Complementary And Alternative Medicine Approaches Research Articles

Non-Pharmacological Treatments for ADHD in Youth.

Complementary and alternative medicine (CAM) in psychiatry or integrative psychiatry covers a wide range of biological, psychological and mind-body treatments that enhance standard medical practices and patient outcomes. While CAM approaches are popular amongst patients in their practice as well as in self-report because of their ease of use, health professionals have received limited education in these interventions and often are unaware of their patients' use of CAM treatments. This overview highlights evidence-based CAM treatments for attention deficit hyperactivity disorder (ADHD) including dietary interventions, phytomedicines, mind-body practices and neurofeedback. While conventional treatments are the mainstays for ADHD, there are a large number of available treatments that can be used to enhance treatment response. With improved education and further scientific and clinical research, validated integrative treatments will provide more effective, lower risk and lower cost care for patients with ADHD.

(547) Use of complementary and alternative medicine approaches for cancer pain management in Chinese-American immigrants

Cancer is the leading cause of death in Chinese-Americans, and many patients have poorly controlled pain. The use of complementary and alternative medicine (CAM) approaches for symptom management may be common in this population due to cultural factors. Little is known about the use of CAM approaches to manage cancer pain among Chinese-Americans. We evaluated CAM use for cancer pain management in a sample of 170 first-generation, non-English-speaking Chinese-Americans (mean age 64.3 years, SD=13.7; 62.4% female; 84.7% Cantonese-speaking only, with low acculturation scores, mean=6.1/25.0).

Complementary and Alternative Medicine Use and Adherence to Asthma Medications Among Latino and Non-Latino White Families

ObjectiveThe current study sought to evaluate patterns of complementary and alternative medicine (CAM) use in a sample of Latino and non-Latino white (NLW) children with asthma to determine whether parental beliefs about conventional medications and barriers to obtaining these medications were related to CAM use and to assess whether CAM use was associated with decreased adherence to controller medications. MethodsParticipants included 574 families of children with asthma from NLW, Puerto Rican (PR), and Dominican backgrounds from Rhode Island (RI) and from Island PR. All parents completed a brief checklist of barriers to medication use and an assessment of CAM approaches. A subsample of 259 families had controller medication use monitored objectively for approximately 1 month by MDILog (fluticasone propionate), TrackCap (montelukast), or dosage counter (fluticasone/salmeterol combination). ResultsPrevalence of CAM use was high among Latino families. Perceived barriers to obtaining medication were related to increased CAM use in PR families from RI. Elevated medication concerns were positively associated with CAM use among NLW and Island PR families. CAM use was positively related to objective adherence within NLW families, and unrelated in other groups. ConclusionsCAM use is common among Latino families with asthma. Among some families, CAM use may be initiated as a way to cope with barriers to obtaining medication or when parents have concerns about conventional medications. Families who report CAM use do not appear to be substituting CAM for conventional asthma medication.

Oral administration of the flavanol (−)‐epicatechin bolsters endogenous protection against focal ischemia through the Nrf2 cytoprotective pathway

Consumption of flavan-3-ols, notably (-)-epicatechin (EC), has been highly recommended in complementary and alternative medicine (CAM) due to reports that flavan-3-ols boost antioxidant activity, support vascular function, and prevent cardiovascular disease. To date, in vivo efficacy and mechanisms of action for many CAM therapies, including EC, remain elusive in brain ischemia. In contrast to its purported direct antioxidant role, we hypothesized protection through activation of the endogenous transcriptional factor Nrf2. To screen cellular protection and investigate Nrf2 activation, we adopted a pretreatment paradigm using enriched primary neuronal cultures from mice and washed out EC prior to oxygen glucose deprivation to attenuate direct antioxidant effects. EC protected primary neurons from oxygen glucose deprivation by increasing neuronal viability (40.2±14.1%) and reducing protein oxidation, effects that occurred concomitantly with increased Nrf2-responsive antioxidant protein expression. We also utilized wildtype and Nrf2 C57BL/6 knockout mice in a permanent model of focal brain ischemia to evaluate glial cell regulation and complex sensorimotor functioning. EC-treated wildtype mice displayed a reduction or absence of forelimb motor coordination impairments that were evident in vehicle-treated mice. This protection was associated with reduced anatomical injury (54.5±8.3%) and microglia/macrophage activation/recruitment (56.4±13.0%). The protective effects elicited by EC in both model systems were abolished in tissues and neuronal cultures from Nrf2 knockout mice. Together, these data demonstrate EC protection through Nrf2 and extend the benefits to improved performance on a complex sensorimotor task, highlighting the potential of flavan-3-ols in CAM approaches in minimizing subsequent stroke injury.

