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Prevalence of Complementary and Alternative Medicine and Herbal Remedy Use in Hispanic and Non-Hispanic White Women: Results from the Study of Women's Health Across the Nation

OBJECTIVES

To investigate the prevalence of complementary and alternative medicine (CAM) use, including botanical/herbal remedies, among Hispanic and non-Hispanic white women from the Study of Women's Health Across the Nation (SWAN), New Jersey site. We also examined whether attitudes toward CAM and communication of its use to providers differed for Hispanic and non-Hispanic women.

STUDY DESIGN

SWAN is a community-based, multiethnic cohort study of midlife women. At the 13th SWAN follow-up, women at the New Jersey site completed both a general CAM questionnaire and a culturally sensitive CAM questionnaire designed to capture herbal products commonly used in Hispanic/Latina communities. Prevalence of and attitudes toward CAM use were compared by race/ethnicity and demographic characteristics.

RESULTS

Among 171 women (average age 61.8 years), the overall prevalence of herbal remedy use was high in both Hispanic and non-Hispanic white women (88.8% Hispanic and 81.3% non-Hispanic white), and prayer and herbal teas were the most common modalities used. Women reported the use of multiple herbal modalities (mean 6.6 for Hispanic and 4.0 for non-Hispanic white women; p = 0.001). Hispanic women were less likely to consider herbal treatment drugs (16% vs. 37.5%; p = 0.005) and were less likely to report sharing the use of herbal remedies with their doctors (14.4% Hispanic vs. 34% non-Hispanic white; p = 0.001). The number of modalities used was similar regardless of the number of prescription medications used.

CONCLUSIONS

High prevalence of herbal CAM use was observed for both Hispanic and non-Hispanic white women. Results highlight the need for healthcare providers to query women regarding CAM use to identify potential interactions with traditional treatments and to determine whether CAM is used in lieu of traditional medications.

Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians

OBJECTIVE

Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services.

DESIGN

Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use.

RESULTS

Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind-body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07-2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language.

CONCLUSIONS

CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service.

A sociobehavioral wellness model of acupuncture use in the United States, 2007

OBJECTIVES

The purpose of this study was to provide updated and more comprehensive data on the correlates and patterns of acupuncture use in the United States, applying a sociobehavioral wellness model of utilization. Predisposing factors, enabling resources, need, and personal health practices were investigated. Patterns of recent usage, including assessing the reason for use based on treatment of a health condition, for wellness, or both, were examined. Also, for the first time, attitudes about acupuncture reported by previous users and never users were presented.

DESIGN

Data from the 2007 National Health Interview Survey (NHIS), a cross-sectional, household survey representative of the U.S. civilian population, were used, which included the Complementary and Alternative Medicine supplement. Adults 18 and over (n=22,512) were analyzed. Bivariate prevalence estimates were obtained and logistic regression models were estimated. In addition, all analyses were weighted.

OUTCOME MEASURES

The primary outcome measure was recent use of acupuncture, defined as any use in the past 12 months.

RESULTS

In 2007, 6.8% of adults reported lifetime use of acupuncture and 1.5% reported use in the past 12 months. Multivariate results showed significant effects in the expected directions for multiple variables in each of the four domains of our conceptual model (predisposing factors, enabling resources, need, and personal health practices). Among recent users, close to half reported some mention of wellness as a reason for use. Musculoskeletal conditions and pain were the top health conditions treated and these users, to some extent, integrated conventional and acupuncture care. Negative attitudes or skepticism about acupuncture were not common reasons for nonuse among prior and never users.

CONCLUSIONS

Application of a sociobehavioral wellness model to frame correlates and patterns of recent acupuncture use in the Unites States shows promise.

