An Ounce of Prevention

The best medicine

There are many advantages to preventive health care. It is inexpensive and painless, can help you lead a longer and more productive life, and gives you control over your own well-being. No one wants to get sick or hurt and be subjected to costly and sometimes uncomfortable medical tests, examinations, and procedures. However, all too often day-to-day activities, whether you realize it or not, are setting you up for extended dealings with the medical profession.

Think of preventive health care as an opportunity to look into the future and revise it in your favor. Scientists in the field of preventive medicine are making that a possibility by constructing profiles of your health risks. By knowing the risk factors you face, you can make changes and choices in your lifestyle early enough to minimize problems and have a healthier future.

Youth is often a time of invulnerability, dominated by a feeling of omnipotence. Sometimes it seems that none of the terrible things in the world could possibly happen to you. Some people in the medical profession have named this magical thinking. Magical thinking is, perhaps, what makes dreams possible. But magical thinking can set you up for a rude awakening if you crash into the reality of a cold and uncaring world.

The basis of preventive health care is knowledge-understanding how the way you eat, play, and work can help or harm you-so that you can make beneficial decisions. You can prevent many accidents and diseases by making rather minor lifestyle choices. With information and effort, you can change bad habits into good ones, as long as you know which are which.

Controlling alcohol and other drug abuse is instrumental in reducing your risk of developing serious health problems. In particular, driving under the influence or riding in a car that is being driven by someone who is under the influence is a high-risk proposition. Unsafe sex is another activity that can soon turn a rosy future into one filled with remorse, pain, and even death.

Even simple changes can make a difference. For example, if you usually drive around the campus or shopping mall parking lot looking for a spot close to the entrance so that you don't have to walk far, make a point of parking a block or two away instead. That will give you the opportunity for a brisk walk and some beneficial exercise. Instead of a hot fudge sundae for dessert, substitute one or two pieces of your favorite fruit to cut down on calories and cholesterol. Healthy habits can only help you perform better in your academic, sports, work, and recreational activities-and enjoy them more.

What is the greatest health and safety risk for a young person?

The greatest risk for people between the ages of 15 and 24 is serious injury or death from an accident; 50 to 80 percent of deaths in this age group are caused by accidents, over 70 percent of which are auto accidents. The number two and number three killers are homicide and suicide; cancer is fourth. With the emergence of AIDS in the 1980s, these statistics are about to change. The Centers for Disease Control (CDC) is predicting that by 1991 this deadly sexually transmitted disease will be the number one killer in this age group.

Although "accidental" implies unpredictable or unpreventable, research has shown that many accidents that cripple and kill are predictable and preventable. These accident figures report fatalities. They do not tell us of the serious injuries and permanent damage that result from accidents. Nor do they reflect the cause of the accidents, or how many people killed were passengers and how many were drivers, or how many times alcohol or other drugs were involved.

Is there any way to prevent injury in a car accident?

Sometimes nothing you do can prevent an automobile accident because even the most cautious, skillful driver is at risk if someone else runs a red light or doesn't stop at a stop sign. There is, however, one simple tactic that can greatly reduce the chance and severity of injury in an automobile accident-wearing a seat belt. This precaution can greatly increase your chances of surviving a serious automobile accident. It has been estimated that half the people killed in automobile accidents would have survived if they had been wearing seat belts. As one highway patrolman put it, "I've never had to unbuckle a dead person." In the states where they are in effect, mandatory seat-belt laws have greatly reduced the fatality rate for automobile accidents.

Another major contribution to reducing the risks of an accident is to avoid mixing alcohol and other drugs with driving. Half of all fatal accidents involve drinking drivers. The role that drugs play is currently unknown, but given the other hazards associated with drug use, it makes sense to abstain whenever you're driving. Make it a rule never to drive under the influence of any drug, including alcohol.

In Europe, where penalties for driving while intoxicated are extremely tough, it's standard practice when a group of students go out for an evening of fun for one of them to agree to be the driver and not to drink anything alcoholic that night. This is a safe and simple solution, and if the duties are rotated fairly, it is usually not difficult to make this work. Get information from your local MADD (Mothers Against Drunk Driving) or SADD (Students Against Driving Drunk) chapters on how to apply this plan in your area. The national phone number for MADD is 1-800-443-6233. The address for SADD is P.O. Box 800, Marlboro, MA 01752; the phone number is 1-617-481-3568.

If you've had too much to drink and no one is available to drive you home, don't hesitate to leave your car parked where it is and take a cab. And never allow a drunk driver to drive you home.

Are there other ways to reduce the chances of injuries in a car accident?

Other tips on accident prevention include keeping your car well maintained and making sure your tires are well inflated and have adequate tread. If you do have to stop your car because of a flat tire or other malfunction, always pull well over to the side, as far away from traffic as possible. To avoid being hit by other drivers, have a flashlight and road flares ready in your trunk for such an emergency.

If and when you buy a car, consider getting one with an air bag, which will further protect you from injury. A larger car offers more crash protection, but it's also usually more expensive to run. Before buying a car, check the latest data on which makes and models are rated highest for overall safety.

How can motorcycle injuries be prevented?

Defensive driving is your best protection against accidents. Act as though you are invisible to cars. Do not expect them to see you. Many campus police departments offer courses in safety for motorcycle, motor scooter, and bicycle riders. Take one before you take your first drive. Motorcycle accidents are common and serious. In 1985, 4,423 motorcyclists were killed. For each death approximately 90 to 100 other riders had seriousinjuries that required hospitalization.

To prevent serious injury or death, wear a helmet. Wearing a helmet is mandatory in some states. Where that regulation applies, anyone who doesn't use a helmet is breaking the law, including the passenger riding behind the driver. When helmet laws were repealed in 26 states in 1976, there was a 44 percent increase in motorcycle fatalities in the next 3 years (National Highway Safety Administration: A Report to Congress on the Effect of Motorcycle Helmet Use Law Repeal, Department of Transportation, 1980). Fatality and injury figures do not tell the full story of the loss of loved ones, the expense of care, the cost of lost productivity, and the pain and remorse felt by the victims.

