Prevalence of Complementary and Alternative Medicine in Immigrants

Perceptions of Cultural Adaptations and Other Characteristics of Weight Management Interventions among Hispanic/Latinx Immigrants

Hispanic/Latinx immigrants have high obesity rates, yet they participate less in weight management interventions. This cross-sectional online study recruited Hispanic/ Latinx immigrants living in the United States (US). In a within-subject experimental crossover component, participants were presented with brief information about a hypothetical weight management intervention that was culturally adapted for Hispanics/ Latinx, or a standard intervention (not adapted) and asked about their willingness to enroll. Participants also reported their preferences for weight management intervention features. Participants (n = 54) were majority female (51.9%), aged 51 years or older (56.0%), American citizens (87.0%), and immigrated to US ≥10 years ago (81.7%), with a mean BMI 29.6 + 3.7 kg/m2. There was no difference in willingness to enroll in a culturally adapted (46.3%) compared to standard intervention (48.1%), though more participants preferred a culturally adapted intervention (68.5%). Preference for a culturally adapted intervention was greater among females (p = 0.008) and those with lower acculturation (p = 0.052). Use of non-evidence-based complementary and alternative medicine strategies was common and associated with greater willingness to enroll in a behavioral program (p = 0.007). Preferences for intervention features varied. These findings may inform efforts to increase the reach of weight management interventions for Hispanic/Latinx immigrants.

Prevalence of Chronic Pain by Immigration Status and Latino Ethnicity

OBJECTIVE

The goal of this study was to evaluate the Latino paradox and healthy migrant hypotheses by estimating the association between the prevalence of chronic pain, immigration status, and Latino ethnicity.

METHODS

This cross-sectional study analyzed pooled data from 85,395 adult participants of the 2019-2021 National Health Interview Survey. The dependent variables were any pain and chronic pain in the past 3 months. The independent variables were immigration status (US born, naturalized citizen, non-citizen) and Latino ethnicity.

RESULTS

Chronic pain was prevalent for nearly a quarter of US born non-Latino adults (24%) and non-citizen non-Latino adults had the lowest prevalence at 8%. In multivariable adjusted models, US born non-Latino immigration status and ethnicity was associated with a higher probability of reporting chronic pain in the last 3 months compared to US born Latino adults (-3.0%; 95% CI = -4.4%, -1.6%), naturalized citizen non-Latino adults (-4.7%; 95% CI = -5.9%, -3.4%), naturalized citizen Latino adults (-6.7%; 95% CI = -8.5%, -4.9%), non-citizen non-Latino adults (-3.1%; 95% CI = -4.7%, -1.5%), and non-citizen Latino adults (-8.9%; 95% CI = -10.8%, -7.0%).

CONCLUSION

US Born non-Latino adults reported the highest prevalence of chronic pain and non-citizen Latino adults reported the lowest prevalence of chronic pain providing support for the Latino paradox and healthy migrant effect hypotheses.

Racial and Ethnic Variation in Complementary and Integrative Health Therapy Use Among US Veterans

Importance

White individuals are the greatest users of complementary and integrative health (CIH) therapies in the general population, but this might partially be due to differences in age, health condition, and location. Identifying the nuances in racial and ethnic differences in care is one important step to addressing them.

Objective

To evaluate racial and ethnic differences in Veterans Affairs (VA)-covered CIH therapy use in a more nuanced manner by examining the association of 5 demographic characteristics, health conditions, and medical facility locations with those differences.

Design, Setting, and Participants

Retrospective cross-sectional observational study of VA health care system users, using electronic health record and administrative data at all VA medical facilities and community-based clinics. Participants included veterans with nonmissing race and ethnicity data using VA-funded health care between October 2018 and September 2019. Data were analyzed from June 2022 to April 2023.

Main Outcome and Measure

Any use of VA-covered acupuncture, chiropractic care, massage therapy, yoga, or meditation/mindfulness.

Results

The sample consisted of 5 260 807 veterans with a mean (SD) age of 62.3 (16.4) years and was 91% male (4 788 267 veterans), 67% non-Hispanic White (3 547 140 veterans), 6% Hispanic (328 396 veterans), and 17% Black (903 699 veterans). Chiropractic care was the most used CIH therapy among non-Hispanic White veterans, Hispanic veterans, and veterans of other races and ethnicities, while acupuncture was the most commonly used therapy among Black veterans. When not accounting for the location of the VA medical facilities in which veterans used health care, Black veterans appeared more likely to use yoga and meditation than non-Hispanic White veterans and far less likely to use chiropractic care, while those of Hispanic or other race and ethnicity appeared more likely to use massage than non-Hispanic White veterans. However, those differences mostly disappeared once controlling for medical facility location, with few exceptions-after adjustment Black veterans were less likely than non-Hispanic White veterans to use yoga and more likely to use chiropractic care.

Conclusions and Relevance

This large-scale, cross-sectional study found racial and ethnic differences in use of 4 of 5 CIH therapies among VA health care system users when not considering their medical facility location. Given those differences mostly disappeared once medical facilities were accounted for, the results demonstrated the importance of considering facilities and residential locations when examining racial differences in CIH therapy use. Medical facilities could be a proxy for the racial and ethnic composition of their patients, CIH therapy availability, regional patient or clinician attitudes, or therapy availability.

