Key points

• Most chronic diseases are caused by a short list of risk factors: tobacco use, poor nutrition, physical inactivity, and excessive alcohol use.
• By avoiding these risks and getting good preventive care, you can improve your chance of staying well, feeling good, and living longer.

Quit Smoking

Stopping smoking (or never starting) lowers the risk of serious health problems, such as heart disease, cancer, type 2 diabetes, and lung disease, as well as premature death—even for longtime smokers. Take the first step and call 1-800-QUIT-NOW for FREE support.

Eat Healthy

Eating healthy helps prevent, delay, and manage heart disease, type 2 diabetes, and other chronic diseases. A balanced, healthy dietary pattern includes a variety of fruits, vegetables, whole grains, lean protein, and low-fat dairy products and limits added sugars, saturated fats, and sodium.

Get Regular Physical Activity

Regular physical activity can help you prevent, delay, or manage chronic diseases. Aim for moderate intensity physical activity (like brisk walking or gardening) for at least 150 minutes a week, with muscle-strengthening activities 2 days a week.

Limit Alcohol

Over time, excessive drinking can lead to high blood pressure, various cancers, heart disease, stroke, and liver disease. By not drinking too much, you can reduce these health risks.

Get Screened

To prevent chronic diseases or catch them early, visit your doctor regularly for preventive services.

Take Care of Your Teeth

Oral diseases—which range from cavities and gum disease to oral cancer—cause pain and disability for millions of Americans. To help prevent these problems, drink fluoridated water, brush with fluoride toothpaste twice a day, and floss daily. Visit your dentist at least once a year, even if you have no natural teeth or have dentures.

Get Enough Sleep

Insufficient sleep has been linked to the development and poor management of diabetes, heart disease, obesity, and depression. Adults should get at least 7 hours of sleep daily.

Know Your Family History

If you have a family history of a chronic disease, like cancer, heart disease, diabetes, or osteoporosis, you may be more likely to develop that disease yourself. Share your family health history with your doctor, who can help you take steps to prevent these conditions or catch them early.

Sleep difficulties are very common, can cause problems with daytime functioning and may contribute to many other medical conditions. There is help available for the two most common sleep issues - insomnia and obstructive sleep apnea.

What's Important to Know?

Maintaining Healthy Sleep

Getting high quality sleep is key for good health. Sleeping well is just as important as exercise and eating wisely. If you are already getting quality sleep, here are some tips to help you continue sleeping well:

• Allow yourself enough time to sleep at night.
• Keep a regular sleep schedule every day.
• Allow time to unwind before bed.
• Avoid alcohol and caffeine before bedtime.
• Exercise regularly.
• Avoid napping.
• Keep the bedroom quiet, dark, and comfortable.
• Avoid using electronic devices in the bedroom (TV, cell phones, tablets, computers). White noise from fans or sound machines is fine.
• Use the bed only for sleep and intimacy.
• Identify stressors & continue to manage stress.

Poor Sleep Is Related To:

• Obesity
• Heart disease and stroke
• Diabetes
• Pain
• Depression, anxiety, and irritability
• Concentration and memory problems
• Accidents and impaired work performance

Want to Know More?

One in three people have problems sleeping at some point in their lives. There’s a big difference between one night of poor sleep and trouble that persists. If your sleep trouble goes on for months, you may have a sleep disorder.

The two most common sleep disorders are:
Insomnia Disorder and Obstructive Sleep Apnea Disorder.

Insomnia symptoms include difficulty with:

• Falling asleep
• Staying asleep
• Waking too early

Obstructive Sleep Apnea is a sleep disorder caused by blocking of the airway during sleep. Symptoms can include:

• Loud snoring
• Excessive daytime sleepiness
• Observed episodes of stopped breathing during sleep
• Waking up gasping or choking
• Difficulty concentrating during the day

Effective treatments are available for both Insomnia and Sleep Apnea.

Talk to your health care team to learn about alternatives to sleep medications, including virtual insomnia treatment options.

Pay attention to stress. Tools are available to help you manage and reduce your stress.

What's Important to Know?

If you are having difficulty coping with the demands of your life, you are experiencing stress. Everyone has stress. While some challenge in life is healthy, too much stress can create problems.

If you are overly stressed for too long, that stress can put your health at risk. If you have too much stress, your body will let you know in different ways, and you may:

• Have difficulty concentrating
• Feel worried and fearful
• Feel “wound up”— with sweaty palms, pounding heart, and tense muscles
• Feel irritable toward others
• Feel tired

Strive for a healthy weight. Managing your weight helps you stay healthy now and in the future.

