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Douglas M. C. Wilson Donna Ciliska

Lifestyle Assessment: Development
And Use of the FANTASTIC Checklist
SUMMARY SOMMAIRE
An important aspect of health promotion is Un des aspects importants de la promotion de la
the assessment of lifestyle factors over which sante est l'evaluation des facteurs du style de vie sur
patients have some control. Health lesquels les patients peuvent exercer un certain
controle. Souvent, a cause d'une pratique
professionals often do not have time to surchargee, les professionnels de la sante n'ont pas
integrate a comprehensive lifestyle inquiry le temps d'inclure dans leur histoire de cas une
into a busy practice. This artide, the first in a revue complete du style de vie. Cet article, le
six-part series on lifestyle assessment, premier d'une serie de cinq sur l'evaluation du style
describes the development and rationale of a de vie, decrit le developpement et la rationelle d'un
simple patient questionnaire called simple questionnaire du patient appele
FANTASTIC, utilise initialement comme moyen
FANTASTIC, which initially was used as a mnemotechnique pour aider les patients et les
mnemonic memory aid for patients and medecins du Departement de me'decine familiale de
physicians in the Department of Family l'Universite McMaster. L'inventaire de ce
Medicine at McMaster University. The questionnaire couvre les aspects physiques,
inventory encompasses the physical, emotionnels et sociaux de la sante juges pertinents
quant a la morbidite, la mortalite et la qualite de vie.
emotional and social components of health Une etude de fiabilite a revele un taux global de
believed to be relevant to morbidity, mortality fiabilite acceptable et les parties inadequates du
and quality of life. A retest reliability study questionnaire ont ete ameliorees. Nous avons note
demonstrated acceptable overall reliability, une bonne acceptation de la part du patient tant de
and the inadequate components of the la version ecrite que de la version pour
micro-ordinateur.
checklist have been improved. Patient
acceptance of both the written and
microcomputer versions of the questionnaire
has been high. (Can Fam Physician 1984;
30:1527-1532)
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Dr. Wilson is an associate health behaviors. In fact, major reports play in affecting the level of health in
professor in the Department of issued by both the Canadian4 and the country. The lifestyle category was
Family Medicine, and Ms. Ciliska American! departments of health and thought to consist of an individual's
is an assistant professor in the welfare have stressed the need for a decisions which affect his health and
School of Nursing, both at reorientation in health care, from a over which he has some control. Be-
McMaster University. Reprint model based on treating disease to one cause poor personal decisions and
requests to: Dr. Douglas M. C. based on health promotion and disease health habits can create self-imposed
Wilson, Department of Family prevention. As a conceptual frame- risks resulting in premature illness or
Medicine, McMaster University, work for such a model, the Lalonde re- death, the improvement of lifestyle is
Hamilton, ON. L8N 3Z5. port4 introduced the Health Field Con- an important goal for achieving a bet-
cept, which consists of four broad ter level of health.
I N RECENT YEARS there has been elements: human biology, environ- The American report, "Healthy
marked interest in health promo- ment, lifestyle, and health care organi- People: The Surgeon-General's Report
tion. I-3 Family physicians, family zation. These elements were arrived at of Health Promotion and Disease Pre-
practice nurses, community health by examining the causes and underly- vention"5 points out that, "It is the
nurses, educators and health educators ing factors of sickness and death in controllability of many risks-and,
are helping people to examine their Canada and by assessing the part they often, the significance of controlling
CAN. FAM. PHYSICIAN Vol. 30: JULY 1984 1 527
even a few-that lies at the heart of expectancy predictions. An appraised tor should enquire about family, ca-
disease prevention and health promo- age which exceeds chronological age reer, and other important lifestyle fac-
tion". The report makes the specific may precipitate unnecessary anxiety, tors. In arriving at a list of important
link between lifestyle and disease. confusion and hypochondriasis. To lifestyle characteristics, we used the
Studies have shown that a few good others, particularly the unemployed, College objective that "The physician
health habits can positively affect the and the economically underprivileged, shall be able to define health as the
length and quality of life, as does a recommendation aimed at increased state of physical, emotional, and social
maintaining a strong network of social lifespan may have absolutely no ap- well-being. " 9
contacts with family and friends.6' 7 A peal. However, such people may wel- A CFPC survey of 1,500 Canadian
series of studies in Alameda County, come suggestions to improve their sit- family doctors asked how frequently
California7 demonstrated substantial uation. they raised questions about specific
increases in the longevity of people In their "assessment of health lifestyle practices. 10 Seventy-five per-
who exercise vigorously and regularly, hazard/health risk appraisal", Wagner cent of this sample indicated that they
