, 595 electrocardiogram (ECG, EKG), 347, 347 f electrocution, 604, 604 f, 605 electrolytes, 164 embryo, 444 embryonic development, 444–445, 445 f emergency equipment, in car, 599 emotional benefits, of abstinence, 462 emotional changes in adolescence, 390–392, 390 f in adulthood, 395, 397–398, 399–400 emotional health, 1 1, 12 f, 26, 61 emotional intimacy, 41 1, 460, 461, 464, 479 emotional maturity, 392 emotions drug effects on, 231expression of, 61, 63–65management of, 64–65response to stress and, 80–81, 81 f empathy, 58 emphysema, 268 enabling, 250 encephalitis, 319 endocrine glands, 545 endocrine system, 545–547, 545 f, 546 t endometriosis, 440t endorphins, 128 endurance cardiorespiratory, 129, 135, 135 t, 136–137, 136 f muscular, 127, 128, 128 f, 135 t, 136 f, 137–138 energy balance, 193–194 energy content, of food, 155–156, 155 f energy requirements, 192–193 of activities, 193, 193 f, 213f engagement, 41 1–412 enriched foods, 170f environment, 15, 548–550, 548f environmental health, 12f, 13, 26 environmental pathogens, 319, 319 fE Copyright © by Holt, Rinehart and Winston. All rights reserved. 676 INDEXINDEX fatty-acid deficiency, 158 fatty acids, 158, 159 FDA (Food and Drug Administration), 222, 226, 553 t, 562, 565 fear, 65 Federal Trade Commission (FTC), 563 female reproductive system, 436–442, 524–525 anatomy of, 437–438, 437 f, 438 f functions of, 436 preventing problems with, 441problems of, 440, 440 t fertilization, 430, 443, 524 fetal alcohol syndrome (FAS), 250–251, 415, 447 f, 447 t fetal development, 445, 445 f fetus, 445 fever, 166 fiber, dietary, 156 f, 157, 157 f fight-or-flight response, 80, 81f, 547 financial concerns in adulthood, 396, 398, 400caring for children, 416health insurance, 560–561 fingernails, 571, 571 f firearm safety, 606–607, 606 f, 607f fire prevention, 604, 604 f first aid, 576 first trimester, 444–445, 445 f fitness program, 133–138. See also physical fitness FITT formula, 136–137, 136 f flashbacks, 300 flatulence, 208 flexibility, 127, 129, 129 f, 135 t, 138 floods, 610, 610 f flu, 210, 318, 332 t flukes, 333 fluoride, 163t flu vaccine, 325 folacin, 162t folate, 162t, 180–181, 446 folic acid, 162t follicle stimulating hormone (FSH), 438, 525 food activities and, 193, 193 f, 213f energy content of, 155–156, 155 f, 192–193, 194 f food allergy, 208–209 Food and Drug Administration (FDA), 222, 226, 553 t, 562, 565 foodborne diseases, 209–210, 318–319, 319f food challenge, 208–209 food choices, 191, 191 f food groups, 171, 171–173 f Food Guide Pyramid, 171, 171–173 f food handling, 210 food intake, 190–191 food intolerance, 209 food labels, 168–169, 168f, 169–170, 170 f food preservatives, 170f food-related illnesses, 207–210glycogen, 156f, 157, 192, 192 f goals, 38–40, 50 action plan for, 41–42in fitness program, 135realistic, 88setting, 27 f, 28, 39–40, 477, 615 gonorrhea, 487t Good Samaritan laws, 577 good sport, 131 GREAT decisions model, 30–31, 30f, 615, 616–617 grieving process, 90, 91 group therapy, 72 guilt, 65 gum diseases, 573 gun safety, 606–607, 606 f, 607f hair, 566, 566 f, 570 hair care, 570–571, 570 f hallucinogens, 295, 296 t, 300 hand signals, bicycle, 603, 603 f handwashing, 328, 328 f hangover, 243 hashish, 288t, 290 hate crime, 104 hazing, 110 HDL (high-density lipoprotein), 159 head lice, 318, 321, 571 health, 66 behaviors causing health problems, 9–10, 10 f in your community, 17–20components of, 1 1–13, 12 f emotional, 1 1, 12 f, 26 environmental, 12 f, 13, 26 life skills and improving, 614–615mental, 12, 12 f, 26 optimal, 13physical, 1 1, 12 f, 26 physical fitness and, 126–132risk factors for health problems, 7, 7 t self-assessment of, 27, 27 f, 614 social, 12, 12 f, 26 spiritual, 12 f, 13, 26 taking charge of yourself, 15–16, 15 t health agencies, 628–631 health careers, 632–641 healthcare products, 562–563, 563 f healthcare provider, 557 evaluation of, 558initial visit with, 557–558 healthcare provider visit fact sheet, 557, 558f healthcare services, 556–559 healthcare team, 228 health claims, on food labels, 170 f health department, local and state, 553, 561 health education, 18, 18 f health insurance, 560–561 health literacy, 15, 15 tHfood safety, 210, 552 f foot odor, 567 foreskin, 432 formula-fed infants, 177 fortified foods, 170f foster families, 420 fracture, 143t, 592, 593 fraud, 562 free radicals, 162 freshness date, 170f friendships, 456, 457 f, 458 supportive friends, 54 frostbite, 591 fructose, 156, 156 f, 170 fruit sugar, 156f FSH (follicle stimulating hormone), 438, 525 FTC (Federal Trade Commission), 563 functional foods, 170f funerals, 91 fungal diseases, 317, 317 f, 321, 333 fungi, 317, 317 f gallbladder, 538f gamma butyrolactone (GBL), 144 t gamma hydroxybutyrate (GHB), 288 t, 292 gangs, 104 GAS (general adaptation syndrome), 82 gas, intestinal, 208 gastric bypass, 201 gastroesophageal reflux disorder (GERD), 539 gateway drugs, 291 GBL (gamma butyrolactone), 144 t general adaptation syndrome (GAS), 82 generic medicines, 224–225 genes, 196, 362, 363, 366 gene therapy, 369, 370 genetically modified foods, 170f genetic counseling, 368, 368 f genetic discrimination, 370 genetic disorders, 362. See also hereditary diseases genetic engineering, 363 genetic fingerprinting, 363 genetic information, uses of, 370 genetic technology, 362–363 genital herpes, 484, 488 t genome, 369 GERD (gastroesophageal reflux disorder), 539 germ, 157, 157 f gestational diabetes, 356t, 357, 447 t GHB (gamma hydroxybutyrate), 288 t, 292 giardiasis, 319 gingivitis, 573 glaucoma, 377 glucose, 156, 156 f, 192 glucose meter, 18 glycerol, 158G Copyright © by Holt, Rinehart and Winston. All rights reserved. INDEX 677INDEX health maintenance organization (HMO), 561 Health on the Net (HON), 565 health-related fitness, 128–130, 130 f healthy fitness zones (HFZ), 135 healthy life, skills for, 614–615, 614 f Healthy People 2010, 555 hearing, 521 protection of, 574–575, 607 hearing aids, 379 hearing impairment, 378–379 heart, 532–533 effect of alcohol on, 243, 245, 245 f effect of tobacco on, 269 f, 270 heart attack, 159, 343, 345, 582 warning signs of, 345 heartbeat, 533 heartburn, 207, 539, 539 f heart disease lifestyle and, 66 prevention of, 127, 157, 158 f, 159, 181 risk factors for, 7, 7 t, 130, 155, 194, 270 stress and, 82, 83 heart sounds, 534 heart transplant, 347 heat exhaustion, 143t, 590 heat-related emergencies, 590–591 heatstroke, 590–591 Heimlich maneuver, 586, 586 f helper T cells (CD4+ cells), 500, 500 f, 501, 501f, 507 hemoglobin, 165, 367, 532 hemophilia, 362, 367 t hepatitis, 246, 318, 332, 332 t, 488 t herbal cigarettes, 265 herbal remedies, 226 hereditary diseases, 366–370 coping with, 368–369, 368 f medical treatment for, 369–370types of, 367–368 heredity, 14 alcoholism and, 249body weight and, 196lifestyle diseases and, 342 hernia, 434 heroin, 296t, 299 HFZ (healthy fitness zones), 135 HGH (human growth hormone), 547 hiccups, 537 high blood pressure, 127, 164, 181, 343, 344 alcohol use and, 245, 245 f ethnicity and, 342risk factors for, 155weight and, 194 high-density lipoprotein (HDL), 159 high-fructose corn syrup, 170 high-risk population, 552–553 hinge joints, 528, 529 f HIV (human immunodeficiency virus), 9, 371, 489 t, 496–497, 500–501. See alsoAIDSibuprofen, 221, 227 idealization, 66t illegal drugs, 284. See also drugs “I” messages, 57–58 immune disorders, 371–375 immune

system, 324, 371, 542–544, 542f effects of alcohol on, 245 f effects of tobacco on, 269 f, 270 impaired driving, 598 implantation, 444 implanted drug pumps, 221, 221 f incest, 11 4 incomplete proteins, 160, 160 f indirect pressure, 34, 34 t infants choking in, 587, 587 f CPR for, 584, 584 f HIV-infected, 503nutrition in infancy, 177rescue breathing for, 581, 581 f with teen parents, 478 infatuation, 411 infectious diseases, 66, 316–321 from animals, 319, 319 f body defenses against, 322–324, 323 f caring for yourself when sick, 326causes of, 316–318, 316 f, 317f common diseases, 329–334deaths from, 337 f environmental pathogens, 319, 319 f foodborne, 209–210, 318–319, 319 f global health issues, 334person-to-person spread of, 318, 319 f preventing spread of, 327–328protecting yourself from, 322–328public health issues, 552–554symptoms of, 326treatment of, 320–321waterborne, 318–319, 319 f when to seek medical care, 326 infertility in females, 441in males, 434 inflammation, 323 inflammatory response, 323 inflections (voice), 57 ingested drugs, 221, 221 f ingredient list, 169–170, 170 f inguinal hernia, 433t inhalants, 288t, 291, 291 f inhaled drugs, 221, 221 f inhibitions, 243 injected drugs, 221, 221 f inner ear, 521, 521 f inpatient care, 559 insoluble fiber, 157 insomnia, 148 insulin, 220t, 355, 363, 539, 546 insulin pump, implanted, 17 integrity, 54 internal bleeding, 588, 589Icommunity action to slow spread of, 509 development of AIDS, 497, 502 drug abuse and, 299infection of T cells, 500, 500 f, 501, 501 f living with, 510, 510 f