What's Important to Know?

Maintaining a healthy weight can help you feel good and have energy to do the things you want to do. It can also help you prevent and manage many chronic diseases and conditions. Obesity increases your risk for diabetes, high blood pressure, cholesterol problems, heart disease, gallbladder disease, female health disorders, arthritis, some types of cancer, and sleep apnea. If you currently have a higher body weight, losing as little as 5-10% of your current weight can lower your risks for these diseases.

Body mass index (BMI) is a useful screening tool for adult overweight and obesity. Using a BMI Calculator may help you learn about your degree of risk and care options. Body weight is linked to energy balance. There are complex factors that affect your weight and your energy balance, which can be thought of as calories in and calories out. These factors may be from a person’s body, mind, environment, and society. Weight management focuses on some of the factors within your control like:

• Adjusting your daily calorie intake.
• Adjusting your daily activity level.
• A combination of both.

When Striving to Maintain a Healthy Weight, Remember to:

1. Make a commitment. Start by writing down the reasons you want to manage your weight. Focus on the many benefits you could experience including improved sleep, better mood, decreased pain, improved blood pressure or blood sugar.
2. Gradually adopt healthy lifestyle habits. Make 1-2 small changes at a time so you can continue with them long-term.
   • Move more and sit less during your day. Try to include at least 2½ hours each week of moderate-intensity activity that makes you breathe a little harder and sweat.
   • Eat when you are hungry, pay attention to when you are full, and seek satisfying foods that you enjoy, such as vegetables and fruit for fiber and lean protein options.
   • Use herbs and spices so you can gradually reduce excess salt, sugar, and dietary fat.
   • Drink enough water to help your body function properly. Drinking 9-13 cups of fluid each day is recommended for most adults.
3. Develop connections with others and look for purpose and meaning in your life. Do activities that satisfy your social, emotional, and spiritual needs to enhance your overall wellbeing.

Being physically active can improve your health. Any amount of physical activity is better than none. A single bout of activity provides immediate health benefits such as lowering anxiety and blood pressure and improving quality of sleep. There are even more long-term health benefits.

What's Important to Know?

All adults should avoid inactivity by moving more and sitting less. Regular physical activity lowers the risk of depression, type 2 diabetes, heart disease, high blood pressure, obesity, stroke, and 8 types of cancer. It may also reduce the risk of weight gain, dementia and falls, improve bone health, endurance and help you feel more energetic. Be active for any and all reasons that are meaningful to you!

Physical activity is anything that gets the body moving. It can be moderate intensity, meaning that you can talk while being active, or it can be vigorous intensity, meaning that you cannot say more than a few words without taking a breath. Choose activities that you enjoy and start at a comfortable level. Once the activity begins to seem easy, be active for a longer amount of time, or be active more often, or a combination of both.

Physical activity is safe for almost everyone, and its health benefits far outweigh the risks. Even if you think you are out of shape, or have not been active in a long time, you can still be active safely. Unless you have a chronic condition, such as diabetes, heart disease or arthritis, or you have active symptoms, such as chest pain or pressure, dizziness, or joint pain, you do not need to talk to your health care team before starting activity. If you have a concern about a health condition, talk with your health care team about the types and amounts of activity that are best for you.

For important health benefits, do at least 2½ hours of moderate-intensity or 1¼ hours of vigorous-intensity aerobic activity each week, or an equal combination of both. Any amount of activity is better than none and your episodes of activity can last any amount of time. You should be active as often as possible during the day and week.

Do muscle strengthening activities at least twice each week and try to use muscles from all parts of your body—the legs, hips, back, chest, abdomen, shoulders and arms. Stretching regularly can improve flexibility, joint motion, circulation, and can also help relieve stress.

Eating wisely is important at every stage of life.

What's Important to Know?

