1. Turn back to My Unhealthy Behavior on Page 3 and review Part 2. Write the behavior that you think you can change under question 1 on page 8, My Health Behavior Change Goal.

2. Write a statement that describes your current thoughts related to this behavior. Refer to pages 4 and 5, Self- Talk About Change.

3. Identify you current stage of change.

6. Write a specific goal for changing the health behavior you’ve selected.

7. Let’s brainstorm a list of barriers that might stop a person from changing his or her behavior.

8. Write 3 benefits of reaching your goal.

9. Write the names of people who can help you reach your health goal.

10. DO NOT WRITE ON THIS UNTIL I TELL YOU TO!!!

11. I’m not going to go by the vending machines at school, so I won’t be tempted to buy junk food for lunch.

12. I’m to start hanging out with Sarah because she likes to exercise.

13. I’m going to watch a program on public television about the dangers of smoking.

14. Instead of coming home and watching TV, I’m going to come home and walk around the block 5 times.

15. I’m going to buy myself a new pair of jeans if I stay on my exercise program for 5 weeks.

16. I’m going to write a contract that promises I will drink 8 glasses of water a day. I’m going to show it to my mom and my best friend so they can help me meet my goal.

17. Jim said I could call him if I was about to smoke. He’s already quit, so he knows what I’m going through.

18. I’m going to go to bed earlier so it’s easier to get up in time to eat breakfast.

19. I’m going to count to 10 before I grab a soda from the refrigerator.

20. I’m going to leave a note on the refrigerator door to remind me to eat at least 5 fruits and vegetables a day.

21. You may now follow the directions and complete the worksheet.