phases and symptoms of, 501–502prevention of, 505–506, 506 t teens and, 498–499, 504testing for, 507transmission of, 502–504treatment of, 508–509, 508 f in U.S., 498, 513 f worldwide, 496, 497–498, 497 f HIV-antibody tests, 507 hives, 372 HIV positive, 507 HMO (health maintenance organization), 561 home healthcare services, 559 home safety, 604–605, 605 f homicide, 8, 10, 121 f HON (Health on the Net), 565 HONcode, 565 hookworms, 333 hopelessness, 95 hormones, 388, 545–547 menstrual cycle and, 438, 439, 453 f as type of medicine, 220 t HPV (human papilloma virus), 488 t huffing, 291 Human Genome Project, 369 human growth hormone (HGH), 547 human immunodeficiency virus (HIV), 9, 371, 489 t, 496–497, 500–501. See alsoAIDS community action to slow spread of, 509 development of AIDS, 497, 502drug abuse and, 299infection of T cells, 500, 500 f, 501, 501 f living with, 510, 510 f phases and symptoms of, 501–502prevention of, 505–506, 506 t teens and, 498–499, 504testing for, 507transmission of, 502–504treatment of, 508–509, 508 f in U. S., 498, 513 f worldwide, 496, 497–498, 497 f human papilloma virus (HPV), 488 t hunger, 190, 196 hunter safety, 606–607, 607 f Huntington’s disease, 367, 367 t hurricane, 609 hygiene, 327 hypertension, 344. See also high blood pressure hyperthermia, 590 hypochondria, 71t hypoglycemia, 546 hypothermia, 591 Copyright © by Holt, Rinehart and Winston. All rights reserved. 678 INDEXINDEX internal pressure, to be sexually active, 464 Internet, medical information on, 46–47, 564–565 intervention, 306 intestinal gas, 208 intestine, effect of tobacco on, 269 f, 270 intoxication, 242 intravenous drug use, 503 iodine, 163t iron, 163t, 165, 179, 180–181, 182 iron-deficiency anemia, 165 iron supplements, 165 iron toxicity, 165 irradiated foods, 170f jealousy, 65, 458 jock itch, 333, 433 t, 434 Johnson, Ervin “Magic,” 510, 510 f joint injuries, 592–593 joints, 528–529, 529f, 530 junk food, 155, 175–176 Kaposi’s sarcoma, 502 keloids, 569 keratin, 566, 570 Ketamine, 288t, 293 kidney, 540, 540 f kissing disease, 318 knee, 531, 531 f knuckles, cracking of, 528 kreteks, 265 lactic acid, 531 lacto-ovo vegetarian diet, 181 lactose, 156f, 170 lactose intolerance, 209 large intestine, 538, 538 f, 539 larynx, 536, 536 f laughing gas, 291 LDL (low-density lipoprotein), 159 leukemia, 351t, 543 leukocytes, 535 LH (luteinizing hormone), 438, 525 lice, 317f life change stressors, 79, 79 t life expectancy, 402 life skills, 26–28, 27f, 614–615, 614 f lifestyle diseases, 66, 340–342, 553 causes of, 340 risk factors for, 340, 341–342, 341 f life-threatening injuries, 576 ligaments, 129, 531 f, 593 ligament sprain, 143t lightening, 608 lipids, 158LKJevaluation of, 27 f, 28, 615 fast-food ads, 186–187 prescription drug ads, 238–239pressure from, 34 t about tobacco use, 272violence in, 102 Medicaid, 561 medical advances, 17, 17 f, 18f medical alert bracelet, 356f medical emergencies, 576–579 medical history, 369 medical licensing, 555 medical research, 18 medical social worker, 638 Medicare, 561 medicines, 218–219, 222–229. See also drugs allergies to, 226–227, 226 f drug interactions, 227over-the-counter, 220–221, 220 t, 224–225 prescription, 220–221, 220 t, 223, 228 types of, 220–221, 220 t wise use of, 228–229, 229 f melanin, 566, 568 melanoma, 568 memorial services, 91 menarche, 389 meningitis, 331 menopause, 397 menstrual cramps, 440t, 441 menstrual cycle, 438–439, 439f, 525 hormones, 438, 439, 453 f menstruation, 389, 438, 439 f, 525 mental benefits, of exercise, 127 f, 128 mental changes in adolescence, 390–392, 390 f in adulthood, 395, 397–398, 399–400 mental disorders, 12, 68–72, 71t mental health, 12, 12 f, 26, 61 metabolic rate, 127 metabolism, 155 metastasis, 350, 350 f methadone, 306 methamphetamine, 296t, 297 meth labs, 297 methylphenidate (Ritalin), 220 t, 295, 297 MHR (maximum heart rate), 134 middle adulthood, 397–399, 399 t middle-age spread, 179 middle ear, 521, 521 f midlife crisis, 398 milk sugar, 156f minerals, 154, 163, 163t food label information, 169in vegetarian diet, 182 mineral supplements, 164 mini-bike safety, 600–601 minor in possession (MIP), 255 miscarriage, 271, 446, 447 t mistakes, Stop, Think, and Go process to correct, 32 mononucleosis, 318, 332 tliquid formula diet, 200t listening skills, 59, 59 f liver, 538f effects of alcohol on, 243, 245 f, 246 loneliness, 65 look-alike drugs, 293 loss (emotional), 89–92 love between family members, 421in marriage, 41 1 low-density lipoprotein (LDL), 159 low sodium foods, 168 LSD, 300 lung cancer, 268, 271, 350, 351 t lungs, 536, 536 f, 540 f effect of tobacco on, 268, 269 f luteinizing hormone (LH), 438, 525 Lyme disease, 319 lymph, 542 lymphatic system, 324, 542, 542 f lymphatic vessels, 542, 542 f lymph nodes, 324, 542, 542 f lymphocytes, 542, 543, 543 t lymphoma, 351t macrophages, 543, 543 t macular degeneration, 377 MADD (Mothers Against Drunk Driving), 258 magnesium, 163t magnetic resonance imaging (MRI), 352 ma huang, 144t mainstream smoke, 270–271 major depression, 71t Making GREAT Decisions model, 30–31, 30f, 615, 616–617 malaria, 317f, 318, 319, 333 male reproductive system, 430–435, 522–523 anatomy of, 431–432, 431 f, 432 f functions of, 430preventing problems with, 434problems of, 433, 433 t malignant tumor, 349 malnutrition, 164 maltose, 170 mammogram, 352, 442 f managed-care plans, 561 marijuana, 219, 231, 288 t, 289–290, 289f marriage, 396, 410–414, 461 teen, 412 Maslow’s hierarchy of needs, 62–63, 62 f matrix of nails, 571 maximum heart rate (MHR), 134 MD (Doctor of Medicine), 556, 632 MDMA (Ecstasy), 288 t, 292 measles, 318, 332 t media messages, 28 about alcohol use, 257about body image, 203about drug abuse, 284M Copyright © by Holt, Rinehart and Winston. All rights reserved. INDEX 679INDEX monosodium glutamate (MSG), 170 t monounsaturated fats, 159 moods, drug effects on, 231 morphine, 221, 299 Mothers Against Drunk Driving (MADD), 258 motorcycle safety, 600, 600 f motor nerves, 517, 518, 519 motor vehicle accidents, 8, 10, 23 f, 253, 253f, 397 motor vehicle safety, 598–601, 598 f mouth, 538, 538 f effects of alcohol on, 243, 245 f, 246 mouth to mouth, 580 movement disorders, 379–380, 379 f MRI (magnetic resonance imaging), 352 MS (multiple sclerosis), 374–375, 375 f MSG (monosodium glutamate), 170 t mucous membranes, 323, 323 f mucus, 323, 537, 539 multiple sclerosis (MS), 374–375, 375 f mumps, 332t muscle fibers, 530 muscle injuries, 592–593 muscle strain, 143t muscular dystrophy, 362 muscular endurance, 127, 128, 128 f fitness standards for teens, 135 t getting FITT, 136 f, 137–138 muscular strength, 127, 128 fitness standards for teens, 135 t getting FITT, 136 f, 137–138 muscular system, 530–531, 530 f effect of exercise on, 531 mushrooms, hallucinogenic, 300 mutations, 366 nail care, 571, 571 f nasal cavity, 536, 536 f national health agencies, 553–554, 554 t National Institutes of Health (NIH), 553 t, 565 natural childbirth, 449 natural disasters, 608–610 natural products, 226 natural resources, 550 neck injury, 593 needle sharing, 503, 506 negative influences, 33 negative stress, 81 negotiation, 106 neonatal abstinence syndrome, 303 nephrons, 540, 541 f nerves, 516 repair of damaged nerves, 518 nervous system, 516–521, 545 nervous system cancer, 351t neurons, 230, 516, 517, 517f neurotransmitters, 230–231, 231 f, 233, 517, 517 f neutrophils, 543, 543 tNovaries, 430, 437, 437f, 438 f, 524, 524 f, 525f, 545 f, 546 t overcrowding, 553 overdose, 284 overfishing, 551 overpopulation, 550 over-the-counter medicines (OTC medicines), 220–221, 220 t, 224–225, 225f overtraining, 141 overuse injuries, 141–142 overweight, 193, 194–195, 194f, 197, 198. See also obesity; weight cardiovascular disease and, 348 diabetes and, 358 ovulation, 438, 439, 439 f, 524, 525 ovum, 430, 524 oxygen, 536 oxygen debt, 531 ozone, 549 PA (physician’s assistant), 556 pacemaker (cardiac), 347, 533 pain relievers, 237f pancreas, 538f, 539, 545, 545 f, 546 t pancreatic cancer, 354 pandemic, 497 panic disorder, 70, 71 t pantothenic acid (vitamin B 5), 162 t Pap smear, 441 Paralympics, 132 paralysis, 379, 518 paraphrasing, 59 paraplegia, 379 parasitic infections, 317f, 318 common infections, 333sexually transmitted, 488, 489 t treatment of, 321 parathyroid gland, 545, 546 t parental behavior, effects of, 417 parental responsibilities, 415, 416 parenthood, 415–417 child development, 450 parents teens as, 463, 478, 478 f of teens, 416 Parkinson’s disease, 379 passive communication, 56, 56 t pasteurized foods, 170f pathogens, 316f, 317, 317 f, 543, 544 f patient’s rights, 559 PCP (phencyclidine), 288 t,293 PCP (primary care physician), 556, 559 peanut allergy, 209 peer mediation, 106, 106f, 107 peer pressure, 33, 51, 256, 285 pelvic exam, 441 pelvic inflammatory disease (PID), 486 t penicillin, 218, 219 penis, 431–432, 431f, 432 f, 522 f, 523 periosteum, 527, 528, 528 fPniacin (vitamin B 3), 162 t nicotine, 219, 231, 264, 