A healthy eating routine can help boost your health now and for years to come. Small changes matter. Look at your current eating routine. Choose one or two changes for better nutrition. For example:

1. Follow a healthy dietary pattern that is right for you.
2. Choose nutrient-dense food and drink choices that you enjoy, reflect your culture, and fit your budget.
3. Focus on nutrient-dense foods and drinks to meet food group needs and stay within appropriate calorie limits. A healthy eating pattern includes:
   • Vegetables of all types - dark green, red, and orange in color as well as legumes (beans, peas, and lentils).
   • Fruits - especially whole fresh fruits - but they may be canned or frozen too.
   • Grains - at least half of which are high fiber whole-grains.
   • Dairy - fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy alternatives.
   • An assortment of protein foods - lean meats, poultry, and eggs; seafood; legumes (beans, peas, lentils); and nuts, seeds, and soy products.
   • Oils - vegetable oils and oils in food, such as seafood and nuts
4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages. For example:
   • Added sugars - Consume less than 10% of your daily calories from added sugars. These are sugars and syrups that are added to foods or beverages when they are processed or prepared.
   • Saturated fat - Consume less than 10% of your daily calories from saturated fats and avoid trans-fats.
   • Sodium - Limit to no more than 2,300 mg of sodium per day. Choose foods with little added salt and make meals without salt when possible. Adults with high blood pressure may benefit from limiting to 1,500 mg of sodium per day.
   • Alcoholic beverages - Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting to 2 drinks or less in a day for men and 1 drink or less in a day for women and people over age 64. Drinking less is better for health than drinking more. Children, pregnant women, and those with certain medical conditions who should not drink any alcohol.

If you choose to drink alcohol, drink in moderation. Avoid "binge drinking." If you are concerned about your drinking, talk to your VA health care team about getting help.

What's Important to Know?

If you choose to drink alcohol, drink in moderation. This helps reduce your risk for alcohol-related health problems. Here are the recommended drink limits:

One standard drink is equivalent to:

• Female: No more than 1 drink in a single day and no more than 7 drinks per week
• Male: No more than 2 drinks in a single day and no more than 14 drinks per week
• All adults age 65 and older: No more than 1 drink a day and no more than 7 drinks per week
• Pregnant people or those who might be pregnant: Do not drink any alcohol

Do not binge drink. Binge drinking means drinking:

• 4 or more drinks on one occasion for females and all adults age 65 and older
• 5 or more drinks on one occasion for males

Note: The above guidelines for female and male are based on binary sex assigned at birth and not on gender identity. There are no established drinking guidelines for transgender, non-binary, gender diverse, and intersex people. There are differences in how their bodies handle or process alcohol. These individuals should talk with their health care team about recommended drink limits.

One standard drink is equal to any one of the following:

• 12 oz. regular beer, usually about 5% alcohol
• 8-9 oz. malt liquor (7% alcohol)
• 5 oz. table wine (12% alcohol)
• 1.5 oz. 80-proof hard liquor (40% alcohol)

For many adults, drinking small amounts of alcohol does not cause serious health problems. However, as we age, our bodies do not process alcohol as easily. People who drink within recommended limits are at lower risk for developing problems with alcohol use. Some people, such as children, anyone who is pregnant or might be pregnant, and those with certain medical conditions, should not drink any alcohol.

Be tobacco free! Don't use commercial tobacco in any form*. If you are using tobacco, the VA can help you stop. Avoid secondhand smoke. If you are pregnant, both you and your baby will have better health.

*Tobacco in this document refers to commercial tobacco products such as cigarettes, cigars, chewing tobacco, and others, and does not include the sacred and traditional use of tobacco by some American Indian and Alaska Native communities.

What's Important to Know?

Stopping tobacco use is the single most important thing you can do to improve your health and protect your family’s health. If you stop smoking or using other forms of tobacco, you and your family will experience short and long-term health benefits. It’s never too late to stop—your health will improve at any age after stopping tobacco!

All forms of commercial tobacco use— including cigarettes, cigars, pipes, snuff, snus, chewing tobacco and more—are harmful. Tobacco use harms nearly every organ of the body and causes:

• Cancers
• Heart disease and stroke
• Chronic obstructive pulmonary disease (COPD) and other lung/breathing problems
• Complications in those who are pregnant

Cigarette smoking is the largest cause of preventable illness and death in the United States. One in five deaths are caused by cigarette smoking and secondhand smoke.

Secondhand smoke is the smoke released from a burning cigarette, cigar or pipe, as well as the smoke exhaled by the smoker. There is no safe level of secondhand smoke. It can cause harmful effects on non-smokers’ health and can increase their risk of heart disease, lung cancer, and other health problems by 20-30%.

Good things happen as soon as you stop. You’ll breathe easier, save money, smell better, sleep better, and have more energy for activities that ease stress and bring you joy. If you’re pregnant, your baby will be healthier. You’ll also be protecting your health and protecting your family and friends from secondhand smoke.

Be involved in your health care. There are many ways to take an active role. Work with your health care team to meet your health goals and accomplish what matters most to you.

What's Important to Know?

