Office of Prevention, Education, and Control

Your Health 

is Golden

Heart Health

Promotion

Activities for

Vietnamese

Communities

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

N A TIONAL I NSTITUTES O F H EAL T H

N ATIONAL H EART , L UNG , AND B LOOD I NSTITUTE
Your Health 

is Golden

Heart Health

Promotion

Activities for

Vietnamese

Communities

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

Administrative Use Only

February 2006
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Section 1: Getting Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Finding a Leader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Where to Find a Leader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Talking to Potential Leaders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Finding a Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Making Photocopies of the Handouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Incentives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Section 2: Conducting Your Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Learning Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Five Tips for Success. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Section 3: Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Section 4: Additional Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Section 5: Staying in Touch with Your Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Table of Contents
Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

A. Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

B. Heart Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

C. Vietnamese Community Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

D. Sample Promotional Flyer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

E. Healthy Heart Attitude Assessment Form (pretest) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

F. Stages of Behavior Change Tip Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

G. Heart Disease Risk Factors: Frequently Asked Questions. . . . . . . . . . . . . . . . . . . . . . . . . 27

H. Get Fit! Physical Activity Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

I. How to Create a Nutrition Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

J. Huong Quê: How to Do a Heart Healthy Cooking Demonstration . . . . . . . . . . . . . . . . . . . 35

K. Sample Evaluation (posttest) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

L. Watch Your Weight: BMI Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

M. Heart Disease Risk Factors You Can Do Something About. . . . . . . . . . . . . . . . . . . . . . . . 43

N. Wallet Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
1

This activity guide is designed for you—

community health educators—to organize

discussion-based activities for adults and

seniors in your community. These activities aim 

to increase the participants’ awareness of heart 

disease through a strategic public health model.

Community members will review scenarios about

heart disease risk and share personal experiences

about living in a heart healthy way. Health educators can conduct these activities in clinics, 

community centers, schools, senior centers, parks,

and even in someone’s home. The key is to educate in fun, engaging ways. By the end of the 

discussions, the participants will have acquired 

the knowledge, self-confidence, and motivation 

to begin leading heart healthy lives.

The low-cost ideas in this guide come from the

Vietnamese community and offer practices to

address a critical public health problem. You may

use this guide alone or to augment an existing 

program in your community. The discussions are

arranged by risk factors for heart disease, but you

may skip to any section you like.

We dedicate this guide to all those who are 

committed to making a difference in Vietnamese

communities and who realize that change—both

personal and environmental—is possible. When

you use this guide, you do a rewarding and 

important service to your community.

We hope that you will come back to Your Health is

Golden many times. It contains endless possibilities!

We want to hear from you! Please tell us what

worked and what did not work for you. Write to:

Violet Ryo-Hwa Woo, M.S., M.P.H.

Public Health Advisor

Office of Prevention, Education, and Control

National Heart, Lung, and Blood Institute

31 Center Drive, MSC 2480

Bethesda, MD 20892-2480

Introduction

The National, Heart, Lung, and Blood Institute

appreciatively acknowledges Julie Tu for her

energy in developing Your Health is Golden!

Heart Health Promotion Activities for Vietnamese

Communities and her dedication to helping the

Asian and Pacific Islander communities live

healthier lives.
2

Section 1:

Getting Started

We are happy that you want to take action

to bring heart health information to your

community and make a difference. As a

first step, get your community thinking and talking

about heart health. Gathering background information on the health needs of the Vietnamese 

community is essential before you hold your 

activities. This is an excellent way to become

familiar with some of the health issues and concerns of the community in which you live and/or

work. Use the Vietnamese community profile on

pages 21–22 as a start.

Each discussion topic should last up to an hour.

There are a total of eight discussion topics. They

can be done all at once or individually. You may

want to offer participants blood pressure and blood

cholesterol screenings, nutrition classes, food

demonstrations, information on community and

support groups, and referrals. For the session on

smoking, you may consider the help of a certified

instructor. Ask the local chapter of your American

Lung Association, American Heart Association, the

YMCA (Young Men’s Christian Association) and

YWCA (Young Women’s Christian Association),

Registered Dietitians, or county extension programs about training classes or trained instructors.

Additional activities take place after the discussions

are concluded.

Located in the appendix are handouts, hands-on

activity ideas, evaluations, and additional information you might find helpful. For a planning

checklist, see the box on the right.

What Do You Need? 

An Activity Planner’s Checklist

■ Read this entire guide before organizing

your activity.

■ Find a leader and send this guide and a 

letter confirming the date, time, and location

to him or her 4 weeks before your activity.

■ Reserve the location for your activity.

■ (Optional) Arrange additional activities.

■ Develop a list of local agencies that conduct

smoking cessation classes or offer support

groups for participants who want to quit

smoking. The American Lung Association,

a local hospital, or regional health maintenance organization (HMO) are just some

examples.

■ Develop a referral list of doctors, Registered

Dietitians (RDs), and health educators in

the community who work with local clinics.

■ Distribute flyers to promote your community

activity. 

■ Recruit participants.

■ Make copies of handouts.
3

Finding a Leader

As the activity planner, you may want to do the

discussion yourself. Or you may choose to make

arrangements (finding a site, arranging screenings,

and organizing marketing activities) and find a

leader(s) to carry out the discussion. A good

leader has enthusiasm, patience, understanding,

and compassion—someone who works comfortably with the public. Try and find a leader two

months before your activity date. Your leader

should have prior experience or knowledge in

working with Vietnamese people on an individual

and on a group level and be fluent in the language

in which the program will be conducted. See the

box below for tips for selecting a leader.

Where to Find a Leader

To find a leader, you may contact a local medical

society, community resource center, communitybased organization, hospital community outreach

program, local health department, local nursing

organization, local clinic, or nonprofit agency like

the American Heart Association or the American

Red Cross. You can also speak with administrators

and key persons at your organization for suggestions or referrals. Explain how your discussion

activities will benefit your community by raising

awareness of heart disease and promoting heart

healthy lifestyles. If you plan to offer blood 

pressure and/or blood cholesterol screenings, 

contact a local health care provider, hospital, health

department, or nonprofit agency. Request two to

four volunteers (depending on the number of 

participants that you expect) to conduct the screenings and supply necessary kits and equipment.

Talking to Potential Leaders

Let volunteers know that they are not expected to

be experts on heart disease. Tell them that you will

send them Your Health is Golden! Heart Health

Promotion Activities for Vietnamese Communities

to help them prepare for the presentation and group

discussion.

You may want to say:

“This is a 1-hour activity [or more, depending on how many discussion topics you

want to cover] developed by the National

Heart, Lung, and Blood Institute, of the

National Institutes of Health, and [insert

the name of your organization]. It is userfriendly and easy to adapt for different

Vietnamese communities. The discussions

will help Vietnamese people learn about the

risk factors for heart disease, so that they

can make heart healthy choices in their

lives. In addition, there may be blood cholesterol and blood pressure screenings,

referrals, nutrition counseling, and food

demonstrations. Please review the guide.

It provides useful background information

about heart disease and detailed information and materials that you can use for the

discussions. Thank you for your time and

service to the Vietnamese community.”

Tips for Selecting a Leader

Find someone who:

■ Works well with the public.

■ Has an understanding and respect for

Vietnamese culture, values, and people.

■ Is fully committed to improving the 

heart health of Vietnamese.

■ Is willing to be trained.

■ May share demographic characteristics

and common language with the 

participants.
4

Finding a Location

Decide where you want to hold your discussion

activities and contact the site's manager to reserve

the facility six to eight weeks in advance of your

event. Request a blackboard or dry erase board,

flip chart, table, overhead projector and screen or

computer laptop and LCD monitor (if available),

and chairs for the participants. If you expect a

large group, ask for a microphone. You will need

to reserve the room for enough time to accommodate your entire presentation and discussion. Ask

for extra tables and chairs if you plan to offer

screenings or food demonstrations. You may need

to schedule more time if you provide these extra

activities. Request that a staff member from the

facility attend the program to troubleshoot audiovisual equipment and to make sure that all the

items you requested are available. See the box to

the right for ideas on possible locations.

Marketing

One of the best ways to find participants for your

activity is to advertise the event. Once you have

your leader and location confirmed, you should

prepare to advertise your event(s).

Distribute copies of the promotional flyer (page

23). Pass them out at community events; post

them in clinics, hospitals, WIC (Women, Infants,

and Children) centers, libraries, grocery stores,

restaurants, cooperative extension service centers,

social service agencies, health departments,

recreation centers, community centers, schools,

churches, and temples; and take them door-to-door.

Tell your friends and neighbors. Word-of-mouth

is a good way to promote your community

activity.

Making Photocopies of 

the Handouts

At a local print shop, prepare enough copies of

your handouts and evaluation form for all 

participants. Having photocopies ready during 

the discussions is best, so that your participants can

go home with ready-to-use materials to reinforce

information learned from the discussions.

Ideas for Locations

■ Recreation center

■ Senior center

■ Community center

■ An individual’s home

■ Temples

■ Churches

■ Health departments or clinics

■ Youth center

■ Library

■ Worksites

■ School cafeteria, gymnasium, 

or auditorium

■ A common area where Vietnamese gather

Note: Make sure your location and the

arrangement of the room are conducive to

open discussion. Make your participants

feel comfortable so that they can freely

exchange their ideas with one another.
5

Incentives

In the Vietnamese culture, nothing is more important than the love shown by family, friends, and a

supportive community. Show your participants the

same level of love and respect that Vietnamese

people share with those they care about. You can

provide nutritious snacks and light refreshments

during your activity and/or give a small thank you

gift for participation. Incentives are an effective

way to recruit participants, maintain participation,

reinforce positive behavior, and motivate others.

Recognize each participant’s achievements and

reinforce the benefits for participation: living heart

healthy, feeling better, having more energy, and

having fun with others. Identify incentives and

rewards during the planning phase, and build them

into your budget. Some ideas for incentives are

gift certificates, coupons, small trinkets, certificates, or T-shirts. Show your participants that you

care for them and their community, and are committed to working with them to make personal

lifestyle changes.

Section 2: Conducting

Your Activity

Overview

The discussions are located in the Appendix,

pages 10–45. There are eight discussion

topics altogether, plus introduction and 

concluding activities. Depending on your community’s needs, you may choose to cover all of the

discussion topics or only a select few. When you

have completed all your discussions, do a quick

review, and then have participants fill out an 

evaluation form.

Discussion

It is recommended that you spend 60 minutes on

each discussion topic. Each discussion is organized into three parts: story, discussion, and skill.