maintain normal weight, eat breakfast, et a18 pointed out arithmetic impreci- always discuss smoking, 51% discuss
do not snack between meals, avoid sion for calculating assessment of mor- alcohol intake, and 37% discuss nutri-
smoking, limit alcohol consumption, tality risks. The assumed efficacy for tion. The family physicians only
and sleep seven to nine hours a night. motivating behavioral change could sometimes asked questions about ca-
If lifestyle is, in fact, an important de- not be substantiated from evidence reer, drug abuse, activity, family and
terminant of health, then it becomes collected from programs, users and de- leisure activities. When asked if it
essential to develop tools for measur- velopers. The researchers argued that would help to have more information
ing a person's lifestyle. Such tools are their analysis included behaviors for on helping patients with lifestyle
useful for both the patient, who can which scientific evidence of their pre- issues, 91% of questionnaire respon-
use the tool to evaluate and modify his dictive importance remains controver- dents said that printed material con-
or her own lifestyle, and the health sial (e.g., exercise and reductions in taining specific instructions would be
professional who wants to take a holis- cholesterol intake to lower the risk of helpful.
tic approach to patient care. An assess- death from coronary heart disease). Breslow 's7 seven health habits were
ment tool can facilitate confrontation, Wagner et al8 felt that use of Fram- combined with questions about seat-
lifestyle education and counselling. ingham data, which is based on the belt use to represent the physical fac-
Although health hazard appraisal tools middle-aged, middle class, to predict tors that can influence mortality and,
currently exist, we have found these to the risk of younger people produced to some extent, morbidity and well-
be risk-based, and many do not focus nonsensical risk factor values. Small ness, i.e., activity; nutrition (break-
on factors which the individual can changes in total risk translate into dra-
control. matic alterations in risk age for those fast, snacks, weight); tobacco; alco-
under 35, because the ten year risk of hol; sleep; seatbelt use and toxins.
Health Risk Appraisal death rises very slowly for that group. Beck and Burns"I have studied the
Health risk appraisal instruments The researchers criticized the non- emotional factors related to lifestyle.
have a number of limitations when standardized method of measuring and In their work on cognitive therapy,
used in a family practice setting. Some recording blood pressure and choles- these authors suggested that personal
are very lengthy and time-consuming, terol levels. They said that when a insight is important for controlling
and thus are impractical for a busy value was not written down, an anxiety, depression, and other nega-
average value was inserted. An error tive thoughts. Holmes' 12 and Selye'sl3
physician. Computer processed assess- of 20% in the blood pressure level ap- research on stress provided a frame-
ment forms often require up to six work for some of the current investiga-
weeks before a printout is available. parently can create an error of several
This delay in feedback may interfere years in the computation of risk age.8 tions into how human beings can adapt
Other lifestyle questionnaires are in a healthy way to stress in their envi-
with the process of data collection, available, but these are much longer ronment. Sections on insight and stress
sharing, education and treatment. A and, we believe, more co mplicated to are therefore included on FANTAS-
patient is more easily motivated to im- use than one called FANTASTIC, TIC.
prove his lifestyle when there is imme- which is a simple but comprehensive
diate feedback. Some instruments also Although the social components of
include 'blaming the victim' types of instrument. lifestyle and their relationship to health
questions on family history of breast are more difficult to study, Epstein'4
cancer, and other characteristics that
FANTASTIC and Satir'5 have examined this area.
the patient can do nothing about. Lifestyle Assessment They developed guidelines for health
An assessment which focuses on FANTASTIC originated as a mne- relationships in family settings. Pal-
likely causes of death is a negative ap- monic aid that one of us (Dr. Wilson) more1I and Ulrich17 also looked at ca-
proach to health promotion. It also im- used while a member of the Commit- reer and other occupational factors that
plies a narrower definition of health, tee on Examinations of The College of can affect morbidity. Finally, Rosen-*
which does not include everyday mat- Family Physicians of Canada (CFPC). man and Friedman 18 looked at and
ters and quality of life. The triad of One of the College's eductational ob- classified behaviors which can affect
physical, emotional and social func- jectives is for family physicians to be risk factors for disease. Family, career
tioning is not represented. able to take a holistic approach to pa- and type of personality complete the
Some patients, particularly the el- tient care. In order to learn about the FANTASTIC lifestyle inventory (see
derly, may become depressed with life patient's environment, the family doc- Figures 1 and 2).
1528 CAN. FAM. PHYSICIAN Vol. 30: JULY 1984
 Fig. 1.
FANTASTIC lifestyle assessment inventory

