Use of alternative therapies among Mexican Americans in the Texas Rio Grande Valley

Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature

BACKGROUND

Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.

OBJECTIVE

There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level.

SEARCH STRATEGY

Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021.

INCLUSION CRITERIA

Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review.

DATA EXTRACTION AND ANALYSIS

Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status.

RESULTS

A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%).

CONCLUSION

This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: a scoping review of the literature. J Integr Med. 2023; Epub ahead of print.

Commentary on Metabolic Health Disparities Affecting the Rio Grande Valley Mexican American Population: Seeking Answers Using Animal Models

Mexican Americans living in the Rio Grande Valley (RGV) have a high prevalence of type 2 diabetes (T2D). The US-Mexico border frontier has a unique blended culture of American lifestyle and Mexican traditions. Some examples of the cultural traditions are the food and the use of herbal medicine, but these traditions are in danger of disappearing after a very short number of generations living in the United States. This article describes the use of animal models under experimental conditions to solve practical questions (etiology or treatment). We performed studies with murine (ie, mouse and rat) models to elucidate the characteristics of medicinal plants that modulate glucose metabolism and inflammation and protect from bone loss, complications related to T2D. The University of Texas Rio Grande Valley researchers also have collaborated with the University of Texas Health Science Center at San Antonio researchers in performing studies in nonhuman primates (NHP) (ie, baboon) to understand the effect of T2D and diets on organs and tissues. With the new knowledge gained from the use of animal models (murine and NHP), new therapies are discovered for the prevention and treatment of T2D and its related complications, such as bone loss and nonalcoholic fatty liver disease, all of which the Mexican American and other human populations are at high risk of developing.

The monetary burden of cysticercosis in Mexico

Background

Taenia solium cysticercosis is a public health and agricultural problem in many low and middle-income countries where health education, sanitation, pig management practices and meat inspection infrastructure are insufficient. Cysticercosis affects both human and animal health and has important economic consequences. Very few studies have been conducted to evaluate the monetary burden of cysticercosis. This study aimed at estimating the 2015 costs associated with cysticercosis in humans and pigs in Mexico.

Methods

The monetary burden of human cysticercosis was estimated based on costs incurred by living with and treating epilepsy and severe chronic headaches associated with neurocysticercosis (NCC). The estimated cost of porcine cysticercosis took into consideration losses due to the reduction in the price of cysticercosis-infected animals. Epidemiologic and economic data were obtained from the published literature, government reports, and setting-specific questionnaires. Latin hypercube sampling methods were employed to sample the distributions of uncertain parameters and to estimate 95% credible regions (95% CRs). All results are reported in 2015 U.S.$.

Findings

The overall monetary burden associated with NCC morbidity was estimated at U.S.$215,775,056 (95% CR U.S.$109,309,560 –U.S.$361,924,224), with U.S.$436 (95% CR: U.S.$296 –U.S.$604) lost per patient. If loss of future years of income and productivity due to NCC-associated deaths was included, this value increased by U.S.$54.26 million, assuming that these individuals earned Mexico’s median wage salary. An additional U.S.$19,507,171 (95% CR U.S.$5,734,782 –U.S.$35,913,487) was estimated to be lost due to porcine cysticercosis.

Conclusions

This study suggests that T. solium cysticercosis results in considerable monetary losses to Mexico.

Taenia solium cysticercosis is a parasitic disease, which can be transmitted between humans and pigs in areas of the world where pigs are raised in a traditional manner and latrines are not always used by the local population. Because cysticercosis affects humans and pigs, it is important to assess how much this infection costs both the public health and agricultural sectors in endemic countries such as Mexico. Costs associated with infection of both humans and pigs, in Mexico, were estimated using the literature, questionnaires, and publicly available data. Study findings suggest that T. solium cysticercosis results in considerable monetary losses to Mexico. The methodology developed here can be applied to estimate the monetary burden of cysticercosis in other regions in order to better prioritize disease control initiatives.