Whether or not it is a legal requirement in your state, because of the seriousness of motorcycle accidents, it makes sense to wear a helmet for even a short ride. It can save your life and minimize the danger of a head injury. Adequate protective clothing can also help protect you against road burns in case of a spill. See below for a list of safety tips for motorcyclists.

How should a motorcycle helmet be chosen?

As with many things in life, you get what you pay for. A general rule is that the more expensive a helmet, the better it is. All motorcycle helmets must have approval from the Department of Transportation. The next most important factor is fit. Don't buy a used helmet; if it has been in an accident, it may no longer provide adequate protection.

Motorcycle and Moped Safety Tips

  1. The wearing of a helmet while riding a motorcycle, motor scooter, or moped is highly recommended.
  2. Do not carry passengers unless the vehicle is designed to carry two persons.
  3. Make sure that all required safety equipment (headlights, brake lights, brakes, mirrors, etc.) is in proper working condition.
  4. Obey all traffic laws, i.e., stop signs, right of way-and avoid lane sharing.
  5. Avoid oil spills and wet roadways; these obstacles can cause the driver to lose control of the motorcycle, motor scooter, or moped.
  6. Don't let unlicensed or inexperienced drivers operate your motorcycle or motor scooter.
  7. Watch out for cars making sudden lane changes or sudden turns.
  8. It is recommended that you drive with your headlights on (better chance of being seen by drivers of cars and trucks).
  9. Wait for pedestrians to clear crosswalks; don't try to drive around them.
  10. Look to make sure the lane is clear before changing lanes.
  11. Obey all speed laws, and travel at a safe speed.
  12. Be alert to car doors that are opening.
  13. Don't carry oversized loads on a motorcycle or motor scooter.
  14. Wear appropriate clothing when riding a motorcycle or motor scooter (i.e., pants, shoes, heavy jacket, boots, etc.).
  15. Maintain a good distance between you and the cars around you.
  16. Most important of all, don't drink and drive.

Source: University of California Police Department.

Is a helmet necessary for bicycle riding?

Helmets should also be worn by anyone riding a motor scooter or a bicycle. Bicycle helmet standards have been established by the American National Standards Institute (ANSI) and the Snell Memorial Foundation in California. Check for their approval hen you purchase a helmet. The shell should be rigid and smooth, preferably made of polycarbonate or fiberglass. The liner should be at least 1/2 inch thick for shock absorption. The helmet must have a strap the wearer uses at all times.

Motorcycle and bicycle helmets are designed to absorb the energy of a crash, which causes some damage to the helmet. The damage may not be readily apparent, but a helmet that has been involved in a crash should be replaced or returned to the manufacturer for inspection before you trust it with your life again. Beware of secondhand helmets.

Do not ride your bike at dusk or after dark, when you are less visible than during the day. Even if you wear reflective clothing and have reflective lights, cars traveling at high rates of speed may not see you until it is too late.

What precautions should be taken to avoid other kinds of accidents?

After car and motorcycle, motor scooter, and bicycle accidents, the most common kinds are drownings and on-the-job accidents. Accidental drownings usually occur in summer and are most often associated with alcohol or other drugs or with swimming in unknown waters. To prevent injury, know your swimming and diving limits and know the area well. Never dive into a stream without knowing its depth; a fractured neck and paralysis could be the result. If you swim or surf in a new area, check with the locals for sandbars, rip currents, and hidden rocks. If you get caught in a current, don't fight it; rather, swim perpendicular to it and you will swim out of it.

Because drinking and using drugs impair your timing and judgment, don't mix them with water activities. If swimming is not your strong point, take a swim class to increase your skills before a summer of water-skiing or boating.

What about injuries at work?

On-the-job injuries - getting scalded by hot steam, being burned by hot grease, or straining your back by lifting something heavy - are very common. Most of these accidents are preventable with proper training. If you work, make sure that you are given sufficient training. If necessary, wear protective clothing and equipment such as goggles, masks, reinforced shoes, gloves, and hard hats.

If you lift heavy objects, learn the proper techniques for lifting, and never lift something beyond your capability. If you work around fumes or dust, make sure there is adequate ventilation, and wear an air-filter mask to limit the amount of dust you breathe. If you work around noise (at 90 decibels for 8 hours or 115 decibels for 1/2 hour), federal standards mandate that you wear earplugs and that your exposure to the noise is limited. If you have questions about the safety of your work site, check with the local branch of the Occupational Safety and Health Administration (OSHA). See Chart 11.4 for more information on safe decibel levels.

What else can be done to prevent accidents?

The following questions are designed to see how aware you are of behavior that puts you at risk and of ways to reduce your chance of having an accident. If you answer no to any of the questions, you can and should take action to reduce your risk.

  1. Do you drive within the speed limit and drive defensively?
  2. Do you avoid driving when drinking or find another way home if the driver is impaired?
  3. Do you avoid driving when you feel unusually tired or if you are taking medications such as antihistamines or pain killers, which are known to impair alertness?
  4. Is your car safe to drive? Are the tires, windshield wipers, lights, brakes, and steering in good condition?
  5. When driving, do you keep a distance of 1 yard for each mile per hour of speed between you and the car in front of you?
  6. Do you have headrests that extend above the midline of your skull?
  7. Do you make sure you and your passengers always wear seat belts?
  8. Do you carry a spare tire, a flashlight, a fire extinguisher, and flares in your car?
  9. Before swimming, do you check the water depth and inquire about local hazards?
  10. Do you always wear a helmet when riding a bike, motorcycle, or motor scooter? Do you drive as though you were invisible to other drivers?
  11. When taking up a new and potentially dangerous activity like hang gliding, do you get proper instruction?

Besides accidents, what other medical problems can be prevented?

Although no one has a crystal ball to anticipate and possibly prevent every problem, there are some common concerns that are likely to affect you or someone you know. With knowledge and minor changes in lifestyle, you can reduce your chances of encountering these problems. There are four main areas in preventive medicine that can be helpful to you.

  1. You can learn how to reduce your chances of getting AIDS or another sexually transmitted disease (STD).
  2. You can be screened for medical problems, such as high blood pressure, which may have no obvious symptoms.
  3. You can make lifestyle changes now to prevent medical problems such as heart disease, osteoporosis, and cancer later.
  4. You can maintain up-to-date immunizations to prevent infectious diseases (see Infectious Disease).