FANTASTIC LIFESTYLE ASSESSMENT

Based on the past month rate yourself in each of the areas below:
Maximum Your
2 points 1 point No points score score
Communication with others is open, almost always the of hardly ever 2
honest and clearff o almost always time
of
pAMILYI giveand receive affection |almostalways the time hardlyever 2
LRIENDS | I get the emotional support that I almost always some | hardly ever 2
need the time
Active Exercise-30 minutes times twice a week seldom
e.g. running, cycling, fast walk weekly or never 2
ACTIVITY Relaxation and enjoyment of leisure almost daily some of hardiy ever 2 -
tim e the tim e

o
Balanced meals almost always thetime hardly ever 2
ft so~ ~ ~ ~ ~ ~ ~ ~otetme
EMUTRITION | breakfast daily almost always tshmetm hardly ever 2
Excess sugar, salt, animal fats, or minimaluse some of frequently 2
junk foodsm the time
Ideal weight within within 20 lbs. not within 2
10lbs.(4kg.) (8kg.) 20 Ibs. (8 kg.)
Tobacco in the past year none pipe only cigarettes 2
T OBACCO Abuse of drugs: prescribed and seldom or some of frequently 2
OXINS unprescribed never the time
Coffee, tea, cola 3npderday 3-6 per day 6 or more 2

Average intake per day

_____ ____ ____ ____ ____ ____
less than
2 drinks_
2 drinks more than 2
_ _ _ _ _ _ _
2 _ _

LCOHOL Alcohol & driving dnekv& drive only rarely fairly often 2

ILEEP 1 7 - 9 hrs. sleep per night almost always tshometm

LEmosth ofi hardly
omefeever 2
EATBELTS Frequency of seat belt use always mostof
t someof | 2 |
TRESS the_ime thetim

Major stressful events in past year none 1 -2 3 or more 2

Sense of time urgency; impatience hardly ever thetime

o almost always 2
PE OF Competitive and aggressive hardly ever some of
the time
almost always 2
PERSON- _ -

ALITY Feel ngs of anger & hostility hardly ever thoetime almost always
Positive thinker almost always some of hardly ever 2
making,________________ _ students,etc. rondthe time
| ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~~h timesio alos always
some of
hardl ever alotlwy

NSIGH AnDepressionr hardly ever sometiof almost always 2

some of
Satisfied in job or role almost always th tme hardly ever 2
AREER
(Includes home- God_eatonhpswihthsesmeo
GoReainhpwthhse almost always smof hardly ever 2
Lmaking,students,etc. around _______ the time ___________
TOTAL

Name Sex MO FE

Occupation Year of birth_ Clinical Version

( 1983 Dr. Douglas Wilson, Department of Family Medicine, McMaster University, Hamilton, Ont. Canada L8N 3Z5 Rev. 06.83

CAN. FAM. PHYSICIAN Vol. 30: JULY 1984 1529

Fig. 2.
Legend for scores on FANTASTIC lifestyle assessment.

tIIESTYtE

What does your score mean?