Conventional and Complementary Therapy Use among Mexican Farmworkers in North Carolina: Applying the I-CAM-Q

Objectives: This analysis documents the use of conventional health-care providers, traditional healers, and complementary therapies by Mexican farmworkers; identifies the purposes and perceived helpfulness of these modalities; and delineates variation in the use of traditional healers and complementary therapies. Methods: Two-hundred Mexican farmworkers in North Carolina completed interviews May-September, 2017. The International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) elicited use of conventional health-care providers, traditional healers, and complementary therapies in the previous 12 months. Results: Most of the farmworkers had been treated by a conventional provider (63.0%). One-in-five had been treated by any traditional healer; 19.5% had been treated by a sobador, 4.5% by a curandero, 2.0% by an herbalist, and 2.0% by a spiritual healer. Conventional providers (69.8%) and sobadores (84.6%) most often treated acute conditions; 62.5% had used an herb, 46.0% a vitamin, 57.0% an over-the-counter medicine, and 13.5% a home remedy. Participants used various self-care practices, including music (36.5%), sleep (18.0%), prayer for health (15.0%), and social media (14.0%). Education was inversely associated with the use of a traditional healer and herbs; treatment by a conventional health-care provider was positively associated with using a traditional healer and vitamins. Conclusions: Mexican farmworkers use conventional health-care providers as well as traditional healers and complementary therapies. Research on how use of complementary therapies and a system of medical pluralism affects farmworker health is needed. Health-care providers need to recognize complementary therapy use and provide patient education about ineffective or harmful therapies.

The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

Background

Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.

Methods

Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition.

Results

The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).

Conclusions

This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.

Strategies for Providing Culturally Appropriate Pharmaceutical Care to the Hispanic Patient

As the American Hispanic population grows, the need for health care services for individuals who do not speak English is becoming increasingly apparent. Spanish-speaking persons encounter difficulties accessing health care. This article focusses on the special needs of the Spanish-speaking individual in the health care system and presents strategies for providing culturally appropriate care.

Health Care Seeking Among Mexican American Men

This focused ethnography explored health care seeking beliefs and behaviors of Mexican American men living in south central Washington State. Data collection included interviews with 36 research participants living in the community, participant observation in the research setting, and examination of ethnographic documents and cultural artifacts. Four major themes were identified: the identity of manhood dictates health care seeking, health means being able to be a man by fulfilling cultural obligations, illness means not being able to be a man, and men seek health care when their manhood is threatened or impaired. Machismo, the cultural concept of manliness, persisted among men despite the level of acculturation and other factors. Women influenced men’s health care seeking behaviors. To fulfill their obligations, men must stay healthy and seek care when needed. Knowing when and why men do not seek health care enables nurses to better understand and serve the Mexican American community.

Nurse-Curanderas

Bilingual nurse-curanderas are an emerging group of health care providers who blend the profession of nursing with Hispanic folk healing,thus providing culturally competent care to one of the largest growing minority groups in the United States. Nursecuranderas integrate curanderismo (Hispanic folk healing) with allopathic health care,evaluate safety and efficacy,and implement appropriate interventions. This balance reduces cultural conflict and improves outcomes by increasing patient compliance with the treatment regimen. A Spanish-English glossary of terms used is included.

Use of complementary and alternative medicines and supplements by Mexican-origin patients in a U.S.-Mexico border HIV clinic

This article draws from a study investigating the influence of institutional and psychosocial factors on adherence to antiretroviral (ARV) medications by Mexican-origin persons living with HIV (PWLH) on the U.S.-Mexico border and seeking treatment at a clinic in El Paso, Texas. Among 113 participants, many individuals reported using complementary and alternative medicines (CAM) to support general health and their immune systems and to address symptoms of HIV-related diseases and ARV side effects. CAM were seen as complementing ARV treatment; however, CAM use was often not reported to health care providers out of concern about disapproval and loss of care privileges. This finding challenges researchers and providers to consider seriously how Hispanic populations, with their CAM use, may exhibit the hybridization of health and healing. Information on CAM use needs to be available to providers to assess the benefits and contraindications of use and to develop realistic and effective care strategies.

Self care and health-seeking behavior of migrant farmworkers

There are an estimated three million migrant and seasonal farmworkers (MSFW) in the United States. In addition to the inherent dangers of farm work, numerous factors place MSFW at even greater risk for work-related injuries. Little is known about how MSFW care for work-related injuries, and how the decision to seek professional care is made. A prospective survey using face-to-face structured interviews was used to explore the type and frequency of occupational injuries as well as self-care and health-care seeking practices of MSFW. Musculoskeletal injuries were the most commonly reported injuries, followed by injuries of the skin and chemical exposure. Self care with over-the-counter remedies was the predominant method of dealing with injuries, and, with the exception of chemical exposure, was found to be for the most part, appropriate. The reported use of alternative medicine or herbal remedies was low. Future research efforts should focus on ergonomic modifications and farmworker education to reduce or prevent musculoskeletal injuries. The number of reported chemical exposures and inappropriate treatment draw attention to the need for continued efforts for both primary prevention of exposure and optimal treatment once exposure occurs.