Some discussion topics have optional activities for

you to do, if you have time. Follow the script as it

is written. The story is accompanied by a series of

illustrations. While you are reading the story

aloud, show the illustrations to your participants

for them to follow along. You may need to enlarge

the illustrations if they are too small. The discussion

offers time for your participants to react to what

they heard in the story. Use the discussion questions

to spark dialogue among group members. As your

participants are talking, you may want to write

down their comments on a board or flip chart. If

you are asked a question you cannot answer, it’s

okay. You can use the frequently asked questions

handout on pages 27–31, or give the correct

answer at a following session. In the last part of

the discussion, participants will learn a skill related

to the particular topic, or risk factor. For example,

the skill for the high blood pressure activity

includes learning what blood pressure numbers

mean and what a normal blood pressure level is.

Agenda

■ Introduction—5 minutes

■ Activity (each)—30 minutes

■ Review—10 minutes

■ Evaluation—15 minutes

■ Additional activities (optional)—

1 to 2 hours as needed
6

Some activities will contain an optional activity that

you can do if you have the time.

Learning Objectives

At the end of the discussions, each participant 

will be able to:

State that heart disease can be prevented.

Identify the six heart disease risk factors that

people can do something about.

Identify at least three changes that people can

make to lower their risk of heart disease.

Recognize the importance of having regular

blood pressure and blood cholesterol testing as

part of a healthy lifestyle.

At the end of the discussions, each participant will

learn that:

A blood pressure of less than 120/80 (“120 over

80”) mmHg is normal.

A total blood cholesterol level of less than 200

mg/dL is best.

An LDL cholesterol level of less than 100

mg/dL is best for people at high risk for heart

disease. An LDL cholesterol level of less than

70 mg/dL is best for people at very high risk

for heart disease.

People can quit smoking with support from 

their family, friends, and community.

Adults should have at least 30 minutes of 

moderate physical activity on most, preferably

all, days of the week.

A body mass index (BMI) of 18.5 to 24.9 is a

healthy BMI. A waist measurement of more

than 88.9 cm (35 inches) for women and more

than 101.6 cm (40 inches) for men is high. A

high waist circumference increases your risk 

for heart disease.

Foods moderate in calories and lower in salt and

sodium, saturated and trans fat, and cholesterol

are part of a heart healthy diet.

The most important thing to do when experiencing heart attack signs is to promptly 

call 9-1-1.

Five Tips for Success 

1. Be sensitive to the needs of your audience.

During group learning and open exchange, try to

be respectful of Vietnamese peoples’ behaviors

and culture, particularly the importance of 

family dynamics.

2. Set goals for heart health. Learning to live

heart healthy is easier if you have a goal to work

towards. You can set group goals or let the 

participants set their own goals related to outcomes such as maintaining or reducing weight,

lowering blood pressure, lowering blood 

cholesterol, being more physically active, 

choosing healthy foods, or quitting smoking.

3. Let your participants be your guide. The 

discussions don’t have to be too structured.

Observe how your participants react to the 

activities, and let the rest flow naturally.

4. Set an example. If you display honest, open,

and positive behavior for an engaging discussion,

your participants will too.

5. Practice makes perfect. Be prepared. Practice

each activity several times before you execute 

it in front of a group. Each activity lasts 

approximately 60 minutes, so plan your time

accordingly.
7

Section 3: Evaluation

Ashort participant evaluation is a good way

to assess how you are as a leader and how

successful the activity was. Keep it short

and simple. It can be written or spoken. You may

use the healthy heart attitude assessment form

(pretest) on pages 24–25 before you begin your

discussions to determine how ready your participants are to commit to living heart healthy and

begin to change their lifestyle behaviors. When

you have completed your discussions, you may use

the short evaluation form (posttest) on pages 37–39

to determine how well you did as a leader and if

the activities were successful in increasing knowledge and affecting attitude and behavior changes.

If some participants choose not to complete the

evaluation form, you may ask them a few 

questions while they are waiting to participate 

in an additional activity or as they are leaving the

room. Thank the participants for attending, and

give them a thank you gift, if applicable.

Section 4: 

Additional Activities

You can personalize your discussions with

additional activities based on the needs 

and interests of the group leader or the 

participants. Activities such as free screening 

services, food demonstrations, heart healthy cooking

demonstration, smoking cessation class, or cardiopulmonary resuscitation (CPR) instruction are all

good heart healthy activity ideas. Look to a local

medical school, clinic, or hospital for people who

can help you out with screening or CPR instruction.

Ask for nutrition or exercise physiology students or

instructors at culinary schools to volunteer for

nutrition and physical activities.

If you are preparing additional activities for your

participants, you may want to add additional 

questions to your evaluation form and then delay

the evaluation until after all of your activities are

completed.

Section 5: 

Staying in Touch with

Your Community

After you have completed your discussions,

you should maintain the momentum in the

community by beginning to plan for future

programs based on the information that you gathered. Read over the evaluation results and record

feedback from volunteers. Their suggestions can

only help to improve your program and make it

even better. You can even ask motivated and

enthusiastic participants of your group to become

leaders for discussion-based activities in their own

communities. Also, spread the word about heart

healthy activities in other Vietnamese communities

in your area. Talk to other people involved with

heart health community-based interventions to see

what they have done. Over time, you can add new

information to your discussions and more activities

and discussion topics to your program.
9

A. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

B. Heart Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

C. Vietnamese Community Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

D. Sample Program Flyer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

E. Healthy Heart Attitude Assessment Form (pretest) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

F. Stages of Behavior Change Tip Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

G. Heart Disease Risk Factors: Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

H. Get Fit! Physical Activity Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

I. How to Create a Nutrition Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

J. Huong Quê: How to Do a Heart Healthy Cooking Demonstration . . . . . . . . . . . . . . . . . . . . . . . . 35

K. Sample Evaluation (posttest) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

L. Watch Your Weight: BMI Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

M. Heart Disease Risk Factors You Can Do Something About . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

N. Wallet Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Appendices
10

A. Discussion

Introduction

Do: Introduce yourself to the group. You may 

follow with an opening poem or traditional song

and dance.

Say: Welcome to Your Health is Golden activity

group, made possible by the National Heart, Lung,

and Blood Institute and [name of your organization].

My name is _____________________, and I will

be the leader for today’s program. Before we

begin, I would like to take a moment to introduce

the people who are helping me today. [Introduce

your team.] We will be spending the next hour [or

more, depending on how many discussion topics

you want to cover] talking about a very serious

problem that can affect all Vietnamese people—

heart disease. In the company of friends you will

learn important facts about heart disease and how

we can take care of our hearts. This is a friendly,

supportive, and caring environment where we can

learn and exchange ideas on heart health.

Do: Have the participants introduce themselves.

Ask them if they would like to add a personal 

story about themselves or someone they know 

with heart disease.

Icebreaker Activity

If you feel that the participants are a little shy, start

your activity with an icebreaker (a fun group game)

to make the participants feel more comfortable.

Icebreakers are designed to get people talking,

thinking, and learning in a casual, fun, and nonthreatening way. Icebreaker activities usually last

10–15 minutes. This icebreaker activity is called

Close to My Heart, Part I. Each participant will

receive a heart made from red construction paper

(see page 20 for the template). On the heart-shaped

card, each participant will write down his/her personal goal for heart health. Then each participant

will read his or her goal aloud, identifying himself

or herself and explaining his or her personal goal.

If you would like to do the followup activity to 

this icebreaker at the end of your program (see 

the closing on page 19), ask each participant to

hold onto their card until the end.

Topic 1: The Heart, Heart Disease, 

and Its Risk Factors

Say: This is an interactive program that allows us

to talk about matters of the heart. Let’s take a look

at how the heart works. The heart is a muscular

organ the size of your fist. The heart functions like

a water pump. The heart pumps 5 liters of blood

per minute to all parts of your body and beats

about 100,000 times a day, but the heart is more

than a pumping machine. It is what gives you

life—the power to breathe, to be active, and to love

others. If you don’t take care of your heart, you

will become sick.

Say: Heart disease is one way you can become sick. 

Ask: What do you know about heart disease?

Say: Heart disease is caused by risk factors. A

risk factor is a trait or habit that makes a person

more likely to develop heart disease. The more

risk factors a person has, the greater the person’s

chance for developing heart disease. There are two

types of risk factors for heart disease—ones you

can change and ones you can’t change. The ones

that you cannot change are age, gender, and heredity

(what runs in your family). For today’s activities, 

I want to concentrate on the risk factors that you

can change. They are high blood pressure, high

blood cholesterol, smoking, physical inactivity,

overweight and obesity, and diabetes. We will 

learn more about risk factors you can change by

listening to stories about the Le family.
11

Topic 2: High Blood Pressure

Say: High blood pressure is known as the silent

killer because it has no signs or symptoms. High

blood pressure occurs when the pressure of blood

in the blood vessels stays high over a period of

time making the heart work harder. Listen to the

following story about high blood pressure, and 

follow along with the pictures.

Story: Anh Dung Le loves Vietnamese food. 

He enjoys herbs with pho and the meat and/or 

vegetable dishes, but he cannot eat a meal without

nuoc mam, a tasty fish sauce that is a staple of

Vietnamese dishes. At his last doctor’s appointment, his blood pressure was high—143 over 96.

This made him very worried. One of the first

things his doctor recommended was to cut down 

on salt and sodium, primarily the nuoc mam.

Father: Anh Dung Le

Daughter: Kieu Thi Le

Son: Thanh Le

Grandfather: Dac Kien Le

Grandmother: Binh Thi Le 

Mother: Hanh Phuc Le
12

Discussion: 

Ask:

Do you think it would be easy for Anh Dung Le

to cut down on salt and sodium in his diet?

How would you advise him to cut down on salt

and sodium in his diet?

Can you think of other ways (i.e., health 

behaviors) to lower high blood pressure other

than changing a person’s diet?

Skill: Know Your Numbers! You should get your

blood pressure checked at least every two years—

or more often if you have high blood pressure or

prehypertension. When you get your blood pressure checked, the health care professional who

takes your blood pressure will give you a reading

in the form of numbers. That person may say,

“Your blood pressure is 120 over 80.” Blood pressure is always given as two numbers, systolic and

diastolic. The first number (120), systolic, is the

pressure of the blood when the heart is beating.

The second number (80), diastolic, is the pressure

of the blood when the heart is at rest. Blood pressure is measured in millimeters of mercury (mmHg).

If your blood pressure is less than 120 over 80, that

is normal. Good for you! You can keep it that

way by maintaining a healthy weight, eating foods

with less salt and sodium, eating potassium-rich

fruits and vegetables, and being physically active.

