Preventing Cancer

Preventing Cancer

A wellness lifestyle implies taking responsibility for your health and making wise choices. The purpose of this chapter is to discuss how to decrease cancer risk,which is strongly affected by personal lifestyle choices. Adult cancer is largely a preventable disease. While no one would choose to have cancera, person might choose to use tobacco, tan excessively or eat a high-fat diet, factors that can initiate and promote cancer. You will learn which behaviors increase health risks and how to decrease those risks to enhance your state of wellness. This chapter covers what cancer is, its controllable risk factors, early detection, self-exams common cancers and their symptoms, preventive behaviors, and treatments.

Prevention, rather than treatment, is emphasized because it is in prevention that we have the greatest control.

CANCER INCIDENCE

Cancer is the second most common cause of death in the United States after heart disease. See Figure l2-1,for cancer death rates by site and gender. According to present rates, about one in three Americans will eventually have cancer. While cancer is most common in people over age 55, it can strike at any age. The earlier a cancer is detected the simpler the treatment is and the higher the survival rate is. We know that simple lifestyle changes can cut your risk ofcancer. For this reason,it is important to understand cancer risk factors and warning signals and to practic self-exams.

WHAT IS CANCER?

Cancer is not a single disease but a group of over 100 different diseases chracterized by abnormal cell growth and replication. Normally,cell sgrow and are replaced in an orderly manner. Enough new cells grow to replace the ones that are worn out and iniured. Cancer cells lack

Age-adjusted cancer death rates.

SOURCE: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, MD 2003. *Age-adjusted to the 2000 U.S. standard population.

controls to stop the growth process and continue to grow and multiply without restraint. This loss of control of cell growth may be due to a variety of factors. Ultraviolet radiation from sunlight, tobacco smoke, viral infections, diet, and chemicals in food and the environment all have been implicated.

It is possible that all of us at some time experience potentially cancerous changesin our cells.These precancerous cells usually die or are destroyed by the immune system. Few live long enough to cause harm. If one abnormal cell survives it can replicate in to billions of cells, forming a lump or tumor. Tumors may be benign or malignant. Benign tumors are usually nonthreatening. Although they can grow large enough to interfere with organs and bodily functions, they seldom caused eath.They usually resembles urroundingt issue, remainl ocalized and spread by expansion like a wart or mole. They do not spread to other parts of the body. They can be removed completely by surgery and are not likely to recur. Malignant tumors are cancerous. They differ from surrounding tissue and tend to spread through metastasis. In metastasis cells break a way from the primary tumor and migrate to other tissues through the lymph or blood system and continue to grow. They have lethal potential because they invade and destroy normal tissues and spread to other parts of the body.

HOW TO CUT YOUR RISK OF CANCER: PRIMARY RISK FACTORS

People hear so much about cancer, they often get the feeling that everything causes cancer. If everything causecs ancer the resems to be no use in trying to avoid it. They feel that there is little they can do to make a difference in their cancerr isk or that it is not worth the effort.

They are wrong.Cancer,like heart disease is, largely preventable.Up to 80 percent of cancers may be related to lifestyle factors over which you have control. Only 5 percent can be blamed on environmentafl actors.These cancer so ccurasa result of cumulative exposureto carcinogens, substances that cause cancer, and/or a weakened immune system that does not effectively scavenge precancerouc sells.There are five major risk factorsf or developing cancert hat are within your control.

Primary risk factors for cancer are:

· Tobacco use

· Sun overexposure

· Diet

· Inactivity

· Obesity

Several other factors contribute to an increased risk of cancer Secondary risk factors for cancer home of which are controllable,in clude:

· Excessiv aelcohol consumption

· Exposure to home iral infections, for example, hepatitis B

· Exposure to radiation,workplace hazards and certain chemicals

Preventable factors that initiate cancer are associated with different death rates. For example, skin cancers, mainly caused by ultraviolet exposure are the most common form of cancer but are highly curable, and so few people die from them. Lung cancer, mainly from cigarettes moking,is far less common but very deadly and kills far more people. The percentage of cancer deaths attributable to preventable causes of cancer is shown in Figure.

Choices you make daily can greatly cut your cancer risk. It is a matter of education and habit change. What follows is a discussion of what you can do.

Tobacco Use

This includes cigarettes, pipes,cigarss, nuff,and chewing tobacco.Tobaccoc ontainsm any carcinogensth at increaset he risk of developings everal types of cancers. (See Chapter 13 for additional information on the effects of tobacco.) Frequente xposureto toxins ingested from tobacco products weakens the immune system and decreaset she body's ability to cleanse it self of precancerous cells. In addition, when a smoker is exposed to other carcinogenst, here seems to be a synergistic effect that multiplies cancer rates beyond what would be expected from the effect of each carcinogen alone. For example, smoking combined with the use of alcohol greatly increaset she risk of cancer. The number of smokers is decreasing in the United States.However,the use of smokeless tobacco,especially "dipping snuff" has increased. Where as tobacco use is most often implicated in lung cancer,tobacco products can produce a variety

SOURCE: Harvard Center for Cancer Prevention. Harvard Report on Cancer Prevention. Vol. 1: Causes of Human Cancer. Cancer Causes and Control 7 (Suppl): 1996.

of oral cancers,including cancer of the lip, tongue, mouth, and throat. Spit tobacco, also known as smokeless tobacco or chews nuffor dip, can cause cancer of the mouth and throat after as little as 3 years of use. Changes in the oral mucosa are found as soon as 7 days after using spit tobacco. Over 2,000 chemical ingredients,including formaldehyde, cadmium, arsenic, and nitrosamines, are in these types of tobacco. Nitrosamines are powerful cancer-causincgh emicals that are 50 times higher in spit tobacco than in cigarettes. This makes it even more dangerousth an smoking and in less time. Smokeless tobacco use can cause a whitish leathery patch, called leukoplakia, to develop in the mouth where the tobacco is placed between the cheek and the gums. Over half to two-thirds of smokeless tabacco user shave thesep recanceroulse sions. Smokeless tobacco user sincrease their risk of oral cancero ver 50 times compared with nonusers.Other problems include tooth decay, mouth sores, permattenl gum recession, tooth loss, bad breath, drooling, and stained teeth. Spit tobacco is not a safe alternative to smoking. It is "cancer in a can."

The good news is that cancers caused by tobacco are 100 percent preventable .If you don't use tobacco, don't start. If you are a tobacco user, quit. People who quit, no matter at what age, live longer, healthier lives than do those who keep using tobacco. For the majority of Americans who don't use tobacco, reducing sun exposure and eating healthfully are the most powerful tools for decreasincg ancer risk.

Sun Overexposure

Overexposure to the sun is the main cause of skin cancer. It is estimated to strike one of every six Americans, making it the most common cancer. We have been a nation of sun worshipers and are seeing the consequences. How ironic that the price of a "healthy" tan can be premature skin aging and wrinkling and skin cancer. It is never good to lie in the sun to tan, but you can still enjoy outdoor activities and minimize the negative effects by following the guidelinesin Table1 2-1.

How to Reduce Sun Exposure

Diet

About one-third of cancers can be prevented by a healthful diet. Certain foods seem to be relate to an increase or decreasien home kinds of cancers for instance, a high-fat diet seems to play a role in the development of breast, colon, and prostate cancers. A multitude of studies show that by eating whole-grain foods, fruits, and vegetables and by avoiding high-fat red meat, bacon, and processed meats,we could significantly reduce our overall cancer risk.

