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Yi EHG, Jang Y, Liang J. Utilization of Traditional Complementary and Alternative Medicine Across Ethnically Diverse Asian Americans. J Immigr Minor Health 2024; 26:527-538. [PMID: 38334856 DOI: 10.1007/s10903-024-01583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
We conducted an analysis to identify factors influencing the use of traditional complementary and alternative medicine (TCAM), with a particular emphasis on ethnic variations. Using the 2015 Asian American Quality of Life survey (N = 2,609), logistic regression analyses were performed, considering acculturation, health status, healthcare accessibility/utilization, and socio-demographic factors. Ethnicity, specifically being Chinese or Korean Americans, having chronic medical conditions, experiencing unmet healthcare needs, and having regular check-ups were significant predictors of TCAM use among Asian Americans as a whole. However, when we delved into sub-ethnic groups, different patterns were found. Among Vietnamese and Filipino Americans, having unmet healthcare needs emerged as the most prominent predictor of TCAM use. Furthermore, acculturation level and English proficiency were significant in predicting Vietnamese and Filipino Americans' TCAM use, with the direction varying by sub-ethnicity. Being old emerged as a predictor of TCAM use for Chinese, Indian, Korean, and 'other' Americans. Our findings underscore the importance of adopting an ethnically sensitive approach when addressing the healthcare needs of diverse Asian American populations.
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Affiliation(s)
- Eun-Hye Grace Yi
- Department of Social Work, California State University, Fullerton, CA, USA.
| | - Yuri Jang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jiaming Liang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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2
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Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
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Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
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Kelton K, Young JR, Evans MK, Eshera YM, Blakey SM, Mann AJD, Pugh MJ, Calhoun PS, Beckham JC, Kimbrel NA. Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness. Complement Ther Clin Pract 2022; 49:101644. [PMID: 35947938 PMCID: PMC9669216 DOI: 10.1016/j.ctcp.2022.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
Complementary and integrative health (CIH) approaches have gained empirical support and are increasingly being utilized among veterans to treat a myriad of conditions. A cluster of medically unexplained chronic symptoms including fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems, often referred to as Gulf War Illness (GWI) prominently affect US Gulf War era (GWE) veterans, yet little is known about CIH use within this population. Using data collected as part of a larger study (n = 1153), we examined the influence of demographic characteristics, military experiences, and symptom severity on CIH utilization, and utilization differences between GWE veterans with and without GWI. Over half of the sample (58.5%) used at least one CIH modality in the past six months. Women veterans, white veterans, and veterans with higher levels of education were more likely to use CIH. GWE veterans with a GWI diagnosis and higher GWI symptom severity were more likely to use at least one CIH treatment in the past six months. Over three quarters (82.7%) of veterans who endorsed using CIH to treat GWI symptoms reported that it was helpful for their symptoms. Almost three quarters (71.5%) of veterans indicated that they would use at least one CIH approach if it was available at VA. Results provide a deeper understanding of the likelihood and characteristics of veterans utilizing CIH to treat health and GWI symptoms and may inform expansion of CIH modalities for GWE veterans, particularly those with GWI.
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Affiliation(s)
- Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX, USA; National Center for Homelessness Among Veterans, USA.
| | - Jonathan R Young
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Mariah K Evans
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Yasmine M Eshera
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Shannon M Blakey
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System and IDEAS Center of Innovation, Salt Lake City UT, USA; University of Utah School of Medicine, Department of Medicine, Salt Lake City UT, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
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Salihu EY, Ebert Wallace L. Use and attitudes toward complementary and alternative medicine among university students: The role of gender and race. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-10. [PMID: 36084175 DOI: 10.1080/07448481.2022.2115296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/01/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Purpose: This study assessed gender, race, use of complementary and alternative medicine (CAM), attitudes toward CAM, and disclosure of CAM use to health providers using an online survey of 506 students at a regional public university. Methods: Ordinary least squares regression models were used to examine relationships of interest, including use, attitudes, and disclosure of CAM by self-identified gender and race. Results: The most common therapy reported included vitamins and mineral supplements, and participants of all racial and gender identities expressed generally positive attitudes toward CAM. Women reported using CAM significantly more often than men, and Whites more often than non-Whites. Conclusions: White respondents were more likely to disclose the use of CAM to healthcare providers compared to African American respondents, and women reported disclosure more often than men. A significant interaction between gender and race was noted for attitudes toward CAM for Whites and African Americans, with White women most positive toward CAM.