Correlates of longitudinal use of complementary and alternative medicine among people with osteoarthritis: findings from the osteoarthritis initiative

Purpose: Although correlates of complementary and alternative medicine (CAM) have been described using cross-sectional study designs, data describing use patterns over time are sparse. The purpose of this study was to describe correlates of CAM usage patterns among persons with radiographically confirmed knee osteoarthritis (OA). Methods:We included 2,114 participants of the Osteoarthritis Initiative with radiographic tibiofemoral knee OA in at least one knee at baseline who had five assessments completed over 4 years. Trained interviewers asked “During the past 6 months, did you use the following health supplements for joint pain or arthritis?” with separate questions for chondroitin sulfate and glucosamine (GLU/CHON). Participants also reported use of provider based CAM (e.g. acupuncture, ayurveda, naturopathy, biofeedback, homeopathy, Reiki, chiropractic, message) and patient self-directed CAM therapies (e.g. biologically-based supplements (SAME, MSM, vitamins, herbs), biologically-based diets, biologically-based topical agents, magnet therapy, mind-body interventions (Tai Chi, Yoga, Chi Gong, or Pilates, relaxation, spiritual activities)). Correlates of treatment approach for OA considered included sociodemographic indicators, body mass index, overall measures of mental and physical well-being, and clinical indices of knee OA. Polytomous logistic regression provided adjusted odds ratio estimates (aOR) and 95% confidence intervals (CI). Results: Fifty-five percent reported no use of GLU/CHON at any of the five assessments, 18.6% reported use at one or two times, 13.4% at three or four times, and 12.8% at all assessments. Relative to non-Hispanic Whites, Blacks had reduced odds of reports of GLU/CHON use on multiple assessments (aOR use 1-2 times: 0.59; (95% CI: 0.41-0.86); aOR use 3-4 times: 0.38; (95% CI: 0.23-0.61); aOR use 5 times: 0.13; (95% CI: 0.060.28)). Those with greater than college graduate education relative to those with < high school education had increased odds of GLU/CHON use on multiple assessments (aOR use 1-2 times: 1.55; (95% CI: 1.03-2.32); aOR use 3-4 times: 1.91; (95% CI: 1.16-3.16); aOR use 5 times: 1.69; (95% CI: 1.02-2.80)). Worst pain at baseline was inversely associated with GLU/ CHON use on every assessment (WOMAC Pain aOR use 5 times: 0.69; (95% CI: 0.53-0.89). Increased quality of life at baseline was inversely correlated with GLU/CHON use at every assessment ((KOOS Quality of Life aORuse 5 times: 0.81; (95% CI: 0.65-1.00). Increased K-L grade tended to correlate with increased GLU/CHON use reports on multiple assessments. Patients reporting other self-directed CAM practices at baseline were more likely to report GLU/CHON use on multiple assessments ((aOR use 1-2 times:1.94; (95% CI: 1.46-2.57); aOR use 3-4 times: 2.36; (95% CI:1.71-3.26); aOR use 5 times: 3.15; (95% CI: 2.26-4.37)). Relative to Whites, Blacks were more likely to report self-directed CAM use on multiple assessments and less likely to report provider-based CAM use. Women were more likely to report self-directed CAM use on multiple assessments. Patients who reported multiple CAM approaches at baseline (e.g. patient-based CAM, provider-based CAM, GLU/CHON) were more likely to report use of such approaches on multiple assessments. Conclusions: CAM therapies are commonly used to treat joint and arthritis pain among persons with knee OA, but reports of use over time is limited. The extent to which low use of CAM on multiple assessments is owing to lack of effectiveness or other factors remains unknown.

PC-FACS

PC-FACS

Complementary integrative approach for treating pruritus

Complementary and alternative medicine (CAM) is a conservative and increasingly popular approach to treat pruritus for both patients and medical providers. CAM includes natural products, mind-body medicine, and manipulative and body-based practices. In this overview, we summarize current evidence, possible mechanisms and clinical approaches for treating pruritus with CAM techniques. We focus on pruritus associated with atopic dermatitis, herpes zoster, chronic urticaria, burns, and postoperative contexts where the evidence for CAM approaches is promising.