The food pyramid in and the dietary guidelines are excellent models to follow. However, many Americans are not making these simple dietary adjustments. OnIy 24 percent of Americans eat the recommended five or more servings of fruits and vegetablesa day. Eating a variety of fruits, grains,and vegetableiss not only more healthful but less expensive than buying a lot of high-fat meat and highly processed foods such as hot dogs, fries, chips, doughnuts, and junk cereals Concerns have been voiced about pesticide and chemicalr esidues in fruits and vegetablesa, s well as about irradiation of fresh produce and poultry. There is no doubt that the production, processing and transportation of food in our mass-market world raise concern necessitate further research. Nevertheless we do know that sun exposure, a fatty diet, inactiviry obewsity and tobacco products are highly controllable are as here your behavior has a major impact. Taking positive steps in these are as makes more sense than worrying about food products over which you have little control.

Cancer Deaths Preventable by a Healthy Diet

By making positive choices in your daily diet and following the guidelines listed here,you can promote good health now and reduce your cancer risk in the future.

1.Decrease fat intake, particukulary from animal sources. Eat low-fat meats and dairy products, as well as vegetarian meals. Cut way back on fried foods (averageo ne serving or lessa day) and fatty sweets (pastry cookies) Decrease consumption of foods high in saturated fat and transfat. Limit consumption of red meat, particularly high-fat meat. High-fat diets are related to an increased risk of cancer of the colon, rectum,prostate,and endometrium. Some studies have also linked a high-fat diet with an increased risk of breast cancer. Whether this risk is related to the amount of fat, type of fat, caloriesin fat, or home other factor in dietary fats is not yet clear.

2. Choose most of the foods you eat from plant sources. Eat five to nine serving so fruits and vegetables a day, as well as six or more servings of whole-grain breads and cereals b, own rice,pasta,or beans.

Diets rich in fruits and vegetables (French fries don't count) protecty ou againstm any cancers, particularly those occurring in the gastrointestinal and respiratory tracts, uch as cancers ofther colon, lung, stomach,esophagusm, outh, and throat. Grains are important sources of many nutrients, such as selenium and folic acid, which somes tudies ave associated with a lower risk of colon cancer. It is not yet known exactly what factors in plant foods provide protective benefits. Fiber has long been thought to be protective against colon cancer but recents tudies leave this open to question. Certainly consuming more plant foods leavesless room for high-fat,emptycalorie foods, and plant foods are rich in essential vitamins, minerals, and protective phytochemicals,natural plant substances that help ward off cancer. Some phytochemicals may block carcinogenb sefore they have a chance to cause cancera, and others may stop cancer cells from multiplying or spreading. Scientists are studying many substances in plants in an effort to learn specifically what substances or combinations of substances a reprotective a gainstc ancer.

Healthy Changes

One-Day Sample Menu

3.Eat craciferuos vegteable : Broccoli,

cauliflower,

brusselss prouts,

cabbaget,

turnip greens

and other members of the mustard family help prevent certainc cancers from developing. Phytochemicals unique to crucifera (cabbaget, turnip, and mustard family) stimulate liver enzymes responsible for inactivating toxic chemicals.

4. Include foods rich in vitamins C and E, folic acid, and beta-caroteinney in your diet each day:

Citrus fruits,

tomatoes green peppers,

Baked potatoes,

broccoli, and strawberries

are high in vitamin C.

Dark-green and deep-yellow fresh vegetables and fruits sucha scarrots corn, spinach winter squash peaches

and apricots contain up to 500 or more natural carotenoids.Wrile much research as focused on beta-carotene, many other carotenoids are stronger antioxidants, and it may be that a combination of these and other phytochemicals makes them cancer-protective. Green and leafy vegetables whole grains,

egg yolks,

nuts,and wheat germ contain folic acid and vitamin E. Folic acid is a B vitamin that guards againts cell mutations and chromosome a bnormalities that may be involved in the initiation of cancer. Folic acid works synergistically with other antioxidant vitamins and phytochemicals to neutralize free radicals, potentially dangerous substances that produce precancerouse cellular damage. These foods also help strengthen the body's immune system.

5. Consume charcoal-grilled salted and nitrite-cured, smoked and pickled foods in moderation: Charring and cooking meats at high temperatures from long periods produces carcinogens. The preservative nitrate in processed meats such a hot dogs, luncheon meats,bacon,beefs ticks,and beef jerlqy forms cancer-causinsg substance when broken down by the body.

hot dogs

6. Consumе tree to four seraings of low-fat dairy products and other calcium-rich foods daily: Calcium binds with bile acids and prevents abnormal cell growth in the digestive tract, reducing the risk of colorectal cancer. Also, processed cheese contains a cancer inhibitor, a form of linoleic acid, which may be incorporated in to body cells of people who consume it, locking in a defense a gainst cancer.

7. Include sol foods in your diet.If you are not eating soy foods now, it's a good time to start. Soy not

only has heart-healthy benefits,it may protect against breast and prostate cancer. Breast and prostate cancer rates are far lower in some Asian countries where soy foods are consumed daily.While American and Asian diets differ in many ways,when scientists compared 1 ,200 Japanese women who had breast cancer with 23,000 who did not, the cancer-free women ate much more soy foods than did those with cancer. A study in Singapore found that premenopausa women who consumed the most soy had over 50 percent less risk of breast cancer than did those who ate the least.Researches state that soy appears to work by increasing the production of enzymes that detoxify free radicals .Researchears also believe that phytochemicalsin soy called phytoestrogen may estrogenre ceptors and prevent the growth and proliferation of certain cancers that feed on estrogen .However,it is possible to get too much of a good thing. Breast cancer patients and those at high risk for breast cancer should not load up on soy or take or take isoflavone pills extracted from soy.

While one to two servings a day are fine, there is concern that too much soy could cause estrogen imbalances that stimulate breast cancer growth. Soybeans and products such as tofu, soy milk, and tempeh are good sources of protective phytochemicals. While many Americans are unfamiliar with soy-based foods,dubiousa bout the taste,or unfamiliar with how to prepare them, soy dishes can be tasry and soy is easy to work into your daily diet. Try soy burgerss, soy corn dogs,or soy chicken nuggets or try soy milk on breakfast cereal.Soy burgerc rumbles work well in spaghettsi auce and chili. Soy nuts make a good snack. Even one serving of soy a day decreases cancer rates.

8. Include egood fats in your diet. Omega-3 fats from flaxseed and fatty fish such as salmon, sardines, and tuna may slow tumor growth. The monounsaturated fat in canola and olive oils may also be protective.Aim for two to four servingso fish a week. Add ground flxseed to the batters for baked goods and to cereal and yogurt.

Inactivity

Physical fitness appears to have a protective effect against cancer mortality. Experts speculate that exercise enhanceso verall health and well-being and stimulates the immune system, which may then scavenge abnormal cells more effectively. Having a strong immune system is a key factor in preventing cancer because we are exposed to carcinogens every day. Researchers also speculate that exercised ecreases the production of some reproductive hormones in both men and women, decreasing the risk of cancers that depend on these hormones to develop, such as breast and prostate cancers. Many studies have found an association between physical activity and a reduced risk of breast cancer. In one study, women who exercised at least four times a week had a 37 percent lower risk of breastc ancert han did their sedentary peers. A study of Harvard alumni found that men who bumed at least 1,000 calories a week in physical activity had half the risk for colon cancer of inactive men. (One thousand calories is the approximatee quivalent of walking 2 miles a day, 5 days a week.)