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Affiliation(s)
- Ejura Yetunde Salihu
- Health Services Research in Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Sociology and Anthropology, Western Illinois University, Macomb, Illinois, USA
| | - Lora Ebert Wallace
- Department of Sociology and Anthropology, Western Illinois University, Macomb, Illinois, USA
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Berger JT, Miller DR. Health Disparities, Systemic Racism, and Failures of Cultural Competence. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:4-10. [PMID: 33955810 DOI: 10.1080/15265161.2021.1915411] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Instead, it has adopted a culture-based agenda through the framework of cultural competence to address disparities despite a paucity of supporting data. Cultural competence is ethnocentric in orientation and its content sustains biases that are long-standing in health care. Moreover, Cultural competence is based on a number of flawed assumptions and is not structured around a set of clearly stated ethical values. In this paper, we will demonstrate ways in which Cultural competence reflects embedded ethnocentrism, perpetuates entrenched biases, and fails to recognize the depth and breadth of systemic racism as these relate to the stated goal of Cultural competence-the mitigation of health disparities. In addition, we offer a reframed approach to health disparities in medical education.
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Scott R, Nahin RL, Weber W. Longitudinal Analysis of Complementary Health Approaches in Adults Aged 25-74 Years from the Midlife in the U.S. Survey Sample. J Altern Complement Med 2021; 27:550-568. [PMID: 33877882 DOI: 10.1089/acm.2020.0414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Complementary health approaches include herbal products and mind-body practices. Several studies have identified predictors for complementary health approach use, yet there are two gaps: (1) How does use change? (2) Do factors associated with use influence this change over time? Using the Midlife in the United States (MIDUS), we examined how sociodemographic factors affected use longitudinally, and whether these associations differed between new and continued/discontinued use of herbal products, meditation, chiropractic, and massage therapy. Design: MIDUS is a national probability sample of adults aged 25 or older that has collected more than 20 years of longitudinal data, including the use of complementary health approaches. We employed the Andersen Model as a framework to identify predisposing, enabling, and health need factors associated with complementary health approach use based on previously identified and hypothesized factors. We ran Chi-square analyses to first test bivariate associations between our independent variables and four modalities to further guide logistic regression models. Results: Each of the four approaches examined saw substantial increases in prevalent use. However, only about 25% to 38% of individuals continued use from one wave to the next, whereas only 2%-9% of individuals who did not use a given approach in a wave reported use in the subsequent wave. Age, spiritual importance, and previous wave one use were all significantly associated with new use across all four modalities. Previous wave one use was associated with continued/discontinued use for all modalities. Age and education were significantly associated with discontinued use of chiropractic. Conclusion: We present the first longitudinal analysis of complementary health approaches in a nationally representative sample. These data distinguish between new and continued/discontinued use of complementary health approaches over time and provide insights into the interpretation of complementary health approach prevalence data, as well as important predictors of use.
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Affiliation(s)
- Remle Scott
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Richard L Nahin
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Wendy Weber
- Clinical Research in Complementary and Integrative Health Branch, National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
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Felicilda-Reynaldo RFD, Choi SY, Driscoll SD, Albright CL. A National Survey of Complementary and Alternative Medicine Use for Treatment Among Asian-Americans. J Immigr Minor Health 2020; 22:762-770. [PMID: 31583560 PMCID: PMC7117985 DOI: 10.1007/s10903-019-00936-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Rhea Faye D Felicilda-Reynaldo
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster 402, Honolulu, HI, 96822, USA.
| | - So Yung Choi
- Biostatistics Core, Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Susan D Driscoll
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster 402, Honolulu, HI, 96822, USA
| | - Cheryl L Albright
- Office of Public Health Studies, Myron B. Thompson School of Social Work, School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
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Pescosolido BA, Manago B, Olafsdottir S. The global use of diverse medical systems. Soc Sci Med 2019; 267:112721. [PMID: 31870508 DOI: 10.1016/j.socscimed.2019.112721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
In 1969, anthropologist Irwin Press introduced the concept of dual use in an attempt to lay to rest the idea that individuals in the real world must choose between allopathic and alternative systems. While providers of medical traditions have a vested interest in seeing the public use one system exclusively, individuals do not. Yet, utilization research generally follows a bifurcated research agenda. thwarting our understanding of how the population uses health care resources. Here, we frame a global analysis of individuals' yearly use of different medical systems. Using the Network Episode Model (NEM), we shift the focus to patterns of care and lay out seven hypotheses, testing whether socio-demographic, cultural, access and health factors are associated with use of one, another, or both system. Data from the 2011 International Social Survey Program's Health Module, reveals that the use of alternative systems alone has virtually disappeared as a pattern of care while dual use remains relevant. Using multilevel models to take into account country differences, we find that being older or younger (i.e., curvilinear effect), female, out-group member, employed, unsatisfied with last allopathic visit; or, reporting barriers to allopathic options, chronic illness, poor health, or positive assessment of alternative options are associated with dual use. Education, income, rural residence, or reporting sufficient insurance coverage are insignificant. Thus, nearly all hypotheses reveal the complexity of contemporary utilization behavior.
