Youth High-Risk Behavior
youth high-risk behavior The US Centers for Disease Control and Prevention's (CDC's) Youth Risk Behavior Surveillance System (YRBSS) monitors behaviors among young people that can adversely affect their health. Key areas of focus include tobacco use, substance abuse, sexual activity, pregnancy, violent behavior, accidental injuries, physical inactivity, eating habits, and attempted suicide. YRBSS data help public health organizations develop intervention strategies and programs to reduce adverse health consequences among youth. The CDC surveys students in middle schools and high schools throughout the United States to collect YRBSS data.
HIGH-RISK HEALTH BEHAVIORS AMONG YOUTH
anabolic steroid use binge drinking
carrying a weapon cigarette smoking
does not drink milk does not eat fruit, vegetables
drinking and driving failure to wear bike helmet
fast food consumption fighting
ILLICIT DRUG USE lack of seat belt use
laxatives or diet aids to multiple sex partners
lose weight no regular physical nonsmoking TOBACCO use exercise
overweight or obese regular ALCOHOL consumption
riding with intoxicated driver sexual activity without a suicide ideation or attempts condom
See also lifestyle and health; Healthy People 2010.
The current time is one of a paradigm shift in the nature and delivery of health care that affects everyone- researchers, patients, doctors, and insurers-alike. Tremendous discoveries in medicine are leading to a reexamination of attitudes and practices across the spectrums of health and of disease. As conventional medicine intensifies its focus on lifestyle management and preventive measures and on viewing the patient as a "whole" person (the holistic view common to many alternative and complementary health systems), both doctors and individuals are finding therapeutic value in incorporating many alternative and complementary therapies within integrative treatment plans.
This section, "Alternative and Complementary Approaches," presents an overview discussion of treatment approaches that are beyond the boundaries of conventional medicine yet still within the realm of which conventional doctors may responsibly include them as elements of integrative treatment plans. The entries that follow represent the range of the alternative and complementary therapies available from ancient healing systems, such as traditional Chinese medicine (tcm) and Ayurveda, to medicinal herbs and botanicals. As well, several entries present methods that are controversial and potentially hazardous from the conventional medicine perspective, such as chelation therapy. Such entries are included not to give them credibility but because widespread misper-ceptions about them persist despite a clinically valid body of knowledge that supports concerns about their risks.
Context and Perspective
This section presents the discussion of alternative and complementary approaches within the context and perspective of conventional medicine as practiced in the United States, as this is the orientation of The Facts On File Encyclopedia of Health and Medicine. Some conventional doctors share the interest and enthusiasm of patients who want to incorporate alternative and complementary therapies, and some conventional doctors are less willing to entertain such inclusions. Much depends on the convergence of the patient's interests and condition with the doctor's knowledge and trust in specific alternative and complementary therapies. The efficacy of some ancient healing systems and methods is perhaps more trustworthy than that of isolated or obscure practices. The challenge for doctors and patients alike is to evaluate what bodies of knowledge exists about popular therapies, to understand which of them may have therapeutic value.
Most alternative therapies derive from healing systems deeply rooted in philosophical frameworks that differ dramatically from those of conventional Western medicine. A conventional physician's training does not include most of these methods, even the most studied or popular ones. Doctors must instead rely on evaluating the available research to determine whether, how, and when alternative and complementary approaches are appropriate in conjunction with conventional care. For some methods, not much data are available. As knowledge about these approaches increases, many conventional doctors may be more confident about incorporating them. Indeed, some conventional doctors seek additional education and certification in alternative and complementary therapies such as ACUPUNCTURE and herbalism so they can offer their patients a broader spectrum of therapeutic and preventive options.
The conventional framework that guides the practice of medicine in the United States is physician centered and based in measurable evidence and reliably repeatable results through controlled clinical studies. Though the true measure of a treatment's success is whether people improve or worsen with its use, evidence-based standards give conventional physicians a sense of reasonable expectation when making treatment decisions and recommendations. Many conventional doctors are increasingly interested and willing to add responsible alternative and complementary therapies to integrative treatment plans when they have reasonable expectations for how such therapies may benefit the patient's condition or quality of life.
When looking at the broad range of alternative and complementary approaches from acupuncture to prayer and spirituality to visualization it is also important to understand how patients look to these methods in preventive and lifestyle contexts. Meditation and yoga, for example, have become fairly mainstream as practices to reduce stress and are gaining acceptance for their abilities to influence health conditions such as hypertension (high blood pressure). As researchers and doctors learn more about the pathways and mechanisms of mind-body interactions, they understand more fully how lifestyle and preventive health measures, with a holistic view of the individual, are important. Within such a context, yoga and exercise become comparable complements to good health. Whether one or the other is "alternative" or "conventional" has little relevance; each benefits health in similar ways.