265, 267 addiction to, 266, 268 nicotine substitutes, 274 NIH (National Institutes of Health), 553 t, 565 nitrous oxide, 291 nocturnal emissions, 431 nonessential amino acids, 160 nonrenewable resources, 550 nonverbal communication, 60 norepinephrine, 547 NP (nurse practitioner), 556 NREM sleep, 148 nuclear families, 419 nurse practitioner (NP), 556 nutrient deficiency, 164 nutrient density, 175 nutrients, 154, 622–627 nutrition, 154–156, 553. See also diet in adulthood, 179 for athletes, 179–180, 179 f in childhood, 177Food Guide Pyramid, 171, 171–173 f food labels, 168–169, 168 f, 169–170, 170f during long-term illness, 181in pregnancy, 180–181for teens, 178 nutritional needs, 167–174 obesity, 155, 158, 194–195, 194f, 197. See alsoweight obsessions, 70 obsessive-compulsive disorder, 70, 71 t Occupational Safety and Health Adminis- tration (OSHA), 555, 605 oil gland, 566f older adulthood, 399–400, 399 t, 405 f olfactory nerve, 518 omega-3 fatty acids, 159 opiates, 295, 296 t, 299 opium, 219, 299 opportunistic infections, 501, 502 optic nerve, 520, 520 f oral cancer, 265, 265 f, 268, 354, 573 organic foods, 170f OSHA (Occupational Safety and Health Administration), 555, 605 osteoarthritis, 374 osteoblasts, 527 osteoporosis, 131, 155, 164, 164 f, 397 OTC medicines (over-the-counter medicines), 220–221, 220 t, 224–225, 225f otitis media, 378 outbreak, 552 outer ear, 521, 521 f outpatient care, 559 ovarian cancer, 351t, 441 ovarian cyst, 440tO Copyright © by Holt, Rinehart and Winston. All rights reserved. 680 INDEXINDEX peripheral nervous system (PNS), 516, 516f, 517 peristalsis, 538 personal behavioral stressors, 79 personal health records, 369 personal limits, regarding sexual activity, 465 personal things, giving away, 95 personal watercraft, 612 persuasion, 34t phagocytes, 535 pharynx, 536, 536 f, 538 f phencyclidine (PCP), 300 phobia, 12, 70, 71 t phosphorus, 163t physical barriers, to infectious disease, 322–323, 323 f physical changes in adolescence, 388–390 in adulthood, 395, 397, 399 physical dependence, 233, 233 f physical fitness, 126–132. See also exercise asthma and, 132benefits of, 126–128, 126 f, 127 f diabetes and, 132disability and, 132, 132 f fitness program, 133–138health and, 126–132health-related, 128–130, 130 f skill-related, 130, 130 f sports and, 130–131 physical health, 1 1, 12 f, 26 physicians, 556, 632 physician’s assistant (PA), 556 PI (public intoxication), 255 PID (pelvic inflammatory disease), 486 t pimple, 567 pineal gland, 545, 545 f, 546 t pinworms, 333 pipe tobacco, 264, 265 pituitary gland, 545, 545 f, 546 t pivot joints, 529, 529 f placenta, 525 placental stage, 448–449, 449 f plaque in blood vessel walls, 159dental, 572 plasma, 535, 535 f plasma cells, 543t platelets, 535, 535 f, 543 PMS (premenstrual syndrome), 440 t pneumonia, 502 PNS (peripheral nervous system), 516, 516f, 517 Poison Control Center, 597 poisons, 596–597, 596 t pollution, 548, 549 t, 551 polyunsaturated fats, 159 portion size, 186–187, 199 positive attitude, 16, 86 positive influences, 33 positive stress, 80, 81 post-traumatic stress disorder, 70, 71 t potassium, 163tpuberty, 388 delayed, 440 t physical changes in boys, 388, 389–390, 389 f, 523 physical changes in girls, 388, 389, 389f, 524 pubic lice, 489t public health, 17, 18, 18 f, 334, 552–554, 553t ways individuals can affect society, 19–20, 20 f public intoxication (PI), 255 public policy, 18, 18 f public service announcement (PSA), 20, 20f pupil, 520f purging, 204 pus, 323 put-downs, 34t pyridoxine (vitamin B 6), 162 t, 180, 539 quackery, 562, 563 quadriplegia, 379 radiation therapy, 352, 352 f rape, 1 16 help for victim of, 1 18protecting yourself from, 1 17 rationalization, 66t RDAs (Recommended Dietary Allowances), 167 reaction time, 130 receptors, 545 Recommended Dietary Allowances (RDAs), 167 recovering, from drug abuse, 305 recovery, of fatigued muscles, 140 recreational safety, 61 1–613 recreational vehicles, 600–601 rectum, 538, 538 f recycling, 551 red blood cells, 535, 535 f, 536, 543 Red Cross, 554, 554 f reduced sodium foods, 168 referral, 556, 559 reflex, 519, 519 f refusal skills, 27f, 28, 35, 35 t, 615, 618–619, 618f dealing with pressure, 37, 45 t, 618, 619 practicing, 36, 37, 618preventing abuse, 1 12refusing alcohol, 256–257, 261 f refusing drugs, 307–308refusing sexual activity, 466, 467refusing tobacco, 276saying no with respect, 37 regression, 66tRQpower, 1 15, 130 PPO (preferred provider organization), 551 preexisting condition, 561 pregnancy, 443–447 alcohol use during, 250–251, 446 drug abuse during, 303, 303 f, 415, 446 keeping healthy during, 446–447nutrition during, 180–181, 446problems during, 447, 447 t STDs and, 485teen, 476, 477–478tobacco use during, 271, 415 premarital education classes, 412 premature birth, 271, 446, 447 t premenstrual syndrome (PMS), 440 t premium, 560, 561 prenatal care, 446–447 prescription, 221 prescription medicines, 220–221, 220 t, 228, 223 information in prescription, 223labeling of, 228media messages about, 238–239misuse of, 223, 237 f questions to ask your doctor about, 223 pressure from others, 33–37persistent, 37, 618, 619refusal skills and, 35–37, 618, 619types of, 34, 34 t pressure point, 588f, 589 primary care physician (PCP), 556, 559 prioritizing, 87, 88 problem drinking, 248, 248 f progesterone changes in female body and, 388, 389, 397, 525, 547 ovaries/ovulation and, 437, 438 progressive overload principle, 140 projection, 66t prostate cancer, 350, 351 t, 352, 433 t detection of, 435 prostate gland, 432, 432f, 522 f, 523 prostate specific antigen test (PSA test), 352 prostatitis, 433t protease inhibitors, 508 protective factors, discouraging sexual activity, 467 proteins, 154, 159–160 Calories per gram, 155, 155 f, 192, 192 f in meat-free diet, 181–182 protozoa, 317f, 318 protozoan diseases, 317f, 318, 321, 333 provider, 561 PSA (public service announcement), 20, 20f PSA test (prostate specific antigen test), 352 psilocybin, 300 psychoactive drugs, 223 psychologist, 62 psychotherapy, 72 Copyright © by Holt, Rinehart and Winston. All rights reserved. INDEX 681INDEX relapse, 306 relaxation techniques, 84 remarriage, 413–414, 413 f REM sleep, 148 renal arteries, 540, 541 f renal veins, 540, 541 f renewable resources, 550 repetitions (weight training), 137–138 repression, 66t reproduction, 430 reproductive system female, 436–442, 524–525 male, 430–435, 522–523 rescue breathing, 578, 580–581, 580f, 581f, 583, 583 f, 584, 584 f resiliency, 85, 85 t resistance (weight training), 137 resources, 28 respect disrespectful people, 1 1 1between family members, 420lack of, 103–104 respiratory disease, 10, 337 f, 351t respiratory system, 536–537, 536 f responsibilities of marriage, 41 1of parenthood, 415–416of teens, 393–394 responsible relationships, 456–459, 457 f resting heart rate (RHR), 129, 134, 134 f retina, 520, 520 f Rett syndrome, 379 Reye’s syndrome, 227 rheumatoid arthritis, 371, 373, 374 Rh incompatibility, 447t RHR (resting heart rate), 129, 134, 134 f rib muscles, 537, 537 f riboflavin (vitamin B 2), 162 t RICE technique, 142–143, 142 f, 143 t, 593 ringworm, 317, 333 risk factors, for health problems, 7, 7 t, 8 Ritalin (methylphenidate), 220 t, 295, 297 rites-of-passage, 406–407 RN (registered nurse), 632 Rocky Mountain spotted fever, 319 rohypnol, 296t, 298 roid rage, 294 role models, 34t root canal, 573 roundworms, 318 rubella, 446 saccharine, 170f SADD (Students Against Destructive Decisions), 258 salicin, 219 salivary glands, 538f salmeterol, 220t salmonellosis, 331 salt intake, 164, 402Ssexual assault, 1 16, 11 8 sexual harassment, 11 5 sexual intercourse, 443 sexual intimacy, 460 sexually transmitted diseases (STDs), 9, 480–483, 484–485, 490 alcohol use and, 255 asymptomatic, 480bacterial, 486, 486–487 t epidemic of, 480mistaken ideas about, 484–485parasites, 488, 489 t permanent damage from, 485in pregnancy, 485prevention of, 434, 441, 461, 462, 482–483 seeking treatment for, 490, 490 f teens and, 481–482viral, 488, 488–489 t shin splint, 143t shock, 578–579 siblings, 419 sickle cell anemia, 362, 367–368, 367 f, 367t side effects, of drugs, 219, 227 sidestream smoke, 270 SIDS (sudden infant death syndrome), 271, 446 sign language, 380f single-gene diseases, 367–368, 367 t single-parent families, 419, 425 f sinus infection, 331 skeletal muscles, 530, 530 f skeletal system, 526–528, 527 f skeleton, 525 skill-related fitness, 130, 130 f skin, 322, 323 f, 540 f, 566, 566 f skin cancer, 351t, 352, 354, 549, 568 skin care, 566–569, 567 f skinfold thickness, 197 sleep, 84, 146–148, 324 sleep apnea, 148, 194 sleep deprivation, 146 sleep disorders, 148 small intestine, 538, 538 f, 539 effects of alcohol on, 245 f, 246 smallpox, 334 smoke detector, 604, 604 f smokeless tobacco, 264, 265 smooth muscle, 530 snacks, 176 sneezing, 318, 319 f, 328 snowmobile safety, 600–601 snuff, 264, 265, 267 social benefits of abstinence, 462of physical fitness, 