This is true for women as well. A Harvard study of women found that for every day a woman walks a half hour, her risk of colon canceris decreased by 10 percent.Other studies show that the more you exercise the more protection you get.Exercise appears to prevent colon cancer by helping to speed food through the digestive system, leaving less time for carcinogens to remain in contact with the colon.

Inactivity may be a greater risk than obesity in the cancere quation.

Studies done at the Cooper Institute in Dallas have shown that exerciseis beneficial in reducing cancer risk evenf or those who are over weight. Thousands of people were treadmill tested for cardiorespiratory fitness and then tracked for long-term health. Studies based on that data indicated that physically active individuals who are overweight have a lower risk of cancer than

SOURCE: S. N. Blair, H. W. Kohl III, R. S. Paffenbarger, Jr., D. G. Clark, K. H. Cooper, and L. W. Gibbons, "Physical Fitness and All Cause Mortality: A Prospective Study of Healthy Men and Women." Journal of the American Medical Association 262 (1989): 2395-1401.

do people who are overweight and sedentary though they still have a higher risk than do those who are thinner and fit. –Whatever your weight, good health habits can pay off.

Obesity

Body size matters in cancer risk.Obese individuals,particularly those who are obese and sedentary increase their risk of all cancers. The more overweight person is, the greater the risk. A 16-year study of more than 900,000 U.S. adults indicated that those with the highest body mass index had a death rate from all cancers more than 50 percent higher than that of normal-weight individuals.

They estimated that increased body weight was associated with up to one in five cancerd eathsin the United States. In creased risk is due to a combination of factors,including sedentaryli festyle,greater caloric intake, greater fat intake, and body fat-mediated hormonal factors.A study of nearly 6 3,000 women by the American Cancer Society indicated that the weight a woman gains after age 18 predicts lifetime risk of breast cancer.Those who gained 20 to 30 pounds had 40 percent increase in breast cancer rates, and those who gained over 70 pounds doubled their risk as compared to women who maintained their weight. Fat cells produce estrogen which makes breast cancer grow.They estimate that weight contributes to one in every two to three breast cancer deaths. Location of fat, as well as amount, affects cancer risk. People who carry extra weight in the abdomen are at higher risk for breast and prostate cancer. The good news is that those who are apple-shaped(as opposed to pear-shaped having bigger thighs and hips) can reduce their risk by losing weight.

It appearst o be fairly easy for apple-shaped people to lose weight where it counts because fat leaves the abdomen first.

Researcherse believe that weight loss reduces the amount of sex hormones and insulin-related cellular growth factors a vailable to stimulate possible precancerous cell grow thin the reproductive organs.To reach and maintain a healthy body weight, see Chapter 11 for into formation on how to balance caloric intake with physical activity.

SECONDARY RISK FACTORS FOR CANCER

While the primary factors are the strongest contributors to increased cancer risk,several other preventable factors also a effect the risk of having cancer.They include excessive alcohol consumption;exposure to some viral infections; and exposure to radiation,work place hazards and certain chemicals.

Excessive Alcohol Consumption

Avoid alcohol or limit alcohol intake to two drinks a day for men and one drink a day for women. Excessive alcohol consumption increases the risk of several cancers.

Esophageal and liver cancers occur more frequently among heavy drinkers of alcohol, especially when the drinking is accompanied by smoking cigarettes or chewing tobacco. Coupled with poor diet, alcohol increases the risk of developing colon cancer because it interferes with folic acid metabolism. Studies have also shown an increased risk of breast cancer in women who regularly consume more than three alcoholic drinks per week.

Factors that cause this effect are not yet known, but researchers speculate that the association may be due to the carcinogenic effect of alcohol,its break down products in the body, alcohol-mediatecd hanges in the levels of hormones such as estrogens. Whatever the cause, for those who drink regularly, reducing alcohol consumption is a good way to decrease the risk of cancer.

Exposure to Some Virol Infections

Some viral infections can initiate cellular damage that leads to cancer. For example, the hepatitis B virus is linked to liver cancer, human papilloma virus (HPV) is linked to cervical cancer and human immunodeficiency virus (HIV) is linked to Kaposi's sarcoma.

Risk of exposure to these infections can be reduced by behavioral changes.For example,condom used during sex

can prevent sexual exposure to hepatitis B ,HPV and HIV. This is particularly important for young adults,because the highest-risk age group for STDs is in the late teens to early 20s.

Exposure to Radiation, Workploce Hazards, ond Certain Chemicals

Avoid excessive exposure to ionizing radiation. Ionizing radiation includes X rays, radon, and UV radiation. While most medical X rayse mit low-dose radiation,it is still wise to use protective shields to cover body areas not being X rayed.

There is also a potential problem of radioactive radon gas in the home in certain areas of the country. You can buy an inexpensive radon detector to test for radon,which increases the risk for lung cancer, especially in cigarettes mokers. If you detect radon, professionals can advise you regarding s eps Preventing Cancer

Preventing Cancer

Prevention, rather than treatment, is emphasized because it is in prevention that we have the greatest control.

CANCER INCIDENCE

WHAT IS CANCER?

Age-adjusted cancer death rates.

HOW TO CUT YOUR RISK OF CANCER: PRIMARY RISK FACTORS

Primary risk factors for cancer are:

· Tobacco use

· Sun overexposure

· Diet

· Inactivity

· Obesity

Several other factors contribute to an increased risk of cancer Secondary risk factors for cancer home of which are controllable,in clude:

· Excessiv aelcohol consumption

· Exposure to home iral infections, for example, hepatitis B

· Exposure to radiation,workplace hazards and certain chemicals

Choices you make daily can greatly cut your cancer risk. It is a matter of education and habit change. What follows is a discussion of what you can do.

Tobacco Use

SOURCE: Harvard Center for Cancer Prevention. Harvard Report on Cancer Prevention. Vol. 1: Causes of Human Cancer. Cancer Causes and Control 7 (Suppl): 1996.

Sun Overexposure

How to Reduce Sun Exposure

Diet

Cancer Deaths Preventable by a Healthy Diet

By making positive choices in your daily diet and following the guidelines listed here,you can promote good health now and reduce your cancer risk in the future.

Healthy Changes

One-Day Sample Menu

3.Eat craciferuos vegteable : Broccoli,

cauliflower,

brusselss prouts,

cabbaget,

turnip greens

4. Include foods rich in vitamins C and E, folic acid, and beta-caroteinney in your diet each day:

Citrus fruits,

tomatoes green peppers,

Baked potatoes,

broccoli, and strawberries

are high in vitamin C.

Dark-green and deep-yellow fresh vegetables and fruits sucha scarrots corn, spinach winter squash peaches

egg yolks,

hot dogs

7. Include sol foods in your diet.If you are not eating soy foods now, it's a good time to start. Soy not

Inactivity

Inactivity may be a greater risk than obesity in the cancere quation.

do people who are overweight and sedentary though they still have a higher risk than do those who are thinner and fit. –Whatever your weight, good health habits can pay off.

Obesity

It appearst o be fairly easy for apple-shaped people to lose weight where it counts because fat leaves the abdomen first.

SECONDARY RISK FACTORS FOR CANCER

Excessive Alcohol Consumption

Avoid alcohol or limit alcohol intake to two drinks a day for men and one drink a day for women. Excessive alcohol consumption increases the risk of several cancers.