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Affiliation(s)
| | - Bianca Manago
- Department of Sociology, Vanderbilt University, Nashville, TN, USA
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Johnson PJ, Jou J, Rockwood TH, Upchurch DM. Perceived Benefits of Using Complementary and Alternative Medicine by Race/Ethnicity Among Midlife and Older Adults in the United States. J Aging Health 2019; 31:1376-1397. [PMID: 29900809 PMCID: PMC8048740 DOI: 10.1177/0898264318780023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe, for a national sample of midlife and older adults, the types of complementary and alternative medicine (CAM) used for health and wellness and the perceived benefits of CAM use by race/ethnicity. Method: Using data from the 2012 National Health Interview Survey, we ran multiple logistic regression models to estimate the odds of each perceived benefit among adults ages 50 and older. Results: More than 38% of midlife and older adults used CAM in the past year. For six of seven perceived benefits examined, we found significant differences by race/ethnicity, with each group having higher odds of two or more perceived benefits compared with non-Hispanic Whites. Discussion: Although racial/ethnic minority groups are less likely to use CAM compared with non-Hispanic Whites, those who use CAM perceive great benefit. Future research should examine the potential contribution of evidence-based CAM to promoting health and well-being in a diverse aging population.
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Affiliation(s)
| | - Judy Jou
- University of California, Los Angeles, USA
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Tilburt J, Yost KJ, Lenz HJ, Zúñiga ML, O'Byrne T, Branda ME, Leppin AL, Kimball B, Fernandez C, Jatoi A, Barwise A, Kumbamu A, Montori V, Koenig BA, Geller G, Larson S, Roter DL. A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context. Oncologist 2019; 24:e1180-e1189. [PMID: 31101701 DOI: 10.1634/theoncologist.2019-0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about how complementary and alternative medicine (CAM) is discussed in cancer care across varied settings in the U.S. METHODS In two practices affiliated with one academic medical center in southern California (SoCal), and one in the upper Midwest (UM), we audio-recorded patient-clinician interactions in medical oncology outpatient practices. We counted the frequency and duration of CAM-related conversations. We coded recordings using the Roter Interaction Analysis System. We used chi-square tests for bivariate analysis of categorical variables and generalized linear models for continuous variables to examine associations between dialogue characteristics, practice setting, and population characteristics with the occurrence of CAM discussion in each setting followed by multivariate models adjusting for clinician clustering. RESULTS Sixty-one clinicians and 529 patients participated. Sixty-two of 529 (12%) interactions included CAM discussions, with significantly more observed in the SoCal university practice than in the other settings. Visits that included CAM were on average 6 minutes longer, with CAM content lasting an average of 78 seconds. In bivariate tests of association, conversations containing CAM included more psychosocial statements from both clinicians and patients, higher patient-centeredness, more positive patient and clinician affect, and greater patient engagement. In a multivariable model including significant bivariate terms, conversations containing CAM were independently associated with higher patient-centeredness, slightly longer visits, and being at the SoCal university site. CONCLUSION The frequency of CAM-related discussion in oncology varied substantially across sites. Visits that included CAM discussion were longer and more patient centered. IMPLICATIONS FOR PRACTICE The Institute of Medicine and the American Society of Clinical Oncology have called for more open discussions of complementary and alternative medicine (CAM). But little is known about the role population characteristics and care contexts may play in the frequency and nature of those discussions. The present data characterizing actual conversations in practice complements a much larger literature based on patient and clinician self-report about CAM disclosure and use. It was found that CAM discussions in academic oncology visits varied significantly by practice context, that the majority were initiated by the patient, and that they may occur more when visit time exists for lifestyle, self-care, and psychosocial concerns.
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Affiliation(s)
- Jon Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Thomas O'Byrne
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan E Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron L Leppin
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittany Kimball
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia Barwise
- Division of Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Montori
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara A Koenig
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Larson
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center. Complement Ther Clin Pract 2016; 25:59-67. [PMID: 27863611 DOI: 10.1016/j.ctcp.2016.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/12/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC). METHODS Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks. RESULTS Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's < 0.05). CONCLUSIONS Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms.