127 f, 128 social changes in adolescence, 392–394in adulthood, 396, 398, 400 social drinking, 248 social health, 12, 12 f, 26 society body image and, 203SAMHSA (Substance Abuse and Mental Health Services Administration),553t sanitation, 553, 555 S-A node (sinoatrial node), 533 satiety, 191, 196 saturated fats, 158, 158 f scabies, 489t schedule, 88 schizophrenia, 71, 71 t SCID (severe combined immunodeficiency disease), 371 scrotum, 431, 431 f, 522, 522 f seat belts, 10, 598, 599 sebaceous glands, 570 secondhand smoke, 271 second trimester, 445, 445 f sedatives, 220t sedentary lifestyle, 9, 10f selenium, 163t self-actualization, 62–63 self-concept, 52 self-confidence, 87 self-diagnosis, Internet and, 46–47 self-esteem, 12, 16, 50–54, 128, 620–621 benefits of high self-esteem, 50–51, 51 f improving, 52, 53, 620–621risks of low self-esteem, 51, 51 f self-examination breast, 352, 442of skin, 352testicular, 352, 435 self-respect, 50 self-talk, 53, 65, 86 sell by date, 170f semen, 432, 523 semimovable joints, 528, 529 f seminal vesicles, 431f,432, 432f, 522 f, 523 seminiferous tubules, 431, 522 semivegetarian diet, 181 sensory nerves, 517, 518, 519 serotonin, 231 serving size, 168, 186–187 set(weight training), 138 severe combined immunodeficiency disease (SCID), 371 sex,lifestyle diseases and, 342 sexual abuse, 1 14, 11 7 sexual activity, 464–468. See also absti- nence; sexually transmitteddiseases alcohol use and, 255, 468, 481, 482, 506 avoiding pressure situations, 465drug abuse and, 468, 481, 482, 506eliminating risks of, 479with multiple partners, 481, 506previous, 468protective factors against, 467refusal of, 466, 467risk factors for, 468risks of, 9, 10 f, 476–477 spread of HIV by, 503 Copyright © by Holt, Rinehart and Winston. All rights reserved. 682 INDEXINDEX society (continued) costs of tobacco use for, 273 effect of alcoholism on, 251effect of drug abuse on, 303–305influences on wellness for, 14ways of addressing health problems, 17–18, 18 f sodium, 163t, 164, 168 soft spot, 526 soluble fiber, 157 speaking skills, 57–58 specialists, 556, 559 Special Olympics, 132 speed, 130 sperm, 430, 431, 522–523 SPF (sun protection factor), 568 spinal cord, 516, 516 f, 519, 519 f spinal injury, 379, 518, 577, 579, 593 spinal nerves, 519 spine, 527f spiritual health, 12f, 13, 26 spleen, 542, 542 f splint, 592 split ends, 570 sports. See also athletes being a good sport, 131choosing your sport, 130competition and, 131fitness and, 130–131safety tips, 612–613, 612 f sports drinks, 165f, 179 sports injuries, 139–145 acute, 139avoiding, 139–142, 140 f chronic, 139recovery from, 143treatment of, 142–143, 143 t sprain, 593 starch, 156–157, 156 f STDs (sexually transmitted diseases), 9, 480–490 alcohol use and, 255asymptomatic, 480bacterial, 486, 486–487 t epidemic of, 480mistaken ideas about, 484–485parasites, 488, 489 t permanent damage from, 485in pregnancy, 485prevention of, 434, 441, 461, 462, 482–483 seeking treatment for, 490, 490 f teens and, 481–482viral, 488, 488–489 t stent, arterial, 347 step-parent, 419 steroid anti-inflammatory medicines, 220t steroids, anabolic, 144 t, 145, 288 t, 293–294 stimulants, 220t, 237 f, 295, 296 t, 297 for weight management, 200ttanning beds, 568 tapeworms, 318, 333, 333 f target heart rate zone, 134 tars, 264, 265, 267 tartar, 572 tattoos, 569 T cell count, 507 T cells, 543, 543 t tears, 323 teasing, 34t technology, solving health problems with, 18, 18 f teen parents, 463, 478, 478f teen pregnancy, 476, 477–478 teen relationships, 456–459. See also dating teens. See also adolescence alcohol and, 250, 253–256body mass index and, 198causes of death for, 8, 9, 23 f, 121f communication with parents, 391conflicts between, 103–104, 103 f fitness standards for, 135 t HIV infection and, 498–499illegal drug use and, 285–286impact of divorce on, 413, 413 f impact of remarriage on, 414inhalants and, 291interacting with older adults, 400marriages involving, 412nutritional needs of, 178overweight, 194, 194 f paid jobs outside the home, 394parents of, 416sleep and, 147STDs and, 481–482suicide and, 94, 94 f teeth, 538, 572–573 temazepam, 220t tendinitis, 143t tendons, 129, 531 f, 593 tendon strain, 143t tension, 83 tension headache, 82, 83 tension-releasing exercises, 84 testes, 389, 430, 431, 431f, 522, 522 f, 545 f testicular cancer, 352, 430, 430 f, 433 t detection of, 434–435 testicular self-examination, 435 testicular torsion, 433t testosterone, 145, 388, 431, 523, 547 tetanus, 319, 330 tetanus booster, 589 tetrahydrocannabinol (THC), 289 thermal burns, 595 thiamin (vitamin B 1), 162 t thinking stressors, 78 third trimester, 445, 445 f threats, 34t throat, effects of alcohol on, 243, 245 f, 246Tstomach, 538, 538 f, 539 effects of alcohol on, 243, 245 f, 246 effects of tobacco on, 269 f, 270 Stop, Think, and Go process, to correct mistakes, 32 strain, 593 strength, muscular, 127, 128, 135 t, 136 f, 137–138 strength training, 131 strep throat, 330 stress, 16, 78–82 causes of, 78–79 emotional response to, 80–81, 81 f, 86–87 health and, 78–82, 348job-related, 99 f loss and, 89physical response to, 80, 81 f stress fracture, 143t stress hormones, 547, 547 f stress management, 83–88 building resiliency, 85, 85 t changing your attitude, 86–87relaxation techniques, 84taking care of yourself, 83–84time management, 87–90 stressors, 78, 79t, 83 stress reduction, 128 stress-related disorders, 82 stretching exercises, 129, 138, 141 stroke, 270, 343, 344, 541 Students Against Destructive Decisions (SADD), 258 subcutaneous layer, 566, 566 f sublimation, 66t, 67, 67 f Substance Abuse and Mental Health Services Administration(SAMHSA), 553 t sucrose, 156, 156 f, 170 sudden infant death syndrome (SIDS), 271, 446 sudden sniffing death syndrome, 291 suffocation, 604, 605 sugars, 156, 156 f suicide, 8, 10, 51, 93–96, 94f warning signs of, 95 sulfites, 170f sulfur, 163t sunburn, 132t, 568 sun exposure, 341, 354 sun protection factor (SPF), 568 sunscreen, 568 supportive network, 111 surgery, for cancer, 352 sutures, 526 sweat, 323 sweat glands, 540, 566 f sweating, 166 swollen glands, 542 symptom, 68, 326 synapses, 230–231, 231 f, 517, 517 f syphilis, 487t systolic pressure, 346 Copyright © by Holt, Rinehart and Winston. All rights reserved. INDEX 683INDEX thymus, 542f, 543, 545, 545 f, 546 t thyroid gland, 545, 545 f, 546 t ticks, 319 time management, 87–90 tinnitus, 378, 574 tobacco-free life, 272–278, 402 tobacco, 264–271 cancer and, 354 cardiovascular disease and, 7 t, 348 dangers of, 264–265, 266, 267–271, 269f effect on families, 273effect on society, 273effects of smoke

on nonsmokers, 270–271 legal issues of, 273lifestyle diseases and, 341, 341 f long-term effects of, 10, 268–270, 268 f, 269f during pregnancy, 271, 415public policy about, 18reasons for, 272refusing tobacco, 276short-term effects of, 267smokeless, 264–265stopping smoking, 20, 274–275, 277 Tolerable Upper Intake Levels (ULs), 167, 180 tolerance of others, 104 tonsils, 542, 542 f tooth brushing technique, 573, 573 f tooth decay, 573 topically applied drugs, 221, 221 f tornado, 609 Tourette’s syndrome, 379 toxemia, 447t toxic shock syndrome (TSS), 440 t toxoplasmosis, 502 trachea, 536, 536 f transdermal patch, 221, 221 f trichomoniasis, 489t triglycerides, 158 TSS (toxic shock syndrome), 440 t tuberculosis, 337f, 502 tumors, 349 typhoid, 319 ulcers, 207 ULs (Tolerable Upper Intake Levels), 167, 180 ultrasound of fetus, 447of heart, 347 ultraviolet radiation (UV radiation), 549, 566, 568 umbilical cord, 444 uncontrollable risk factors, 7, 7t underweight, 198, 200 undescended testes, 433t, 434 UNICEF (United Nations Children’s Fund), 553 t, 554Uwater, in human body, 165–166 waterborne diseases, 318–319 water loss, 165–166 water pills, 200t water pollutants, 549t, 550 water requirement, 154, 165–166, 165f, 541f of athletes, 179–180 water safety, 61 1, 61 1 f water-soluble vitamins, 162, 162 t weather disasters, 608–610 Web sites, medical information on, 46–47, 564–565 weight, 190–195. See also obesity; overweight cardiovascular disease and, 7 t, 348 heredity and, 196 lifestyle diseases and, 341, 341 f maintaining healthy weight, 195, 196–201 weight-loss diet, 195 weight management, 198–200 changing eating habits, 199dangerous practices, 200–201, 200 t exercise and, 199, 199 f weight training, 128, 137, 179 wellness, 13 cultural influences on, 14environmental influences on, 15hereditary influences on, 14practicing wellness, 27, 27 f, 614 social influences on, 14taking charge of yourself, 15–16, 15 t wellness continuum, 13, 13 f wet dreams, 431 white blood cells, 324, 535, 535 f, 543, 543 t WHO (World Health Organization), 553 t, 554 whole-grain products, 157f wilderness safety, 613 withdrawal, 233, 233f, 252workplace safety, 604–605, 605 f World Health Organization (WHO), 553 t, 554 wounds, 588–589, 588 f yeast infection, 321 yellow fever, 319 yoga, 138 “you” messages, 57–58 young adulthood, 395–397, 399 