Complementary and Alternative Therapies Used by Turkish Breast Cancer Patients Undergoing Chemotherapy

Background: Most breast cancer patients use complementary and alternative medicine (CAM), usually in parallel with their conventional treatments. This study was planned to determine the prevalence and determining factors for use of CAM by breast cancer patients undergoing chemotherapy. Patients and Methods: This descriptive study was carried out between October 2010 and May 2011, and included 96 patients at the Istanbul University Institute of Oncology. The Patient Characteristics form and Complementary and Alternative Medicine Scale were used for data collection. Descriptive and nonparametric tests were performed, and logistic regression analysis was used to predict factors affecting CAM use. Results: Praying was the most frequently used form of CAM, and most of the herbal supplements used by patients were harmless. Herbal use was higher among patients who had local disease (relative risk (RR) 4.48%, 95% confidence interval (CI) 1.12–17.95), and worship was more common among those who had not undergone surgery (RR 4.66%, 95% CI 1.64–13.20). Conclusion: The CAM approaches used by patients were found to be safe. However, sage and flax seed usage for estrogen- and progesterone-positive patients and exercise for patients with spinal metastasis can be inappropriate approaches. It is important to question and inform patients about CAM use during treatment.

Use of complementary and alternative medicine among patients with radiographic-confirmed knee osteoarthritis

To examine use of complementary and alternative medicine (CAM) among individuals with radiographic-confirmed osteoarthritis (OA) of the knee. We included 2679 participants of the Osteoarthritis Initiative with radiographic tibiofemoral knee OA in at least one knee at baseline. Trained interviewers asked a series of specific questions relating to current OA treatments including CAM therapies (seven categories - alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and three types of biologically based therapies) and conventional medications. Participants were classified as: (1)conventional medication users only, (2) CAM users only; (3) users of both; and (4) users of neither. Polytomous logistic regression identified correlates of treatment approaches including sociodemographics and clinical/functional correlates. CAM use was prevalent (47%), with 24% reporting use of both CAM and conventional medication approaches. Multi-joint OA was correlated with all treatments (adjusted odds ratios (aOR) conventional medications only: 1.62; CAM only: 1.37 and both: 2.16). X-ray evidence of severe narrowing (OARSI grade 3) was associated with use of glucosamine/chondroitin (aOR: 2.20) and use of both (aOR: 1.98). The Western Ontario and McMaster Universities (WOMAC)-Pain Score was correlated with conventional medication use, either alone (aOR: 1.28) or in combination with CAM (aOR: 1.41 per one standard deviation change). Knee Outcomes in Osteoarthritis Survey (KOOS)-Quality of Life (QOL) and Short Form (SF)-12 Physical Scale scores were inversely related to all treatments. CAM is commonly used to treat joint and arthritis pain among persons with knee OA. The extent to which these treatments are effective in managing symptoms and slowing disease progression remains to be proven.

Use of complementary and alternative medicine by patients seen at the dermatology department of a tertiary care center

The use of complementary and alternative medicine (CAM) among patients with dermatologic conditions has not been well studied. The aim of this study was to evaluate the frequency and pattern of CAM use in patients referred to the dermatology department of a tertiary care center. Patients referred to the dermatology department of an academic tertiary referral center between February 2, 2010, and February 10, 2010, were invited to participate in an 86-question survey regarding CAM use during the previous year. A total of 300 patients completed the survey, of whom 154 (51%) were women. Eighty-two percent ( n = 247) of the respondents had used some type of CAM during the previous year. The most frequently used treatment and technique was massage therapy (33%), and the most commonly used vitamin was vitamin C (31%). Herbs or other dietary supplements were used by 58% ( n = 173) of patients. Seventy-eight percent ( n = 235) of patients stated that physicians should consider incorporating CAM approaches into their treatment recommendations, and 89% of patients ( n = 267) stated that our dermatology department should study CAM approaches in research studies. CAM utilization is high among patients at a large academic dermatology department. Patients indicated a strong preference for having CAM approaches incorporated into their treatment recommendations and believed in the value of clinical studies to further refine the role of CAM.

Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model

Teamwork is a contemporary way to try to improve the healthcare system, not only for the patients but also for the practitioners involved. A new type of interprofessional working arrangement, integrative healthcare (IHC) clinics, has emerged in the last two decades. The literature on interprofessional collaboration is steadily increasing, but little is known about the collaborative organization of the biomedical and complementary and alternative medicine (CAM) practitioners that make up the teams in these clinics. The relationship-centered care model was used to guide an exploration of the interprofessional teamwork within a Canadian IHC setting. A sample of 31 IHC clinics and 228 biomedical and CAM practitioners were included. Eighty-nine questionnaires were returned from 25 clinics, representing a 62% practitioner response rate (within clinic responders). This study established that within the analytical model, practitioners behaviors and skills are the main factors associated with job satisfaction and inter-practitioner conflicts in interprofessional IHC practice. The results of the study also suggested the importance of interprofessional exposure for healthcare practitioners who are being expected to serve a clientele that is increasingly interested in being both cured and healed by the integration of biomedical and CAM paradigms and approaches.

Adaptive Coping Strategies and Attitudes Toward Health and Healing in German Homeopathy and Acupuncture Users

Although acupuncture and homeopathy both have a theoretical background that refers to immaterial forces difficult to verify, they are nevertheless used and accepted as effective treatments by many individuals. We intended to investigate whether and how users of acupuncture and homeopathy differ with respect to sociodemographic data, adaptive coping strategies, and attitudes toward complementary and alternative medicine (CAM). In an anonymous questionnaire survey among 5,830 elderly German health insurants, we identified individuals who used CAM within the last five years. Acupuncture was used by 10% of the population, homeopathy by 7%, and both by 5%. More men than women used acupuncture, whereas homeopathy was used equally by women and men. Acupuncture users had a reduced physical health status compared to homeopathy users. In most cases, it was not a disappointment with conventional medicine that accounted for CAM usage. Stepwise regression analyses revealed that the best predictors of acupuncture and homeopathy usage were the conviction that CAM is more profound and expends more time, fear of the side effects of conventional medicine, and high scores in the measure of search for information and alternative help. Negative predictors were physical health, male gender, age, and trust in a scientific rationale of treatments. We found that usage of distinct CAM approaches might depend on particular psychosocial profiles, attitudes, and convictions. In contrast to homeopathy users, acupuncture users seemed to be much more pragmatic and referred more often to an expected scientific background of chosen treatment. Our findings fill a gap of knowledge that needs further attention.

Complementary and Alternative Medicine and Supportive Care at Leading Cancer Centers: A Systematic Analysis of Websites

With increasing frequency, patients with cancer and their family members are turning to the Internet to educate themselves about their disease and treatment options, including complementary and alternative medicine (CAM) and supportive care. However, very little is known about how national leading cancer centers represent these therapies via their websites. Simulating the perspective of an information-seeking patient or family member, we performed a systematic analysis of the websites of 41 National Cancer Institute designated comprehensive cancer centers. Two researchers independently evaluated websites, recorded CAM information, and rated quality of the websites using a 4-item Likert scale (overall, information, presentation, and navigation) with Cronbach's alpha = 0.97. Rating was adequately correlated between the two raters (correlation coefficient 0.8). Of 41 centers, 12 (29%) did not have functional websites with regard to information related to CAM. The most common CAM approaches mentioned were: acupuncture (59%), meditation/nutrition/spiritual support/yoga (56% for each), massage therapy (54%), and music therapy (51%). Twenty-three (23; 56%) presented information on support groups, 19 (46%) on patient seminars, 18 (44%) on survivorship effort, and 17 (41%) on symptom management clinics. Twenty-nine (29) (71%) of these websites had a telephone number available, 22 (54%) mentioned at least one ongoing research opportunity, and 19 (46%) provided links to the National Center for Complementary and Alternative Medicine website. Median rating of the quality of websites was 50 of 100, with only 7 (17%) of centers receiving a composite score 80 (excellent) or better. While a growing number of leading cancer centers provide information about CAM and supportive oncology information for patients via their websites, the quality and ease of navigation of these sites remain highly variable. Effective development and redesign of many of the websites is needed to better inform and empower patients and families seeking CAM and supportive care information.