Research opportunities with curanderos to address childhood overweight in Latino families

Curanderos are consulted as an adjunct or alternative to biomedical health care in the greater southwest, although the extent of their involvement in obesity prevention and treatment is poorly understood. Seven curanderos participated in audiotaped interviews about their work with families and beliefs about childhood feeding and overweight. Themes reflected curanderos' beliefs about their practice and childhood obesity. Curanderos approach their work as a calling, emphasizing elements from nature in etiology and cure. From the curandero's standpoint, essential elements of obesity management must acknowledge the socially marginalized experiences of Latinos. We encountered working with curanderos as problematic, and this likely reflected our differing personal characteristics and a tension between our healing professions. Curanderos could serve as collaborators in childhood obesity interventions if we craft health messages and delivery modes that resonate with Latino families and address ethical and communication issues on the research team.

Health disparities and health-seeking behavior among Latino men: a review of the literature

Many studies examining Latino health-seeking behavior have focused on comparing Latinos with other ethnic groups, primarily with Whites and African Americans. However, without the benefit of intragroup or intracultural comparisons, such studies fail to identify the subtle variation in health-seeking strategies and the range of needs within the Latino ethnic group, and thus are compromised in their capacity to guide and improve practice and policy. This article reviews the literature regarding health-seeking behavior and Latino men. Important factors identified include gender, occupation, and responsiveness of the health care system along with characteristics of the individual.

Integrated primary care and behavioral health services for Latinos: a blueprint and research agenda

Disparities in Latino utilization of mental health services have been documented for some years. Factors such as stigma, low rates of health insurance, paucity of culturally competent providers, and linguistic inaccessibility have contributed to this underutilization. The documented tendency of many Latinos to experience the mind and body as a unified whole, often referred to as "non-dualism"; provides a unique opportunity to address these disparities in utilization. This article advocates a specific model of engagement of Latinos into a continuum of needed behavioral health services via the primary care clinic, and suggests a variety of clinical and administrative outcome measures for evaluating the effectiveness of the model. The model centers on the inclusion of a behavioral health specialist who is "nested" within the primary care team. The preparation and perspectives of clinically trained social workers make them ideal for this role.

The complementarity and substitution between unconventional and mainstream medicine among racial and ethnic groups in the United States

OBJECTIVES

To describe racial and ethnic differences in the utilization patterns of 12 common types of complementary and alternative medicine (CAM) and mainstream medicine (MSM) and to test whether a specific CAM type is a substitute for or a complement to MSM among five racial and ethnic groups in the United States.

METHODS

The Medical Expenditure Panel Survey in 1996 and 1998 were used. The sample of 46,673 respondents was stratified into non-Hispanic whites (NHW), Hispanics, blacks, Asians, and other races. Twelve types of CAM visits and visits to office-based and outpatient physicians were used to describe the pattern of CAM and MSM use. Utilization patterns among each racial and ethnic group were established and compared. Multivariate analyses were conducted to test whether each type of CAM and MSM were complements or substitutes within a racial and ethnic group, controlling for respondents' sociodemographics and health.

RESULTS

Significant intergroup differences in the prevalence rates of using various types of CAM were found. In particular, for some racial and ethnic groups, CAM can be either a substitute for or a complement to MSM visits, depending on the CAM type. More complementary relationships between CAM and physician visits were found in NHW and Asians than in other groups. All significant relationships between CAM types and physician visits among Hispanics and other races (predominantly Native American Indians) were substitution.

CONCLUSIONS

Complementarity and substitution of CAM and MSM varied by racial and ethnic groups and by type of CAM. Culturally sensitive approaches are needed in successful integration of CAM in treatment management.

Chiropractic and CAM utilization: a descriptive review

OBJECTIVE

To conduct a descriptive review of the scientific literature examining use rates of modalities and procedures used by CAM clinicians to manage chronic LBP and other conditions

DATA SOURCES

A literature of PubMed and MANTIS was performed using the key terms Chiropractic; Low Back Pain; Utilization Rate; Use Rate; Complementary and Alternative Medicine; and Health Services in various combinations.