t zero tolerance laws, 254 zinc, 163t, 180, 182 zygote, 443 ZYuniversal precautions, 506, 506 t unsaturated fats, 158–159, 158 f ureter, 540, 541 f urethra of females, 437, 437 f, 524 f of males, 431 f, 432 f, 522 f, 523, 524 f urine and, 432, 540 urinary cancer, 351t urinary tract, 540 urination, 541 urine, 540, 541 uterus, 437f, 438, 438f, 444, 524, 524 f, 525, 525 f UV radiation (ultraviolet radiation), 549, 566, 568 vaccination, 325, 327, 544 f, 553, 554 vaccines, 220t, 325 vagina, 437, 437f, 438 f, 448, 448 f, 525, 525f vaginal irritation, 441 vaginitis, 440t values, 12, 31 vas deferens, 431f, 432, 432f, 522 f, 523 vegans, 181, 182 vegetarian diet, 181–182, 181 f veins, 532f, 534, 534 f verbal communication, 57 very low carbohydrate diets, 200t villi, 539 violence, 51, 102, 102f, 121f avoiding danger, 105, 106 f conflicts between teens, 103–104, 103 f drug abuse and, 303 in families of alcoholics, 250protecting yourself from, 1 17 viral diseases, 316f, 317 common diseases, 332sexually transmitted, 488, 488–489 t treatment of, 321 viral load, 507 viruses, 316f, 317 vision, 520 protection of, 575, 607 visual impairment, 377–378 vitamins, 154, 161–162 bacterial synthesis of, 539during pregnancy, 180food label information, 169in vegetarian diet, 182sources and functions of, 161 t, 162t visual impairments and, 378 vitamin supplements, 164 vomiting, 166 wakes, 91 warm up, 141 waste disposal, 553 WV Copyright © by Holt, Rinehart and Winston. All rights reserved. 684(continued from p. iv) Richard Storey, Ph.D. Professor of Biology Colorado College Colorado Springs, Colorado Marianne Suarez, Ph.D. Postdoctoral Psychology Fellow Center on Child Abuse and Neglect University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma Nathan R. Sullivan, M.S.W. Associate Professor College of Social WorkThe University of KentuckyLexington, Kentucky Josey Templeton, Ed.D. Associate Professor Department of Health, Exercise, and Sports Medicine The Citadel, Military College of South Carolina Charleston, South Carolina Marianne Turow, R.D., L.D. Associate Professor The Culinary Institute of AmericaHyde Park, New York Martin Van Dyke, Ph.D. Professor of Chemistry Emeritus Front Range Community CollegeWestminster, Colorado Graham Watts, Ph.D. Assistant Professor of Health and Safety The University of IndianaBloomington, IndianaDavid Ho, M.D. Professor and Scientific Director Aaron Diamond AIDS Research Center The Rockefeller UniversityNew York, New York Ichiro Kawachi, Ph.D., M.D. Associate Professor of Health and Social Behavior School of Public HealthHarvard UniversityBoston, Massachusetts Leland Lim, M.D., Ph.D. Year II Resident Department of Neurology and Neurological Sciences Stanford University School of Medicine Stanford UniversityPalo Alto, California Iris F. Litt, M.D. Professor Department of Pediatrics and Adolescent Medicine School of Biomedical and Biological Sciences Stanford UniversityPalo Alto, California Ronald G. Munson, M.D.,F.A.A.F.P. Assistant Clinical Professor, Family Practice Health Sciences CenterThe University of TexasSan Antonio, Texas Alexander V. Prokhorov, M.D.,Ph.D. Associate Professor of Behavioral Science M.D. Anderson Cancer CenterThe University of Texas Houston, Texas Gregory A. Schmale, M.D. Assistant Professor Pediatrics and Adolescent Sports Medicine University of WashingtonSeattle, WashingtonHans Steiner, M.D. Professor of Psychiatry and Director of Training Division of Child Psychiatry and Child Development Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford, California Toni Alvarez, L.P.C. Counselor Children’s SolutionsRound Rock, Texas Nancy Daley, Ph.D., L.P.C., C.P.M. Psychologist Austin, Texas Sharon Deutschlander Executive Director Alcohol and Drug Abuse ServicesPort Allegany, Pennsylvania Terry Erwin Hunter Educational Coordinator for the State of Texas Texas Hunter Education ProgramTexas Parks and Wildlife Department Austin, Texas Linda K. Gaul, Ph.D. Epidemiologist Texas Department of HealthAustin, Texas Georgia Girvan Research Specialist Idaho Radar Network CenterBoise State UniversityBoise, Idaho Linda Jones, M.S.P.H. Manager of Systems Development Unit Children with Special Healthcare Needs Division Texas Department of HealthAustin, TexasPROFESSIONAL REVIEWERSMEDICAL REVIEWERS ACADEMIC REVIEWERSAcknowledgments Copyright © by Holt, Rinehart and Winston. All rights reserved. 685William Joy President The Joy Group Wheaton, Illinois Edie Leonard, R.D., L.D. Nutrition Educator Portland, Oregon JoAnn Cope Powell, Ph.D. Learning Specialist and Licensed Psychologist Counseling, Learning and Career Services University of Texas Learning Center The University of TexasAustin, Texas Hal Resides Safety Manager Corpus Christi, Texas Eric Tiemann, E.M.T. Emergency Medical Services Hazardous Waste DivisionTravis County Emergency Medical Services Austin, Texas Lynne E. Whitt Executive Vice President National Center for Health Education New York, New York Dan Aude Magnet Programs Coordinator Montgomery Public SchoolsMontgomery, Alabama Andrew Banks Sexuality Educator LifeGuard Character and Sexuality Education Austin, Texas Robert Baronak Biological Sciences Teacher Donegal High SchoolMount Joy, PennsylvaniaJudy Blanchard District Health Coordinator Newtown Public SchoolsNewtown, Connecticut David Blinn Secondary Sciences Teacher Wrenshall High SchoolWrenshall, Minnesota Johanna Chase School Health Educator Los Angeles County Office of Education Downey, California Michelle Deery Health and Physical Education Teacher Donegal High SchoolMount Joy, Pennsylvania Donna DeFriese Communications Teacher Soddy Daisy High SchoolSoddy Daisy, Tennessee Stacy Feinberg, L.M.H.C. Family Counselor for Autism Broward County School SystemCoral Gables, Florida Arthur Goldsmith Secondary Sciences Teacher Hallendale High SchoolHallendale, Florida Calvin Gross Sports Coach and Health Teacher Rochester High SchoolRochester Hills, Michigan Jacqueline Horowitz-Olstfeld Exceptional Student Educator Broward County School DistrictFort Lauderdale, Florida Jay Jones Sports Coach and Health Teacher Olathe North High SchoolOlathe, Kansas Lincoln LaRoe Coach, United States Olympic Rowing Team Milwaukee, OregonSteward Lipsky Secondary Sciences Teacher Seward High SchoolNew York, New York Alyson Mike Science and Health Teacher East Helena Public School SystemEast Helena, Montana Donna Norwood Secondary Sciences Teacher Monroe High SchoolMonroe, North Carolina Jenna Robles Health Teacher Escondido High SchoolEscondido, California Denice Lee Sandefur Secondary Sciences and Health Teacher Nucla High SchoolNucla, Colorado Bert Sherwood Science and Health Specialist Socorro Independent School District El Paso, Texas Carla Thompson Health Teacher Antioch Community High SchoolAntioch, Illinois Dan Utley Sports Coach and Health Teacher Hilton Head High SchoolHilton Head Island, South Carolina Alexis Wright Principal Rye Country Day SchoolRye, New York Joe Zelmanski Curriculum Coordinator Rochester Adams High SchoolRochester Hills, MichiganTEACHER REVIEWERS Copyright © by Holt, Rinehart and Winston. All rights reserved. 686Executive Editor, High School Biological Sciences and Health Susan Feldkamp Managing Editor Debbie Starr Senior Editor Laura Juárez de Ku Editorial Development Team Helene S. Engler-ChaouatAmy FryNiamh Gray-WilsonAngela HemmeterJoe Slapak Copyeditors Dawn Marie Spinozza, Copyediting Manager Anne-Marie De WittJane A. KirschmanKira J. Watkins Editorial Support Staff Jeanne GrahamMary HelblingShannon OehlerStephanie S. SanchezTanu’e White Editorial Interns Kristina BigelowErica GarzaSarah RayKenneth G. RaymondKyle StockAudra Teinert Online Products Bob Tucek, Executive Editor Wesley M. BainCatherine GallagherDouglas P. Rutley Production Mimi Stockdell, Senior Production Manager Mary T. 