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Tollefson M, Wisneski L, Sayre N, Helton J, Matuszewicz E, Jensen C. Integrative Healthcare: An Exploration of Students Who Choose This Undergraduate Major. J Altern Complement Med 2015; 22:166-70. [PMID: 26595170 DOI: 10.1089/acm.2015.0219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Given the dearth of literature on this topic, the aim of this study was to understand who chooses to study integrative healthcare at an academic institution and why they choose to do so, the demographic characteristics of the student population, their background, and postgraduate plans. DESIGN A cross-sectional survey design. SETTING Data were collected at a large, urban, public university with a well-established undergraduate bachelor of science program in integrative healthcare. PARTICIPANTS A total of 105 declared integrative health undergraduate majors. MEASUREMENTS Online research software collected anonymous survey responses during a 2-month period. RESULTS Survey participants were more likely to be white and full-time students compared with the general undergraduate population. Many respondents discovered the integrative health major and then decided to enroll at the university. Most had used complementary and alternative medicine modalities, such as massage, yoga, and meditation. More than half of the survey participants were dissatisfied with conventional/Western medicine and its providers. Most respondents had a personal interest in complementary and alternative medicine and holistic health that influenced their decision to declare the major. Additionally, more than half of the respondents want to become a complementary and alternative medicine provider. Most survey participants plan to pursue postgraduate training/education in an integrative healthcare-related field. CONCLUSION Students who choose to study integrative healthcare in an undergraduate academic institution may mirror the patient population of complementary and alternative medicine practitioners. Their profile, rationale, exposures, intentions, and directions may be helpful to universities considering adding this type of program or postgraduate education programs in attracting new students to integrative health fields. It also informs existing integrative healthcare programs regarding program enhancement. A larger sample involving more integrative health academic institutions would be useful for a future study.
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Affiliation(s)
- Michelle Tollefson
- 1 Department of Health Professions, Metropolitan State University of Denver , Denver, CO
| | | | - Nancy Sayre
- 1 Department of Health Professions, Metropolitan State University of Denver , Denver, CO
| | - Jeffrey Helton
- 1 Department of Health Professions, Metropolitan State University of Denver , Denver, CO
| | - Emily Matuszewicz
- 1 Department of Health Professions, Metropolitan State University of Denver , Denver, CO
| | - Carol Jensen
- 1 Department of Health Professions, Metropolitan State University of Denver , Denver, CO
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13
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Burnett-Zeigler I, Schuette S, Victorson D, Wisner KL. Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. J Altern Complement Med 2015; 22:115-24. [PMID: 26540645 DOI: 10.1089/acm.2015.0038] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.
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Affiliation(s)
- Inger Burnett-Zeigler
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - Stephanie Schuette
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - David Victorson
- 2 Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - Katherine L Wisner
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
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Hasan SS, Feng SR, Ahmadi K, Ahmad KM, Chong DWK, Anwar M, Badarudin NZ. Factors Influencing Concomitant Use of Complementary and Alternative Medicines with Warfarin. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2010.tb00563.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shahzad S Hasan
- Department of Pharmacy Practice; International Medical University; Kuala Lumpur
| | - Siow R Feng
- Department of Pharmacy Practice; International Medical University; Kuala Lumpur
| | - Keivan Ahmadi
- Department of Pharmacy Practice; International Medical University; Kuala Lumpur
| | | | - David WK Chong
- Department of Pharmacy Practice; International Medical University; Kuala Lumpur
| | - Mudassir Anwar
- Department of Pharmacy Practice; International Medical University; Kuala Lumpur
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Ethnicity and the use of “Accepted” and “Rejected” Complementary/Alternative Medical Therapies in Canada: Evidence from the Canadian Community Health Survey. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0275-4959(2012)0000030008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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16
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Reinhard MJ, Nassif TH, Bloeser K, Dursa EK, Barth SK, Benetato B, Schneiderman A. CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans. Med Care 2015; 52:S45-9. [PMID: 25397822 DOI: 10.1097/mlr.0000000000000229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is increasingly seen as an adjunct to traditional plans of care. This study utilized a representative sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and OEF/OIF-era veterans to explore the prevalence and characteristics of CAM users. RESEARCH DESIGN The National Health Study for a New Generation of US Veterans (NewGen) is a longitudinal health study of a population-based cohort of OEF/OIF (deployed) and OEF/OIF-era (nondeployed) veterans. Data from the 2009-2011 NewGen survey (n=20,563) were analyzed to determine prevalence of CAM use by demographic and military characteristics, the types of CAM modalities used, and where the modalities were sought. Results were weighted to the entire population of OEF/OIF and OEF/OIF-era veterans. RESULTS There was no statistically significant association between CAM use and deployment. Those who used Department of Veterans Affairs (VA) health care after separation were more likely to be CAM users compared with those who did not use VA care; however, the majority of veterans using CAM are using it outside the VA health care system. Massage was the most prevalent CAM modality followed by chiropractic treatment; males were less likely to use CAM than women. CONCLUSIONS CAM modalities are being utilized by OEF/OIF veterans for health problems mainly outside the VA. Policymakers should determine appropriate use of these modalities.