If your blood pressure number is 120 over 80 to

139 over 89, then you have prehypertension. Your

blood pressure could be a problem. Act now to

change what you eat, be more physically active, and

lose extra weight, if you are overweight. If your

blood pressure number is 140 over 90 or more, you

have high blood pressure. Talk to a doctor to learn

how you can lower your blood pressure.

Say: During this activity, we have learned that if

you are losing weight, if you are overweight or

obese, or maintaining a healthy weight, we can

take other actions to help prevent or lower high

blood pressure. You can help prevent or lower

high blood pressure by eating foods that are low in 

saturated fat, total fat and cholesterol, eating lots 

of fruits and vegetables, and choosing low-fat or

fat-free milk and milk-products while staying within

calorie needs. It’s important to go easy on the 

alcohol. Drinking too much alcohol can increase

your risk for high blood pressure. If you drink

alcoholic beverages, drink only a moderate amount.

This means only one drink a day for women and

two drinks a day for men. If you smoke, try to quit

smoking today. Smoking injures blood vessel

walls and speeds up the process of hardening the

arteries. It can increase your chance of having a

stroke, heart disease, peripheral arterial disease, and

several types of cancer. Because diabetics are at

high risk for heart disease or stroke, they should

work with their health care professional to control

both high blood pressure and high blood sugar.
13

Topic 3: High Blood Cholesterol

Say: Cholesterol in your arteries is like rust in a

pipe. Too much cholesterol in the blood clogs the

arteries, which can lead to heart disease. Listen to

the following story about high blood cholesterol,

and follow along with the pictures.

Story: Binh Thi Le helps her daughter-in-law in

the kitchen to prepare dinner every day. When she

cooks, she uses animal fat. She doesn’t remove

skin from chicken or duck and she doesn’t skim

the fat off cold, refrigerated broth before reheating

for the next meal. These cooking habits can raise

blood cholesterol.

Discussion:

Ask:

What can Binh Thi Le do to make her cooking

more heart healthy and lower in saturated fat for

her family?

What kinds of cooking habits to lower saturated

fat are you currently practicing or would consider

practicing in your kitchen? 

Skill: Know Your Numbers! Blood cholesterol

levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. Try to keep your

total blood cholesterol level less than 200 mg/dL.

That is best. Stay active and eat foods low in saturated fat, trans fat, and cholesterol. It is also

important to keep your LDL cholesterol level at an

optimal level to prevent heart disease. Try to keep

your LDL cholesterol level below 100 mg/dL, if

you are at high risk for heart disease. If you are at

very high risk for heart disease, try to keep your

LDL cholesterol level below 70 mg/dL. Talk to

your doctor to learn about your heart disease risk,

ways you can lower your total blood cholesterol,

and help set your goal for lowering your LDL

cholesterol level. (For more information on LDL

cholesterol and to learn about HDL cholesterol,

please see pages 28–29.)

Optional Activity: Nutrition display activity

Prepare the nutrition display (as described on page

34) and present it to your group. Participants will

learn how much saturated and trans fat they can

cut out of their diet by eating a lower fat alternative to a popular Vietnamese dish.
14

Topic 4: Smoking

Say: In the Vietnamese culture, in homeland, 

people smoked to display strength or power within

the community. The reality is that smokers put 

their own health and their family’s health at risk 

by hurting their lungs and hearts. In the United

States, more than 400,000 people die each year

from smoking-related diseases. More than 2,000

people die each day. Smoking can also raise blood

pressure and increase one’s chance of a heart attack.

Listen to the following story about smoking, and

follow along with the pictures.

Story: Thanh Le is a junior in high school. He

has many friends; most of them are Vietnamese.

When they are together, they have a good time

talking, laughing, and having fun. Thanh Le feels

a lot of pressure to smoke with his friends. Thanh

Le has tried smoking. He doesn’t like it, but he

wants to smoke to fit in with his friends. He wants

to look cool. He fears that if he doesn’t become a

regular smoker, he won’t have any friends at all.

Discussion: 

Ask:

What would you ask Thanh Le do to in this 

situation?

Do you know someone like Thanh Le?

Does this kind of peer pressure exist quite often

in your community? Does peer pressure exist

for everyone in the community, not just the

younger generation?

Do you know of anyone who smokes to relieve

stress? What stress-relieving activities can you

think of to replace smoking?

What kind of support exists in your community

for quitting smoking (e.g., family, friends, health

care professionals, classes)?

Skill: If you smoke, there are things you can do 

to quit smoking. Try:

Setting a goal for yourself. Say, “I will quit

smoking today,” or “I will quit smoking on 

my birthday.”

Talking to someone who has quit smoking.

Keeping yourself and your hands busy by finding an activity you enjoy doing, like riding a

bike or cooking a healthy meal for yourself or

your family.

Getting support and encouragement. Join a quit

smoking program, ask your doctor for advice, 

or find a friend to quit with you.
15

Topic 5: Physical Inactivity

Say: Being physically inactive can double your

chances of heart disease and can take years away

from your life. It can increase your risk of high

blood pressure, high blood cholesterol, and diabetes,

and it may lead to overweight or obesity. Listen 

to the following story about physical inactivity,

and follow along with the pictures.

Story: Binh Thi Le is the matriarch of the Le family and watches over everyone. She is concerned

that her son and daughter-in-law are too tired and

stressed after work to engage in physical activity.

She thinks her grandchildren spend too much time

on the computer or in front of the TV. She is worried that their mostly sedentary lives

are bad for their health. She wants

to start a daily ritual where the

entire family walks together for at

least 30 minutes after dinner.

Discussion:

Ask:

Can you identify with any of the characters

mentioned in the story? In what way?

Do you have time to engage in a physical 

activity for at least 30 minutes on most, 

preferably all, days of the week with your 

family? What kind of activities do you do? 

Can you think of other ways that you can be

physically active during the day?

Skill: Physical activity is very important. It is 

recommended that adults do at least 30 minutes 

of physical activity on most, preferably all, days 

of the week. You can do at least 30 minutes all 

at once, or you can start slowly and build up to 

30 minutes each day by being active for at least 

10 minutes three times a day. Children and

teenagers should be physically active for 60 minutes most days of the week, but preferably every

day of the week. Physical activity does not have to

be done alone; it can be done with family, friends,

or neighbors. Some activities you can try are:

walking during your lunch break or after dinner

with your family, riding your bike to work or

school, asking your friends to join you at an aerobics class, or walking up the stairs instead of taking the elevator. An additional 30 minutes of physical activity per day may assist in preventing weight

gain for persons who were overweight/obese. To

sustain weight loss, the additional 30 minutes of

physical activity may be needed.

Optional Activity: If your participants are interested in forming a physical activity group, pass out

the Get Fit! Physical Activity Groups handout,

pages 32–33.
16

Topic 6: Overweight and Obesity

Say: Overweight occurs when extra calories are

stored as fat in your body. Being overweight

increases your risk of developing high blood 

pressure, high blood cholesterol, and diabetes.

Listen to the following story about overweight 

and obesity, and follow along with the pictures.

Story: Hanh Phuc Le is a busy, overworked 

mother with two jobs. She doesn’t have enough

time to make a healthy, traditional Vietnamese 

dinner every day, so she often stops at a local fast

food restaurant to buy some quick take out, adding

to the dishes that her mother-in-law makes. Fast

food eating has taken a toll on her family’s health.

She consulted with friends and learned how to

make pho with lean beef and a salad tossed with a

simple but delicious salad dressing made of lime

juice, garlic, chilies, and sugar substitute in less

than 30 minutes. Salads are great for busy families

because they are easy to prepare, delicious, and

healthy. They are also fun to make with her 

children who like to toss the ingredients once

they’re in the bowl.

Discussion:

Ask:

Do you ever feel strapped for time like Hanh

Phuc Le?

Do you want to make heart healthy meals that

save you time and energy?

What tips can you share that will make cooking

for the family less time-consuming but still

healthy?

Skill: Teach your participants how to calculate their

body mass index, or BMI. The BMI is a measure

of your weight relative to your height. This information (along with your waist measurement) can

help you find your risk for developing conditions

such as heart disease, stroke, and diabetes that are

related to being overweight or obese.

Pass out the BMI chart on pages 40–42 and review

what BMI means. Read the directions aloud for 

the participants to follow along and find their BMI.

Ask the participants to record their BMI on the

handout. 
17

When your participants are done calculating their

BMI, say: If you are overweight or obese, try to

lose weight slowly. Lose 0.45 to 0.9 kg (1 to 2

pounds) a week. To lose weight, you will need to

cut 500 to 1,000 calories each day from your current

diet. Also, eat sensible portions and be physically

active at least 60 minutes on most days of the

week. We have learned that if you are losing

weight, if you are overweight or obese, or maintaining a healthy weight, we can take other actions

to help prevent or lower high blood pressure. You

can help prevent or lower high blood pressure by

eating foods that are low in saturated fat, total fat

and cholesterol, eating lots of fruits and vegetables,

and choosing low-fat or fat-free milk and milkproducts while staying within calorie needs. If you

are at a healthy weight, good for you! Try not to

gain extra weight. 

Also check your waist circumference. Waist 

circumference is the measure of your waistline 

and is another way to determine heart disease risk. A waist measurement of more than 88.9 cm (35

inches) for women and more than 101.6 cm (40

inches) for men is high. A high waist measurement

increases your risk for heart disease. If you lose

weight, you may lose the extra weight from around

your waist.

Optional Activity:To demonstrate how to 

prepare a quick, heart healthy dish, try the recipe

on pages 35–36 with your participants.

Topic 7: Diabetes

Say: Diabetes, or high blood sugar, is serious.

When your blood sugar is high, your body cannot

use the food that you eat for energy. Diabetes can

lead to heart attacks, blindness, kidney disease, and

amputations. Listen to the following story about

diabetes, and follow along with the pictures.
Story: Hanh Phuc Le’s best friend has diabetes.

Since coming to the United States more than 

20 years ago, she has developed unhealthy eating

habits. Eating high calorie foods, including

sweets, and not being physically active can lead to

weight gain, and being overweight is a risk factor

for type II diabetes. Hanh Phuc Le is concerned

about diabetes in her own family.

Discussion:

Ask:

What do you know about diabetes? 

Do you know anyone with diabetes?

Skill: Protect yourself against diabetes.

Depending on your individual situation have your

doctor check your blood sugar level every year,

beginning at the age of 45. You should be tested at

a younger age if you are at risk for diabetes. Your

chances of getting diabetes are greater if:

You are overweight, especially if you have extra

weight around the waist.

You are not physically active.

You have a family member with diabetes.

You had diabetes during pregnancy (gestational

diabetes) or gave birth to at least one baby

weighing more than nine pounds.