Chronic pain management by ethnically and racially diverse older adults: pharmacological and nonpharmacological pain therapies

SUMMARY Aims: Exploration of racial and ethnic group differences in noncancer chronic pain management in older adults. Participants & methods: Qualitative data, which were collected in semistructured face-to-face interviews with 44 racially and ethnically diverse community-dwelling older adults (ten African–Americans, ten Hispanics, 12 Afro–Caribbeans and 12 non-Hispanic whites), were analyzed using constant comparative analysis. Results: The three racial and ethnic minority groups were more likely to use culturally based treatments (e.g., herbal tea and avocado leaves), home remedies and folk medicine, and/or psychological therapies (e.g., distraction and relaxation) than non-Hispanic whites to manage chronic pain. African–Americans relied on religious coping methods. Non-Hispanic whites were more likely to use physical interventions such as massage and chiropractic treatment. Conclusion: Study findings suggest differences by ethnicity in preferred pain interventions for an older adult population.

Effect of back massage intervention on anxiety, comfort, and physiologic responses in patients with congestive heart failure

BACKGROUND

Patients suffering from congestive heart failure (CHF) frequently feel physical suffering and anxiety.

OBJECTIVES

The researchers investigated whether back massage could reduce anxiety, discomfort, and physical suffering in patients with CHF. The effects of gender and severity-dependent response of back massage on anxiety and discomfort in patients were also analyzed.

DESIGN

The study used a quasi-experimental design with one group pretest and posttest.

PARTICIPANTS

Sixty-four participants were recruited in southern Taiwan.

OUTCOME MEASURES

The modified State Anxiety Inventory, the discomfort Visual Analogue Scale, electronic blood pressure (BP) gauges, stethoscopes and the pulse oximetry were used in this study.

RESULTS

The participants' systolic BP (F (3, 189)=18.91, p<0.01), diastolic BP (F (3, 189)=13.40, p<0.01), heart rate (F (3, 189)=26.28, p<0.01), and respiratory rates (F (3, 189)=5.77, p<0.01) were significantly decreased after back massage. Oxygen saturation levels showed significant increases (F (3, 189)=42.82, p<0.01). Male participants revealed a more significant reduction in anxiety than the female participants (F (1, 50)=7.27, p=0.01). Those with more severe heart failure and greater levels of anxiety (F (2, 61)=4.31, p=0.02) and systolic BP (F (2, 61)=3.86, p=0.03) demonstrated significantly greater responses to back massage.

CONCLUSIONS

Back massage significantly reduced anxiety in the study population. Systolic BP decreased to a greater degree in the male participants, particularly in those with severe heart failure and greater levels of anxiety and higher systolic BP. This study was conducted without a control group. Randomized clinical trials are needed to validate the effectiveness of back massage on patients with CHF.

Complementary or controversial care? The opinions of professionals on complementary and alternative interventions for Autistic Spectrum Disorder

The use of complementary and alternative interventions is growing and gaining popularity, both in the UK and internationally, with significant financial and emotional implications. Complementary and alternative interventions are often utilised by parents of children with Autistic Spectrum Disorders and research has investigated parental beliefs. There is, however, limited understanding regarding what professionals believe about the use of alternative treatments. In this paper we explore the opinions of a range of different professionals about alternative treatments and found that while some have an open-minded opinion, there was a tendency to hold beliefs that these treatments are ineffective, that they give false hope and have potential to harm the child. We discuss the implications for this in terms of the importance of an open dialogue between professionals and families and consider the importance of this in relation to the popularity of these interventions.

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

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.

A multivariate test of an expanded Andersen Health Care utilization model for complementary and alternative medicine (CAM) use in African Americans

OBJECTIVES

The objectives of this study were (1) to determine which Andersen Model variables [predisposing, enabling, and need (PEN)] are related to complementary and alternative medicine (CAM) use by African Americans in the past 12 months; and (2) to determine whether the addition of disease states to the Model will explain significant variation in CAM use in the past 12 months.

DESIGN

The 2002 National Health Interview Survey was used with 4256 African American adults (n = 23,828,268 weighted) selected as the study population. The dependent variable, CAM Past 12 Months, represented participants' use of at least 1 of 17 CAM modalities during the past 12 months. The Andersen Model variables [predisposing (e.g., age); enabling (e.g., insurance); and need (e.g., medical conditions)] and prevalent disease states (> or =10%) comprised the independent variables. Logistic regression analyses, incorporating the sampling weights, were employed.