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Affiliation(s)
- Matthew J Reinhard
- *War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center †Georgetown University Medical School, Department of Psychiatry ‡American University School of Education, Teaching and Health §US Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program, Washington, DC ∥Veterans Affairs Greenville NC CBOC ¶East Carolina University, College of Nursing, Greenville, NC
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Gale N. The Sociology of Traditional, Complementary and Alternative Medicine. SOCIOLOGY COMPASS 2014; 8:805-822. [PMID: 25177359 PMCID: PMC4146620 DOI: 10.1111/soc4.12182] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 05/20/2023]
Abstract
Complementary and alternative medicine (CAM) and traditional medicine (TM) are important social phenomena. This article reviews the sociological literature on the topic. First, it addresses the question of terminology, arguing that the naming process is a glimpse into the complexities of power and history that characterize the field. Second, focusing on the last 15 years of scholarship, it considers how sociological research on users and practitioners of TM/CAM has developed in that time. Third, it addresses two newer strands of work termed here the 'big picture' and the 'big question'. The big picture includes concepts that offer interpretation of what is happening at a societal level to constrain and enable observed patterns of social practice (pluralism, integration, hybridity and activism). The big question, 'Does it work?', is one of epistemology and focuses on two developing fields of critical enquiry - first, social critiques of medical science knowledge production and, second, attempts to explain the nature of interventions, i.e. how they work. Finally, the article examines the role of sociology moving forward.
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Affiliation(s)
- Nicola Gale
- *Correspondence address: Nicola Gale, Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK. E-mail:
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Cui Y, Hargreaves MK, Shu XO, Liu J, Kenerson DM, Signorello LB, Blot WJ. Prevalence and correlates of complementary and alternative medicine services use in low-income African Americans and whites: a report from the Southern Community Cohort Study. J Altern Complement Med 2012; 18:844-9. [PMID: 22866972 DOI: 10.1089/acm.2011.0363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aimed to examine the prevalence, trends, and correlates of practitioner-based complementary and alternative medicine (CAM) services use according to race in a socioeconomically disadvantaged population. DESIGN Included in this cross-sectional analysis were 50,176 African Americans (AAs) and 19,038 whites enrolled into the Southern Community Cohort Study from March 2002 through September 2009. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of CAM services use associated with participant characteristics. OUTCOME MEASURES Outcomes include the prevalence of and trends in use of CAM services during 2002-2009 and correlates of use by race. RESULTS CAM services use during 2002-2009 was greater among whites (11.7%) than among AAs (8.5%), but no significant temporal trends within the 8-year period were observed. The significant associations were observed for CAM services use with higher educational attainment (OR 1.78, 95% CI: 1.61-1.96 for college versus less than high school), household income (OR 1.61, 95% CI: 1.44-1.81 for ≥$50,000 versus <$15,000), and having a history of a chronic disease (OR 1.34, 95% CI: 1.21-1.47) among both AAs and whites. Significant differences in findings between AAs and whites were seen for age (with a sharp decline in use with older age among AAs but not whites), sex (with the excess of female users more striking among whites), employment (with the unemployed among AAs but not whites more likely to be users), alcohol consumption (with white but not AA drinkers more likely to report CAM services use), and cigarette smoking status (with negative association of use with current smokers more striking among whites). CONCLUSIONS CAM services use is associated with sociodemographic and health-related factors, and racial differences in such use exist. The descriptive findings of this study help supplement the limited information on CAM use among low-income and minority populations in the United States.
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Affiliation(s)
- Yong Cui
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37203, USA.
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Spinks J, Hollingsworth B. Policy implications of complementary and alternative medicine use in Australia: data from the National Health Survey. J Altern Complement Med 2012; 18:371-8. [PMID: 22515796 DOI: 10.1089/acm.2010.0817] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The objective of this study was to investigate the drivers of complementary and alternative medicine (CAM) use in the general population in Australia and to identify key policy implications. DATA AND METHODS The National Health Survey 2007/2008, a representative survey of the Australian population, provides information on CAM use (practitioners and products) in the last 12 months. All adult respondents (N=15,779) aged 18 years or older are included in this study. Logistic regression is employed to determine the effect of socio-economic, condition-specific, health behavior variables, and private health insurance status on CAM use. RESULTS In addition to socio-economic variables known to affect CAM use, individuals who have a chronic condition, particularly a mental health condition, are more likely to use CAM. There does not appear to be a correlation between CAM use and more frequent General Practitioner use; however, ancillary private health insurance is correlated with a greater likelihood of CAM use, as expected. CONCLUSIONS The Australian government does not currently intervene in the CAM market in a systematic way. CAM is clearly considered to be a legitimate and important component of health care for many Australians, despite the limited availability of clinical evidence for its efficacy and safety. Policy interventions may include the regulation of CAM products, practitioners, and information as well as providing subsidies for cost-effective modalities.
