Statements	Never	Sometimes	Often	Routinely
1	I discuss my problems and concerns with people close to me.
2	I choose a diet low in fat, saturate fat, and cholesterol.
3	I report any unusual signs or symptoms to a physician or other health professional.
4	I follow a planned exercise program.
5	I get enough sleep.
6	I feel I am growing and changing in positive ways.
7	I praise other people easily for their achievements.
8	I limit use of sugars and food containing sugar (sweets).
9	I read or watch TV programs about improving health.
10	I exercise vigorously for 20 or more minutes at least three times a week (such as brisk walking, bicycling, aerobic dancing, using a stair climber).
11	I take some time for relaxation each day.
12	I believe that my life has purpose.
13	I maintain meaningful and fulfilling relationships with others.
14	I eat 6–11 servings of bread, cereal, rice, and pasta each day.
15	I question health professionals in order to understand their instructions.
16	I take part in light to moderate physical activity (such as sustained walking 30–40 min 5 or more times a week).
17	I accept those things in my life which I cannot change.
18	I look forward to the future.
19	I spend time with close friends.
20	I eat 2–4 servings of fruit each day.
21	I get a second opinion when I question my healthcare provider’s advice.
22	I take part in leisure-time (recreational) physical activities (such as swimming, dancing, bicycling).
23	I concentrate on pleasant thoughts at bedtime.
24	I feel content and at peace with myself.
25	I find it easy to show concern, love, and warmth to others.
26	I eat 3–5 servings of vegetables each day.
27	I do stretching exercises at least 3 times per week.
28	I use specific methods to control my stress.
29	I work toward long-term goals in my life.
30	I touch and am touched by people I care about
31	I eat 2–3 servings of milk, yogurt, or cheese each day.
32	I inspect my body at least monthly for physical changes/danger signs
33	I get exercise during usual daily activities (such as walking during lunch, using stairs instead of elevators, parting car away from destination and walking).
34	I balance time between work and play
35	I find each day interesting and challenging.
36	I find ways to meet my needs for intimacy.
37	I eat only 2–3 servings from the meat, poultry, fish, dried beans, eggs, and nuts group each day
38	I ask for information from health professionals about how to take good care of myself.
39	I check my pulse rate when exercising.
40	I practice relaxation or mediation for 15–20 min daily.
41	I am aware of what is important to me in life.
42	I read labels to identify nutrient, fat, and sodium content in packaged food.
43	I attend educational programs on personal health care.
44	I reach my target heart rate when exercising.
45	I pace myself to prevent tiredness.
46	I feel connected with some force greater than myself.
47	I settle conflicts with others through discussion and compromise.
48	I eat breakfast.
49	I seek guidance or counseling when necessary.
50	I expose myself to new experiences and challenges.