Your blood pressure is 140/90 mmHg or higher,

or you have been told that you have high blood

pressure.

Your cholesterol levels are not normal. Your

HDL cholesterol (or “good” cholesterol) is 

40 mg/dL or lower, or your triglyceride level is

150 mg/dL or higher. (For more information on

HDL cholesterol, please see pages 28–29.)

To lower your risk of having diabetes: try to maintain a healthy weight and stay physically active.

Topic 8: Heart Attack

Say: Every year, about 1.1 million people in the

United States have a heart attack and close to half

of them die. A heart attack occurs when the blood

supply going to a portion of the heart through one

of the coronary arteries is blocked. When a heart

attack occurs, quick action and medical treatment

can restore the blood flow to the heart and keep

heart muscle from dying. But, this can happen

only if the person receives medical help right

away. Treatment should be given as soon as possible, ideally within one hour after symptoms start.

The more heart muscle is saved, the better chance

a heart attack patient has of surviving and resuming a normal life. Listen to the following story

about heart attack and follow along with the pictures on page 19.

Story: Kieu Thi Le is a medical student and is 

currently learning about heart attacks in class. She

learns that every minute of a heart attack counts.

She is concerned that her family won’t know what

to do in case someone has a heart attack, or that

they might not be able to get help quickly enough

in the event that such an emergency occurs.

Discussion:

Ask:

What do you know about heart attacks?

Are you concerned about a heart attack 

happening to you or a loved one?

Will you know what to do in the event that 

a heart attack occurs?

18
19

Skill: It is important to know how to recognize a

heart attack for yourself and others around you.1

Delay can be deadly. Know the warning signs

most commonly reported by heart attack patients. 

They are:

Your chest hurts or feels squeezed. Most heart

attacks involve some type of discomfort in the

center of the chest that lasts more than a few

minutes. It can feel like uncomfortable pressure,

squeezing, fullness, or pain. The discomfort can

range from mild to severe.

Discomfort in one or both arms, back, neck jaw,

or stomach.

Shortness of breath. You may feel like you

can’t breathe or catch your breath. This can

occur with or without chest discomfort.

Breaking out in a cold sweat. People having a

heart attack can also break out in a cold sweat.

Nausea. Some heart attack patients feel or get

sick to their stomach.

Light-headedness. People having a heart attack

may also feel light-headed.

You do not need to have all of the symptoms 

at once to be having a heart attack. If you or

someone you are with is having heart attack signs,

the most important thing to remember is this—

call 9-1-1 within 5 minutes or less. A heart

attack can happen anywhere—at home, work,

school, or while you are shopping. Don’t be afraid

to call 9-1-1 to get help right away.

Closing

You may end your activity with a poem or traditional song or dance. If you have time, you may 

do a followup activity to the icebreaker. (For

details on the icebreaker activity, see page 10.)

This activity is called Close to My Heart, Part II.

Each participant will look at his or her heart card

and review the goal he or she set for himself or

herself at the beginning of the group sessions. 

He or she will think of three ways he or she can

accomplish the goal based on new knowledge and

acquired skills. He or she will present these goals

to the group. The group will help one another

identify ways in which each participant can make

time in his/her day to engage in at least one of the

heart healthy activities.

1 Although both men and women have heart attacks, there are differences in how women and men respond to a heart attack. Women are

less likely than men to believe they are having a heart attack and more

likely to delay in seeking emergency treatment. As with men, women’s

most common heart attack symptom is chest pain or discomfort.

However, women are somewhat more likely than men to experience

some of the other common symptoms, particularly shortness of breath,

nausea/vomiting, and back or jaw pain.
20

B. Heart Template

Use this shape to cut out the heart (see page 10).
21

C. Vietnamese Community Profile

Historical Background2

As Saigon fell to the Communists in 1975,

approximately 135,000 Vietnamese citizens fled

to the United States. They were mostly young,

well-educated, English-speaking, urban

dwellers; 55 percent were Roman Catholic.

From 1977 to 1979, more than 500,000

Vietnamese citizens fled to the United States.

This second wave of Vietnamese refugees were

less educated, less literate in Vietnamese and

English, less familiar with Western culture, and

more rural than those in the first wave.

The third wave of refugees arrived from 1985 to

1991. This group included both Vietnamese and

ethnic Chinese people from Vietnam who were

brought to the United States through family

reunification programs.

Sociodemographic Information 

Vietnamese people make up more than 10 percent of the Asian American and Pacific Islander

population. They are the fifth largest Asian ethnic group in the United States.3

Most Vietnamese people come from what was

once the Republic of Vietnam, known as South

Vietnam. The South Vietnamese government,

an ally of the United States, collapsed under

military pressure from Communist North

Vietnam in April of 1975.4

The largest numbers of Vietnamese people now

live in Southern California, particularly in Los

Angeles and Orange County. Large numbers

also resettled in Houston and Dallas, Texas; the

suburbs of Washington, D.C.; Pennsylvania;

Minnesota; Massachusetts; New York; Illinois;

and Washington State.

Now in the United States, approximately 75 

percent of Vietnamese people are foreign-born.5

Approximately 62 percent of Vietnamese people

in the United States do not speak English very

well.6

Heart Disease in the Vietnamese

Community

Heart disease is the second leading cause of

death for Vietnamese people.7

Among Vietnamese people in California, 

38 percent of men and 32 percent of women

have high blood cholesterol.8

A survey of a Vietnamese American rural 

community in the South found that 44 percent

of the survey participants had high blood pressure. Of that percentage, 27 percent of them

had blood pressure measurements in excess 

of 179/100. (A person with a blood pressure 

of 140/90 mmHg or higher has high blood pressure.) Researchers attribute this finding to the

high percentage of participants who eat a high

salt and sodium diet (56 percent), do not engage

in regular physical activity (75 percent), consume

alcohol regularly (21 percent), and/or smoke 

(18 percent).9

2 LaBorde P, Duong B. Vietnamese Cultural Profile. EthnoMed.

University of Washington, July 1992.

3 The Asian Population: 2000. Census, 2002. 4 Southeast Asia Action Resource Center. Southeast Asian

Communities. www.searac.org

5 We the People: Asians in the United States. U.S. Census,

December, 2004.

6 Ibid.

7 Centers for Disease Control and Prevention. Chronic Disease in

Minority Populations. Atlanta: CDC, 1992. 8 California Department of Health Services. County Health Status

Profiles, 1998. Sacramento, CA: California Department of Health

Services, Center for Health Statistics, 1998.

9 Duong, DA, Bohannon AS, Ross MC. A Descriptive Study of

Hypertension in Vietnamese Americans. Journal of Community

Health Nursing. 2001; 18(1): 1 – 11.
22

Values, Traditions, and Health

Many Vietnamese customs are rooted in the

Confucian respect for both education and for

family and elders. Vietnamese families often

have two to four generations living under one

roof. There is the immediate family (nha) and

the extended family (ho).10

Other Vietnamese customs are rooted in the

Taoist desire to avoid conflict. To avoid confrontation or disrespect, many may not vocalize

disagreement. Instead of responding negatively,

they may not answer a question.

Traditional healing practices vary greatly

between ethnic groups. Some mountain

dwelling groups intertwine medicine and religion. Sickness is believed to have come from

the wrath of gods. The healer or shaman, who

is a priest, is considered superhuman and negotiates with the gods to remove sickness. If the

priest or physician fails to cure the illness, it 

is not their failure but the will of the gods.

Conversion to Christianity and urban living 

has lessened the use of shamans, but the belief

in external causes of sickness remains. Often 

people resist invasive techniques and see a

physician who does not intrude on the body 

as being the best healer.

Lowland peasant groups and urbanites from

Vietnam employ a medicinal system based on

Chinese medicine. This system is based on the

premise that living things are composed of four

basic elements—air, fire, water, and earth—with

associated characteristics of cold, hot, wet, and

dry. This hot/cold belief system is common to

many Vietnamese people, regardless of their

educational status or occupation. Many see 

traditional herbal remedies, tonics, massage, 

and avoidance of excess as the pathway to 

good health.

The use of traditional healing practices in the

United States has a stronger link to rural versus

urban living before immigration than to length

of stay in this country. Many Vietnamese people

(especially the elderly) distrust Western health

care, but they also may be reluctant to reveal

this distrust to a Western health care provider.

Many see suffering and illness as an unavoidable

part of life. Some also feel that the length of

one’s life is predetermined and that prolonging

life or saving life is futile. Stoicism is a highly

respected personal trait, but it can prevent people

from seeking care.

Special Issues to Consider

A weak heart is typically associated with 

palpitations, dizziness, faintness, and feeling 

of panic.

Many Vietnamese refugees suffer from posttraumatic stress disorder (PTSD), depression, anxiety,

psychosis, and adjustment reactions. In traditional Vietnamese culture, it is not acceptable 

to discuss stress or emotional disorders. Thus,

many with these disorders present initially with

somatic complaints.

Cultural barriers to care include a vague understanding and distrust of Western medicine, 

resistance to invasive procedures, and poor

physician – patient communication.

10 McBride MR, Marioka-Douglas N, Yeo G. Aging and Health: Asian

and Pacific Islander Elders. Second Edition. Stanford Geriatric

Education Center Working Paper Series Number 3, Ethnogeriatric

Reviews. Stanford, California, 1996.
23

D. Sample Promotional Flyer

Súc Khoe Là Vàng! Your Health is Golden!

Join your community for heart healthy activities.

Did you know that almost one of five Vietnamese people dies of heart disease?

Love your heart for a healthy life!

In this activity, you will:

Learn how to keep your heart and your family’s hearts healthy.

Learn about high blood pressure and high blood cholesterol.

Learn how to be more physically active, eat heart healthy, keep a healthy weight, 

and stop smoking.

Get bilingual take-home materials you can share with your family.

Enjoy role-playing and other activities that make learning about your heart health fun.

Bring your family and friends to a fun and free community event to talk about how you can protect

yourself and your family from heart disease.

Day/date:

Time:

Location:

For more information, call:

This session is sponsored by [add your organization name here], in partnership with the National Heart,

Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services.

’
24

E. Healthy Heart Attitude Assessment Form (pretest)

On the line below, please draw a heart ♥ at the point that best reflects how important it is for you 

to make heart healthy lifestyle changes.

On the line below, please draw a heart ♥ at the point that best reflects how important you think 

it is in making heart healthy lifestyle changes.

On the scale below, please draw a heart ♥ at the point that best reflects how ready you are right 

now to make heart healthy lifestyle changes.