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Affiliation(s)
- Jean Spinks
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
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Shippee TP, Schafer MH, Ferraro KF. Beyond the barriers: racial discrimination and use of complementary and alternative medicine among Black Americans. Soc Sci Med 2012; 74:1155-62. [PMID: 22386637 PMCID: PMC3341177 DOI: 10.1016/j.socscimed.2012.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 12/09/2011] [Accepted: 01/05/2012] [Indexed: 01/06/2023]
Abstract
This article examines whether self-reported racial discrimination is associated with greater use of complementary and alternative medicine (CAM) and assesses whether the effects of reported racial discrimination are specific to the setting in which the unfair treatment occurred (i.e., medical or nonmedical settings). Data were drawn from the National Survey of Midlife Development in the United States (MIDUS) of Black adults aged 25 and older at baseline (N=201). Analyses account for multiple forms of discrimination: major lifetime discriminatory events and everyday discrimination (more commonplace negative occurrences). Using logistic and negative binomial regression, results reveal that racial discrimination was associated with a higher likelihood of using any type of CAM as well as using more modalities of CAM. Also, both discrimination in health care and discrimination in nonmedical contexts predicted greater use of CAM. The findings underscore the tenet that health care choices, while influenced by health status and availability of health care resources, are also shaped by perceived barriers. The experience of racial discrimination among Black people is associated with greater use of alternative means of health care, as a way to cope with the barriers they experience in institutional settings in the United States.
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Affiliation(s)
- Tetyana Pylypiv Shippee
- University of Minnesota, Division of Health Policy and Management, 712 Delaware St. SE, Mayo Building, D371, Minneapolis, MN 55407, USA.
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Bishop FL, Lewith GT. Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 7:11-28. [PMID: 18955327 PMCID: PMC2816378 DOI: 10.1093/ecam/nen023] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 02/25/2008] [Indexed: 01/16/2023]
Abstract
Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies.
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Affiliation(s)
- Felicity L Bishop
- Complementary Medicine Research Unit, School of Medicine, University of Southampton, Hampshire, UK
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Fritts M, Calvo A, Jonas W, Bezold C. Integrative medicine and health disparities: a scoping meeting. Explore (NY) 2009; 5:228-41. [PMID: 19608112 DOI: 10.1016/j.explore.2009.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reyes-Ortiz CA, Rodriguez M, Markides KS. The role of spirituality healing with perceptions of the medical encounter among Latinos. J Gen Intern Med 2009; 24 Suppl 3:542-7. [PMID: 19842004 PMCID: PMC2764036 DOI: 10.1007/s11606-009-1067-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the relationship between spirituality healing and perceptions about the medical encounter among Latinos. OBJECTIVES To examine the association between spirituality healing and attitudes of self-reported perceptions about the medical encounter. DESIGN A cross-sectional telephone survey. PARTICIPANTS 3,728 Latinos aged >or=18 years residing in the United States from Wave 1 of the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey. MEASUREMENTS Dependent variables were ever prayed for healing (yes/no), ever asked others to pray for healing (yes/no), considered important spiritual healing (very vs. somewhat or not important), and ever consulted a 'curandero' (folk healer in Latin America) (yes/no). The primary independent variables were feelings about the last time seeing a Doctor (confused by information given, or frustrated by lack of information) and perception of quality of medical care (excellent, good, fair or poor) within the past 12 months. RESULTS Six percent of individuals reported that they had ever consulted a curandero, 60% prayed for healing, 49% asked others to pray for healing, and 69% considered spiritual healing as very important. In multivariable analyses, feeling confused was associated with increased odds of consulting a curandero (OR = 1.58; 95% CI, 1.02-2.45), praying for healing (OR = 1.30; 95% CI, 1.03-1.64), asking others to pray for healing (OR = 1.29; 95% CI, 1.03-1.62), and considering spiritual healing as very important (OR = 1.30; 95% CI, 1.01-1.66). Feeling frustrated by a lack of information was associated with asking others to pray for healing (OR = 1.29; 95% CI, 1.04-1.60). A better perception of quality of medical care was associated with lower odds of consulting a curandero (OR = 0.83; 95% CI, 0.70-0.98). CONCLUSION Feelings about the medical encounter were associated with spirituality healing, praying for healing, and asking others to pray for healing. Feeling confused and perception of poor quality of medical care were associated with consulting a curandero.
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Affiliation(s)
- Carlos A Reyes-Ortiz
- Department of Social & Behavioral Sciences (CARO), School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard (EAD-711B), Fort Worth, TX, 76107-2699, USA.