Historical Traditions in Alternative Healing Systems
The oldest known healing systems still in practice today, traditional Chinese medicine (TCM) and Ayurveda, date to perhaps 3000 b.c.e., well before the advent of written language. Native American healing originating among the indigenous cultures of the North American continent melds spirituality and health in much the same fashion as does India's Ayurveda and, archaeological evidence suggests, could have origins that are nearly as ancient. In these systems, healers passed their knowledge from one to another, generation to generation, through tradition and experience. In some cultures each successive generation developed improvements on the methods of healing their ancestors used, and in other cultures each generation of healers practiced in precise compliance with the traditions they learned from the generations before them.
Some alternative healing systems are relatively modern, emerging within the past 100 or 200 years as outgrowths of what were the medical practices of their times. Though common perception views alternative and complementary therapies as Eastern in their philosophies and practices, these newer systems-notably homeopathy, natur-opathy, and OSTEOPATHY-are Western in origin and orientation. One alternative healing method, chiropractic, is uniquely American.
ALTERNATIVE HEALING SYSTEMS
Ayurveda homeopathy
native American healing naturopathy osteopathy traditional Chinese medicine (tcm)
COMMON ALTERNATIVE AND COMPLEMENTARY THERAPIES
ACUPUNCTURE ART THERAPY
Chinese herbal remedies
FLOWER ESSENCES
MAGNET THERAPY
MEDICINAL HERBS AND BOTANICALS
OSTEOPATHIC MANIPULATIVE
TREATMENT (OMT) VISUALIZATION YOGA
AROMATHERAPY BIOFEEDBACK CRANIOSACRAL MASSAGE HYPNOSIS MASSAGE THERAPY NUTRITIONAL THERAPY PRAYER AND SPIRITUALITY TAI CHI
VITAMIN AND MINERAL THERAPY
Interest in, and use of, alternative therapies is a growing phenomenon in the United States. According to a 2002 survey by the US National Center for Complementary and Alternative Medicine (NCCAM) and the US Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS), nearly two thirds of Americans use some form of alternative health practice, most of them to complement their conventional medical care.
Surveys show that half choose alternative therapies on their own to complement conventional therapies, a quarter use alternative therapies their
conventional physicians recommend, and a quarter use alternative therapies on their own because they believe conventional medicine will not help their conditions. Nearly 12 million Americans seek relief from BACK PAIN alone through alternative and complementary therapies (excluding prayer). Other common uses of alternative and complementary therapies (excluding prayer) include arthritis and JOINT PAIN, chronic HEADACHE, FIBROMYALGIA, anxiety and DEPRESSION, chronic gastrointestinal conditions, hypertension, and MENOPAUSE discomfort. Many people use alternative and complementary therapies to provide relief during cancer treatment and from cancer symptoms.
Alternative/Complementary Practice
Percentage of Americans Who Use
prayer specifically for one's own
health prayer by others for one's
health natural products deep BREATHING EXERCISES participation in prayer group for
one's own health
MEDITATION CHIROPRACTIC care YOGA
43.0 percent
24.4 percent 18.9 percent 11.6 percent
9.6 percent 7.6 percent 7.5 percent 5.1 percent massage 5.0 percent
diet-based therapies 3.5 percent
Source: Barnes, P; Powell-Griner, E; McFann, K; and Nahin, R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.
"First, Do No Harm"
Alternative and complementary approaches often draw people to try them on their own, without consulting their conventional doctors. People may be curious about certain methods, frustrated or disappointed with the results of conventional treatments, or have limited access to conventional health care. In choosing from alternative and complementary therapies, it is prudent to learn as much as possible about the method so as to "first, do no harm" as the time-honored medical dictum cautions. And, when possible, seek the advice of a conventional doctor to gain perspective to what often is confusing or conflicting information.
Though it is seldom harmful to drink green tea, do yoga, or have Reiki, some alternative and complementary methods may be hazardous as may be some conventional methods-for people who have certain health conditions. For example, people who have rheumatoid arthritis or other degenerative musculoskeletal disorders may risk serious injury with craniosacral therapy, osteo-pathic manipulative treatment (omt), or chiropractic manipulation. Nutritional therapy may alter medication needs for people who have diabetes, malabsorption disorders, or conditions affecting the liver or kidneys. It is important to choose the most reliable and credible methods and practitioners, and to coordinate care among all the providers involved in its delivery, conventional and complementary.
Using alternative and complementary approaches in coordination with conventional treatments may alleviate some symptoms but cannot effectively substitute for conventional medical care for many health conditions ranging from HYPOTHYROIDISM to CANCER.
For people who are undergoing conventional medical treatment such as chemotherapy or radiation therapy, it is worthy to ask doctors what to eat, how and when to exercise, and what measures can support health; the environment of the body changes dramatically during such therapies, and sometimes approaches that are supportive and complementary to the conventional treatment can lessen the harshness of the experience. For many circumstances, however, available information fails to provide clear answers and it becomes a matter of trusting the doctor and making common sense decisions.