What is the best protection against AIDS?

The risk of getting acquired immune deficiency syndrome (AIDS) is a realistic concern. Statistics from the Centers for Disease Control (CDC) predict that AIDS will become the number one killer of young adults by the year 1991, surpassing accidental death, homicide, suicide, and cancer. The disease is transmitted by the direct exchange of bodily fluids such as blood, semen, and vaginal secretions; any sexual contact can bring some risk of contracting the human immunodeficiency virus (HIV), which is the infectious agent responsible. The virus weakens the immune system, subjecting the victims to infections that persons with healthy immune systems would be able to overcome.

Sexual abstinence or a mutually monogamous relationship with an uninfected partner is the best insurance against acquiring the disease. Since there is no guarantee of safe sex outside of these settings, for all other sexual encounters careful adherence to the guidelines of "safer sex" must be followed. To lessen your risk, use condoms, reduce the number of sexual partners you have, avoid intravenous use of drugs, and never share needles. Review Sexual Health for detailed information about how to use condoms and other methods to reduce the risk of AIDS.

If you are not a homosexual or bisexual male, a hemophiliac, or an IV drug user or did not receive a blood transfusion before April 1985, your chances of contracting the disease are low. However, as AIDS moves into the heterosexual community, your chances of contracting the disease, whether you are male or female, will steadily rise, so don't be casual about taking every possible precaution.

If AIDS follows a rate of infection similar to that of gonorrhea, syphilis, or hepatitis B, there will be hundreds of thousands of deaths in the United States before a cure is found or a vaccine is developed. And now that different strains of the virus are being discovered, developing a vaccine is going to be even more difficult. At this point, no miracle of modern medicine is going to protect you from AIDS. The only protection is your own knowledge, behavior, and practice of safer sex.

How can herpes and other sexually transmitted diseases be prevented?

The precautions that apply to AIDS also apply to herpes, gonorrhea, syphilis, genital warts, and diseases caused by chlamydia. The risk of contracting these diseases is greatly reduced by practicing safer sex. If you find this subject difficult to broach, particularly with a new sexual partner, the real problem may be that you are not ready to share the most intimate parts of your body with that person. See Sexual Health for guidelines on how to discuss safer sex with a potential partner.

How often should students have a complete physical examination?

Most experts recommend a general physical examination at least once during the teenage years. If no problems are detected and there are no symptoms, a general examination could subsequently be done every 3 to 5 years.

At the time of your physical, your immunizations will be reviewed and a medical history will be taken. If there is a family history of a medical problem such as diabetes or high cholesterol, you will be checked further with screening laboratory tests to make sure you don't have the same problem. Your hearing and vision will be checked and your blood pressure measured. You will also be examined for other possible problems-a heart murmur, a nodule in the thyroid, skin changes, and breast or testicular masses. Blood and urine tests will disclose any other conditions you should know about-for example, sickle cell anemia (in African Americans).

Although a full physical examination need not be done every year, an annual gynecologic examination is recommended for all women after they begin sexual activity or starting at age 18 (see page 385 for more information).

Can young people be checked for "hidden" problems?

Several medical problems can be detected by screening: high blood pressure, vision disorders, hearing loss, elevated cholesterol, and precancerous conditions. One of the most important in terms of future health risk is high blood pressure, or hypertension. It affects up to 60 million Americans and, in its early stages, has no symptoms. If undetected and untreated, it leads to heart disease, strokes, and kidney disease.

A person with mild hypertension has approximately double the average risk of dying before age 65; with severe hypertension the risk is quadrupled. Hypertension begins in childhood. There is a definite familial tendency toward the disease, so be sure to get checked if anyone in your family has been known to have hypertension. Although the reason is not known, urban black males have the highest rate of hypertension, approximately double the rate in white males.

Why does hypertension have no symptoms?

There are no symptoms unless the blood pressure is extremely elevated. In most people blood pressure increases gradually without obvious physical changes until damage has already been done.

If you have high blood pressure, your heart has to work harder to pump blood, and the heart and arteries undergo excessive wear and tear. Eventually the increased pressure is transmitted to other organs such as the kidney and the brain, causing degenerative changes. The damage weakens the walls of the blood vessels and leads to deposits of fatty tissue, or atheromas, and narrowing of the arteries. Ultimately this process leads to diminished blood flow (ischemia) or to rupture of the blood vessels. These changes, which take years to develop, result in strokes and heart attacks.

The symptoms of very high blood pressure range from a feeling of mild ill health to headaches, chest pain, dizziness, difficulty with vision, nosebleeds, swelling of tissues, and difficulty in breathing.

How is blood pressure measured?

Arterial blood pressure is measured by an instrument called a sphygmomanometer. A rubber cuff, which is wrapped around your upper arm, is attached to a gauge, or manometer, which measures pressure in units of millimeters of mercury (mmHg). The cuff is inflated until it is tight enough to stop the flow of blood. As the cuff is slowly deflated, the tester listens through a stethoscope for the sounds of blood forcing its way back into the main artery of your arm. A reading is taken of this maximum pressure on the cuff's gauge. The first sound of blood coming into the arm determines the systolic pressure (the pressure when the heart beats). The tester continues to deflate the cuff and listens until the sounds have disappeared, which marks the diastolic pressure (the pressure between heartbeats).

The systolic pressure, the peak pressure generated by the heart's contraction, is always the higher number. The diastolic pressure, the resting pressure in the blood vessels, is always the lower number. An average reading thus may be 120/70. The range of normal values depends somewhat on age (blood pressure rises slightly with age), but for young adults the systolic pressure should be no higher than 140 and the diastolic no higher than 85 (some experts say 90).

You should have your blood pressure measured at least once by the time you are 18 and then once a year after that unless it was elevated at the first reading. If your blood pressure is high, the tester will usually have you relax for a few minutes and then recheck it. Excitement, anxiety, and physical activity can cause it to be elevated. If it remains high, you may be asked to come back several times to have it rechecked. Try to relax before the pressure is measured. You may be more relaxed if your blood pressure is taken outside a doctor's office; check with your student health service to see if they offer blood pressure testing at locations on campus.