DATA SELECTION

A total of 137 papers were selected, based upon including information about chiropractic utilization, CAM utilization and low back pain and other conditions.

DATA SYNTHESIS

Information was extracted from each paper addressing use of chiropractic and CAM, and is summarized in tabular form.

RESULTS

Thematic analysis of the paper topics indicated that there were 5 functional areas covered by the literature: back pain papers, general chiropractic papers, insurance-related papers, general CAM-related papers; and worker's compensation papers.

CONCLUSION

Studies looking at chiropractic utilization demonstrate that the rates vary, but generally fall into a range from around 6% to 12% of the population, most of whom seek chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine.

Race/ethnicity and women's use of complementary and alternative medicine in the United States: results of a national survey

OBJECTIVES

We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans.

METHODS

We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women.

RESULTS

Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans.

CONCLUSIONS

CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.

Herbal Remedies Used by Selected Migrant Farmworkers in El Paso, Texas

CONTEXT

Little is known about the use of complementary and alternative medicine among the approximately 1.6 million migrant farmworkers in the United States.

PURPOSE

To evaluate the use of medicinal plants and natural remedies among a convenience sample of 100 migrant farmworkers living temporarily in a migrant worker center in El Paso, Texas.

METHODS

A structured interview instrument was designed to elicit information about reasons for medicinal herb use, form in which herbs were ingested, serious side effects experienced, location of purchase, effectiveness of treatment, and use of allopathic medications.

FINDINGS

The majority of workers used herbal remedies or other natural products because they believed them to be more effective than pharmaceuticals and because of tradition. Most learned about herbal remedies from a relative, primarily from their mother, and the majority who used herbal remedies believed them to be very helpful in treating specific illnesses. No adverse reactions to any herbal remedy were reported. The majority of participants did not inform their physician about their use of herbal remedies. According to the literature, potential adverse interactions between herbal remedies used and allopathic medications included gastrointestinal irritation, renal toxicity, and hypoglycemia.

CONCLUSIONS

Health care providers must be knowledgeable about the use of herbal remedies among migrant farmworkers. By showing an understanding of and sensitivity to the use of these remedies, health care providers will be able to conduct more comprehensive health assessments of migrant workers and their families and provide them with more culturally competent care.

Use of complementary and alternative medicine among American women

INTRODUCTION AND BACKGROUND

Although women are increasingly using complementary and alternative (CAM) therapies, a national profile characterizing women who use CAM has yet to be described. The purpose of this study is to provide prevalence estimates of recent CAM use among American women and to examine sociodemographic and other characteristics associated with use.

METHODS

Data from the 1999 National Health Interview Survey are used for the analysis. Three operational definitions of recent CAM use are employed (any CAM, type-specific, and domain-specific use). All proportions and prevalence estimates are weighted and standard errors are adjusted to account for complex sample design; weighted logistic regression (with coefficient variance adjustment) is also used.

RESULTS

Overall, 33.5% of American women used CAM in the past 12 months. Spiritual healing/prayer and herbal medicine are the most commonly used, and hypnosis, biofeedback, and energy healing are the least common. Multivariate results show that women who are older, have more education, poorer health, or live in the west or midwest (versus south) are more likely to use CAM. Compared to whites, blacks, Hispanics, and Asians are less likely to use CAM. Foreign-born women, those with lower income, or who live in the Northeast are also less likely to use CAM. Insurance status is not independently associated with CAM use.

CONCLUSIONS AND DISCUSSION

This study provides one of the first comprehensive investigations of CAM use among American women. Future research examining the determinants of CAM use, incorporating attitudinal and health conditions, as well as clinical efficacy, effectiveness, and health outcome studies of specific CAM therapies are warranted.

Acculturation and adherence: issues for health care providers working with clients of Mexican origin

Providing care to clients who come from different countries is a challenge for the American health care providers as they traverse the issues of cultural health beliefs and practices and language and knowledge deficits. It is just as difficult for the clients as they face new cultural customs, language barriers, and unfamiliar health care systems and medical management plans. Both parties face acculturation and adherence challenges. This article intends to address these issues as they pertain to clients of Mexican origin and to identify key points to be considered by providers when working with this population.