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Seattle, WashingtonElectronic Publishing Robert Franklin, EP Manager EP Team Leaders Juan BaqueraSally DewhirstChristopher LucasNanda PatelJoAnn Stringer Senior Production Artists Katrina GnaderLana KauppKim Orne Production Artists Sara BullerEllen KennedyPatty Zepeda Quality Control Barry BishopBecky Golden-HarrellAngela PriddyEllen Rees New Media Armin Gutzmer, Director of Development Melanie Baccus, New Media Coordinator Lydia Doty, Senior Project Manager Marsh Flournoy, Quality Assurance Analyst Cathy Kuhles, Technical Assistant Tara F. Ross, Senior Project Manager Ancillary Development and Production Publicom, Inc., Cambridge, MassachusettsSTAFF CREDITS Copyright © by Holt, Rinehart and Winston. All rights reserved. CREDITS 687CREDITSIllustration Credits Frontmatter: Page xii, Morgan-Cain & Associates; xvii, Ortelius Design. Chapter 1: Page 9, Leslie Kell; 10, Gary Locke/Suzanne Craig Represents Inc.;13, Fian Arroyo; 23, Leslie Kell. Chapter 2: Page 26, Fian Arroyo; 27, Leslie Kell; 38, Marty Roper/Planet Rep. Chapter 4: Page 87, Gary Locke/Suzanne Craig Represents Inc.; 99, Leslie Kell. Chapter 5:Page 121, Leslie Kell. Chapter 6: Page 139, Dan Vascon- cellos; 151, Leslie Kell. Chapter 7: Page 158, Leslie Kell;165, Leslie Kell;167, Marty Roper/Planet Rep; 185, Leslie Kell.Chapter 8: Page 193-194, Leslie Kell; 213, Leslie Kell. Chapter 9: Page 221, Articulate Graphics/Deborah Wolfe Ltd.; 231, Articulate Graphics/ Deborah Wolfe Ltd.; 224,Marty Roper/Planet Rep; 237, Leslie Kell. Chapter 1 1: Page 265, Leslie Kell; 275, Gary Locke/Suzanne Craig RepresentsInc.; 280, Rick Herman. Chapter 12: Page 291, Articulate Graphics/Deborah Wolfe Ltd.; 290, Leslie Kell; 31 1, LeslieKell. Chapter 13: Page 322, Dan Vasconcellos; 337, Leslie Kell. Chapter 14: Page 345, Articulate Graphics/Deborah Wolfe Ltd.; 346, Leslie Kell; 361, Leslie Kell. Chapter 15: Page 373(tr), Leslie Kell; 373(tl), ArticulateGraphics/Deborah Wolfe Ltd.; 383, Leslie Kell. Chapter 16: Page 405, Leslie Kell. Chapter 17: Page 425, Leslie Kell. Chapter 18: Page 431-432,Christy Krames; 437-439,Christy Krames; 439, Leslie Kell; 448-449, Christy Krames; 453,Leslie Kell. Chapter 19: Page 457, Dan Vasconcellos; 462, Dan Vasconcellos; 471, Leslie Kell. Chapter 20: Page 481,Leslie Kell; 493, Leslie Kell. Chapter 21: Page 497, Argosy; 498, Leslie Kell; 501, Leslie Kell; 513, Leslie Kell.HOW YOUR BODY WORKS: Page 516, John Karapelou; 517, Morgan-Cain & Associates; 518, Christy Krames; 519(tr),Articulate Graphics/Deborah Wolfe Ltd.; 519(tl), JohnKarapelou; 520-521, Keith Kasnot; 522, Christy Krames; 524,Christy Krames; 525, Christy Krames; 527, John Karapelou;528, Network Graphics; 529-531, John Karapelou; 532,Morgan-Cain & Associates; 534, Christy Krames & Morgan-Cain & Associates; 536-538, John Karapelou; 540, JohnKarapelou; 541, Christy Krames; 544, Articulate Graphics/Deborah Wolfe Ltd.; 545, John Karapelou; FIRST AID AND SAFETY: All illustrations in the chapter done by Marcia Hartsock/The Medical Art Company. WHAT YOU NEED TO KNOW ABOUT: Page 566, Morgan-Cain & Associates; 572, Articulate Graphics/ Deborah Wolfe Ltd. YOUR HEALTH YOUR WORLD: Gary Locke/Suzanne Craig Represents Inc. Photography Credits Abbreviations used :(t) top, (b) bottom, (c) center, (l) left, (r) right, (bkgd) background Border design on Contents in Brief page, Table of Contents pages, Analyzing Data features, Real Life Activity features,and Life Skills features, Digital Image ©2004 EyeWire i (c), Scott Van Osdol/HRW; ii (tr), ©Chad Slattery/Getty Images/Stone; v (all), Peter Van Steen/HRW; v (bl), Peter VanSteen/HRW TABLE OF CONTENTS: vi (tl), Corbis Images; vi (bl), David Young-Wolff/PhotoEdit; vii (br), John Langford/ HRW; viii (tl), ©Clay Patrick McBride/Photonica; viii (cl), Digital Image©2004 Artville; ix (cr), Digital Image ©2004 EyeWire; ix (bl),©Ariel Skelley/CORBIS; x (tl), John Langford/HRW; xi (tl),©Don Smetzer/Getty Images/ Stone; xi (cr), CatrinaGenovese/Index Stock Imagery/ PictureQuest; xi (br), DigitalImage ©2004 PhotoDisc; xii (bl), K. Beebe/Custom MedicalStock Photo; xiii (tr), ©Ariel Skelley/CORBIS; xiv (tl), MaryKate Denny/ PhotoEdit; xiv (bl,bc), ©2004 Luciano A. Leonc/o MIRA; xiv (br), Michael Newman/PhotoEdit; xv (cr),©Bob Daemmrich/The Image Works; xvi (c), Digital Image©2004 PhotoDisc UNIT 1: 2-3 (all), ©Werran/Ochsner/Photonica Chapter 1: 4- 5 (all), Digital Image ©2004 PhotoDisc; 6 (bl), Grantpix/Index Stock Imagery, Inc.; 8 (t), John Langford/HRW; 1 1 (cr), Digital Image ©2004 Artville; 12 (tc), ©DavidYoung-Wolff/Getty Images/Stone; 14 (bc), Corbis Images; 16(tl), Victoria Smith/HRW; 17 (cr), ©Richard Radstone/Getty Images/Taxi; 18 (tcr), ©Martin H. Simon/ Corbis SABA; 18 (tr), ©Rob Gage/Getty Images/Taxi; 18 (tcl), ©Saturn Stills/ SPL/Photo Researchers, Inc.; 18 (tl), ©V.C.L./Getty Images/ Taxi; 19 (br), David Young-Wolff/ PhotoEdit; 20 (tl), DavidWeintraub/Stock Boston Chapter 2: 24-25 (all), ©Nancy Richmond/The Image Works; 29 (br), Robert Wood/HRW;31 (br), Jonathan Nourok/PhotoEdit; 32 (cl), CorbisImages/HRW; 33 (cr), Spencer Grant/PhotoEdit; 34 (tr, cr),Digital Image ©2004 PhotoDisc; 34 (cl), John Langford/ HRW; 35 (tr), Myrleen Ferguson Cate/Photo Edit; 36 (bl),Mary Kate Denny/PhotoEdit; 39 (tr), Peter Van Steen/HRW;40 (b), ©Bob Daemmrich/The Image Works; 41 (br), ©BobBishop/FoodPix; 171 (eggs), Corbis Images; 171 (broccoli),Corbis Images; 171 (potato), Christina Peters/FoodPix; 171(carrot), ©Burke/Triolo Productions/Getty Images/FoodPix; 171 (grapes), ©Stockbyte; 171 (tomato), ©Stockbyte; 171 (strawberries), Corbis Images; 171 (orange), ©Stockbyte; 171 (oatmeal), Sam Dudgeon/HRW; 171 (pretzel), Digital Image ©2004 PhotoDisc; 171 (bread), Victoria Smith/ HRW; 171 (candy), Digital Image ©2004 PhotoDisc; 171 (pasta), ©Stockbyte; 172 (tl), Sam Dudgeon/HRW; 172 (tc, bc), Peter Van Steen/HRW; 173 (tc, c), Peter Van Steen/HRW; 173 (cl,br), Sam Dudgeon/HRW; 175 (br), John Langford/HRW;177 (b), ©Jon Riley/Getty Images/ Stone; 178 (br), Digital Image ©2004 PhotoDisc; 179 (cr), ©Tom Hauck/Allsport/ Getty Images; 180 (tr), ©Peter Cade/Getty Images/Stone; 181 (tr), Sam Dudgeon/HRW; 182 (tl), Peter Van Steen/HRW;183 (tr), Digital Image ©2004 PhotoDisc; 183 (tl), Peter Van Steen/HRW; 183 (bl), ©Tom Hauck/Allsport/Getty Images; 186 (bl), Victoria Smith/HRW; 187 (tr), Digital Image ©2004 PhotoDisc Chapter 8: 188-189 (all), Rubberball Produc- tions®; 191 (t), Ed Lallo/HRW; 193 (tl, cl), Digital Image ©2004 PhotoDisc; 193 (c, cr), ©Scott Markewitz/Getty Images/Taxi; 193 (br), Jonathan Nourok/ PhotoEdit/Picture-Quest; 194 (tl), Victoria Smith/HRW; 195 (tr), MerrittVincent/PhotoEdit/PictureQuest; 196 (cl), ©Layne Kennedy/ CORBIS; 197 (br), ©V.C.L./Getty Images/Taxi; 200 (br), Peter Van Steen/HRW; 202 (cl), Digital Image ©2004 PhotoDisc; 203 (br), Ed Lallo/ HRW; 204 (b), ©Charles Thatcher/Getty Images/Stone; 205 (tr), Nina Berman/SIPA Press; 207 (cr), Victoria Smith/HRW; 208 (cl), ©Zigy Kaluzny/Getty Images/ Stone; 209 (bc, br), John Langford/HRW; 21 1 (tr), ©Scott Markewitz/Getty Images/Taxi; 21 1 (cl), Digital Image ©2004 PhotoDisc UNIT 3: 214-215 (all), ©David Job/Getty Images/Stone Chapter 9: 216-217 (all), ©Romilly Lockyer/Getty Images/ The Image Bank; 218 (cl), Bob Daemmrich/Stock Boston; 219 (tc), Digital Image ©2004 Artville; 219 (tl), ©Richard Hamilton Smith/CORBIS; 219 (tr), ©R. Laurence/Photo Researchers, Inc.; 222 (cl), Sam Dudgeon/HRW; 223 (tr), ©CC Studio/SPL/Photo Researchers, Inc.; 225 (t), Victoria Smith/HRW; 226 (bl), ©Dr. P. Marazzi/Photo Researchers, Inc.; 227 (tr), ©Color Day Production/Getty Images/The Image Bank; 229 (cr), Digital Image ©2004 Artville; 230 (cl), Digital Image ©2004 PhotoDisc; 232 (br), ©Clay Patrick McBride/ Photonica; 235 (tr), Bob Daemmrich/Stock Boston; 235 (cl), Digital Image ©2004 Artville; 235 (bl), ©Clay Patrick McBride/Photonica; 238 (bl), Victoria Smith/ HRW; 239 (tl), Victoria Smith/HRW Chapter 10: 240-241 (all), Mike Derer/AP/Wide World Photos; 242 (cl), SamDudgeon/ HRW; 243 (tr), ©Chad Slattery/Getty Images/ Stone; 244 (bl), ©Simon Battensby/Getty Images/Stone; 247 (bl), Digital Image ©2004 PhotoDisc; 249 (tr), ©Nick White/Getty Images/Taxi; 250 (cl), Peter Byron/ PhotoEdit;252 (tl), Mary Kate Denny/PhotoEdit; 253 (br), PaulConklin/PhotoEdit; 255 (b), Digital Image ©2004 PhotoDisc; 256 (cl), Steven Skjold/Painet; 257 (br), ©Syracuse Newspapers/Kevin Jacobus/The Image Works; 258 (tr, tc), ©2004 Luciano A. Leon c/o MIRA; 258 (tl), Michael Newman/PhotoEdit; 259 (tr), ©Syracuse Newspapers/Kevin Jacobus/The Image Works; 259 (cl), Peter Byron/PhotoEdit;259 (bl), Digital Image ©2004 PhotoDisc Chapter 1 1: 262- 263 (all), ©SuperStock; 264 (cl), ©Terry Williams/Getty Images/The Image Bank; 265 (tr), Photo courtesy of OralHealth America/Romano & Associates; 266 (tr), LouieBalukoff/AP/Wide World Photos; 268 (tl), Victor R. Caivano/AP/Wide World Photos; 269 (tr), Gladden Willis/VisualsUnlimited; 269 (bc), ©Martin M. Rotker/Photo Researchers, Inc.; 269 (tc), Carolina Biological/Visuals Unlimited; 269(bl), Visuals Unlimited; 269 (tl), Custom Medical StockPhoto; 269 (c), Victoria Smith/HRW; 270 (br), CustomMedical Stock Photo; 271 (tr), ©Collection CNRI/ Phototake; 272 (cl), ©Peter Poulides/Getty Images/Stone; 273 (bl), Bruce Coleman, Inc.; 276 (bl), ©Image 100/ CORBIS; 277 (br), Don Couch/HRW; 278 (tl), Bill Haber/AP/Wide WorldPhotos Chapter 12: 282-283 (all), ©Spencer Rowell/Getty Images/Taxi; 284 (tr), ©Ted Horowitz/Corbis Stock Market; 284 (cl, cr), ©2002 PhotoAlto; 284 (bl), ©Ariel Skelley/ Corbis Stock Market; 284 (br), Corbis Images; 285 (tl),Digital Image ©2004 PhotoDisc; 286 (tl), Digital Image ©2004 PhotoDisc; 287 (br), Darrin Jenkins/Pictor/Image State; 289 (b), ©Phil Schermeister/CORBIS; 292 (tl), Eric Mason/AP/Wide World Photos; 293 (cr), Patriot-News, JoeHermitt/ AP/Wide World Photos; 294 (tl), Corbis Images/HRW; 295 (br), William F. Campbell/TimePix; 297 (tr), ©Clay Patrick McBride/Photonica; 298 (b), Victoria Smith/Daemmrich/The