Not important Important Very important

Not important Important Very important

Not ready to 

make a change 

or commitment

Thinking of 

making lifestyle

changes

Planning on 

making lifestyle

changes

Already living 

heart healthy 

for less than 

6 months

Already living 

heart healthy 

for 6 months 

or more
25

Below is a list of heart healthy habits. Circle the ones you are willing to try first.

♥ Choose foods that are low in sodium.

♥ Prepare foods with little or no salt.

♥ Eat foods lower in saturated fat and trans fat.

♥ Eat foods low in cholesterol.

♥ Prepare foods with a smaller amount of vegetable oil than you normally use.

♥ Be physically active for at least 30 minutes on most, preferably all, days of the week. 

Try an activity like walking three times a day for at least 10 minutes each time.

♥ Try to eat at least 2 cups of fruits and 21

⁄2 cups of vegetables per day (for a 2000 calorie diet).

♥ Eat a variety of fruits and vegetables each day.

♥ Eat a variety of grains each day with at least half the grains coming from whole grains.

♥ Eat 3 cups per day of fat-free or low-fat milk or milk products (for a 2000 calorie diet).

♥ Watch the body weight. Keep a healthy weight or lose weight, if overweight. Ask the doctor for help.

♥ Stop smoking. Pledge not to smoke cigarettes and to keep the home smoke free.

♥ If drinking alcohol, drink in moderation.

♥ Check blood pressure, blood cholesterol, and blood sugar (to assess diabetes level) regularly.
26

F. Stages of Behavior Change 

Tip Sheet

Stages of Behavior Change

Prochaska and DiClemente

Behavior change is a process, not an event.

Individuals have different levels of motivation for

change, or they may be at different stages of readiness for change. The goal is to help people move

into a new stage. Before beginning any community

intervention program, determine at which stage

your community’s members are. Your community

may have residents that are in different stages from

one another. A successful intervention program

meets the needs of the entire community. The

stages of behavior change are:

PRECONTEMPLATION: Not ready to change

These people are unaware of a problem and

have not yet thought about the desired behavior

change. They might have tried unsuccessfully

to change their behavior, but do not intend to

continue to try.

TIP: Highlight the importance and significance

of the problem. Motivate them and capture

their attention. Identify barriers to engage in

the desired behavior as well as its benefits.

CONTEMPLATION: Thinking about change

These are people who have not engaged in the

desired behavior but are considering it.

TIP: These people are more positive about

changing a behavior but need to eliminate 

barriers. They must be motivated and need

emphasis on the personal benefits to be

achieved.

READY FOR ACTION: Getting ready to

make a change

These people are making a mental plan to

accomplish the behavior change.

TIP: Help them in setting goals and developing

concrete plans. Teaching specific “how-to” 

information is important.

ACTION: Ready to make a change

People have taken steps to accomplish the

desired behavior.

TIP: They are positive about changing habits.

They may need some final, specific “how-to” 

information, and positive feedback, social support, and reinforcement.

MAINTENANCE: Continuing to support the

behavior change

People have taken the desired action and know

they would like to continue.

TIP: Reinforce and support the continuation 

of the behavior. 
27

G. Heart Disease Risk Factors:

Frequently Asked Questions

BLOOD PRESSURE QUESTIONS

Q: What is blood pressure?

A: Blood pressure is the force applied by the blood

against the walls of your arteries. Blood pressure

is needed to move the blood through your body.

Q: Why are two numbers given for blood 

pressure?

A: Blood pressure is always given as two numbers,

systolic and diastolic pressures. Usually they are

written one above the other, such as 120/80 mmHg.

The top number, systolic, tells you how much pressure is used to pump blood. The bottom number,

diastolic, tells you how much pressure there is

between heartbeats, when your heart is at rest. 

Q: What is high blood pressure?

A: High blood pressure occurs when the pressure

in the arteries stays high because of resistance to

blood flow through the arteries. This means that

the heart has to work harder to carry blood to the

rest of the body.

Q: What are the signs of high blood pressure?

A: High blood pressure usually has no signs or

symptoms. It is called the silent killer. A person

can have high blood pressure and still feel fine.

That is why it is important that you have your

blood pressure checked. Ask the doctor what 

your number is and what the number means.

Q: What is considered a high blood pressure

level?

A: 140/90 mmHg or higher.

Q: What is considered a normal blood pressure

level?

A: Less than 120/80 mmHg.

Q: What is prehypertension?

A: 120/80 mmHg to 139/89 mmHg. You do not

have high blood pressure yet but are likely to

develop it in the future unless you adopt healthy

lifestyle changes.

Q: Is hypertension the same thing as having

high blood pressure? 

A: Yes, hypertension means high blood pressure.

A person who has a blood pressure of 140/90

mmHg or higher on two or more separate visits to

a health care provider is considered to have high

blood pressure or hypertension. If blood pressure

stays too high, a person can have a heart attack,

heart failure, stroke, kidney disease, and other 

life-threatening illnesses.

Q: How can I lower my high blood pressure 

and eat a healthy diet?

A: To lower high blood pressure, try to:

♥ Choose foods that are low in salt and sodium.

♥ Eat more fruits and vegetables.

♥ Eat more nonfat or low-fat milk and milk

products.

♥ Choose whole grain products and cereal

more often.

♥ Lose weight if you are overweight.

♥ Be physically active at least 30 minutes on

most, preferably all, days of the week.

♥ If you drink alcohol, do so in moderation.

♥ Take your medicine as your doctor tells you.

♥ Have your blood pressure checked at least

every two years or more often if you have

high blood pressure or prehypertension.
28

Q: Does stress cause you to have high blood

pressure? 

A: Stress can cause your blood pressure to go 

up but only for a little while. This change in blood

pressure is normal. High blood pressure occurs

when the pressure stays high over a period of time.

Q: Does smoking cause high blood pressure?

A: Smoking injures blood vessel walls and speeds

up the process of hardening of the arteries. Even

though it does not cause high blood pressure,

smoking is bad for anyone, especially those with

high blood pressure. If you smoke, quit. If you

don't smoke, don't start. Once you quit, your risk 

of having a heart attack is reduced after the first

year. You have a lot to gain by quitting.

SODIUM AND SALT QUESTIONS

Q: Why should I cut back on salt and sodium?

A: Eating a diet lower in salt or sodium may prevent high blood pressure and help lower high blood

pressure. It is recommended that a person eat no

more than 2,300 milligrams (mg) of sodium per

day, which includes sodium naturally found in

foods. One teaspoon of salt contains about 2,300

mg of sodium. Look on the nutrition facts label on

food to find the amount of sodium in packaged

foods. Choose foods labeled “sodium free,” “low

sodium,” or “no salt added.” Most restaurant foods

are very high in sodium. Decrease the times you

eat out or get take-out food.

Q: How can I add flavor to my foods without salt?

A: Start by slowly using less and less salt in your

cooking. Condiments such as nuoc mam, soy

sauce, and monosodium glutamate (MSG) should

be used less often. They have a lot of sodium.

Use more herbs and spices instead of salt to add

flavor to your food. They will make your food

taste even better. If you cook with soy sauce, try

the low sodium or light soy sauce versions.

BLOOD CHOLESTEROL QUESTIONS 

Q: What is blood cholesterol?

A: Cholesterol is a waxy substance in your arteries.

Too much cholesterol from foods high in saturated

fat, trans fat, and dietary cholesterol can clog your

arteries, narrowing the opening. The narrowed

arteries may also become completely blocked by 

a blood clot. Narrowed and blocked arteries can

lead to angina11

, heart attack, stroke, kidney disease,

blindness, and poor blood circulation.

Q: What do the total blood cholesterols mean?

A: A total blood cholesterol level of less than 

200 mg/dL is desirable. A total blood cholesterol

level between 200–239 mg/dL is borderline high.

Depending on your other risk factors, you may 

be at a higher risk for heart disease. Talk to your 

doctor about your overall risk for heart disease. 

A total blood cholesterol level of 240 mg/dL or

more is high. You are at a higher risk for clogged

arteries and a heart attack. Talk to your doctor to

determine your risk for heart disease.

Q: What do “good” and “bad” cholesterol mean?

A: HDL (high density lipoprotein), or “good 

cholesterol,” helps clean fat and cholesterol from

arteries by carrying it to the liver for removal from

the body. LDL (low density lipoprotein), or “bad

cholesterol,” deposits cholesterol in your arteries

and causes them to become clogged.

11 Angina is chest pain or discomfort that occurs when your heart 

muscle does not get enough blood. Angina may feel like pressure 

or a squeezing pain in your chest. The pain may also occur in your

shoulders, arms, neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of coronary heart disease, the most common

type of heart disease.
29

Q: What do your LDL cholesterol numbers mean?

A: An LDL cholesterol level of less than 100

mg/dL is recommended, if you are at high risk for

heart disease. If you are at very high risk, try to

keep your LDL cholesterol below 70 mg/dL. An

LDL cholesterol level of 100–129 mg/dL is near

optimal. An LDL cholesterol level of 130–159

mg/dL is borderline high. An LDL cholesterol

level of 160–189 mg/dL is high. An LDL cholesterol of 190 mg/dL and above is very high. Talk 

to your doctor to learn about your heart disease

risk and to determine your LDL goal.

Q: What is the ideal HDL cholesterol level?

A: Keep your HDL cholesterol level above 40

mg/dL. The higher the better!

Q: What is saturated fat?

A: Saturated fat is one type of fat that raises LDL

cholesterol. Many foods contain saturated fat.

Eating too much saturated fat will raise your blood

cholesterol more than anything else you eat. This

will raise your chances of developing heart disease.

Saturated fats are found mainly in animal products,

such as whole milk, ice cream, fatty meats, lard,

and some vegetable oils (coconut oil, palm oil, and

palm kernel oil).

Q: What is trans fat?

A: Trans fat is a type of unsaturated fat that raises

LDL cholesterol. Trans fat is formed when vegetable oil is hardened to become margarine or 

shortening through a process called “hydrogenation.”

The harder the margarine or shortening, the more

likely it is to contain more trans fat. Eating too

much trans fat, along with saturated fat, will raise

your blood cholesterol. This will raise your chances

of developing heart disease. Trans fat is found 

in foods that have hydrogenated fats/oils, such as

candy bars, baked goods (cookies, pies, and crackers), fried foods (fried chicken, French fries, and

chips), and stick margarine.

Q: What is dietary cholesterol?

A: Cholesterol in foods is called dietary cholesterol. Cholesterol present in the foods you eat may

raise your blood cholesterol, but eating foods with 

saturated fat can raise your blood cholesterol even

higher. Dietary cholesterol is found in foods that

come from animals (egg yolks, dairy products,

meat, poultry, fish, and shellfish, squid, shrimp, 

and organ meats like liver and tripe).