Exposure to Some Virol Infections

Risk of exposure to these infections can be reduced by behavioral changes.For example,condom used during sex

can prevent sexual exposure to hepatitis B ,HPV and HIV. This is particularly important for young adults,because the highest-risk age group for STDs is in the late teens to early 20s.

Exposure to Radiation, Workploce Hazards, ond Certain Chemicals

Be aware of hazards in the workplace. Exposure to asbestos and other industrial material increases the risk, especially when combined with smoking. Minimize exposure to these products by wearing protective clothing and equipment and following standard safety procedures.

Limit your exposure to pesticides and insecticides. Not all chemicals are carcinogenic but a few that are proven carcinogens include benzene PCBs, DDT vinyl chloride, arsenic, aflatoxin, chloroform, and formaldehyde.

Read and follow label instructions with house hold and garden chemicals and use natural products when possible( e.g.,soap spray to kill aphids)

EARLY DETECTION

Early detection means taking action to diagnose cancer in its eadiest, most treatables tage.This includes three parts:

· Knowing cancer's warning signals

· Practicing self-exams

· Having regular cancer-related the checkups a physican

Once metastases spread from the primary site,cancer becomes much more difficult to cure. Although not all cancers can be detected through self-exams such exams, along with awareness of cancer's seven warning signals (Table 12-5), can alert a person to the need to consult a physician.

Cancer's Seven Warning Signals (CAUTION)

See your physician for cancer-related checkups. Even f you have no symptoms,it is important for early detection of cancer to have periodic cancer-related checkups (Table 12-6). Until all cancers can be prevented, protect yourself with knowledge about cancer signs,self-exams early detection,regular checkups and prompt treatment.

For most people without symptoms, cancer-related checkups are recommended every 3 years from ages 20 to 39 and annually for those ove rage 4 0. People who are at high risk for certainc ancers may need tests more often.

Comon cancers

Wrile many types f cancers exist,some are much more common than others.The most common cancersin frequency of occurrence are:

For men in the 15-to 34-year-old age group,testicular cancer is the most common.While it is second in occurrence for both men and women, lung cancer is the leading cause of cancer deaths b cause of its low survival rate.

Although they are the most frequently occurring cancers, affectingnearly one in six Americans,skin cancers

Screening Guidelines for Early Detection of Cancer

Excludes basal and squamous cell skin cancers and in situ carcinoma except urinary bladder. Percentages may not total 100 percent due to rounding. SOURCE: 2004, American Cancer Society, Inc., Surveillance Research.

are not usually included in cancer statistics because almost all nonmelanoma skin cancers are easily cured if detectede arly. Even so,there are over 9 ,800 skin cancer deaths yea1ry. S eeFigure 12-5 for leading sites of new cancer cases and deaths.Common cancers w ll be discussed in alphabetical order.

Breast Cancer

Breaste cancer is the most common cancer in women,but it is more curable than lung cancer and so it ranks as the second leading cancer killer.It is estimated that the lifetime risk of breast cancer is one in nine. Getting older is the most important risk factor for breast cancer. However, breast cancer can occur at any age. Although rare, about2 percent of bfeast cancers are in men. Other risk factors for breast cancer include:

· Having had breast cancer before.

· Having a sister or mother who had breast cancer, especially if she had it before menopause.

· Increased breast density.

· A long menstrual history (starting menstruation before age 12 and/or experiencing menopause after age 50). This exposes the body to high estrogen levels longer.

· Obesity, especially after menopause (fat cells produce estrogen).

· Never having a child or having the first child after age 30.

· Consumption of one or more alcoholic drinks a day

Inherited susceptibility accounts f r only 5 percent of breast cancers but if a woman has a strong family history there is a screening test for the genes that increase the risk. Preventive behaviors include regular exercise, maintaining a healthy weight, eating a healthy diet, and little or no use of alcohol.

The earliest sign of breast cancer is usually an abnormality found on a mammogram. Once the cancer has grown, signs include a breast lump, thickening, swelling, dimpling,tenderness and nipple pain, discharge and retraction.

Breast pain is generally due to other conditions and is not usually an early sign of cancer.

Mammograms are the most important tool for detecting breast cance and a woman should have one annually from the age of 40.The breast self-exam which previously had been recommended once a month, is still useful for those at high risk-a personal history of cancer or a closer elative with breast cancer. However,a self-exam typically detects larger cancers that have been growing for 5 years where as a mammogram can detect cancers that have grown for only 2 years and are still too small to be felt. A mammogram can detect 80 to 85 percent of cancers and geatly increases survival rates.Treatment involves some combination of surgery radiation, and chemotherapy. A breast self-exam can detect cancer in its early, curable stage and should be practiced monthly.

Colon ond Rectal Cancer

In populations where fruits and vegetablesa re consumed in abundance and animal foods are scarce

Breast self-exam (BSE). SOURCE: Reproduced with

permission from the Oncology Group, New York, New York.

colon cancer is a rare disease. In the United States, however, it is the third leading cancer killer. A genetic tendency to develop noncancerous polyps in the colon, combined with a diet high in animal fat and low in fruits and vegetables may cause half, perhapsall, colon cancers. Chronic exposure to carcinogens in high-fat and highly refined and processed foods can eventually stimulate precancerous changes in cells.

This does not mean that you are doomed by poor childhood eating habits, but many studies consistently indicate that eating a diet rich in fruits, vegetables, whole grains, and beans can protect you against many forms of cancer. High levels of physical activity also are associated with a lower risk of colon cancer-by increasing intestinal motility and limiting exposure of colon cells to potentially carcinogenic compounds.

Risk factors for colon cancer include:

• Age. Over 90 percent of cases occur after age 50.

• Having a personal or family history of colon cancer, colon polyps, or inflammatory bowel disease.

• Smoking.

• Alcohol consumption.

• Obesity.

• A high-fat, low-fiber diet and low consumption of plant foods.

• Sedentary lifestyle.

Preventive behaviors include not smoking, maintaining a healthy weight, eating five to eight servings or more of fruits and vegetableds aily, consuming little or no alcohol, and exercising 3 0 minutes or more most days of the week. In addition, researchin dicates that low-dose aspirin may have an anti-inflammatory effect.

Early-stage colon cancer usually has no symptoms. Late-staged is disease may cause blood in the stool, a change in bowel habits, and lower abdominal cramping. There are severat lests that can detect colon and rectal cancer at an early,treatable stage inluding a fecal occult blood test and digital rectal exam( see Table12-6) Screenings hould begin at age 4 0 or earlier if there is a strong personal or family history of polyps or colon cancer.Some cancers can be treated by early detection and removal of polyps. teatment usually involves surgery if the disease is localized, with Chemotherapy and radiation addedi f it may haves pread.

Lung Cancer

Lung cancer is a rare diseas except amongs mokers. Exposure to sidestream cigarettes moke ncreases the risk for nonsmokers. Lung tissue damage and cellular changes that precede lung cancer have been observed in 93 percent of active smokers but in only 6 percent of exsmokers and 1 percent of nonsmokers. If a smoker quits, these early precancerou cellular changes are r err.reversible, and the damaged bronchial lining often retums to normal.

If the smoker continues, the abnormal cell growth may progress to cancer.