Image Works; 42 (tl), Peter Van Steen/HRW; 43 (tr), Robert Wood/HRW; 43 (cl), Corbis Images/HRW; 47 (tr), Sam Dudgeon/HRW Chapter 3: 48-49 (all), David Young-Wolff/PhotoEdit; 50 (cl), ©Dick Clintsman/ Getty Images/Stone; 51 (all), ©Stockbyte; 52 (tr), Michael Newman/PhotoEdit; 53 (br), Victoria Smith/HRW; 55 (cr),Spencer Grant/PhotoEdit; 56 (cl), John Langford/HRW; 58(bl), John Langford/HRW; 59 (tr), ©Reed Kaestner/CORBIS; 60 (tl), ©Bruce Ayres/Getty Images/Stone; 61 (cr), Digital Image ©2004 EyeWire; 64 (bl), Digital Image ©2004 PhotoDisc; 65 (tr), Jim Cooper/AP/Wide World Photos; 67 (tr), Ralf-Finn Hestoft/Index Stock Imagery, Inc.; 68 (cl), ©Lisette Le Bon/SuperStock; 69 (tl), ©Arthur Tilley/Getty Images/ Taxi; 70 (bl), ©Charles Nes/Getty Images/Stone; 72 (tl), ©Jon Bradley/Getty Images/Stone; 73 (tr), ©Lisette Le Bon/SuperStock; 73 (cl), ©Dick Clintsman/Getty Images/ Stone; 73 (bl), ©Arthur Tilley/Getty Images/Taxi Chapter 4: 76-77 (all), Digital Image ©2004 PhotoDisc; 78 (cl), ©Benelux Press/Getty Images/Taxi; 80 (tl), ©Chris Shinn/ Getty Images/Stone; 81 (all), John Langford/HRW; 83 (br), ©Lori Adamski Peek/Getty Images/Stone; 84 (cl), ©Jack Hollingsworth/CORBIS; 86 (bl), ©David Rosenberg/Getty Images/Stone; 88 (tl), ©Color Day Production/Getty Images/ The Image Bank; 89 (cr), age fotostock/Jonnie Miles; 90 (b), ©Ewa Grochowiak/Corbis Sygma; 91 (br), ©Annie Griffiths Belt/CORBIS; 93 (cr), ©Richard Lord/The Image Works; 94 (b), ©Laurence Monneret/Getty Images/Stone; 96 (tl), ©Christian Lantry/Getty Images/Stone; 97 (tr), ©Benelux Press/Getty Images/Taxi; 97 (cl), ©Ewa Grochowiak/Corbis Sygma; 97 (bl), ©Richard Lord/The Image Works Chapter 5: 100-101 (all), ©Lucidio Studio Inc./CORBIS; 102 (tl), ©Seth Kushner/Getty Images/Stone; 103 (bl), George Emmons/ Index Stock Imagery, Inc.; 104 (tl), ©Spencer Rowell/ Getty Images/Taxi; 105 (tr), Robert F. Bukaty/AP/Wide World Photos; 106 (b), John Langford/HRW; 108 (cl), ©Robert Essel/Corbis Stock Market; 109 (bc), ©Lawrence Manning/ CORBIS; 1 10 (tl), ©Karine Dilthey/Getty Images/Taxi; 1 1 1 (bl), Digital Image ©2004 PhotoDisc; 1 12 (br), John Langford/HRW; 1 13 (tr), ©Bruce Ayres/ Getty Images/Stone; 1 14 (cl), ©Denis Felix/Getty Images/ Taxi; 1 17 (br), Grantpix/ Index Stock Imagery, Inc.; 1 18 (tl), SW Production/IndexStock Imagery, Inc.; 1 19 (tr), ©Lawrence Manning/CORBIS; 1 19 (cl), Digital Image ©2004 PhotoDisc; 1 19 (bl), ©Denis Felix/Getty Images/ Taxi UNIT 2: 122-123 (all), ©Dick Clintsman/Getty Images/ Stone Chapter 6: 124-125 (all), ©Lori Adamski Peek/ Getty Images/Stone; 126 (cl), Scott Vallance/HRW; 127 (bc), John Langford/HRW; 127 (cl), ©V.C.L./Getty Images/Taxi; 127 (cr), ©SPL/Photo Researchers, Inc.; 127 (br), ©Photo Researchers, Inc.; 128 (bl), ©Lawrence Migdale/Getty Images/Stone; 129 (tr), ©Michael Darter/ Photonica; 130 (bl), ©Syracuse Newspapers/The Image Works; 131 (tl), David Young-Wolff/PhotoEdit; 132 (tl), Mary Steinbacher/PhotoEdit; 132 (cl), Bob Daemmrich/ Stock Boston,Inc./PictureQuest; 133 (cr), ©James Muldowney/Getty Images/Stone; 134 (bl), Michael Newman/PictureQuest; 136(cr), Mark Gibson Photography; 136 (cl), David Schmidt/Masterfile; 136 (br), Steve Fitzpatrick/Masterfile; 136 (bl),Andrew Olney/ Masterfile; 140 (b), Mark Gibson Photog-raphy; 141 (tr), ©Terje Rakke/Getty Images/The Image Bank; 142 (bl), ©Bob Daemmrich/The Image Works; 144 (cl), Custom Medical Stock Photo; 146 (cl), ©David Lassman/ Syracuse Newspapers/The Image Works; 147 (tr), DigitalImage ©2004 PhotoDisc; 147 (br), ©Malcolm Piers/Getty Images/The Image Bank; 149 (tr), Bob Daemmrich/StockBoston, Inc./PictureQuest; 149 (cl), ©James Muldowney/ Getty Images/Stone; 149 (bl), ©Bob Daemmrich/The Image Works Chapter 7: 152-153 (all), Carl A. Stimac/ The Image Finders; 154 (cl), Scott Lanza/FoodPix; 155 (tl, br, bl), SamDudgeon/HRW; 155 (tr, bc), Digital Image ©2004 PhotoDisc; 156 (cl), Peter Van Steen/HRW; 157 (tr), DigitalImage ©2004 PhotoDisc; 157 (tc), Sam Dudgeon/HRW; 158 (tc), Digital Image ©2004 PhotoDisc; 159 (cr), Digital Image ©2004 PhotoDisc; 160 (all), Sam Dudgeon/HRW; 161 (cr), Sam Dudgeon/ HRW; 162 (tr), Sam Dudgeon/HRW; 162 (c),Corbis Images; 162 (br, bc), Digital Image ©2004 PhotoDisc; 163 (tr), ©Stockbyte; 163 (cr, bc), Digital Image ©2004 PhotoDisc; 164 (cl), Peter Griffith/Masterfile; 164 (tr, br), ©Dr. M. Klein/Peter Arnold, Inc.; 165 (tr, br), Sam Dudgeon/ HRW; 165 (tl), John Langford/HRW; 166 (tl), ©Robert Daly/Getty Images/Stone; 168 (tl), Victoria Smith/HRW; 171(oil), Digital Image ©2004 PhotoDisc; 171 (yogurt), Sam Dudgeon/HRW; 171 (milk), Corbis Images; 171 (cheese), ©Stockbyte; 171 (fish), ©Stockbyte; 171 (chicken), David Copyright © by Holt, Rinehart and Winston. All rights reserved. 688 CREDITSCREDITS HRW; 299 (tr), Gari Wyn Williams/Pictor/Image State; 300 (tl), Chuck Nacke/Woodfin Camp/PictureQuest; 301 (cr),Robert F. Bukaty/AP/Wide World Photos; 302 (bl), DonCouch/HRW; 303 (tr), ©Annie Griffiths Belt/ CORBIS; 304 (br), Akos Szilvasi/Stock, Boston Inc./ PictureQuest; 305 (tr),Paul Conklin/ PhotoEdit/PictureQuest; 305 (tl), ©Moritz Steiger/Getty Images/The Image Bank; 306 (b), Mary KateDenny/PhotoEdit; 307 (br), Digital Image ©2004 PhotoDisc; 308 (tl), ©Lori Adamski Peek/Getty Images/Stone; 309 (tr), ©2002 PhotoAlto; 309 (cl), Eric Mason/AP/Wide World Photos UNIT 4: 312-313 (all), ©R.W. Jones/CORBIS Chapter 13: 314-315 (all), ©Jim Sulley/The Image Works; 316 (bl), ©Dr. P. Marazzi/SPL/Photo Researchers, Inc.; 316 (br), ©Lowell Georgia/Photo Researchers, Inc.; 316 (bc), ©Oliver Meckes/ Photo Researchers, Inc.; 316 (c), ©Oliver Meckes/ Gelderblom/Photo Researchers, Inc.; 317 (cl), ©John Watney/Photo Researchers, Inc.; 317 (cr), NMSB/Custom Medical Stock Photo; 317 (br), ©Oliver Meckes/Photo Researchers, Inc.; 317 (bl), ©David Scharf/Peter Arnold, Inc.; 317 (c), ©Meckes/Ottawa/ Photo Researchers, Inc.; 317 (bc), ©Mark Clarke/SPL/ Photo Researchers, Inc.; 319 (cl), ©Matt Meadows/Peter Arnold, Inc.; 319 (bc), Michael Newman/ PhotoEdit; 319 (cr), John Langford/HRW; 319 (br), ©Jack K. Clark/The Image Works; 323 (tc), ©Don Smetzer/Getty Images/ Stone; 323 (tl), Custom Medical Stock Photo; 323 (tc, tr), Sam Dudgeon/HRW; 324 (cl), ©Bill O’Conner/Peter Arnold, Inc.; 325 (tr), Michelle Bridwell/PhotoEdit; 326 (b),Kenneth Jarecke/Contact Press Images; 327 (br), Peter VanSteen/HRW; 328 (tl), Digital Image ©2004 PhotoDisc; 329 (bl), Davis Barber/PhotoEdit; 330 (bkgd), Sam Dudgeon/HRW; 330 (bl), Bob Daemmrich/ Stock Boston; 332 (tl),Mary Kate Denny/PhotoEdit; 333 (br), ©Andrew Syred/ SPL/Photo Researchers, Inc.; 334 (tl), ©S. Nagendra/Photo Researchers, Inc.; 335 (tr), NMSB/Custom Medical StockPhoto; 335 (cl), Sam Dudgeon/HRW; 335 (bl), ©S. Nagendra/ Photo Researchers, Inc. Chapter 14: 338-339 (all), ©Peter Cade/Getty Images/The Image Bank; 341 (bl), Digital Image ©2004 EyeWire; 342 (tl), Digital Image ©2004 PhotoDisc; 343 (cr), Peter Van Steen/HRW; 344 (c), VictoriaSmith/HRW; 344 (tc), Art & Science/Custom Medical StockPhoto; 344 (bc), ©Adamsmith/SuperStock; 345 (tr), Digital Image ©2004 PhotoDisc; 347 (tr), ©Geoff Tompkinson/SPL/ Photo Researchers, INC.; 348 (tl), Mark Gallup/Pictor/ImageState; 349 (br), AP Photo/Midland Daily News/Jan-MichaelStump; 351 (bc), ©Triller-Berretti/Barts Medical Library/ Phototake; 351 (tr), ©Photo Researchers, Inc.; 353 (br), Sam Dudgeon/HRW; 355 (br), ©Yoav Levy/Phototake; 356 (cl), Michael Newman/PhotoEdit; 357 (tl), Jan Sonnenmair/ Aurora; 358 (tl), ©Tim Bieber/Getty Images/ The Image Bank; 359 (tr), ©Photo Researchers, Inc.; 359 (cl), Peter Van Steen/HRW; 359 (bl), Michael Newman/ PhotoEdit; 362(bl), Laurie Bayer/Image State; 362 (cl), ©David Parker/SPL/ Photo Researchers, Inc.; 362-363 (b), ©Dept. Of Clinical Cytogenetics, Addenbrookes Hospital/SPL/PhotoResearchers, Inc. Chapter 15: 364-365 (all), ©Ariel Skelley/CORBIS; 366 (cl), ©Arthur Tilley/Getty Images/Taxi; 367 (tr), ©Meckes/Ottawa/ Photo Researchers, Inc.; 368 (bl), ©James King-Holmes/ Photo Researchers, Inc.; 368 (bc), ©Dept. of Clinical Cytogenetics, Addenbrookes Hospital/ SPL/Photo Researchers, Inc.; 370 (tl), ©Ken Eward/BioGrafx/ Photo Researchers, Inc.; 371 (cr), ©Jennie Woodcock/Reflec- tions Photolibrary/CORBIS; 372 (tl), Sam Dudgeon/HRW;372 (cl), ©Ralph C. Eagle, Jr./Photo Researchers, Inc.; 374 (tl), ©Ed Kashi/CORBIS; 374 (tr), ©Salisbury District Hospital/Photo Researchers, Inc.; 375 (tr), DavidZalubowski/AP/Wide World Photos; 376 (bl), Chuck Close,Self-Portrait, 1993, oil on canvas, 72 x 60”, Portrait of theartist with work in progress, Photograph by Ellen PageWilson, Courtesy of PaceWildenstein ©Chuck Close; 377 (br), Peter Van Steen/HRW; 378 (bl), Steph/VISUAL/ZUMAPress; 379 (b), ©Tim Wright/ CORBIS; 380 (cl), ©Jack Kurtz/The Image Works; 381 (tr), ©Meckes/Ottawa/Photo Researchers, Inc.; 381 (cl), David Zalubowski/AP/WideWorld Photos; 381 (bl), ©Tim Wright/CORBIS UNIT 5: 384-385 (all), ©Rob Lewine/CORBIS Chapter