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

Complementary and alternative medicine (CAM) and supportive care at leading cancer centers: A systematic analysis of websites

e17528 Background: With increasing frequency, cancer patients and their family members are turning to the Internet to educate themselves about their disease and treatment options, including CAM and supportive care. However, very little is known about how national leading cancer centers represent these therapies via their websites. Methods: Simulating the patients’ perspective, we performed a systematic analysis of the websites of 41 National Cancer Institute (NCI) designated comprehensive cancer centers. Two researchers independently evaluated websites, recorded CAM information, and rated quality of the websites using a 4-item Likert scale (overall, information, presentation, and navigation) with Cronbach's alpha = 0.97. Rating was adequately correlated between the two raters (correlation coefficient 0.8). Results: Of 41 centers, 12 (29%) did not have functional websites with regards to information related to CAM. The most common CAM approaches mentioned were: acupuncture (59%), meditation/nutrition/spiritual support/yoga (56% for each), massage therapy (54%), and music therapy (51%). Twenty-three (56%) presented information on support groups, 19 (46%) on patient seminars, 18 (44%) on survivorship effort, and 17 (41%) on symptom management clinics. Twenty-nine (71%) of these websites had a telephone number available, 22 (54%) mentioned at least one ongoing research opportunity, and 19 (46%) provided links to the National Center for Complementary and Alternative Medicine website. Median rating of the quality of websites was 50 out of 100, with only 7 (17%) of centers receiving a composite score 80 (excellent) or better. Conclusions: While a growing number of leading cancer centers provide information about CAM and supportive oncology information for patients via their websites, the quality and ease of navigation of these sites remain highly variable. Effective development and redesign of many of the websites is needed to better inform and empower patients and families seeking CAM and supportive care information. No significant financial relationships to disclose.

Systematic Assessment of the Quality of Research Studies of Conventional and Alternative Treatment(s) of Primary Headache State of the Data at the Mid-Point of the Decade of Pain Control and Research

Background: Diversity of treatments used for headache, and varied quality of research conduct and reporting make it difficult to accurately assess the literature and to determine the best treatment(s) for patients. Objectives: To compare the quality of available research evidence describing the effects and outcomes of conventional, and complementary and alternative medicine (CAM) approaches to treating primary (migraine, tension, and/or cluster-type) headache. Study Design: A systematic review of quality of research studies of conventional and alternative treatment(s) of primary headache. Methods: Randomized, controlled clinical trials (RCTs) of treatment(s) of chronic primary headache (in English between 1979 to June 2004) were searched through MEDLINE, PsycInfo, EMBASE, Cochrane Library, and the NIH databases. Studies were evaluated using standard approaches for assessing and analyzing quality indicators. Results: 125 studies of conventional, and 121 CAM treatments met inclusion criteria. 80% of studies of conventional treatment(s) reported positive effects (P&lt;0.05), versus 73% of studies of CAM approaches (chi2 = 3.798, 1 df, p=0.051). Overall, the literature addressing the treatment of primary headache received a mean Jadad score of 2.72 out of 5 (SD 1.1). The mean Jadad score for studies of conventional therapeutics was significantly better than for those studies of CAM approaches: 3.21 ± 0.9 vs 2.23 ± 1.1 (t=7.72, 246 df, mean difference 0.98, p &lt; 0.0005). Conclusions: Studies of conventional treatments scored higher on reporting quality than studies of CAM approaches. It is possible that these differences may reflect distinctions in 1) methodologic integrity, 2) therapeutic paradigm(s), and/or 3) bias(es) in the approach(es) used to evaluate certain types of therapies. Each of these possibilities — and the implications — is addressed and considered. Key words: chronic headache, complementary and alternative medicine, research quality, randomized controlled trial, Jadad scores

Survey of complementary and alternative therapies used by children with specific learning difficulties (dyslexia)