Q: How can you lower your blood cholesterol?

A: The best way to lower your blood cholesterol

level, especially your “bad” LDL cholesterol, is to

eat a heart healthy diet low in saturated fat, trans

fat, and cholesterol, be physically active at least 

30 minutes on most, preferably all, days of the

week, and maintain a healthy weight.

Q: Who should have their blood cholesterol 

tested?

A: All adults 20 years of age or older should have

their blood cholesterol checked at least once every

five years.

Q: Do children and adults benefit from eating

foods low in saturated fat, trans fat, and 

cholesterol?

A: Children age 2 and older as well as adults of all

ages can benefit from a diet low in saturated fat,

trans fat, and cholesterol. Eating fruits and vegetables as snacks, instead of french fries and fatty

chips, is a good way to cut down on saturated and

trans fats. Teach these simple behaviors to children to establish heart healthy habits early.
30

Q: What are triglycerides?

A: Triglycerides are a type of fat in the blood.

They come from fat that you eat and are made in

the body. When you eat too many calories or a

diet too high in carbohydrates, more triglycerides

are made. People with high triglycerides often

have low HDL cholesterol. When your triglycerides are high, you are also at increased risk for

heart disease. To keep your triglycerides at a

healthy level, you can:

♥ Maintain a healthy weight or lose weight, if

you are overweight.

♥ Be physically active for at least 30 minutes

on most, preferably all, days of the week.

♥ Eat a heart healthy diet that is low in saturated

fat, trans fat, and cholesterol, and within

your calorie requirements.

♥ Eat a variety of whole grains, fruits, and 

vegetables.

♥ Avoid smoking and drinking alcohol. 

PHYSICAL ACTIVITY QUESTIONS 

Q: What are the benefits of regular physical

activity?

A: Regular physical activity:

♥ Makes you more energetic.

♥ Helps you maintain weight loss and healthy

weight.

♥ Helps you lower your blood pressure.

♥ Helps you lower your blood cholesterol.

♥ Makes you sleep better.

♥ Reduces stress.

Q: How much moderate physical activity do I need

to do to decrease the risk for heart disease?

A: To reduce your risk of heart disease, engage in

at least 30 minutes of moderate-intensity physical

activity—above your usual daily activities—at work

or home on most, preferably all, days of the week.

Q: Do children and adolescents need to do a lot

of physical activity?

A: Children and adolescents should engage in at

least 60 minutes of physical activity on most,

preferably all, days of the week.

Q: What kind of activities can I do to improve

my heart health?

A: Activities such as brisk walking, gardening, 

biking, running, and swimming can improve your

heart health.

SMOKING QUESTIONS 

Q: What is the best way to quit smoking?

A: Experts say three ways to quit smoking are:

♥ Use the nicotine patch or nicotine gum.

The nicotine in the patch or gum can reduce the

craving for nicotine when you stop smoking.

Ask your doctor for advice and follow the package directions before using the patch or gum.

♥ Get support and encouragement. Family,

friends, and your doctor can offer you encouragement and support. You can also attend a

quit-smoking program for added counseling 

and support.

♥ Learn how to handle stress and urges to

smoke. Be aware of the things that make you

want to smoke. Distract yourself from thinking

about smoking by doing things you enjoy, such

as talking to your friends, walking, dancing, or

working around the house.
31

Q: If I quit smoking, will I gain weight?

A: You are likely to gain weight when you quit

smoking, especially if you gained weight on 

previous attempts to quit. Most smokers gain less

than 10 pounds. The amount of weight you may

gain from quitting will be a minor health risk 

compared to the risk of continued smoking. Focus

your attention on quitting smoking first. After you

have quit smoking successfully, you can take steps

to lose weight. While you are quitting, eat plenty

of fruits and vegetables, get physical activity 

regularly, get plenty of sleep, and avoid high 

calorie foods.

WEIGHT CONTROL QUESTIONS 

Q: Is skipping meals a good way to lose weight?

A: No, skipping meals to lose weight is not a good

idea. Try distributing your calorie intake over the

day, and avoid overeating at any one meal.

Q: What is the best way to lose weight?

A: The best way to lose weight is to do so 

gradually:

♥ Choose foods that are lower in calories, 

saturated fat, and sugar.

♥ Prepare foods without added salt, sugar, 

and fat.

♥ Reduce the portion size that you eat.

♥ Add physical activity to your daily schedule.

Q: Can being overweight raise my risk of heart

disease?

A: Yes, it can! Being overweight raises your risk

for high blood cholesterol, high blood pressure,

and diabetes. Even if you do not have high blood

pressure or high blood cholesterol, being overweight may increase your risk of heart disease.

Q: How can I help my family eat heart healthy?

A: ♥ Make a heart healthy meal plan for each day.

♥ Shop with a grocery list, so you won’t be

tempted to buy foods that are high in calories

and fat.

♥ Bake, broil, boil, or steam foods instead of

frying them.

♥ When eating out, ask for dishes prepared

without or with very little salt (sodium) and

without or with very little added fats or oils.

♥ Be a role model—eat the way you want your

family to eat.

♥ Stock your kitchen with healthy snacks and

foods.

♥ Use sauces high in sodium (e.g., nuoc mam

and soy sauce) less often. Choose a low 

sodium or light sauce, if there is one, such 

as low sodium or light soy sauce.

♥ Use herbs and spices instead of salt when

you cook.

♥ Serve fresh fruits and vegetables. 

♥ Choose foods that are low in saturated fat,

trans fat, and cholesterol.

♥ Avoid using coconut milk when you cook

because it is high in calories and saturated fat. 
32

H. Get Fit! Physical Activity

Groups

Encourage people to form physical activity groups.

Not only do participants get the benefits of physical

activity, they also form strong friendships and challenge one another to better heart health. Walking

clubs are just one example of a popular group

activity. Walking is moderate, inexpensive, and an

easy form of physical activity. There can be different types of physical activity groups. Swimming,

running, and gardening are other good group activities. To encourage other members of the community to join the physical activity group, post flyers

in common areas where community members are

most likely to gather.

Tips For Physical Activity Groups:

1. Lead by example.

A successful physical activity group must be led by

example. Forming the group is relatively easy—

maintaining the energy and momentum is hard.

Choose a highly motivated, energized, and dedicated person as group leader. 

2. Keep on schedule.

Staying strong and healthy should be one of your

group mottos. Draw up a schedule, based on group

participants’ abilities, and stick to it. This will help

build endurance and stamina slowly while preventing injuries.

3. Safety first.

Make sure you walk on marked trails. At night, use

only lighted paths. Watch your surroundings and be

on the lookout for suspicious people. If you cannot

find a safe or indoor facility to do your physical

activity, try to confine your activity to the daylight

hours. Try not to use locations that are not easily

accessible, especially by public transportation. Try

not to use trails that are too hilly, rocky, or uneven.

The leader is ultimately responsible for the safety of

all group participants. No one should be left behind.

4. Take time for recognition and celebration.

It is important to provide an incentive program that

validates the efforts of the participants. Use items

that promote heart health for active people.

5. Stretch.

Stretching is a good way to warm up your 

muscles before physical activity and to aid in 

muscle recovery after physical activity. With 

your group members, try the stretching exercises

on the next page.

6. Count your way towards heart health.

Encourage everyone to wear a pedometer. A

pedometer counts the number of steps walked.

This helps the participants set physical activity

goals and achieve them. Try to find a local organization to donate pedometers to your group.

7. Build community support.

Involve others in the planning and get the acceptance of the decisionmakers and medical staff.

Explain to the medical staff how important it is 

for them to refer patients to the walking program.

8. Keep good records.

Develop a recordkeeping system for participants

and their goals and achievements. Review the

records and tally them on a regular basis so that

awards can be presented in a timely way.

9. Provide health and nutrition classes.

Provide health education information to the participants, such as heart healthy shopping and cooking

tips. Promote getting physical exams, screenings,

and annual checkups. Invite knowledgeable speakers (i.e., health care professional, registered dietitian, health educator) to talk about healthy eating,

physical activity, and balancing your food intake

and physical activity.
33

Stretching Exercises

Do these stretches gently and slowly. Do not bounce.

1. Deep Breathing

Arms up, breathe in,

arms down, breathe

out. Two times each.

2. Neck Stretches

Side to side. Two

times.

3. Shoulder Stretches

Up and down five times

on each side.

4. Side Stretches

Up and down five times

in each direction.

5. Waist Stretches

Side to side three times

in each direction.

6. Twists

Side to side three times

in each direction.

7. Back and Leg

Stretches

Down and up five times.

8. Back Stretches

Arms through legs 

six times.

9. Leg Stretch (1)

Hold on to ankle, four times 

on each side.

10. Leg Stretch (2)

Down and up five times.

11. Leg Stretch (3)

Move heels up and down six

times.

Developed by the California Diabetes Program, Department of Health Services, State of California.
34

I. How to Create a Nutrition

Display

Nutrition displays visually help participants learn

about healthy food choices. Displays can reinforce

nutrition information from your group discussion.

They can even motivate your participants to eat 

in a heart healthy way. Many different kinds of

nutrition displays can be created to be used in any

setting. For instance, displays can show the amount

of sodium or fat in specific foods or how to make

the best choices at fast food restaurants. The sample

nutrition display below can be used to show your

participants a heart healthy alternative to fried

spring rolls (cha giò).

Nutrition Display: How Much Fat Is in Fried

Spring Rolls (Cha Giò)?

Materials needed:

Foam-core board or poster board, 

20 inches x 30 inches

Pictures of food or food models

Dark-colored plastic spoons 

Light-colored clay 

Velcro strips 

Scissors

Markers

Glue

Directions:

1. Find out how much fat is in the food product(s)

you want to display. In this case, one serving of

fresh spring rolls (goi cuôn) is compared to one

serving of fried spring rolls (cha giò). Convert

that quantity into teaspoons (4 grams of fat = 

1 teaspoon). 

2. Cover as many plastic spoons as you need with

the appropriate amount of clay. Make sure to

glue the clay onto the spoon.

3. With scissors, cut out the text and food pictures

(if you have any) for your food display.

4. On the board, arrange the text, food pictures,

and spoons where you want them. 

5. Glue the text and food pictures onto the board.

6. Cut the Velcro into squares. Glue one part of

the Velcro (female) to the back of each spoon,

one at the top of the handle and one at the bottom where the spoon curves. 

7. Glue the other part of the Velcro (male) to the

poster board, where the spoon will be placed.

8. Attach the spoons to the board, matching up the

Velcro squares.