What can be done about hypertension?

In many cases, reducing your weight and your salt intake, increasing your exercise and relaxation time, and stopping smoking can control the blood pressure and keep it within a normal range without medication. If detected early, hypertension can be controlled and, in some cases, cured. Your clinician will evaluate the possible causes of your hypertension. Most cases are known as essential hypertension, meaning that no correctable cause is found for the high blood pressure.

What other medical examinations are important?

Both men and women should have yearly genital examinations to check for changes that could be precancerous. A man should have his testicles and breasts checked and be instructed in self examination. A woman should have breast and pelvic examinations and be instructed in breast self-examination. At the same time a clinician can check the thyroid gland (located at the base of the neck just under the larynx, or voice box) for nodules and the skin for changes. You should become familiar with self-examination of your skin, breasts, and (for men) testicles. The thyroid gland may be more difficult for you to examine yourself. There are many causes of benign, or noncancerous, conditions that arise in the thyroid gland. If you notice any enlargement or change in the thyroid area, seek medical attention.

How and why should a man check his testicles?

There is an increasing rate of testicular cancer among young men. Risk is increased if you have a history of undescended testicles. Men should perform a testicular self-examination monthly. Any lump or irregularity should be brought to the immediate attention of a physician. With early detection, testicular cancer responds to treatment.

The best time to examine your testicles is during or after a hot bath or shower. The heat causes the testicles to descend and relaxes the scrotum. This makes it easier to find any abnormalities. Follow these simple instructions recommended by the American Cancer Society:

  1. Examine each testicle with the fingers of both hands, placing your index and middle fingers on the underside of the testicle and your thumbs on top of the testicle.
  2. Gently but firmly roll the testicle between the thumbs and fingers.
  3. Do not mistake the epididymis for an abnormality. This soft, tubelike structure is found at the top edge and along the back of the testicle. It collects sperm from the testicle and carries it to the vas deferens, the tube that carries sperm up to the prostate gland and into the urethra during ejaculation. You can feel the vas deferens and blood vessels (known also as the spermatic cord) above the epididymis. Because the left spermatic cord is longer, the left testes may be lower in the scrotum.
  4. Feel for any irregularity or lumps on the surface of the testes. Also feel for hardness, swelling, pain or a difference in size between the two testes. If you notice pain, a lump, or anyother abnormality, report it to your doctor right away. Most lumps are found on the sides of the testicles, but some appear on the front. Monthly self-examination is a simple painless way to decrease your risk.

How should a woman check herself for breast cancer?

Early detection of breast cancer is very important. One woman in 11 will develop breast cancer, and if there is a family history of the disease, the chances are increased. Careful self-examination on a monthly basis, just after your period ends, should be performed so that you can detect any changes in your breasts.

The first time you examine yourself may be confusing and even frightening because you're not familiar with the normal contours of your breasts. Lumps or bumps are present naturally as part of the breast architecture. If you know what your breasts normally feel like, you will be able to identify a change in the breast tissue. Anything that feels different should be checked further. You may find simple cysts, benign sacs of fluid that develop toward the end of the menstrual cycle (just before the period starts). They develop in response to the rising levels of hormones just before you menstruate. The cysts may be multiple and tender; they usually decrease in size after your period. It is not your responsibility to decide what the condition is. Have any change evaluated at your student health center or by your own physician.

A gynecologic examination, which you should have once a year, will include a breast examination. The clinician can also demonstrate the technique of self-examination and make sure you are doing it correctly. If you have a family history of breast cancer, a mammogram is recommended for further screening. Otherwise, mammography is routinely recommended after age 35. The benefit of early detection exceeds the risk of the small amount of radiation present in modern mammograms.

If you do detect any lumps or changes in the breast, it does not necessarily mean they are cancer. It does mean that you should see a physician as soon as possible to have them evaluated.

In the shower: Examine your breasts during a bath or shower; hands glide easier over wet skin. Fingers flat, move gently over every part of each breast. Use the right hand to examine the left breast, left hand for right breast. Check for any lump, hard knot, or thickening.

Before a mirror: Inspect your breasts with arms at your sides Next raise your arms high overhead. Look for any changes in contour of each breast-a swelling, dimpling of skin, or changes in the nipple. Then, rest palms on hips and press down firmly to flex your chest muscles. Left and right breast will not exactly match-few women's breasts do. Regular inspection shows what is normal for you and will give you confidence in your examination.

Lying down: To examine your right breast put a pillow or folded towel under your right shoulder Place right hand behind your head-this distributes breast tissue more evenly on the chest. With left hand, fingers flat, press gently in small circular motions around an imaginary clock face. Begin at outermost top of your right breast for 12 o'clock, then move to 1 o'clock, and so on around the circle back to 12. A ridge of firm tissue in the lower curve of each breast is normal. Then move in an inch, toward the nipple; keep circling to examine every part of your breast, including nipple. This requires at least three more circles. Now slowly repeat procedure on your left breast with a pillow under your left shoulder and left hand behind head. Notice how your breast structure feels.

Finally, squeeze the nipple of each breast gently between thumb and index finger. Any discharge, clear or bloody, should be reported to your doctor immediately.

How can I be sure I have been doing my breast examination correctly?

The best way to determine if your examination is correct is to do it in the presence of a trained clinician, who can double-check your examination. If you notice some thickening of the breast tissue or some areas that appear to be lumpy, your clinician will advise you to keep track of those areas and to return for reevaluation if you notice any changes in them. A good method is to draw a diagram of the way your breasts look and feel to you. You can then refer to the diagram each month to see if there have been changes.

What are fibrocystic breasts?

Fibrocystic disease of the breast is a common and benign condition that refers to a broad spectrum of changes. In general, it describes breasts that feel lumpy, or irregular, to the examiner. The changes may fluctuate during the menstrual cycle and may be associated with pain and swelling, particularly in the upper, outer quadrants of the breasts. Since breasts are glands that respond to the hormonal changes of the menstrual cycle, the changes are mediated by the influence of hormones on the breast. Between 50 and 80 percent of premenopausal women experience these changes.