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Definitions and patterns of CAM use by the lay public. Complement Ther Med 2009; 17:71-7. [DOI: 10.1016/j.ctim.2008.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 09/11/2008] [Accepted: 09/11/2008] [Indexed: 01/28/2023] Open
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Shelley BM, Sussman AL, Williams RL, Segal AR, Crabtree BF. 'They don't ask me so I don't tell them': patient-clinician communication about traditional, complementary, and alternative medicine. Ann Fam Med 2009; 7:139-47. [PMID: 19273869 PMCID: PMC2653970 DOI: 10.1370/afm.947] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although high rates of traditional medicine and complementary and alternative medicine (TM/CAM) use have been well documented, there has been less attention to the factors influencing communication between patients and their primary care clinicians about TM/CAM. Such communication can be important in anticipating possible drug-herb interactions and in assuring agreement about therapeutic plans. METHODS We used sequential, multistage, qualitative methods, including focus groups, in-depth interviews, and a video vignette, to explore communication about TM/CAM between patients and their primary care clinicians. The study was conducted in RIOS Net (Research Involved in Outpatient Settings Network), a Southwestern US practice-based research network, situated largely in Hispanic and American Indian communities where TM/CAM is an important part of self-care. RESULTS One hundred fourteen patients, 41 clinic staff members, and 19 primary care clinicians in 8 clinic sites participated. The degree and nature of TM/ CAM communication is based on certain conditions in the clinical encounter. We categorized these findings into 3 themes: acceptance/nonjudgment, initiation of communication, and safety/efficacy. Perceived clinician receptivity to and initiation of discussion about TM/CAM strongly influenced patients' decisions to communicate; perceived clinician expertise in TM/CAM was less important. Clinicians' comfort with patients' self-care approaches and their level of concern about lack of scientific evidence of effectiveness and safety of TM/CAM influenced their communication about TM/CAM with patients. CONCLUSIONS Specific communication barriers limit patient-clinician communication about TM/CAM. Clinicians who wish to communicate more effectively with their patients about these topics and better integrate the types of care their patients use can change the communication dynamic with simple strategies designed to overcome these barriers.
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Affiliation(s)
- Brian M Shelley
- First Choice Community Healthcare, Albuquerque, New Mexico 87105, USA.
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Stratton TD, McGivern-Snofsky JL. Toward a sociological understanding of complementary and alternative medicine use. J Altern Complement Med 2009; 14:777-83. [PMID: 18578592 DOI: 10.1089/acm.2007.7006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The wide array of treatments and modalities comprising complementary and alternative medicine (CAM) represent a growing option for many individuals. Seeking to better understand this, much research has centered on identifying sociodemographic (e.g., age, gender, race) or social-psychologic (e.g., absorption, depression, coping) correlates of using CAM therapies. In contrast, sociological perspectives recognize the influence of larger-scale, external forces on individuals' motivations to seek alternative or complementary care. AIM This paper, then, illustrates current and potential sociological approaches to understanding CAM use, and the importance of social forces that influence persons' decisions to utilize (or not) "unconventional" medical care.
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Affiliation(s)
- Terry D Stratton
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40506-9983, USA.
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Upchurch DM, Burke A, Dye C, Chyu L, Kusunoki Y, Greendale GA. A sociobehavioral model of acupuncture use, patterns, and satisfaction among women in the United States, 2002. Womens Health Issues 2008; 18:62-71. [PMID: 18069003 DOI: 10.1016/j.whi.2007.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 08/13/2007] [Accepted: 08/20/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the correlates of recent acupuncture use among American women, applying a sociobehavioral model of utilization of conventional health care. Patterns of use, satisfaction, and reasons for acupuncture use are also examined. METHODS The 2002 National Health Interview Survey (NHIS) is used, which included the Alternative Health/Complementary Alternative Medicine Supplement. All analyses and estimates used the NHIS individual-level sampling weights; variance estimates were adjusted to account for complex sample design. Bivariate statistics and logistic regression were used. We included data from 17,112 women. RESULTS Prevalence of recent acupuncture use was low (1.1%), but translates to >1.2 million American women. Multivariate results showed the effects of race and ethnicity on acupuncture use were contingent on educational level. Women living in the West were more likely to use acupuncture, as were women with fair health status, former smokers, current moderate/heavy alcohol users, and women with a higher body mass index. Women tended to use acupuncture for conditions not commonly well treated by conventional medicine (e.g., chronic pain) and the majority reported using acupuncture in conjunction with conventional medicine. CONCLUSIONS Predisposing and enabling factors, as well as medical need and personal health practices, are associated with women's recent use of acupuncture services, including several that are also associated with conventional health care services.
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Affiliation(s)
- Dawn M Upchurch
- UCLA School of Public Health, Los Angeles, CA 90095-1772, USA.