Choose Goi Cuôn As Part of 

a Heart Healthy Meal

8 cha giò = 5 teaspoons of fat

8 goi cuôn = 1⁄4 teaspoons of fat
35

J. Huong Quê: How to Do a Heart

Healthy Cooking Demonstration

Cooking demonstrations can show people that food

can be prepared in a heart healthy way and still be

tasty. A cooking demonstration can be a simple

activity (e.g., how to remove skin from chicken),

or it can be a more sophisticated activity (e.g., how

to prepare Vietnamese Spring Rolls). Cooking

demonstrations are effective because the audience

can see how the food is prepared and they can

sample the results. To help conduct food demonstrations, you may want to recruit volunteers from

the local health department, local American Dietetic

Association, Cooperative Extension Service, or local

culinary schools that specialize in Vietnamese cuisine. 

Involve the participants as much as possible in 

the preparation and presentation stages of your

demonstration. For example, have them wash the

spinach, chop the tomatoes, or dish out samples for

the taste test. This helps them learn and see that

heart healthy cooking is easy to do. Also, don’t 

forget about food safety! Teach the participants

about hand washing, refrigeration, preventing food

contamination, and other food safety tips.

Use this heart healthy recipe to show your participants how to make easy and quick flavorful dishes

without a lot of calories, fat, salt, and sodium. For

other Asian recipes, see the Keep the Beat: Heart

Healthy Recipes book from the National Heart,

Lung, and Blood Institute.

Fresh Spring Rolls (Goi Cuôn)

Ingredients:

1 cup carrots cut into long, thin strips

2 cups bean sprouts

2 cups cucumber, seeded and cut into

long, thin strips

1 cup minced scallions

1

⁄2 cup chopped fresh cilantro

1

⁄4 cup chopped fresh mint

8 rice paper wrappers

Directions:

1. Toss first six ingredients in a large bowl.

2. Soak one rice paper wrapper in warm water until

soft (1 to 2 minutes). Shake off excess water.

3. Place vegetable filling off-center on rice paper

and fold like an egg roll.

4. Repeat with remaining vegetable filling and rice

paper wrappers.

Cooking Demonstration: 

A Planner’s Checklist

■ Is food allowed at your facility?

■ Is water accessible?

■ Is electricity available?

■ Is lighting adequate?

■ Are tables and chairs available?

■ Is your facility properly equipped (e.g.,

refrigerator, oven, stove, microwave)?

■ Does your recipe complement your heart

health message?

■ Is your recipe too difficult for your audience

or too time-consuming?

■ Do you have all the necessary cooking

utensils and ingredients ready and within

reach?

■ Do you have incentives (e.g., recipes on

note cards, heart healthy cookbooks)?

■ Do you have enough napkins, plates, and

eating utensils for the taste test?
36

Yield: 8 servings

Serving Size: 1 roll

Nutritional Information Per Serving:

Calories: 70

Total fat: 1 g

Saturated fat: 0 g

Trans fat: 0 g

Cholesterol: 0 mg

Sodium: 28 mg

Total carbohydrate: 16 g

Dietary fiber: 2 g

Sugars: 2 g

Protein: 3 g

Vitamin A: 3039 IU

Vitamin C: 8 mg

Calcium: 25 mg

Iron: 1 mg

Potassium: 161 mg
37

K. Sample Evaluation (posttest)

We would like your opinion of the program that you attended today. Please fill out this form as completely 

as possible. Thank you!

1. How would you rate the program that you attended today?

■ Excellent

■ Good

■ Fair

■ Poor

2. How would you rate the leader?

■ Excellent

■ Good 

■ Fair

■ Poor

3. Check YES or NO for the following statements. YES NO

a. The content was presented in a clear and effective way. ■ ■

b. The activities were appropriate, educational, and fun. ■ ■

c. The handouts and visuals added to my learning. ■ ■

d. This program is useful to my community and me. ■ ■

4. On the scale below, please draw a heart ♥ at the point that best reflects how prepared you are right

now to make heart healthy lifestyle changes.

Not prepared Prepared Very prepared
38

5. On the scales below, please draw a heart ♥ at the point that best reflects how you feel about being heart

healthy.

a. Being physically active at least 30 minutes on most, preferably all, days of the week.

b. Eating out at fast food restaurants less often.

c. Eating foods low in saturated fat, trans fat, and cholesterol, and moderate in total fat.

d. Using half the amount of salt and sodium that I normally use.

e. Maintaining a healthy weight, or losing weight if I am overweight.

f. Having my blood pressure, blood cholesterol, and blood sugar checked regularly.

Not thinking 

of doing

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doing

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39

g. Quitting smoking.

h. Drinking alcohol in moderation, if I drink.

i. Eating more fruits and vegetables.

6. What did you like about this program?

___________________________________________________________________________________________

___________________________________________________________________________________________

7. What did you dislike about this program?

___________________________________________________________________________________________

___________________________________________________________________________________________

8. How would you improve this program for the future?

___________________________________________________________________________________________

___________________________________________________________________________________________

9. What topics would you like to see covered in future programs that we didn’t cover today?

___________________________________________________________________________________________

___________________________________________________________________________________________

10. Other comments?

___________________________________________________________________________________________

___________________________________________________________________________________________

Thank you!

Not thinking 

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doing

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40

L. Watch Your Weight

Check the chart to find your body mass index (BMI).

Directions: To use the chart, find your height in the left-hand column labeled “height.” Move across to your

body weight. The number at the top of the column is the BMI for your height and weight.

HEALTHY WEIGHT OVERWEIGHT OBESE

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31

HEIGHT WEIGHT

(m/ft-in) (kg/lb)

1.37 35.9 37.7 39.5 41.4 43.2 45.0 47.3 49.1 50.9 52.7 54.5 56.4 58.2

4’6” 79 83 87 91 95 99 104 108 112 116 120 124 128

1.40 37.3 39.1 40.9 43.2 45.0 46.8 48.6 50.9 52.7 54.5 56.8 58.6 60.5

4’7” 82 86 90 95 99 103 107 112 116 120 125 129 133

1.42 38.6 40.5 42.7 44.5 46.4 48.6 50.5 52.7 54.5 56.8 58.6 60.9 62.7

4’8” 85 89 94 98 102 107 111 116 120 125 129 134 138

1.45 40.0 41.8 44.1 45.9 48.2 50.5 52.3 54.5 56.8 58.6 60.9 62.7 65.0

4’9” 88 92 97 101 106 111 115 120 125 129 134 138 143

1.47 41.4 43.2 45.5 47.7 50.0 52.3 54.1 56.4 58.6 60.9 62.7 65.0 67.3

4’10” 91 95 100 105 110 115 119 124 129 134 138 143 148

1.50 42.7 45.0 47.3 49.5 51.8 54.1 56.4 58.2 60.5 62.7 65.0 67.3 69.5

4’11” 94 99 104 109 114 119 124 128 133 138 143 148 153

1.52 44.1 46.4 48.6 50.9 53.6 55.9 58.2 60.5 62.7 65.0 67.3 69.5 71.8

5’0” 97 102 107 112 118 123 128 133 138 143 148 153 158

1.55 45.5 48.2 50.5 52.7 55.5 57.7 60.0 62.3 65.0 67.3 69.5 71.8 74.5

5’1” 100 106 111 116 122 127 132 137 143 148 153 158 164

1.57 47.3 49.5 52.3 54.5 57.3 59.5 61.8 64.5 66.8 69.5 71.8 74.5 76.8

5’2” 104 109 115 120 126 131 136 142 147 153 158 164 169

1.60 48.6 51.4 53.6 56.4 59.1 61.4 64.1 66.4 69.1 71.8 74.1 76.8 79.5

5’3” 107 113 118 124 130 135 141 146 152 158 163 169 175

1.63 50.0 52.7 55.5 58.2 60.9 63.6 65.9 68.6 71.4 74.1 76.8 79.1 81.8

5’4” 110 116 122 128 134 140 145 151 157 163 169 174 180

1.65 51.8 54.5 57.3 60.0 62.7 65.5 68.2 70.9 73.6 76.4 79.1 81.8 84.5

5’5” 114 120 126 132 138 144 150 156 162 168 174 180 186

1.68 53.6 56.4 59.1 61.8 64.5 67.3 70.5 73.2 75.9 78.6 81.4 84.5 87.3

5’6” 118 124 130 136 142 148 155 161 167 173 179 186 192

1.70 55.0 57.7 60.9 63.6 66.4 69.5 72.3 75.5 78.2 80.9 84.1 86.8 90.0

5’7” 121 127 134 140 146 153 159 166 172 178 185 191 198

1.73 56.8 59.5 62.7 65.5 68.6 71.8 74.5 77.7 80.5 83.6 86.4 89.5 92.3

5’8” 125 131 138 144 151 158 164 171 177 184 190 197 203

1.75 58.2 61.4 64.5 67.7 70.5 73.6 76.8 80.0 82.7 85.9 89.1 92.3 95.0

5’9” 128 135 142 149 155 162 169 176 182 189 196 203 209

1.78 60.0 63.2 66.4 69.5 72.7 75.9 79.1 82.3 85.5 88.6 91.8 95.0 98.2

5’10” 132 139 146 153 160 167 174 181 188 195 202 209 216
41

HEALTHY WEIGHT OVERWEIGHT OBESE

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31

HEIGHT WEIGHT

(m/ft-in) (kg/lb)

1.80 61.8 65.0 68.2 71.4 75.0 78.2 81.4 84.5 87.7 90.9 94.5 97.7 100.9

5’11” 136 143 150 157 165 172 179 186 193 200 208 215 222

1.83 63.6 66.8 70.0 73.6 76.8 80.5 83.6 86.8 90.5 93.6 96.8 100.5 103.6

6’0” 140 147 154 162 169 177 184 191 199 206 213 221 228

1.85 65.5 68.6 72.3 75.5 79.1 82.7 85.9 89.5 93.2 96.4 99.5 103.2 106.8

6’1” 144 151 159 166 174 182 189 197 205 212 219 227 235

1.88 67.3 70.9 74.1 77.7 81.4 84.5 88.2 91.8 95.5 99.1 102.3 105.9 109.5

6’2” 148 156 163 171 179 186 194 202 210 218 225 233 241

1.91 69.1 72.7 76.4 80.0 83.6 87.3 90.9 94.5 98.2 101.8 105.5 109.1 112.7

6’3” 152 160 168 176 184 192 200 208 216 224 232 240 248

1.93 70.9 74.5 78.2 81.8 85.9 89.5 93.2 96.8 100.5 104.5 108.2 111.8 115.5

6’4” 156 164 172 180 189 197 205 213 221 230 238 246 254

*Weight is measured with underwear but no shoes.
42

My weight My BMI category

What is BMI?