It is not thought that fibrocystic breast changes are precancerous. Some physicians may recommend a breast biopsy if a dominant lump is present in the midst of the fibrocystic changes. A biopsy involves the removal of a small sample of breast tissue for study under the microscope by a pathologist. It will determine the cause of the lump.

How can fibrocystic changes be treated?

Some experts believe that elimination of caffeine from the diet and the addition of vitamin E, 400 IU (international units) per day, can reduce the pain and cyclic swelling. No one is sure how these two factors influence the breast, but some centers report up to 60 percent of women with fibrocystic change respond to this regimen.

Normal breasts often feel lumpy because they are composed of milk glands and fat. Small cysts of fibrous material can make a breast feel extra lumpy. A majority of women form these cysts. Breast cancer may appear as a hard lump. If found early by self-examination, it can be cured.

Are there other ways of detecting cancer at an early stage?

For women, an annual pelvic examination and a Pap smear, or test, are the key to early detection of cervical and endometrial cancer. The Pap smear detects abnormal cells that may be forming on the cervix, so that treatment can be started before a cancer develops. Although the guidelines can change, most gynecologists recommend a Pap smear as soon as a woman begins sexual activity or by age 18, and then yearly.

Cancer of the cervix has been associated with having multiple sexual partners, beginning intercourse at an early age, and being infected by the condyloma, or genital wart, virus. With early detection, cervical cancer is treatable and curable.

Women whose mothers took the synthetic hormone diethylstilbestrol (DES) during pregnancy are at risk for developing a rare form of genital cancer. Until 1971 DES was given to pregnant women to prevent miscarriage. If you were born after 1971, it is extremely unlikely that your mother could have taken DES. There is also some evidence that men born to women who took DES are at increased risk for genital cancer. Further research has shown that DES is associated with many types of cancer. It is very important for both male and female children of women who took this drug to maintain a rigorous examination schedule for early detection of cancer.

What is rape?

Rape is a crime of violence. In its broadest definition, rape is any kind of sexual activity against a person's wishes. It involves the physical use or implied threat of force to control and subdue the victim. Rape is an act of violence reflecting the attacker's anger, need to control, and aggression rather than a sexual act.

In the United States, a rape is committed every 6 minutes. Most victims are women, but men also are raped. It can happen to any woman, at any time, anywhere; 40 to 50 percent of rapes are by an acquaintance (see the date rape section below). Rape is an underreported violent crime. Victims often do not report it because of shame, embarrassment, fear of retribution, or distrust of the legal-medical system. Based on the incidents reported, approximately I in 10 women in the United States have been raped.

Many misconceptions about rape exist. Two of the most erroneous and damaging are that the victim "asked for it" or could have stopped the rapist. When force or threat of force is used, the victim is thinking only about surviving the attack. Usually victims of rape by strangers are selected arbitrarily. Almost all rapes involve the threat of death or of great physical harm. During a rape, survival is the primary instinct, and the victim will protect herself as best she can. In some cases, overwhelming fear may cause a woman to become unable to resist. This should not be considered acceptance or cooperation in any sense of the terms. If you are raped and survive, you did the right thing because you are still alive.

Contrary to popular belief, rapists are not sex-starved psychopaths. Most lead everyday lives and go to work, school or college. Up to a third are married.

What can I do to prevent rape?

You can reduce your vulnerability to attack. Studies show the more aggressive you appear, the less likely someone is to attack you. When outside at night, avoid deserted streets, parking lots, and shortcuts. Walk on well-lighted streets, near the curb, and away from bushes. Try to walk with others or call the campus escort service. If this service doesn't exist on your campus, call the campus police for escort and get a volunteer escort service started.

Stay alert for suspicious-looking people. Don't overload your arms with books and bags, making yourself look defenseless. Cross the street to avoid groups of men or a solitary man. Dress so that you can run if necessary. If you face danger, yell "Fire!"-not "Help" or "Rape". Carry your keys so that you can use them as a weapon and also so that you don't have to fumble for them when you reach your door or car. Carry a stickpin, umbrella, or whistle as a legal weapon. Don't hitchhike or pick up hitchhikers. Park in well-lighted areas and always lock your car. Check the back seat before getting in. Keep all doors locked when driving. Avoid taking an elevator with a single man in it.

Study in a part of the library where you are in easy, visual contact with others. At home, keep lights on at all entrances. Insist that approaches and stairwells of your apartment building are well lighted. Make sure your door has a dead bolt, and check all visitors, preferably through a peephole. Verify everyone's identity, particularly repairmen and delivery men. Use only your last name on the door and mailbox. Rapes increase in warm weather when people leave their windows open. Use a lock that restricts the window opening to 5 inches. Keep your shades drawn.

What should a person who is raped do?

First, a rape victim should get to a safe place and then call the police and a friend or family member to come. The victim should not shower, bathe, or douche. All clothing and any other physical evidence should be saved. The nearest rape hot line or rape treatment center (listed under "Rape" in the white pages of the phone book) should be called for a referral to a medical center. If none is listed, the person should go to the nearest emergency room.

Medical care after a rape is important for several reasons. Physical evidence that an assault took place will be collected. Treatment to prevent a sexually transmitted disease or a pregnancy can be given. Often a trained counselor will meet and stay with the victim during the entire police and medical interviews. The counselor will also help with the emotional and psychological aftermath of a rape and will arrange for follow-up counseling.

What about the aftermath of a rape?

Rape is always traumatic, physically as well as emotionally. It is an attack on the integrity of a woman, leaving her feeling powerless, vulnerable, violated, and humiliated. Psychological damage is usually as severe as, if not more severe than, physical injury and may take considerable time and therapy to heal. A person may feel severely depressed, fearful, dependent, numb, anxious, shameful, and unable to be alone. Flashbacks to the rape may occur.

If you have been raped, remember that you are not alone. Rape has happened to thousands of women who have struggled and recovered, although it was not easy. Not talking about it does not make the terrible feelings go away. Seek help from your counseling center, rape treatment center, church or synagogue, or student health center.

What is date rape?

Date rape, or acquaintance rape, is forced sexual assault by someone you know or are dating. It is the most common type of rape on campus. It can occur at any stage of a relationship. In one survey, 25 percent of college women reported being forced or coerced into having sex. Most date rapes occur on the weekends in the rapist's car or home.