Playing an active role in your health care is key to meeting your health goals. To get the most out of your visit, plan the questions you want to ask and the things you want to discuss. When you leave your visit, know what actions to take to best manage your health. Here are some specific ways to be more involved:

Before your visit:

• Write down your health goals, needs, questions, and concerns.
• Make a list of all the medicines you take, including vitamins and supplements.

During your visit:

• Tell your team about your health goals, needs, and treatment preferences.
• Share any health questions and concerns with your team at the beginning of your visit.
• Tell your team about your past illnesses, hospital stays, surgeries, and any other health issues you may be experiencing.
• Share your list of medicines and why you take them. Ask for written instructions to take home with you for any current or new medicines.
• Work together with your team to create a treatment plan that meets your health goals, needs, and preferences, and that addresses what matters most to you.

• Take notes about what you and your health care team discuss and decide. Bring a family member or friend to help.
• Ask about next steps in your health care plan, such as additional appointments and treatments or how you will access test results.
• Share steps that you plan to take reach your health goals. If you are unsure, ask your team for help in identifying specific actions you might take to follow through with your plan.
• Ask your team any other questions you have at the end of your visit. Speak up if you have concerns or think something is wrong.

After your visit:

• Tell your team if you have more questions or concerns, or if there is a change in your health.

Recommendations for preventive services depend on your age, sex, health status, and family history. Find out which screening tests and immunizations are recommended for you.

What's Important to Know?

It’s important to keep up with your screening tests and immunizations to prevent certain kinds of illness. Recommendations for preventive services depend on your age, sex, health status, and family history. Every person is different.

All preventive services have possible benefits (pros) and harms (cons). Depending on your values and preferences about these benefits and harms, you may wish to receive additional, fewer, or different services than those that are recommended. Talk with your health care team about their recommendations for screening tests and immunizations that are right for you.

“Screening” means looking for a condition before there are any signs or symptoms of that condition. If you already have a symptom of the condition, you should talk with your provider about it, even if you were recently screened and no problem was found.

Regardless of age, gender, health status and family history, you should be screened for alcohol abuse, depression, high blood pressure, human immunodeficiency virus (HIV), military sexual trauma, obesity, posttraumatic stress disorder (PTSD), and tobacco use.

You should also follow the appropriate cancer screening guidelines. Keeping up with immunizations is also important to stay healthy. You should receive a flu shot every year and a tetanus shot at least every 10 years but some Veterans may need it sooner (indicated for wound management if greater than 5 years has passed since your last shot and those Veterans that are pregnant should receive Tdap vaccine during every pregnancy from 27-36 weeks of gestation).

If you have not received a COVID-19 vaccine already, you can best protect yourself by doing so now. COVID-19 vaccines are highly effective in preventing serious illness from COVID-19. They will also protect you from newer virus variants that may spread more easily and affect you more severely. COVID-19 vaccines may be given at the same time as other vaccines, including influenza vaccines. Vaccination is the best way to protect yourself, your family, and your community.

These are actions you can take to protect yourself and those you love from harm and injury. Common safety issues are sexually transmitted infections, falls, violence and self-harm.

Intimate partner violence (IPV), also called domestic violence, affects millions of Americans. IPV is the most common cause of injury to women in the U.S. IPV is defined as actual or threatened emotional, physical, or sexual abuse or stalking behaviors by an intimate partner.

These are actions you can take to protect yourself and those you love from harm and injury. Common safety issues are sexually transmitted infections, falls, motor vehicle crashes, violence and self-harm.

What's Important to Know?

Falls are a leading cause of fractures, injuries, loss of function, and deaths among older adults. About half of all falls happen at home, and there are practical things you can do to reduce your risk of falling there. Engaging in regular physical activity, monitoring or avoiding certain medications, and getting your eyes checked may reduce your risk of falling. Other things you can do to prevent falls are:

• Remove small throw rugs to prevent tripping and falling. If you choose to use them, anchor them with double-sided tape or anti-slip mats underneath.
• Improve the lighting in your home. As you get older, you need brighter lights to help you see well. Hang lightweight curtains or shades to reduce glare. Include night lights in areas you may walk at night.
• Wear shoes inside and outside the house. Avoid going barefoot or wearing slippers.
• Remove clutter (papers, books, clothes, shoes, etc.) from stairs and places where you walk so you will be less likely to trip. Install handrails and lights in all staircases.