BMI measures weight in relation to height.

The BMI ranges for adults show that the risk for

cardiovascular disease increases at higher levels

of BMI (overweight and obesity).

Waist circumference: 

A waist measurement of more than 88.9 cm 

(35 inches) for women and more than 101.6 cm

(40 inches) for men is high. A high waist measurement increases your risk for heart disease. 

What does your BMI mean?

Healthy weight (BMI from 18.5 to 24.9)

Good for you! Try not to gain weight.

Overweight (BMI from 25 to 29.9) 

Do not gain any weight, especially if your waist

measurement is high. You need to lose weight if

you have two or more risk factors and:

Are overweight, or

Have a high waist measurement

Ask your doctor or dietitian for help.

Obese (BMI is 30 or higher)

You need to lose weight slowly. Lose approximately

0.45 to 0.9 kg (1 to 2 pounds) a week. Ask your

doctor or dietitian for help.

My waist measurement
43

M. Heart Disease Risk Factors That You Can Do Something About

RISK FACTORS FACTS YOU NEED TO KNOW TAKE THESE STEPS TO 

PREVENT HEART DISEASE

High blood pressure 

and Prehypertension

High blood pressure is 

called the silent killer 

because it has no signs 

or symptoms, yet it can 

cause very serious illness.

Prehypertension also has 

no signs or symptoms. 

You do not have high 

blood pressure yet but are 

likely to develop it in the 

future unless you adopt 

healthy lifestyle changes.

High blood cholesterol

Cholesterol in your 

arteries is like rust in a 

pipe. When there is too 

much cholesterol in the 

blood, the arteries 

become clogged, which 

leads to heart disease.

Check your blood pressure at least every

2 years. If you have high blood pressure

or prehypertension, have your health care

provider check your blood pressure 

regularly and more often.

Choose and prepare foods with little or

no salt and sodium.

Eat more fruits, vegetables, whole grains,

low-fat or fat-free milk and milk products

within your calorie requirements.

Aim for a healthy weight.

Be physically active at least 30 minutes

on most, preferably all, days of the week.

If you drink alcohol, do so in moderation.

If your doctor prescribes blood pressure

medicine, take it as prescribed.

If you smoke, stop smoking now or cut

back gradually.

When your blood pressure is high, your

heart works harder than it should to move

blood to all parts of the body. If not treated,

high blood pressure can lead to stroke

(brain attack), heart attack, eye and kidney

problems, and death.

Check your blood pressure numbers

(mmHg*):

Category Systolic Diastolic

Normal <120 <80

Prehypertension 120 – 139 80 – 89 

Hypertension ≥140 ≥90

*Millimeters of mercury

Check your total cholesterol numbers

(mg/dL): 

Desirable <200

Borderline high 200 – 239

High ≥240

Check your LDL cholesterol numbers

(mg/dL):

Optimal (for people at very <70

high risk for heart disease)

Optimal (for people at high <100

risk for heart disease)

Near optimal 100 – 129 

Borderline high 130 – 159 

High 160 – 189 

Very high ≥190

HDL cholesterol levels of 60 mg/dL or more

help lower your risk for heart disease, while

a level less than 40 mg/dL is a major risk

factor for heart disease.

Triglycerides

A normal triglyceride level is less than 150

mg/dL.

A “lipoprotein profile,” which measures all

of your cholesterol levels (total, LDL, and

HDL) and triglycerides, can be done at a

doctor’s office.

Get your blood cholesterol levels checked

at least once every 5 years if you are age

20 or older.

Learn what your numbers mean. If they

are high, ask your doctor how you can

lower them.

Eat fewer foods high in saturated fat,

trans fat, and cholesterol.

Stay physically active at least 30 minutes

on most, preferably all, days of the week.

Aim for a healthy weight.

In addition to the above, this can help 

control triglycerides:

Eat a heart healthy diet that is not too

high in carbohydrates. High carbohydrate

diets have been shown to play a role in

raising triglycerides. Choose fiber-rich

fruits and vegetables and whole grains

often.

Avoid smoking and alcohol. Smoking 

raises triglycerides and lowers HDL

cholesterol. Excess alcohol also raises

triglycerides.
44

RISK FACTORS FACTS YOU NEED TO KNOW TAKE THESE STEPS TO 

PREVENT HEART DISEASE

Smoking

You put your health, your

family’s health, and your

friend’s health at risk

when you smoke.

Cigarette smoking is addictive. It harms

your heart and lungs. It can raise your

blood cholesterol and those of others

around the smoker.

Stop smoking now or cut back gradually.

If you can’t quit the first time, keep trying.

If you don’t smoke, don’t start.

Physical inactivity

Physical inactivity can 

double your chances of

heart disease and can 

take away years from 

your life.

Physical inactivity increases your risk

of high blood pressure, high blood

cholesterol, and diabetes. 

Adults should do at least 30 minutes

of moderate physical activity on most,

preferably all, days of the week. 

Children should aim for 60 minutes of

moderate physical activity each day.

Stay physically active. You can build up

to 30 minutes on most, preferably all,

days of the week by being physically

active for at least 10 minutes three times

a day.

Try walking, biking, swimming, and 

playing soccer.

Overweight

Check your BMI to see 

if you are overweight.

Being overweight 

increases your risk of

developing high blood

pressure, high blood 

cholesterol, heart 

disease, stroke, and 

diabetes. 

Check your BMI and waist circumference:

Category BMI

Normal 18.5 – 24.9 

Overweight 25 – 29.9 

Obese ≥30

A waist measurement of more than 88.9 cm

(35 inches) for a woman and more than

101.6 cm (40 inches) for a man increases 

the risk of heart disease.

Get your BMI and waist circumference

measured.

Keep a healthy weight. Try not to gain

extra weight.

If you are overweight, try to lose weight

slowly. Lose approximately 0.45 to 0.9

kg (1 to 2 pounds) a week.

Eat sensible portions and be physically

active every day.

Diabetes

Blood sugar is high

because it cannot move

into body cells and be

burned as fuel.

Diabetes is serious; you may not know

that you have it. It can lead to heart

attacks, blindness, amputations, and 

kidney disease.

Being overweight is a major risk factor 

for diabetes.

Find out if you have diabetes. 

Get your blood sugar level checked

every year, beginning at age 45. You

should be tested at a younger age and

more often if you are at risk for diabetes.
45

N. Wallet Card

Try these tips for a healthy heart!

More + fruits, vegetables, whole grains, 

low-fat or fat-free milk or milk products

+ physical activity

Less – salt (sodium), saturated fat, trans fat,

cholesterol, and added sugars 

– BMI, waist circumference

None 0 cigarettes

= Heart Health

Always eat a healthy diet within your calorie requirements.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health Name ______________________________

National Heart, Lung, and Blood Institute

Know Your Numbers! Your Personal Record

It may save your life. For Blood Pressure and Cholesterol

Blood Pressure Blood Cholesterol

It is best to have a reading less It is best to have a total 

than 120/80. A reading of 140/90 cholesterol less than 200.

or more is high blood pressure. A level of 240 or higher 

may lead to a heart attack.

Have your health care provider check your blood pressure 

and blood cholesterol levels regularly.

Date Blood Pressure Cholesterol

/

/

/

/

/

/

/

/

/

/

/

/

♥

♥

Súc Khoe Là Vàng!

Your Health is Golden!

Prevent Heart Disease

Get your blood pressure and 

blood cholesterol checked.
46

The NHLBI Health Information Center is a service

of the National Heart, Lung, and Blood Institute of

the National Institutes of Health. The Health

Information Center provides information to health

professionals, patients, and the public about the

treatment, diagnosis, and prevention of heart, lung,

and blood diseases. 

NHLBI Health Information Center

P.O. Box 30105

Bethesda, MD 20824-0105

Phone: (301) 592-8573

TTY: (240) 629-3255

Fax: (301) 592-8563

Web site: www.nhlbi.nih.gov

To learn more about the Vietnamese population

and heart disease, look for the following publications on the NHLBI Web site: www.nhlbi.nih.gov.

Nguòi Viêt Nam Mong Muô ́n Có Trái Tim Khoe

Manh: Hãy Khám Kiêm Tra Tim—Biêt Sô ́ Do

Huyêt Áp Cua Ban

Vietnamese Aspire for Healthy Hearts: Keep Your

Heart In Check—Know Your Blood Pressure

Number (Publication No. 04-5201)

Nguòi Viêt Nam Mong Muô ́n Có Trái Tim Khoe

Manh: Siêng Nang Hoat Dông Dê Trái Tim Khoe

Manh.

Vietnamese Aspire for Healthy Hearts: Be Active

for a Healthier Heart (Publication No. 04-5202)

Nguòi Viêt Nam Mong Muô ́n Có Trái Tim Khoe

Manh: Sô ́ng Lành Manh Vói Dinh Duõng Tôt.

Vietnamese Aspire for Healthy Hearts: Serve Up a

Healthy Life With Good Nutrition (Publication No.

04-5203)

Nguòi Viêt Nam Mong Muô ́n Có Trái Tim Khoe

Manh: Dùng Dôt Bo Cuôc Dòi—Ban Hãy Nhe

Nhàng Vói Trái Tim Mình.

Vietnamese Aspire for Healthy Hearts: Don’t Burn

Your Life Away—Be Good to Your Heart

(Publication No. 04-5204)

Cardiovascular Risk in the Vietnamese Community:

Formative Research from Houston, Texas 

Addressing Cardiovascular Health in Asian

Americans and Pacific Islanders: A Background

Report (Publication No. 00-3647)

Asian American and Pacific Islander Workshops

Summary Report on Cardiovascular Health

(Publication No. 01-3793)

For information on the impact of heart disease on

other Asian American and Pacific Islander populations, please check the NHLBI Web site. 

Additional Resources

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DISCRIMINATION PROHIBITED: Under provisions 

of applicable public laws enacted by Congress since

1964, no person in the United States shall, on the

grounds of race, color, national origin, handicap, or age,

be excluded from participation in, be denied the benefits

of, or be subjected to discrimination under any program

or activity (or, on the basis of sex, with respect to any

education program and activity) receiving Federal 

financial assistance. In addition, Executive Order 11141

prohibits discrimination on the basis of age by contractors

and subcontractors in the performance of Federal 

contracts, and Executive Order 11246 States that no 

federally funded contractor may discriminate against any

employee or applicant for employment because of race,

color, religion, sex, or national origin. Therefore, the

National Heart, Lung, and Blood Institute must be operated

in compliance with these laws and Executive Orders.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

Administrative Use Only

February 2006