Science Meets Tradition: Evidence and Standards
Scientific evidence is scarce for many alternative and complementary therapies. Many therapies have evolved over centuries of use and produce reliable results even though contemporary clinical science cannot yet explain the mechanisms of the method. Acupuncture, for example, has been an integral component of TCM, as well as other healing systems, for several thousand years. At
acupuncture's foundation, within these systems, is the presence of an extensive network of energy channels, called meridians, in the body. Though these meridians are not tangible, perceptible structures in the conventional sense, they are nonetheless a centuries-old map of energy pathways in the body. That contemporary researchers have yet to quantify them does not necessarily invalidate their existence. Indeed, not until the invention of devices such as the microscope in the eighteenth century, and really not until its application in exploring the structure of the human body in the nineteenth century, did scientists discover the networks of nerves that convey information and instructions from the BRAIN to each cell in the body. Medical science is ever-evolving, and new technologies continually reveal new and paradigm-shifting discoveries (such as mapping the human genome).
Herbal remedies and medicinal foods contain numerous potentially active ingredients. Conventional clinical studies of the intact substance, such as the soybean, may yield different results than studies of the substance's known active ingredients, such as SOY isoflavones. A substance may appear to be a "heal-all," raising questions about PLACEBO effect. And yet the substance may simply have such broad-reaching actions in the body, such as stimulating the immune system, that it truly does have healing effects for numerous health conditions.
Evidence of effectiveness and mechanism of action may be in short supply simply because the clinical research studies that are today the foundation of conventional medicine may not have investigated a particular therapy or may have produced inconclusive findings. Sometimes multiple studies generate conflicting data. Some methods have been copiously studied, though according to standards other than those common in the United States. And, of course, numerous "therapies" are available that have dubious therapeutic value (and may appear clearly ineffective or even harmful) and have no foundation within the context of any healing system.
As a result of these mixed circumstances, there is considerable disagreement among conventional doctors and clinical scientists about the effectiveness and potential risks of many alternative and
complementary therapies. These possibilities apply as well to conventional therapies. Researchers do not fully understand the mechanisms of many drugs, such as levodopa to treat Parkinson's disease, the tricyclic antidepressant medications, and many of the medications doctors prescribe to treat heart conditions. However, empirical evidence (observable, reproducible effects) support their effectiveness to the extent that conventional doctors are comfortable using them. Such is becoming the case with some alternative and complementary approaches that lend themselves to empirical study, such as acupuncture.
As the current health-care paradigm continues to change, it is natural to expect conflicting viewpoints about the best standard of care to emerge. Until there is a truly integrated approach, there will be a higher level of responsibility on the individual to participate in health-care decisions and to choose care that is wise and effective. This applies as much to the choice to use acupuncture as to enroll in a clinical study for an experimental drug or treatment.
Breakthrough Research and Treatment Advances
Advances in medical technology, particularly imaging procedures, have made possible the study of alternative and complementary therapies in ways that allow researchers to explore how they alter physiologic functions. Positron emission tomography (pet) scan and magnetic resonance imaging (mri), for example, allow researchers to observe, in real time, the changes that take place in the brain and other parts of the body with therapies such as hypnosis, acupuncture, meditation, visualization, and even prayer. Numerous studies underway are investigating alternative therapies such as botanical and herbal remedies to relieve the discomforts of menopause, cancer and cardiovascular disease prevention and treatment claims, methods for pain management, and mind-body interventions to mitigate the symptoms of chronic health conditions.
The current health-care culture is reaching for new understanding that can unify technology, conventional techniques, and complementary methods in a single, amazing paradigm for treatment of the human being in health and in illness. Within this paradigm is the potential for many of
the complementary approaches to be as "conventional" in their use and application as advances in technology such as GENE THERAPY, molecular medicine, diagnostic imaging, ORGAN TRANSPLANTATION, BIOLOGICAL RESPONSE MODIFIER, and PHARMACOGE-NOMICS.
Even today, hospitals are quietly becoming models of such an integrative paradigm. Neonatal intensive care units employ MASSAGE THERAPY and music therapy to soothe the fragile premature infants born before their bodies and systems developed fully. Patients waiting for organ transplants or undergoing high-tech cancer treatments receive instruction in meditation and visualization. Reflection gardens, labyrinths, Native American prayer wheels, meditation rooms, and chapels provide quiet, calming environments for prayer and contemplation.
This is a time of record breakthroughs in medical discoveries. Researchers are exploring more and more experimental treatments, conventional as well as alternative and complementary. Keeping up with the incredible pace of new knowledge challenges doctors and individuals alike. What is clear already is that as knowledge increases, the best care will be that which presents an informed integrative approach guided by progressive conventional doctors based on individual patient needs, using the simplest, most effective methods for restoring and maintaining health.