Home remedies for type 2 diabetes used by Mexican Americans in El Paso, Texas

The purpose of this article is to examine the use of herbal remedies to treat Type 2 diabetes among Mexican Americans in El Paso County, Texas, on the U.S.-Mexico border. Interviews were conducted in Spanish with 22 Mexican American adults diagnosed with Type 2 diabetes mellitus. Open-ended questions were used to elicit theparticipants' beliefs about the appropriate treatment of Type 2 diabetes, including both Western biomedical and herbal therapy. Kleinman's explanatory model of illness served as the framework, and the grounded theory method was used for data analysis. A majority of participants were taking prescribed Western medications in conjunction with traditional Mexican folk remedies. Participants relied on the advice of family, friends, and neighbors to provide them with guidance, and some herbs used by participants were not indicated for the treatment of diabetes. Health care providers should be aware that Mexican American clients may make choices about herbal remedies without expert guidance and advice.

Evaluation of the use of complementary and alternative medicine in the largest United States-Mexico border city

STUDY OBJECTIVE

To evaluate the use of complementary and alternative medicine (CAM) in the El Paso, Texas, region.

DESIGN

Prospective observational study conducted from April-October 2000.

SETTING

Several hospitals and clinics.

SUBJECTS

Five hundred forty-seven participants.

INTERVENTION

Semi-structured interview with a bilingual questionnaire.

MEASUREMENTS AND MAIN RESULTS

Complementary and alternative medicine was used in 77% of our population. The most common CAM providers were massage therapists (19.4%) and herbalists (12.4%). The most common herbal or home remedies were chamomile (13.1%) and aloe vera (8.5%). The most common nutritional or commercial products were multivitamins (16%), ginseng (3.6%), and ginkgo biloba (2.8%). We identified 599 CAM usages that could result in drug interactions, disease interactions, or adverse reactions.

CONCLUSIONS

A wide range of CAM use was documented in this study. Our results indicate that Hispanics in this area use CAM at a higher rate than national trends. Many of these therapies can adversely affect a variety of disease states and drug therapies.

Surveys of complementary and alternative medicine: part I. General trends and demographic groups

Data from the surveys of the Harvard team, led by David Eisenberg, M.D., are frequently used as a summary first paragraph introduction to the status of complementary and alternative medicine (CAM) in the United States. However, there is now a substantial body of literature on various facets of CAM use. Six national surveys to date are briefly discussed and summarized in a table. Some surveys have been conducted at a regional level. Three are summarized but there are too few data yet to draw any conclusions. Eighteen more exploratory surveys of specific subpopulations are presented to help draw a clearer picture of income, ethnic, and age groups. The search strategy is provided. The changing terminology in the field, the development of the CAM survey, and some common shortcomings are also addressed.

Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model

This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.

A comparison of the use of alternative therapies among Mexican Americans and Anglo-Americans in the Texas Rio Grande Valley

In a descriptive study with a convenience sample of 60 Mexican Americans and 60 Anglo-Americans, four research questions were asked: (a) What kinds of and how frequently are alternative therapies used by the Mexican Americans and Anglos in the Texas Rio Grande Valley? (b) Is there a difference in the kinds and amounts of therapies used by the two groups? (c) Do the participants self-report this information to their established, conventional, care provider? and (d) What are the participants' subjective reports about these therapies? Findings showed that both groups used alternative practitioners, but that Mexican Americans reported using them more than twice as often as did Anglo-Americans. The most prevalent therapies sought by Mexican Americans were prayer, herbal medicine, massage, relaxation, spiritual healing, and chiropratic. The most prevalent therapies sought by Anglo-Americans were prayer, massage, chiropractic, herbal medicine, megavitamin therapy, and spiritual healing. Almost twice as many Mexican Americans (45%) report discussing their therapies with their established primary health provider than did Anglos (26.7%).

A review of the concept of culture in holistic nursing literature

Core Value IV of the American Holistic Nurses' Association includes valuing the client's cultural background. The authors reviewed all article abstracts from two major holistic nursing journals for a 3-year period (N = 198). References to concepts of culture or ethnicity were found in only 9.6% of abstracts. Many theorists and researchers did not discuss how the theory or research findings varied between culturally or ethnically diverse samples. When culture is a core value, practitioners and researchers cannot assume that culture has been considered without stating what was the interaction of culture with the phenomenon of concern. The authors recommend that nurses develop cultural competence in caring for clients from differing cultural orientations by (a) committing to improve their knowledge of multiple cultures; (b) exploring their own cultural background; (c) seeking exposure to cultures other than their own; and (d) regularly discussing culture and ethnicity in nursing theory, research, and practice.

