Individuals often use complementary modalities to treat symptoms or adverse effects of conventional medical therapies, for pain control, to improve quality of life during treatment of diseases such as cancer and other chronic conditions, or to promote health. This widespread use of complementary and alternative medicine (CAM) emphasizes the need for conventional healthcare practitioners to understand the effects of CAM practices and products.

The editors of this issue of Family & Community Health (FCH) (31:3) initially deliberated whether or not to limit both the manuscripts for this issue to studies and the manuscripts related to a particular category of CAM practices to the use of CAM practices and products within specific populations or to selected CAM practices and the current underlying theories and beliefs. As time passed, it became clear that perhaps we are not ready for this level of specificity given the large and diverse, yet emerging set of CAM modalities and practices, and the developing theories and beliefs about all of it. Our early deliberations may suggest an avenue for future CAM-related issues of the FCH.

In this issue, we include 2 articles that report on the use of a mind-body therapy (relaxation-guided imagery [R-GI]) in 2 different study populations, 1 article focused on CAM use in Appalachia, 1 article discussing interview data from a study of African American men diagnosed with prostate cancer, and 3 reviews of literature on CAM therapies for use in 3 different chronic problems. We anticipate that the articles included will add to the existing understanding of the potential use of CAM in family and community health, heighten awareness of the need for more research in this field, and strengthen the close tie of many evidence-based CAM modalities to health promotion. We believe that there are an increasing number of practitioners who desire education and training for total healthcare and seek to acquire new knowledge and skills related to the integration of best CAM practices with conventional healthcare strategies. To this end, we selected the following articles for this special issue of the FCH.

In the first article, Jallo and colleagues describe a 12-week R-GI intervention designed as a primary prevention strategy for stress management for African American women during the second trimester of pregnancy. These authors focus on the contributing role that stress plays in one's life and go even further by focusing upon the minimization of the stress response itself. In a second evidence-based article that also used an R-GI intervention, Menzies and Kim describe a pilot study with a sample of Hispanic adults diagnosed with fibromyalgia who through a 10-week R-GI intervention demonstrated improvement in self-efficacy for managing daily pain and other symptoms as well as functional status. In both of these articles, the researchers' objective was for the R-GI intervention to decrease the cognitive, affective, behavioral, and physiologic reactivity of the study participants to their life circumstances. The CAM intervention of R-GI offered the study participants not only a particular lens through which to view their stress and other symptoms but also specific actions they could take that were designed to help them cultivate greater self-control. In addition, these 2 articles provide the reader with excellent background information on the populations studied and on developing and implementing an intervention using R-GI.

Jones and his colleagues discuss a community-based qualitative study in which they found that social support from family members and friends plays an important role in how African American men cope with their treatment and recovery from prostate cancer. The authors describe how family members and other close friends respond to the diagnosis of prostate cancer in the men who are important in their lives, making clear the implications for involving family members and, when necessary, close friends in communication about diagnosis and treatment options. The interviews gave the men an opportunity to view their illness as a chance for greater self- and family awareness and genuine healing.

Authors Barish and Snyder, building upon their experiences at a remote medical clinic held annually in Appalachia, explore the unique features of the culture in this region that influence healthcare practices of persons living there, including their use of CAM. In addition to the impact that culture has on healthcare in the region, the authors describe influences from the environmental, social, and economic contexts in which the Appalachian people live. The insight gained and shared by Barish and Snyder is applicable to other rural remote communities.

Alexander and colleagues, in a review of the literature on social determinants of physical activity, describe the positive short-term effect of yoga on multiple diabetes-related outcomes for persons with type 2 diabetes mellitus. These authors identify the context of one's social environment, including interpersonal relationships, community characteristics, and social discrimination, each of which may potentially influence the adoption and maintenance of health behaviors such as physical activity, including yoga practice.

In a second literature review that focuses on family caregivers of persons with dementia, Rose and colleagues suggest that cranial electrical stimulation, an energy-based CAM modality, may be a viable intervention for relief of sleep and mood disturbances, problems for which conventional pharmacologic treatment poses numerous risks and side effects in the elderly population. The third literature review by Selfe and Taylor provides an overview of articles (English language only) indexed in MEDLINE or CINAHL describing randomized controlled trials of the effects of needle or electroacupuncture on knee osteoarthritis, a common problem seen in families and communities across our nation. Ten trials representing 1,456 participants provide evidence that the CAM therapy acupuncture is an effective treatment for pain and physical dysfunction associated with osteoarthritis of the knee.

The evidenced-based articles describe CAM modalities that have potential usefulness as adjunctive therapies in given populations. Likewise, the 3 literature reviews focus on an aspect of CAM but differ regarding the CAM modality reviewed and the clinical problem that may benefit from the integration of the modality into individual treatment plans. The articles illustrate the importance of research to provide data to guide future research and the integration of evidence-based CAM practices in healthcare to ensure the best possible outcomes.

The articles presented are by authors who began their CAM research at the University of Virginia School of Nursing Center for the Study of Complementary and Alternative Therapies (CSCAT). The center was established in 1995 as a National Institutes of Health-funded center to examine the potential role of selected CAM modalities in reducing symptoms and enhancing physical and psychologic function and improving quality of life for individuals.

We express appreciation for the assistance of Jewel Holmberg, Administrative Assistant in CSCAT, who provided thoughtful and invaluable editorial support to us and managed the administrative details associated with receiving, reviewing, and bringing each manuscript to its final form.

Ann Gill Taylor, EdD, RN, FAAN

Guest Editor, Research Assistant Professor, University of Virginia School of Nursing, Charlottesville

Audrey E. Snyder, PhD, RN, FAANP

Guest Editor, Betty Norman Norris Professor of Nursing and Director, Center for the Study of Complementary and Alternative Therapies, University of Virginia School of Nursing, Charlottesville