Between 1950 and 1990, lung cancer deaths increasedin women by over 400 percent and surpassed breast cancer deaths by 50 percent. Lung cancir, the leading cancer killer for both men and women,has a low survival rate because it is seldom discovered in its earliest stages. Symptoms include chronic cough, blood streaked sputum, chest pain, and persistent lung infections.By the time it has grown large enough to produce noticeable symptoms or to be visible on X ray,it is already well advanced. It metastasizes readily through the blood stream to the brain and other organs and is difficult to treat. Surgery is usually the first-trearmenr option, followed by chemotherapy and radiation. The 5year rate for lung cancer survival is 15 percent and has not changed despite advanceis in cancer treatment in 40 years. The best way to prevent lung cancer is not to smoke and to avoid environmental tobacco smoke.

Prostate Cancer

This is the most common cancer( excluding skin cancer) and the secondle ading cause of cancer deathsin men.It affects about one in six men over a lifetime. The prostate gland produces seminal fluid. It wraps around the urethra, the tube that transports urine from the bladder to outside the body. When it swells from infection or disease it blocks urinary flow.

Factors that increase risk of prostate cancer in clude:

• Age over 50 (risk increases with age)

• High-fat diet

• African American (incidence is far higher than for white men)

• Family history of prostate cancer

Preventive behaviors include consuming a low-fat, high-plant food diet and exercising 3 0 minutes or more most days of the week. Symptoms include difficulty

Starting or stopping urination;weak urine flow; blood in the urine; painful urination; need to urinate frequently, particularly at night; and pain in the lower back, pelvis, or thighs.These signs are very general and can be caused by many other conditions. The methods for detecting prostate cancer are the prostate-specific-antigen test (PSA) and the digital rectal exam. These should be done annually starting at age 50 or earlier.

Skin Cancer

Skin cancer accounts for 40 percent of cancers. Sun overexposured uring childhood and the teen years accounts for over three-fourths of your lifetime exposure to the sun's ultraviolet radiation. Vell-browned skin is a sign of injury to the skin, not a sign of health. While anyone can get skin cancer,people are most susceptible if they work out in the sun, live in sunny climates, or have blond or red hair, light-colored eyes, or fair skin that doesn't tan easily (Table 12-7).

What Is Your Skin Type?

There are three types of skin cancer that may be caused by UV radiation: basal cell, squamous cell, and malignantm elanoma. Basal cell cancers th e most common, are raised pearly nodules that involve the outer layers of skin. Squamous cell cancer are either wartlike growths that ulcerate in the center or pinkish, raised, opaquen odules.These cancers are rarely fatal, do not tend to metastasize and canb e removed by a physician.See Figure 12-7 for typical examples.

Malignant melanoma, which usually starts as a darkw art or mole, is the most rapidly increasingty pe of skin cancer in the United States. It has a deadly tendency to metastasize and accounts for over 75percent of skin cancer deaths.The problem is particularly severe for men and whites. Men die of melanoma at twice the rate of women. People with naturally dark skin, type VI, have a built-in measure of protection. About 98 percent of malignant melanoma occurs in whites, though African Americans tend to be diagnosed at a laters tage.Malignant melanoma diagnosed at an early stage can be treated but when it penetrates even one-tenth of an inch into the skin, the survival rate decreasebsy 50 percent.

Contributingt o increasing rates of skin cancer is the fact that in the upper at mosphere the thinning ozone layer allows more of the sun's damaging ultraviolet radiation to reach the skin. As a result, skin cancer rates are increasing by about 4 percent per yeat faster than those for any other cancer. A.pproximately 90 percent of skin cancers can be prevented by protecting the skin rom the sun's rays.

While young people often think of themselves as immune to skin cancern, early one-third of melanomas occur in people under age 45. The most common sites are the upper b ack and the back of the legs,but it can occur anywhere from the scalp to the soles of the feet. You don't have to be a dermatologis to recognize a potential melanoma.Know what skin cancer looks like and examine your skin at least once a year using the skin self,exam in Figure l2-B.Learn where your moles are and what they look like, and then you will notice if there are any changes.If you find unusual moles or skins pots,the American Melanoma Society suggests using the ABCDE test for early detection of malignant melanoma (Figure12-9).Besides moles,watch for sores that do not heal;unusual bumps;and chronically scaly, red,or pinkish patches of skin. If detecte dearln skin cancer has an 85 to 99 percent cure rate.Surgery is the usualt reatment for basal and squamous cell cancers,and radiation is used occasionally.Malignant melanoma requiresn ot only surgery for the tumor but often removalo fadjacent lymph nodes.Table72-8s ummarizes the risk factors for skin cancer.

Basal and squamous cell cancers.

2. ABCDE test for malignant melanoma.

Risk Factors for Skin Cance

Testicular Cancer

Most people think that cancer is a disease old people get.Cancer of the testicle is different. It is not one of the most common types of cancer in this country but it is the most common cancer in young men between the ages of 15 and 34. Warning signs include a swelling or hard lump in the testicle, a dull ache in the lower abdomen and groin, a sensation of heaviness and pain in the testes.Your risk of getting testicular cancer is 40 times higher if you have a testicle that never descended into the scrotum or descended after age 6.

Testicular self-exam (TSE). SOURCE: Reproduced with permission from the Oncology Group, New York, New York

Lives could be saved if more testicularc ancers were detected and treatede arly.The S-yeasr urvival rate oftesticular cancer is 91 percent. Treatment does not mean losing your "manhood" or your ability to have normal sex, and it doesn't mean you can't have children.

Men discover most testicular cancers by leaming how to examinet heir testicles.In doing this once a month, you can greatly increase the chances of finding a testicular cancere arly if it does occur.,All young men should learn and practice the monthly testicular self examination, which is detailed in Figure 12-10,from adolescence. The technique is simple.

Uterine and Cervical Cancer

With the widespread use of Paps mears for early detection, the death rate from uterine cancer has declined.

Cervical cancer, often seen in young women, has been linked to the human papillomavirus (HPV), which can be spread through sexual contact. fusk factors for cervical canceri nclude:

• Becoming sexually active at an early age

• Having had several different sex partners

• Genital infections such as herpes and HIV

• Smoking (it weakens the immune system)

A Pap test, in which cells from the cervix and uterine lining are examined under a microscope is a simple procedure that can be done at intervals by physicians as a part of each pelvic examination.There are usually no symptoms with early-stagec cervical cancer.When the cells invade nearby tissue, symptoms include abnormal bleeding, bleeding between periods or after sex, and increased vaginal discharge. Bleeding after menopause may also indicate cervicac lancer. If cervicac lanceris detected at an early stage it can easily be removed.Use of the Pap test, along with timely treatment, can prevent nearly all deaths from cervical cancer.Use of condoms can prevents exuailn fections that initiate the disease.

Uterine cancer affects the lining of the uterus and is most common in women over age 50. The risk factors are similar to those for breast cancer, including obesity and increased lifetime estrogen exposure. Symptoms include abnormal uterine bleeding and spotting,especially after menopause. Uterine cancer is usually treated with surgery radiation, chemotherapy, and/or hormones.

COPING WITH CANCER

What can you do when someone you care about is diagnosed with cancer?Many of us will face this at some time in our lives because cancer affects one in three people.