Dyslexia is a common learning difficulty affecting up to 10% of British children that is associated with a wide range of cognitive, emotional and physical symptoms. In the absence of effective conventional treatment, it is likely that parents will seek complementary and alternative medicine (CAM) to try and help their children. However, little is known about the level of CAM use or the type of CAM used by dyslexic children. This study assessed: (1) the lifetime use of CAM by dyslexic children, (2) the role of socio-demographic factors in CAM use by dyslexic children, (3) parental attitudes towards CAM use in the treatment of dyslexia, and (4) how parents' understanding of dyslexia affects CAM use. A semi-structured questionnaire-based survey of parents of 148 dyslexic school children was undertaken. The children had been recruited to a university research programme investigating the effectiveness of a complementary therapy for the treatment of learning difficulties. Lifetime use of CAM was 55.4% (82 children). The most popular CAM approaches were nutritional supplements/special diets (63 children) followed by homeopathy (29 children) and osteopathy/chiropractic manipulation (29 children). Socio-demographic factors did not predict CAM use. In total, parents of 101 dyslexic children reported that an interest in CAM for the treatment of dyslexia was based on their preference for CAM for their families more generally. Parents who thought that dyslexia was a 'medical/health' disorder were more likely to have used CAM with their children (p<0.01) than other parents in this survey. Educational and health professionals should be aware that many dyslexic children use CAM. Parents of dyslexic children should be provided with evidence-based advice to help them make informed therapeutic choices.

Integrating biomedical and CAM approaches: The experiences of people living with HIV/AIDS

This paper discusses the perspectives of 18 people who were living with HIV/AIDS in Melbourne, Australia, and who were using complementary and alternative medicine (CAM) alongside biomedicine. I argue that although people may perceive the holistic focus of CAM to be more desirable than the more pathogenic focus of biomedicine, a holistic approach is also associated with limitations. In this study, participants were motivated to use CAM because of the perceived limitations of biomedicine and also because of a desire to have control over how their illness was managed. However the majority of participants were not interested in the philosophical principles of CAM, rather in whether these therapies were effective and manageable. These findings suggest that although people may hold different beliefs about CAM as compared with biomedicine, an approach to healthcare that has a practical focus on both clinical outcomes and patient wellbeing may be acceptable to most people.

Use of Antidepressants and Complementary and Alternative Medicine Among Outpatients With Depression in Taiwan

Understanding use of complementary and alternative medicine (CAM) and antidepressants during patient's recovery for depression is important to enhance their psychological functioning and promote positive health care outcomes. This study investigated the use of antidepressant treatment and CAM in outpatients with depression 1 month after discharge from psychiatric hospitalization. Telephone surveys were conducted. Of the 201 participants, 50.2% reported using CAM 1 month after discharge. Nearly 41% (n = 82) used a combination of both antidepressant treatment and CAM after hospital discharge. The most commonly used CAMs were spiritual healing, relaxation techniques, and herbal medicine. Symptom relief was the top reason participants used CAM for depression. A number of factors were associated with higher odds of using CAM. CAM is often considered as a valued component of holistic care plan after discharge. It is important for nurses to identify the CAM approaches patients are using so that this information can assist in the education of patients and family about the benefits of contemporary treatments for depression, possible interactions when combining treatments, and the CAM and conventional medicine that can be helpful to relieve depression symptoms and psychological distress.

Familial and Perceived Risk of Breast Cancer in Relation to Use of Complementary Medicine

To examine the use of complementary and alternative medicine (CAM) by women with varying levels of familial and perceived risk of breast cancer with the goal of preventing breast cancer. Cross-sectional data on CAM use were collected on 2,198 women (mean age, 63 years) personally unaffected by breast cancer in the Minnesota Breast Cancer Family Study. CAM use was compared across women at high, moderate, or average risk based on family history, as well as across categories of perceived risk of breast cancer. CAM use was also examined in relation to screening and general health behaviors, worry about breast cancer, and optimism. Half (49.5%) of the women reported using at least one CAM modality with the intent of preventing breast cancer. Univariate analyses indicated that greater overall CAM use was related to greater perceived risk (P = 0.018), more general health behaviors (P < 0.0001), more breast cancer screening behaviors (P = 0.0002), greater optimism (P = 0.0002), and higher educational attainment (P < 0.0001). Multivariate analysis revealed that general health behaviors (P < 0.0001), education (P = 0.0027), and optimism (P = 0.037) were significant predictors of CAM use when in the same model with perceived risk and breast cancer screening behaviors. Many women use CAM with the goal of preventing breast cancer. General health-promoting behaviors, education, and optimism predict CAM use. Evidence-based guidance is needed for the public and health care providers on the potential and limitations of specific CAM approaches to affect cancer risk.