If you score:
42 - 50 - Congratulations-You are in control.
35 - 41 - Good work-You are on the right track.
30 - 34- Fair
20 - 29 - Somewhat low-you could take more control.
0 - 19 - You are in thedanger zone (but honesty is your real strength).
Note: The total score does not mean that you have failed. There is always the
chance to change your lifestyle - starting now. Look at the areas where you
scored a 0 or 1 and decide which areas you want to work on first.
Tips:
1. Don't try to change all the areas at once. This will be too overwhelming for
you.
2. Writing down your proposed changes and your overall goal will help you
to succeed.
3. Make changes in small steps towards the overall goal.
4. Enlist the help of a friend to make similar changes and/or to support you
in your attempts.
5. Congratulate yourself for achieving each step. Give yourself appropriate
rewards.
6. Ask your family physician, nurse or health department for more informa-
tion on any of these areas.

1530 CAN. FAM. PHYSICIAN Vol. 30: JULY 1984

 In an unpublished survey of 37 phy- stress, were found in a large, prospec- tures that make FANTASTIC helpful
sicians and nurses at McMaster Uni- tive epidemiological study20 to be im- as a lifestyle inventory (see Table 1).
versity, respondents were asked to portant variables in predicting who
rank which three lifestyle factors they will develop peptic ulcer disease. A Development and Evaluation
judged to be most significant with re- busy family physiciafi, who often runs During the past two years, our inter-
spect to mortality, morbidity, quality behind the appointment schedule, disciplinary work group has used liter-
of life and effectiveness of interven- deals with the presenting problems of ature reviews, consumer feedback,
tion. In order, the highest rated were his patients. Although he may suspect group discussions, and questionnaire
tobacco use, alcohol and driving, seat- lifestyle factors he often believes a scores from the test-retest study to re-
belt use, giving and receiving affec- comprehensive assessment is over- vise the questionnaire several times.
tion, and depression. Those areas rated whelming, and too time consuming. Although the group realized that life-
as having minimal significance were Patients can complete the FANTAS- style and its relationship to health are
eating breakfast, snacks and junk TIC lifestyle checklist or microcom- complex areas just beginning to be un-
food, seven to nine hours of sleep each puter program in about ten minutes, derstood, our research efforts began
day, competitive aggressive behavior, while they wait for their appointment. with practical questions. The first
and positive thinking. The family physician can see at a question was: "Is FANTASTIC a reli-
In this survey, we attempted to look glance areas which may require atten- able instrument?" This was thought to
at the merit of assigning different tion. When a patient scores low, fam- be an important question, because
weightings to the 25 components of ily physicians can readily see the areas Best23 discovered a serious problem of
FANTASTIC. For example, it seemed needing education or behavior change. unreliability in his study of health haz-
to some of our group that, based on ev- A total score or "wellness index" of ard appraisal and lifestyle change pro-
idence from the literature, tobacco use less than 70% is less than the mean grams. He found respondents did not
may be five times as significant as eat- score of about 100 patients in a family answer questions similarly in retests,
ing breakfast each day. However, practice study.2' A mean score of 56% even when it did not seem possible to
agreement could not be reached among was recorded by a group of women answer the questions differently. For
physicians, nurses, other health pro- with low socioeconomic status.22 This instance, some respondents gave dif-
fessionals and patients for weighting score rose significantly following a six ferent answers to questions about
differences on the instrument. Some week course of lifestyle education frame size, height and sexual history.
people judged the family/friends cate- workshops. The differences in scores We conducted a retest reliability
gories, particularly support, to be on the 0-50 instrument were +5.4 study. Only four areas of FANTAS-
among the most significant lifestyle (10.8%) compared with +1.6 (3.2%) TIC had correlation coefficients less
items; others rated them to be of rela- in a cohort group receiving no inter- than 0.75.21 These were questions re-
tively little importance. Based on this vention (p 0.029).22
=