Although date rape is as traumatic and serious and illegal as other forms of rape, it is often not reported. (See below for ways to prevent date rape.)

Why does date rape happen?

Either the man or the woman or both may be intoxicated or using drugs, which lessens inhibition. Messages about what each partner wants may be unclear. The man may interpret seductive dress and agreeing to go to his room as a consent to have sex. He may interpret a "maybe" or an unconvincing "no" as a "yes," or he may think the woman is just playing hard to get. The woman may consent to going to the man's room as a way of continuing the date. She may enjoy a certain amount of kissing or petting but may not want to have intercourse. She may be forced into it by the man's greater strength. She may have consented to sex before. Remember: You always have the right to change your mind and say "no."

Certain patterns develop in a situation that can lead to date rape. Often social pressure, lack of a ride home, or use of alcohol or other drugs increases a woman's vulnerability. The man begins with an intrusion into her physical or psychological space (for example, a hand on the thigh, unhooking her bra) to test her response. It can be a subtle move that the woman may ignore. A woman may feel intuitively that something is wrong. If she doesn't pay attention to her feelings, the rapist may be able to get her alone. He may try to get her drunk or stoned.

He may make her feel obligated to provide sexual favors as payment for a date or as a way of keeping the relationship. He may then use force.

How can I avoid date rape?

WOMEN

MEN

How can the chance of getting skin cancer be reduced?

Research indicates that exposure to sunlight is a primary cause of skin cancer. Sunlight is also a prime cause of skin aging. Light-skinned people are at greater risk than are dark-skinned people, whose more heavily pigmented skin protects them from the cancer-causing ultraviolet rays. (See Common Medical Problems for a discussion of sunburn.)

The damage done to the skin by the sun starts early in life. It may not be recognized until the teen or young adult years, when solar elastosis is the first change. This premature aging and wrinkling of the skin is accompanied by mottling and darkly pigmented patches. This skin is more likely to become cancerous. Premalignant skin lesions appear as reddened areas covered by scales or as sores that don't heal. Even teenagers can get skin cancer. The two most common and treatable forms of skin cancer are basal cell cancer and squamous cell cancer. They appear as pearly pimples with a crust or an area of red, scaly patches.

The most feared skin cancer is melanoma, a dark brown or black molelike growth. It can originate in a mole, or nevus, or arise as a new mole. The risk for melanoma is increased in families with a history of abnormal moles, which are known as dysplastic nevi.

Melanoma is a very aggressive form of skin cancer that is capable of rapid spread and can cause death. Reducing exposure to sunlight and avoiding sunburn lessen the risk of developing this disease. Know your skin and its moles. If there is any change, consult a physician for evaluation.

Is getting a tan from a tanning salon safer than tanning in the sun?

Most experts say no. The machines in tanning salons produce ultraviolet alpha (UVA) light instead of ultraviolet beta (UVB) light. Although UVA doesn't burn the skin, it damages the deep layers of the skin, which can lead to premature aging and cancer. The UVA radiation can also cause weakening of the immune system, cataracts (if goggles aren't worn), allergic reactions, and increased risk of skin cancer. In 1987 there were 1,700 visits to emergency rooms for injuries related to overexposure in tanning booths. Despite claims to the contrary, the base tan from a tanning salon does not give complete protection from burning.

If you are exposed to enough sunlight, you can burn even though you have a base tan.

There are no federal and virtually no state regulations governing the tanning salon industry. Machines are not regularly checked for safety, and there are no guidelines for safe use. Decide for yourself if the short-lived cosmetic effect of a tan is worth the known risks of skin cancer and premature aging.

Do sunscreens block UVA rays as well as UVB rays?

Most common sunscreen ingredients (derivatives of PABA, or para-aminobenzoic acid) filter the ultraviolet beta (UVB) rays effectively. But they are less effective against the ultraviolet alpha (UVA) rays, which used to be thought harmless. The UVA rays can damage the skin's connective tissue and lead to premature aging and to cancer.

To protect yourself against UVA rays, choose a sunscreen that contains a benzone compound (benzophenone or oxybenzone) and a PABA compound or other UVB block. Brands that protect against UVB as well as some UVA rays are Bain de Soleil 15, PreSun 15, Sundown 8 and 15, Clinique 19, Elizabeth Arden 15, and Estee Lauder sunscreens.

Besides potent anti-UV ingredients, choose a sunscreen with a sun protection factor (SPF) of at least 15. Apply the sunscreen an hour before exposure to allow time for it to penetrate the outer skin layer. "Waterproof" means the product maintains its SPF after four 20-minute swims, "water resistant" after two swims. Use generous amounts of the sunscreen and reapply frequently. For sensitive areas such as lips, nose, and ears, use an opaque sun block like zinc oxide or titanium dioxide.

What are the early warning signs of other types of cancer?

Many forms of cancer will inevitably develop. Early detection is extremely important to increase your chances of survival and to make the treatment less severe. Know the seven warning signs of cancer as published by the American Cancer Society:

  1. Change in bowel or bladder habits
  2. Sore that does not heal
  3. Unusual bleeding or discharge
  4. Thickening or lump in breast or elsewhere
  5. Indigestion or difficulty in swallowing
  6. Obvious change in wart or mole
  7. Nagging cough or hoarseness

None of these symptoms means you have cancer, but they should not be ignored. If any one of the signs persists for more than 2 weeks, seek medical attention. You can improve your early-detection abilities by learning the basic techniques of self-examination.

Are there ways to reduce the chance of getting cancer?

Evidence is accumulating that lifestyle and dietary changes can affect your chance of getting or not getting cancer. Although there has been tremendous progress in the detection and treatment of cancer, the disease still strikes one in four Americans. Not all the causes are known, but many researchers believe that risk factors have been identified in one-half to two-thirds of cancers. With forethought you can recognize and avoid those risks.

Diet is thought to play a role and is a factor you can control. A high-fat, low-fiber diet has been associated with prostate, breast, and intestinal cancers. Foods with nitrates and nitrites, which are used to preserve processed meats as well as smoked and barbecued foods, are also thought to be carcinogenic.

What are some other risk factors to avoid?