RESULTS

Among predisposing factors, CAM use was associated with middle-aged to older, more educated, and female African Americans. Region (Northeast less likely than South) was the only significant enabling factor. Need factors had the most frequent relationships, with more medical conditions, more physician visits, better health status, prescription and over-the-counter medication use, more frequent exercise, and having activities of daily living limitations being associated with CAM use. After adjusting for PEN factors, the disease states of pain/aching joints, recurring pain, and migraine were related to CAM use.

CONCLUSIONS

African American CAM users are middle-aged to older, female, educated, and have more medical conditions (especially pain-related). Users report higher utilization of "traditional" care (e.g., physician visits), indicating that CAM is likely a complement to conventional treatment in this population. Health care providers should use these factors as prompts for inquiring about CAM use in African American patients.

If you build it, will they come? A free-care acupuncture clinic for minority adolescents in an urban hospital

OBJECTIVE

To describe the establishment and integration of a free-care acupuncture clinic within an urban hospital with an underserved minority adolescent population and to study patient utilization.

BACKGROUND

Surveys often show low use of acupuncture among underserved non-Asian minority populations. We hypothesized that it would be possible to integrate an acupuncture clinic into a biomedical setting. We also hypothesized that the removal of economic and logistical barriers would increase usage of an acupuncture service among minority adolescent and pediatric populations, who may otherwise have had little cultural exposure to the modality.

METHODS

A review of the process involved in establishing a free acupuncture clinic, and an analysis of visit data.

RESULTS

A free faculty-supervised student acupuncture clinic was successfully integrated into an urban hospital-based adolescent clinic serving predominantly low-income minorities. During 2004-2006, the acupuncture clinic had 544 visits for a wide range of conditions. Visits increased 65% from the first to the third year of operation.

CONCLUSIONS

An acupuncture service can be successfully integrated into care provided by an urban hospital that serves low-income minority and immigrant patients. Strategic removal of barriers to access can result in patients previously unfamiliar with acupuncture choosing to access the modality.

Health practices and vaginal microbicide acceptability among urban black women

BACKGROUND

Intravaginal topical microbicides are being investigated for prevention of HIV transmission. Use of vaginal microbicides will constitute a new type of practice, occurring in the context of other vaginal practices related to contraception, hygiene, and self-care, which are affected by cultural norms and personal beliefs. Given the high rate of HIV infection among black women, research on practices and decision making relevant to microbicide acceptability is needed in this population.

METHODS

Twenty-three black women in New York City, aged 25-64, completed in-person semistructured interviews and self-administered questionnaires. Quantitative analyses examined vaginal practices and willingness to use microbicides. Qualitative analyses explored underlying decision-making processes involved in choices regarding vaginal practices and general healthcare.

RESULTS

Willingness to use vaginal products for HIV prevention was high, especially among more educated women. Safety was a major concern, and women were cautious about using vaginal products. Whereas some viewed synthetic products as having potentially harmful side effects, others perceived natural products as risky because of insufficient testing. Choices about vaginal practices were affected by assessments of risk and efficacy, prior experience, cultural background, and general approach to healthcare.

CONCLUSIONS

The majority of women in the sample expressed willingness to use a vaginal product for HIV prevention. Decision-making processes regarding vaginal practices were complex and were affected by social, cultural, and personal factors. Although specific preferences may vary, attitudes toward using a vaginal product are likely to be positive when side effects are minimal and the product is considered safe.

Patterns of complementary and alternative medicine use in African Americans

OBJECTIVES

This study sought to determine (1) characteristics of complementary and alternative medicine (CAM) users in the African-American (AA) population; (2) the prevalence of CAM use; and (3) CAM use for treatment and prevention of disease.

DESIGN

The authors analyzed data from the 2002 National Health Interview Survey (NHIS), which included 4256 AA adults representing 23,828,268 AA adults nationwide. Chi-squared tests based on weighted data were used to examine differences in CAM users and nonusers.

OUTCOME MEASURES

CAM use was categorized as CAM Ever, CAM Past 12 Months, and CAM for Treatment.