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Wen M. Racial and ethnic differences in general health status and limiting health conditions among American children: parental reports in the 1999 national survey of America's families. ETHNICITY & HEALTH 2007; 12:401-422. [PMID: 17978941 DOI: 10.1080/13557850701300657] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES This research investigates the association between race/ethnicity and child health, and examines the role of family structure, family socioeconomic status (SES), and healthcare factors in this association. Five major racial/ethnic groups in the US are studied. Two child health outcomes, including parent-rated health and limiting health condition, are examined. The analysis is stratified into three age groups: age 0-5, age 6-11, and age 12-17. DESIGN Cross-sectional study using data from a large, nationally representative sample collected in 1999 in the US. RESULTS Older age groups tend to exhibit larger racial/ethnic disparities in child health. Except for some age groups of Asian youths, minority children and adolescents generally show higher risks of fair or poor parent-rated health and limiting health condition relative to Whites. Family SES partly explains the effects of Black, Hispanic, and Native American groups, but significant amount of residual effects remain. Family structure explains some Black effects, but not for other minority groups. Healthcare factors do not contribute much to the racial/ethnic differences. Both family structure and healthcare factors are important factors of child health in their own right. None of the social factors examined can explain the effects of the Asian group. Data also show that economic resources play a more salient role in child health than parental education, especially in young children. In addition, healthcare factors, to some extent, can explain why children from higher SES families fare better in health. CONCLUSION Racial/ethnic disparities in health start early in life. Except for Asians, class explains a substantial amount, but not all, of these disparities. Healthcare factors play some role in explaining health disparities by class. Structural solution seems to be needed to reduce disparities by race/ethnicity among youths.
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Affiliation(s)
- Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT 84112, USA.
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Fitzgerald M, Culbert T, Finkelstein M, Green M, Johnson A, Chen S. The Effect of Gender and Ethnicity on Children’s Attitudes and Preferences for Essential Oils: A Pilot Study. Explore (NY) 2007; 3:378-85. [PMID: 17681258 DOI: 10.1016/j.explore.2007.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Indexed: 11/17/2022]
Abstract
CONTEXT Aromatherapy is frequently recommended for children but children's preferences for specific essential oils are not well documented. OBJECTIVE To measure preferences of school aged children for essential oils based on gender and ethnicity. DESIGN Descriptive study measuring children's responses to and preferences for selected essential oils. SETTING Pediatric integrative medicine clinic in a Midwestern children's hospital. PARTICIPANTS Healthy school-age children of Latino (N = 39) and non-Latino Caucasian (NLC) (N = 48) ethnicity, 41.7% of the NLC group and 59.0% of the Latino Group were males. INTERVENTION Participants smelled single essential oils, answered three forced choice questions and one open ended question, order of exposure was varied. OUTCOME MEASURES Participants evaluated each scent's effect on mood and energy, stated their preferences, indicated if scents evoked particular thoughts and selected a favorite essential oil. RESULTS Females were more likely to feel happy when smelling sweet orange (p = .043). Female Latinos were more likely than NLC females to find sweet orange calming (56.2% vs. 18.5%). Male Latinos were more likely (65.2%) to describe peppermint as "energetic" than male NLC (30%). Children chose an essential oil that they rated as "making them feel happy" (72.6%) and/or as "liking the most" (64.3%). Other results that approached statistical significance were: females felt more energetic with spearmint (p = .055). Latinos preferred spearmint over NLC (p = .075), and all males felt more energetic when smelling ginger (p = .091). Ginger and lavender were the least preferred. Results indicate that children have specific essential oil scent preferences. There is trend toward differences based on gender and ethnicity.
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Affiliation(s)
- Maura Fitzgerald
- Integrative Medicine Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
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Loera JA, Reyes-Ortiz C, Kuo YF. Predictors of complementary and alternative medicine use among older Mexican Americans. Complement Ther Clin Pract 2007; 13:224-31. [PMID: 17950177 DOI: 10.1016/j.ctcp.2007.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 03/02/2007] [Indexed: 11/17/2022]
Abstract
To determine predictors of complementary and alternative medicine (CAM) use, we used a cohort of 1445 non-institutionalized Mexican Americans aged 65 and older from the first wave (1993-1994) of the Hispanic Established Population for the Epidemiologic Study of the Elderly, followed until 2000-2001. The main outcome was use of any CAM (herbal medicine, chiropractic, acupuncture, massage therapy, relaxation techniques or spiritual healing) in the past 12 months and was assessed at 7 years of follow-up. Potential predictors of CAM use at baseline included sociodemographics, acculturation factors, and medical conditions. The overall rate of CAM use among older Mexican Americans was 31.6%. Independent predictors of higher CAM use were female gender, being on Medicaid, frequent church attendance and higher number of medical conditions. In contrast, subjects who were born in US and spoke either Spanish or English at interview had lower CAM use compared with subjects who were born in Mexico.
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Affiliation(s)
- Jose A Loera
- Department of Internal Medicine-Geriatrics Division, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.
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