Use of and attitudes about alternative and complementary therapies among outpatients and physicians at a municipal hospital

OBJECTIVES

To survey outpatients and physicians about their use of, knowledge of, and interest in alternative therapies.

DESIGN

Anonymous self-administered survey.

SETTINGS/LOCATION

Outpatient clinics at a major municipal medical center.

SUBJECTS

Outpatients visiting clinics and staff physicians.

INTERVENTIONS

Patient survey about overall use of 7 categories and 19 types of alternative therapies, and their desire to have specific therapies offered at the institution. Survey to physicians about whether their patients used the same categories and types of alternative therapies, whether they provided or recommended their use, and their interest in having them available at the institution.

OUTCOME MEASURES

Frequency of use of different alternative therapies by gender and race. Frequency of patient use of alternative therapies according to their physicians and frequency of physicians who provide or recommend alternative therapies.

RESULTS

A total of 567 outpatients completed questionnaires during the survey week. When given a list of alternative therapies, 85% of patients acknowledged use of one or more alternative therapies. When Diet/Nutrition was excluded, 42% reported use of alternative therapies. No differences in overall use were seen by age, sex, or race; but when Diet/Nutrition was excluded, women were more likely to use alternative therapies, and use of Manual Healing and Herbal Medicine differed by race. Of the 85 responding physicians, 86% reported that their ambulatory patients used alternative therapies. Similar proportions (35%-38%) of patients and physicians wanted Manual Healing and Mind/Body Control therapies to be available.

CONCLUSIONS

Frequency of use of alternative therapies was high, and similar according to patients and physicians. Overall use did not differ by gender and race, except when Diet/Nutrition was excluded. Patients and physicians had similar interests in having alternative therapies provided, and both were hampered by lack of information about many therapies.

Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model

This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.

Hispanic mothers' knowledge and care of their children with respiratory illnesses: a pilot study

This pilot study was designed to identify Hispanic mothers' knowledge and health practices regarding caring for their children with respiratory illnesses. Using an interview guide, the researchers identified the mothers' perceptions of their children's health, the etiology and symptoms of asthma and other respiratory illnesses, health practices, folk illnesses, services sought and language barriers when using health services. The findings suggest that Hispanic mothers have limited knowledge of respiratory illnesses and use culturally related practices when caring for their sick children. Implications for pediatric nursing practice are discussed, and strategies to improve care for Hispanic families are presented.

Health and quality of life within Colonias settlements along the United States and Mexico border

The Colonies settlements along the United States-Mexican border are reflective of third-world communities. Although most of the residents are U.S. citizens, they lack the basic educational and work opportunities found in most parts of the country. Because of the limited infrastructure, diseases controlled in most parts of the world are epidemic within these communities. Using the Giger and Davidhizar Transcultural Assessment Model, public health nurses can be instrumental in coordinating services in partnership with community members to enhance health and social service programs.

An integrative model for holistic community health nursing

Health and nursing are shifting from acute care to community settings, causing confusion for clients and professionals. Although the holistic nursing perspective has improved care to human beings in interaction with their environment and has moved nursing away from pathology-focused care, the community as the focus of care has not been addressed. This article presents an integrated model of community health that expands holistic nursing to the community as client. The model clarifies nursing care for the individual, family, aggregate, and community. One can focus on any one level, with the awareness that each is part of a unified whole. Holistic community nursing completes the circle of care by moving beyond the particular part to focus on the greatest health for the community. The intent is to help nurses describe their unique areas of expertise within the complex community system and to establish a basis for collaboration and partnership.

Patterns of Mental Health Care Among Mexican Americans

1. Extending cultural care beyond language enhances the use of mental health services and fosters a mutually agreed-on plan of care. 2. Understanding cultural characteristics facilitates an understanding of behavior, family and social dynamics, and adaptation patterns to stress that can empower clients to work toward their goals and validate the impact of emotions and behaviors on others. 3. Culturally appropriate mental health care reflects a synthesis among communication, space, social organization, time, environmental control, and biological variables.