You may have mixed emotions: anger and griefihat this could happen to someone close to you, fear of the future, or compassion and sympathy for what that person is facing.You might feel uncomfortable around that person, not knowing what to say or do, and tend to avoid him or her or avoid discussing the illness.What can you do? Plenty. First, you should realizethat cancers overallh avea 50 percentc urer ate.Second,loving support from friends and family members in creases the quality of life and survival rate to such an extent that it is a powerful adjunct to medical treatment. A study at Stanford University found that women with advanced breast cancer who participated in week lysupport groups doubled their predicted life expectancy and lived an average of 18 months longer than did those who were not in support groups.Here ares everatl hingsy ou can do to help a friend or loved one deal with cancer

1. Share your thoughts and feelings and encourage your friend to do so. Allow your friend to express hopes,fears,and sadness; acceptt hose feelings without trying to changet hem. Showingy our loveand concern and discussing mutual fears can bring you closer and provide great comfort. There is no right way to feel about cancer, no right way to react. Being honest and open strengthens relationships.

2. Offer to accompanyy our friend on a visit to the doctor or hospital. You can provide transportation to and from treatments take notes while the doctor gives instructions,and provides upport.

3. Instead of saying "Call me if you need anything," offer specific help: cook a meal,do the dishes do laundry walk the dog, take the kids to the park, pick up medicine from the pharmacy.

4. Encourage your friend to join you in some enjoy able activities:go to a movie or rent some comedy videos,go for a walk together,go on a picnic, or have a potluck dinner with friends.

5. Contact a cancer survivor who can talk to your friend, answer questions and sharethe insights of someone who has walked down the same road.

6. Help your friend contact a cancer support group. Whi1e you can't know what your friend is going through, other cancer patients do and can provide the kind of open discussion and empathy that reduces distress and strengthens copings kills.

Providet ransportation to meetings. Some resource that may help you locates upport groups: the American Cancer Society (800-227-2345) and the National Cancer Institute's Cancer Information Service( 800-422-6237)Also check with your friend's physician,church,or hospital or on the Internet.

What if you are diagnosed with cancer? How can you cope? Here are some suggestions:

1. Take an active role: learn everything you can about the cancer and its treatments.

2. Ask lots of questions so that you understand what is happening to you and what your options are.

Think about what you can do to enhance your recovery and discussit with your doctor.

3. Take care of yourself. Exercise,eat healthfully get enoughs leep,manage stress.Your immune system needse very advantage you can give it. If you don't feel like going for a walk, try stretching or doing yoga. Ask your doctor how long you need to wait after a chemotherapy treatment to exercise.

4. Build a support system. Many studies point to the positive effect of a good support system on health and the immune system. Some friends w on't feel comfortable knowing that you have cancer because of their fear of the disease or the fear that you will die. They may not know what to say or do, and as a resulty ou could becomes ocially is olated. Have friends nd relativesjo in you in a walk, a meal, shopping, or going to a movie. Ask friends for help with researcht,ransportation to medical appointments cooking meals,home maintenance, and soon. Learn to accept help graciously.

5. Talk abouty our feelings. Sharing your concems openly and honestly with a friend or family member may bring you closer and help you cope better.

5. Find a cancer support group. Talk to a cancer survivor. We don't know why, but there is something about sharing experiencets hat helps people in support groups live longer than do those who go it alone.

7. Main tain your sense of humor. Do somethingt hat makes you laugh every day.Watch a funny video, have a good laugh with a friend. A sense of humor helps you cope with cancer and treatments. Cultivate positive feelings to mobilize your body's healinge nergies and make yourself feel better.

Exploring Lifetime Wellness Issues

We are present wellness as a lifestyle where positive choices result in optimal functioning and enhanced living. You have gained knowledge that will help you make informed decisions and have learned skills needed for making behavioral change. You are now "wellness educated." With knowledge comes responsibility, and so you no longer have the luxury of saying, "I didn't know!" You know which choices contribute to wellness and which ones do not. You can choose to eat right, exercise, and manage stress or choose not to. You know the possible consequences of such choices. The challenge of wellness is ongoing, whereas college coursework eventually comes to an end. A new career, different living environments, and family responsibilities will bring many changes to your life. During these changes, the wellness lifestyle can prevail. We hope it will grow for you. Wellness is a process, not a solution. It is a journey, not a destination. And remember that wellness involves a balance among and integration of all seven dimensions of wellness. This final chapter focuses on some important issues for you to consider as you plan for the future.

PARTNERS IN PREVENTION

The Healthy People 2010 document sets high goals for the health and well-being of the American people. It emphasizes personal responsibility and self-empowerment as the means for increasing the quality and quantity of life. Some people need to know the facts to make informed decisions. Others need positive influences to motivate them to make appropriate choices. For the wellness lifestyle to permeate our culture, support systems within communities must be available. While emphasizing personal responsibility, we cannot overlook the importance of the collective burden of responsibility of governmental policies, a wellness curriculum in the schools, corporate action, and the American family. Although personal behaviors contribute to the leading causes of death, behaviors occur in and are influenced by the environment. Advertisements, television programs, and popular songs that glamorize drinking, violence, sex, and immoral behavior undermine our nation's health and well-being. For example, cigarette ads show likable young people in upscale settings enjoying smoking. The subliminal message is that cigarettes must not be so bad if such bright, attractive people are not afraid to smoke. In these ads, though, there are never dirty ashtrays, nicotine-stained teeth, or anyone coughing or getting chemotherapy. There is no dangerously underweight baby lying in intensive care. There is no one dying. An important part of wellness education is deciphering these messages and knowing what promotes well-being. Individuals, families, communities, corporations, and the government share the task of enhancing the well-being of Americans. You are wellness educated, and so part of this challenge of culture change rests with you. How will you affect this change? Are you read to become a leader and an example of wellness to those around you?

CAREER WELLNESS

Your job will be a prominent facet of your adult life. You will spend at least 50 percent of your waking hours at work if you maintain a full-time job or career. Cellular/digital phones, computers, e-mail, and fax machines have altered the complexion of American work. Twenty-four-hour manufacturing and retail shopping, the Internet, home-based businesses, voice mail, and telemarketing have revolutionized the business place. Even with

enhanced technology and conveniences, the working hours of most Americans are longer than they were 50 years ago. These realities make the workplace a likely place to receive information and support regarding personal health improvement and wellness living. Leaders in business and industry are beginning to see employee wellness as an asset to be maintained and enhanced. When employees are happy and healthy, productivity increases. The promotion of wellness programs in business and industry is based on four related premises:

1. Prevention is preferable to curing.

2. Teaching people to stay healthy is generally less expensive than treating them when they are ill.

3. Healthful lifestyles offer a better quality of life, higher morale, increased productivity, and possibly increased longevity.

4. Health promotion programs promote a favorable corporate image and help attract healthy, capable employees who see these programs as a valuable employee benefit.

Rising medical insurance costs, employee absenteeism, and sick leaves cut deeply into profits and lead to increases in the cost of doing business. On average, U.S. Fortune 500 corporations spend 61.2 percent of aftertax profits on medical care for employees, dependents, and retirees. As a result, corporate officials are experimenting with ways of incorporating wellness into the workplace. This exciting avenue for health promotion can bring about changes in behavior for an improved lifestyle and enhance personal relationships. Wellness in the workplace can be promoted in a variety of ways. Programs can involve:

Diagnosis (assessment of current health and habits). Examples: blood pressure screenings, cholesterol and glucose testing.

Education (give information about health enhancement). Examples: brochures on stress management, newsletters with back care information or healthy recipes.