Among the significant risks is exposure to asbestos fibers, automobile exhaust, sunlight, X rays, or cigarette smoke. Cigarette smoke is a key factor in a variety of diseases, including lung, bladder, and mouth cancers. Smoking combined with other risk factors greatly increases the chances of developing cancer and heart disease. Smokers exposed to asbestos are 50 times more likely to develop lung cancer than are nonsmokers with the same exposure. Even if you don't smoke yourself but live with a smoker, your chances of developing lung cancer may be doubled.

Using smokeless tobacco or chewing tobacco or smoking a pipe or cigar may minimize the risk of lung cancer but will greatly increase the possibility of developing cancer of the mouth, lip, larynx, pharynx, and esophagus. These cancers can be just as deadly as lung cancer and much quicker to develop. And using smokeless tobacco is just as addicting as smoking regular cigarettes.

Being overweight by more than 20 pounds, which is also associated with the development of cancer, may be related to a high-fat diet combined with lack of exercise-factors in a variety of diseases. In the opinion of many cancer researchers, the risk of developing cancer can be reduced by increasing fiber in your diet and reducing fat. By fiber we mean the undigestible parts of plants-the cellulose in celery and the fiber-filled coating of whole grains such as brown rice and whole wheat. The most protective type seems to be the water-insoluble fiber found in wheat, bran, and vegetables. It goes through the digestive system relatively untouched, speeding transit time and adding water to the stool. Fiber therefore decreases constipation and may protect against cancer by decreasing the amount of time that potential carcinogens are in the colon. High-fiber diets also decrease cholesterol and the incidence of hemorrhoids.

To make sure you get enough fiber, eat three or four servings of whole grains a day. If that is not convenient on a regular basis, add a serving of 1 to 2 tablespoons of oat bran, unprocessed Miller's bran (available in most supermarkets or health food stores), or psyllium (see below) to cereal or yogurt at each meal.

Are there general nutrition guidelines for avoiding cancer?

Ongoing research in the field of nutrition as it affects cancer indicates that it is prudent to observe the following guidelines:

  1. Maintain body weight within 5 pounds of your recommended weight.
  2. Decrease the consumption of animal fat to less than 20 percent of your diet, total fat to less than 30 percent.
  3. Decrease the use of processed meats that contain nitrates. Also decrease the use of smoked, pickled, and barbecued meats. The scorched skin and fat from barbecuing contain carcinogens.
  4. Increase your intake of fresh fruits and vegetables and whole-grain breads to at least four servings a day.
  5. Add 1 to 6 tablespoons of a fiber supplement such as oat bran flakes, unprocessed bran, or psyllium (contained in commercial products like Metamucil, Fiberall, and Penderm) to your daily diet. Fiber will also lower your cholesterol, to your daily diet.
  6. Eat more yellow vegetables, which contain beta carotene, a substance that some researchers think may protect against cancer.
  7. Use alcohol only in moderation. Certain cancers, such as cancer of the esophagus, are strongly linked to excessive alcohol use.

Are there other medical problems that can be prevented?

To some extent, yes. If you know the risks that are based on your family history as well as the risks inherent in the American lifestyle, you can make choices about diet, habits, and activities to reduce your risks. By informing yourself, you can make better choices when you are young and adaptable to changes that will improve your health.

Lifestyle changes can have a positive effect on your risk of future medical problems-not only of cancer, as discussed above, but also of heart disease, osteoporosis, and low back pain.

How can the risks of developing heart disease be reduced?

It is increasingly evident that heart disease, the leading overall cause of death in America, has its beginnings in childhood. Between 80 and 90 percent of all heart disease cases are related to one or more of the following risk factors: overweight, high blood pressure, elevated cholesterol level, cigarette smoking, high blood sugar level, stressful lifestyle, and lack of exercise. Eliminating or at least modifying these risk factors in your teenage or young adult years will decrease your chance of developing heart disease later.

The one significant risk factor not mentioned above is your genetic background. If you have a family history of heart disease or elevated cholesterol, you are more likely to develop the problem. However, it has been shown that by early intervention, nearly all these risk factors can be decreased. By learning to make healthful choices on diet, activity, and weight control, you can lower the chance of developing heart disease.

Start by maintaining your body weight within 5 pounds of your ideal weight (see Nutrition). Make exercise a part of your life. Follow the guidelines in Exercise to establish a regular exercise pattern that you will enjoy. As little as 20 to 30 minutes of aerobic exercise 3 or 4 times a week have been shown to be protective. Statistics document that people who were athletic during their college years have lower rates of heart disease in their later years. The same is true for people whose work involves a high degree of physical activity.

If you are a smoker, quit! Smokers have a 70 percent greater risk of developing heart disease than do nonsmokers. Cigarette smoking is the single most preventable cause of, and contributor to, death. If you live or work with smokers and inhale passive smoke, your risk of heart disease is also increased. Do what you can to get others to stop smoking and affecting your health.

Make an appointment with the student health center or your family doctor for a physical and get your blood pressure, blood sugar, and cholesterol levels checked. Elevated blood pressure, blood sugar, weight, and cholesterol levels can often be controlled through diet and exercise. A diet low in fat and cholesterol and high in complex carbohydrates and fiber, coupled with regular exercise, can help to reduce cholesterol and high blood pressure. Cholesterol should be 180 mg/dL or less for people 18 to 29 years old. Reducing and managing stress in your life can also lower your chances of developing heart disease. (Review chapter 8 for methods of stress reduction and management.)

You might think that because you are young and strong and feel fine, there is no reason to be concerned about diseases that may be far in the future. But risk factors do their damage gradually and are hidden for as many as 20 or 30 years before the warning signs develop. And in about 25 percent of heart disease cases, the first sign of trouble is sudden death. Given those statistics, it doesn't make sense to wait for the symptoms to appear.

Is osteoporosis hereditary?

The chance of your developing osteoporosis is increased if you have a family history of the disease. In osteoporosis an older person may lose height and sometimes have a "hunchback" appearance. The condition affects women primarily and involves the progressive loss of minerals, principally calcium, from bone tissue. Bones become porous, weak, and susceptible to fractures and collapse, even with minimal trauma. Decrease in bone mass, or thinning bones, was once thought to be an inevitable part of the aging process but is now to a large degree considered preventable and treatable.