experience, and Wainer's"9 article TABLE 1

"Estimating Coefficients in Linear
Models: It Don't Make No Never- How Can Strengths of the FANTASTIC
mind",'9 our study group decided to FANTASTIC Be Used? Lifestyle Inventory*
forego differential weighting. Wainer The questionnaire has been used at
demonstrated "that the resulting pre- McMaster to evaluate residents and 1. Single page can be completed
diction is apt to be very close to the op- students and their holistic approach to quickly
timal one, were the optimal weights 2. Components are easily
patient care. When shared directly remembered
known, and often better than one with learners, the FANTASTIC ques- 3. Holistic (concerned with 'wellness'
which does not use optimal tionnaire has been found to be an ef- or quality of life, and physical,
weights". 19 fective teaching tool. The individual social and emotional wellbeing, as
The FANTASTIC questionnaire in- practitioner may also find FANTAS- well as mortality risk)
corporates physical, emotional, and TIC useful for collecting data from pa- 4. Can be used for self-assessment
social lifestyle factors. The ongoing tients, especially in wellness assess- 5. Component and total scores are
development and testing of the ques- ments, during life crises, or for reference points for ongoing
tionnaire has been undertaken at patients who have stress-related dis- assessment
6. Results are available immediately
McMaster by an interdisciplinary eases such as duodenal ulcer, depres- 7. Can be combined immediately
group consisting of two physicians, sion and migraine. At McMaster, we with a tailored prescription and
four nurse practitioners, and a librarian have discovered that patients find follow up plan
with a special interest in consumer FANTASTIC helpful as a self-assess- 8. Time-saving method of
health education. ment tool which can be used on an on- incorporating lifestyle data into a
The aspects of lifestyle over which going basis to evaluate strengths and visit and the health record
patients have control either have weaknesses in lifestyle. 9. Questions are relevant, and based
on everyday life
proven relationship to morbidity and 10. Includes only behaviors which can
mortality (e.g., cigaret smoking and The Strengths be controlled, and thereby
coronary heart disease) or are related minimizes 'blaming the victim'
to wellness or quality of life (e.g., Of FANTASTIC
family support, career satisfaction, Patients, colleagues, and medical * Identified by patients, colleagues,
anxiety). Some soft areas, such as lack students in McMaster's Department of and medical students at McMaster
of family support and coping with Family Practice have identified fea- University.
1531
CAN. FAM. PHYSICIAN Vol. 30: JULY 1984
 In acute and chronic urinary tract infections
*NegGram* BRAND OF NALIDIXIC ACID
SAFETY DEMONSTRATED IN lating to family, activity, nutrition and 5. Richmond JB (ed): Healthy People: The
* Pregnancy (beyond the 1st trimester) career. We have improved the reliabil- Surgeon General's Report on Health Pro-
* Infants (beyond 3 months) motion and Disease Prevention. Washing-
*The elderly without increased potential for CNS ity of these questions by using Best's23 ton, DC., U.S. Department of Health, Ed-
stimulation suggestion to sttess accuracy of inter- ucation and Welfare, 1979.
* Moderate renal impairment and, with caution in pretation of questions. The correlation 6. Salonen JT, Puska P, Mustaniemi H:
severe renal impairment coefficient of total scores is now 0.88, Changes in morbidity and mortality during
*Acute or recurrent infection comprehensive community program to con-
OPTIMAL DOSAGE
suggesting overall reliability of FAN-
TASTIC as an index of lifestyle be- trol cardiovascular diseases, 1972-1977,