Use of Complementary and Alternative Medicine for Prostate Cancer among African Americans, African Immigrants and Caribbean Immigrants

Black men have the highest rate of prostate cancer (PCa) morbidity and mortality in the US, and often receive delayed and/or poorer-quality treatment. This inequity has led many to turn to complementary and alternative medicine/therapies (CAM). However, little is known about the use of these therapies within the Black community. The purpose of this study was to describe types of CAM therapies used, and the reasons behind their use for overall health and PCa treatment and prevention among three groups of Black males, namely African Americans, Caribbean Immigrants and African Immigrants. This study used a mixed-methods design with a quantitative phase (n = 575) followed by a qualitative phase (n = 61) with participants recruited from various parts of the country. Results revealed differences among subgroups in CAM use for overall health and PCa, as well as differences in the types of CAM therapies used and differences in the reasons behind their use. The findings of this study reveal a prevalence of CAM use for overall health and PCa within three different groups of Black men and identifies the specific CAM used. There were significant differences in the types of CAM used by each subgroup for both overall health and PCa. This study also shows that there is value in looking at Black subgroups distinctively, for their rates of CAM use and reasons for use, are distinctly different.

A National Survey of Complementary and Alternative Medicine Use for Treatment Among Asian-Americans

Asian Americans (AAs) are more likely to use complementary and alternative medicine (CAM) compared to other race/ethnicities, yet previous studies have conflicting results. The 2012 National Health Interview Survey data was analyzed to investigate AA's (n = 2214) CAM use for treatment. AAs were divided into four subgroups: Chinese, Asian Indian, Filipino, and Other Asian. Only 9% of AAs reported using CAM for treatment, with 6% indicating CAM use specifically for chronic conditions. This could be a form of medical pluralism, a mixture of Eastern and Western health approaches. The "Other Asian" subgroup reported highest use of CAM for treatment. Significant predictors included age (≥ 65 years) and high educational attainment (≥ college degree). Sociodemographic factors were also significant predictors within Asian subgroups. Further investigation of this and other forms of medical pluralism among AAs are needed to explore potential cofounders and risks like underreporting, CAM schedules/dosages, cultural influences, and CAM's impact on one's health.

Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.

Incorporation of integrative medicine education into undergraduate medical education: a longitudinal study

OBJECTIVE

Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person. We implemented a longitudinal IM short-course curriculum into our medical school education. This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students.

METHODS

A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies. Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school. Paired data analysis was done, and only students who completed surveys at both time points were included in final analyses.

RESULTS

Of 52 students in each class, 17 (33%) in the class of 2015 and 22 (42%) in the class of 2016 completed both surveys. After the IM curriculum, students' knowledge of and comfort with several IM therapies-biofeedback, mindfulness, and the use of St. John's wort-improved significantly. Students' personal health practices also improved, including better sleep, exercise, and stress management for the class of 2015. Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year.

CONCLUSION

It is feasible to incorporate IM education into undergraduate medical education, and this is associated with improvement in students' knowledge of IM and personal health practices.

Diabetes Cultural Beliefs and Traditional Medicine Use Among Health Center Patients in Oaxaca, Mexico

Type II diabetes mellitus is currently the leading cause of death in Mexico. Oaxaca is one of the poorest states in Mexico with the largest concentration of indigenous people in the country. Despite the alarming increase of diabetes rates in this region, little is known about the indigenous populations' cultural understandings and related practices for this chronic disease. This study examined diabetes cultural beliefs and traditional medicine use among a sample of 158 adults with and without diabetes in Oaxaca, Mexico. Individuals with and without diabetes did not differ in their traditional culture beliefs regarding diabetes in this study. Younger age (OR = 1.04) and stronger beliefs in punitive and mystical retribution (OR = 5.42) regarding diabetes causality increased the likelihood of using traditional medicine (p < .05). Findings may aid in the development of culturally tailored programs to address diabetes prevention and management efforts in the region.

Complementary and Alternative Medicine and Influenza Vaccine Uptake in US Children

BACKGROUND

Complementary and alternative medicine (CAM) is increasingly used in the United States. Although CAM is mostly used in conjunction with conventional medicine, some CAM practitioners recommend against vaccination, and children who saw naturopathic physicians or chiropractors were less likely to receive vaccines and more likely to get vaccine-preventable diseases. Nothing is known about how child CAM usage affects influenza vaccination.

METHODS

This nationally representative study analyzed ∼9000 children from the Child Complementary and Alternative Medicine File of the 2012 National Health Interview Survey. Adjusting for health services use factors, it examined influenza vaccination odds by ever using major CAM domains: (1) alternative medical systems (AMS; eg, acupuncture); (2) biologically-based therapies, excluding multivitamins/multiminerals (eg, herbal supplements); (3) multivitamins/multiminerals; (4) manipulative and body-based therapies (MBBT; eg, chiropractic manipulation); and (5) mind-body therapies (eg, yoga).

RESULTS

Influenza vaccination uptake was lower among children ever (versus never) using AMS (33% vs 43%; P = .008) or MBBT (35% vs 43%; P = .002) but higher by using multivitamins/multiminerals (45% vs 39%; P < .001). In multivariate analyses, multivitamin/multimineral use lost significance, but children ever (versus never) using any AMS or MBBT had lower uptake (respective odds ratios: 0.61 [95% confidence interval: 0.44-0.85]; and 0.74 [0.58-0.94]).

CONCLUSIONS

Children who have ever used certain CAM domains that may require contact with vaccine-hesitant CAM practitioners are vulnerable to lower annual uptake of influenza vaccination. Opportunity exists for US public health, policy, and medical professionals to improve child health by better engaging parents of children using particular domains of CAM and CAM practitioners advising them.