Behavior Modification (give on-site help and support in making a specific behavior change). Examples: healthy food choices in the cafeteria, employee workout center, smoking cessation classes. Regardless of how they are organized, most corporate health promotion programs aim to facilitate behavior change. Employers realize that the work and nonwork parts of our lives are interactive. That is, job satisfaction is also dependent on family happiness, leisure pursuits, and feelings of worth. Knowing this, employers are actively pursuing a multidimensional approach to supporting employee wellness. Examples are flexible work hours, child care, on-the-job retraining, sports team participation, job sharing, smoke-free work sites, parental leaves, family hikes and picnics, and children's fitness classes. Several forward-thinking companies are responding to the needs of employees with elderly parents by providing elder care as well as providing substance abuse and marital counseling. Spouses and children of employees account for 40 to 60 percent of a company's health-care expenditures, and so such multidimensional programs can be cost-effective.

Due to the growing interest in and emphasis on wellness in business and industry, many employers prefer hiring personnel who have already adopted a wellness lifestyle. This should be added incentive for you to continue healthy living. As a potential employee, your confirmed dedication to wellness may also influence your final selection of a job and your chances of getting hired. You may favor a company that is highly supportive of wellness and provides wellness programs for employees, and that company may favor you. Remember how important a supportive environment is in the maintenance of positive lifestyle choices. Many college students, pressured by school demands, feel they will have more time to exercise and eat right once they graduate. Your life will most likely be as busy, if not more so, once you begin your career. Time restraints and demands will always be with you. Making wellness living an important part of your current lifestyle will help you maintain it after graduation, as a habit.

FAMILY WELLNESS

In all cultures, the family unit is the primary transmitter of values and attitudes in the society. Each partner in a relationship comes with values, norms, and expectations derived from his or her family. Couples continue to grow, interact, and develop a value framework. If and when children come along, the parental role of maintaining the culture from generation to generation is created. The interacting dynamics of a family unit promote the spiritual, physical, psychological, and social growth of each member.

The family units in today's society are not identical. Single parents, divorce, combined families, and joint custody are realities that have changed the American family structure. Dual careers have altered the role of women within the family. Such changes affect the balance between work life and family life, often creating role conflicts, stress, and changing values. Regardless of the makeup of the family unit, nurturance remains essential for all members to strive toward full potential.

The Well Relationship

Many romantic fairy tales conclude with "and they lived happily ever after." Whereas these words end the story, marriage is most often the beginning of the story

of a relationship in real life. Whom you marry or choose to spend your life with is possibly the most important decision you will make in your life. Much of your happiness and life satisfaction will be based on the success of this relationship. Like the wellness lifestyle, a relationship demands conscious effort, commitment, and sacrifice. It is a partnership that involves change and growth. Many factors influence the success of a marriage relationship. Look at the top 10 list of key elements that help build a strong and lasting relationship. As in wellness growth, partner growth is a process. It doesn't happen all at once. Enjoy each step along the path.

The Well Child

It will be your challenge as a parent to initiate wellness living in your child. All dimensions (emotional, social, physical, intellectual, spiritual, environmental, and occupational) demand your attention. If you favor behaviors that promote wellness, your children will follow your example. Family wellness patterns can set the stage

for a lifelong pattern of self-responsibility. Self-responsibility relies on learning and practicing skills; therefore, you can be the master teacher of wellness and help your child grow as a decision maker. Children do not learn just in school. They learn by watching you, too. If you exercise, eat nutritiously, read instead of watch television, handle stress, communicate your feelings, and display attitudes of cooperation and respect, your child will too. Studies show that the strongest predictors of lifetime exercise activity in children are enjoyment of physical activity, family support of physical activity, and direct parental modeling of physical activity. Nearly half of youths age 10 to 18 do not engage in enough physical activity to derive any aerobic or endurance benefit. Forty percent of children age 5 to 8 have at least one major heart disease risk factor. Obesity in children and teens is rising rapidly, and because of budget problems, many schools are eliminating physical education. Children with unhealthy habits have a greater likelihood of growing up to be unhealthy adults, and so part of every parent's responsibility should be to create an environment for children that is conducive to optimum health and wellness. This includes being a positive role model. Aristotle expressed it best when he wrote, "Good habits formed at youth make all the difference."

The self-concept of most children is formed by the time they start kindergarten; therefore, you as parents will be prime molders of that self-concept. Positive selfesteem is an important foundation as a child moves into larger social spheres beyond the family. A child with a high degree of self-worth is able to confront life's situations with confidence and optimism. Optimism and selfconfidence are the building blocks for wellness living. Although it is popularly believed that risk-taking behavior among teenagers and preteens is most strongly influenced by peer pressure, research by adolescent medicine specialists has shown that family closeness plays a key role. Young people who have a balance of strong attachment to family and parental encouragement to be independent are least likely to take part in high-risk activities (alcohol and drug use, sexual activities, cigarette experimentation) that could seriously affect their well-being. Although the broad concept of wellness is difficult for young children to understand, they can become aware and learn the value of specific wellness choices. Their capacity to understand the cause and effect of certain choices depends on their age and maturity level. Can children learn to fasten their seat belts habitually? Select fruits for snacks? Show respect for others? Appreciate nature? Enjoy vigorous exercise? Of course, they can. Look at Table 15-1 for examples of wellness behaviors that parents are instrumental in developing in their children.

PERSONAL SAFETY ISSUES

Throughout this book we have tried to increase your awareness of risks and personal choices that affect your wellness. Injuries and illnesses stemming from accidents and environmental hazards sometimes seem to be beyond the average person's control.

Wellness Behaviors That Can Be Developed by a Young Child

Especially accidents which are the fifth overall cause of death in the United States (and the number one cause of death among 15- to 44-year-olds)-often appear to be a matter of chance. You can substantially reduce the risks you are exposed to while driving, traveling, getting around campus, and working around your apartment or house by heeding basic safety precautions. Some of these precautions seem like common sense, yet for whatever reason, many people fail to follow even commonsense precautions. Federal, state, and local regulations have been established to help protect us from a variety of traffic, fire, water, and air travel tragedies. But laws and regulations cannot make people act. When you strive for high-level wellness, you must take seriously all lifestyle choices. The wellness concept is centered on an ongoing personal commitment to positive choices, and so safety awareness and responsibility cannot be excluded. We tend to focus solely on the impact an accident has on the physical dimension of wellness. The truth is, such a trauma can equally affect the emotional, social, occupational, and even spiritual dimensions. The following personal safety issues will focus on choices that can help you control risks in your immediate environment.

Automobile Seat Belts

Motor vehicle crashes are the leading cause of death for every age from 4 through 33. In talking about motor vehicle collisions, we deliberately chose not to use the word accident, which would imply a luck/fate approach to the topic. Instead, we use crash because it is well understood what specific actions you can take to reduce risks. Drunk-driving laws, child car-restraint regulations, seat belt laws, availability of air bags, and designated driver programs have done much to curtail traffic fatalities. Still, according to the National Highway Traffic Safety Administration, nearly 43,000 Americans died in 2002 in car crashes, the highest number since 1990. Of these casualties, 59 percent were not wearing seat belts. Even though 49 states and the District of Columbia have safety belt use laws in effect, only about 73 percent of Americans buckle up. The importance of using seat belts cannot be overstated. Even if you practice all the other advice in this book (exercise regularly, eat a nutritious diet, don't smoke, etc.), one crash without a seat belt could immediately and irrevocably end your wellness program. It does not make sense, if we care about health and wellness, not to buckle up. Table 15-2 lists the most common excuses people give for choosing not to use their seat belts. We hope you do not use the same flimsy excuses.