for acute infection it q.i.d. for 1-2 weeks in North Karelia. Br Med J 1979; 2:1178-
for chronic suppression tt b.i.d. for 3-6 months haviors. 1183.
of recurrent UT.I. We also selected out the six com- 7. Belloc NB, Breslow L: Relationship of
INDICATIONS: Acute and chronic urinary tract infec- mon items assessed by both FANTAS- physical health status and health practices.
tions caused by Gram-negative pathogens sensitive to TIC and Evalu Life.21 Appraised Prev Med 1972; 1:409-421.
nalidixic acid. age ± chronological age on Evalu 8. Wagner EH, Beery WL, Schoenbach VJ,
et al: An assessment of health haz-
SIDE EFFECTS: NegGram is generallywelltolerated by Life was compared with the FANTAS- ard/health risk appraisal. Am J Public
patients with normal and impaired renal function. Side TIC score and the correlation coeffi- Health 1982; 72:347-352.
effects are usually minor and cannot always be differ- 9. College of Family Physicians of Can-
entiated from symptoms of the infection itself. They in- cient was only 0.47. (One explanation ada: Educational Objectives for Certifica-
clude gastrointestinal upset and complaints ofdrowsi- for this low correlation is that the two tion in Family Medicine. Willowdale, ON.,
ness and weakness. Skin rashes occasionally occur instruments do not measure the same College of Family Physicians of Canada,
and are usually photo-allergic in character. There may things). 1982.
betransient subjectivevisual disturbance, particularly
increased colour perception.This isthoughtto beasso- We have surveyed about 100 pa- 10. Rice DI: College survey of lifestyle
ciated with a peak in blood levels of the drug. Over- tients to discover their reaction to both counselling. Can Fam Physician 1983;
dosage, coupled with certain predisposing factors, questionnaires and to microcomputer 29:865-866.
may cause convulsions. Benign increased intracranial 11. Burns DD, Beck AT: Cognitive Behav-
pressure occurs rarely in infants and young children. versions of FANTASTIC.21 Eighty- ior Modification of Mood Disorders in
This is similar to that reported with the tetracyclines eight percent of patients reported that Cognitive Behavior Therapy, Research and
and corticosteroids, is associated with high dosage, they found filling out lifestyle ques- Application. New York, Plenum Press,
and is reversible. Haemolytic anaemia may occur in tionnaires to be a helpful reminder of 1978, pp 109-134.
patients with glucose--hosphate dehydrogenase 12. Holmes TH, Rahe RH: The social read-
deficiency. Eosinophilia,thrombocytopeniaand leuko- their health behavior. Patients were justment scale. J Psychosom Res 1967;
penia have been reported, rarely. even more satisfied with the micro- 11:213-218.
PRECAUTIONS: Usewith caution in patientswith liver computer program. More than 90% 13. Selye H: Stress Without Distress.
disease. Patients should avoid excessive exposure to ranked it as "highly liked, useful, in- Toronto, McLelland and Stewart, 1977.
sunlight. Do not administer to patients who are in the 14. Epstein N: The McMaster model of
first trimester of pregnancy. NegGram should not be formative and of low difficulty". Most family functioning. J Marr Fam Counsel
given to infants before the age of 3 months. patients agreed that family physicians 1978; 10:19-31.
A urinary metabolite of NegGram may interfere with have a responsibility to assess lifestyle 15. Satir V: Peoplemaking. Palo Alto,
tests for urinary glucose with Clinitestt and Benedict's information. CA., Science and Behavior Books, Inc,
reagent. 1972.
Enzymatic tests such as Clinistixt are not affected. 16. Palmore EB: Physical, mental and so-
Nalidixic acid may enhance the effects of oral antico-