Most of the women affected are over the age of 50, but increasing evidence suggests that younger women may also be at risk. All women except blacks are at risk after menopause. Black women have a higher bone density and seem to be more resistant to the bone-resorbing effects of certain hormones. The decrease in estrogen levels that occurs when menstruation stops results in very rapid loss of bone mass. Younger women are at risk of some bone loss if their menses stop for 3 months or more.

What are the increased risk factors of osteoporosis?

Any of the following circumstances may indicate a greater risk of developing osteoporosis:

  1. Family history of osteoporosis
  2. Low body weight
  3. Low levels of exercise
  4. Diet high in phosphorous and protein but low in calcium (carbonated beverages contain phosphorous)
  5. Use of cortisone pills (prednisone, for example, but not birth control pills)
  6. Chronic kidney disease
  7. Cigarette smoking
  8. Fair complexion
  9. Lack of vitamin D or little exposure to sunlight
  10. Episodes of amenorrhea

What can prevent osteoporosis?

Prevention of osteoporosis has to begin when you are young. Bone formation is an ongoing, dynamic process during your entire life. Peak or maximum bone density is developed between the ages of 10 and 20 and continues until age 35. If a person doesn't have an adequate calcium intake during that period, bone mass may never be adequate. Pregnancy and breast feeding take a further toll on bone reserves if calcium intake is not increased. Young women can decrease their risk of osteoporosis well in advance by adopting good health habits that give them the densest, healthiest bones possible.

Take the following steps to reduce your risks of developing osteoporosis:

  1. Get an adequate daily supply of calcium. This is essential. Most American women get only 300 to 600 milligrams per day in their normal diet instead of the 1,000 to 1,200 milligrams they need. To ensure adequate calcium intake, include three or four dairy servings (1 cup equals approximately 300 milligrams of calcium) in your daily diet. Salmon, sardines, tofu products, and green leafy vegetables are also sources of calcium but at lower levels than dairy products. See Nutrition for more information on calcium.
  2. Take a calcium supplement if you are unable to take in adequate calcium from food sources. A calcium carbonate supplement is preferable to other types because of its higher concentration of elemental, or uncombined, calcium. Since calcium in a supplement is not so well absorbed as calcium in food, limit supplements to the amount you are unable to get in food. Always drink a large glass of water with a calcium supplement to reduce the risk of developing calcium kidney stones. Don't take a calcium supplement with other vitamins or minerals, especially iron, which may interfere with calcium absorption.
  3. Don't use antacids containing aluminum, which interferes with the absorption of calcium and other minerals.
  4. Decrease the amount of phosphorous in your diet by substituting water and fruit juices for soft drinks.
  5. Get out in the sun for 15 minutes a day for the vitamin D you need. If your class schedule or the climate in your area rules out a daily dose of sunlight, consider taking a 200 unit supplement of vitamin D.
  6. Seek medical advice to find out the cause and correct the problem of amenorrhea, the cessation or absence of menstruation, especially if it is coupled with low body weight or an eating disorder. Some women who have amenorrhea have shown as much as 10 to 25 percent bone loss within 1 to 2 years after they stopped having periods. Women with amenorrhea have higher calcium needs- 1,500 milligrams, or about five dairy servings, a day.
  7. Be aware of increased calcium needs (up to 1,500 milligrams per day) during pregnancy and lactation.
  8. Limit alcohol intake. Alcohol has been shown to depress new bone formation.
  9. Don't smoke. Smokers have been found to have an increased risk of osteoporosis.
  10. Get in shape by doing some type of weight-bearing exercise. Regular exercise and the proper amounts of calcium in your diet are your best insurance against developing osteoporosis at a later age.

What causes low back pain?

Low back pain is associated with such factors as a sedentary lifestyle, high levels of stress, and obesity. It is not necessarily part of the aging process. At some time in their lives most Americans will have at least one episode of back pain, which is a major reason for time lost from work. The causes of back pain are multiple and complex. It may result from one episode of trauma, or it could develop after years of neglecting the strength and flexibility of the back. It is often thought to be the result of weak and distended abdominal muscles and poor posture.

The pain usually originates in strained or torn muscles, ligaments, or tendons. Some pain is caused by a protrusion of the disk, a pillowlike structure that provides cushioning between the vertebrae of the spinal column.

How can low back pain be avoided?

Most low back pain can be avoided by strengthening your back and abdominal muscles, sitting and walking with good posture, and using correct biomechanics in lifting and other activities of daily living.

Go to your health center for evaluation of acute pain. If you have had a prior episode of back pain but currently have no problems, check the YMCA for inexpensive classes in self-care of the back.

Here are some tips for preventing back pain.

  1. Strengthen abdominal muscles by doing bent-knee sit-ups. Include lateral twists to strengthen the oblique abdominal muscles. Tight, strong abdominal muscles take 60 to 80 percent of the load off your back.
  2. Sit and stand with correct erect posture. To check your posture, imagine a string dropped from your ear to the floor, aligning your shoulders and hips in a straight line.
  3. Reduce environmental causes of back strain-an uncomfortable car seat or chair or mattress. Your mattress should be firm. If it's not, a 3/4-inch sheet of plywood placed under it will give you the necessary support.
  4. Never lift anything heavier than you can easily manage. Use proper body mechanics when lifting: keep your back straight, squat directly in front of the object to be lifted, then rise and let your legs and thighs do the work.
  5. Avoid gaining weight.
  6. Increase the strength and flexibility of your back muscles and joints by beginning a gradual conditioning program. Weekend athletes who strain underutilized muscles or persons who start a program too vigorously run the risk of back injury.

Preventive health care puts you in the driver's seat. When you take responsibility for your health, you gain more than freedom from disease. You become the creator of a way of life that maximizes your energy and potential.

Developing healthy habits doesn't mean you are going to miss out on a lot of fun or that your life is going to be miserable and boring. On the contrary, you will physically feel better and have a more productive life. You will live life as a participant instead of a spectator.

Physicians and health care providers can serve as educators to motivate and help you learn which choices to make. Let us know how you are doing. We'd like to hear from you!