16: 386-387 (all), John Langford/HRW; 388 (cl), Digital Image ©2004 PhotoDisc; 389 (br, bl), Digital Image ©2004 PhotoDisc; 390 (cl), Digital Image ©2004 PhotoDisc; 395 (cr), John Langford/HRW; 396 (bl), Digital Image ©2004 PhotoDisc; 397 (br), ©Steven Peters/Getty Images/Stone; 398 (tl), ©Laurence Fleury/ Explorer/Photo Researchers, Inc.; 399 (br), ©Nick Sinclair/Photonica; 400 (tl), Digital Image ©2004 PhotoDisc; 401 (br), ©Mark Scott/Getty Images/Taxi; 402 (tl), ©vq production/Iconotec; 403 (tr), ©Mark Scott/544 (tl), ©Richard Price/Getty Images/Taxi; 547 (tr), ©Spencer Rowell/Getty Images/Taxi EXPRESS LESSON/WHAT YOU NEED TO KNOW ABOUT:548 (b), ©Jamsen/Premium/Panoramic Images, Chicago 2004; 550 (bl), ©Kelly-Mooney Photography/ CORBIS; 552 (bl), Custom Medical Stock Photo; 554 (tl), Mark Richards/PhotoEdit; 554 (cl), Laurent Rebours/AP/Wide WorldPhotos; 554 (cr), Custom Medical Stock Photo; 554 (tr), ©Howard Davies/CORBIS; 555 (tr), ©Digital Vision; 556 (br), Digital Image ©2004 PhotoDisc; 557 (tl), ©Chronis Jons/Getty Images/Stone; 558 (bl), ©COMSTOCK, Inc.; 560 (tr), Digital Image ©2004 Artville; 563 (tc), Sam Dudgeon/ HRW; 567 (tr), Digital Image ©2004 PhotoDisc; 568 (tl), David Young-Wolff/PhotoEdit; 569 (tr), Digital Image ©2004 EyeWire; 570 (bl), ©Donna Day/Getty Images/Stone; 571 (tr), Randy Taylor/Index Stock Imagery, Inc.; 573 (tc), K.Beebe/Custom Medical Stock Photo; 573 (tr), ©Jennie Woodcock/Reflections Photolibrary/CORBIS; 574 (bl, cl, bc),Peter Van Steen/HRW; 574 (br), Corbis Images/ HRW; 574(cr), ©Peter Gridley/Getty Images/Taxi EXPRESS LESSON/FIRST AID & SAFETY: 578 (bl), ©Ariel Skelley/CORBIS; 586 (t), Custom Medical Stock Photo; 586(br), A. Bartel/Custom Medical Stock Photo; 587 (tr), ©Ken Lax/Photo Researchers, Inc.; 588 (bc), Bob Winsett/IndexStock Imagery, Inc.; 590 (br), Bob Daemmrich Photo, Inc.;591 (tr), Lisa Davis/HRW; 593 (tr), ©SPL/Photo Researchers, Inc.; 594 (tc), ©Sinclair Stammers/SPL/Photo Researchers, Inc.; 594 (c), ©Dr P. Marazzi/SPL/Photo Researchers, Inc.; 594 (bc), ©John Radcliffe Hospital/SPL/Photo Researchers, Inc.; 596 (t), ©Garry Watson/SPL/Photo Researchers, Inc.; 596 (tc), ©Michael & Patricia Fogden/CORBIS; 596 (bc), Digital Image ©2004 EyeWire; 596 (b), Mr. Yuk is a regis- tered trademark of Children’s Hospital of Pittsburgh.; 597(cr), ©Larry West/Getty Images/Taxi; 598 (bl), ©Tim Wright/ CORBIS; 599 (br), Digital Image ©2004 PhotoDisc; 599 (tr), ©Marc Romanelli/Getty Images/The Image Bank; 600 (tr), ©Marc Romanelli/Getty Images/The Image Bank; 602 (tc), Sam Dudgeon/HRW; 602 (bl), ©Ariel Skelley/CORBIS; 603 (all), Victoria Smith/HRW; 604 (tr), John Langford/HRW;604 (cr), Peter Van Steen/ HRW; 604 (br), Corbis Images/HRW; 605 (tr), Susan Van Etten/PhotoEdit; 606 (bl), SpencerGrant/PhotoEdit; 607 (tr), Digital Image ©2004 PhotoDisc; 608 (br), Victoria Smith/HRW; 608 (bc), Digital Image ©2004 Artville; 609 (tc), Digital Image ©2004 PhotoDisc; 609 (c), Sam Dudgeon/HRW; 609 (br), Victoria Smith/HRW;609 (tr), Digital Image ©2004 EyeWire; 610 (tr), ©Getty Images; 612 (br), Digital Image ©2004 PhotoDisc; 613 (tr), ©Richard Hutchings/CORBIS LIFE SKILLS QUICK REVIEW: 615 (tr), Peter Van Steen/HRW; 616 (bl), David Young Wolff/PhotoEdit; 617(tr), Corbis Images/HRW; 618 (cl), ©Brad Wilson/ Photonica; 620 (bl), ©Areil Skelley/CORBIS; 621 (t), ©David H. Wells/CORBIS REFERENCE GUIDE/HEALTH CAREERS: 632 (br), Spencer Grant/PhotoEdit; 632 (bc), Digital Image ©2004 PhotoDisc; 632 (tl), Digital Image ©2004 EyeWire; 633 (tr), Jeff Greenberg/Visuals Unlimited; 633 (tl), Digital Image ©2004 Artville; 634 (tr), Digital Image ©2004 PhotoDisc; 635 (tl), Michael Newman/PhotoEdit; 635 (b), ©John Madere/Corbis Stock Market; 635 (tc), Digital Image ©2004 Artville; 636 (bl), A. Ramey/PhotoEdit; 636 (tr), Digital Image ©2004 PhotoDisc; 637 (tl), Jeff Dunn/Stock Boston; 637 (br), Sam Dudgeon/HRW; 637 (inset), Digital Image ©2004 PhotoDisc; 638 (br), A. Ramey/PhotoEdit; 638 (tl), DigitalImage ©2004 PhotoDisc; 639 (br), Jeff Greenberg/PhotoEdit; 639 (tl), Digital Image ©2004 Artville; 640 (tl), Mark Richard/PhotoEdit; 640 (br), Mark Gibson Photography; 641(tl), Tom Carter/PhotoEdit; 641 (br), Charles Gupton/ StockBoston; 641 (c), Digital Image ©2004 ArtvilleGetty Images/Taxi; 403 (cl), Digital Image ©2004 PhotoDisc; 403 (bl), ©Laurence Fleury/Explorer/Photo Researchers, Inc.; 406 (bl), Victoria Smith/HRW; 406 (cl), Digital Image ©2004 PhotoDisc; 407 (tr), Paul Perez-www.latinfocus.com Chapter 17: 408-409 (all), ©Kaluzny-Thatcher/Getty Images/ Stone; 410 (bl), Peter Van Steen/HRW; 410 (bc), ©Bruce Ayres/Getty Images/ Stone; 410 (br), Diana Goetting/HRW; 41 1 (tr), ©Steve Chenn/CORBIS; 412 (cl), Ed Lallo/HRW; 413 (cr), Michael Newman/PhotoEdit; 415 (cr), ©Ron Chapple/ Getty Images/Taxi; 417 (tr), ©Stephanie Rausser/Getty Images/Taxi; 418 (bl), AP/Wide World Photos; 419 (bl), BillBachmann/PhotoEdit; 420 (bl), Robert Wood/HRW; 422(tl), ©Tom Stewart/Corbis Stock Market; 423 (tr), ©Stephanie Rausser/Getty Images/Taxi; 423 (cr), ©Ron Chapple/Getty Images/Taxi; 423 (bl), Bill Bachmann/ PhotoEdit UNIT 6: 426-427 (all), ©Saul Bromberger & Sandra Hoover/Raw Talent Photo Chapter 18: 428-429 (all), Jim McGuire/Index Stock Imagery, Inc.; 430 (bl), ©AFP/CORBIS; 432 (tl), ©Jason Burns/Dr. Ryder/ Phototake; 433 (bl), ©Quest/SPL/Photo Researchers, Inc.; 434 (tl), ©Jake Martin/ Allsport/Stone; 435 (tr), Sam Dudgeon/HRW; 436 (cl), AP Photo/Stuart Ramson; 438 (tl), ©Professors P.M. Motta & J. Van Blerkom/SPL/Photo Researchers, Inc.; 440 (br), ©SPL/ Photo Researchers, Inc.; 441 (cr), ©Neo Vision/ Photonica; 442 (tl), K. Beebe/ Custom Medical Stock Photo; 443 (cr), ©Dennis Kunkel/ Phototake; 445 (tl, tc, tr), Lennart Nilsson/Albert Bonniers Publishing Co.; 446 (bl), ©Leland Bobbe/Getty Images/Stone; 447 (tr), ©David H. Wells/ CORBIS; 449 (cr), ©Dianne Fiumara/Getty Images/Stone; 450 (tl, cl), Gene Whitworth/HRW; 450 (bl), Susan Feldkamp/HRW; 451 (tr), ©Dennis Kunkel/Phototake; 451 (cl), ©AFP/ CORBIS; 451 (bl), ©Dianne Fiumara/Getty Images/Stone Chapter 19: 454-455 (all), ©Chad Slattery/ Getty Images/Stone; 456 (tl), Catrina Genovese/ Index StockImagery/PictureQuest; 458 (tl), Digital Image ©2004 PhotoDisc; 460 (cl), Digital Image ©2004 PhotoDisc; 461 (tl), ©Richard Shock/Getty Images/Stone; 463 (tr), George Emmons/Index Stock Imagery, Inc.; 464 (br), Digital Image ©2004 PhotoDisc; 464 (cl), ©Stockbyte; 465 (bl), Digital Image ©2004 PhotoDisc; 467 (br), ©Bob Daemmrich/The Image Works; 468 (tl), ©Tom McCarthy/ PhotoEdit; 469 (tr), Catrina Genovese/Index Stock Imagery/PictureQuest; 469(cl, bl), Digital Image ©2004 PhotoDisc; 472 (bl), Nostalgia Cards ©SuperStock; 473 (tl), Ewing Galloway/Index Stock Imagery, Inc.; 473 (tr), ©Image 100/CORBIS Chapter 20: 474-475 (all), ©Charles Gupton/CORBIS; 476 (all), Peter Van Steen/HRW; 477 (all), Digital Image ©2004 PhotoDisc; 478 (all), Peter Van Steen/HRW; 480 (cl), John Langford/ HRW; 481 (tr), John Langford/HRW; 483 (tl), ©Don Smetzer/ Getty Images/Stone; 484 (cl), Digital Image ©2004 PhotoDisc; 485 (cr), Digital Image ©2004 PhotoDisc; 486 (br), Siebert/Custom Medical Stock Photo; 487 (c), ©SIU/ Peter Arnold, Inc.; 487 (br), Science VU/Visuals Unlimited;488 (br), DR. P. Marazzi/SPL/Custom Medical Stock Photo;490 (tl), Victoria Smith/HRW; 491 (tr, cr), Peter Van Steen/HRW; 491 (cl), ©Don Smetzer/ Getty Images/Stone; 491 (bl), Digital Image ©2004 PhotoDisc Chapter 21: 494-495 (all), Aaron Haupt/Stock Boston; 496 (bl), Digital Image ©2004 PhotoDisc; 499 (t), Digital Image ©2004 PhotoDisc; 500 (cl), ©Nibsc/ Photo Researchers, Inc.; 502 (tl), ©Bruce Ayres/Getty Images/Stone; 503 (cr), ©Conor Caffrey/SPL/ Photo Researchers, Inc.; 504 (tl), Ed Zurga/AP/Wide WorldPhotos; 505 (cr), Digital Image ©2004 Artville; 507 (tr), ©Tony Craddock/SPL/Photo Researchers, Inc.; 508 (b), Jakub Mosur/AP/Wide World Photos; 509 (br), ©David Lassman/ The Image Works; 509 (c), Digital Image ©2004 PhotoDisc; 510 (tl), Ed Bailey/AP/Wide World Photos; 51 1 (tr), DigitalImage ©2004 PhotoDisc; 51 1 (cr), ©Bruce Ayres/Getty Images/Stone; 51 1 (bl), Jakub Mosur/AP/ Wide World Photos INTRODUCTION TO HEALTH HANDBOOK: 514-515 (all), Sam Dudgeon/HRWEXPRESS LESSON/HOW YOUR BODY WORKS: 516 (br), David Young-Wolff/PhotoEdit; 523 (tr), Michael Newman/ PhotoEdit; 525 (tc), ©Dennis Kunkel/ Phototake; 526 (bl, bc), Digital Image ©2004 EyeWire; 529 (all), Sergio Purtell/ Foca/HRW; 531 (tr), ©Nathan Bilow/Allsport/Getty Images; 534 (cr), ©Ed Reschke/Peter Arnold, Inc.; 535 (tl), Robert Caughey/Visuals Unlimited; 535 (cl, bl), David M. Phillips/ Visuals Unlimited; 535 (tr), ©Spencer Rowell/Getty Images/ Taxi; 539 (tr), ©Roy Morsch/CORBIS; 541 (tr), SW Production/ Index Stock Imagery, Inc.; 542 (bl), CarolGuenzi Agents/ Index Stock Imagery, Inc.; 543 (tl), ©Juergen Berger, Max-Planck Institute/SPL/Photo Researchers, Inc.; Copyright © by Holt, Rinehart and Winston. All rights reserved.