To prevent injury, seat belts not only must be worn but must be worn properly every time. You are most likely to survive an automobile crash without injury if you follow these recommendations:

1. Wear the seat belt low across the pelvis, not the abdomen. In a crash, a force of 20 to 50 times your body weight is exerted against the belt. The bony pelvis can withstand this load, whereas internal organs would be injured if the belt were higher, across the abdomen.

2. Keep the belt snug. A loose belt offers little protection and may compound injuries if you are thrown against it. You can also slide forward under a loose belt and suffer head or neck injuries from the shoulder strap

Why I Don't Buckle Up

3. Never wear the shoulder strap under your arm or behind your back. When properly worn, this strap rests on the middle of the collarbone and the upper chest.

4. Never share a belt. In a crash, a parent sharing a belt with a child can crush the child. Each passenger must have his or her own belt. Also, it is impossible to hold a child in your arms in a collision. In a crash, a 20-pound baby is propelled forward with the force of 400 pounds.

5. If you are pregnant, wear the seat belt under the abdomen—across the upper thighs and as low on the hips as possible. The shoulder strap should go across your shoulder and chest. The fetus is at much greater risk when the mother does not wear a

seat belt. The leading cause of fetal death in a crash is death of the mother.

Most newer automobile models include two front seat inflatable air bags as standard equipment, and many have optional side air bags. These bags will be valuable in preventing thousands of deaths and injuries. Your seat belt, however, is still your first line of defense in all crashes. Air bags inflate with great speed and force. Therefore, infants and young children should ride in the back seat of a car-in proper safety seats or restraints. Children and even small, frail adults riding in the passenger side have suffered injuries as a result of air bag deployment. Remember, an air bag can never substitute for a seat belt or for defensive driving.

Driving Safety

Driving is on average approximately 10 times more dangerous than traveling by airplane or train. However, if you are a low-risk driver, you are far less likely to die in a car crash than a high-risk driver is. Statistics define a lowrisk driver to be a 40-year-old who is sober when driving and who wears a seat belt; a high-risk driver is an 18-yearold intoxicated male traveling in a lightweight car without wearing a seat belt. The best driver is also a defensive driver-one who can anticipate potential danger and respond appropriately. Attitude is a key ingredient in defensive driving. Speeding, following too closely, and improper lane changing are the most common traffic infractions leading to crashes. Speeding is the most prevalent factor contributing to car crashes. Thirty percent of all fatal crashes are caused by speeding. Driver inattention has also become a major contributor to crashes. Drivers focusing on newspapers, makeup, snacks, cellular phones, and CD players cause an estimated 50 percent of crashes (see Figure 15-1). Cars have become mobile offices and living rooms, causing driver inattention to be the fourth most serious detriment to safe driving, behind drunken driving, aggressive driving, and speeding. A driving risk causing new concern is driving while drowsy (DWD). DWD has been an underrated risk factor in crashes. DWD accounts for as many as 100,000 car crashes, 1,500 deaths, and 71,000 injuries annually in the United States. Surveys show that 37 percent of drivers have admitted to nodding off while driving. For a variety of reasons, more Americans (even teenagers) are juggling jobs (sometimes more than one), school, and family responsibilities. Loss of sleep and driving at odd

Driver distraction is responsible for an estimated 5,000 crashes every day. Look at the most common behaviors that draw attention away from the driving task. (Percentages are the numbers of drivers who engage in such distractions.) SOURCE: AAA Foundation for Traffic Safety, August 2003.

hours have become commonplace. Today's economy and high-tech boom have increased the number of people who work at night. Data indicates that one in five workers reports to work at night. A "24/7 world" demands an around-the-clock workforce. As a result, many Americans do not get enough sleep. Sleep deprivation affects many aspects of personal well-being, including driving safety. Getting 6 to 8 hours less sleep than usual over a week not only impairs mental efficiency and reaction time but also weakens the immune system and causes depression, anxiety, and irritability. Combining drowsiness with the comforts in modern vehicles (cruise control, cell phones, CD players, contoured reclining seats), it is easy to lose sight of the fact that driving a powerful automobile carries tremendous responsibility and demands constant attention. Finally, keeping your automobile in good running order with routine maintenance, as well as carrying emergency supplies (tools, flashlight, blankets, a first-aid kit, flares, "send help" signs, jumper cables), shows a preventive and preparedness mind-set.

Personal Safety Awareness

Falls, drownings, fires, tornadoes, floods, rape, lightning, thefts, chokings, bicycle accidents, assaults, vandalism— these predicaments don't just happen to other people. You may find yourself facing any of these situations at some time. Though chance is one factor, you do have some control over your fate. You have the capacity to handle a variety of emergencies, possibly minimizing any ill effects. Advanced planning and preparation is the key. Look carefully at the top 10 ways to avoid personal injury and think seriously about each item as it relates to you. Do you adhere to these common-sense safety precautions?

Crime Prevention

As much as we hate to admit it, crime and violence are a real part of contemporary U.S. life. Whether you are at school, traveling, at work, or going about daily living routines, you can become a victim. Even in the idyllic setting of a college campus, assaults, sexual attacks, and thefts occur. You can help protect yourself from being a victim by taking some basic precautions. A constant awareness of your environment is the best weapon for guarding your personal safety. Always be alert to your surroundings whether in your car, on the street, or at home. There is nothing extraordinary about the following personal safety tips. They are simple examples of assuming self-responsibility for your wellness.

1. Always lock your house, apartment, residence hall room, and car-even when you are there.

2. At night, park in well-lit spots and walk in brightly lit areas.

3. Never walk alone at night or in unpopulated areas. Nearly one in five rapes occurs on unfamiliar, darkened, isolated streets. Use a campus escort service if one is available. Even during daylight hours, always enlist the company of at least one other person when jogging or exercising outside.

4. Beware of suspicious persons in buildings, hallways, parking areas, elevators, stairwells, and rest rooms. Note their description and contact the police or security.

5. Don't let strangers know when you are home alone.

6. Glance into your car, checking the seats and floor, before getting in.

7. Never hitchhike or pick up hitchhikers.

8. If you are being harassed, turn and proceed toward lights and people. If someone accosts you, yell "fire" instead of "help," because more people are likely to respond.

9. Watch your alcohol consumption. Drinking puts you at risk and makes you vulnerable to assault, robbery, and rape.

10. Secure all valuables and don'tflaunt expensive possessions.

11. When you are walking alone, walk with your shoulders back and your head held high. Keep a strong and steady pace. Remain alert and be aware of your surroundings. Muggers and rapists rarely attack those who appear assured and confident. Also, walk facing traffic, even if you're on the sidewalk. This prevents an assailant in a car from sneaking up on you from the rear.

12. Don't wear headphones or other devices that would make it difficult to predict and avoid a confrontation.

13. Let a roommate or a friend know where you are going and how longyou might begone when you leave campus.

Not all accidents and injuries are preventable. Some just happen. However, many accidents and personal traumas are preventable with some basic precautions. Too often after an accident or tragic event

someone says, "I wish I would have. . . ." Always have a plan of action. Play a mental game of "what if'-where you would go and what you would do should a dangerous situation occur. Trust your instincts. Research shows that a large percentage of people who have been assaulted had a feeling something was wrong just before being attacked. Being careful may seem boring to some, but it is the wellness way.