• Keep items you use often in cabinets that you can reach easily without using a step stool.
• Install grab bars next to your toilet and in your tub or shower. Make sure you use non-slip mats in the bathtub and on shower floors.
• Use a walker or a cane for extra support.
• Engage in physical activity such as balance training exercises or Tai Chi, to help reduce your risk of falling by increasing your strength and balance. Lack of physical activity leads to weakness and increases your chances of falling.

It is important to recognize signs that you or someone you know may be in crisis.

What's Important to Know?

People can experience emotional or mental health distress in response to a wide range of situations. Distress may be triggered by troubles such as problems in personal relationships or loss of a job. This distress can get worse and lead some people to consider hurting or even killing themselves (suicide). In general, Veterans are at a higher risk of suicide than civilians.

These warning signs may indicate that someone is experiencing emotional distress, a crisis and/or possibly having thoughts of suicide:

• Hopelessness, feeling like there's no way out
• Anxiety, agitation, sleeplessness, or mood swings
• Talking about death, dying, or suicide
• Feeling like there is no reason to live
• Feeling like a burden to others
• Rage or anger
• Engaging in risky activities without thinking about possible harm
• Increasing or excessive tobacco, alcohol, or drug abuse
• Withdrawing from family and friends
• Feeling overwhelming guilt or shame

These signs require immediate attention:

• Thinking about killing yourself
• Looking for ways to kill yourself
• Self-destructive behavior such as drug abuse, reckless behaviors, weapon use, etc.
• During times of crisis or hopelessness, consider removing firearms from the home or using a gun lock or gun safe to make them less accessible.

If you or someone else is in a serious crisis and having thoughts of suicide:

• Seek immediate help from your health care team or the nearest hospital emergency room
• Call 911
• Call the Veterans Crisis Line at 988, Press 1

• Contact the Veterans Crisis Line Text Service: 838255
• Contact the Veterans Chat Service

Sexually Transmitted Infections (STIs) are infections you can get or give someone by having sex while you or your partner are infected.

What's Important to Know?

Sexually Transmitted Infections (STIs), often referred to as Sexually Transmitted Diseases (STDs), are infections you can get or give someone by having sex while you or your partner has an infection. STIs are the same thing as sexually transmitted diseases (STDs). Many STIs do not have symptoms. You and/or your partner can have an STI and pass it on without knowing it. Some STIs can cause organ damage and infertility. Having one STI may raise your risk for getting other STIs. Some examples of STIs are chlamydia, gonorrhea, syphilis, trichomonas, human immunodeficiency virus (HIV), and human papillomavirus (HPV). HPV is the most common STI in the United States and can cause cervical and anal cancer. Recently, Mpox has been identified as a STI, though it can also spread through other modes such as skin to skin contact. If you or your partner have skin sores or blisters, this could be a sign of mpox or another infection.

You can get STIs from any sexual activity, whether it involves the mouth, anus, vagina, or penis. Although the risk is lower, STIs can also be transmitted by shared sex toys. If you are pregnant, you can pass on some to your baby before or during your baby’s birth. Most STIs can be treated and cured. Some cannot be cured but can be managed by taking medicines. If you are treated for an STI, your sex partner(s) may also need to be treated to prevent you from being re-infected.

The best way to prevent STIs is by using a barrier such as a condom or dental dam. You need to use a new, unused lubricated latex condom every time you have sex for the entire sex act. But not all types of condoms are effective at reducing the spread of STI. For those allergic to latex, polyurethane and polyisoprene condoms offer protection from STIs but may break more easily. Lambskin condoms and birth control pills can help prevent pregnancy, but they will not protect you from STIs. Limiting your number of sex partners can also reduce your risk of getting an STI. Research is ongoing and new methods of prevention may become available. Talk to your health care team if you wish to learn more.

Vaccines are available through VA that can help prevent you from getting certain STIs. These are:

• HPV
• Hepatitis A
• Hepatitis B
• Mpox

Multiple medications are available to protect yourself against HIV infection. HIV pre-exposure prophylaxis (PrEP) is a medication (oral medication or injection) that is highly effective at preventing HIV infection for people at risk. It can lower your risk of getting HIV from sex by about 99% when taken correctly. HIV post-exposure prophylaxis (PEP) is medication taken to prevent HIV in emergency situations after a possible exposure. It must be taken within 72 hours of exposure. For some people who have had a bacterial STI in the past year and are at high risk for another, an antibiotic may be recommended after sexual contact.

Getting tested and knowing your status is also an important part of reducing the spread of STIs. If you are at risk for one STI, you are at risk for all STIs!