agulants.
Conclusion cialfactors in predicting longevity. Geron-
Primary care health professionals tologist 1969; 9:103-108.
DOSAGE: ADULTS: 4 gdaily by mouth in divided doses. 17. Ulrich VH: Relationship between mor-
An initial daily dosage of8 Caplets is recommended for have recognized the need to incorpo- bidity and job satisfaction. Z Gesamte Hyg
1-2 weeks. Forchronic suppressive therapy in the case rate lifestyle assessment and counsel- 1980; 26:451-457.
of recurrent U.TI., the recommended dose is 2 g ling into their practices. 1-3, 10 We have 18. Rosenman RH, Friedman M: Type A
(4 Caplets) per day for 3-6 months, at which time fur- identified some factors associated with Behaviour and Your Heart. New York,
ther clinical assessment should be made. Fawcett Crest Books, 1974, pp 69-84.
CHILDREN: approx. 55 mg/kg of body weight per day morbidity, mortality and quality of 19. Wainer H: Estimating coefficients in
in divided doses. life. We have found the FANTASTIC linear models: It don't make no nevermind.
NegGram should not be given to infants under three lifestyle checklist to be a reliable and Psychol Bull 1976; 83:213-217.
months of age. 20. Zyzanski S, Medalie J, Frost AGI, et
SUPPLIED: SUSPENSION: Each 5 ml of raspberry fla- simple method for people to quickly al: Work vs. home environment influences:
vored 5% suspension contains: nalidixic acid 250 mg. assess lifestyle behaviors. The com- An incidence of peptic ulcer. Read before
Available in 100 ml and 454 ml bottles. pleted assessment is helpful in plan- the Department of Family Medicine,
TABLETS: Each scored, compressed, capsule-shaped, ning strategies for change. School of Medicine, Case Western Reserve
yellow Caplet tablet contains: nalidixic acid 500 mg. University, Cleveland, OH., Oct 1983.
Available in bottles of 100, 500 and 1000 Caplets. 21. Wilson D, Evans CE, Ciliska D, et al:
Product Monograph available on request. The FANTASTIC lifestyle questionnaire:
REFERENCES: 1. Stamey, T.A. and Bragonje, J.: Re- References Development and preliminary evaluation.
sistance to Nalidixic Acid: A Misconception Due To Proceedings of the 18th Annual Meeting of
Underdosage, JAMA 236:16 1857-1860, Oct. 1976. 1. Bedworth AE, Bedworth DA: Health for the Society of Prospective Medicine, Que-
2. Harrison, L.H., and Cox, C.E., Bacteriologic and Human Effectiveness. Englewood Cliffs, bec City, PQ., Oct 1982.
Pharmacodynamic Aspects of Nalidixic Acid, Journal NJ., Prentice-Hall, 1982. 22. Nielsen E, Ciliska D: The effect of a
of Urology, Vol. 104, Dec. 1970. p. 908. 2. Pender NJ: Health Promotion in Nurs- health promotion workshop on lifestyle
3. Keys, T.F., Antimicrobials Commonly Used For Uri- ing Practice. Norwalk, CT., Appleton- change in socioeconomically disadvan-
nary Tract Infection, Mayo Clinic Proc. Vol. 52: 680- Century-Croft, 1982. taged mothers. Proceedings of the 19th An-
682, Nov. 1977. 3. Taylor RB, Ureda JR, Denham JW: nual Meeting of the Society of Prospective
4. Stamey, T.A., Part Il: The Clinical Aspects of Uri- Health Promotion: Principles and Clinical Medicine, Atlanta, GA., Oct 1983.
nary Tract Infections, Postgraduate Medical Journal Applications. Norwalk, CT., Appleton- 23. Best JA: Health hazard appraisal and
47, 21-26, 1971. Century-Croft, 1982. the evaluation of lifestyle. Proceedings of
4. Lalonde M: A New Perspective on the the 13th Annual Meeting of the Society of

qvW|
n.,*, ~ ~IAlurora, Ontario IcP
Division of Sterliog Drag Ltd*^

Trademark,
*~~~~Reg. Ames Company
Trade Mark ^*Registered
A^

User Ltd.
of Canada
Health of Canadians. Ottawa, ON., De-
partment of Health and Welfare, 1974.
Prospective Medicine, Kansas City, MO.,
Oct. 1, 1977.
1 532 CAN. FAM. PHYSICIAN Vol. 30: JULY 1984