RESULTS

A total of 23,828,268 (weighted) AAs were identified in the NHIS dataset. Of those, 67.6% used CAM in the past 12 months, when prayer for health was included. Users were more likely older (43.3 +/- 0.4 versus 39.5 +/- 0.5 years; p < 0.0001); female (60.9% versus 44.0%; p < 0.0001), college educated (17.4% versus 9.8%; p < 0.0001); and insured (91.0% versus 88.1%; p < 0.0001) compared to nonusers. Prayer was the most common CAM used by more than 60% of respondents, followed by herbals (14.2%) and relaxation (13.6%). A majority utilized CAM to treat illness. The use of CAM was significantly (p < 0.0001) higher across all the disease states common in AAs compared to nonuse.

CONCLUSIONS

A substantial number of AAs use CAM, with use varying across sociodemographic characteristics. Prayer was the most commonly used therapy. Overall, CAM was most often used for the treatment of specific conditions as opposed to prevention, and its use was common among AAs with prevalent disease states. The extent to which CAM served as a complement or an alternative to conventional medical treatment among AAs is unknown and should be investigated.

Acupuncture use in the United States: findings from the National Health Interview Survey

OBJECTIVE

Acupuncture has become an important provider-based complementary and alternative medicine (CAM) treatment. To improve understanding of its role in personal health care, an analysis of national data was conducted to examine user sociodemographics, conditions treated, and the relationship of use with conventional Western medical care.

DESIGN

A nationally representative cross-sectional survey.

SETTING

The 2002 National Health Interview Survey (NHIS), conducted in all 50 states and the District of Columbia.

PARTICIPANTS

Thirty-one-thousand and forty-four (31,044) adults who completed the NHIS Sample Adult Core.

OUTCOME MEASURES

The primary outcome measure was recent use of acupuncture, defined as use within the previous 12 months.

RESULTS

In the 2002 NHIS sample, 4.1% of the respondents reported lifetime use, and 1.1% (representing 2.13 million Americans) reported recent use of acupuncture. Recent use (n = 327) was positively associated with being an Asian female, living in the West or Northeast, having poorer self-reported health status, a higher level of education, and being an ex-smoker. Among recent users, the most typical treatment regimen was two to four treatments (34.5%), with musculoskeletal complaints being the most frequently reported conditions, led by back pain (34.0%). Reports of perceived benefit were generally high. Respondents indicated that acupuncture was used both as an alternative and as a complementary therapy. A reasonable number also reported being referred to acupuncture by a conventional medical professional (25.3%). The cross-sectional nature of the data precluded analysis of transitions in health care use (between conventional and CAM treatments) over time.

CONCLUSIONS

Utilization of acupuncture was somewhat lower than expected given its significant national and international recognition and its visibility in the media. This may in part be a function of provider availability and cultural factors.

Changes in Blood Pressure After Various Forms of Therapeutic Massage: A Preliminary Study

OBJECTIVES

The objective of this study was to determine the change in blood pressure (BP) in normotensive and prehypertensive adults resulting from a therapeutic massage, and the factors associated with such changes, including demographic and massage characteristics.

DESIGN

SETTINGS/LOCATION

National University of Health Sciences Massage Therapy Clinic, Lombard, IL.

SUBJECTS

The subjects were 150 current adult massage therapy clients with BP lower than 150/95.

INTERVENTIONS

BP was measured before and after a therapeutic massage.

OUTCOME MEASURES

Change in BP and potential associated factors such as type of massage, duration of massage, specific body area massaged, amount of massage pressure, and demographic characteristics were studied.

RESULTS

Overall, systolic BP decreased by 1.8 mm Hg and diastolic BP increased by 0.1 mm Hg. Demographic factors associated with BP decrease included younger age (p = 0.01) and taller stature (p = 0.09). Type of massage was associated with change in BP: Swedish massage had the greatest effect at BP reduction. Trigger point therapy and sports massage both increased the systolic BP, and if both forms of massage were included in a session, both the systolic and diastolic BP readings significantly increased. No other massage factors were associated with a significant change in BP.

CONCLUSIONS

Type of massage was the main factor affecting change in BP. Increases in BP were noted for potentially painful massage techniques, including trigger point therapy.